Weekly IDSR Bulletin

During Epidemiological Week 9, the national completeness of reporting on the One Health Surveillance Platform (OHSP) was recorded at 95.3%. This represents a slight decrease compared to the high-performance levels observed in earlier weeks of the year. Despite the dip, the national average remains well above the 80% threshold required for effective public health decision-making. It is imperative that district surveillance teams identify specific facilities that failed to report to ensure no critical health events are missed. Consistent reporting across all districts allows the Ministry to maintain a comprehensive understanding of the country’s disease landscape.

Moving forward, the focus must remain on supporting health facilities that have shown a downward trend in submission rates. The surveillance secretariat will continue to monitor non-reporting units to determine if technical barriers or staffing shortages are contributing to the decline. Surveillance officers at the district level should prioritize providing feedback to facility focal persons to emphasize the value of every single report. Improving completeness to at least 98% is a key objective for the second quarter of 2026. Maintaining high data quality and completeness is essential for triggering timely responses to potential health emergencies across the nation.

The national timeliness of reporting for Week 9 was 94.7%, indicating a robust adherence to the weekly reporting deadlines. This high level of timeliness is crucial for the early detection and containment of disease outbreaks before they escalate into national crises. The surveillance system depends on receiving data within the stipulated timeframe to allow for real-time analysis and action. When reports are submitted on time, rapid response teams can be deployed more effectively to hotspots of infection. The current performance reflects the dedication of health facility focal persons and district coordinators in prioritizing surveillance tasks.

However, we continue to observe a gap between the best-performing districts and those that frequently struggle with meeting the Monday noon deadline. Some districts and central hospitals have been specifically flagged for needing improvement in their reporting speed this week. Addressing issues such as internet connectivity and data entry backlogs at the facility level will be necessary to bridge this performance gap. The national goal remains to achieve 100% timeliness to ensure the surveillance system operates at its maximum potential. Continued mentorship and technical support will be provided to the lagging reporting units to ensure they meet national standards consistently.

Event-Based Surveillance (EBS) detected twenty-six (26) signals during Week 9, highlighting the sensitivity of our community and facility-level alert systems. These signals are vital as they often capture unusual health events that routine indicator-based surveillance might miss in the early stages. The diverse nature of these alerts suggests that both the general public and health workers are maintaining a high level of vigilance. Each signal represents a potential threat that must be meticulously investigated to determine its public health significance. This proactive detection is a cornerstone of Malawi’s commitment to early warning systems for emerging infectious diseases.

Once a signal is recorded, the responsibility shifts to the District Rapid Response Teams (DRRTs) to conduct immediate verification and risk assessments. It is essential that all twenty-six signals reported this week are followed up with documented outcomes to close the surveillance loop. Delayed investigations can lead to missed opportunities for containing localized outbreaks at their source. We encourage all districts to ensure their EBS focal persons are adequately resourced to perform these critical field investigations promptly. Strengthening the linkage between signal detection and rapid field response remains a top priority for the Public Health Institute of Malawi in the coming months.

Malaria continues to be the leading cause of morbidity in Malawi, with 21,314 cases and 5 deaths reported in Week 9. Although the number of cases shows a downward trend compared to the peak season, the mortality rate remains a serious concern for public health. Each death signifies a potential failure in early diagnosis or the management of severe malaria at the facility level. It is crucial that clinicians strictly adhere to the national treatment guidelines, including the use of injectable artesunate for severe cases. Health facilities must also ensure they maintain adequate stocks of both rapid diagnostic tests and artemisinin-based combination therapies.

Prevention efforts, such as the consistent use of insecticide-treated bed nets, must be emphasized during community outreach and routine health education sessions. We are also monitoring districts with unusually high case-fatality rates to determine if there are specific gaps in care-seeking behavior or clinical expertise. Community health workers play a vital role in identifying signs of severe illness and ensuring timely referral to higher levels of care. The National Malaria Control Program will continue to utilize this surveillance data to target resources to the most burdened districts. Reducing the malaria burden requires a sustained multi-sectoral approach involving environmental management and robust clinical services.

