Weekly Bulletin on Outbreak and other Emergencies: Week 46: 13- 19 November 2023

Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment WEEKLY BULLETIN ON OUTBREAKS AND OTHER WEEK 46: 13 - 19 NOVEMBER 2023 1 (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 ¤ Graded events † 45 Protracted 3 events 2 Protracted 2 events 0 Protracted 1 event 1 WEEKLY BULLETIN ON OUTBREAKS AND OTHER EMERGENCIES Ongoing events 1513 Humanitarian crises 21 Outbreaks 133 Protracted 3 events t 6 Protract 1 events 1 Grade 1 events 0 Grade 3 events 3 3 Grade 2 events New events 8 1 Week 46: 13- 19 November 2023 Data as reported by: 17:00; 19 November 2023 4 104 16 827 144 3 483 3 358 0 94 0 4 141 3 334 283 48 - 1 064 62 450 0 829 9 5 052 3 491 0 4 504 18 165 0 31 0 026 10 664 93 266 675 3 155 125 036 1 972 4 072 533 102 595 22 056 396 15 396 113 25 189 389 88 321 834 96 211 1 464 500 816 7 574 48 982 306 8 136 294 6868617997 171 339 4 091 133 194 1 468 50 937 172 42 973 846 9 513 315 7 822 194 10 189 103 301 096 1 046 105 384 1 934 343 881 4 058 264 639 5 686 233 417 2 243 63 847 414 68 211 1 424 170 647 3 632 343 073 5 688 12 586 372 9 350 176 33 144 743 271 822 6 881 329 862 2 797 53 749 15 88 728 2 686 7 763 125 18 499 138 34 490 706 9 105 161 3323 259 39 443 290 6 562 80 17 229 183 019 46738 302 88 993 1 971 28 014 163 15 828 345 767 4 70 628 1 146 1 174 0 2 753 7 2300 10 1 455 2 1 255 786 186 01 126 3 6 046 5829 171 19 58 673 1 758 384 0 1 178 0 29 280 131 423 0 5 0 08 1 210 11 2 0 123 4 171 657 1 462 3 0 2 137 31 5 0 270 4 1 062 4 180 0 03 013 6592 104 1 336 79 86520 7 0 1 000 000 156 0 1 0 10297 164 5 853 0 30 0 1217 06 31 0 593 14 64 0 1 094 000 30911 580 838 1 200 000 3 400 000 6 100 000 7 243 47 12 000 000 4 500 000 6 310 000 9 400 000 409 5 391 000 53 468 11 52628 11 1 144 0 12141 1 1 72 3 3 811 11 502 0 20 4 1 0 1 - 1 1 250 0 69 2 267 458 679 13 0 2 074 627 1 425 1 1 285 3 034 297 131 15 3 396 84 10 Legend Malaria Floods, Cyclonic 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 Chikungunya Plague Leishmaniasis Crimean-Congo haemorrhagic fever Hepatitis E Monkeypox Cholera Lassa fever Measles Deaths Cases Acute Food Insecurity cVDPV2 Anthrax COVID-19 Meningitis Typhoid fever Malnutrition crisis Marburg Ebola virus disease Sudan virus disease Drought Influenza like illness Rift Valley fever Diphteria Skin injury from unknown chemical exposure Enteric Outbreak Acute watery diarrhoea “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.” Emergency Preparedness and Response Health Emergency Information and Risk Assessment Ungraded events Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment WEEKLY BULLETIN ON OUTBREAKS AND OTHER WEEK 46: 13 - 19 NOVEMBER 2023 1 Overview Ongoing events IDSR Report All events currently being monitored This Weekly Bulletin focuses on public health emergencies occurring in the WHO African region. This week’s articles cover:  Humanitarian situation in Chad  Diphtheria in South Africa  Measles in Cameroon 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:  An outbreak of diphtheria has been reported in a correctional facility in the Western Cape Province of South Africa. Although the outbreak appears to be under control as a result of immediate public health measures, the occurrence of the disease in a closed and access- limited setting could contribute to amplifying transmission and hindering the response, particularly case and contact isolation. Tailored planning from health authorities is required to address specific challenges posed by the confined and access-controlled environment.  Measles is endemic in Cameroon, with outbreaks occurring almost every year affecting several health districts. After the covid-19 pandemic, there has been a relative decrease in attendance at healthcare facilities for routine vaccination activities, negatively impacting the achievement of indicators related to vaccination coverage rates. The ongoing outbreak wave started earlier this year and shares similar characteristics with the previous year’s outbreaks. Notably, positive cases of measles are being recorded among non-vaccinated individuals, and there is a low rate of local response activities implementation in the affected districts. Additionally, Cameroon is facing other disease outbreaks including Cholera, Mpox, Polio vaccine derived and Covid-19, emphasizing the need for health authorities to enhance public health interventions, such as vaccination, public awareness, and the provision of adequate resources to control the outbreaks. Contents Overview 1 8 9 2 - 7 Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment WEEKLY BULLETIN ON OUTBREAKS AND OTHER WEEK 46: 13 - 19 NOVEMBER 2023 2 Humanitarian Crisis EVENT DESCRIPTION The ongoing crisis in Sudan continues to pose a significant humanitarian emergency in Chad, particularly impacting the eastern regions. As of 5 November 2023, over 570 000 people, including Sudanese and Chadians, have fled from Darfur to Chad, seeking refuge in various formal and informal camps spread across 11 health districts in the provinces of Ennedi East, Ouaddaï, Sila, and Wadi Fira.This mass displacement has resulted in a complex humanitarian situation, aggravated by series of interconnected challenges related to funding, human resources, health facilities and medical supplies. Resource mobilization was the critical issue, with the Humanitarian Response Plan (HRP) receiving less than 9.0% of the required funds. This has affected the adequate deployment of health human resources leading to a notable shortage of essential personnel, including epidemiologists, surgeons, and nurses. This situation was compounded by an insufficient supply of essential medicines, medical materials, and equipment to provide urgent care, particularly for the injured, pregnant women, and children exhibiting severe acute malnutrition symptoms. The lack of adequate transportation for rapid patient referral, such as medical ambulances or helicopters further impede the response. In addition, Chad is facing several outbreaks, including measles and dengue fever. A total of 815 suspected cases of Measles, including one death (CFR 0.1%), have been reported from four Eastern provinces of Chad. Of the suspected cases, 80 (9.8%) were laboratory confirmed, including 30 cases (37.5%) from Wadi Fira, 25 cases (31.3%) from Quaddai, 18 cases (22.5%) from Sila and 7 cases (8.7%) from Ennedi East provinces. Three (75.0%) of the provinces affected by the measles outbreak, reported a total of 51 cases of Dengue fever. Quaddai province displayed the highest number of cases (n=33, 64.7 %), followed by Wadifira (n=12, 23.5 %) and Sila (n=6, 11.8 %). As of 5 November 2023, a total of 3 724 people have been injured, with many requiring surgical interventions supported by Médecins Sans Frontières-France (MSF-F), Première Urgence Internationale (PUI), the International Committee of the Red Cross (ICRC), and an international emergency team deployed by the World Health Organization (WHO). Of note, the situation in the regions of West, Central, and South Darfur of Sudan remains volatile, with recent events in El-Geneina, the capital of West Dafur affecting the stability of the humanitarian corridor. Key figures indicate that more than 2 million people have been affected, with 931 647 in need of humanitarian assistance and 531 622 displaced. Women were the most affected population (56.0%), with a significant number of children under five also at risk. PUBLIC HEALTH ACTIONS  WHO is coordinating the international Support, and incident management through three field offices created in Abéché, Farchana and Adré to strengthen partner coordination. WHO along with other partners including Médecins Sans Frontières-France (MSF-F), Première Urgence Internationale (PUI) and International Committee of the Red Cross (ICRC) is providing medical care and support to the affected population.  An international emergency team has been deployed to provide medical assistance, particularly for surgical procedures.  Efforts to control the spread of dengue fever and measles outbreaks are underway.  Mobile clinics are being provided with support from Alliance pour l’Action Médicale Internationale (ALIMA) to improve access to essential health services in the camps and affected regions.  30 national health workers were trained to establish Emergency Medical Teams (EMTs) focusing on primary health care (PHC).  The Ministry of Public Health and Prevention has received 98.1 tons (equivalent to 167 146.7 USD) of drugs and medical equipment for free healthcare in affected areas. Additionally, support has been provided to NGOs and other Technical and Financial Go to overview Go to map of the outbreaks Chad Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment WEEKLY BULLETIN ON OUTBREAKS AND OTHER WEEK 46: 13 - 19 NOVEMBER 2023 3 Go to overview Go to map of the outbreaks Source: UNHCR Snapshot of humanitarian crisis in Chad, as at 17 November 2023 Partners (TFPs) to facilitate operations from WHO AFRO emergency warehouses in Nairobi and Dakar.  Regular monitoring and reporting of the situation are being conducted to manage the crisis effectively.  