Weekly IDSR Bulletin

National completeness for epidemiological week 10 was recorded at a strong 96.0%, reflecting consistent engagement across all districts. This high level of reporting ensures that our public health visibility remains sharp during the transition between weather seasons. When nearly all facilities submit data, we can trust that the national disease burden is being captured with high fidelity. Every single percentage point contributes to a more accurate risk assessment for the Ministry of Health and its stakeholders. The One Health Surveillance Platform has clearly become the backbone of our data management culture nationwide. We commend the district coordinators who have pushed their teams to maintain this standard throughout the current quarter. Sustained completeness is the first step toward effective disease control and equitable resource allocation for all Malawians.

Despite this success, the 4.0% gap represents facilities that are currently operating in a data blind spot. It is essential that district health management teams identify these specific non-reporting units to address technical or staffing bottlenecks. If a facility consistently fails to report, it may hide localized outbreaks that could easily spread to neighboring communities. Our goal remains a 100% completeness rate to ensure that no single citizen is left out of the surveillance safety net. Zonal epidemiology officers should provide targeted mentorship to facilities struggling with digital data entry procedures. We are also looking into enhancing the mobile reporting features of the OHSP to make submission easier for remote clinics. Future bulletins will track the progress of these specific “laggard” facilities to ensure they are brought back into the fold. Collective accountability is what drives the integrity of our national health information system.

Timeliness in week 10 also stood at 96.0%, mirroring the completeness rate and indicating a highly responsive surveillance workforce. Reporting on time is critical because it allows the national secretariat to analyze data while the epidemiological events are still fresh. A delay of even 24 hours can hinder the rapid deployment of response teams to a potential cholera or measles cluster. This week’s performance shows that the vast majority of our focal persons treat the Monday deadline with professional urgency. It reflects a maturing system where data is viewed as a vital tool for clinical and public health action. We recognize that maintaining such timeliness requires significant effort in areas with poor internet connectivity or power supply. The resilience shown by our data clerks under these conditions is a major asset to the nation. Timely data translates directly into saved lives through faster decision-making and resource mobilization.

However, we must address the remaining 4.0% of reports that arrived after the established national deadline. Late reports often stall the generation of this very bulletin and delay the feedback loop to the districts. District Health Officers should review their internal validation workflows to ensure that data does not sit idle before submission. We have observed that timeliness often dips during periods of high clinical workload, which is precisely when data is most needed. It is important to cross-train multiple staff members at the facility level to handle reporting duties during staff absences. PHIM will continue to publish the list of districts meeting the timeliness target to encourage healthy competition and shared learning. We are also planning to implement automated reminders within the OHSP to help facility staff keep track of deadlines. Ensuring 100% timeliness will solidify Malawi’s position as a regional leader in real-time epidemiological surveillance. Let us all work together to ensure that no report arrives too late to make a difference.

During week 10, the Event-Based Surveillance (EBS) system captured a total of fourteen (14) distinct signals across various districts. While this is a decrease from the nineteen signals reported in week 2, it indicates a functioning community-level alert system. EBS is specifically designed to catch “unusual” events that might not fit into standard diagnostic categories in the early stages. Each signal represents a proactive observation by a community health worker or a vigilant community member. The distribution of these signals across regions suggests that our training on signal detection is yielding results. Every signal must be treated as a potential public health threat until a formal risk assessment is completed. This sensitive “radar” is what allows us to identify outbreaks before they escalate into full-blown national crises. We value the alertness of the community health surveillance assistants who are our eyes and ears on the ground.

