Surveillance and control of arboviral diseases in the WHO African region: assessment of country capacities

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assessment of country capacities Surveillance and control of arboviral diseases in the WHO African Region: Surveillance and control of arboviral diseases in the WHO African region: assessment of country capacities ISBN 978-92-4-005291-8 (electronic version) ISBN 978-92-4-005292-5 (print version) © World Health Organization on behalf of the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, 2022 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. 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Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. Surveillance and control of arboviral diseases in the WHO African region: assessment of country capacities. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see https://www.who.int/publications/book-orders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/copyright. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO, including TDR, concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO, including TDR, in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO, including TDR, to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO, including TDR, be liable for damages arising from its use. Photo credits Cover photo: Shutterstock © Anton Ivanov, Page 5: Shutterstock © Dennis Diatel, Page 9: Shutterstock © Damian Ryszawy, Page 31: © Gildas Yahouedo, Page 36: WHO © Nimal Garnage, Page 38: WHO © Mark Edwards, Page 80: Shutterstock © Kvini iii Contents 01 CHAPTER Introduction Pages 01-05 04 CHAPTER Regional capacity assessment Pages 51-53 02 CHAPTER Methods Pages 06-08 05 CHAPTER Discussion and suggestions for moving forward Pages 54-60 01 ANNEX Questionnaire Pages 66-79 03 CHAPTER Results Pages 09-50 06 CHAPTER Conclusions Page 61 07 CHAPTER References Pages 62-65 02 ANNEX Details of the country, subregional and regional scores for each domain Pages 80-88 03 ANNEX Current transmission and burden of arboviral diseases in the 47 countries Pages 89-136 Contents ACKNOWLEDGEMENTS Page vi ABBREVIATIONS AND ACRONYMS Page vii EXECUTIVE SUMMARY Page viii iv Surveillance and control of arboviral diseases in the WHO African Region List of boxes, tables and figures Contents Box 1. Identified weaknesses in disease surveillance systems 11 Box 2. Identified weaknesses in diagnostic and case notification 20 Box 3. Weaknesses identified in the management of cases and severe cases 26 Box 4. Weaknesses in virological surveillance identified 30 Box 5. Identified weaknesses in routine vector surveillance and control 36 Box 6. Identified weaknesses in community sensitization and participation in non-epidemic periods 43 Box 7. Weaknesses identified in preparedness for arboviral disease outbreaks and epidemics 47 Table 1. National guidelines on arboviral disease surveillance and control 11 Table 2. Case data recording tools for surveillance 15 Table 3. Collected outbreak risk factors 16 Table 4. Subregions and countries that notify arboviral diseases 21 Table 5. Proportions of case confirmation 22 Table 6. Expressed needs for the adequate detection of arboviruses 23 Table 7. Countries with no national guidance or facilities for management of cases and severe cases of arboviral diseases 27 Table 8. Arboviruses that are or were circulating in the 47 countries 31 Table 9. Potential public health threat of Aedes vectors in the African Region 39 Table 10. Identified gaps and suggestions for moving forward in the countries identified 56 vFig. 1. African countries that participated in the survey in 2021 07 Fig. 2. Status of indicators of disease surveillance capacity in the 47 countries 10 Fig. 3. Country capacity for arboviral disease surveillance 19 Fig. 4. Status of indicators of diagnostic and case notification in the 47 countries 20 Fig. 5. Country capacity for the diagnostic and case notification of arboviral diseases 25 Fig. 6. Status of indicators of management of cases and severe cases  in the 47 countries 26 Fig. 7. Country capacity for management of cases and severe cases of arboviral diseases 29 Fig. 8. Status of indicators of virological surveillance in the 47 countries 30 Fig. 9. Country capacity for the virological surveillance of arboviruses 34 Fig. 10. Status of indicators of routine vector surveillance and control in the 47 countries 35 Fig. 11. Country capacity for routine vector surveillance and control 42 Fig. 12. Status of indicators of community sensitization and participation in non-epidemic periods in the 47 countries 43 Fig. 13. Country capacity for community sensitization and participation in non-epidemic periods 46 Fig. 14. Status of indicators of preparedness for arboviral disease outbreaks and epidemics in the 47 countries 47 Fig. 15. Country capacity for preparedness for arboviral disease outbreaks and epidemics 50 Fig. 16. Average regional and subregional capacity in the seven domains assessed 51 Fig. 17. Overall country capacity in the seven domains assessed 52 Contents For all maps presented in this document: The boundaries and names shown and the designations used on the maps included in this document do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. (Data source: World Health Organization. Map production: TDR & NTD. World Health Organization. © WHO 2022. All rights reserved.) vi Surveillance and control of arboviral diseases in the WHO African Region Acknowledgements This report is the result of a collaboration between the Special Programme for Research and Training in Tropical Diseases (TDR), the Neglected Tropical Diseases department at WHO (NTD) and the Tropical and Vector-borne Diseases department of the WHO Regional Office for Africa. It was written jointly by a team composed of A. Gildas Yahouedo (consultant, TDR), Florence Fouque (TDR), Corinne S. Merle (TDR), Raman Velayudhan (NTD) and Emmanuel Chanda (Regional Office for Africa). The authors would like to thank Dr Ingrid Rabe (consultant, WHO), Dr Diana Rojas Alvarez (EID/WHE) and Giuseppina Ortu for their inputs into development of the questionnaire, Dr Lamine Diawara and Dr Abderahmane K. Tfeil (WHO Inter-country Support Team for West Africa), Dr Elizabeth Juma (WHO Inter-country Support Team for East–Southern Africa) and Dr Spes Caritas Ntabangana (WHO Inter-country Support Team for Central Africa) for their contributions to this survey. We also thank the WHO representatives of the corresponding countries and their staff for extensive assistance during the survey. We are grateful to the staff of the ministries of health of the 47 countries and all those who kindly devoted time to collect information and complete the questionnaire. They are listed below. Algeria: Houria Khelifi Angola: Fernanda Isabel Martins da Graca do Espirito Santos Alves; Pedro Afonso Benin: Raoul Saizonou; Telesphore Houansou; Sonia Viviane Bedie; Mariam Okê Botswana: Godira Segoea; Tuduetso Molefi Burkina Faso: Marie Chantal Haoua Kambire-Diarra; Issaka Yameogo Burundi: Leopold Ouedraogo; Jérôme Ndaruhutse Cabo Verde: Edith Pereira; Carolina Cardoso Da Silva Gomes; Antonio Moreira Cameroon: Etienne Nnomzo’o; Linda Esso Central African Republic: Aristide Désiré Komangoya-Nzonzo Chad: Daoudongar Honore Djimrassengar; Ibrahim Djeomboro; Mahamat Saleh Issakha Diar Comoros: Ahamada Nassuri; Tadjidine Youssouf Congo: Hermann Ongouo; Jean-Mermoz Youndouka Côte d’Ivoire: N’goran Raphaël Ndri; Lucien Konan Democratic Republic of the Congo: Bacary Sambou; Patrick Bahizi Bizoza; Alain Bokota; Narcisse Basosila Equatorial Guinea: Angela Katherine Lao Seoane Eritrea: Assefash Zehaie Kassahun; Selam Mihreteab Eswatini: Makhoselive Dlamini Ethiopia: Messay Gebremariam; Yosef Asrat Gabon: Ghislaine Nkone Asseko; Armel Boubindji Nzobaba; Firmin Mwatha Gambia: Sharmila Lareef-Jah; Sana Malang Sambou Ghana: Felicia Owusu-Antwi; Christopher Tamal viiAbbreviations and acronyms Abbreviations and acronyms NTD Department of Control of Neglected Tropical Diseases CSPEP Community sensitization and participation in non-epidemic periods DCN Diagnostic and case notification DS Disease surveillance ES Entomological surveillance MCSC Management of cases and severe cases PAO Preparedness for arboviral disease outbreaks/epidemics RVSC Routine vector surveillance and control TDR Special Programme for Research and Training in Tropical Diseases VS Virological surveillance WHO World Health Organization Guinea: Ahmadou Barry; Sâa Moïse Kagbadouno; N’faly Magassouba; Jean Traore; Sory Conde Guinea-Bissau: Mie Okamura; Cristovao Manjuba Kenya: James Otieno; Joyce Kerubo Onsongo; Wyckliff Omondi; Rosemary Sang; David Poumo Tchouassi Lesotho: Susan Tembo Liberia: Moses Kerkula Jeuronlon Madagascar: Henintsoa Rabarijaona Ep Ratovo; Glenn Edosoa; Virginie Rajaonarivony Malawi: Ishmael Nyasulu Mali: Boubacar Sidibe; Bourahima Koné Mauritania: Lemlih Baba Yarguate; Abbass Barro Mauritius: Faisal Shaikh; Ajoy Nundoochan; Ambicadutt Bheecarry; Khouaildi Bin Elahee Mozambique: Sonia Casimiro Trigo; Baltazar Candrinho; Albertina Chihale Namibia: Sirak Hailu Bantiewalu; Stark Katokele Niger : Bienvenu Baruani; Aichatou Mahaman Nigeria : Aliyu Suleiman Rwanda: Jules Mugabo Semahore; Adeline Kabeja; Emmanuel Hakizimana; Julien Niyingabira Sao Tome and Principe: Claudina Augusto Da Cruz; Vilfrido Santana Gil Senegal: Mady Ba; Ngayo Sy Seychelles: Doreen Hotive Sierra Leone: Louisa Ganda South Africa: Joseph Muiruri Kibachio Mwangi; Tsakani Furumele; Wayne W. Ramkrishna; Erica Myburgh South Sudan: Mutale Nsakashalo Senkwe; Pita Jane Hillary Ajo; Angelo Goup Thon Togo: Kokou Mawule Davi; Kissaou Kourkou Kpante Uganda: Bayo Segun Fatunmbi; Alfred Mubangizi United Republic of Tanzania: Jovin Kitau; Baraka Nzobo; Azma Simba Zambia: Freddie Masaninga Zimbabwe: Jasper Pasipamire; Isaac Phiri viii Surveillance and control of arboviral diseases in the WHO African Region The growing threat and recent epidemics of Aedes-borne arboviral infections in Africa has put into question the adequacy of public health systems to control these vector-borne diseases. Adequacy relies on countries’ capacity to assure timely, effective epidemiological and entomological surveillance and control of arboviral diseases to identify, prevent and respond to outbreaks. The Special Programme for Research and Training in Tropical Diseases (TDR), the WHO department of control of Neglected Tropical Diseases (NTD) and the WHO Regional Office for Africa conducted a cross-sectional survey to determine the current capacity of countries in the African Region. A self-administered questionnaire covering seven relevant domains was used to measure capacity. All 47 countries in the African Region contributed to the survey, and all the results for each dimension at regional and sub-regional levels are reported here. In general, the countries had adequate capacity for general disease surveillance, arbovirus diagnosis and notification and preparedness for disease outbreaks due to their long experience in the control of malaria and other diseases. Their capacities are not, however, adequately oriented to the surveillance and control of arboviral diseases, and huge gaps were identified in the management of cases and severe cases of arboviral diseases, virological surveillance, entomological surveillance and control of Aedes vectors and community sensitization and engagement related to arboviral diseases. The main challenge is the weakness of systems for arbovirus surveillance in humans, vectors and animals for early detection of outbreak events. Furthermore, despite the existence of a preparedness plan for outbreak events, cases and severe cases of arboviral diseases are not effectively managed in all countries because of lack of clinical knowledge and infrastructure. The gaps explain current country status with regard to arbovirus transmission and/or the perceived risk of arboviral diseases outbreaks. This report calls on countries to address the gaps in order to be adequately prepared for arboviral diseases. The gaps are summarized, and possible ways to move forward are proposed. Planning and addressing these gaps according to the local context will undoubtedly be significant for protecting communities against the growing threat of arboviral diseases in the African Region. Executive summary “The main challenge is the weakness of systems for arbovirus surveillance in humans, vectors and animals for early detection of outbreak events. “ 01Introduction Populations worldwide, except those living in very cold climates, have experiences in emerging and re-emerging arboviral (arthropod-borne viruses) diseases during the past two decades. The spread of arboviruses is favoured by anthropogenic factors such as human travel, unplanned urbanization, deforestation and livestock movements (1–3); environmental factors such as climate change that allows vectors to invade, establish and amplify the viruses in new ecosystems; and evolutionary factors such as changes in viral genetics as well as vector genomes (4–8). Such factors are dynamic, and their interactions, combined with lack of efficient vector control, few specific treatments and a general lack of licensed vaccines or strategies against Aedes-borne infections, pose major threats and public health challenges to control programmes (9–11). Healthmap (https://www.healthmap.org/en/) often shows the global alerts of the occurrence of arboviruses in any online source worldwide when selecting these diseases. According to the WHO department of Control of Neglected Tropical Diseases (NTDs), in 2020, dengue was the most prevalent viral infection transmitted by Aedes mosquitoes, with more than 3.9 billion people at risk of contracting the disease worldwide and an estimated 96 million symptomatic cases and 40 000 deaths every year. Arboviruses are transmitted by blood-feeding arthropod vectors, including mosquitoes, ticks, sand flies, mites, midges and lice (1, 11–13); blood transfusion, organ transplantation, perinatal transmission, breast-feeding, laboratory exposures are other less important modes of transmission (14). Except for the African swine fever virus, which has double-stranded DNA (15), all the other arboviruses harbour an RNA genome and belong to one of five families: Flaviviridae, Togaviridae, Bunyaviridae, Rhabdoviridae and Reoviridae (11). The Aedes-borne viruses consist of a subgroup that are transmitted mainly by females of the mosquito species Aedes aegypti and Ae. albopictus (16, 17), such as dengue, chikungunya, Zika and yellow fever viruses (18). Examples of arboviruses of medical importance not transmitted by Aedes spp. include the West Nile virus, Japanese encephalitis and Sindbis viruses (Culex-borne) (19, 20), Crimean–Congo haemorrhagic fever virus, tick-borne encephalitis virus (21, 22) and Toscana virus (sandfly-borne) (23). The clinical signs and symptoms of arboviral infections range from mild febrile condition to severe forms, including haemorrhagic shock and encephalitis, and are classified as neuroinvasive and non-neuroinvasive disease according to the US Centers for Disease Control and Prevention (14). The neuroinvasive category includes aseptic meningitis, encephalitis and acute flaccid paralysis, while the non-neuroinvasive category consists of headache, arthralgia, rash, myalgia, polyarthralgia, arthritis and gastrointestinal symptoms (14). The symptoms imputed to dengue infection range from myalgia, rash, petechiae, leukopenia and mild Introduction CHAPTER 1 CHAPTER 1 02 Surveillance and control of arboviral diseases in the WHO African Region bleeding during the febrile phase to capillary leak, shock, severe haemorrhage and severe organ involvement at the critical phase (24, 25). The symptoms reported for yellow fever infection include fever, muscle pain, backache, headache, vomiting and loss of appetite during the viraemic phase and high fever, chills, jaundice, bleeding from the mouth, nose, eyes and stomach, sometimes with renal and/or cardiovascular dysfunction during the toxaemic phase (26). The symptoms of Zika virus infection overlap with some of those of dengue and chikungunya and include fever, maculopapular rashes, nonpurulent conjunctivitis, muscle and joint pain, headache and vomiting (25, 27). Guillain-Barré syndrome was associated with Zika virus infection in an outbreak in French Polynesia (28), and other neurological syndromes were observed in patients in Brazil (29). Patients with chikungunya are often symptomatic (30), with arthralgia, joint pain (ankles, wrists, fingers), migratory polyarthritis and vesiculobullous eruptions and ulcers (25, 31). Most arboviral infections, however, are asymptomatic and vary in each individual. More detailed accounts of the association of clinical signs and symptoms with specific arboviral infections can be found in the literature (25, 32). The arboviral diseases that have caused the most morbidity and mortality in recent decades are Zika, dengue, yellow fever and chikungunya (33). All are considered to be leading epidemic-prone diseases and require mandatory notification in many countries (34). To contain these arboviral diseases, we must look back to the measures that led to successful control in the past. Clearly, countries in Latin America, South-East Asia and the Indian Ocean were the most heavily affected by arboviral diseases or reported more cases (35). Badurdeen and collaborators (36) described the experiences of these affected countries and identified the strengths and limitations in their surveillance, outbreak preparedness, detection and response, recommending preparation of a contingency plan that could be adjusted by each country. African countries appear to be most in need of strengthening surveillance and control of arboviral diseases, because they have less experience in the control of arboviral diseases than of malaria, they are located in the tropical areas conducive to the spread of Aedes spp. and are facing an increasing burden of these diseases (37–39). The WHO weekly bulletin on outbreaks and other emergencies reported several dengue outbreaks in Burkina Faso, Côte d’Ivoire, Liberia, Mali, Senegal and Seychelles in 2017; yellow fever outbreaks in Angola, Burkina Faso, Chad, Kenya, Mali and the United Republic of Tanzania in the same year (40); and recent outbreaks of yellow fever in Ethiopia, Nigeria and Uganda (41–43). All these countries were caught off guard by the outbreaks due to inadequate epidemiological and entomological surveillance and weak Aedes vector control systems. It is therefore essential to strengthen country capacity in these areas for the control of Aedes-borne arbovirus transmission and the response to outbreaks, in line with the priorities listed in the WHO Global Vector Control Response 2017-2030, such as a national vector control needs assessment (priority 1) and national entomology and cross-sectoral workforce assessment and strengthening of vector surveillance systems (priority 2) (44). 03Introduction In 2018–2019, TDR, in collaboration with the WHO NTD department and the Western Africa Health Organization, conducted an evaluation of country capacity for the surveillance and control of arboviral diseases in 16 Western African countries. The report (to be published) indicates that western African countries require support and paves the way for future situation analyses of country capacity. Following the evaluation in West Africa and in view of the urgency of preparing the health systems of African countries against the growing threat of arboviral diseases, TDR, WHO NTD and the WHO Regional Office for Africa extended the evaluation to all countries in the African Region. This report summarizes the results of the evaluation, which demonstrates the strengths and weaknesses in subregions and in the Region as a whole and indicates ways of strengthening national and regional capacity. “The clinical signs and symptoms of arboviral infections range from mild febrile condition to severe forms, including haemorrhagic shock and encephalitis. “

05Introduction 06 CHAPTER 2 Surveillance and control of arboviral diseases in the WHO African Region The capacities of countries in the African region were assessed from a questionnaire adapted from that used for western African countries, with additional questions and more options for answers. The questionnaire (Annex 1) was in English and French, was available in hard copy (Word document) and an e-version, designed with LimeSurvey (45) and was hosted locally on the WHO online platform. The questionnaire consisted of 73 questions, of which 45 were scored, to explore countries’ capacity in seven domains: 1. Disease surveillance system – 10 questions 2. Diagnosis and case notification – 5 questions 3. Management of cases and severe cases – 3 questions 4. Virological surveillance – 2 questions 5. Routine vector surveillance and control – 13 questions 6. Community sensitization and participation in non-epidemic periods – 5 questions 7. Preparedness for arboviral disease outbreaks and epidemics – 7 questions The questions in each domain addressed specific indicators of capacity, and a final open question (not scored) elicited the perceived factors of success and failure of activities in the domain. The non-scored questions were open-ended to capture details of capacity indicators and data on cases of arboviral diseases during the previous 5 years (2015–2019). The questionnaires were filled in by national experts at ministries of health, national health departments and research institutes in collaboration with WHO national professional officers and inter-country support teams, who were trained in filling in the questionnaire and submitting electronic versions to the WHO online platform. All the responses submitted were checked for consistency and completeness, and respondents were contacted again to complete unanswered questions or to provide further details on their responses when necessary. The responses from the 47 countries (Fig. 1) were analysed to assess capacity in countries, subregions and the Region from the capacity indicators for each domain in the questionnaire. To determine country scores, each indicator was given the same weight in the scoring system regardless of the domain, country or subregion, and the domains were given equal weight in the final scoring. Each country was given the same weight in the score of the subregion, and the three subregions (West Africa, Central Africa, East–Southern Africa) were given equal weight in the regional score. The rationale of the scoring was to score 1 (“on track”) for each response that fully matched the definition of the capacity indicator, 0.5 (“in progress”) if the response either matched the definition but gave few details (when requested) or if it matched some Methods 07Methods of the components of the definition of the indicator, or 0 (“not on track”) if it did not match the definition at all. A score of 0.5 was given when there was limited nationwide capacity, the capacity was not explicitly related to arboviral diseases or when the capacity was not relevant to the criteria for prevention, control and management of arboviral diseases. For instances, countries with limited capacity for Aedes vector control but mainly targeted Anopheles (malaria vector) would be scored 0.5, as the capacity exists but requires strengthening to include arboviral vectors. Countries that had only one notifiable arboviral disease were also scored 0.5 because they had a disease notification system that should be extended to include other arboviral diseases. A scoring programme for the 45 scored questions was generated with Python 3.7.0 (46) and run on Jupyter Notebook 6.1.3 (47). The answers from countries were scored automatically, leaving unscored the answers that required review. These were scored manually after review. All data were managed with Python, and statistical analyses and graph designs were performed with R 4.0.5 (48). Fig. 1. African countries that participated in the survey in 2021 AN GOLA BU RU N D I B E N I N BU RKI N A FASO BOTSWAN A CEN TRAL AFR I CAN RE PU BL I C CAM EROON COMOROS CABO VE RD E ALGER I A ER I TREA ETH I OP I A GABON GH AN A GU I N EA GAM B I A GU I N EA-B I SSAU EQUATOR I AL GU I N EA KEN YA L I B E R I A LE SOTH O MADAGASCAR M AL I M OZAM B I QU E M AU R I TAN I A M AU R I TI U S M ALAWI N AM I B I A N I GE R N I GE R I A RWAN DA SEN EGAL SI E RRA L EON E SOU TH SU DAN SAO TOM E AN D PR I N CI P E E SWATI N I SEYCH E LLE S CH AD TOGO U N I TED REPU BL I C OF TAN ZAN I A U GAN DA SOU TH AFR I CA ZAM B I A ZI M BABWE DEM OCRATI C RE PU BL I C OF TH E CON GOCON GO CÔTE D ’ I VO I RE 0 1 000 2000 km N ot a p p l i ca b l e Ou tsi d e Afr i ca n Regi on D a ta n ot a va i l a b l e Pa rti c i p a ti n g cou n tr i es Cou n try p a rti c i p a ti on 08 CHAPTER 2 Surveillance and control of arboviral diseases in the WHO African Region The scores were calculated as follow: • Country score in a domain = total score of the indicators in the domain maximal score for that domain × 100 • Subregional score in a domain = sum of the country scores for the domain in the subregion total number of countries in the subregion × 100 • Regional score in a domain = sum of subregional scores in the domain total number of subregions × 100 • National capacity = sum of the national scores per domain in % total number of domains (7) • Subregional capacity = sum of national capacity in % total number of countries in the subregion • Regional capacity = sum of subregional capacity in % total number of subregions (3) Capacity was classified into four categories according to the scores obtained: • Inadequate capacity: 0 < score < 50% • Partially satisfactory capacity: 50% ≤ score < 70% • Almost adequate capacity: 70% ≤ score < 90% • Adequate capacity: 90% ≤ score ≤ 100% 09Results The section reports the outcomes for the seven domains addressed in the questionnaire. For each domain, a figure depicts the country outcomes for the corresponding capacity indicators with a table listing the indicators. The outcomes include “On track”, “Progress”, “Not on track” and “No answer”. Identified weaknesses in each domain are summarized in boxes, followed by an overview of the indicators of each domain at subregional and regional levels. Country capacity is classified according to each domain and mapped to indicate the situation of each country and the regional situation. Details of the country, subregional and regional scores for each domain are summarized in Annex 2. Results CHAPTER 3 10 CHAPTER 3 Surveillance and control of arboviral diseases in the WHO African Region Ten capacity indicators were assessed for this domain, ranging from the existence of national guidelines on arbovirus disease surveillance and control to training of staff in activities related to the domain. 3.1 Disease surveillance system Fig. 2. Status of indicators of disease surveillance capacity in the 47 countries On track Progress Not on track No answer Code Indicator DS01 Formally approved national guidelines on arbovirus surveillance and control DS02 A national programme on arboviral disease surveillance DS03 Mandatory case reporting DS04 National epidemiological surveillance of arboviral diseases in humans DS05 Recording of case data for surveillance purposes DS06 National epidemiological surveillance of arboviral diseases in animals DS07 Sentinel animal surveillance or epizootic surveillance DS08 Analysis of outbreak risk factors DS09 Accessible individual and aggregated surveillance data in the health structure DS10 Regular training of staff in use of disease surveillance tools Zimbabwe Zambia United Republic of Tanzania Uganda South Sudan South Africa Seychelles Rwanda Namibia Mozambique Mauritius Malawi Madagascar Lesotho Kenya Ethiopia Eswatini Eritrea Comoros Botswana Sao Tome and Principe Gabon Equatorial Guinea Democratic Republic of the Congo Congo Chad Central African Republic Cameroon Burundi Angola Togo Sierra Leone Senegal Nigeria Niger Mauritania Mali Liberia Guinea−Bissau Guinea Ghana Gambia Côte dʼIvoire Cabo Verde Burkina Faso Benin Algeria D S0 1 D S0 2 D S0 3 D S0 4 D S0 5 D S0 6 D S0 7 D S0 8 D S0 9 D S1 0 W est A frica Central A frica East-Southern A frica 11Results DS01. Formally approved national guidelines on arbovirus surveillance and control (question 1) Table 1 lists the answers received on this capacity indicator in the three subregions. Thirteen of the 47 countries (28%) reported that they had no guidelines on arboviral disease surveillance or control. Most of these countries are located in East–Southern Africa. The source commonly used by 26 countries (55%) was the WHO technical guidelines for integrated disease surveillance and response (49), whereas 7 had national guidelines. The guidelines covered yellow fever in 26 countries, dengue in 23, chikungunya in 18, Zika in 14 countries and other arboviral diseases (West Nile fever, Rift Valley fever, Sindbis fever, Congo–Crimean haemorrhagic fever, viral haemorrhagic fevers) in 15 countries. Box 1. Identified weaknesses in disease surveillance systems • Lack of financial, human, technical and logistical resources • Quasi-absence of epidemiological surveillance of arboviral diseases in animals • Limited collection and analysis of outbreak risk factors • No regular training of staff working in disease surveillance • Surveillance data not available and accessible at all health structure levels • Inadequate epidemiological surveillance of arboviral diseases in humans • Lack of the community awareness on arboviral diseases Table 1. National guidelines on arboviral disease surveillance and control Guidelines West Africa Central Africa East–Southern Africa Technical guidelines for integrated disease surveillance and response (49) Algeria, Benin, Cabo Verde, Côte d’Ivoire, Ghana, Guinea, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Togo Cameroon, Chad, Congo, Democratic Republic of the Congo, Gabon, Sao Tome and Principe Comoros, Eritrea, Namibia, Seychelles, South Sudan, United Republic of Tanzania, Zambia National guidelines Burkina Faso Equatorial Guinea Ethiopia, Madagascar, Mauritius, Rwanda, South Africa No guidelinesa Gambia, Guinea-Bissau, Sierra Leone Angola, Burundi, Central African Republic Botswana, Eswatini, Kenya, Lesotho, Mozambique, Uganda, Zimbabwe Don’t know Malawi a Countries that reported that they had no guidelines on arboviral disease surveillance and control 12 CHAPTER 3 Surveillance and control of arboviral diseases in the WHO African Region DS02. A national programme on arboviral disease surveillance (question 2, Fig. 2) Eleven countries (23%) reported that they had no national programme on arboviral disease surveillance: six in East–Southern Africa (Botswana, Eswatini, Lesotho, Malawi, South Africa and Uganda), three in Central Africa (Burundi, Cameroon and Equatorial Guinea) and two in West Africa (Guinea-Bissau and Togo). Most countries (34, 72%) reported activities related to arboviral disease surveillance that were integrated into another health programmes. Two countries (Ethiopia and Zimbabwe) reported that they had a specific programme on arboviral disease surveillance. West Africa. None of the countries in this subregion reported a specific programme on arboviral disease surveillance. In most, a package of activities was integrated into another programme, such as the national zoonotic disease control programme in Algeria, the epidemiological surveillance, monitoring and evaluation department in Benin, the national programme for the control of vector-borne diseases in Cabo Verde, the epidemiology and surveillance departments in Ghana and Mauritania, the disease control and outbreak response programme in Nigeria and the national institute of public hygiene in Côte d’Ivoire. Other countries (Burkina Faso, Guinea, Mali, Senegal and Sierra Leone) reported that arboviral disease surveillance had been assigned to their programme of integrated disease surveillance and response. Gambia, Liberia and Niger did not report which programme included arboviral disease surveillance. Central Africa. Burundi, Cameroon and Equatorial Guinea did not report a national programme. Arboviral disease surveillance was assigned to the national malaria control programme in Angola and Congo, to the epidemiological surveillance department at the Ministry of Health in Chad, to the vector control department in the Central African Republic, to the department of disease control in the Democratic Republic of the Congo and to the integrated disease surveillance and response programme in Sao Tome and Principe. Gabon did not specify the programme that addressed arboviral disease surveillance. East–Southern Africa. In this subregion, 12 countries reported integration of arboviral disease surveillance into other programmes: into the surveillance system in Comoros, the integrated disease surveillance and response programme and national malaria control programme in Eritrea, the malaria and disease surveillance programme in Kenya, the sentinel fever surveillance programme in Madagascar, the permanent border surveillance system in Mauritius, the directorate of special programmes for primary health care and health information and research in Namibia, the public health surveillance and emergency preparedness and response division in Rwanda, the disease surveillance and response unit in the Ministry of Health in Seychelles, and the integrated disease surveillance and response programme in South Sudan, the United Republic of Tanzania and Zambia. Mozambique did not specify the programme responsible for arboviral disease surveillance. “72% of countries reported activities related to arboviral disease surveillance that were integrated into another health programmes. “ 13Results DS03. Mandatory case reporting (question 3) Cases were reported in 43 countries (91%). Of these, 23 noted that case reporting was mandatory for all the major arboviral diseases, while 20 noted that reporting was mandatory for only some arboviral diseases. Botswana and Mozambique reported that case reporting was not compulsory, and Malawi and Uganda replied “Don’t know” to the question. West Africa. Case reporting is mandatory in all 17 countries in the subregion. In 11 countries (Benin, Cabo Verde, Côte d’Ivoire, Guinea, Guinea-Bissau, Liberia, Mali, Mauritania, Niger, Sierra Leone and Togo), reporting is mandatory for all cases of arboviral disease for which a diagnosis is available. In the other six countries, reporting was mandatory for cases of only some arboviral diseases: Algeria (chikungunya, dengue, yellow fever, Zika, West Nile fever, Rift Valley fever); Burkina Faso (dengue, yellow fever, Zika, Rift Valley fever); and Ghana, Nigeria and Senegal (yellow fever, dengue). Senegal indicated that other arboviral diseases could be included by the national health authorities. Central Africa. Case reporting is mandatory in all 10 countries in the subregion. Burundi, Central African Republic, Congo, Equatorial Guinea and Gabon noted reporting of all cases of arboviral disease for which a diagnosis is available. Reporting was mandatory for only some arboviral diseases in Angola (dengue, yellow fever), Cameroon (chikungunya, dengue, yellow fever, all haemorrhagic fevers), Chad (chikungunya, dengue, yellow fever), Democratic Republic of the Congo (chikungunya, yellow fever) and Sao Tome and Principe (dengue, yellow fever). East–Southern Africa. In six countries, Eritrea, Seychelles, South Africa, South Sudan, United Republic of Tanzania and Zambia, reporting was mandatory for all cases of arboviral disease for which a diagnosis was available. In the other 10 countries, case reporting was mandatory for only some arboviral diseases: Comoros and Madagascar (chikungunya, dengue), Eswatini (yellow fever, Rift Valley fever, chikungunya and dengue), Ethiopia (yellow fever, dengue and viral haemorrhagic fevers), Kenya (yellow fever, Rift Valley fever), Lesotho (yellow fever), Mauritius (dengue, chikungunya, Zika, Rift Valley fever, West Nile fever), Rwanda (Rift Valley fever, yellow fever, chikungunya and haemorrhagic fevers), Zimbabwe (yellow fever, Rift Valley fever) and Namibia (yellow fever). DS04. National epidemiological surveillance of arboviral diseases in humans (question 4) Twenty-five countries (53%) reported having conducted national epidemiological surveillance in the previous 2 years: 12 in West Africa, 7 in Central Africa and 6 in East–Southern Africa. Eighteen countries (38%) had not conducted such surveillance: 12 in East–Southern Africa, 4 in West Africa and 2 in Central Africa. Four countries did not reply to the question. 