Epidemiological Updates on Outbreaks and Public Health Emergencies in AFRO Region 20 April 2018 WHO Health Emergencies, WHO Liberia Country Office

Content Lassa fever Nigeria Crimean-Congo hemorrhagic fever Namibia Cholera Zimbabwe Cholera Uganda Other Events under follow-up AFRO Region 05 2018

Outbreaks and public health emergencies in AFRO Region 9 Humanitarian Crises 49 Outbreaks Source: week 15, 2018 AFRO bulletin on outbreaks and public health emergencies

Lassa fever Nigeria 422 confirmed/probable cases 114 death CFR: 27% Week 15 (April 09-15, 2018): five new confirmed cases from four States - Edo (2), Ebonyi (1), Kogi (1), and Adamawa (1) with three new deaths in confirmed cases from Ebonyi (1), Adamawa (1) and Kogi(1) 1 January to 15 April 2018: a total of 1849 suspected cases have been reported from 21 states. 413 were confirmed positive, 9 are probable, 1422 are negative (not a case) and 5 are awaiting laboratory results (pending) 21 states have recorded at least one confirmed case across 70 Local Government Areas Contact tracing A total of 4713 contacts have been identified from 21 states. 603 (12.8%) are currently being followed up, 4152 (87%) have completed 21 days follow up while 7(0.2%) were lost follow up 28 (36%) have tested positive from five states Source: NCDC week 15, 2018 Lassa fever situation report

Crimean-Congo haemorrhagic fever Namibia 2 cases 1 death CFR: 50% 1st Case: 36-year-old man with onset of symptoms on 22 March 2018 Symptoms: initially diarrhea and vomiting followed by nose bleeding, thrombocytopenia, low platelet count, and severe epistaxis Probable exposure: assisted a neighbor with the slaughter of a tick-infested cow on 21 March 2018 blood sample confirmed for CCHF at South Africa’s National Institute for Communicable Diseases (NICD) Case-patient died in isolation at Windhoek Central Hospital on 3 April 2018 2nd Case: presented on 3 April 2018 with a history of tick bites and symptoms of vomiting and fever; no epidemiological links with the previous case; blood specimen taken and results awaited; in a stable condition as of 6 April 2018. Public Health Response Coordination meetings held and response pillar activated Contact tracing; infection control training; disinfection and fumigation; risk communication Source: week 15, 2018 AFRO bulletin on outbreaks and public health emergencies

Cholera Zimbabwe 8 cases 2 deaths CFR: 25% Public Health Response 7 April 2018: MoH notified WHO of a new cholera outbreak in Stoneridge, a peri-urban suburb 15 km south of Harare’s city centre. Index case: 24-year-old male whose symptoms of diarrhoea and vomiting began on 22 March 2018 admitted on 23 March 2018 until his death on 5 April 2018. 46-year-old father (deceased) and infant brother both suffered from diarrhoea and vomiting, and both their stool samples tested positive for Vibrio cholerae serotype Ogawa. As of 11 April 2018, 8 cases (4 suspected, 3 confirmed, 1 probable), and 2 deaths (CFR 25%). Seven cases originate from Stoneridge and one from Belvedere West. Public Health Response social mob; distributing Aquatab water purification tablets, buckets with taps, and detergent in the community; cholera treatment center set-up Source: week 15, 2018 AFRO bulletin on outbreaks and public health emergencies

Cholera Uganda 2,091 cases 44 deaths CFR: 2.1% Public Health Response The Ugandan Ministry of Health officially declared the outbreak on 23 February 2018. Since 26 March 2018 an additional 265 cases with eight deaths have been reported As of 9 April 2018, a cumulative total of 2 091 suspected cholera cases with 44 deaths (CFR-2.1%) reported across four sub-counties, namely Kyangwali, Kabwoya, Buseruka, Bugambe and Kahoora division. Most of the cases are newly arrived refugees from the province of Ituri in the Democratic Republic of the Congo. To date 24 out of 97 specimens tested positive for Vibrio cholerae by culture and 152 samples tested positive on cholera rapid diagnostic test. Public Health Response Coordination meetings; surveillance and active case search; case management in cholera treatment centers; WASH activities: latrine construction, disinfection of households, distribution of Aquatabs, installation of hand washing facilities

Other Events AFRO Region Ghana – Lassa fever: 1 case, 1 death CFR-100%. On 1 March 2018, WHO was notified of a confirmed case of Lassa fever. Madagascar – plague: From 1 August 2017 to 10 April 2018, a total of 2 673 cases of plague were notified, including 557 confirmed, 829 probable and 1 287 suspected cases. Pulmonary - 2 032, Bubonic - 436 Septicaemic - 1 and 204 cases unspecified. Namibia – Listeriosis: On 13 March 2018, WHO was notified of a confirmed case of listeria in Windhoek. The patient has no travel history outside Namibia. Investigations are ongoing to establish if there are any links between this case and the outbreak in South Africa. São Tomé and Principé - Necrotising cellulitis/ fasciitis: From week 40 in 2016 to week 13 in 2018, a total of 2,555 cases have been notified.

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