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Tuesday 11th December 2018

News

WHO Outbreaks

Ebola virus disease – Democratic Republic of the Congo

Responding to the Ebola virus disease (EVD) outbreak in north-eastern parts of the Democratic Republic of the Congo continues to be a multifaceted challenge. By utilising proven public health measures (contact tracing, engaging communities) as well as new tools at hand (vaccine and therapeutics), WHO remains confident the outbreak can be contained and brought to an end. During the reporting period (28 November – 4 December 2018), 35 new cases were reported from nine health zones in North Kivu and Ituri provinces: Beni (8), Komanda (eight), Katwa (eight), Vuhovi (three), Kalunguta (two), Butembo (two), Mabalako (two), Masereka (one), and Mutwanga (one). Recent cases in Komanda and Mabalako health zones follow an extended period (exceeding two incubation periods) without detection of new cases; highlighting the risk of reintroduction of the virus, and the need to maintain enhanced surveillance. Cases in the Komanda originated from an infection of a mother and her children in Beni. While insecurity in Komanda will challenge the response activities, control measures including contact tracing and vaccination were initiated soon after the detection of cases.

Ebola virus disease – Democratic Republic of the Congo

As the Ebola virus disease (EVD) outbreak approaches five months since declaration, responding to the outbreak continues to be a challenge; nevertheless, in collaboration with the Ministry of Health (MoH) and partners, WHO remains focused on the ongoing containment efforts to end the outbreak.

Ebola virus disease – Democratic Republic of the Congo

Containing the ongoing Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo is a complex and challenging task but WHO remains confident that the outbreak can be successfully contained in collaboration with the Ministry of Health (MoH) and partners.

Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia

From 16 through 30 October 2018, the International Health Regulations (IHR 2005) National Focal Point of Saudi Arabia reported four additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including one death.

Ebola virus disease – Democratic Republic of the Congo

New measures to overcome obstacles in responding to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo are having a positive impact. The Ministry of Health (MoH), WHO and partners continue to be confident that, despite challenges, the outbreak can be contained.

Ebola virus disease – Democratic Republic of the Congo

As the Ebola virus disease (EVD) outbreak enters the fourth month since declaration, and case numbers surpass 300, substantial progress has been achieved in all aspects of the response.

Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia

From 17 September through 15 October 2018, the International Health Regulations (IHR 2005) National Focal Point of Saudi Arabia reported eight additional cases of MERS-CoV infection, including three deaths. Of the eight cases reported, three were hospital contacts from one hospital in Dammam and two were household contacts in Riyadh. Details of these cases can be found in a separate document (see link below). From 2012 through 15 October 2018, the total global number of laboratory-confirmed MERS-CoV cases reported to WHO is 2262 with 803 associated deaths.

Ebola virus disease – Democratic Republic of the Congo

The increase over the past four weeks in confirmed case incidence (Figure 1), most notably in the city of Beni and communities around Butembo, is concerning.

Circulating vaccine-derived poliovirus type 2 – Niger

From July through September 2018, six cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported from Niger, genetically linked to a cVDPV2 case in Jigawa and Katsina States, Nigeria. The virus was isolated from children with acute flaccid paralysis (AFP) from Zinder region, located in the south of Niger and on the border with Nigeria, with dates of onset of paralysis ranging from 18 July through 16 September 2018. This outbreak has also affected Jigawa, Katsina, Yobe, Gombe, and Borno states in Nigeria, with 17 cases reported since April 2018.

Ebola virus disease – Democratic Republic of the Congo

Security incidents over the past week, ranging from clashes between rebel and government forces resulting in civilian deaths to response vehicles being pelted with stones, continued to cause community distress and severely impede response activities for the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo.

Ebola virus disease – Democratic Republic of the Congo

The response to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo has seen significant improvements over the past weeks, including strong performances by field teams conducting vaccinations, and improved community engagement and risk communication in priority areas. However, as new cases continue to emerge from Beni and appear closer to security ‘red zones’, it is clear that risks remain and that strong response measures need to be prioritized. The virus’ spread is partly due to security conditions that severely impact frontline and health workers, at times forcing the suspension of response activities and increasing the risk that the virus may spread to neighbouring provinces and countries. The MoH, WHO and partners continue to rapidly adapt to these challenging circumstances, scaling up all pillars of the response: surveillance, contact tracing, community engagement, laboratory testing, infection prevention and control, safe and dignified burials, vaccination, and therapeutics. Due to the challenges faced in Democratic Republic of the Congo, the 1st Meeting of the 2018 International Health Regulations (IHR) Emergency Committee for Ebola Viral Disease in the Democratic Republic of the Congo took place on 17 October. Due primarily to the strength and tempo of current response operations, it was the view of the Committee that the conditions for a Public Health Emergency of International Concern (PHEIC) have not been met. The Committee further concluded that the current outbreak has several characteristics of particular concern: the risk of more rapid spread given EVD presence in urban environments; that there are several outbreaks in remote and hard to reach areas; and that health care staff have been infected. Risk of international spread also remains very high due to the outbreak’s proximity to significant regional traffic. Logistical challenges due to poor infrastructure continue to affect surveillance, case detection and confirmation, contact tracing, and access to vaccines and therapeutics.