During Week 9, a total of 437 cases of bloody diarrhoea were reported across the country, showing a significant decrease from the previous month’s levels. This reduction is a positive sign, yet the persistent reporting of hundreds of cases weekly indicates ongoing challenges with sanitation and hygiene. Bloody diarrhoea is often associated with Shigellosis, which can spread rapidly in areas with inadequate access to clean water and soap. Health facilities should continue to prioritize laboratory investigation for these cases to identify the specific causative agents. Understanding the local epidemiology of enteric diseases is essential for tailoring effective public health interventions and treatment protocols.

Districts reporting clusters of bloody diarrhoea must conduct environmental assessments to identify contaminated water sources or poor waste disposal practices. Public health messaging should focus on the “Five Keys to Safer Food” and the importance of handwashing with soap at critical times. We also urge healthcare providers to maintain high clinical suspicion for potential cholera cases among patients presenting with severe diarrhoeal illness. Continued monitoring of these trends will help determine if the current downward trajectory is sustained or if new hotspots are emerging. Strengthening water, sanitation, and hygiene (WASH) infrastructure remains the most effective long-term strategy for preventing these infections.

The cholera situation in Week 9 involved sixty-six (66) suspected cases and three (3) laboratory-confirmed cases, with no deaths reported. While the number of confirmed cases remains low, the presence of sixty-six suspected cases suggests that the risk of transmission is still high in certain communities. It is encouraging that zero deaths were recorded, reflecting effective clinical management and early care-seeking behavior in the affected areas. However, the discovery of any confirmed case proves that the Vibrio cholerae bacterium is actively circulating and poses a threat to public health. Rapid containment of these early cases is necessary to prevent a widespread outbreak during the current rainy season.

Response activities must focus on intensive contact tracing and the provision of safe water and sanitation in the immediate vicinity of confirmed cases. We recommend that all suspected cases are managed in designated cholera treatment units to prevent cross-infection within regular hospital wards. Health education should be intensified in known hotspots to ensure that the community knows how to prepare and use Oral Rehydration Salts at home. The Ministry of Health and its partners are continuing to distribute water treatment chemicals and hygiene kits to high-risk populations. Vigilant surveillance at the community level is essential for identifying the very first signs of a potential cluster of cases.

Only one (1) maternal death was reported during Week 9, which represents a notable decline compared to the levels seen earlier in the year. While the reduction in mortality is positive, the goal of the health system remains the total elimination of preventable maternal deaths. Every maternal death is a profound loss and must be investigated thoroughly to understand the contributing clinical and social factors. Maternal mortality remains a key indicator of the quality and accessibility of emergency obstetric and neonatal care services. We must ensure that all pregnant women have access to skilled birth attendants and timely referral systems when complications arise.

The District Health Management Team is required to conduct a Maternal and Perinatal Death Surveillance and Response (MPDSR) audit for this case. These audits are essential for identifying system failures, such as delays in seeking care, transportation challenges, or gaps in facility-level management. The lessons learned from this specific audit must be translated into actionable improvements for the maternity department and community referral pathways. Continuous training for midwives and clinicians on managing postpartum hemorrhage and eclampsia is a priority for reducing such fatalities. We remain committed to ensuring that no woman dies while giving life due to preventable causes.

Severe Acute Respiratory Infection (SARI) surveillance identified only two (2) cases during Week 9, with no associated deaths reported. This significant drop in SARI morbidity compared to previous weeks may be due to seasonal variations or a temporary decline in circulating respiratory pathogens. However, the low number of reported cases also warrants a review of surveillance sensitivity at the facility level to ensure cases are not being missed. It is vital that healthcare workers continue to screen all patients presenting with fever and cough for potential SARI. Maintaining a high level of vigilance is necessary for the early detection of respiratory viruses with pandemic potential, such as influenza or SARS-CoV-2.

Sentinel sites should continue to collect samples for laboratory testing to monitor the types of viruses circulating in the population. Accurate viral surveillance helps inform national treatment guidelines and public health strategies for managing respiratory illness. Even with low case numbers, facilities must ensure that oxygen therapy equipment and essential medicines are ready for any sudden influx of patients. We also encourage the public to continue practicing good respiratory hygiene and to seek medical attention if they experience difficulty breathing. The surveillance secretariat will continue to monitor SARI trends closely to detect any unusual increases in respiratory morbidity or mortality.

