Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 1 Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment This Weekly Bulletin focuses on selected acute public health emergencies occurring in the WHO African Region. The WHO Health Emergencies Programme is currently monitoring 68 events in the region. This week’s edition covers key ongoing events, including: Cyclone Kenneth in Comoros and Mozambique Ebola virus disease in Democratic Republic of the Congo Measles in Nigeria Humanitarian crisis in Mali. 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 largely been controlled and thus closed. Major issues and challenges include: Tropical Cyclone Kenneth has hit the Comoros Islands and parts of Mozambique, barely weeks after tropical Cyclone Idai devastated Mozambique, as well as Malawi and Zimbabwe. While the death toll and injuries have been relatively low, damage to physical infrastructure, crops and livestock were significant, impacting on the livelihoods of the affected communities. The immediate humanitarian needs include ensuring access to the affected people, relocation of displaced families and provision of shelter, food, potable water and healthcare services, as well as restoration of electricity and communication. The Ebola virus disease (EVD) outbreak in Democratic Republic of the Congo continues, with increasing incidence. This recent rise in the number of new cases could be partly attributed to the disruption of response interventions following the latest spate of insecurity, including the attacks on the response teams, and continuing pockets of community mistrust. The response teams are beginning to restore full operations in all outbreak affected areas and hope to halt this trend. Overview New event Ongoing events Summary of major issues, challenges and proposed actions All events currently being monitored 2 Contents Overview 7 3 4 - 6 8 Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 3 EVENT DESCRIPTION On 23 April 2019, a tropical storm north of Madagascar strengthened into tropical Cyclone Kenneth, whose path passed over the northern tip of the Comoros Islands and northern Mozambique. In the Comoros Islands, the tropical cyclone hit the northern Ngazidja Island during the night of 24 April 2019, with violent winds and torrential rains. Reports from the national authorities indicate that four deaths occurred in Grande Comore Island, with 182 injuries. A total of 41 161 people have been affected, of whom 14 541 were displaced. More than 10 800 houses were destroyed, including 3 818 completely damaged and 7 013 houses partially destroyed. There was significant crop loss, with an estimated 63% of food crops, 35% of cash crops and 34% of fruit trees destroyed. At least 628 cattle, 222 sheep and 770 goats were reported killed. Schools and many water tanks were also damaged, and the country’s electricity grid was damaged, leaving most people without power and impacting access to healthcare. In Mozambique, tropical Cyclone Kenneth made landfall in the evening of 25 April 2019 between the districts of Macomia and Mocimboa da Praia, in Cabo Delgado Province. A rapid aerial assessment showed that Ibo, Macomia and Quissanga districts in Cabo Delgado were particularly hard-hit. Islands in Ibo District suffered extensive damage, with nearly all homes on Matemo island destroyed. Five people were reported dead and 11 injured. More than 35 100 houses were damaged, with 3 805 totally destroyed and 31 305 partially destroyed. As of 27 April 2019, 23 760 people across eight districts were displaced in 39 temporary reception centers. Five health facilities were reportedly damaged, including the maternity ward in the Macomia Hospital. At least 75 classrooms were destroyed or damaged, impacting 3 909 learners. Electricity on Ibo island was cut off and phone communications severed for most of the island’s inhabitants. The weather system caused by Cyclone Kenneth continues to hang over Cabo Delgado Province in Mozambique. Consequently, torrential rains have been falling in and around Pemba from 27 to 28 April 2019, causing flash and riverine flooding on 28 April 2019, including in the nearby area of Mieze. PUBLIC HEALTH ACTIONS In Comoros, the National Disaster Agency activated its National Contingency Plan, with the establishment of a fixed command post within the General Directorate of Civil Security (DGSC). Multi- sectoral rapid assessments are being carried out by the government (with the support of UN and partners) to ascertain the extent of the impact of the cyclone. The National Red Cross is in the field; funding and kits are being provided by WHO, UNICEF, and UNFPA. WHO has deployed three technical experts to Comoros to support the response efforts. About 125 civil security personnel were deployed on the ground on the evening of April 24, 2019 to support and assure the security and safety of populations. In Mozambique, at least 30 000 people were evacuated from areas at highest risk. A response plan is being developed by affected provinces, with the WFP, IOM and UNICEF deploying people in the field and WHO prepositioning staff within the next 24 hours. On 28 April 2019, Brazilian search and rescue teams rescued at least 350 people in the Natite, Chiguaguare, Mieze, Jozina Machel and Paquitequete neighborhoods in Pemba. On 28 April 2019, a truckload of medical supplies from Beira arrived in Pemba to provide essential medicines. Go to overview Go to map of the outbreaks SITUATION INTERPRETATION Tropical Cyclone Kenneth, which hit the Comoros Islands and parts of Mozambique, caused significant physical and infrastructural damage in both countries. Currently, there are urgent needs for shelter, clean water, sanitation and hygiene kits, food and non-food items, power generation and telecommunication equipment. A major new humanitarian operation is required in areas affected by tropical cyclone Kenneth, at a time when the ongoing response to Cyclone Idai (targeting three million people in three countries) remain critically underfunded. The humanitarian and development partners, and the donor communities are requested, once again, to support these efforts to prevent the disaster becoming even worse for already vulnerable populations. Geographical location of the impact of tropical cyclone Kenneth in Comoros and Mozambique, 25 April 2019. 157 Cyclone Kenneth Comoros and Mozambique New event Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 4 EVENT DESCRIPTION The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces, Democratic Republic of the Congo continues, with Katwa Health Zone still the main hot spot in the past 21 days. Since the last report on 21 April 2019 (Weekly Bulletin 16), 103 new confirmed EVD cases have been reported, with an additional 60 deaths. As of 27 April 2019, a total of 1 439 EVD cases, including 1 373 confirmed and 66 probable cases have been reported. To date, confirmed cases have been reported from 21 health zones: Beni (258), Biena (7), Butembo (139), Kalunguta (59), Katwa (470), Kayna (7), Kyondo (17), Mabalako (105), Mangurujipa (5), Masereka (33), Musienene (18), Mutwanga (4), Oicha (40), Vuhovi (78) and Lubero (4) in North Kivu Province; and Rwampara (1), Komanda (28), Mandima (88), Nyankunde (1), and Tchomia (2) in Ituri Province. As of 27 April 2019, the number of health areas reporting at least one confirmed case in the last 21 days (6-27 April 2019) is 13. A total of 930 deaths were recorded, including 864 among confirmed cases, resulting in a case fatality ratio among confirmed cases of 63% (864/1 373). The cumulative number of health workers infected is 92, with 33 deaths. Katwa is still the main focus of the outbreak, reporting 46% (129/280) of all confirmed cases in the past 21 days. As of 27 April 2019, all 18 health areas in this health zone reported at least one confirmed case in this period, while Butembo, Mandima and Vuhovi have reported 30% of new confirmed cases in this time. Ten health zones, namely Kalunguta, Komanda, Vuhovi, Beni, Biena, Butembo, Katwa, Mabalako, Mandima and Musienene have notified new confirmed cases in the past three days and are points of attention. Contact tracing is ongoing in 15 health zones, with contact tracing and registration of alerts resuming in the Butembo coordination area. A total of 11 841 contacts were recorded on 27 April 2019, of which 9 795 have been seen in the past 24 hours (83%; varies between 62-100% among reporting zones). Of 1 026 alerts processed (of which 972 were new) in reporting health zones, 934 (91%). Of the 922 alerts investigated, 176 (26%) were validated as suspected cases, with 69 deaths. PUBLIC HEALTH ACTIONS Surveillance activities continue, including case investigations, active case finding in health facilities and communities, and identification and listing of contacts around the latest confirmed cases. Collaboration between health authorities in the Democratic Republic of the Congo and Uganda continues around monitoring displaced contacts. As of 27 April 2019, a cumulative total of 106 872 people has been vaccinated since the start of the outbreak. Point of Entry/Point of Control (PoE/PoC) screening continues, with over 53 million screenings to date. A total of 72/80 (90%) PoE/PoC were operational as of 27 April 2019. There are continued community reintegration and psychosocial activities for patients discharged from ETCs, along with psychoeducation sessions to strengthen community engagement and collaboration in the response. Infection prevention and control (IPC) and water, sanitation and hygiene (WASH) activities continue with decontamination of households where confirmed cases had stayed in Beni, Butembo, Katwa, Musienene, Mandima, Mabalako and Biena. Community awareness and mobilization sessions are being strengthened, with sensitization of representatives of Vuaghala village on the risks associated with EVD and commitment to the management of community incidents in Vuhovi Health Zone; more than 1 500 grassroots leaders have been provided with awareness of EVD prevention and response and community incident management at the Walse Vonkutu Chief Administrative Office inauguration ceremony; chiefs in Beni were involved in a work session to solicit their support in response activities, while further community engagement activities took place in Beni and Komanda around cured patients and ETCs. Go to overview Go to map of the outbreaks SITUATION INTERPRETATION The increasing number of new EVD cases in the Democratic Republic of the Congo is deeply concerning. However, geographic spread is still limited to two provinces and there is no spread to neighbouring countries. There is deepening commitment to strengthening community engagement, seen as one of the main drivers of this continued transmission. This outbreak remains one of the most challenging ever in terms of the situation on the ground, calling for extraordinary response measures. All national and local authorities and partners are committed to this response. Continued implementation of public health measures, along with strengthened community engagement, will ultimately bring this outbreak to a close. Geographical distribution of confirmed and probable Ebola virus disease cases reported from 1 May 2018 to 27 April 2019, North Kivu and Ituri provinces, Democratic Republic of the Congo. 