14 CHAPTER 3 Surveillance and control of arboviral diseases in the WHO African Region West Africa. Twelve countries reported having conducted epidemiological surveillance of arboviral diseases in the previous 2 years: Algeria, Benin, Burkina Faso, Cabo Verde, Côte d’Ivoire, Gambia, Guinea, Mali, Mauritania, Niger, Senegal and Sierra Leone. Surveillance was conducted continually in Algeria, Mauritania and Niger, routinely (period self-determined) in Gambia, weekly in Benin, Burkina Faso, Guinea and Sierra Leone, every trimester in Côte d’Ivoire and once a year in Cabo Verde, Mali and Senegal. Some countries reported having conducted active surveillance (Côte d’Ivoire, Mauritania, Sierra Leone) or passive surveillance (Benin, Burkina Faso and Cabo Verde), and the rest conducted a combination of active and passive surveillance (Algeria, Gambia, Guinea, Mali, Niger and Senegal). Four countries (Guinea-Bissau, Liberia, Nigeria and Togo) did not report any surveillance. Ghana replied “Don’t know” to the question. Central Africa. Seven countries (Angola, Cameroon, Chad, Congo, Democratic Republic of the Congo, Equatorial Guinea, Gabon) reported surveillance of arboviral diseases in humans in the previous 2 years. Surveillance was conducted weekly in Cameroon, Congo, Equatorial Guinea and Gabon, every trimester in Angola, every semester in Chad and once a year in Democratic Republic of the Congo. Surveillance was primarily active in Democratic Republic of the Congo and a combination of active and passive surveillance in Angola, Cameroon, Chad, Congo, Equatorial Guinea and Gabon. Two countries (Burundi and Central African Republic) did not report surveillance, and Sao Tome and Principe replied “Don’t know” to the question. East–Southern Africa. Six countries (Comoros, Ethiopia, Madagascar, Mauritius, South Africa, South Sudan) reported epidemiological surveillance of arboviral diseases in the previous 2 years. Surveillance was continuous in South Africa, routine in South Sudan, weekly in Ethiopia, every trimester in Madagascar and annual in Comoros. Surveillance was passive in Comoros and Ethiopia, active in South Africa and a combination of active and passive in Madagascar, Mauritius and South Sudan. Twelve countries (Botswana, Eritrea, Eswatini, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, United Republic of Tanzania, Zambia and Zimbabwe) did not report surveillance. Seychelles and Uganda replied “Don’t know” to the question. DS05. Recording of case data for surveillance purposes; and DS09. Accessibility of individual and aggregated data on surveillance in the health structure (questions 5 and 9) Central African Republic was the only country that reported that “no tool” was available at the Ministry of Health. Of the other countries, five had paper-based record systems at all levels, five had fully electronic systems at all levels, and 25 (53%) (10 in West Africa, 11 in East–Southern Africa and 4 in Central Africa) reported that they used a mixture of paper-based and electronic systems at all levels of their health structure (Table 2). “53% of countries reported that they used a mixture of paper-based and electronic systems for surveillance. “ 15Results Four countries (8%) (Botswana, Central African Republic, Guinea-Bissau, Mozambique) reported having no individual or aggregated data at any level of their health structure. Sierra Leone reported the availability of both individual and aggregated data at district level. The other countries had either individual or aggregated data available at least at national level. DS06. National epidemiological surveillance of arboviral diseases in animals; and DS07. Sentinel animal surveillance or epizootic surveillance (questions 6 and 7) Twenty-one countries (45%) (11 in East–Southern Africa, 7 in West Africa, 3 in Central Africa) did not report surveillance in animals in the previous 2 years, and 15 (5 in each subregion) (32%) replied “Don’t know” to the question. Only 11 countries (23%) (2 in Central Africa, 4 in East–Southern Africa, 5 in West Africa) replied positively. The frequency of surveillance was continuous in Cameroon, weekly in Guinea and Equatorial Guinea, every trimester in Madagascar, every semester in Liberia and annual in Algeria, Comoros, Mali, Mauritius, Senegal and United Republic of Tanzania. Surveillance was active in Liberia, passive in Comoros, Madagascar and Senegal, and a combination of active and passive in Algeria, Cameroon, Equatorial Guinea, Guinea, Mali, Mauritius and United Republic of Tanzania. Only four countries (Cameroon, Madagascar, Mali and Senegal) provided their surveillance reports. Table 2. Case data recording tools for surveillance System West Africa Central Africa East–Southern Africa Electronic at all levels Benin, Guinea Cameroon Lesotho, Rwanda Electronic at specific levels Niger Ethiopia, Uganda Mixed methods at all levels Algeria, Cabo Verde, Côte d’Ivoire, Ghana, Guinea- Bissau, Liberia, Mali, Mauritania, Senegal, Togo Burundi, Chad, Congo, Gabon Eswatini, Kenya, Madagascar, Malawi, Mauritius, Seychelles, South Africa, South Sudan, United Republic of Tanzania, Zambia, Zimbabwe Mixed methods at specific levels Nigeria, Sierra Leone Paper-based at all levels Gambia Angola, Equatorial Guinea, Sao Tome and Principe Comoros Paper-based at specific levels Burkina Faso Democratic Republic of the Congo No tool Central African Republic 16 CHAPTER 3 Surveillance and control of arboviral diseases in the WHO African Region Twenty-four countries (51%) (10 in West Africa, 9 in East–Southern Africa, 5 in Central Africa) did not report epizootic surveillance of arboviruses; 17 countries (36%) (8 in East–Southern Africa, 5 in West Africa, 4 in Central Africa) replied “Don’t know” to the question; and only 5 countries (Comoros, Kenya, Niger, Senegal, South Africa) reported epizootic surveillance. Surveillance was focused on Rift Valley fever in all five countries and also on yellow fever in Comoros, Kenya and Niger. Senegal and Comoros had also added Crimean –Congo haemorrhagic fever and Q-fever, respectively. Senegal was the only country that attached its surveillance report. DS08. Analysis of outbreak risk factors (question 8) Twenty-seven countries (57%) (13 in East–Southern Africa, 8 in West Africa, 6 in Central Africa) did not regularly collect or analyse data on outbreak risk factors, and four countries replied “Don’t know” to the question. Only 15 countries (8 in West Africa, 4 in East–Southern Africa, 3 in Central Africa) (32%) replied in the affirmative. Table 3 lists the outbreak risk factors reported. Table 3. Collected outbreak risk factors Indicator West Africa Central Africa East–Southern Africa House index Algeria, Cabo Verde, Côte d’Ivoire, Guinea, Mali, Niger, Senegal Mauritius, South Sudan, United Republic of Tanzania Breteau index Algeria, Cabo Verde, Côte d’Ivoire, Guinea, Mali, Niger, Senegal Mauritius, South Sudan Container index Algeria, Cabo Verde, Côte d’Ivoire, Guinea, Mali, Senegal Angola Mauritius, South Sudan Temperature Senegal Mauritius, United Republic of Tanzania Rainfall Niger, Senegal Chad Mauritius, South Africa, South Sudan, United Republic of Tanzania Migration of a non-immune population Guinea Chad Other Algeria (lymph index), Senegal (pupae index) Mauritius (seasonal migratory birds and imported livestock) 17Results DS010. Regular training of staff in use of disease surveillance tools (question 10) Eight countries (17%) (Botswana, Central African Republic, Chad, Congo, Ethiopia, Guinea-Bissau, Liberia, Mozambique) reported that their staff were not trained regularly in disease surveillance. Malawi replied “Don’t know” to the question. The training frequency in the other 39 countries (83%) was once in 16 countries (8 in West Africa, 6 in East–Southern Africa, 2 in Central Africa) and routine in 13 countries (2 in Central Africa, 6 in East–Southern Africa, 5 in West Africa). No information on training frequency was reported by the other 10 countries. The type of training ranged from data management and analysis with Excel®, STATA, R, SAS, Epi Info and Open Data Kit; data mapping with geographical information system software; and use of the guidelines on integrated disease surveillance and response. Perceived reasons for success or failure of the disease surveillance system (not scored) Nearly all the countries (45, 96%) replied to this open question. Their challenges were related mainly to inadequate political commitment or leadership, lack of or limited financial support, insufficient well-qualified human resources, lack of or limited technical and logistical resources and lack of community awareness on arboviral diseases. Other concerns were: • no specific guidelines on arboviral disease surveillance • no programme dedicated to arboviral disease surveillance • poor compliance with the guidelines on integrated disease surveillance and response • no cooperation between ministries of health and public health bodies on activities related to arboviral disease surveillance • difficulty in engaging the private sector • lack of coordination among sectors for joint work • lack of priority of arboviral disease surveillance • lack of community education, sensitization and engagement on issues related to arboviral diseases • closure of some local health facilities due to insecurity • dependence on external donors. Some of the 45 countries also reported factors considered as strengths in this system. “Challenges were related mainly to inadequate political commitment or leadership, lack of or limited financial support, insufficient well-qualified human resources, lack of or limited technical and logistical resources and lack of community awareness on arboviral diseases. “ 18 CHAPTER 3 Surveillance and control of arboviral diseases in the WHO African Region West Africa • technical, logistical and human resources to conduct surveillance (Algeria, Cabo Verde) • functional surveillance systems (Burkina Faso, Mali, Sierra Leone) • laboratory resources and qualified human resources (Côte d’Ivoire) • expertise and opportunities for collaboration (Ghana) • surveillance structures from community to national level (Guinea, Liberia) • good organization of the “health pyramid” for active surveillance of suspected cases of arboviral diseases, existence of various collaborations (WHO, Pasteur Institute) and use of the “One Health” approach (Senegal) Central Africa • political commitment gained in recent epidemics and routine surveillance system in place (Cameroon) • existence of a yellow fever focal point (Burundi) • availability of disease surveillance data (Democratic Republic of the Congo) • designation of arboviral diseases as diseases for surveillance (Gabon), like yellow fever and dengue in Sao Tome and Principe East–Southern Africa • support from the SEGA (epidemiological surveillance and alert management) One Health network,1 existence of sentinel sites and real-time electronic notification in the public health system (Comoros) • use of and regular training of new health workers in integrated disease surveillance and response (Eritrea) • multidisciplinary working groups for arboviral disease surveillance (Eswatini) • national guidelines and strategic documents, capacity-building, adequate budget for regular disease surveillance (Ethiopia) • health facilities in all communes, including in remote areas (Madagascar) • systematic screening of travellers, blood donors and livestock (Mauritius) • surveillance of yellow fever and other epidemic-prone diseases (South Sudan) • well-developed disease surveillance system, trained staff and good Internet coverage (Zimbabwe) Fig. 3 summarizes the status of disease surveillance systems in the African Region. 1 https://www.epiconcept.fr/en/produit/sega-one-health-network/ “No countries have adequate capacity for arboviral disease surveillance. “ 19Results Based on total scores: inadequate capacity, 0 < score < 50%; partially satisfactory capacity, 50% ≤ score < 70%; almost adequate capacity, 70% ≤ score < 90%; adequate capacity, 90% ≤ score ≤ 100%. Fig. 3. Country capacity for arboviral disease surveillance AN GOLA BU RU N D I B E N I N BU RKI N A FASO BOTSWAN A CEN TRAL AFR I CAN RE PU BL I C CAM EROON COMOROS CABO VE RD E ALGER I A ER I TREA ETH I OP I A GABON GH AN A GU I N EA GAM B I A GU I N EA-B I SSAU EQUATOR I AL GU I N EA KEN YA L I B E R I A LE SOTH O MADAGASCAR M AL I M OZAM B I QU E M AU R I TAN I A M AU R I TI U S M ALAWI N AM I B I A N I GE R N I GE R I A RWAN DA SEN EGAL SI E RRA L EON E SOU TH SU DAN SAO TOM E AN D PR I N CI P E E SWATI N I SEYCH E LLE S CH AD TOGO U N I TED REPU BL I C OF TAN ZAN I A U GAN DA SOU TH AFR I CA ZAM B I A ZI M BABWE DEM OCRATI C RE PU BL I C OF TH E CON GOCON GO CÔTE D ’ I VO I RE 0 1 000 2000 km N ot a p p l i ca b l e Ou tsi d e Afr i ca n Regi on D a ta n ot a va i l a b l e Ad eq u a te ca p a ci ty Alm ost a d eq u a te ca p a ci ty Pa rti a l l y sa ti sfa ctory ca p a ci ty I n a d eq u a te ca p a ci ty D i sea se su rve i l l en ce Inadequate capaci tyPa rti a l l y sati sfactory capaci tyAlmost a dequ ate capaci tyD ata n ot a va i l a b l eOu tsi de Afr i can Regi on 20 CHAPTER 3 Surveillance and control of arboviral diseases in the WHO African Region Diagnosis and case notification are considered core capacity requirements for a disease surveillance and response system (49). Country capacity was assessed from five indicators in this domain (Fig. 4). 3.2 Diagnosis and case notification Fig. 4. Status of indicators of diagnostic and case notification in the 47 countries On track Progress Not on track No answer Code Indicator DCN01 Notification of suspected and confirmed cases of major arboviral diseases DCN02 Laboratory confirmation of suspected cases of major arboviral diseases DCN03 Confirmation of positive cases of arboviral disease by a national reference laboratory DCN04 Laboratory testing capacity for detection of arboviruses DCN05 Regular training of health-care workers in notification of Aedes-borne arboviral diseases Zimbabwe Zambia United Republic of Tanzania Uganda South Sudan South Africa Seychelles Rwanda Namibia Mozambique Mauritius Malawi Madagascar Lesotho Kenya Ethiopia Eswatini Eritrea Comoros Botswana Sao Tome and Principe Gabon Equatorial Guinea Democratic Republic of the Congo Congo Chad Central African Republic Cameroon Burundi Angola Togo Sierra Leone Senegal Nigeria Niger Mauritania Mali Liberia Guinea−Bissau Guinea Ghana Gambia Côte dʼIvoire Cabo Verde Burkina Faso Benin Algeria D CN 01 D CN 02 D CN 03 D CN 04 D CN 05 W est A frica Central A frica East-Southern A frica Box 2. Identified weaknesses in diagnostic and case notification • Limited case reporting and notification • Limited confirmation of suspected cases • Limited confirmation of positive cases of arboviral disease by a national reference laboratory • Insufficient laboratory testing capacity for detection of arboviruses • Limited regular training for health-care workers in diagnosis and case notification 21Results DCN01. Notification of suspected and confirmed cases of major arboviral diseases (question 16) Nine countries (19%) reported that cases of arboviral disease were not reported: three in Central Africa (Central African Republic, Equatorial Guinea, Sao Tome and Principe), five in East–Southern Africa (Botswana, Eswatini, Malawi, Uganda, Zimbabwe) and one in West Africa (Guinea- Bissau). In 26 countries (55%), however, both suspected and confirmed cases are notified: 4 in Central Africa, 12 in East–Southern Africa, 10 in West Africa (Fig. 4). Eight countries reported that only suspected cases are notified (Burkina Faso, Burundi, Gambia, Mali, Senegal, Sierra Leone, Togo, Zambia), whereas others notified only confirmed cases (Angola, Democratic Republic of the Congo, South Africa). Table 4 lists the arboviral diseases notified by countries and the numbers according to subregion. Table 4. Subregions and countries that notify arboviral diseases Arboviral disease African Region West Africa Central Africa East–Southern Africa Total Suspected cases Confirmed cases Suspected cases Confirmed cases Suspected cases Confirmed cases Dengue 30 3 11 3 2 0 11 Yellow fever 32 6 8 2 5 4 7 Chikungunya 19 2 2 2 3 1 9 Zika 14 3 3 2 1 0 5 Rift Valley fever 7 1 2 0 0 0 4 Crimean–Congo haemorrhagic fever 3 1 1 0 0 0 1 West Nile fever 1 0 1 0 0 0 0 DCN02. Laboratory confirmation of suspected cases of major arboviral diseases; DCN03. Confirmation of positive cases of arboviral disease by a national reference laboratory; and DCN04. Laboratory testing capacity for detection of arboviruses (questions 17–19) Eleven countries (23%) reported that suspected cases were not confirmed: three in Central Africa (Burundi, Central African Republic, Sao Tome and Principe), six in East–Southern Africa (Botswana, Comoros, Eritrea, Eswatini, Mozambique, Zimbabwe) and two in West Africa (Guinea-Bissau, Nigeria). Thirty-three countries (70%) reported that suspected cases were confirmed: 8 countries only during outbreaks (Chad, Congo, Democratic 22 CHAPTER 3 Surveillance and control of arboviral diseases in the WHO African Region Fifteen countries (32%) reported that positive cases of arboviral disease had not been confirmed by a reference laboratory in the previous 2 years: two in Central Africa (Burundi, Central African Republic), nine in East– Southern Africa (Botswana, Comoros, Eritrea, Eswatini, Lesotho, Malawi, Rwanda, United Republic of Tanzania, Zambia) and four in West Africa (Guinea-Bissau, Niger, Sierra Leone, Togo). Of these, five countries (Botswana, Central African Republic, Eritrea, Guinea-Bissau, Togo) did not send their samples abroad for confirmation, whereas nine sought technical support overseas. Twenty-seven countries (57%) reported that positive cases were confirmed by a national reference laboratory or through collaboration overseas. Most countries reported use of various laboratory testing methods for arbovirus detection and confirmation. In decreasing order, they used reverse transcriptase polymerase chain reaction, immunoglobulin M and G antibodies, antigen testing, virus isolation, neutralizing antibody testing, viral gene and genome sequencing. Eritrea did not report use of any of these methods for arbovirus detection. Twelve countries (26%) did not reply to the question. Republic of the Congo, Lesotho, Madagascar, Mauritania, Namibia, United Republic of Tanzania), 9 countries routinely and 16 countries both routinely and during outbreaks. Some of the 33 countries also reported the percentage of suspected cases tested for confirmation (Table 5). Table 5. Proportions of case confirmation Case confirmation (%) West Africa Central Africa East–Southern Africa Ro ut in el y 100% Côte d’Ivoire, Gambia, Sierra Leone None Ethiopia, Mauritius, South Africa 20–25% None Gabon None 10–20% Benin Angola None < 10% Burkina Faso, Guinea, Senegal, Cabo Verde Cameroon Rwanda Du ri ng ou tb re ak s 50–100% Côte d’Ivoire Gabon Mauritius, Namibia, Rwanda 20–40% Guinea None None 10–20% Burkina Faso, Togo None Ethiopia, South Sudan < 10% Senegal None None 23Results Training was reported as a critical component at all levels of public health structures and as a huge gap. Thirty-two countries (68%) reported that they did not provide regular training for health-care workers in detection and notification of Aedes-borne arboviral diseases. Only eight countries (17%) replied in the affirmative. Additional capacity for adequate detection of arboviral diseases (not scored); and DCN05. Regular training of health-care workers in notification of Aedes-borne arboviral diseases (question 21) Most countries reported additional requirements for satisfactory detection of arboviruses: 35 countries (74%) for staff training and laboratory equipment and 21 countries (45%) for staff (full-time equivalent). Table 6 provides more details according to subregion. Table 6. Expressed needs for the adequate detection of arboviruses Additional requirements West Africa Central Africa East–Southern Africa Additional staff training Algeria, Benin, Burkina Faso, Côte d’Ivoire, Gambia, Ghana, Guinea, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone, Togo Burundi, Cameroon, Central African Republic, Chad, Congo, Equatorial Guinea, Gabon, Sao Tome and Principe Comoros, Eritrea, Eswatini, Ethiopia, Kenya, Madagascar, Mauritius, Mozambique, Namibia, Rwanda, South Sudan, United Republic of Tanzania, Zambia, Zimbabwe Additional laboratory equipment Benin, Burkina Faso, Cabo Verde, Côte d’Ivoire, Gambia, Ghana, Guinea, Liberia, Mali, Niger, Nigeria, Sierra Leone, Togo Angola, Burundi, Cameroon, Central African Republic, Congo, Equatorial Guinea, Gabon, Sao Tome and Principe Comoros, Eritrea, Eswatini, Ethiopia, Kenya, Madagascar, Mauritius, Mozambique, Namibia, Rwanda, South Africa, South Sudan, United Republic of Tanzania, Zambia, Zimbabwe Additional staff (full-time equivalent) Benin, Ghana, Liberia, Niger, Senegal, Sierra Leone, Guinea Burundi, Cameroon, Central African Republic, Congo, Sao Tome and Principe Comoros, Eswatini, Ethiopia, Madagascar, Mauritius, Namibia, Rwanda, South Sudan, United Republic of Tanzania, Zimbabwe 24 CHAPTER 3 Surveillance and control of arboviral diseases in the WHO African Region Personal perceptions of factors of success and challenges in relation to case detection and notification (not scored) Forty-three countries (91%) replied to the question. The challenges reported are similar to those cited for disease surveillance: lack of political commitment and leadership, limited financial support, insufficient qualified human resources, insufficient training, limited technical and logistical laboratory resources and lack of community awareness about arboviral diseases. Other concerns were: • logistical challenges in sending samples nationally and internationally for quality control • difficulty of health-care workers in filling out notification forms • weak surveillance systems • lack of laboratory resources for case detection and confirmation • no WHO-certified laboratory for arbovirus disease diagnosis • limited active case detection • limited resources for data management • no programme for arboviral disease surveillance • lack of priority of arboviral diseases in the reporting system • lack of arbovirus-specific guidelines and knowledge about arboviral disease surveillance • difficulty in engaging the private sector • lack of community engagement The factors of success cited by some countries included: • continued staff training, a national reference laboratory and a functional surveillance system (Algeria, Cabo Verde, Mauritius, Senegal) • guidelines and well-defined reporting channels (Burkina Faso, Eswatini, Ethiopia, Gabon, Nigeria) • a functional surveillance system (Cameroon) • a diagnostic platform at the Pasteur Institute (Central African Republic) • a national epidemiological surveillance or entomology department, regional collaboration through the “One health” approach (Comoros) • trained staff (Côte d’Ivoire, Guinea, Mauritania) • experience of health-care workers in vigilance and case notification of existing and emerging infectious diseases (Eritrea) • surveillance staff (Togo) Fig. 5 summarizes the status of diagnostic and case notification in the African Region. “Factors of success included continued staff training, a national reference laboratory and a functional surveillance  system. “ 25Results Based on total scores: inadequate capacity, 0 < score < 50%; partially satisfactory capacity, 50% ≤ score < 70%; almost adequate capacity, 70% ≤ score < 90%; adequate capacity, 90% ≤ score ≤ 100%. Fig. 5. Country capacity for the diagnostic and case notification of arboviral diseases AN GOLA BU RU N D I B E N I N BU RKI N A FASO BOTSWAN A CEN TRAL AFR I CAN RE PU BL I C CAM EROON COMOROS CABO VE RD E ALGER I A ER I TREA ETH I OP I A GABON GH AN A GU I N EA GAM B I A GU I N EA-B I SSAU EQUATOR I AL GU I N EA KEN YA L I B E R I A LE SOTH O MADAGASCAR M AL I M OZAM B I QU E M AU R I TAN I A M AU R I TI U S M ALAWI N AM I B I A N I GE R N I GE R I A RWAN DA SEN EGAL SI E RRA L EON E SOU TH SU DAN SAO TOM E AN D PR I N CI P E E SWATI N I SEYCH E LLE S CH AD TOGO U N I TED REPU BL I C OF TAN ZAN I A U GAN DA SOU TH AFR I CA ZAM B I A ZI M BABWE DEM OCRATI C RE PU BL I C OF TH E CON GOCON GO CÔTE D ’ I VO I RE 0 1 000 2000 km N ot a p p l i ca b l e Ou tsi d e Afr i ca n Regi on D a ta n ot a va i l a b l e Ad eq u a te ca p a ci ty Alm ost a d eq u a te ca p a ci ty Pa rti a l l y sa ti sfa ctory ca p a ci ty I n a d eq u a te ca p a ci ty D i a gn osi s & ca se n oti fi ca ti on Inadequate capaci tyPa rti a l l y sati sfactory capaci tyAlmost a dequ ate capaci tyAdequ ate capaci tyOu tsi de Afr i can Regi onD ata n ot ava i l a b l e 26 CHAPTER 3 Surveillance and control of arboviral diseases in the WHO African Region Management of cases is considered a core function of health systems (49). Country capacity was assessed from three indicators in this domain. 3.3 Management of cases and severe cases Fig. 6. Status of indicators of management of cases and severe cases in the 47 countries On track Progress Not on track No answer Code Indicator MCSC01 Availability of standardized procedures or guidelines for triage and management of cases and severe cases of arboviral diseases MCSC02 Facilities for management of patients with severe arboviral disease MCSC03 Regular training of health-care workers in clinical diagnosis and management of Aedes-borne arboviral diseases Zimbabwe Zambia United Republic of Tanzania Uganda South Sudan South Africa Seychelles Rwanda Namibia Mozambique Mauritius Malawi Madagascar Lesotho Kenya Ethiopia Eswatini Eritrea Comoros Botswana Sao Tome and Principe Gabon Equatorial Guinea Democratic Republic of the Congo Congo Chad Central African Republic Cameroon Burundi Angola Togo Sierra Leone Senegal Nigeria Niger Mauritania Mali Liberia Guinea−Bissau Guinea Ghana Gambia Côte dʼIvoire Cabo Verde Burkina Faso Benin Algeria M CS C0 1 M CS C0 2 M CS C0 3 W est A frica Central A frica East-Southern A frica Box 3. Weaknesses identified in the management of cases and severe cases • Limited availability of guidelines on clinical management of cases of Aedes-borne arboviral diseases • Insufficient medical equipment for managing severe cases • Gaps in training of health-care workers in clinical management of severe cases 27Results MCSC01. Availability of standardized procedures or guidelines for triage and management of cases and severe cases of arboviral diseases; MCSC02. Facilities for management of patients with severe arboviral disease (questions 23 and 24) Most countries (25, 53%) reported that they had no standardized national procedures or guidance for the management of cases and severe cases: 5 in Central Africa, 15 in East–Southern Africa, 5 in West Africa (Table 7); however, 20 countries (43%) replied in the affirmative. Table 7. Countries with no national guidance or facilities for management of cases and severe cases of arboviral diseases Guidance or facilities for managing cases and severe cases West Africa Central Africa East–Southern Africa No guidance Gambia, Guinea-Bissau, Liberia, Sierra Leone, Togo Burundi, Cameroon, Central African Republic, Equatorial Guinea, Sao Tome and Principe Botswana, Comoros, Eswatini, Ethiopia, Kenya, Lesotho, Madagascar, Malawi, Mozambique, Namibia, South Africa, Uganda, United Republic of Tanzania, Zambia, Zimbabwe No facilities Benin, Burkina Faso, Gambia, Guinea-Bissau, Liberia, Niger, Sierra Leone, Togo Burundi, Cameroon, Central African Republic, Chad, Democratic Republic of the Congo, Gabon, Sao Tome and Principe Comoros, Eritrea, Eswatini, Ethiopia, Mozambique, Seychelles, Zambia, Zimbabwe With regard to facilities for the management of cases of arboviral diseases, 23 countries (49%) reported that they had no special area for such patients: eight in West Africa, eight in East–Southern Africa and seven in Central Africa (Table 7). Countries reported that these cases were managed in general hospitals (Ethiopia, Sierra Leone, Seychelles), isolation units or selected health facilities (Cameroon, Democratic Republic of the Congo) or as outpatients (Chad). Sixteen countries (36%) reported facilities for the management of severe cases of arboviral diseases. Eleven countries (23%) (Algeria, Cabo Verde, Comoros, Eritrea, Ethiopia, Guinea, Mauritius, Namibia, Sao Tome and Principe, South Sudan, United Republic of Tanzania) reported that beds were available in the event of a large disease outbreak. 28 CHAPTER 3 Surveillance and control of arboviral diseases in the WHO African Region MCSC03. Regular training of health-care workers in clinical diagnosis and management of Aedes-borne arboviral diseases (question 26) As for the previous domain, thirty-three countries (70%) reported that they did not provide regular training for their health-care workers in clinical diagnosis and management of Aedes-borne arboviral diseases: six in Central Africa, fourteen in East–Southern Africa and thirteen in West Africa. Only eleven countries (23%) replied in the affirmative. Personal perceptions of the factors for success and challenges in case management (not scored) Thirty-eight countries (81%) replied to the question, similarly to those for previous domains. The reported challenges were related to political commitment and leadership, limited financial support, insufficient qualified human resources, training gaps, limited laboratory technical and logistical resources and lack of the community awareness on arboviral diseases. Other concerns were: • lack of prioritization of arboviral diseases • delays in case notification • lack of guidelines and a case management system • no specific management facilities • lack of laboratory and health facility infrastructure • lack of neglected tropical disease departments that include arboviral diseases • inadequate logistics in health facilities during outbreaks • incorrect treatment of cases of arboviral disease as malaria or influenza • insecurity • high turnover of health-care workers • inadequate availability of essential medicines in lower-level facilities The factors for success reported by some countries included: • adequate stocks of medicines and free treatment for patients with dengue (Burkina Faso) • experience gained from past epidemics (Cabo Verde) • logistical support for the management of cases through the SEGA2 One Health network, possible herd immunity of populations gained through past dengue and chikungunya epidemics (Comoros) • trained staff; a department dedicated to the management of severe cases (Côte d’Ivoire) • early treatment-seeking by the public and prompt management of patients (Eritrea) • screening for febrile illnesses in selected hospitals (Liberia) 2 https://www.epiconcept.fr/en/produit/sega-one-health-network/ “Only 11 countries reported providing regular training for their health-care workers in clinical diagnosis and management of Aedes-borne arboviral diseases. “ 29Results • health facilities with the necessary numbers of health-care workers and case definitions (Madagascar) • routine and permanent surveillance as well as case notification (Mali) • case management centralized and free of charge (Mauritius) • a syndromic sentinel surveillance system to identify febrile episodes and cases of suspected arboviral disease, speedy delivery of test results at the Pasteur Institute in Dakar (Senegal) Fig. 7 shows country capacity for the management of cases and severe cases of arboviral diseases. Based on total scores: inadequate capacity, 0 < score < 50%; partially satisfactory capacity, 50% ≤ score < 70%; almost adequate capacity, 70% ≤ score < 90%; adequate capacity, 90% ≤ score ≤ 100%. Fig. 7. Country capacity for management of cases and severe cases of arboviral diseases AN GOLA BU RU N D I B E N I N BU RKI N A FASO BOTSWAN A CEN TRAL AFR I CAN RE PU BL I C CAM EROON COMOROS CABO VE RD E ALGER I A ER I TREA ETH I OP I A GABON GH AN A GU I N EA GAM B I A GU I N EA-B I SSAU EQUATOR I AL GU I N EA KEN YA L I B E R I A LE SOTH O MADAGASCAR M AL I M OZAM B I QU E M AU R I TAN I A M AU R I TI U S M ALAWI N AM I B I A N I GE R N I GE R I A RWAN DA SEN EGAL SI E RRA L EON E SOU TH SU DAN SAO TOM E AN D PR I N CI P E E SWATI N I SEYCH E LLE S CH AD TOGO U N I TED REPU BL I C OF TAN ZAN I A U GAN DA SOU TH AFR I CA ZAM B I A ZI M BABWE DEM OCRATI C RE PU BL I C OF TH E CON GOCON GO CÔTE D ’ I VO I RE 0 1 000 2000 km N ot a p p l i ca b l e Ou tsi d e Afr i ca n Regi on D a ta n ot a va i l a b l e Ad eq u a te ca p a ci ty Alm ost a d eq u a te ca p a ci ty Pa rti a l l y sa ti sfa ctory ca p a ci ty I n a d eq u a te ca p a ci ty M a n agem en t o f ca ses & severe ca ses <Null>Adequ ate capaci tyI n adequ ate capaci tyN APa rti a l l y sati sfa ctory capaci ty 30 CHAPTER 3 Surveillance and control of arboviral diseases in the WHO African Region Country capacity for virological laboratory-based surveillance was assessed according to two capacity indicators (Fig. 8). 