New York City United States

Current Infectious Disease Outbreaks for NYC Providers July 26, 2019

Last 2019 Con- Disease Deaths Notes and References (R 1, 2, 3) Update Cases firmed

New York City As of July 22, 2019, there have been 637 confirmed measles cases identified in New York City (NYC) since October. Most have involved members of the Orthodox Jewish community in Brooklyn. On April 9, the NYC Health Commis- Measles 22-Jul 637 637 0 sioner declared a public health emergency, ordering all unvaccinated adults and children in certain Brooklyn ZIP codes to be vaccinated. Persons found unvaccinated or non-immune in these ZIP codes have been subject to fines. Measles incidence has dropped dramatically in recent weeks. United States The sustained 2018-19 outbreak of hepatitis A (HAV) has persisted in multiple eastern, southern, and midwestern

states. Of the >22,000 nationwide cases reported as of July 19, >13,000 (59%) have been hospitalized. Twenty-three >22,000 >22,000 Hepatitis A 19-Jul 216 (1%) states continue to report cases (AZ, CO, LA, AL, NM, AR, MO, MI, IL, OH, WV, KY, IN, TN, VA, NC, SC, FL, GA, (2018-19) (2018-19) NH, MA, ID, and NJ). Risk factors continue to be homelessness and IV drug use. On October 24, the Advisory Com-

mittee on Immunization Practices (ACIP) recommended HAV vaccination for homeless persons >1 year old. R 1, 2 As of July 18, a total of 1,148 measles cases have been reported from 30 states — WA, TX , OK, NJ, NY, PA, CA, Measles 18-Jul 1,148 1,148 — CO, CT, IL, KY, TN, NH, OR, GA, FL, IN, MD, MA, MI, MO, IA, NV, AZ, VT, RI, VA, ID, AK, and OH. This is the greatest case load in the US since 1992. The majority of cases have been in NYC and nearby NYS counties. R 1 PulseNet identified an outbreak of Shiga toxin-producing E. coli 0103 and 0121. As of July 16, a total of 21 cases have been reported from 7 states (CT, FL, MI, MO, NJ,NY, and PA). Eight have been hospitalized and there have been no *E. coli 0103 16-Jul 21 21 0 cases of hemolytic uremic syndrome or deaths. Epidemiologic and traceback information identified a strong associa- and 0121 tion with consumption of bison burgers. Northfork Bison Distributions, Inc. (Quebec) has recalled ground bison and bison patties produced between February 22 and April 30. R 1 A second person from McKinley County, New Mexico died of hantavirus pulmonary syndrome (HPS). This is the sec- Hantavirus 25-Jun 2 2 1 ond HPS case reported in 2019 in New Mexico. R 1 2

A Legionnaires’ disease (LD) outbreak in Atlanta has been linked to the Sheraton Atlanta. As of July22, a total of 9 LD *Legionnaires’ cases have been confirmed by the Georgia Department of Public Health (GDPH) in persons who attended a confer- 22-Jul 9 9 0 disease ence at the hotel. No further information has been released. GDPH has asked all persons who were guests at the hotel from June 12 - July 15 to fill out an on-line survey. R 1 2

The Hawaii Department of Health reported a sixth case of infection with the rat lungworm, Angiostrongylus cantonensis *Rat lung- 10-Jul 6 6 0 on the island of Hawaii’s western half. Half of the infections have been in visitors to the island from the mainland who worm were unaware of the risk when consuming fresh produce. R 1 1 Last 2019 Con- Disease Deaths Notes and References (R 1, 2, 3) Update Cases firmed

United States As of July 19, a total of 768 cases of salmonellosis have been reported from 48 states, following contact with chicks and ducklings in backyard flocks from multiple hatcheries. One hundred twenty-two cases were hospitalized; 2 have Salmonellosis 19-Jul 768 768 2 (0.2%) died. Onset dates range from January 1 to May 24. Infections have been with many Salmonella serotypes: Braenderup, Montevideo, Agona, Anatum, Infantis, Newport, Alachua, Enteritidis, Manhattan, Muenchen, and Oranienburg. R 1

