Epidemiological Update on Public Health Emergencies WHO Country Office, Liberia 1 September 2017

Content Public Health Emergencies 1 2 3 4 5 Flood/Mudslide: Sierra Leone 2 Crimean-Congo hemorrhagic fever: Mauritania 3 Hepatitis E: Niger 4 Cholera: AFRO Region 5 Other Events Under Follow-up Public Health Emergencies

Public Health Emergencies (AFRO) 14 Humanitarian Crises 35 Outbreaks 3 Grade 3 events 8 Grade 1 events 6 Grade 2 events 32 Ungraded events Source: WHO Health Emergencies AFRO week 34 bulletin on outbreaks and public health emergencies

Flood/Mudslide: Sierra Leone 26/27 August 2017: New flooding appeared in downtown Freetown a health centre, the bridge and a school at Kroo Bay affected. One dead and two injured As of 29 August 2017: 1,424 households directly affected (5,962 people in 6 communities) Including 904 children under 5 years and 113 pregnant women. 78% of households reported the death of family member in Regent community 47% had their house destroyed Recent survey (in greater Freetown flooded communities): alarming contamination of faecal coliforms in water sources and actively used community wells Sierra Leone Landslide & Flash Flooding - Number of vulnerable individuals (as of 29 Aug 2017) Areas affected include Culvert, Dwarzark, Kamayama, Kanikay, Kaningo and Regent – Western area Rural and Urban, Freetown Source: UNDAC team in collaboration with the UN Resident Coordinator’s Office in Sierra Leone, Situation Report No 7

Flood/Mudslide: Sierra Leone Public Health Measures Coordination: Office of the National Security (Government of Sierra Leone) providing the leadership, national Incident command center and the Public health National emergency operational centers activated Shelter: Two temporary sites, Old Skool at Hill Station and Juba Barracks have been set up to relocate the most vulnerable people affected WASH: Water, soap and disinfectants were provided to four hospitals in Freetown. Health education focusing on diarrhoea prevention was carried out in and around the hospitals. A total of 441,000 litres of water have been supplied through water trucking. Rain water harvesting systems (RWHSs) installed in both Regent, Kaningo and Pentagon. Food: WFP food distributions have been completed for the first round. Second food distribution scheduled for 4 September Vaccination: The International Coordination Group (ICG) has approved 1,036,000 doses of Oral Cholera Vaccine (Euvichol) 518,000 direct beneficiaries targeted in communities at risk. Vaccination is expected to start in two weeks • Mental Health: Mental health and community engagement teams are working to continue delivery of quality psychological first aid to survivors The efforts to mitigate the impact of the disaster that struck communities in Freetown have improved, with most urgent lifesaving needs being progressively addressed. The initial emergency phase of care for the wounded, body recovery and safe and dignified burials is gradually shifting to resettlement, disease prevention and health systems strengthening. In particular, provision of essential household items, food aid, health, and WASH actions are being undertaken. The risk of disease outbreaks remains high with flooding of wells and latrines, proliferation of mosquitoes, and overcrowded and suboptimal living conditions. WHO is supporting local authorities to heighten surveillance and preparedness for malaria, waterborne diseases and other potential outbreaks.

Crimean-Congo hemorrhagic fever: Mauritania 24 August 2017: Mauritania Ministry of Health notified WHO of a confirmed case (47-year-old shepherd) in Boutilimit Prefecture 20 August 2017: Symptoms onset 22 August 2017: admitted at Sheikh Hamed Hospital with bleeding from the gums, persistent headache, fever, and diarrhoea Blood sample was shipped to the National Institute for Public Health Research (NIPHR) 23 August 2017: The laboratory result released as IgM positive CCHF by enzyme-linked immunosorbent assay (ELISA) Public Health Measures Rapid response team deployed to conduct outbreak investigations and support the local response Patient isolated and continues to receive care Medical personnel in the hospital have been oriented on standard IPC measures. Geographical distribution of Crimean-Congo hemorrhagic fever, Mauritania, 24 August 2017 The confirmation of CCHF in Boutilimit comes after two recent events where patients referred from Mauritania to Dakar, Senegal tested positive for the disease between May and June 2017 (reported in Weekly Bulletins 19 and 25). The previous cases originated from the capital city, Nouakchott, which is about 150 km away from the current foci. This may be indicative of the relative prevalence of the reservoir and vector for the CCHF virus (Hyalomma ticks) in the country. Mauritania experienced a fairly large CCHF outbreak in 2003, involving 38 cases with a case fatality rate of 28.6%. Over 90% of the cases (35/38) were resident in Nouakchott. Source: WHO Health Emergencies AFRO week 34 bulletin on outbreaks and public health emergencies

Hepatitis E: Niger Week 32 (ending 13 August 2017): 37 new suspected cases reported The last death was reported on 7 July 2017. 2 January – 13 August 2017: 1,610 suspected cases including 38 deaths (case fatality rate 2.4%) The majority of cases originated from Diffa Health District (912), followed by N’Guigmi (286), and Bosso (235). Women 930 (58%) of the total cases As of 15 August 2017: samples collected from 85.7% (1 380/1 610) of suspected cases 653 samples were tested. 441 (67.5%) were positive for hepatitis E by polymerase chain reaction (PCR). Public Health Measures Surveillance strengthened across all affected regions and active case search is continuing Trucking of drinking water, disinfection and chlorination at water points, distribution of chlorine tablets (Aquatab) to households, and installation of hand washing facilities at the health centers. Geographical distribution of hepatitis E cases in Niger, 2 January - 15 August 2017 Although there has been a gradual decrease in the number of reported cases of hepatitis E in Niger, continued strengthening of surveillance, along with timeliness and completeness of reporting is required. This is particularly important given the risk of escalation posed by the coming rainy season. The major drivers of the outbreak remain limited access to safe drinking water, inadequate sanitation and poor personal and food safety practices. Weekly trend of hepatitis E cases in Niger, week 11 - week 32, 2017 Source: WHO Health Emergencies AFRO week 34 bulletin on outbreaks and public health emergencies

Cholera – AFRO Region Democratic Republic of Congo (2017): 21,068 cases with 501 deaths (CFR: 2.4%) Tanzania (15 Aug 2015 – 16 Jul 2017): 30,786 cases with 484 deaths (CFR:1.6%) South Sudan (20 Feb – 17 Jul 2017): 19,532 cases with 355 deaths (CFR: 1.8%) Nigeria (7 – 30 June 2017): 1,978 cases with 35 deaths (CFR: 1.8%) Kenya (2017): 2,232 cases with 33 deaths (CFR:1.5%) Angola (4 Jan – 6 August 2017): 468 cases with 24 deaths (CFR: 5.3%) Burundi: 22 cases with 1 death Chad: 116 cases with 17 deaths (CFR: 14.7%) Geographical distribution of cholera in WHO African Region, January – June 2017

Other Events Under Follow-up AWD in Ethiopia: 40,457 cases with 817 deaths (CFR- 2.0%) Hepatitis E in Chad: 1,735 suspected/confirmed cases with 19 deaths (CFR-1.1%) Dengue Fever in Ivory Coast: 858 suspected/confirmed cases with 2 deaths (CFR-0.2%) Dengue Fever in Mali 1 case with zero deaths Dengue Fever in Senegal Measles in Ethiopia: 2,607 suspected cases Landslide in DR Congo More than 50 household affected, over 200 persons killed (18 August 2017)

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