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WEEKLY BULLETIN on OUTBREAKS and OTHER EMERGENCIES Week 7: 10 - 16 February 2020 Data As Reported By: 17:00; 16 February 2020

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WEEKLY BULLETIN on OUTBREAKS and OTHER EMERGENCIES Week 7: 10 - 16 February 2020 Data As Reported By: 17:00; 16 February 2020 WEEKLY BULLETIN ON OUTBREAKS AND OTHER EMERGENCIES Week 7: 10 - 16 February 2020 Data as reported by: 17:00; 16 February 2020 REGIONAL OFFICE FOR Africa WHO Health Emergencies Programme 1 68 56 13 New event Ongoing events Outbreaks Humanitarian crises 22 0 14 7 20 0 2 0 84 0 Senegal Niger 1 276 14 1 0 Mali 41 7 336 7 Guinea Burkina Faso 52 0 Chad 1 251 0 4 690 18 26 2 Côte d’Ivoire Nigeria Sierra léone 9 0 895 15 South Sudan 1 873 1 226 47 167 2 1 714 6 7 4 139 0 Central African 5 0 Liberia Ghana Cameroon Benin Republic 16 0 4 732 26 Ethiopia 1 618 5 1 364 62 5 392 82 Togo 1 170 14 2 1 Democratic Republic Uganda 3 0 1 0 55 7 84 0 of Congo 1 0 83 13 Congo 15 5 Kenya 3 432 2 253 2 2 Legend 191 1 6 0 38 34 163 0 18 009 221 Measles Humanitarian crisis 637 1 11 600 0 2 651 43 Burundi Hepatitis E 8 892 300 3 294 Monkeypox Seychelles 84 0 Yellow fever Lassa fever 79 0 Dengue fever Cholera Angola 222 4 Ebola virus disease Rift Valley Fever Comoros 3 0 2 0 Chikungunya Malawi 218 0 cVDPV2 Zambia Leishmaniasis 3 0 Anthrax Plague Malaria Zimbabwe Crimean-Congo haemorrhagic fever Namibia Floods 286 1 Cases Meningitis Deaths 7 063 59 Countries reported in the document Non WHO African Region N WHO Member States with no reported events W E 3 0 Lesotho South Africa 20 0 S Graded events † 3 15 1 Grade 3 events Grade 2 events Grade 1 events 43 22 20 31 Ungraded events ProtractedProtracted 3 3 events events Protracted 2 events ProtractedProtracted 1 1 events event Health Emergency Information and Risk Assessment Overview This Weekly Bulletin focuses on public health emergencies occurring in the WHO Contents African Region. The WHO Health Emergencies Programme is currently monitoring 69 events in the region. This week’s main articles cover key new and ongoing events, including: 1 Overview Measles in Central African Republic 2 - 5 Ongoing events Measles in Chad Cholera in Democratic Republic of the Congo 6 Summary of major issues, challenges Ebola virus disease in Democratic Republic of the Congo and proposed actions For each of these events, a brief description, followed by public health measures implemented and an interpretation of the situation is provided. 7 All events currently being monitored A table is provided at the end of the bulletin with information on all new and ongoing public health events currently being monitored in the region, as well as recent events that have largely been controlled and thus closed. Major issues and challenges include: Central African Republic is experiencing a measles outbreak within the overall context of a complex humanitarian emergency. The incidence cases have rapidly increased in the past weeks and new areas have been affected, including in the urban area of Bangui. A recent risk assessment indicates a high potential for the spread of the disease. While some response measures have been taken, including reactive vaccination in some health zones, these have not conclusively brought the outbreak under control. There is a need for the national authorities and partners to step up response to the ongoing outbreak to avoid further escalation of the situation. The protracted cholera outbreak in Democratic Republic of the Congo is showing signs of improving lately, although the situation is still serious. The number of cases reported on a weekly basis is still very high, at around 500. While this reduction is encouraging, there is a need to sustain the ongoing control interventions. It is also important to address the primary underlying predisposing factors, including provision of potable water and improved sanitation. Alleviating the security situation in the country would go a long way in addressing the root cause of the multiple health problems. 1 Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment Ongoing events 157 5 724 83 1.4% Measles Central African Republic Cases Deaths CFR EVENT DESCRIPTION Geographic distribution of suspected measles cases and deaths in Central The measles outbreak in Central African Republic, formally declared African Republic, Week 1, 2019 – week 6, 2020. by the Ministry of Health on 24 January 2020, is evolving rapidly in numbers and expanding geographically. The incidence cases have risen sharply in the last weeks, following weeks of a gradual decline in the weekly trend in December 2019. In week 6 (week ending 9 February 2020), a total of 82 suspected measles cases and no deaths were reported, compared to 195 cases and one death in week 5 and 483 cases and no deaths in week 4. Between weeks 1-6 of 2020, a total of 1 498 suspected measles cases, including 15 deaths (case fatality ratio 0.3 %) have