Epidemiological Update on Public Health Emergencies WHO Country Office, Liberia 27 October 2017

Content Public Health Emergencies 1 2 3 4 5 5 Marburg Virus Disease : Uganda 2 Dengue: Burkina Faso 3 Monkey Pox: Nigeria 4 Pneumonic Plague: Madagascar 5 Cholera: AFR Region 5 Other Events Under Follow-up Public Health Emergencies

Public Health Emergencies (AFRO) 12 Humanitarian Crises 33 Outbreaks 2 Grade 3 events 10 Grade 1 events 7 Grade 2 events 23 Ungraded events Source: WHO Health Emergencies AFRO week 42 bulletin on outbreaks and public health emergencies

Marburg Virus Disease : Uganda 17 October 2017: Uganda’s Ministry of Public Health notified WHO of an outbreak of Marburg virus disease in Kween District, central part of the country Index case: death of a 50-year-old woman who became ill on 3 October 2017 and was initially admitted to a local health facility (Kaproron Health Centre IV) on 5 October 2017 with fever and bleeding diathesis. She died on 11 October and was buried on 13 October 2017 under local cultural customs. (RT-PCR positive for Marburg Virus at the Uganda Virus Research Institute (UVRI) in Entebbe on 17 October 2017. Chronologically, the first case (probable) : 30 year-old male, who worked as a game hunter and lived near a cave with heavy presence of bats. On 20 September 2017, he was admitted to Kaproron Health Centre IV with high fever, vomiting and diarrhoea, which did not respond to antimalarial. Geographical distribution of cases of Marburg virus disease cases in Uganda, 3 - 17 October 2017 Further investigations established that the index case had nursed and participated in the burial rituals of her brother, who is considered the primary (first) case in this outbreak. Source: WHO AFRO Situation Report No. 1: Marburg Virus Disease in Uganda

Marburg Virus Disease : Uganda As his condition deteriorated and was transferred to Kapchorwa Hospital on 25 September 2017 where he died with no laboratory specimens collected. He was given a traditional burial on 27 September 2017, which was attended by an estimated 200 people. The third (probable) case is the brother of the first two cases, who transported his sister (the index case) to the hospital and subsequently became symptomatic. On 19 October 2017, health authority in Kapchorwa Hospital detected a fourth suspected case in a 2-year-old child admitted with similar symptoms. As of 19 October 2017, four (4) suspected cases including two (2) deaths (CFR – 50%) of Marburg virus disease: one confirmed, two probable and one suspect To date, 41 contacts have been identified and are being followed up. Public Health Response National Task Force has been reactivated and (IMS) established The District Task Force established and an emergency response plan is being developed. A rapid response team deployed to Kween and Kapchorwa Districts The Minister of Health held a press conference to inform the public of the outbreak, alley anxiety and disseminate preventive messages. Active surveillance has been initiated Training of Healthcare workers on (IPC protocols, safe and dignified burial, Case mgt) Source: WHO AFRO Situation Report No. 1: Marburg Virus Disease Outbreak in Uganda

Geographical distribution of cases of monkey pox cases in Nigeria, Monkey Pox: Nigeria On 26 September 2017: Nigeria Centre for Disease Control (NCDC) notified WHO of a suspected outbreak of monkey pox in Yenagoa Local Government Area (LGA), Bayelsa State. The initial cluster of cases: two brothers, and their uncle including a neighbor developed fever and generalized skin rash over a period of 6 weeks. Their illnesses were self-limiting apart from one case, an 11-year-old male, who additionally developed painful swelling of the jaw and presented to a local private hospital. A differential diagnosis of chickenpox or impetigo was made before the child was transferred to Niger Delta University Teaching Hospital. Suspicion of monkey pox prompted the collection of laboratory specimens, as well as field investigations which established that there was a captured monkey in the neighborhood, that young boys regularly played with, before it was killed and eaten about a month prior to onset of illness. Geographical distribution of cases of monkey pox cases in Nigeria, 26 September - 19 October 2017 Source: WHO AFRO Situation Report No. 6: Monkey Pox in Nigeria

Monkey Pox: Nigeria On 19 October 2017, a total of 22 suspected cases were reported from Bayelsa State, with seven cases admitted. Cumulatively, 86 cases have been reported from 10 states: Akwa Ibom, Cross River, Delta, Ekiti, Enugu, Federal Capital Territory, Imo, Lagos, Nasarawa, and Rivers. The majority of cases are male (77%) and aged 21-30 years. however, a recovering patient has reportedly committed suicide – issues surrounding the death are being investigated. Samples collected from 83 cases of the 86 3 (3.6%) have been confirmed by either RT - PCR All three confirmed samples were from Yenagoa LGA, Bayelsa State. Public Health Response Multi-sectoral national response coordination committee established under the leadership of the Nigerian Centres for Disease Control (NCDC) and the Federal Ministry of Health Rapid response teams deployed Case investigations are ongoing to identify the primary source(s) of infection. Active case search at the community and health facility levels in the affected areas. Training of healthcare workers - diagnosis, contact tracing and clinical management Risk communication activities are ongoing SITUATION INTERPRETATION Monkeypox is a relatively rare zoonosis that occurs sporadically in remote parts of Central and West Africa, often near tropical rainforests. While most cases are self-limiting within 14-21 days, severe disease is more common among children and may be fatal. Confrmation of this outbreak has, however, been challenged by long delays in the collection, referral and testing of samples. Nonetheless, now that the circulation of monkeypox virus has been confrmed (at least in Bayelsa State), there is greater impetus for local authorities and international partners to investigate and control this event. Equally concerning is the observation of exaggerated and incorrect public perception about the cause, risk and severity of disease; reports of stigmatisation of cases which hinders sample collection and other patient-centred response activities; and the unethical use of patient’s photographs on social media, leading to further stigmatization and concealment. Community engagement activities must be strengthened to counter these perceptions. Geographical distribution of monkeypox cases in Nigeria, 26 September - 19 October 2017 86 Cases 0 0% Deaths CFR Go to overview Go to map of the outbreaks Health Emergency Information and Risk Assessment 0 Source: WHO AFRO Situation Report No. 6: Monkey Pox in Nigeria

