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The following is a description of the current situation in the United Republic of Tanzania regarding unofficial reports of a number of cases of illness and a summary of WHO efforts to obtain information about this situation. As specified in Article 9 of the International Health Regulations (IHR), WHO may take into account reports from sources other than notifications from Member States and shall assess these reports according to established epidemiological principles under the IHR. View the full article

The intensity of the Ebola virus disease (EVD) transmission in the Democratic Republic of the Congo increased slightly from last week, with 57 new confirmed cases reported in North Kivu and Ituri provinces from 11-17 September 2019, versus 40 in the previous week. View the full article

On 16 August 2019, Regional Health Authorities in Andalusia, Spain, reported an outbreak of listeriosis, caused by the bacteria Listeria monocytogenes (L. monocytogenes), associated with the consumption of a chilled roasted pork meat product manufactured in Spain by Magrudis Company Limited and sold under the brand name “La Mechá”. View the full article

Ebola virus disease (EVD) transmission in the Democratic Republic of the Congo continued to ease this past week, with 40 new confirmed cases reported in North Kivu and Ituri provinces; this is the lowest weekly incidence since March 2019. While these signs are promising, it remains too soon to tell if this trend will persist. Emerging hotspots continue to pose challenges in terms of accessibility, insecurity, and violence. Surveillance indicators highlight that public health risks of further spread remain very high. During the past 21 days (from 21 August through 10 September 2019), a total of 157 confirmed cases were reported form 15 health zones (Table 1, Figure 2), with the majority coming from the health zones of Kalunguta (19%, n=30), Beni (18%, n=28), Mambasa (16%, n=25), and Mandima (13%, n=20). Alimbongo, Oicha, and Pinga health zones recently passed 21 days without a new confirmed case of EVD. View the full article

The intensity of Ebola virus disease (EVD) transmission in the North Kivu, South Kivu, and Ituri provinces remains substantial, with 57 new cases reported since the last EVD in the Democratic Republic of the Congo Disease Outbreak News Update on 29 August. View the full article

In Nigeria and West Africa, a cVDPV2 outbreak originating from Jigawa state, Nigeria, continues to spread. In Ghana, cVDPV2 was isolated from an acute flaccid paralysis (AFP) case in Ando-Nyamanu, Chereponi district, Northern Region, bordering Togo. The case was a two-year old girl who had experienced onset of paralysis on 27 July 2019. Stool samples were taken on 27 and 28 July 2019, and sent to the National Polio Laboratory at the Noguchi Memorial Institute for Medical Research for further laboratory investigations. The sample tested positive for cVDPV2 on 17 August 2019. Sequencing of the sample from the AFP case revealed 25 nucleotide differences compared to the reference Sabin 2 and 6 nucleotides, with the closest sequencing match made with an AFP case originating from Jigsaw state, Nigeria from 2018. Earlier, a related cVDPV2 strain had been isolated from an environmental sample, collected on 11 June 2019, from Northern Region in Ghana. Both isolated viruses were linked to an outbreak originating in Jigawa, Nigeria, in 2018. In the past, this same strain had spread within Nigeria, and internationally to the Republic of Niger, Benin, and Cameroon. The last indigenous wild poliovirus was reported in 2000. This is the first ever reported cVDPV2 outbreak reported in the country. View the full article

The Ebola virus disease (EVD) outbreak in North Kivu, South Kivu, and Ituri provinces in the Democratic Republic of the Congo continued this week with similar transmission intensity to the previous six weeks, with an average of 77 cases per week (Figure 1). View the full article

From 1 through 31 July 2019, the National IHR Focal Point of Saudi Arabia reported 9 additional laboratory-confirmed cases of Middle East respiratory syndrome (MERS-CoV) infection and 4 associated deaths. The cases were reported from Riyadh (5 cases), Najran (3 cases), Al-Qassim (1 case) regions. There were no clusters of cases reported during this time period. The link below provides details of the 9 reported cases : View the full article

The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces in the Democratic Republic of the Congo continued this week with similar transmission intensity (Figure 1). View the full article