Risk communication on the crisis is being implemented to inform people of the situation and mobilize resources for the response. Ultimately, there is a regular publication of the weekly Situation Report (SITREP) of the Eastern Humanitarian Crisis. SITUATION INTERPRETATION The current situation in Chad, stemming from the Sudanese crisis, poses a signifi cant public health challenge. The infl ux of refugees has strained the existing health infrastructure, leading to a dire need for enhanced medical and humanitarian assistance. The outbreaks of dengue fever and measles further compound the complexity of the crisis. The involvement of international organizations and emergency teams is crucial in addressing the immediate healthcare needs and controlling disease outbreaks. Future strategies should focus on strengthening the healthcare system, ensuring an adequate medical supply, and improving access to healthcare for the vulnerable populations in the affected regions. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment WEEKLY BULLETIN ON OUTBREAKS AND OTHER WEEK 46: 13 - 19 NOVEMBER 2023 4 Diphtheria EVENT DESCRIPTION On 9 November 2023, the South African Minister of Health announced a Diphtheria outbreak at Pollsmoor Correctional Centre in the Western Cape Province. On 28 October 2023, a 19-year-old male inmate at the correctional facility developed symptoms of toxigenic diphtheria, including. fever, difficulty swallowing, sore throat, swollen neck, and shortness of breath. He was referred to a local hospital for further evaluation and was found to have tonsillitis, the presence of a pseudomembrane, and subsequently developed renal and cardiac complications. Throat swabs were collected the same day and submitted to the local National Health Laboratory Service and the National Institute for Communicable Diseases for confirmatory testing. The results were positive for diphtheria, on 2 November 2023. The case died on 5 November 2023, despite receiving diphtheria antitoxin on 2 November 2023. As of 8 November 2023, a total of 74 contacts, including 55 inmates, 13 correctional staff, and six low-risk contacts (including hospital staff and patients) have been identified and were subjected to throat swabs collection for laboratory testing. Eight inmates (10.8%) tested positive for diphtheria, with two (25.0%) exhibiting mild symptoms and six (75.0%) being asymptomatic. Two staff members exhibited symptoms compatible with diphtheria and are awaiting laboratory test results. The age range of the cases was between 18 and 23 years. Earlier this year, South Africa reported 12 laboratory- confirmed cases of diphtheria in Gauteng, KwaZulu- Natal, and Western Cape Provinces, including seven (58.3%) non-toxigenic and five (41.7%) toxigenic cases. Of the seven non-toxigenic cases, three (42.9%) had cutaneous lesions, three (42.9%) presented with myocarditis and one (14.3%) was asymptomatic. Almost 80.0% (n=4) of the toxigenic cases had respiratory diphtheria and only one (20.0%) developed cutaneous diphtheria. All cases were reported from the Western Cape Province. PUBLIC HEALTH ACTIONS  The Western Cape Department of Health initiated a public health response on 2 November 2023 involving regular meetings with the Western Cape Department of Correctional Services, National Department of Health, National Health Laboratory Service, National Institute for Communicable Diseases, and other relevant stakeholders.  Contact tracing is being implemented for early case detection and to control the chain of transmission in the correctional setting.  Immediate contacts of confirmed cases have been isolated to prevent further spread of the disease.  PCR testing are ongoing at the National Institute for Communicable Diseases with 13 pending results, so far.  Antibiotic prophylaxis and vaccination were administered to the identified contacts. A vaccination campaign is planned by the Western Cape Department of Health and the Department of Correctional Services to target all 240 staff and 1200 inmates in the affected cell block. SITUATION INTERPRETATION Diphtheria is a vaccine-preventable disease caused by exotoxin-producing Corynebacterium diphtheriae, transmitted from person to person through close physical and respiratory contact. Correctional facilities are high-risk environments for infectious disease outbreak including diphtheria. It is imperative that all cases be managed in isolation and contacts should remain under monitoring and in isolation for the recommended period. Appropriate public health interventions including vaccination should be maintained and sustained to control the outbreak. South Africa Go to overview Go to map of the outbreaks 9 Cases 1 Deaths 11.1% CFR Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment WEEKLY BULLETIN ON OUTBREAKS AND OTHER WEEK 46: 13 - 19 NOVEMBER 2023 5 Go to overview Go to map of the outbreaks Distribution of cases of Diphtheria in the West Cape Province (correctional facility) in South Africa, as of 8 November 2023 Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment WEEKLY BULLETIN ON OUTBREAKS AND OTHER WEEK 46: 13 - 19 NOVEMBER 2023 6 Measles EVENT DESCRIPTION Since the beginning of 2023, Cameroon has been dealing with a measles outbreak that has impacted all 10 regions of the country spanning across 62 health districts out of the total 189. The outbreak remains active in 24 health districts across seven regions. During epidemiological week 44 (ending 5 November 2023), 13 new confirmed measles cases were reported from one new health district, namely Dang district indicating a sharp increase in cases compared to the previous week. Of note, during epidemiological week 43 (ending 29 October 2023), four confirmed cases were reported with no new affected health district. As of 5 November 2023, a cumulative total of 6 034 confirmed measles cases including 31 related deaths (CFR 0.5%) were reported in Cameroun from all 10 regions of the country. Of the reported cases, 453 (7.5%) cases were IgM-positive, 5 529 (91.6%) were epidemiologically linked and 52 (0.9%), were clinically compatibles. The Centre region had the highest cumulative attack rate of 50.9 per 100 000 followed by the Littoral region (33.7 per 100 000), South-West region (21.7 per 100 000), and Far- North region (17.3 per 100 000). Each of the remaining six regions showed the cumulative attack rate below 15.0 per 100 000 and the overall attack rate was 23.2 per 100 000 inhabitants. Children aged between 9 and 59 months were the most affected accounting for 3 331 cases (55.2%) followed by children under 9 months of age (n=682, 11.5%). Over 70.0% (n=4 314) of the confirmed cases were unvaccinated against measles with 51.8% (n=2 235) of them being children aged between 9 to 59 months. A total of 59 (93.6%) districts systematically investigated at least one suspected case (target: ≥ 80.0% of districts reporting measles cases should conduct case investigation) and the investigation rate was 4.4 cases per 100 000 inhabitants (target: ≥ 2.0 cases/100 000). The percentage of adequate samples received at the laboratory after collection was 96.4% (target ≥ 80%), with specifically 86.8% (target ≥ 80%) of samples received at the laboratory within five days period after collection. The timeliness for laboratory results feedback within 4 days was 75.4% (target ≥ 80%). As of September 2023, of the 24 health districts currently in active outbreak, complete routine immunization against measles have been performed in only four (16.7 %) health districts, achieving at least 80.0% coverage for the Measles-containing-vaccine second dose (MCV2), as per WHO recommendations. PUBLIC HEALTH ACTIONS  Regular meetings at the Ministry of health with its partners to assess measles outbreak situation in the country are ongoing.  The Ministry of Health continues to support the affected districts with regular follow up on local response activities, including in-depth case investigations at all the affected health districts.  A national follow-up vaccination campaign against measles and rubella took place in Cameroon between 5-9 July 2023, targeting 5.5 million children aged 9 to 59 months. The campaign achieved a vaccination coverage of 93.0%. In addition, local vaccination activities against measles have been conducted in some health districts.  Readiness activities in the non-affected districts are ongoing including refresher trainings for healthcare workers on measles case detection, management, and reporting.  