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MINISTRY OF HEALTH PUBLIC HEALTH AUTHORITY

EPIDEMIOLOGY AND STATISTICS SECTIONDISEASE SURVEILLANCE AND RESPONSE UNIT

P.O.Box 52, Seychelles Hospital, Mahé, Republic of Seychelles Office: 438(8012, 8082, 8161, 8477)

Hotlines: 2606000, 2606001E-Mail:D SR U @ h e a l t h . g o v .sc

2014 ANNUAL EPIDEMIOLOGICAL REPORT

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TABLE OF CONTENTS1 TIMELINESS OF REPORTS...........................................................................................................3

2 DOCTOR’S CONSULTATIONS.....................................................................................................4

3 NOTIFIABLE DISEASES AND SURVEILLANCE ACTIVITIES OF IMPORTANCE...............6

3.1 HIV AND AIDS.........................................................................................................................6

3.2 HIV.............................................................................................................................................6

3.3 AIDS...........................................................................................................................................9

3.4 AIDS RELATED DEATHS.......................................................................................................9

3.5 PREVENTION OF MOTHER TO CHILD TRANSMISSION OF HIV (PMTCT) ...............11

3.6 HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART) ..........................................12

3.7 HIV TESTING .........................................................................................................................12

3.8 HEPATITIS B ..........................................................................................................................13

3.9 HEPATITIS C ..........................................................................................................................14

3.10 SYPHILIS ..............................................................................................................................16

3.11 GONORRHEA ......................................................................................................................16

3.12 CHLAMYDIA TRACHOMATIS .........................................................................................18

3.13 TUBERCULOSIS ..................................................................................................................19

4 NOTIFIABLE DISEASES UNDER WEEKLY SURVEILLANCE .............................................20

4.1 GASTROENTERITIS .............................................................................................................20

4.2 INFLUENZA LIKE ILLNESS ................................................................................................21

4.3 PNEUMONIA ..........................................................................................................................22

4.4 CONJUNCTIVITIS .................................................................................................................23

4.5 METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) ...........................24

4.6 LEPTOSPIROSIS ....................................................................................................................24

4.7 MALARIA ...............................................................................................................................26

5 EPIDEMIC FOR 2014 ....................................................................................................................27

5.1 HAND, FOOT AND MOUTH DISEASE (HFMD) ................................................................27

6 OTHER SURVEILLANCE ACTIVITIES .....................................................................................28

6.1 ILI AND SARI SURVEILLANCE .........................................................................................28

6.2 BLOOD SAFETY ....................................................................................................................29

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1 TIMELINESS OF REPORTS

Timely reporting is defined as notifiable diseases seen during the reporting week being notified to the DSRU via either web based surveillance, telephone or paper reporting on Tuesday of the following week by 3pm. Timely reporting is important in disease surveillance for timely analysis and interpretation of data and its translation into recommendations and actions.

Graph 1. Timeliness in disease reporting by reporting sites in 2014, Seychelles

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There has been a significant improvement in timely reporting throughout the year 2014, however no reporting site attained 100% timely reporting. From 32 reporting sites, 23 (72%) achieved an average timely reporting of 75% and above, a 28% increase compared with the year 2013. Nine (28%) reporting sites had a timely reporting of less than 75%. Anse Royale recorded the highest percentage at 98% followed by Anse Aux Pins at 94% and both Les Mamelles and Youth Health Centre at 92%. The year 2014, an average of 13% increase in timely reporting compared with the year 2013. Of note the private sector is responsible for an estimated 25% of consultations, but does not comply with the weekly reporting requirements therefore does not feature in this report.

Graph 2. Timeliness in disease reporting by reporting sites, 2013-‐ 2014, Seychelles

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2 DOCTOR’S CONSULTATIONS

A total of 396,595 doctor’s consultation was reported by web- based‐ surveillance in 2014 representing an increase of 12% in the total doctor’s consultations compared to 353,340 doctor’s consultation in 2013. English River reported the highest doctor’s consultations at 74,165 representing 19% of the total number of doctor’s consultations followed by the Surgical Outpatient Department (SOPD) at 37,921 (10%) and Anse Royale at 37,263 (9%) doctor’s consultations.