On 23 June 2019, a vaccine-derived poliovirus type 1 (VDPV1) was isolated from a two -year- old child with acute flaccid paralysis (AFP), with onset of paralysis on 22 May 2019 from Kayin state, Myanmar. Subsequently, on 11 July 2019, a genetically linked VDPV1 was isolated from the same state from a 5-year 6-month-old child with AFP, with date of onset of paralysis on 14 June, and it was classified as circulating VDPV1 (cVDPV1) on 12 July 2019. On 25 July 2019, cVDPV1 was isolated from a third AFP case from the same state, with date of onset of paralysis on 23 May 2019. Subsequently, on 19 August 2019, a fourth case of VDPV1 has been confirmed in a six-year-old child, with onset of paralysis on 23 July 2019. The child has no history of vaccination with OPV. In addition, the virus has also been isolated from seven healthy community contacts. These linked viruses have 25 to 31 nucleotide changes from Sabin 1. All cases and contacts are from Hpapun township of Kayin state, Myanmar. Myanmar’s routine immunization coverage is estimated at 91% for three doses of bivalent oral polio vaccine (bOPV) in 2018. Neighbouring countries including Thailand and other countries in South East Asia have been informed of the confirmed cVDPV1, and subnational surveillance is being strengthened across the region. In 2018, Myanmar and Kayin state met certification standards for AFP surveillance with non-polio AFP rate of 3.45, and stool adequacy rate of 100% for Kayin state. View the full article

The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces in the Democratic Republic of the Congo continued this week with similar transmission intensity to recent weeks, with an average of 81 cases per week (range 68 to 91 cases per week) in the past six weeks (Figure 1). View the full article

The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces in the Democratic Republic of the Congo continued this week with similar transmission intensity to recent weeks with an average of 86 cases per week (range 80 to 91 cases per week) in the past six weeks (Figure 1). View the full article

The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces in the Democratic Republic of the Congo continued this week with similar transmission intensity to recent weeks, with an average of 85 cases per week (range 79 to 91 cases per week) in the past six weeks (Figure 1). View the full article

The summaries below provide a situational update on circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreaks in the WHO African and Eastern Mediterranean regions. No wild poliovirus has been detected on the African continent since September 2016. In the Lake Chad Basin (LCB) sub-region, multiple cVDPV2 outbreaks continue to spread. All the countries that comprise the sub-region (Niger, Cameroon, and Nigeria) have reported outbreaks in either human or environmental samples. View the full article

The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces in Democratic Republic of the Congo is ongoing amidst a complex crisis, and we continue to observe sustained local transmission and a high number of cases. View the full article

From 1 through 30 June 2019, the National International Health Regulations (IHR) Focal Point of Saudi Arabia reported 7 additional cases of Middle East respiratory syndrome (MERS-CoV) infection. These cases were from Al-Qassim (3 cases), Riyadh (2 cases), Madinah (1 death) and Eastern (1 case) regions. One of the newly reported cases is a health care worker, contact of a case included in the Disease outbreak news published on 16 July 2019 (Case no. 14). Two deaths were reported, one (Case no. 5) from the current reporting month, and a second death (Case no. 13) previously described as a case in the Disease outbreak news on 16 July 2019 . The link below provides details of the 7 reported cases : View the full article

On 17 July 2019, the Director-General convened the Emergency Committee under the International Health Regulations (IHR) to review the situation on the Ebola outbreak in the Democratic Republic of the Congo (DRC). It was the fourth time the Director-General convened the Committee for this event since the declaration of the outbreak in August 2018 (previous meetings were held in October 2018, April 2019, and June 2019). The Director-General accepted the Emergency Committee’s recommendation that the outbreak constitutes a Public Health Emergency of International Concern (PHEIC). The decision was based on the recent developments in the outbreak, including the geographical expansion of the virus. The declaration of the PHEIC is not a reflection on the performance of the response team but rather a measure that recognizes the possible increased national and regional risks and the need for intensified and coordinated action to manage them. The Committee and WHO do not recommend any restrictions on travel or trade, which can hamper the fight against Ebola by affecting the movement of people and supplies. Further information, including temporary recommendations advised by the Emergency Committee, is available in the statement, speech by WHO Director General, and news release. The outbreak of Ebola virus disease (EVD) in North Kivu and Ituri provinces continued this past week with similar transmission intensity to recent weeks. While the stability of the transmission intensity of the outbreak is an indication of the strong response efforts to limit local transmission in affected health zones, the spread of EVD into new geographical areas and continued insecurity in the affected regions continue to complicate the control of the outbreak. View the full article

From 1 through 31 May 2019, the National International Health Regulations (IHR) Focal Point of Saudi Arabia reported 14 additional cases of Middle East respiratory syndrome (MERS-CoV) infection, including five deaths. Of the 14 cases reported, four cases were associated with two separate clusters. Cluster 1 involved two cases (case no. 6 and case no. 7) living in the same household in Alkharj, Riyadh, and cluster 2 involved one patient (case no. 9) and one healthcare worker (case no. 11) in Riyadh. The link below provides details of the 14 reported cases: View the full article

