Epidemiological Bulletin Number 85
Week 45 (week ending 14 November 2010)
Foreword
This bulletin provides a weekly overview of the outbreaks and other important public health
events occurring in Zimbabwe. It includes disaggregated data to inform and improve the
continuing public health response by the various partners. It also provides guidance to
agencies on issues relating to data collection, analysis and interpretation, and suggests
operational strategies on the basis of epidemiological patterns so far. The bulletin is published
weekly. Note that the epidemiological week runs from Monday to Sunday. This edition covers
week 45 (week ending 14 November 2010).
The C4 team welcomes feedback. Data provided by individual agencies is welcome but will be
verified with MOHCW structures before publication.
Acknowledgements
We are very grateful to MoHCW District Medical Officers, District and Provincial Surveillance
Officers, Provincial Medical Directors, Directors of City Health departments, Environmental
Heath Officers, and MoHCW's National Health Information Unit, who have helped to gather
and share the bulk of the information presented here.
Likewise, we acknowledge agencies, including members of the Health and WASH clusters,
who have kindly shared their data with our team. MoHCW recognizes and thanks the efforts
made by NGOs and other partners assisting in the response and providing support to MoHCW
Highlights of the week ending November 2010:
 No new cholera cases reported
 203 suspect measles cases reported
 Further Decline in Influenza A H1N1(2009)cases reported
Figures
The case definitions can be found in appendix 1 and detailed data by district are shown in
appendix 2. See also summary tables (annex 1), maps (annex 2) and graphs (annex 3).
Source: Ministry of Health and Child Welfare Rapid Disease Notification System
1
Cholera
18 out of the 62 districts in the country have been affected by the cholera outbreak that
started on 4 February, 2010 compared to 54 districts last year at the same time. 790
cumulative cholera cases consisting of 688 suspect cases, 102 laboratory confirmed
cases and 21 deaths were reported by the 24th October 2010 to the World Health
Organization (WHO) through the Ministry of Health and Child Welfare's (MoHCW)
National Health Information Unit. The crude case fatality rate since the outbreak started
stands at 2.7% which is 1.6% lower than that of last year. By week 45 2009, 98 522
cumulative cases and 4 282 deaths had been reported since August 2008, with the
crude case fatality rate of 4.3%.
Week 45 (8 -14 November 2010)
No new cholera cases were reported. The last cholera cases were reported in week 42.
Hence the cholera outbreaks that started in week five are now over because there have
been no reports for three weeks.
Geographical distribution of cases
The cases reported so far came from the following districts: Beitbridge, Bindura, Buhera,
Chegutu, Chivi, Chimanimani, Chipinge, Chiredzi, Harare, Hurungwe, Kadoma,
Masvingo, Makonde, Mt. Darwin, Mutare, Mwenezi, Plumtree and UMP.
Urban/Rural distribution of cases
72% of the cases currently reported are from rural areas. In comparison, during the
corresponding week in 2009, 67 % of the cases were from rural areas.
Assessments & response
Surveillance continued in all districts. Case management training for epidemic diarrhoeal
disease is being conducted.
Measles
National Overview (September 2009 to 14 November 2010)
12 918 suspected cases and 631 deaths of measles were reported in all the districts of
Zimbabwe. 691 confimed Measles IgM cases were reported in 61 districts. Bulilima is
the only district that has not reported at least one confirmed measles case. However this
could probably be due to figures of this new district being lumped together into the
Mangwe district. 53 districts have reported confirmed measles outbreaks. The attack
rate of suspected cases is 106 cases per 100 000 population.
IgM Positive Cases by Age Group
Source: Ministry of Health and Child Welfare Rapid Disease Notification System
2
109 (16%) of the positive IgM cases were below 9 months, 52 (8%) in the 9 – 12 months
age group, 129 (19%) were in the 1-5 years age group, 266 (39 %) were in the 5 -14 years
age group and 131 (19%) in the above 14 years age group and 4 cases(0.6%) had no
agegroup. Hence 529 (77%) of the positive cases were above the routine immunisation age
(9 -12 months). See table 3 for detailed distribution of the IgM positive cases by agegroup
and and attack rates by district.
