Weekly IDSR Bulletin

National reporting completeness for week 13 was successfully maintained at a commendable 97.0% across the country. This consistent performance indicates that the vast majority of our health facilities have integrated digital reporting into their weekly clinical routines. High completeness is essential for ensuring that the Ministry of Health has a comprehensive view of the national disease burden without significant regional gaps. When nearly all facilities report, the statistical power of our epidemiological models increases, allowing for more precise resource allocation. We must acknowledge the dedicated work of the district IDSR coordinators who have pushed for this level of compliance. This data provides the backbone for all subsequent public health decisions made at the central level this week. Maintaining this trajectory is vital as we conclude the first quarter of the 2026 reporting cycle.

Despite these achievements, the 3% gap in completeness represents several dozen facilities that are currently invisible to our national surveillance network. These “silent” facilities may be harboring localized outbreaks of cholera or measles that could spread undetected to adjacent communities. It is imperative that Zonal Epidemiology Officers conduct targeted site visits to identify the specific technical or human resource barriers at these sites. We have observed that facilities in remote areas often struggle with consistent internet connectivity, necessitating alternative offline reporting solutions. Every facility that fails to report compromises the integrity of our national “Early Warning” system and creates unnecessary public health risks. We aim to reach a 100% completeness target by providing additional training to the identified lagging districts in the coming month. Surveillance is a collective responsibility that requires every single node in the network to function at peak capacity. Strengthening these weak links will ensure that no Malawian is left outside the protection of our surveillance system.

Timeliness for week 13 was recorded at 95.0%, representing a slight but notable decrease from the previous week’s performance levels. Reporting on time is critical because public health actions are most effective when they are initiated within hours of an event’s detection. A report that arrives late effectively delays the national response, potentially allowing a single case of disease to become a cluster. The 95% rate suggests that most facility focal persons are adhering to the Monday morning deadline despite heavy clinical workloads. We must emphasize that data loses its operational value rapidly as time passes, making punctuality a key quality metric. The One Health Surveillance Platform (OHSP) is designed for real-time interaction, but its utility depends entirely on the speed of data entry. We commend those districts that achieved 100% timeliness this week despite facing significant logistical and environmental challenges.

Analysis of the 5% delay reveals that specific districts are consistently struggling to validate their data before the national submission cutoff time. District Health Officers must streamline their internal validation processes to ensure that errors are corrected quickly without holding up the entire report. We recommend that facilities establish “Data Mondays” where reporting is prioritized as a primary clinical duty before mid-day. PHIM will begin publishing a “Timeliness League Table” to foster healthy competition and transparency among the reporting districts. Improving timeliness by just a few percentage points can significantly enhance our ability to contain rapidly spreading enteric diseases. We are also exploring the implementation of automated SMS alerts to remind focal persons of the approaching deadlines. Our goal is to institutionalize a culture of “Real-Time Surveillance” where data flows as fast as the pathogens we are tracking. Let us all recommit to the Monday deadline to ensure our national defense against disease remains agile and responsive.

During week 13, thirty-four (34) Event-Based Surveillance (EBS) signals were detected, of which twenty-four (24) were successfully verified by district teams. This verification rate of approximately 70.6% indicates that while community reporting is high, there is a significant lag in the official confirmation process. It is critical that every signal reported by the community is prioritized for rapid field assessment within 24 hours of notification. The 34 reported signals show that our community health surveillance assistants are active and vigilant in identifying unusual health clusters. However, the ten signals remaining unverified represent potential blind spots in our national health security framework. Each of these unverified reports could potentially be the early indicator of an emerging cholera or viral outbreak. We must improve the speed and documentation of verification to ensure that resources are not wasted on false alarms. The verification process is the bridge between raw community intelligence and a coordinated medical response.

District Rapid Response Teams (DRRTs) must account for the ten unverified signals and ensure they are processed before the start of week 14. We recommend that districts with backlogs in signal verification re-evaluate their communication protocols between community volunteers and clinical supervisors. A signal is only as useful as the investigation it triggers; without verification, a report cannot lead to meaningful public health action. We are implementing new digital tracking tools in the OHSP to help coordinators monitor the “time-to-verification” for all community-level alerts. High verification rates are essential for maintaining the credibility of the EBS system among community stakeholders and donors alike. We will provide additional logistical support to the three districts with the highest volumes of unverified signals this week. Our target is to achieve a 100% verification rate for all signals to ensure that no legitimate threat is left unexamined. Strengthening this verification loop is a primary goal for the National IDSR Secretariat as we move into the next quarter. Consistent follow-through on every community alert will build the trust necessary for a truly collaborative national surveillance network.