Graph 3. The number of doctor’s consultations by reporting sites, January to December 2014, Seychelles

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Graph 4. The number of doctor’s consultations by reporting sites, 2013-‐ 2014, Seychelles

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The total number of doctor’s consultations in 2014 was 396595 of which 56582 was due to notifiable diseases (14%). A reduction of 1.3% in notifiable diseases reported in 2014 compared with the year 2013. Gastroenteritis in the five years old and above was the most prevalent notifiable disease reported, representing 8.72%, followed by Influenza like Illness 3.05%, Gastroenteritis in the less than five years old 2.67% and MRSA 2.03% respectively.

Consultations due to Hypertension represented 57.86% (32743) cases of the total notifiable diseases reported in 2014, (0.69% (395) new cases and 57.17% (32348) chronic cases) followed byDiabetes at 19.31% (10270), (1.59% (169) new cases and 17.70% (10101) chronic cases, Stroke at 0.30% and Myocardial Infarction at 0.07% respectively. There was a 20% reduction in new cases of Hypertension and 12% increase in new cases of Diabetes compared to the year 2013. Five strokes’ related deaths were reported compared with 16 in the year 2013 and 5 Myocardial Infarction related deaths compared with 12 in the year 2013.

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3 NOTIFIABLE DISEASES AND SURVEILLANCE ACTIVITIES OF IMPORTANCE

3.1 HIV AND AIDS

Local Situation from 1987 to 2014

Cumulative HIV Cases 667 (387M/280F)

Cumulative AIDS Cases 283 (175M/108F)

Cumulative Deaths 136 (82M/54F)

Cumulative HIV Positive Pregnancies 108

Living with HIV 441 (246M/195F)

Cumulative Cases on HAART 231 (125M/106F)

Left Seychelles 92 (59M/33)

Cumulative Loss to Follow-‐ Up Cases 64 (40M/24F)

Cumulative Drop–outs on HAART 55 (28M/27F)

3.2 HIV

Since the first HIV case was diagnosed in Seychelles in 1987, a cumulative of 667 (387M/280F) HIV cases representing 58% males and 42% females have been reported to date. Currently, 441 (246M/195F) cases are living with HIV representing 56% males and 44% females. Main probable mode of transmission at diagnosis was heterosexual 57% and intravenous drug use 31% of the cases diagnosed in 2014.

The year 2014 has reported the highest number of new cases for HIV since 1987 with 91(55M/36F) cases, an increase of 94% compared to 2013, age ranging from 1 month old to 71 years old, both females.

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Graph 5. New reported cases of HIV from 1987 to 2014 in Seychelles.

Out of the 441 (246M/195F) cases living with HIV, 64 (40M/24F) cases did not access the service for over six months representing 15% of loss to follow-‐up (LTFU). A cumulative of 231 (125M/106F) cases was on Highly Active Antiretroviral Therapy (HAART) by the end of 2014 representing 52% of people living with HIV. Of note, 55(28M/27F) cases representing 19% of cases eligible for treatment as per WHO recommended guidelines defaulted treatment for more than three months in 2014.

Graph 6. New HIV cases by age group at diagnosis from 1987 to 2014 in Seychelles.

The age groups most affected were the 25 -‐ 29 and 30 -‐ 34 years old representing 33% of the HIV cases reported from 1987 to 2014. The 50 years old and above represented 15% of the total

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number of cases. Males were more predominantly affected throughout the years compared tofemales.

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Graph 7. People living with HIV by age group and sex in 2014 in Seychelles.

With the availability of treatment, improvement in management of HIV over the years, an increasing number of cases are aging with the disease, 23% of the cases living with HIV were in the 50 years old and above age group by the end of 2014.

Table 1. The main probable modes of transmission of HIV in 2014

Cases PercentageHeterosexual 52 57IDU 28 31Bisexual/MSM 9 10FSW 1 1MTCT 1 1

Probable modes of transmission at diagnosis in 2014; Heterosexual 57%, Intravenous Drug Use 31% and Men having Sex with Men 10 % respectively.

