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Thursday 21st February 2019

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WHO Outbreaks

Ebola virus disease – Democratic Republic of the Congo

The Ebola virus disease (EVD) outbreak is continuing with moderate intensity. Katwa and Butembo remain the major health zones of concern, while simultaneously, small clusters continue to occur in various geographically dispersed locations. During the last 21 days (30 January – 19 February 2019), 79 new cases have been reported from 40 health areas within 12 health zones (Figure 1), including: Katwa (46), Butembo (15), Kyondo (4), Vuhovi (4), Kalunguta (2), Oicha (2), Biena (1), Mabalako (1), Manguredjipa (1), Masereka (1), Mutwanga (1), and Rwampara (1).1 No new cases have been reported from the Beni in the last three weeks. This is a significant achievement given the previous intensity of the outbreak in this area. Elsewhere, trends in the case incidence (Figure 2) have been encouraging; however, other indicators (such as the continued high proportion of community deaths, persistent delays in case detection, documented local travel amongst many cases, and relatively low numbers of cases among contacts under surveillance) suggest a high risk of further chains of transmission in affected communities. Response teams must maintain a high degree of vigilance across all areas with declining case and contact tracing activity, as with areas with active cases, to rapidly detect new cases and prevent onward transmission.

Circulating vaccine-derived poliovirus type 1 – Papua New Guinea

On 26 June 2018, an outbreak of circulating vaccine-derived poliovirus type 1 (cVDPV1) was declared in Papua New Guinea following laboratory confirmation of cVDPV1 isolation in two healthy community contacts of the index case. Since the declaration, a total of 26 confirmed cVDPV1 cases have been reported in the following nine provinces: Eastern Highlands (six), Enga (five), East Sepik (four), Madang (three), Morobe (three), Jiwaka (two), Gulf (one), Southern Highlands (one), and National Capital District (NCD) (one). The last laboratory-confirmed case reported having experienced the onset of paralysis in late October 2018. Environmental surveillance continues on a bimonthly basis in Port Moresby and Lae to complement active acute flaccid paralysis (AFP) case search efforts. To date, there have been five rounds of Supplementary Immunisation Activities (SIA) conducted from July to December 2018. Consultants from WHO and UNICEF have been deployed to provide technical support during pre-campaign preparations and implementation to ensure high quality SIAs and improve AFP case detection. The first round of SIA targeted children under five years of age in three high-risk provinces. The second round included children under five years of age in all nine provinces. The third and fourth rounds of SIA included National Immunisation Days (NIDs) which were aimed at children less than 15 years of age and achieved a coverage of 93% and 97% respectively. The fifth round of SIA was a sub-national campaign conducted in four priority provinces (NCD, Central, Enga, and Angoram district in East Sepik province). Planning is currently ongoing for additional NIDs in 2019.

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

From 1 January through 31 January 2019, the International Health Regulations (IHR) National Focal Point of Saudi Arabia reported fourteen additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including three deaths.

Lassa Fever – Nigeria

From 1 January through 10 February 2019, 327 cases of Lassa fever (324 confirmed cases and three probable cases) with 72 deaths (case fatality ratio = 22%) have been reported across 20 states and the Federal Capital Territory, with the majority of cases being reported from Edo (108) and Ondo (103) States.

Ebola virus disease – Democratic Republic of the Congo

Despite slightly fewer cases reported during the past week (Figure 1), current epidemiological indicators highlight that the Ebola virus disease (EVD) outbreak is continuing with moderate intensity. Katwa and Butembo remain the major health zones of concern, while simultaneously, small clusters continue to occur in various geographically dispersed regions. During the last 21 days (23 January – 12 February 2019), 97 new cases have been reported from 13 health zones (Figure 2), including: Katwa (59), Butembo (12), Beni (7), Kyondo (4), Oicha (4), Vuhovi (3), Biena (2), Kalunguta (2), Komanda (1), Manguredjipa (1), Mabalako (1), Masereka (1), and Mutwanga (1).1 The recent case reported in the Komanda health zone was a resident of Katwa who was exposed to the virus, and subsequently travelled to both Bunia and Komanda. This case comes one month after the last reported case in Ituri Province; underscoring the high risks of reintroduction to previously affected areas, as well as the potential for spread to new ones. As of 12 February, 823 EVD cases2 (762 confirmed and 61 probable) have been reported, including 517 deaths (overall case fatality ratio: 63%). Cumulatively, cases have been reported from 118 of 287 health areas across 18 health zones, of which 37 health areas have reported a case in the last 21 days. Thus far, 283 people have been discharged from Ebola Treatment Centers (ETCs) and enrolled in a dedicated monitoring and support programme. One new health worker infection was reported in Katwa. To date, a total of 68 health workers have been infected.