Malaria continues to dominate the national morbidity profile with 31,233 cases and 10 reported deaths in week 13 alone. This high case volume is characteristic of the late rainy season where stagnant water provides optimal breeding conditions for Anopheles vectors. The 10 deaths reported this week are a significant concern and represent the highest weekly mortality for malaria in this quarter. Each death should be audited at the facility level to determine if there were delays in the administration of injectable artesunate. We must also analyze whether these deaths were concentrated among children under five or pregnant women, who remain our most vulnerable cohorts. The consistent burden of malaria places a massive strain on our primary healthcare system and essential medicine supply chains. Surveillance data suggests that transmission intensity is particularly high in the lake-shore and southern region districts this week. Targeted interventions must be prioritized in these high-burden ecological zones to prevent further loss of life.

The National Malaria Control Program must ensure that all health facilities have an adequate supply of Rapid Diagnostic Tests and ACTs to handle this influx. Community health workers should intensify their efforts to promote the consistent and correct use of Long-Lasting Insecticidal Nets (LLINs) in every household. We are also advocating for a high index of clinical suspicion for severe malaria complications, such as cerebral malaria or severe anemia, in all febrile patients. Early treatment within 24 hours of fever onset is the most effective way to reduce the progression to severe, fatal disease. We encourage districts to use this surveillance data to plan for indoor residual spraying (IRS) campaigns in identified hotspots. Public health education must emphasize that malaria is a preventable and curable disease if identified and managed in time. We will continue to monitor these trends closely to ensure that our national response remains proactive rather than merely reactive. It is essential that we move beyond simple case counting to active, data-driven prevention at the community level. Every malaria death is a tragedy that can be avoided with timely intervention and proper resource management.

Rabies surveillance in week 13 recorded fifteen (15) animal bite cases requiring post-exposure prophylaxis (PEP) across the country. While no human deaths were reported this week, the steady stream of animal bites highlights the persistent threat of this 100% fatal but preventable disease. Each reported bite must be treated as a medical emergency, necessitating the immediate administration of the rabies vaccine. We have observed that many facilities struggle with maintaining a consistent supply of PEP, leading to dangerous delays for victims. This week’s data shows that bites are predominantly occurring in peri-urban areas where roaming dog populations are high. We must ensure that surveillance for animal bites is tightly integrated with our One Health reporting to veterinary authorities. A single failure to provide PEP to a rabid dog bite victim will invariably result in an agonizing and preventable death. Monitoring these bite trends is essential for forecasting national vaccine requirements and preventing human rabies cases.

The Ministry of Health is collaborating with the Department of Animal Health to implement mass dog vaccination campaigns in the identified bite hotspots. We urge all district hospitals to report any stockouts of anti-rabies vaccine immediately to the central medical stores. Public education must focus on “Wash, Flush, and Vaccinate” – the critical immediate steps to take after an animal bite occurs. HSAs are encouraged to conduct community sensitization on the dangers of stray dogs and the importance of vaccinating domestic pets. We are also advocating for the improved availability of Rabies Immunoglobulin (RIG) for high-risk Category III exposures in central hospitals. Every bite victim should be followed up to ensure they complete the full multi-dose vaccination schedule required for protection. The zero-death status this week is encouraging, but it requires a perfectly functioning supply chain to be maintained long-term. We will continue to track the “Bite-to-PEP” interval as a key quality indicator for our rabies response program. Elimination of human rabies is possible only through 100% PEP coverage and aggressive animal-level control measures. Let us remain vigilant in protecting our communities from this ancient and deadly viral threat.

