Epidemiological Update on Public Health Emergencies WHO Country Office, Liberia 20 July 2018

Content Cholera: DRC Cholera: Cameroon Hepatitis E: Namibia Ebola Virus Disease: DRC Other Events Under Follow - up

Public Health Emergencies (AFRO) 10 Humanitarian Crises 48 Outbreaks 2 Grade 3 events 5 Grade 1 events 39 Ungraded events 2 Grade 2 events Health EMERGENCIES Program

Geographical distribution of cholera cases in DRC week 28, 2018 Cholera: DRC Geographical distribution of cholera cases in DRC week 28, 2018 The cholera outbreak continues to evolves with 518 new cases including 38 deaths (CFR - 7.3%) reported in week 28, 2018. Since January 2018, a total of 13,229 cholera cases with 339 deaths (CFR - 2.6%), has been reported Fourteen of 26 provinces reported at least one cholera case during the reporting week The Kasai region remains the most affected, with 50% of cases reported in week 28. Generally, there is an increased trend in the number of cases across the country. PUBLIC HEALTH ACTIONS Strengthening the surveillance system and active search case affected areas. Management of cholera cases in different CTU IPC practices are being improved through use of PPE

Cholera: Cameroon Geographical distribution of cholera cases in Cameroon, Week 20 – 28 2018 The outbreak continues to escalate with new heath areas reporting cases The initial two cases were reported in week 20, 2018 from Guirviza Health area on the border with Nigeria The case-patients reportedly consumed food items from the Nigerian side of the border with subsequent onset of symptoms. Since week 20, 2018, 38 suspected cases including 4 deaths with (CFR – 10.5%) 5 Lab confirmed The MoH of Cameroon has activated the incident management system (IMS) at both the central and regional levels to coordinate the response Enhanced surveillance in affected districts is being carried out through active search for cases in the communities PUBLIC HEALTH ACTIONS Cases are isolated and managed at local health facilities Cholera kits have been dispatched Communication and social mobilization activities are ongoing WASH activities are being scaled up

Hepatitis E: Namibia Geographical distribution of hepatitis E cases in Namibia, Jan - July 2018 The outbreak of hepatitis E in Namibia continues to spread to other regions of the country. During week 28, 63 new suspected cases were reported as compared to 64 cases in week 27, 2018), indicating continuous upsurge of cases. Three regions are currently experiencing outbreaks of hepatitis E including Khomas (capital Windhoek) Omusati (bordering Angola) Erongo, in central-western Namibia Over 90% of cases reported are epidemiologically linked to the cases in Windhoek. From Jan 2018, a total of 1,915 cases including 17 deaths (CFR - 0.9%) 178 laboratory confirmed 1,355 have epidemiological PUBLIC HEALTH ACTIONS A national HEMC continues to lead the response Active surveillance, WASH and IPC measures are being enhanced in affected districts. Environmental cleanliness campaigns have been conducted

Ebola Virus Disease: DRC Geographical distribution Ebola virus disease cases, DRC, 1 April – 9 July 2018 (n=53) The MoH and WHO continue to closely monitor the EVD outbreak in the DRC No new laboratory-confirmed EVD cases have been detected since the last case developed symptoms on 2 June 2018. On 12 June, the last confirmed Ebola virus disease was discharged following two negative tests A period of 42 days (2 incubation periods) must elapse before the outbreak can be declared over. Since 4 April 2018: 53 suspected cases including 29 deaths have been reported (CFR – 55%) 38 confirmed, 14 probable Risk Assessment: National level: very high due to the serious nature of the disease Regional level: High confirmed case in Mbandaka, located on a major national and international river, increases the risk for further spread to neighboring countries. At global level: Risk is currently considered low. The review included the development of a 90-day enhanced surveillance and response plan for the continuation of core activities after the end of the outbreak, as well as planning for sustaining local and national capacities for to ongoing health emergency response across the Democratic Republic of the Congo On 3 July 2018, WHO reviewed the level of public health risk associated with the current outbreak. The latest assessment concluded that the current Ebola virus disease outbreak has largely been contained, considering that over 21 days (one maximum incubation period) have elapsed since the last laboratory-confirmed case was discharged and that contact tracing activities ended on 27 June 2018. However, there remains a risk of resurgence from potentially undetected transmission chains and possible sexual transmission of the virus by male survivors. It is therefore, critical to maintain all key response pillars until the end of the outbreak is declared. Strengthened surveillance mechanisms and a survivor monitoring program are in place to mitigate, rapidly detect and respond to respond to such events. Based on these factors, WHO considers the public health risk to be moderate at the national level. Risk Assessment: National level: High Regional level: Low At global level: Low

Distribution of cVDPV2 cases cVDPV2: DRC Distribution of cVDPV2 cases 13 Feb - 15 July, DRC No new confirmed case was reported during week 28, 2018 Since 13 February 2018, a total of 21 cases of AFP has been confirmed for cVDPV2. In June 2018, the last confirmed case from Ituri Province close to the border with Uganda, from an AFP case with onset of paralysis on 5 May 2018 was reported. Circulation of the strain was confirmed when the same strain was isolated in stool specimens from two healthy community contacts. WHO assessed the overall public health risk National level - very high International spread - high WHO Advice Countries with frequent travel with DRC should strengthen AFP surveillance travelers be fully vaccinated against polio The latest case of cVDPV2 was reported from Kambove, Haut Katanga Province from an AFP case with onset of paralysis on 14 May 2018. As of 13 July 2018, a total of 29 cases with onest in 2017 (22 cases) and 2018 (7 cases) have been confrmed. Six provinces have been affected, namely Haut-Lomami (9 cases), Maniema (2 cases), Tanganyika (14 cases), Haut Katanga (2 case), Mongala (1 case), and Ituri (1 case). Te outbreak has been ongoing since February 2017. A public health emergency was ofcially declared by the Ministry of Health on 13 February 2018 when samples from 21 cases of acute flaccid paralysis were confrmed retrospectively for vaccine-derived polio virus type 2.

Other Events Under follow -Up Hepatitis E (HEV) : South Sudan Since 3 January 2018, a total of 116 suspected cases have been reported Of these, 16 have been confirmed by Laboratory. Use of stagnant water for domestic or recreation purposes is likely to be source of infection. Lassa Fever: Nigeria Six new confirmed cases were reported in wk 28 Since week 1, 2018: 2,201 suspected cases including 116 (CFR-25.3%) Of these, 459 cases Lab confirmed Rift Valley Fever: Uganda Since 29 June 2018, 8 suspected cases including 2 deaths have been reported 4 Lab confirmed (CFR – 50%) 4 Suspected Cholera: Niger The outbreak was confirmed in Maradi Region on the border with Nigeria Since 4 July 2018, a total of 23 cases with one death (CFR 4.3%) 3 specimen have been tested positive Measles : Mali Since week 1 of 2018, a total of 1,136 suspected cases with zero deaths have been reported Of these, 265 have been confirmed (IgM-positive) Measles: Ethiopia During week 28, 2018, 56 new cases were reported. Since week 1, 2018, a total of 2,625 suspected cases have been reported across the country of which 699 have been Laboratory confirmed

THANK YOU