As of July 5, a total of 71 cases of salmonellosis due to Salmonella Uganda have been reported by 6 northeastern states Salmonella 5-Jul 62 62 0 (NY, PA, NJ, CT, RI, MA), FL and TX, including 27 hospitalizations and no deaths. Illness onsets have ranged from Janu- Uganda ary 14 to June 16. Cavi brand whole, fresh papayas distributed by Agroson’s LLC have been implicated. R 1 As of July 17, PulseNet has identified an outbreak of multi-drug resistant salmonellosis due to serotypes 1 4,[5],12:i:-, Infantis, Newport, and London. A total of 93 cases from 27 states have been reported, including 20 hospitalizations *Salmonellosis 17-Jul 93 93 0 and no deaths. Epidemiologic, laboratory, and traceback information indicates that exposure to pig ear dog treats is the likely cause of the outbreak. Pet Supplies Plus recalled pig ear dog treats stocked in open bins. R 1 As of June 27, a total of 4 Legionnaires’ disease cases have been linked to exposures as patients in an Oak Lawn, IL Legionnaires’ 27-Jun 4 4 — hospital (Advocate Christ Medical Center). Two of the patients were hospitalized there within the past 2 months. A disease public health investigation is ongoing. R 1 Caribbean, Central America, and South America In 2019 as of June 29, a total of >1.5 million dengue cases, including >775,000 laboratory-confirmed, and 606 deaths, have been reported to the Pan American Health Organization (PAHO). Brazil ( >1.2 million), Colombia (>65,000), Nicaragua (>49,000), Mexico (>32,000), and Honduras (>18,500) have reported the most cases. Cases have been Dengue 29-Jun 1,508,000 >755,000 606 confirmed in all Central and South American countries except Uruguay. Most dengue cases in the Caribbean (>8,600) have been reported by the Dominican Republic and Jamaica. Guadeloupe, Martinique, Antigua/Barbuda, Trinidad/Tobago, and 10 other islands also have reported cases. R 1 In 2018, >80,000 chikungunya cases were reported in the Americas and the Caribbean. In 2019 as of June 8, Brazil has reported 38,000 cases (Rio de Janeiro, Minas Gerais, Tocantins, Pará and Acre regions); Colombia reported >300 Chikungunya 8-Jun >39,000 — 15 cases; and Peru reported >125 cases. To date in 2019, chikungunya cases also have reported in Paraguay, El Salva- dor, Mexico, and Nicaragua. R 1 2 So far in 2019, a total of ~10,300 Zika cases have been reported to PAHO. In addition to Brazil’s 7,705 reported Zika 6-Jul ~10,300 2,460 — cases, countries throughout Central America, Mexico, Peru, Bolivia, Colombia, Paraguay, Argentina, and Venezuela, have reported Zika cases. All Caribbean countries have not reported to PAHO. R 1 2 In 2018, of the >16,000 reported measles cases in the Americas and Caribbean, >60% and 34% were reported in Bra- zil and Venezuela, respectively. So far in 2019, most of the >14,000 suspected cases have been reported by Brazil Measles 18-May >14,000 1,323 — and Venezuela, Confirmed cases also have been reported in Argentina, Chile, Colombia, Costa Rica, Mexico, and the Bahamas. R 1 2 3