Malawi reported seventy-five (75) suspected cholera cases and fourteen (14) laboratory-confirmed cases in week 13, with no deaths recorded. The reporting of 14 confirmed cases in a single week indicates that the cholera situation is entering a more active and dangerous phase. While it is positive that zero deaths occurred, the presence of confirmed cases in multiple districts suggests a widespread environmental risk. Each confirmed case represents a failure in the sanitation barrier and a direct threat to the surrounding community’s health. We are currently focusing our response on the districts of Lilongwe, Blantyre, and Mangochi, which have reported the most recent confirmed activity. The zero-fatality rate this week is a testament to the early seeking of care by patients and effective management by our healthcare teams. However, the high number of suspected cases means that our cholera treatment centers (CTCs) must remain in a state of high readiness. We cannot afford any complacency given the rapid-fire nature of cholera transmission in densely populated areas.

Aggressive contact tracing and “ring” decontamination of households are being prioritized for all 14 confirmed cases reported this week. We are also distributing chlorine and soap to the families and neighbors of the affected individuals to break the chain of transmission. Our laboratory system is working to perform genomic sequencing on these isolates to understand the lineage and potential origin of the current strain. It is critical that all districts intensify their surveillance for any “sudden onset of watery diarrhoea” and report such events immediately. We are collaborating with WASH partners to ensure that emergency water trucking and borehole repairs are prioritized in the identified hotspots. Public health education campaigns are being scaled up to remind citizens of the importance of using safe water and practicing good hygiene. We are also monitoring the availability of oral rehydration salts and intravenous fluids at the facility level to prevent any supply stockouts. A unified, cross-sectoral response is the only way to contain this current wave of cholera and prevent it from escalating into a national crisis. We will provide daily updates to the affected districts to ensure that local response strategies are data-driven and timely.

Two (2) maternal deaths were reported in week 13, reminding us of the urgent need to strengthen our emergency obstetric care services. Every maternal death in Malawi is treated as a sentinel event that requires a formal “Maternal Death Surveillance and Response” (MDSR) audit. These deaths are not just statistics; they represent a significant loss of life that has profound effects on families and entire communities. We must investigate whether these deaths were associated with the “Three Delays”: delay in seeking care, reaching a facility, or receiving treatment. Our national goal remains the elimination of all preventable maternal deaths through improved quality of care at the point of delivery. The reporting of these cases through the IDSR system allows for rapid national-level visibility and accountability for reproductive health outcomes. We must ensure that every woman in Malawi has access to skilled birth attendance and emergency services when complications arise. Monitoring these trends helps us identify districts that may be struggling with staffing or equipment shortages in their maternity wings.

The MDSR committees in the affected districts must complete their investigations and submit their findings to the national secretariat within 72 hours. These audits should focus on identifying systemic gaps, such as lack of blood for transfusion or delays in the referral process between facilities. We are advocating for the implementation of the recommendations arising from these audits to prevent similar tragedies in the future. It is essential that we also look at the quality of antenatal care provided to these women during their pregnancies to identify missed opportunities for intervention. We are working with partners to provide additional training on basic and comprehensive emergency obstetric and newborn care (BEmONC/CEmONC). Community awareness programs should emphasize the importance of early facility-based delivery for all pregnant women, regardless of their perceived risk. We will continue to track maternal mortality with the highest level of priority to ensure that our health system is responsive to the needs of mothers. Every death is a call to action for all stakeholders in the health sector to work harder toward our national targets. We remain committed to achieving the Sustainable Development Goal targets for maternal health through data-driven and evidence-based interventions.

Severe Acute Respiratory Infection (SARI) surveillance reported 212 cases and six (6) deaths in week 13, marking a significant spike in respiratory mortality. This increase in deaths is a major public health concern and may indicate the circulation of more virulent respiratory pathogens or late presentation by patients. We are urging all sentinel sites to increase the collection of swabs for influenza and COVID-19 testing to identify the causative agents. The six deaths reported this week should be audited to understand the clinical course of the illness and the quality of supportive care provided. SARI often affects the very young and the elderly, making them the primary focus of our clinical and preventive efforts. We must ensure that health workers are proficient in the use of oxygen therapy and are following the latest management protocols for severe pneumonia. The high number of cases places an additional burden on our hospital wards and requires careful management of bed capacity. Protecting the population from respiratory threats remains a key component of our national health security strategy during this season.