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3.3 AIDS

Graph 8. New AIDS reported cases from 1993 to 2014 in Seychelles.

Since the first AIDS case in 1993, a cumulative of 283 (175M/108F) AIDS cases was reported by December 2014 of which 62% males and 38% females. There were 19(11M/8F) new AIDS cases reported in 2014, a reduction of 9% compared to 21 new cases in 2013, 14 were newly diagnosed HIV cases and 5 were known HIV cases who progressed to AIDS.

3.4 AIDS RELATED DEATHS

Graph 9. New AIDS related deaths by year from 1993 to 2014 in Seychelles.

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A cumulative of 136 (82M/54F) AIDS related deaths has been reported since 1993 to 2014, 60% of deaths occurred in males and 40% in females.

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Graph 10. AIDS mortality amongst PLWHA from 1993 to 2014 in Seychelles.

The AIDS mortality from 1993 to 2000 has generally been on the increase, with the introduction of Highly Active Antiretroviral Therapy (HAART) in 2001, a sustained decline in the trend has been noted over the years with though an increase in mortality in 2014.In 2002 there were 6 deaths (7%) out of 87 PLWHA, 5 deaths (3%) out of 175 PLWHA in 2006, 8 deaths (3%) out of 294 PLWHA in 2010 but an increase in AIDS mortality was noted in 2014 with 19 deaths (4%) out of 441 PLWHA. The year 2014 reported the highest number of AIDS related deaths since 1993, an increase of 137% compared to 8 cases in 2013 and age ranging from 16 to 66 years. Of the 19 death cases, 42% were newly diagnosed with HIV in 2014, 47% were those who have defaulted treatment and follow- up‐ and 11% died of cancers.

Possible contributing factors towards the increase in AIDS mortality were loss to follow up and late presentation of cases. In 2014, 15% of PLWHA did not access the service for over six months, 19% of cases eligible for treatment defaulted treatment for more than three months and late presentation of cases. In 2014, 42% of AIDS related deaths were newly diagnosed HIV cases who were in late stage of AIDS.

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3.5 PREVENTION OF MOTHER TO CHILD TRANSMISSION OF HIV (PMTCT)

A cumulative of 108 HIV positive pregnancies have been reported from 1987 to 2014, 83(77%) have benefited from the PMTCT program since its introduction in 2001 from monotherapy to tri- t‐ herapy today.

Graph 11. New HIV positive pregnancies from 1988 to 2014 in Seychelles.

**2001: The year in which the Prevention of Mother to Child Transmission program was introduced in Seychelles.

There were 10 new HIV positive pregnancies reported for the year 2014, an increase of 43% compared to 2013 (7), age ranging from 16 to 35 years old. Before the PMTCT era, 8 out of the 23 babies born from HIV positive mothers were infected with HIV representing a mother to child transmission of 35% compared to 3 out of the 80 babies since the introduction of PMTCT program representing a mother to child transmission of 4%. Only 4 of the 10 HIV positive pregnant mothers delivered in 2014.

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3.6 HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART)

By the end of 2014, there were 231(125M/106F) cases on Highly Active Antiretroviral Therapy (HAART), representing 52% of PLWHA. However, a number of treatment drop- outs‐ are reported every year. By the end of 2014, a total of 55(28M/27F) cases representing 19% of cases eligible for treatment as per WHO recommended guidelines defaulted treatment for more than three months.

Graph 12. HIV cases on HAART and drop-‐outs by year of initiation.

In 2014, 64 (33M/31F) new HIV cases were initiated on Highly Active Antiretroviral Therapy (HAART), representing 52% males and 48% females respectively, an increase of 5% in new cases started on treatment compared to 2013. Of the 64 new cases initiated on HAART in 2014, 19% (12) defaulted treatment for more than three months during the course of the year.

