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On 10 October 2019, the Sudan International Health Regulations (IHR) National Focal Point (NFP) notified WHO of 99 suspected cases of dengue fever in Kassala State. The first reported case presented to the health facilities on 8 August 2019 with symptoms including high-grade fever, headache, and joint pain, with or without vomiting. From 8 August through 4 November 2019, a total of 1,197 suspected cases of dengue fever including five deaths have been reported from seven states: Kassala (1,111 cases; 3 deaths), West Darfur (43 cases; 1 death), North Darfur (29 cases; 1 death), Red Sea (9 cases; 0 deaths), South Darfur (3 cases; 0 deaths), Gadarif (1 case; 0 deaths) and North Kordofan (1 case; 0 deaths). View the full article

Seven new confirmed cases were reported in the past week (13 to 19 November) in the ongoing Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces. View the full article

On 13 November 2019, the Venezuela International Health Regulations (IHR) National Focal Point (NFP) and the Venezuela PAHO/WHO Country Office shared information about a confirmed case of yellow fever in Bolivar State. The case-patient is a 46-year-old male resident of the municipality of Gran Sabana, Bolivar State. He was in the locality of Uriman municipality of Gran Sabana within the 19 days prior to the onset of symptoms. Symptom onset was on 14 September 2019, and included fever, chills, nausea, vomiting, epistaxis, petechiae, and diarrhoea. On 26 September 2019, he visited a public hospital in the municipality of Heres where his condition deteriorated, with moderate dehydration, bleeding from the gums, jaundice, choluria, abdominal pain, and hepatomegaly. As of 13 November 2019, the patient remains hospitalized with chronic renal failure and moderate anaemia. On 26 September 2019, the first serum sample was sent to the National Reference Laboratory, the National Institute of Hygiene “Rafael Rangel” per its acronym in Spanish, IHRR1 , in Caracas. On 13 November 2019, the sample tested positive for yellow fever by reverse-transcriptase polymerase chain reaction (RT-PCR), and negative for dengue on 14 November 2019 by RT-PCR. On 10 October 2019, a second serum sample was taken and sent to the IHRR; for which the results are still pending. View the full article

Health authorities in Pakistan are responding to an ongoing outbreak of dengue fever. This outbreak was first reported on 8 July 2019 by the Khyber Teaching Hospital in Peshawar, Khyber Pakhtunkhwa (KP) province. Since then, three other provinces (Punjab, Balochistan, and Sindh), as well as Islamabad Capital Territory (ICT), and Azad Jammu and Kashmir (AJK; one of the two autonomous territories) have also reported cases of dengue fever. From 8 July to 12 November 2019, a total of 47,120 confirmed cases of dengue fever, including 75 deaths, were reported from the four provinces (KP, Punjab, Balochistan, and Sindh), Islamabad, and AJK. View the full article

Six new confirmed cases were reported in the past week (6 to 12 November) in the ongoing Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces. View the full article

On 10 October 2019, the National IHR Focal Point for Sudan notified WHO of 47 suspected cases of Rift Valley Fever (RVF), including two deaths in Arb’aat Area, Towashan Village, in El Qaneb locality, Red Sea State. The suspected cases presented with high-grade fever, headaches, joint pain, vomiting. There were no hemorrhagic signs or symptoms observed. The first case presented to the health facility on 19 September 2019. On 28 September 2019, a total of 14 samples were sent to the National Public Health Laboratory in Khartoum, and 5 tested positive for RVF by Immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) and reverse-transcriptase polymerase chain reaction (RT-PCR). These samples were also tested for malaria and were found negative. View the full article

Fifteen confirmed cases were reported in the past week (30 October – 5 November) in the ongoing Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces View the full article

