Weekly IDSR Bulletin
Epidemiological Week 15 (6-12 April, 2026)
Editorial Team
I. Performance & Surveillance
Reporting Completeness & Timeliness Analysis
The national reporting performance for Epidemiological Week 15 has reached a robust 95% for completeness and 90% for timeliness across the One Health Surveillance platform. This high level of reporting indicates a commendable commitment from the majority of health facilities to maintain the integrity of our national early warning systems. The data reflects a near universal engagement from district health management teams, ensuring that the health landscape is monitored with minimal blind spots. Such consistent reporting is the backbone of our ability to detect and respond to public health threats in realtime.
Comparing this to the previous period, Week 15 shows a remarkable recovery from the performance dips seen in Week 14, where completeness stood at 88% and timeliness at a concerning 78%. This 7 percentage point jump in completeness and a 12 percentage point surge in timeliness represent a successful mitigation of the technical and administrative bottlenecks reported in the prior week. While Week 14 was characterized by platform access issues and reporting fatigue, the current week demonstrates that intensive follow-ups and system stabilization measures have effectively re-engaged the reporting units. This week-on-week growth signifies a resilient surveillance infrastructure capable of rebounding quickly from operational challenges.
Moving forward, the National IDSR team recommends that the remaining 5% of non-reporting districts undergo a targeted data audit to identify facility-specific barriers, whether they be related to human resource turnover or localized internet connectivity issues. We urge District Environmental Health Officers (DEHOs) to prioritize “zero-reporting” facilities for immediate supervisory visits to ensure that the 100% completeness target is achieved in the coming week. Furthermore, the stabilization of timeliness at 90% must be protected by reinforcing the Monday 10:00 AM deadline as a non-negotiable standard for all public and private reporting entities to facilitate timely national decision making.
II. Disease Morbidity
Malaria Morbidity & Mortality
Malaria continues to dominate the public health landscape in Malawi, with Week 15 recording a significant burden of 31,695 cases and 8 associated deaths. This high volume of cases underscores the persistent endemicity of the disease and its heavy toll on the primary healthcare system, particularly among vulnerable populations in rural areas. The mortality reported this week highlights critical gaps in either early care-seeking behavior at the community level or the quality of inpatient management for severe cases at the facility level. As the leading cause of morbidity, malaria remains the most significant pressure point for medical supplies and personnel nationwide.
When contrasted with Week 14, the data reveals a worrying upward trajectory in both morbidity and mortality. Total cases rose by approximately 6%, climbing from 29,915 to 31,695, while deaths increased from 6 to 8. This simultaneous rise suggests that the transmission season is peaking or that environmental factors, such as stagnant water from recent rainfall, are facilitating increased vector breeding. The steady increase in case numbers over the last two weeks serves as an alarm that current prevention measures, including LLIN usage and indoor residual spraying where applicable, may need reinforcement to prevent the healthcare system from being overwhelmed by seasonal surges.
To address this rising trend, we recommend that all health facilities conduct an immediate inventory check to ensure an uninterrupted supply of Rapid Diagnostic Tests (RDTs) and Artemisinin-based Combination Therapy (ACT). Communities must be re-sensitized through local radio and health surveillance assistants on the importance of reporting to a health facility within 24 hours of fever onset to prevent progression to severe malaria. Additionally, clinical teams in districts with high mortality rates should conduct maternal and child health audits to identify if there are specific delays in the administration of injectable artesunate for severe cases, ensuring that life-saving protocols are strictly followed.
Enteric Diseases (Typhoid & Diarrhoea)
The surveillance of enteric diseases in Week 15 has flagged a significant concern, with Typhoid fever cases reaching 124 and Bloody Diarrhoea cases totaling 605. A notable observation this week is the concentration of Typhoid reports coming from urban private facilities, specifically Malmed and Shifa Private Clinics, which suggests a localized but intense transmission cycle in metropolitan settings. These diseases serve as critical indicators of the underlying sanitation and water safety standards within our communities. The presence of these pathogens in urban centers often points toward contaminated food chains or breaches in the municipal water supply infrastructure that require immediate technical investigation.
Comparing these figures to Week 14 reveals a sharp escalation in the enteric disease profile, particularly for Typhoid fever which saw a 40% increase from 88 cases to 124. Bloody Diarrhoea also followed an upward trend, rising from 552 cases in the previous week to 605. This synchronous rise across multiple enteric indicators suggests a widespread environmental contamination issue that has worsened over the seven-day period. While Week 14 showed signs of localized clusters, Week 15 confirms that the transmission is expanding geographically and in intensity, demanding a shift from passive monitoring to active environmental intervention to halt the spread before it transforms into a larger-scale epidemic.
The Secretariat recommends an immediate multi-sectoral response involving environmental health officers and water board authorities to conduct water quality testing at the household level in the catchment areas of the reporting clinics. We also advise health facilities to intensify stool sample collection for culture and sensitivity testing to monitor for potential antibiotic resistance patterns in these enteric pathogens. Furthermore, public health teams should launch targeted “Wash Your Hands” and “Boil Water” campaigns in high-incidence urban neighborhoods. Food safety inspections at marketplaces and among street vendors must be revitalized to identify and eliminate potential point sources of infection that are driving this weekly increase.
