WEEKLY BULLETIN ON OUTBREAKS AND OTHER EMERGENCIES Week 18: 26 April to 2 May 2021 Data as reported by: 17:00; 2 May 2021 REGIONAL OFFICE FOR Africa WHO Health Emergencies Programme 1 130 116 13 New event Ongoing events Outbreaks Humanitarian crises 64 0 122 522 3 270 Algeria ¤ 36 13 612 0 5 901 175 Mauritania 7 2 13 915 489 110 0 7 0 Niger 18 448 455 Mali 3 671 10 567 0 6 0 2 079 4 4 828 170 Eritrea Cape Verde 40 433 1 110 Chad Senegal 5 074 189 61 0 Gambia 27 0 3 0 24 368 224 1 069 5 Guinea-Bissau 847 17 7 0 Burkina Faso 236 49 258 384 3 726 0 165 167 2 063 Guinea 13 319 157 12 3 736 67 1 1 23 12 Benin 30 0 Nigeria 1 873 72 0 Ethiopia 540 2 556 5 6 188 15 Sierra Leone Togo 3 473 296 52 14 Ghana 70 607 1 064 6 411 88 Côte d'Ivoire 10 583 115 14 484 479 65 0 40 0 Liberia 17 0 South Sudan Central African Republic 1 029 2 49 0 97 17 25 0 22 333 268 46 150 287 92 683 779 Cameroon 7 0 28 676 137 843 20 3 1 160 422 2 763 655 2 91 0 123 12 6 1 488 6 4 057 79 13 010 7 694 112 Equatorial Guinea Uganda 1 0 542 8 Sao Tome and Principe 32 11 2 066 85 41 973 342 Kenya Legend 7 821 99 Gabon Congo 2 012 73 Rwanda Humanitarian crisis 2 310 35 25 253 337 Measles 23 075 139 Democratic Republic of the Congo 11 016 147 Burundi 4 046 6 Monkeypox Ebola virus disease Seychelles 29 965 768 235 0 420 29 United Republic of Tanzania Lassa fever Skin disease of unknown etiology 191 0 5 941 26 509 21 Cholera Yellow fever 63 1 6 257 229 26 993 602 cVDPV2 Dengue fever 91 693 1 253 Comoros Angola Malawi COVID-19 Leishmaniasis 34 096 1 148 862 0 3 840 146 Zambia 133 0 Mozambique Anthrax Plague 2 952 40 798 3 Crimean-Congo haemorrhagic fever 37 630 666 Avian influenza Zimbabwe Rift Valley fever 69 984 815 Madagascar Mauritius Malaria 38 281 1 570 10 227 66 West Nile fever 46 934 712 Hepatitis E 1 206 16 Namibia Countries reported in the document Botswana Acute Food Insecurity Countries outside WHO African Region 48 654 643 Acute Food WHO Member States with no reported events Eswatini Insecurity Not applicable 18 458 671 Cases South Africa Lesotho Deaths 10 733 318 1 575 471 54 148 Graded events † “The boundaries and names shown and the designations used on this map do not imply the expression of any (2) opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate borderlines for which there may not yet be full agreement.” 0 410 820 Kilometers 24 2 6 Grade 3 events Grade 2 events Grade 1 events 2 23 30 501 Ungraded events ProtractedProtracted 3 3 events events Protracted 2 events ProtractedProtracted 1 1 events event Health Emergency Information and Risk Assessment Overview Contents This Weekly Bulletin focuses on public health emergencies occurring in the WHO African Region. The WHO Health Emergencies Programme is currently monitoring 130 events in the region. This week’s articles cover: 1 Overview End of outbreak declaration, Ebola virus diseases in Democratic Republic of the Congo COVID-19 across the WHO African region 2 -6 Ongoing events Ebola virus disease in Guinea Summary of major 7 For each of these events, a brief description, followed by public health measures issues, challenges implemented and an interpretation of the situation is provided. and proposed actions A table is provided at the end of the bulletin with information on all new and ongoing 8 All events currently public health events currently being monitored in the region, as well as recent events that being monitored have been controlled and closed. Major issues and challenges include: South Africa recorded the highest number of cases in the past seven days, although with a minimal overall percentage decrease. During the past week, Uganda has become the first country to confirm the presence of the variant first identified in India, which is a potential threat to the East African area. The risk of COVID-19 resurgence remains high in African countries due to poor adherence to public health measures, mass gatherings, and low testing and vaccination rates. The current upsurge in India could also have a negative implication on vaccine availability globally, particularly in Africa. Health worker infections remain of concern as the numbers continue to increase across the region. The situation in Guinea remains stable, with no new confirmed cases for the past 21 days. However, the presence of 19 new suspected cases is of concern, as is the continued presence of a known confirmed case in the community. Alert reporting by the community is poor, with most reported through active case search and there continues to be resistance to safe and dignified burial. The WHO response plan is still only 17% funded, which threatens to derail ongoing response measures. 