Epidemiological Update on Public Health Emergencies WHO Country Office, Liberia 25 August 2017

Content Public Health Emergencies 1 2 3 4 5 6 Flood/Mudslide: Sierra Leone 2 Dengue Fever: Ivory Coast 3 Lassa Fever: Nigeria 4 Necrotizing Cellulitis/Fasciitis: Sao Tome & Principe Cholera: AFRO Region 5 Other Events Under Follow-up 6 Public Health Emergencies

Public Health Emergencies (AFRO) 14 Humanitarian Crises 29 Outbreaks 3 Grade 3 events 8 Grade 1 events 6 Grade 2 events 26 Ungraded events Source: WHO Health Emergencies AFRO week 33 bulletin on outbreaks and public health emergencies

Flood/Mudslide: Sierra Leone Night of 13th August/ morning of the 14th August: incessant heavy rainfall within and around Freetown resulted in mudslide and massive floods hundreds of people killed/ thousands displaced As of 24 August 2017: 499 burials conducted Men: 173 Women: 169 Children: 157 1,247 households have been affected in 6 communities with 5,905 persons dis-placed Areas affected include Culvert, Dwarzark, Kamayama, Kanikay, Kaningo and Regent – Western area Rural and Urban, Freetown Map of areas affected by floods/mudslides in Sierra Leone, as of 23 August 2017 Source: WHO Sierra Leone Country Office Floods and Mudslide Situation Report No 10

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 Rapid risk assessment: multi-sector rapid risk assessment was conducted to determine the magnitude of the disaster Search and rescue operations are still ongoing, but are being transitioned into recovery operations. Case Management: One hundred and fifty (150) trauma cases treated and discharged trauma kits as well as cholera kits have been delivered to the country Surveillance/Preparedness: heightened surveillance of 5 priority conditions (Cholera, Diarrhoea with severe dehydration in children under 5, Dysentery, Typhoid and Malaria) Three months Cholera preparedness and response developed IPC: personnel deployed in the affected communities to address hand washing hygiene, safe food handling water chlorination, and community education on safe waste disposal • Mental Health: Mental health and community engagement teams are working to deliver quality psychological first aid to survivors The search, rescue and recovery operations are being hampered by continuous rainfall, difficult terrain and lack of heavy earth-moving equipment. The informal urbanization of Freetown has resulted in advanced deforestation and disorganized, un-gazetted population settlements, scattered over steep hills as well as in low-lying flood-prone valley areas. Freetown has, therefore, been historically prone to floods, which have occurred annually since 2008. The most recent floods in September 2015 in the Western Area, Bo, Pujehun, and Bonthe Districts displaced an estimated 15 000 people. With climate change, the frequency, pattern and severity of flooding are expected to change, becoming more unpredictable and more damaging. High population density, poor infrastructure, poor drainage, inadequate water and sanitation services and the continuing rainy season – are all enabling conditions for possible outbreak of cholera and other water borne disease

Dengue: Ivory Coast 18 to 25 July: 122 new suspected cases (Abidjan 120), Daloa (1), and Adzopé (1). As of 25 July 2017: 858 suspected cases including 2 deaths 263 cases confirmed Dengue type 3: 76 positive Dengue type 3: 174 positive Dengue type 1: 13 positive 112 samples are IgM + of which 77 cross-reactions yellow fever Public Health Measures End of the mosquito control campaign in the communes of Cocody, Bingerville and Marcory, and Treichville. In total, 46,381 breeding sites have been treated, including 4,569 tires Continue to raise awareness among the population Geographical distribution of confirmed cases of dengue per commune, Ivory Coast, Week 17 – 29, 2017 Evolution of suspect and positive cases of dengue epidemic, Ivory Coast, Week 17-29, 2017 The weather conditions and coastal location including urban and semi-urban settings, as well as the high entomological indices observed during the initial rapid assessment validated the potential risk for dengue outbreak in the country. The low case fatality rate shows adequate case management but strengthening education of health care workers, vector control, laboratory and surveillance interventions is imperative to contain this outbreak Source: WHO Côte d'Ivoire Country Office Dengue outbreak Situation Report No. 14 of 25 July 2017

Nigeria: Lassa Fever Week 32 ending 13 August 2017: 10 new confirmed cases including 1 death from 5 states 8 confirmed including 2 deaths Since December 2016: 710 suspected cases including 114 deaths (CFR 16.1%) 227 confirmed,14 probable 82 deaths among confirmed and probable cases (CFR 34%) 18 out of 36 (50%) states have reported at least one confirmed case Public Health Measures Confirmed cases are being managed at identified treatment and isolation centers Active surveillance enhanced in all the affected states while contact tracing is ongoing NCDC distributed PPE and other protection equipments medical centers Geographic distribution of Lassa fever in Nigeria, December 2016 - 13 August 2017 During the imminent national Lassa fever review and preparedness meeting, the national authorities need to come up with feasible ways to boost efforts in each of the key response pillars ahead of the next season, including encouraging good community hygiene to reduce rodent activity through proven effective measures, such as storing grain and other foodstuffs in rodent-proof containers, disposing of garbage far from the home, maintaining clean households and keeping cats. Source: WHO Health Emergencies AFRO week 33 bulletin on outbreaks and public health emergencies

Necrotizing Cellulitis/Fasciitis: Sao Tome & Principe Week 33: 23 new cases September 2016 – 20 August 2017: 1,908 cases Public Health Measures A case management protocol has been developed and clinical staff trained in its use. Epidemiological surveillance and investigation of reported cases are ongoing. Twenty-eight patients have undergone surgery, including 19 skin grafts. A communication plan has been developed, addressing general hygiene messages and risk factors. About 30 international multidisciplinary experts are deployed to support the response activities. Geographical distribution of necrotizing cellulitis/fasciitis cases in São Tomé and Principe, September 2016 - 13 August 2017 Recent data show an increase in the number of cases which raises concerns. The number of new cases continues to be higher than expected, which is estimated to be below 20 cases per month. In addition, the mode of transmission has not been established and laboratory capacity remains low. Therefore, continued research and support to the country in terms of technical and financial assistance is required. Weekly trend of necrotizing cellulitis/fasciitis in São Tomé and Principe, week 40, 2016 - week 33, 2017

Cholera – AFRO Region Democratic Republic of Congo (2017): 19,915 cases with 490 deaths (CFR: 2.5%) Tanzania (15 Aug 2015 – 16 Jul 2017): 30,719 cases with 483 deaths (CFR:1.6%) South Sudan (20 Feb – 17 Jul 2017): 19,532 cases with 352 deaths (CFR: 1.8%) Nigeria (7 – 30 June 2017): 1,978 cases with 35 deaths (CFR: 1.8%) Kenya (2017): 1,551 cases with 25 deaths (CFR:1.6%) Angola (4 Jan – 6 August 2017): 468 cases with 24 deaths (CFR: 5.3%) Burundi: 6 cases with zero deaths Geographical distribution of cholera cases in Tanzania, week 32, 2017

Other Events Under Follow-up AWD in Ethiopia: 40,457 cases with 817 deaths (CFR- 2.0%) Hepatitis E in Chad: 1,712 suspected/confirmed cases with 19 deaths (CFR-1.1%) Hepatitis E in Niger: 1,610 suspected/confirmed cases with 38 deaths (CFR-2.4%) Measles in Ethiopia: 2,601 suspected cases Landslide in DR Congo More than 50 household affected, over 200 persons killed (18 August 2017)

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