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From 29 April to 5 May 2020, no new cases of Ebola virus disease (EVD) have been reported from North Kivu Province, Democratic Republic of the Congo. View the full article

Burundi has been experiencing an increase in the number of confirmed cases of measles since November 2019. This outbreak initially started in a refugee transit camp (Centre de transit de Cishemere, Cibitoke Health district), whose inhabitants had arrived from measles-affected provinces of the Democratic Republic of Congo. Refugees spend 21 days in the Transit Camp of Cishemere before they are sent to permanent camps in Nyankanda and Bwagiriza refugee camps in Butezi, Kavumu camp of Cankuzo, Garsowe camp of Muyinga and Mulumba camp at Kiremba. The outbreak was identified when suspected measles cases had been reported by the local residents in the surrounding areas, highlighting pockets of under-vaccinated populations. According to WHO/UNICEF 2018 estimates, measles first dose vaccination coverage is relatively high (88%), and slightly lower for the second dose (77%). However, this does not reflect the vaccination coverage of incoming refugees. View the full article

From 1 through 31 March 2020, the National IHR Focal Point of Saudi Arabia reported 15 additional cases of MERS-CoV infection, including five associated deaths. The cases were reported from Riyadh (7 cases), Makkah (4 cases), Najran (3 cases), and Al Qassim (1 case) regions. The link below provides details of the 15 reported cases. View the full article

From 22 to 28 April 2020, one new confirmed case of Ebola virus disease (EVD) was reported from Beni Health Zone in North Kivu Province, Democratic Republic of the Congo (Figure 1). This person was listed as a contact of a confirmed case, a family member who was reported on 17 April. The person was vaccinated on 20 April and was followed by the contact tracing team, though not on a regular basis due to insecurity. Since the resurgence of the outbreak on 10 April 2020, seven confirmed cases have been reported, all from Beni Health Zone. Of these, one is receiving care at the Beni Ebola treatment centre (ETC), one who was receiving care at the ETC recovered and was discharged, and one remains in the community. Response teams are engaging with the community in order to try to bring that person to the ETC for access to treatment and supportive care, and to prevent further transmission in the community. Four of the people confirmed to have Ebola died, including two community deaths and two deaths in the ETC in Beni. View the full article

Mexico is experiencing a measles outbreak. Between 1 January and 2 April 2020, 1,364 probable1cases of measles were reported, of which 124 were laboratory confirmed, 991 were discarded and 328 remain under investigation. The age of the confirmed measles cases ranged from three months to 68 years (median=20 years), and 59% were male. Analysis conducted by the National Reference Laboratory (InDRE) identified the genotype D8 (similar to other countries in the Region), linage MVs/GirSomnath.IND/42.16/ for 17 of the confirmed cases. Of the 124 confirmed cases, 105 were in Mexico City, 18 in Mexico State, and one in Campeche State; the following is a summary of the epidemiological situation in each: View the full article

Through event-based surveillance performed throughout 2019, WHO became aware of a dengue outbreak in Mayotte, France, since July 2019. View the full article

From 15 to 21 April 2020, three new confirmed cases of Ebola virus disease (EVD) were reported in the Democratic Republic of the Congo, all from Beni Health Zone in North Kivu Province (Figure 1). View the full article

On 3 March 2020, the Ethiopian Public Health Institute (EPHI) reported three suspected yellow fever cases in Enor Ener Woreda, Gurage zone, SNNPR. The three reported cases were members of the same household (father, mother and son) located in a rural kebele. Two of three samples tested positive at national level by reverse transcriptase-polymerase chain reaction (RT-PCR) and were subsequently confirmed positive by plaque reduction neutralization testing (PRNT) at the regional reference laboratory, Uganda Viral Research Institute (UVRI) on 28 March 2020. In response to the positive RT-PCR results, the EPHI and Ministry of Health performed an in-depth investigation and response, supported by partners including WHO. View the full article

