(2) Algeria Mali Chad Niger Angola EthiopiaNigeria South Africa Namibia Mauritania Zambia Kenya Democratic Republic of the Congo Mozambique Botswana Congo Madagascar South Sudan Cameroon Zimbabwe Gabon Ghana Guinea United Republic of Tanzania Uganda Central African Republic Côte d'Ivoire Senegal Burkina Faso Benin Eritrea Liberia Malawi TogoSierra Leone Lesotho Burundi Rwanda Eswatini Guinea-Bissau Gambia Equatorial Guinea Mauritius Comoros Cape Verde Sao Tome and Principe Seychelles 0 820410 Kilometers ¤ REGIONAL OFFICE FOR Africa WHO Health Emergencies Programme Health Emergency Information and Risk Assessment Graded events † 2 Ungraded events Protracted 3 events 2 Protracted 2 events 0 Protracted 1 event 1 WEEKLY BULLETIN ON OUTBREAKS AND OTHER EMERGENCIES Ongoing events 1160 Humanitarian crises 13 Outbreaks 103 Protracted 3 events 3 3 Protracted 1 events 50 Grade 1 events 1 Grade 3 events 20 2 Grade 2 events New event Week 17: 19-25 April 2021 Data as reported by: 17:00; 25 April 2021 2 012 73 10 227 66 236 49 7 0 3 473 296 3 1 190 0 110 0 1 069 5 5556 63 0 2540 97 17 6 257 229 542 8 1 488 6 1 873 916 2 798 3 420 29 28 676 137 843 20 42 079 14 484 479 40 0 25 0 110 0 862 0 133 0 012 07 43 0 7 2 52 14 655 2 164 719 2 062 2 952 40 65 998 991 1 575 471 54 148 7 720 97 13 263 156 6 224 85 10 678 144 45 820 281 29 610 756 18 442 671 252 279 3 551 22 433 138 92 166 777 2 066 85 18 257 454 47 776 625 24 593 330 5 170 26 509 21 5 074 189 4 770 169 3 605 10 1 203 15 25 609 579 91 358 1 246 38 086 1 557 69 665 807 22 358 203 35 746 599 41 655 341 156 787 2 622 5 857 173 3 726 67 061 030 13 627 467 120 922 3 207 45 855 691 3 874 6 34 016 1 148 4 044 79 10 532 114 235 0 10 728 316 7 0 27 0 3 829 146 12 6 23 12 63 1 1 1 17847 36 13 156 188 049 12 787 121 2 297 35 7 559 107 017 26321 985 072 3 0 6 0567 0 40 135 1 102 64 0 Legend Ebola virus disease Malaria Humanitarian crisis Dengue fever Yellow fever Countries outside WHO African Region WHO Member States with no reported events Not applicable Countries reported in the document Plague Leishmaniasis Crimean-Congo haemorrhagic fever West Nile fever Rift Valley fever Skin disease of unknown etiology Hepatitis E Avian influenza Monkeypox Cholera Lassa fever Measles Deaths Cases Acute Food Insecurity Acute Food Insecurity cVDPV2 Anthrax COVID-19 “The boundaries and names shown and the designations used on this map 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 borderlines for which there may not yet be full agreement.” 32 11 Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 1 Overview Ongoing events Summary of major issues, challenges and proposed actions All events currently being monitored This Weekly Bulletin focuses on public health emergencies occurring in the WHO African Region. The WHO Health Emergencies Programme is currently monitoring 116 events in the region. This week’s articles cover: COVID-19 across the WHO African region Ebola virus disease in Guinea Ebola virus disease in Democratic Republic of the Congo For each of these events, a brief description, followed by public health measures implemented and an interpretation of the situation is provided. A table is provided at the end of the bulletin with information on all new and ongoing public health events currently being monitored in the region, as well as recent events that have been controlled and closed. Major issues and challenges include: Over a year after Ethiopia reported its first COVID-19 case, it is now reporting the highest number of daily cases, surpassing South Africa for more than a month. The top five countries reporting the highest case numbers include South Africa, Nigeria, Kenya, and Algeria. The regional cumulative case fatality ratio has remained high at 2.5% for more than two months, above the global average of 2.1%. Health worker infections remain of concern as the numbers continue to increase across the region. There have been no new confirmed EVD cases in Guinea in the past weeks. However, there are still contacts lost to follow up and a confirmed case remains in the community. Alert reporting is suboptimal, with little community surveillance and poor 24-hour follow-up. In addition, the source of infection in Gouécké has not yet been identified since the declaration of the outbreak in Guinea. The funding gap for response actions remains, which requires urgent attention. There have been no new Ebola virus disease cases in Democratic Republic of the Congo for 54 days and there are nine days to go before the end of outbreak declaration. Challenges with contact follow-up, difficulties with feedback from health zones and inadequate funding for all response pillars all continue, however. Insecurity in the affected areas continues to impact response. Authorities and partners need urgently to address these challenges and ensure that the response funding gap is closed, so that the post-outbreak situation remains stable. Contents Overview 1 6 2 -5 7 Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 2 157 African region 2.5% CFR In the past seven days (19 - 25 April 2021), a total of 42 051 new cases of COVID-19 were reported in the African Region, a 20.3% decrease compared to the previous week with an average of 6 007 new cases Twenty-five (54.4%) countries reported a decrease in new cases, while 19 (41.3%) had an increase in new daily cases in the past seven days. Only Senegal did not show a significant change in case numbers during this reporting period. Most of the new cases reported this week were from Ethiopia (10 251; 24.4%), South Africa (8 702; 20.7%), Kenya (5 134; 12.2%), Madagascar (2 948; 7.0%) and Cabo Verde (1 892; 4.5%). In Ethiopia, COVID-19 cases and deaths dramatically increased and have remain high since end of March 2021. Tribal conflict, extensive flooding and the historic, devastating locust outbreak have exacerbated the humanitarian impacts on the COVID-19 response. Kenya continues to experience a third wave of COVID-19 outbreak, although with a noticeable decline in new daily cases. Twenty (43.5%) countries reported a decline in reported deaths, while 10 (21.7%) had an increase in the past seven days. Overall, 1 023 deaths, a 7.8% decrease in daily deaths, reported by 45 countries, has been observed during the reporting week. South Africa reported the highest number of deaths (412, 40.3%) followed by Ethiopia with 181 (17.7%) and Kenya 141 (13.8%). Since the declaration of the COVID-19 pandemic (between 25 February 2020 and 25 April 2021), the total number of confirmed cases in the WHO African Region is over 3.2 million with more than 2.9 million recoveries, giving a recovery rate of 90.5% of confirmed case patients. The death toll has now reached more than 81 000. Even when the African Region is one of the least affected globally, it has a high cumulative case fatality ratio of 2.5%, which is above the global average of 2.1%. The top five countries reporting the highest case numbers include South Africa (1 575 471 cases, 48.7% of all cases), Ethiopia (252 279 cases, 7.8%), Nigeria (164 719 cases, 5.1%), Kenya 156 787 cases, 4.8%) and Algeria (120 922 cases, 3.7%), accounting for 2 270 178 (70.0%) of all cases. The United Republic of Tanzania has reported no new confirmed cases in our database in the last 354 days. The average cumulative attack rate (number of cases per million) in the African region is estimated at 2 970 /million population, ranging from 9/million to 52 958 million. Seychelles (52 958 cases/million population), Cabo Verde (40 656 cases/million), South Africa (26 904 cases/ million), Namibia (19 152 cases/million) and Botswana (18 719 cases/million), are the five countries with the highest attack rate in the region. Liberia (425 cases/million), Democratic Republic of Congo (341 cases/million), Chad (299 cases/million), Burundi (294 cases/million), and Niger (228 cases/million) are the five countries with the lowest cumulative attack rate. South Africa leads with the highest number of deaths in the region (54 148 deaths, 66.3%).This is followed by Ethiopia (3 551, 4.3%), Algeria (3 207, 3.9%), Kenya (2 622, 3.2%), and Nigeria (2 062, 2.5%), accounting for 80.3% (65 590) of cumulative deaths. The median number of deaths per million in the African 3 240 968 81 656 Cases Deaths Go to overview Go to map of the outbreaks Coronavirus disease 2019 region is estimated at 26.1/million population (range: 0.4/million – 925/million) with an average cumulative death rate (per million) in the African region estimated at 74.8/million population. South Africa (925 deaths/million population), Eswatini (584/million), Cabo Verde (369/million), Botswana (282/million), Seychelles (266 million) and Namibia (250/million) are the five countries with the highest number of COVID-19 related deaths per million population. Uganda (7.7/million population) Burkina Faso (7.6/ million), Eritrea (3.1/million), Burundi (0.5/million) and United Republic of Tanzania (0.4/million) have the lowest number of COVID-19 related deaths per million population. During this reporting period, 82 health worker infections were reported from Namibia (68), Togo (13), and Seychelles (1). A total of 1 045 new health worker infections were also reported retrospectively from South Africa (688), Kenya (166), Chad (102), Ethiopia (74), and Togo (15). Currently, 109 599 (3.4% of all cases) health worker infections have been reported from 46 countries (48.0% of all countries) in the region. South Africa (55 672, 51.0%), Algeria (11 936, 11.0%) and Ghana (4 763, 4.3%), have recorded the highest number of health worker infections among countries. Zimbabwe (11.1%), Liberia (11.0%), and Guinea-Bissau (10.1%), have the highest country specific proportion of health worker infections. Only Eritrea has not reported any healthcare worker infections. As of 25 April 2021, the total number of confirmed COVID-19 cases on the African continent amounted to over 4.5 million. Total death counts now stand at more than 120 461 deaths (case fatality ratio 2.7%), and more than 4 million people have recovered. Forty-seven countries had received over 34.5 million COVID-19 vaccines by 23 April 2021 through the COVAX facility, bilateral deals or donations. Forty-one African countries have received 18.2 million COVAX doses. This includes 18 million AstraZeneca (Covishield) vaccines from the Serum Institute of India, and around 200 000 Pfizer vaccine doses. One of the major vaccination challenges is the low number of vaccine doses available for Africa. A total of 16.7 million doses had been administered by 21 April 2021. Forty-one countries are vaccinating using COVAX-funded vaccines, with 5.9 million COVAX doses reported as administered. Globally, over 960 million doses have been administered; around 1.7% of these were administered in Africa, of which Morocco has administered 68%, and Nigeria has administered 8.0% of their total polulation. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 3 The weekly distribution of confirmed cases of COVID-19 in the WHO African Region by reporting date, 25 February 2020 – 25 April 2021 (n = 3 240 968) SITUATION INTERPRETATION The African region continues to observe a decrease in both daily case and death counts. Ethiopia has reported the highest number of cases for more than a month, surpassing South Africa. The constant reduction in new weekly cases and deaths could result in complacency around COVID-19 response measures in regional populations, with subsequent non-adherence to preventive measures. It is important that the public receive accurate information about how the virus is spreading and be reminded of the importance of public health measures. This will require a strong risk communications strategy from governments. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 4 Countries with reported laboratory-confirmed COVID-19 cases and deaths: Data as of 25 April 2021 Country Total cases Total deaths Recovered Total Case Fatality Ratio (%) Health Worker infections South Africa 1 575 471 54 148 1 501 185 3.4 % 55 672 Ethiopia 252 279 3 551 192 747 1.4 % 2 933 Nigeria 164 719 2 062 154 926 1.3 % 3 175 Kenya 156 787 2 622 106 588 1.7 % 4 698 Algeria 120 922 3 207 84 299 2.7 % 11 936 Ghana 92 166 777 89 920 0.8 % 4 763 Zambia 91 358 1 246 89 574 1.4 % 814 Mozambique 69 665 807 62 501 1.2 % 3 484 Cameroon 65 998 991 60 031 1.5 % 2 153 Namibia 47 776 625 45 558 1.3 % 2 050 Botswana 45 855 691 41 338 1.5 % 61 Côte d'Ivoire 45 820 281 45 343 0.6 % 898 Uganda 41 655 341 40 898 0.8 % 1 931 Senegal 40 135 1102 38 861 2.7 % 419 Zimbabwe 38 086 1557 35 123 4.1 % 4 210 Madagascar 35 746 599 28 433 1.7 % 70 Malawi 34 016 1147 31 908 3.4 % 1 630 DRC 29 576 756 26 156 2.6 % 256 Angola 25 609 579 23 092 2.3 % 939 Rwanda 24 593 330 22 941 1.3 % 682 Gabon 22 433 138 19 074 0.6 % 345 Cabo Verde 22 358 203 19 206 0.9 % 140 Guinea 21 953 140 19 230 0.6 % 682 Eswatini 18 442 671 17 737 3.6 % 572 Mauritania 18 257 454 17 587 2.5 % 24 Mali 13 627 467 8 071 3.4 % 87 Burkina Faso 13 263 156 12 937 1.2 % 288 Togo 12 787 121 10 699 0.9 % 874 Lesotho 10 728 316 6 267 2.9 % 473 Congo 10 678 144 9 631 1.3 % 202 South Sudan 10 532 114 10 250 1.1 % 391 Benin 7 720 97 7 510 1.3 % 139 Equatorial Guinea 7 559 107 7 097 1.4 % 401 Central African Republic 6 224 85 5 246 1.4 % 1 Gambia 5 857 173 5 284 3.0 % 142 Niger 5 191 191 4 834 3.7 % 304 Seychelles 5 170 26 4 675 0.5 % 293 Chad 4 770 169 4 389 3.5 % 292 Sierra Leone 4 044 79 2 993 2.0 % 249 Burundi 3 874 6 3 506 0.2 % 38 Comoros 3 829 146 3 650 3.8 % 154 Guinea-Bissau 3 726 67 3 252 1.8 % 377 Eritrea 3 605 10 3 410 0.3 % 0 Sao Tome and Principe 2 297 35 2 234 1.5 % 102 Liberia 2 097 85 1 940 4.1 % 224 Mauritius 1 206 16 1 020 1.3 % 30 United Republic of Tanzania 509 21 180 4.1 % 1 Cumulative Cases (N=47) 3 240 968 81 656 2 933 331 2.5 % 109 599 *Total cases includes one probable case from Democratic Republic of the Congo Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 5 EVENT DESCRIPTION No new confirmed Ebola virus disease (EVD) cases have been reported in Nzerekore prefecture, the site of the current EVD outbreak in Guinea as of 24 April 2021. There is currently one active sub-prefecture and one in alert, all in the prefecture of Nzerekore. As of 24 April 2021, a total of 23 cases have been reported, including 16 confirmed cases, and 7 probable cases, of which 9 have recovered, and 12 have died (case fatality ratio 52.2%). The number of health workers infected remains five. There is one confirmed case, being treated by a traditional healer, in Kpagalaye village. Negotiations are underway to move the patient to an Ebola treatment centre. The majority of the confirmed and probable cases reported are female (13/23; 60.9%) and the most affected age group are those over 40 years. As of 24 April 2021, all 34 recorded contacts had been followed up in Nzerekore. A total of 328 contacts have been vaccinated. There were 53 alerts notified on 24 April 2021, of which 18 (23.0%) were investigated within 24 hours, and 10 were validated, all of which were deaths. Eight of these were sampled. Most alerts came from active case search. PUBLIC HEALTH ACTIONS Daily incident management system meetings take place with WHO, and have been moved to the WHO sub-office in Nzerekore. A discussion on the countdown to the end of outbreak is underway with the Ministry of Health. A joint UNICEF and WHO workshop has been held online, to ensure effective post-outbreak strategies. Coordinated efforts are underway for vaccination and other response pillars in Kpagalaye. There are continued monitoring efforts underway around the Soulouta sub-prefecture cluster around 48 notified alerts, three of which were deaths. A cumulative total of 8 082 people have been vaccinated, including 622 high-risk contacts, 6 926 contacts-of-contacts and 519 probable contacts, including 2 434 frontline workers. Five patients, all suspected cases, are currently hospitalized in the Epidemic Diseases Hospital treatment centre. Infection prevention and control (IPC) activities include supervision of training in a health facility in Conakry and orientation on triage and the three-bucket technique for bio-cleaning; reorganization of the triage system in four health facilities in Nzerekore, followed by briefing of eight Go to overview Go to map of the outbreaks The distribution of Ebola virus diseases cases in Guinea as of 24 April 2021 157 Ebola virus disease Guinea 52.2% CFR 23 12 Cases Deaths health workers on EVD prevention and implementation of an IPC improvement plan. Two water drilling points were rehabilitated in Nzerekore. There was support for sample collection in eight out of ten death alerts and two samples not collected in the community. Risk communication and community engagement (RCCE) included monitoring of prevention and management activities in Gouecke, and a socio-anthropological interview with the patient discharged from the Goecke treatment centre to assess his perception of the centre, along with selection of 11 interviewers for the socio-anthropological research, and follow-up on the overcoming of community response resistance in Kpaglaye. SITUATION INTERPRETATION Although there have been no new confirmed infections in Guinea in the past weeks, there are still contacts lost and one confirmed case not in isolation. In addition, alerts continue to be received, although few are reported by the community and 24-hour follow- up is inadequate. Community surveillance in Nzerekore and neighbouring provinces requires strengthening. The source of the outbreak in Gouecke has still not been identified, leaving potential unknown chains of transmission. In addition, the WHO response plan is still only 17.0% funded. This gap needs urgently to be filled if the momentum of response is to continue. Ongoing events Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 6 EVENT DESCRIPTION As of 25 April 2021 there has been no new confirmed cases of Ebola virus disease (EVD) in North Kivu for 54 consecutive days, which translates into nine days before the possible declaration of the end of the outbreak. Since the start of the outbreak there have been 11 confirmed cases, with one probable case and six deaths (case fatality ratio 50.0%). Two health workers have been infected, accounting for 16.6% of cases. All 17 health areas in the northern part of North Kivu reported alerts on 25 April 2021. There were 791 alerts reported and all were investigated, of which 61 were validated as suspected cases, with 60 (98.0%) sampled. The validated case that was not sampled was a death in Mutwanga Health Zone, where there were no sampling kits available. There are no confirmed patients admitted in the Ebola treatment centres, and 106 suspected patients are being followed in isolation in the health facilities, one in Alimbongo, one in Beni, 63 in Biena, six in Butembo, three in Kalunguta, two each in Kyondo and Lubero, 13 in Katwa, three each in Kayna and Manguredjipa, one in Masereka and eight in Musienene. PUBLIC HEALTH ACTIONS Daily coordination meetings continue, chaired by the coordinator of the pool of supervisors based in Butembo, with participation of partners. A mixed mission (surveillance, infection prevention and control and risk communication and community engagement) continues to provide support to management teams in Kalunguta, Beni, Oicha and Mabalako health zones. Vaccine activity stopped on 31 March 2021. As of that date, a total of 1 898 people have been vaccinated; 1 169 in Biena, 360 in Katwa, 297 in Butembo and 72 in Musienene. Front line providers make up 542 of those vaccinated. Since the start of the outbreak, 3 969 samples have been received and analysed for EVD. On 25 April 2021, a total of 15 death alerts were received, of which 14 (93.3%) were sampled. Eleven (73.3%) safe and dignified burials were carried out. Insecurity in Mutwanga Health Zone prevented one safe and dignified burial, two were not performed because of refusal by family members in Manguredjipa and Musienene and one body that is still in the mortuary in Katwa Health Zone. Infection prevention and control (IPC) activities included assessment of 17 health facilities in six health zones and monitoring and support for 48 health facilities in eight health zones. Go to overview Go to map of the outbreaks The distribution of Ebola virus disease cases in Democratic Republic of the Congo as of 25 April 2021 157 Ebola virus disease Democratic Republic of the Congo 50.0% CFR 12 6 Cases Deaths Ten out of the 17 affected health zones reported on risk communication and community engagement activities, which included visits to households by community action committees and sensitization of 309 people in Butembo, Mabalako and Katwa health zones. A total of 17 645 travellers were registered at 16 out of 22 operational Points of Entry/Points of Control, of which 15 808 (89.6%) were screened, 17 702 (88.9%) washed their hands and 15 808 (94.2%) received education around EVD; seven alerts were raised and one was validated and sent to an isolation facility. SITUATION INTERPRETATION The current EVD outbreak is now nine days off declaration of the end. However, challenges continue, with insecurity causing restricted movements for some partners, poor feedback from health areas and insufficient funds to support all pillars of the response. In addition there is low capacity at health facilities for isolation of suspected patients. An operational plan needs to be developed and validated for the 90-day post outbreak phase before 3 May 2021, in order to strengthen local health systems. Authorities and partners need urgently to address the challenges and ensure adequate funding for all response pillars to ensure that the situation remains stable post-outbreak. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 7Go to overview Go to map of the outbreaks Major issues and challenges The African region continues to experience established community transmission of COVID-19 across the region, however with an overall decrease in both new case and deaths counts. Numbers of health worker infections are still a concern, as is the relatively high case fatality ratio, even with deaths declining overall. Guinea continues to experience challenges around locating contacts lost to follow-up, isolating suspected patients and the continuing presence of a confirmed case in the community. Community surveillance remains poor, with most alerts reported through active case finding and poor 24-hour follow-up. A continuing funding gap for response activities will seriously impact continued surveillance and the required strengthening in contact follow-up and alert reporting if not closed. The EVD outbreak in Butembo, North Kivu is nine days off declaration of end of outbreak. However, alert management is problematic as is poor feedback from health zones. In addition, funding is running out and there are gaps in human resources that still need to be addressed. Proposed actions The African region needs to continue to implement all public health and social measures to prevent transmission of COVID-19. It is also important that the public receive accurate information about how the virus is spreading and be reminded of the importance of public health measures. Authorities and partners in Guinea need to strengthen active case searching in the community, along with alert management and contact tracing. Partners need to provide sufficient funds for continuing response as a matter of urgency. Insecurity continues to threaten the response to the current EVD outbreak in Democratic Republic of the Congo, although there have been no new cases for the past 54 days. However, authorities and partners need urgently to fill gaps in human resources and secure sufficient funding to continue the response in order to prevent a resurgence in cases. Summary of major issues, challenges and proposed actions Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 8Go to overview Go to map of the outbreaks All events currently being monitored by WHO AFRO Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Ongoing Events Algeria Brucellosis Ungraded 01-Jan-21 12-Apr-2021 64 64 0 0.0% The outbreak began in January 2021 in the wilaya of Batna where a cumulative of 64 cases have been confirmed as of 12 April 2021. Four cases were confirmed in January, 12 cases in February, and 48 cases in March. During March 50% of cases were among goat breeders and people having contact with contaminated animals. A total of 21 cases have been hospitalized, but all have been discharged with no deaths reported. Algeria COVID-19 Grade 3 25-Feb-2020 25-Feb-2020 25-Apr-2021 120 922 120 922 3207 2.7% From 25 February 2020 to 25 April 2021, a total of 120 922 confirmed cases of COVID-19 with 3 207 deaths (CFR 2.7%) have been reported from Algeria. A total of 84 299 cases have recovered. Angola COVID-19 Grade 3 21-Mar-20 21-Mar-20 25-Apr-2021 25 609 25 609 579 2.3% The first COVID-19 confirmed case was reported in Angola on 21 March 2020. As of 25 April 2021, a total of 25 609 confirmed COVID-19 cases have been reported in the country with 579 deaths and 23 092 recoveries. Angola Measles Ungraded 4-May-2019 01-Jan-21 31-Mar-21 63 17 1 1.6% In 2020, Angola reported between January and August a total of 1 220 suspected cases of which 1 008 have been confirmed, and 5 recorded(CFR 0.4%). From January to March 2021, Angola has reported 63 suspected cases, of which 17 were confirmed and one death recorded (CFR 1.6%). The confirmed cases are between 6 and 59 months. The affected provinces are: Uige, Quitexe, Banga (Cuanza Norte) and Dande (Bengo). A Catch up campaign was conducted on the end of March. Angola Poliomyelitis (cVDPV2) Grade 2 8-May-2019 01-Jan-19 21-Apr-2021 133 133 0 0.0% No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There were three cases reported in 2020. The total number of cases reported in 2019 remains 130. These cases are from several outbreaks which occurred in 2019. Benin COVID-19 Grade 3 17-Mar-20 16-Mar-20 19-Apr-2021 7720 7720 97 - The Ministry of Health in Benin announced the first confirmed case of COVID-19 on 16 March 2020. As of 19 April 2021, a total of 7 720 cases have been reported in the country with 97 deaths and 7 510 recoveries. Benin Poliomyelitis (cVDPV2) Grade 2 8-Aug-2019 8-Aug-2019 21-Apr-2021 12 12 0 0.0% No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There were three cVDPV2 cases reported in 2020, and 8 in 2019. These cases are all linked to the Jigawa outbreak in Nigeria. Botswana COVID-19 Grade 3 30-Mar-20 28-Mar-20 19-Apr-2021 45855 45855 691 1.5% On 30 March 2020, the Minister of Health and Wellness in Botswana reported three confirmed cases of COVID-19. As of 19 April 2021, a total of 45 855 confirmed COVID-19 cases were reported in the country including 691 deaths and 41 338 recovered cases. Burkina Faso Humanitarian crisis Grade 2 01-Jan-19 01-Jan-19 1-Feb-2021 - - - - Since 2015, the security situation in the Sahel and East of Burkina Faso has gradually deteriorated as a result of attacks by armed groups. This has resulted in mass displacement of a total of 1 034 609 internally displaced persons registered as of 31 October 2020 in all 13 regions in the country. The presence of jihadist groups and self-defence units have created an increasingly volatile security situation. Attacks on the health system, intimidation and kidnapping of health workers, theft of medicines, continue to be reported. As of 30 September, 2020, 95 health facilities (7.5% of health facilities in six regions) were closed, and 199 other health facilities are working partially. Central Burkina Faso (including capital Ouagadougou area, and the Centre-Nord Region) was affected by heavy rain in September 2020, which trigered floods and resulted in casualties and damages. Food and nutrition insecurity issues linger at alarming levels specifically in the conflict areas. In 2021, 3.5 million people are in need of humanitarian assistance, more than 1.5 million people are in need of protection, and more than 250,000 people are in phase 4 “emergency” conditions for food insecurity. Burkina Faso COVID-19 Grade 3 10-Mar-20 09-Mar-20 24-Apr-2021 13263 13263 156 1.2% Between 9 March 2020 and 24 April 2021, a total of 13 263 confirmed cases of COVID-19 with 156 deaths and 12 937 recoveries have been reported from Burkina Faso. Burkina Faso Hepatitis E Grade 1 07-Sep-20 17-Sep-20 28-Mar-21 847 10 17 2.0% From 8 September to 28 March 2021, there were a total of 847 cases of febrile jaundice detected, including 706 in the Barsalogho health district, North Central Region of Burkina Faso. The outbreak has mainly affected internally displaced persons in the district, including 15 of 17 deaths that were among pregnant or postpartum women. Hepatitis E was confirmed in ten cases. Eight out of nine samples were IgM positive for hepatitis E at a hospital laboratory in Montpellier, France on 25 September 2020; three samples tested IgM positive for yellow fever and 1 sample was undetermined at the Laboratoire National de Référence des Fièvres Hémorragiques Virales (LNR-FHV) in Centre Muraz; a total of four samples were sent to IPD for confirmation. Results showed two samples tested PCR positive for Hepatitis E; seroneutralization results revealed 4 positive yellow fever results, however with very low titres; and 0 samples tested RT-PCR positive for yellow fever. This has now been confirmed as a hepatitis E outbreak. Burkina Faso Poliomyelitis (cVDPV2) Grade 2 01-Jan-19 21-Apr-2021 61 61 0 0.0% No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week, the number of 2020 cases still 61. The country is affected by different outbreaks, one linked to the Jigawa outbreak in Nigeria and one to the Savanes outbreak in Togo. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 9 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Burundi COVID-19 Grade 3 31-Mar-20 18-Mar-20 24-Apr-2021 3 874 3 874 6 0.2% On 31 March 2020, the Minister of Health in Burundi reported the first two confirmed cases of COVID-19. As of 24 April 2021, the total number of confirmed COVID-19 cases is 3 874, including six deaths and 3 506 recovered. Burundi Measles Ungraded 23-Mar-20 01-Jan-21 31-Mar-21 235 191 0 0.0% Burundi has been experiencing measles outbreaks since November 2019 in camps hosting Congolese refugees and the disease spread in the host community in the district of Citiboke. A total of 1879 cases were reported in 45 of the 47 districts of the country throughout 2020. As of the beginning of the year 2021, Burundi reported a total of 191 confirmed measles cases (IgM+, Epi-link and Compatible) and 2 districts in epidemic situation against (Bubanza and Bugarama). Outbreak investigations ongoing in Bugarama. Cameroon Humanitarian crisis (Far North, North, Adamawa & East) Protracted 2 31-Dec-2013 27-Jun-17 28-Feb-2021 - - - - Cameroon continues to face a humanitarian crisis in the Far North Region linked to the terrorist attacks by the Boko Haram group resulting in significant population displacement. The United Nations Department of Safety and Security identified 42 security incidents in February 2021. UNHCR protection monitoring through INTERSOS, reported 525 protection incidents in the same month of which Logone and Chari departments recorded the highest number of incidents. According to OCHA reports, an estimated 1 million people need assistance, 322 000 people are internally displaced, 69 900 are camp refugees, and 46 300 are refuges in the region not in camps. In December 2020, a tripartite agreement between UNHCR, Nigeria, and Cameroon agreed to voluntarily repatriate 5 000 Nigerian refugees which is in process. Cameroon Humanitarian crisis (NW & SW) Protracted 2 01-Oct-16 27-Jun-18 30-Mar-21 - - - - Conflict and violence in the North-West and South-West regions continue to cause mass displacement in the area with more than 10 741 people fleeing their homes during the month of February. As of 30 March 2021, there were an estimated 705 800 internally displaced and an estimated 63 200 Cameroon refugees in Nigeria. Among the divisions most affected are Donga-Mantung, Bui, Boyo, Mezam, and Nwa in the NW, and Lebialem and Manyu divisions in the SW. Much of the violence remains between parties of the ongoing conflict including non-state armed groups and vigilante groups which often affect community members caught in the crossfire. There have also been reports of targeted attacks on various groups such as traditional leaders and school staff. Cameroon COVID-19 Grade 3 06-Mar-20 06-Mar-20 14-Apr-2021 65 998 65 998 991 1.5% The Cameroon Ministry of Health announced the confirmation of the first COVD-19 case on 6 March 2020. As of 14 April 2021, a total of 65 998 cases have been reported, including 991 deaths and 60 031 recoveries. Cameroon Measles Ungraded 2-Apr-2019 01-Jan-21 4-Apr-2021 843 - 20 2.4% From January to 4 April 2021, Cameroon has reported 843 cases and a total of 20 deaths. There is an ongoing outbreak in the east Region ( yokadouma). Cameroon Poliomyelitis (cVDPV2) Grade 2 01-Jan-20 01-Jan-20 21-Apr-2021 7 7 0 0.0% No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There were seven cases reported in 2020. Cameroon Yellow fever Ungraded 7-Feb-2021 04-Jan-21 18-Apr-2021 3 3 1 33.3% On 11 January 2021, the Centre Pasteur du Cameroon confirmed by seroneutralization a case of yellow fever in the health district of Dschang in Cameroon. The case was a 36-year-old female resident of the Doumbouo health area, Dschang health district, whose onset of symptoms occurred on 19 December 2020 with jaundice. She died on 1 February 2021 following surgery for a gallbladder abscess. Between 1 February and 18 March 2021, four additional cases tested IgM positive for yellow fever, of which two were confirmed by seroneutralization from the health districts of Yagoua (confirmed on 15 March 2021) and Maga (confirmed on 26 March 2021). Cape Verde COVID-19 Grade 3 19-Mar-20 18-Mar-20 25-Apr-2021 22358 22358 203 - The first COVID-19 confirmed case was reported in Cape Verde on 19 March 2020. As of 25 April 2021, a total of 22 358 confirmed COVID-19 cases including 203 deaths and 19 206 recoveries were reported in the country. Central African Republic Humanitarian crisis Protracted 2 11-Dec-2013 11-Dec-2013 14-Apr-2021 - - - - Civil unrest and food insecurity in most parts of the country, including major cities, continue to cause a complex humanitarian situation. The security situation remains tense with the persistence of inter-ethnic tensions within rival armed groups in the Northeast of the country, mainly in Ndele, Birao, Batangafo and Bria. According to OCHA figures, 2.8 million people are in need of assistance, 738 000 people are internally displaced as of 31 March, and 650 000 persons are refugees in neighboring countries. In March, 33 571 new IDPs were registered mostly in the Nangha Boguila, Bozoum, Paoua, Kouango and Alindao sub-prefectures and in the outskirts of Bouar. Displacement was also noted in surrounding bushes and axes such as Bossangoa – Nana-Bakassa and Paoua–Bozoum. In March, 37 171 people returned mainly in the Bangassou, Rafai, Bambari, Grimari, Baboua, Bimbo, Birao, Markounda and Bouar sub-prefectures due to the controlling of towns by armed forces. Central African Republic COVID-19 Grade 3 14-Mar-20 14-Mar-20 21-Apr-2021 6 224 6224 85 1.4% The Ministry of Health and population announced the confirmation of the first COVID-19 case in the Central African Republic on 14 March 2020. As of 21 April March 2021, a total of 6 224 confirmed cases, 85 deaths and 5 246 recovered were reported. Central African Republic Measles Grade 2 15-Mar-19 01-Jan-19 14-Oct-20 28676 443 137 - As of 14 October 2020, a total of 28 676 suspected cases have been notified and 137 deaths within 22 affected districts. A total of 32 new cases and 0 deaths were reported as of epi week 40. The majority of cases are under five years of age, followed by the 5 to under 15 year old age group. Response activities are ongoing in the affected health districts. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 10 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Central African Republic Poliomyelitis (cVDPV2) Grade 2 24-May-2019 24-May-2019 21-Apr-2021 25 25 0 0.0% No new cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported this week. There were 4 cVDPV2 cases reported in 2020 and 21 cases in 2019 from several outbreaks. Chad COVID-19 Grade 3 19-Mar-20 19-Mar-20 25-Apr-2021 4770 4770 169 3.5% The first COVID-19 confirmed case was reported in Chad on 19 March 2020. As of 25 April 2021, a total of 4 770 confirmed COVID-19 cases were reported in the country including 169 deaths and 4 389 cases who have recovered. Chad Measles Ungraded 24-May-2018 01-Jan-21 18-Apr-2021 1069 87 5 0.5% In 2020, Chad reported 8 785 cases, with 363 confirmed cases and 41 deaths. Since 1 January 2021 to date(18 April 2021), there have been 1 069 cases reported, 87 of which were confirmed by IgM, and five deaths. Chad Poliomyelitis (cVDPV2) Grade 2 18-Oct-19 09-Sep-19 21-Apr-2021 110 110 0 0.0% No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) reported in this week. There were 99 cVDPV2 cases reported in 2020 from three different outbreaks. There were 11 cases reported in 2019. The risk of further cVDPV2 spread across the Lake Chad subregion remains high. Comoros COVID-19 Grade 3 30-Apr-2020 30-Apr-2020 25-Apr-2021 3 829 3 829 146 3.8% The first case of confirmed COVID-19 was notified on 30 April 2020 in Comoros. As of 25 April 2021, a total of 3 829 confirmed COVID-19 cases, including 146 deaths and 3 650 recoveries were reported in the country. Congo COVID-19 Grade 3 14-Mar-20 14-Mar-20 20-Apr-2021 10 678 10 678 144 1.3% The Government of Congo announced the confirmation of the first case of COVID-19 in Congo on 14 March 2020. As of 20 April 2021, a total of 10 678 cases including 144 deaths and 9 631 recovered cases have been reported in the country. Côte d'Ivoire COVID-19 Grade 3 11-Mar-20 11-Mar-20 24-Apr-2021 45820 45820 281 - Since 11 March 2020, a total of 45 820 confirmed cases of COVID-19 have been reported from Côte d'Ivoire including 281 deaths, and a total of 45 343 recoveries. Côte d'Ivoire Poliomyelitis (cVDPV2) Grade 2 29-Oct-19 29-Oct-19 21-Apr-2021 72 72 0 0.0% No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. The total number of 2020 still 72. Democratic Republic of the Congo Humanitarian crisis Grade 3 20-Dec-2016 17-Apr-2017 4-Apr-2021 - - - - The prolonged and complex humanitarian crisis in DRC continues with 5.2 million internally displaced persons (IDP), 19.6 million people food insecure and in need of emergency assistance, and 11.3 million people in need of emergency health assistance. The main provinces affected are Ituri, Tanganyika, North and South Kivu. There has been prolonged movement in Ituri province of IDPs in various territories, most recently in Irumu and Mambasa where the largest movement was nearly 8 250 people moving as of 4 April 2021 from several localities to Boga Center and its surroundings. The Boga Center area has experienced strong demographic pressure whose indigenous population is estimated at nearly 15K inhabitants. IDPs present multisectoral needs (access to health care, protection, essential housing items, food, hygiene and sanitation). In North Kivu, Beni is a hot spot for armed attacks against civilians, with instances of rape, organized lootings, destruction of health centers and shelters, killings, and robbing of livestock. On 7 April 2021, there were two attacks by suspected ADF militants in Kainama and Kilya. There is population movement among Bapfuna group since March 2021 following clashes between FARDC troops and APCLS which is expected to continue. Since July 2020 to date, NDC-R Guidon and NDC-R Bwira have clashed causing a large population movement towards Pinga center (around 30K IDPs received by host families). In South Kivu, around 40K people were displaced due to clashes between Nyatura armed group and Raïa Mutomboki militiamen in Kaleha territory on 1 April 2021. In Tanganyika provice, six road axes remain closed due to insecurity predominately cause by Mayi Mayi Malaika activities in neighboring Kabambare territory. Democratic Republic of the Congo Cholera Grade 3 16-Jan-15 01-Jan-20 28-Mar-21 2 012 - 73 3.6% In 2021, from epidemiological week 1 to 12 (ending on 28 March 2021), 2 012 suspected cholera cases including 73 deaths (case-fatality rate 3.6%) were recorded in 51 health zones across 11 provinces of the Democratic Republic of the Congo. This is a 68% decrease in the number of suspected cholera cases compared to the same period in 2020, but the number of deaths remains stable between these two years. The endemic provinces are the most affected. In 2020, 30 304 suspected cholera cases including 514 deaths (case fatality 1.7%) were reported in 179 health zones across 23 provinces. Democratic Republic of the Congo COVID-19 Grade 3 10-Mar-20 10-Mar-20 25-Apr-2021 29610 29610 756 - Since the start of the COVID-19 outbreak, declared on 10 March 2020, a total of 29 610 confirmed cases and one probable case, including 756 deaths have been reported. A total of 26 156 people have recovered. Democratic Republic of the Congo Ebola virus disease Grade 2 7-Feb-2021 7-Feb-2021 4-Apr-2021 12 11 6 50.0% Detailed update given above. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 11 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Democratic Republic of the Congo Monkeypox Ungraded n/a 01-Jan-20 31-Dec-2020 6257 39 229 3.7% From epidemiological week 50 to 53 of 2020, there were 269 suspect cases of monkeypox and 4 deaths registered across the country. Between epidemiological week 1 and week 53, a total of 6 257 suspected cases including 229 deaths (CFR 3.7%) were reported in 133 health zones from 17 out of 26 provinces in the country. During the same period in 2019, 5 288 suspected cases and 107 deaths (CFR 2.0%) were reported in 132 health zones from 18 provinces. Overall, there is a regressive trend from epidemiological week 33 to 53 of 2020 (276 cases vs 76 cases). Democratic Republic of the Congo Plague Ungraded 12-Mar-19 01-Jan-20 25-Dec-2020 420 - 29 6.9% Ituri province notified an upsurge of plague cases in the health zone of Rethy during 2020. From 1 January to 25 December 2020, a total of 420 cases with 29 deaths (CFR 6.9%) were notified in 5 out of 22 health areas of Rety health zone. Plague is considered endemic in Ituri province. In 2019, from week 1 to 52, a total of 48 cases of bubonic plague including eight deaths have been reported in the country. Actions undertaken include ongoing strengthening in surveillance with the support of Malteser International and WHO; decontamination of households of cases; case managemenent and free preventive distribution of doxycycline (in adults) and cotrimoxazole (in children) to contacts; raising awareness for community engagement; and briefing health providers in the affected health areas. Democratic Republic of the Congo Poliomyelitis (cVDPV2) Grade 2 15-Feb-2018 01-Jan-18 21-Apr-2021 190 190 0 0.0% No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There is so far one case in 2021. The total number of 2020 cases remains at 81. The case count for 2019 remains 88. There were 20 cases reported in 2018. The country continues to be affected by several other genetically-distinct cVDPV2s (notably in Kasai, Kwilu, Kwango and Sankuru provinces). Equatorial Guinea COVID-19 Grade 3 14-Mar-20 14-Mar-20 21-Apr-2021 7 559 7 559 107 - The Ministry of Health and Welfare announced the first confirmed COVID-19 case on 14 March 2020. As of 21 April 2021, a total of 7 559 cases have been reported in the country with 107 deaths and 7 097 recoveries. Eritrea COVID-19 Grade 3 21-Mar-20 21-Mar-20 23-Apr-2021 3 605 3 605 10 0.3% The first COVID-19 confirmed case was reported in Eritrea on 21 March 2020. As of 23 April 2021, a total of 3 605 confirmed COVID-19 cases with 10 deaths were reported in the country. A total of 3 410 patients have recovered from the disease. Eswatini COVID-19 Grade 3 13-Mar-20 13-Mar-20 25-Apr-2021 18442 18442 671 3.6% The first case of COVID-19 was confirmed in the kingdom of Eswatini on 13 March 2020. As of 25 April 2021, a total of 18 442 cases have been reported in the country including 17 737 recoveries. A total of 671 associated deaths have been reported. Ethiopia Humanitarian crisis (Conflict in Tigray) Grade 2 04-Nov-20 04-Nov-20 14-Apr-2021 - - - - The access situation in Tigray is fluid and constantly changing. Despite recent improvements in access, active conflict in various areas this week restricted humanitarian response. In addition to insecurity, humanitarian partners continue to flag challenges with capacity and resources to be able to scale up to the level needed to respond across Tigray. Ethiopia Cholera Ungraded 14-May-2019 12-May-2019 14-Mar-21 14 484 14 484 479 3.3% In week 10 (week ending 14 March 2021), 29 new suspected cases with no associated deaths were reported. Most of the cases were reported from SNNP, Tigray and Oromia. Ethiopia COVID-19 Grade 3 13-Mar-20 13-Mar-20 25-Apr-2021 252 279 252279 3551 1.4% Since the confirmation of the first case on 13 March 2020, Ethiopia has confirmed a total of 252 279 cases of COVID-19 as of 18 April 2021, with 3 551 deaths and 192 747 recoveries. Ethiopia Measles Ungraded 14-Jan-17 01-Jan-19 10-Jan-21 1873 - - In week 01 (week ending 10 January 2021), the measles outbreak is still ongoing in the country. A total of 37 new suspected cases were reported during the week with one associated death mainly from SNNPR, Oromia, Amhara and Benishangul regions. Ethiopia Poliomyelitis (cVDPV2) Grade 2 24-Jun-19 20-May-2019 21-Apr-2021 40 40 0 0.0% No new cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) reported this week. The total number of 2020 cases still 26. The total number of cVDPV2 cases reported is 40. Gabon COVID-19 Grade 3 12-Mar-20 12-Mar-20 23-Apr-2021 22 433 22 433 138 - On 12 March 2020, the Ministry of Health announced the confirmation of the first COVID-19 case in the country. As of 23 April 2021, a total of 22 433 cases including 138 deaths and 19 074 recoveries have been reported in the country. Gambia COVID-19 Grade 3 17-Mar-20 17-Mar-20 23-Apr-2021 5 857 5 857 173 3.0% The first COVID-19 confirmed case was reported in the Gambia on 17 March 2020. As of 23 April 2021, a total of 5 857 confirmed COVID-19 cases including 173 deaths, and 5 284 recoveries have been reported in the country. Ghana COVID-19 Grade 3 12-Mar-20 12-Mar-20 21-Apr-2021 92166 92166 777 - As of 21 April 2021, a total of 92 166 confirmed COVID-19 cases have been reported in Ghana. There have been 777 deaths and 89 920 recoveries reported. Ghana Poliomyelitis (cVDPV2) Grade 2 09-Jul-19 08-Jul-19 21-Apr-2021 30 30 0 0.0% No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There were 12 cases reported in 2020, while the total number of 2019 cases remains 18. One cVDPV2 positive environmental sample was reported in the Eastern province. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 12 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Guinea COVID-19 Grade 3 13-Mar-20 13-Mar-20 25-Apr-2021 21985 21985 263 - The Ministry of Health in Guinea announced the first confirmed case of COVID-19 on 13 March 2020. As of 25 April 2021, a total of 21 985 cases including 19 271 recovered cases and 263 deaths have been reported in the country. Guinea Ebola virus disease Grade 3 14-Feb-2021 13-Feb-2021 4-Apr-2021 23 16 12 52.2% Detailed update given above. Guinea Lassa Fever Ungraded 11-Jul-20 11-Jul-20 4-Aug-2020 1 1 1 100.0% A case of Lassa fever was confirmed on 11 July 2020 by the Haemorrhagic Fever laboratory in Guéckédou. The case patient is a 28-year-old, female, 22 weeks of pregnancy, living in the village of Kondian, in the rural district of Koundou Lengo Bengou. She fell ill on 07 June 2020 with chest pain and no history of travel or being in contact with a foreigner a month before her illness. She consulted at Koundou health centre on 10 July 2020, with fever, cough, myalgia, diarrhoea, vomiting, sore throat, and chest pain. The malaria RDT performed was positive. She was treated for malaria and transferred to Guéckédou hospital the same day, where the diagnosis of haemorrhagic fever was made. A diagnostic test for haemorrhagic fever performed at the Haemorrhagic Fever laboratory in Guéckédou was positive for lassa fever. The patient died the next day. A dignified and secure burial was carried out by the Red Cross on 12 July 2020. Guinea Measles Ungraded 09-May-2018 01-Jan-19 18-Jan-21 6188 366 15 0.2% For epidemiological week 53 of 2020, there were a cumulative number of 6 118 cases and 15 deaths. During week 44 of 2019 (week ending 3 November 2019), 127 suspected cases of measles were reported. From week 1 to 44 (1 January - 3 November 2019), a total of 4 690 suspected cases including 18 deaths (CFR 0.4%) have been reported. Of the 4 690 suspected cases, 1 773 were sampled, of which 1 091 tested positive for measles by serology. Three localities in three health districts are in the epidemic phase, namely, Wanindara in Ratoma health district, Dounet in Mamou health district and Soumpoura in Tougue health district. Guinea Poliomyelitis (cVDPV2) Grade 2 22-Jul-20 22-Jul-20 21-Apr-2021 49 49 0 0.0% No cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. So far we have 5 cases in 2021. The total number of 2020 cases has been corrected to 44. Guinea Yellow fever Grade 2 19-Nov-20 06-Nov-20 15-Dec-2020 52 0 14 26.9% A total of 48 suspected yellow fever cases have been notified in Guinea: 46 suspect cases from Koundara commune (northern part of Guinea), 1 suspect case from Kouroussa (center of Guinea), and 1 suspect case Dubreka (north of Conakry). Among the samples collected, there are 10 probable cases (IgM positive) tested by the Laboratoire des Fievres Hemorragiques Virales at Nongo, and are now en route to IP Dakar for confirmatory testing. Guinea- Bissau COVID-19 Grade 3 25-Mar-20 25-Mar-20 24-Apr-2021 3 726 3 726 67 1.8% On 25 March 2020, the Ministry of Health of Guinea Bissau reported the first COVID-19 confirmed case in the country. As of 24 April 2021, the country has reported 3 726 confirmed cases of COVID-19 with 3 252 recoveries and 67 deaths. Kenya COVID-19 Grade 3 13-Mar-20 13-Mar-20 25-Apr-2021 156787 156787 2622 1.7% On 12 March 2020, the Ministry of Health announced the confirmation of one new COVID-19 case in the country. As of 25 April 2021, 156 787 confirmed COVID-19 cases including 2 622 deaths and 106 588 recoveries have been reported in the country. Kenya Leishmaniasis Ungraded 31-Mar-19 03-Jan-20 16-Mar-21 542 542 8 1.5% Since January 2020, a total of 542 visceral leishmaniasis confirmed cases with eight deaths (CFR 1.5%), have been reported in seven counties namely: Marsabit, Garissa, Kitui, Baringo, West Pokot, Mandera and Wajir. The outbreak is active in three counties, West Pokot, Mandera and Wajir. Kenya Measles Ungraded 6-May-2019 20-Oct-19 16-Mar-21 655 58 2 0.3% An outbreak of measles has been reported in nine sub-counties spread across five counties namely West Pokot, Garissa, Wajir, Tana River and Kilifi. Total cases reported are 655 out of which 58 were confirmed and two deaths (CFR 0.3%). The outbreak is active in West Pokot County. Kenya Rift Valley fever Ungraded 14-Jan-21 09-Mar-21 32 14 11 34.4% Rift Valley fever (RVF) in humans has been reported in Isiolo and Mandera counties and in animals in Isiolo, Mandera, Murang’a and Garissa counties in Kenya.The first case of suspected RVF was reported in late November 2020 following a sudden death of an adult male who was a herder. This was a case from Sericho ward in Garbatulla subcounty, Isiolo county. Other deaths with symptoms such as fevers, joint pains, headache and general malaise were also reported in Gafarsa and Erisaboru locations within Garbatulla subcounty as well as Korbesa in Merti subcounty. A confirmed case of RVF in Madera county reported end of December has since died; he was involved in the slaugher of four sick camels. All the affected cases were males age ranging from 13 to 70 years. As of 2 March 2021, there are a 32 total cases reported, of which 14 are confirmed and 11 deaths. Lesotho COVID-19 Grade 3 13-May-2020 13-May-2020 24-Apr-2021 10 728 10 728 316 - Since the first confirmed COVID-19 case was reported in Lesotho on 13 May 2020, until 24 April 2021, a total of 10 728 cases of COVID-19 have been reported, including 6 267 recoveries and 316 deaths. Liberia COVID-19 Grade 3 16-Mar-20 16-Mar-20 4-Apr-2021 2066 2066 85 4.1% From 16 March 2020 to 4 April 2021, a total of 2 066 cases including 85 deaths and 1 922 recoveries have been reported from all 15 counties of Liberia. Montserrado County, which hosts the country's capital city, remains at the epicenter of the outbreak. Liberia Measles Ungraded 24-Sep-17 01-Jan-19 19-Jan-21 43 4 0 0.0% In week 3 (week ending 19 January 2021), 19 suspected cases were reported from Bomi (6) Rivercess (3), Nimba (2), Grand Kru (2), Sinoe (2), Grand Gedeh (1), Lofa (1), River Gee (1) and Bong (1) Counties. Since the beginning of 2021, 43 cases have been reported across the country, of which 4 are laboratory-confirmed and 22 are clinically confirmed. Madagascar COVID-19 Grade 3 20-Mar-20 20-Mar-20 24-Apr-2021 35 746 35 746 599 1.7% Madagascar Ministry of Health announced the confirmation of the first COVID-19 case on 20 March 2020. As of 24 April 2021, a total of 35 746 cases have been reported in the country, out of which 28 433 have recovered and 599 deaths reported. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 13 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Madagascar Malaria Ungraded 08-Mar-21 08-Mar-21 08-Mar-21 There is an increase of 41% in the number of malaria cases for the last quarter of 2020 compared to the same period of the previous year for 31 districts in Madagascar. Malawi COVID-19 Grade 3 2-Apr-2020 2-Apr-2020 25-Apr-2021 34 016 34 016 1 147 3.4% On 2 April 2020, the president of Malawi announced the first confirmed cases of COVID-19 in the country. As of 25 April 2021, the country has a total of 34 016 confirmed cases with 1 147 deaths and 31 908 recoveries. Mali Humanitarian crisis Protracted 1 n/a n/a 8-Feb-2021 - - - - The precarious security situation continues to gradually spread to the southern regions of the country. Issues such as inter and intra-community conflicts, activism of non-state armed groups, consequences of counter-insurgency operations, crime and banditry continue to weaken the Malian context. Natural disasters (droughts and floods) and COVID-19 compound the health and non-health impacts affecting all basic social sectors as well as the protection of household livelihoods. According to OCHA reports, an estimated 5.9 million people need humanitarian assistance. As of January 2021, an estimated 358 212 people are refugees or internally displaced. Mali COVID-19 Grade 3 25-Mar-20 25-Mar-20 25-Apr-2021 13 627 13 627 467 3.4% On 25 March 2020, the Ministry of Health of Mali reported the first COVID-19 confirmed cases in the country. As of 25 April 2021, a total of 13 627 confirmed COVID-19 cases have been reported in the country including 467 deaths and 8 071 recoveries. Mali Measles Ungraded 20-Feb-2018 01-Jan-19 24-Jan-21 110 12 0 0.0% During week 3 (week ending 24 January 2021), 21 suspected cases of measles were reported from five regions in the country. Since 1 January 2021, 110 suspected cases, 12 of which were confirmed have been reported. Mauritania COVID-19 Grade 3 13-Mar-20 13-Mar-20 25-Apr-2021 18 257 18 257 454 2.5% The government of Mauritania announced its first confirmed COVID-19 case on 13 March 2020. As of 25 April 2021, a total of 18 257 cases including 454 deaths and 17 587 recovered cases have been reported in the country. Mauritania Dengue Ungraded 11-May-2020 3-May-2020 02-Nov-20 7 7 0 0.0% Between 16 to 24 October 2020, 5 cases of dengue fever have been suspected at Etewvigh Clinic in Tevragh Zeina district, and all have been confirmed by RT-PCR at the National Institute of Research in Public Health (INRSP). On 3 May 2020, two suspected cases of dengue fever were admitted to hospital in Mauritania. On May 4 2020, it was found that the majority of consultations at the hospital had a history of unexplained fever. Thus, samples from the two suspected cases were collected and sent to the National Institute of Research in Public Health (INRSP). On 5 May 2020 the 2 cases were confirmed by RT-PCR positive for Dengue virus with DENV-1 serotype. The cases were discharged from hospital and declared cured after symptomatic treatment. A rapid investigation was carried out at city level and a further 5 additional cases (4 women and 1 man) distributed in 4 districts of Atar (Atar, Tineri, Aghnemrite and Edebaye) were detected. Mauritania Rift Valley Fever Grade 1 09-Oct-20 04-Sep-20 28-Sep-20 36 36 13 36.1% The Ministry of Health notified the WHO of 8 cases, including 7 deaths, of Rift Valley Fever (RVF) (PCR positive) in breeders, which occurred between13 September 2020 and 1 October 2020, in several localities in the departments of Tidjikja and Moudjéria (Tagant region), Guerou department (Assaba region) and Chinguetty department (Adrar region). The 7 deaths occurred in the Tagant region (5) and in the Assaba region (2). All these deaths occurred among hospitalized cases with fever and haemorrhagic syndrome (petechiae, gingivorrhagia) and vomiting, in the 3 departments of the region. As of 5 October 2020, a total of 88 samples of suspected cases have been sent to the National Institute for Public Health Research (INRSP): 36 were positive (by PCR and Elisa), 46 were negative. Six sample result are still pending. Confirmed cases have been reported in 9 regions (Adrar, Assaba, Brakna, Hodh Elchargui, Hodh El Gharby, Tagant, Trarza, Gorgol et Noukchott Sud). The continuous surveillance of RVF at the animal level has confirmed the outbreaks in the Assaba, Tagant, Brakna, Trarza and Hodh Elgharbi regions. The results of 165 samples taken in the period from 16-23 September 2020, show that 33 camelids, 4 small ruminants and 6 cattle were positive. Mauritius COVID-19 Grade 3 18-Mar-20 18-Mar-20 17-Apr-2021 1 203 1 203 15 1.2% The Republic of Mauritius announced the first three positive cases of COVID-19 on 18 March 2020. As of 17 April 2021, a total of 1 203 confirmed COVID-19 cases including 15 deaths and 934 recovered cases have been reported in the country. Mozambique Humanitarian crisis in Cabo Delgado Grade 2 01-Jan-20 01-Jan-20 18-Apr-2021 - - - - The security situation in Cabo Delgado over the last 7 days remains volatile and uncertain. After the attack on Palma sede on 24 March 2021, there has been movement of troops and IDPs in the area. As of 17 April 2021, an estimated number of 20 955 IDPs had been registered arriving by foot, bus, boat and air from Palma to the four districts. In the last week, there have been rumors and unconfirmed reports of non-state armed group attacks in various areas of the Cabo Delgado province contributing to the continual concern about the security situation. Mozambique Cholera Ungraded 20-Feb-2020 31-Jan-20 17-Jan-21 2 952 108 40 1.40% As of 17 January 2021 there have been a total of 2 952 cases and 40 deaths (case fatality ratio 1.4%) reported in the Cabo Delgado province in seven districts: Mocimboa da Praia (380 cases), Ibo (440 cases), Macomia (247 cases), Pemba (685 cases), Metuge (571 cases), Chiure (377 cases) and Montepuez (252 cases). The districts of Mocimboa da Praia and Macomia have not been reporting data because of ongoing insurgent attacks in the area. Mozambique COVID-19 Grade 3 22-Mar-20 22-Mar-20 25-Apr-2021 69 665 69 665 807 1.2% The first COVID-19 confirmed case was reported in Mozambique on 22 March 2020. As of 25 April 2021, a total of 69 665 confirmed COVID-19 cases were reported in the country including 807 deaths and 62 501 recoveries. Mozambique Measles Ungraded 25-Jun-20 01-Jan-20 22-Jul-20 862 140 0 0.0% There are measles outbreaks in six districts of Zambezia. The outbreak was declared in March 2020 at the Nauela Administrative Post, Alto Molócuè district. As of week 21, there were 862 suspected cases reported, 711 suspected cases tested, 140 IgM+ for measles, no epi-linked cases reported, and no deaths. So far there are 67 cases from Nampula, 18 from Cabo Delgado, 17 from Zambezia and 13 from Niassa provinces. 