Epidemiological Update on Public Health Emergencies WHO Country Office, Liberia 29 September 2017

Content Public Health Emergencies 1 2 3 4 5 6 Flood/Mudslide: Sierra Leone 2 Cholera: Nigeria 3 Lassa Fever: Nigeria 4 Yellow Fever: Nigeria Cholera: AFRO Region 5 Other Events Under Follow-up 6 Public Health Emergencies

Public Health Emergencies (AFRO) 16 Humanitarian Crises 30 Outbreaks 4 Grade 3 events 10 Grade 1 events 7 Grade 2 events 24 Ungraded events Source: WHO Health Emergencies AFRO week 38 bulletin on outbreaks and public health emergencies

Flood/Mudslide: Sierra Leone The search for dead bodies has formally stopped 502 burials have taken place 500 people have been declared missing. In total, 1 247 households in six communities have been affected and nearly 6 000 people displaced. Two camps established for the affected individuals as resettlement continues. 15 – 20 September 2017: The first of the two rounds of the OCV campaign conducted. Target population: 500 000 at-risk persons in the Western Area Urban and Western Area Rural districts of Freetown . Preliminary administrative coverage: over 96% The second round will be conducted in early October 2017. Eight cholera treatment units ready for use in the event of an outbreak. Number of vulnerable individuals in Sierra Leone landslide and flash floods, as of 29 Aug 2017 The mudslides and flooding damaged sanitation facilities and water pipes, thus contaminating communal water sources. The major public health concerns, therefore, included occurrence of epidemics that can be exacerbated by over-crowding, poor hygiene and inadequate access to clean and safe water.

Cholera: Nigeria Public Health Measures In week 37 (week ending 17 September 2017): 651 new suspected cases reported from five states Cumulative outbreak cases: 7 052 cases including 149 deaths (case fatality rate 2.1%) from eight states, namely Borno, Kaduna, Kano, Kebbi, Kwara, Lagos, Oyo, and Zamfara, as of 18 September 2017. Public Health Measures The Public Health Emergency Operations Centre (PHEOC) has been activated Active case search undertaken in hot spots and at-risk communities. Case management is being provided at identified treatment/isolation facilities In Borno State over 5 504 households have been reached with WASH services 5-day oral cholera vaccine (OCV) campaign was launched in 5 LGAs in Borno State Target: 915 005 people. Vaccinated: 844 305 people (96% coverage) Risk communication has been intensified in the affected states. Geographical distribution of cholera cases in Nigeria, week 18 - 37, 2017 TThe cholera outbreak in Nigeria, especially in Borno State, remains a concern. Borno State is currently home to over 5.5 million internally displaced persons (IDPs) and host communities, living in overcrowded conditions with limited social services. Potable water supplies, proper sanitation facilities and safe hygiene practices are inadequate. Recent flooding is also restricting access to several affected areas, which is also being compounded by the insecurity. It is anticipated that the ongoing interventions, augmented by the high uptake of the OCV campaign, will quickly bring the outbreak in Borno State to an end.

Nigeria: Lassa Fever Public Health Measures During week 37: two new confirmed cases and no deaths were reported from Edo State. Outbreak is still active in nine states Ondo, Edo, Plateau, Bauchi, Lagos, Ogun, Kaduna, Kwara, and Kogi reported at least one confirmed case in the past 21 days. Since December 2016: 854 suspected cases including 118 deaths (CFR 13.8%) 258 confirmed,14 probable 86 deaths among confirmed and probable cases (CFR 31.6%) 19 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 The NCDC distributed response materials for VHF to the affected states Geographical distribution of Lassa fever cases in Nigeria, December 2016 - 17 September 2017 The trend of Lassa fever cases in Nigeria has been encouraging in recent weeks. It is widely anticipated that this current trend is leading to the final end of the outbreak. Nevertheless, it is important to sustain the current control interventions until the outbreak is ultimately contained. Weekly trend of Lassa fever in Nigeria, week 49, 2016 - week 37, 2017

Nigeria: Yellow Fever Public Health Measures On 15 September 2017: the Nigeria Federal Ministry of Health notified WHO of a confirmed yellow fever case (7yo, female) in Ifelodun Local Government Area (LGA), Kwara State. 16 August 2017: developed symptoms, including fever, vomiting and abdominal pain on. No previous vaccination history No history of travel outside the state in the last 2 years 29 August 2017: positive test by PCR at the Lagos University Teaching Hospital (LUTH). Public Health Measures A joint team deployed to support the State Government of Kwara NCDC, the National Primary Health Care Development Agency and WHO conduct a detailed investigation and risk assessment. Planning is underway for a reactive mass vaccination campaign in the affected LGA as well as neighboring areas. Geographical distribution of yellow fever case in Nigeria, 16 August – 22 September 2017 Vaccine coverage rates in Ifelodun LGA have substantially improved since then but the overall population herd immunity probably remains suboptimal. The last mass vaccination campaign in Kwara State was in 1987. Accordingly, a reactive vaccination campaign is warranted to prevent a larger outbreak. However, further investigations are needed to better define the target population for such as campaign. Likewise, further investigations, including population movement and local vector density, will help to reveal the risk of further amplification. Based on the available information, the likelihood of further spread among the local population is moderate.

Cholera – AFRO Region Democratic Republic of Congo (2017): 23,959 cases with 528 deaths (CFR: 2.2%) Tanzania (15 Aug 2015 – 16 Jul 2017): 30,719 cases with 483 deaths (CFR:1.6%) South Sudan (20 Feb – 17 Jul 2017): 19,889 cases with 355 deaths (CFR: 1.8%) Nigeria (7 – 30 June 2017): 7,052 cases with 149 deaths (CFR: 2.1%) Kenya (2017): 2,857 cases with 50 deaths (CFR:1.8%) 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: 44,218 cases with 832 deaths (CFR- 1.9%) Hepatitis E in Chad: 1,783 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: 2,607 suspected cases Dengue in Ivory Coast: 1231 suspected cases with 2 deaths (CFR-0.2%) Abidjan city remains the epicentre of this outbreak, accounting for 97% of the total reported cases. The main health districts affected include Cocody, Abobo, Bingerville and Yopougon. Of the cases confirmed, 181 were dengue virus serotype 2 (DENV-2), 78 were DENV-3 and 13 were DENV-1. In addition, 39 samples were confirmed IgM positive by serology.

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