Current Infectious Disease Outbreaks for NYC Providers

July 12, 2019

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

New York City As of July 8, 2019, there have been 620 confirmed measles cases identified in New York City (NYC) since October. Most have involved members of the Orthodox Jewish community. Fifty-eight percent of cases are less than five years old, of whom 90% were unvaccinated. To-date, there have been numerous hospitalizations and ICU admissions, but no Measles 08-Jul 620 620 0 deaths. Measles incidence has dropped dramatically in recent weeks. On April 9, the NYC Health Commissioner de- clared 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 are subject to fines. Measles outbreaks also have occurred n New York’s Rockland, Orange, and Monroe Counties. R 1 2 United States The sustained 2018-19 outbreak of hepatitis A has persisted in multiple eastern and midwestern states. Of the >20,300

nationwide cases reported as of June 28, >11,800 (58%) have been hospitalized. Twenty-three states continue to re- >20,300 >20,300 Hepatitis A 28-Jun 179 port cases (AZ, CO, LA, AL, NM, AR, MO, MI, IL, OH, WV, KY, IN, TN, VA, NC, SC, FL, GA, NH, MA, ID, and NJ). (2018-19) (2018-19) Main risk factors continue to be homelessness and IV drug use. On October 24, the Advisory Committee on Immun-

ization Practices (ACIP) recommended hepatitis A vaccination for all homeless persons over one year old. R 1, 2 As of June 27, a total of 1,095 measles cases have been reported from 28 states — WA, TX , OK, NJ, NY, PA, CA, Measles 27-Jun 1,095 1,095 — CO, CT, IL, KY, TN, NH, OR, GA, FL, IN, MD, MA, MI, MO, IA, NV, AZ, VT, RI, VA, and ID. 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 As of June 15, a total of 17 cases of E. coli O26 (STEC) infections have been reported in 8 states (CA, MO OH, PA, NY, NJ, CT, and RI), including 3 hospitalizations. Onsets have ranged from December 11, 2018 to April 18, 2019. Ill- E. coli O26 24-Jun 17 17 0 ness has been linked to eating raw dough made from flour manufactured by ADM Milling Co., and specifically, of Baker’s Choice All-Purpose Flour. R 1

Two cases of Powassan virus infection were reported in Sussex County, in northwestern NJ. Powassan virus is trans- Powassan 8-Jun 2 1 1 (50%) mitted by the blacklegged Ixodes scapularis tick, the same vector as in Lyme disease and babesiosis. One case recounted virus being bitten by a tick while gardening. 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

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

United States As of June 13, a total of 279 cases of salmonellosis have been reported from 41 states, following contact with chicks Salmonellosis 13-Jun 279 279 0 and ducklings in backyard flocks. Forty cases were hospitalized. Onset dates range from January 1 to May 24. Infections have been due to Salmonella Braenderup, S. Montevideo, S. Agona, S. Anatum, S. Infantis, and S. Newport. 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 (NY, PA, NJ, CT, RI, MA) plus FL and TX, including 27 hospitalizations and no deaths. Illness onsets have ranged from 5-Jul 62 62 0 Uganda January 14 to June 16. Cavi brand whole, fresh papayas distributed by Agroson’s LLC have been implicated in the out- break. 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

