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The Ministry of Health (MoH), WHO and partners have continued to face challenges in the containment and control of the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo. The number of reported cases increased during recent weeks, most notably from the Katwa health zone where response teams have faced pockets of community mistrust. The outbreak has also extended southwards to Kayina health zone, a high security risk area. Teams are working actively to build community trust and scale up response activities around these new clusters. Figure 1 shows that as of 22 January 2019, there have been a total of 713 EVD cases1 (664 confirmed and 49 probable), including 439 deaths (overall case fatality ratio: 62%). Thus far, 247 people have been discharged from Ebola Treatment Centres (ETCs), with many having enrolled in a dedicated program for monitoring and supporting survivors. Among cases with a reported age and sex, 59% (420/710) of cases were female, and 30% (214/708) were aged less than 18 years; including 108 infants and children under 5 years. Sixty-one healthcare workers have been infected to date. View the full article

On 19 December 2018, the Argentinian Ministry of Health and Social Development issued an epidemiological alert regarding an increase in cases of hantavirus pulmonary syndrome (HPS) in Epuyén, Chubut Province. Between 28 October 2018 – 20 January of 2019, a total of 29 laboratory-confirmed cases of HPS, including 11 deaths have been reported in Epuyén, Chubut Province. Epuyén has a population of approximately 2 000 persons, and Chubut Province is located in Patagonia in southern Argentina. The index case had environmental exposure prior to symptom onset on 2 November, and subsequently attended a party on 3 November. Six cases who also attended the party experienced the onset of symptoms between 20-27 November 2018. An additional 17 cases, all of whom were epidemiologically-linked to previously confirmed cases, experienced symptom onset between 7 December 2018 and 3 January 2019 (Figure 1). Potential human-to-human transmission is currently under investigation. View the full article

The Ministry of Health (MoH), WHO and partners continue to respond to the ongoing Ebola virus disease (EVD) outbreak in one of the most complex settings possible. A high number of cases are still being reported, most notably from the metropolitan areas of Katwa Health Zone during the past week. The decline in case incidence has continued in Beni; a positive indication of how effective the response can be despite multiple challenges. Trends in the number of new cases occurring (Figure 1) reflect the continuation of the outbreak across a number of geographically dispersed areas. During the last 21 days (26 December 2018 through 15 January 2019), 79 new cases have been reported from 11 health zones (Figure 2), including: Katwa (36), Oicha (14), Butembo (11), Beni (4), Mabalako (4), Kalungata (3), Kyondo (3), Komanda (1), Musienene (1), Biena (1) and Manguredjipa (1). The latter is a newly affected health zone, although the case likely acquired the infection in Mabalako Health Zone. View the full article

WHO is supporting the Ministry of Public Health of Madagascar to respond to an unusually large measles outbreak. View the full article

From 1 December 2018 through 31 December 2018, the International Health Regulations (IHR) National Focal Point of Saudi Arabia reported five additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection. View the full article

WHO and partners continue to respond to the ongoing Ebola virus disease (EVD) outbreak in one of the most complex settings possible. View the full article

On 22 November 2018, the World Health Organization was informed of a cluster of suspected Yellow fever (YF) cases and deaths in Edo State, Nigeria. View the full article

As of October 2018, genetically-linked circulating vaccine-derived poliovirus type 2 (cVDPV2) isolates were detected in two cases from Haut-Katanga province (Mufunga-Sampwe district) in the Democratic Republic of the Congo. The first case was a 11-year old child who experienced onset of acute flaccid paralysis (AFP) on 6 October. The second case was a 29-month old child who experienced onset of symptoms on 7 October, and is a known contact of the first case. The isolated viruses are a new emergence and unrelated to previously-detected cVDPV2s affecting the country. This is the fourth distinct outbreak of cVDPV2 detected in the country since June 2017. In total, 42 cVDPV2 cases have now been confirmed since detection of the first outbreak in June 2017, 20 cases of which were detected in 2018. In February 2018, the government declared cVDPV2 to be a national public health emergency. On 26 July 2018, the Minister of Health, WHO Director General, the Regional Director for Africa, and provincial governors convened an urgent, high-level meeting and signed the ‘Kinshasa Declaration for Polio Eradication’. Provincial governors pledged to provide the necessary oversight, accountability and resources required to urgently improve the quality of the outbreak response being implemented across the country. It is imperative that the remaining operational gaps in outbreak response are urgently filled with the appropriate oversight and engagement. View the full article