2 Last 2019 Con- Disease Deaths Notes Update Cases firmed

Haiti As of March 13, a total of 218 cholera cases, including 3 deaths, have been reported in 2019. In comparison, 3,786 Cholera 6-Jul 458 — 3 (0.6%) cholera cases were reported in 2018 and 13,681 cases in 2017. Since the outbreak began in 2010, Haiti has reported 819,963 suspected cases and 9,792 deaths (1.2%). R 1 2 3 4 In 2018, a total of 375 probable cases were reported, including 105 confirmed and 14 (13.3%) deaths. The highest inci- Diphtheria 1-Jun 70 6 1 (8.2%) dence has been in children 6-14 years old followed by 1-5 year olds. As of June 1, a total of 70 diphtheria cases have been reported in Haiti in 2019, including 6 confirmed and one death (8.2%). R 1 Brazil This is the beginning of yellow fever season. As of June 9, a total of 82 confirmed cases (all presumed to be sylvatic) have been reported in the southern states of São Paulo (68), Parana (13), and Santa Catarina (1) This may indicate the Yellow fever 9-Jun 82 82 14(17%) emergence of a 3rd wave of yellow fever expansion into south and southeastern Brazil. Epizootics among non-human primates have been confirmed in both of the two southern states. Travelers to Brazil are advised to get vaccinated more than 10 days before travel. R 1 Peru In 2019 and as of July 3, a total of 653 cases of Guillain-Barré syndrome (GBS). The outbreak peak was the week of Guillain- 10 June 3-9 when 314 cases were reported. Since then, weekly numbers are much less. The Ministry of Health has de- Barré 3-Jul 653 232 (1.5%) clared states of emergency five Peruvian regions: Lima, Piura, Junín, La Libertad, and Lambayeque. A 2018 GBS out- syndrome break in Peru was due to infection from an enterovirus. The cause of the outbreak remains unknown. R 1 2 Venezuela A diphtheria outbreak that began in 2016 has continued in Venezuela. As of June 22, a total of 324 cases and 15 deaths 15 Diphtheria 22-Jun 324 — have been reported in 2019. This compares with 1,102 cases and 50 (13.6%) deaths in 2018. With Venezuela’s collaps- (4.6%) ing healthcare system, childhood vaccination has been affected. R 1 2 Europe Between January 2018 and January 2019, >70,000 measles cases were confirmed throughout WHO’s European Re- gion. So far in 2019, measles outbreaks have occurred in all regions of Europe. A total of >56,105 cases, including 18 deaths, were reported in Ukraine alone as of July 15.. Outbreaks have been reported in most European countries, Measles 15-Jul >71,000 >71,000 45 including Serbia (5,798), North Macedonia (1,814), Romania (2,152), France (2,125), Poland (1,290), Bulgaria (1,053), Italy (1,096), Lithuania (787), Czech Republic (558), Germany (436), the United Kingdom (522), Switzerland (205), Slovakia (194), Spain (224) and Austria (134) R 1 2 3

3 Last 2019 Disease Confirmed Deaths Notes Update Cases

*West Nile The West Nile virus season has begun in Europe. As of July 18, Greece (5) and Romania (1) have reported cases I are- 18-Jul 6 6 0 virus as where cases have been reported previously. Greece also has reported two equine outbreaks. R 1 France More than 80 persons in France have been infected with Salmonella Typhimurium; 13 were hospitalized. Illness has *Salmonellosis 20-Jul >80 >80 0 been linked to consumption of Italian capocollo, a pork cold cut, produced by Di Vittorio with ingredients from France and Germany. The product has been recalled. R 1 Switzerland So far in 2019, approximately 50 cases of Q fever have been confirmed in Switzerland; 20 reside in the southern, Ital- Q fever 3-Jun ~50 ~50 0 ian-speaking canton of Ticino. “Several” cases of Q fever have been reported by public health authorities in recent weeks in Ticino’s Maggia Valley, where farmers have been ordered to vaccinate their goats. R 1 Arabian Peninsula and Middle East Saudi Arabia In 2019, as of July 25, the Ministry of Health (MOH) has reported a total of 166 cases of MERS-CoA infection. Overall, the incidence tempo has slowly considerably since a large nosocomial outbreak in March, though cases continue to be reported in geographically dispersed locations. The past 5 weeks, cases have been reported from the central Al- 37 Qassim Region (Ar Rass, Buraidah), Riyadh City, and in the south (Najran). Over the past few months, cases have been MERS-CoA 25-Jul 166 166 (22.3%)) reported from across the country. Recently, some cases isolated at home with mild or no illness may have progressed to serious disease requiring hospi- talization. This might be worth keeping in mind when evaluating patients with possible MERS. R 1 (See epidemic curve, map, and nosocomial transmission diagram on p. 12 of this report.) Yemen As of July 8, at least 440,000 suspected cases of cholera have been reported in Yemen in 2019, which already is more 610 than all reported cases in 2018. More than 3,500 cases have been culture-confirmed. Most cases have been reported Cholera 8-Jul >440,000 3,508 (0.002%) from Governates in the western areas. Yemen’s water, sanitation, electricity, and health care infrastructures have been decimated by the civil war raging there since 2014. R 1 2 3 4