3.4 Virological surveillance Fig. 8. Status of indicators of virological surveillance in the 47 countries On track Progress Not on track No answer Code Indicator VS01 Arbovirus surveillance VS02 Regular training of health-care workers in virological surveillance of arboviruses Zimbabwe Zambia United Republic of Tanzania Uganda South Sudan South Africa Seychelles Rwanda Namibia Mozambique Mauritius Malawi Madagascar Lesotho Kenya Ethiopia Eswatini Eritrea Comoros Botswana Sao Tome and Principe Gabon Equatorial Guinea Democratic Republic of the Congo Congo Chad Central African Republic Cameroon Burundi Angola Togo Sierra Leone Senegal Nigeria Niger Mauritania Mali Liberia Guinea−Bissau Guinea Ghana Gambia Côte dʼIvoire Cabo Verde Burkina Faso Benin Algeria VS 01 VS 02 W est A frica Central A frica East-Southern A frica Box 4. Weaknesses in virological surveillance identified • Limited virological surveillance • Inadequate regular training of health- care workers in virological surveillance of arboviruses 31Results VS01. Arbovirus surveillance (question 28) Table 8 lists the arboviruses known to circulate in the 47 countries. In decreasing order, dengue virus was reported by 26 countries (55%), yellow fever virus by 24 (51%), chikungunya virus by 19 (40%) and Zika virus by 9 (19%). Other arboviruses reported accounted for 51%. Table 8. Arboviruses that are or were circulating in the 47 countries Region Country Number of arboviruses reported Dengue virus Chiku- ngunya virus Zika virus Yellow fever virus Rift Valley fever virus West Nile virus Crimea–Congo haemorrhagic fever virus Others W es t A fr ic a Algeria 2  Toscana virus Benin 2   Burkina Faso 2   Cabo Verde 0 Côte d’Ivoire 2   Gambia Not reported Ghana 2   Guinea 5      Guinea-Bissau 2   Liberia 3    Mali 4     Mauritania 1  Niger 2   Nigeria 2   Senegal 7        Sierra Leone 0 Togo 2   32 CHAPTER 3 Surveillance and control of arboviral diseases in the WHO African Region Region Country Number of arboviruses reported Dengue virus Chiku- ngunya virus Zika virus Yellow fever virus Rift Valley fever virus West Nile virus Crimea–Congo haemorrhagic fever virus Others Ce nt ra l A fr ic a Angola 2   Burundi 0 Cameroon 1  Central African Republic 7       Onyong- nyong virus Chad 2   Congo 3    Democratic Republic of the Congo 2   Equatorial Guinea 1  Gabon 4     Sao Tome and Principe 0 Ea st -S ou th er n Af ri ca Botswana 0 Comoros 3    Eritrea 2   Eswatini 0 Ethiopia 7       Sandfly fever virus Kenya 8        Onyong- nyong virus Lesotho 0 Madagascar 3    Malawi 0 Mauritius 2 Sporadic outbreak  Mozambique 2   Namibia 2   Rwanda 1  Seychelles 2   South Africa 4    Sindbis virus South Sudan 1  Uganda 0 United Republic of Tanzania 5      Zambia 4     Zimbabwe 0 33Results VS02. Regular training of health-care workers in arbovirus surveillance (question 31) Thirty-nine countries (83%) reported that regular training was not provided for health-care workers in virological surveillance of arboviruses: 8 in Central Africa, 17 in East–Southern Africa and 14 in West Africa (Fig. 8). Six countries replied in the affirmative. Personal perceptions of factors of success and challenges in relation to virological surveillance (not scored) Forty countries (85%) replied to the question, with remarks similar to those for previous domains. The reported challenges were related to political commitment and leadership, limited financial support, insufficient qualified human resources, insufficient training, limited laboratory technical resources, reagents and logistics and lack of community awareness about arboviral diseases. Other concerns were: • lack of standardized laboratories for the diagnosis of arboviruses • difficulty in diagnosis because of delays in blood sampling • weak surveillance system • no programme for virological surveillance • disruptions due to COVID-19 • lack of capacity, sampling equipment and laboratories to conduct tests for virological surveillance • insecurity • no routine surveillance • issues with the quality of blood sampling, storage and transport The factors for success reported by countries in this domain included: • national reference laboratories (Algeria, Burkina Faso) • experience gained in previous dengue and Zika epidemics (Cabo Verde) • well-qualified staff, a specific programme on arboviruses (Côte d’Ivoire) • community surveillance systems, logistical resources for transport of samples and availability of laboratory resources (Guinea) • case definitions and reporting tools (Nigeria) • a well-equipped technical platform capable of detecting more than 200 viruses (Senegal) Fig. 9 shows country capacity for virological surveillance. “Thirty-nine countries (83%) reported that regular training was not provided for health-care workers in virological surveillance of arboviruses. “ 34 CHAPTER 3 Surveillance and control of arboviral diseases in the WHO African Region Based on total scores: inadequate capacity, 0 < score < 50%; partially satisfactory capacity, 50% ≤ score < 70%; almost adequate capacity, 70% ≤ score < 90%; adequate capacity, 90% ≤ score ≤ 100%. Fig. 9. Country capacity for the virological surveillance of arboviruses AN GOLA BU RU N D I B E N I N BU RKI N A FASO BOTSWAN A CEN TRAL AFR I CAN RE PU BL I C CAM EROON COMOROS CABO VE RD E ALGER I A ER I TREA ETH I OP I A GABON GH AN A GU I N EA GAM B I A GU I N EA-B I SSAU EQUATOR I AL GU I N EA KEN YA L I B E R I A LE SOTH O MADAGASCAR M AL I M OZAM B I QU E M AU R I TAN I A M AU R I TI U S M ALAWI N AM I B I A N I GE R N I GE R I A RWAN DA SEN EGAL SI E RRA L EON E SOU TH SU DAN SAO TOM E AN D PR I N CI P E E SWATI N I SEYCH E LLE S CH AD TOGO U N I TED REPU BL I C OF TAN ZAN I A U GAN DA SOU TH AFR I CA ZAM B I A ZI M BABWE DEM OCRATI C RE PU BL I C OF TH E CON GOCON GO CÔTE D ’ I VO I RE 0 1 000 2000 km N ot a p p l i ca b l e Ou tsi d e Afr i ca n Regi on D a ta n ot a va i l a b l e Ad eq u a te ca p a ci ty Alm ost a d eq u a te ca p a ci ty Pa rti a l l y sa ti sfa ctory ca p a ci ty I n a d eq u a te ca p a ci ty Vi ro l ogi ca l su rve i l l a n ce <Null>Adequ ate capaci tyAlmost a dequ ate capaci tyI n adequ ate capaci tyN APa rti a l l y sati sfactory capaci ty 35Results These capacities were assessed on the basis of 13 indicators (Fig. 10).3.5 Routine vector surveillance and control Fig. 10. Status of indicators of routine vector surveillance and control in the 47 countries On track Progress Not on track No answer Code Indicator RVSC01 A national institution or agency for arbovirus vector surveillance RVSC02 A national record of Ae. aegypti or Ae. albopictus RVSC03 Entomological surveillance of vectors of arboviruses RVSC04 A formal institution for reporting entomological surveillance data to the ministry of health RVSC05 Surveillance of adult vectors of arboviruses RVSC06 Surveillance of larvae and pupae of vectors of arboviruses RVSC07 Identification of vectors of arboviruses RVSC08 Determination of minimum infection rates for major arboviral diseases RVSC09 A national laboratory for screening collected mosquito pools for arboviruses RVSC10 Implementation of core vector control approaches RVSC11 Regular training of staff in vector control and surveillance RVSC12 A plan for control of mosquito- borne diseases including indicators that would result in recommendations for vector control RVSC13 Monitoring of insecticide resistance among vectors of arboviruses Zimbabwe Zambia United Republic of Tanzania Uganda South Sudan South Africa Seychelles Rwanda Namibia Mozambique Mauritius Malawi Madagascar Lesotho Kenya Ethiopia Eswatini Eritrea Comoros Botswana Sao Tome and Principe Gabon Equatorial Guinea Democratic Republic of the Congo Congo Chad Central African Republic Cameroon Burundi Angola Togo Sierra Leone Senegal Nigeria Niger Mauritania Mali Liberia Guinea−Bissau Guinea Ghana Gambia Côte dʼIvoire Cabo Verde Burkina Faso Benin Algeria RV SC 01 RV SC 02 RV SC 03 RV SC 04 RV SC 05 RV SC 06 RV SC 07 RV SC 08 RV SC 09 RV SC 10 RV SC 11 RV SC 12 RV SC 13 W est A frica Central A frica East-Southern A frica 36 CHAPTER 3 Surveillance and control of arboviral diseases in the WHO African Region RVSC01. A national institution or agency for arbovirus vector surveillance; RVSC02. A national record of Ae. aegypti or Aedes albopictus (questions 33 and 34) Nineteen countries (40%) reported that they did not have a national institution or other entity responsible for arbovirus vector surveillance: four in Central Africa, seven in East–Southern Africa and eight in West Africa, whereas 24 (51%) replied in the affirmative. The institutions were national malaria control programmes (Burundi, Comoros, Côte d’Ivoire, Mozambique), national vector-borne disease control programmes or neglected tropical disease departments (Namibia, Kenya), universities (Togo), national research institutes (Algeria, Benin, Cabo Verde, Democratic Republic of the Congo, Ghana) or special departments within the ministry of health (Central African Republic, Eritrea, Lesotho, Seychelles, South Sudan). With regard to national records on Ae. aegypti and Ae. albopictus in the previous 5 years, 15 countries (32%) replied in the affirmative for Ae. aegypti, 2 (4%) for Ae. albopictus and 11 (23%) for both species. Ten countries (21%) indicated that neither vector had been identified in their country at the time of the survey but did not exclude their presence. Box 5. Identified weaknesses in routine vector surveillance and control • Limited programme or structure dedicated to Aedes vector surveillance • Poor entomological surveillance of Aedes mosquitoes • Limited control of the vectors of arboviruses • Lack of expertise in entomology and vector control with respect to arboviral diseases • Lack of surveillance of resistance of Aedes to insecticides • No regular training sessions for specialists in vector control and surveillance of Aedes vectors 37Results RVSC03. Entomological surveillance of vectors of arboviruses; RVSC04. A formal institution for reporting entomological surveillance data to the ministry of health; RVSC05. Surveillance of adult vectors of arboviruses; RVSC06. Surveillance of larvae and pupae of vectors of arboviruses; RVSC07. Identification of vectors of arboviruses; RVSC13. Monitoring of insecticide resistance among vectors of arboviruses (questions 35–38 and 46) Twenty-five countries (53%) reported that they had not conducted entomological surveillance for vectors of arboviruses in the previous 2 years: 2 in Central Africa, 13 in East–Southern Africa and 10 in West Africa. Fifteen countries (32%) had conducted such surveillance, whereas seven countries replied “Don’t know”. Surveillance was restricted to specific locations in 11 countries (23%) and was countrywide in 3 countries. Four countries (Benin, Comoros, Mali and Sierra Leone) provided their surveillance reports, and nine countries reported the number of sentinel surveillance sites at the time of the survey: 10 sites in Benin and Mauritius; 6 sites in Comoros, Côte d’Ivoire; 4 sites in Angola, Democratic Republic of the Congo, Mali and Sierra Leone; and 3 sites in Algeria. Entomological surveillance was conducted once a year in Comoros, Kenya and Sierra Leone; every semester in Democratic Republic of the Congo and Mali; and every trimester in Angola, Benin and Côte d’Ivoire. Algeria and Equatorial Guinea conducted surveillance weekly, Mauritius monthly and Gambia on an ad hoc basis. The institutions responsible for reporting entomological surveillance data to the ministry of health or health department were state or provincial health agencies in 16 countries, universities or other academic institutions in 16 countries, national agencies in 6 countries, local mosquito control organizations in 5 countries and city health departments in 4 countries. Surprisingly, private companies were not mentioned by any country. Surveillance of adult mosquitoes was not conducted in most countries: 23 (49%) reported that they had not conducted surveillance of adult Aedes, and 22 (47%) reported no surveillance of larvae or pupae; however, 17 countries (36%) and 20 countries (43%), respectively, had conducted such surveillance. Twenty-five countries (53%) indicated that they identified the species of mosquito trapped, while 11 (23%) did not. Most countries (37, 79%) reported that they did not have a surveillance system to monitor the resistance of Aedes to insecticides. These comprised all 10 countries in Central Africa, 16 in East–Southern Africa and 11 in West Africa. Only 5 countries (11%) reported having such a system. “Surveillance of adult mosquitoes was not conducted in most countries. “ 38 CHAPTER 3 Surveillance and control of arboviral diseases in the WHO African Region RVSC08. Determination of minimum infection rates for major arboviral diseases; RVSC09. A national laboratory for screening mosquito pools for arboviruses (questions 40 and 41) Twenty-four countries (51%) reported that they did not calculate minimum infection rates, while 12 (26%) responded in the affirmative. Kenya reported estimation of minimum infection rates in outbreak situations and during vector competence studies, and Senegal reported calculation of minimum infection rates for dengue, yellow fever, Rift Valley fever and Crimea-Congo haemorrhagic fever. Five countries did not conduct screening of mosquito pools for arboviruses (Benin, Eritrea, Gambia, Niger and Seychelles). Eighteen countries replied “Not applicable” to the question, as Aedes surveillance was not conducted at national level: four in Central Africa (Burundi, Cameroon, Congo, Sao Tome and Principe), six in East–Southern Africa (Eswatini, Lesotho, Malawi, Mozambique, Namibia, Rwanda) and eight in West Africa (Burkina Faso, Cabo Verde, Guinea, Guinea-Bissau, Liberia, Mauritania, Nigeria, Togo). The remaining 24 countries reported screening of mosquito pools for arboviruses in national institutions, university laboratories or public health centres. 39Results Potential public health threat of Ae. albopictus and Ae. aegypti (not scored) Table 9 illustrates the potential public health threat of Aedes vectors by country and region. Table 9. Potential public health threat of Aedes vectors in the African Region Potential public health threat West Africa Central Africa East–Southern Africa Aedes aegypti Found occasionally and does not pose a significant public health threat Mauritania, Niger Burundi Eswatini, Zambia, Zimbabwe Abundant, and arboviruses are circulating Benin, Côte d’Ivoire, Guinea, Liberia, Senegal, Sierra Leone Angola, Cameroon Kenya, Mozambique Restricted to a few sites and does not pose a significant public health threat Gambia Spreading and poses a significant public health threat Burkina Faso, Cabo Verde, Guinea-Bissau, Togo Central African Republic, Congo, Democratic Republic of the Congo, Sao Tome and Principe Comoros, Eritrea, Ethiopia, South Africa, South Sudan, United Republic of Tanzania Stable in some areas and poses a significant public health threat Mali Madagascar No data Algeria, Ghana, Nigeria Chad, Equatorial Guinea, Gabon Botswana, Lesotho, Malawi, Namibia, Rwanda, Uganda Not present Mauritius, Seychelles Aedes albopictus Found occasionally and does not pose a significant public health threat Burkina Faso, Côte d’Ivoire, Guinea, Niger Zimbabwe Abundant, and arboviruses are circulating Sierra Leone Seychelles Restricted to a few sites and does not pose a significant public health threat Benin, Gambia, Nigeria Sao Tome and Principe Madagascar, United Republic of Tanzania Spreading and poses a significant public health threat Algeria Central African Republic, Congo, Democratic Republic of the Congo Ethiopia, Mauritius, Mozambique, South Africa Stable in selected areas and pose a significant public health threat Mali Comoros No data Ghana, Guinea-Bissau, Liberia, Mauritania, Senegal, Togo Angola, Burundi, Chad, Equatorial Guinea, Gabon Botswana, Eritrea, Eswatini, Kenya, Lesotho, Malawi, Namibia, Rwanda, South Sudan, Uganda, Zambia Not present Cabo Verde 40 CHAPTER 3 Surveillance and control of arboviral diseases in the WHO African Region RVSC10. Implementation of core vector control approaches; RVSC12. A plan for control of mosquito-borne diseases including indicators that would result in recommendations for vector control (questions 43 and 45) Sixteen countries (34%) reported that no adulticiding and/or larviciding operations had been conducted in the previous 2 years: three in Central Africa (Cameroon, Central African Republic, Congo), seven in West Africa (Gambia, Guinea-Bissau, Liberia, Mauritania, Nigeria, Sierra Leone, Togo) and six in East–Southern Africa (Lesotho, Malawi, Mozambique, Namibia, Rwanda, Zambia). These results do not necessarily indicate lack of capacity for vector control but rather the situation in the country at the time of the survey. Twenty-seven countries (57%) reported that they had conducted adulticiding and/or larviciding: 7 in Central Africa, 11 in East– Southern Africa and 9 in West Africa. Six countries indicated that they would have conducted vector control if sufficient funds were available: Gambia, Liberia, Mauritania, Namibia, Nigeria and Sierra Leone, while six others replied in the negative without indicating the reason: Central African Republic, Lesotho, Mozambique, Rwanda, Togo and Zambia. Countries were asked whether they followed a plan for vector control activities for mosquito-borne disease control. Twenty-three countries (49%) replied that they had no formal plan: 6 in Central Africa, 5 in East–Southern Africa and 12 in West Africa. Fourteen countries (30%) reported that they had a plan but no indicator that would result in a recommendation to trigger vector control: four in Central Africa, eight in East–Southern Africa and two in West Africa. Only eight countries reported a plan with indicators to trigger vector control. The indicators were: concurrent human cases (Côte d’Ivoire, Eswatini, South Africa, South Sudan, Zimbabwe), Breteau index (Cabo Verde, Côte d’Ivoire, Mauritius, South Sudan), house or container index (Cabo Verde, Côte d’Ivoire, South Sudan), vector density (Côte d’Ivoire, Zimbabwe) and minimum infection rate (Zimbabwe). RVSC11. Regular training of staff in vector control and surveillance (question 44) Similar gaps in training were reported as for previous domains. Twenty- four countries (51%) reported that they did not provide regular training for staff responsible for vector control and surveillance: 5 in Central Africa, 10 in East–Southern Africa and 9 in West Africa. Eleven countries (23%) reported that their staff were trained in both activities, whereas four countries reported training only in vector control. “Only eight countries reported a plan with indicators to trigger vector control. “ 41Results Personal perceptions of factors of success and challenges in vector surveillance and control (not scored) Forty countries (85%) replied to the question, with results similar to those for previous domains. The reported challenges were related to political commitment and leadership, lack of or limited financial support dedicated to vector surveillance and control, lack of or insufficient qualified human resources, training gaps and limited laboratory technical and logistical resources. Other concerns included: • difficulty in accessing houses for spraying or to install mosquito traps (Angola) • no vector control programme or department (Burkina Faso, Guinea) • no surveillance system (Burundi, Cameroon, Equatorial Guinea, Guinea) • vector control focused on malaria vectors (Comoros, Guinea, Namibia) • no coordination of vector control activities (Congo, Guinea) • limited technical resources and laboratory reagents for monitoring insecticide resistance, difficulty in obtaining insecticides, obsolete equipment (Côte d’Ivoire, Guinea) • no national guidelines on Aedes vector surveillance and control (Ethiopia, Guinea) • limited collaboration between public health institutes and the ministry of health for surveillance and control of vectors of arboviruses (Ethiopia) • insecurity (Mali) The factors of success reported by countries in this domain included: • availability of expertise and standard operating procedure (Algeria, Senegal) • insectariums and vector control programmes (Côte d’Ivoire) • motivated, well-trained, well-organized vector control teams, availability of insecticides and monitoring of Aedes resistance to insecticides (Cabo Verde) • malaria vector control programmes and entomology departments (Comoros, Eswatini, South Sudan) • vector control programmes for malaria and human African trypanosomiasis and renowned researchers working on mosquitoes and tsetse flies • a strategic plan for surveillance of diseases with epidemic potential (Guinea) • collaboration between the national malaria control programme and multisectoral entities (Madagascar) Fig. 11 shows the situation of routine surveillance and control of Aedes vectors in African Region. 42 CHAPTER 3 Surveillance and control of arboviral diseases in the WHO African Region Based on total scores: inadequate capacity, 0 < score < 50%; partially satisfactory capacity, 50% ≤ score < 70%; almost adequate capacity, 70% ≤ score < 90%; adequate capacity, 90% ≤ score ≤ 100%. Fig. 11. Country capacity for routine vector surveillance and control AN GOLA BU RU N D I B E N I N BU RKI N A FASO BOTSWAN A CEN TRAL AFR I CAN RE PU BL I C CAM EROON COMOROS CABO VE RD E ALGER I A ER I TREA ETH I OP I A GABON GH AN A GU I N EA GAM B I A GU I N EA-B I SSAU EQUATOR I AL GU I N EA KEN YA L I B E R I A LE SOTH O MADAGASCAR M AL I M OZAM B I QU E M AU R I TAN I A M AU R I TI U S M ALAWI N AM I B I A N I GE R N I GE R I A RWAN DA SEN EGAL SI E RRA L EON E SOU TH SU DAN SAO TOM E AN D PR I N CI P E E SWATI N I SEYCH E LLE S CH AD TOGO U N I TED REPU BL I C OF TAN ZAN I A U GAN DA SOU TH AFR I CA ZAM B I A ZI M BABWE DEM OCRATI C RE PU BL I C OF TH E CON GOCON GO CÔTE D ’ I VO I RE 0 1 000 2000 km N ot a p p l i ca b l e Ou tsi d e Afr i ca n Regi on D a ta n ot a va i l a b l e Ad eq u a te ca p a ci ty Alm ost a d eq u a te ca p a ci ty Pa rti a l l y sa ti sfa ctory ca p a ci ty I n a d eq u a te ca p a ci ty Rou ti n e vector su rve i l l a n ce & con tro l <Null>Adequ ate capaci tyAlmost a dequ ate capaci tyI n adequ ate capaci tyN APa rti a l l y sati sfactory capaci ty 43Results Five capacity indicators were used to assess country capacity in this domain. 3.6 Community sensitization and participation in non-epidemic periods Fig. 12. Status of indicators of community sensitization and participation in non-epidemic periods in the 47 countries On track Progress Not on track No answer Code Indicator CSPEP01 Community outreach programme on arboviral diseases and vectors CSPEP02 Effective communication of an outreach programme on local risks of transmission and possible vector control activities CSPEP03 Regular training of staff responsible for community sensitization and mobilization CSPEP04 Geographical extension of the outreach programme CSPEP05 Financial resources for the outreach programme Zimbabwe Zambia United Republic of Tanzania Uganda South Sudan South Africa Seychelles Rwanda Namibia Mozambique Mauritius Malawi Madagascar Lesotho Kenya Ethiopia Eswatini Eritrea Comoros Botswana Sao Tome and Principe Gabon Equatorial Guinea Democratic Republic of the Congo Congo Chad Central African Republic Cameroon Burundi Angola Togo Sierra Leone Senegal Nigeria Niger Mauritania Mali Liberia Guinea−Bissau Guinea Ghana Gambia Côte dʼIvoire Cabo Verde Burkina Faso Benin Algeria C SP EP 01 C SP EP 02 C SP EP 03 C SP EP 04 C SP EP 05 W est A frica C entral A frica East-Southern A frica Box 6. Identified weaknesses in community sensitization and participation in non-epidemic periods • Lack of financial support • Large gaps in training of health-care workers and community health-care workers • Lack of educational and reference materials for community sensitization and education for both health departments and communities 44 CHAPTER 3 Surveillance and control of arboviral diseases in the WHO African Region Almost all the countries (43, 94%) reported an outreach programme. Four did not have such a programme: Congo, Guinea-Bissau, Liberia and Sao Tome and Principe. The existence of an outreach programme contrasted with their operational status, however, as 19 countries (40%) reported that their national arboviral disease programmes had not publicly communicated on any activities and had not issued prevention messages related to arboviral diseases in the previous 2 years: five in Central Africa, nine in East–Southern Africa and five in West Africa. Six countries (Eswatini, Gambia, Lesotho, Mauritania, Togo, Zimbabwe) reported that they had not communicated on arboviral diseases in the previous 2 years because there was no perceived risk of transmission. Nevertheless, 26 countries (55%) reported that messages on prevention or on activities related to the control of arboviral diseases had been communicated by national, state or local public health agencies. The channels used to deliver messages to local communities were, in decreasing order, television and radio, press releases, town, community or neighbourhood meetings, agency webpage, social media, door-to-door outreach, passive distribution of information brochures, mosques and churches. Most countries indicated that their communications were national (23 countries, 49%), while six countries (13%) issued communications only in selected areas (Burkina Faso, Chad, Madagascar, Senegal, South Africa, South Sudan). One of the major challenges identified for outreach programmes was financial support. Forty-three countries (91%) reported that they received insufficient funds to cover staff time and activities: 9 in Central Africa, 19 in East–Southern Africa and 15 in West Africa. Only Algeria reported that the necessary funds were available. The second important challenge was reported to be training. Thirty-seven countries (79%) did not provide regular training for staff responsible for community sensitization and mobilization to ensure acceptance of interventions for the control of arboviral diseases: 8 in Central Africa, 17 in East–Southern Africa and 12 in West Africa. Other requirements necessary to achieve adequate capacity included: • educational materials for the public in 35 countries: 5 in Central Africa, 19 in East–Southern Africa and 11 in West Africa • educational and reference materials for trainers and communities in 34 countries: 7 in Central Africa, 16 in East–Southern Africa and 11 in West Africa • educational and reference materials for local health departments in 31 countries: 8 in Central Africa, 14 in East–Southern Africa and 9 in West Africa • additional staff in 23 countries: 7 in Central Africa, 12 in East–Southern Africa and 4 in West Africa “94% of countries reported an outreach programme. “ 45Results Personal perceptions of factors for success and challenges in relation to community participation (not scored) Forty-two countries (89%) answered the question. The reported challenges were related to political commitment, lack of financial support for community sensitization and participation in activities, lack of qualified human resources and training and limited logistical resources. Other concerns included: • misunderstanding or misinterpretation of messages in the community (Angola) • no outreach programme (Cameroon, Eswatini, Guinea-Bissau) • few community health workers (Comoros, Eswatini, Mauritania) • no communication plan (Congo) • limited communication on arboviral diseases (Equatorial Guinea) • no national strategic guidelines for outreach programmes (Ethiopia) • poor stakeholder engagement (Ethiopia, Guinea) • limited educational materials (Ghana) • lack of local data for setting priorities (Malawi) • insecurity (Mali) • little awareness among community health workers about arboviral diseases and vector control (Namibia) The factors for success reported by some countries in this domain included: • adequate human and material resources (Algeria) • translation of messages into local languages, use of television for communication (Angola) • an outreach programme and dedicated staff at all levels of the health pyramid (Benin) • events-based activities (Burkina Faso) • experience gained from past epidemics and specific days dedicated to cleaning at national and local levels (Cabo Verde) • availability of the community to participate in activities for the control of arboviral diseases (Democratic Republic of the Congo) • good community acceptance of interventions (Eritrea) • multisectoral collaboration in epidemic situations (Madagascar) Fig. 13 shows country capacity in relation to community sensitization and participation in non-epidemic periods in the African Region. 46 CHAPTER 3 Surveillance and control of arboviral diseases in the WHO African Region Based on total scores: inadequate capacity, 0 < score < 50%; partially satisfactory capacity, 50% ≤ score < 70%; almost adequate capacity, 70% ≤ score < 90%; adequate capacity, 90% ≤ score ≤ 100%. Fig. 13. Country capacity for community sensitization and participation in non-epidemic periods AN GOLA BU RU N D I B E N I N BU RKI N A FASO BOTSWAN A CEN TRAL AFR I CAN RE PU BL I C CAM EROON COMOROS CABO VE RD E ALGER I A ER I TREA ETH I OP I A GABON GH AN A GU I N EA GAM B I A GU I N EA-B I SSAU EQUATOR I AL GU I N EA KEN YA L I B E R I A LE SOTH O MADAGASCAR M AL I M OZAM B I QU E M AU R I TAN I A M AU R I TI U S M ALAWI N AM I B I A N I GE R N I GE R I A RWAN DA SEN EGAL SI E RRA L EON E SOU TH SU DAN SAO TOM E AN D PR I N CI P E E SWATI N I SEYCH E LLE S CH AD TOGO U N I TED REPU BL I C OF TAN ZAN I A U GAN DA SOU TH AFR I CA ZAM B I A ZI M BABWE DEM OCRATI C RE PU BL I C OF TH E CON GOCON GO CÔTE D ’ I VO I RE 0 1 000 2000 km N ot a p p l i ca b l e Ou tsi d e Afr i ca n Regi on D a ta n ot a va i l a b l e Ad eq u a te ca p a ci ty Alm ost a d eq u a te ca p a ci ty Pa rti a l l y sa ti sfa ctory ca p a ci ty I n a d eq u a te ca p a ci ty Comm u n i ty sen si ti za ti on & p a rti c i p a ti on i n n on -ep i d em i c p er i od s <Null>Adequ ate capaci tyAlmost a dequ ate capaci tyI n adequ ate capaci tyN APa rti a l l y sati sfactory capaci ty 47Results A critical aspect of any outbreak is timely collective action to reduce both the temporal and the spatial spread of the disease. For collective action to be taken without delay, countries must be prepared in advance. Five capacity indicators were used to screen country capacity in this domain (Fig. 14). 