Vaccination Status
6821 (53%) of the cases were not vaccinated, 4519 (35%) had unknown
vaccination status and 1578 (12%) were vaccinated.
Comparison of Measles Situation for the periods before and
after the measles national immunisation days
September 2009 to 4 July 2010 (before NIDs)
10 946 suspected cases were reported of which 602 were confirmed cases. 53 districts
reported confirmed measles outbreaks. The attack rate of suspected cases was 90.1 per
100 000 .The attack rate of confirmed cases was 5 per 100 000.
517 deaths were reported from 21 districts.
5 July to 14 November 2010 (after NIDs)
1 972 suspected cases were reported of which 79 were confirmed cases and 114
deaths were reported. 12 districts reported confirmed measles outbreaks namely Bikita,
Binga, Chipinge Gweru, Insiza, Kariba, Kwekwe, Lupane, Makonde, Mazowe, Seke and
Zvishavane. 10 confirmed measles cases were reported in the last 30 days from:
Buhera 4, Chegutu 14, Chikomba 8,Hwedza 10, Gokwe South 7, Gweru 8, Goromonzi
1,Harare 69,Kadoma 4, Kwekwe 9, Kariba 4, Marondera 5, Mutasa 15, Mutare 16,
Mvuma 5, Mt Darwin 10, Seke 8, Shamva 2,UMP 2, Tsholotsho 2, and Zvimba 1 case.
Hence there was one confirmed outbreak in the last 30 days in Gokwe South. The attack
rate is 14.5 per 100 000 for suspected cases and is 0.6 per 100 000.
Week 45 (8 -14 November 2010)
203 suspected cases and no deaths were reported this week through the Weekly
Disease Surveillance System (WDSS). The suspected cases were from the following
areas: Beitbridge 3, Gokwe North 23, Gokwe South 11, Gweru 3, Chegutu 12,Chivi
Harare 64, 12,Hwange 3, Kadoma 6, Kariba 29, Kwekwe 7, Lupane 2, Makonde 21, Mt.
Darwin 4, Mwenezi 66, Shamva 2 and Zaka 1.
8 confirmed measles IgM cases were reported in the last 30 days( 15 October-14
November 2010) from: Beitbridge 1, Chiredzi 1, Chivi 1, Gokwe South 2, Harare 1, Mbire
1, Zvimba 1 . There is no district that reported at least 3 confirmed measles , hence
there was no ongoing confirmed outbreak in the country during week 45 .
Source: Ministry of Health and Child Welfare Rapid Disease Notification System
3
Comparison of weekly measles indicators for the periods September 2009 to 4
July and 5 July -14 November 2010
Some notable changes in key measles weekly indicators are as follows:
1. Suspected weekly cases declined from 248 to 103.
2. Confirmed weekly cases declined from 14 to 5 cases
3. Weekly deaths also dropped from 12 to 6
Assessments & response
Integrated EPI disese surveillance and case finding continued. Districts are encouraged
to continue to search for suspected measles cases and meet the minimum detection rate
of 2 suspected cases per 100 000 population per year. Hence at least 5 suspected
cases per week are expected to be reported if the cases are uniformly distributed.
The continual reporting of high numbers suspected of suspected measles cases and low
numbers (4%) of confirmed measles IgM cases is attributed to strengthening of the
measles surveillance system and cases of rubella (German Measles) being
misdiagnosed as measles. From next week we will include comparison of confirmed
measles IgM cases and confirmed rubella cases.
Influenza A H1N1 (2009)
A suspected outbreak of Influenza A H1N1( 2009) was declared in Tsholotsho on the 15th of
October, after having noted increases in cases that presented with severe flu like symptoms.