From 10 to 14 April 2020, three new confirmed cases of Ebola virus disease (EVD) were reported in the ongoing outbreak in the Democratic Republic of the Congo (Figure 1). View the full article

On 3 March 2020, the Ministry of Health of South Sudan reported two presumptive positive cases of yellow fever in Kajo Keni county, Central Equatoria State, South Sudan. Both the cases were subsequently confirmed positive by plaque reduction neutralization testing (PRNT) at the regional reference laboratory, Uganda Viral Research Institute (UVRI) on 28 March. The cases were identified through a cross-border rapid response team investigation mounted in response to the recently declared outbreak in bordering Moyo district, Uganda. During the investigation, the team collected 41 blood samples from five villages which were in close proximity to the bordering Moyo district, Uganda. Of the 41 individuals whose samples were collected, nine (22%) had history of fever, but none had history of jaundice. The individuals represented a spectrum of occupations typical for the area (farming, forestry, homemaker, soldier). Most of the individuals investigated were between 20-45 years of age, and 18 (44%) of these individuals were female. View the full article

No new cases have been reported in the ongoing Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo since 17 February 2020 (Figure 1). View the full article

From 1 through 29 February 2020, the National IHR Focal Point of Saudi Arabia reported 18 additional cases of MERS-CoV infection, including five associated deaths. The cases were reported from Riyadh (seven cases), Hafer Albatin (two cases), Najran (two cases), Eastern (two cases), Aljouf (one case), Makkah (one case), Hail (one case), Taif (one case) and Jeddah (one case) regions. Among reported cases of MERS-CoV infection, majority (16 cases) were male, and only two cases were female. The age of reported cases ranged from 34 to 81 years. No cases were reported among healthcare workers. The link below provides details of the 18 reported cases. View the full article

Since 17 February 2020, no new cases have been reported in the ongoing Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo. While this is a positive development, there is still a high risk of re-emergence of EVD given the current challenges related to limited resources amidst other local and global emergencies, continued insecurity and population displacement in previous hotspots, and limited access to some affected communities. It is therefore critical to maintain surveillance and response operations in the period leading up to the declaration of the end of the outbreak, as well as after the declaration – as outlined in the WHO recommended criteria for declaring the end of the EVD outbreak. Ongoing outbreak response efforts continue, which include investigating and validating new alert cases, supporting appropriate care and rapid diagnosis of suspected cases (which continue to be detected), supporting survivors through a multi-disciplinary programme, and strategically transitioning activities. From 24 to 31 March, an average of 4082 alerts were reported and investigated daily. Of these alerts, 274 were validated as suspected cases, requiring specialized care and laboratory testing to rule-out EVD. From 23 to 29 March, 2376 samples were tested including: 1322 blood samples from alive, suspected cases; 365 swabs from community deaths; and 689 samples from re-tested patients. Overall, laboratory activity decreased by 14% compared to the prior week. View the full article

No new cases have been reported in the ongoing Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo since 17 February 2020 (Figure 1). View the full article

There have been no new cases of Ebola virus disease (EVD) reported in the ongoing outbreak in the Democratic Republic of the Congo since 17 February 2020. However, because there is still a risk of re-emergence of EVD, it is critical to maintain surveillance and response operations until and after the end of outbreak declaration – as outlined in the WHO recommended criteria for declaring the end of the EVD outbreak. Unfortunately, the response faces increasing limitations that could result in delayed detection and control of flare-ups. These limitations include a funding shortfall, ongoing insecurity and lack of access to some areas, and limited staffing and resources amidst other local and global emergencies. View the full article