42% are <5 years old; 48% are aged 5-14 years. Namibia COVID-19 Grade 3 14-Mar-20 14-Mar-20 24-Apr-2021 47 776 47 776 625 0.0% The first case of COVID-19 was first detected in Namibia on the 14 March 2020. As of 24 April 2021, a total of 47 776 comfirmed cases with 45 558 recovered and 625 deaths have been reported. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 14 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Namibia Hepatitis E Protracted 1 18-Dec-2017 08-Sep-17 10-Jan-21 10 227 10 227 66 0.6% During this reporting period, 28 December 2020 - 10 January (weeks 53 & 01), a total of 5 HEV (Hepatitis E Virus) cases were reported country-wide. Since the beginning of the outbreak in December 2017, a cumulative total of 10 227 cases (2 099 laboratory-confirmed, 4 744 epidemiologically linked, and 1 187 suspected cases) including 66 deaths (CFR 0.8%) have been reported countrywide. Khomas Region remains the most affected region, accounting for 5 103 (50%) of reported cases, followed by Erongo 1 916 (19%) since the outbreak began. Niger Humanitarian crisis Protracted 1 1-Feb-2015 1-Feb-2015 14-Apr-2021 - - - - The Tillaberi region continues to experience a deterioration of the security situation perpetrated by non-state armed groups (NASG) along the borders of Mali and Burkina Faso which negatively impacts the population. There are frequent killings of civilians, targeted assassinations against customary and religious leaders, kidnappings, extortion of property and livestock, and gender-based violence causing problems for access to education, health, WASH services, shelter, protection, and food insecurity. There have been at least two serious attacks in 2021, one occurring on 2 January when 105 civilians were killed in Tchomabangou and Zaroum-Darey, and another on 15 March when 64 civilians were killed in Banibangou. According to OCHA statistics, 3.8 million people need humanitarian assistance in 2021, 313 000 are IDPs, 234 000 are refugees, and 2 million are food insecure (with 511 332 affected by food insecurity in the Tillaberi region alone). Niger COVID-19 Grade 3 19-Mar-20 19-Mar-20 11-Apr-2021 5 074 5 074 189 3.7% From 19 March 2020 to 11 April 2021, a total of 5 074 cases with 189 deaths have been reported across the country. A total of 4 747 recoveries have been reported from the country. Niger Measles Ungraded 10-May-2019 01-Jan-20 31-May-2020 2 079 241 4 0.2% From week 1 to 22 of 2020, Niger reported a total measles suspected case count of 2 079 of which there were 241 lab confirmed (IgM positive) and 4 deaths in 8 regions: Agadez (50 cases, 0 deaths), Diffa: (4 cases, 0 deaths), Dosso (27 cases, 0 deaths), Maradi (101 cases, 2 deaths), Niamey (23 cases, 0 deaths), Tahoua (62 cases, 1 death), Tillaberi (67 cases, 0 deaths) and Zinder (167 cases, 1 death). In 2019 a total of 10 207 suspected measles cases were reported from eight regions in the country. So far, 24 districts have been affected by outbreaks in 2020. Nigeria Humanitarian crisis Protracted 3 10-Oct-16 n/a 17-Apr-2021 - - - - Attacks on Nigerian Armed Forces (NAF) by non-state armed groups (NASG) have escalated in the past week leading to harming of civilians and targeting of humanitarian workers. The violent attacks have been ongoing for months and growing insecurity has affected operations in Borno state in Monguno, Ngala, Dikwa, and Damask. The latter two have halted UN and INGO operations altogether as of 17 April 2021. IDP camps were not targeted, but some 8 800 IDPs and 76 000 host community members of Damask are expected to be impacted by the effects of the attacks. The aid programmes affected include food distribution, WASH, health, and nutrition which will be paused for a significant period until security can be maintained and recovery can begin. Nigeria Avian influenza Ungraded 04-Mar-21 09-Mar-21 09-Mar-21 7 7 0 As of 3 March 2021 a total of seven confirmed cases with no deaths have been reported in two States (Plateau and Kano). Forty-five samples were collected from bird handlers who had contact with confirmed positive and suspected birds in Kano and Plateau States, of which seven tested positive at the Nigeria Centre for Disease Control National Reference Laboratory for influenza A - Kano (4) and Plateau (3). Nigeria Cholera 12-Jan-21 30-Mar-21 97 97 17 17.5% A cholera outbreak was detected in Benue State, Nigeria and resulted in 10 deaths in the region Agatu.The Agatu outbreak is reported to have started in December 2020, in Obagaji, the LGA headquarters. An immediate response on the spot assessment of the alert in Abinsi by a Rapid Response of the Ministry of Health was done. As of 30 March 2021, 39 persons, mostly children have been affected with 7 deaths giving a CFR of 17.9%. Fifty-eight cases have been recorded in Abinsi settlement of Guma LGA with 10 deaths (CFR 17.2%). Nigeria COVID-19 Grade 3 27-Feb-2020 27-Feb-2020 25-Apr-2021 164719 164719 2062 - The first case of COVID-19 was first detected in Nigeria on the 27 February 2020. As of 25 April 2021, a total of 164 719 comfirmed cases with 154 926 recovered and 2 062 deaths have been reported. Nigeria Lassa fever Ungraded 01-Jan-21 01-Jan-21 4-Apr-2021 236 233 49 20.8% Three (3) new cases were reported from Ondo State during the week ending 4 April 2021. Of the 14 states affected, Edo (102), Ondo (64), and Taraba (18) states accounts for 79% of all confirmed cases reported to date. New cases have declined since the end of week 11 (week ending 21 March 2021). Nigeria Measles Ungraded 25-Sep-17 01-Jan-21 14-Mar-21 540 4 2 0.4% In the year 2020, Nigeria has reported 9 316 confirmed cases, with 55 deaths, CFR 0.6%. As of january 2021 to 14 March 2021, 540 suspected cases have been reported from 74 LGA's in 17 states and FCT. 4 cases were laboratory confirmed and 2 deaths recorded. Nigeria Poliomyelitis (cVDPV2) Grade 2 01-Jun-18 01-Jan-18 21-Apr-2021 63 63 0 0.0% No new case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There are so far 3 cases in 2021. There were 8 cVDPV2 cases reported in 2020, 18 cVDPV2 cases reported in 2019 and 34 in 2018. Nigeria Yellow fever Ungraded 01-Nov-20 29-Jan-21 3 473 169 296 8.0% As of 29 January 2021, there have been a cumulative total of 3 112 suspected cases of yellow fever, of which 109 cases have been confirmed, from 488 LGA (63%) across all states and the Federal Capital Territory (FCT). Laboratory results in-country show 70 cases confirmed by PCR, with 148 presumptive positive, 13 inconclusive and 1 526 negative. Laboratory results for 148 samples sent to Institut Pasteur Dakar show 41 (27.7%) confirmed, 16 negative and 91 pending. Rwanda COVID-19 Grade 3 14-Mar-20 14-Mar-20 25-Apr-2021 24 593 24 593 330 1.3% The Rwanda Ministry of Health announced the confirmation of the first COVD-19 case on 14 March 2020. As of 25 April 2021, a total of 24 593 cases with 330 deaths and 22 941 recovered cases have been reported in the country. Sao Tome and Principe COVID-19 Grade 3 6-Apr-2020 6-Apr-2020 25-Apr-2021 2 297 2 297 35 - On 6 April 2020, the Ministry of Health of Sao Tome and Principe reported the country’s first case of COVID-19. As of 25 April 2021, a total of 2 297 confirmed cases of COVID-19 have been reported, including 35 deaths. A total of 2 234 cases have been reported as recoveries. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 15 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Senegal COVID-19 Grade 3 02-Mar-20 02-Mar-20 25-Apr-2021 40135 40135 1102 - From 2 March 2020 to 25 April 2021, a total of 40 135 confirmed cases of COVID-19 including 1 102 deaths and 38 861 recoveries have been reported in Senegal. Senegal Dengue Ungraded 01-Sep-20 07-Sep-20 07-Sep-20 27 27 0 0.0% In 2020, the first confirmed case of dengue in Senegal was reported in August. It was a 30-year-old man who tested positive for dengue serotype 2 (IgM) on 14 August 2020 by the IPD. The onset of symptoms began on 10 July 2020 and symptoms included fever, headache, and arthralgia. As of 20 December 2020, 27 confirmed cases of dengue had been reported in 6 regions of Senegal: Dakar, Tambacounda, Kédougou, Kaffrine, Thiès, and Kaolack. Dengue is therefore the most common VHF reported in Senegal in 2020. Senegal Rift Valley Fever Ungraded 23-Oct-20 23-Oct-20 15-Nov-20 3 3 0 0.0% The Institut Pasteur of Dakar through the directorate of diseases prevention notified the district of Matam of two confirmed cases of Rift Valley fever (RVF-IgM positive) on 23 October 2020, one in a 20-year-old, male, living in Bokidiawé. He consulted at the health post on 13 October 2020 for an infectious syndrome without history of travel with an axillary temperature of 39.6 degree Celsius. The onset of symptoms is one day before the consultation date. The second case, is a 24 year-old man, living in Bokidiawé. he consulted the health post on 2 October 2020 for an infectious syndrome without notion of travel with an axillary temperature of 38.2 degree Celsius. The onset of symptoms is three days before the date of consultation. An additional case of confirmed RVF was notified later. Senegal West Nile fever Ungraded 23-Oct-20 23-Oct-20 15-Nov-20 6 6 0 0.0% The Institut Pasteur of Dakar through the directorate of diseases prevention notified to the district of Matam of one confirmed cases of West Nile fever (IgM positive) on 23 October 2020, in a 32-year-old female living in Bokidiawe. She consulted at the health post of Bokidiawe on 7 October 2020 for an infectious syndrome without history of travel with axillary temperature of 38.2 degree Celsius. The symptoms occurred 2 days before the consultation. Five additional cases were notified later in Tambacounda, Matam, Dakar et Ziguinchor regions. Senegal Yellow fever Ungraded 17-Dec-2020 7 7 2 28.6% From 29 October to 17 December 2020, there have been 7 cases confirmed (IP Dakar) with yellow fever in three regions of Senegal bordering Mauritania and Mali: 4 in Kidira health district (Tambacounda Region), 1 in Thilogne health district (Matam Region), 1 in Saraya district and 1 in Kedougou district (the latter two are both from Kedougou Region). Two deaths have been notified. Seychelles COVID-19 Grade 3 14-Mar-20 14-Mar-20 22-Apr-2021 5 170 5 170 26 - Since the first COVID-19 confirmed cases were reported in Seychelles 14 March 2020, as of 22 April 2021 a total of 5 170 cases have been confirmed, including 4 675 recoveries and 26 deaths have been reported. Sierra Leone COVID-19 Grade 3 31-Mar-20 27-Mar-20 25-Apr-2021 4 044 4 044 79 2.0% On 31 March 2020, the President of Sierra Leone reported the first confirmed COVID-19 case in the country. As of 25 April 2021, a total of 4 040 confirmed COVID-19 cases were reported in the country including 79 deaths and 2 993 recovered cases. South Africa COVID-19 Grade 3 05-Mar-20 03-Mar-20 25-Apr-2021 1 575 471 1 575 471 54 148 3.4% Since the start of the COVID-19 pandemic in South Africa a cumulative total of 1 575 471 confirmed cases and 54 148 deaths have been reported, with 1 501 185 recoveries. South Sudan Acute Food Insecurity Grade 2 18-Dec-2020 5-Apr-2021 16-Apr-2021 - - - People in parts of South Sudan continue to face the highest levels of food insecurity since the country declared independence 10 years ago. For many, their situation has deteriorated as a result of compounding shocks, including flooding, ongoing violence and displacement, the impact of which has eroded the livelihoods and coping strategies of vulnerable communities across the country. According to Integrated Food Security Phase Classification (IPC) projections, from December to March 2021, an estimated 5.8 million people (48 per cent of the population) faced Crisis levels of food insecurity (IPC Phase 3) or worse - a figure that is expected to increase to 7.2 million (60 per cent of the population) in the upcoming lean season of April-July 2021. In the six priority 1 locations, 810,000 people are deemed to be in Crisis or worse levels of food insecurity (IPC Phase 3+) according to IPC projections. This includes over 300,000 children suffering from Severe Acute Malnutrition (SAM) and some 480,000 pregnant and lactating women who are acutely malnourished and in need of treatment. South Sudan Humanitarian crisis Protracted 3 15-Aug-2016 n/a 28-Feb-2021 - - - - An estimated 30 000 IDPs from Tonj North County are currently sheltering in Thiet and Tonj town in Tonj South Countyas residents flee for fear of revenge attacks. Humanitarian organizations are working with the authorities to verify and assess the needs of the IDPs in Tonj South. The humanitarian activities including pre- positioning of health supplies, livestock vaccination and a polio immunization campaign have been affected by sub-nation violence in Greater Tonj areas. South Sudan COVID-19 Grade 3 5-Apr-2020 2-Apr-2020 24-Apr-2021 10 532 10 532 114 1.1% On 5 April 2020, the Ministry of Health of South Sudan reported the country’s first case of COVID-19. As of 24 April 2021, a total of 10 532 confirmed COVID-19 cases were reported in the country including 114 deaths and 10 250 recovered cases. South Sudan Hepatitis E Ungraded - 03-Jan-19 11-Apr-2021 556 556 5 0.9% The current outbreak in Bentiu UN Protection of Civilians (POC), which started at the beginning of 2019, has continued with 7 new cases reported in week 14 (week ending 11 April 2021). As of the reporting date, a total of 556cases of hepatitis E including five deaths have been reported. South Sudan Measles Ungraded 24-Nov-18 19-Sep-19 22-Jun-20 916 50 2 0.2% Between week 38 of 2019 to week 25 of 2020, a total of 916 suspected cases of measles of which 50 were laboratory-confirmed and 2 deaths (CFR 0.6%) have been reported. The outbreak has affected 8 counties (Tonj East, Magwi, Bor, Kapoeta East, Aweil East and Wau) and Bentiu Protection of Civilians Sites (POC). Tanzania, United Republic of COVID-19 Grade 3 16-Mar-20 16-Mar-20 11-Apr-2021 509 509 21 4.1% The Ministry of Health, Community Health Community Development, Gender, Elderly and Children in Tanzania reported the country’s first case of COVID-19 on 16 March 2020. As of 29 November 2020, a total of 509 cases have been reported in the country including 21 deaths. The last information on confirmed COVID-19 cases was shared by Tanzania mainland on 29 April 2020 and Zanzibar last shared information on on-going COVID-19 outbreak on 7 May 2020. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 16 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Togo COVID-19 Grade 3 06-Mar-20 01-Mar-20 24-Apr-2021 12 787 12 787 121 0.9% On 6 March 2020, the Ministry of Health and Public Hygiene of Togo announced the confirmation of its first case of COVID-19. As of 24 April 2021, a total of 12 787 cases including 121 deaths and 10 699 recovered cases have been reported in the country. Togo Poliomyelitis (cVDPV2) Grade 2 18-Oct-19 13-Sep-19 21-Apr-2021 17 17 0 0.0% No new case of cVDPV2 was reported during the past week. There were nine cases in 2020 while the total number of cVDPV2 cases reported in 2019 remains eight. Uganda Humanitarian crisis Ungraded 20-Jul-17 n/a 31-Jan-21 - - - - As of 31 January 2021, Uganda was hosting 1 424 325 refugees, majority of whom were resident in Bidibidi, Adjumani, Nakivale, Kyangwali and Kyaka Li districts. Most of the refugees were from South Sudan (65.3%), DRC (31.0%) and Burundi (3.6%). Uganda Cholera Ungraded 11-May-2020 29-Apr-2020 07-Sep-20 1 488 17 6 0.4% As of 7 September 2020, there are 1 488 cases, 483 in Moroto, 543 in Nabilatuk, 72 in Napak, 390 in Kotido. On 11 May 2020, a cholera outbreak was confirmed in Moroto district. The index case was a 17-year-old male patient from Natapar Kocuc Village, Loputuk parish, Nadunget Subcounty who was seen on 29 April 2020 with acute watery diarrhoea and severe dehydration. On 4 May 2020 more cases with similar symptoms from the same location with the index case were seen and cholera was suspected. On 11 May 2020, CPHL confirming Vibrio cholerae serotype 01 Inaba detected in 7 out of 8 stool samples that were collected. As of 12 June 2020, the cumulative number of cases is 682 including 6 deaths. Uganda COVID-19 Grade 3 21-Mar-20 21-Mar-20 23-Apr-2021 41 655 41 655 341 0.8% The first COVID-19 confirmed case was reported in Uganda on 21 March 2020. As of 23 April 2021, a total of 41 655 confirmed COVID-19 cases, 40 898 recoveries with 341 deaths. Zambia COVID-19 Grade 3 18-Mar-20 18-Mar-20 25-Apr-2021 91 358 91 358 1 246 1.4% The first COVID-19 confirmed case was reported in Zambia on 18 March 2020. As of 25 April 2021, a total of 91 358 confirmed COVID-19 cases were reported in the country including 1 246 deaths and 89 574 recovered cases. Zimbabwe Anthrax Ungraded 6-May-2019 6-May-2019 07-Mar-21 798 3 0.4% The anthrax outbreak is ongoing in Zimbabwe. From Week 1 to 11 of 2021, there were 51 cases reported. This outbreak started in Week 36, 2019, affecting mainly Buhera and Gokwe North and South districts but a surge in cases started appearing in week 38 when cases were reported in some other areas. The cumulative figures for anthrax are 747 cases and 3 deaths as of Week 52 of 2020. Zimbabwe COVID-19 Grade 3 20-Mar-20 20-Mar-20 25-Apr-2021 38086 38086 1557 4.1% The first COVID-19 confirmed case was reported in Zimbabwe on 20 March 2020. As of 25 April 2021, a total of 38 086 confirmed COVID-19 cases were reported in the country including 1 557 deaths and 35 123 cases that recovered. †Grading is an internal WHO process, based on the Emergency Response Framework. For further information, please see the Emergency Response Framework: http://www.who.int/hac/about/erf/en/. Data are taken from the most recently available situation reports sent to WHO AFRO. Numbers are subject to change as the situations are dynamic. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 17 © WHO Regional Office for Africa This is not an official publication of the World Health Organization. Correspondence on this publication may be directed to: Dr Benido Impouma Programme Area Manager, Health Information & Risk Assessment WHO Emergency Preparedness and Response WHO Regional Office for Africa P O Box. 06 Cité du Djoué, Brazzaville, Congo Email: afrooutbreak@who.int Requests for permission to reproduce or translate this publication – whether for sale or for non- commercial distribution – should be sent to the same address. 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 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 lines on maps represent approximate borderlines for which there may not yet be full agreement. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization or its Regional Office for Africa be liable for damages arising from its use. 2Health Emergency Information and Risk Assessment REGIONAL OFFICE FOR Africa Editorial Team B. Impouma C. Okot B. Farham G. Williams J. Kimenyi E. Kibangou O. Ogundiran T. Lee D. Niyukuri T. Metcalf J. Nguna Production Team A. Bukhari T. Mlanda R. Ngom F. Moussana Contributors R. Nansseu (Democratic Republic of the Congo) K. Mory (Guinea) Y. Abdoulaye (Democratic Republic of the Congo) Graphic design A. Moussongo Editorial Advisory Group Dr. Salam Gueye, Regional Emergency Director B. Impouma Y. Ali Ahmed N. Nsenga M. Djingarey Data sources Data and information is provided by Member States through WHO Country Offices via regular situation reports, teleconferences and email exchanges. Situations are evolving and dynamic therefore numbers stated are subject to change.