157 Ebola virus disease Democratic Republic of the Congo 1 439 Cases 930 65% Deaths CFR Ongoing events Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 5 EVENT DESCRIPTION Nigeria has been experiencing an increasing number of measles cases since the beginning of the year. The increase in measles cases across the country intensified in early March 2019, prompting the activation of the national measles Emergency Operations Centre (EOC) to enhance response efforts. In week 15 (week ending 14 April 2019), a total of 1 925 suspected measles cases, with 11 deaths (case fatality ratio 0.6%), were recorded across 31 states. Borno State in northeast Nigeria was the most affected, having reported 958 suspected cases, constituting about 50% of the total cases reported across the country during the week. Since the disease trend peaked in week 12 (week ending 24 March 2019) when 2 567 cases were reported, there has been a slight decline in the weekly number of cases. From 1 January to 14 April 2019, a cumulative total of 20 127 cases with 50 deaths (CFR 0.25%) have been recorded from 621 Local Government Areas (LGAs) across 36 states and the Federal Capital Territory (FCT). Of 4 338 samples tested, 819 were laboratory-confirmed (IgM-positive) for measles infection. Borno and Katsina states are the most affected constituting 48.4% and 13.3% of the cumulative cases, respectively. Further review of the epidemiological situation is being carried out and additional information on this outbreak will be provided. PUBLIC HEALTH ACTIONS Since week 9 (week ending 3 March 2019), a multi-agency national Emergency Operations Centre (EOC) was activated by the national authorities and continues to coordinate response to the measles outbreaks across the country, with support from WHO and partners. A national measles outbreak action plan has been developed to guide response actions. Two phases of measles reactive vaccination campaigns targeting children aged six months to nine years have been conducted in selected LGAs in Borno State. Measles reactive campaigns are also being planned for in Katsina and Yobe states. Three sub-regional in-country laboratories are supporting testing of measles samples across the country. Rapid response teams (RRT) have been deployed to affected states to support response efforts, including strengthening surveillance, case management, reactive vaccination and other field-based activities. Intensified surveillance is ongoing in all states and case-based data including line lists are being transmitted to the national level on a weekly basis. SITUATION INTERPRETATION The measles outbreak in Nigeria is occurring at a time when there is a global rise in measles cases. The high incidence and recurrent outbreaks of measles are linked to sub-optimal immunization coverage. With several years of low immunization coverage, large numbers of susceptible people have accumulated in the population, leading to the recurrent measles outbreaks. There is a need to adapt strategies aimed at enhancing immunization uptake and utilization across Nigeria (and all the countries in the region) through engaging communities and strengthening outreach programmes targeting hard- to-reach and inaccessible populations. These efforts are critical in mitigating the current outbreaks of measles and its impact on the population. Go to overview Go to map of the outbreaks Geographical distribution of measles cases and deaths in Nigeria, 1 January – 14 April 2019. 157 Measles Nigeria 20 127 Cases 50 0.25% Deaths CFR Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 6 Humanitarian Snapshot in Mali, January 2019 EVENT DESCRIPTION Mali continues to endure a protracted humanitarian emergency in the Northern and Central regions of the country, arising from dual political and security crises since January 2012. Nearly 500 000 people have been displaced since then. To date, the International Organization for Migration (IOM) estimates that 99 039 individuals in 20 206 households are displaced, mainly from Timbuktu, Gao, Ménaka, and Segou. In the latest security incident on 23 March 2019, at least 160 persons were killed in Ogossadou, Mopti Region, with 65 wounded, including 35 seriously injured. Over 410 houses and 80 granaries were burnt; while 850 people in 124 households were displaced as a result of the inter-ethnic conflict. Acts of retaliation have already been registered, with six civilians killed between 25 and 26 March 2019. This recent incident led to a political crisis, with the resignation of the Prime Minister. The new government is not yet in place. Health needs are high as access to health services is poor and disease epidemics pose a major risk. Measles epidemics have been reported in 19 districts out of 75. Since the beginning of the year, 42 health districts have registered at least one confirmed case of measles. The Koulikoro region recorded nearly 38% of all confirmed measles cases, followed by Segou region (16%) and Kayes (15%). In addition, malnutrition is high, with a global acute malnutrition rate of 10% and severe acute malnutrition rate of 2%. The situation is reported to be worst in Timbuktu, Gao, Menaka, Segou and Bamako regions. PUBLIC HEALTH ACTIONS On 26 March 2019, a joint rapid assessment mission was carried out in Ogossagou, Bankass District following the inter-ethnic attack on 23 March 2019. WHO has deployed 30 field medical officers to provide technical support to the regions and their partners to strengthen health information management, health/nutrition sub-cluster coordination, health and humanitarian operations, and eradication of poliomyelitis in Mali. Other partners such as UNICEF are working with WHO to strengthen responses to the measles outbreak, malnutrition and HIV/AIDS. International Medical Corps (IMC) conducted a rapid assessment of mental health needs and psychosocial support (SMSPS) in four regions of Mali from December 2018 - January 2019. SITUATION INTERPRETATION The humanitarian situation in Mali continues to worsen as insecurity and political crises prevail. The absence of civil administration and security apparatus in some areas has weakened the rule of law and increased the vulnerability of the populations to all forms of violence. This vacuum has also impacted on the provision of basic social services and disrupted economic and trade activities. These, in addition to limited access to farmlands, have markedly affected the livelihoods of the communities. The response to the humanitarian situation is also being complicated by underfunding. In 2019, about 1.4 million people have been targeted for humanitarian health assistance. However, of the US$ 12.9 million requested for (as part of the Humanitarian Response Plan 2019), only 13% has been funded in the first quarter of year. Go to overview Go to map of the outbreaks 157 Humanitarian crisis Mali 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 Tropical Cyclone Kenneth has caused severe damage to physical infrastructure, crops and livestock in the Comoros islands and Mozambique. Early alerts and readiness measures taken beforehand significantly reduced the death toll and injuries to humans. There is a need to rapidly scale up humanitarian response in the affected areas in order to restore the livelihoods of the affected communities. For the health sector, the restoration of healthcare services is of utmost importance to prevent, prepare for and respond to outbreaks of communicable diseases as well as provide trauma care, psychosocial counselling and treatment of common and chronic illnesses. There has been an increase in the number of new EVD cases in Democratic Republic of the Congo in the past weeks, and the situation is deeply concerning. This rise is not unexpected and, in part, likely a result of the increased security challenges, including the recent attacks on the response teams, and pockets of community mistrust, which slowed some response activities in affected areas for a few days. Most outbreak response activities have been restored in most affected areas, and this latest trend should be reversed. Proposed actions The national authorities and partners in Comoros and Mozambique need to step up provision of immediate humanitarian aid such as water, food, non-food items, shelter, etc. The donor community are requested to provide the requisite funding for the immediate and long-term humanitarian assistance. The national authorities and partners in the Democratic Republic of the Congo need to continue implementing proven and innovative public health measures, including continued community engagement to counter the mistrust that is significantly hampering response efforts. Summary of major issues, challenges and proposed actions Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 8 Go to overview Go to map of the outbreaks All events currently being monitored by WHO AFRO Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments New Events Comoros Cyclone Kenneth Ungraded 23-Apr-19 24-Apr-19 25-Apr-19 - - - - Detailed update given above. Mozambique Cyclone Kenneth Ungraded 25-Apr-19 25-Apr-19 28-Apr-19 - - - - Detailed update given above. Ongoing Events Burkina Faso Humani-tarian crisis Ungraded 01-Jan-19 01-Jan-19 26-Apr-19 - - - - The security situation in Burkina Faso has gradually deteriorated since 2015 initially in the regions of the Sahel then in the East, and attacks by armed groups have increased and spread over several regions of the country. As of 02 April 2019, the country has registered 135 589 inter- nally displaced persons, more than half of them since the beginning of 2019. Currently, Burkina Faso is hosting a total of 25 182 refugees. Cameroon Humani- tarian crisis (Far North, North, Adamawa & East) Protract- ed 2 31-Dec-13 27-Jun-17 19-Apr-19 - - - - Cameroon continues to face a humanitarian crisis in the far North region linked to the Boko Haram group terrorist attacks, with significant displacement of the traumatized population. The Minao camp has reached a total of 57 094 refugees, which is above its capacity. Several attacks targeting both public facilities, such as schools and health facilities and private goods continue to be registered at the border between Cameroon and Nigeria. The Far North region is currently facing a measles outbreak in five districts (Kousseri, Mada, Makary, Goulfey and Koza). Cameroon Humani- tarian crisis (NW & SW) G2 01-Oct-16 27-Jun-18 19-Apr-19 - - - - The Northwest and Southwest regions crisis which started in 2016 remain a concern. Sporadic armed attacks between alleged separatist groups, the military and commu- nities continue to be reported. An attack on 4 April 2019 by Cameroo- nian security forces on Meluf village located near a separatist’s camp in North West region led to the death of five civilians. Several houses have been looted and seven burnt down. Violence in and near health facilities since late March is affecting access to health for civilians. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 9 Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments Cameroon Cholera G1 24-May-18 18-May-18 26-Apr-19 1 052 98 63 6.00% Cameroon continues to report cases of cholera in 2019. Seven new suspected cases including one death were notified by Pitoa, Garoua 1 and Garoua 2 health districts from 1 to 5 April 2019. In March 2019, additional five new confirmed cases were notified by Institut Pasteur Laboratory in Cameroon. As of 5 April 2019, a total of 1 039 suspected cases were reported. Cameroon Measles Ungraded 02-Apr-19 01-Jan-19 18-Apr-19 718 450 0 0% The measles outbreak is ongoing in Cameroon. The number of cases started increasing since the beginning of this year and peaked in epidemiological week 7, 2019 with 130 suspected cases reported. Since the beginning of the year 2019, a to- tal of 718 suspected cases, including 56 confirmed cases with laboratory test and 394 by epidemiological link were reported. The outbreak is affecting six districts, which are: Kousseri, Mada, Goulfey, Makary, Koza et Ngaoundere rural. Central African Republic Humani- tarian crisis Protract- ed 2 11-Dec-13 11-Dec-13 14-Apr-19 - - - - A total of 2 768 internal displaced persons arrived in Baboua and Beloko following military opera- tions conducted by MINUSCA at Zoukombo in the North Ouest of the country. Humanitarian actors intervening in the area had to suspend their activities for security reasons. The closure of the South Sudan border and the health district of Haut-Mbomou remain a concern for the humanitarian community. Central African Republic Hepatitis E Ungraded 02-Oct-18 10-Sep-18 21-Apr-19 187 142 1 0.50% No new suspected case of hepatitis E has been confirmed positive since epidemiological week 14 (Week ending on 14 April 2019). From 10 September 2018 to 21April 2019, a total of 187 cases of acute jaundice syndrome including 142 confirmed for viral hepatitis E have been re- ported. The age group between 5 to 45 years old is more affected. Central African Republic Measles Ungraded 15-Mar-19 11-Feb-19 31-Mar-19 151 19 2 1.30% The measles outbreak is ongoing in three health districts (Paoua, Batangafo and Vakaga) in the country. From epidemiological week 5 to week 13, a total of 151 suspected measles cases , including 19 con- firmed, were notified in Paoua (83 cases), Batangafo (5 cases), and Vak- aga( 63 cases and 1 death). About 80% of cases are under 5 years of age with a high proportion of male. Sev- eral of the cases are returnees from the outskirts of the city of Goree (Chad) in March 2019 following the opening of the borders. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 10 Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments Central African Republic Monkey- pox Ungraded 20-Mar-18 02-Mar-18 03-Mar-19 34 25 2 5.90% Three cases, including one con- firmed, were reported in Ippy in week 9 (week ending 3 March 2019). Since 2 October 2018, clusters of cases have been identified across three health districts, namely; Mbai- ki district with nine cases including eight confirmed, Bangassou district with five cases including three confirmed, and Bossembele district with four cases including three confirmed. One death was reported in Bossembele. Chad Measles Ungraded 24-May-18 01-Jan-19 27-Apr-19 12 990 0 119 0.9% In week 16 (week ending on 21 April 2019) 1 369 suspected cases including 24 deaths were reported. To date suspected measles cases have been reported from 119 out of 126 districts in the country. Currently 78 districts are reporting suspected epi- demics compared to 76 at week 1(. Chad Meningitis Ungraded 20-Mar-19 01-Jan-19 07-Apr-19 596 45 7.60% Cases of meningitis continue to be reported in two districts in Mandoul region. In week 14 (week ending on 7 April 2019), 36 new suspected cases and 1 associated death were reported. The district of Goundi was in alert phase with an AR of 8.2 and the district of Bedjondo remained in alert phase with an AR of 3.0 Congo Chikun-gunya G1 22-Jan-19 07-Jan-19 14-Apr-2019 6 149 61 0 0.00% An outbreak of chikungunya affect- ing eight departments (Kouilou, Bouenza, Pointe Noire, Plateaux, Pool and Brazaville, Niari, Lekou- mu) is on ongoing in the Republic of Congo. From 7 January to 14 April 2019, a total of 6 149 suspected cases including 61 confirmed were re- ported. Entomological investigation showed the presence of the vector, Aedes albopictus. Congo Monkey-pox Ungraded 09-Mar-19 09-Mar-19 16-Mar-19 9 2 0 0.00% The Republic of Congo is reporting cases of monkey pox since February 2019. Two samples from Makon- tipoko village in Gambona district tested in the INRB-Kinshasa turned positive for Monkey pox (PCR OPX). Côte d'Ivoire Dengue Fever Ungraded 15-Feb-19 01-Jan-19 15-Mar-19 56 11 0 0.00% The Institut Pasteur of Ivory Coast confirmed 5 positive cases of dengue fever on the 15 February 2019. As of 15 March 2019, a total of 56 suspected cases and 11 confirmed cases have been reported in nine over hundred and one districts. The Cocody-bingerville health district have reported the majority of the suspected and confirmed cases. Three cases of dengue serotype 3 and five cases of Dengue serotype 1 have been isolated during this outbreak. The age group between 15 to 44 years old is more affected (55%) and the sex ratio (F/M) is 1.5. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 11 Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments Democratic Republic of the Congo Humani- tarian crisis G3 20-Dec-16 17-Apr-17 17-Mar-19 - - - - The humanitarian situation remains complex. Attacks by unidentified assailants in North Kivu led to the suspension of MSF activities in Butembo Ebola treatment Centre. In Tanganyika province, UNPFA reports 1 127 cases of sexual vio- lence based on gender recorded in 2018. Rape represents 42% of cases, although forced marriage of children also has a high incidence, more than half of the victims are IDP's. In Kasai, there is a relative return of calm after the inter-communal tension from 24 to 26 February 2019 which disrupted humanitarian interventions. Ituri Province, Djugu Territory, 6 035 returnees need assistance. Democratic Republic of the Congo Chikun- gunya Ungraded 08-Feb-19 30-Sep-18 24-Feb-19 330 48 0 0.00% During week 8 of 2019 (week ending 24 February 2019), 17 suspected cases of chikungunya were reported in the province of Kinshasa with 12 cases in Binza Ozone Health Zone, two cases in the Police Health Zone and three cases in the health zone of Mount Ngafula 2. Democratic Republic of the Congo Cholera G3 16-Jan-15 01-Jan-19 07-Apr-19 8 522 - 206 2.40% In week 14 (week ending on 7 April 2019), 460 suspected cholera cases including 9 deaths (CFR 1.9%) were reported from 51 health zones in 13 provinces. To date 8522 suspected cases including 206 deaths (CFR 2.4%) have been reported in 18 out of 26 provinces. Most of the cases have been reported from the eastern endemic provinces (Upper Katanga, Upper Lomami, North Kivu, South Kivu, and Tanganyika). Democratic Republic of the Congo Ebola virus disease G3 31-Jul-18 11-May-18 27-Apr-19 1 439 1 373 930 65% Detailed update given above. Democratic Republic of the Congo Measles Ungraded 10-Jan-17 01-Jan-19 31-Mar-19 56 442 1 023 1.80% In week 14 (week ending on 7 April 2019), 5105 cases including 75 deaths have been reported. Since the beginning of the year, 56 442 cases including 1 023 deaths (CFR 1.81%) have been reported. Cases continue to be reported in an increasing manner. To date there are 39 health zones with confirmed epidemic. The most affected provinces are Tshopo, Lualaba, and Upper Lomami. Democratic Republic of the Congo Monkey- pox Ungraded n/a 01-Jan-19 07-Apr-19 1 059 - 26 2.50% In week 14 (week ending 7 April 2019), 91 new suspected cases including five deaths were reported. The cases of monkeypox have been confirmed in the Provincial Health Divisions of Ecuador, North Ubangi, and South Ubangi. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 12 Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments Democratic Republic of the Congo Polio- myelitis (cVDPV2) G2 15-Feb-18 n/a 24-Apr-19 45 45 0 0.00% One case of circulating vaccine-de- rived poliovirus type 2 (cVDPV2) was reported this week in the Demo- cratic Republic of the Congo (DRC) in Kamonia, Kasai State. The onset of paralysis was reported on 8 Feb- ruary 2019. This is the first cVDPV case in DRC in 2019. DRC is affect- ed now by five separate cVDPV2 outbreaks, in the provinces of Haut Katanga; Mongala, Maniema; Haut Lomami/Tanganika/Haut Katanga/ Ituri and Kasai. Ethiopia Humani-tarian crisis G2 15-Nov-15 n/a 09-Apr-19 - - - - The humanitarian crisis in Ethiopia continues with growing and cyclical waves of humanitarian emergen- cies. In mid-March 2019, a rapidly evolving situation involving IDPs was reported in West Guji and Gedeo zones of Oromia and SNNP respectively. The numbers of IDPs is fluid and increasing daily, with official government estimates of 675 737 for Gedeo and 319 822 reported from West Guji as of 31 March 2019. Across the whole country, the num- bers of IDPs is estimated at about 2.7 million. Ethiopia Measles Protract-ed 1 14-Jan-17 01-Jan-19 23-Apr-19 136 59 - - Measles outbreak is ongoing in Oro- mia and Solami regions. Vaccination campaign is being planned to target 6.7 million children aged 6 months to 14 years. Targeted populations are internally displaced populations and host communities Guinea Measles Ungraded 09-May-18 01-Jan-19 21-Apr-19 964 409 14 1.50% In week 16 (week ending on 21April 2019) 106 new suspected measles and 45 confirmed cases were report- ed. In this year there have been 964 suspected measles cases including 409 confirmed cases and 14 deaths (CFR 1.5%) have been reported. Currently there are eight localities in epidemic including the urban communes of Coyah, Dixinn, Du- bréka, Matoto, Ratoma, Fria, Matam and the sub-prefecture of Manéah (Coyah). Of the total, 59% of IgM + cases were unvaccinated and 84% of IgM + cases are children under 5 years of age. Kenya Cholera Ungraded 21-Jan-19 02-Jan-19 22-Apr-19 1 463 81 8 0.50% Since January 2019, cholera outbreak has been reported in Narok, Kajiado, Nairobi, Garissa and Machakos Counties. Narok county has con- tolled the outbreak. Kajiado, Garissa and NairobiCounty have reported a second wave of the outbreak since January 2019. As of 22 April 2019, Nairobi hospital reported a total of 65 cases, majority being staff members and students within the same institution including one death (CFR 1.5%). Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 13 Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments Kenya Dengue fever Ungraded 30-Jan-19 15-Oct-18 08-Apr-19 660 286 0 0.00% The outbreak in Mombasa County which has affected all the six sub-counties (Kisauni, Jomvu, Nyali, Likoni, Changamwe and Mvita) remains active. Total cases reported so far are 660 with 286 confirmed by PCR. However, these are likely grossly underestimated due to underreporting. Kenya Leishman-iasis Ungraded 31-Mar-19 01-Jan-19 22-Apr-19 295 127 7 2.40% A kala-azar outbreak has been reported in Marsabit and Wajir counties. Cases have been reported since the beginning of January 2019 with a peak in March 2019. Marsabit has reported 260 cases including 7 deaths with 100 positives by RDT rk39 and Wajir county has reported 35 cases with 100 positives by RDT. Kenya Measles Ungraded 03-Sep-18 28-Aug-18 08-Apr-19 418 41 5 1.20% In the past week 15 new cases were reported. Wajir county has reported a total of 269 cases, Tana River county 131 cases and Kilifi county 7 cases. In total, 418 cases including 5 deaths have been reported in 2019. Liberia Lassa fever Ungraded 23-Jan-19 01-Jan-19 14-Apr-19 22 19 7 31.80% During week 15 (week ending 14 April 2019), two suspected cases were reported from Grand Bassa and Montserrado Counties. Test results are pending. Since the beginning of the year, 54 suspected cases have been reported across the country, of which 19 tested positive by RT-PCR while 32 were discarded due to nega- tive test results and three pending testing. Liberia Measles Ungraded 24-Sep-17 01-Jan-19 14-Apr-19 748 65 5 0.70% In week 15 (week ending 14 April 2019), 34 suspected cases were reported from 11 out of 15 counties across the country. Since the beginning of 2019, 748 cases have been reported across the country, of which 65 are laboratory-con- firmed, 69 are epi-linked, and 386 are clinically confirmed. Sanoyea and Fuamah Districts, Bong County, Firestone District, Margibi County and Kolahun and Voinjama Dis- tricts, Lofa County are currently in outbreak phase Madagascar Measles G2 26-Oct-18 03-Sep-18 18-Apr-19 135 067 884 0.70% In week 15 (week ending on 14 April 2019), 245 cases were reported, a significant decrease compared to the previous week 14 (week ending 7 April) when 1 284 cases were reported. The general trend has been decreasing over the last four weeks. 12 out of 15 samples tested positive for IgM during week 15. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 14 Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments Malawi Flood G2 09-Mar-19 05-Mar-19 14-Apr-19 - - - - Tropical Cyclone which formed in the Mozambique Channel, drifted to Malawi on 5 March 2019 causing heavy persistent rains accompanied by strong winds leading to heavy flooding in Southern Malawi. a total of 15 districts and two cities were af- fected. As of 12 April 2019, a total of 868 895 people have been affected, 86 796 were displaced and living in 173 camps, 672 were injured, 59 died and 3 were missing. Mali Humani-tarian crisis Protract- ed 1 n/a n/a 31-Mar-19 - - - - Detailed update given above. Mali Measles Ungraded 20-Feb-18 01-Jan-19 14-Apr-19 708 249 0 0.00% Between epi week 1 and 15 (week ending 14 April 2019), 708 suspect- ed measles cases have been reported, including 249 IgM positive cases. Outbreak response activities con- tinues to be implemented including investigation and case management, continued epidemiological surveil- lance, public awareness of disease prevention measures. Mauritius Dengue fever Ungraded 26-Feb-19 26-Feb-19 25-Apr-19 106 106 0 0.00% The dengue fever outbreak is ongo- ing in Mauritius. From 26 February 2019 to 25 April 2019, a total of 109 cases (including 4 imported cases) have been reported. The district of Port Louis recorded the highest number of locally transmitted cases of dengue (94) followed by Plaines Wilhems (5), Pamplemousses (2) and Savanne (1). A peak was observed on 23 April 2019 (15 cases) with an overall decreasing trend since then to last reporting date. There had been four imported cases of dengue, one from India and three from Reunion Island. Public health response activities are ongoing in affected areas. Mauritius Measles Ungraded 23-May-18 19-Mar-18 21-Apr-19 1 469 1 469 4 0.30% During week 16 (week ending 21 April 2019), zero new confirmed cases were reported across the country. From 21 March 2018 to 21 April 2019, a total of 1 449 laborato- ry-confirmed cases were reported. Of 17 throat swabs analyzed, the genotype D8 was detected in 13 samples. The trend is decreasing since the peak in week 24 of 2018. The most affected districts are Port Louis and Black River. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 15 Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments Mozambique Cholera Ungraded 27-Mar-19 27-Mar-19 18-Apr-19 6 385 - 8 0.10% In week 15 (from 8 to 14 April 2019), a total of 2 315 cases and 2 deaths were reported. Beira district continued to be the most affected district with an overall attack rate of 909 cases per 100 000 population. Since the declaration of the cholera outbreak on 27 March 2019, and up to 18 April 2019, 6 382 cases and eight deaths were reported (CFR 0.1%). These cases were reported from the four districts (Beira, Buzi, Dondo and Nhamatanda) of Sofala Province originally affected by this outbreak. Of 4 402 cases for which gender was reported, 51% were male. Mozambique Flood/cy-clone G3 15-Mar-19 15-Mar-19 13-Apr-19 - - - - As of 13 April 2019, the official death toll remained at 602 people and the number of houses destroyed remained at 239 732, with 50% of them, totally destroyed and the number of displaced people in col- lective sites remained at 73 296. The screening for malnutrition in more than 2 100 children (6-59 months) as of 13 April 2019 showed that 62 children had severe acute malnu- trition and 131 had moderate acute malnutrition Mozambique Polio- myelitis (cVDPV2) G2 07-Dec-18 07-Dec-18 24-Apr-19 2 2 0 0.00% No new case of circulating vac- cine-derived poliovirus type 2 (cVD- PV2) has been reported this week. One circulating vaccine-derived poliovirus type 2 (cVDPV2) isolate was detected, from an acute flaccid paralysis (AFP) case (with onset of paralysis on 21 October 2018, in a six-year old girl with no history of vaccination, from Molumbo district, Zambezia province), and two isolated from a community contact of the case reported on 10 and 17 December 2018. (source: GPEI) Namibia Hepatitis E G1 18-Dec-17 08-Sep-17 14-Apr-19 5 014 871 42 0.80% During week 15 (week ending 14 April 2019), 39 suspected cases with zero deaths, were reported from three regions across the country, namely; Khomas (21), Erongo (13), and Omusati(5). This is a slight decrease compared to the previous two weeks when a total of 47 sus- pected cases were reported. Of the cumulative 5 014 cases, 288 (5.7%) are among pregnant and post-par- tum women. A total of 20 deaths have been reported among maternal cases. Khomas Region remains the most affected region, reporting 67% of HEV cases country-wide, followed by Erongo 23%. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 16 Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments Niger Humani-tarian crisis Protract- ed 1 01-Feb-15 01-Feb-15 04-Apr-19 - - - - The security situation in Diffa continues to worsen following Boko Haram attacks in that region. A total of 15 000 people from the villages of Gueskerou and Chetimari were newly displaced in Diffa region due to the increasing number of attacks against civilians by Boko Haram. In March alone, 20 attacks were regis- tered leading to the death of at least 90 civilians. Humanitarian needs in the affected area include shelter, food, health and protection. Nigeria Humani-tarian crisis Protract- ed 3 10-Oct-16 n/a 31-Mar-19 - - - - The humanitarian crisis in the Northeastern part of Nigeria persists with continued population displace- ment from security-compromised areas characterized by overcrowded population in many camps in the region.The number of measles cases being reported also remains high. A vaccination campaign was conducted in February to respond to the increased number of cases of measles reported over the recent months. Nigeria Lassa fever G2 24-Mar-15 01-Jan-19 14-Apr-19 555 540 137 24.70% In reporting week 15 (week ending on 14 April 2019), three new con- firmed cases were reported from two states - Edo (1) and Plateau (2) with zero new deaths. This is the lowest number of cases reported since the beginning of the year following a gradual decline in the weekly num- ber of cases since week 10. A total of 1 162 contacts are currently under follow-up across 20 states. Nigeria Measles Ungraded 25-Sep-17 01-Jan-19 20-Apr-19 20 127 819 50 0.20% Detailed update given above. Nigeria Monkey-pox Ungraded 26-Sep-17 24-Sep-17 31-Mar-19 328 132 7 2.10% The outbreak is ongoing in the country with five new cases reported in week 14 (week ending on 7 April 2019). In total, 23 suspected cases have been reported in 2019 from 13 LGAs across 9 ststes. Ten cases were laboratory confirmed from 5 LGAs in 4 states. Nigeria Polio- myelitis (cVDPV2) Ungraded 01-Jun-18 01-Jan-18 24-Apr-19 41 41 0 0.00% Two cases of circulating vaccine-de- rived poliovirus type 2 have been reported in the past week: one from Ilorin West in Kwara State and one from Mashegu in Niger State. The onset of paralysis was on 20 March and 18 March 2019 respectively. There are seven cVDPV2 cases reported in 2019 so far. The total number of cVDPV2 cases in 2018 remains 34. The country is now affected by three separate cVDPV2 outbreaks, the first centered in Jiga- wa State with subsequent spread to other states as well as to neighbour- ing Republic of Niger, the second in Sokoto State and the third one in Bauchi State. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 17 Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments Nigeria Yellow fever Ungraded 14-Sep-17 01-Jan-19 31-Mar-19 673 5 0 0.00% In week 13 (week ending on 31 March 2019), 75 suspected cases were reported including two one presumptive positive case from Imo State. Five confirmed cases were reported from samples sent to IP Dakar (Edo (2), Ondo (2) and Imo (1)). The last confirmed case was reported on 22 March 2019 from IP Dakar. Reported cases have been decreasing gradually since week 9 in 2019. São Tomé and Príncipe Necrotising cellulitis/ fasciitis Protract- ed 2 10-Jan-17 25-Sep-16 31-Mar-19 3 224 - 0 0.00% As of week 13 in 2019 (week ending 31 March 2019), two new cases were notified from two districts: Agua Grande (1), Me-zochi (1). The na- tional attack rate as of week 13, 2019 is 16.3 per 1 000 population. Sierra Leone Lassa fever Ungraded 06-Mar-19 15-Feb-19 07-Apr-19 5 5 3 60.00% During week 14 (week ending 7 April 2019), six suspected cases were reported from Kenema district, of which two tested positive. Since the beginning of 2019, 58 suspected cases have been reported across the country, of which five have tested positive. All confirmed cases are from Kenema district. South Sudan Humani-tarian crisis Protract- ed 3 15-Aug-16 n/a 21-Apr-19 - - - - The humanitarian crisis is ongoing in South Sudan with an estimat- ed 1.87 million IDPs in various locations in the country. In Western Bahr el Ghazal, some 1 600 new IDPs arrived in Wau PoC AA site while another 640 IDPs were newly displaced in Hai Masna. The IDPs are mainly from the Lou community coming from Jur County and have fled out of fear of cattle keeper inci- dents, the latest of which occurred in early March. Measles remains a major public health threat with outbreaks confirmed in multiple counties in 2019. South Sudan Hepatitis E Ungraded - 03-Jan-18 14-Apr-19 195 13 2 1.00% During Epi week 15 (week ending on 14 April 2019) two new cases were reported. To date there have been 36 cumulative cases includ- ing 13 confirmed by PCR and two deaths compared to 159 HEV cases reported in 2018. More than half (52%) of the cases are male and the most affected age group is 15-44 years (30.6%). The most likely cause of infection was use of unsafe drink- ing water. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 18 Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments South Sudan Measles Ungraded 24-Nov-18 24-Nov-18 25-Apr-19 908 62 7 0.80% Since the beginning of 2019, measles outbreak has been confirmed in 11 counties and three Protection of Civilians (PoC) sites (Juba, Bentiu, and Malakal). The affected counties are Abyei, Juba, Pibor, Gogrial West, Gogrial East, Mayom, Melut, Aweil South, Tonj North, Aweil West and Aweil Center counties. Since the beginning of 2019 until 25 April there have been 908 cases reported including 62 laboratory confirmed cases and seven deaths (CFR 0.8%). South Sudan Rubella Ungraded 27-Oct-18 27-Oct-18 07-Apr-19 225 52 0 0.00% Since 25 October 2018 until 7 April 2019, there are a total of 225 suspected rubella including 41 confirmed rubella cases have been reported from Malakal (178 cases including 41 lab confirmed cases), Aweil (35 cases), Bor South (4 cas- es), Gogrial west (5 cases) and Yirol east (3 cases). Tanzania, Unit- ed Republic of Cholera Ungraded 07-Feb-19 26-Jan-19 21-Apr-19 226 3 3 1.30% In week 16 (week ending on 21 April 2019), 19 new cases and zero death were reported from: Longido Dis- trict Council (two cases) in Arusha Region; Handeni DC (one case) and Pangani DC (8 cases) in Tanga Re- gion. In the past four weeks, Tanga region reported 61 (93.8%) out of 61 cases. Of the nine districts that have reported cholera cases in 2019, sev- en have confirmed the outbreak by laboratory culture, one district(N- gorongoro DC) tested by RDT and one district (Simanjiro DC) did not confirm by laboratory tests. Tanzania, Unit- ed Republic of Dengue fever Ungraded 31-Jan-19 01-Aug-18 21-Apr-19 529 27 0 0.00% In the week ending 21 April 2019, 55 new cases of dengue fever were reported in the country. Cases were reported from Dar es salaam (53 cases) and Tanga Region (2 cases). Uganda Humani- tarian crisis - refugee Ungraded 20-Jul-17 n/a 31-Mar-19 - - - - During the month of March 2019, 3 662 new refugees and asylum-seek- ers were registered from the Democratic Republic of Congo and 4 101 from South Sudan. The influx of refugees has strained Uganda's public services, creating tensions between refugees and host commu- nities. Malnutrition (high SAM and GAM rates) among refugees is of particular concern. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 19 Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments Uganda Crime- an-Congo haemor- rhagic fever (CCHF) Ungraded 17-Apr-19 24-May-18 17-Apr-19 17 13 4 23.50% A new confirmed case of Crime- an-Congo haemorrhagic fever (CCHF) has been reported from Uganda. The case-patient is a 32-year-old male resident of Katabi sub-county in Wakiso district, who tested positive for the virus post- humously. He died at a hospital in Wakiso while in admission and was buried in Butagaya, Nakakulwe vil- lage, Jinja on 12 April 2019. A total of 21 contacts have been identified and are being monitored. Since May 2018, a total of 17 cases have been reported across Uganda. Uganda Food- borne illness Ungraded 18-Mar-19 12-Feb-19 18-Mar-19 233 1 0.40% Two districts, Amudat (97 cases with one death) and Napak (154 cases), have been affected by a suspected food-borne illness outbreak. The outbreak is linked to a UN World Food Program (WFP)’s recent distribution of fortified blended food (Super Cereal) to several health facilities in the affected districts as part of a nutrition program for preg- nant and lactating mothers as well as under-five children. The recipients reportedly made and ate meals on return to their homes after which several people started presenting with symptoms of mental disorders, hallucinations, irritability with fever and abdominal pain by the next day. Test results from food and biological samples sent to laboratories in Uganda, Kenya, and South Africa are pending. Uganda Measles Ungraded 08-Aug-17 01-Jan-19 05-Mar-19 364 201 0 0.00% Between 1 January to 5 March 2019, 228 suspected cases, of which 201 have been confirmed (epidemi- ologically-linked and laboratory confirmed) were reported in mul- tiple districts. No death is reported among confirmed cases. From January to December 2018, a total of 3 652 suspected cases including 892 confirmed (epidemiological-linked and laboratory confirmed) were reported across the country. One death was reported among the confirmed cases. Fifty-three districts in the country have reported measles outbreaks. Zambia Cholera Ungraded 22-Mar-19 16-Mar-19 22-Mar-19 45 6 3 6.70% A cholera outbreak in Nsama district, Northern Province, Zambia was notified to WHO by the MOH on 22 March 2019. The index case, a 9-year-old child from Chaushi vil- lage, developed signs and symptoms on 16 March 2019. From 16 – 22 March 2019, a total of 45 cases with three deaths were reported, of which six have been laboratory confirmed. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 20 Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments Zambia Measles (suspected) Ungraded 03-Mar-19 04-Dec-19 03-Mar-19 93 0 0 0.00% A total of 93 suspected cases have been reported from Chibali zone, Lavushimanda district in Muchin- ga Province, Zambia. Of these, 50% are below five years old, 47% between five to fifteen years of age, and 3% above 15 years old. All of the suspected cases were reportedly not previously vaccinated against measles. Although clinical signs and symptoms point to measles, it has not been possible to confirm the aetiological agent of the disease by laboratory testing as the country did not have measles reagents. Zimbabwe Cholera G2 06-Sep-18 06-Sep-18 31-Mar-19 10 722 312 69 0.60% No new case has been reported across the country since 12 March 2019. A second round of oral cholera vaccine was recently concluded. Zimbabwe Floods/land slides G2 15-Mar-19 15-Mar-19 10-Apr-19 - - - - The Cyclone Idai hit 3 provinces neighboring Mozambique namely Manicaland, Masvingo and Masho- naland East provinces on 15 March 2019. The Government has reported that around 270 000 people are affected by the floods and cyclone, and 299 deaths, with 186 injuries have occurred. Chimanimani and Chipinge districts, in South Eastern Zimbabwe, are most affected, with at least half of the population impacted, with households needing shelter assistance also in Mutare, and Buhera districts. Zimbabwe Typhoid fever Ungraded - 01-Oct-17 19-Dec-18 5 159 262 15 0.30% There has been a resurgence of typhoid fever in Harare, the capital city of Zimbabwe, since mid-Sep- tember 2018. The increase started in week 37 (week ending 16 September 2018) when 61 suspected cases were reported, compared to 10 cases (which lies within normal range) in week 36. The weekly incidence eventually peaked in week 41 (week ending 14 October 2018), with 130 cases and has since been declining gradually. There were 34 suspected cases reported in week 49 (week ending 9 December 2018). Closed Events Kenya Rift Valley fever (RVF) Ungraded 01-Feb-19 18-Jan-19 04-Mar-19 169 16 0 0.00% A total of 169 human cases have been reported from Murang’a (22) and Nyandarua (147) Counties. The outbreak in Murang’a County has been brought under control while Nyandarua remains active. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 21 Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments Tanzania, Unit- ed Republic of Anthrax Ungraded 28-Feb-19 18-Feb-19 07-Apr-19 91 3 6 6.60% No new cases were reported in week 16 (week ending 21 April 2019). The cummulative number of cases re- ported is 91 with 6 associated deaths. Momba District in Songwe Region last reported a case on 7 January 2019 (total 81 cases, four deaths) while Moshi DC in Kilimanajro Re- gion last reported on 3 March 2019 (total 10 cases, two deaths). †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 22 © 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 Health Emergencies Programme 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. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 23 2
Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 1 Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment This Weekly Bulletin focuses on selected acute public health emergencies occurring in the WHO African Region. The WHO Health Emergencies Programme is currently monitoring 68 events in the region. This week’s edition covers key ongoing events, including: Cyclone Kenneth in Comoros and Mozambique Ebola virus disease in Democratic Republic of the Congo Measles in Nigeria Humanitarian crisis in Mali. 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 largely been controlled and thus closed. Major issues and challenges include: Tropical Cyclone Kenneth has hit the Comoros Islands and parts of Mozambique, barely weeks after tropical Cyclone Idai devastated Mozambique, as well as Malawi and Zimbabwe. While the death toll and injuries have been relatively low, damage to physical infrastructure, crops and livestock were significant, impacting on the livelihoods of the affected communities. The immediate humanitarian needs include ensuring access to the affected people, relocation of displaced families and provision of shelter, food, potable water and healthcare services, as well as restoration of electricity and communication. The Ebola virus disease (EVD) outbreak in Democratic Republic of the Congo continues, with increasing incidence. This recent rise in the number of new cases could be partly attributed to the disruption of response interventions following the latest spate of insecurity, including the attacks on the response teams, and continuing pockets of community mistrust. The response teams are beginning to restore full operations in all outbreak affected areas and hope to halt this trend. Overview New event Ongoing events Summary of major issues, challenges and proposed actions All events currently being monitored 2 Contents Overview 7 3 4 - 6 8 Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 3 EVENT DESCRIPTION On 23 April 2019, a tropical storm north of Madagascar strengthened into tropical Cyclone Kenneth, whose path passed over the northern tip of the Comoros Islands and northern Mozambique. In the Comoros Islands, the tropical cyclone hit the northern Ngazidja Island during the night of 24 April 2019, with violent winds and torrential rains. Reports from the national authorities indicate that four deaths occurred in Grande Comore Island, with 182 injuries. A total of 41 161 people have been affected, of whom 14 541 were displaced. More than 10 800 houses were destroyed, including 3 818 completely damaged and 7 013 houses partially destroyed. There was significant crop loss, with an estimated 63% of food crops, 35% of cash crops and 34% of fruit trees destroyed. At least 628 cattle, 222 sheep and 770 goats were reported killed. Schools and many water tanks were also damaged, and the country’s electricity grid was damaged, leaving most people without power and impacting access to healthcare. In Mozambique, tropical Cyclone Kenneth made landfall in the evening of 25 April 2019 between the districts of Macomia and Mocimboa da Praia, in Cabo Delgado Province. A rapid aerial assessment showed that Ibo, Macomia and Quissanga districts in Cabo Delgado were particularly hard-hit. Islands in Ibo District suffered extensive damage, with nearly all homes on Matemo island destroyed. Five people were reported dead and 11 injured. More than 35 100 houses were damaged, with 3 805 totally destroyed and 31 305 partially destroyed. As of 27 April 2019, 23 760 people across eight districts were displaced in 39 temporary reception centers. Five health facilities were reportedly damaged, including the maternity ward in the Macomia Hospital. At least 75 classrooms were destroyed or damaged, impacting 3 909 learners. Electricity on Ibo island was cut off and phone communications severed for most of the island’s inhabitants. The weather system caused by Cyclone Kenneth continues to hang over Cabo Delgado Province in Mozambique. Consequently, torrential rains have been falling in and around Pemba from 27 to 28 April 2019, causing flash and riverine flooding on 28 April 2019, including in the nearby area of Mieze. PUBLIC HEALTH ACTIONS In Comoros, the National Disaster Agency activated its National Contingency Plan, with the establishment of a fixed command post within the General Directorate of Civil Security (DGSC). Multi- sectoral rapid assessments are being carried out by the government (with the support of UN and partners) to ascertain the extent of the impact of the cyclone. The National Red Cross is in the field; funding and kits are being provided by WHO, UNICEF, and UNFPA. WHO has deployed three technical experts to Comoros to support the response efforts. About 125 civil security personnel were deployed on the ground on the evening of April 24, 2019 to support and assure the security and safety of populations. In Mozambique, at least 30 000 people were evacuated from areas at highest risk. A response plan is being developed by affected provinces, with the WFP, IOM and UNICEF deploying people in the field and WHO prepositioning staff within the next 24 hours. On 28 April 2019, Brazilian search and rescue teams rescued at least 350 people in the Natite, Chiguaguare, Mieze, Jozina Machel and Paquitequete neighborhoods in Pemba. On 28 April 2019, a truckload of medical supplies from Beira arrived in Pemba to provide essential medicines. Go to overview Go to map of the outbreaks SITUATION INTERPRETATION Tropical Cyclone Kenneth, which hit the Comoros Islands and parts of Mozambique, caused significant physical and infrastructural damage in both countries. Currently, there are urgent needs for shelter, clean water, sanitation and hygiene kits, food and non-food items, power generation and telecommunication equipment. A major new humanitarian operation is required in areas affected by tropical cyclone Kenneth, at a time when the ongoing response to Cyclone Idai (targeting three million people in three countries) remain critically underfunded. The humanitarian and development partners, and the donor communities are requested, once again, to support these efforts to prevent the disaster becoming even worse for already vulnerable populations. Geographical location of the impact of tropical cyclone Kenneth in Comoros and Mozambique, 25 April 2019. 157 Cyclone Kenneth Comoros and Mozambique New event Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 4 EVENT DESCRIPTION The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces, Democratic Republic of the Congo continues, with Katwa Health Zone still the main hot spot in the past 21 days. Since the last report on 21 April 2019 (Weekly Bulletin 16), 103 new confirmed EVD cases have been reported, with an additional 60 deaths. As of 27 April 2019, a total of 1 439 EVD cases, including 1 373 confirmed and 66 probable cases have been reported. To date, confirmed cases have been reported from 21 health zones: Beni (258), Biena (7), Butembo (139), Kalunguta (59), Katwa (470), Kayna (7), Kyondo (17), Mabalako (105), Mangurujipa (5), Masereka (33), Musienene (18), Mutwanga (4), Oicha (40), Vuhovi (78) and Lubero (4) in North Kivu Province; and Rwampara (1), Komanda (28), Mandima (88), Nyankunde (1), and Tchomia (2) in Ituri Province. As of 27 April 2019, the number of health areas reporting at least one confirmed case in the last 21 days (6-27 April 2019) is 13. A total of 930 deaths were recorded, including 864 among confirmed cases, resulting in a case fatality ratio among confirmed cases of 63% (864/1 373). The cumulative number of health workers infected is 92, with 33 deaths. Katwa is still the main focus of the outbreak, reporting 46% (129/280) of all confirmed cases in the past 21 days. As of 27 April 2019, all 18 health areas in this health zone reported at least one confirmed case in this period, while Butembo, Mandima and Vuhovi have reported 30% of new confirmed cases in this time. Ten health zones, namely Kalunguta, Komanda, Vuhovi, Beni, Biena, Butembo, Katwa, Mabalako, Mandima and Musienene have notified new confirmed cases in the past three days and are points of attention. Contact tracing is ongoing in 15 health zones, with contact tracing and registration of alerts resuming in the Butembo coordination area. A total of 11 841 contacts were recorded on 27 April 2019, of which 9 795 have been seen in the past 24 hours (83%; varies between 62-100% among reporting zones). Of 1 026 alerts processed (of which 972 were new) in reporting health zones, 934 (91%). Of the 922 alerts investigated, 176 (26%) were validated as suspected cases, with 69 deaths. PUBLIC HEALTH ACTIONS Surveillance activities continue, including case investigations, active case finding in health facilities and communities, and identification and listing of contacts around the latest confirmed cases. Collaboration between health authorities in the Democratic Republic of the Congo and Uganda continues around monitoring displaced contacts. As of 27 April 2019, a cumulative total of 106 872 people has been vaccinated since the start of the outbreak. Point of Entry/Point of Control (PoE/PoC) screening continues, with over 53 million screenings to date. A total of 72/80 (90%) PoE/PoC were operational as of 27 April 2019. There are continued community reintegration and psychosocial activities for patients discharged from ETCs, along with psychoeducation sessions to strengthen community engagement and collaboration in the response. Infection prevention and control (IPC) and water, sanitation and hygiene (WASH) activities continue with decontamination of households where confirmed cases had stayed in Beni, Butembo, Katwa, Musienene, Mandima, Mabalako and Biena. Community awareness and mobilization sessions are being strengthened, with sensitization of representatives of Vuaghala village on the risks associated with EVD and commitment to the management of community incidents in Vuhovi Health Zone; more than 1 500 grassroots leaders have been provided with awareness of EVD prevention and response and community incident management at the Walse Vonkutu Chief Administrative Office inauguration ceremony; chiefs in Beni were involved in a work session to solicit their support in response activities, while further community engagement activities took place in Beni and Komanda around cured patients and ETCs. Go to overview Go to map of the outbreaks SITUATION INTERPRETATION The increasing number of new EVD cases in the Democratic Republic of the Congo is deeply concerning. However, geographic spread is still limited to two provinces and there is no spread to neighbouring countries. There is deepening commitment to strengthening community engagement, seen as one of the main drivers of this continued transmission. This outbreak remains one of the most challenging ever in terms of the situation on the ground, calling for extraordinary response measures. All national and local authorities and partners are committed to this response. Continued implementation of public health measures, along with strengthened community engagement, will ultimately bring this outbreak to a close. Geographical distribution of confirmed and probable Ebola virus disease cases reported from 1 May 2018 to 27 April 2019, North Kivu and Ituri provinces, Democratic Republic of the Congo. 