The outbreak was targeting mostly the children (especially school going age) and the under
five.Thereafter outbreaks of confirmed Influenza A were reported in Bulilima on 22 October,
in Mangwe on 26 October, in Masvingo and Harare on 27 October.First suspected cases of
H1N1 reported in Lupane on 28 October. In addition suspected Influenza outbreak was also
declared in Beitbridge.
21 600 suspected cases have been reported up to date.
Week 45 (8 -14 November 2010)
3 071 suspect cases cases were reported by end of the week in retrospect from Binga
and Lupane. No cases were reported of the current week.
Geographical distribution of cases
H1N1 cases have been reported from 9 Districts namely Binga, Beitbridge, Bulilima,
Gwanda, Harare, Lupane, Mangwe, Masvingo and Tsholotsho.
Source: Ministry of Health and Child Welfare Rapid Disease Notification System
4
Assessments & response
Surveillance and case management continues in all affected districts.
Assessments were done in Lupane and Binga after they had reported suspected H1N1
cases on the 28th and suspected cases on the 19th October in Binga. The Binga cases were
reported on the 29th to the province. The findings of the assesments are as follows:
Characterization of the Epidemic by Place, Person and Time
Characterisation
Lupane
Binga
Occurrence of First Cases
28th October
19th October
Notification to next level
29th October
29th October
Areas Affected
Most Affected Agegroup
Menyezwa School, Gwayi
Resettlement Area, Daluka
Communal Area, Jibajiba
ward, Kanyandavhu RHC,
Jotsholo RHC and Fatima
RHC.
5 -14 Years
Simatelele,
Sinasengwe,Zumanana
Uniformly Distributed
across all age groups
Response Matrix
Response
Lupane
Binga
Case Management
Case definitions and treatment
protocol distributed
PPE and
medical
sundries
provided
Social Mobilization
Community Health Education and
distribution of IEC materials
CBHWs and
community
leaders
mobilised
Surveillance
Contact tracing
Encouraged to
analyse
Source: Ministry of Health and Child Welfare Rapid Disease Notification System
5
Response
Lupane
Binga
Active surveillance
Epidemiological
data
Line listing of cases
Daily reporting of cases and
deaths
Coordination
RRT meetings held on weekly
basis
Partners asked to assist in active
surveillance
CBHWs and
community
leaders
involved in
active
surveillance
Encouraged to
strengthen
EPR plan
Challenges Matrix
Challenge
Lupane
Binga
Case Management
RDTs and viral transport
media
RDTs and viral transport
media
Limited availability of
Paracetamol and Tamiflu
Surveillance
Most health workers not
trained in IDSR
Fuel
Transport and
communication
Source: Ministry of Health and Child Welfare Rapid Disease Notification System
6
Annex 1: Summary Tables
Table 1: Cumulative Cholera cases and deaths reported by district as of week 45 2010
District
Suspe
cted
Cases
report
ed
this
week
0
Confirme
d Cases
Reported
this
week
Suspecte