The next critical step for these 14 signals is immediate verification and risk assessment by District Rapid Response Teams. A signal only becomes an actionable public health event once it has been investigated and validated in the field. We have noticed that while signal detection is improving, the documentation of the follow-up investigation remains a weakness. It is vital that DRRTs record every investigative step and outcome in the One Health Surveillance Platform. Without this documentation, we cannot assess the effectiveness of our response or learn from the signals that were false alarms. We urge district coordinators to prioritize the “closing the loop” on every alert generated this week. Strengthening the linkage between signal detection and rapid field response is a top priority for our 2026 surveillance strategy. Training on “Signal-to-Action” workflows will be rolled out in the coming months to enhance this capability. Our community’s safety depends on our ability to not just listen to signals, but to act upon them decisively.

Malaria remains the highest cause of morbidity in Malawi, with 33,365 cases and 8 associated deaths reported in week 10. This case volume indicates that transmission remains high, particularly in districts experiencing heavy rainfall and increased vector activity. The eight deaths reported this week are a tragic reminder that severe malaria is still a major killer in our communities. Each of these deaths should be subjected to a clinical audit to identify any delays in care-seeking or treatment. We are monitoring these trends closely to ensure that our supply chain for anti-malarials remains robust and uninterrupted. High-burden districts must prioritize the distribution of insecticide-treated nets and promote their consistent use among the population. Surveillance data shows that certain southern districts are reporting higher-than-expected case densities this month. Our response must be data-driven, focusing resources on the specific hotspots where transmission is most intense right now.

Preventing malaria deaths requires a combination of community awareness and high-quality clinical management at the facility level. Parents must be encouraged to bring children with fever to a health facility within 24 hours for testing. Early diagnosis and treatment with effective ACTs are the most reliable ways to prevent progression to severe disease. Health facility managers should ensure that their staff are fully trained in the management of severe malaria complications. We are also advocating for improved environmental management to reduce mosquito breeding sites around households and public areas. The national malaria control program is reviewing this week’s data to plan for upcoming indoor residual spraying campaigns. It is essential that we maintain high coverage of all prevention interventions to see a significant drop in these numbers. Every malaria death is a public health failure that we must work tirelessly to eliminate in the near future. Collaborative efforts between the government, partners, and the community are essential for achieving a malaria-free Malawi.

A total of 775 cases of bloody diarrhoea were reported in week 10, representing a significant enteric disease burden. This condition is often a marker for Shigellosis or other bacterial pathogens that thrive in areas with poor sanitation. During the rainy season, the risk of water source contamination increases, leading to spikes in diarrhoeal diseases. We must ensure that all health facilities are collecting stool samples for culture and sensitivity testing from these patients. Understanding the antibiotic resistance patterns of circulating pathogens is crucial for updating our treatment guidelines. Every case of bloody diarrhoea should be managed with the same level of urgency as a potential cholera case. Community health workers should intensify education on handwashing with soap and the use of treated drinking water. The current case count suggests that our water and sanitation infrastructure needs urgent attention in several districts. We cannot afford to overlook these “silent” enteric threats while focusing on more visible outbreaks.

The geographical distribution of these 775 cases points to specific clusters that require immediate environmental health investigations. District environmental health officers should inspect water points in the most affected traditional authorities to identify sources of contamination. We are also monitoring for any signs of antibiotic treatment failure, which could indicate the emergence of resistant strains. Public health messaging must be reinforced to ensure that families know how to properly treat water at the household level. Schools and markets should be targeted for hygiene promotion to prevent the rapid spread of infection in crowded settings. We are collaborating with the Ministry of Water to prioritize the repair of broken boreholes in the high-incidence zones identified this week. Surveillance focal persons are reminded to report any sudden increase in cases within a single community as a priority alert. By addressing the root causes of bloody diarrhoea, we also strengthen our defense against other waterborne diseases. Let us maintain a high index of suspicion and respond aggressively to every cluster of enteric illness. Safe water and proper sanitation are non-negotiable rights for every citizen in our country.

