The national reporting performance for Epidemiological Week 26 has registered a minor decline in completeness, sliding to 95.0% from the 97.0% recorded in Week 25, 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, successfully 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 progress. Central Hospitals and the South West Zone excelled, both registering 100.0% for completeness, with Central Hospitals achieving 100.0% timeliness and South West Zone at 98.0%. The Central East Zone reported 88.0% completeness and 87.0% timeliness, while the North Zone reached 95.0% completeness and 90.0% timeliness. Out of the 33 designated national reporting sites, 27 (82.0%) successfully met the minimum target of greater than or equal to 80% for both indicators. However, localized administrative friction has escalated: Nkhotakota DHO (39.0% on both metrics), Dedza DHO (76.0% on both), and Balaka DHO (78.0% on both) failed to surpass the minimum reporting targets for both completeness and timeliness. Additionally, Karonga DHO (83.0% completeness, 70.0% timeliness), Machinga DHO (91.0% completeness, 61.0% timeliness), and Mzimba South DHO (88.0% completeness, 79.0% 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 Nkhotakota, Dedza, Balaka, Karonga, Machinga, and Mzimba South 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.

Malaria continues to stand as the dominant clinical and priority condition under active surveillance in Malawi, with Epidemiological Week 26 recording a substantial national burden of Confirmed cases totaling 20,369 (comprising 20,080 OPD cases and 289 IPD cases) alongside 5 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 Blantyre DHO (2,386 OPD cases, 6 IPD cases), Chikwawa DHO (2,278 OPD cases, 4 IPD cases), and Mangochi DHO (2,123 OPD cases, 13 IPD cases).

When contrasted with the preceding baseline in Epidemiological Week 25, the malaria data reveals an encouraging decrease of 8.34% in weekly cases (dropping from 22,223 down to 20,369 cases). However, weekly confirmed inpatient deaths rose slightly from 4 cases in Week 25 up to 5 cases in Week 26. This slight upward shift in clinical mortality highlights the critical importance of early therapeutic timing and immediate access to intensive supportive protocols across high-burden districts to offset complications and prevent fatal pediatric outcomes.

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 5 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.

The surveillance of waterborne enteric pathogens in Epidemiological Week 26 has flagged persistent transmission risks. Waterborne enteric diseases remain highly prevalent, with Diarrhoea with blood (Bloody Diarrhoea) cases recorded at 629 (including 625 OPD cases and 4 IPD cases) and Typhoid fever cases recorded at 47 (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 25, the enteric profile shows a significant downward trajectory. Typhoid fever cases decreased by 44.0%, declining from 84 cases in Week 25 down to 47 cases in Week 26. Similarly, Bloody Diarrhoea cases decreased from 638 cases to 629 cases. Despite this national reduction, a notable concentration of Typhoid cases remains localized within Lilongwe, Blantyre, and Mchinji districts, representing the primary share of the national Typhoid fever burden in Week 26, 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.

Epidemiological Week 26 recorded an encouraging decline in Cholera activity, with 1 new suspected Cholera case, 0 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 25 shows a sharp downward trend in weekly suspected Cholera cases, declining from 8 in Week 25 to 1 in Week 26. Since the season started on 1 November 2025, Malawi has recorded a cumulative total of 3,009 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.

Severe Acute Respiratory Infections (SARI) presented 71 clinical cases and 1 inpatient death during Epidemiological Week 26. The severe respiratory burden continues to affect central districts, with Lilongwe DHO reporting 34 SARI cases (47.9% of the national load) and the SARI-associated death. Other districts with active respiratory caseloads include Mchinji DHO (11 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 25, the SARI surveillance data displays a positive downward trajectory in both morbidity and clinical mortality. National SARI cases fell by 16.5%, dropping from 85 cases in Week 25 down to 71 cases in Week 26. Concurrently, SARI-associated deaths decreased from 3 cases to 1 case. 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.

Vaccine-Preventable Disease (VPD) surveillance remains a high-priority public health activity. In Week 26, Malawi reported 69 new suspected measles alerts, bringing the cumulative alerts to 1,617 with 695 confirmed measles-rubella cases in 2026. Cumulative laboratory-confirmed cases are distributed across 23 districts, with Balaka reporting the highest proportion at 24.1% (80 cases) and Nsanje at 17.1% (68 cases). Under the IDSR framework, Acute Flaccid Paralysis (AFP) surveillance recorded 5 cases, and Meningococcal meningitis recorded 9 cases (including 2 deaths), highlighting the need for active case searching.

When compared to Epidemiological Week 25, weekly Measles alerts rose slightly, moving from 56 cases to 69 cases. AFP alerts fell from 9 cases in Week 25 to 5 cases in Week 26, reflecting stable surveillance reporting. Conversely, suspected Meningococcal meningitis cases fell slightly, moving from 11 cases in Week 25 down to 9 cases in Week 26, requiring immediate laboratory verification. Polio outbreak containment remains a high priority following the confirmation of 16 environmental sewage isolates since January 2026, with Round 3 of the nOPV2 campaign completed, achieving 105% coverage.

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 5 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 subsequent vaccination campaigns, and the measles situation in Balaka district must receive focused attention.