Regular updates of the measles databases and dashboards for effective monitoring of the affected health districts continues. SITUATION INTERPRETATION Cameroon is facing a protracted measles outbreak that started since 2019. Suboptimal immunization coverage is identified as the main driver for recurrent measles outbreaks in the country. Furthermore, delays in case investigations and low rate of local response activities implementation in the affected health districts are also impacting the overall capacity to control this outbreak. National authorities, with support from partners, should enhance and scale up vaccination activities, surveillance, risk communication, and community engagement efforts to control the outbreak. Go to overview Go to map of the outbreaks Cameroon 6 034 Cases 31 Deaths 0.5% CFR Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment WEEKLY BULLETIN ON OUTBREAKS AND OTHER WEEK 46: 13 - 19 NOVEMBER 2023 7 Distribution of cases of Measles by regions in Cameroon, as of 5 November 2023 Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment WEEKLY BULLETIN ON OUTBREAKS AND OTHER WEEK 46: 13 - 19 NOVEMBER 2023 8 Go to overview Go to map of the outbreaks Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR New Events Senegal Crimean Congo Hemorhagic Fever (CCHF) Ungraded 11/13/2023 11/13/2023 11/14/2023 2 2 1 50.0% Two new cases of Crimean Congo Hemorhagic Fever (CCHF) were reported in Dahra and Matam districts of Senegal ,following a confiramtion of the disease through polymerase chain reaction (PCR) testing on 10 November 2023 at the Pasteur Institute of Dakar. Both patients are females of 27 years-old and 70 years-old respectively . The case from Dahra district has dead ( CFR 50%). Togo Dengue Fever Ungraded 11/14/2023 11/14/2023 11/14/2023 8 2 1 12.5% The Togo Ministry of Health officially notified cases of dengue fever to WHO on 14 November 2023. As of 16 November, eight cases have been detected, including two confirmed by polymerase chain reaction (PCR) testing at the national reference laboratory.Among the eight cases, one has died. Zimbabwe Anthrax Ungraded 11/13/2023 1/1/2023 11/14/2023 412 0 0.0% As of 14 November 2023, there have been a total of 285 cases from Gokwe North and 127 cases from Gokwe South, in Midlands province of Zimbabwe. The outbreak began in week 1 of 2023 and is still ongoing Ongoing Events Algeria COVID-19 Protracted 3 2/25/2020 2/25/2020 8/24/2023 271,853 271,853 6,881 - From 25 February 2020 to 24 August 2023, a total of 271 853 confirmed cases of COVID-19 with 6 881 deaths have been reported from Algeria. Algeria Poliomyelitis (cVDPV2) Grade 2 7/14/2022 4/11/2022 10/25/2023 3 3 - - According to Global Polio Eradication Initiative, no case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There were three cases reported in 2022. Angola COVID-19 Protracted 3 3/21/2020 3/21/2020 10/16/2023 105,968 105,968 1,936 1.8% The first confirmed COVID-19 case was reported in Angola on 21 March 2020. As of 16 October 2023, 105 968 confirmed COVID-19 cases have been reported in the country, with 1 936 deaths. Benin COVID-19 Protracted 3 3/17/2020 3/16/2020 5/3/2023 28,014 28,014 163 0.6% The Ministry of Health in Benin announced the first confirmed case of COVID-19 on 16 March 2020. As of 3 May 2023, a total of 28 014 cases have been reported in the country, with 163 deaths and 27 847 recoveries. Benin Poliomyelitis (cVDPV2) Grade 2 8/8/2019 8/24/2019 10/25/2023 30 30 0 0.0% There have been three cases reported in 2023. There are 13 cases reported in 2022. Six cases were reported in 2021 and 2020, and eight in 2019. Botswana COVID-19 Protracted 3 3/30/2020 3/30/2020 10/23/2023 330,321 330,321 2799 0.9% On 30 March 2020, the Minister of Health and Wellness in Botswana reported three confirmed cases of COVID-19. As of 13 October 2023, a total of 330 321 confirmed COVID-19 cases were reported in the country including 2 799 deaths. Burkina Faso Humanitarian crisis (Sahel Region) Grade 2 1/1/2019 1/1/2019 10/26/2023 2,100,000 - - - Since 2015, the security situation in the Sahel and Eastern Burkina Faso has gradually deteriorated due to attacks by armed groups. Access to healthcare services remains a major challenge for the affected population. As of October 2023, 5.5million People were in need of humanitarian assistance and over 2.0million IDPs registered. The situation remains fluid. Burkina Faso Chikungunya Ungraded 9/6/2023 9/19/2023 10/24/2023 214 214 0 0.0% On 6 September 2023, the reference laboratory for viral hemorrhagic fevers confirmed a case of chikungunya in a patient from the Pouytenga health district whose sample was collected as part of sentinel surveillance for dengue and other arboviruses. As of 24 October, 214 confirmed cases and no deaths were reported from six health districts: Pouytenga (193, 90%), Ouagadougou (10), Zorgho (8), Koudougou (2), and Bobo Dioulasso (1). Burkina Faso COVID-19 Protracted 3 3/10/2020 3/9/2020 5/3/2023 22,056 22,056 396 1.8% Between 9 March 2020 and 3 May 2023, a total of 22 056 confirmed cases of COVID-19 with 396 deaths and 21 596 recoveries have been reported from Burkina Faso. Burkina Faso Dengue fever Ungraded 9/11/2023 1/1/2023 9/19/2023 64,774 128 214 0.3% From the beginning of the outbreak in January to October 30, 2023, a total of 64 774 suspected cases have been documented, with 2 7540 probable cases and 214 fatalities. Burundi Cholera Grade 3 1/1/2023 12/14/2022 11/19/2023 1,314 175 9 - All events currently being monitored by WHO AFRO Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment WEEKLY BULLETIN ON OUTBREAKS AND OTHER WEEK 46: 13 - 19 NOVEMBER 2023 9 The ongoing cholera outbreak was officially declared on 1 January 2023. Cumulatively, a total of 1 314 cases with nine deaths (CFR 0.7%) have been reported as of 19 November 2023 Burundi COVID-19 Protracted 3 3/31/2020 3/18/2020 10/1/2023 54,366 54,266 15 0.0% On 31 March 2020, the Minister of Health in Burundi reported the first two confirmed cases of COVID-19. As of 10 September 2023, the total number of confirmed COVID-19 cases is 54 366, including 54 266 recoveries and 15 deaths. Burundi Poliomyelitis (cVDPV2) Grade 2 3/17/2023 1/1/2022 10/5/2023 2 2 0 0.0% No cVDPV2 case was reported this week. There is one case reported this year and one last year. Cameroon Humanitarian crisis (North, Adamawa & East) Protracted 2 12/31/2013 6/27/2017 11/13/2023 - - - According to UNHCR, Cameroon hosts about 484 969 refugees and asylum-seekers (475 729 refugees and 9 240 asylum seekers) as of 30 October 2023. Refugees from the Central African Republic are mostly hosted in the rural areas in the eastern part of the country (North, Adamawa, and East) and are estimated to be 354 078 refugees by the UNHCR as of 31 October 2023. Cameroon Humanitarian crisis (Noth- West & South-West ) Protracted 2 10/1/2016 6/27/2018 11/15/2023 - - - - In the North-West and South-West regions, the unstable security situation and persistent violence are exacerbating humanitarian needs. Affected people continue to flee their homes to neighboring villages and communities. Between January and July 2023, humanitarian and security partners reported the displacement of more than 42 000 people in both regions Cameroon Humanitarian crisis (Sahel Region) Grade 2 12/31/2013 6/27/2017 11/13/2023 - - - - The Far North region of Cameroon is still facing humanitarian crisis. Localities of this region situated at the border area with Nigeria and Chad, as well as the Lake Chad area, remain the most affected by the armed conflict. Between August and September this year, nearly 6 000 newly displaced people were registered in the Mokolo district following repeated attacks by non-state armed groups. More than 2 200 new asylum seekers/refugees were registered for the same period at the Gourenguel transit site, in Mokolo district of Mayo-Tsanaga department. Cameroon Cholera Grade 3 8/31/2021 10/25/2021 10/12/2023 20,933 2,050 492 - From 25 Oct 2021 to 12 October 2023, a total of 20 933 cases of cholera including 2 050 laboratory-confirmed cases and 492 deaths (CFR 2.4%) have been reported from nine regions. Three regions are still active (Centre, Littoral, and South-West). Patients’ ages range from 2 months to 103 years with a median of 28 years, and the sex ratio M/F is 1.3. Cameroon COVID-19 Protracted 3 3/6/2020 3/6/2020 11/5/2023 125,226 125,226 1,974 - The Cameroon Ministry of Health confirmed the first COVID-19 case on 6 March 2020. As of 5 November 2023, 125 226 cases have been reported, including 1 974 deaths. Cameroon Measles Ungraded 4/2/2019 1/1/2023 11/5/2023 6,034 6,034 31 - From week 1 through week 44 (ending 5 November 2023), 6 034 confirmed measles cases have been reported in Cameroon, including 453 IgM+, 52 clinically compatible and 5 529 epidemiologically linked. At least 31 related deaths (CFR 0.5%) have been reported in 2023. Cameroon Mpox Protracted 2 2/24/2022 1/1/2022 10/12/2023 45 45 3 6.7% From 1 January to 12 October 2023, 108 suspected cases of Mpox, including 27 laboratory-confirmed and no deaths have been reported. In 2022, 18 confirmed cases and three deaths were reported in the country. Cameroon Poliomyelitis (cVDPV2) Grade 2 5/23/2019 1/1/2020 10/1/2023 13 13 0 0.0% There were three cases reported in 2022, three others reported in 2021, and seven cases reported in 2020. Cape Verde COVID-19 Protracted 3 3/19/2020 3/18/2020 7/8/2023 64,143 64,143 414 0.6% The first confirmed COVID-19 case was reported in Cape Verde on 19 March 2020. As of 8 July 2023, 64 143 confirmed COVID-19 cases, including 414 deaths and 63 645 recoveries, were reported in the country. Cape Verde Dengue Ungraded 11/6/2023 11/6/2023 11/6/2023 6 2 0 1.2% On 6 November 2023, the Ministry of health Surveillance Service reported to the WHO country office two confirmed cases of Dengue through Polymerase Chain Reaction (PCR) testing and one borderline case in the city of Praia, Santiago Island, Cabo Verde. The same day three more suspected cases were reported from the Central Hospital Dr. Agostinho Neto giving a total of six cases including two confirmed with zero death. Central African Republic Humanitarian crisis Protracted 2 12/11/2013 12/11/2013 11/20/2023 - - - - The Central African Republic (CAR) has been facing humanitarian crisis for more than a decade following military-political conflicts. Of the country population of 6.1 million inhabitants, more than half (3.4 million), need humanitarian assistance in 2023. More than 520 000 people are currently internally displaced, 2.5 million are registered as returnees, and 0.75 million are refugees mainly from Chad and Sudan. Central African Republic COVID-19 Protracted 3 3/14/2020 3/14/2020 6/18/2023 15,404 15,404 113 0.7% 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 18 June 2023, a total of 15 404 confirmed cases, 113 deaths and 15 252 recoveries were reported. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment WEEKLY BULLETIN ON OUTBREAKS AND OTHER WEEK 46: 13 - 19 NOVEMBER 2023 10 Central African Republic Measles Ungraded 3/13/2022 1/1/2023 8/20/2023 2,055 1,145 3 - From week 1 to week 33 (ending 20 August 2023), the Ministry of Health and Population has recorded 1 145 confirmed measles cases, including 102 laboratory-confirmed cases, 1 043 epidemiologically linked cases. Three deaths have been reported. The measles outbreak is ongoing in 13 (37%) out of 35 health districts Central African Republic Mpox Protracted 2 3/3/2022 3/4/2022 5/28/2023 31 31 1 3.2% From 4 March 2022 to 28 May 2023, 31 confirmed cases of Mpox and one death have been reported in the country. Since the start of 2023, the country has reported 14 laboratory-confirmed cases, including one death. The last cases were reported during week 21 (ending 28 May) in from Baboua-Abba and Paoua districts. Central African Republic Poliomyelitis (cVDPV2) Grade 2 5/24/2019 5/24/2019 10/1/2023 46 46 0 0.0% Fifteen cases have been reported in the country this year. In addition, six cases were reported in 2022. Although no new cases were reported in 2021, four cVDPV2 cases were reported in 2020 and 21 cases in 2019 from several outbreaks. Central African Republic Yellow Fever Ungraded 6/12/2023 1/1/2023 10/22/2023 6 6 0 0.0% There is an ongoing yellow fever outbreak in the Central African Republic (CAR). This year from week 1 through week 42 (ending 22 October ) , six confirmed cases of yellow fever were recorded for the following districts : Sangha-Mbaéré (1), Berbérati (1), Bambari (2), Mbaïki (1) and Bossembélé (1). In addition, four out of 35 health districts for country ( 11%) , are currently in a yellow fever outbreak Chad Humanitarian crisis (Sahel region) Grade 2 2/11/2022 3/1/2016 11/12/2023 - - - - With the ongoing Sudanese crisis, over 570 000 Sudanese and Chadian people fled Darfur to converge to the eastern entry points of Chad. Chad is the most affected country by the crisis in Sudan as it hosts 49.6% of Sudanese refugees, with thousands of new arrivals every week. These refugees live in numerous formal and informal camps located in 11 health districts across four provinces (Ennedi East, Ouaddaï, Sila and Wadi Fira). Chad COVID-19 Protracted 3 3/19/2020 3/19/2022 5/3/2023 7,822 7,822 194 2.5% The first confirmed COVID-19 case was reported in Chad on 19 March 2020. As of 26 April 2023, a total of 7 822 confirmed COVID-19 cases were reported in the country, including 194 deaths. Chad Dengue Ungraded 8/5/2023 8/6/2023 10/1/2023 1,342 41 1 - Chad health authorities declared the dengue outbreak officially on 15 August 2023. As of 1 October 2023, a total of 1 342 suspected cases, 41 confirmed and one death are reported. Chad Measles Ungraded 5/24/2018 1/1/2023 8/6/2023 8,984 820 4 0.0% As of Week 31 of 2023 (ending 6 August), 8 489 suspected cases and four measles-related deaths (CFR 0.1%) have been reported from 143 out of 150 districts in Chad. A total of 820 samples tested IgM positive for measles and 178 tested IgM+ for rubella. Chad Poliomyelitis (cVDPV2) Grade 2 10/18/2019 9/9/2019 10/1/2023 193 193 0 0.0% There have been 34 cases reported this year. In addition, 44 cVDPV2 cases were reported in 2022, 106 cVDPV2 cases were reported in 2020 from three different outbreaks and nine others were reported in 2019. Comoros COVID-19 Protracted 3 4/30/2020 4/30/2020 10/12/2023 9,109 9,109 160 1.8% The first case of confirmed COVID-19 was notified on 30 April 2020 in Comoros. As of 23 May 2023, a total of 9 109 confirmed COVID-19 cases, including 160 deaths, were reported in the country. Congo COVID-19 Protracted 3 3/14/2020 3/14/2020 5/14/2023 25,195 25,195 389 1.6% The Government of Congo announced the confirmation of the first case of COVID-19 in Congo on 14 March 2020. As of 14 May 2023, a total of 25 195 cases, including 389 deaths, have been reported in the country. Congo Mpox Protracted 2 5/23/2022 8/22/2023 10/11/2023 22 18 2 9.1% From 22 August to 11 October 2023, (18) laboratory-confirmed cases of Mpox, (4) probable cases and (2) deaths were reported from Likouala and Brazzaville Departments. From week 1 to week 36 of 2022 (week ending 11 September 2022), (5) laboratory-confirmed cases and (5) probable cases, including (3) deaths were reported from Likouala, Sangha and Pointe-Noire Departments. Congo Poliomyelitis (cVDPV1) Grade 2 3/21/2023 3/1/2023 10/1/2023 1 1 - - A case of circulating vaccine-derived poliovirus type 1 (cVDPV1) was confirmed on 1 March 2023 in a 15-year-old child living in Dolisie, Niari Department, with onset of paralysis on 26 September 2022. Côte d'Ivoire COVID-19 Protracted 3 3/11/2020 3/11/2020 7/11/2023 88,338 88,338 835 0.9% Since 11 March 2020, a total of 88 338 confirmed cases of COVID-19 have been reported from Côte d'Ivoire, including 835 deaths and a total of 87 497 recoveries. Côte d'Ivoire Dengue fever Ungraded 7/10/2023 6/19/2023 9/30/2023 3,189 259 27 - An outbreak of Dengue fever is ongoing in Ivory Coast. A total of 3189 cases have been reported from 19 June to 30 September 2023, with 259 confirmed cases and 27 deaths (CFR: 0.8%). Democratic Republic of the Congo Humanitarian crisis Grade 3 12/20/2016 4/17/2017 11/11/2023 - - - - Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment WEEKLY BULLETIN ON OUTBREAKS AND OTHER WEEK 46: 13 - 19 NOVEMBER 2023 11 Humanitarian situation in The Democratic Republic of the Congo (DRC) remains concerning. In North Kivu province, there are about 454 000 new internally displaced persons (IDPs) recorded since the resumption of armed clashes in October. In South Kivu province , a total of 13 343 IDPs arrived in various localities from 30 October 30 to 5 November fleeing armed conflict in their villages. Democratic Republic of the Congo Cholera Grade 3 1/16/2015 1/1/2023 9/17/2023 29,874 1,866 107 - During the epidemiological week 37 (week ending 17 September 2023), 741 new cases and ten deaths were reported. This marks an increase compared to the preceding week (624 cases, 0 deaths). Cumulatively, 29 874 cases with 107 deaths (CFR 0.4%) have been documented across six provinces in the country. Democratic Republic of the Congo COVID-19 Protracted 3 3/10/2020 3/10/2020 8/19/2023 96,230 96,230 1,468 - Since the start of the COVID-19 outbreak, declared on 10 March 2020, a total of 96 230 confirmed cases, including 1 468 deaths, have been reported as of week 33 of 2023. Democratic Republic of the Congo Measles Ungraded 10/12/2021 1/1/2023 10/1/2023 247,160 3,429 4,567 - Measles outbreak is still ongoing in the Democratic Republic of the Congo (DRC). A total of 286 out of 572 health zones have had measles outbreaks since the start of this year. As of week 39, (ending 1 October), a total of 247 160 suspected measles cases and 4 567 deaths (CFR 1.8%) have been reported, 6 227 have been investigated of which 3 429 were IgM positive for measles, and 583 were IgM positive for rubella Democratic Republic of the Congo Mpox Protracted 2 3/30/2019 1/1/2022 7/4/2023 734 734 3 0.4% From 1 January 2022 through 13 April 2023, the Democratic Republic of the Congo reported 734 confirmed Mpox cases, with three death among the confirmed cases. Democratic Republic of the Congo Poliomyelitis (cVDPV1) Grade 2 8/27/2022 8/27/2022 11/8/2023 226 226 0 0.0% There have been 79 cases reported this year and 147 cases in 2022 Democratic Republic of the Congo Poliomyelitis (cVDPV2) Grade 2 2/26/2021 1/1/2022 11/8/2023 475 475 0 0.0% There have been 103 cases reported this year and 372 cases in 2022. No cVDPV2 cases were reported this week. The number of cases reported this year was revised. Equatorial Guinea COVID-19 Protracted 3 3/14/2020 3/14/2020 7/26/2023 17,229 17,229 183 - The Ministry of Health and Welfare announced the first confirmed COVID-19 case on 14 March 2020. As of 23 February 2023, a total of 17 229 cases have been reported in the country, with 183 deaths and 16 907 recoveries. Eritrea COVID-19 Protracted 3 3/21/2020 3/21/2020 5/3/2023 10,189 10,189 103 1.0% The first confirmed COVID-19 case was reported in Eritrea on 21 March 2020. As of 30 October 2022, 10 189 confirmed COVID-19 cases with 103 deaths were reported in the country. A total of 10 085 patients have recovered from the disease. Eritrea Poliomyelitis (cVDPV2) Grade 2 6/2/2022 6/7/2022 9/26/2023 2 2 0 0.0% No new case of cVDPV2 in 2023 as at week 43. One case was reported in 2022, and another one reported in 2021. The latter case was confirmed on 2 June 2022 by the Ethiopian National Polio Laboratory. Eswatini COVID-19 Protracted 3 3/13/2020 3/13/2020 10/23/2023 75,052 75,052 1,427 1.9% The first case of COVID-19 was confirmed in the kingdom of Eswatini on 17 March 2020. As of 18 October 2023, a total of 75 052 cases have been reported with 1 427 associated deaths. Ethiopia Floods Ungraded 11/8/2023 11/2/2023 11/6/2023 - - - As per the Somali Regional State Disaster Risk Management-Bureau (DRMB), following heavy and continuous rainfall in almost all Somali region and highlands of Oromia regions, rivers including Web Genale and related tributaries have burst their banks resulting the worst flooding for 30 last years. As of 6 November 2023, more than 42 301 households (253 801 individuals) are affected, and 23 132 households (138 792 