Caribbean, Central America, and South America In 2019 as of Jun 8, a total of >1.2 million dengue cases, including >608,000 laboratory-confirmed, have been reported to the Pan American Health Organization (PAHO). Brazil ( >1.1 million), Colombia (>52,000), Nicaragua Dengue 15-Jun 1,290,000 >605,000 489 (>33,000), Mexico (>24,500), and Honduras (>12,800) have reported the most cases. Cases have been confirmed in all Central and South American countries except Uruguay. Most dengue cases in the Caribbean (>7,000) have been reported by the Dominican Republic, Jamaica, and Guadeloupe, , Martinique, and Trinidad/Tobago. 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 ~8,000 Zika cases have been reported to PAHO. In addition to Brazil’s 6,526 reported cas- Zika 15-Jun ~8,000 — — es, countries throughout Central America, Mexico, Peru, Bolivia, Colombia, and Venezuela, have reported Zika cases. 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 In 2018, a total of 3,786 cholera cases were reported in Haiti, compared with 13,681 cases in 2017. As of March 13, a Cholera 16-Mar 218 — 3 (1.4%) total of 218 cholera cases, including 3 deaths, have been reported. Since the outbreak began in 2010, Haiti has report- ed 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 Argentina The number of confirmed hantavirus cases in Argentina is now 50, including 13 (26%) deaths. The epicenter of the out- Hantavirus 10-May 50 50 13 (26%) break has been Epuyen, an Andean village in Chubut province. Over the past two months, cases also have been detect- ed in Rio Negro and Jujuy provinces. Infection with the endemic Andes virus has been confirmed. R 1 2 Bolivia In recent weeks, multiple foci of hantavirus infections have been reported in Bolivia. In Cochabamba department, 8 Hantavirus 20-May 16 16 5 (31%) cases of suspected hantavirus pulmonary syndrome (HPS) were reported. In Santa Cruz department, 2 soldiers died and 8 more were hospitalized with suspected HPS. Two cases were reported recently in Tarija Department. 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 3 Last 2019 Disease Confirmed Deaths Notes Update Cases 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 >55,100 cases, including 16 deaths, were reported in Ukraine alone as of Jun 4. Outbreaks have been reported in most European countries, in- Measles 1-Jul >70,000 >70,000 42 cluding Serbia (5,797), North Macedonia (1,734), Romania (1,533), France (1,453), Poland (1,044), Bulgaria (866), Italy (864), Lithuania (709), Czech Republic (545), Germany (400), the United Kingdom (322), Swit- zerland (196), Slovakia (194), Spain (189) and Austria (125) R 1 2 3 Norway A large outbreak of gastroenteritis on the southwestern Norway island of Askøy, just north of Bergen, is thought to Campylobac- 11-Jun ~2,000 36 — be due to contaminated drinking water. Campylobacter has been cultured from 36 stool specimens, though the illness- teriosis es may be the result of polymicrobial contamination. 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 United Kingdom Six nosocomial listeriosis cases have been reported by Public Health England. Three patients in Manchester and Liver- Listeriosis 7-Jun 6 6 3 (50%) pool have died. Packaged sandwiches produced by The Good Food Chain have been implicated. Sandwich meat by North Country Cooked Meats yielded Listeria that was indistinguishable from the outbreak strain. R 1 Arabian Peninsula and Middle East Saudi Arabia In 2019, as of July 10, the Ministry of Health (MOH) has reported a total of 161 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 three weeks, cases have been reported from the central Al- 37 Qassim Region (Ar Rass), Riyadh City, and in the south (Najran). Over the past two months, cases have been reported MERS-CoA 10-Jul 161 161 (23%)) 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.)

4 Last 2019 Disease Confirmed Deaths Notes Update Cases

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 >77,000, >60,000 >60,400, >23,500, and >21,000 dengue cases, respectively. Cambodia Dengue 17-Jun >269,000 — — (>9,000), Singapore (>5,600) the Maldives (>2,500), Laos (>4,200), India (>5,500), Indonesia (>1,000), Timor- Leste, Nepal, and Pakistan also have reported cases. R 1 2 3

So far in 2019, Thailand has reported ~4,000 chikungunya cases, most of which are in its southern districts near Ma- Chikungunya 22-Jun >5,400 — — laysia. The Maldives and Malaysia (largely in Kuala Langat District) have reported >1,220 and >200 cases, respec- tively. India (Tamil Nadu) and Indonesia (Depok, West Java) also have reported cases. R 1 2 3 India In mid-December, an initial two cases of Kyasanur Forest disease (KFD) were announced in Karnataka state. Since Kyasanur then, incidence has continued steadily despite vaccination efforts. As of May 1, a total of 307 cases of KFD have been 15 reported in the Shivamogga, Shimoga, Uttara Kannada, Sagar taluk, Udupi, Aralagodu and Chikkamagaluru districts of Forest 1-May 307 307 (4.9%) Karnataka state, including 15 deaths. Multiple deaths in non-human primates preceded human cases. A third round of disease KFD vaccination (87% effective after third vaccine) is being planned. In March and April, Kerala state also reported 6 cases in Wayanad district, including 2 deaths. R 1 Acute en- A pediatric outbreak of acute encephalitis syndrome (AES) has been reported in the northern Indian state of Assam, cephalitis 10-Jul 189 ?? 14 south of Tibet. The hardest hit district has been Dibrugath’s Muzaffarpur district. Most AES cases are thought to be syndrome due to the vaccine-preventable disease, Japanese encephalitis. R 1 Pakistan and Afghanistan

Already in 2019, a total of 41 infections with wild poliovirus type 1 (WPV1) have been reported in Pakistan (12 cases Polio in 2018), including 9 in the past week (Balochistan province). Environmental samples have yielded WPV1 from three 10-Jul 51 51 — (WPV1) provinces (Sindh, Balochistan, Punjab, and Lahore). In Afghanistan, a total of 10 WPV1 infections have been reported in 2019, compared with 21 in 2018. No new cases were reported over the past two weeks. R 1