(2) Algeria Mali Chad Niger Angola EthiopiaNigeria South Africa Namibia Mauritania Zambia Kenya Democratic Republic of the Congo Mozambique Botswana Congo Madagascar South Sudan Cameroon Zimbabwe Gabon Ghana Guinea United Republic of Tanzania Uganda Central African Republic Côte d'Ivoire Senegal Burkina Faso Benin Eritrea Liberia Malawi TogoSierra Leone Lesotho Burundi Rwanda Eswatini Guinea-Bissau Gambia Equatorial Guinea Mauritius Comoros Cape Verde Sao Tome and Principe Seychelles 0 820410 Kilometers ¤ REGIONAL OFFICE FOR Africa WHO Health Emergencies Programme Health Emergency Information and Risk Assessment Graded events † 2 Ungraded events Protracted 3 events 2 Protracted 2 events 0 Protracted 1 event 1 WEEKLY BULLETIN ON OUTBREAKS AND OTHER EMERGENCIES Ongoing events 1160 Humanitarian crises 13 Outbreaks 103 Protracted 3 events 3 3 Protracted 1 events 50 Grade 1 events 1 Grade 3 events 20 2 Grade 2 events New event Week 17: 19-25 April 2021 Data as reported by: 17:00; 25 April 2021 2 012 73 10 227 66 236 49 7 0 3 473 296 3 1 190 0 110 0 1 069 5 5556 63 0 2540 97 17 6 257 229 542 8 1 488 6 1 873 916 2 798 3 420 29 28 676 137 843 20 42 079 14 484 479 40 0 25 0 110 0 862 0 133 0 012 07 43 0 7 2 52 14 655 2 164 719 2 062 2 952 40 65 998 991 1 575 471 54 148 7 720 97 13 263 156 6 224 85 10 678 144 45 820 281 29 610 756 18 442 671 252 279 3 551 22 433 138 92 166 777 2 066 85 18 257 454 47 776 625 24 593 330 5 170 26 509 21 5 074 189 4 770 169 3 605 10 1 203 15 25 609 579 91 358 1 246 38 086 1 557 69 665 807 22 358 203 35 746 599 41 655 341 156 787 2 622 5 857 173 3 726 67 061 030 13 627 467 120 922 3 207 45 855 691 3 874 6 34 016 1 148 4 044 79 10 532 114 235 0 10 728 316 7 0 27 0 3 829 146 12 6 23 12 63 1 1 1 17847 36 13 156 188 049 12 787 121 2 297 35 7 559 107 017 26321 985 072 3 0 6 0567 0 40 135 1 102 64 0 Legend Ebola virus disease Malaria Humanitarian crisis Dengue fever Yellow fever Countries outside WHO African Region WHO Member States with no reported events Not applicable Countries reported in the document Plague Leishmaniasis Crimean-Congo haemorrhagic fever West Nile fever Rift Valley fever Skin disease of unknown etiology Hepatitis E Avian influenza Monkeypox Cholera Lassa fever Measles Deaths Cases Acute Food Insecurity Acute Food Insecurity cVDPV2 Anthrax COVID-19 “The boundaries and names shown and the designations used on this map 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 borderlines for which there may not yet be full agreement.” 32 11 Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 1 Overview Ongoing events Summary of major issues, challenges and proposed actions All events currently being monitored This Weekly Bulletin focuses on public health emergencies occurring in the WHO African Region. The WHO Health Emergencies Programme is currently monitoring 116 events in the region. This week’s articles cover: COVID-19 across the WHO African region Ebola virus disease in Guinea Ebola virus disease in Democratic Republic of the Congo For each of these events, a brief description, followed by public health measures implemented and an interpretation of the situation is provided. A table is provided at the end of the bulletin with information on all new and ongoing public health events currently being monitored in the region, as well as recent events that have been controlled and closed. Major issues and challenges include: Over a year after Ethiopia reported its first COVID-19 case, it is now reporting the highest number of daily cases, surpassing South Africa for more than a month. The top five countries reporting the highest case numbers include South Africa, Nigeria, Kenya, and Algeria. The regional cumulative case fatality ratio has remained high at 2.5% for more than two months, above the global average of 2.1%. Health worker infections remain of concern as the numbers continue to increase across the region. There have been no new confirmed EVD cases in Guinea in the past weeks. However, there are still contacts lost to follow up and a confirmed case remains in the community. Alert reporting is suboptimal, with little community surveillance and poor 24-hour follow-up. In addition, the source of infection in Gouécké has not yet been identified since the declaration of the outbreak in Guinea. The funding gap for response actions remains, which requires urgent attention. There have been no new Ebola virus disease cases in Democratic Republic of the Congo for 54 days and there are nine days to go before the end of outbreak declaration. Challenges with contact follow-up, difficulties with feedback from health zones and inadequate funding for all response pillars all continue, however. Insecurity in the affected areas continues to impact response. Authorities and partners need urgently to address these challenges and ensure that the response funding gap is closed, so that the post-outbreak situation remains stable. Contents Overview 1 6 2 -5 7 Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 2 157 African region 2.5% CFR In the past seven days (19 - 25 April 2021), a total of 42 051 new cases of COVID-19 were reported in the African Region, a 20.3% decrease compared to the previous week with an average of 6 007 new cases Twenty-five (54.4%) countries reported a decrease in new cases, while 19 (41.3%) had an increase in new daily cases in the past seven days. Only Senegal did not show a significant change in case numbers during this reporting period. Most of the new cases reported this week were from Ethiopia (10 251; 24.4%), South Africa (8 702; 20.7%), Kenya (5 134; 12.2%), Madagascar (2 948; 7.0%) and Cabo Verde (1 892; 4.5%). In Ethiopia, COVID-19 cases and deaths dramatically increased and have remain high since end of March 2021. Tribal conflict, extensive flooding and the historic, devastating locust outbreak have exacerbated the humanitarian impacts on the COVID-19 response. Kenya continues to experience a third wave of COVID-19 outbreak, although with a noticeable decline in new daily cases. Twenty (43.5%) countries reported a decline in reported deaths, while 10 (21.7%) had an increase in the past seven days. Overall, 1 023 deaths, a 7.8% decrease in daily deaths, reported by 45 countries, has been observed during the reporting week. South Africa reported the highest number of deaths (412, 40.3%) followed by Ethiopia with 181 (17.7%) and Kenya 141 (13.8%). Since the declaration of the COVID-19 pandemic (between 25 February 2020 and 25 April 2021), the total number of confirmed cases in the WHO African Region is over 3.2 million with more than 2.9 million recoveries, giving a recovery rate of 90.5% of confirmed case patients. The death toll has now reached more than 81 000. Even when the African Region is one of the least affected globally, it has a high cumulative case fatality ratio of 2.5%, which is above the global average of 2.1%. The top five countries reporting the highest case numbers include South Africa (1 575 471 cases, 48.7% of all cases), Ethiopia (252 279 cases, 7.8%), Nigeria (164 719 cases, 5.1%), Kenya 156 787 cases, 4.8%) and Algeria (120 922 cases, 3.7%), accounting for 2 270 178 (70.0%) of all cases. The United Republic of Tanzania has reported no new confirmed cases in our database in the last 354 days. The average cumulative attack rate (number of cases per million) in the African region is estimated at 2 970 /million population, ranging from 9/million to 52 958 million. Seychelles (52 958 cases/million population), Cabo Verde (40 656 cases/million), South Africa (26 904 cases/ million), Namibia (19 152 cases/million) and Botswana (18 719 cases/million), are the five countries with the highest attack rate in the region. Liberia (425 cases/million), Democratic Republic of Congo (341 cases/million), Chad (299 cases/million), Burundi (294 cases/million), and Niger (228 cases/million) are the five countries with the lowest cumulative attack rate. South Africa leads with the highest number of deaths in the region (54 148 deaths, 66.3%).This is followed by Ethiopia (3 551, 4.3%), Algeria (3 207, 3.9%), Kenya (2 622, 3.2%), and Nigeria (2 062, 2.5%), accounting for 80.3% (65 590) of cumulative deaths. The median number of deaths per million in the African 3 240 968 81 656 Cases Deaths Go to overview Go to map of the outbreaks Coronavirus disease 2019 region is estimated at 26.1/million population (range: 0.4/million – 925/million) with an average cumulative death rate (per million) in the African region estimated at 74.8/million population. South Africa (925 deaths/million population), Eswatini (584/million), Cabo Verde (369/million), Botswana (282/million), Seychelles (266 million) and Namibia (250/million) are the five countries with the highest number of COVID-19 related deaths per million population. Uganda (7.7/million population) Burkina Faso (7.6/ million), Eritrea (3.1/million), Burundi (0.5/million) and United Republic of Tanzania (0.4/million) have the lowest number of COVID-19 related deaths per million population. During this reporting period, 82 health worker infections were reported from Namibia (68), Togo (13), and Seychelles (1). A total of 1 045 new health worker infections were also reported retrospectively from South Africa (688), Kenya (166), Chad (102), Ethiopia (74), and Togo (15). Currently, 109 599 (3.4% of all cases) health worker infections have been reported from 46 countries (48.0% of all countries) in the region. South Africa (55 672, 51.0%), Algeria (11 936, 11.0%) and Ghana (4 763, 4.3%), have recorded the highest number of health worker infections among countries. Zimbabwe (11.1%), Liberia (11.0%), and Guinea-Bissau (10.1%), have the highest country specific proportion of health worker infections. Only Eritrea has not reported any healthcare worker infections. As of 25 April 2021, the total number of confirmed COVID-19 cases on the African continent amounted to over 4.5 million. Total death counts now stand at more than 120 461 deaths (case fatality ratio 2.7%), and more than 4 million people have recovered. Forty-seven countries had received over 34.5 million COVID-19 vaccines by 23 April 2021 through the COVAX facility, bilateral deals or donations. Forty-one African countries have received 18.2 million COVAX doses. This includes 18 million AstraZeneca (Covishield) vaccines from the Serum Institute of India, and around 200 000 Pfizer vaccine doses. One of the major vaccination challenges is the low number of vaccine doses available for Africa. A total of 16.7 million doses had been administered by 21 April 2021. Forty-one countries are vaccinating using COVAX-funded vaccines, with 5.9 million COVAX doses reported as administered. Globally, over 960 million doses have been administered; around 1.7% of these were administered in Africa, of which Morocco has administered 68%, and Nigeria has administered 8.0% of their total polulation. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 3 The weekly distribution of confirmed cases of COVID-19 in the WHO African Region by reporting date, 25 February 2020 – 25 April 2021 (n = 3 240 968) SITUATION INTERPRETATION The African region continues to observe a decrease in both daily case and death counts. Ethiopia has reported the highest number of cases for more than a month, surpassing South Africa. The constant reduction in new weekly cases and deaths could result in complacency around COVID-19 response measures in regional populations, with subsequent non-adherence to preventive measures. It is important that the public receive accurate information about how the virus is spreading and be reminded of the importance of public health measures. This will require a strong risk communications strategy from governments. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 4 Countries with reported laboratory-confirmed COVID-19 cases and deaths: Data as of 25 April 2021 Country Total cases Total deaths Recovered Total Case Fatality Ratio (%) Health Worker infections South Africa 1 575 471 54 148 1 501 185 3.4 % 55 672 Ethiopia 252 279 3 551 192 747 1.4 % 2 933 Nigeria 164 719 2 062 154 926 1.3 % 3 175 Kenya 156 787 2 622 106 588 1.7 % 4 698 Algeria 120 922 3 207 84 299 2.7 % 11 936 Ghana 92 166 777 89 920 0.8 % 4 763 Zambia 91 358 1 246 89 574 1.4 % 814 Mozambique 69 665 807 62 501 1.2 % 3 484 Cameroon 65 998 991 60 031 1.5 % 2 153 Namibia 47 776 625 45 558 1.3 % 2 050 Botswana 45 855 691 41 338 1.5 % 61 Côte d'Ivoire 45 820 281 45 343 0.6 % 898 Uganda 41 655 341 40 898 0.8 % 1 931 Senegal 40 135 1102 38 861 2.7 % 419 Zimbabwe 38 086 1557 35 123 4.1 % 4 210 Madagascar 35 746 599 28 433 1.7 % 70 Malawi 34 016 1147 31 908 3.4 % 1 630 DRC 29 576 756 26 156 2.6 % 256 Angola 25 609 579 23 092 2.3 % 939 Rwanda 24 593 330 22 941 1.3 % 682 Gabon 22 433 138 19 074 0.6 % 345 Cabo Verde 22 358 203 19 206 0.9 % 140 Guinea 21 953 140 19 230 0.6 % 682 Eswatini 18 442 671 17 737 3.6 % 572 Mauritania 18 257 454 17 587 2.5 % 24 Mali 13 627 467 8 071 3.4 % 87 Burkina Faso 13 263 156 12 937 1.2 % 288 Togo 12 787 121 10 699 0.9 % 874 Lesotho 10 728 316 6 267 2.9 % 473 Congo 10 678 144 9 631 1.3 % 202 South Sudan 10 532 114 10 250 1.1 % 391 Benin 7 720 97 7 510 1.3 % 139 Equatorial Guinea 7 559 107 7 097 1.4 % 401 Central African Republic 6 224 85 5 246 1.4 % 1 Gambia 5 857 173 5 284 3.0 % 142 Niger 5 191 191 4 834 3.7 % 304 Seychelles 5 170 26 4 675 0.5 % 293 Chad 4 770 169 4 389 3.5 % 292 Sierra Leone 4 044 79 2 993 2.0 % 249 Burundi 3 874 6 3 506 0.2 % 38 Comoros 3 829 146 3 650 3.8 % 154 Guinea-Bissau 3 726 67 3 252 1.8 % 377 Eritrea 3 605 10 3 410 0.3 % 0 Sao Tome and Principe 2 297 35 2 234 1.5 % 102 Liberia 2 097 85 1 940 4.1 % 224 Mauritius 1 206 16 1 020 1.3 % 30 United Republic of Tanzania 509 21 180 4.1 % 1 Cumulative Cases (N=47) 3 240 968 81 656 2 933 331 2.5 % 109 599 *Total cases includes one probable case from Democratic Republic of the Congo Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 5 EVENT DESCRIPTION No new confirmed Ebola virus disease (EVD) cases have been reported in Nzerekore prefecture, the site of the current EVD outbreak in Guinea as of 24 April 2021. There is currently one active sub-prefecture and one in alert, all in the prefecture of Nzerekore. As of 24 April 2021, a total of 23 cases have been reported, including 16 confirmed cases, and 7 probable cases, of which 9 have recovered, and 12 have died (case fatality ratio 52.2%). The number of health workers infected remains five. There is one confirmed case, being treated by a traditional healer, in Kpagalaye village. Negotiations are underway to move the patient to an Ebola treatment centre. The majority of the confirmed and probable cases reported are female (13/23; 60.9%) and the most affected age group are those over 40 years. As of 24 April 2021, all 34 recorded contacts had been followed up in Nzerekore. A total of 328 contacts have been vaccinated. There were 53 alerts notified on 24 April 2021, of which 18 (23.0%) were investigated within 24 hours, and 10 were validated, all of which were deaths. Eight of these were sampled. Most alerts came from active case search. PUBLIC HEALTH ACTIONS Daily incident management system meetings take place with WHO, and have been moved to the WHO sub-office in Nzerekore. A discussion on the countdown to the end of outbreak is underway with the Ministry of Health. A joint UNICEF and WHO workshop has been held online, to ensure effective post-outbreak strategies. Coordinated efforts are underway for vaccination and other response pillars in Kpagalaye. There are continued monitoring efforts underway around the Soulouta sub-prefecture cluster around 48 notified alerts, three of which were deaths. A cumulative total of 8 082 people have been vaccinated, including 622 high-risk contacts, 6 926 contacts-of-contacts and 519 probable contacts, including 2 434 frontline workers. Five patients, all suspected cases, are currently hospitalized in the Epidemic Diseases Hospital treatment centre. Infection prevention and control (IPC) activities include supervision of training in a health facility in Conakry and orientation on triage and the three-bucket technique for bio-cleaning; reorganization of the triage system in four health facilities in Nzerekore, followed by briefing of eight Go to overview Go to map of the outbreaks The distribution of Ebola virus diseases cases in Guinea as of 24 April 2021 157 Ebola virus disease Guinea 52.2% CFR 23 12 Cases Deaths health workers on EVD prevention and implementation of an IPC improvement plan. Two water drilling points were rehabilitated in Nzerekore. There was support for sample collection in eight out of ten death alerts and two samples not collected in the community. Risk communication and community engagement (RCCE) included monitoring of prevention and management activities in Gouecke, and a socio-anthropological interview with the patient discharged from the Goecke treatment centre to assess his perception of the centre, along with selection of 11 interviewers for the socio-anthropological research, and follow-up on the overcoming of community response resistance in Kpaglaye. SITUATION INTERPRETATION Although there have been no new confirmed infections in Guinea in the past weeks, there are still contacts lost and one confirmed case not in isolation. In addition, alerts continue to be received, although few are reported by the community and 24-hour follow- up is inadequate. Community surveillance in Nzerekore and neighbouring provinces requires strengthening. The source of the outbreak in Gouecke has still not been identified, leaving potential unknown chains of transmission. In addition, the WHO response plan is still only 17.0% funded. This gap needs urgently to be filled if the momentum of response is to continue. Ongoing events Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 6 EVENT DESCRIPTION As of 25 April 2021 there has been no new confirmed cases of Ebola virus disease (EVD) in North Kivu for 54 consecutive days, which translates into nine days before the possible declaration of the end of the outbreak. Since the start of the outbreak there have been 11 confirmed cases, with one probable case and six deaths (case fatality ratio 50.0%). Two health workers have been infected, accounting for 16.6% of cases. All 17 health areas in the northern part of North Kivu reported alerts on 25 April 2021. There were 791 alerts reported and all were investigated, of which 61 were validated as suspected cases, with 60 (98.0%) sampled. The validated case that was not sampled was a death in Mutwanga Health Zone, where there were no sampling kits available. There are no confirmed patients admitted in the Ebola treatment centres, and 106 suspected patients are being followed in isolation in the health facilities, one in Alimbongo, one in Beni, 63 in Biena, six in Butembo, three in Kalunguta, two each in Kyondo and Lubero, 13 in Katwa, three each in Kayna and Manguredjipa, one in Masereka and eight in Musienene. PUBLIC HEALTH ACTIONS Daily coordination meetings continue, chaired by the coordinator of the pool of supervisors based in Butembo, with participation of partners. A mixed mission (surveillance, infection prevention and control and risk communication and community engagement) continues to provide support to management teams in Kalunguta, Beni, Oicha and Mabalako health zones. Vaccine activity stopped on 31 March 2021. As of that date, a total of 1 898 people have been vaccinated; 1 169 in Biena, 360 in Katwa, 297 in Butembo and 72 in Musienene. Front line providers make up 542 of those vaccinated. Since the start of the outbreak, 3 969 samples have been received and analysed for EVD. On 25 April 2021, a total of 15 death alerts were received, of which 14 (93.3%) were sampled. Eleven (73.3%) safe and dignified burials were carried out. Insecurity in Mutwanga Health Zone prevented one safe and dignified burial, two were not performed because of refusal by family members in Manguredjipa and Musienene and one body that is still in the mortuary in Katwa Health Zone. Infection prevention and control (IPC) activities included assessment of 17 health facilities in six health zones and monitoring and support for 48 health facilities in eight health zones. Go to overview Go to map of the outbreaks The distribution of Ebola virus disease cases in Democratic Republic of the Congo as of 25 April 2021 157 Ebola virus disease Democratic Republic of the Congo 50.0% CFR 12 6 Cases Deaths Ten out of the 17 affected health zones reported on risk communication and community engagement activities, which included visits to households by community action committees and sensitization of 309 people in Butembo, Mabalako and Katwa health zones. A total of 17 645 travellers were registered at 16 out of 22 operational Points of Entry/Points of Control, of which 15 808 (89.6%) were screened, 17 702 (88.9%) washed their hands and 15 808 (94.2%) received education around EVD; seven alerts were raised and one was validated and sent to an isolation facility. SITUATION INTERPRETATION The current EVD outbreak is now nine days off declaration of the end. However, challenges continue, with insecurity causing restricted movements for some partners, poor feedback from health areas and insufficient funds to support all pillars of the response. In addition there is low capacity at health facilities for isolation of suspected patients. An operational plan needs to be developed and validated for the 90-day post outbreak phase before 3 May 2021, in order to strengthen local health systems. Authorities and partners need urgently to address the challenges and ensure adequate funding for all response pillars to ensure that the situation remains stable post-outbreak. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 7Go to overview Go to map of the outbreaks Major issues and challenges The African region continues to experience established community transmission of COVID-19 across the region, however with an overall decrease in both new case and deaths counts. Numbers of health worker infections are still a concern, as is the relatively high case fatality ratio, even with deaths declining overall. Guinea continues to experience challenges around locating contacts lost to follow-up, isolating suspected patients and the continuing presence of a confirmed case in the community. Community surveillance remains poor, with most alerts reported through active case finding and poor 24-hour follow-up. A continuing funding gap for response activities will seriously impact continued surveillance and the required strengthening in contact follow-up and alert reporting if not closed. The EVD outbreak in Butembo, North Kivu is nine days off declaration of end of outbreak. However, alert management is problematic as is poor feedback from health zones. In addition, funding is running out and there are gaps in human resources that still need to be addressed. Proposed actions The African region needs to continue to implement all public health and social measures to prevent transmission of COVID-19. It is also important that the public receive accurate information about how the virus is spreading and be reminded of the importance of public health measures. Authorities and partners in Guinea need to strengthen active case searching in the community, along with alert management and contact tracing. Partners need to provide sufficient funds for continuing response as a matter of urgency. Insecurity continues to threaten the response to the current EVD outbreak in Democratic Republic of the Congo, although there have been no new cases for the past 54 days. However, authorities and partners need urgently to fill gaps in human resources and secure sufficient funding to continue the response in order to prevent a resurgence in cases. Summary of major issues, challenges and proposed actions Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 8Go to overview Go to map of the outbreaks All events currently being monitored by WHO AFRO Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Ongoing Events Algeria Brucellosis Ungraded 01-Jan-21 12-Apr-2021 64 64 0 0.0% The outbreak began in January 2021 in the wilaya of Batna where a cumulative of 64 cases have been confirmed as of 12 April 2021. Four cases were confirmed in January, 12 cases in February, and 48 cases in March. During March 50% of cases were among goat breeders and people having contact with contaminated animals. A total of 21 cases have been hospitalized, but all have been discharged with no deaths reported. Algeria COVID-19 Grade 3 25-Feb-2020 25-Feb-2020 25-Apr-2021 120 922 120 922 3207 2.7% From 25 February 2020 to 25 April 2021, a total of 120 922 confirmed cases of COVID-19 with 3 207 deaths (CFR 2.7%) have been reported from Algeria. A total of 84 299 cases have recovered. Angola COVID-19 Grade 3 21-Mar-20 21-Mar-20 25-Apr-2021 25 609 25 609 579 2.3% The first COVID-19 confirmed case was reported in Angola on 21 March 2020. As of 25 April 2021, a total of 25 609 confirmed COVID-19 cases have been reported in the country with 579 deaths and 23 092 recoveries. Angola Measles Ungraded 4-May-2019 01-Jan-21 31-Mar-21 63 17 1 1.6% In 2020, Angola reported between January and August a total of 1 220 suspected cases of which 1 008 have been confirmed, and 5 recorded(CFR 0.4%). From January to March 2021, Angola has reported 63 suspected cases, of which 17 were confirmed and one death recorded (CFR 1.6%). The confirmed cases are between 6 and 59 months. The affected provinces are: Uige, Quitexe, Banga (Cuanza Norte) and Dande (Bengo). A Catch up campaign was conducted on the end of March. Angola Poliomyelitis (cVDPV2) Grade 2 8-May-2019 01-Jan-19 21-Apr-2021 133 133 0 0.0% No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There were three cases reported in 2020. The total number of cases reported in 2019 remains 130. These cases are from several outbreaks which occurred in 2019. Benin COVID-19 Grade 3 17-Mar-20 16-Mar-20 19-Apr-2021 7720 7720 97 - The Ministry of Health in Benin announced the first confirmed case of COVID-19 on 16 March 2020. As of 19 April 2021, a total of 7 720 cases have been reported in the country with 97 deaths and 7 510 recoveries. Benin Poliomyelitis (cVDPV2) Grade 2 8-Aug-2019 8-Aug-2019 21-Apr-2021 12 12 0 0.0% No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There were three cVDPV2 cases reported in 2020, and 8 in 2019. These cases are all linked to the Jigawa outbreak in Nigeria. Botswana COVID-19 Grade 3 30-Mar-20 28-Mar-20 19-Apr-2021 45855 45855 691 1.5% On 30 March 2020, the Minister of Health and Wellness in Botswana reported three confirmed cases of COVID-19. As of 19 April 2021, a total of 45 855 confirmed COVID-19 cases were reported in the country including 691 deaths and 41 338 recovered cases. Burkina Faso Humanitarian crisis Grade 2 01-Jan-19 01-Jan-19 1-Feb-2021 - - - - Since 2015, the security situation in the Sahel and East of Burkina Faso has gradually deteriorated as a result of attacks by armed groups. This has resulted in mass displacement of a total of 1 034 609 internally displaced persons registered as of 31 October 2020 in all 13 regions in the country. The presence of jihadist groups and self-defence units have created an increasingly volatile security situation. Attacks on the health system, intimidation and kidnapping of health workers, theft of medicines, continue to be reported. As of 30 September, 2020, 95 health facilities (7.5% of health facilities in six regions) were closed, and 199 other health facilities are working partially. Central Burkina Faso (including capital Ouagadougou area, and the Centre-Nord Region) was affected by heavy rain in September 2020, which trigered floods and resulted in casualties and damages. Food and nutrition insecurity issues linger at alarming levels specifically in the conflict areas. In 2021, 3.5 million people are in need of humanitarian assistance, more than 1.5 million people are in need of protection, and more than 250,000 people are in phase 4 “emergency” conditions for food insecurity. Burkina Faso COVID-19 Grade 3 10-Mar-20 09-Mar-20 24-Apr-2021 13263 13263 156 1.2% Between 9 March 2020 and 24 April 2021, a total of 13 263 confirmed cases of COVID-19 with 156 deaths and 12 937 recoveries have been reported from Burkina Faso. Burkina Faso Hepatitis E Grade 1 07-Sep-20 17-Sep-20 28-Mar-21 847 10 17 2.0% From 8 September to 28 March 2021, there were a total of 847 cases of febrile jaundice detected, including 706 in the Barsalogho health district, North Central Region of Burkina Faso. The outbreak has mainly affected internally displaced persons in the district, including 15 of 17 deaths that were among pregnant or postpartum women. Hepatitis E was confirmed in ten cases. Eight out of nine samples were IgM positive for hepatitis E at a hospital laboratory in Montpellier, France on 25 September 2020; three samples tested IgM positive for yellow fever and 1 sample was undetermined at the Laboratoire National de Référence des Fièvres Hémorragiques Virales (LNR-FHV) in Centre Muraz; a total of four samples were sent to IPD for confirmation. Results showed two samples tested PCR positive for Hepatitis E; seroneutralization results revealed 4 positive yellow fever results, however with very low titres; and 0 samples tested RT-PCR positive for yellow fever. This has now been confirmed as a hepatitis E outbreak. Burkina Faso Poliomyelitis (cVDPV2) Grade 2 01-Jan-19 21-Apr-2021 61 61 0 0.0% No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week, the number of 2020 cases still 61. The country is affected by different outbreaks, one linked to the Jigawa outbreak in Nigeria and one to the Savanes outbreak in Togo. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 9 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Burundi COVID-19 Grade 3 31-Mar-20 18-Mar-20 24-Apr-2021 3 874 3 874 6 0.2% On 31 March 2020, the Minister of Health in Burundi reported the first two confirmed cases of COVID-19. As of 24 April 2021, the total number of confirmed COVID-19 cases is 3 874, including six deaths and 3 506 recovered. Burundi Measles Ungraded 23-Mar-20 01-Jan-21 31-Mar-21 235 191 0 0.0% Burundi has been experiencing measles outbreaks since November 2019 in camps hosting Congolese refugees and the disease spread in the host community in the district of Citiboke. A total of 1879 cases were reported in 45 of the 47 districts of the country throughout 2020. As of the beginning of the year 2021, Burundi reported a total of 191 confirmed measles cases (IgM+, Epi-link and Compatible) and 2 districts in epidemic situation against (Bubanza and Bugarama). Outbreak investigations ongoing in Bugarama. Cameroon Humanitarian crisis (Far North, North, Adamawa & East) Protracted 2 31-Dec-2013 27-Jun-17 28-Feb-2021 - - - - Cameroon continues to face a humanitarian crisis in the Far North Region linked to the terrorist attacks by the Boko Haram group resulting in significant population displacement. The United Nations Department of Safety and Security identified 42 security incidents in February 2021. UNHCR protection monitoring through INTERSOS, reported 525 protection incidents in the same month of which Logone and Chari departments recorded the highest number of incidents. According to OCHA reports, an estimated 1 million people need assistance, 322 000 people are internally displaced, 69 900 are camp refugees, and 46 300 are refuges in the region not in camps. In December 2020, a tripartite agreement between UNHCR, Nigeria, and Cameroon agreed to voluntarily repatriate 5 000 Nigerian refugees which is in process. Cameroon Humanitarian crisis (NW & SW) Protracted 2 01-Oct-16 27-Jun-18 30-Mar-21 - - - - Conflict and violence in the North-West and South-West regions continue to cause mass displacement in the area with more than 10 741 people fleeing their homes during the month of February. As of 30 March 2021, there were an estimated 705 800 internally displaced and an estimated 63 200 Cameroon refugees in Nigeria. Among the divisions most affected are Donga-Mantung, Bui, Boyo, Mezam, and Nwa in the NW, and Lebialem and Manyu divisions in the SW. Much of the violence remains between parties of the ongoing conflict including non-state armed groups and vigilante groups which often affect community members caught in the crossfire. There have also been reports of targeted attacks on various groups such as traditional leaders and school staff. Cameroon COVID-19 Grade 3 06-Mar-20 06-Mar-20 14-Apr-2021 65 998 65 998 991 1.5% The Cameroon Ministry of Health announced the confirmation of the first COVD-19 case on 6 March 2020. As of 14 April 2021, a total of 65 998 cases have been reported, including 991 deaths and 60 031 recoveries. Cameroon Measles Ungraded 2-Apr-2019 01-Jan-21 4-Apr-2021 843 - 20 2.4% From January to 4 April 2021, Cameroon has reported 843 cases and a total of 20 deaths. There is an ongoing outbreak in the east Region ( yokadouma). Cameroon Poliomyelitis (cVDPV2) Grade 2 01-Jan-20 01-Jan-20 21-Apr-2021 7 7 0 0.0% No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There were seven cases reported in 2020. Cameroon Yellow fever Ungraded 7-Feb-2021 04-Jan-21 18-Apr-2021 3 3 1 33.3% On 11 January 2021, the Centre Pasteur du Cameroon confirmed by seroneutralization a case of yellow fever in the health district of Dschang in Cameroon. The case was a 36-year-old female resident of the Doumbouo health area, Dschang health district, whose onset of symptoms occurred on 19 December 2020 with jaundice. She died on 1 February 2021 following surgery for a gallbladder abscess. Between 1 February and 18 March 2021, four additional cases tested IgM positive for yellow fever, of which two were confirmed by seroneutralization from the health districts of Yagoua (confirmed on 15 March 2021) and Maga (confirmed on 26 March 2021). Cape Verde COVID-19 Grade 3 19-Mar-20 18-Mar-20 25-Apr-2021 22358 22358 203 - The first COVID-19 confirmed case was reported in Cape Verde on 19 March 2020. As of 25 April 2021, a total of 22 358 confirmed COVID-19 cases including 203 deaths and 19 206 recoveries were reported in the country. Central African Republic Humanitarian crisis Protracted 2 11-Dec-2013 11-Dec-2013 14-Apr-2021 - - - - Civil unrest and food insecurity in most parts of the country, including major cities, continue to cause a complex humanitarian situation. The security situation remains tense with the persistence of inter-ethnic tensions within rival armed groups in the Northeast of the country, mainly in Ndele, Birao, Batangafo and Bria. According to OCHA figures, 2.8 million people are in need of assistance, 738 000 people are internally displaced as of 31 March, and 650 000 persons are refugees in neighboring countries. In March, 33 571 new IDPs were registered mostly in the Nangha Boguila, Bozoum, Paoua, Kouango and Alindao sub-prefectures and in the outskirts of Bouar. Displacement was also noted in surrounding bushes and axes such as Bossangoa – Nana-Bakassa and Paoua–Bozoum. In March, 37 171 people returned mainly in the Bangassou, Rafai, Bambari, Grimari, Baboua, Bimbo, Birao, Markounda and Bouar sub-prefectures due to the controlling of towns by armed forces. Central African Republic COVID-19 Grade 3 14-Mar-20 14-Mar-20 21-Apr-2021 6 224 6224 85 1.4% The Ministry of Health and population announced the confirmation of the first COVID-19 case in the Central African Republic on 14 March 2020. As of 21 April March 2021, a total of 6 224 confirmed cases, 85 deaths and 5 246 recovered were reported. Central African Republic Measles Grade 2 15-Mar-19 01-Jan-19 14-Oct-20 28676 443 137 - As of 14 October 2020, a total of 28 676 suspected cases have been notified and 137 deaths within 22 affected districts. A total of 32 new cases and 0 deaths were reported as of epi week 40. The majority of cases are under five years of age, followed by the 5 to under 15 year old age group. Response activities are ongoing in the affected health districts. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 10 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Central African Republic Poliomyelitis (cVDPV2) Grade 2 24-May-2019 24-May-2019 21-Apr-2021 25 25 0 0.0% No new cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported this week. There were 4 cVDPV2 cases reported in 2020 and 21 cases in 2019 from several outbreaks. Chad COVID-19 Grade 3 19-Mar-20 19-Mar-20 25-Apr-2021 4770 4770 169 3.5% The first COVID-19 confirmed case was reported in Chad on 19 March 2020. As of 25 April 2021, a total of 4 770 confirmed COVID-19 cases were reported in the country including 169 deaths and 4 389 cases who have recovered. Chad Measles Ungraded 24-May-2018 01-Jan-21 18-Apr-2021 1069 87 5 0.5% In 2020, Chad reported 8 785 cases, with 363 confirmed cases and 41 deaths. Since 1 January 2021 to date(18 April 2021), there have been 1 069 cases reported, 87 of which were confirmed by IgM, and five deaths. Chad Poliomyelitis (cVDPV2) Grade 2 18-Oct-19 09-Sep-19 21-Apr-2021 110 110 0 0.0% No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) reported in this week. There were 99 cVDPV2 cases reported in 2020 from three different outbreaks. There were 11 cases reported in 2019. The risk of further cVDPV2 spread across the Lake Chad subregion remains high. Comoros COVID-19 Grade 3 30-Apr-2020 30-Apr-2020 25-Apr-2021 3 829 3 829 146 3.8% The first case of confirmed COVID-19 was notified on 30 April 2020 in Comoros. As of 25 April 2021, a total of 3 829 confirmed COVID-19 cases, including 146 deaths and 3 650 recoveries were reported in the country. Congo COVID-19 Grade 3 14-Mar-20 14-Mar-20 20-Apr-2021 10 678 10 678 144 1.3% The Government of Congo announced the confirmation of the first case of COVID-19 in Congo on 14 March 2020. As of 20 April 2021, a total of 10 678 cases including 144 deaths and 9 631 recovered cases have been reported in the country. Côte d'Ivoire COVID-19 Grade 3 11-Mar-20 11-Mar-20 24-Apr-2021 45820 45820 281 - Since 11 March 2020, a total of 45 820 confirmed cases of COVID-19 have been reported from Côte d'Ivoire including 281 deaths, and a total of 45 343 recoveries. Côte d'Ivoire Poliomyelitis (cVDPV2) Grade 2 29-Oct-19 29-Oct-19 21-Apr-2021 72 72 0 0.0% No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. The total number of 2020 still 72. Democratic Republic of the Congo Humanitarian crisis Grade 3 20-Dec-2016 17-Apr-2017 4-Apr-2021 - - - - The prolonged and complex humanitarian crisis in DRC continues with 5.2 million internally displaced persons (IDP), 19.6 million people food insecure and in need of emergency assistance, and 11.3 million people in need of emergency health assistance. The main provinces affected are Ituri, Tanganyika, North and South Kivu. There has been prolonged movement in Ituri province of IDPs in various territories, most recently in Irumu and Mambasa where the largest movement was nearly 8 250 people moving as of 4 April 2021 from several localities to Boga Center and its surroundings. The Boga Center area has experienced strong demographic pressure whose indigenous population is estimated at nearly 15K inhabitants. IDPs present multisectoral needs (access to health care, protection, essential housing items, food, hygiene and sanitation). In North Kivu, Beni is a hot spot for armed attacks against civilians, with instances of rape, organized lootings, destruction of health centers and shelters, killings, and robbing of livestock. On 7 April 2021, there were two attacks by suspected ADF militants in Kainama and Kilya. There is population movement among Bapfuna group since March 2021 following clashes between FARDC troops and APCLS which is expected to continue. Since July 2020 to date, NDC-R Guidon and NDC-R Bwira have clashed causing a large population movement towards Pinga center (around 30K IDPs received by host families). In South Kivu, around 40K people were displaced due to clashes between Nyatura armed group and Raïa Mutomboki militiamen in Kaleha territory on 1 April 2021. In Tanganyika provice, six road axes remain closed due to insecurity predominately cause by Mayi Mayi Malaika activities in neighboring Kabambare territory. Democratic Republic of the Congo Cholera Grade 3 16-Jan-15 01-Jan-20 28-Mar-21 2 012 - 73 3.6% In 2021, from epidemiological week 1 to 12 (ending on 28 March 2021), 2 012 suspected cholera cases including 73 deaths (case-fatality rate 3.6%) were recorded in 51 health zones across 11 provinces of the Democratic Republic of the Congo. This is a 68% decrease in the number of suspected cholera cases compared to the same period in 2020, but the number of deaths remains stable between these two years. The endemic provinces are the most affected. In 2020, 30 304 suspected cholera cases including 514 deaths (case fatality 1.7%) were reported in 179 health zones across 23 provinces. Democratic Republic of the Congo COVID-19 Grade 3 10-Mar-20 10-Mar-20 25-Apr-2021 29610 29610 756 - Since the start of the COVID-19 outbreak, declared on 10 March 2020, a total of 29 610 confirmed cases and one probable case, including 756 deaths have been reported. A total of 26 156 people have recovered. Democratic Republic of the Congo Ebola virus disease Grade 2 7-Feb-2021 7-Feb-2021 4-Apr-2021 12 11 6 50.0% Detailed update given above. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 11 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Democratic Republic of the Congo Monkeypox Ungraded n/a 01-Jan-20 31-Dec-2020 6257 39 229 3.7% From epidemiological week 50 to 53 of 2020, there were 269 suspect cases of monkeypox and 4 deaths registered across the country. Between epidemiological week 1 and week 53, a total of 6 257 suspected cases including 229 deaths (CFR 3.7%) were reported in 133 health zones from 17 out of 26 provinces in the country. During the same period in 2019, 5 288 suspected cases and 107 deaths (CFR 2.0%) were reported in 132 health zones from 18 provinces. Overall, there is a regressive trend from epidemiological week 33 to 53 of 2020 (276 cases vs 76 cases). Democratic Republic of the Congo Plague Ungraded 12-Mar-19 01-Jan-20 25-Dec-2020 420 - 29 6.9% Ituri province notified an upsurge of plague cases in the health zone of Rethy during 2020. From 1 January to 25 December 2020, a total of 420 cases with 29 deaths (CFR 6.9%) were notified in 5 out of 22 health areas of Rety health zone. Plague is considered endemic in Ituri province. In 2019, from week 1 to 52, a total of 48 cases of bubonic plague including eight deaths have been reported in the country. Actions undertaken include ongoing strengthening in surveillance with the support of Malteser International and WHO; decontamination of households of cases; case managemenent and free preventive distribution of doxycycline (in adults) and cotrimoxazole (in children) to contacts; raising awareness for community engagement; and briefing health providers in the affected health areas. Democratic Republic of the Congo Poliomyelitis (cVDPV2) Grade 2 15-Feb-2018 01-Jan-18 21-Apr-2021 190 190 0 0.0% No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There is so far one case in 2021. The total number of 2020 cases remains at 81. The case count for 2019 remains 88. There were 20 cases reported in 2018. The country continues to be affected by several other genetically-distinct cVDPV2s (notably in Kasai, Kwilu, Kwango and Sankuru provinces). Equatorial Guinea COVID-19 Grade 3 14-Mar-20 14-Mar-20 21-Apr-2021 7 559 7 559 107 - The Ministry of Health and Welfare announced the first confirmed COVID-19 case on 14 March 2020. As of 21 April 2021, a total of 7 559 cases have been reported in the country with 107 deaths and 7 097 recoveries. Eritrea COVID-19 Grade 3 21-Mar-20 21-Mar-20 23-Apr-2021 3 605 3 605 10 0.3% The first COVID-19 confirmed case was reported in Eritrea on 21 March 2020. As of 23 April 2021, a total of 3 605 confirmed COVID-19 cases with 10 deaths were reported in the country. A total of 3 410 patients have recovered from the disease. Eswatini COVID-19 Grade 3 13-Mar-20 13-Mar-20 25-Apr-2021 18442 18442 671 3.6% The first case of COVID-19 was confirmed in the kingdom of Eswatini on 13 March 2020. As of 25 April 2021, a total of 18 442 cases have been reported in the country including 17 737 recoveries. A total of 671 associated deaths have been reported. Ethiopia Humanitarian crisis (Conflict in Tigray) Grade 2 04-Nov-20 04-Nov-20 14-Apr-2021 - - - - The access situation in Tigray is fluid and constantly changing. Despite recent improvements in access, active conflict in various areas this week restricted humanitarian response. In addition to insecurity, humanitarian partners continue to flag challenges with capacity and resources to be able to scale up to the level needed to respond across Tigray. Ethiopia Cholera Ungraded 14-May-2019 12-May-2019 14-Mar-21 14 484 14 484 479 3.3% In week 10 (week ending 14 March 2021), 29 new suspected cases with no associated deaths were reported. Most of the cases were reported from SNNP, Tigray and Oromia. Ethiopia COVID-19 Grade 3 13-Mar-20 13-Mar-20 25-Apr-2021 252 279 252279 3551 1.4% Since the confirmation of the first case on 13 March 2020, Ethiopia has confirmed a total of 252 279 cases of COVID-19 as of 18 April 2021, with 3 551 deaths and 192 747 recoveries. Ethiopia Measles Ungraded 14-Jan-17 01-Jan-19 10-Jan-21 1873 - - In week 01 (week ending 10 January 2021), the measles outbreak is still ongoing in the country. A total of 37 new suspected cases were reported during the week with one associated death mainly from SNNPR, Oromia, Amhara and Benishangul regions. Ethiopia Poliomyelitis (cVDPV2) Grade 2 24-Jun-19 20-May-2019 21-Apr-2021 40 40 0 0.0% No new cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) reported this week. The total number of 2020 cases still 26. The total number of cVDPV2 cases reported is 40. Gabon COVID-19 Grade 3 12-Mar-20 12-Mar-20 23-Apr-2021 22 433 22 433 138 - On 12 March 2020, the Ministry of Health announced the confirmation of the first COVID-19 case in the country. As of 23 April 2021, a total of 22 433 cases including 138 deaths and 19 074 recoveries have been reported in the country. Gambia COVID-19 Grade 3 17-Mar-20 17-Mar-20 23-Apr-2021 5 857 5 857 173 3.0% The first COVID-19 confirmed case was reported in the Gambia on 17 March 2020. As of 23 April 2021, a total of 5 857 confirmed COVID-19 cases including 173 deaths, and 5 284 recoveries have been reported in the country. Ghana COVID-19 Grade 3 12-Mar-20 12-Mar-20 21-Apr-2021 92166 92166 777 - As of 21 April 2021, a total of 92 166 confirmed COVID-19 cases have been reported in Ghana. There have been 777 deaths and 89 920 recoveries reported. Ghana Poliomyelitis (cVDPV2) Grade 2 09-Jul-19 08-Jul-19 21-Apr-2021 30 30 0 0.0% No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There were 12 cases reported in 2020, while the total number of 2019 cases remains 18. One cVDPV2 positive environmental sample was reported in the Eastern province. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 12 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Guinea COVID-19 Grade 3 13-Mar-20 13-Mar-20 25-Apr-2021 21985 21985 263 - The Ministry of Health in Guinea announced the first confirmed case of COVID-19 on 13 March 2020. As of 25 April 2021, a total of 21 985 cases including 19 271 recovered cases and 263 deaths have been reported in the country. Guinea Ebola virus disease Grade 3 14-Feb-2021 13-Feb-2021 4-Apr-2021 23 16 12 52.2% Detailed update given above. Guinea Lassa Fever Ungraded 11-Jul-20 11-Jul-20 4-Aug-2020 1 1 1 100.0% A case of Lassa fever was confirmed on 11 July 2020 by the Haemorrhagic Fever laboratory in Guéckédou. The case patient is a 28-year-old, female, 22 weeks of pregnancy, living in the village of Kondian, in the rural district of Koundou Lengo Bengou. She fell ill on 07 June 2020 with chest pain and no history of travel or being in contact with a foreigner a month before her illness. She consulted at Koundou health centre on 10 July 2020, with fever, cough, myalgia, diarrhoea, vomiting, sore throat, and chest pain. The malaria RDT performed was positive. She was treated for malaria and transferred to Guéckédou hospital the same day, where the diagnosis of haemorrhagic fever was made. A diagnostic test for haemorrhagic fever performed at the Haemorrhagic Fever laboratory in Guéckédou was positive for lassa fever. The patient died the next day. A dignified and secure burial was carried out by the Red Cross on 12 July 2020. Guinea Measles Ungraded 09-May-2018 01-Jan-19 18-Jan-21 6188 366 15 0.2% For epidemiological week 53 of 2020, there were a cumulative number of 6 118 cases and 15 deaths. During week 44 of 2019 (week ending 3 November 2019), 127 suspected cases of measles were reported. From week 1 to 44 (1 January - 3 November 2019), a total of 4 690 suspected cases including 18 deaths (CFR 0.4%) have been reported. Of the 4 690 suspected cases, 1 773 were sampled, of which 1 091 tested positive for measles by serology. Three localities in three health districts are in the epidemic phase, namely, Wanindara in Ratoma health district, Dounet in Mamou health district and Soumpoura in Tougue health district. Guinea Poliomyelitis (cVDPV2) Grade 2 22-Jul-20 22-Jul-20 21-Apr-2021 49 49 0 0.0% No cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. So far we have 5 cases in 2021. The total number of 2020 cases has been corrected to 44. Guinea Yellow fever Grade 2 19-Nov-20 06-Nov-20 15-Dec-2020 52 0 14 26.9% A total of 48 suspected yellow fever cases have been notified in Guinea: 46 suspect cases from Koundara commune (northern part of Guinea), 1 suspect case from Kouroussa (center of Guinea), and 1 suspect case Dubreka (north of Conakry). Among the samples collected, there are 10 probable cases (IgM positive) tested by the Laboratoire des Fievres Hemorragiques Virales at Nongo, and are now en route to IP Dakar for confirmatory testing. Guinea- Bissau COVID-19 Grade 3 25-Mar-20 25-Mar-20 24-Apr-2021 3 726 3 726 67 1.8% On 25 March 2020, the Ministry of Health of Guinea Bissau reported the first COVID-19 confirmed case in the country. As of 24 April 2021, the country has reported 3 726 confirmed cases of COVID-19 with 3 252 recoveries and 67 deaths. Kenya COVID-19 Grade 3 13-Mar-20 13-Mar-20 25-Apr-2021 156787 156787 2622 1.7% On 12 March 2020, the Ministry of Health announced the confirmation of one new COVID-19 case in the country. As of 25 April 2021, 156 787 confirmed COVID-19 cases including 2 622 deaths and 106 588 recoveries have been reported in the country. Kenya Leishmaniasis Ungraded 31-Mar-19 03-Jan-20 16-Mar-21 542 542 8 1.5% Since January 2020, a total of 542 visceral leishmaniasis confirmed cases with eight deaths (CFR 1.5%), have been reported in seven counties namely: Marsabit, Garissa, Kitui, Baringo, West Pokot, Mandera and Wajir. The outbreak is active in three counties, West Pokot, Mandera and Wajir. Kenya Measles Ungraded 6-May-2019 20-Oct-19 16-Mar-21 655 58 2 0.3% An outbreak of measles has been reported in nine sub-counties spread across five counties namely West Pokot, Garissa, Wajir, Tana River and Kilifi. Total cases reported are 655 out of which 58 were confirmed and two deaths (CFR 0.3%). The outbreak is active in West Pokot County. Kenya Rift Valley fever Ungraded 14-Jan-21 09-Mar-21 32 14 11 34.4% Rift Valley fever (RVF) in humans has been reported in Isiolo and Mandera counties and in animals in Isiolo, Mandera, Murang’a and Garissa counties in Kenya.The first case of suspected RVF was reported in late November 2020 following a sudden death of an adult male who was a herder. This was a case from Sericho ward in Garbatulla subcounty, Isiolo county. Other deaths with symptoms such as fevers, joint pains, headache and general malaise were also reported in Gafarsa and Erisaboru locations within Garbatulla subcounty as well as Korbesa in Merti subcounty. A confirmed case of RVF in Madera county reported end of December has since died; he was involved in the slaugher of four sick camels. All the affected cases were males age ranging from 13 to 70 years. As of 2 March 2021, there are a 32 total cases reported, of which 14 are confirmed and 11 deaths. Lesotho COVID-19 Grade 3 13-May-2020 13-May-2020 24-Apr-2021 10 728 10 728 316 - Since the first confirmed COVID-19 case was reported in Lesotho on 13 May 2020, until 24 April 2021, a total of 10 728 cases of COVID-19 have been reported, including 6 267 recoveries and 316 deaths. Liberia COVID-19 Grade 3 16-Mar-20 16-Mar-20 4-Apr-2021 2066 2066 85 4.1% From 16 March 2020 to 4 April 2021, a total of 2 066 cases including 85 deaths and 1 922 recoveries have been reported from all 15 counties of Liberia. Montserrado County, which hosts the country's capital city, remains at the epicenter of the outbreak. Liberia Measles Ungraded 24-Sep-17 01-Jan-19 19-Jan-21 43 4 0 0.0% In week 3 (week ending 19 January 2021), 19 suspected cases were reported from Bomi (6) Rivercess (3), Nimba (2), Grand Kru (2), Sinoe (2), Grand Gedeh (1), Lofa (1), River Gee (1) and Bong (1) Counties. Since the beginning of 2021, 43 cases have been reported across the country, of which 4 are laboratory-confirmed and 22 are clinically confirmed. Madagascar COVID-19 Grade 3 20-Mar-20 20-Mar-20 24-Apr-2021 35 746 35 746 599 1.7% Madagascar Ministry of Health announced the confirmation of the first COVID-19 case on 20 March 2020. As of 24 April 2021, a total of 35 746 cases have been reported in the country, out of which 28 433 have recovered and 599 deaths reported. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 13 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Madagascar Malaria Ungraded 08-Mar-21 08-Mar-21 08-Mar-21 There is an increase of 41% in the number of malaria cases for the last quarter of 2020 compared to the same period of the previous year for 31 districts in Madagascar. Malawi COVID-19 Grade 3 2-Apr-2020 2-Apr-2020 25-Apr-2021 34 016 34 016 1 147 3.4% On 2 April 2020, the president of Malawi announced the first confirmed cases of COVID-19 in the country. As of 25 April 2021, the country has a total of 34 016 confirmed cases with 1 147 deaths and 31 908 recoveries. Mali Humanitarian crisis Protracted 1 n/a n/a 8-Feb-2021 - - - - The precarious security situation continues to gradually spread to the southern regions of the country. Issues such as inter and intra-community conflicts, activism of non-state armed groups, consequences of counter-insurgency operations, crime and banditry continue to weaken the Malian context. Natural disasters (droughts and floods) and COVID-19 compound the health and non-health impacts affecting all basic social sectors as well as the protection of household livelihoods. According to OCHA reports, an estimated 5.9 million people need humanitarian assistance. As of January 2021, an estimated 358 212 people are refugees or internally displaced. Mali COVID-19 Grade 3 25-Mar-20 25-Mar-20 25-Apr-2021 13 627 13 627 467 3.4% On 25 March 2020, the Ministry of Health of Mali reported the first COVID-19 confirmed cases in the country. As of 25 April 2021, a total of 13 627 confirmed COVID-19 cases have been reported in the country including 467 deaths and 8 071 recoveries. Mali Measles Ungraded 20-Feb-2018 01-Jan-19 24-Jan-21 110 12 0 0.0% During week 3 (week ending 24 January 2021), 21 suspected cases of measles were reported from five regions in the country. Since 1 January 2021, 110 suspected cases, 12 of which were confirmed have been reported. Mauritania COVID-19 Grade 3 13-Mar-20 13-Mar-20 25-Apr-2021 18 257 18 257 454 2.5% The government of Mauritania announced its first confirmed COVID-19 case on 13 March 2020. As of 25 April 2021, a total of 18 257 cases including 454 deaths and 17 587 recovered cases have been reported in the country. Mauritania Dengue Ungraded 11-May-2020 3-May-2020 02-Nov-20 7 7 0 0.0% Between 16 to 24 October 2020, 5 cases of dengue fever have been suspected at Etewvigh Clinic in Tevragh Zeina district, and all have been confirmed by RT-PCR at the National Institute of Research in Public Health (INRSP). On 3 May 2020, two suspected cases of dengue fever were admitted to hospital in Mauritania. On May 4 2020, it was found that the majority of consultations at the hospital had a history of unexplained fever. Thus, samples from the two suspected cases were collected and sent to the National Institute of Research in Public Health (INRSP). On 5 May 2020 the 2 cases were confirmed by RT-PCR positive for Dengue virus with DENV-1 serotype. The cases were discharged from hospital and declared cured after symptomatic treatment. A rapid investigation was carried out at city level and a further 5 additional cases (4 women and 1 man) distributed in 4 districts of Atar (Atar, Tineri, Aghnemrite and Edebaye) were detected. Mauritania Rift Valley Fever Grade 1 09-Oct-20 04-Sep-20 28-Sep-20 36 36 13 36.1% The Ministry of Health notified the WHO of 8 cases, including 7 deaths, of Rift Valley Fever (RVF) (PCR positive) in breeders, which occurred between13 September 2020 and 1 October 2020, in several localities in the departments of Tidjikja and Moudjéria (Tagant region), Guerou department (Assaba region) and Chinguetty department (Adrar region). The 7 deaths occurred in the Tagant region (5) and in the Assaba region (2). All these deaths occurred among hospitalized cases with fever and haemorrhagic syndrome (petechiae, gingivorrhagia) and vomiting, in the 3 departments of the region. As of 5 October 2020, a total of 88 samples of suspected cases have been sent to the National Institute for Public Health Research (INRSP): 36 were positive (by PCR and Elisa), 46 were negative. Six sample result are still pending. Confirmed cases have been reported in 9 regions (Adrar, Assaba, Brakna, Hodh Elchargui, Hodh El Gharby, Tagant, Trarza, Gorgol et Noukchott Sud). The continuous surveillance of RVF at the animal level has confirmed the outbreaks in the Assaba, Tagant, Brakna, Trarza and Hodh Elgharbi regions. The results of 165 samples taken in the period from 16-23 September 2020, show that 33 camelids, 4 small ruminants and 6 cattle were positive. Mauritius COVID-19 Grade 3 18-Mar-20 18-Mar-20 17-Apr-2021 1 203 1 203 15 1.2% The Republic of Mauritius announced the first three positive cases of COVID-19 on 18 March 2020. As of 17 April 2021, a total of 1 203 confirmed COVID-19 cases including 15 deaths and 934 recovered cases have been reported in the country. Mozambique Humanitarian crisis in Cabo Delgado Grade 2 01-Jan-20 01-Jan-20 18-Apr-2021 - - - - The security situation in Cabo Delgado over the last 7 days remains volatile and uncertain. After the attack on Palma sede on 24 March 2021, there has been movement of troops and IDPs in the area. As of 17 April 2021, an estimated number of 20 955 IDPs had been registered arriving by foot, bus, boat and air from Palma to the four districts. In the last week, there have been rumors and unconfirmed reports of non-state armed group attacks in various areas of the Cabo Delgado province contributing to the continual concern about the security situation. Mozambique Cholera Ungraded 20-Feb-2020 31-Jan-20 17-Jan-21 2 952 108 40 1.40% As of 17 January 2021 there have been a total of 2 952 cases and 40 deaths (case fatality ratio 1.4%) reported in the Cabo Delgado province in seven districts: Mocimboa da Praia (380 cases), Ibo (440 cases), Macomia (247 cases), Pemba (685 cases), Metuge (571 cases), Chiure (377 cases) and Montepuez (252 cases). The districts of Mocimboa da Praia and Macomia have not been reporting data because of ongoing insurgent attacks in the area. Mozambique COVID-19 Grade 3 22-Mar-20 22-Mar-20 25-Apr-2021 69 665 69 665 807 1.2% The first COVID-19 confirmed case was reported in Mozambique on 22 March 2020. As of 25 April 2021, a total of 69 665 confirmed COVID-19 cases were reported in the country including 807 deaths and 62 501 recoveries. Mozambique Measles Ungraded 25-Jun-20 01-Jan-20 22-Jul-20 862 140 0 0.0% There are measles outbreaks in six districts of Zambezia. The outbreak was declared in March 2020 at the Nauela Administrative Post, Alto Molócuè district. As of week 21, there were 862 suspected cases reported, 711 suspected cases tested, 140 IgM+ for measles, no epi-linked cases reported, and no deaths. So far there are 67 cases from Nampula, 18 from Cabo Delgado, 17 from Zambezia and 13 from Niassa provinces. 