Chikungunya – Sudan

On 31 May 2018, the State Ministry of Health (SMOH) of the Red Sea State in Sudan reported four suspected cases of chikungunya fever from Swakin locality, in Red Sea State. Among the signs and symptoms were sudden onset of fever, headache, joint pain and swelling, muscle pain and/or inability to walk. The first suspected case of chikungunya in the neighboring Kassala State was reported on 8 August 2018, in a male travelling from the Red Sea State. Since then cases have been reported in three localities of the State (Kassala, West Kassala and Rural Kassala). On 10 August, among 24 collected blood samples, 22 samples tested positive for chikungunya by PCR and ELISA at the National Public Health Laboratory (NPHL) in Khartoum. On 9 September, an additional 100 samples were collected and pooled in batches of ten: 50% of pools tested positive for mixed chikungunya and dengue viruses, and all pools were positive for chikungunya virus.

Ebola virus disease – Democratic Republic of the Congo

The response to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo is becoming increasingly undermined by security challenges in at-risk areas, particularly Beni. These incidents severely impact both civilians and frontline workers, forcing suspension of EVD response activities and increasing the risk that the virus will continue to spread. WHO continues to distinguish between the incidents of conflict between rebel and government forces, and pockets of community push-back on the response. A recent increase in the incidence of new cases (Figure 1) is the result of the multitude of challenges faced by response teams. This also reflects improved active surveillance and reporting from the community. Since the last Disease Outbreak News (data as of 2 October), 29 new confirmed EVD cases were reported: 23 from Beni, four from Butembo, one from Mabalako, and one from Masereka Health Zones in North Kivu Province. Fifteen of these confirmed cases have been linked to known cases or were linked retrospectively through case to transmission chains within the respective communities, while fourteen recently reported cases remain under investigation.

Cholera – Zimbabwe

Since the last Disease Outbreak News was published on 20 September (with data as of 15 September), an additional 4914 cases have been reported including 92 laboratory-confirmed cases (Figure 1).

Cholera – Niger

On 15 July, the outbreak of cholera was officially declared by the Ministry of Public Health of Niger. The first three cases were residents of Nigeria from Jibiya Local Government Area (LGA) in Katsina State on the border with Niger. The cases were all from the same family and reportedly had an onset of symptoms in Jibiya LGA before seeking treatment on 5 July 2018 at a health facility in a bordering town in Niger. Vibrio cholerae serotype O1 Inaba was confirmed in stool samples from all three cases, one of which died within minutes of admission. In addition to these cases, six cases were reported in the following two days from villages in Niger located approximately 4km away from Jibiya LGA. Since then, the outbreak has continuously expanded geographically and in magnitude with peaks of around 400 cases reported in two weeks in August and in early September.

Monkeypox – Nigeria

On 26 September 2017, WHO was alerted to a suspected outbreak of monkeypox in Yenagoa Local Government Area (LGA) in Bayelsa State, Nigeria. The index cluster was reported in a family. All of whom developed similar symptoms of fever and generalized skin rash over a period of four weeks. Epidemiological investigations into the cluster show that all infected cases had a contact with monkey about a month prior to onset.

Ebola virus disease – Democratic Republic of the Congo

The response to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo is at a critical juncture. WHO faces a precarious situation given recent increases in insecurity, incidents of community mistrust, and increased geographical spread.

Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia

From 1 June through 16 September 2018, the International Health Regulations (IHR 2005) National Focal Point of Saudi Arabia reported 32 additional cases of Middle East Respiratory Syndrome (MERS), including 10 deaths.

Ebola virus disease – Democratic Republic of the Congo

The response to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo is at a critical juncture. While substantial progress has been made, the situation is precarious given recent increases in insecurity, incidents of community reluctance and geographical spread.

Ebola virus disease – Democratic Republic of the Congo

The Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo remains active. While substantial progress has been made to limit the spread of the disease to new areas and the situation in Mangina (Mabalako Health Zone) is stabilizing, the cities of Beni and Butembo have become the new hotspot. Response teams continue to enhance activities to mitigate potential clusters in these cities and prevent spread to other areas.

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