Asia Dengue is endemic throughout Asia. Already in 2019, the Philippines, Vietnam, Malaysia, Sri Lanka, and Thai- land have reported >92,000, >81,100 >69,700, >28,000, and >40,400 dengue cases, respectively. Cambodia ~365,000 — — Dengue 14-Jul (>20,500), Singapore (>7,400) the Maldives (>2,800), Laos (>8,000), India (>5,500), Bangladesh (4,500), Indo- nesia (>1,000), Nepal (1,500), Pakistan (2,500), Timor-Leste,and Taiwan also have reported cases. R 1 2 3

4 Last 2019 Disease Confirmed Deaths Notes Update Cases

So far in 2019, Thailand has reported ~4,500 chikungunya cases, most of which are in its southern districts near Ma- Chikungunya 22-Jun >6,000 — — laysia. The Maldives and Malaysia (largely in Kuala Langat District) have reported >1,296 and >200 cases, respectively. India (Tamil Nadu) and Indonesia (Depok, West Java) also have reported cases. R 1 2 3 India Acute en- Since April, >1,560 cases of acute encephalitis syndrome (AES) have been reported in the northern Indian state of As- cephalitis 20-Jul ~1,600 ?? ?? sam, south of Tibet. Of them, ~440 have been confirmed as Japanese encephalitis, a vaccine-preventable disease. Cases syndrome also have been reported in Nagaland and in Manipur states, east of Bangladesh. R 1 Pakistan and Afghanistan

Already in 2019, a total of 45 infections with wild poliovirus type 1 (WPV1) have been reported in Pakistan (12 cases Polio in 2018). Environmental samples have yielded WPV1 from two provinces (Sindh and Balochistan). In Afghanistan, a 24-Jul 56 56 — (WPV1) total of 11 WPV1 infections have been reported in 2019, compared with 21 in 2018. No new cases were reported over the past week. R 1

Pakistan A pediatric HIV outbreak has been identified in Ratodero Taluka (Larkana district, Sindh province). More than 30,000 HIV 3-Jul 876 876 — were screened once the outbreak was suspected and 876 diagnoses were confirmed, of whom 719 (82%) are children <15 years old. All those tested have been surveyed and assessment of risk factors in ongoing. R 1 Philippines WHO and the FDA of the Philippines announced that counterfeit and falsified rabies vaccine (Verorab, Speeda, and *Falsified 26-Jul — — — Rabipur) and anti-rabies serum (EquiRab) are in commercial circulation. If a patient presents with a history of animal rabies PEP bite and post-exposure prophylaxis (PEP) in the Philippines, providers can consider this information. R 1

Taiwan Twelve cases of Japanese encephalitis (JE), a vaccine-preventable disease, have been confirmed in Kaohsiung City and Japanese en- 10-Jul 12 12 1 (8.3%) Chiayi City, indicating that the JE transmission season has started in Taiwan. One has died. The Culex mosquito vector cephalitis is abundant in Taiwan. R 1 Australia and the Pacific Already, 2019 promises to record significant dengue incidence. As of June 28, New Caledonia has reported 3,700 cases (DENV-2). Australia has reported 87% more cases by July 2 (700) than at the same time last year. In French Dengue 2-Jul >4,900 — — Polynesia, 500 cases have been reported as of June 30 in Moorea, Raiatea, Bora Bora, Palau, Rangiroa, Vana- tu, the Cook Islands, Wallis and Fortuna, and Tahiti, including 106 cases due to DENV-2 on Tahiti (for the first time since 2000), Moorea, Bora Bora and Nuku Hiva. R 1 2 3 5 Last 2019 Disease Confirmed Deaths Notes Update Cases Africa