Yellow fever – Brazil

Brazil is currently in the seasonal period for yellow fever, which occurs from December through May. The expansion of the historical area of yellow fever transmission to areas in the south-east of the country in areas along the Atlantic coast previously considered risk-free led to two waves of transmission (Figure 1). One during the 2016–2017 seasonal period, with 778 human cases, including 262 deaths, and another during the 2017–2018 seasonal period, with 1376 human cases, including 483 deaths. From December 2018 through January 2019, 361 confirmed human cases, including eight deaths, have been reported in 11 municipalities of two states of Brazil. In the southern part of São Paulo state, seven municipalities:El dorado (16 cases), Jacupiranga (1 case), Iporanga (7 cases), Cananeia (3 cases), Cajati (2), Pariquera-Açu (1), and Sete Barras (1) reported confirmed cases. In the same state, additional cases in Vargem (1) and Serra Negra (1) municipalities were confirmed on the border with Minas Gerais State. Additionally, two cases have been confirmed in the municipalities of Antonina and Adrianópolis, located in the eastern part of Paraná State. These are the first confirmed yellow fever cases reported since 2015 from Paraná, a populous state with an international border. Among these confirmed cases, 89% (32/36) are male, the median age is 43 years, and at least 64% (23/36) are rural workers.

Middle East respiratory syndrome coronavirus (MERS-CoV) – Oman

From 27 January and 31 January 2019, the International Health Regulations (IHR) National Focal Point of Oman reported five cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection.

Ebola virus disease – Democratic Republic of the Congo

The Ebola virus disease (EVD) in the Democratic Republic of the Congo continues with relatively high numbers of cases reported in recent weeks (Figure 1), and some encouraging signs. Katwa and Butembo health zones remain the epicentres of the outbreak, reporting 71% of cases in the last three weeks, with smaller clusters continuing to occur concurrently across a geographically dispersed area. As of 5 February, 789 EVD cases1 (735 confirmed and 54 probable) have been reported, including 488 deaths (overall case fatality ratio: 62%). Thus far, 267 people have been discharged from Ebola Treatment Centres (ETCs) and enrolled in a dedicated monitoring and support programme. Among cases with available information regarding age and sex, 58% (454/788) were female, and 30% (232/786) were aged less than 18 years; including 116 children under five years. Five new health worker infections were reported in Katwa (4) and Kalunguta (1); overall 67 health workers have been affected to date.

Dengue fever – Jamaica

On 3 January 2019, the International Health Regulations (IHR) National Focal Point of Jamaica notified WHO of an increase in dengue cases in Jamaica. From 1 January though 21 January 2019, 339 suspected and confirmed cases including six deaths were reported (Figure 1). In 2018, a total of 986 suspected and confirmed cases of dengue including 13 deaths have been reported. The number of reported dengue cases in 2018 was 4.5 times higher than that reported in 2017 (215 cases including six deaths). Cases reported to date for 2019 exceed the epidemic threshold (Figure 2).

Ebola virus disease – Democratic Republic of the Congo

The Ministry of Health (MoH), WHO and partners continue to respond to an outbreak of Ebola virus disease (EVD), despite persistent challenges around security and community mistrust impacting response measures.

Gonococcal infection – United Kingdom

On 7 January 2019, the International Health Regulations (IHR) National Focal Point for the United Kingdom of Great Britain and Northern Ireland notified WHO about two cases of extensive drug resistant (XDR) Neisseria gonorrhoeae infection diagnosed in the United Kingdom.

Circulating vaccine-derived poliovirus type 2 – Mozambique

On 17 January 2019, two genetically-linked circulating vaccine-derived poliovirus type 2 (cVDPV2) isolates were reported from Molumbo district, Zambezia province, Mozambique. The first one, was from an acute flaccid paralysis (AFP) case with onset of paralysis on 21 October 2018, a six-year old girl with no history of vaccination, and the second isolate was from a community contact of the first case, a child aged one-year old.

