Epidemiological Update on Public Health Emergencies WHO Country Office, Liberia 21 Jul 2017

Content Public Health Emergencies 1 2 3 4 5 6 Rift Valley Fever: Mali Lassa Fever: Nigeria 3 Hepatitis E – Nigeria 4 Dengue: AFRO 5 Necrotising Cellulitis/Fascitiis: Sao Tome Other Events Under Follow-up 6 Public Health Emergencies

Public Health Emergencies (AFRO) 10 Humanitarian Crises 27 Outbreaks 3 Grade 3 events 7 Grade 1 events 6 Grade 2 events 21 Ungraded events Source: WHO Health Emergencies AFRO week 28 bulletin on outbreaks and public health emergencies

Rift Valley Fever: Mali A single case, 10-year old son of a farmer, detected in the Koulikoro Region in western Mali. 7 June 2017: presented to a local health centre 7 July 2017: The Institute Pasteur Dakar confirms diagnosis Public Health Measures 7 July 2017: district rapid response team deployed Blood samples collected: 32 humans 100 domestic animals. Laboratory results pending Active case finding, animal health surveys, mapping and health promotion communications are planned Geographical distribution of Rift Valley fever cases in Mali, 7 June - 14 July 2017 Presented to a local health centre on 7 June 2017 with fever, jaundice, vomiting, and localised muscle pain. The rainy season and transhumance increases the risk of spread to neighbouring communities and countries. Urgent investigations, under the One Health approach, are needed to determine if there is an ongoing RVF epizootic in the area, and implement prevention and control measures.

Lassa Fever: Nigeria Week 27 (week ending 9 July 2017): 13 new suspected cases with two deaths Ondo (8) and Plateau (5) States. From December 2016-July 11, 2017: 549 cases with 109 deaths (CFR-19.9%) Confirmed: 196 with 63 deaths (CFR-32%) Five states affected: Anambra, Rivers, Ondo, Edo and Plateau Public Health Measures Enhanced surveillance and contact tracing activities Case management and IPC activities Social mobilization activities Planning is underway for a 2016/2017 national Lassa fever outbreak review and preparedness meeting Geographical distribution of Lassa fever cases in Nigeria, December 2016 - 7 July 2017 Nigeria is concurrently experiencing a protracted humanitarian crisis, as well as outbreaks of cholera and hepatitis E, which are collectively stretching the public health response capacity of the country and partners. Continued and enhanced efforts by the local governments and partners are crucial to bring this outbreak under control and minimize the impact of this often fatal viral infection.

Hepatitis E: Nigeria On 18 June 2017: Nigerian Ministry of Health notified WHO 3 May 2017: first case detected in Damasak, a locality at the border with the Republic of Niger The outbreak is currently active in Ngala (n=256), Damasak (n=35) and Monguno (n=15) Ngala: 38 pregnant women with four deaths (CFR = 11%). As of 18 July 2017: 310 suspected cases with 4 deaths (CFR: 1.3%); 66 confirmed Public Health Measures Health workers are being trained on disease surveillance, including application of case definitions The Nigeria Red Cross is implementing WASH interventions, including hygiene promotion, and establishing boreholes Case management, mainly supportive care, is being provided at the local health facilities with the support of partners. • Screening of returnees at the points of entry.   The outbreak is occurring in the aftermath of increasing population movements within the Lake Chad ba - sin, following the gradually improving security situation. The Diffa region in Niger and the Salamat region in Chad have ongoing outbreaks of hepatitis E. The increasing population movement within the region therefore set the stage for trans-boundary propagation of the disease. The areas located between north-east Nigeria, south of Chad and Niger, and the northern part of Cameroon have limited access to safe water and low latrine coverage with subsequent open defecation practices. These factors are the main drivers of the current hepatitis E outbreak in Nigeria and the region. The disease is known to spread fast in internally displaced persons (IDP) and refugee settings.

Dengue – AFRO Region Ivory Coast: 444 suspected cases with 2 deaths (CFR: 0.5%) 136 cases confirmed Type 2 dengue positive: 71% (96/136) Type 3 dengue positive: 32 Type 1 dengue Positive: 8 Cocody remains the epicenter accounting for 97% of the total caseload Togo: 12 confirmed cases with zero deaths Kenya: 1,199 cases with 1 death (CFR:<0.1%) 672 confirmed by RDT and serology Mombasa County (n=1,117) and Wajir County (n=82) Mauritania: 1 case of dengue hemorrhagic fever Geographical distribution of dengue fever cases in Kenya, 23 March 2017 - 11 July 2017 Vector control activities are ongoing, including inspection and identification of mosquito breeding sites, subsequent larviciding, targeted indoor residual spaying of households and institutions. Weekly trend of Dengue cases, Ivory Coast, Week 17 – 26, 2017 Public Health Response: Enhanced disease surveillance Case management for patients Vector control activities and Health promotion have been scaled up

Dengue - Seychelles 10 July-16 July 2017: 106 suspected cases reported Since end of 2015 to date: over 3551 suspected cases reported Laboratory confirmed: 1263 cases out of 2747 suspected cases tested Reduction in the number of positive cases confirmed since week 23 Due to change from exhaustive surveillance to sentinel surveillance Epidemic curve of Dengue cases by laboratory confirmation from 2015-week 28, 2017, Seychelles Positivity rate amongst samples tested by week number from 2015-week 28,2017, Seychelles

Necrotizing Cellulitis/Fasciitis: Sao Tome Week 28: 12 new cases From week 38, 2016 – week 28, 2017: 1,801 cases Attack rate: 9.3 cases per 1000 Male: 57% Female: 43% Age ≥35: 50% Public Health Response Geographic distribution of cases of Necrotizing cellulitis/Fasciitis, Sao Tome & Principe, Week 38, 2016 – Week 28, 2017 January –July 11, 2017 Trend of cases of Necrotizing cellulitis/Fasciitis, Sao Tome & Principe, Week 38, 2016 – Week 28, 2017 January –July 11, 2017

Other Events Under Follow-up AWD in Ethiopia: - 38,230 cases with 792 deaths (CFR- 2.1%) Cholera in Tanzania: - 29775 cases including 463 deaths (CFR-1.6%) Cholera in South Sudan: 11,700 cases including 194 deaths (CFR-1.6%) Meningitis in Niger: 3,292 cases with 189 deaths (CFR 5.7%) Hepatitis E in Chad: 1,631 suspected/confirmed cases with 18 deaths (CFR-1.1%) Hepatitis E in Niger: 1,096 suspected/confirmed cases with 34 deaths (CFR-3.1% Cholera in Nigeria: 1558 cases with 11 deaths (CFR 0.7%) Measles in Ethiopia: 2,246 suspected cases 989 confirmed cases 56 clinically-compatible). Hepatitis E in Nigeria: 146 cases with 2 deaths (CFR 1.4%) Cholera in Kenya: - 1,136 cases with 12 death (CFR 10%) Cholera in DRC: 44,415 with 1244 deaths (CFR-2.8%) Meningitis in Nigeria: - 14,513 cases with 1,166 deaths (CFR: 8%)

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