The outbreak of Ebola virus disease (EVD) in North Kivu and Ituri provinces, Democratic Republic of the Congo continues this past week with a similar transmission intensity to the previous week. View the full article

The outbreak of Ebola virus disease (EVD) in North Kivu and Ituri provinces, Democratic Republic of the Congo continued with a steady transmission intensity this week. Indicators demonstrated the early signs of transmission easing in intensity in some major hotspots, such as Butembo and Katwa. The current hotspots are the health zones of Beni, Mabalako, and Mandima, with some cases being exported from these hotspot areas into unaffected health zones. There is a slight but notable increase in the number of new cases occurring in areas that previously had lower rates of transmission, such as the Komanda, Lubero, and Rwampara/ Bunia health zones. On 30 June, a case who had travelled overland from Beni was confirmed in Ariwara, more than 460 kilometres north of Beni, towards the borders with Uganda and South Sudan. This is the first confirmed case in this health zone, and a response team was deployed from Bunia to investigate and implement public health actions in Ariwara. Uganda and South Sudan have mobilized quickly, building on the preparedness efforts during the last months. Arua district in Uganda shares a border with Ariwara health zone, with high volume of trade and population movement. The Arua District Task Force in Arua mobilized on 2 July to agree on a plan of action, the Ministry of Health (MoH) immediately dispatched the National Rapid Response Team for needs assessment, and the vaccination team from Kasese was also dispatched to Arua district on 3 July to start vaccinating the front-line health workers. In South Sudan, WHO and the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) convened a joint meeting with implementing partners on 2 July to plan and coordinate field missions. Joint teams were dispatched to Yei State on 3 July to support operational readiness activities. In the 21 days from 12 June through 02 July 2019, 73 health areas within 20 health zones reported new cases, representing 11% of the 664 health areas within North Kivu and Ituri provinces (Figure 2). During this period, a total of 285 confirmed cases were reported, the majority of which were from the health zones of Mabalako (30%, n=85), Beni (27%, n=76), Mandima (8%, n=23), Lubero (6%, n=16) and Kalunguta (5%, n=14). As of 02 July 2019, a total of 2369 EVD cases, including 2275 confirmed and 94 probable cases, were reported (Table 1). A total of 1598 deaths were reported (overall case fatality ratio 68%), including 1504 deaths among confirmed cases. Of the 2369 confirmed and probable cases with known age and sex, 56% (1334) were female, and 29% (691) were children aged less than 18 years. Cases continue to rise among health workers, with the cumulative number infected rising to 130 (6% of total cases). View the full article

On 25 April 2019, the local administration in Larkana district was alerted by media reports of a surge in human immunodeficiency virus (HIV) cases among children in Ratodero Taluka, Larkana district, Sindh province, Pakistan. A screening camp was initially established at Taluka’s main hospital. Later, screening was expanded to other health facilities including selected Rural Health Centers (RHCs) and Basic Health Units (BHUs). HIV rapid test kits that were initially used were replaced with pre-qualified WHO test kits. From 25 April through 28 June 2019, a total of 30,192 people have been screened for HIV, of which 876 were found positive. Eighty-two per cent (719/876) of these were below the age of 15 years. During the screening, several risk factors were identified, including: unsafe intravenous injections during medical procedures; unsafe child delivery practices; unsafe practices at blood banks; poorly implemented infection control programs; and improper collection, storage, segregation and disposal of hospital waste. View the full article

The Ebola virus disease (EVD) outbreak in the North Kivu and Ituri provinces continues at a stable pace this week. Although response operations were temporarily interrupted in Beni following two days of insecurity in the surrounding areas, operations have largely resumed. However, in the town of Musienene, violent threats persist against healthcare workers (HCW) and local security forces providing assistance to the response efforts. Furthermore, response activities in Kambau health area, Manguredjipa health zone were also suspended following security incidents. Of growing concern this week, are the current hotspots of Mabalako, particularly the Aloya health area, and Mandima (Figure 1), which were the first health zones to report EVD cases in August/September 2018. Sporadic reintroduction events in areas such as Vuhovi, which had not reported any new cases in the past 24 days, further compound the evolving situation. Other areas experiencing a similar resurgence in EVD cases after a period of prolonged absence include Komanda and Masereka. View the full article