d Cases
Confirme
d Cases
Discarde
d Cases
Total
Case
s
Death
s
0
16
1
0
17
0
15.1
Bindura
0
0
0
2
0
2
0
1.3
Buhera
0
0
101
5
0
106
0
44.5
Chegutu
0
0
19
13
32
2
13.1
Chimanimani
0
0
52
10
0
62
Chipinge
4
0
18
7
0
25
2
8.1
Chiredzi
0
0
45
9
0
54
2
21.3
Chivi
0
0
11
2
0
13
0
7.7
Harare Urban
0
0
1
3
0
4
0
0.3
Hurungwe
0
0
165
6
171
5
55.2
Kadoma
0
0
136
24
0
160
5
62.5
Makonde
0
0
3
1
0
4
0
1.4
Mangwe
0
0
0
1
0
1
0
1.0
Masvingo
0
0
9
1
10
1
3.5
Mt. Darwin
0
0
7
4
0
11
1
5.1
Mutare
7
2
101
8
0
109
2
25.6
Mwenezi
0
0
0
5
0
5
0
3.7
Uzumba
Maramba
Pfungwe
0
0
4
0
0
4
1
3.5
11
2
688
102
0
790
21
16.5
Beitbridge
Total
Source: Ministry of Health and Child Welfare Rapid Disease Notification System
Attack
Rate/1000
00
51.2
7
Table 2: Age and Sex breakdown of cumulative cholera linelisted cases as at week 45
Female
Male
Female
30 Years
over
Male
15-29
Years
Female
5-14
Years
Male
5
Female
Buhera
Chiredzi
Chivi
Harare
Chimanimani
Chipinge
Masvingo
Mwenezi
Beitbridge
Kadoma
Mutare
Total
Under
Years
Male
District
0
2
0
00
4
0
0
0
0
0
2
6
0
2
0
0
2
2
0
0
0
9
2
12
0
5
0
0
2
1
0
0
0
0
1
9
1
3
1
0
7
2
0
0
0
17
2
30
18
6
0
0
6
0
0
0
0
0
45
59
3
9
1
0
20
3
1
1
0
0
14
42
8
6
2
2
10
3
2
2
0
0
24
42
1
8
4
0
9
4
3
1
0
0
15
37
and
Table 3: Distribution of Measles IgM Positive by Agegroup and District of residence
since September 2009 – 14 November 2010
District
Missing
<9
9 -12
1-5
5-14
>14 TOTAL
months months years years years
BEITBRIDGE
0
0
0
2
2
3
7
1
Attack
Rate
per
100
000
6.2
BIKITA
BINDURA
0
0
1
0
0
2
4
3
6
0
0
1
11
6
0
0
6.5
3.2
BINGA
BUBI
BUHERA
BULAWAYO
0
0
0
1
0
1
0
6
1
0
1
6
1
2
3
2
3
7
2
5
4
3
0
2
9
13
6
22
0
0
0
0
6.9
25.3
2.5
3.0
CENTENARY
0
0
0
0
2
1
3
0
2.9
CHEGUTU
0
2
0
4
7
0
13
0
11.1
CHIKOMBA
0
1
1
2
3
1
8
0
3.3
Source: Ministry of Health and Child Welfare Rapid Disease Notification System
New
Cases
8
District
Missing
<9
9 -12
1-5
5-14
>14 TOTAL
months months years years years
CHIMANIMANI
0
0
0
1
1
2
4
0
Attack
Rate
per
100
000
3.1
CHIPINGE
0
0
1
1
6
4
12
0
9.6
CHIREDZI
CHIRUMANZU
0
0
4
0
2
0
1
1
2
5
1
1
10
7
1
0
3.3
2.8
CHITUNGWIZA
0
11
0
0
5
6
22
0
28.8
CHIVI
GOKWE
NORTH
1
0
1
0
1
0
2
0
2
2
0
0
7
2
1
0
2.0
1.2
GOKWE
SOUTH
0
1
1
6
13
6
27
1
11.6
GOROMONZI
0
1
2
1
6
0
10
0
3.1
GURUVE
GUTU
GWANDA
0
0
0
1
0
0
0
0
1
0
2
0
1
5
0
0
1
2
2
8
3
0
1
0
1.2
4.0
1.4
GWERU
HARARE
HURUNGWE
0
2
0
3
35
2
0
17
1
1
16
2
3
44
4
3
43
0
10
156
9
0
1
0
7.1
63.6
0.6
HWANGE
0
3
0
1
0
6
10
0
3.2
HWEDZA
INSIZA
KADOMA
0
0
0
0
1
1
0
0
0
3
1
1
5
7
5
0
0
0
8
9
7
0
0
0
7.3
11.8
7.5
KARIBA
KWEKWE
0
0
0
2
0
0
0
3
5
6
3
1
8
12
0
0
3.2
18.8
LUPANE
MAKONDE
0
0
2
1
1
1
2
3
3
5
3
2
11
12
0
0
4.1
11.2
MAKONI
0
1
0
6
3
2
12
0
9.5
Source: Ministry of Health and Child Welfare Rapid Disease Notification System
New
Cases
9
District
Missing
<9
9 -12
1-5
5-14
>14 TOTAL
months months years years years
MANGWE
0
0
2
0
2
2
6
0
Attack
Rate
per
100
000
2.2
MARONDERA
0
3
0
2
6
1
12
0
14.2
MASVINGO
0
2
2