3.7 HIV TESTING

The HIV incidence amongst the blood tested has remained constant at 5 per 1000 HIV tests for the year 2006 to 2008 but increased to 6 per 1000 HIV tests in 2009. From 2010 to 2012, there was a decreasing trend in the incidence but an increase in the incidence from 5 per 1000 HIV tests in 2013 to 9 per 1000 HIV tests was observed in 2014.

The number of tests conducted over the years has remained more or less constant. A total of 10,283 HIV tests were conducted in 2014, an increase of 8% compared to 2013. HIV tests were conducted in all VCT centers, Wards, Antenatal Clinics and the Blood Transfusion Center.

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Graph 13. Incidence of HIV amongst total number of HIV tests conducted from 2006 to 2014.

3.8 HEPATITIS B

A cumulative of 38 cases of Hepatitis B detected since 2008 to 2014 out of which 7 cases (19%) were females and 31 cases (81%) were males. Out of the 38 cases, 1 case, a male had Hepatitis B and HIV co- infection.‐ A total of 10(9M/1F) cases were reported in 2014, an increase of 100% compared to 2013. There were 4,854 Hepatitis B tests conducted in 2014, an increase of 6% compared to 2013.The incidence of Hepatitis B has remained constant since 2011 to 2013 at around 1 per 1000 tests; an incidence of 2.06 per 1000 tests was recorded in 2014.

Graph 14. Incidence of Hepatitis B from 2010 to 2014 in Seychelles.

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3.9 HEPATITIS C

A cumulative of 486 cases of Hepatitis C reported from 2002 to 2014, 399(82%) males and 87(18%) females. Out of the 486 cases, there were 56 (43M/13F) HIV and Hepatitis C co-‐infection and 18 (11M/7F) Hepatitis C related deaths.

Graph 15. New Hepatitis C cases from 2008 to 2014 in Seychelles.

For the year 2014, 93(78M/15F) new cases of Hepatitis C were detected representing a reduction of 4% in new reported cases compared to 2013, the youngest was a 15 year old and the eldest a 52 year old, both males. The age group most affected was the 20 to 34 years representing 76% of the total cases reported for 2014. There were 28 (24M/4F) new cases of HIV and Hepatitis C co-‐ infection, 12(8M/4F) Hepatitis C related deaths and 4 Hepatitis C pregnancies reported. Of note 3 amongst the 12 Hepatitis C related deaths in 2014 were newly Hepatitis C diagnosed cases for the year.

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Graph 16. Hepatitis C cases by age group at diagnosis from 2008 to 2014 in Seychelles.

** Missing age

The age groups most affected were the 20- 24‐ and 25- 29‐ years old, representing 59% of the total number of Hepatitis cases reported from 2008 to 2014.

Graph 17. Incidence of Hepatitis C per 1000 Hepatitis C tests conducted from 2010 to 2014.

No data is available for 2005 to 2007. There was a gradual increase in the incidence of Hepatitis C reported from 24 per 1000 tests in 2010 to 50 per 1000 tests in 2012 followed by a rapid declineto 26 per 1000 tests in 2013 and 23 per 1000 tests in 2014. Of the 486 cases reported to date,483 (99%) cases were confirmed to be Intravenous Drug Users. An increase of 13% was also observed in the number of Hepatitis C tests conducted in 2014 compared to 2013.

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3.10 SYPHILIS

A reduction of 19% in new syphilis cases and a reduction of 1.34% in the number of RPR/TPHA tests performed for 2014 when compared to 2013.

A general increasing trend in the incidence of syphilis observed from 60 per 10000 RPR/TPHA tests in 2010 to 91 per 10000 RPR/TPHA tests in 2013, an increase of 52%. In 2014 there was a reported incidence of 74 per 10000 tests, representing a reduction of 19% compared to 2013.

Graph 18. Incidence of syphilis per 10000 RPR/TPHA tests conducted from 2008 to 2014, Seychelles

** Results for tests done prior to 2010 were not available.

3.11 GONORRHEA

Increasing trend in the incidence of Gonorrhea over the years from 1 per 100 tests in 2006, 8 per 100 tests in 2008 to 22 per 100 tests in 2011 respectively. A significant decline in incidence was observed from 19 per 100 tests in 2013 to 10.29 per 100 tests in 2014, a reduction of 46% in 2014 compared to 2013.