On 9 October 2019, the French authorities reported an autochthonous Zika virus (ZKV) case in Hyeres, Var department, France. The case had reported symptom onset on 29 July 2019. No travel history to Zika endemic countries was reported for the patient or partner. Since this notification, French authorities reported an additional two probable autochthonous ZKV cases, identified through active case finding, in Hyeres, in the same area and same timeframe (symptom onsets of the three cases from 6 to 15 August 2019). All three patients have recovered. Epidemiological and entomological field investigations by French authorities are still ongoing to determine the possible route(s) of transmission for these cases, prevent further spread and detect possible associated cases. View the full article

The ongoing Ebola virus disease (EVD) outbreak in the North Kivu and Ituri provinces saw a stabilization in the number of new cases this past week, with 19 confirmed cases reported in the past week (23–29 October), essentially equivalent to the 20 confirmed cases the week before. View the full article

On 7 October 2019, the National IHR Focal Point of the United Arab Emirates (UAE) notified WHO of one laboratory-confirmed case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection. The patient is a 44-year-old male non-national farmer from Al Ain city, Abu Dhabi region, UAE. He developed fever, runny nose, headache, vomiting, productive cough and shortness of breath on 25 September 2019, and was admitted to hospital on 29 September. A nasopharyngeal aspirate was collected and tested positive for MERS-CoV by reverse-transcriptase polymerase chain reaction (RT-PCR) on 3 October at the Shiekh Khalifa Medical Center laboratory. The patient has underlying comorbidities including diabetes mellitus, hypertension and hyperlipidemia. He has a history of close contact with dromedary camels and sheep at nearby farms during the 14 days prior to the onset of symptoms. He has no history of recent travel and has not been involved in the slaughtering of animals. As of 14 October, the patient is in stable condition and is currently in an intensive care unit (ICU). View the full article

The number of confirmed cases of Ebola virus disease (EVD) remains relatively low this week, with 21 new confirmed cases reported in North Kivu and Ituri provinces during the epidemiological week of 14 – 20 October. View the full article

On 27 September 2019 , a circulating vaccine-derived poliovirus type 1 (cVDPV1) has been confirmed in environmental samples in Philippines. The virus has been isolated from ten environmental samples, all genetically related, which were collected from one sewage collection site and its tributary pumping stations in Manila, between 1 July and 23 September 2019. This sewage collection site in the city of Manila has a catchment area of over 600,000 people. Vaccine-derived polioviruses are rarely occurring forms of the poliovirus that have genetically changed from the attenuated (weakened) virus contained in oral polio vaccine. They only occur when the vaccine virus is allowed to pass from person to person for a long time, which can only happen in places with limited immunization coverage and inadequate sanitation and hygiene. Over time, as it is passed between more unimmunized people, it can regain the ability to cause disease. When the population is fully immunized with both oral polio vaccine and inactivated polio vaccine, this kind of transmission cannot take place. The gut immunity in people immunized with oral polio vaccine stops the virus from being passed on. Full immunization therefore protects against both vaccine-derived and wild polio viruses. View the full article

Health authorities in Lebanon are responding to an outbreak of measles. From 1 November 2018 through 12 October 2019, a total of 1,171 cases have been reported, of which 675 (57.6%) were laboratory confirmed, 8 (0.7%) epidemiologically linked cases, and 488 (41.7%) were clinically diagnosed. No associated deaths have been reported as of now. Measles cases have been reported in all eight Lebanese governorates, with Aakar, Baalbek-El-Hermel, Bekaa North, and Mount Lebanon governorates most affected. Ninety percent of suspected measles cases were Lebanese nationals, while 10% were Syrians living in informal settlements and in residential areas. The cumulative incidence of measles among Lebanese was higher than that of Syrians (22.4 versus 11.1 per 100,000 population respectively). View the full article

From 1 through 30 September 2019, the National IHR Focal Point of Saudi Arabia reported 4 additional laboratory-confirmed cases of Middle East respiratory syndrome (MERS-CoV) infection and one associated death. The cases were reported from Al-Qassim (2 cases), Riyadh (1 case), and Al-Ahsaa (1 case) regions. The link below provides details of the 4 reported cases: View the full article