In week 10, Malawi reported sixty-seven (67) suspected cholera cases and four (4) laboratory-confirmed cases, with no deaths. While the number of confirmed cases is low, the presence of nearly seventy suspected cases indicates ongoing transmission risk. It is encouraging that zero deaths were reported, showing that our cholera treatment centers are providing effective rehydration. However, we must remain vigilant as cholera can explode into a massive outbreak within a very short timeframe. Each suspected case represents a potential chain of transmission that must be broken through aggressive contact tracing. Confirmed cases this week were primarily located in districts with known challenges in safe water access. We are pre-positioning cholera kits and supplies in these areas to ensure readiness for any escalation. The surveillance system is the primary tool for mapping these cases and targeting our preventive interventions. We must not allow “cholera fatigue” to diminish our response efforts during this critical rainy season.

Aggressive decontamination of households and public spaces where cases have been identified is currently underway in the affected districts. We are also working with local leaders to ensure that community members understand the importance of seeking help early. Early treatment with oral rehydration salts can be life-saving and prevents the development of severe, lethal dehydration. Our laboratory capacity for cholera testing is being monitored to ensure that results are returned to the field within 24 hours. We are also tracking the availability of chlorine for water treatment at both the facility and community levels. Collaborative meetings with partners are held daily at PHIM to review the latest data and adjust our national response plan. It is essential that every district remains in a high state of alert, even those that have not yet reported a case. Cholera is a cross-border threat that requires a unified and well-coordinated response from all sectors of society. We will continue to provide transparent and timely updates on the cholera situation through these weekly bulletins. Together, we can prevent a repeat of the massive outbreaks seen in previous years through early action.

The reporting of two (2) maternal deaths in week 10 is a somber reminder of the challenges in our reproductive health system. Every maternal death is considered a sentinel event that triggers a mandatory national-level review and local clinical audit. These deaths represent not just a statistic, but the loss of a mother and a devastating impact on a family. We must investigate whether these deaths were due to delays in seeking care, reaching a facility, or receiving treatment. Maternal mortality is a key indicator of the overall quality and accessibility of our healthcare system. The Ministry of Health remains committed to achieving the goal of zero preventable maternal deaths in Malawi. We are working to strengthen the capacity of our maternity wards and ensure they are adequately staffed and supplied. It is vital that we learn from every tragedy to prevent future occurrences in our health facilities. Monitoring maternal mortality trends helps us identify districts that require additional support and clinical mentorship.

Clinical audits for these two deaths must be completed within the next seven days to identify the root causes. These audits are essential for identifying systemic gaps such as lack of blood for transfusion or shortage of essential medicines. We must also look at the quality of antenatal care these women received prior to their delivery. Community awareness programs should emphasize the importance of early booking and delivery in a health facility under skilled supervision. We are advocating for improved transport systems to ensure pregnant women in remote areas can reach emergency care in time. Zonal supervisors should follow up with the affected districts to ensure that the audit recommendations are being implemented. Our goal is to create a culture of safety where every pregnancy is monitored and every delivery is safe. We will continue to track maternal mortality with the highest priority in our surveillance reports to ensure accountability. Strengthening the linkage between community surveillance and facility-based care is a key strategy for reducing these deaths. Every mother’s life is precious, and we must do everything in our power to protect them during childbirth.

Week 10 saw 241 cases of Severe Acute Respiratory Infection (SARI) and three (3) associated deaths reported nationwide. This represents a significant increase in respiratory morbidity compared to the very low numbers reported in week 9. Such a jump in cases often follows changes in weather patterns or the introduction of new viral strains into the community. We must ensure that our sentinel sites are collecting swabs for influenza and COVID-19 testing to identify the causative agents. The three deaths this week underscore the potential severity of respiratory infections in vulnerable populations. Healthcare workers are reminded to practice strict infection prevention and control (IPC) measures when managing SARI patients. Early identification of severe cases and prompt initiation of supportive care, including oxygen therapy, are critical for survival. We are monitoring the availability of respiratory medicines and supplies across all central and district hospitals. Protecting our population from respiratory threats requires a vigilant and well-equipped healthcare workforce at all levels.