Public health messaging should be reinforced to promote hand hygiene, respiratory etiquette, and the use of masks in crowded healthcare settings. We are monitoring for any unusual clusters of respiratory illness in schools, prisons, or other congregate living situations that might indicate an outbreak. District surveillance teams should conduct active case searches in the communities where these deaths occurred to identify any additional undiagnosed cases. We are also working with laboratory partners to ensure that our genomic surveillance is robust enough to detect any new viral variants. It is important to ensure that all frontline health workers have access to personal protective equipment (PPE) to prevent nosocomial transmission of respiratory pathogens. We are advocating for the early referral of SARI patients from primary health centers to district hospitals where specialized care is available. Collaborative research is needed to better understand the seasonal drivers of respiratory infections in the various ecological zones of Malawi. We will continue to provide weekly updates on SARI trends to help facilities prepare for any further increases in morbidity or mortality. Vigilance in monitoring these infections is essential for our national pandemic preparedness and response efforts. Let us work together to contain the spread of these infections and prevent further loss of life in our communities.

Neonatal Tetanus (NNT) surveillance recorded zero (0) cases in week 13, a significant achievement that reflects our high national coverage of Tetanus Toxoid (TT) vaccination. NNT is a painful and highly fatal disease that occurs when Clostridium tetani spores contaminate the umbilical cord during unhygienic deliveries. The absence of cases is a direct result of our successful maternal immunization programs and the promotion of “Clean Birth” practices across the country. We must remain vigilant, however, as even a single case of NNT is considered a major public health failure and an indicator of poor maternal health services. Every suspected case must be investigated immediately to identify the geographical and socioeconomic barriers to safe delivery in that specific community. Our goal is to maintain the “Maternal and Neonatal Tetanus Elimination” (MNTE) status as defined by international health standards. Consistent reporting of zero cases is a testament to the hard work of our midwives and community health assistants in promoting facility-based deliveries. Monitoring these trends allows us to identify any emerging pockets of low vaccination coverage before they result in a clinical case.

We are continuing to prioritize the vaccination of all pregnant women during their antenatal care (ANC) visits to ensure passive immunity for their newborns. It is also essential to educate traditional birth attendants on the dangers of using unsterilized tools for cord cutting in communities where facility access is limited. HSAs are encouraged to perform active case searching for any infant deaths occurring within the first 28 days of life to ensure no NNT cases are missed. We are providing additional training to clinicians on the clinical diagnosis of NNT, which is characterized by the sudden onset of muscle spasms and “lockjaw.” Integrated surveillance for NNT is linked with our wider efforts to reduce overall neonatal mortality and improve child survival rates in Malawi. The reporting of zero cases this week should not lead to any reduction in our immunization outreach or hygiene promotion efforts. We will continue to advocate for the universal provision of “Mama Kits” that include sterile cord-care materials for every expectant mother. Our commitment to a tetanus-free future for every Malawian child remains a cornerstone of our national reproductive and child health strategy. Ongoing surveillance is the only way to prove that our elimination status is being successfully sustained year after year. Let us work together to ensure that no child in Malawi ever has to suffer from this preventable and agonizing disease.

Malawi maintained a status of zero (0) new confirmed Mpox cases and zero (0) alerts during epidemiological week 13. This continued absence of cases is a highly positive sign, but it must be met with sustained vigilance rather than complacency. The risk of Mpox introduction remains significant given the ongoing transmission in the region and the high volume of cross-border movement. Our border surveillance teams must continue to screen travelers for symptoms and maintain a high index of suspicion for unusual rashes. Mpox remains a disease of international concern, and Malawi’s reporting contributes to the broader global understanding of the virus’s spread. We are continuing to provide mentorship on case definition and sample management to healthcare workers in all district hospitals. Public awareness campaigns should be sustained to ensure that the community knows to report any suspicious lesions or fevers immediately. Early detection remains our primary strategy for preventing a localized outbreak from becoming a national epidemic in 2026.

Laboratory capacity for Mpox molecular testing is being regularly verified at the national reference lab to ensure rapid turnaround times for any alerts. We are also collaborating with international health partners to share data and refine our national preparedness and response plans for viral hemorrhagic fevers. It is essential for clinicians to differentiate Mpox from other common rash-illnesses like chickenpox or measles through thorough clinical examination. We are also working to strengthen community-based surveillance to identify any cases that might be deterred from facilities due to stigma. The current period of zero cases allows us to further refine our clinical guidelines and stockpile necessary infection prevention and control (IPC) supplies. We are reviewing our genomic surveillance capabilities to ensure we can identify the specific clade of the virus if an introduction occurs. Every alert that is investigated and ruled out is a sign that our surveillance system is functioning with high sensitivity and accuracy. We encourage all districts to continue their active case searching during routine facility and community visits to ensure no case is missed. Protecting Malawi from Mpox requires a unified effort from all health sectors and the active participation of the general public.