It has been over 21 days since the last confirmed case of Ebola virus disease (EVD) has been reported (Figure 1). On 9 March, the last 46 contacts finished their follow-up. These are important milestones in the outbreak as over one maximum incubation period has passed without any confirmed cases of EVD. However, there is still a high risk of re-emergence of EVD, and a critical need to maintain response operations – as outlined in the WHO recommended criteria for declaring the end of the EVD outbreak. Extensive surveillance, pathogen detection, clinical management and other response activities are currently ongoing. These include, but are not limited to, investigating and validating new alert cases, supporting appropriate care and rapid diagnostics of suspected cases which continue to be detected each day, and supporting survivors through a multi-disciplinary programme to help mitigate potential risks of re-emergence. Over the course of the past week (4–10 March 2020), over 32 000 alerts were reported and investigated, and 2584 alerts were validated as suspected cases; requiring specialized care and laboratory testing to rule-out EVD. From 2 to 8 March, 2818 samples were tested including: 1574 blood samples from alive, suspected cases; 376 swabs from community deaths; and 868 samples from re-tested patients. Overall, this was a 16% decrease in testing compared to the previous week. View the full article

On 18 February 2020, the National IHR Focal Point for Qatar reported one laboratory-confirmed case of Middle East Respiratory Syndrome coronavirus infection (MERS-CoV) to WHO. View the full article

On 12 February 2020, the European Centre for Disease Prevention and Control (ECDC) reported an increase in the number of cases of dengue infection in French Guiana, Guadeloupe, Martinique, and Saint-Martin. In January 2020, health authorities in the region declared a dengue epidemic in Guadeloupe and Saint-Martin and indicated that Martinique is also at-risk of an epidemic. Dengue epidemics in these territories usually occur when there is a shift in the predominant circulating DENV serotype, and non-immune populations (e.g., tourists, new immigrants, or people not previously exposed to the circulating serotypes) are exposed to the new serotype through human movements within the territories or across neighboring countries. Local transmission occurs through the Aedes mosquito vector present on the islands and in French Guiana. View the full article

No new cases of Ebola virus disease have been reported since 17 February, and on 3 March, the only person confirmed to have EVD in the last 21 days (Figure 1) was discharged from an Ebola Treatment Centre after recovering and testing negative twice for the virus. This is an important milestone in the outbreak. However, there is still a high risk of re-emergence of EVD, and a critical need to maintain response operations – as outlined in the WHO recommended criteria for declaring the end of the EVD outbreak. As of 3 March 2020, a total of 3444 EVD cases were reported from 29 health zones (Table 1, Figure 2), including 3310 confirmed and 134 probable cases, of which 2264 cases died (overall case fatality ratio 66%). Of the total confirmed and probable cases, 56% (n=1927) were female, 28% (n=973) were children aged less than 18 years, and 5% (n=171) were health care workers. View the full article

The Central African Republic (CAR) has experienced an upsurge in measles cases as a result of outbreaks since 2019. View the full article

Ontario Confirms New Positive Case of COVID-19 All Protocols Followed and Risk to Ontarians Remains Low February 28, 2020 9:56 P.M. Ministry of Health TORONTO — Today, Dr. David Williams, Chief Medical Officer of Health, confirmed a new positive case of COVID-19 in Toronto. This is the eighth case in Ontario. Ontario's first three cases are all resolved, with each of those patients having two consecutive negative tests at least 24 hours apart. After arriving in Toronto on February 20, 2020, a man in his 80s presented himself at Scarborough Health Network's General Hospital's emergency department on February 27, 2020, with a travel history to Egypt. As per established infection prevention and control protocols, the patient was cared for at the hospital using all appropriate precautions, including being isolated as he was tested for COVID-19. The man was discharged home the same day feeling well and, per protocols, went into self-isolation where he remains. Throughout his travels, the man wore a mask. Toronto Public Health is actively engaged in contact tracing and case management. At this time the virus is not circulating locally, however given the global circumstances, Ontario is actively working with city and health partners to plan for the potential of local spread. The province continues to carefully monitor this situation and encourage residents to stay informed by regularly reviewing credible information sources. Dr. Williams will provide an update on the situation at the regularly scheduled media briefing on Monday, March 2, 2020 at 3:00 p.m. at the Queen's Park media studio. Visit Ontario's website to learn more about how the province continues to protect Ontarians from COVID-19. Media Contacts