5 Last 2019 Disease Confirmed Deaths Notes Update Cases

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 Taiwan Japanese Twelve cases of Japanese encephalitis (JE), a vaccine-preventable disease, have been confirmed in Kaohsiung City and Encepha- 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 litis is abundant in Taiwan. R 1 Australia and the Pacific Already, 2019 promises to record significant dengue incidence. As of May 27, New Caledonia has reported 3,447 cases (DENV-2). Australia has reported 68% more cases by June 5 (569) than at the same time last year. In French Dengue 5-Jun >4,350 — — Polynesia, 338 cases have been reported as of June 16 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 Australia A 25-year-old unvaccinated mare from New South Wales (area of Scone) died of Hendra virus infection after a short Hendra 19-Jun 1 (equine) 1 (equine) 1 neurological illness. Health authorities have implemented surveillance of horses and humans that live on the affected virus property. Since Hendra virus was discovered in 1994, only 7 human cases have been documented. R 1

Africa

So far in 2019, compared with 80 cases in 2018, a total of 22 cases of circulating vaccine-derived poliovirus (cVDPV) infection have been reported in Nigeria (9), Somalia (3), Niger (1), Ethiopia (1), DRC (6) and Angola (2). In Polio 10-Jul 22 22 — 2018, outbreaks of cVDPV persisted in Nigeria, (Jigawa, Katsina, Borno, and Sokoto states). Somalia (Lower Juba), (cVDPV) 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 >107,000; >30,000; and >22,000 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 As of June 16, a total of >22,600 cases of dengue have been reported in Côte d’Ivoire, Tanzania, Kenya, and on Dengue 16-Jun >22,600 — — Mauritius and the island of Réunion, where incidence may have started to decrease, yet 17,000 confirmed cases of both DENV-1 and DENV-2 have been reported as of Jun 16. R 1 2 3

6 Last 2019 Disease Confirmed Deaths Notes Update Cases Africa In February, >6,000 cutaneous leishmaniasis cases were reported in North Africa over the past 6 months. Most have Leishmania– been diagnosed along the Mediterranean coast (west of Tripoli) of Libya (>5,000), followed by central and southwest- 23-Jun >7,000 — — sis ern Tunisia (~1,300) and in the Ghardaia Province of Algeria (~400). A major kala-azar outbreak with >1,300 cases has been ongoing in Kenya since April. Leishmaniasis also can be found in South Sudan and Somalia. R 1 2 Algeria In 2019, a total of 154 brucellosis cases have been reported in the northwestern province of Tiaret. Recent cases have Brucellosis 10-Jun 154 154 — 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 June 21, a total of 21,005 measles cases have been reported in 2019, including 207 (1.0%) deaths, as the epidem- 207 Measles 21-Jun 21,005 97 ic continues to spread geographically. Of the country’s 126 districts, 117 (93%) have now been affected. The mean age (1.0%)% of cases is ~2 years, with ~50% of cases being <1 year old. R 1 2 3 Côte d’Ivoire A dengue outbreak in Côte d’Ivoire was first reported on February 15. As of June 25, a total of 1,853 cases have been Dengue 25-Jun 1,853 195 2 (0.1%) reported, including 195 laboratory-confirmed and 2 (0.1%) deaths. The outbreak has been located in the upscale sub- urbs of the capital city, Abidjan. DEN-1 is the predominant serotype, though DEN-3 also has been identified. R 1 Congo A chikungunya outbreak was declared on February 2. As of June 9, a total of 10,462 cases, including 61 confirmed, have been reported by health authorities. Cases have been reported in 9 of 12 departments: Kouilou (most affected), Chikungunya 09-Jun 10,462 61 0 Pool., Bouenza, Pointe-Noire, Plateaux, Niari, Lékoumou, Brazzaville, and Cuvette. Aedes albopictus, a competent mos- quito vector, was found during investigations. R 1 2 3 4 Democratic Republic of Congo As of Jun 16, a total of 12,711 cholera cases have been reported in the DRC in 2019, including 276 (2.2%) deaths. 276 Outbreaks have been reported in 20 (77%) of the 26 DRC provinces. Approximately 90% of the cases have been re- Cholera 16-Jun 12,711 — (2.2%) 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 So far in 2019 and as of June 16, a total of 2,331 suspected monkeypox cases have been reported in DRC, including 50 Monkeypox 16-Jun 2,331 Unclear 208 in the past two reporting weeks; 50 (2.1%) have died. An unknown number of cases have been confirmed from (2.1%) the Ecuador, North Ubangi, and South Ubangi Provincial Health Divisions. R 1 2 3 4

7 Last 2019 Con- Disease Deaths Notes Update Cases firmed

Democratic Republic of Congo Already in 2019 as of June 16, a total of 107,061 measles cases have been reported in DRC, including 1,879 deaths 1,879 Measles 16-Jun 107,061 782 (1.8%). In the past week, >3,200 cases and 64 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

Over the last 3 months, the Ebola virus disease (EVD) outbreak in northeastern DRC expanded dramatically, fueled by a breakdown in control efforts that were interrupted by security breakdowns and resistance of local communities. Incidence in Katwa, Butembo, and Mandima have continued to trend downward. However, incidence increased again in Mabalako and once again in Beni., and in areas that previously had fewer cases (e.g., Komanda, Lubero, and Rwam- para/Bunia health zones. On June 30, a case who traveled from Beni was confirmed 460 km north in Ariwara health zone, near the borders with Uganda and South Sudan. For now, no further cases have been reported in that area.