3.7 Preparedness for outbreaks and epidemics of arboviral disease Fig. 14. Status of indicators of preparedness for arboviral disease outbreaks and epidemics in the 47 countries On track Progress Not on track No answer Code Indicator PAO01 A national committee for surveillance of outbreaks and response PAO02 A national outbreak response and contingency plan PAO03 Definition or definitions of arboviral disease outbreaks PAO04 Cooperation agreements in outbreak situations PAO05 Vector control interventions during outbreaks PAO06 Emergency fund for arboviral disease outbreak response PAO07 Regular training of staff responsible for preparedness for arboviral disease outbreaks and epidemics Zimbabwe Zambia United Republic of Tanzania Uganda South Sudan South Africa Seychelles Rwanda Namibia Mozambique Mauritius Malawi Madagascar Lesotho Kenya Ethiopia Eswatini Eritrea Comoros Botswana Sao Tome and Principe Gabon Equatorial Guinea Democratic Republic of the Congo Congo Chad Central African Republic Cameroon Burundi Angola Togo Sierra Leone Senegal Nigeria Niger Mauritania Mali Liberia Guinea−Bissau Guinea Ghana Gambia Côte dʼIvoire Cabo Verde Burkina Faso Benin Algeria P A O 01 P A O 02 P A O 03 P A O 04 P A O 05 P A O 06 P A O 07 W est A frica C entral A frica East-Southern A frica Box 7. Weaknesses identified in preparedness for arboviral disease outbreaks and epidemics • Lack of adequate training in arboviral disease outbreaks • Lack of financial support for activities related to outbreak preparedness 48 CHAPTER 3 Surveillance and control of arboviral diseases in the WHO African Region PAO01. A national committee for surveillance and outbreak response; PAO02. A national outbreak response and contingency plan; PAO03. Definition or definitions of arboviral disease outbreaks (questions 56–58) Guinea-Bissau, Malawi and Namibia were the only three countries that reported they had no national surveillance and outbreak response committee. Although 43 countries reported they had such a committee, 16 countries (34%) did not have a contingency plan for organizing health-care services during an outbreak: five in Central Africa, six in East–Southern Africa and five in West Africa. Twenty-eight countries (60%) reported having such a plan. With regard to definition of arboviral disease outbreaks, 10 countries (21%) indicated that they had no established criteria for declaring an outbreak of dengue, Zika, chikungunya or any other arboviral disease in their countries: one in Central Africa (Central African Republic), five in East–Southern Africa (Botswana, Eswatini, Kenya, Namibia, Zimbabwe) and four in West Africa (Gambia, Guinea-Bissau, Niger, Togo). Thirty-four countries (72%) had definitions for arboviral disease outbreaks. PAO04. Cooperation agreements in outbreak situations (question 59) Only nine countries (19%) reported that they had no established collaboration with national or regional research institutions or international agencies that could be activated in case of an arboviral disease outbreak. Thirty-one countries (66%) indicated that they could rely on such a collaboration. These included: • universities (Algeria, Central African Republic, Côte d’Ivoire, Togo) • national research or public health institutes (Burundi, Congo, Kenya, Mauritania, Mali) • regional support (Comoros, Guinea-Bissau, Mauritius) • WHO (Burkina Faso, Cabo Verde, Congo, Ethiopia, Niger, Sierra Leone) • other international institutions, such as the United Nations Children’s Fund, US Centers for Disease Control and Prevention, Food and Agriculture Organization of the United Nations, United Nations Development Programme, International Cooperation Centre on Agrarian Research for Development (Comoros, Niger, South Africa, Zimbabwe) PAO05. Vector control interventions during outbreaks (question 60) Ten countries (21%) reported that vector control interventions had not been used in emergencies, while 37 countries (79%) had done so. “Thirty-four countries (72%) had definitions for arboviral disease outbreaks. “ 49Results PAO06. Emergency fund for arboviral disease outbreak response (question 61) Financial challenges were reported by most countries in the survey. Thirty-four countries (72%) reported that they did not have an emergency fund or a specified emergency funding mechanism for arbovirus disease outbreak response in the previous 2 years: 7 in Central Africa, 17 in East– Southern Africa and 10 in West Africa. These results do not entirely reflect the capacity of these countries to address arboviral disease outbreaks, as the question referred only to the previous 2 years and funding mobilization might depend on a country’s risk of an arboviral disease outbreak. Only nine countries (19%) indicated that they had emergency funds for an arboviral disease outbreak response in the previous 2 years. PAO07. Regular training of staff responsible for preparedness for arboviral disease outbreaks and epidemics (question 62) The responses in this domain reflect those to previous questions regarding training. Thirty-four countries (72%) reported that they did not provide regular training for staff and had no committee in charge of preparedness for arboviral disease outbreaks and epidemics: 8 in Central Africa, 15 in East–Southern Africa and 11 in West Africa. Nine countries (19%) reported regular training of staff. Personal perceptions of factors for success and challenges in relation to preparedness for arboviral disease outbreaks and epidemics (not scored) Thirty-seven countries (79%) replied to the question. The reported challenges were related to political commitment, lack of financial support dedicated to community sensitization and participation in activities, lack of qualified human resources, lack of regular training of health professionals in preparedness and limited logistical resources. Other concerns included: • delays in fund mobilization (Angola, Ethiopia) • lack of priority for preparedness for arboviral disease outbreaks and epidemics (Benin) • no outreach programme (Comoros, Democratic Republic of the Congo) • unsuccessful collaboration between national and regional research institutions (Eritrea) • no contingency plan and no preparedness for events related to arboviral disease outbreaks (Eswatini) • difficult working conditions (Guinea-Bissau) 50 CHAPTER 3 Surveillance and control of arboviral diseases in the WHO African Region The factors for success in this domain reported by some countries included: • human and financial resources (Algeria, Cabo Verde, Côte d’Ivoire) • an annual response plan for arboviral diseases (Burkina Faso) • health emergency response centres (Burkina Faso) • contingency plans (Cabo Verde, Gabon) • multisectoral collaboration (Comoros) Fig. 15 shows country preparedness for arboviral disease outbreaks and epidemics in the African Region. Fig. 15. Country capacity for preparedness for arboviral disease outbreaks and epidemics AN GOLA BU RU N D I B E N I N BU RKI N A FASO BOTSWAN A CEN TRAL AFR I CAN RE PU BL I C CAM EROON COMOROS CABO VE RD E ALGER I A ER I TREA ETH I OP I A GABON GH AN A GU I N EA GAM B I A GU I N EA-B I SSAU EQUATOR I AL GU I N EA KEN YA L I B E R I A LE SOTH O MADAGASCAR M AL I M OZAM B I QU E M AU R I TAN I A M AU R I TI U S M ALAWI N AM I B I A N I GE R N I GE R I A RWAN DA SEN EGAL SI E RRA L EON E SOU TH SU DAN SAO TOM E AN D PR I N CI P E E SWATI N I SEYCH E LLE S CH AD TOGO U N I TED REPU BL I C OF TAN ZAN I A U GAN DA SOU TH AFR I CA ZAM B I A ZI M BABWE DEM OCRATI C RE PU BL I C OF TH E CON GOCON GO CÔTE D ’ I VO I RE 0 1 000 2000 km N ot a p p l i ca b l e Ou tsi d e Afr i ca n Regi on D a ta n ot a va i l a b l e Ad eq u a te ca p a ci ty Alm ost a d eq u a te ca p a ci ty Pa rti a l l y sa ti sfa ctory ca p a ci ty I n a d eq u a te ca p a ci ty P repa red n ess fo r ou tb rea ks & ep i d em i cs <Null>Adequ ate capaci tyAlmost a dequ ate capaci tyI n adequ ate capaci tyN APa rti a l l y sati sfactory capaci ty Based on total scores: inadequate capacity, 0 < score < 50%; partially satisfactory capacity, 50% ≤ score < 70%; almost adequate capacity, 70% ≤ score < 90%; adequate capacity, 90% ≤ score ≤ 100%. 51Regional capacity assessment Regional and subregional capacity for arboviral disease surveillance and control are summarized in Fig. 16. Regional capacity assessment Fig. 16. Average regional and subregional capacity in the seven domains assessed 33.8 39.9 42.7 45.8 52.4 53 57.8 46.5 PAO CSPEP RVSC VS MCSC DCN DS Regional capacity 0 20 40 60 80 Percentage (%) 43.1 47.1 47.5 47.6 62.9 64.7 64.7 54 PAO CSPEP RVSC VS MCSC DCN DS WA capacity 0 20 40 60 80 0 20 40 60 80 0 20 40 60 80 Percentage (%) 30 38 41.2 45 49 49 57.9 44.3 PAO CSPEP RVSC VS MCSC DCN DS CA capacity Percentage (%) 27.5 28.3 42.5 43.5 47 48.8 50.7 41.2 PAO CSPEP RVSC VS MCSC DCN DS ESA capacity Percentage (%) Percentages are average scores for each domain. WA, West Africa; CA, Central Africa; ESA, East–Southern Africa; DS: disease surveillance system; DCN: diagnostic and case notification; MCSC: management of cases and severe cases; VS: virological surveillance; RVSC: routine vector surveillance and control; CSPEP: community sensitization and participation in non-epidemic periods; PAO: preparedness for arboviral disease outbreaks and epidemics. CHAPTER 4 52 CHAPTER 4 Surveillance and control of arboviral diseases in the WHO African Region Based on total scores: inadequate capacity, 0 < score < 50%; partially satisfactory capacity, 50% ≤ score < 70%; almost adequate capacity, 70% ≤ score < 90%; adequate capacity, 90% ≤ score ≤ 100%. As a whole, the WHO African Region has “inadequate capacity” to control arboviral diseases in due form, as the regional average score was 46.5% (Fig. 16). No domain scored more than 60%, indicating that strengthening is necessary in all seven domains. The areas of work to be strengthened, in increasing order of priority (i.e., from lowest to highest capacity) are: • management of cases and severe cases • virological surveillance • community sensitization and participation in non-epidemic periods • routine vector surveillance and control • diagnosis and case notification • disease surveillance • preparedness for arboviral disease outbreaks and epidemics At subregional level, West Africa has partially satisfactory capacity and Central Africa and East–Southern Africa have inadequate capacity in all domains except for preparedness for arboviral disease outbreaks and epidemics (Fig. 17). Details of each country’s situation regarding the seven domains are provided in Annex 2. 4.1 Region Fig. 17. Overall country capacity in the seven domains assessed AN GOLA BU RU N D I B E N I N BU RKI N A FASO BOTSWAN A CEN TRAL AFR I CAN RE PU BL I C CAM EROON COMOROS CABO VE RD E ALGER I A ER I TREA ETH I OP I A GABON GH AN A GU I N EA GAM B I A GU I N EA-B I SSAU EQUATOR I AL GU I N EA KEN YA L I B E R I A LE SOTH O MADAGASCAR M AL I M OZAM B I QU E M AU R I TAN I A M AU R I TI U S M ALAWI N AM I B I A N I GE R N I GE R I A RWAN DA SEN EGAL SI E RRA L EON E SOU TH SU DAN SAO TOM E AN D PR I N CI P E E SWATI N I SEYCH E LLE S CH AD TOGO U N I TED REPU BL I C OF TAN ZAN I A U GAN DA SOU TH AFR I CA ZAM B I A ZI M BABWE DEM OCRATI C RE PU BL I C OF TH E CON GOCON GO CÔTE D ’ I VO I RE 0 1 000 2000 km N ot a p p l i ca b l e Ou tsi d e Afr i ca n Regi on D a ta n ot a va i l a b l e Ad eq u a te ca p a ci ty Alm ost a d eq u a te ca p a ci ty Pa rti a l l y sa ti sfa ctory ca p a ci ty I n a d eq u a te ca p a ci ty Cou n try ca p a ci ti es <Null>Adequ ate capaci tyAlmost a dequ ate capaci tyI n adequ ate capaci tyN APa rti a l l y sati sfactory capaci ty 53Regional capacity assessment West Africa was the only subregion in which capacity is increasing in three of the seven domains: disease surveillance, diagnosis and case notification and preparedness for arboviral disease outbreaks and epidemics, with average scores for these domains of 50–70%. The subregion had “inadequate capacity” in the four remaining domains, with average scores of < 50% (Fig. 16). With regard to surveillance and control of arboviral diseases overall, most countries in West Africa (15 of 17, 88%) had “inadequate capacity” or “partially satisfactory capacity”. Only Algeria and Cabo Verde had “adequate capacity” and “almost adequate capacity”, respectively, for surveillance and control of arboviral diseases. In all the other countries, capacity should be strengthened. In Central Africa, more domains were challenged, as the subregion had “inadequate capacity” in all, except for “preparedness for arboviral disease outbreaks and epidemics” (Fig. 16). Except for Angola and Democratic Republic of the Congo, which had “almost adequate capacity”, the other eight countries (80%) had “inadequate” or “partially satisfactory” capacity. This subregion showed similar trends to those of Central Africa, as “inadequate capacity” was found in all domains other than “preparedness for arboviral disease outbreaks and epidemics”. Fig. 17 shows that only Mauritius and South Sudan had “almost adequate capacity”, while the remaining 18 countries (90%) had “inadequate” or “partially satisfactory” capacity. 4.2 West Africa 4.3 Central Africa 4.4 East–Southern Africa 54 CHAPTER 5 Surveillance and control of arboviral diseases in the WHO African Region This situation analysis of country capacity for epidemiological and entomological surveillance and control of arboviral diseases is based on answers to a self-administered questionnaire. The answers provide an overview of existing capacity as well as the weaknesses in addressing the growing threat of these diseases. Of the 47 countries that participated in the survey, only six (13%) (Algeria, Angola, Cabo Verde, Democratic Republic of the Congo, Mauritius and South Sudan) were found to have “adequate” or “almost adequate” capacity for arboviral disease surveillance and control. This indicates that most countries on the continent would experience detrimental effects if waves of epidemics of arboviral diseases occur. The capacity of some countries should, however, be viewed in the context of their current situation with regard to transmission of arboviruses. Ae. aegypti and Ae. albopictus are reported to be present in 32 and 23 countries, respectively (Table 9). The presence of both vectors on the continent has also been reported in the literature (50, 51), confirming the data shared by countries. As in this report, Ae. aegypti has been reported as more prevalent on the continent than Ae. albopictus (50, 51). The preponderance of Ae. aegypti over Ae. albopictus, which originated from Asia (52), is explained by its long establishment in Africa, from which it may even have originated, although a genetic study has linked its origin to the southwestern Indian Ocean (53). Although its origin is under investigation, its wide distribution in continental Africa is a certainty, as reported in Gabon, Ghana, Namibia and Nigeria in the past few years (50, 51, 54). Arboviruses were reported in 38 countries (Table 8) – more countries than those ones that reported the presence of Ae. aegypti and Ae. albopictus. This discrepancy confirms that the vectors are present in some countries that have no data on their presence, although they are involved in the transmission of arboviruses. These countries include Chad, Equatorial Guinea, Gabon, Ghana and Namibia. The presence of arboviruses has also been reported in other countries: Rift Valley fever virus in Botswana, Gambia and Zimbabwe; yellow fever and chikungunya viruses in Burundi, Sierra Leone and Uganda; dengue virus in Cabo Verde, Sao Tome and Principe and Uganda; and Zika virus in Burundi (50, 51, 55–57). These observations underline the importance of collaboration and communication among researchers and national health departments and authorities to maximize the effectiveness of the surveillance of arboviral diseases and evaluation of risks of transmission. Discussion and suggestions for moving forward 55Discussion and suggestions for moving forward Most countries (24/47) did not report cases or deaths from arboviral disease during the past 5 years. A common response was “data not available”, which could indicate either “no data” or “data exist but are not available at national level”. Some countries reported that individual or aggregated data were available only at regional and district levels of the health structure. Lack of such epidemiological data at national level indicates an inadequate arboviral disease surveillance system, making it difficult for countries to evaluate the burden of arboviral diseases. Ignorance of a danger (here, silent circulation of arboviruses) means that countries do not take preventive or control actions, and a weak disease surveillance system (here, the arboviral disease surveillance system) cannot indicate whether that danger exists or not. In another words, countries with or without arbovirus transmission must have robust disease surveillance systems, including for arboviral diseases, in order to assess the threat and trigger action, including prevention. Overall, the countries have huge gaps in their capacity for the management of cases and severe cases, virological surveillance, entomological surveillance and control of Aedes vectors and community sensitization and engagement on arboviral diseases. The countries had some capacity for disease surveillance in general, diagnosis and notification of arboviral disease and preparedness for disease outbreaks. Their crucial challenge is weak systems for surveillance of arboviruses in humans, vectors and animals for early detection of outbreaks. In addition, despite preparedness for disease outbreaks, cases and severe cases of arboviral diseases might not be managed adequately in all the countries because of huge gaps in clinical knowledge and infrastructure. Three recurrent gaps were reported by most countries for all seven domains: lack of training and retraining for staff involved in surveillance and control of arboviral diseases, lack of financial and technical support and lack of community awareness on arboviral diseases. Table 10 summarizes the main gaps identified in each domain and suggests possible actions to address those gaps. Most of the proposed actions are derived from the Global Vector Control Response and WHO guidance to countries for control of arboviral diseases and diseases in general. They should be adapted locally and prioritized according to each country’s situation. Countries in each subregion are listed according to the scores obtained in each domain. Thus, the absence of other country names in each main category does not necessarily imply that they do not also have such gaps. 5.1 Main weaknesses and possible actions 56 CHAPTER 5 Surveillance and control of arboviral diseases in the WHO African Region Ta bl e 10 . I de nt ifi ed g ap s an d su gg es ti on s fo r m ov in g fo rw ar d in t he c ou nt ri es id en ti fie d R ec ur re nt g ap s: tr ai ni ng , l ac k of fi na nc ia l a nd te ch ni ca l s up po rt , l im ite d aw ar en es s of a rb ov ir al d is ea se s R ec ur re nt s ug ge st ed a ct io ns : • cl ea r tr ai ni ng p la n em ph as iz in g st af fin g ne ed s, ty pe o f t ra in in g, fr eq ue nc y an d bu dg et • co ns id er o nl in e G lo ba l V ec to r Co nt ro l R es po ns e co ur se s an d fr ee a nd /o r di st an ce tr ai ni ng • lo bb yi ng le gi sl at or s an d do m es tic a nd e xt er na l f un de rs • co nd uc tin g aw ar en es s ca m pa ig ns o n ar bo vi ra l d is ea se s M ai n ga ps id en tifi ed Sp ec ifi c ga ps Su gg es te d w ay s fo r m ov in g fo rw ar d Co un tr ie s W es t A fr ic a Ce nt ra l A fr ic a Ea st –S ou th er n Af ri ca Li m ite d vi ro lo gi ca l su rv ei lla nc e in h um an s an d in ad eq ua te di ag no si s an d ca se no tifi ca tio n • N o ro ut in e su rv ei lla nc e • In te gr at e ar bo vi ru s su rv ei lla nc e in to th e na tio na l w or k pa ck ag e w ith d is ea se s, s uc h as m al ar ia , w ith a d ed ic at ed p ro je ct ed b ud ge t. Ga m bi a, G ui ne a Bi ss au , N ig er ia Bu ru nd i, Ce nt ra l Af ri ca n Re pu bl ic , Co ng o, E qu at or ia l- Gu in ea , S ao T om e an d Pr in ci pe Bo ts w an a, C om or os , Er itr ea , E sw at in i, Le so th o, M al aw i, M oz am bi qu e, N am ib ia , Se yc he lle s, U ga nd a, Za m bi a, Z im ba bw e • Li m ite d co nfi rm at io n of su sp ec te d an d po si tiv e ca se s an d di ffi cu lty in s hi pp in g sa m pl es a br oa d fo r qu al ity co nt ro l • In cr ea se la bo ra to ry te ch ni ca l, lo gi st ic al a nd hu m an r es ou rc es , a nd p ri or iti ze r eg io na l co lla bo ra tio n fo r qu al ity c on tr ol te st in g in th e ab se nc e of a r el ia bl e do m es tic la bo ra to ry . Be ni n, B ur ki na F as o, Cô te d ’Iv oi re , G ha na , Gu in ea , L ib er ia , M al i, M au ri ta ni a, N ig er , Se ne ga l, To go Ca m er oo n, C ha d, Ga bo n Et hi op ia , M ad ag as ca r, Rw an da , S ou th A fr ic a, So ut h Su da n, U ni te d Re pu bl ic o f T an za ni a • Li m ite d ca se r ep or tin g • Co m pl y w ith th e gu id el in es fo r i nt eg ra te d di se as e su rv ei lla nc e an d re sp on se ( 34 ), in cl ud in g fo r ar bo vi ra l d is ea se s, a nd m ak e re po rt in g of a ll m aj or a rb ov ir al d is ea se s m an da to ry . • In su ffi ci en t w el l- qu al ifi ed h um an re so ur ce s • Re cr ui t n ew q ua lifi ed s ta ff an d/ or d ev el op a tr ai ni ng p la n fo r tr ai ni ng a nd r et ra in in g av ai la bl e  st af f. 57Discussion and suggestions for moving forward M ai n ga ps id en tifi ed Sp ec ifi c ga ps Su gg es te d w ay s fo r m ov in g fo rw ar d Co un tr ie s W es t A fr ic a Ce nt ra l A fr ic a Ea st –S ou th er n Af ri ca Po or e nt om ol og ic al su rv ei lla nc e an d co nt ro l o f v ec to rs of a rb ov ir us es • Li m ite d pr og ra m m e or s tr uc tu re de di ca te d to e nt om ol og ic al su rv ei lla nc e an d co nt ro l o f ve ct or s of a rb ov ir us es • In te gr at e ac tiv iti es r el at ed to e nt om ol og ic al su rv ei lla nc e an d co nt ro l o f v ec to rs o f ar bo vi ru se s in to th e sa m e na tio na l w or k pa ck ag e w ith m al ar ia a nd o th er v ec to r- bo rn e di se as es . A d ep ar tm en t o f n eg le ct ed tr op ic al di se as es s ho ul d be c re at ed in c ou nt ri es w ith ou t o ne . Bu rk in a Fa so , Eq ua to ri al G ui ne a, Ga m bi a, G ui ne a, Gu in ea -B is sa u, Li be ri a, M al i, M au ri ta ni a, N ig er , N ig er ia , T og o Ca m er oo n, C en tr al Af ri ca n Re pu bl ic , Co ng o, G ab on Bo ts w an a, E sw at in i, Le so th o, M ad ag as ca r, M al aw i, N am ib ia , Rw an da , U ga nd a, Za m bi a, • La ck o f n at io na l g ui de lin es o n Ae de s ve ct or s ur ve ill an ce a nd co nt ro l • Co nd uc t a n at io na l n ee ds a ss es sm en t f or ve ct or c on tr ol w ith a to ol s uc h as th at de ve lo pe d by W H O an d TD R (5 8) , a nd u se th e re po rt to g en er at e a na tio na l v ec to r co nt ro l s tr at eg ic p la n in li ne w ith th e Gl ob al Ve ct or C on tr ol R es po ns e (4 4) . R ef er to W H O gu id an ce d oc um en ts ( 59 , 6 0) . • La ck o f e xp er tis e in e nt om ol og y an d co nt ro l o f A ed es v ec to rs • Fe llo w sh ip s fo r no n- ac ad em ic e nt om ol og is ts an d en su re a c le ar c ar ee r pa th w ay fo r en to m ol og is ts to a ro us e th ei r in te re st Gh an a, S en eg al , Si er ra L eo ne Bu ru nd i, Ch ad , S ao To m e an d Pr in ci pe M oz am bi qu e, Se yc he lle s, S ou th Af ri ca , U ni te d Re pu bl ic o f T an za ni a, Zi m ba bw e • Li m ite d co lla bo ra tio n am on g pu bl ic h ea lth a nd r es ea rc h in st itu te s an d th e m in is tr y of he al th fo r su rv ei lla nc e an d co nt ro l o f v ec to rs o f a rb ov ir us es • Im pl em en t a nd p ro m ot e a m ul tis ec to ra l ap pr oa ch w ith th e co nc ep tu al fr am ew or k de ve lo pe d by W H O an d TD R (6 1) . In ad eq ua te m an ag em en t o f ca se s an d se ve re ca se s of A ed es - bo rn e ar bo vi ra l di se as es • Li m ite d gu id el in es o n cl in ic al m an ag em en t o f c as es o f A ed es - bo rn e ar bo vi ra l d is ea se s • Re fe r to th e in te gr at ed m an ag em en t s tr at eg y fo r ar bo vi ra l d is ea se p re ve nt io n an d co nt ro l de ve lo pe d an d re vi ew ed b y W H O in 2 02 0 (6 2) an d ot he r gu id an ce b y W H O an d TD R (6 3) . Be ni n, B ur ki na F as o, Ga m bi a, G ui ne a- Bi ss au , L ib er ia , N ig er , N ig er ia , S ie rr a Le on e, To go Bu ru nd i, Ca m er oo n, Ce nt ra l A fr ic an Re pu bl ic , C ha d, Eq ua to ri al G ui ne a, Ga bo n, S ao T om e an d Pr in ci pe Bo ts w an a, C om or os , Es w at in i, Et hi op ia , Ke ny a, L es ot ho , M ad ag as ca r, M al aw i, M oz am bi qu e, N am ib ia , Se yc he lle s, S ou th Af ri ca , U ga nd a, U ni te d Re pu bl ic o f T an za ni a, Za m bi a, Z im ba bw e • La ck o f h ea lth -c ar e in fr as tr uc tu re an d es se nt ia l m ed ic in es a t l ow er le ve ls • Lo bb y le gi sl at or s an d do m es tic a nd e xt er na l fu nd er s to c ov er th e ga p in r es ou rc es . Cô te d ’Iv oi re , G ha na , Gu in ea , M al i, M au ri ta ni a An go la , D em oc ra tic Re pu bl ic o f t he C on go Er itr ea , R w an da • H ig h tu rn ov er o f h ea lth -c ar e w or ke rs • Re cr ui t a nd tr ai n ne w h ea lth s ta ff in in te gr at ed m an ag em en t o f a rb ov ir al d is ea se p re ve nt io n an d co nt ro l. Ta bl e 10 . I de nt ifi ed g ap s an d su gg es ti on s fo r m ov in g fo rw ar d in t he c ou nt ri es id en ti fie d R ec ur re nt g ap s: tr ai ni ng , l ac k of fi na nc ia l a nd te ch ni ca l s up po rt , l im ite d aw ar en es s of a rb ov ir al d is ea se s R ec ur re nt s ug ge st ed a ct io ns : • cl ea r tr ai ni ng p la n em ph as iz in g st af fin g ne ed s, ty pe o f t ra in in g, fr eq ue nc y an d bu dg et • co ns id er o nl in e G lo ba l V ec to r Co nt ro l R es po ns e co ur se s an d fr ee a nd /o r di st an ce tr ai ni ng • lo bb yi ng le gi sl at or s an d do m es tic a nd e xt er na l f un de rs • co nd uc tin g aw ar en es s ca m pa ig ns o n ar bo vi ra l d is ea se s M ai n ga ps id en tifi ed Sp ec ifi c ga ps Su gg es te d w ay s fo r m ov in g fo rw ar d Co un tr ie s W es t A fr ic a Ce nt ra l A fr ic a Ea st –S ou th er n Af ri ca Li m ite d vi ro lo gi ca l su rv ei lla nc e in h um an s an d in ad eq ua te di ag no si s an d ca se no tifi ca tio n • N o ro ut in e su rv ei lla nc e • In te gr at e ar bo vi ru s su rv ei lla nc e in to th e na tio na l w or k pa ck ag e w ith d is ea se s, s uc h as m al ar ia , w ith a d ed ic at ed p ro je ct ed b ud ge t. Ga m bi a, G ui ne a Bi ss au , N ig er ia Bu ru nd i, Ce nt ra l Af ri ca n Re pu bl ic , Co ng o, E qu at or ia l- Gu in ea , S ao T om e an d Pr in ci pe Bo ts w an a, C om or os , Er itr ea , E sw at in i, Le so th o, M al aw i, M oz am bi qu e, N am ib ia , Se yc he lle s, U ga nd a, Za m bi a, Z im ba bw e • Li m ite d co nfi rm at io n of su sp ec te d an d po si tiv e ca se s an d di ffi cu lty in s hi pp in g sa m pl es a br oa d fo r qu al ity co nt ro l • In cr ea se la bo ra to ry te ch ni ca l, lo gi st ic al a nd hu m an r es ou rc es , a nd p ri or iti ze r eg io na l co lla bo ra tio n fo r qu al ity c on tr ol te st in g in th e ab se nc e of a r el ia bl e do m es tic la bo ra to ry . Be ni n, B ur ki na F as o, Cô te d ’Iv oi re , G ha na , Gu in ea , L ib er ia , M al i, M au ri ta ni a, N ig er , Se ne ga l, To go Ca m er oo n, C ha d, Ga bo n Et hi op ia , M ad ag as ca r, Rw an da , S ou th A fr ic a, So ut h Su da n, U ni te d Re pu bl ic o f T an za ni a • Li m ite d ca se r ep or tin g • Co m pl y w ith th e gu id el in es fo r i nt eg ra te d di se as e su rv ei lla nc e an d re sp on se ( 34 ), in cl ud in g fo r ar bo vi ra l d is ea se s, a nd m ak e re po rt in g of a ll m aj or a rb ov ir al d is ea se s m an da to ry . • In su ffi ci en t w el l- qu al ifi ed h um an re so ur ce s • Re cr ui t n ew q ua lifi ed s ta ff an d/ or d ev el op a tr ai ni ng p la n fo r tr ai ni ng a nd r et ra in in g av ai la bl e  st af f. 58 CHAPTER 5 Surveillance and control of arboviral diseases in the WHO African Region M ai n ga ps id en tifi ed Sp ec ifi c ga ps Su gg es te d w ay s fo r m ov in g fo rw ar d Co un tr ie s W es t A fr ic a Ce nt ra l A fr ic a Ea st –S ou th er n Af ri ca La ck o f c om m un ity se ns iti za tio n an d en ga ge m en t o n ar bo vi ra l d is ea se s • Ab se nc e of o ut re ac h pr og ra m m e on a rb ov ir al d is ea se s • Es ta bl is h ou tr ea ch p ro gr am m es o n or in cl ud in g ar bo vi ra l d is ea se s, a t l ea st a t di st ri ct le ve l. Bu rk in a Fa so , G ha na , Gu in ea -B is sa u, Li be ri a, M au ri ta ni a, N ig er , N ig er ia , Se ne ga l, To go Bu ru nd i, Ca m er oo n, Ce nt ra l A fr ic an Re pu bl ic , C on go , Eq ua to ri al G ui ne a, S ao To m e an d Pr in ci pe Bo ts w an a, C om or os , Es w at in i, Et hi op ia , Ke ny a, M al aw i, M oz am bi qu e, N am ib ia , Rw an da , S ou th S ud an , U ni te d Re pu bl ic o f Ta nz an ia , Z am bi a • Ab se nc e of n at io na l e du ca tio na l an d re fe re nc e m at er ia ls fo r co m m un ity s en si tiz at io n an d ed uc at io n • Re fe r to W H O gu id an ce o n co m m un ity en ga ge m en t a nd o th er d oc um en ts ( 64 –6 6) . • Li m ite d nu m be r of c om m un ity he al th w or ke rs • Re cr ui t n ew , q ua lifi ed c om m un ity h ea lth w or ke rs a nd /o r tr ai n ex is tin g st af f. Be ni n, C ôt e d’ Iv oi re , Ga m bi a, M al i An go la , C ha d, G ab on , M ad ag as ca r Er itr ea , M au ri tiu s, Se yc he lle s, S ou th Af ri ca , Z im ba bw e In ad eq ua te ep id em io lo gi ca l su rv ei lla nc e of ar bo vi ra l d is ea se s • La ck o f a s pe ci fic n at io na l pr og ra m m e on o r in cl ud in g su rv ei lla nc e of a rb ov ir al di se as es • Cr ea te a d ep ar tm en t o f n eg le ct ed tr op ic al di se as es th at in cl ud es a rb ov ir al d is ea se s, o r in te gr at e su rv ei lla nc e of a rb ov ir al d is ea se s in to th e na tio na l w or k pa ck ag e on m al ar ia a nd ot he r ve ct or -b or ne d is ea se s. Gu in ea -B is sa u, N ig er ia Bu ru nd i, Ce nt ra l Af ri ca n Re pu bl ic Bo ts w an a, E ri tr ea , Es w at in i, Et hi op ia , Ke ny a, L es ot ho , M ad ag as ca r, M al aw i, M oz am bi qu e, N am ib ia , Rw an da , S ey ch el le s, U ga nd a, Z am bi a, Zi m ba bw e • In ad eq ua te e pi de m io lo gi ca l su rv ei lla nc e of a rb ov ir al di se as es in a ni m al s • Es ta bl is h a de ci si on fr am ew or k fo r ep id em io lo gi ca l s ur ve ill an ce o f a rb ov ir al di se as es , i nc lu di ng in a ni m al s. Be ni n, B ur ki na F as o, Ga m bi a, G ha na , Li be ri a, M au ri ta ni a, Si er ra L eo ne , T og o An go la , C am er oo n, Ch ad , C on go , De m oc ra tic R ep ub lic of th e Co ng o, Eq ua to ri al G ui ne a, Ga bo n, S ao T om e an d Pr in ci pe Er itr ea , E th io pi a, M ad ag as ca r, Rw an da , Se yc he lle s, Z am bi a • N o co lle ct io n or a na ly si s of ou tb re ak r is k fa ct or s • In te gr at e co lle ct io n an d an al ys is o f r is k fa ct or s fo r ar bo vi ra l d is ea se o ut br ea ks in to th e ac tiv iti es o f t he d ep ar tm en t o f n eg le ct ed tr op ic al d is ea se s. • Li m ite d co lla bo ra tio n be tw ee n pu bl ic h ea lth b od ie s an d m in is tr y of h ea lth in th e su rv ei lla nc e of ar bo vi ra l d is ea se s • Im pl em en t a nd p ro m ot e a m ul tis ec to ra l ap pr oa ch w ith th e co nc ep tu al fr am ew or k de ve lo pe d by W H O an d TD R (6 1) . 59Discussion and suggestions for moving forward M ai n ga ps id en tifi ed Sp ec ifi c ga ps Su gg es te d w ay s fo r m ov in g fo rw ar d Co un tr ie s W es t A fr ic a Ce nt ra l A fr ic a Ea st –S ou th er n Af ri ca In ad eq ua te pr ep ar ed ne ss fo r ar bo vi ra l d is ea se ou tb re ak s an d ep id em ic s • N o co nt in ge nc y pl an • Al l c ou nt ri es s ho ul d ha ve a c on tin ge nc y pl an (6 7) . Ga m bi a, G ui ne a- Bi ss au , N ig er , N ig er ia , To go Ca m er oo n, C en tr al Af ri ca n Re pu bl ic M al aw i, Bo ts w an a, Es w at in i, M oz am bi qu e, N am ib ia , K en ya , Le so th o • N o pr ep ar ed ne ss fo r ev en ts re la te d to a rb ov ir al d is ea se ou tb re ak s • De ve lo p a bu si ne ss c as e fo r ar bo vi ra l di se as es o ut br ea ks , a nd u se it to in vo lv e th e pr iv at e se ct or in a ct iv iti es a nd fi na nc in g fo r ou tb re ak p re pa re dn es s. Be ni n, G ui ne a Bu ru nd i, Eq ua to ri al Gu in ea , G ab on , S ao To m e an d Pr in ci pe Er itr ea , S ou th A fr ic a, U ga nd a, Z am bi a, Zi m ba bw e • Li m ite d co lla bo ra tio n am on g na tio na l a nd r eg io na l i ns ta nc es • Im pl em en t a nd p ro m ot e a m ul tis ec to ra l ap pr oa ch w ith th e co nc ep tu al fr am ew or k de ve lo pe d by W H O an d TD R (6 1) . • Di ffi cu lty in c om m un ity se ns iti za tio n an d pa rt ic ip at io n in ac tiv iti es • Re fe r to W H O gu id an ce o n co m m un ity en ga ge m en t a nd o th er s do cu m en ts ( 64 –6 6) . M ai n ga ps id en tifi ed Sp ec ifi c ga ps Su gg es te d w ay s fo r m ov in g fo rw ar d Co un tr ie s W es t A fr ic a Ce nt ra l A fr ic a Ea st –S ou th er n Af ri ca La ck o f c om m un ity se ns iti za tio n an d en ga ge m en t o n ar bo vi ra l d is ea se s • Ab se nc e of o ut re ac h pr og ra m m e on a rb ov ir al d is ea se s • Es ta bl is h ou tr ea ch p ro gr am m es o n or in cl ud in g ar bo vi ra l d is ea se s, a t l ea st a t di st ri ct le ve l. Bu rk in a Fa so , G ha na , Gu in ea -B is sa u, Li be ri a, M au ri ta ni a, N ig er , N ig er ia , Se ne ga l, To go Bu ru nd i, Ca m er oo n, Ce nt ra l A fr ic an Re pu bl ic , C on go , Eq ua to ri al G ui ne a, S ao To m e an d Pr in ci pe Bo ts w an a, C om or os , Es w at in i, Et hi op ia , Ke ny a, M al aw i, M oz am bi qu e, N am ib ia , Rw an da , S ou th S ud an , U ni te d Re pu bl ic o f Ta nz an ia , Z am bi a • Ab se nc e of n at io na l e du ca tio na l an d re fe re nc e m at er ia ls fo r co m m un ity s en si tiz at io n an d ed uc at io n • Re fe r to W H O gu id an ce o n co m m un ity en ga ge m en t a nd o th er d oc um en ts ( 64 –6 6) . • Li m ite d nu m be r of c om m un ity he al th w or ke rs • Re cr ui t n ew , q ua lifi ed c om m un ity h ea lth w or ke rs a nd /o r tr ai n ex is tin g st af f. Be ni n, C ôt e d’ Iv oi re , Ga m bi a, M al i An go la , C ha d, G ab on , M ad ag as ca r Er itr ea , M au ri tiu s, Se yc he lle s, S ou th Af ri ca , Z im ba bw e In ad eq ua te ep id em io lo gi ca l su rv ei lla nc e of ar bo vi ra l d is ea se s • La ck o f a s pe ci fic n at io na l pr og ra m m e on o r in cl ud in g su rv ei lla nc e of a rb ov ir al di se as es • Cr ea te a d ep ar tm en t o f n eg le ct ed tr op ic al di se as es th at in cl ud es a rb ov ir al d is ea se s, o r in te gr at e su rv ei lla nc e of a rb ov ir al d is ea se s in to th e na tio na l w or k pa ck ag e on m al ar ia a nd ot he r ve ct or -b or ne d is ea se s. Gu in ea -B is sa u, N ig er ia Bu ru nd i, Ce nt ra l Af ri ca n Re pu bl ic Bo ts w an a, E ri tr ea , Es w at in i, Et hi op ia , Ke ny a, L es ot ho , M ad ag as ca r, M al aw i, M oz am bi qu e, N am ib ia , Rw an da , S ey ch el le s, U ga nd a, Z am bi a, Zi m ba bw e • In ad eq ua te e pi de m io lo gi ca l su rv ei lla nc e of a rb ov ir al di se as es in a ni m al s • Es ta bl is h a de ci si on fr am ew or k fo r ep id em io lo gi ca l s ur ve ill an ce o f a rb ov ir al di se as es , i nc lu di ng in a ni m al s. Be ni n, B ur ki na F as o, Ga m bi a, G ha na , Li be ri a, M au ri ta ni a, Si er ra L eo ne , T og o An go la , C am er oo n, Ch ad , C on go , De m oc ra tic R ep ub lic of th e Co ng o, Eq ua to ri al G ui ne a, Ga bo n, S ao T om e an d Pr in ci pe Er itr ea , E th io pi a, M ad ag as ca r, Rw an da , Se yc he lle s, Z am bi a • N o co lle ct io n or a na ly si s of ou tb re ak r is k fa ct or s • In te gr at e co lle ct io n an d an al ys is o f r is k fa ct or s fo r ar bo vi ra l d is ea se o ut br ea ks in to th e ac tiv iti es o f t he d ep ar tm en t o f n eg le ct ed tr op ic al d is ea se s. • Li m ite d co lla bo ra tio n be tw ee n pu bl ic h ea lth b od ie s an d m in is tr y of h ea lth in th e su rv ei lla nc e of ar bo vi ra l d is ea se s • Im pl em en t a nd p ro m ot e a m ul tis ec to ra l ap pr oa ch w ith th e co nc ep tu al fr am ew or k de ve lo pe d by W H O an d TD R (6 1) . 60 Surveillance and control of arboviral diseases in the WHO African Region CHAPTER 5 This survey has some strengths but also certain limitations. The questionnaire was self-administered, and the country focal persons collected information from national experts. Only one of the 47 countries sought clarification of the questionnaire, indicating that the questions were clear. Nevertheless, some participants might have misunderstood some questions, which might have affected their responses. Self-administered questionnaires are prone to bias and cannot replace onsite review and assessment of country capacity. The scoring system developed for each domain was not tested for internal consistency; therefore, the scores of countries should be considered only indicative of their capacity for specific activities. The list of answer options for most of the questions facilitated comprehension and guided participants in choosing the appropriate one(s). However, the “Yes” or “No” option did not incite participants to provide clarifications or justifications even when they were required, and the details behind the binary answers were not available. The “don’t know” option, which was scored “0”, did not reflect the actual situation of the indicator in the country, which could have been positive or negative. The “don’t know” answers could have affected the scores in a specific domain as well as a country’s total score. The study was conducted during the first semester of 2021, a difficult period for all public health systems and health professionals due to the COVID-19 pandemic. This might have affected the results, as many national resource professionals were deployed to COVID-19-related concerns. This might also explain some of the “don’t know” answers. 