Dengue: Burkina Faso Geographical distribution of Dengue cases in Burkina Faso as of 17 October 2017 The outbreak of dengue fever in Burkina Faso is rapidly evolving, with a dramatic increase in weekly incidence Week 42: 1,130 new suspected cases and no deaths were reported across the country Cumulatively, 4,098 suspect cases, including 11 deaths (CFR - 0.3%) have been reported. Epidemic declare on 28/09/2017 92% (12) of the country’s 13 health regions, with 65.4% of cases reported in the central region, particularly in the city of Ouagadougou. To date, 205 samples have been sent. 110 (54%) positive for dengue on RT - PCR Further characterization of 72 samples has identified three dengue virus serotypes: DENV-2 (58 positive), DENV-3 (12 positive) and DENV-1 (2 positive). Public Health Response Weekly change in the attack rate of suspected and probable cases of dengue in the city of Ouagadougou from Week 1 to Week 42, 2017

Pneumonic Plague: Madagascar 13 September 2017: Madagascar Ministry of Public Health notified WHO of an outbreak of pneumonic plague death of a 47-year-old woman with respiratory disease in Soavinandriana Hospital, Antananarivo on 11 September 2017 RDT positive for plague at the Institut Pasteur de Madagascar triggered investigation Index case: 31-year-old male from Tamatave, developed a malaria-like illness on 23 August 2017 Travelled by public transport on 27 August 2017 while symptomatic, and died on the way Generated contacts who became secondary cases and onward transmission Cumulative: 1,365 cases (suspected, probable and confirmed) with 106 deaths (CFR 7.8%); while 54 health workers have been affected reported from 40 districts in 14 regions. pneumonic plague: 915 cases (67%) Bubonic plague: 275 (20.1%) Septicaemic plague: One case Unspecified: 174 cases Geographical distribution of cases of plague in Madagascar as of 19 October 2017 Plague is endemic in Madagascar, especially in the central highlands, where a seasonal upsurge (predominantly the bubonic form) occurs each year, usually between August and September. There are three forms of plague infection, depending on the route of infection: bubonic, septicaemic and pneumonic Source: WHO AFRO Situation Report No. 6: Pneumonic Plague Outbreak in Madagascar

Pneumonic Plague: Madagascar On 27 October 2017, 70% (3467) of 4990 contacts were followed up and provided with prophylactic antibiotics. 141 contacts completed the 7-day follow up without developing symptoms. A total of seven contacts developed symptoms and became suspected cases. Of the 1365 cases, Confirmed: 219 (PCR or RDT), Probable: 520 and remain suspected: 626 (additional laboratory results are in process). Eleven strains of Yersinia pestis have been isolated and were sensitive to antibiotics Public Health Response Multi-sectoral national response coordination committee established under the leadership of the Minister of Public Health Rapid response teams deployed Case investigations including the identification of potential exposures are being conducted. Active case search at the community and health facility levels in the affected areas. Training of healthcare workers - diagnosis, contact tracing and clinical management Risk Assessment National Level: High Regional Level: Moderate due to frequent flights to neighboring Indian Ocean islands WHO has classified the event as a Grade 2 emergency, based on its internal Emergency Response Framework. About 70% (3467) of 4990 contacts identified have completed their 7-day follow-up and a course of prophylactic antibiotics. A total of seven contacts developed symptoms and became suspected cases. On 24 October 2017, 1165 out of 1239 (94%) contacts were followed up and provided with prophylactic antibiotics. Source: WHO AFRO Situation Report No. 1: Pneumonic Plague Outbreak in Madagascar

Cholera – AFRO Region Democratic Republic of Congo (2017): 38,154 cases with 702 deaths (CFR: 1.8%) Tanzania (15 Aug 2015 – 16 Jul 2017): 30,719 cases with 483 deaths (CFR:1.6%) South Sudan (20 Feb – 17 Jul 2017): 21,097 cases with 418 deaths (CFR: 2%) Nigeria (7 – 30 June 2017): 7,052 cases with 149 deaths (CFR: 2.1%) Kenya (2017): 3,244 cases with 60 deaths (CFR:1.8%) Angola (4 Jan – 6 August 2017): 468 cases with 24 deaths (CFR: 5.3%) Chad: 492 cases with 63 deaths (12.8%) Geographical distribution of cholera cases in Tanzania, week 32, 2017

Other Events Under Follow-up AWD in Ethiopia: 47,340 cases with 859 deaths (CFR- 1.8%) 521 new cases reported in wk 41 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: 3151 suspected cases: 382 new cases reported in wk 42 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 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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