Pakistan Health Authorities have reported an ongoing outbreak of extensively drug resistant (XDR) typhoid fever that began in the Hyderabad district of Sindh province in November 2016. An increasing trend of typhoid fever cases caused by antimicrobial resistant (AMR) strains of Salmonella enterica serovar Typhi (or S. Typhi) poses a notable public health concern. In May 2018, the case definitions for non-resistant, multi-drug resistant (MDR) and XDR typhoid fever were formally agreed by the Regional Disease Surveillance and Response Unit (RDSRU) in Karachi, following a review by an expert group of epidemiologists, clinicians and microbiologists from Pakistan. All typhoid fever cases reported from 2016 to 2018 were reviewed and classified according to these case definitions (see Table 1). From 1 November 2016 through 9 December 2018, 5 274 cases of XDR typhoid out of 8 188 typhoid fever cases were reported by the Provincial Disease Surveillance and Response Unit (PDSRU) in Sindh province, Pakistan. Sixty-nine percent of cases were reported in Karachi (the capital city), 27% in Hyderabad district, and 4% in other districts in the province (Table 2). The circulating XDR strain of S. Typhi haplotype 58 was resistant to first and second-line antibiotics as well as third generation cephalosporins. Informal reports of XDR typhoid cases occurring in other parts of Pakistan were made and required further verification. View the full article

Responding to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo continues to be a complex challenge. View the full article

On 22 November 2018, the World Health Organization (WHO) was informed by Dutch authorities of a laboratory-confirmed case of yellow fever. The case-patient is a 26 year-old male who visited Gambia from 3 through 17 November 2018, with a three day trip to Senegal from 12 through 14 November. He had no history of vaccination for yellow fever prior to the trip. On 18 November 2018, the case-patient developed symptoms including fever, nausea and vomiting. On19 November 2018 he was hospitalized with symptoms of acute liver failure and he is still in hospital as of 10 December. The International Health Regulations National Focal Point (IHR NFP) from the Netherlands has notified counterparts in Gambia and Senegal about the case, and about the exact locations visited by the patient. There have been no other reports of confirmed yellow fever cases from Senegal, Gambia or The Netherlands at this time. View the full article

The Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo is occurring in an unforgiving context. Non-engagement from communities and conflict continue to hamper response activities in some affected areas. Moreover, poor infection prevention and control (IPC) practices across numerous private and public health centers remain a major source of amplification of the outbreak and risk to health and other frontline workers. Despite these challenges, substantial progress has been made on multiple fronts to address the situation, and daily successes are being observed in the implementation of proven public health measures alongside newer tools, such as vaccination and novel therapeutics. Together with the Ministry of Health (MoH) and our partners, WHO is further scaling up our response to the developing situation. WHO especially emphasizes the need to continuously improve quality, judiciously deploy new tools at our disposal, and sustain international commitment to response efforts well into 2019. Nonetheless, we remain confident the outbreak can be brought to a conclusion. View the full article

Responding to the Ebola virus disease (EVD) outbreak in north-eastern parts of the Democratic Republic of the Congo continues to be a multifaceted challenge. By utilising proven public health measures (contact tracing, engaging communities) as well as new tools at hand (vaccine and therapeutics), WHO remains confident the outbreak can be contained and brought to an end. During the reporting period (28 November – 4 December 2018), 35 new cases were reported from nine health zones in North Kivu and Ituri provinces: Beni (8), Komanda (eight), Katwa (eight), Vuhovi (three), Kalunguta (two), Butembo (two), Mabalako (two), Masereka (one), and Mutwanga (one). Recent cases in Komanda and Mabalako health zones follow an extended period (exceeding two incubation periods) without detection of new cases; highlighting the risk of reintroduction of the virus, and the need to maintain enhanced surveillance. Cases in the Komanda originated from an infection of a mother and her children in Beni. While insecurity in Komanda will challenge the response activities, control measures including contact tracing and vaccination were initiated soon after the detection of cases. View the full article

As the Ebola virus disease (EVD) outbreak approaches five months since declaration, responding to the outbreak continues to be a challenge; nevertheless, in collaboration with the Ministry of Health (MoH) and partners, WHO remains focused on the ongoing containment efforts to end the outbreak. View the full article

Containing the ongoing Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo is a complex and challenging task but WHO remains confident that the outbreak can be successfully contained in collaboration with the Ministry of Health (MoH) and partners. View the full article

From 16 through 30 October 2018, the International Health Regulations (IHR 2005) National Focal Point of Saudi Arabia reported four additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including one death. View the full article

New measures to overcome obstacles in responding to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo are having a positive impact. The Ministry of Health (MoH), WHO and partners continue to be confident that, despite challenges, the outbreak can be contained. View the full article