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Graph 19. Incidence of Gonorrhea per 100 tests conducted from 2005 to 2014 in Seychelles.

* Incomplete data

A total of 1030 tests for Gonorrhea were conducted in 2014, a reduction of 3% compared to 2013, of which 106(84M/22F) were positive for gonorrhea representing a case detection rate of 10%. The youngest case was a 15- year-‐ old‐ female and eldest a 57- year-‐ old‐ male. The 15- 24‐ years age group was more predominantly affected representing 46% of the total reported cases.

Table 2. Sensitivity and resistant patterns of gonorrhea detected in 2014.

Resistant SensitiveCiprofloxacin 59% 21%Ceftriaxone 11% 82%Cefixime 18% 69%

Antimicrobial sensitivity testing was conducted for Ciprofloxacin, Ceftriaxone and Cefixime, the three main antibiotics of choice amongst the gonorrhea cases detected in 2014. Ceftriaxone was the most sensitive at 82% followed by Cefixime at 69% and Ciprofloxacin was the least sensitive at 21%.

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Graph 20. Tests results for Gonorrhea from 2005 to 2014, Seychelles

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The number of suspected cases of Gonorrhea screened has gradually increased over the years from 680 tests in 2006, 896 tests in 2011 to 1030 tests in 2014 respectively.

3.12 CHLAMYDIA TRACHOMATIS

A total of 4705 tests for Chlamydia Trachomatis were conducted from 2005 to 2014 with 762 positive cases reported representing a case detection of 16%. A fluctuating trend in the incidence over the years was observed from 9.76 per 100 tests in 2006, 14.65 per 100 tests in 2011, 27.21 per 100 tests in 2013 and 19.61 per 100 tests in 2014 respectively.

Graph 21. Incidence of Chlamydia Trachomatis per 100 tests conducted from 2005 to 2014, Seychelles

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The year 2014 reported a reduction of 9% in the number of tests conducted and a reduction of 28% in positivity compared to 2013. The youngest was at 2 weeks old with opthalmia neonatorum and eldest a 68 year old, both males. The age group most predominantly affected was the 20-‐29 years, representing 48% of the cases.

3.13 TUBERCULOSIS

A cumulative of 591 confirmed tuberculosis cases have been reported from 1979 to 2014, 31 tuberculosis related deaths out of 591 cases since 1976 and 31 cases of HIV & TB Co–infection reported from 2000 to 2014. No data available for the previous years.

Graph 22. Tuberculosis cases from 1979 to 2014, Seychelles.

In 2014, there were 7 (5M/2F) newly confirmed tuberculosis cases reported, a reduction of 69% in new cases compared to 23 cases in 2013. Of note 14% of the new cases were expatriates. There was 1 case(male) of HIV & TB Co-‐ Infection but no tuberculosis related deaths reported. No cases of MDR or XDR TB have been reported to date in Seychelles.

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4 NOTIFIABLE DISEASES UNDER WEEKLY SURVEILLANCE

4.1 GASTROENTERITIS

Graph 23a. Gastroenteritis in the less than five years old, 2014, Seychelles

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Gastroenteritis for both age groups remained the notifiable disease with the highest disease burden for the year 2014 though a 14% reduction in the number of reported cases compared to the year 2013. In 2014 amongst the less than five years old there were two epidemics from which Rota Virus were isolated during the period of week 8 to 17 and week 28 to 40. The Attack Rate (AR) remained above the epidemic threshold with a maximum of 87.74/10000 population recorded in week 12 but generally below the maximum AR for the previous five years There was a 17% reduction in the number of cases in 2014 (1513) compared with the year 2013 (1819). Of note, 21% of the cases were admitted to the Paediatric Ward.

Graph 23b. Gastroenteritis in the five years old and above, 2014, Seychelles.

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rcFor the five years old and above a 13% reduction in the number of cases was observed in 2014 (4933) compared with the year 2013 (5668). The AR remained above the epidemic threshold throughout the year 2014 with the highest AR recorded at week 31 at 20.23/10000 population.