This week saw a continued, gradual decrease in the number of new Ebola virus disease (EVD) cases from the hotspots of Katwa and Butembo compared to the previous weeks. However, these encouraging signs are offset by a marked increase in case incidence in Mabalako Health Zone, and especially in Aloya Health Area (Figure 1). While the spread of EVD to new geographic areas remains low, in the health zones of Bunia, Lubero, Komanda and Rwampara, recent reintroduction events illustrate the high risks in previously affected areas. Along with the rise in cases in Mabalako, there was also an accompanying increase in healthcare worker (HCW) and nosocomial infections. These findings highlight the ongoing need to comprehensively strengthen the infection prevention and control measures in the various healthcare facilities operating in these areas. The occurrence of EVD infections in these health areas also place a strain on the already limited security resources needed to facilitate access for effective response activities to continue. In addition to operational challenges encountered on the ground by healthcare workers during the past ten months, the overall EVD outbreak response effort is confronting substantial difficulty in maintaining scale in the context of a US $54 million funding shortage. Without adequate funding to fill this gap, response activities will be compromised, negatively impacting the entire response, resulting in a drastic reduction in vital health services available and a cessation of operations during a critical time of the outbreak. Member States and other donors are strongly encouraged to help meet this funding gap in order to ensure that hard won progress in containing this EVD outbreak will not suffer a potentially devastating setback due to financial limitations. View the full article

On 11 June 2019, the Ugandan Ministry of Health (MoH) has confirmed a case of Ebola Virus Disease (EVD) in Kasese district, Uganda. The patient is a 5-year-old child from the Democratic Republic of the Congo who travelled with his family from Mabalako Health Zone in Democratic Republic of the Congo after attending, on 1 June 2019, the funeral of his grandfather (confirmed EVD case on 2 June 2019). On 10 June 2019, the child and the family entered the country through Bwera border post and sought medical care at Kagando hospital where health workers identified Ebola as a possible cause of illness. The child was transferred to Bwera Ebola Treatment Unit (ETU) for management. The confirmation of Ebola Virus was made on 11 June 2019 at the Uganda Virus Research Institute (UVRI), and the child has deceased in the early hours of 12 June 2019. Two other suspected cases, a 50-year-old female (grandmother of the first case) and 3-year-old male (younger brother of the first case) part of the family members who travelled together with the first confirmed child were also admitted in the same ETU and were confirmed for EVD by UVRI on 12 June 2019. The 50 year-old-female died during the night between 12 and 13 June. 27 other contacts have been identified and are being monitored. Healthcare workers from both health care facilities where the child was treated have been previously vaccinated. All three confirmed cases are imported from Democratic Republic of the Congo and belong to the same family who travelled together from Mabalako Health Zone, an area currently affected by Ebola outbreak in North Kivu, Democratic Republic of the Congo. To date, they remain as a single episode of EVD in Uganda, and the geographical spread in Uganda appears to be limited to one district near Democratic Republic of the Congo border. Further investigations are ongoing both in Uganda and Democratic Republic of the Congo to assess the full extent of the outbreak. View the full article

The Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) continues to show a decrease in the number of new cases in hotspots such as Katwa, Beni and Kalunguta health zones. However, in other areas such as Mabalako and Butembo, moderate rates of transmission continue. With ongoing EVD transmission within communities in 12 health zones in North Kivu and Ituri provinces, factors such as persistent delays in case detection, approximately a third of cases dying outside of Ebola treatment or transit centres, and high population mobility, pose a high risk of geographical spread both within the DRC and to neighbouring countries. This was highlighted by the recent exportation of cases to Uganda – the first confirmed cases detected outside of North Kivu and Ituri province since the onset of the outbreak over 10 months ago. For more information, please see Disease Outbreak News on EVD in Uganda Weekly decrease in the incidence of new cases have been reported in several health zones; however, increase or a continuation of the outbreak has been observed in others (Figure 1). In the 21 days, between 22 May to 11 June 2019, 62 health areas within 12 health zones reported new cases, representing 9% of the 664 health areas within North Kivu and Ituri provinces (Figure 2). During this period, a total of 212 confirmed cases were reported, the majority of which were from the health zones of Mabalako (33%, n=69), Butembo (18%, n=39), Katwa (14%, n=30) Mandima (11%, n=23) and Beni (9%, n=20). Single confirmed cases were also reported from Rwampara and Komanda health zones this past week following a prolonged period since the last reported case, with both cases acquiring the infection in the aforementioned hotspots. View the full article