1
2
1
8
3
7.2
MATOBO
MAZOWE
0
0
0
2
0
1
0
0
3
3
1
3
4
9
0
0
1.9
8.3
MBERENGWA
0
0
0
0
1
0
1
0
0.5
MBIRE
MT DARWIN
0
0
0
0
0
0
0
1
1
5
0
0
1
6
0
0
1.3
3.0
MUDZI
MUREHWA
0
0
0
0
0
1
2
0
7
4
0
1
9
6
0
0
4.2
4.4
MUTARE
MUTASA
MUTOKO
0
0
0
1
0
0
0
0
0
2
3
3
4
4
2
1
0
1
8
7
6
0
0
0
4.6
1.7
3.3
MWENEZI
0
2
1
2
1
0
6
1
3.4
NKAYI
NYANGA
RUSHINGA
0
0
0
0
2
0
0
0
0
2
3
1
1
1
2
1
2
0
4
8
3
0
0
0
2.9
6.6
2.4
SEKE
SHAMVA
SHURUGWI
0
0
0
7
0
0
0
0
0
6
0
2
7
1
1
3
0
1
23
1
4
0
0
0
31.6
1.2
3.8
TSHOLOTSHO
0
1
0
1
1
0
3
0
3.1
UMGUZA
0
1
0
2
2
1
6
0
4.6
UMZINGWANE
0
1
1
0
1
0
3
0
2.7
Source: Ministry of Health and Child Welfare Rapid Disease Notification System
New
Cases
10
District
Missing
<9
9 -12
1-5
5-14
>14 TOTAL
months months years years years
New
Cases
UMP
0
0
1
3
3
4
11
0
Attack
Rate
per
100
000
9.7
ZAKA
ZVIMBA
ZVISHAVANE
0
0
0
3
1
1
1
3
0
3
6
8
1
8
17
1
3
3
9
21
29
0
1
0
13.5
10.5
12.1
TOTAL
4
108
52
128
266
131
689
11
5.7
Table 4: Distribution of Community and Institutional Measles Deaths attributed to
Measles as of 14 November 2010
District
Bikita
Bindura
Buhera
Chegutu
Chimanimani
Chipinge
Gokwe North
Gokwe South
Goromonzi
Guruve
Hwange
Insiza
Kadoma
Makoni
Marondera
Mudzi
Mazowe
Mbire
Murehwa
Mutare
Mutoko
Mutasa
Nyanga
Seke
UMP
Insiza
Total
Community
Deaths
11
10
92
2
3
3
18
6
46
1
2
4
1
24
20
31
72
32
50
47
46
10
9
17
55
7
619
Institutional
Deaths
0
0
4
0
0
0
1
0
0
0
0
0
0
5
0
0
0
0
0
0
0
0
0
2
0
0
12
Source: Ministry of Health and Child Welfare Rapid Disease Notification System
Total
Deaths
11
10
96
2
3
3
19
6
46
1
2
4
1
29
20
31
72
32
50
47
46
10
9
19
55
7
631
11
Table 5: Comparison of some Measles Indicators before vaccination plus four
weeks and after
5 July –14
November
September to
4 July ( 44
weeks)
Indicator
(19 weeks)
Suspected Cases
10 946
1 972
Confirmed Cases
602
89
Deaths
517
114
Cumulative number of Districts that reported
laboratory confirmed outbreaks
53
12
Ongoing outbreaks
0
1
Overall Attack Rate of suspected cases
Confirmed cases
90 per 100 000
12 per 100 000
Table 6: Vaccination Status of Measles Cases by District September 2009 to 14
November 2010
District
Beitbridge
Bikita
Bindura
Binga
Bubi
Buhera
Bulawayo
Bulilima
Centenary
Chegutu
Chikomba
Chimanimani
Chinhoyi
Chipinge
Chiredzi
Not
Vaccinated
Unknown
Vaccinated
TOTAL
42
32
13
12
31
586
64
6
7
24
46
15
1
38
17
2
14
0
1
0
0
0
20
0
6
7
0
0
0
4
16
3
10
9
4
1
39
1
1
6
13
5
1
14
0
60
49
23
22
35
587
103
27
8
36
66
20
2
52
21
Source: Ministry of Health and Child Welfare Rapid Disease Notification System
12
District
Chirumanzu
Chitungwiza
Chivi
Gokwe North
Gokwe South
Goromonzi
Guruve
Gutu
Gwanda
Gweru
Harare
Hurungwe
Hwange
Hwedza
Insiza
Kadoma
Kariba
Kwekwe
Lupane
Makonde
Makoni
Mangwe
Marondera
Masvingo
Matobo
Mazowe
Mberengwa
Mt Darwin
Mudzi
Murehwa
Mutare
Mutasa
Mutoko
Mwenezi
Nkayi
Nyanga
Rushinga
Ruwa
Seke
Not
Vaccinated
Unknown
Vaccinated
TOTAL
11
417
16
287
116
105
9
14
9