So far in 2019, compared with 80 cases in 2018, a total of 39 cases of circulating vaccine-derived poliovirus (cVDPV) infection have been reported in Nigeria (12), Somalia (3), Niger (1), Ethiopia (1), DRC (15), Central African Polio 24-Jul 39 39 — Republic (4) and Angola (3). In 2018, outbreaks of cVDPV persisted in Nigeria, (Jigawa, Katsina, Borno, and Sokoto (cVDPV) states). Somalia (Lower Juba), DRC (Haut Katanga, Haut Lomami, Mongala, and Maniema Provinces), Niger (Zinder province) and Mozambique (Zambézia province). R 1 The most severe outbreak has been in Madagascar, with >145,000 cases in 2019. DRC, Nigeria, and Chad have reported >118,000; >30,000; and >22,900 cases, respectively, in 2019. To a lesser extent, Angola, Cameroon, Cen- Measles 2-Jul >325,000 >5,000 — tral African Republic, Niger, Liberia, Sierra Leone, Mauritius, Ethiopia, South Sudan, Mali, Guinea, Uganda, Kenya, and Tunisia also have reported cases. R 1 2 3 In 2019 and as of July 9, a total of >54,000 cases of dengue have been reported in Côte d’Ivoire (1,853), Tanzania Dengue 9-Jul >54,000 >17,000 — (6,089), Kenya, and on Mauritius (123) and the island of Réunion (47,000), where incidence may have started to decrease, yet 17,000 confirmed cases of both DENV-1 and DENV-2 have been reported as of Jul 9. R 1 2 3

In February, >6,000 cutaneous leishmaniasis cases were reported in North Africa over the past 6 months. Most have Leishman- been diagnosed along the Mediterranean coast (west of Tripoli) of Libya (>5,000), followed by central and southwest- 23-Jun >7,000 — — iasis ern Tunisia (~1,300) and in the Ghardaia Province of Algeria (~400). A major kala-azar outbreak with >1,700 cases has been ongoing in Kenya since April. Leishmaniasis also can be found in South Sudan and Somalia. R 1 2 Algeria

Brucello- In 2019, a total of 154 brucellosis cases have been reported in the northwestern province of Tiaret. Recent cases have 10-Jun 154 154 — sis occurred in the city of Ksar Chellala, following consumption of milk curds. R 1 Burundi Burundi currently has epidemic levels of malaria throughout the country. In 2019, as of May 26, more than 3.2 million 1273 Malaria 26-May 3,207,552 — suspected cases of malaria have been reported, which is >50% more than at the same time in 2018. Health authorities (0.04%) are hampered by a lack of resources to mount a comprehensive, nationwide malaria prevention campaign. R 1 Chad As of July 14, a total of 22,997 measles cases have been reported in 2019, including 225 (0.98%) deaths, as the epidem- 225 Measles 14-Jul 22,997 133 ic continues to spread geographically. Of the country’s 126 districts, 118 (94%) have now been affected. Sixty percent (0.98%) of cases are <5 years old., of whom 77% were not vaccinated. R 1 2 3 Côte d’Ivoire A dengue outbreak in Côte d’Ivoire was first reported on February 15. As of July 14, a total of 2,514 cases have been reported, including 300 laboratory-confirmed and 2 (0.1%) deaths. The trend in reported cases has been decreasing Dengue 14-Jul 2,514 300 2 (0.1%) since mid-June. The outbreak has been located in the upscale suburbs of the capital city, Abidjan. DEN-1 is the pre- dominant serotype, though DEN-3 also has been identified. R 1 2