individuals) were reported displaced while 24 people lost their lives due to floods. Ethiopia Food insecurity (Horn of Africa crisis) Grade 3 2/17/2022 1/1/2022 11/20/2023 - - - - Emergency (IPC Phase 4) outcomes with households in Catastrophe (IPC Phase 5) are expected to persist in southern, southeastern, and northern Ethiopia as per the Famine Early Warning Systems Network (FEWS NET) outlook update. Furthermore, forecasted above-average rainfall driven by El Niño and positive Indian Ocean Dipole conditions – brings not only opportunities like improved harvests and livestock reproduction, but also risks such as displacement, crop losses, and livestock diseases Ethiopia Humanitarian crisis (Northern Ethiopia) Protracted 1 11/4/2020 11/4/2020 10/6/2023 - - - - In Amhara region, there is an ongoing security concerns after conflict emerged early August. Partners are still unable to access many areas, and diseases surveillance not fully resumed because of limited internet access. Furthermore, armed conflict in Sudan has forced hundreds of thousands of people to flee to neighboring countries. As of 16 September 2023, over 81 000 people have arrived in Ethiopia through multiple border crossing points in Amhara, Benishangul Gumz, and Gambella Regions Ethiopia Cholera Grade 3 9/17/2022 9/17/2022 10/26/2023 24,559 24,559 321 1.3% Since the index case in August 2022, there have been 24 559 cholera cases as at week 42 of 2023. Within this same period, there have been 321 deaths (CFR 1.3%). Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment WEEKLY BULLETIN ON OUTBREAKS AND OTHER WEEK 46: 13 - 19 NOVEMBER 2023 12 Ethiopia COVID-19 Protracted 3 3/13/2020 3/13/2020 9/21/2023 501,060 500,946 7,574 - Since the confirmation of the first case on 21 March 2020, Ethiopia has confirmed a total of 501 060 cases of COVID-19 as of week 38, 2023, with 7 574 deaths and 488 159 recoveries. Ethiopia Dengue Ungraded 5/16/2023 5/10/2023 10/24/2023 10,233 10,233 4 0.0% Since 4 April 2023, two districts (Logia and Mille) in the Afar region of northeastern Ethiopia have been experiencing an outbreak of dengue fever. As of 18th October 2023, a total of 10 233 cases and 4 deaths associated deaths (CFR 0.04%) have been reported. Ethiopia Malaria Ungraded 1/31/2023 1/1/2023 10/8/2023 - - - With the ongoing malaria outbreak in Ethiopia, a total of 76 995 malaria cases were reported in Epi-week 40, an increase by 13.9% when compared with week 39. Nine new deaths reported in the week 40, including six from Oromia and three from South West regions. About 891 Woredas reported at least one malaria cases across the country Ethiopia Measles Ungraded 4/13/2017 1/1/2023 10/23/2023 18,899 18,899 149 0.8% Since August 12, 2023, a total of 237 Woredas across all regions in Ethiopia have been affected by measles outbreak, Currently outbreak remains active in 25 Woredas located in six regions: As at 18 October 2023, a total of 18,899 cases with 149 deaths have been reported, a Case Fatality Rate (CFR) of 0.76%. Ethiopia Poliomyelitis (cVDPV2) Grade 2 6/24/2019 5/20/2019 10/26/2023 69 69 0 0.0% As of week 42, 2023, there have been a total of 69 reported cases of circulating vaccine-derived poliovirus type 2 (cVDPV2). There was one case reported in 2022, one case in 2021, 10 cases in 2020, and 43 cases in 2019. It's important to highlight that no cases have been reported in 2023. Gabon COVID-19 Protracted 3 3/12/2020 3/12/2020 10/22/2023 48,992 48,992 307 0.6% On 12 March 2020, the Ministry of Health announced the confirmation of the first COVID-19 case in the country. As of 9 October 2023, a total of 48 992 cases, including 307 deaths and 48 676 recoveries have been reported. No New cases reported since then Gambia COVID-19 Protracted 3 3/17/2020 3/17/2020 9/21/2023 12,684 12,684 372 2.9% A total of 12 684 cummulative cases have been reported with 372 deaths(CFR=2.9%). Noteably, 58% of confirmed cases are male. Ghana Floods Ungraded 10/13/2023 10/16/2023 10/30/2023 25,629 25,629 0 0.0% As at 16 October 2023, flooding has impacted seven districts and 81 communities downstream, resulting in damage to infrastructure and the displacement of 25,629 residents, with 5,027 seeking refuge in safe havens and the remainder staying with relatives. Approximately 400 houses were completely submerged, while flash floods engulfed 125 farmlands and destroyed 400 fish cages from eight fish farms, incurring an estimated damage cost of Four Hundred Million Ghana Cedis. Ghana COVID-19 Protracted 3 3/12/2020 3/12/2020 9/21/2023 171,665 171,665 1,462 - As at week 36 of 2023, Ghana has had a cummulative 171 665 cases and 1 462 deaths(CFR 0.9%). The most recent cases (5) were from the Bibiani-Anhwiaso-Bekwai, Ayawaso West and Tema respective districts. Ghana Mpox Protracted 2 6/8/2022 5/24/2022 9/21/2023 133 133 5 3.8% As of week 36, there have been 133 confirmed and 5 deaths(CFR 3.8%) reported from 261 Districts. Ghana Poliomyelitis (cVDPV2) Grade 2 8/23/2019 7/23/2019 9/21/2023 34 34 - - Ghana first reported a cVDPV2 outbreak in 2019. The country has a cumulative of 34 cVDPV2 AFP cases. 19 cVDPV2 cases were documented in 2019, 12 in 2020 and 3 in 2022. No new case was documented as of week 38 2023. Guinea COVID-19 Protracted 3 3/13/2020 3/13/2020 5/3/2023 38,462 38,462 467 1.2% The Ministry of Health in Guinea announced the first confirmed case of COVID-19 on 13 March 2020. As of 3 May 2023, a total of 38 462 cases, including 37 407 recovered cases and 467 deaths, have been reported in the country. Guinea Diphtheria Grade 2 8/21/2023 7/4/2023 10/4/2023 456 14 57 12.5% An outbreak of diphtheria has been reported in the Kankan region of Guinea since 4 July 2023. As of 4 October 2023, 456 suspected cases have been reported, including 14 confirmed cases. A total of 57 deaths have been recorded. Of the reported cases, 59% are female. The 1-4 years age group is the most affected with 365 cases. Siguiri District has reported the highest number of cases (429 cases, 94 %). Guinea-Bissau COVID-19 Protracted 3 3/25/2020 3/25/2020 4/9/2023 9,614 9,614 177 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 9 April 2023, the country has reported 9 614 confirmed cases of COVID-19 with 9 315 recoveries and 177 deaths. Kenya Floods Ungraded 11/9/2023 11/8/2023 11/9/2023 - - - Since the middle October 2023 , heavy rainfall has been hitting most of Kenya, causing flooding across the country. Areas of particular concern include Mandera, Garissa, Wajir, and Tana River and parts of the upper eastern areas of the country. According to UN OCHA over 61 380 people have been affected, nearly 36 000 people have been displaced and 17 people have died. Floods have also led to infrastructure damage, livestock and property losses, and restricted access to roads in various regions in Kenya Kenya Food insecurity (Horn of Africa crisis) Grade 3 2/17/2022 1/1/2022 11/20/2023 - - - - Climate forecasts indicate that the October to December 2023 short rains in northern and eastern Kenya will likely have an early onset and be cumulatively above average, supported by a strong El Niño event. The rains are expected to improve forage, pasture, and water resources in pastoral areas, supporting livestock body. However, there is an elevated risk that the above-average rainfall will result in flooding in the flood-prone parts of the country and outbreaks of diseases like Rift Valley Fever in pastoral areas. Pastoral areas remain in Crisis (IPC Phase 3) as the pastoral lean season concludes Kenya Anthrax Ungraded 4/10/2023 10/23/2023 20 3 15.0% As of 31st August 2023, cumulative 20 cases and 3 deaths were reported. 17 of these cases and 3 deaths were reported In April-May 2023, In August 2023, 3 new cases emerged in Kandara sub-county, all cases were linked to the handling of an infected animal. No new cases have been reported after August. Kenya Cholera Grade 3 10/19/2022 10/5/2022 10/22/2023 12,121 577 202 - Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment WEEKLY BULLETIN ON OUTBREAKS AND OTHER WEEK 46: 13 - 19 NOVEMBER 2023 13 A cholera outbreak has been ongoing in Kenya since 26 October 2022. As of 22 October 2023, a total of 12 121 cases, with 577 confirmed by culture, and 202 deaths (CFR 1.7%) have been reported in 27 affected Counties. Kenya COVID-19 Protracted 3 3/13/2020 3/13/2020 10/24/2023 343,999 343,999 5,689 - On 12 March 2020, the Ministry of Health announced the confirmation of one new COVID-19 case in the country. As of 18 October 2023, 343 955 confirmed COVID-19 cases have been reported, including 5 689 deaths and 44 new cases in the country. Kenya Leishmaniasis (visceral) Ungraded 3/31/2019 1/3/2020 10/22/2023 2,395 2,205 10 - A cumulative total of 2 395 cases and 10 deaths (CFR 0.4%) have been reported in Kenya since 20 July 2020. The outbreak is currently active in only one county; West Pokot County. No new cases were reported in the last epi week (since 10 August). Kenya Measles Ungraded 6/29/2022 1/1/2023 10/22/2023 1,325 259 23 - The outbreak has been continuous since 2022, affecting 13 counties in 2023. Cumulatively, 1 325 cases, with 256 confirmed cases and 23 deaths (CFR 1.7%) have been reported as of 22 October 2023. There have been new cases in week 41 Kenya Poliomyelitis (cVDPV2) Grade 2 7/6/2023 5/26/2023 10/5/2023 5 5 0 0.0% No cVDPV2 cases were reported this week. There have been five cases reported in 2021. Lesotho COVID-19 Protracted 3 5/13/2020 5/13/2020 10/23/2023 35,836 35,836 706 2.1% Since the first confirmed COVID-19 case was reported in Lesotho on 13 May 2020 until 13 October 2023, a total of 35836 cases of COVID-19 have been reported, and 706 deaths. Liberia COVID-19 Protracted 3 3/16/2020 3/16/2020 9/21/2023 8,161 8,161 295 3.6% Cumulatively, from March 16, 2020, when the first case was confirmed in Liberia, until July 17, 2023, there have been 8 161 confirmed cases and 294 deaths. No new confirmed COVID-19 cases have been reported, and there are currently zero active cases in the country. Liberia Lassa Fever Ungraded 3/3/2022 1/6/2022 10/30/2023 353 96 27 7.6% From January 6, 2022, to week 42 of 2023, a cummulative total of 353 cases have been reported with 96 confirmed and 27 deaths.