Public health messaging should continue to promote hand hygiene and respiratory etiquette to reduce the spread of viruses. We are particularly concerned about the risk of respiratory outbreaks in crowded settings such as schools, prisons, and displacement camps. District surveillance teams should investigate any sudden clusters of fever and cough to rule out potential outbreaks. The current trend suggests that we may be entering a period of increased respiratory virus circulation. We are working with our laboratory partners to enhance the turnaround time for respiratory viral panels. Information on the specific viruses circulating will be shared with clinicians to guide their patient management strategies. It is also important to ensure that high-risk groups, such as the elderly and those with comorbidities, are monitored closely. We will continue to provide weekly updates on SARI trends to help facilities prepare for any further increase in patient volume. Vigilance in monitoring respiratory infections is a key component of our national pandemic preparedness and response strategy. Let us work together to contain the spread of these infections and prevent further mortality in our communities.

A total of seventy-four (74) cases of Adverse Events Following Immunization (AEFI) were reported in week 10. The reporting of these events is a sign of a robust and transparent vaccine safety monitoring system. Most of these cases were minor and expected reactions, such as fever or pain at the injection site, which resolved quickly. It is essential that health workers continue to report all AEFI, regardless of their perceived severity or relationship to the vaccine. This data is reviewed by a national committee to ensure that the vaccines used in our programs remain safe for the public. High reporting rates reflect the vigilance of our immunization teams and the trust of the community in our surveillance. We have not identified any serious or life-threatening AEFI patterns during this reporting period, which is reassuring for our health programs. Maintaining public confidence in vaccines is vital for achieving high immunization coverage and protecting our children from preventable diseases. We will continue to monitor these reports with the highest level of scientific scrutiny and transparency.

Training for health workers on AEFI detection and management is being reinforced during routine supervision visits. It is important to distinguish between events caused by the vaccine and coincidental events that happen around the time of vaccination. Clear communication with parents and caregivers about potential side effects helps to manage expectations and reduce vaccine hesitancy. We are also monitoring the quality of vaccine storage and handling, as improper cold chain management can sometimes lead to localized AEFI clusters. The national immunization program is using this data to continuously improve the safety and quality of its services. Any serious AEFI would trigger an immediate field investigation and a formal causality assessment by the national expert committee. We encourage the public to report any unusual health events following vaccination to their nearest health facility or via the health hotline. Our commitment to vaccine safety is absolute, and we will not compromise on the health of our citizens. Transparency in reporting and addressing these events is the foundation of a successful and sustainable immunization program. We appreciate the hard work of all the frontline workers who ensure that every dose is safe and every event is recorded.

Malawi reported zero (0) new confirmed Mpox cases and zero (0) Mpox alerts during epidemiological week 10. This continued status of zero cases is an excellent indicator that our current containment and awareness strategies are effective. However, we must not become complacent, as the risk of cross-border transmission from neighboring countries remains significant. Our border screening teams and surveillance focal persons in border districts must remain in a state of high alert. Mpox is a disease of international concern, and we have a global responsibility to maintain a sensitive detection system. We are continuing to provide training on Mpox case identification and sample collection to healthcare workers in high-risk areas. Public awareness campaigns are ongoing to ensure that the population knows the signs and symptoms of the disease. Early detection is our best tool for preventing a widespread outbreak of this viral pathogen in our communities. We are proud of the vigilance shown by our health workforce in maintaining this “zero case” status for another week.

Laboratory readiness for Mpox testing is being maintained at the national reference lab to ensure we can respond to any new alert. We are also collaborating with regional partners to monitor the spread of the virus across the continent and adjust our risk assessments. It is important for clinicians to maintain a high index of suspicion for any patient with an unexplained rash or fever. We are also working to strengthen our community-based surveillance to identify any “hidden” cases that might not reach health facilities. The current period of zero cases provides a window of opportunity to further strengthen our clinical and laboratory systems. We are reviewing our national Mpox response plan to incorporate lessons learned from the global outbreak and regional trends. Every alert, even if eventually discarded, is a sign that our surveillance system is “awake” and functioning as intended. We encourage the public to report any suspicious illness through the official channels without fear of stigma. Protecting Malawi from Mpox requires a collective effort and a commitment to transparency and rapid response. We will continue to provide weekly status updates to keep all stakeholders informed of our national situation.