6 Last 2019 Disease Confirmed Deaths Notes Update Cases Africa Congo A chikungunya outbreak was declared on February 2. As of July 7, a total of 11,050 cases, including 148 confirmed, have been reported by health authorities. A downward trend in incidence has been seen. Cases have been reported in Chikungunya 07-Jul 11,050 148 0 9 of 12 departments: Kouilou (most affected), Pool., Bouenza, Pointe-Noire, Plateaux, Niari, Lékoumou, Brazzaville, and Cuvette. Aedes albopictus, a competent mosquito vector, was found during investigations. R 1 2 3 Democratic Republic of Congo As of Jun 30, a total of 13,400 cholera cases have been reported in the DRC in 2019, including 280 (2.1%) deaths. 280 Outbreaks have been reported in 20 (77%) of the 26 DRC provinces. Approximately 90% of the cases have been re- Cholera 30-Jun 13,400 — (2.1%) ported from eastern provinces where cholera is now considered endemic: Tanganyika, Upper Katanga, Upper Loma- mi, North Kivu and South Kivu. R 1 2 3 Already in 2019 as of June 30, a total of 118,647 measles cases have been reported in DRC, including 2,061 deaths 2,061 Measles 30-Jun 118,647 782 (1.8%). In the past week, >3,300 cases and 77 deaths were reported. More than 64% of cases in 2019 have been from (1.8%) Tshopo, Lualaba, Kasai, and Upper Lomami provinces. R 1 2 3 In 2019 and as of June 30, a total of 2,636 cases of monkeypox have been reported, including 58 (2.2%) deaths. In the 58 Monkeypox 30-Jun 2,636 — past week, most cases were reported from Sankuru and Ecuador provinces. North and South Ubangi also have re- (2.2%) ported cases in recent months. R 1 2 3 The last month has seen a worsening of the Ebola virus disease (EVD) outbreak in northeastern DRC’s North Kivu and Ituri provinces, including a dramatic increase in transmission within the Beni health zone and from there into sur- rounding areas. Violence and community unrest continued to interfere with response activities; 2 public health workers murdered in Beni. As of July 24, a total of 2,620 EVD cases, of whom 140 (5%) were health workers, have been reported, including 2,526 confirmed and 94 probable; 1,756 (67.0%) have died. Fifty-six percent of cases have been female and 28% (737) have been children <18 years old. In the 21 days from June 30 to July 21, a total of 65 health areas within 18 health zones reported new cases, representing 16% of the 664 health areas with North Kivu and Ituri provinces. During this period, a total of 254 confirmed cases were reported, the majority of whom were from the health zones of Beni (52%; n=123), Mandima (9%; n=22), Mabalako (11%, n=28), and Katwa (7%; n=18). A total of 1,756 Ebola 24-Jul 2,620 2,,526 171,052 Ebola vaccinations have been administered as of July 21. (67.0%) In mid-June, 3 EVD cases were confirmed for the first time in Uganda after a family crossed the border from the DRC; no additional cases were detected there. Then on June 30, an ill contact traveled undetected from Beni 460 km north to the Ariwara health zone, near the borders with Uganda and South Sudan, where he was confirmed; no secondary cases have been identified there. And on July 13, an EVD case was confirmed in Goma, the provincial capital of North Kiva, <1 mile from the Rwandan border and a city of 1-2 million people. Intensive follow-up of contacts failed to iden- tify additional cases, and EVD surveillance on roads into and out of Goma and along the border with Rwanda were intensified. Three days later, WHO declared a Public Health Emergency of International Concern (PHEIC). R 1 2 3 (See epidemic curve and maps on p. 13 of this report.)

7 Last 2019 Con- Disease Deaths Notes Update Cases firmed

Democratic Republic of Congo In the past week, 4 cases of acute flaccid paralysis following infection with circulating vaccine-derived poliovirus 2 *cVDPV 24-Jul 15 15 0 (cVDPV2) were reported in the DRC. So far in 2019, 15 cVDPV2 cases have been reported (20 in 2018). Most recently, cases were reported in the following provinces: West Kalonda, Nyanga, Kasai, Tshumbe, and Sankuru. R 1 Egypt Public Health England has determined that 20 persons infected with a Shiga toxin-producing E. coli (STEC) were ex- *Shiga toxin- posed during travel to the Hurghada region (Red Sea governorate) of Egypt. It has not been determined yet whether a producing E. 17-Jul 20 20 0 food, beverage, or water supply was contaminated. To date, 4 persons have been hospitalized; hemolytic uremic syn- coli (STEC) drome (HUS) was confirmed in one patient. R 1 Ethiopia In Ethiopia as of June 30, a total of 6,889 measles cases have been reported in 2019, including 59 laboratory-confirmed. Measles 30-Jun 6,889 59 — The impacted areas have been Oromia, Amhara, and Solami regions. A vaccination campaign is being planned to target 6.7 million displaced children aged 6 months to 14 years. R 1 Guinea As of June 9, a total of 2,304 measles cases, including 14 (0.6%) deaths have been reported, compared with 1,863 total 14 Measles 09-Jun 2,304 712 cases in 2018. Of 1,201 specimens tested, 712 (59.3%) have been positive. Disease transmission currently is most (0.6%) acute in Matoto, Ratoma, Dixinn, Labé, Matam, ,Dubreka, Coyah, Maferinyah, Kegneko, and Manéah. R 1 2 3 Kenya Leishmani- 24 As of July 14, a kala-azar outbreak in Marsabit, Wajir, and now Garissa counties has led to 1,734 suspected cases, in- 14-Jul 1,734 389 asis (1.4%) cluding 389 confirmed with rapid diagnostic testing and 24 deaths (1.4%). R 1 2 3 A cholera outbreak that began in early January has been contained in Nairobi and Narok. As of July 14, a total of 3,433 24 Cholera 14-Jul 3,433 141 cases have been reported, including 141 confirmed and 24 (0.7%) deaths. Cases continue to be reported from Kajiado, (0.7%) Garissa, Wajir, Mombassa, Machakos, and Nairobi Counties. R 1 2 3 Liberia As of June 23, Liberia has reported a total of 32 suspected cases of Lassa fever, including 22 confirmed with RT-PCR Lassa fever 23-Jun 32 22 8 (25%) and 8 (25%) deaths, in 2019. Cases have been reported in Nimba, Bong, Grand Kru, Grand Bassa, and Montserrado Counties. R 1 2 3 As of June 30, a total of 1,120 measles cases from across the country, including 110 confirmed. Bong, Margibi, and Lofa Measles 30-Jun 1,120 110 5 (0.%) Counties have been hard-hit. R 1 2 3