The number of confirmed cases of Ebola virus disease (EVD) has been relatively low in recent weeks, with 15 new confirmed cases reported in North Kivu and Ituri provinces during the epidemiological week of 7 October through 13 October (Figure 1). View the full article

On 8 September, Sudan’s Federal Ministry of Health (FMoH) notified WHO about a cholera outbreak in four localities in the Blue Nile State (BNS), south-eastern Sudan, bordering Ethiopia and South Sudan. The first case was detected on 28 of August 2019. From 28 August through 12 October 2019, a total of 278 suspected cholera cases, including 8 deaths (case fatality ratio: 2.88 %), have been reported from four localities in Blue Nile State including Al Roseries (113), Ad Damazin (55), Wad Almahi (3) and Baw (5), and five localities in Sinnar State including Abu Hugar (80), Singa (4), Alsoky (14), Aldaly wa Almzmom (3) and Sennar (1) . One hundred seventy two cases were female (62%), and 238 (93.1%) were over 5 years of age. View the full article

The number of reported cases of Ebola virus disease (EVD) consistently declined in recent weeks, with 14 new confirmed cases reported in North Kivu and Ituri provinces during the epidemiological week of 30 September through 6 October (Figure 1). View the full article

On 8 September, Sudan’s Federal Ministry of Health (FMoH) notified WHO about a cholera outbreak in four localities in the Blue Nile State (BNS), south-eastern Sudan, bordering Ethiopia and South Sudan. The first case was detected on 28 of August 2019. From 28 August through 8 October 2019, a total of 247 suspected cholera cases, including 8 deaths (case fatality ratio: 3.5 %), have been reported from four localities in Blue Nile State including Al Roseries (99), Ad Damazin (52), Wad Almahi (3) and Baw (2), and five localities in Sennar State including Abu Hugar (71), Singa (4), Alsoky (13), Aldaly wa Almzmom (2) and Sennar (1) . One hundred fifty cases were female (61%), and 238 (94.4%) were over 5 years of age. View the full article

On 29 August 2019, a suspected yellow fever case was reported from Kano state with a travel history to Yankari game reserve, Alkaleri Local Government Area (LGA), Bauchi state, Nigeria. From 29 August through 22 September 2019, Nigeria reported an outbreak of yellow fever with an epi-centre in the Yankari game reserve of Alkaleri LGA, Bauchi state. According to Nigeria Centre for Disease Control (NCDC), 231 suspected cases have been reported in four states including Bauchi (110), Borno (109), Gombe (10), and Kano (2), of which there have been 13 presumptive positive by IgM testing and 24 cases positive by reverse-transcriptase polymerase chain reaction (RT-PCR) at national laboratories. Of 24 cases confirmed by RT-PCR (20 cases in Bauchi, three in Gombe and one in Kano state), six deaths were reported, all from Alkaleri LGA, Bauchi state, resulting in a case fatality ratio of 25% among the confirmed cases. The vaccination history for the 231 suspected yellow fever cases is not known, and the results of follow-up testing from regional reference laboratory Institute Pasteur Dakar (IPD) are not yet available. View the full article

The Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo continues this week with 20 new confirmed cases reported in North Kivu and Ituri provinces from 25 September-1 October 2019, versus 29 in the previous week. View the full article

The Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo continues this week with 29 new confirmed cases reported in North Kivu and Ituri provinces from 18-24 September 2019, versus 57 in the previous week. View the full article

From 1 through 31 August 2019, the National IHR Focal Point of Saudi Arabia reported 6 additional laboratory-confirmed cases of Middle East respiratory syndrome (MERS-CoV) infection and one associated death. The cases were reported from Riyadh (3 cases), Taif (1 case), Quriyat (1 case), and Najran (1 case) regions. One of the cases reported (Case #4) is a household contact identified during the contact tracing investigation of Case #2. The link below provides details of the 6 reported cases : View the full article