(CFR 7.9%). Liberia Measles Ungraded 2/3/2022 12/13/2021 10/30/2023 12,967 12,298 95 - Since the measles outbreak started on 13 December 2021, there have been 12 967 suspected cases, 12 298 confirmed cases, and 95 deaths with CFR 0.7% in 15 affected Counties as of week 42 of 2023. Montserrado County has recorded the highest number of deaths (69). Liberia Mpox Protracted 2 7/21/2022 7/23/2022 10/30/2023 119 7 0 0.0% Liberia confirmed its first case of Mpox on 23 July 2022, with a cumualtive total of 119 suspected cases reported and 7 confirmed. The most recent case was in week 42 of 2023 in Grand Kru and Nimba counties. Madagascar Malnutrition crisis Protracted 2 7/1/2021 1/1/2021 10/23/2023 2,200,000 - - - About 2.2 million people in Madagascar face food insecurity, including 479 000 children with acute malnutrition. Over 115 000 children need treatment for acute malnutrition this year. The situation is particularly dire in the Grand South and Grand South-east regions, where two out of five people are severely food insecure. Madagascar COVID-19 Protracted 3 3/20/2020 3/20/2020 10/23/2023 68,352 68,352 1,425 2.2% The Madagascar Ministry of Health confirmed the first COVID-19 case on 20 March 2020. As of 13 October 2023, a total of 68 352 confirmed cases, including 1 425 deaths, have been reported in the country. Malawi Cholera Grade 3 3/3/2022 3/3/2022 10/15/2023 59,040 59,016 1,768 - Twenty-nine districts have reported Cholera cases since March 2022 in the Machinga district. As of 15 October 2023, a cumulative total of 59 040 cases and 1 768 deaths (CFR 3.0%) have been reported since the onset of the outbreak. Malawi COVID-19 Protracted 3 4/2/2020 4/2/2020 8/27/2023 88,905 88,905 2,686 - On 2 April 2020, the president of Malawi announced the first confirmed cases of COVID-19 in the country. As of 27 August 2023, the country has 88 905 confirmed cases with 2 686 deaths. Malawi Measles Ungraded 11/6/2023 11/6/2023 11/6/2023 32 11 2 6.3% On 6 November 2023, the Ministry of Health (MoH) released a press release on confirmed measles outbreak in Lilongwe district following the notification of 11 laboratory confirmed cases within the same geographical area 36. As of 6 November, 32 suspected cases including 11 confirmed are reported. Two suspected measles related deaths were also reported Malawi Poliomyelitis (WPV1) Grade 2 1/31/2022 2/1/2022 10/4/2023 1 1 0 0.0% One positive case of wild WPV1 was detected in Lilongwe from a child with the date of onset of paralysis on 19 November 2021. No other cases have been reported. Malawi continues participating in the multi-country, subregional outbreak response to control the WPV1 outbreak. Mali Humanitarian crisis (Sahel region) Grade 2 9/11/2017 9/7/2023 - - - - Mali is facing prolonged conflict, poverty, climate shocks, and growing insecurity. However, the current Humanitarian Response Plan for Mali is severely underfunded, with only 11% of the required funding secured. There has been a significant increase in IDPs in the regions of Kidal (32.8%) and Ménaka (20%). As of week 30 ( ending 30 July 2023) , over 7.5 million people are in need of humanitarian assistance. Mali Chikungunya Ungraded 10/2/2023 9/26/2023 10/5/2023 1 1 0 0.0% The Ministry of Health of Mali has announced that a case of Chikungunya has been confirmed by real-time polymerase chain reaction (RT-PCR) on 30 September 2023 in commune VI of the Bamako district. The case is a 35-year-old male resident of Kayes Liberté in the Kayes health district with onset of symptoms on 26 September 2023. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment WEEKLY BULLETIN ON OUTBREAKS AND OTHER WEEK 46: 13 - 19 NOVEMBER 2023 14 Mali COVID-19 Protracted 3 3/25/2020 3/25/2020 10/16/2023 33,159 33,159 743 2.2% On 25 March 2020, the Ministry of Health of Mali reported the first COVID-19 confirmed cases in the country. As of 16 October 2023, a total of 33 159 confirmed COVID-19 cases have been reported in the country, including 743 deaths. Mali Dengue Fever Ungraded 9/12/2023 8/31/2023 10/29/2023 494 62 1 0.0% On 9 September 2023, the Malian Ministry of Health reported a case of dengue in a 44-year-old female resident of Bacodjicoroni Golf, commune V, Bamako district. The case had onset of symptoms on 31 August 2023. On 9 September 2023, the sample collected from the case was confirmed positive for dengue virus by real-time polymerase chain reaction (RT-PCR) at the University Clinical Research Center (UCRC) laboratory. As of 29 October 2023, 494 suspected cases, including 62 confirmed cases and one death have been reported. Mali Measles Ungraded 2/20/2018 1/1/2023 9/24/2023 382 344 0 0.0% From the beginning of the year through 24 Septembre 2023, 760 suspected measles cases were tested in Mali, and 344 were laboratory confirmed. Mauritania COVID-19 Protracted 3 3/13/2020 3/13/2020 7/2/2023 63,712 63,712 997 1.7% The government of Mauritania announced its first confirmed COVID-19 case on 13 March 2020. As of 2 July 2023, a total of 63 712 cases, including 997 deaths and 62 713 recovered have been reported in the country. Mauritania Crimean- Congo haemorrhagic fever (CCHF) Ungraded 7/27/2023 7/17/2023 9/17/2023 2 2 1 50.0% Two Crimean-Congo haemorrhagic fever (CCHF) cases were confirmed in Mauritania since the beginning of 2023. The first case was a 58-year-old male from Tevarett district of Nouakchott North region who had reportedly been infected in the Ouad Naga district of Trarza region and developed a febrile illness on 17 July 2023. He was tested and died in Dakar, Senegal, on 26 July 2023. His results returned positive for CCHF on 27 July 2023. The second case is a 23-year-old female from Libheir locality in Barkeol district of Assaba region with date of symptom onset as of 5 September 2023. She tested positive for CCHF by RT-PCR on 9 September 2023. No epidemiological link was established between the two confirmed cases. Mauritania Diphtheria Grade 2 10/26/2023 10/8/2023 10/19/2023 8 4 50.0% On 19 October 2023, the Mauritanian Ministry of Health reported suspected cases of diphtheria. The first case had onset of symptoms on 8 October 2023. A total of eight suspected cases, including four deaths, have been reported as of 29 October 2023. Mauritania Measles Ungraded 3/7/2023 12/26/2022 9/17/2023 730 269 5 0.7% Mauritania has been experiencing a measles outbreak since early 2023. A total of 20 districts have reached the epidemic threshold, including four currently experiencing an outbreak (Kaédi, Ksar, Monguel et Rosso). As of 17 September 2023, the country has reported 730 suspected cases of measles (269 confirmed, including 173 laboratory- confirmed cases and 96 epidemiologically linked cases). Five deaths, including two community deaths, have been reported among confirmed cases. Mauritius COVID-19 Protracted 3 3/18/2020 3/18/2020 10/22/2023 296,069 296,069 1,052 0.4% The Republic of Mauritius announced the first three positive cases of COVID-19 on 18 March 2020. As of 22 October 2023, a total of 296 069 confirmed COVID-19 cases, including 1 052 deaths have been reported in the country. Mauritius Dengue fever Ungraded 7/10/2023 6/8/2023 10/1/2023 262 0 0.0% Mauritius has been experiencing an outbreak of dengue fever since early June. As of 1 October 2023, 262 suspected cases have been reported, including 203 in Mauritius Island and 59 in Rodrigues Island. Mozambique Humanitarian crisis in Cabo Delgado Protracted 2 1/1/2020 10/12/2023 8/6/2023 - - - - Most poor and very poor households in Mozambique face Minimal (IPC Phase 1) outcomes as the ongoing harvest improves food access and availability. In Cabo Delgado, ongoing humanitarian assistance drives Stressed (IPC Phase 2) outcomes, with Crisis (IPC Phase 3) outcomes persisting in conflict-affected areas. There have been a reduced number of attacks. Mozambique Cholera Grade 3 9/14/2022 10/12/2023 10/23/2023 34,943 34,943 146 - The current cholera outbreak in the country started in Niassa province on 14 September 2022. As of 15 October 2023, 34 943 cholera cases have been recorded with 146 deaths (CRF 0.4%) in 11 affected provinces, 65 of the 67 affected districts have ended the outbreak . Mozambique COVID-19 Protracted 3 3/22/2020 3/22/2020 10/23/2023 233,654 233,654 2,249 1.0% The first confirmed COVID-19 case was reported in Mozambique on 22 March 2020. As of 18 October 2023, a total of 233 654 confirmed COVID-19 cases were reported in the country, including 2 249 deaths. Mozambique Poliomyelitis (cVDPV2) Grade 2 12/7/2018 1/1/2021 10/23/2023 6 6 0 0.0% According to the Global Polio Eradication Initiative, no case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. The number of cases in 2022 remains four. There were two cases reported in 2021. No cVDPV2 cases reported in 2023 Mozambique Poliomyelitis (WPV1) Grade 2 5/17/2022 5/18/2022 10/4/2023 8 8 0 0.0% According to the Global Polio Eradication Initiative, there was no WPV1 case reported this week. There were eight cases reported on 10 August 2022. Namibia COVID-19 Protracted 3 3/14/2020 3/14/2020 8/25/2023 172,088 172,088 4,098 - The first case of COVID-19 was detected in Namibia on the 14 March 2020. As of 25 August 2023, a total of 172 088 confirmed cases with 4 098 deaths have been reported. Niger Humanitarian crisis (Sahel region) Grade 2 2/1/2015 2/1/2015 10/30/2023 4,300,000 - - - The number of internally displaced people in Niger has reached a record high, with an increase from 1.9 million in 2017 to 4.3 million individuals (15% population) in 2023, indicating a significant rise in the need for humanitarian assistance. On 28 July, Niger experienced a military coup and this marks the third Sahel country in less than three years. Acute food insecurity affects 3.3 million people, while a staggering 7.3 million are at risk of their situation deteriorating due to the ongoing crisis. Niger COVID-19 Protracted 3 3/19/2020 3/19/2020 5/1/2023 9,513 9,513 315 3.3% From 19 March 2020 to 1 May 2023, a total of 9 513 cases with 315 deaths have been reported across the country. A total of 9 203 recoveries have been reported from the country. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment WEEKLY BULLETIN ON OUTBREAKS AND OTHER WEEK 46: 13 - 19 NOVEMBER 2023 15 Niger Diphtheria Grade 2 8/28/2023 7/4/2023 10/23/2023 1,690 100 75 - An outbreak of diphtheria has been confirmed in Matameye health district, Zinder region. The first case was reported on 17 July 2023. As of 23 October 2023, a total of 1690 suspected cases, including 75 deaths (CFR:4.4) were reported from 20 health districts. Public health response activities are ongoing in affected districts. Niger Measles Ungraded 4/5/2022 1/1/2022 10/16/2023 1,802 567 0 - As of epidemiological week 41, 2023 ( ending 16 October ) , 1 802 suspected measles cases were reported, of which 995 were investigated across 66 districts in the eight regions. Of these cases, 57% (n=578) were laboratory-confirmed. Additionally, 91% (n=66) of the districts reported at least one suspected case, and 36 (49%) health districts have reached the epidemic threshold since the beginning of the year. Niger Meningitis Ungraded 12/7/2022 10/31/2022 10/16/2023 2,261 736 129 - A meningitis outbreak was been declared in the Dungass health district in Zinder region. The first case was reported on 31 October 2022 and confirmed on 23 November 2022, with Neisseria meningitidis identified as the causative agent. As of 16 October 2023, 2 261 suspected cases of meningitis, including 736 laboratory-confirmed cases and 129 deaths (CFR 5.7%) were reported. Niger Poliomyelitis (cVDPV2) Grade 2 1/1/2020 1/1/2021 10/25/2023 34 34 0 0.0% No new case of cVDPV2 was reported during this week. The total number of cases reported in 2022 is 16. There were 18 cases reported in 2021. Nigeria Humanitarian crisis (Sahel region) Grade 2 10/10/2016 10/10/2016 9/7/2023 8,300,000 8,300,000 - People face emergency levels of food insecurity, with very high rates of severe acute malnutrition that could lead to death in Borno, Adamawa and Yobe states. As of week 30, 2023, over 6 million people are targetted for humanitarian aid, 8.3 million people are in need of humanitarian assistance, 2.2 million IDPs, and 4.3 million people in need of food security aid. Nigeria Cholera Grade 3 1/1/2023 8/27/2023 2,860 84 2.9% From 1 January to 27 August 2023, a cumulative total of 2 860 suspected cholera cases and 84 deaths (CFR 2.9%) were reported from 124 Local Government Areas in 25 states. Of all suspected cases, 51% are male, and the age groups most affected are <5 years, followed by 5-14 years. The most affected states are Zamfara (787), Cross River (718), Katsina (302), Bayelsa (265) and Ebonyi (227). Nigeria COVID-19 Protracted 3 2/27/2020 2/27/2020 8/15/2023 266,675 266,675 3155 1.2% The first case of COVID-19 was first detected in Nigeria on 27 February 2020. As of 15 August 2023, a total of 266 675 confirmed cases with 259 953 recovered and 3 155 deaths have been reported. Nigeria Diphtheria Grade 2 12/1/2022 12/1/2022 7/31/2023 4,160 1,534 137 7.5% Between week 19, 2022 and week 31, 2023, 4 160 suspected cases of diphtheria were reported from 27 states in Nigeria. Kano (3 233), Yobe (477), and Katsina (132) States have reported the most cases. A total of 137 deaths were recorded among confirmed cases (CFR 7.5%). Of suspected cases, 1 534 were confirmed, including 87 laboratory- confirmed, 158 epidemiologically linked, and 1 289 clinically compatible. Nigeria Lassa Fever Ungraded 1/8/2023 1/1/2023 9/17/2023 7,352 1,068 181 - In week 37, 2023, Nigeria recorded 79 cases of Lassa fever, with zero deaths. From week 1 to week 37, a cumulative total of 7 352 suspected cases were reported across 28 states and 112 local government areas. Among these cases, 1 068 were confirmed, and 181 are deaths (CFR 16.9%). The states of Ondo, Edo, and Bauchi account for 75% of all confirmed cases. Nigeria Mpox Protracted 2 1/31/2022 1/1/2022 7/9/2023 843 843 9 1.1% From 1 January to 9 July 2023, Nigeria has reported 843 monkeypox confirmed cases with nine deaths (CFR 1.1%). Nigeria Poliomyelitis (cVDPV2) Grade 2 6/1/2018 1/1/2022 10/25/2023 74 67 - - No cVDPV2 case was reported this week. There have been 26 cVDPV2 cases reported this year and 48 cases in 2022. Rwanda COVID-19 Protracted 3 3/14/2020 3/14/2020 2/26/2023 133,194 133,194 1468 1.1% The Rwanda Ministry of Health announced the confirmation of the first COVD-19 case on 14 March 2020. As of 26 February 2023, a total of 133 194 cases with 1 468 deaths and 131 647 recovered cases have been reported in the country. Sao Tome and Principe COVID-19 Protracted 3 4/7/2020 4/6/2020 10/23/2023 6,599 6,599 80 - On 6 April 2020, the Ministry of Health of Sao Tome and Principe reported the country’s first case of COVID-19. As of 18 October 2023, a total of 6 599 confirmed cases of COVID-19 have been reported, including 80 deaths. A total of 6 519 cases have been reported as recoveries. Senegal Chikungunya Ungraded 6/8/2023 6/8/2023 10/1/2023 230 230 0 0.0% On 24 July 2023, the Institut Pasteur in Dakar reported an IgM-confirmed case of Chikungunya from the Sokone district. As of 1 October 2023, there were 230 confirmed cases from six regions, with Kedougou (164) and Tambacounda (60) being the most affected. Senegal COVID-19 Protracted 3 3/2/2020 3/2/2020 4/28/2023 88,997 88,997 1971 2.2% From 2 March 2020 to 28 April 2023, a total of 88 997 confirmed cases of COVID-19 including 1 971 deaths and 87 024 recoveries have been reported in Senegal. Senegal Dengue Ungraded 11/14/2022 1/1/2023 10/1/2023 55 55 0 0.0% A total of 55 dengue confirmed cases have been reported in 15 districts of Senegal from week 1 to week 39 of 2023. The majority of cases have been reported from Thilogne (38; 69.1%) and Pikine (4; 7.3%) districts. Senegal Measles Ungraded 7/4/2022 1/1/2023 10/1/2023 467 467 0 0.0% From epidemic week 1 to 39 of 2023 (ending 1 October 2023), 467 confirmed cases of measles with no deaths were reported in Senegal. Seychelles COVID-19 Protracted 3 3/14/2020 3/14/2020 2/28/2023 50,937 50,937 172 0.3% Since the first COVID-19 confirmed cases were reported in Seychelles on 14 March 2020 as of 28 February 2023, a total of 50 937 cases have been confirmed, including 50 750 recoveries and 172 deaths have been reported. Sierra Leone COVID-19 Protracted 3 3/31/2020 3/27/2020 9/21/2023 7636 7,636 126 1.7% On 31 March 2020, Sierra Leone reported the first confirmed COVID-19 case in the country. As of week 38, 2023, 7 636 cases, 126 deaths, CFR (1.7%). Since the beginning of 2023 there have been six confirmed COVID 19 cases. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment WEEKLY BULLETIN ON OUTBREAKS AND OTHER WEEK 46: 13 - 19 NOVEMBER 2023 16 South Africa COVID-19 Protracted 3 3/5/2020 3/5/2020 4/24/2023 4,072,533 4,072,533 102,595 2.5% Since the start of the COVID-19 pandemic in South Africa through 24 April 2023, a cumulative total of 4 072 533 confirmed cases and 102 595 deaths have been reported. South Africa Diphtheria Grade 2 11/9/2023 11/8/2023 11/9/2023 11 9 1 9.1% On 9 November 2023, health authorities of South Africa declared diphtheria outbreak at the Pollsmoor Correctional Centre in the Western Cape Province following a confirmation through culture laboratory testing on 2 November of the disease in a 19-year-old male inmate who died on 5 November 2023. Investigations detected 55 inmates as close contacts. Of them, eight were positive. Two staff members displayed symptoms compatible with diphtheria and have received treatment whilst waiting for their laboratory test results. Cumulatively, 11 cases including nine confirmed and one death are reported so far from this Correctional Centre as of 8 November 2023. South Africa Measles Ungraded 10/17/2022 10/13/2022 10/2/2023 7,054 1,199 0 - From 8 October 2022 to 2 October 2023, a total of 1 199 laboratory-confirmed cases were reported from eight provinces with declared measles outbreaks in Limpopo (524 cases), Mpumalanga (119 cases), North West (222 cases), Gauteng (217 cases), Free State (35 cases), Western Cape (19), KwaZulu-Natal (47) and Northern Cape (7). South Sudan Food insecurity (Horn of Africa crisis) Grade 3 12/18/2020 4/5/2021 11/20/2023 - - - - Approximately 5.83 million people, almost half of South Sudan’s population (46 %) , are experiencing high levels of acute food insecurity classified as IPC Phase 3 or above (Crisis or worse) between September to November 2023. In the harvest/post-harvest projection period of December 2023 to March 2024, the situation is projected to improve marginally as a result of reduced intensity of climatic shocks South Sudan Humanitarian crisis Protracted 3 8/15/2016 8/15/2016 10/3/2023 - - - - The number of people in need of humanitarian assistance is estimated to be 9.4 million this year in South Sudan according to the humanitarian community. With the ongoing conflict in Sudan, as of 29 September, 291 224 individuals have been recorded at border crossing into South Sudan since the fighting in Sudan erupted on 15 April 2023. South Sudan COVID-19 Protracted 3 4/5/2020 4/5/2020 10/4/2023 18,368 18,368 138 - On 5 April 2020, the Ministry of Health of South Sudan reported the country’s first case of COVID-19. As of 4 October 2023, a total of 18 368 confirmed COVID-19 cases were reported in the country including 138 deaths South Sudan Hepatitis E Ungraded 1/3/2018 1/1/2019 8/27/2023 4,253 1,517 27 - The current outbreak in the Bentiu IDP camp is ongoing. In 2023, 326 cases of AJS have been reported, of which 28 tested positive for HEV by RDT. As of 27 August 2023, a total of 4 253 cases of acute jaundice syndrome (AJS) including 27 deaths (CFR 0.7%) have been reported since January 2019. South Sudan Measles Ungraded 2/23/2022 1/1/2023 10/29/2023 6,957 521 150 - In 2023, from week 1 through week 43 (ending 29 October ) a total of 6 957 with 150 related deaths have been reported with a CFR of 2.2% . About 65% of cases are in children less than five years of age with 76.6% of all related deaths. Tanzania, United Republic of Cholera Grade 3 10/3/2023 9/7/2023 11/10/2023 638 53 15 2.4% On 3 October 2023, WHO was notified about a Cholera outbreak affecting three regions of Tanzania Mainland: Mara, bordering Kenya, Arusha and Kigoma. As of 10 November 2023, a total of 638 cases including 15 deaths (CFR 2.4%) were reported from thirteen districts of Mara, Kigoma, Arusha, Kilimanjaro, Singida, Simiyu and Dodoma regions. Three cases were admitted in Singida (1) and Dodoma (2). Of the 72 samples tested by culture, 53 showed growth of Vibrio cholerae. Women account for 54.1% (345) of cases, and 43.3% (280) of cases are aged between 15 and 44 years. Tanzania, United Republic of COVID-19 Protracted 3 3/16/2020 3/16/2020 10/23/2023 43,078 43,078 846 - 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 18 October 2023, a total of 43 078 confirmed cases have been reported in Tanzania Mainland including 846 deaths. Tanzania, United Republic of Poliomyelitis (cVDPV2) Grade 2 7/19/2023 7/17/2023 9/21/2023 3 1 0 0.0% 2 new cVDPV2 cases was reported in week 35. 3 suspected cases have been reported cummulatively. Togo COVID-19 Protracted 3 3/6/2020 3/1/2020 5/3/2023 39,483 39,483 290 - 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 3 May 2023, a total of 39 483 cases, including 290 deaths and 39 178 recovered cases, have been reported in the country. Togo Poliomyelitis (cVDPV2) Grade 2 10/18/2019 9/13/2019 10/26/2023 19 19 0 0.0% No cVDPV2 case was reported this week. There were two cases reported in 2022. No cases were reported in 2021. There were nine cases in 2020, while the total number of cVDPV2 cases reported in 2019 remains at eight. Uganda Food insecurity (Horn of Africa crisis) Grade 3 2/17/2022 1/1/2022 11/20/2023 - - - - In the Karamoja region of Uganda, it is anticipated that the food security situation will slightly improve in the projection period (September 2023 – February 2024), with the population in IPC Phase 3 or above reducing from 582,000 people (45%) to 342,000 (27%). About 48,000 people (4% of the population analysed) will be in IPC Phase 4 (Emergency) and 293,000 people (23% of the population analysed) will be in IPC Phase 3 (Crisis). The districts of Abim, Amudat, Karenga and Nakapiripirit are projected to improve from IPC Phase 3 (Crisis) to Phase 2 (Stressed), whereas the rest will remain in IPC Phase 3 (Crisis) through the projection period Uganda Cholera Grade 3 7/25/2023 7/25/2023 9/14/2023 80 31 10 12.5% Cholera outbreak was officially confirmed on 25 July, 2023 after three samples turned positive for cholera in Uganda. The four samples were collected from suspected cholera cases from Sigulu Islands, Namayingo district. Cumulatively, 81 cases of cholera with 10 deaths have been reported as of 14 September 2023. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment WEEKLY BULLETIN ON OUTBREAKS AND OTHER WEEK 46: 13 - 19 NOVEMBER 2023 17 †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. Uganda COVID-19 Protracted 3 3/21/2020 3/21/2020 8/28/2023 171,843 171,843 3,632 - The first COVID-19 confirmed case was reported in Uganda on 21 March 2020. As of 28 August 2023, a total of 171 843 confirmed COVID-19 cases with 3 632 deaths were reported. Uganda Malaria Ungraded 6/5/2023 7/2/2023 10/1/2023 - - - Malaria outbreak is still ongoing in Uganda. The districts of Tororo, Bugiri, Butaleja, Budaka, Pallisa, Namutumba and Butebo, Kumi and Alebtong, have seen cases drop to below epidemic thresholds following several interventions. During the last reporting period (week 39), a total of 194 226 cases and 18 deaths have been reported and only three districts are now in outbreak. Uganda Meales Ungraded 10/4/2023 9/28/2023 11/1/2023 78 14 0 0.0% The Ministry of Health declared a measles outbreak on 28 September 2023 following confirmation of suspected measles cases at the Uganda Virus Research Institute (UVRI) from Panyadoli Health Center IV in Kiryandongo District. As of 1 November 2023, 78 suspected cases with 14 confirmed cases and no deaths have been reported. Uganda Rift Valley fever (RVF) Ungraded 9/25/2023 1/1/2023 9/10/2023 181 53 13 7.2% Between week 1 and week 36 (week ending 10 September 2023), a total of 181 suspected cases of RVF including 53 confirmed and 13 deaths (CFR 7.2%) were reported from Kabale, Rubanda, Mbarara, Isingiro, Bushenyi, Nakaseke, Kazo and Kakumiro districts. In week 36, districts with active human RVF outbreaks were Kakumiro, Mbarara and Nakaseke dictricts. The last RVF case from Kakumiro district was confirmed on 4 September 2023. Zambia Anthrax Ungraded 11/1/2023 10/12/2022 10/31/2023 337 4 1.2% On 1 November 2023, WHO was notified of a human anthrax outbreak in Zambia. The first cases were recorded in the Sinazongwe district of Southern province in October 2022. Between 12 October 2022 and 31 October 2023, a total of 337 cases and 4 deaths (CFR 1.2%) were reported from six provinces; Southern, Western, Eastern, Lusaka, Northwestern, and Muchinga provinces. Zambia Cholera Grade 3 1/24/2023 1/20/2023 9/10/2023 887 329 19 2.1% Cumulatively, 887 cases from eight districts; Mpulungu, Vubwi, Nsama, Nchelenge, Mwansabombwe, Chipata, Chipangali and Lusangazi. A total of 19 deaths have been reported. Zambia COVID-19 Protracted 3 3/18/2020 3/18/2020 5/11/2023 343,995 343,995 4,058 - The first COVID-19 confirmed case was reported in Zambia on 18 March 2020. As of 11 May 2023, a total of 343 995 confirmed COVID-19 cases were reported in the country including 4 058 deaths. Zambia Measles Ungraded 6/13/2022 6/13/2022 8/12/2023 3,715 367 31 - A measles outbreak continues to evolve in Lusaka, North-western and Southern provinces affecting several districts. Cumulatively, the provinces have recorded 3 715 measles cases and 31 deaths as of 12 August 2023. Zimbabwe Cholera Grade 3 2/12/2023 2/12/2023 10/1/2023 4,472 930 125 - The first cholera outbreak in the country in 2023 started on the 12 February 2023. Cumulatively there were 4 472 cholera cases with 125 deaths (CFR 2.8%) as of 2 October 2023. All of the ten provinces are affected with majority of the cases reported from Manicaland, Harare, Mash West and Mash Cent provinces. Zimbabwe COVID-19 Protracted 3 3/20/2020 3/20/2020 7/25/2023 265,731 265,731 5,714 - The first COVID-19 confirmed case was reported in Zimbabwe on 20 March 2020. As of 25 August 2023, a total of 265 731 confirmed COVID-19 cases were reported in the country including 5 714 deaths. © 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 Etien Luc Koua Programme Area Manager, Health Emergency Information and Risk Assessment Programme. 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. Health Emergency Information and Risk Assessment AFRO Contributors G. Sie Williams J. Nguna A.J. Mischael D. Gianni-Ferrari K. Freddy Kavoga F. Sarah Dansowaa R. Mangoza Zaza G. Akpan C. Okot WCO Contributors • Joseph WAMALA (South Africa) • Christian DOUBA (Cameroon) • Nicole MBARGA (Cameroon) • Stéphane TEWO (Chad) • Jorge CASTILLA ECHENIQUE (Chad) Editorial Advisory Group Dr Salam Gueye, Regional Emergency Director E. Koua D. Chamla F. Braka 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. Health Emergency Information and Risk Assessment AFRO Contributors G. Sie Williams J. Nguna A.J. Mischael D. Gianni-Ferrari K. Freddy Kavoga F. Sarah Dansowaa R. Mangoza Zaza G. Akpan C. Okot WCO Contributors • Joseph WAMALA (South Africa) • Christian DOUBA (Cameroon) • Nicole MBARGA (Cameroon) • Stéphane TEWO (Chad) • Jorge CASTILLA ECHENIQUE (Chad) Editorial Advisory Group Dr Salam Gueye, Regional Emergency Director E. Koua D. Chamla F. Braka 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.