Epidemiological Update on Public Health Emergencies WHO Country Office, Liberia 01 June 2018

Content Public Health Emergencies Ebola Virus Disease: DRC 1 Ebola Virus Disease: DRC Lassa Fever: Nigeria 2 3 Anthrax: Uganda 4 Cholera: Tanzania 5 Other Events Under Follow - up Public Health Emergencies

Public Health Emergencies (AFRO) 10 Humanitarian Crises 54 Outbreaks 2 Grade 3 events 5 Grade 1 events 5 Grade 2 events 43 Ungraded events Health EMERGENCIES Program Source: WHO Health Emergencies AFRO week 21 bulletin on outbreaks and public health emergencies

Ebola Virus Disease: DRC The EVD outbreak in Equateur Province, Democratic Republic of Congo is still active On 27 May 2018: One new suspected EVD case was reported. There were no new confirmed cases and Deaths Since 4 April 2018: 56 suspected cases, including 25 deaths (CFR 46.9%). 35 cases confirmed 13 probable (deaths for which specimens were not obtained) 3 remain suspected 5 HCWs have been affected with two deaths A total of 906 contacts have been recorded and are being followed up actively Geographical distribution of EVD in DRC 4 Apr - 27 May 2018 The index case in this outbreak has not yet been identified and epidemiologic investigations are ongoing, including laboratory testing. The outbreak is still localized to the three health zones initially affected: Iboko (27 cases and 6 deaths), Bikoro (22 cases and 16 deaths) and Wangata (5 cases and 3 deaths) Risk Assessment: National level: very high Regional level: High At global level: Risk is currently considered low Source: WHO Health Emergencies AFRO week 21 bulletin on outbreaks and public health emergencies

Public Health Measures WHO recommends the implementation of proven strategies for the prevention and control of the Ebola outbreak. Strengthening the multi -sectorial coordination Enhanced surveillance Strengthening diagnostic capabilities A total of 426 people have been vaccinated in two rings in Mbandaka since the launch of the ring vaccination exercise on 21 may 2018 WHO and partners have completed Assessment of EVD readiness in six neighboring countries: Burundi, CAR, Congo, Rwanda, South Sudan and Tanzania. Cross border surveillance at POEs has been strengthened According to the advice of the IHR Emergency Committee (EC), which was convened by the WHO Director-General on 18th May 2018, WHO currently advises against the application of any travel or trade restrictions to Democratic Republic of the Congo. In addition, the EC advised that exit screening at airports and ports on the Congo River is considered to be of great importance to detect probable cases and to prevent the international spread of Ebola; entry screening, particularly in distant airports, is not considered to be of any public health or cost-benefit value. The IHR Emergency Committee advised that currently the outbreak does not meet the criteria for a Public health emergency of international concern, but the vigorous response of the Government should continue to be supported by the international community.   As of 28 May, 23 countries have implemented entry screening for international travellers coming from Democratic Republic of the Congo, but there are currently no restrictions of international traffic in place. WHO continues to monitor travel and trade measures in relation to this event. WHO is working with partners on the ground (IOM and CDC) to map the points of entry in airports, ports and ground crossings, and to set up or further strengthen appropriate screening systems at strategic points of entry. Source: WHO Health Emergencies AFRO week 21 bulletin on outbreaks and public health emergencies

Lassa fever: Nigeria From January - 31 May 2018: Epicurve of Lassa fever Confirmed (431) and Probable (10) Cases in Nigeria week 1- 21, 2018 From January - 31 May 2018: a total of 1,968 s suspected cases have been reported from 21 states Of these: 431 were confirmed including 108 deaths (CFR – 25.%), 10 are probable, 1,523 negative and 4 pending 38 health care workers have been affected A total of 5,327 contacts have been identified 55(1%) are being followed up, 5261(98.8%) have completed 21 days 11(0.2%) lost to follow up. 82 symptomatic contacts of which 28 (36%) have tested positive PUBLIC HEALTH ACTIONS National Lassa fever After Action Review Meeting (AARM) scheduled for 5 - 7 of June 2018 National intensive clinical workshop on diagnosis, management and control of Lassa Fever in scheduled for 12 - 14 June 2018 National Lassa fever multi-sectorial EOC TWG continues to coordinate the response activities at all levels Source: WHO Health Emergencies AFRO week 21 bulletin on outbreaks and public health emergencies

Human Anthrax: Uganda Since February 2018: Uganda has been experiencing recurrent outbreaks of anthrax with four districts being affected As of 30 May 2018: 83 human cases 10 cases confirmed 7 probable In-depth epidemiologic and ecological investigations are ongoing Geographical distribution of anthrax cases in Uganda, 3 February - 23 May 2018 PUBLIC HEALTH MEASURES: Active surveillance is ongoing for humans and animal cases Communication and social mobilization Case management is ongoing in the local health facilities. Source: WHO Health Emergencies AFRO week 21 bulletin on outbreaks and public health emergencies

Weekly trend of cholera cases in Tanzania Mainland, Cholera: Tanzania Weekly trend of cholera cases in Tanzania Mainland, Week 1, 2018 – week 21, 2018 The cholera outbreak in Tanzania has escalated in recent weeks In week 20: 249 new suspected cholera cases with eight deaths (CFR - 3.2%) have been reported, compared to 44 cases reported in week 19. As of 29, May 2018: 2,105 suspected cholera cases, including 44 deaths (CFR-2%) Three out of 26 regions currently have active transmission, PUBLIC HEALTH MEASURES: Active Surveillance for AWD ongoing WASH activities are ongoing Risk communication and social mobilization The outbreak of cholera in Tanzania Mainland is getting worse, with a rapid increase in the number of new cases seen in recent weeks. The ongoing heavy seasonal rain is facilitating the transmission of infection, unhindered by any concrete response on the ground Source: WHO Health Emergencies AFRO week 21 bulletin on outbreaks and public health emergencies

Other Events Under Follow-up Cholera: Zimbabwe: Since 23 March 2018: a total of 64 suspected cases with three deaths (CFR - 4.7%) have been reported, as of 16 May 2018. Of these, 22 cases have been confirmed, two cases classified as probable and 38 cases remained suspected Measles: Guinea A total of 1, 113 suspected cases including nine deaths 267 samples tested IGM positive. 76% were not vaccinated for measles despite vaccination campaign efforts in 2017 Listeriosis : South Africa As of 29 May 2018: 1, 033 confirmed cases, including 204 deaths (CFR - 19.8%) have been reported Gauteng Province has been the most affected, with 59% of the total caseload Monkey Pox: CAR On 20 May 2018: 20 cases including one death have been reported. Nine samples have tested positive for Monkey Pox Measles: Algeria A total of 2, 320 cases including 5 deaths have been reported

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