8 Last 2019 Disease Confirmed Deaths Notes Update Cases

Mali As of June 30, a total of 980 measles case were reported in Mali, including 261 confirmed. Cases have been reported Measles 30-Jun 980 261 0 recently in the following health districts: Koulikoro, Segou, Kayes, Mopti, Bamako, Kidal, and Babamba. R 1 2 3

Mayotte Between December 11 and July 5, a total of 141 Rift Valley fever (RVF) cases were reported on the island of Mayotte, which is between Madagascar and Mozambique. There has been a significant decrease in RVF incidence over the past Rift Valley 5-Jul 141 141 0 three months. Seventy-five percent of the cases have been male. Most cases have been concentrated Centre-West and fever North area of the island. One hundred twenty-three separate animal RVF outbreaks also have been documented in the Mayotte’s central and western regions. R 1 2 3 4 Mozambique Tropical Cyclones Idai and Kenneth, hitting Mozambique in March and April, caused widespread flooding, crop loss, and devastation to infrastructure. As of June 25, a total of 7,502 cholera cases have been reported in central Sofala (especially Beira district) and northern Cabo Delgado provinces. However, the situation may have stabilized, which Cholera 25-Jun 7,052 — 8 (0.1%) Sofala not reporting any cases for nearly 3 weeks. Due to severe damage to healthcare, sanitation, and water facilities and infrastructure, affected areas will remain especially vulnerable to waterborne and vectorborne disease. Wide areas of the coastal regions remain without utilities and with severely damaged roads. R 1 2 3

Namibia The hepatitis E outbreak that started nearly one year ago has persisted, become protracted, and has intensified over the past two weeks. The outbreak, which at first was restricted to the Windhoek district in the Khomas Region (still Hepatitis E 30-Jun 5,561 1,124 46 (0.8%) the most affected region), spread to 10 other regions: Erongo, Omusati, Oshana, Omaheke, Ogangqwena, Ohangwen, Oshikoto, Kavango, Otjozo and Hardap. As of June 30, a total of 5,561 hepatitis E cases had been identified. Forty-six (0.8%) cases have died, of whom 20 (43.0%) were either pregnant or post-partum women. R 1 2 3 4 Niger

As of June 23, a total of 9,221 measles cases, including 47 (0.5%) deaths have been reported by Niger in 2019. Most Measles 23-Jun 9,221 0 47 (0.5%) have occurred in Maradi and Tahoua regions, followed by Zinder, Niamy, Tilaberi, Agadez, Diffa, and Dofo. R 1 2 Nigeria As of July 14, there have been a total of 622 laboratory-confirmed and 17 probable Lassa fever cases reported in 2019, including 18 healthcare workers, two of whom died. One hundred thirty six (22.6%) deaths have occurred in con- 140 Lassa fever 14-Jul 639 622 firmed cases. The steady decline seen in the past months has continued. Ninety-two percent of confirmed cases have (21.9%) been from Edo, Ondo, Ebonyi, Bauchi, Taraba, and Plateau States. The emergency phase of the outbreak has been declared over. R 1 2 3