5.2 Limitations 61Conclusions CHAPTER 6 This situation analysis of country capacity for epidemiological and entomological surveillance and control of arboviral diseases indicates the existing strengths in the WHO African Region that could be used to build capacity in the relevant domains and also unveils weaknesses to be overcome. The Region could use its capacity for malaria control to reorient or support work on arboviral diseases. These diseases should receive more attention at country level in order to benefit from institutional resources, such as research centres, universities and university hospitals involved in entomological and epidemiological studies and malaria vector control. Other sources of support are nongovernmental organizations engaged in various activities at community level, regional and pan-Africa bodies such as the Western Africa Health Organization, the Economic Community of West African States, the West African Economic and Monetary Union, the Pan-African Mosquito Control Association and SEGA, and also technical and financial support from United Nations agencies such as WHO, TDR, the United Nations Development Programme and the United Nations Children’s Fund and international institutions (e.g. US Centers for Disease Control and Prevention, United States Agency for International Development, World Bank). Besides leveraging existing capacity, most countries must address three recurrent gaps: training and advocacy of all types of staff involved in arboviral diseases surveillance and control activities; inadequate finance and sustainable technical support and resources means; and community awareness of arboviral diseases. Other gaps must be addressed in each domain to ensure that countries’ capacity is adequate to detect promptly the cases and their confirmation in the face of the growing threat of arboviral diseases. Another critical point is the coordination, monitoring and evaluation of activities, from the community to the highest level of the public health system. Leadership, responsibility and accountability should be established at all levels. This survey in the WHO African Region shows what is missing and where it is missing, and it can be used to guide regional and national plans to address the gaps to make countries better prepared to overcome arboviral disease threats. The report might be considered a cornerstone for regional arboviral disease prevention and control. The next step should be to use the report to raise regional awareness about arboviral diseases, raise adequate funds according to need, help countries to build their capacity by training, provide short-term technical support and expertise and set up regional networks for sharing experience in the control of arboviral diseases. National and international research institutions might work with countries by addressing issues of surveillance and other concerns mentioned in the report. This report also helps to improve surveillance and control during the post-pandemic period utilising the lessons learnt during this time and enhancing the capacity to a sustainable level. Conclusions 62 Surveillance and control of arboviral diseases in the WHO African Region CHAPTER 7 1. Rainey SM, Shah P, Kohl A, Dietrich I. Understanding the Wolbachia-mediated inhibition of arboviruses in mosquitoes: progress and challenges. J Gen Virol. 2014;95:517–30. 2. Weaver SC, Reisen WK. 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Geneva: World Health Organization; undated (https:// pdf4pro.com/amp/view/module-b5-world-health-organization-63320e.html). 66. McCloskey DJ, Akintobi TH, Bonham A, Cook J, Coyne-Beasley T. Principles of community engagement. Second edition. Bethesda (MD: National Institutes of Health; 2011:197. 67. WHO guidance for contingency planning (WHO/WHE/CPI/2018.13). Geneva: World Health Organization; 2018 (https://apps.who.int/iris/handle/10665/260554). Annex 1 66 Surveillance and control of arboviral diseases in the WHO African Region Annex 1. Questionnaire This assessment of the current situation of countries related to the surveillance of arboviral diseases and the control of Aedes vectors in the WHO African Region is being performed in order to: • identify strengths and weaknesses • propose possible means for strengthening national and regional capacity • serve to raise regional awareness of arboviral diseases and to encourage support A. Disease surveillance system (Total score = 10) Code No. Item Answers (provide references as appropriate) Score Rationale DS01 1 Do you have any written arbovirus surveillance and control plan(s)/ guideline(s) for your country?  Yes, specifically for these diseases  Yes, we use general surveillance guidelines that include arboviral diseases. If so, please specify guidelines: 1 It is considered that a country which has a written arbovirus surveillance and control plan(s)/guideline(s) that is(are) specifically for arboviral diseases or included in a general guideline will score 1 for this question. The other options will score 0.  No (if no, jump to question 2)  Don’t know 0 1b For which of the following arboviruses do you have written surveillance and control plans for your country? Please choose all that apply:  Chikungunya virus  Dengue virus  Yellow fever virus  Zika virus  Other, please specify: NA This will be described in the report but will not be scored. 1c If you answer “Yes” to question 1, please upload surveillance and control plan(s) or protocol(s), or guideline(s) Kindly attach the aforementioned documents along with the survey NA This will be described in the report but will not be scored. DS02 2 Is there a specific National Programme for arboviral diseases surveillance or is it integrated in another programme? Please select the appropriate answer:  Specific programme  Integrated in another programme If so, please specify: 1 It is considered that a country which has a specific National Programme for arboviral diseases surveillance or integrated in another programme will score 1. The other options will score 0.  No programme 0 DS03 3 Is reporting arboviral disease cases mandatory in your country?  Yes, for all major arboviral diseases 1 It is considered that a country for which it is mandatory to report the major arboviral disease cases (Dengue, YF, Chikungunya, Zika, RVF, WNV, O’Nyong-Nyong etc.) will score 1. If it is only for certain arboviral diseases, it will score 0.5 The other options will score 0.  Yes, but only for some arboviral diseases If so, specify: 0.5  No  Don’t know 0 67Annexes Code No. Item Answers (provide references as appropriate) Score Rationale DS04 4 In the last 2 years, did your country conduct national epidemiological surveillance for arboviral disease in humans? Please choose one of the following:  Yes 1 For this question 4 (i.e. 4, 4b, 4c and 4d) it is considered that if a country conducted a national epidemiological surveillance within the last 2 years, the country will score 1. The rest will be described in the report but not be scored.  No (If no, jump to next question)  Don’t know 0 4b How often was the surveillance conducted? Please choose one of the following:  Once a year  Every trimester  Every semester  Others Please specify NA 4c If yes to question 4, what type of national epidemiological surveillance was conducted? Please choose one the following:  Primarily active  Primarily passive  Combination of active and passive NA 4d If yes to question 4, please kindly upload the report on the surveillance Please kindly upload the report on the surveillance NA DS05 5 What are the tools used for recording cases data for surveillance purposes? Please select all that apply.  Paper based, all levels of the health care system 1 It is considered that a surveillance system that is fully electronic or mixed method (paper & electronic) will score 1. A system that is paper-based will score 0.5. Other system will be scored: 0 if there is no tool for recording data on cases or if there is no recording of data on cases 0.5 if the tool used is paper-based, 1 if the tool used is electronic  Paper based, but only in specific levels of the health care system If so, specify which level:  Electronic system, all levels  Electronic system, but only in specific levels of the health care system If so, specify which level:  Mixed method, all levels  Mixed method, but only in specific levels of the health care system If so, specify which level: 1  Other (Please specify) 0/1/ 0.5 DS06 6 During the last 2 years, did your country conduct national epidemiological surveillance for arboviral disease in animals (zoonotic reservoirs)?  Yes 1 It is considered that a country that conducted within the last 2 years a national epidemiological surveillance for arboviral disease in animals will score 1.  No  Don’t know 0 6b If yes to question 6, how often was the surveillance conducted? Please choose one of the following:  Once a year  Every trimester  Every semester  Other (Please specify) NA This will be described in the report but will not be scored. 6c If yes to question 6, what type of national epidemiological surveillance was conducted in animals (zoonotic reservoirs)?  Primarily active  Primarily passive  Combination of active and passive NA This will be described in the report but will not be scored. 6d If yes to question 6, please kindly upload a report on the surveillance Please kindly upload a report on the surveillance NA This will be described in the report but will not be scored. Annex 1 68 Surveillance and control of arboviral diseases in the WHO African Region Code No. Item Answers (provide references as appropriate) Score Rationale DS07 7 Does your country (or local jurisdictions within the country) utilize sentinel animal surveillance or epizootic surveillance, e.g., in non-human primates, for yellow fever or for other arboviruses? Please choose only one of the following:  Yes 1 A country (or local jurisdictions within the country) that utilizes sentinel animal surveillance or epizootic surveillance, e.g., non-human primates, for yellow fever or for other arboviruses will score 1. The other options will score 0.  No (Jump if No)  Don’t know 0 7b If Yes to question 7, for which viruses? Please choose what apply:  Rift Valley Fever  Yellow Fever  Oropouche  Others (enter viruses in comment field) NA This will be described in the report but will not be scored. 7c If Yes to question 7, please kindly upload a report on the surveillance Please kindly upload a report on the surveillance NA This will be described in the report but will not be scored. DS08 8 Are arboviral outbreak risk factors routinely collected and analysed?  Yes 1 A country that collected and analyzed arboviral disease outbreak risk factors routinely will score 1. The other options will score 0.  No  Don’t know 0 8b If yes to question 8, which of the following risk factors are collected and analyzed?  House Index  Breteau Index  Container Index  Temperatures  Rainfall  Migration of a non-immune population  Other: Please specify NA This will be described in the report but will not be scored. DS09 9 For which level of the health structure are individual and aggregated data available? (select all relevant levels)  Primary Health care level,  Individual data  Aggregated data  District level  Individual data  Aggregated data  Regional level  Individual data  Aggregated data  National level  Individual data  Aggregated data 1 A country in which individual and aggregated data are available at all levels will score 1. A country in which only individual data are available at primary health care level, and aggregated data at all the other levels will score 1. A country in which individual and aggregated data are not available at any levels will score 0. A country in which individual and/or aggregated data are at least available at national level will score 0.5. DS10 10 Which training has been provided to the Staff working on disease surveillance data?  Basic training on Excel and Geographic Information System, only once  Basic training on Excel and Geographic Information System, routinely (e.g. once a year) 0.5 A country that provided advanced statistical software for data analysis (e.g. STATA, R, SAS, etc.) and geographic information system routinely or only once to the staff working on the disease surveillance data will score 1. A country that provided basic training on Excel and geographic information system routinely or only once to the staff working on the disease surveillance data will score 0.5. The other options will score 0, 0.5 or 1 depending on the types and frequencies of the trainings.  Training on advanced statistical software for data analysis (e.g. STATA, R, SAS, etc.) and Geographic Information System, only once  Training on advanced statistical software for data analysis (e.g. STATA, R, SAS, etc.) and Geographic Information System, routinely (e.g. once a year) 1  Other types of training and frequency. If so, please specify: 0.5/1  No training  Don’t know 0 DS11 11 What is your personal perception of factors of a) success and b) barriers/ challenges regarding arboviral diseases surveillance? Please enter your answer here: NA This will be described in the report but will not be scored. 69Annexes B. Diagnosis and case notification (Total score = 5) Code No. Item Answers (provide references as appropriate) Score Rationale DCN01 12 Select the type of cases reported by the system?  Suspected cases  Confirmed cases 0.5 A country in which both suspected and confirmed cases are reported by the system will score 1 A country in which only suspected cases are reported by the system will score 0.5 A country in which only confirmed cases are reported by the system will score 0.5 The other options will score 0  Both suspected and confirmed cases 1  No report 0 12b If you answer reporting cases, please upload the reference used for these case definitions Please kindly upload a reference NA This will be described in the report but will not be scored. 12c More precisely, select the type of cases reported for different arboviral diseases  Chikungunya, suspected cases  Chikungunya, confirmed cases  Chikungunya, both cases  Dengue, suspected cases  Dengue, confirmed cases  Dengue, both cases  Yellow fever, suspected cases  Yellow fever, confirmed cases  Yellow fever, both cases  Zika, suspected cases  Zika, confirmed cases  Zika, both cases  Other If so, please specify the arboviral disease and type of reporting NA This will be described in the report but will not be scored. DCN02 13 Is lab confirmation of suspected cases done?  Yes 1 A country that performed a lab confirmation of suspected cases will score 1. The other options will score 0  No  Don’t know 0 13b If yes to question 13, do you conduct it routinely or during outbreak?  Yes, routinely  Yes, during outbreak  Both NA This will be described in the report but will not be scored. 13c Since you answered yes to question 13b, what is the average percentage of suspected cases your country gets lab-confirmed? Please enter your answer here:  Routinely: ________% in a year  During outbreaks: ______% per identified cluster NA These will be described in the report but will not be scored. DCN03 14 In the last two years, were the positive cases of arboviruses confirmed by a national reference laboratory?  Yes, for all arboviral infections. Please specify them 1 A country in which the positive cases of major (Dengue, YF, Chikungunya, Zika, RVF, WNV, O’Nyong-Nyong etc.) arbovirus infections were confirmed by a national reference laboratory in the last 2 years will score 1. A country in which the positive cases of some arbovirus infections were confirmed by a national reference laboratory in the last 2 years will score 1. Other options will score 0.  Yes, but only for some arboviral infections. Please specify them 0.5  No 0 14b In the event, your country does not have capacities to type and serotype arboviruses, do you send samples for typing to other countries?  Yes Please specify where: NA These will be described in the report but will not be scored.  No Annex 1 70 Surveillance and control of arboviral diseases in the WHO African Region Code No. Item Answers (provide references as appropriate) Score Rationale DCN04 15 Overall, what testing capacity(ies) is(are) available in your country? Please tick the right box(es). Virus Antigen testing IgM antibody testing IgG antibody testing Neutralizing antibody testing Virus isolation RT-PCR or other nucleic acid amplification test Viral gene/ Genome Sequencing Chikungunya        Dengue        Zika        Yellow fever        Other:        Specify: 1 A country with capacities to conduct RT-PCR, other nucleic acid amplification tests, viral gene/genome sequencing, antibody/ antigen testing, virus isolation will score 1. A country with capacities to conduct only RDTs will score 0.5 A country with no testing capacity will score 0. 16 Which additional capacities would be most needed for your country to perform adequately the testing for arboviral diseases?  Additional staff FTE (estimate number of FTE). Please specify:  Additional staff training Please specify:  Additional lab equipment, reagents, etc Please specify:  Other capacity needs. Please specify NA This will be described in the report but will not be scored. DCN05 17 Does your country provide regular training sessions for healthcare workers on notification of Aedes-borne arboviral diseases?  Yes. If so, please specify: 1 A country that provided regular training sessions for healthcare workers on notification of Aedes-borne arboviral diseases will score 1 if the training is specified and 0.5 if not specified. Other options will score 0.  No  Don’t know 0 18 Personal perception of factors of a) success and b) barriers/challenges with respect to case notification Please enter your answer here: NA This will be described in the report but will not be scored. C. Management of cases and severe cases (Total score = 3) Code No. Item Answer (provide references as appropriate) Score Rationale MCSC01 19 Does your country have clinical guidelines for healthcare workers on diagnosis and clinical management of cases and severe cases of Aedes-borne arboviral diseases?  Yes 1 A country that has clinical guidelines for healthcare workers on diagnosis and clinical management of cases and severe cases of Aedes-borne arboviral diseases will score 1. The other options will score 0.  No  Don’t know 0 19b If yes to question 19, please kindly upload the clinical guidelines for arboviral disease management, or provide electronic link(s). Please, kindly upload the guidelines Please provide with the electronic link(s) here: NA This will be described in the report but will not be scored. MCSC02 20 Are severe cases of arboviral diseases managed into a special area (part of an hospital, beds)?  Yes 1 A country in which severe cases of arboviral diseases are managed into a special area (part of an hospital, beds) will score 1. The other options will score 0.  No If so, where are severe patients sent to?  Don’t know 0 21 How many beds are available per 100,000 population for in the event of a large disease outbreak? Please enter your answer here: NA This will be described in the report but will not be scored. 71Annexes Code No. Item Answer (provide references as appropriate) Score Rationale MCSC03 22 Does your country provide regular training sessions for healthcare workers on clinical diagnosis AND management of Aedes-borne arboviral diseases?  Yes, specific training is provided If so, please specify 1 A country that provided regular training sessions for healthcare workers on clinical diagnosis AND management of Aedes-borne arboviral diseases will score 1 if the training is specified and 0.5 if not specified. Other options will score 0.  No 0 Don’t know 23 Personal perception of factors of a) success and b) barriers/challenges with respect to case management Please enter your answer here: NA This will be described in the report but will not be scored. D. Virological surveillance (Total score = 2) Code No. Item Answer (provide references as appropriate) Score Rationale 24 Which arboviruses are known to circulate in your country?  Chikungunya virus  Dengue viruses  Yellow fever virus  Zika virus  Other (please specify) NA This will be described in the report but will not be scored. VS01 25 Do you perform virological surveillance on humans? Please select all that apply  Yes, via virus isolation  Yes, via RT-PCR  Yes, via other acid nucleic testing If so, please specify  Serological testing If so, please specify 1 A country that performs a virological surveillance regardless the testing method will score 1. A country that does not perform a virological surveillance will score 0.  No 0 25b If yes to question 25, what type of samples do you use for virological surveillance?  Samples from suspected arboviral diseases routinely notified  Samples routinely reported via HMIS of unidentified fevers from any type of health care level.  Other type of samples. Please specify NA This will be described in the report but will not be scored. 26 If yes to question 25, for which viruses do you perform virological surveillance? (check all that apply)  Chikungunya virus  Dengue viruses  Yellow fever virus  Zika virus  Other (please specify) NA This will be described in the report but will not be scored. VS02 27 Does your country provide regular training sessions for healthcare workers on arboviruses virological surveillance?  Yes 1 A country that provided regular training sessions for healthcare workers on arboviruses virological surveillance will score 1. The other options will score 0.  No  Don’t know 0 28 Personal perception of factors of a) success and b) barriers/challenges with respect to virological surveillance Please enter your answer here: NA This will be described in the report but will not be scored. Annex 1 72 Surveillance and control of arboviral diseases in the WHO African Region E. Routine vector surveillance and control (Total score = 13) Code No. Item Answer (provide references as appropriate) Score Rationale RVSC01 29 Is there an agency or service in charge of arbovirus vectors surveillance in your country?  Yes. If so, please specify: 1 A country that has an agency or service in charge of the surveillance of arbovirus vectors will score 1. The other options will score 0.  No  Don’t know 0 RVSC02 30 Is there a record of Aedes aegypti or Aedes albopictus being found in your country in the past 5 years? Please choose only one of the following  Yes, only Aedes aegypti  Yes, only Aedes albopictus  Yes, both Aedes aegypti and Aedes albopictus  None found in the country at this time 1 A country that has a record of Aedes aegypti or Aedes albopictus found in its territory in the last 5 years will score 1. A country in which there was no Aedes aegypti or Aedes albopictus found in the last 5 years will score 1. The other options will score 0.  Unknown within the country at this time  Don’t know 0 RVSC03 31 For the last 2 years, did your country conduct entomologic surveillance for arboviral infections in mosquito vectors?  Yes 1 A country that conduct entomological surveillance for arboviral infections in mosquito vectors during the last 2 years will score 1. The other options will score 0.  No  Don’t know 0 31b If yes to question 31, kindly upload the report Kindly upload the report NA This will be described in the report but will not be scored. 31c If yes to question 31, is it country wide programmes or restricted to specific locations?  Country wide  Restricted to specific locations Please specify where:  Don’t know NA This will be described in the report but will not be scored. 31d How many sentinel surveillance sites do you have? Please enter your answer here: NA This will be described in the report but will not be scored. 31e How often was the surveillance conducted? Please choose one of the following:  Once a year  Every trimester  Every semester  Others (Please specify) NA This will be described in the report but will not be scored. RVSC04 32 Which institution/department is in charge of reporting entomologic surveillance data to the national ministry of health/health department? (Check all that apply)  State/provincial health agencies  Other national agency  City/country health departments  Local mosquito control districts or similar organisations  Universities or academic institutions  Private companies  Other Please specify 1 A country that has an institution/department in charge of reporting entomologic surveillance data to the national ministry of health/health department will score 1. A country that does not have such an institution/department will score 0. RVSC05 33 Do you conduct Adult mosquito surveillance for species responsible for outbreak?  Yes 1 A country that conducts adult mosquito surveillance for species responsible for outbreaks will score 1. The other options will score 0.  No  Don’t know 0 RVSC06 34 Do you conduct Larval/Pupal mosquito surveillance for species responsible for outbreak?  Yes 1 A country that conducts larval/pupal mosquito surveillance for species responsible for outbreaks will score 1. The other options will score 0.  No  Don’t know 0 RVSC07 35 Are mosquitoes trapped identified to species?  Yes 1 A country that conducts species identification on mosquitoes trapped will score 1. The other options will score 0.  No  Don’t know 0 73Annexes Code No. Item Answer (provide references as appropriate) Score Rationale RVSC08 36 Does your agency either calculate minimum infection rates (MIR) for at least Dengue/ Chikungunya/Zika/ Yellow Fever with your mosquito data or receive such data from other agencies? Please choose only one of the following:  Yes, our agency makes the MIR estimations  Yes, the MIR are estimated by another institution. If so, please specify 1 A country that calculates either minimum infection rates (MIR) for at least Dengue/ Chikungunya/Zika/Yellow fever with its mosquito data or receives such data from other agencies will score 1. The other options will score 0.  No  Don’t know 0 RVSC09 37 Which laboratories perform testing for arboviruses on mosquito pools collected in your country in the last two years? (check all that apply)  National public health laboratory 1 A country with a laboratory that performs testing for arboviruses on mosquito pools collected during the last two years will score 1. A country that conducts mosquito surveillance without tests for arboviruses on mosquito pools collected during the last two years will score 0.5 A country that does not conduct mosquito surveillance will score 0. The option “Other” will score: 1 if there is a national institution that performed testing for arboviruses on mosquito pools collected during the last two years 0.5 if there is a national institution that conducted mosquito surveillance without tests for arboviruses on mosquito pools collected during the last two years  State public health laboratory  Local health department laboratory  University or academic institution  Local MCD (if different from county health dep’t)  Mosquito surveillance done, but no testing done on mosquito pools 0.5  Not applicable (no mosquito surveillance done) 0  Other 0.5/ 1 38a Please describe the potential public health threat from Aedes aegypti in your country. Please choose only one of the following:  Aedes aegypti populations are abundant and arbovirus(es) is (are) circulating  Aedes aegypti populations are spreading and pose a significant public health threat  Aedes aegypti populations are restricted to few sites and do not yet pose a significant threat  Aedes aegypti populations are stable in select areas and pose a significant threat  Aedes aegypti mosquitoes are only occasionally found and do not pose a significant public health threat  Other Please specify NA This will be described in the report but will not be scored. 38b Please describe the potential public health threat from Aedes albopictus in your country. Please choose only one of the following:  Aedes albopictus populations are abundant and arbovirus(es) is (are) circulating  Aedes albopictus populations are spreading and pose a significant public health threat  Aedes albopictus populations are restricted to few sites and do not yet pose a significant threat  Aedes albopictus populations are stable in select areas and pose a significant threat  Aedes albopictus mosquitoes are only occasionally found and do not pose a significant public health threat  Other Please specify NA This will be described in the report but will not be scored. Annex 1 74 Surveillance and control of arboviral diseases in the WHO African Region Code No. Item Answer (provide references as appropriate) Score Rationale RVSC10 39 For the last two years, did your country conduct adulticiding and/ or larviciding activities in local jurisdictions (either using government staff and resources, or subcontracting to a different entity to do so)? Please choose only one of the following:  Yes, adulticiding only  Yes, adulticiding and larviciding  Yes, larviciding only  No, neither adulticiding nor larviciding  Other Please specify 1 An endemic country for vector borne diseases (VBDs) that conducted at least adulticiding and/or larviciding during the last 2 years will score 1. An endemic country for VBDs that did not conduct at least adulticiding or larviciding during the last 2 years will score 0. The other options will score 1 if they relate to peri-focal treatments, larval source management, space spraying, house improvements. All personal protection measures (topical repellents, insecticide-treated clothes, spatial/ airborne repellents will not be scored as their public health values are not proved This scoring is not applicable for non- endemic countries for VBDs. 39b If no to question 39, would your country have conducted or financially supported adulticiding/larviciding or source reduction activities in the last two years if sufficient funding were available?  Yes  No  Don’t know NA This will be described in the report but will not be scored. 39c If yes to question 39, which adulticides and/or larvicides (brand and product name) were used? Please enter your answer here: NA This will be described in the report but will not be scored. RVSC11 40 Does your country provide regular training sessions for staff in charge of vector control and vector surveillance?  Yes, for both 1 A country that provided regular training sessions for staff in charge of vector control and vector surveillance will score 1; 0.5 if only for vector surveillance; 0.5 if only for vector control. The other options will score 0.  Yes, only for vector surveillance  Yes, only for vector control 0.5  No  Don’t know 0 RVSC12 41 For the last two years, did your country have a plan for mosquito- borne disease control that includes a threshold (e.g. level of vector mosquito abundance or minimum infection rate) that would result in a recommendation for mosquito adulticiding/other mosquito reduction measures?  Yes 1 A country that has a plan for mosquito-borne disease control that includes a threshold (e.g. level of vector mosquito abundance or minimum infection rate) that would result in a recommendation for mosquito adulticiding/other mosquito reduction measures will score 1. A country that has a plan without any specific threshold will score 0.5. The other option will score 0.  No – have a plan but there is no specific threshold 0.5  No – do not have a formal plan that includes adulticiding to control mosquito-borne diseases 0 41b If you answer yes to question 41, which indicator(s) is(are) used as threshold(s)?  Concurrent human cases  Minimum infection rate  Vector density  Breteau Index  House Index  Container Index  Other: Please specify NA This will be described in the report but will not be scored. RVSC13 42 Is there a surveillance system in place for monitoring Aedes resistance to the insecticide(s) used?  Yes 1 A country that has a surveillance system in place for monitoring Aedes resistance to the insecticide(s) will score 1. The other options will score 0.  No  Don’t know 0 43 Personal perception on factors of a) success and b) barriers/challenges with respect to vector surveillance and control in the country Please enter your answer here: NA This will be described in the report but will not be scored. 75Annexes F. Community sensitization and participation during non-epidemic periods (Total score = 5) Code No. Item Answer (provide references as appropriate) Score Rationale CSPEP01 44 What entity(ies) is(are) in charge of the outreach program in your country? Please specify 1 A country with an outreach program will score 1. If not, it will score 0. CSPEP02 45 Did your national arboviral disease program issue notifications to the public about local transmission risk and/or possible vector-control activities (e.g. larviciding, adulticiding, community mobilization and participation, etc.) as a prevention message for arboviral diseases in last 2 years? (Check all that apply)  Yes, through national public health agency  Yes, through state/local health agencies 1 A country in which there is a notification to the public about local transmission risk and/or possible vector-control activities (e.g. larviciding, adulticiding, community mobilization and participation, etc.) as a prevention message for arboviral diseases in last 2 years will score 1. Those without notifications due to the absence of risk of transmission in the last 2 years will score 0.5. Those without notifications will score 0.  