Acute Flaccid Paralysis (AFP) surveillance remains a top priority, with three (3) new cases reported and investigated in week 10. These cases are currently undergoing laboratory testing to rule out the presence of poliovirus and ensure our polio-free status. AFP surveillance is a key requirement for global polio eradication, and Malawi must meet strict performance targets for case detection. Each case requires the collection of two stool samples within 14 days of the onset of paralysis to be considered “adequate.” We are also closely monitoring for any suspected measles cases, as even a single case can indicate a gap in population immunity. Measles is highly contagious and can lead to severe complications or death in unvaccinated children. We are urging all districts to maintain high routine immunization coverage to prevent the recurrence of measles outbreaks. Surveillance focal persons should conduct active case searches for AFP and measles during their routine facility visits. Ensuring that every child is protected from these preventable diseases is a core mission of our public health system.

The success of our AFP surveillance depends on the awareness of both healthcare workers and the community about the signs of paralysis. We are providing regular updates and mentorship to facility staff on how to identify and report AFP cases promptly. It is also important to ensure that the cold chain for stool sample transport is strictly maintained until they reach the laboratory. For measles, we are conducting a review of our vaccination data in the areas where suspected cases were reported this week. Any child found to be missing their scheduled doses should be immunized immediately to close the immunity gap. We are also planning for upcoming supplemental immunization activities to boost population immunity in high-risk districts. Collaborating with community leaders is essential for ensuring that all children are reached during vaccination campaigns. We will continue to share the laboratory results for the AFP cases as soon as they become available from the reference lab. Maintaining a high level of vigilance for these vaccine-preventable diseases is essential for the long-term health of our nation’s children. Let us work together to ensure that Polio and Measles remain diseases of the past in Malawi.

Week 10 saw a sharp increase in Typhoid fever cases, with fifty-four (54) cases reported compared to just eighteen in week 9. This jump in cases is a significant epidemiological signal that requires an immediate and coordinated response at the district level. Typhoid fever is primarily spread through contaminated food and water, often flourishing in areas with inadequate sanitation infrastructure. The current increase during the rainy season suggests that water sources may have been compromised by surface runoff. We are urging all affected districts to conduct immediate environmental health investigations to identify the source of the infection. Laboratory confirmation through blood culture is essential for distinguishing typhoid from other febrile illnesses like malaria. We must also ensure that patients are being treated with the correct antibiotics according to our national guidelines. Typhoid can lead to severe complications, including intestinal perforation, if it is not diagnosed and treated promptly. Our surveillance system is working at full capacity to map these cases and identify any emerging hotspots.

The prevention of typhoid fever relies heavily on improving access to safe water and promoting rigorous hygiene practices in our communities. We are advocating for the boiling or treatment of all drinking water in the districts that are currently reporting increased cases. Public health teams should also target food vendors and markets for hygiene education and inspection to prevent foodborne transmission. We are also monitoring the impact of the Typhoid Conjugate Vaccine (TCV) in the populations where it has been rolled out. Vaccination remains a key long-term strategy for reducing the national burden of typhoid and protecting our children. We are collaborating with the Ministry of Water to prioritize the repair and maintenance of water systems in high-risk areas. It is essential that we address the root causes of this disease to prevent it from becoming a persistent public health problem. Surveillance focal persons should continue to report every suspected case of typhoid with the highest priority to enable rapid response. We will provide further updates on the typhoid situation as more data and laboratory results become available. Working together, we can contain this current increase and protect the health and well-being of our citizens through effective prevention.