After arriving in Toronto on February 20, 2020, a man in his 80s presented himself at Scarborough Health Network's General Hospital's emergency department on February 27, 2020, with a travel history to Egypt. https://news.ontario.ca/mohltc/en/2020/02/ontario-confirms-new-positive-case-of-covid-19-1.html

Media Statement For Immediate Release Friday, Feb. 28, 2020 Contact: CDC Media Relations (404) 639-3286 CDC Announces Additional COVID-19 Presumptive Positive Cases The Centers for Disease Control and Prevention (CDC) is aware of four new presumptive positive cases of COVID-19 announced by state public health authorities who are currently conducting investigations. California has announced a second possible instance of community spread. Oregon has announced its first possible instance of community spread. The state of Washington has announced two presumptive cases. One is likely travel related. The other is the state’s first possible instance of community spread. Community spread means spread of an illness for which the source of infection is unknown. One previous possible instance of community spread was announced in California on February 26. The four patients tested positive for the virus that causes COVID-19 in their respective states using the CDC-developed rRT-PCR. They are considered presumptive positive cases pending CDC confirmatory testing. However, CDC and State and local public health authorities are proceeding with public health investigations and response activities as if these were confirmed cases. With both confirmed and presumptive positive cases, CDC recommends healthcare providers follow the Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings. These four cases bring the total number of COVID-19 cases detected through the U.S. public health system to 19. The federal government has been working closely with state, local, tribal, and territorial partners, as well as public health partners, to respond to this public health threat. Unprecedented, aggressive efforts have been taken to contain the spread and mitigate the impact of this virus. CDC and federal partners have been preparing for the detection of additional instances of person-to-person spread of COVID-19 for weeks. The federal government will continue to respond aggressively to this rapidly evolving situation. For more information about COVID-19 visit www.cdc.gov/covid19. ###