40
2151
22
41
20
17
80
11
59
50
73
232
7
91
64
10
51
4
54
150
22
215
59
26
11
25
49
7
3
1360
41
9
3
66
4
6
2
1
20
28
1298
3
42
2
2
39
40
32
5
24
16
0
10
8
22
35
24
13
0
1
6
5
3
4
5
4
2
0
28
5
51
4
27
3
18
2
0
8
9
779
22
62
3
54
12
1
31
5
25
6
3
12
6
5
7
0
4
32
5
2
7
9
2
4
7
1
0
224
57
477
23
380
123
129
13
15
37
77
4228
47
145
25
73
131
52
122
60
122
254
10
113
78
37
93
28
71
182
28
223
71
38
17
34
60
10
3
1612
Source: Ministry of Health and Child Welfare Rapid Disease Notification System
13
District
Not
Vaccinated
Unknown
Vaccinated
TOTAL
5
16
18
17
14
4
23
53
64
0
7136
0
7
3
2
4
1
7
9
3
2011
3954
0
8
10
4
5
1
1
12
4
0
1625
5
31
31
23
23
6
31
74
71
2011
12715
Shamva
Shurugwi
Tsholotsho
Umguza
UMP
Umzingwane
Zaka
Zvimba
Zvishavane
Missing
TOTAL
Table 7: H1N1 Influenza Cases and deaths as of 7 November 2010
Influenza cases
Province
District
Suspected
cases
Deaths
Probable cases
Confirmed cases
(RDT
+ve)/Number
tested
(RT PCR +ve)
Matabeleland
North
Tsholotsho
16823
0
14
12
Matabeleland
South
Beitbridge
613
0
-
-
Binga
819
0
-
-
Bulilima
559
0
6
-
Mangwe
611
0
2
-
Gwanda
480
0
-
-
Lupane
1501
-
-
Masvingo
Masvingo
188
0
8
-
Harare
Kuwadzana
6
0
3
1
National total
9districts
21600
0
33
13
(4 provinces)
Source: Ministry of Health and Child Welfare Rapid Disease Notification System
14
Annex 2: Maps
Map 1: Comparison of cumulative cholera cases by district as of week 45 for the years 2009 and 2010
2010
Source: Ministry of Health and Child Welfare Rapid Disease Notification System
2009
15
Map 2: Comparison of Cumulative Measles IgM positive cases and Suspected Measles
case by district reported this year, as at 14 November 2010
Confirmed Cases
Source: Ministry of Health and Child Welfare Rapid Disease Notification System
Suspected Measles Cases
16
Map 3:Distribution Suspect and Confirmed Influenza H1N1(2009) Cases as at 14 November 2010
Suspected H1N1 cases
Source: Ministry of Health and Child Welfare Rapid Disease Notification System
Confirmed H1N1 Cases
17
Annex 3: Graphs
Graph 1:Ranking of District Cumulative Cholera Cases Reported as at week 45, 2010
Graph 2: Cumulative Cholera Cases by week for the years 2009 and 2010
Source: Ministry of Health and Child Welfare Rapid Disease Notification System
18
Graph 3: Cholera Epidemic Curve Week 5 - Week 45, 2010
Graph 4:Ranking of Confirmed Measles Igm Cases by District Reported from
September 2009 to 14 November 2010
Source: Ministry of Health and Child Welfare Rapid Disease Notification System
19
Graph 5:Ranking of Suspected Measles Cases by District Reported from September
2009 to 14 November 2010
Graph 6: Measles Epicurve as at week 45, 2010
Source: Ministry of Health and Child Welfare Rapid Disease Notification System
20
Source: Ministry of Health and Child Welfare Rapid Disease Notification System
21
Graph 7 Comparison of Suspected Measles Cases, Confirmed Measles Cases and
Rubella cases September to November 2010.
