Weekly IDSR Bulletin
Epidemiological Week 25 (15-21 June, 2026)
Editorial Team
I. Performance & Surveillance
Reporting Completeness & Timeliness Analysis
The national reporting performance for Epidemiological Week 25 has achieved an encouraging upward trajectory. Reporting completeness increased to 97.0% from 94.0% in Week 24, while reporting timeliness on the One Health Surveillance Platform (OHSP) was successfully maintained at 93.0% over the same period. This performance reflects a highly resilient surveillance infrastructure and active platform engagement across the majority of clinical points. All subnational health zones, including Central Hospitals, met the targeted national minimum threshold of greater than or equal to 80% for both reporting metrics in this cycle, protecting the overall sensitivity of our integrated disease detection networks.
At the subnational level, reporting metrics display diverse but strong progress. Central Hospitals achieved an outstanding performance, registering 100.0% for both completeness and timeliness. Similarly, the Central West and South West Zones excelled, each reporting 99.0% completeness and 98.0% timeliness. Out of the 33 designated national reporting sites (Districts and Central Hospitals), 30 (91.0%) successfully met the minimum target of greater than or equal to 80% for both indicators. However, localized administrative friction persists: Rumphi DHO failed to surpass the minimum reporting targets for both completeness and timeliness (61.0% on both metrics), while Karonga DHO (91.0% completeness, 74.0% timeliness) and Zomba DHO (98.0% completeness, 60.0% timeliness) failed specifically on the timeliness metric.
To restore tracking uniformity and eliminate operational latency, the National IDSR Secretariat directs immediate remedial measures. District Health Officers in Rumphi, Karonga, and Zomba must execute rapid administrative interventions to eliminate processing bottlenecks and platform entry delays. Zonal Epidemiology Officers and IDSR coordinators must ensure timely verification and validation of clinical data immediately after facility focal points submit weekly forms to maintain optimal responsiveness on the OHSP.
II. Disease Morbidity
Malaria Morbidity & Mortality
Malaria continues to stand as the dominant clinical and priority condition under active surveillance in Malawi, with Epidemiological Week 25 recording a substantial national burden of 22,223 clinical cases (comprising 21,841 OPD cases and 382 IPD cases) alongside 4 associated inpatient deaths. This persistent morbidity load indicates active transmission dynamics across multiple zones, maintaining constant pressure on primary clinical facilities and essential antimalarial stocks. High-burden districts continue to represent key transmission hot spots requiring close monitoring, particularly Mangochi DHO (2,326 OPD cases, 23 IPD cases) and Blantyre DHO (2,513 OPD cases, 2 IPD cases).
When contrasted with the preceding baseline in Epidemiological Week 24, the malaria data reveals a highly positive decrease of 11.9% in weekly cases (dropping from 25,225 down to 22,223 cases). Weekly confirmed inpatient deaths also fell from 10 cases in Week 24 down to 4 cases in Week 25. This downward trend in mortality is encouraging, suggesting stable therapeutic timing and effective clinical management. However, vector control and early care-seeking behaviors remain critical to offset seasonal breeding dynamics and prevent severe pediatric complications across high-burden catchments.
To sustain this downward transmission trend and prevent fatal outcomes, we recommend that the National Malaria Control Program continues to coordinate immediate antimalarial supply chain audits to ensure uninterrupted buffer stocks of Artemisinin-based Combination Therapy (ACTs) and Rapid Diagnostic Tests (RDTs). Clinical supervisors must conduct rigorous mortality audits on the 4 recorded deaths to identify any delays in therapeutic administration. Concurrently, Health Surveillance Assistants (HSAs) must continue to scale up risk communication campaigns highlighting immediate care-seeking behaviors for febrile illnesses.
Enteric Diseases (Typhoid & Diarrhoea)
The surveillance of waterborne enteric pathogens in Epidemiological Week 25 has flagged persistent transmission risks. Waterborne enteric diseases remain highly prevalent, with Diarrhoea with blood (Bloody Diarrhoea) cases recorded at 638 (including 629 OPD cases and 9 IPD cases) and Typhoid fever cases recorded at 84 (OPD Typhoid cases). Waterborne disease transmission remains a persistent threat, especially in urban and peri-urban locations with compromised water and sanitation networks, demanding a rapid transition from passive clinical tracking to active environmental health interventions.
When compared to the baseline figures from Epidemiological Week 24, the enteric profile shows a significant downward trajectory. Typhoid fever cases decreased by 22.2%, declining from 108 cases in Week 24 down to 84 cases in Week 25. Similarly, Bloody Diarrhoea cases decreased from 671 cases to 638 cases. Despite this national reduction, a notable concentration of Typhoid cases remains localized within Lilongwe DHO (25 cases) and Blantyre DHO (24 cases), representing 58.3% of the national Typhoid fever burden in Week 25, which demands immediate localized interventions.
Based on these findings, we recommend that Lilongwe, Blantyre, and Mchinji DHOs deploy rapid response teams to conduct systematic water quality monitoring and food safety inspections. Clinical teams must ensure stool and blood cultures are collected from suspected cases to monitor potential antimicrobial resistance patterns and guide precise therapy. Furthermore, environmental health officers must implement localized water treatment protocols, distribute chlorine solutions, and conduct extensive hygiene sensitization campaigns to break enteric transmission chains.
