Epidemiological Update on Public Health Emergencies WHO Country Office, Liberia 20 October 2017

Content Public Health Emergencies 1 2 3 4 5 6 Monkey pox: Nigeria Marburg: Uganda 3 Dengue Fever: Burkina Faso 4 Plague: Madagascar 5 Cholera: AFRO Region 6 Other Events Under Follow-up Public Health Emergencies

Public Health Emergencies (AFRO) 12 Humanitarian Crises 32 Outbreaks 4 Grade 3 events 10 Grade 1 events 6 Grade 2 events 24 Ungraded events Source: WHO Health Emergencies AFRO week 41 bulletin on outbreaks and public health emergencies

Marburg: Uganda 17 October 2017: Ministry of Health of Uganda notified WHO of a confirmed outbreak of MVD in Kween District, Eastern Uganda. 19 October 2017: Outbreak officially declared by the Ministry of Health As of 19 October 2017, 4 cases have been reported 1 confirmed case 2 probable cases which had epidemiological links to the confirmed case, and 1 suspected case from the same community Primary case: 42 year-old male, game hunter and lived near a cave with heavy presence of bats. Died on 25 September 2017 in admission having presented with signs and symptoms of high fever, vomiting and diarrhea which did not respond to antimalarial treatment 27 September 2017: traditional burial ceremony; estimated 200 people attended No samples were collected First case: Sister of primary case (aged 50 years), who nursed him and participated in the burial rituals, Died on 11 October 2017 after presentation of hemorrhagic signs 13 October 2017: traditional burial ceremony Posthumous samples collected on 11 October was confirmed at Uganda Virus Research Institute (UVRI) for Marburg virus infection by RT-PCR

Monkey pox: Nigeria Seven cases still on admission Monkeypox outbreak has been confirmed in Yenagoa LGA of Bayelsa State 14 samples tested so far Three confirmed positive by PCR A total of 21 suspected cases with zero deaths has been reported from Bayelsa State Seven cases still on admission Since the onset of the outbreak, 74 suspected cases have been recorded in 11 States including the Federal Capital Territory Sixty-six (66) samples collected 204 contacts under follow-up Public Health Response NCDC coordinates response through EOC Risk communication and active engagement Surveillance: active case search, contact tracing, revised case investigation forms Case management: treatment of cases at isolation ward Distribution of Suspected & Confirmed Monkey pox Cases by State, Nigeria, 2017 Epicurve of Suspected Monkey pox, Nigeria, 2017 Source: Nigeria Center for Disease Control Situation Report No. 3, October 16, 2017

Update on ongoing Events

Dengue Fever: Burkina Faso Week 40 (week ending 8 October 2017): 525 suspected cases including two deaths (CFR 0.4%) reported From 1 January and 8 October 2017: 2,298 (suspected, probable and confirmed) cases and nine deaths (CFR 0.4%) reported across the country Probable cases: 1 514 (65.8%) after testing positive on rapid diagnostic tests (RDTs) 205 samples referred to the national VHF laboratory 110 (54%) were positive on PCR Further characterization of 72 samples identified three serotypes of dengue virus (DENV): DENV-2 (80.6%), DENV-3 (16.7%) and DENV-1 (2.8%) 77.8% of cases reported in the central region, particularly the city of Ouagadougou Weekly attack rates of dengue fever cases in Ouagadougou, week 1 - 40, 2017 Public Health Response Early warning system established A total of 5 000 RDTs distributed to reference health centers to facilitate early diagnosis Development and dissemination of a national dengue management algorithm Mass media dissemination of dengue awareness and key prevention measures

Plague: Madagascar 17 October 2017: 244 new cases with 13 deaths reported 16 confirmed, 90 probable and 138 suspected Since the onset of the epidemic, a total of 1032 cases with 89 deaths have been reported 116 confirmed, 375 probable and 541 suspected 695 pulmonary form, 247 bubonic form, 1 case of septicemic form, and 89 unspecified Overall, 12/22 regions and 29/114 districts have reported cases of pulmonary plague Total contacts under follow-up: 3,747 Public Health Response A high level coordination forum established and chaired by the Prime Minister Since 27 September 2017, the Institut Pasteur de Madagascar (IPM) distributed 1 918 rapid diagnostic tests (RDTs) Red Cross is setting up a 60-bed treatment facility The protocol for case management of plague is under review, based on results of sensitivity testing and availability of antibiotics. USAID has donated 18,000 respirator masks, 100,000 simple masks Source: Report on the Epidemiological Situation of Plague in Madagascar, 17 Oct 2017

Plague: Madagascar Distribution of cases of pulmonary and bubonic plague in the last 2 weeks, 03/10/2017 - 17/10/2017, Madagascar Evolution of reported cases of pulmonary and bubonic plague 01/08/2017 - 17/10/2017, Madagascar Evolution of confirmed and probable cases of pulmonary plague notified 01/08/2017 - 17/10/2017, Madagascar [N = 695]

Cholera – AFRO Region Democratic Republic of Congo Wk 40, 2,243 new cases including 27 deaths 2017: 36,300 cases with 676 deaths (CFR: 1.9%) Uganda: (26 Sept-6 Oct 2017): 157 cases with 3 deaths (CFR 1.9%) Tanzania (2017): 3,194 cases with 52 deaths (CFR:1.6%) South Sudan (20 Feb – 17 Jul 2017): 20,689 cases with 378 deaths (CFR: 1.8%) Nigeria (2017): 7,052 cases with 149 deaths (CFR: 2.1%) Kenya (2017): 3,059 cases with 56 deaths (CFR:1.8%) Zambia (4 – 13 October 2017): 44 cases with 1 death (2.3%) Angola (4 Jan – 6 August 2017): 468 cases with 21 deaths (CFR: 4.5%) Geographical distribution of cholera cases in Democratic Republic Of the Congo, week 38, 2017

Other Events Under Follow-up AWD in Ethiopia: 45, 922, with 836 deaths (CFR-1.82%). 405 new cases reported in week 39 Hepatitis E in Chad: 1,783 suspected/confirmed cases with 19 deaths (CFR-1.1%) Measles in Ethiopia: 3151 suspected cases. 382 were new cases were reported in week 39 Monkey pox in Congo (18 January – 30 September 2017): 88 cases with 6 deaths Dengue in Mali: 262 suspected cases with 25 confirmed Dengue in Ivory Coast: 16 new cases in week 36 from Abidjan 1231 suspected cases with 2 deaths (CFR-0.2%) Abidjan city remains the epi-centre of this outbreak, accounting for 97% of the total reported cases. 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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