1,646 In the 21 days from June 17 to July 7, a total of 70 health areas within 21 health zones reported new cases, represent- Ebola 09-Jul 2,437 2,343 (67.6%) ing 11% of the 664 health areas with North Kivu and Ituri provinces. During this period, a total of 250 confirmed cases were reported, the majority of which were from the health zones of Beni (36%; n=91) and Mabalako (22%, n=54). As of July 9, a total of 2,437 EVD cases, of which 131 (5%) are health workers, have been reported, including 2,437 confirmed and 94 probable; 1,646 (67.6%) have died. Fifty-six percent of cases have been female and 29% (700) have been children <18 years old. As of July 6, a total of 154,037 Ebola vaccinations had been administered. R 1 2 3 (See epidemic curve and maps on p. 13 of this report.) 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- 22 As of June 23, a kala-azar outbreak in Marsabit and Wajir counties has led to 1,648 suspected cases, including 321 con- 23-Jun 1,648 321 asis (1.3%) firmed with rapid diagnostic testing and 22 deaths (1.3%). R 1 2 3 A cholera outbreak that began in early January has been contained in Nairobi and Narok. As of June 23, a total of 20 Cholera 23-Jun 3,036 129 3,036 cases have been reported, including 129 confirmed and 20 (0.7%) deaths. Cases continue to be reported from (0.7%) Kajiado, Garissa, Wajir, Mombassa, and Nairobi Counties. R 1 2 3

8 Last 2019 Disease Confirmed Deaths Notes Update Cases

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 1,099 measles cases from across the country, including 103 confirmed. Eleven Gbehlay-Geh Measles 30-Jun 1,099 103 5 (0.5%) District, Nimba County has been especially hard-hit recently. R 1 2 3 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 24-Jun 5,423 1/041 45 (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 24, a total of 5,423 hepatitis E cases had been identified. Forty-five 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

9 Last 2019 Disease Confirmed Deaths Notes Update Cases

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 As of June 30, there have been a total of 603 laboratory-confirmed and 17 probable Lassa fever cases reported in 136 2019, including 18 healthcare workers, two of whom died. One hundred thirty six (22.6%) deaths have occurred in Lassa fever 30-Jun 620 603 (22.6%) confirmed cases. The steady decline seen in the past months has continued. The emergency phase of the outbreak has been declared over. (Outbreak expected to be closed next report.) 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 con- firmed. 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 past reporting few reporting weeks, Dar es Salaam and Tanga regions reported cases. As of June 30, a total of 408 Cholera 30-June 408 14 7 (1.7%) suspected cases, including 7 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. Children under 5 years old accounted for more 64% of confirmed cases; all but one live in rural areas. R 1 2 Measles 2-July 1,275 604 6 (0.5%)

On May 14, the Ugandan Ministry of Health reported that routine sampling for a sentinel surveillance program identi- fied 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 10 Last 2019 Disease Confirmed Deaths Notes Update Cases

Uganda 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 Zambia Since April 3 and as of June 7, a total of 253 suspected cholera cases, including 31 confirmed, have reported by Zambi- Cholera 7-Jun 253 31 6 (2.4%) an health authorities; 6 (2.4%) have died. Most cases (96%) have occurred in Mpulungu District, Northern Province, near to Lake Tanganyika. The disease has spread to neighboring Mbala District . R 1

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

Gastroenteritis/multiple pathogens (US, Multistate) * Hantavirus (US, New Mexico) Salmonella Concord (US, Multistate) * Salmonella Uganda (US, Multistate) Legionnaires’ disease (US, OH) * Legionnaires’ disease (US, IL) E. coli O26 (France) * HIV (Pakistan) Hantavirus (Germany) * Dengue (Côte d’Ivoire) Chikungunya (Spain) * Lassa fever (Sierra Leone) Polio (cVDPV) (Papua New Guinea) Rat hepatitis E (Hong Kong) Nipah (India) Cholera (Somalia)

11 MERS-CoV Cholera

Qaisumah Buraidah Riyadh Qusaiba Al Kharj Unayzah

Medina

Najran

12 Ebola virus disease out- break, North Kivu and Ituri Provinces, Democratic Republic of Congo

As of July 10, 2019

13 14