42% are <5 years old; 48% are aged 5-14 years. Namibia COVID-19 Grade 3 14-Mar-20 14-Mar-20 24-Apr-2021 47 776 47 776 625 0.0% The first case of COVID-19 was first detected in Namibia on the 14 March 2020. As of 24 April 2021, a total of 47 776 comfirmed cases with 45 558 recovered and 625 deaths have been reported. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 14 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Namibia Hepatitis E Protracted 1 18-Dec-2017 08-Sep-17 10-Jan-21 10 227 10 227 66 0.6% During this reporting period, 28 December 2020 - 10 January (weeks 53 & 01), a total of 5 HEV (Hepatitis E Virus) cases were reported country-wide. Since the beginning of the outbreak in December 2017, a cumulative total of 10 227 cases (2 099 laboratory-confirmed, 4 744 epidemiologically linked, and 1 187 suspected cases) including 66 deaths (CFR 0.8%) have been reported countrywide. Khomas Region remains the most affected region, accounting for 5 103 (50%) of reported cases, followed by Erongo 1 916 (19%) since the outbreak began. Niger Humanitarian crisis Protracted 1 1-Feb-2015 1-Feb-2015 14-Apr-2021 - - - - The Tillaberi region continues to experience a deterioration of the security situation perpetrated by non-state armed groups (NASG) along the borders of Mali and Burkina Faso which negatively impacts the population. There are frequent killings of civilians, targeted assassinations against customary and religious leaders, kidnappings, extortion of property and livestock, and gender-based violence causing problems for access to education, health, WASH services, shelter, protection, and food insecurity. There have been at least two serious attacks in 2021, one occurring on 2 January when 105 civilians were killed in Tchomabangou and Zaroum-Darey, and another on 15 March when 64 civilians were killed in Banibangou. According to OCHA statistics, 3.8 million people need humanitarian assistance in 2021, 313 000 are IDPs, 234 000 are refugees, and 2 million are food insecure (with 511 332 affected by food insecurity in the Tillaberi region alone). Niger COVID-19 Grade 3 19-Mar-20 19-Mar-20 11-Apr-2021 5 074 5 074 189 3.7% From 19 March 2020 to 11 April 2021, a total of 5 074 cases with 189 deaths have been reported across the country. A total of 4 747 recoveries have been reported from the country. Niger Measles Ungraded 10-May-2019 01-Jan-20 31-May-2020 2 079 241 4 0.2% From week 1 to 22 of 2020, Niger reported a total measles suspected case count of 2 079 of which there were 241 lab confirmed (IgM positive) and 4 deaths in 8 regions: Agadez (50 cases, 0 deaths), Diffa: (4 cases, 0 deaths), Dosso (27 cases, 0 deaths), Maradi (101 cases, 2 deaths), Niamey (23 cases, 0 deaths), Tahoua (62 cases, 1 death), Tillaberi (67 cases, 0 deaths) and Zinder (167 cases, 1 death). In 2019 a total of 10 207 suspected measles cases were reported from eight regions in the country. So far, 24 districts have been affected by outbreaks in 2020. Nigeria Humanitarian crisis Protracted 3 10-Oct-16 n/a 17-Apr-2021 - - - - Attacks on Nigerian Armed Forces (NAF) by non-state armed groups (NASG) have escalated in the past week leading to harming of civilians and targeting of humanitarian workers. The violent attacks have been ongoing for months and growing insecurity has affected operations in Borno state in Monguno, Ngala, Dikwa, and Damask. The latter two have halted UN and INGO operations altogether as of 17 April 2021. IDP camps were not targeted, but some 8 800 IDPs and 76 000 host community members of Damask are expected to be impacted by the effects of the attacks. The aid programmes affected include food distribution, WASH, health, and nutrition which will be paused for a significant period until security can be maintained and recovery can begin. Nigeria Avian influenza Ungraded 04-Mar-21 09-Mar-21 09-Mar-21 7 7 0 As of 3 March 2021 a total of seven confirmed cases with no deaths have been reported in two States (Plateau and Kano). Forty-five samples were collected from bird handlers who had contact with confirmed positive and suspected birds in Kano and Plateau States, of which seven tested positive at the Nigeria Centre for Disease Control National Reference Laboratory for influenza A - Kano (4) and Plateau (3). Nigeria Cholera 12-Jan-21 30-Mar-21 97 97 17 17.5% A cholera outbreak was detected in Benue State, Nigeria and resulted in 10 deaths in the region Agatu.The Agatu outbreak is reported to have started in December 2020, in Obagaji, the LGA headquarters. An immediate response on the spot assessment of the alert in Abinsi by a Rapid Response of the Ministry of Health was done. As of 30 March 2021, 39 persons, mostly children have been affected with 7 deaths giving a CFR of 17.9%. Fifty-eight cases have been recorded in Abinsi settlement of Guma LGA with 10 deaths (CFR 17.2%). Nigeria COVID-19 Grade 3 27-Feb-2020 27-Feb-2020 25-Apr-2021 164719 164719 2062 - The first case of COVID-19 was first detected in Nigeria on the 27 February 2020. As of 25 April 2021, a total of 164 719 comfirmed cases with 154 926 recovered and 2 062 deaths have been reported. Nigeria Lassa fever Ungraded 01-Jan-21 01-Jan-21 4-Apr-2021 236 233 49 20.8% Three (3) new cases were reported from Ondo State during the week ending 4 April 2021. Of the 14 states affected, Edo (102), Ondo (64), and Taraba (18) states accounts for 79% of all confirmed cases reported to date. New cases have declined since the end of week 11 (week ending 21 March 2021). Nigeria Measles Ungraded 25-Sep-17 01-Jan-21 14-Mar-21 540 4 2 0.4% In the year 2020, Nigeria has reported 9 316 confirmed cases, with 55 deaths, CFR 0.6%. As of january 2021 to 14 March 2021, 540 suspected cases have been reported from 74 LGA's in 17 states and FCT. 4 cases were laboratory confirmed and 2 deaths recorded. Nigeria Poliomyelitis (cVDPV2) Grade 2 01-Jun-18 01-Jan-18 21-Apr-2021 63 63 0 0.0% No new case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There are so far 3 cases in 2021. There were 8 cVDPV2 cases reported in 2020, 18 cVDPV2 cases reported in 2019 and 34 in 2018. Nigeria Yellow fever Ungraded 01-Nov-20 29-Jan-21 3 473 169 296 8.0% As of 29 January 2021, there have been a cumulative total of 3 112 suspected cases of yellow fever, of which 109 cases have been confirmed, from 488 LGA (63%) across all states and the Federal Capital Territory (FCT). Laboratory results in-country show 70 cases confirmed by PCR, with 148 presumptive positive, 13 inconclusive and 1 526 negative. Laboratory results for 148 samples sent to Institut Pasteur Dakar show 41 (27.7%) confirmed, 16 negative and 91 pending. Rwanda COVID-19 Grade 3 14-Mar-20 14-Mar-20 25-Apr-2021 24 593 24 593 330 1.3% The Rwanda Ministry of Health announced the confirmation of the first COVD-19 case on 14 March 2020. As of 25 April 2021, a total of 24 593 cases with 330 deaths and 22 941 recovered cases have been reported in the country. Sao Tome and Principe COVID-19 Grade 3 6-Apr-2020 6-Apr-2020 25-Apr-2021 2 297 2 297 35 - On 6 April 2020, the Ministry of Health of Sao Tome and Principe reported the country’s first case of COVID-19. As of 25 April 2021, a total of 2 297 confirmed cases of COVID-19 have been reported, including 35 deaths. A total of 2 234 cases have been reported as recoveries. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 15 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Senegal COVID-19 Grade 3 02-Mar-20 02-Mar-20 25-Apr-2021 40135 40135 1102 - From 2 March 2020 to 25 April 2021, a total of 40 135 confirmed cases of COVID-19 including 1 102 deaths and 38 861 recoveries have been reported in Senegal. Senegal Dengue Ungraded 01-Sep-20 07-Sep-20 07-Sep-20 27 27 0 0.0% In 2020, the first confirmed case of dengue in Senegal was reported in August. It was a 30-year-old man who tested positive for dengue serotype 2 (IgM) on 14 August 2020 by the IPD. The onset of symptoms began on 10 July 2020 and symptoms included fever, headache, and arthralgia. As of 20 December 2020, 27 confirmed cases of dengue had been reported in 6 regions of Senegal: Dakar, Tambacounda, Kédougou, Kaffrine, Thiès, and Kaolack. Dengue is therefore the most common VHF reported in Senegal in 2020. Senegal Rift Valley Fever Ungraded 23-Oct-20 23-Oct-20 15-Nov-20 3 3 0 0.0% The Institut Pasteur of Dakar through the directorate of diseases prevention notified the district of Matam of two confirmed cases of Rift Valley fever (RVF-IgM positive) on 23 October 2020, one in a 20-year-old, male, living in Bokidiawé. He consulted at the health post on 13 October 2020 for an infectious syndrome without history of travel with an axillary temperature of 39.6 degree Celsius. The onset of symptoms is one day before the consultation date. The second case, is a 24 year-old man, living in Bokidiawé. he consulted the health post on 2 October 2020 for an infectious syndrome without notion of travel with an axillary temperature of 38.2 degree Celsius. The onset of symptoms is three days before the date of consultation. An additional case of confirmed RVF was notified later. Senegal West Nile fever Ungraded 23-Oct-20 23-Oct-20 15-Nov-20 6 6 0 0.0% The Institut Pasteur of Dakar through the directorate of diseases prevention notified to the district of Matam of one confirmed cases of West Nile fever (IgM positive) on 23 October 2020, in a 32-year-old female living in Bokidiawe. She consulted at the health post of Bokidiawe on 7 October 2020 for an infectious syndrome without history of travel with axillary temperature of 38.2 degree Celsius. The symptoms occurred 2 days before the consultation. Five additional cases were notified later in Tambacounda, Matam, Dakar et Ziguinchor regions. Senegal Yellow fever Ungraded 17-Dec-2020 7 7 2 28.6% From 29 October to 17 December 2020, there have been 7 cases confirmed (IP Dakar) with yellow fever in three regions of Senegal bordering Mauritania and Mali: 4 in Kidira health district (Tambacounda Region), 1 in Thilogne health district (Matam Region), 1 in Saraya district and 1 in Kedougou district (the latter two are both from Kedougou Region). Two deaths have been notified. Seychelles COVID-19 Grade 3 14-Mar-20 14-Mar-20 22-Apr-2021 5 170 5 170 26 - Since the first COVID-19 confirmed cases were reported in Seychelles 14 March 2020, as of 22 April 2021 a total of 5 170 cases have been confirmed, including 4 675 recoveries and 26 deaths have been reported. Sierra Leone COVID-19 Grade 3 31-Mar-20 27-Mar-20 25-Apr-2021 4 044 4 044 79 2.0% On 31 March 2020, the President of Sierra Leone reported the first confirmed COVID-19 case in the country. As of 25 April 2021, a total of 4 040 confirmed COVID-19 cases were reported in the country including 79 deaths and 2 993 recovered cases. South Africa COVID-19 Grade 3 05-Mar-20 03-Mar-20 25-Apr-2021 1 575 471 1 575 471 54 148 3.4% Since the start of the COVID-19 pandemic in South Africa a cumulative total of 1 575 471 confirmed cases and 54 148 deaths have been reported, with 1 501 185 recoveries. South Sudan Acute Food Insecurity Grade 2 18-Dec-2020 5-Apr-2021 16-Apr-2021 - - - People in parts of South Sudan continue to face the highest levels of food insecurity since the country declared independence 10 years ago. For many, their situation has deteriorated as a result of compounding shocks, including flooding, ongoing violence and displacement, the impact of which has eroded the livelihoods and coping strategies of vulnerable communities across the country. According to Integrated Food Security Phase Classification (IPC) projections, from December to March 2021, an estimated 5.8 million people (48 per cent of the population) faced Crisis levels of food insecurity (IPC Phase 3) or worse - a figure that is expected to increase to 7.2 million (60 per cent of the population) in the upcoming lean season of April-July 2021. In the six priority 1 locations, 810,000 people are deemed to be in Crisis or worse levels of food insecurity (IPC Phase 3+) according to IPC projections. This includes over 300,000 children suffering from Severe Acute Malnutrition (SAM) and some 480,000 pregnant and lactating women who are acutely malnourished and in need of treatment. South Sudan Humanitarian crisis Protracted 3 15-Aug-2016 n/a 28-Feb-2021 - - - - An estimated 30 000 IDPs from Tonj North County are currently sheltering in Thiet and Tonj town in Tonj South Countyas residents flee for fear of revenge attacks. Humanitarian organizations are working with the authorities to verify and assess the needs of the IDPs in Tonj South. The humanitarian activities including pre- positioning of health supplies, livestock vaccination and a polio immunization campaign have been affected by sub-nation violence in Greater Tonj areas. South Sudan COVID-19 Grade 3 5-Apr-2020 2-Apr-2020 24-Apr-2021 10 532 10 532 114 1.1% On 5 April 2020, the Ministry of Health of South Sudan reported the country’s first case of COVID-19. As of 24 April 2021, a total of 10 532 confirmed COVID-19 cases were reported in the country including 114 deaths and 10 250 recovered cases. South Sudan Hepatitis E Ungraded - 03-Jan-19 11-Apr-2021 556 556 5 0.9% The current outbreak in Bentiu UN Protection of Civilians (POC), which started at the beginning of 2019, has continued with 7 new cases reported in week 14 (week ending 11 April 2021). As of the reporting date, a total of 556cases of hepatitis E including five deaths have been reported. South Sudan Measles Ungraded 24-Nov-18 19-Sep-19 22-Jun-20 916 50 2 0.2% Between week 38 of 2019 to week 25 of 2020, a total of 916 suspected cases of measles of which 50 were laboratory-confirmed and 2 deaths (CFR 0.6%) have been reported. The outbreak has affected 8 counties (Tonj East, Magwi, Bor, Kapoeta East, Aweil East and Wau) and Bentiu Protection of Civilians Sites (POC). Tanzania, United Republic of COVID-19 Grade 3 16-Mar-20 16-Mar-20 11-Apr-2021 509 509 21 4.1% The Ministry of Health, Community Health Community Development, Gender, Elderly and Children in Tanzania reported the country’s first case of COVID-19 on 16 March 2020. As of 29 November 2020, a total of 509 cases have been reported in the country including 21 deaths. The last information on confirmed COVID-19 cases was shared by Tanzania mainland on 29 April 2020 and Zanzibar last shared information on on-going COVID-19 outbreak on 7 May 2020. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 16 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Togo COVID-19 Grade 3 06-Mar-20 01-Mar-20 24-Apr-2021 12 787 12 787 121 0.9% On 6 March 2020, the Ministry of Health and Public Hygiene of Togo announced the confirmation of its first case of COVID-19. As of 24 April 2021, a total of 12 787 cases including 121 deaths and 10 699 recovered cases have been reported in the country. Togo Poliomyelitis (cVDPV2) Grade 2 18-Oct-19 13-Sep-19 21-Apr-2021 17 17 0 0.0% No new case of cVDPV2 was reported during the past week. There were nine cases in 2020 while the total number of cVDPV2 cases reported in 2019 remains eight. Uganda Humanitarian crisis Ungraded 20-Jul-17 n/a 31-Jan-21 - - - - As of 31 January 2021, Uganda was hosting 1 424 325 refugees, majority of whom were resident in Bidibidi, Adjumani, Nakivale, Kyangwali and Kyaka Li districts. Most of the refugees were from South Sudan (65.3%), DRC (31.0%) and Burundi (3.6%). Uganda Cholera Ungraded 11-May-2020 29-Apr-2020 07-Sep-20 1 488 17 6 0.4% As of 7 September 2020, there are 1 488 cases, 483 in Moroto, 543 in Nabilatuk, 72 in Napak, 390 in Kotido. On 11 May 2020, a cholera outbreak was confirmed in Moroto district. The index case was a 17-year-old male patient from Natapar Kocuc Village, Loputuk parish, Nadunget Subcounty who was seen on 29 April 2020 with acute watery diarrhoea and severe dehydration. On 4 May 2020 more cases with similar symptoms from the same location with the index case were seen and cholera was suspected. On 11 May 2020, CPHL confirming Vibrio cholerae serotype 01 Inaba detected in 7 out of 8 stool samples that were collected. As of 12 June 2020, the cumulative number of cases is 682 including 6 deaths. Uganda COVID-19 Grade 3 21-Mar-20 21-Mar-20 23-Apr-2021 41 655 41 655 341 0.8% The first COVID-19 confirmed case was reported in Uganda on 21 March 2020. As of 23 April 2021, a total of 41 655 confirmed COVID-19 cases, 40 898 recoveries with 341 deaths. Zambia COVID-19 Grade 3 18-Mar-20 18-Mar-20 25-Apr-2021 91 358 91 358 1 246 1.4% The first COVID-19 confirmed case was reported in Zambia on 18 March 2020. As of 25 April 2021, a total of 91 358 confirmed COVID-19 cases were reported in the country including 1 246 deaths and 89 574 recovered cases. Zimbabwe Anthrax Ungraded 6-May-2019 6-May-2019 07-Mar-21 798 3 0.4% The anthrax outbreak is ongoing in Zimbabwe. From Week 1 to 11 of 2021, there were 51 cases reported. This outbreak started in Week 36, 2019, affecting mainly Buhera and Gokwe North and South districts but a surge in cases started appearing in week 38 when cases were reported in some other areas. The cumulative figures for anthrax are 747 cases and 3 deaths as of Week 52 of 2020. Zimbabwe COVID-19 Grade 3 20-Mar-20 20-Mar-20 25-Apr-2021 38086 38086 1557 4.1% The first COVID-19 confirmed case was reported in Zimbabwe on 20 March 2020. As of 25 April 2021, a total of 38 086 confirmed COVID-19 cases were reported in the country including 1 557 deaths and 35 123 cases that recovered. †Grading is an internal WHO process, based on the Emergency Response Framework. For further information, please see the Emergency Response Framework: http://www.who.int/hac/about/erf/en/. Data are taken from the most recently available situation reports sent to WHO AFRO. Numbers are subject to change as the situations are dynamic. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 17 © WHO Regional Office for Africa This is not an official publication of the World Health Organization. Correspondence on this publication may be directed to: Dr Benido Impouma Programme Area Manager, Health Information & Risk Assessment WHO Emergency Preparedness and Response WHO Regional Office for Africa P O Box. 06 Cité du Djoué, Brazzaville, Congo Email: afrooutbreak@who.int Requests for permission to reproduce or translate this publication – whether for sale or for non- commercial distribution – should be sent to the same address. 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 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 lines on maps represent approximate borderlines for which there may not yet be full agreement. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization or its Regional Office for Africa be liable for damages arising from its use. 2Health Emergency Information and Risk Assessment REGIONAL OFFICE FOR Africa Editorial Team B. Impouma C. Okot B. Farham G. Williams J. Kimenyi E. Kibangou O. Ogundiran T. Lee D. Niyukuri T. Metcalf J. Nguna Production Team A. Bukhari T. Mlanda R. Ngom F. Moussana Contributors R. Nansseu (Democratic Republic of the Congo) K. Mory (Guinea) Y. Abdoulaye (Democratic Republic of the Congo) Graphic design A. Moussongo Editorial Advisory Group Dr. Salam Gueye, Regional Emergency Director B. Impouma Y. Ali Ahmed N. Nsenga M. Djingarey Data sources Data and information is provided by Member States through WHO Country Offices via regular situation reports, teleconferences and email exchanges. Situations are evolving and dynamic therefore numbers stated are subject to change.