been reported in 13 out of the 35 districts in the country. Of the 13 districts with active measles outbreaks, five have been newly affected in 2020, namely Bangui in an urban area, Baboua-Abba, Nangha-Boguila, Bossémbélé, and Ouango-Gambo in rural areas. The last two districts around Bangui 1 (Bangui II and Bangui III) in urban areas and Bouar, Bozoum in rural areas reported suspected measles cases. Laboratory tests are ongoing. The measles outbreak in Central African Republic has been ongoing since early 2019 (week 5 of 2019) and continued through to 2020. There was an upsurge in cases in the last half of 2019, with a steady decline in December 2019. From 1 January 2019 to 9 February 2020, a total of 5 724 suspected measles cases, including 83 deaths Weekly trend of suspected measles cases and deaths in Central African (case fatality ratio 1.45%) have been reported in 13 health districts. Republic, Week 1, 2019 – week 6, 2020. Laboratory samples examined at the reference laboratory of the Institut Pasteur in Bangui showed a total of 220 cases confirmed IgM +. The majority (72%) of the affected people are under five years of age, followed by the age group 5 to 10 years (18%). PUBLIC HEALTH ACTIONS Number of cases The Public Health Emergency Operations Centre has been activated to coordinate the response to the measles outbreak The Ministry of Health, with support from WHO and other Weeks partners, has developed a comprehensive response plan to guide response activities and facilitate resource mobilization. Disease surveillance has been strengthened in the affected areas SITUATION INTERPRETATION to ensure early detection of suspected cases. The ongoing measles outbreak in Central African Republic is worsening, A referral system for severe measles cases for transfer to the with a rapid increase in the number of new cases and newly affected district health hospital has been set up and free care is being areas, including the urban centre of Bangui. The outbreak continues offered to measles-affected patients. in the health districts where a reactive measles vaccination campaign was conducted in December 2019, targeting children between 6 to Distribution of drugs and medical supplies to support provision of free medical care is ongoing, supported by partners. 59 months. Moreover, up to 18% of the affected people are in the age group of 5 to 10 years. Isolation facilities have been established in the district hospitals. A recent risk assessment carried out in the country shows that 25 (71%) The routine immunization programme is being strengthened. of the 35 districts are at a high risk for a measles epidemic, implying the increased likelihood of further spread of the current outbreak across Health promotion and risk communication activities are ongoing. the country. Overall, immunization coverage against measles has been RRA and Grading were conducted and the outbreak was graded suboptimal since 2013, with less than 60% coverage for the first dose level 2 on 11 February 2020. at 9 months. About 5% of children under five years suffer moderate malnutrition, increasing their susceptibility to infectious diseases and The Ministry of health and partners continue to make efforts to potential complications. Provision of healthcare services, including mobilise funds to respond to this outbreak. immunization, has been markedly compromised by the prolonged insecurity. The current situation is concerning and calls for urgent action. The national authorities and health partners need to fast track implementation of reactive measles vaccination campaigns and related control activities, done within the context of humanitarian response to the complex emergency. Go to overview 2 Go to map of the outbreaks Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 157 5 810 28 0.5% Measles Chad Cases Deaths CFR EVENT DESCRIPTION Geographic distribution of suspected measles cases in Chad, The measles outbreak in Chad continues to evolve, with the number weeks 1 - 6, 2020. of new cases rapidly increasing in the last weeks, as is the growing number of affected districts. In week 6 (week ending 9 February 2020), a total of 352 suspected measles cases and four deaths have been reported from 26 districts, compared to 219 suspected cases reported in week 5 from 23 districts. The number of new cases has been gradually increasing since week 1 of 2020, when 127 suspected cases were reported. From weeks 1-6, 2020, a cumulative total of 1 276 suspected measles cases, including 14 deaths (case fatality ratio 1.1%), have been reported from 52 (41%) out of 126 districts of the country. Of 37 suspected cases investigated, 31 were positive for measles immunoglobulin (IgM). Most, 78%, of the investigated cases never received any vaccination against measles. Sixty percent of the investigated cases were under five years of age while 19% were between 5 and 14 years and 14% were 15 years and above.
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