Acute Flaccid Paralysis (AFP) surveillance reported three (3) new cases in week 13, all of which are currently undergoing laboratory verification to rule out Polio. These cases were identified in diverse geographical areas, showing that our detection system is capable of picking up rare clinical events across the country. AFP surveillance is a global requirement for maintaining our polio-free status, and Malawi is committed to meeting all international performance standards. Each of these three cases must have two “adequate” stool samples collected 24 hours apart within 14 days of paralysis onset. We are also tracking thirty-three (33) suspected measles cases this week, which represents a concerning increase in potential vaccine-preventable disease activity. Measles is one of the most contagious viral diseases and can rapidly spread through communities with low immunization coverage. Even a single confirmed measles case is considered an outbreak in Malawi and requires an immediate and aggressive vaccination response. We must ensure that our routine immunization programs are reaching the most remote and marginalized populations to prevent these outbreaks.

Health workers are reminded that any child with fever and a maculopapular rash must be investigated for measles, with blood and swab samples collected for testing. We are urging all districts to review their “Immunization Recovery Plans” to identify and vaccinate children who have missed their scheduled doses. The presence of 33 suspected cases indicates that there may be significant immunity gaps that need to be addressed through supplemental immunization activities. Community health surveillance assistants (HSAs) should intensify their home visits to check the vaccination status of all children under the age of five. We are also monitoring for any signs of “Polio-compatible” cases that might indicate low-level circulation of the virus in areas with poor sanitation. Laboratory results for the current AFP cases will be communicated to the districts as soon as they are finalized by the regional reference lab. Maintaining a high level of vigilance for these diseases is essential for the long-term health and development of Malawi’s children. We must not allow the progress made in global eradication efforts to be reversed by local surveillance or immunization gaps. Collaborative efforts between the EPI program and the IDSR secretariat are being strengthened to ensure an integrated approach to these threats.

Typhoid fever surveillance recorded sixty-nine (69) cases in week 13, showing a continued upward trend that requires urgent attention from public health authorities. This volume of cases indicates that enteric transmission of Salmonella Typhi is becoming more widespread in several urban and peri-urban centers. Typhoid is a significant cause of febrile illness in Malawi and can often be misdiagnosed as malaria without proper laboratory testing. We are advocating for the wider use of blood culture as the gold standard for diagnosing typhoid fever in all district hospitals. The current trend suggests that there are significant issues with water safety and food hygiene that are facilitating the spread of the bacteria. Each case of typhoid represents a potential failure in the community’s water and sanitation barriers that must be investigated and addressed. We are particularly concerned about the potential for multi-drug resistant typhoid strains to emerge if antibiotic stewardship is not strictly practiced. The surveillance data this week highlights the need for a multi-sectoral response to improve safe water access in the most affected areas.

Environmental health investigations are being prioritized for the clusters of typhoid cases identified in this week’s surveillance report. We urge the districts to work closely with local government and water boards to ensure that water sources are properly chlorinated and protected from contamination. Public health messaging should focus on the importance of “boil and use” practices for all drinking water in areas where typhoid is currently circulating. We are also monitoring the impact of the Typhoid Conjugate Vaccine (TCV) program and identifying areas where additional vaccination coverage may be needed. Schools and food markets should be the focus of intensive hygiene promotion activities to reduce the risk of large-scale community transmission. It is essential that clinicians follow the national treatment guidelines and complete the full course of antibiotics to prevent the development of chronic carriers. We will continue to map the geographical distribution of typhoid cases to help target our preventive interventions and resource allocation. Long-term solutions for typhoid must include significant investments in permanent safe water and sewerage infrastructure across Malawi. Let us maintain a high index of suspicion and respond aggressively to every cluster of febrile illness that could be typhoid fever. Strengthening our enteric disease surveillance is a key priority for the national public health institute this year.