For immediate release: February 28, 2020 (20-026) Contact: Lisa Stromme Warren, Washington State Department of Health, 253-512-7100 Contact: Hilary Karasz, Public Health Seattle-King County, 206-423-2542 Contact: Heather Thomas, Snohomish Health District, 425-508-4980 Contact: Kathy Reeves, Everett School District, 425-319-4143 Additional Cases of COVID-19 in Washington State OLYMPIA – The Washington State Department of Health, Public Health – Seattle & King County, and Snohomish Health District, are announcing two new cases of COVID-19, currently classified as “presumptive positives.” A presumptive positive is a test that comes back positive at the Public Health Laboratory and is pending confirmation at the Centers for Disease Control and Prevention (CDC.) The individuals reside in both King and Snohomish Counties. In King County, a woman in her 50s with confirmed travel to Daegu, South Korea is a presumptive positive. She is currently in home isolation. In Snohomish County, a person under the age of 18 with no travel history is also a presumptive positive. He is currently in home isolation as well. That patient visited Seattle Children’s North Clinic on Monday, Feb. 24. Snohomish County Health District is working alongside the Everett Public Schools to ensure the safety of students and staff at Jackson High School, where this student attends. Everett Public Schools is taking this very seriously and in an abundance of caution, the superintendent has decided to close Jackson High School on Monday to allow three days for deep cleaning. While the King County case is believed to be travel-related, we don’t know how or where the new Snohomish County case was infected. We are working hard to find and identify how the patients were exposed as well as tracing people who might have been exposed to this patient. “Now that we are able to expedite test results here at the Public Health Lab in Shoreline, we’re getting results on suspected local cases a lot faster,” said State Health Officer Dr. Kathy Lofy. “Given the extent of global spread, we expect to identify more individuals with COVID-19 in Washington. We want to emphasize the importance of practicing good health habits.” COVID-19 has the potential to be a serious health risk in our country. Health departments at the federal, state, and local level are working together and with other partners to prepare. Healthcare systems are getting ready to potentially see more patients than usual. Schools are receiving updated guidance on what to do to stay safe if they have cases, and what preventative measures they should take if they do not. How can you prevent the spread of COVID-19? Prevention starts with practicing good personal health habits: Wash your hands often with soap and water, Stay home when you’re sick, Cover your coughs and sneezes with a tissue, Clean frequently touched surfaces and objects. Getting plenty of rest, drinking fluids, eating healthy foods, and managing your stress can help you prevent getting COVID-19 and recover from it if you do. DOH has established a call center to address questions from the public. If you have questions about what is happening in Washington state please call 1-800-525-0127 and press #. More information on COVID-19 is available from: Public Health Seattle-King County Snohomish County Health District Washington State Department of Health Centers for Disease Control and Prevention ### For immediate release: February 28, 2020 (20-026) Contact: Lisa Stromme Warren, Washington State Department of Health, 253-512-7100 Contact: Hilary Karasz, Public Health Seattle-King County, 206-423-2542 Contact: Heather Thomas, Snohomish Health District, 425-508-4980 Contact: Kathy Reeves, Everett School District, 425-319-4143 Additional Cases of COVID-19 in Washington State OLYMPIA – The Washington State Department of Health, Public Health – Seattle & King County, and Snohomish Health District, are announcing two new cases of COVID-19, currently classified as “presumptive positives.” A presumptive positive is a test that comes back positive at the Public Health Laboratory and is pending confirmation at the Centers for Disease Control and Prevention (CDC.) The individuals reside in both King and Snohomish Counties. In King County, a woman in her 50s with confirmed travel to Daegu, South Korea is a presumptive positive. She is currently in home isolation. In Snohomish County, a person under the age of 18 with no travel history is also a presumptive positive. He is currently in home isolation as well. That patient visited Seattle Children’s North Clinic on Monday, Feb. 24. Snohomish County Health District is working alongside the Everett Public Schools to ensure the safety of students and staff at Jackson High School, where this student attends. Everett Public Schools is taking this very seriously and in an abundance of caution, the superintendent has decided to close Jackson High School on Monday to allow three days for deep cleaning. While the King County case is believed to be travel-related, we don’t know how or where the new Snohomish County case was infected. We are working hard to find and identify how the patients were exposed as well as tracing people who might have been exposed to this patient. “Now that we are able to expedite test results here at the Public Health Lab in Shoreline, we’re getting results on suspected local cases a lot faster,” said State Health Officer Dr. Kathy Lofy. “Given the extent of global spread, we expect to identify more individuals with COVID-19 in Washington. We want to emphasize the importance of practicing good health habits.” COVID-19 has the potential to be a serious health risk in our country. Health departments at the federal, state, and local level are working together and with other partners to prepare. Healthcare systems are getting ready to potentially see more patients than usual. Schools are receiving updated guidance on what to do to stay safe if they have cases, and what preventative measures they should take if they do not. How can you prevent the spread of COVID-19? Prevention starts with practicing good personal health habits: Wash your hands often with soap and water, Stay home when you’re sick, Cover your coughs and sneezes with a tissue, Clean frequently touched surfaces and objects. Getting plenty of rest, drinking fluids, eating healthy foods, and managing your stress can help you prevent getting COVID-19 and recover from it if you do. DOH has established a call center to address questions from the public. If you have questions about what is happening in Washington state please call 1-800-525-0127 and press #. More information on COVID-19 is available from: Public Health Seattle-King County Snohomish County Health District Washington State Department of Health Centers for Disease Control and Prevention ### https://www.doh.wa.gov/Newsroom/Articles/ID/1103/Additional-Cases-of-COVID-19-in-Washington-State

In King County, a woman in her 50s with confirmed travel to Daegu, South Korea is a presumptive positive. She is currently in home isolation. https://www.doh.wa.gov/Newsroom/Articles/ID/1103/Additional-Cases-of-COVID-19-in-Washington-State