The percentage of doctor’s consultation related to Gastroenteritis was highest amongst the five years old and above throughout 2014, the highest recorded percentage was for week 31 at 2.31%.

Graph 23c. Percentage of doctor’s consultation for Gastroenteritis, 2014, Seychelles

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4.2 INFLUENZA LIKE ILLNESS

Graph 24a. Influenza like Illness for 2014, Seychelles

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Throughout the year 2014 there has been a 50% reduction in the number of cases (1726) of Influenza like Illness reported compared with 2013 (3469). There was an outbreak from week 2 to week 17 with the highest AR recorded at 15.34/10000 population for week 14. As of week 18 the influenza activity has remained below the epidemic threshold until week 53. The percentage of doctor’s consultation was highest for week 7 at 1.26%.

Graph 24b. Percentage of doctor’s consultation for Influenza like Illness, 2014, Seychelles

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4.3 PNEUMONIA

Graph 25a. Pneumonia in the less than five years old, 2014, Seychelles

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Pneumonia in the less than five years old has declined by 4% in the number of cases in 2014(90) compared to 2013 (94) and an increase of 11% in the five years old and above in 2014 (260) compared with the year 2013 (235). Fluctuating trends has been observed for Pneumonia in both age groups throughout the year 2014.

Graph 25b. Pneumonia in the five years old and above, 2014, Seychelles

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4.4 CONJUNCTIVITIS

Graph 26. Conjunctivitis for 2014, Seychelles

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A reduction of 1% in the number of cases for Conjunctivitis in 2014 (1490) compared with the year 2013 (1506). The AR was generally below the epidemic threshold and no major outbreak was reported throughout the year 2014.

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4.5 METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS (MRSA)

Graph 27. MRSA for 2014, Seychelles

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There was an increase of 11% in the number of cases of MRSA in 2014 (1147) compared with the year 2013 (1034). MRSA was generally similar with the maximum AR recorded during the previous four years. The highest AR was recorded at 4.11/10000 population for week 41. Throughout 2014, 40% of the reported cases were males and 60% females.

4.6 LEPTOSPIROSIS

Leptospirosis in Seychelles is of significant Public Health importance. Over the years, on average around 600 suspected cases have been reported annually. From 2007 to 2014, over 4000 suspected cases were reported of which 307 were confirmed positive for Leptospirosis. The year 2014 was of no exception, a total of 672 suspected cases were reported of which 50 (49M/1F) were confirmed for leptospirosis representing an increase of 78% in confirmed cases compared to 2013 (28 cases). Out of the 50 confirmed leptospirosis cases there were 11 deaths, representing a fatality of 22% for the year 2014 and an increase of 120% in the number of leptospirosis confirmed deaths in 2014 compared to 5 deaths in 2013. All fatal cases in 2014 were males and age ranging from 14 to 65 years old.

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Graph 28. Confirmed cases of Leptospirosis from 2007 to 2014, Seychelles.

From 2007 to 2014, 307 positive cases of Leptospirosis were reported. More cases were reported in 2007 to 2010 followed by a decline in 2011 but have gradually increased from 2012 onwards.

Graph 29. Confirmed cases of Leptospirosis by gender from 2007 to 2014, Seychelles.

Males were more predominantly affected throughout the years, representing 90% of the confirmed cases compared to 10% in females. A study is ongoing since December 2014 with the main objectives of determining the current burden of Leptospirosis in Seychelles and to identify risk factors associated with the disease.

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4.7 MALARIA

A total of 61 (11%) positive imported malaria cases out of the 567 smears for malaria parasites conducted were reported from 2009 to 2014. A fluctuation in the incidence from 13 per 100 tests in 2012 to 11 per 100 tests in 2013 was observed. In 2014, 11 positive imported malaria cases were reported representing a 21% reduction compared to 2013.

Graph 30. Incidence of imported Malaria from 2009 to 2014, Seychelles.