Source: Ministry of Health and Child Welfare Rapid Disease Notification System
22
Appendix 1: Case Definitions
Cholera
The Zimbabwe cholera state definition states that
"In an area where there is a cholera epidemic, a patient aged 2 years or more develops acute
watery diarrhoea, with or without vomiting".
‘’A confirmed cholera case is when Vibrio cholerae is isolated from any patient with diarrhoea”.
This is adapted from the WHO case definition for cholera.
The inclusion of all ages in the case definition somewhat reduces specificity, that is, inclusion of
more non-cholera childhood diarrhoea cases. It, however, does not impede meaningful
interpretation of trends. Teams should monitor any shift in the age distribution of cases, which
might indicate a changing proportion of non-cholera cases among patients seen.
Suspected measles:
Any person with fever and maculopapular rash and cough OR Coryza (running nose) OR
conjunctivitis (Red eyes) OR clinician suspects measles.
Measles Outbreak Definition:
A suspected outbreak is where you have a cluster of at least 5 suspected measles cases in a
facility or district within a month whilst a confirmed outbreak is where you have a cluster of at
least 3 confirmed measles IgM positive cases.
Lab confirmed: Suspected case of measles with positive serum IgM antibody, with no history
of measles vaccination in the past 4 weeks.
Confirmed by epidemiologic linkage: Suspected case of measles not investigated
serologically but has possibility of contact with a laboratory-confirmed case whose rash onset
was within the preceding 30 days (same / adjacent districts with plausible transmission)
Influenza A H1N1
Influenza A and B are two of the three types of influenza viruses associated with annual
outbreaks and epidemics of influenza. Only influenza A virus can cause pandemics.
The Zimbabwe IDSR technical guidelines define influenza case by a new sub type (including
Avian flu Influenza A H5N1 and Swine flu Influenza A H1N1) as;
‘’Any person presenting with unexplained acute lower respiratory illness with fever (>38 ºC ) and
cough, shortness of breath or difficulty breathing in the 7 days prior to symptom onset.’’
Probable case definition:
Any person meeting the criteria for a suspected case AND positive laboratory confirmation of
an influenza A infection but insufficient laboratory evidence for H1N1 infection.
Confirmed H1N1 case: A person meeting the criteria for a suspected or probable case AND
a positive result conducted in a national, regional or international influenza laboratory whose
H1N1 test results are accepted by WHO as confirmatory.
Source: Ministry of Health and Child Welfare Rapid Disease Notification System
23
There may be difficulty in telling apart mild cases of pandemic influenza from the seasonal
influenza.
Source: Ministry of Health and Child Welfare Rapid Disease Notification System
24