On 16 July 2019, the Ebonyi State Ministry of Health received information about suspected yellow fever cases in Ndingele ward, Izzi Local Government Area (LGA), Nigeria. The cases had symptoms of fever and jaundice, reported with onset since May 2019. As of 30 August 2019, a total of 84 suspected yellow fever cases, including 26 deaths (case fatality ratio: 31 %), have been reported across nine LGAs within Ebonyi State. Of the suspected yellow fever cases, fifty-five per cent (46/84) are male. The most affected age group is 0-9 years (28 cases, 33%), followed by age groups 20-29 years and above 30 years each with 20 cases (24%). The 10-19 year age group has the least number of cases (16 cases, 19%). Seventy-nine per cent of suspected cases (66/84), including seven confirmed cases positive by real-time polymerase chain reaction (RT-PCR) are reported from Izzi LGA which is located in the north-eastern part of the State, bordered with Cross River State in the east, and Benue State in the north. One case has been confirmed in an international worker involved in the extractive industry in Izzi LGA, and residing in adjacent Abakiliki LGA (an urban centre in the State). The assessment conducted by the LGA rapid response team (RRT) and national agencies found low vaccination coverage and poor routine immunization documentation. Community surveys were conducted and yellow fever vaccination coverage was estimated to be 56% (64% for children aged less than 5 years and 48% for those older than 5 years of age). Though Nigeria introduced routine vaccination for yellow fever into the immunization schedule in 2004, most adults remain susceptible and overall population immunity is low. Although no entomological studies were conducted at the time, the geography and vegetation of the affected state is compatible with the presence of the Aedes mosquitoes, as illustrated by the transmission patterns. View the full article

Hearing on “Sounding the Alarm: The Public Health Threats of E-Cigarettes” Date: Wednesday, September 25, 2019 - 10:00am Location: 2123 Rayburn House Office Building Subcommittees: 116th Congress Energy and Commerce (116th Congress) Oversight and Investigations (116th Congress) The Subcommittee on Oversight and Investigations of the Committee on Energy and Commerce will hold a hearing on Wednesday, September 25, at 10 am in the John D. Dingell Room, 2123 Rayburn House Office Building. The hearing is entitled, “Sounding the Alarm: The Public Health Threats of E-Cigarettes.” Key Documents Memorandum from Chairman Pallone to the Subcommittee on Oversight and Investigations Livestream Witnesses Panel I Norman E. Sharpless, M.D. Acting Commissioner Food and Drug Administration Testimony Anne Schuchat, M.D. (RADM, USPHS, RET) Principal Deputy Director Centers for Disease Control and Prevention Testimony Panel II Joneigh Khaldun, M.D., M.P.H. Chief Deputy Director for Health and Chief Medical Executive Michigan Department of Health and Human Services Testimony Elizabeth Cuervo Tilson, M.D., M.P.H. State Health Director and Chief Medical Officer North Carolina Department of Health and Human Services Testimony Lee Norman, M.D., M.H.S., M.B.A. Secretary Kansas Department of Health and Environment Testimony Monica Bharel, M.D., M.P.H. Commissioner Massachusetts Department of Public Health Testimony https://energycommerce.house.gov/committee-activity/hearings/hearing-on-sounding-the-alarm-the-public-health-threats-of-e-cigarettes

On 19 September 2019, the Philippines declared an outbreak of polio. Two cases have been reported to date, both caused by vaccine-derived poliovirus type 2 (VDPV2). Environmental samples taken from sewage in Manila on 13 August and a waterway in Davao on 22 August have also tested positive for VDPV2. The first case was confirmed on 14 September following testing by the National Polio Laboratory at the Research Institute for Tropical Medicine, the Japan National Institute of Infectious Diseases (NIID) and the United States Centers for Disease Control and Prevention (CDC). The case-patient is a 3-year-old girl from Lanao del Sur in the southern Philippines. The virus isolated is genetically linked to VDPV2 previously isolated from environmental samples in Manila and Davao. This indicates that the virus is circulating. View the full article