No 0  No because no risk of transmission in last 2 years in our country 0.5 46 If yes to question 45, which means does your program use for community sensitization, mobilisation and acceptance of interventions in your country? (Check all that apply)  Press releases to electronic and printed media  Public service announcements on television or radio  Passive distribution of informational brochures  Active distribution of informational brochures  Town, community, or neighborhood meetings  Posting information on the home page of your agency’s website  Social media outlets (Facebook, Twitter, etc)  Door-to-door outreach in selected locations  Participation in community clean-ups  Translation of messages into all local languages  Other Please specify NA This will be described in the report but will not be scored. CSPEP03 47 Does your country provide regular training sessions for staff in charge of community sensitization, mobilisation and acceptance of interventions dedicated to control arbovirus diseases?  Yes If yes, please specify: 1 A country that provided regular training sessions for staff in charge of community sensitization, mobilisation and acceptance of interventions dedicated to control arbovirus diseases will score 1 if the training is specified; 0.5 if not specified. Other options will score 0.  No  Don’t know 0 CSPEP04 48 What is the geographical coverage of the outreach program in your country?  Countrywide  Only selected areas. Please specify where: 1 A country in which the outreach program is countrywide or in selected areas will score 1. 0 if no outreach program. No outreach programme 0 CSPEP05 49 Is the community outreach/social mobilization program sufficiently funded to cover staff time, prevention and outreach activities as needed?  Yes 1 A country in which the community outreach/ social mobilization program is sufficiently funded to cover staff time, prevention and outreach activities as needed will score 1. The other options will score 0.  No  Don’t know 0 50 Which resources would help ensure adequate capacity?  Educational materials for the public  Educational and reference materials for providers  Educational and reference materials for local health departments  Additional staff  Staff training  Additional resources (Please specify:) NA This will be described in the report but will not be scored. 51 Personal perception on factors of a) success and b) barriers/challenges with respect to community participation Please enter your answer here: NA This will be described in the report but will not be scored. Annex 1 76 Surveillance and control of arboviral diseases in the WHO African Region G. Preparedness for arboviral disease outbreaks and epidemics (Total score = 7) Code No. Item Answer (provide references as appropriate) Score Rationale PAO01 52 Is there a surveillance and Outbreak response Committee in your country? Or Steering committee  Yes 1 A country with a surveillance and outbreak response Committee will score 1. The other options will score 0.  No  Don’t know 0 PAO02 53 Does your country have a contingency plan to organize healthcare services during an outbreak (including outbreaks of arboviral diseases)?  Yes 1 A country with a contingency plan to organize healthcare services during an outbreak will score 1. The other options will score 0.  No  Don’t know 0 53b If yes to question 53, please upload the contingency plan. Please upload the contingency plan NA This will be described in the report but will not be scored. PAO03 54 Are there defined or established criteria for declaring outbreak for Dengue, Zika, Chikungunya or any other arboviral disease outbreak in your country?  Yes. If so, please provide them one by one: 1 A country that has defined or established criteria for declaring outbreak for Dengue, Zika, Chikungunya or any other arboviral disease outbreak will score 1. The other options will score 0.  No  Don’t know 0 PAO04 55 Do you have already established collaborations with national/regional research institutions/international agencies that are planned to be activated in case of arboviral outbreak?  Yes. If so, please specify institution(s)/agency(ies): 1 A country that has established collaborations with national/regional research institutions/international agencies to be activated in case of arboviral disease outbreak will score 1 if it is specified; 0.5 if not specified. The other options will score 0.  No  Don’t know 0 PAO05 56 What vector control interventions are deployed in case of an emergency? Please enter your answer here 1 A country that deploys specified vector control interventions in case of emergency will score 1. A country that does not deploy specified vector control interventions in case of emergency will score 0. PAO06 57 For the last 2 years, did your country have an emergency fund or a specified emergency funding mechanism for arbovirus outbreak response?  Yes 1 A country with an emergency fund or a specified emergency funding mechanism for arboviral disease outbreak response during the last 2 years will score 1 regardless the origin of that funding. A country without such a funding during the last 2 years will score 0.  No 0  Local funding 1 PAO07 58 Does your country provide regular training sessions for staff/committee in charge of preparedness for arboviral outbreaks/epidemics?  Yes 1 A country that provided regular training sessions for staff/committee in charge of preparedness for arboviral disease outbreaks/epidemics will score 1. Other options will score 0.  No  Don’t know 0 59 Personal perception on factors of a) success and b) barriers/challenges with respect to preparedness of arboviral diseases epidemics in your country Please enter your answer here: NA This will be described in the report but will not be scored. 77Annexes H. Available data on dengue, chikungunya and Zika from 2015 onwards or any year as available at the national health information system. 60. Please provide total number of confirmed cases and deaths for the following arboviral diseases from 2015 to 2019 (if available). Not scored Disease 2015 2016 2017 2018 2019 Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Dengue Chikungunya Zika Rift Valley fever Yellow fever West Nile virus Other arboviral diseases. Please specify 61. Please provide case numbers of mosquito-transmitted locally acquired Aedes-borne arbovirus infections for 2019. Not scored Virus Suspect cases Probable cases Confirmed cases Deaths Chikungunya Dengue Yellow fever Zika Other: Annex 1 78 Surveillance and control of arboviral diseases in the WHO African Region I. Surveillance staffing (not scored) Definitions of terms: Surveillance staff: include those who are involved in human disease surveillance, mosquito (entomological) surveillance, and animal surveillance, e.g., monitoring of non-human primates for yellow fever. Full time equivalent (FTE): Equivalent of the work that would be done at full-time capacity by a single individual. For example, a staff member employed in full time work position but only devoting 50% of their time to arbovirus surveillance would be a 0.5 FTE. 62. During 2019 (prior to the COVID-19 pandemic), indicate below the number of arbovirus surveillance staff at the national level. Surveillance staff include those who are responsible for human disease surveillance, mosquito (entomological) surveillance, and animal surveillance, e.g., monitoring of non-human primates for yellow fever in endemic regions. As the categories below are mutually exclusive, please place each staff person in only one column. Clinicians Epidemiologists Laboratorians Entomologists/ vector control specialists Support staff (administration; logistics; other) Number of full-time equivalents (FTE) 63. Indicate below how many total FTE staff persons are needed at the national level in your country to achieve full epidemiology and laboratory capacity* to conduct arbovirus surveillance. *Full epidemiology and laboratory capacity are defined as: i) ability to complete a standard case report form on every suspect arboviral disease case with laboratory criteria that meets the case definition and report it to the national health authority/ministry of health through appropriate mechanisms; ii) regularly reporting timely surveillance data to local stakeholders; iii) ability to test by IgM/other? for all locally transmitted and likely to be introduced Aedes-borne arboviruses on any serum specimen submitted to national or subnational lab on a suspected case of arboviral disease; and iv) having an environmental surveillance system that includes Aedes mosquito surveillance to monitor vector activity when appropriate in all parts of the country in which there is the potential for human outbreaks of arboviral disease based on past experience. Clinicians Epidemiologists Laboratorians Entomologists/ vector control specialists Support staff (administration; logistics; other) Percentage of full-time equivalents (FTE) 64. Optional comments to explain responses to questions 62 and 63 above. 79Annexes No. Item Answer (provide references as appropriate) 65 The national health authority/ministry of health has access to expertise in clinical management of arboviruses (Check all that apply)  within the ministry of health (e.g., public health medical officers, clinicians in state hospitals)  through other national agency with regulatory authority  through academic institution(s)  private hospitals  does not have access  Other: 66 The national health authority/ministry of health has access to expertise in arbovirus epidemiology (Check all that apply)  within the ministry of health  through other national agency with regulatory authority  through academic institution(s)  does not have access  Other: 67 The national health authority/ministry of health has access to expertise in arbovirus laboratory diagnosis (Check all that apply)  within the ministry of health (e.g. public health laboratory scientists)  through other national agency with regulatory authority  through academic institution(s)  does not have access  Others: 68 The national health authority/ministry of health has access to expertise in entomology (Check all that apply)  within the ministry of health  through other national agency with regulatory authority  through academic institution(s)  does not have access  Others 69. Optional comments to explain responses to any of questions 65–68. Annex 2 80 Surveillance and control of arboviral diseases in the WHO African Region Annex 2. Details of the country, subregional and regional scores for each domain 81Annexes 0 10 15 20 20 20 30 30 30 40 40 45 45 50 50 50 50 50 50 50 50 50 55 55 55 55 55 60 60 60 60 60 65 65 65 70 70 75 75 75 75 80 80 80 85 85 85 47 49 62.9 53 Botswana Mozambique Malawi Central African Republic Guinea−Bissau Uganda Burundi Eswatini Lesotho Kenya Namibia Nigeria Zimbabwe Cameroon Chad Congo Ethiopia Ghana Sao Tome and Principe Sierra Leone Togo Zambia Angola Eritrea Gambia Liberia Rwanda Burkina Faso Equatorial Guinea Gabon Mauritania Seychelles Benin Democratic Republic of the Congo Madagascar Cabo Verde United Republic of Tanzania Côte dʼIvoire Mauritius South Africa South Sudan Comoros Guinea Mali Algeria Niger Senegal East−Southern Africa Central Africa West Africa African Region 0 10 20 30 40 50 60 70 80 90 Percentage (%) Disease surveillance Annex 2 82 Surveillance and control of arboviral diseases in the WHO African Region 0 0 0 0 0 0 0 10 20 20 30 40 40 50 50 50 50 50 50 60 60 60 60 60 60 60 60 60 70 70 70 70 70 70 70 70 70 70 80 80 80 80 80 80 90 90 100 43.5 49 64.7 52.4 Botswana Eswatini Guinea−Bissau Malawi Mozambique Sao Tome and Principe Uganda Equatorial Guinea Central African Republic Zimbabwe Burundi Comoros Eritrea Namibia Nigeria Seychelles Sierra Leone Togo Zambia Burkina Faso Gambia Ghana Lesotho Mali Rwanda Senegal South Africa United Republic of Tanzania Cameroon Chad Congo Côte dʼIvoire Democratic Republic of the Congo Ethiopia Gabon Kenya Mauritania Mauritius Angola Benin Cabo Verde Liberia Madagascar Niger Guinea South Sudan Algeria East−Southern Africa Central Africa West Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) Diagnosis and case notification 83Annexes 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 33.3 33.3 33.3 33.3 33.3 33.3 33.3 33.3 33.3 33.3 33.3 33.3 66.7 66.7 66.7 66.7 66.7 66.7 66.7 66.7 66.7 100 100 100 100 100 100 28.3 30 43.1 33.8 Botswana Burundi Cameroon Central African Republic Chad Comoros Eswatini Ethiopia Gambia Guinea−Bissau Liberia Malawi Mozambique Nigeria Sao Tome and Principe Sierra Leone Togo Uganda Zambia Zimbabwe Benin Burkina Faso Equatorial Guinea Gabon Kenya Lesotho Madagascar Namibia Niger Seychelles South Africa United Republic of Tanzania Angola Côte dʼIvoire Democratic Republic of the Congo Eritrea Ghana Guinea Mali Mauritania Rwanda Algeria Cabo Verde Congo Mauritius Senegal South Sudan East−Southern Africa Central Africa West Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) Management of cases and severe cases Annex 2 84 Surveillance and control of arboviral diseases in the WHO African Region 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 100 100 100 100 100 100 27.5 45 47.1 39.9 Botswana Burundi Congo Eritrea Eswatini Gambia Guinea−Bissau Lesotho Malawi Mozambique Namibia Nigeria Sao Tome and Principe Seychelles Uganda Zambia Zimbabwe Benin Burkina Faso Cameroon Central African Republic Chad Comoros Côte dʼIvoire Equatorial Guinea Ethiopia Gabon Ghana Guinea Liberia Madagascar Mali Mauritania Niger Rwanda Senegal Sierra Leone South Africa South Sudan Togo United Republic of Tanzania Algeria Angola Cabo Verde Democratic Republic of the Congo Kenya Mauritius East−Southern Africa Central Africa West Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) Virological surveillance 85Annexes 7.7 7.7 7.7 7.7 7.7 15.4 15.4 15.4 15.4 23.1 23.1 23.1 26.9 30.8 30.8 30.8 30.8 38.5 38.5 38.5 42.3 46.2 46.2 46.2 50 50 50 50 61.5 65.4 65.4 69.2 73.1 73.1 73.1 73.1 80.8 84.6 92.3 100 41.2 47.5 48.8 45.8 76.9 76.9 76.9 76.9 53.8 53.8 53.8 Botswana Cameroon Congo Nigeria Uganda Gabon Guinea−Bissau Liberia Malawi Guinea Namibia Togo Mauritania Burkina Faso Equatorial Guinea Lesotho Madagascar Central African Republic Niger Rwanda Zambia Eswatini Gambia Mali Chad Mozambique Sao Tome and Principe United Republic of Tanzania Burundi Ghana South Africa Zimbabwe Seychelles Sierra Leone Senegal Comoros Eritrea Ethiopia South Sudan Benin Cabo Verde Democratic Republic of the Congo Kenya Angola Mauritius Côte dʼIvoire Algeria Central Africa West Africa East−Southern Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) Routine vector surveillance and control Annex 2 86 Surveillance and control of arboviral diseases in the WHO African Region 0 0 0 0 20 20 20 20 20 20 20 20 20 30 30 30 40 40 40 40 40 40 40 40 40 40 40 50 50 60 60 60 60 60 60 60 60 60 60 60 70 80 80 80 80 80 100 38 42.5 47.6 42.7 Botswana Congo Guinea−Bissau Liberia Burundi Cameroon Central African Republic Comoros Ethiopia Malawi Nigeria Sao Tome and Principe Zambia Eswatini Mauritania Togo Burkina Faso Equatorial Guinea Ghana Kenya Mozambique Namibia Niger Rwanda Senegal South Sudan United Republic of Tanzania Gambia Zimbabwe Angola Benin Chad Côte dʼIvoire Eritrea Gabon Madagascar Mali Mauritius Seychelles South Africa Lesotho Cabo Verde Democratic Republic of the Congo Guinea Sierra Leone Uganda Algeria Central Africa East−Southern Africa West Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) Community sensitization and participation during non- epidemic periods 87Annexes 0 14.3 14.3 14.3 14.3 28.6 28.6 28.6 28.6 42.9 42.9 42.9 42.9 42.9 50 71.4 71.4 71.4 71.4 71.4 71.4 71.4 71.4 71.4 71.4 71.4 71.4 71.4 71.4 71.4 85.7 85.7 85.7 85.7 85.7 85.7 100 50.7 64.7 57.1 57.1 57.1 57.1 57.1 57.1 57.1 57.1 57.1 57.1 57.9 57.8 Malawi Botswana Eswatini Mozambique Namibia Cameroon Central African Republic Gambia Guinea−Bissau Kenya Lesotho Niger Nigeria Togo Sao Tome and Principe Benin Burundi Equatorial Guinea Eritrea Gabon Guinea South Africa Uganda Zambia Zimbabwe Angola Burkina Faso Chad Comoros Côte dʼIvoire Democratic Republic of the Congo Ethiopia Liberia Madagascar Mauritius Rwanda Senegal Sierra Leone South Sudan United Republic of Tanzania Algeria Congo Ghana Mali Mauritania Seychelles Cabo Verde East−Southern Africa Central Africa West Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) Preparedness for arboviral disease outbreaks and epidemics Annex 2 88 Surveillance and control of arboviral diseases in the WHO African Region 3 7.2 9.1 16.3 17.2 23.5 23.6 24.3 25.3 27.3 28.7 31.4 32.3 33.4 34.2 35.1 38.1 38.8 40.2 44.8 47.8 47.8 49.4 49.4 50.2 50.3 50.6 52.4 52.8 53.5 58 60.3 63.8 64.1 68 69.3 71.4 73.4 80.1 86.7 41.2 44.3 46.5 54.5 55.6 55.6 55.8 57.6 75.7 54 95.8 Botswana Malawi Guinea−Bissau Mozambique Eswatini Uganda Nigeria Sao Tome and Principe Central African Republic Burundi Namibia Zambia Cameroon Zimbabwe Gambia Togo Lesotho Liberia Equatorial Guinea Congo Comoros Ethiopia Burkina Faso Gabon Chad Eritrea Seychelles Sierra Leone Niger United Republic of Tanzania Rwanda Mauritania South Africa Madagascar Kenya Ghana Benin Guinea Mali Senegal Côte dʼIvoire South Sudan Angola Democratic Republic of the Congo Mauritius Cabo Verde Algeria East−Southern Africa Central Africa West Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) Total scores for the seven domains by country and region 89Annexes Annex 3. Current transmission and burden of arboviral diseases in the 47 countries The following mock-ups summarize the current situation in the 47 countries with regard to the transmission and burden of arboviral diseases. The mock-ups include the presence or absence of Aedes aegypti and Ae. albopictus, the circulating arboviruses, national epidemiological data on the numbers of cases and deaths from the major arboviral diseases between 2015 to 2019, graphs showing estimated capacity for surveillance and control of arboviral diseases, the country’s strengths and possible ways forward. Information on the presence of Ae. aegypti, Ae. albopictus and the major circulating arboviruses was completed from scientific publications for countries that did not provide those data. Eswatini and Lesotho might consider the situation in South Africa with respect to Aedes and arboviruses pending further information. The section on possible ways forward should be considered as providing suggestions based on the data reported by countries. Thus, countries should locally adapt and prioritize those suggestions. Annex 3 90 Surveillance and control of arboviral diseases in the WHO African Region Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and West Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 85.7 100 100 100 100 100 85 46.5 54 95.8Algeria West Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance. Strengths • Existence of capacities for disease surveillance including arboviral diseases (AVDs) • Existence of capacities for the diagnostic and case notification including cases of AVDs • Existence of capacities for the management of cases & severe cases of AVDs • Arbovirus surveillance system in place • Entomological Aedes surveillance & control system in place • Community awareness of AVDs and their implication in control activities. • Existence of a national surveillance & outbreak response committee • Existence of emergency funds to respond to AVDs outbreaks Possible ways forward • Consider the development of a national contingency plan on possible AVDs outbreaks Algeria Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes albopictus is reported to be spreading and posing significant public health threats in Algeria. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + Toscana virus +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses Arboviral disease cases & deaths reported from 2015 to 2019 2015 2016 2017 Cases Deaths Cases Deaths Cases Deaths Dengue 2 Chikungunya Zika RVF YF WNVF 26 1 RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus fever. S: Suspected cases, P: Probable cases, C: confirmed cases. No data reported for blank cells. No cases or deaths reported for 2018, and 2019. 91Annexes Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and Central Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 71.4 60 80.8 100 66.7 80 55 46.5 44.3 73.4Angola Central Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Possible ways forward • Consider the development of a national guideline on arbovirus surveillance & control • Consider AVDs surveillance in animals • Provide training to staff working on Aedes surveillance & control, and to community health workers for the sensitization on AVDs at lower levels • Consider the monitoring of insecticide resistance in Aedes vectors Strengths • Existence of a national programme on arboviral diseases (AVDs) surveillance & control, and analysis of outbreak risk factors. • Laboratory testing capacities for arboviruses detection and confirmation of cases • Regular training provided to staff working on the diagnosis & notification of AVDs cases, their management and the virological surveillance • Arboviruses surveillance system in place • Entomological Aedes surveillance & control system in place • Existence of outreach programmes covering large geographical areas • Existence of a national surveillance & outbreak response committee and a contingency plan Angola Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are reported to be abundant and transmitting arboviruses in Angola. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + O’nyong-nyong virus +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses Arboviral disease cases & deaths reported from 2015 to 2019. No cases nor deaths reported Annex 3 92 Surveillance and control of arboviral diseases in the WHO African Region Possible ways forward • Consider AVDs surveillance in animals and the collection & analysis of outbreak risk factors • Consider the development of health facilities for the management of severe cases of AVDs • Consider the monitoring of insecticide resistance in Aedes vectors • Provide regular training for staff working in the 7 domains assessed • Consider the development of regional/international cooperation for support in outbreak situations Strengths • Existence of a national programme and guidelines on arboviral diseases (AVDs) surveillance & control. • Laboratory testing capacities for arboviruses detection and confirmation of cases • Mandatory notification of major AVDs cases • Existence of a national guideline to manage cases & severe cases of AVDs • Arbovirus surveillance system in place • Entomological Aedes surveillance & control system in place • Existence of community outreach programmes on AVDs; community awareness on AVDs and implication in control activities. • Existence of a national surveillance & outbreak response committee and a contingency plan Benin Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are reported to be abundant and transmitting arboviruses while Aedes albopictus are restricted to few sites and do not pose significant Public Health threats in Benin. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019 2019 Cases Deaths S P C Total Dengue 20 0 20 40 2 Chikungunya 98 0 25 123 0 Zika RVF YF 187 187 WNVF RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus fever. S: Suspected cases, P: Probable cases, C: confirmed cases. No data reported for blank cells. No cases/deaths reported for 2015, 2016, 2017, 2018. Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and West Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 57.1 60 76.9 50 33.3 80 65 46.5 54 60.3Benin West Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance 93Annexes Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and East-Southern Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 14.3 0 7.7 0 0 0 0 46.5 41.2 3.1Botswana East-Southern Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Possible ways forward • Consider the filling of gaps to meet with the indicators in the 7 domains assessed. Strengths • Existence of a national surveillance of outbreaks and response committee Botswana Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti is present in the country according to the scientific literature1. • Major arboviruses detected in the country according to the scientific literature1 Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019 No cases nor deaths reported 1 Braack L, Gouveia de Almeida AP, Cornel AJ, Swanepoel R, de Jager C. Mosquito-borne arboviruses of African origin: review of key viruses and vectors. Parasit Vectors. 2018;11:29 Annex 3 94 Surveillance and control of arboviral diseases in the WHO African Region Strengths • Existence of a national programme and guidelines on arboviral diseases (AVDs) surveillance & control. • Laboratory testing capacities for arboviruses detection and confirmation of cases • Existence of a national guideline to manage cases & severe cases of AVDs • Existence of arbovirus surveillance system in Aedes; implementation of core vector control approaches • Existence of community outreach programmes on AVDs covering large geographical areas • Existence of a national surveillance of outbreaks and response committee Possible ways forward • Consider AVDs surveillance in animals and the collection & analysis of outbreak risk factors • Provide regular training for staff working in the 7 domains assessed • Consider the development of health facilities for the management of severe cases of AVDs • Ensure the notification of cases of major AVDs • Consider the entomological surveillance in Aedes • Consider the community engagement on activities related to AVDs control • Consider the development of a national contingency plan including outbreaks of AVDs Burkina Faso Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are reported spreading and posing significant public health threats. Aedes albopictus are occasionally found and do not pose significant public health threats. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019 2016 2017 2019 Cases Deaths Cases Deaths Cases Deaths S P C Total Dengue 59 257 Chikungunya 5278 5278 0 Zika RVF YF WNVF RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile Virus fever. S: Suspected cases, P: Probable cases, C: Confirmed cases. No data reported for blank cells. No cases/deaths reported for 2015 and 2018. Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and West Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 71.4 40 30.8 50 33.3 60 60 46.5 54 49.4Burkina Faso West Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance 95Annexes Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and Central Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 57.1 20 53.8 0 0 30 30 46.5 44.3 27.3Burundi Central Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Strengths • Mandatory notification of cases of major arboviral diseases (AVD) • Existence of laboratory capacities for the detection of arboviruses • Existence of national institutions for arbovirus vector surveillance • Existence of community outreach programmes on AVDs • Existence of a national surveillance of outbreaks & response committee Possible ways forward • Consider the implementation of a national disease surveillance system including AVDs • Provide regular training for staff working in the 7 domains assessed • Consider the strengthening of capacities for the management of cases & severe cases of AVDs including guidelines and adequate health facilities • Consider the strengthening of laboratory capacities for the confirmation of suspected cases • Consider an effective entomological surveillance in Aedes • Consider the effective run of the outreach programmes on AVDs including the community engagement on activities related to AVDs control Burundi Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are reported to be occasionally found and do not pose significant public health threats in the country. • Major arboviruses detected in the country according to the scientific literature1 Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths from 2015 to 2019 No cases nor deaths reported 1 Braack L, Gouveia de Almeida AP, Cornel AJ, Swanepoel R, de Jager C. Mosquito-borne arboviruses of African origin: review of key viruses and vectors. Parasit Vectors. 2018;11:29 Annex 3 96 Surveillance and control of arboviral diseases in the WHO African Region Possible ways forward • Consider AVDs surveillance in animals • Consider the strengthening of the entomological surveillance of vectors of arboviruses • Provide regular training for staff on the use of disease surveillance tools, and for healthcare workers on the notification of cases of major AVDs Strengths • Existence of capacities for disease surveillance including arboviral diseases (AVDs) • Existence of capacities for the diagnostic and case notification including cases of AVDs • Existence of capacities for the management of cases & severe cases of AVDs • Arbovirus surveillance system in place • Aedes surveillance & control system in place • Existence of community outreach programmes on AVDs; community awareness on AVDs and implication in control activities. • Existence of capacities for the preparedness for AVDs outbreaks/epidemics Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and West Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 100 80 76.9 100 100 80 70 46.5 54 86.7Cabo Verde West Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Cabo Verde Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are reported to be spreading and posing significant public health threats while Aedes albopictus are absent for now in the country. • Major arboviruses detected in the country according to the scientific literature1 Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019 2015 2016 2017 2019 Cases Deaths Cases Deaths Cases Deaths Cases Deaths S P C Total Dengue 15 0 4 0 32 0 Chikungunya 2 2 0 Zika 6743 0 764 0 2 2 0 RVF YF WNVF RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus fever. S: Suspected cases, P: Probable cases, C: Confirmed cases. No data reported for blank cells. No cases nor deaths reported for 2018. 1 Braack L, Gouveia de Almeida AP, Cornel AJ, Swanepoel R, de Jager C. Mosquito-borne arboviruses of African origin: review of key viruses and vectors. Parasit Vectors. 2018;11:29 97Annexes Possible ways forward • Consider the collection and analysis of AVDs outbreak risk factors • Consider the strengthening of capacities for the management of cases & severe cases of AVDs including guidelines and adequate health facilities • Consider an effective entomological surveillance and control of Aedes including the monitoring of insecticide resistance • Consider the effective run of the outreach programmes on AVDs including the community engagement on activities related to the control of AVDs • Consider the development of a national contingency plan including outbreaks of AVDs • Provide regular training for staff working in the 7 domains assessed Strengths • Existence of a national guideline on arboviral diseases (AVDs) surveillance & control. • Laboratory testing capacities for the detection of arboviruses and confirmation of cases • Existence of a system for arbovirus surveillance • Existence of community outreach programmes on AVDs • Existence of a national surveillance of outbreaks & response committee Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and Central Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 28.6 20 7.7 50 0 70 50 46.5 44.3 32.3Cameroon Central Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Cameroon Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are reported to be abundant and transmitting arboviruses in the country. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019 2019 Cases Deaths Dengue Chikungunya Zika RVF YF 12 0 WNVF RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile Virus fever. No data reported for blank cells. No data reported for 2015, 2016, 2017 and 2018. Annex 3 98 Surveillance and control of arboviral diseases in the WHO African Region Possible ways forward • Consider the development of a national guideline on AVDs surveillance and control • Consider AVDs surveillance including animals, and the collection & analysis of outbreak risk factors • Strengthening laboratory capacities for the confirmation of suspected cases and the positive cases of AVDs. • Consider the strengthening of capacities for the management of cases & severe cases of AVDs including guidelines and adequate health facilities • Consider strengthening the entomological surveillance in Aedes including the monitoring of insecticide resistance • Consider the development of a national contingency plan including outbreaks of AVDs • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and Central Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 28.6 20 38.5 50 0 20 20 46.5 44.3 25.3Central African Republic Central Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/ Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Strengths • Existence of a national programme on arboviral diseases (AVDs) surveillance & control. • Mandatory notification of cases of major AVDs • Laboratory testing capacity for the detection of arboviruses • Arbovirus surveillance system in place • Entomological Aedes surveillance & control system in place • Existence of community outreach programmes on AVDs • Existence of a national surveillance of outbreaks & response committee Central African Republic Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti and Aedes albopictus are reported to be spreading and posing significant public health threats in the country. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + + + + + O’nyong- nyong virus +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths from 2015 to 2019 No cases nor deaths reported 99Annexes Possible ways forward • Consider the use of guidelines on AVDs surveillance and control • Consider AVDs surveillance in animals • Consider the strengthening of capacities for the management of cases & severe cases of AVDs including guidelines and adequate health facilities • Consider an effective entomological surveillance in Aedes including the monitoring of insecticide resistance • Provide regular training for staff working in the 7 domains assessed Strengths • Existence of a national programme on arboviral diseases (AVDs) surveillance & control. • Laboratory testing capacities for the detection of arboviruses and confirmation of cases • Arbovirus surveillance system in place • Entomological Aedes surveillance & control system in place • Existence of community outreach programmes on AVDs; community awareness on AVDs and implication in control activities. • Existence of capacities for the preparedness for AVDs outbreaks/epidemics Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and Central Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 71.4 60 50 50 0 70 50 46.5 44.3 50.2Chad Central Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Chad Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are present in the country according to the scientific literature1 • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019 2015 2016 2017 2018 2019 Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Dengue Chikungunya Zika RVF YF 428 7 420 8 607 3 544 9 WNVF RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile Virus fever. S: Suspected cases, P: Probable cases, C: Confirmed cases. No data reported for blank cells. 