In Week 9, there were fifty-nine (59) reports of Adverse Events Following Immunization (AEFI) submitted through the surveillance system. Most of these events were minor reactions, such as low-grade fever or localized swelling at the injection site, which are expected after vaccination. The consistent reporting of AEFI is a sign of a healthy surveillance system that prioritizes vaccine safety and public confidence. It is important for health workers to reassure parents that these minor reactions are usually self-limiting and indicate that the immune system is responding to the vaccine. Accurate documentation of all AEFI cases allows the national regulatory authorities to monitor the safety profile of all vaccines used in the country.

Any serious AEFI, such as those requiring hospitalization or resulting in significant disability, must be investigated within 48 hours by the district team. For Week 9, none of the 59 reported cases were classified as serious, which is a reassuring finding for the national immunization program. We continue to encourage health workers to report every event, no matter how minor, to maintain a robust safety database. Transparency in reporting and investigating these events is essential for addressing vaccine hesitancy and ensuring high coverage for life-saving immunizations. The Ministry of Health remains committed to providing the safest possible vaccines to all citizens of Malawi.

For the eighth consecutive week, Malawi has reported zero (0) new confirmed cases of Mpox and zero (0) new alerts during Week 9. This prolonged period without new cases suggests that the public health interventions implemented last year have been effective in halting community transmission. However, the regional situation remains unpredictable, with neighboring countries continuing to report active cases and outbreaks. The risk of cross-border importation remains a significant threat that requires us to maintain high levels of vigilance at all points of entry. We must not allow the current success to lead to complacency in our surveillance and preparedness efforts.

Screening protocols at international airports and border crossings must continue to be strictly enforced to detect any symptomatic travelers. Healthcare workers should remain trained in the identification, isolation, and management of Mpox suspects to ensure rapid containment if a case is imported. We are also continuing our community awareness campaigns to ensure the public knows the symptoms and where to report if they suspect an infection. Maintaining laboratory readiness to test samples quickly is also a key priority for the national reference lab. Our commitment to a “Zero Mpox” status requires constant monitoring and a ready-to-act response framework.

Surveillance for Acute Flaccid Paralysis (AFP) remained active in Week 9, which is critical for maintaining Malawi’s status as a Polio-free nation. AFP is the primary clinical indicator used to monitor for the potential re-introduction of the Poliovirus. Along with AFP, we are also monitoring for any clusters of fever and maculopapular rash that could indicate a Measles outbreak. Measles is highly contagious and can cause significant morbidity and mortality in unvaccinated or under-vaccinated children. High-quality surveillance for these two conditions is a mandatory requirement for global disease eradication and elimination targets.

Every case of AFP must have two stool samples collected within 14 days of the onset of paralysis to ensure an accurate laboratory diagnosis. We urge all district surveillance officers to ensure that these samples reach the national laboratory in good condition and within the required timeframe. For suspected measles, laboratory confirmation through blood samples is essential to distinguish it from other rash-causing illnesses. Any confirmed measles case should trigger an immediate investigation of the child’s vaccination history and a localized immunization response. Strengthening routine immunization coverage is the most effective way to protect our children from these preventable diseases.

Typhoid fever surveillance recorded eighteen (18) cases during Week 9, representing a decrease from the sixty-four (64) cases reported in Week 7. While this decline is encouraging, typhoid fever remains a public health concern due to its strong association with contaminated water and food. The eighteen cases reported this week should still be investigated to identify if they belong to a specific geographic cluster. Typhoid is an enteric fever that can cause severe illness if not treated promptly with appropriate antibiotics. Laboratory confirmation using blood culture remains the gold standard for diagnosis and is encouraged wherever possible at the district level.

Public health interventions should focus on improving water quality and promoting safe food handling practices in areas where cases are reported. The recent introduction of the Typhoid Conjugate Vaccine (TCV) into the routine schedule is expected to significantly reduce the long-term burden of the disease. We urge all parents to ensure their children receive the TCV to provide them with lasting protection against this infection. District health teams should also monitor for any signs of antibiotic resistance in the typhoid strains isolated in their areas. Continued vigilance and multi-sectoral coordination are required to eliminate typhoid as a public health threat in Malawi.