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Nigeria As of May 25, a total of 30,669 suspected measles cases have already been reported in Nigeria, including 1,862 in the 91 Measles 25-May 30,669 1,476 week ending May 19. Borneo State in northeast Nigeria, Yobe, and Katsina State in the north have accounted for 75% (0.3%) of cases. Nigerian health authorities reported >17,000 suspected measles cases in 2018. R 1 2 3 On June 18, health authorities in Adamawa State declared a cholera outbreak in the northeast state. As of June 28, a Cholera 28-Jun 156 16 1 (0.6%) total of 156 suspected cases have been reported, including one death. Vibrio cholera classical O1 strain has been confirmed. Most cases were reported in Yola North, Girei, and Yola South. R 1 2 Sierra Leone Two confirmed Lassa fever cases were confirmed in the week ending May 26, increasing to 7 the total number of con- Lassa fever 16-Jun 7 7 5 (71%) firmed cases in 2019. Five (71%) have died. All were reported in Kenema district, an endemic area. R 1 South Sudan As of June 9, total of 1,187 suspected measles cases, including 72 confirmed, have been reported in 12 South Sudan Measles 9-Jun 1,187 72 7 (0.6%) counties: Abyei, Juba, Pibor, Gogriel West, Gogriel East, Bor South, Melut, Mayom, Tonj North, Awiel South, Awiel West, and Awiel Central. Three Protection of Civilian sites have been affected. R 1 2 3 Tanzania In 2019, a new wave of cholera was reported in 9 Tanzanian Districts, including Longido, Handeni, and Pangani. In the Cholera 14-Jul 424 14 8 (1.9%) past reporting few reporting weeks, Dar es Salaam and Tanga regions reported cases. As of July 14, a total of 424 suspected cases, including 8 deaths, have been reported by health authorities. R 1 2 3 Uganda As of July 2, a total of 1,275 suspected measles cases have been reported in 2019, of whom 604 have been confirmed. Measles 2-July 1,275 604 6 (0.5%) Children under 5 years old accounted for more 64% of confirmed cases; all but one live in rural areas. R 1 2

On May 14, the Ugandan Ministry of Health reported that routine sampling for a sentinel surveillance program identified two cases of yellow fever in widely separated districts. One case originated in Koboko, in the northwest close to Yellow fever 26-May 6 2 0 the borders of South Sudan and the DRC. The second came from a patient in south-central Masaka, which is on close to Lake Victoria. Neither had been vaccinated. A survey by a public health response team determined that there were many unvaccinated persons in both areas. R 1 2 From June 11-13, a total of three confirmed Ebola virus disease (EVD) cases were confirmed in Kasese District in western Uganda. All three died. They were members of the same family, contacts of a confirmed EVD case, who Ebola virus 28-Jun 3 3 3 (100%) crossed over the porous border between the Democratic Republic of Congo (DRC) and Uganda. Following these disease deaths, the remaining family members returned to the DRC. As of June 28, no additional cases related to this cluster have been reported in Uganda. R 1 2

10 Removed from last bi-weekly list: New outbreaks since last bi-weekly list

E. coli O26 (US, Multistate)  Legionnaires’ disease (US, GA)

Powassan virus (US, NJ)  Rat Lungworm (US HI)

Hantavirus (Argentina)  West Nile virus (Europe)

Hantavirus (Bolivia)  Salmonellosis (France)

Campylobacteriosis (Norway)  Falsified rabies PEP (Philippines)

Listeriosis (United Kingdom)  Shiga toxin-producing E. coli (STEC) (Egypt)

Kyasanur Forest disease (India)  cVDPV (DRC) Hendra virus (Australia)

Cholera (Zambia)

11 MERS-CoV Cholera

Qaisumah Buraidah Riyadh Qusaiba Al Kharj Unayzah

Medina

Najran

12 Ebola virus disease outbreak, North Kivu and Ituri Provinces, Democratic Republic of Congo

As of July 21, 2019

13 14