III. Critical Alerts & Mortality
Cholera and Mpox Status
Epidemiological Week 25 recorded 8 new suspected Cholera cases, with 2 new confirmed cases and 0 deaths, reflecting strong case management inside established Cholera Treatment Units (CTUs). On the zoonotic disease front, Mpox surveillance detected zero (0) new confirmed cases and zero (0) alerts. This keeps the cumulative national total stable at 158 confirmed cases and 4 cross-border cases since April 2025. Lilongwe district represents 75.8% (119 cases) of the national load with a case fatality rate (CFR) of 0.63% (1 death on 10 August 2025).
A comparison with Epidemiological Week 24 shows a sharp downward trend in weekly Cholera suspected cases, declining from 42 in Week 24 to 8 in Week 25. Since the season started on 1 November 2025, Malawi has recorded a cumulative total of 3,008 suspected cases with 317 laboratory-confirmed cases and 461 epidemiologically linked cases, alongside 5 deaths (CFR 0.65%). Geographically, 26 of Malawi’s 29 districts have reported at least one suspected case. Meanwhile, Mpox transmission remained completely silent, matching the zero confirmed case baseline from the previous week.
To maintain this Cholera downward trend, the National Incident Management System must continue to direct emergency water, sanitation, and hygiene (WASH) resources to high-incidence hotspots. Oral Cholera Vaccine (OCV) campaigns in selected hotspot districts have achieved a total of 612,477 doses administered (101.3% coverage). For Mpox, District Rapid Response Teams (DRRTs) must remain alert, enforcing active cross-border screening and coordinating with Mozambique and Tanzania to ensure immediate detection of any imported cases.
SARI & Respiratory Mortality
Severe Acute Respiratory Infections (SARI) presented 85 clinical cases and 3 inpatient deaths during Epidemiological Week 25. The severe respiratory burden continues to affect central districts, with Kamuzu Central Hospital (KCH) reporting 28 SARI cases (32.9% of the national load) and 2 SARI-associated deaths. Other districts with active respiratory caseloads include Neno DHO (24 SARI cases) and Dowa DHO (21 SARI cases). This concentration highlights the need for continuous sentinel respiratory surveillance and clinical preparedness in tertiary facilities.
When evaluated against the preceding baseline in Epidemiological Week 24, the SARI surveillance data displays a positive downward trajectory in both morbidity and clinical mortality. National SARI cases fell by 14.1%, dropping from 99 cases in Week 24 down to 85 cases in Week 25. Concurrently, SARI-associated deaths decreased from 4 cases to 3 cases. This decline in severe respiratory cases is encouraging, yet clinical teams must remain highly vigilant to identify and respond to seasonal respiratory pathogens, such as Influenza A/B or RSV.
We recommend that clinical teams at Kamuzu Central Hospital and other sentinel hospitals continue to systematically collect nasopharyngeal swabs from SARI patients for PCR diagnostic analysis. Healthcare facilities must ensure that pediatric oxygen delivery systems, clinical nebulizers, and essential respiratory therapeutics remain fully functional. Furthermore, clinicians must continue to document and report SARI cases on the OHSP, allowing public health teams to identify and respond to any new respiratory anomalies quickly.
IV. Vaccine Preventable Diseases
Measles & VPD Surveillance Distribution
Vaccine-Preventable Disease (VPD) surveillance remains a high-priority public health activity. In Week 25, Malawi reported 56 new suspected measles alerts, bringing the cumulative alerts to 1,548 with 658 confirmed measles-rubella cases in 2026. Cumulative laboratory-confirmed cases are distributed across 23 districts, with Balaka reporting the highest proportion at 20.4% (78 cases) and Nsanje at 16.7% (61 cases). Under the IDSR framework, Acute Flaccid Paralysis (AFP) surveillance recorded 9 cases, and Meningococcal meningitis recorded 11 cases (including 2 deaths), highlighting the need for active case searching.
When compared to Epidemiological Week 24, weekly Measles alerts rose slightly, moving from 49 cases to 56 cases. AFP alerts rose from 3 cases in Week 24 to 9 cases in Week 25, reflecting highly sensitive surveillance reporting. Conversely, suspected Meningococcal meningitis cases fell slightly, moving from 14 cases in Week 24 down to 11 cases in Week 25, requiring immediate laboratory verification. Polio outbreak containment remains a high priority following the confirmation of 16 environmental sewage isolates since January 2026.
We recommend that the Expanded Programme on Immunisation (EPI) continues targeting high-burden districts, particularly Balaka and Nsanje, with supplemental vaccination and outreach. For the 9 reported AFP cases, dual stool samples must be collected and sent to the laboratory under strict cold chain conditions. To prevent poliovirus spread, active community-level surveillance must be prioritized alongside preparations for the upcoming vaccination campaigns, and the measles situation in Dedza district must receive focused attention.
V. Summary of Recommendations
1. Reporting Quality & District Targets
Zomba and Rumphi DHOs must implement immediate data validation procedures to improve completeness and timeliness back to target levels of greater than or equal to 80%, while Karonga DHO must focus specifically on timeliness.
2. Enteric & Outbreak Targeted Interventions
Lilongwe, Blantyre, and Mchinji DHOs are directed to implement targeted interventions against Typhoid fever being reported in the districts, while Dedza district must receive focused attention regarding its measles situation.
3. AEFI Safety Investigation
Mzimba North DHO is directed to perform a detailed vaccine safety investigation on the reported Adverse Events Following Immunization (AEFI) to maintain high community trust in routine childhood immunizations.