As the Ebola virus disease (EVD) outbreak enters the fourth month since declaration, and case numbers surpass 300, substantial progress has been achieved in all aspects of the response. View the full article

From 17 September through 15 October 2018, the International Health Regulations (IHR 2005) National Focal Point of Saudi Arabia reported eight additional cases of MERS-CoV infection, including three deaths. Of the eight cases reported, three were hospital contacts from one hospital in Dammam and two were household contacts in Riyadh. Details of these cases can be found in a separate document (see link below). From 2012 through 15 October 2018, the total global number of laboratory-confirmed MERS-CoV cases reported to WHO is 2262 with 803 associated deaths. View the full article

The increase over the past four weeks in confirmed case incidence (Figure 1), most notably in the city of Beni and communities around Butembo, is concerning. View the full article

From July through September 2018, six cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported from Niger, genetically linked to a cVDPV2 case in Jigawa and Katsina States, Nigeria. The virus was isolated from children with acute flaccid paralysis (AFP) from Zinder region, located in the south of Niger and on the border with Nigeria, with dates of onset of paralysis ranging from 18 July through 16 September 2018. This outbreak has also affected Jigawa, Katsina, Yobe, Gombe, and Borno states in Nigeria, with 17 cases reported since April 2018. View the full article

Security incidents over the past week, ranging from clashes between rebel and government forces resulting in civilian deaths to response vehicles being pelted with stones, continued to cause community distress and severely impede response activities for the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo. View the full article

The response to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo has seen significant improvements over the past weeks, including strong performances by field teams conducting vaccinations, and improved community engagement and risk communication in priority areas. However, as new cases continue to emerge from Beni and appear closer to security ‘red zones’, it is clear that risks remain and that strong response measures need to be prioritized. The virus’ spread is partly due to security conditions that severely impact frontline and health workers, at times forcing the suspension of response activities and increasing the risk that the virus may spread to neighbouring provinces and countries. The MoH, WHO and partners continue to rapidly adapt to these challenging circumstances, scaling up all pillars of the response: surveillance, contact tracing, community engagement, laboratory testing, infection prevention and control, safe and dignified burials, vaccination, and therapeutics. Due to the challenges faced in Democratic Republic of the Congo, the 1st Meeting of the 2018 International Health Regulations (IHR) Emergency Committee for Ebola Viral Disease in the Democratic Republic of the Congo took place on 17 October. Due primarily to the strength and tempo of current response operations, it was the view of the Committee that the conditions for a Public Health Emergency of International Concern (PHEIC) have not been met. The Committee further concluded that the current outbreak has several characteristics of particular concern: the risk of more rapid spread given EVD presence in urban environments; that there are several outbreaks in remote and hard to reach areas; and that health care staff have been infected. Risk of international spread also remains very high due to the outbreak’s proximity to significant regional traffic. Logistical challenges due to poor infrastructure continue to affect surveillance, case detection and confirmation, contact tracing, and access to vaccines and therapeutics. View the full article

On 31 May 2018, the State Ministry of Health (SMOH) of the Red Sea State in Sudan reported four suspected cases of chikungunya fever from Swakin locality, in Red Sea State. Among the signs and symptoms were sudden onset of fever, headache, joint pain and swelling, muscle pain and/or inability to walk. The first suspected case of chikungunya in the neighboring Kassala State was reported on 8 August 2018, in a male travelling from the Red Sea State. Since then cases have been reported in three localities of the State (Kassala, West Kassala and Rural Kassala). On 10 August, among 24 collected blood samples, 22 samples tested positive for chikungunya by PCR and ELISA at the National Public Health Laboratory (NPHL) in Khartoum. On 9 September, an additional 100 samples were collected and pooled in batches of ten: 50% of pools tested positive for mixed chikungunya and dengue viruses, and all pools were positive for chikungunya virus. View the full article

The response to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo is becoming increasingly undermined by security challenges in at-risk areas, particularly Beni. These incidents severely impact both civilians and frontline workers, forcing suspension of EVD response activities and increasing the risk that the virus will continue to spread. WHO continues to distinguish between the incidents of conflict between rebel and government forces, and pockets of community push-back on the response. A recent increase in the incidence of new cases (Figure 1) is the result of the multitude of challenges faced by response teams. This also reflects improved active surveillance and reporting from the community. Since the last Disease Outbreak News (data as of 2 October), 29 new confirmed EVD cases were reported: 23 from Beni, four from Butembo, one from Mabalako, and one from Masereka Health Zones in North Kivu Province. Fifteen of these confirmed cases have been linked to known cases or were linked retrospectively through case to transmission chains within the respective communities, while fourteen recently reported cases remain under investigation. View the full article