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5 EPIDEMIC FOR 2014

5.1 HAND, FOOT AND MOUTH DISEASE (HFMD)

Graph 31. Suspected HFMD cases by date of reporting to health facilities, Seychelles, 2014

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Date of repor2ng

There was an outbreak of HFMD reported in the year 2014; the initial case was reported on the 03rd of May 2014 and the last case on the 25th of July 2014. In total 132 cases were reported, 61% males and 39% females. The less than five years old was mostly affected at 55% and the oldest affected was a 26 years old. All regions were affected with most cases (31.06 %) reported from the Western region.

Influenza B

Influenza

A(H3)

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6 OTHER SURVEILLANCE ACTIVITIES

6.1 ILI AND SARI SURVEILLANCE

Since October 2013, the Disease Surveillance & Response Unit and the Public Health Laboratory started the Seychelles National Influenza and other Respiratory Viruses Sentinel Surveillance which includes the Influenza Like Illnesses (ILI) and Severe Acute Respiratory Illnesses (SARI) surveillance. Such sentinel surveillance has the aim of providing quality data pertaining to Influenza viruses in circulation and epidemiological data on Influenza like Illness (ILI) and Severe Acute Respiratory Infection (SARI) cases. The surveillance is also a mean of determining the proportions of ILI and SARI cases that are due to influenza. ILI and SARI Cases are reported on a weekly basis by the respective focal points from the sentinel sites.

A total of 236(206M/30F) cases of ILI and SARI were reported from the 15 sentinel sites in 2014. Of note, 70(30%) were ILI cases and 166 (70%) were SARI cases. All age groups were affected and there were no reported cases amongst pregnant women. Of note there was a total of 1699 ILI cases reported in 2014 and 339 SARI cases. A targeted sampling of 624 ILI cases and 100% of the SARI cases was not achieved.Males represented 87 % of the total cases compared to 13% in females. There were 5(2M/3F) SARI related deaths reported , a case fatality rate of 3% and all the cases were aged 65 years old and above.

Graph 32. Influenza viruses isolated from week 1 to 53 in 2014, Seychelles.

Of all the tests conducted, 24 cases were confirmed positive for Influenza viruses representing a case detection rate of 10%. The age group most affected was the five years old and above with

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92% of the cases and the least affected was the less than five years representing 8% of the total cases confirmed.

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Influenza A (H3) and Influenza B were the only viruses isolated in 2014 and as observed more cases of Influenza B were reported from week 1 to 15 compared to Influenza A (H3) which has been more predominant from week 16 to week 30. No influenza viruses have been isolated from week 31 onwards.

6.2 BLOOD SAFETY

From 2005 to 2014, 15,774 blood units were donated at the Blood Transfusion Centre at the Seychelles Hospital, and the donations varied from regular, voluntary and family replacement donations.

Graph 33. Illustrates the trend in blood donated units from 2005 to 2014 in Seychelles.

The number of blood units donated from 2005 to 2014 has remained fairly constant over the years with an average of 1400 to 1800 units annually.

A total of 1825(1382M/443F) blood units were donated in 2014, an increase of 11% compared to 2013, and the highest recorded number of blood donated units since 2005 to date. All donated blood units were screened for HIV, Hepatitis B, Hepatitis C and Syphilis in a quality assured manner at the Blood Transfusion Centre prior to transfusion. In 2014, 0.16% of blood-‐donated units tested positive for syphilis and 0.05% tested positive for Hepatitis B and not a single unit tested positive for HIV or Hepatitis C.

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Table 3. Percentage positivity of HIV, HBV, HCV and Syphilis amongst the blood donated units from 2005 to 2014 in Seychelles.

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Total No of units 1444 1566 1773 1472 1455 1606 1528 1461 1644 1610

Percentage Positive HIV * * * * 0.62 0 0 0 0 0

Percentage Positive HCV * * * * 0.21 0.06 0 0 0.06 0.06

Percentage Positive HBV * * * * 0.27 0.06 0 0 0 0

Percentage Positive Syphilis * * * * 0.14 0.25 0.06 0 0.18 0.19

*Missing Data