Ebola virus disease – Democratic Republic of the Congo

The Ministry of Health (MoH), WHO and partners have continued to face challenges in the containment and control of the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo. The number of reported cases increased during recent weeks, most notably from the Katwa health zone where response teams have faced pockets of community mistrust. The outbreak has also extended southwards to Kayina health zone, a high security risk area. Teams are working actively to build community trust and scale up response activities around these new clusters. Figure 1 shows that as of 22 January 2019, there have been a total of 713 EVD cases1 (664 confirmed and 49 probable), including 439 deaths (overall case fatality ratio: 62%). Thus far, 247 people have been discharged from Ebola Treatment Centres (ETCs), with many having enrolled in a dedicated program for monitoring and supporting survivors. Among cases with a reported age and sex, 59% (420/710) of cases were female, and 30% (214/708) were aged less than 18 years; including 108 infants and children under 5 years. Sixty-one healthcare workers have been infected to date.

Hantavirus Pulmonary Syndrome – Argentine Republic

On 19 December 2018, the Argentinian Ministry of Health and Social Development issued an epidemiological alert regarding an increase in cases of hantavirus pulmonary syndrome (HPS) in Epuyén, Chubut Province. Between 28 October 2018 – 20 January of 2019, a total of 29 laboratory-confirmed cases of HPS, including 11 deaths have been reported in Epuyén, Chubut Province. Epuyén has a population of approximately 2 000 persons, and Chubut Province is located in Patagonia in southern Argentina. The index case had environmental exposure prior to symptom onset on 2 November, and subsequently attended a party on 3 November. Six cases who also attended the party experienced the onset of symptoms between 20-27 November 2018. An additional 17 cases, all of whom were epidemiologically-linked to previously confirmed cases, experienced symptom onset between 7 December 2018 and 3 January 2019 (Figure 1). Potential human-to-human transmission is currently under investigation.

Ebola virus disease – Democratic Republic of the Congo

The Ministry of Health (MoH), WHO and partners continue to respond to the ongoing Ebola virus disease (EVD) outbreak in one of the most complex settings possible. A high number of cases are still being reported, most notably from the metropolitan areas of Katwa Health Zone during the past week. The decline in case incidence has continued in Beni; a positive indication of how effective the response can be despite multiple challenges. Trends in the number of new cases occurring (Figure 1) reflect the continuation of the outbreak across a number of geographically dispersed areas. During the last 21 days (26 December 2018 through 15 January 2019), 79 new cases have been reported from 11 health zones (Figure 2), including: Katwa (36), Oicha (14), Butembo (11), Beni (4), Mabalako (4), Kalungata (3), Kyondo (3), Komanda (1), Musienene (1), Biena (1) and Manguredjipa (1). The latter is a newly affected health zone, although the case likely acquired the infection in Mabalako Health Zone.

Measles – Madagascar

WHO is supporting the Ministry of Public Health of Madagascar to respond to an unusually large measles outbreak.

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

From 1 December 2018 through 31 December 2018, the International Health Regulations (IHR) National Focal Point of Saudi Arabia reported five additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection.

Ebola virus disease – Democratic Republic of the Congo

WHO and partners continue to respond to the ongoing Ebola virus disease (EVD) outbreak in one of the most complex settings possible.

Yellow fever – Nigeria

On 22 November 2018, the World Health Organization was informed of a cluster of suspected Yellow fever (YF) cases and deaths in Edo State, Nigeria.

Poliomyelitis - Democratic Republic of the Congo

As of October 2018, genetically-linked circulating vaccine-derived poliovirus type 2 (cVDPV2) isolates were detected in two cases from Haut-Katanga province (Mufunga-Sampwe district) in the Democratic Republic of the Congo. The first case was a 11-year old child who experienced onset of acute flaccid paralysis (AFP) on 6 October. The second case was a 29-month old child who experienced onset of symptoms on 7 October, and is a known contact of the first case. The isolated viruses are a new emergence and unrelated to previously-detected cVDPV2s affecting the country. This is the fourth distinct outbreak of cVDPV2 detected in the country since June 2017. In total, 42 cVDPV2 cases have now been confirmed since detection of the first outbreak in June 2017, 20 cases of which were detected in 2018. In February 2018, the government declared cVDPV2 to be a national public health emergency. On 26 July 2018, the Minister of Health, WHO Director General, the Regional Director for Africa, and provincial governors convened an urgent, high-level meeting and signed the ‘Kinshasa Declaration for Polio Eradication’. Provincial governors pledged to provide the necessary oversight, accountability and resources required to urgently improve the quality of the outbreak response being implemented across the country. It is imperative that the remaining operational gaps in outbreak response are urgently filled with the appropriate oversight and engagement.

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