1 Braack L, Gouveia de Almeida AP, Cornel AJ, Swanepoel R, de Jager C. Mosquito-borne arboviruses of African origin: review of key viruses and vectors. Parasit Vectors. 2018;11:29 Annex 3 100 Surveillance and control of arboviral diseases in the WHO African Region Strengths • Existence of capacities for disease surveillance including arboviral diseases (AVDs) • Mandatory notification of major AVDs cases • Existence of some laboratory testing capacities for the detection of arboviruses • Arbovirus surveillance system in place • Entomological Aedes surveillance & control system in place • Existence of a national entity in charge of community outreach programmes on AVDs • Existence of a national surveillance of outbreaks & response committee and a contingency plan Possible ways forward • Consider the collection & analysis of outbreak risk factors • Strengthening laboratory capacities for the confirmation of suspected cases and the positive cases of AVDs. • Consider the strengthening of capacities for the management of cases & severe cases of AVDs including guidelines and adequate health facilities • Consider the monitoring of insecticide resistance in Aedes vectors • Consider the effective run of the outreach programmes on AVDs including the community engagement on activities related to the control of AVDs • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and East-Southern Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 71.4 20 73.1 50 0 40 80 46.5 41.2 Comoros East-Southern Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) 47.8 PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Comoros Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are reported to be spreading and posing significant public health threats (PHT); Aedes albopictus are stable in select areas and posing significant PHT • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported for last 5 years 2015 2019 Cases Deaths Cases Deaths S P C Total Dengue 132 132 0 Chikungunya 1000 1000 2000 0 Zika RVF 3 YF WNVF RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus fever. S: Suspected cases, P: Probable cases, C: Confirmed cases. No data reported for blank cells. No cases nor deaths reported for 2016, 2017 and 2018. 101Annexes Strengths • Existence of national guidelines on arboviral diseases (AVDs) surveillance & control. • Mandatory notification of major AVDs cases • Laboratory testing capacities for the detection of arboviruses and confirmation of cases • Existence of capacities for the management of cases & severe cases of AVDs • Existence of capacities for the preparedness for AVDs outbreaks/epidemics Possible ways forward • Consider AVDs surveillance in animals and the collection & analysis of outbreak risk factors • Consider capacity building for virological surveillance • Consider capacity building for the entomological surveillance and control of Aedes including the monitoring of insecticide resistance • Consider capacity building for the community sensitization and participation to activities related to AVDs control • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and Central Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 85.7 0 7.7 100 0 70 50 46.5 44.3 44.8Congo Central Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Congo Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti and Aedes albopictus are reported to be spreading and posing significant public health threats in the country. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019. 2018 Cases Deaths Dengue 1 0 Chikungunya Zika RVF YF 1 0 WNVF RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus fever. S: Suspected cases, P: Probable cases, C: Confirmed cases. No data reported for blank cells. No cases nor deaths reported for 2015, 2016, 2017 and 2019. Annex 3 102 Surveillance and control of arboviral diseases in the WHO African Region Strengths • Existence of capacities for disease surveillance including arboviral diseases (AVDs) • Existence of capacities for the diagnostic and case notification including cases of AVDs • Existence of capacities for the management of cases & severe cases of AVDs • Arbovirus surveillance system in place • Entomological Aedes surveillance & control system in place • Existence of community outreach programmes on AVDs; community awareness on AVDs and implication in control activities. • Existence of a national surveillance of outbreaks & response committee and a contingency plan Possible ways forward • Consider the AVDs surveillance in animals • Consider the confirmation of positive cases of AVDs. • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and West Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 71.4 60 92.3 50 66.7 70 75 46.5 54 69.3Côte d’Ivoire West Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Côte d’Ivoire Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are reported to be abundant and transmitting arboviruses; Aedes albopictus are occasionally found and do not pose significant public health threats. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019. 2015 2016 2017 2018 2019 Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Dengue 2 217 2 291 Chikungunya Zika RVF YF 16 2 24 10 89 WNVF RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus fever. S: Suspected cases, P: Probable cases, C: Confirmed cases. No data reported for blank cells. 103Annexes Strengths • Existence of a national programme and guidelines on arboviral diseases (AVDs) surveillance & control. • Laboratory testing capacities for the detection of arboviruses and confirmation of cases • Existence of a national guideline to manage cases & severe cases of AVDs • Arbovirus surveillance system in place • Entomological Aedes surveillance & control system in place • Existence of community outreach programmes on AVDs; community awareness on AVDs and implication in control activities. • Existence of a national surveillance of outbreaks & response committee and a contingency plan Possible ways forward • Consider the surveillance of AVDs in animals • Consider the strengthening of health facilities for the management of severe cases of AVDs • Consider the monitoring of insecticide resistance in Aedes vectors • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and Central Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 71.4 80 76.9 100 66.7 70 65 46.5 44.3 75.7DR Congo Central Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) DR Congo: Democratic Republic of the Congo. PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods- RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Democratic Republic of the Congo Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti and Aedes albopictus are reported to be spreading and posing significant public health threats in the country. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths from 2015 to 2019. No cases nor deaths reported Annex 3 104 Surveillance and control of arboviral diseases in the WHO African Region Strengths • Existence of national guidelines on arboviral diseases (AVDs) surveillance & control. • Mandatory notification of major AVDs cases • Arbovirus surveillance and system in place • Entomological Aedes surveillance & control system in place • Existence of community outreach programmes on AVDs • Existence of a national surveillance of AVDs outbreaks & response committee Possible ways forward • Consider the surveillance of AVDs in animals and the collection & analysis of outbreak risk factors • Consider the strengthening of laboratory capacities for the detection of arboviruses and the confirmation of suspected cases and the positive cases of AVDs • Consider the strengthening of capacities for the management of cases & severe cases of AVDs including guidelines and adequate health facilities • Consider the strengthening of the entomological surveillance in Aedes including the monitoring of insecticide resistance • Consider the effective run of the outreach programmes on AVDs including the community engagement on activities related to the control of AVDs • Consider the development of a national contingency plan including outbreaks of AVDs • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and Central Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 57.1 40 30.8 50 33.3 10 60 46.5 44.3 40.2Equatorial Guinea Central Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Equatorial Guinea Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are found in the country according to the scientific literature1 • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths from 2015 to 2019. No cases nor deaths reported 1 Braack L, Gouveia de Almeida AP, Cornel AJ, Swanepoel R, de Jager C. Mosquito-borne arboviruses of African origin: review of key viruses and vectors. Parasit Vectors. 2018;11:29 105Annexes Strengths • Existence of a national programme and guidelines on arboviral diseases (AVDs) surveillance & control. • Mandatory notification of major AVDs cases • Existence of a national guideline to manage cases & severe cases of AVDs • Aedes surveillance & control system in place • Existence of community outreach programmes on AVDs • Existence of a national surveillance of AVDs out- breaks & response committee Possible ways forward • Consider the surveillance of AVDs in humans, animals, and the collection & analysis of AVDs outbreak risk factors • Consider the strengthening of laboratory capacities for the detection of arboviruses and the confirmation of suspected cases and the positive cases of AVDs • Consider the strengthening of health facilities for the management of severe cases of AVDs • Consider capacity building for virological surveillance • Consider the strengthening of the entomological surveillance of Aedes including the monitoring of insecticide resistance • Consider the community engagement on activities related to AVDs control • Consider the development of a national contingency plan including outbreaks of AVDs Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and East-Southern Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 57.1 60 73.1 0 66.7 40 55 46.5 41.2 50.3Eritrea East-Southern Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Eritrea Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are reported to be spreading and posing significant public health threats in the country. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019. No cases nor deaths reported Annex 3 106 Surveillance and control of arboviral diseases in the WHO African Region Strengths • Existence of partial capacities for Aedes surveillance and control • Existence of community outreach programmes on AVDs Possible ways forward • Consider capacity building for the arboviral disease surveillance • Consider the strengthening of laboratory capacities for the detection of arboviruses and the confirmation of suspected cases and the positive cases of AVDs • Consider the strengthening of capacities for the management of cases & severe cases of AVDs including guidelines and adequate health facilities • Consider capacity building for virological surveillance • Consider capacity building for the entomological surveillance and control of Aedes including the monitoring of insecticide resistance • Consider the effective run of the outreach programmes on AVDs including the community engagement on activities related to the control of AVDs • Existence of a national surveillance of AVDs out- breaks & response committee • Consider the development of a national contingency plan including outbreaks of AVDs • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and East-Southern Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 14.3 30 46.2 0 0 0 30 46.5 41.2 17.2Eswatini East-Southern Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Eswatini Transmission and burden of arboviral diseases Vectors and arboviruses • Presence or absence of Aedes in the country: no data yet (South Africa’s situation may be considered) • Major arboviruses circulating in the country: no data yet (South Africa’s situation may be considered) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019. No cases nor deaths reported 107Annexes Strengths • Existence of a national programme and guidelines on arboviral diseases (AVDs) surveillance & control • Laboratory testing capacities for the detection of arboviruses and confirmation of cases and the positive cases of AVDs • Arbovirus surveillance system in place • Entomological Aedes surveillance & control system in place • Existence of community outreach programmes on AVDs • Existence of a national surveillance of AVDs outbreaks & response committee Possible ways forward • Consider the surveillance of AVDs in animals and the collection & analysis of AVDs outbreak risk factors • Consider the strengthening of capacities for the management of cases & severe cases of AVDs including guidelines and adequate health facilities • Consider the monitoring of insecticide resistance in Aedes vectors • Consider the effective run of the outreach programmes on AVDs including the community engagement on activities related to the control of AVDs • Consider the development of a national contingency plan including outbreaks of AVDs • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and East-Southern Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 71.4 20 73.1 0 50 70 50 46.5 41.2 47.8Ethiopia East-Southern Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Ethiopia Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti and Aedes albopictus are reported to be spreading and posing significant public health threats in Ethiopia. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + + + + + + Sand fly virus +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019. 2017 2018 2019 Cases Deaths Cases Deaths Cases Deaths S P C Total Dengue 974 0 25 999 0 Chikungunya 57268 0 19 57287 0 Zika RVF YF 10 35 WNVF RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus fever. S: Suspected cases, P: Probable cases, C: Confirmed cases. No data reported for blank cells. No cases nor deaths reported for 2015 and 2016 . Annex 3 108 Surveillance and control of arboviral diseases in the WHO African Region Strengths • Existence of a national programme and guidelines on arboviral diseases (AVDs) surveillance & control • Mandatory notification of major AVDs cases • Laboratory testing capacities for the detection of arboviruses and confirmation of cases and the positive cases of AVDs. • Existence of a national guideline to manage cases & severe cases of AVDs • Arbovirus surveillance system in place • Existence of community outreach programmes on AVDs; community awareness on AVDs and implication in control activities. • Existence of a national surveillance of AVDs outbreaks & response committee Possible ways forward • Consider the surveillance of AVDs in animals and the collection & analysis of AVDs outbreak risk factors • Consider the strengthening of health facilities for the management of severe cases of AVDs • Consider capacity building for the entomological surveillance and control of Aedes including the monitoring of insecticide resistance • Consider the development of a national contingency plan including outbreaks of AVDs • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and Central Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 57.1 60 15.4 50 33.3 70 60 46.5 44.3 49.4Gabon Central Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Gabon Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti and Aedes albopictus are found in the country according to the scientific literature1 • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019. No cases nor deaths reported 1 Jiolle D, Moltini-Conclois I, Obame-Nkoghe J, Yangari P, Porciani A, Scheid B, et al. Experimental infections with Zika virus strains reveal high vector competence of Aedes albopictus and Aedes aegypti popu- lations from Gabon (Central Africa) for the African virus lineage. Emerg Microbes Infect. 2021;10:1244–53. 109Annexes Strengths • Existence of a national programme on arboviral diseases (AVDs) surveillance & control • Laboratory testing capacities for the detection of arboviruses and confirmation of AVDs cases • Entomological Aedes surveillance & control system in place • Existence of community outreach programmes on AVDs • Existence of a national surveillance of AVDs outbreaks & response committee and a contingency plan Possible ways forward • Consider the surveillance of AVDs in animals • Consider the strengthening of capacities for the management of cases & severe cases of AVDs including guidelines and adequate health facilities • Consider capacity building for virological surveillance • Consider an effective entomological surveillance in Aedes including the monitoring of insecticide resistance • Consider the development of regional/international cooperation for support in outbreak situations • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and West Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 28.6 50 46.2 0 0 60 55 46.5 54 34.2Gambia West Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Gambia Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti and Aedes albopictus are reported to be restricted to few sites and do not pose significant public health threats in the country. • Major arboviruses found in the country according to the scientific literature1 Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019. 2018 Cases Deaths Dengue Chikungunya Zika RVF 1 YF WNVF RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus fever. S: Suspected cases, P: Probable cases, C: Confirmed cases. No data reported for blank cells. No cases nor deaths reported for 2015, 2016, 2017 and 2019. 1 Braack L, Gouveia de Almeida AP, Cornel AJ, Swanepoel R, de Jager C. Mosquito-borne arboviruses of African origin: review of key viruses and vectors. Parasit Vectors. 2018;11:29 Annex 3 110 Surveillance and control of arboviral diseases in the WHO African Region Strengths • Existence of a national programme and guidelines on arboviral diseases (AVDs) surveillance & control • Laboratory testing capacities for the detection of arboviruses and confirmation of AVDs cases • Existence of capacities for the management of cases & severe cases of AVDs • Arbovirus surveillance system in place • Entomological Aedes surveillance & control system in place • Existence of community outreach programmes on AVDs • Existence of capacities for the preparedness for AVDs outbreaks/epidemics Possible ways forward • Consider the surveillance of AVDs in humans, animals and the collection & analysis of AVDs outbreak risk factors • Consider the monitoring of insecticide resistance in Aedes vectors • Consider the effective run of the outreach programmes on AVDs including the community engagement on activities related to the control of AVDs • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and West Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 85.7 40 53.8 50 66.7 60 50 46.5 54 58Ghana West Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Ghana Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti and Aedes albopictus are present in the country according to the scientific literature 1,2 • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths from 2015 to 2019. No cases nor deaths reported 1 Joannides J, Dzodzomenyo M, Azerigyik F, Agbosu EE, Pratt D, Nyarko Osei JH, et al. Species composition and risk of transmission of some Aedes-borne arboviruses in some sites in Northern Ghana. PLoS One. 2021;16:e0234675. 2 Suzuki T, Osei JH, Sasaki A, Adimazoya M, Appawu M, Boakye D, et al. Risk of transmission of viral haemorrhagic fevers and the insecti- cide susceptibilitystatus of aedes aegypti (linnaeus) in some sites in Accra, Ghana. Ghana Med J. 2016;50:136–41. 111Annexes Strengths • Existence of capacities for disease surveillance including arboviral diseases (AVDs) • Existence of capacities for the diagnostic and case notification including the AVDs cases • Existence of capacities for the management of cases & severe cases of AVDs • Arbovirus surveillance system in place • Existence of community outreach programmes on AVDs; community awareness on AVDs and implication in control activities. • Existence of a national surveillance of AVDs outbreaks & response committee and a contingency plan • Existence of emergency funds to respond to AVDs outbreaks Possible ways forward • Consider capacity building for the entomological surveillance and control of Aedes including the monitoring of insecticide resistance • Consider the development of regional/international cooperation for support in outbreak situations • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and West Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 57.1 80 23.1 50 66.7 90 80 46.5 54 63.8Guinea West Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Guinea Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti and Aedes albopictus are reported to be spreading and posing significant public health threats in the country. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + + + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported for last 5 years 2015 2016 2017 2019 Cases Deaths Cases Deaths Cases Deaths Cases Deaths S P C Total Dengue Chikung unya Zika RVF YF 4 3 6 109 4 0 113 6 WNVF RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus fever. S: Suspected cases, P: Probable cases, C: Confirmed cases. No data reported for blank cells. No cases nor deaths reported for 2018. Annex 3 112 Surveillance and control of arboviral diseases in the WHO African Region Strengths • Mandatory notification of major arboviral diseases (AVDs) cases • Existence of cooperation agreements in outbreak situation • Existence of emergency funds to respond to AVDs outbreaks Possible ways forward • Consider capacity building for the AVDs surveillance • Consider the strengthening of laboratory capacities for the detection of arboviruses and the confirmation of suspected cases and the positive cases of AVDs • Consider the strengthening of capacities for the management of cases & severe cases of AVDs including guidelines and adequate health facilities • Consider capacity building for virological surveillance • Consider capacity building for the entomological surveillance and control of Aedes including the monitoring of insecticide resistance • Consider capacity building for the community sensitization and participation to activities related to the control of AVDs • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and West Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 28.6 0 0 0 0 15.4 20 46.5 54 9.1Guinea-Bissau West Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Guinea-Bissau Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are reported to be spreading and posing significant public health threats in the country. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019. No cases nor deaths reported 113Annexes Strengths • Existence of a national programme on arboviral diseases (AVDs) surveillance & control • Laboratory testing capacities for the detection of arboviruses and confirmation of AVDs cases. • Existence of health facilities for the management of cases & severe cases of AVDs • Arbovirus surveillance system in place • Entomological Aedes surveillance & control system in place • Existence of community outreach programmes on AVDs; community awareness on AVDs and implication in control activities • Existence of a national surveillance of AVDs outbreaks & response committee • Existence of cooperation agreements in outbreak situations Possible ways forward • Consider the use of guidelines on AVDs surveillance and control • Consider the surveillance of AVDs in humans, animals and the collection & analysis of AVDs outbreak risk factors • Consider the use of guidelines for the management of cases and severe cases of AVDs • Consider the monitoring of insecticide resistance in Aedes vectors • Consider the development of a national contingency plan including outbreaks of AVDs • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and East-Southern Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 42.9 40 76.9 100 33.3 70 40 46.5 41.2 57.6Kenya East-Southern Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Kenya Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are reported to be abundant and transmitting arboviruses in the country. • Major arboviruses reported as circulating in the country (see table below). Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + + + + + + O’nyong-nyong virus +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths from 2015 to 2019. 2016 2017 2018 2019 Cases Deaths Cases Deaths Cases Deaths Cases Deaths S P C Total Dengue 1874 32 1537 35 616 616 268 1500 0 Chikungu nya 123 1210 Zika 5 RVF 103 169 169 0 YF WNVF RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus fever. S: Suspected cases, P: Probable cases, C: Confirmed cases. No data reported for blank cells. No cases nor deaths reported for 2015. Annex 3 114 Surveillance and control of arboviral diseases in the WHO African Region Strengths • Laboratory testing capacities for the confirmation of the cases of arboviral diseases (AVDs) and the notification of the major ones • Existence of health facilities to manage cases & severe cases of AVDs • Existence of community outreach programmes on AVDs; community awareness on AVDs and implication in control activities • Existence of a national surveillance of AVDs outbreaks & response committee Possible ways forward • Consider capacity building for the arboviral diseases (AVDs) surveillance • Strengthening laboratory capacities for the detection of arboviruses and the confirmation of positive cases of AVDs • Consider the use of guidelines for the management of cases and severe cases of AVDs • Consider capacity building for virological surveillance • Consider capacity building for the entomological surveillance and control of Aedes including the monitoring of insecticide resistance • Consider the development of a national contingency plan including outbreaks of AVDs • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and East-Southern Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 42.9 70 30.8 0 33.3 60 30 46.5 41.2 38.1Lesotho East-Southern Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease utbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Lesotho Transmission and burden of arboviral diseases Vectors and arboviruses • Presence or absence of Aedes in the country: no data yet (South Africa’s situation may be considered) • Major arboviruses circulating in the country: no data yet (South Africa’s situation may be considered) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019. No cases nor deaths reported 115Annexes Strengths • Existence of a national programme and guidelines on arboviral diseases (AVDs) surveillance & control. • Mandatory notification of major AVDs cases • Laboratory testing capacities for the detection of arboviruses and confirmation of cases and the positive cases of AVDs. • Arbovirus surveillance system in place • Existence of capacities for the preparedness for AVDs outbreaks/epidemics Possible ways forward • Consider the surveillance of AVDs in humans, and the collection & analysis of AVDs outbreak risk factors • Consider the strengthening of capacities for the management of cases & severe cases of AVDs including guidelines and adequate health facilities • Consider capacity building for the entomological surveillance and control of Aedes including the monitoring of insecticide resistance • Consider capacity building for the community sensitization and participation to activities related to the control of AVDs • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and West Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 71.4 0 15.4 50 0 80 55 46.5 54 38.8Liberia West Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Liberia Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are reported to be abundant and transmitting arboviruses. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths from 2015 to 2019 2017 2018 2019 Cases Deaths Cases Deaths Cases Deaths S P C Total Dengue Chikungunya Zika RVF YF 163 2 121 120 120 4 WNVF RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus fever. S: Suspected cases, P: Probable cases, C: Confirmed cases. No data reported for blank cells. No cases nor deaths reported for 2015 and 2016. Annex 3 116 Surveillance and control of arboviral diseases in the WHO African Region Strengths • Existence of a national programme and guidelines on arboviral diseases (AVDs) surveillance & control • Laboratory testing capacities for the detection of arboviruses and confirmation of cases and the positive cases of AVDs. • Existence of health facilities to manage cases & severe cases of AVDs • Arbovirus surveillance system in place • Existence of community outreach programmes on AVDs; community awareness on AVDs and implication in control activities • Existence of a national surveillance of AVDs outbreaks & response committee and a contingency plan • Existence of cooperation agreements in outbreak situations Possible ways forward • Consider the collection & analysis of AVDs outbreak risk factors • Consider the use of guidelines for the management of cases and severe cases of AVDs • Consider capacity building for the entomological surveillance and control of Aedes including the monitoring of insecticide resistance • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and East-Southern Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 71.4 60 30.8 33.3 80 50 65 46.5 41.2 55.8Madagascar East-Southern Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Madagascar Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are reported to be stable in select areas and posing significant public health threats (PHT) while Aedes albopictus are restricted to few sites and do not pose significant PHT. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths from 2015 to 2019. 2018 2019 Cases Deaths Cases Deaths S P C Total Dengue 73 73 Chikungunya 511 2500 258 2758 Zika RVF YF WNVF RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus fever S: Suspected cases, P: Probable cases, C: Confirmed cases. No data reported for blank cells. No cases nor deaths reported for 2015, 2016 and 2017. 117Annexes Strengths • Existence of a national committee on the surveillance of arboviral diseases (AVDs) outbreaks & response Possible ways forward • Consider capacity building for the AVDs surveillance • Consider the strengthening of laboratory capacities for the detection of arboviruses and the confirmation of suspected cases and the positive cases of AVDs. • Consider the strengthening of capacities for the management of cases & severe cases of AVDs including guidelines and adequate health facilities • Consider capacity building for virological surveillance • Consider capacity building for the entomological surveillance and control of Aedes including the monitoring of insecticide resistance • Consider capacity building for the community sensitization and participation to activities related to the control of AVDs • Consider capacity building for the preparedness for AVDs outbreaks/epidemics Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and East-Southern Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 20 15.4 15 0 0 0 0 46.5 41.2 7.2Malawi East-Southern Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Malawi Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti and Aedes albopictus are found in the country according to the scientific literature1. • Major arboviruses found in the country according to the scientific literature1 Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019. No cases nor deaths reported 1 Braack L, Gouveia de Almeida AP, Cornel AJ, Swanepoel R, de Jager C. Mosquito-borne arboviruses of African origin: review of key viruses and vectors. Parasit Vectors. 2018;11:29 Annex 3 118 Surveillance and control of arboviral diseases in the WHO African Region Strengths • Existence of capacities for disease surveillance including arboviral diseases (AVDs) • Laboratory testing capacities for the detection of arboviruses and confirmation of AVDs cases. • Existence of capacities for the management of cases & severe cases of AVDs • Arbovirus surveillance system in place • Entomological Aedes surveillance & control system in place • Existence of community outreach programmes on AVDs; community awareness on AVDs and implication in control activities. • Existence of capacities for the preparedness for AVDs outbreaks/epidemics Possible ways forward • Consider the monitoring of insecticide resistance in Aedes vectors • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and West Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 85.7 60 46.2 50 66.7 60 80 46.5 54 64.1Mali West Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Mali Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti and Aedes albopictus are reported to be stable in select areas and posing significant public health threats in the country. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths from 2015 to 2019. 2015 2016 2017 2018 2019 Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths S P C Total Dengue 15 20 0 9 29 0 Chikun- gunya Zika 2 RVF 2 5 1 YF 181 15 260 0 183 8 226 248 0 0 248 7 WNVF RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus fever. S: Suspected cases, P: Probable cases, C: Confirmed cases. No data reported for blank cells. 