III. Critical Alerts & Mortality
Cholera and Mpox Status
Epidemiological Week 15 has been characterized by a persistent but stable Cholera situation, with 141 suspected cases and 16 laboratory-confirmed cases reported. Crucially, zero deaths were recorded, which is a testament to the effectiveness of the current case management protocols and the readiness of Cholera Treatment Units (CTUs). Simultaneously, the Mpox surveillance system has detected 2 new confirmed cases and 4 alerts, signaling that the virus remains active within the community. While the Cholera numbers are stable, the re-emergence of confirmed Mpox cases highlights a complex dual-threat environment that requires high clinical suspicion and rapid diagnostic turnaround.
In comparison to Week 14, the Cholera data remains virtually static, with suspected cases moving from 144 to 141 and confirmed cases increasing by only one (from 15 to 16). This indicates that while the outbreak is not exponentially growing, it is not yet under full control and remains in a “smoldering” phase that could ignite if WASH conditions deteriorate. However, the Mpox situation shows a distinct change; Week 14 reported zero confirmed cases despite 3 alerts, whereas Week 15 has successfully confirmed 2 cases. This transition from “alert” to “confirmed” status indicates that the surveillance system is working effectively but also that active transmission chains are currently present and undetected in some pockets of the population.
Based on these findings, we recommend that the Ministry of Health maintains a high state of readiness in all Cholera hotspots, with a focus on pre-positioning Oral Rehydration Salts (ORS) and IV fluids. For Mpox, it is critical that District Rapid Response Teams (DRRTs) initiate comprehensive contact tracing for the 2 newly confirmed cases to identify the source of infection and prevent tertiary spread. There is also an urgent need to update the public on Mpox symptoms—specifically the nature of the rash—to encourage early reporting of alerts. Lastly, cross-border surveillance must be strengthened, particularly in districts sharing borders with countries that have documented active Mpox outbreaks, to ensure early detection of imported cases.
SARI & Respiratory Mortality
Severe Acute Respiratory Infection (SARI) remains a major contributor to hospital-based mortality, with 199 cases and 5 deaths reported in Week 15. A disproportionate amount of this burden is carried by Kamuzu Central Hospital (KCH), which accounted for 122 of the national cases (over 60%). This high concentration of SARI cases at a tertiary referral center suggests either a high localized prevalence of respiratory pathogens in the Lilongwe area or a strong referral system that funneling the most severe cases to KCH. The mortality rate of 2.5% for SARI this week is a significant indicator of the severity of illness presenting at our facilities.
The comparative data from Week 14 shows a stable case volume but a concerning spike in mortality. While cases only grew from 196 to 199, the number of deaths more than doubled from 2 in Week 14 to 5 in Week 15. This increase in the Case Fatality Rate (CFR) despite stable morbidity is a red flag that may indicate a more virulent strain of respiratory virus is circulating, or that patients are presenting later in their illness. Furthermore, KCH’s dominance in the data has increased; in Week 14 it reported 79% of the cases, and while its share of the national total remains high, the increase in deaths nationwide suggests that respiratory complications are becoming more fatal across multiple districts.
We recommend that the National Public Health Laboratory (NPHL) prioritizes the virological characterization of samples collected from the 5 deceased SARI cases to identify if Influenza A, B, or SARS-CoV-2 are the primary drivers of this mortality spike. Central and District hospitals should ensure that oxygen therapy equipment and essential antibiotics for secondary bacterial pneumonia are fully functional and available. We also urge clinicians to improve the documentation of underlying comorbidities in SARI patients, as this data is vital for tailoring clinical interventions. Finally, intensified public messaging on respiratory hygiene and the importance of seeking medical help for breathing difficulties is essential to reduce the current trend of late presentations.
IV. Vaccine Preventable Diseases
Measles & VPD Surveillance Distribution
Vaccine-Preventable Disease (VPD) surveillance remains a top priority, with cumulative Measles cases for 2026 now reaching 287 across 23 districts. The current week has seen continued reports from hotspots such as Balaka and Kasungu, which combined account for over 35% of the national burden. Additionally, the Acute Flaccid Paralysis (AFP) surveillance system captured 3 new alerts this week, demonstrating the continued vigilance required to maintain Malawi’s polio-free certification. These indicators are vital for evaluating the coverage and effectiveness of the Expanded Program on Immunization (EPI) and for identifying “zero-dose” communities that remain susceptible to outbreaks.
Comparatively, the Measles situation has shown a steady expansion from Week 14. In the previous bulletin, cases were more concentrated in fewer districts, but Week 15 data shows that the virus has successfully established footholds in 23 out of 29 districts. For AFP, the reporting of 3 cases this week is an improvement in surveillance sensitivity compared to the 1 case reported in Week 14. This increase in AFP alerts is actually a positive indicator of a “sensitive” surveillance system, as we expect to find a certain number of non-polio AFP cases annually to prove that our detection mechanisms are working. The zero-case status for Neonatal Tetanus has been maintained for two consecutive weeks, which is a significant achievement for our maternal health services.
Our recommendation is for districts with high Measles case counts, particularly Balaka and Kasungu, to conduct immediate “mop-up” immunization campaigns targeting children who missed their scheduled doses. Surveillance officers must ensure that every AFP alert is followed by the collection of two stool samples within 14 days of onset, transported under strict cold chain conditions to the national laboratory. We also recommend a review of the “Under-Five” registers in facilities reporting Measles cases to identify the specific age cohorts most affected. Finally, maintaining the zero-case trend for Neonatal Tetanus will require continued focus on ensuring that all pregnant women receive their Tetanus Toxoid vaccinations and are encouraged to deliver in sanitary, facility-based environments.