1 Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment Ongoing events 157 Ebola virus disease Democratic Republic of the Congo End of outbreak declaration The Democratic Republic of the Congo on Monday, 3 May 2021, The distribution of Ebola virus disease cases declared the end of the Ebola virus disease (EVD) outbreak that in Democratic Republic of the Congo as of 1 May 2021 was first announced on 7 February 2021 after a woman resident in Masoya health area in Butembo Health Zone, tested positive for EVD. A total of 12 cases (11 confirmed and 1 probable) were reported, of which eight were known and followed contacts at the time of detection. All 12 cases were reported in four health zones of North Kivu Province, with onset of symptoms reported between 25 January and 26 February 2021. Of these patients, six died (case fatality ratio 50%) and six recovered after receiving appropriate treatment. Two of the cases were health workers, who were infected by the first patient in the outbreak, who both survived. The last confirmed cases were reported on 1 March 2021, all among family members of confirmed cases. The last hospitalized confirmed case tested negative for the second time on 21 March 2021, triggering the 42-day countdown to the declaration of the end of the outbreak. During the course of the outbreak from 7 February to 3 May 2021, the number of alerts gradually increased. As of 1 May 2021, the 17 health zones of the Butembo and Beni division of the North Kivu province had reported 33 229 alerts. Of those 33 199 were investigated within 24 hours of report, 5 054 were validated and 4 332 were tested. Case investigations around the confirmed and probable cases identified 1 194 contacts in 48 health areas of five Since the start of the outbreak and until 1 May, 4 332 samples health zones, all of whom have completed their 21 days follow- have been received and analysed for EVD. up period. A dedicated response group continued to search for From 7 February to 31 March 2021, 1 898 people were contacts lost to follow-up, never seen and displaced for 42 days vaccinated, including 1 169 in Biena, 360 in Katwa, 297 in since last exposure to ensure that no chains of transmission were Butembo and 72 in Musienene. Front line workers made up missed. A total of 1 519 869 travellers were screened at points 542 of those vaccinated. of entry into the country, and at least 1 898 individuals were vaccinated against EVD. Infection prevention and control (IPC) activities included assessment of 136 priority health facilities in four health PUBLIC HEALTH ACTIONS zones and monitoring and support for 456 health facilities in eight health zones. The public health response was coordinated by the Provincial Department of Health, Butembo division in collaboration Risk communication and community engagement with WHO. activities took place in all health zones, which included visits to households by community action committees and Daily coordination meetings took place, chaired by the sensitization of EVD in Butembo, Mabalako and Katwa health coordinator of the pool of supervisors based in Butembo, zones. with participation of partners. SITUATION INTERPRETATION Bordering countries increased surveillance capacity and established EVD preparedness plans The swift initial response to this, the 12th EVD outbreak in the Democratic Republic of the Congo, played a major role in the Surveillance activities were implemented by heath zone (equipe cadre de la zone de santé) and the health area nurse outbreak’s rapid conclusion, as well as in the relatively few people (infirmier titulaire de l’aire de santé) with the financial, infected and dying. Vaccines were rapidly rolled out and provided logistics and HR support of WHO. to high risk contacts and frontline workers as well as to contacts- of-contacts, alerts were reported and followed-up and points WHO supported the setup of the alert surveillance system of entry were monitored and travellers screened and sensitized and the training of the health zone data managers for the to EVD prevention measures. Local authorities and partners accurate and timely daily report of alerts.