119Annexes Strengths • Existence of a national programme and guidelines on arboviral diseases (AVDs) surveillance & control • Mandatory notification of major AVDs cases • Laboratory testing capacities for the detection of arboviruses and confirmation of AVDs cases. • Existence of capacities for the management of cases & severe cases of AVDs • Arbovirus surveillance system in place • Existence of a national surveillance of AVDs outbreaks & response committee • Existence of capacities for the preparedness for AVDs outbreaks/epidemics Possible ways forward • Consider the surveillance of AVDs in animals and the collection & analysis of AVDs outbreak risk factors • Consider the strengthening of the entomological surveillance of Aedes including the monitoring of insecticide resistance • Consider the effective run of the outreach programmes on AVDs including the community engagement on activities related to the control of AVDs • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and West Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 85.7 30 26.9 50 66.7 70 60 46.5 54 55.6Mauritania West Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Mauritania Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are occasionally found and do not pose significant public health threats in the country. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths from 2015 to 2019. 2017 2018 Cases Deaths Cases Deaths Dengue 1 0 155 0 Chikungunya Zika RVF YF WNVF RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus fever. S: Suspected cases, P: Probable cases, C: Confirmed cases. No data reported for blank cells. No cases nor deaths reported for 2015, 2016 and 2019. Annex 3 120 Surveillance and control of arboviral diseases in the WHO African Region Strengths • Existence of capacities for disease surveillance including arboviral diseases (AVDs) • Laboratory testing capacities for the detection of arboviruses and confirmation of AVDs cases. • Existence of capacities for the management of cases & severe cases of AVDs • Arbovirus surveillance system in place • Entomological Aedes surveillance & control system in place • Existence of community outreach programmes on AVDs; community awareness on AVDs and implication in control activities • Existence of capacities for the preparedness for AVDs outbreaks/epidemics Possible ways forward • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and East-Southern Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 71.4 60 84.6 100 70 100 75 46.5 41.2 80.1Mauritius East-Southern Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Mauritius Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are reported to be absent while Aedes albopictus are spreading and posing significant public health threats in the country. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths from 2015 to 2019. 2015 2016 2017 2018 2019 Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths S P C Total Dengue 86 0 26 0 11 0 1 152 152 0 Chikun- gunya 3 0 1 1 1 0 Zika RVF YF WNVF RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus fever. S: Suspected cases, P: Probable cases, C: Confirmed cases. No data reported for blank cells. 121Annexes Strengths • Existence of partial capacities for the entomological Aedes surveillance & control • Existence of a national community outreach programme • Existence of a national contingency plan including AVDs Possible ways forward • Consider capacity building for the AVDs surveillance • Consider the strengthening of laboratory capacities for the detection of arboviruses and the confirmation of suspected cases and the positive cases of AVDs • Consider capacity building for virological surveillance • Consider the strengthening of capacities for the management of cases & severe cases of AVDs including guidelines and adequate health facilities • Consider the strengthening of the entomological surveillance of Aedes including the monitoring of insecticide resistance • Consider the effective run of the outreach programmes on AVDs including the community engagement on activities related to the control of AVDs • Consider capacity building for the preparedness for AVDs outbreaks/epidemics • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and East-Southern Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 40 50 10 0 0 0 46.5 41.2 16.3 14.3 Mozambique East-Southern Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Mozambique Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are reported to be abundant and transmitting arboviruses while Aedes albopictus are spreading and posing significant public health threats in the country. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths from 2015 to 2019. No cases nor deaths reported Annex 3 122 Surveillance and control of arboviral diseases in the WHO African Region Strengths • Existence of a national programme on arboviral diseases (AVDs) surveillance & control • Mandatory notification of major AVDs cases • Laboratory testing capacities for the confirmation of the AVDs cases and the notification of the major ones. • Existence of health facilities to manage cases & severe cases of AVDs • Existence of community outreach programmes on AVD Possible ways forward • Consider the use of the available guidelines on AVDs surveillance and control • Consider the surveillance of AVDs in animals and the collection & analysis of AVDs outbreak risk factors • Consider the use of available guidelines for the management of cases and severe cases of AVDs • Consider capacity building for virological surveillance • Consider the strengthening of the entomological surveillance of Aedes including the monitoring of insecticide resistance • Consider the effective run of the outreach programmes on AVDs including the community engagement on activities related to the control of AVDs • Consider capacity building for the preparedness for AVDs outbreaks/epidemics • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and East-Southern Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 14.3 40 23.1 33.3 50 0 40 46.5 41.2 28.7Namibia East-Southern Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Namibia Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are found in the country according to the scientific literature1,2 • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019. No cases nor deaths reported 1 Braack L, Gouveia de Almeida AP, Cornel AJ, Swanepoel R, de Jager C. Mosquito-borne arboviruses of African origin: review of key vi- ruses and vectors. Parasit Vectors. 2018;11:29 2 Noden BH, Musuuo M, Aku-Akai L, van der Colf B, Chipare I, Wilkin- son R. Risk assessment of flavivirus transmission in Namibia. Acta Tropica. 2014;137:123–9. 123Annexes Strengths • Existence of capacities for disease surveillance including arboviral diseases (AVDs) • Laboratory testing capacities for the detection of arboviruses and confirmation of AVDs cases • Existence of a national guideline to manage cases & severe cases of AVDs • Arbovirus surveillance system in place • Existence of community outreach programmes on AVDs; community awareness on AVDs and implication in control activities • Existence of a national committee for the surveillance of AVDs outbreaks & response Possible ways forward • Consider the surveillance of AVDs in animals • Consider the strengthening of health facilities for the management of severe cases of AVDs • Consider the strengthening of the entomological surveillance of Aedes including the monitoring of insecticide resistance • Consider the development of a national contingency plan including outbreaks of AVDs • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and West Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 42.9 40 38.5 50 33.3 80 85 46.5 54 52.8Niger West Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Niger Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti and Aedes albopictus are reported to be occasionally found and do not pose significant public health threats in the country. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019. 2016 2019 Cases Deaths Cases Deaths S P C Total Dengue 1 0 1 2 0 Chikungunya Zika RVF 361 YF 87 0 0 87 0 WNVF RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus fever. S: Suspected cases, P: Probable cases, C: Confirmed cases. No data reported for blank cells. No cases nor deaths reported for 2015, 2017 and 2018. Annex 3 124 Surveillance and control of arboviral diseases in the WHO African Region Strengths • Existence of a national programme and guidelines on arboviral diseases (AVDs) surveillance & control • Laboratory testing capacities for the detection of the major AVDs cases and their notification • Existence of community outreach programmes on AVDs • Existence of a national committee for the surveillance of AVDs outbreaks & response • Existence of cooperation agreements in outbreak situations Possible ways forward • Consider the surveillance of AVDs in humans, animals and the collection & analysis of AVDs outbreak risk factors • Strengthening laboratory capacities for the confirmation of suspected cases and the positive cases of AVDs • Consider the strengthening of capacities for the management of cases & severe cases of AVDs including guidelines and adequate health facilities • Consider capacity building for virological surveillance • Consider capacity building for the entomological surveillance and control of Aedes including the monitoring of insecticide resistance • Consider the effective run of the outreach programmes on AVDs including the community engagement on activities related to the control of AVDs • Consider the development of a national contingency plan including outbreaks of AVDs Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and West Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 42.9 20 7.7 0 0 50 45 46.5 54 23.6Nigeria West Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Nigeria Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes albopictus are reported to be restricted to few sites and do not pose significant public health threats in the country. Aedes aegypti are also present according to publications1,2 • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019. No cases nor deaths reported 1 Braack L, Gouveia de Almeida AP, Cornel AJ, Swanepoel R, de Jager C. Mosquito-borne arboviruses of African origin: review of key viruses and vectors. Parasit Vectors. 2018;11:29 2 Ayorinde A, Oboh B, Oduola A, Otubanjo O. The Insecticide Sus- ceptibility Status of Aedes aegypti (Diptera: Culicidae) in Farm and Nonfarm Sites of Lagos State, Nigeria. J Insect Sci. 2015;15:75. 125Annexes Strengths • Existence of a national programme and guidelines on arboviral diseases (AVDs) surveillance & control • Laboratory testing capacities for the detection and confirmation of the major AVDs cases and their notification • Existence of a national guideline to manage cases & severe cases of AVDs • Arbovirus surveillance system in place • Existence of community outreach programmes on AVDs • Existence of a national committee for the surveillance of AVDs outbreaks & response and a contingency plan Possible ways forward • Consider the surveillance of AVDs in humans, animals and the collection & analysis of AVDs outbreak risk factors • Consider the strengthening of health facilities for the management of severe cases of AVDs • Consider the strengthening of the entomological surveillance of Aedes including the monitoring of insecticide resistance • Consider the effective run of the outreach programmes on AVDs including the community engagement on activities related to the control of AVDs • Consider the development of regional/international cooperation for support in outbreak situations • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and East-Southern Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 71.4 40 38.5 66.7 60 50 55 46.5 41.2 54.5Rwanda East-Southern Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Rwanda Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are found in the country according to publications1,2. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & death reported for last 5 years No cases nor deaths reported 1 Demanou M, Nyatanyi T, Rusanganwa A, Olu O. Risk Assessment of Yellow Fever Virus Circulation in Rwanda [Internet]. Republic of Rwan- da; 2014 p. 24. Available from: https://rbc. gov.rw/IMG/pdf/ rwanda_yellow_fever_assessment_report.pdf 2 Umuhoza T, Berkvens D, Gafarasi I, Rukelibuga J, Mushonga B, Biryomumaisho S. Seroprevalence of Rift Valley fever in cattle along the Akagera–Nyabarongo rivers, Rwanda. J S Afr Vet Assoc. 2017;88:1379. Annex 3 126 Surveillance and control of arboviral diseases in the WHO African Region Strengths • Existence of capacities for disease surveillance including arboviral diseases (AVDs) • Laboratory testing capacities for the detection and confirmation of the cases for major AVDs and their notification • Existence of capacities for the management of cases & severe cases of AVDs • Arbovirus surveillance system in place • Entomological Aedes surveillance & control system in place • Existence of community outreach programmes on AVDs • Existence of capacities for the preparedness for AVDs outbreaks/epidemics Possible ways forward • Consider the monitoring of insecticide resistance in Aedes vectors • Consider the effective run of the outreach programmes on AVDs including the community engagement on activities related to the control of AVDs • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and West Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 71.4 40 69.2 50 100 60 85 46.5 54 68Senegal West Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Senegal Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are reported to abundant and transmitting arboviruses in the country. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + + + + + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019. 2017 2018 2019 Cases Deaths Cases Deaths Cases Deaths Dengue 138 342 20 1 Chikungunya Zika 2 RVF 1 YF 1 WNVF RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus fever. S: Suspected cases, P: Probable cases, C: Confirmed cases. No data reported for blank cells. No cases nor deaths reported for 2015 and 2016. 127Annexes Strengths • Existence of a national programme and guidelines on arboviral diseases (AVDs) surveillance & control • Mandatory notification of major AVDs cases • Laboratory testing capacities for the confirmation of AVDs cases and the notification of the major ones • Existence of a national guideline to manage cases & severe cases of AVDs • Entomological Aedes surveillance & control system in place • Existence of community outreach programmes on AVDs; community awareness on AVDs and implication in control activities • Existence of capacities for the preparedness for AVDs outbreaks/epidemics Possible ways forward • Consider the surveillance of AVDs in humans, animals and the collection & analysis of AVDs outbreak risk factors • Consider the confirmation of positive cases of AVDs • Consider the strengthening of health facilities for the management of severe cases of AVDs • Consider capacity building for virological surveillance • Consider an effective entomological surveillance in Aedes including the monitoring of insecticide resistance • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and East-Southern Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 85.7 60 65.4 33.3 50 0 60 46.5 41.2 50.6Seychelles East-Southern Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Seychelles Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are reported to be absent in the country while Aedes albopictus are abundant and transmitting arboviruses. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019. No cases nor deaths reported Annex 3 128 Surveillance and control of arboviral diseases in the WHO African Region Strengths • Existence of a national programme on arboviral diseases (AVDs) surveillance & control • Mandatory notification of major AVDs cases • Laboratory testing capacities for the detection and confirmation of cases for the major AVDs • Arbovirus surveillance system in place • Entomological Aedes surveillance & control system in place • Existence of community outreach programmes on AVDs; community awareness on AVDs and implication in control activities • Existence of a national committee for the surveillance of AVDs outbreaks & response • Existence of cooperation agreements in outbreak situations Possible ways forward • Consider the surveillance of AVDs in animals and the collection & analysis of AVDs outbreak risk factors • Consider the confirmation of positive cases of AVDs. • Consider the strengthening of capacities for the management of cases & severe cases of AVDs including guidelines and adequate health facilities • Consider the strengthening of the entomological surveillance of Aedes including the monitoring of insecticide resistance • Consider the development of a national contingency plan including outbreaks of AVDs Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and West Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 71.4 80 65.4 50 0 50 50 46.5 54 52.4Sierra Leone West Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Sierra Leone Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti and Aedes albopictus are reported to be abundant and transmitting arboviruses in the country. • Major arboviruses found in the country according to publications1,2 (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019. 2019 Cases Deaths S P C Total Dengue Chikungunya Zika RVF YF 76 0 0 0 WNVF RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus fever. S: Suspected cases, P: probable cases, C: Confirmed cases. No data reported for blank cells. No cases nor deaths reported for 2015, 2016, 2017 and 2018. 1 Braack L, Gouveia de Almeida AP, Cornel AJ, Swanepoel R, de Jager C. Mosquito-borne arboviruses of African origin: review of key viruses and vectors. Parasit Vectors. 2018;11:29 2 Dariano DF, Taitt CR, Jacobsen KH, Bangura U, Bockarie AS, Bockarie MJ, et al. Surveillance of Vector-Borne Infections (Chikungunya, Dengue, and Malaria) in Bo, Sierra Leone, 2012–2013. Am J Trop Med Hyg. 2017;97:1151–4. 129Annexes Strengths • Existence of a national guideline on arboviral diseases (AVDs) surveillance & control • Mandatory notification of major AVDs cases • Laboratory testing capacities for the detection and confirmation of cases for the major AVDs • Existence of health facilities to manage cases & severe cases of AVDs • Arbovirus surveillance system in place • Entomological Aedes surveillance & control system in place • Existence of community outreach programmes on AVDs; community awareness on AVDs and implication in control activities • Existence of a national committee for the surveillance of AVDs outbreaks & response and a contingency plan • Existence of cooperation agreements in outbreak situations Possible ways forward • Consider the surveillance of AVDs in animals • Consider the confirmation of positive cases of AVDs • Consider the use of available guidelines for the management of cases and severe cases of AVDs • Consider the strengthening of the entomological surveillance of Aedes including the monitoring of insecticide resistance • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and East-Southern Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 57.1 60 53.8 33.3 60 50 75 46.5 41.2 55.6South Africa East-Southern Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance South Africa Strengths • Aedes aegypti and Aedes albopictus are reported to be spreading and posing significant public health threats in the country. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + + Sindbis virus +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths from 2015 to 2019. 2015 2016 2017 2018 2019 Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths S P C Total Dengue 19 0 15 0 13 0 15 0 13 16 29 0 Chikun- gunya 2 0 3 0 2 0 1 0 4 4 0 Zika 3 0 RVF 8 0 YF 5 0 WNVF 8 0 13 0 7 0 2 2 0 RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus fever. S: Suspected cases, P: Probable cases, C: Confirmed cases. No data reported for blank cells. Annex 3 130 Surveillance and control of arboviral diseases in the WHO African Region Strengths • Existence of capacities for disease surveillance including arboviral diseases (AVDs) • Mandatory notification of major AVDs cases • Existence of capacities for the diagnostic and case notification including the AVDs cases • Existence of capacities for the management of cases & severe cases of AVDs • Arbovirus surveillance system in place • Entomological Aedes surveillance & control system in place • Existence of community outreach programmes on AVDs; community awareness on AVDs and implication in control activities • Existence of a national committee for the surveillance of AVDs outbreaks & response and a contingency plan • Existence of cooperation agreements in outbreak situations Possible ways forward • Consider the surveillance of AVDs in animals • Consider the monitoring of insecticide resistance in Aedes vectors • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and East-Southern Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 71.4 40 73.1 100 90 50 75 46.5 41.2 71.4South Sudan East-Southern Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance South Sudan Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are reported to be spreading and posing significant public health threats in the country. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019. 2017 2018 2019 Cases Deaths Cases Deaths Cases Deaths S P C Total Dengue Chikungunya Zika 4 RVF 5 YF 39 3 42 0 WNVF RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus fever. S: Suspected cases, P: Probable cases, C: Confirmed cases. No data reported for blank cells. No cases nor deaths reported for 2015 and 2016. 131Annexes Strengths • Existence of a national programme and guidelines on arboviral diseases (AVDs) surveillance & control • Existence of partial capacities for the entomological Aedes surveillance & control • Existence of community outreach programmes on AVDs; community awareness on AVDs • Existence of a national committee for the surveillance of AVDs outbreaks & response and a contingency plan Possible ways forward • Consider the surveillance of AVDs in humans, animals and the collection & analysis of AVDs outbreak risk factors • Consider the strengthening of laboratory capacities for the detection of arboviruses and the confirmation of suspected cases and the positive cases of AVDs • Consider the strengthening of capacities for the management of cases & severe cases of AVDs including guidelines and adequate health facilities • Consider capacity building for virological surveillance • Consider the strengthening of the entomological surveillance of Aedes including the monitoring of insecticide resistance • Consider the effective run of the outreach programmes on AVDs including the community engagement on activities related to the control of AVDs • Consider the development of regional/international cooperation for support in outbreak situations • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and Central Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 50 20 50 0 0 0 50 46.5 44.3 24.3Sao Tome and Principe Central Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/ Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Sao Tome and Principe Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are reported to be spreading and posing significant public health threats (PHT) while Aedes albopictus are restricted to few sites and do not pose significant PHT in the country. • Major arboviruses found in the country according to publications1,2(see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019. No cases nor deaths reported 1 Chauhan RP, Dessie ZG, Noreddin A, El Zowalaty ME. Systematic Review of Important Viral Diseases in Africa in Light of the ‘One Health’ Concept. Pathogens. 2020;9:301. 2 Yen T-Y, Trovoada dos Santos M de J, Tseng L-F, Chang S-F, Cheng C -F, Carvalho AV de A, et al. Seroprevalence of antibodies against dengue virus among pregnant women in the Democratic Republic of Sao Tome and Principe. Acta Tropica. 2016;155:58–62. Annex 3 132 Surveillance and control of arboviral diseases in the WHO African Region Strengths • Existence of national guidelines on arboviral diseases (AVDs) surveillance & control • Mandatory notification of major AVDs cases • Laboratory testing capacities for the detection and confirmation of cases for the major AVDs • Consider capacity building for virological surveillance • Existence of partial capacities for the entomological Aedes surveillance & control • Existence of community outreach programmes on AVDs • Existence of a national committee for the surveillance of AVDs outbreaks & response and a contingency plan • Existence of cooperation agreements in outbreak situations Possible ways forward • Consider the surveillance of AVDs in humans, animals and the collection & analysis of AVDs outbreak risk factors • Consider the confirmation of positive cases of AVDs. • Consider the strengthening of capacities for the management of cases & severe cases of AVDs including guidelines and adequate health facilities • Consider the strengthening of the entomological surveillance of Aedes including the monitoring of insecticide resistance • Consider the effective run of the outreach programmes on AVDs including the community engagement on activities related to the control of AVDs • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and West Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 42.9 30 23.1 50 0 50 50 46.5 54 35.1Togo West Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Togo Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are reported to be spreading and posing significant public health threats in the country. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019. 2015 2016 2017 2018 2019 Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths S P C Total Dengue 18 0 2 2 0 Chikun- gunya Zika RVF YF 357 0 151 470 372 316 316 0 WNVF RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus fever. S: Suspected cases, P: Probable cases, C: Confirmed cases. No data reported for blank cells. 133Annexes Strengths • Existence of capacities for the community sensitization and participation to the activities related to the control of arboviral diseases (AVDs) • Existence of capacities for the preparedness for AVDs outbreaks/epidemics Possible ways forward • Consider capacity building for the surveillance of AVDs • Consider the strengthening of laboratory capacities for the detection of arboviruses and the confirmation of suspected cases and the positive cases of AVDs • Consider the strengthening of capacities for the management of cases & severe cases of AVDs including guidelines and adequate health facilities • Consider capacity building for virological surveillance • Consider capacity building for the entomological surveillance and control of Aedes including the monitoring of insecticide resistance • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and East-Southern Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 80 7.7 20 0 0 0 46.5 41.2 23.5 57.1 Uganda East-Southern Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Uganda Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti and Aedes albopictus are found in the country according to publications1 • Major arboviruses found in the country according to publications1 (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019. No cases nor deaths reported 1 Braack L, Gouveia de Almeida AP, Cornel AJ, Swanepoel R, de Jager C. Mosquito-borne arboviruses of African origin: review of key vi- ruses and vectors. Parasit Vectors. 2018;11:29 Annex 3 134 Surveillance and control of arboviral diseases in the WHO African Region Strengths • Existence of a national programme and guidelines on arboviral diseases (AVDs) surveillance & control • Mandatory notification of major AVDs cases • Laboratory testing capacities for the detection and confirmation of cases for major AVDs and their notification • Existence of health facilities to manage cases & severe cases of AVDs • Arbovirus surveillance system in place • Entomological Aedes surveillance & control system in place • Existence of community outreach programmes on AVDs; community awareness on AVDs • Existence of a national committee for the surveillance of AVDs outbreaks & response and a contingency plan • Existence of cooperation agreements in outbreak situations Possible ways forward • Consider the surveillance of AVDs in humans • Consider the confirmation of positive cases of AVDs. • Consider the use of available guidelines for the management of cases and severe cases of AVDs • Consider the strengthening of the entomological surveillance of Aedes including the monitoring of insecticide resistance • Consider the effective run of the outreach programmes on AVDs including the community engagement on activities related to the control of AVDs • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and East-Southern Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 0 40 50 50 33.3 71.4 70 46.5 41.2 53.5UR Tanzania East-Southern Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) UR Tanzania: United Republic of Tanzania. PAO: Preparedness for Arboviral Disease Outbreaks/ Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance United Republic of Tanzania Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are reported to be spreading and posing significant public health threats (PHT) while Aedes albopictus are restricted to few sites and do no pose significant PHT. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + + + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019. No cases nor deaths reported 135Annexes Strengths • Existence of a national programme and guidelines on arboviral diseases (AVDs) surveillance & control • Mandatory notification of major AVDs cases • Laboratory testing capacities for the detection and confirmation of cases for major AVDs • Entomological Aedes surveillance & control system in place • Existence of community outreach programmes on AVDs • Existence of a national committee for the surveillance of AVDs outbreaks & response and a contingency plan Possible ways forward • Consider the surveillance of AVDs in humans, animals and the collection & analysis of AVDs outbreak risk factors • Consider the confirmation of positive cases of AVDs. • Consider the strengthening of capacities for the management of cases & severe cases of AVDs including guidelines and adequate health facilities • Consider capacity building for virological surveillance • Consider the strengthening of the entomological surveillance of Aedes including the monitoring of insecticide resistance • Consider the effective run of the outreach programmes on AVDs including the community engagement on activities related to the control of AVDs • Consider the development of regional/international cooperation for support in outbreak situations • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and East-Southern Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 20 42.3 50 50 0 0 46.5 41.2 31.4 57.1 Zambia East-Southern Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Zambia Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti are reported to be occasionally found and do not pose significant public health threats in the country. • Major arboviruses reported as circulating in the country (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported from 2015 to 2019. No cases nor deaths reported Annex 3 136 Surveillance and control of arboviral diseases in the WHO African Region Strengths • Existence of a national programme on arboviral diseases (AVDs) surveillance & control • Entomological Aedes surveillance & control system in place • Existence of community outreach programmes on AVDs • Existence of a national committee for the surveillance of AVDs outbreaks & response and a contingency plan • Existence of cooperation agreements in outbreak situations Possible ways forward • Consider the surveillance of AVDs in humans, animals and the collection & analysis of AVDs outbreak risk factors • Consider the strengthening of laboratory capacities for the detection of arboviruses and the confirmation of suspected cases and the positive cases of AVDs • Consider the strengthening of capacities for the management of cases & severe cases of AVDs including guidelines and adequate health facilities • Consider capacity building for virological surveillance • Consider the monitoring of insecticide resistance in Aedes vectors • Consider the effective run of the outreach programmes on AVDs including the community engagement on activities related to the control of AVDs • Provide regular training for staff working in the 7 domains assessed Capacity for surveillance and control Find below the country capacities for the seven domains explored and those of the WHO African Region and East-Southern Africa sub-region Capacities and domains PAO CSPEP RVSC VS MCSC DCN DS 50 61.5 45 20 0 0 46.5 41.2 33.4 57.1 Zimbabwe East-Southern Africa African Region 0 10 20 30 40 50 60 70 80 90 100 Percentage (%) PAO: Preparedness for Arboviral Disease Outbreaks/Epidemics, CSPEP: Community Sensitization & Participation in non-Epidemic Periods, RVSC: Routine Vector Surveillance & Control, VS: Virological Surveillance, MCSC: Management of Cases & Severe Cases, DCN: Diagnostic & Case Notification, DS: Disease Surveillance Zimbabwe Transmission and burden of arboviral diseases Vectors and arboviruses • Aedes aegypti and Aedes albopictus are reported to be occasionally found and do not pose significant public health threats in the country. • Major arboviruses found in the country according to publications1 (see table below) Dengue virus Chiku- ngunya virus Zika virus RVF virus YF virus WNV CCHFV Others + + +: circulation reported, RVF: Rift Valley fever, YF: Yellow fever, WNVF: West Nile virus, CCHFV: Crimean-Congo haemorrhagic fever virus. No data reported for blank cells, this does not exclude the presence of viruses. Arboviral disease cases & deaths reported for last 5 years No cases nor deaths reported 1 Braack L, Gouveia de Almeida AP, Cornel AJ, Swanepoel R, de Jager C. Mosquito-borne arboviruses of African origin: review of key viruses and vectors. Parasit Vectors. 2018;11:29

TDR World Health Organization 20, Avenue Appia 1211 Geneva 27 Switzerland Email: tdr@who.int Website: https://tdr.who.int/ TDR, the Special Programme for Research and Training in Tropical Diseases, is a global programme of scientific collaboration that helps facilitate, support and influence efforts to combat diseases of poverty. It is co-sponsored by the United Nations Children’s Fund (UNICEF), the United Nations Development Programme (UNDP), the World Bank and World Health Organization (WHO).