157 Ebola virus disease Democratic Republic of the Congo 1 439 Cases 930 65% Deaths CFR Ongoing events Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 5 EVENT DESCRIPTION Nigeria has been experiencing an increasing number of measles cases since the beginning of the year. The increase in measles cases across the country intensified in early March 2019, prompting the activation of the national measles Emergency Operations Centre (EOC) to enhance response efforts. In week 15 (week ending 14 April 2019), a total of 1 925 suspected measles cases, with 11 deaths (case fatality ratio 0.6%), were recorded across 31 states. Borno State in northeast Nigeria was the most affected, having reported 958 suspected cases, constituting about 50% of the total cases reported across the country during the week. Since the disease trend peaked in week 12 (week ending 24 March 2019) when 2 567 cases were reported, there has been a slight decline in the weekly number of cases. From 1 January to 14 April 2019, a cumulative total of 20 127 cases with 50 deaths (CFR 0.25%) have been recorded from 621 Local Government Areas (LGAs) across 36 states and the Federal Capital Territory (FCT). Of 4 338 samples tested, 819 were laboratory-confirmed (IgM-positive) for measles infection. Borno and Katsina states are the most affected constituting 48.4% and 13.3% of the cumulative cases, respectively. Further review of the epidemiological situation is being carried out and additional information on this outbreak will be provided. PUBLIC HEALTH ACTIONS Since week 9 (week ending 3 March 2019), a multi-agency national Emergency Operations Centre (EOC) was activated by the national authorities and continues to coordinate response to the measles outbreaks across the country, with support from WHO and partners. A national measles outbreak action plan has been developed to guide response actions. Two phases of measles reactive vaccination campaigns targeting children aged six months to nine years have been conducted in selected LGAs in Borno State. Measles reactive campaigns are also being planned for in Katsina and Yobe states. Three sub-regional in-country laboratories are supporting testing of measles samples across the country. Rapid response teams (RRT) have been deployed to affected states to support response efforts, including strengthening surveillance, case management, reactive vaccination and other field-based activities. Intensified surveillance is ongoing in all states and case-based data including line lists are being transmitted to the national level on a weekly basis. SITUATION INTERPRETATION The measles outbreak in Nigeria is occurring at a time when there is a global rise in measles cases. The high incidence and recurrent outbreaks of measles are linked to sub-optimal immunization coverage. With several years of low immunization coverage, large numbers of susceptible people have accumulated in the population, leading to the recurrent measles outbreaks. There is a need to adapt strategies aimed at enhancing immunization uptake and utilization across Nigeria (and all the countries in the region) through engaging communities and strengthening outreach programmes targeting hard- to-reach and inaccessible populations. These efforts are critical in mitigating the current outbreaks of measles and its impact on the population. Go to overview Go to map of the outbreaks Geographical distribution of measles cases and deaths in Nigeria, 1 January – 14 April 2019. 157 Measles Nigeria 20 127 Cases 50 0.25% Deaths CFR Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 6 Humanitarian Snapshot in Mali, January 2019 EVENT DESCRIPTION Mali continues to endure a protracted humanitarian emergency in the Northern and Central regions of the country, arising from dual political and security crises since January 2012. Nearly 500 000 people have been displaced since then. To date, the International Organization for Migration (IOM) estimates that 99 039 individuals in 20 206 households are displaced, mainly from Timbuktu, Gao, Ménaka, and Segou. In the latest security incident on 23 March 2019, at least 160 persons were killed in Ogossadou, Mopti Region, with 65 wounded, including 35 seriously injured. Over 410 houses and 80 granaries were burnt; while 850 people in 124 households were displaced as a result of the inter-ethnic conflict. Acts of retaliation have already been registered, with six civilians killed between 25 and 26 March 2019. This recent incident led to a political crisis, with the resignation of the Prime Minister. The new government is not yet in place. Health needs are high as access to health services is poor and disease epidemics pose a major risk. Measles epidemics have been reported in 19 districts out of 75. Since the beginning of the year, 42 health districts have registered at least one confirmed case of measles. The Koulikoro region recorded nearly 38% of all confirmed measles cases, followed by Segou region (16%) and Kayes (15%). In addition, malnutrition is high, with a global acute malnutrition rate of 10% and severe acute malnutrition rate of 2%. The situation is reported to be worst in Timbuktu, Gao, Menaka, Segou and Bamako regions. PUBLIC HEALTH ACTIONS On 26 March 2019, a joint rapid assessment mission was carried out in Ogossagou, Bankass District following the inter-ethnic attack on 23 March 2019. WHO has deployed 30 field medical officers to provide technical support to the regions and their partners to strengthen health information management, health/nutrition sub-cluster coordination, health and humanitarian operations, and eradication of poliomyelitis in Mali. Other partners such as UNICEF are working with WHO to strengthen responses to the measles outbreak, malnutrition and HIV/AIDS. International Medical Corps (IMC) conducted a rapid assessment of mental health needs and psychosocial support (SMSPS) in four regions of Mali from December 2018 - January 2019. SITUATION INTERPRETATION The humanitarian situation in Mali continues to worsen as insecurity and political crises prevail. The absence of civil administration and security apparatus in some areas has weakened the rule of law and increased the vulnerability of the populations to all forms of violence. This vacuum has also impacted on the provision of basic social services and disrupted economic and trade activities. These, in addition to limited access to farmlands, have markedly affected the livelihoods of the communities. The response to the humanitarian situation is also being complicated by underfunding. In 2019, about 1.4 million people have been targeted for humanitarian health assistance. However, of the US$ 12.9 million requested for (as part of the Humanitarian Response Plan 2019), only 13% has been funded in the first quarter of year. Go to overview Go to map of the outbreaks 157 Humanitarian crisis Mali 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 Tropical Cyclone Kenneth has caused severe damage to physical infrastructure, crops and livestock in the Comoros islands and Mozambique. Early alerts and readiness measures taken beforehand significantly reduced the death toll and injuries to humans. There is a need to rapidly scale up humanitarian response in the affected areas in order to restore the livelihoods of the affected communities. For the health sector, the restoration of healthcare services is of utmost importance to prevent, prepare for and respond to outbreaks of communicable diseases as well as provide trauma care, psychosocial counselling and treatment of common and chronic illnesses. There has been an increase in the number of new EVD cases in Democratic Republic of the Congo in the past weeks, and the situation is deeply concerning. This rise is not unexpected and, in part, likely a result of the increased security challenges, including the recent attacks on the response teams, and pockets of community mistrust, which slowed some response activities in affected areas for a few days. Most outbreak response activities have been restored in most affected areas, and this latest trend should be reversed. Proposed actions The national authorities and partners in Comoros and Mozambique need to step up provision of immediate humanitarian aid such as water, food, non-food items, shelter, etc. The donor community are requested to provide the requisite funding for the immediate and long-term humanitarian assistance. The national authorities and partners in the Democratic Republic of the Congo need to continue implementing proven and innovative public health measures, including continued community engagement to counter the mistrust that is significantly hampering response efforts. Summary of major issues, challenges and proposed actions Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 8 Go to overview Go to map of the outbreaks All events currently being monitored by WHO AFRO Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments New Events Comoros Cyclone Kenneth Ungraded 23-Apr-19 24-Apr-19 25-Apr-19 - - - - Detailed update given above. Mozambique Cyclone Kenneth Ungraded 25-Apr-19 25-Apr-19 28-Apr-19 - - - - Detailed update given above. Ongoing Events Burkina Faso Humani-tarian crisis Ungraded 01-Jan-19 01-Jan-19 26-Apr-19 - - - - The security situation in Burkina Faso has gradually deteriorated since 2015 initially in the regions of the Sahel then in the East, and attacks by armed groups have increased and spread over several regions of the country. As of 02 April 2019, the country has registered 135 589 inter- nally displaced persons, more than half of them since the beginning of 2019. Currently, Burkina Faso is hosting a total of 25 182 refugees. Cameroon Humani- tarian crisis (Far North, North, Adamawa & East) Protract- ed 2 31-Dec-13 27-Jun-17 19-Apr-19 - - - - Cameroon continues to face a humanitarian crisis in the far North region linked to the Boko Haram group terrorist attacks, with significant displacement of the traumatized population. The Minao camp has reached a total of 57 094 refugees, which is above its capacity. Several attacks targeting both public facilities, such as schools and health facilities and private goods continue to be registered at the border between Cameroon and Nigeria. The Far North region is currently facing a measles outbreak in five districts (Kousseri, Mada, Makary, Goulfey and Koza). Cameroon Humani- tarian crisis (NW & SW) G2 01-Oct-16 27-Jun-18 19-Apr-19 - - - - The Northwest and Southwest regions crisis which started in 2016 remain a concern. Sporadic armed attacks between alleged separatist groups, the military and commu- nities continue to be reported. An attack on 4 April 2019 by Cameroo- nian security forces on Meluf village located near a separatist’s camp in North West region led to the death of five civilians. Several houses have been looted and seven burnt down. Violence in and near health facilities since late March is affecting access to health for civilians. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 9 Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments Cameroon Cholera G1 24-May-18 18-May-18 26-Apr-19 1 052 98 63 6.00% Cameroon continues to report cases of cholera in 2019. Seven new suspected cases including one death were notified by Pitoa, Garoua 1 and Garoua 2 health districts from 1 to 5 April 2019. In March 2019, additional five new confirmed cases were notified by Institut Pasteur Laboratory in Cameroon. As of 5 April 2019, a total of 1 039 suspected cases were reported. Cameroon Measles Ungraded 02-Apr-19 01-Jan-19 18-Apr-19 718 450 0 0% The measles outbreak is ongoing in Cameroon. The number of cases started increasing since the beginning of this year and peaked in epidemiological week 7, 2019 with 130 suspected cases reported. Since the beginning of the year 2019, a to- tal of 718 suspected cases, including 56 confirmed cases with laboratory test and 394 by epidemiological link were reported. The outbreak is affecting six districts, which are: Kousseri, Mada, Goulfey, Makary, Koza et Ngaoundere rural. Central African Republic Humani- tarian crisis Protract- ed 2 11-Dec-13 11-Dec-13 14-Apr-19 - - - - A total of 2 768 internal displaced persons arrived in Baboua and Beloko following military opera- tions conducted by MINUSCA at Zoukombo in the North Ouest of the country. Humanitarian actors intervening in the area had to suspend their activities for security reasons. The closure of the South Sudan border and the health district of Haut-Mbomou remain a concern for the humanitarian community. Central African Republic Hepatitis E Ungraded 02-Oct-18 10-Sep-18 21-Apr-19 187 142 1 0.50% No new suspected case of hepatitis E has been confirmed positive since epidemiological week 14 (Week ending on 14 April 2019). From 10 September 2018 to 21April 2019, a total of 187 cases of acute jaundice syndrome including 142 confirmed for viral hepatitis E have been re- ported. The age group between 5 to 45 years old is more affected. Central African Republic Measles Ungraded 15-Mar-19 11-Feb-19 31-Mar-19 151 19 2 1.30% The measles outbreak is ongoing in three health districts (Paoua, Batangafo and Vakaga) in the country. From epidemiological week 5 to week 13, a total of 151 suspected measles cases , including 19 con- firmed, were notified in Paoua (83 cases), Batangafo (5 cases), and Vak- aga( 63 cases and 1 death). About 80% of cases are under 5 years of age with a high proportion of male. Sev- eral of the cases are returnees from the outskirts of the city of Goree (Chad) in March 2019 following the opening of the borders. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 10 Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments Central African Republic Monkey- pox Ungraded 20-Mar-18 02-Mar-18 03-Mar-19 34 25 2 5.90% Three cases, including one con- firmed, were reported in Ippy in week 9 (week ending 3 March 2019). Since 2 October 2018, clusters of cases have been identified across three health districts, namely; Mbai- ki district with nine cases including eight confirmed, Bangassou district with five cases including three confirmed, and Bossembele district with four cases including three confirmed. One death was reported in Bossembele. Chad Measles Ungraded 24-May-18 01-Jan-19 27-Apr-19 12 990 0 119 0.9% In week 16 (week ending on 21 April 2019) 1 369 suspected cases including 24 deaths were reported. To date suspected measles cases have been reported from 119 out of 126 districts in the country. Currently 78 districts are reporting suspected epi- demics compared to 76 at week 1(. Chad Meningitis Ungraded 20-Mar-19 01-Jan-19 07-Apr-19 596 45 7.60% Cases of meningitis continue to be reported in two districts in Mandoul region. In week 14 (week ending on 7 April 2019), 36 new suspected cases and 1 associated death were reported. The district of Goundi was in alert phase with an AR of 8.2 and the district of Bedjondo remained in alert phase with an AR of 3.0 Congo Chikun-gunya G1 22-Jan-19 07-Jan-19 14-Apr-2019 6 149 61 0 0.00% An outbreak of chikungunya affect- ing eight departments (Kouilou, Bouenza, Pointe Noire, Plateaux, Pool and Brazaville, Niari, Lekou- mu) is on ongoing in the Republic of Congo. From 7 January to 14 April 2019, a total of 6 149 suspected cases including 61 confirmed were re- ported. Entomological investigation showed the presence of the vector, Aedes albopictus. Congo Monkey-pox Ungraded 09-Mar-19 09-Mar-19 16-Mar-19 9 2 0 0.00% The Republic of Congo is reporting cases of monkey pox since February 2019. Two samples from Makon- tipoko village in Gambona district tested in the INRB-Kinshasa turned positive for Monkey pox (PCR OPX). Côte d'Ivoire Dengue Fever Ungraded 15-Feb-19 01-Jan-19 15-Mar-19 56 11 0 0.00% The Institut Pasteur of Ivory Coast confirmed 5 positive cases of dengue fever on the 15 February 2019. As of 15 March 2019, a total of 56 suspected cases and 11 confirmed cases have been reported in nine over hundred and one districts. The Cocody-bingerville health district have reported the majority of the suspected and confirmed cases. Three cases of dengue serotype 3 and five cases of Dengue serotype 1 have been isolated during this outbreak. The age group between 15 to 44 years old is more affected (55%) and the sex ratio (F/M) is 1.5. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 11 Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments Democratic Republic of the Congo Humani- tarian crisis G3 20-Dec-16 17-Apr-17 17-Mar-19 - - - - The humanitarian situation remains complex. Attacks by unidentified assailants in North Kivu led to the suspension of MSF activities in Butembo Ebola treatment Centre. In Tanganyika province, UNPFA reports 1 127 cases of sexual vio- lence based on gender recorded in 2018. Rape represents 42% of cases, although forced marriage of children also has a high incidence, more than half of the victims are IDP's. In Kasai, there is a relative return of calm after the inter-communal tension from 24 to 26 February 2019 which disrupted humanitarian interventions. Ituri Province, Djugu Territory, 6 035 returnees need assistance. Democratic Republic of the Congo Chikun- gunya Ungraded 08-Feb-19 30-Sep-18 24-Feb-19 330 48 0 0.00% During week 8 of 2019 (week ending 24 February 2019), 17 suspected cases of chikungunya were reported in the province of Kinshasa with 12 cases in Binza Ozone Health Zone, two cases in the Police Health Zone and three cases in the health zone of Mount Ngafula 2. Democratic Republic of the Congo Cholera G3 16-Jan-15 01-Jan-19 07-Apr-19 8 522 - 206 2.40% In week 14 (week ending on 7 April 2019), 460 suspected cholera cases including 9 deaths (CFR 1.9%) were reported from 51 health zones in 13 provinces. To date 8522 suspected cases including 206 deaths (CFR 2.4%) have been reported in 18 out of 26 provinces. Most of the cases have been reported from the eastern endemic provinces (Upper Katanga, Upper Lomami, North Kivu, South Kivu, and Tanganyika). Democratic Republic of the Congo Ebola virus disease G3 31-Jul-18 11-May-18 27-Apr-19 1 439 1 373 930 65% Detailed update given above. Democratic Republic of the Congo Measles Ungraded 10-Jan-17 01-Jan-19 31-Mar-19 56 442 1 023 1.80% In week 14 (week ending on 7 April 2019), 5105 cases including 75 deaths have been reported. Since the beginning of the year, 56 442 cases including 1 023 deaths (CFR 1.81%) have been reported. Cases continue to be reported in an increasing manner. To date there are 39 health zones with confirmed epidemic. The most affected provinces are Tshopo, Lualaba, and Upper Lomami. Democratic Republic of the Congo Monkey- pox Ungraded n/a 01-Jan-19 07-Apr-19 1 059 - 26 2.50% In week 14 (week ending 7 April 2019), 91 new suspected cases including five deaths were reported. The cases of monkeypox have been confirmed in the Provincial Health Divisions of Ecuador, North Ubangi, and South Ubangi. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 12 Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments Democratic Republic of the Congo Polio- myelitis (cVDPV2) G2 15-Feb-18 n/a 24-Apr-19 45 45 0 0.00% One case of circulating vaccine-de- rived poliovirus type 2 (cVDPV2) was reported this week in the Demo- cratic Republic of the Congo (DRC) in Kamonia, Kasai State. The onset of paralysis was reported on 8 Feb- ruary 2019. This is the first cVDPV case in DRC in 2019. DRC is affect- ed now by five separate cVDPV2 outbreaks, in the provinces of Haut Katanga; Mongala, Maniema; Haut Lomami/Tanganika/Haut Katanga/ Ituri and Kasai. Ethiopia Humani-tarian crisis G2 15-Nov-15 n/a 09-Apr-19 - - - - The humanitarian crisis in Ethiopia continues with growing and cyclical waves of humanitarian emergen- cies. In mid-March 2019, a rapidly evolving situation involving IDPs was reported in West Guji and Gedeo zones of Oromia and SNNP respectively. The numbers of IDPs is fluid and increasing daily, with official government estimates of 675 737 for Gedeo and 319 822 reported from West Guji as of 31 March 2019. Across the whole country, the num- bers of IDPs is estimated at about 2.7 million. Ethiopia Measles Protract-ed 1 14-Jan-17 01-Jan-19 23-Apr-19 136 59 - - Measles outbreak is ongoing in Oro- mia and Solami regions. Vaccination campaign is being planned to target 6.7 million children aged 6 months to 14 years. Targeted populations are internally displaced populations and host communities Guinea Measles Ungraded 09-May-18 01-Jan-19 21-Apr-19 964 409 14 1.50% In week 16 (week ending on 21April 2019) 106 new suspected measles and 45 confirmed cases were report- ed. In this year there have been 964 suspected measles cases including 409 confirmed cases and 14 deaths (CFR 1.5%) have been reported. Currently there are eight localities in epidemic including the urban communes of Coyah, Dixinn, Du- bréka, Matoto, Ratoma, Fria, Matam and the sub-prefecture of Manéah (Coyah). Of the total, 59% of IgM + cases were unvaccinated and 84% of IgM + cases are children under 5 years of age. Kenya Cholera Ungraded 21-Jan-19 02-Jan-19 22-Apr-19 1 463 81 8 0.50% Since January 2019, cholera outbreak has been reported in Narok, Kajiado, Nairobi, Garissa and Machakos Counties. Narok county has con- tolled the outbreak. Kajiado, Garissa and NairobiCounty have reported a second wave of the outbreak since January 2019. As of 22 April 2019, Nairobi hospital reported a total of 65 cases, majority being staff members and students within the same institution including one death (CFR 1.5%). Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 13 Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments Kenya Dengue fever Ungraded 30-Jan-19 15-Oct-18 08-Apr-19 660 286 0 0.00% The outbreak in Mombasa County which has affected all the six sub-counties (Kisauni, Jomvu, Nyali, Likoni, Changamwe and Mvita) remains active. Total cases reported so far are 660 with 286 confirmed by PCR. However, these are likely grossly underestimated due to underreporting. Kenya Leishman-iasis Ungraded 31-Mar-19 01-Jan-19 22-Apr-19 295 127 7 2.40% A kala-azar outbreak has been reported in Marsabit and Wajir counties. Cases have been reported since the beginning of January 2019 with a peak in March 2019. Marsabit has reported 260 cases including 7 deaths with 100 positives by RDT rk39 and Wajir county has reported 35 cases with 100 positives by RDT. Kenya Measles Ungraded 03-Sep-18 28-Aug-18 08-Apr-19 418 41 5 1.20% In the past week 15 new cases were reported. Wajir county has reported a total of 269 cases, Tana River county 131 cases and Kilifi county 7 cases. In total, 418 cases including 5 deaths have been reported in 2019. Liberia Lassa fever Ungraded 23-Jan-19 01-Jan-19 14-Apr-19 22 19 7 31.80% During week 15 (week ending 14 April 2019), two suspected cases were reported from Grand Bassa and Montserrado Counties. Test results are pending. Since the beginning of the year, 54 suspected cases have been reported across the country, of which 19 tested positive by RT-PCR while 32 were discarded due to nega- tive test results and three pending testing. Liberia Measles Ungraded 24-Sep-17 01-Jan-19 14-Apr-19 748 65 5 0.70% In week 15 (week ending 14 April 2019), 34 suspected cases were reported from 11 out of 15 counties across the country. Since the beginning of 2019, 748 cases have been reported across the country, of which 65 are laboratory-con- firmed, 69 are epi-linked, and 386 are clinically confirmed. Sanoyea and Fuamah Districts, Bong County, Firestone District, Margibi County and Kolahun and Voinjama Dis- tricts, Lofa County are currently in outbreak phase Madagascar Measles G2 26-Oct-18 03-Sep-18 18-Apr-19 135 067 884 0.70% In week 15 (week ending on 14 April 2019), 245 cases were reported, a significant decrease compared to the previous week 14 (week ending 7 April) when 1 284 cases were reported. The general trend has been decreasing over the last four weeks. 12 out of 15 samples tested positive for IgM during week 15. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 14 Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments Malawi Flood G2 09-Mar-19 05-Mar-19 14-Apr-19 - - - - Tropical Cyclone which formed in the Mozambique Channel, drifted to Malawi on 5 March 2019 causing heavy persistent rains accompanied by strong winds leading to heavy flooding in Southern Malawi. a total of 15 districts and two cities were af- fected. As of 12 April 2019, a total of 868 895 people have been affected, 86 796 were displaced and living in 173 camps, 672 were injured, 59 died and 3 were missing. Mali Humani-tarian crisis Protract- ed 1 n/a n/a 31-Mar-19 - - - - Detailed update given above. Mali Measles Ungraded 20-Feb-18 01-Jan-19 14-Apr-19 708 249 0 0.00% Between epi week 1 and 15 (week ending 14 April 2019), 708 suspect- ed measles cases have been reported, including 249 IgM positive cases. Outbreak response activities con- tinues to be implemented including investigation and case management, continued epidemiological surveil- lance, public awareness of disease prevention measures. Mauritius Dengue fever Ungraded 26-Feb-19 26-Feb-19 25-Apr-19 106 106 0 0.00% The dengue fever outbreak is ongo- ing in Mauritius. From 26 February 2019 to 25 April 2019, a total of 109 cases (including 4 imported cases) have been reported. The district of Port Louis recorded the highest number of locally transmitted cases of dengue (94) followed by Plaines Wilhems (5), Pamplemousses (2) and Savanne (1). A peak was observed on 23 April 2019 (15 cases) with an overall decreasing trend since then to last reporting date. There had been four imported cases of dengue, one from India and three from Reunion Island. Public health response activities are ongoing in affected areas. Mauritius Measles Ungraded 23-May-18 19-Mar-18 21-Apr-19 1 469 1 469 4 0.30% During week 16 (week ending 21 April 2019), zero new confirmed cases were reported across the country. From 21 March 2018 to 21 April 2019, a total of 1 449 laborato- ry-confirmed cases were reported. Of 17 throat swabs analyzed, the genotype D8 was detected in 13 samples. The trend is decreasing since the peak in week 24 of 2018. The most affected districts are Port Louis and Black River. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 15 Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments Mozambique Cholera Ungraded 27-Mar-19 27-Mar-19 18-Apr-19 6 385 - 8 0.10% In week 15 (from 8 to 14 April 2019), a total of 2 315 cases and 2 deaths were reported. Beira district continued to be the most affected district with an overall attack rate of 909 cases per 100 000 population. Since the declaration of the cholera outbreak on 27 March 2019, and up to 18 April 2019, 6 382 cases and eight deaths were reported (CFR 0.1%). These cases were reported from the four districts (Beira, Buzi, Dondo and Nhamatanda) of Sofala Province originally affected by this outbreak. Of 4 402 cases for which gender was reported, 51% were male. Mozambique Flood/cy-clone G3 15-Mar-19 15-Mar-19 13-Apr-19 - - - - As of 13 April 2019, the official death toll remained at 602 people and the number of houses destroyed remained at 239 732, with 50% of them, totally destroyed and the number of displaced people in col- lective sites remained at 73 296. The screening for malnutrition in more than 2 100 children (6-59 months) as of 13 April 2019 showed that 62 children had severe acute malnu- trition and 131 had moderate acute malnutrition Mozambique Polio- myelitis (cVDPV2) G2 07-Dec-18 07-Dec-18 24-Apr-19 2 2 0 0.00% No new case of circulating vac- cine-derived poliovirus type 2 (cVD- PV2) has been reported this week. One circulating vaccine-derived poliovirus type 2 (cVDPV2) isolate was detected, from an acute flaccid paralysis (AFP) case (with onset of paralysis on 21 October 2018, in a six-year old girl with no history of vaccination, from Molumbo district, Zambezia province), and two isolated from a community contact of the case reported on 10 and 17 December 2018. (source: GPEI) Namibia Hepatitis E G1 18-Dec-17 08-Sep-17 14-Apr-19 5 014 871 42 0.80% During week 15 (week ending 14 April 2019), 39 suspected cases with zero deaths, were reported from three regions across the country, namely; Khomas (21), Erongo (13), and Omusati(5). This is a slight decrease compared to the previous two weeks when a total of 47 sus- pected cases were reported. Of the cumulative 5 014 cases, 288 (5.7%) are among pregnant and post-par- tum women. A total of 20 deaths have been reported among maternal cases. Khomas Region remains the most affected region, reporting 67% of HEV cases country-wide, followed by Erongo 23%. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 16 Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments Niger Humani-tarian crisis Protract- ed 1 01-Feb-15 01-Feb-15 04-Apr-19 - - - - The security situation in Diffa continues to worsen following Boko Haram attacks in that region. A total of 15 000 people from the villages of Gueskerou and Chetimari were newly displaced in Diffa region due to the increasing number of attacks against civilians by Boko Haram. In March alone, 20 attacks were regis- tered leading to the death of at least 90 civilians. Humanitarian needs in the affected area include shelter, food, health and protection. Nigeria Humani-tarian crisis Protract- ed 3 10-Oct-16 n/a 31-Mar-19 - - - - The humanitarian crisis in the Northeastern part of Nigeria persists with continued population displace- ment from security-compromised areas characterized by overcrowded population in many camps in the region.The number of measles cases being reported also remains high. A vaccination campaign was conducted in February to respond to the increased number of cases of measles reported over the recent months. Nigeria Lassa fever G2 24-Mar-15 01-Jan-19 14-Apr-19 555 540 137 24.70% In reporting week 15 (week ending on 14 April 2019), three new con- firmed cases were reported from two states - Edo (1) and Plateau (2) with zero new deaths. This is the lowest number of cases reported since the beginning of the year following a gradual decline in the weekly num- ber of cases since week 10. A total of 1 162 contacts are currently under follow-up across 20 states. Nigeria Measles Ungraded 25-Sep-17 01-Jan-19 20-Apr-19 20 127 819 50 0.20% Detailed update given above. Nigeria Monkey-pox Ungraded 26-Sep-17 24-Sep-17 31-Mar-19 328 132 7 2.10% The outbreak is ongoing in the country with five new cases reported in week 14 (week ending on 7 April 2019). In total, 23 suspected cases have been reported in 2019 from 13 LGAs across 9 ststes. Ten cases were laboratory confirmed from 5 LGAs in 4 states. Nigeria Polio- myelitis (cVDPV2) Ungraded 01-Jun-18 01-Jan-18 24-Apr-19 41 41 0 0.00% Two cases of circulating vaccine-de- rived poliovirus type 2 have been reported in the past week: one from Ilorin West in Kwara State and one from Mashegu in Niger State. The onset of paralysis was on 20 March and 18 March 2019 respectively. There are seven cVDPV2 cases reported in 2019 so far. The total number of cVDPV2 cases in 2018 remains 34. The country is now affected by three separate cVDPV2 outbreaks, the first centered in Jiga- wa State with subsequent spread to other states as well as to neighbour- ing Republic of Niger, the second in Sokoto State and the third one in Bauchi State. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 17 Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments Nigeria Yellow fever Ungraded 14-Sep-17 01-Jan-19 31-Mar-19 673 5 0 0.00% In week 13 (week ending on 31 March 2019), 75 suspected cases were reported including two one presumptive positive case from Imo State. Five confirmed cases were reported from samples sent to IP Dakar (Edo (2), Ondo (2) and Imo (1)). The last confirmed case was reported on 22 March 2019 from IP Dakar. Reported cases have been decreasing gradually since week 9 in 2019. São Tomé and Príncipe Necrotising cellulitis/ fasciitis Protract- ed 2 10-Jan-17 25-Sep-16 31-Mar-19 3 224 - 0 0.00% As of week 13 in 2019 (week ending 31 March 2019), two new cases were notified from two districts: Agua Grande (1), Me-zochi (1). The na- tional attack rate as of week 13, 2019 is 16.3 per 1 000 population. Sierra Leone Lassa fever Ungraded 06-Mar-19 15-Feb-19 07-Apr-19 5 5 3 60.00% During week 14 (week ending 7 April 2019), six suspected cases were reported from Kenema district, of which two tested positive. Since the beginning of 2019, 58 suspected cases have been reported across the country, of which five have tested positive. All confirmed cases are from Kenema district. South Sudan Humani-tarian crisis Protract- ed 3 15-Aug-16 n/a 21-Apr-19 - - - - The humanitarian crisis is ongoing in South Sudan with an estimat- ed 1.87 million IDPs in various locations in the country. In Western Bahr el Ghazal, some 1 600 new IDPs arrived in Wau PoC AA site while another 640 IDPs were newly displaced in Hai Masna. The IDPs are mainly from the Lou community coming from Jur County and have fled out of fear of cattle keeper inci- dents, the latest of which occurred in early March. Measles remains a major public health threat with outbreaks confirmed in multiple counties in 2019. South Sudan Hepatitis E Ungraded - 03-Jan-18 14-Apr-19 195 13 2 1.00% During Epi week 15 (week ending on 14 April 2019) two new cases were reported. To date there have been 36 cumulative cases includ- ing 13 confirmed by PCR and two deaths compared to 159 HEV cases reported in 2018. More than half (52%) of the cases are male and the most affected age group is 15-44 years (30.6%). The most likely cause of infection was use of unsafe drink- ing water. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 18 Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments South Sudan Measles Ungraded 24-Nov-18 24-Nov-18 25-Apr-19 908 62 7 0.80% Since the beginning of 2019, measles outbreak has been confirmed in 11 counties and three Protection of Civilians (PoC) sites (Juba, Bentiu, and Malakal). The affected counties are Abyei, Juba, Pibor, Gogrial West, Gogrial East, Mayom, Melut, Aweil South, Tonj North, Aweil West and Aweil Center counties. Since the beginning of 2019 until 25 April there have been 908 cases reported including 62 laboratory confirmed cases and seven deaths (CFR 0.8%). South Sudan Rubella Ungraded 27-Oct-18 27-Oct-18 07-Apr-19 225 52 0 0.00% Since 25 October 2018 until 7 April 2019, there are a total of 225 suspected rubella including 41 confirmed rubella cases have been reported from Malakal (178 cases including 41 lab confirmed cases), Aweil (35 cases), Bor South (4 cas- es), Gogrial west (5 cases) and Yirol east (3 cases). Tanzania, Unit- ed Republic of Cholera Ungraded 07-Feb-19 26-Jan-19 21-Apr-19 226 3 3 1.30% In week 16 (week ending on 21 April 2019), 19 new cases and zero death were reported from: Longido Dis- trict Council (two cases) in Arusha Region; Handeni DC (one case) and Pangani DC (8 cases) in Tanga Re- gion. In the past four weeks, Tanga region reported 61 (93.8%) out of 61 cases. Of the nine districts that have reported cholera cases in 2019, sev- en have confirmed the outbreak by laboratory culture, one district(N- gorongoro DC) tested by RDT and one district (Simanjiro DC) did not confirm by laboratory tests. Tanzania, Unit- ed Republic of Dengue fever Ungraded 31-Jan-19 01-Aug-18 21-Apr-19 529 27 0 0.00% In the week ending 21 April 2019, 55 new cases of dengue fever were reported in the country. Cases were reported from Dar es salaam (53 cases) and Tanga Region (2 cases). Uganda Humani- tarian crisis - refugee Ungraded 20-Jul-17 n/a 31-Mar-19 - - - - During the month of March 2019, 3 662 new refugees and asylum-seek- ers were registered from the Democratic Republic of Congo and 4 101 from South Sudan. The influx of refugees has strained Uganda's public services, creating tensions between refugees and host commu- nities. Malnutrition (high SAM and GAM rates) among refugees is of particular concern. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 19 Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments Uganda Crime- an-Congo haemor- rhagic fever (CCHF) Ungraded 17-Apr-19 24-May-18 17-Apr-19 17 13 4 23.50% A new confirmed case of Crime- an-Congo haemorrhagic fever (CCHF) has been reported from Uganda. The case-patient is a 32-year-old male resident of Katabi sub-county in Wakiso district, who tested positive for the virus post- humously. He died at a hospital in Wakiso while in admission and was buried in Butagaya, Nakakulwe vil- lage, Jinja on 12 April 2019. A total of 21 contacts have been identified and are being monitored. Since May 2018, a total of 17 cases have been reported across Uganda. Uganda Food- borne illness Ungraded 18-Mar-19 12-Feb-19 18-Mar-19 233 1 0.40% Two districts, Amudat (97 cases with one death) and Napak (154 cases), have been affected by a suspected food-borne illness outbreak. The outbreak is linked to a UN World Food Program (WFP)’s recent distribution of fortified blended food (Super Cereal) to several health facilities in the affected districts as part of a nutrition program for preg- nant and lactating mothers as well as under-five children. The recipients reportedly made and ate meals on return to their homes after which several people started presenting with symptoms of mental disorders, hallucinations, irritability with fever and abdominal pain by the next day. Test results from food and biological samples sent to laboratories in Uganda, Kenya, and South Africa are pending. Uganda Measles Ungraded 08-Aug-17 01-Jan-19 05-Mar-19 364 201 0 0.00% Between 1 January to 5 March 2019, 228 suspected cases, of which 201 have been confirmed (epidemi- ologically-linked and laboratory confirmed) were reported in mul- tiple districts. No death is reported among confirmed cases. From January to December 2018, a total of 3 652 suspected cases including 892 confirmed (epidemiological-linked and laboratory confirmed) were reported across the country. One death was reported among the confirmed cases. Fifty-three districts in the country have reported measles outbreaks. Zambia Cholera Ungraded 22-Mar-19 16-Mar-19 22-Mar-19 45 6 3 6.70% A cholera outbreak in Nsama district, Northern Province, Zambia was notified to WHO by the MOH on 22 March 2019. The index case, a 9-year-old child from Chaushi vil- lage, developed signs and symptoms on 16 March 2019. From 16 – 22 March 2019, a total of 45 cases with three deaths were reported, of which six have been laboratory confirmed. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 20 Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments Zambia Measles (suspected) Ungraded 03-Mar-19 04-Dec-19 03-Mar-19 93 0 0 0.00% A total of 93 suspected cases have been reported from Chibali zone, Lavushimanda district in Muchin- ga Province, Zambia. Of these, 50% are below five years old, 47% between five to fifteen years of age, and 3% above 15 years old. All of the suspected cases were reportedly not previously vaccinated against measles. Although clinical signs and symptoms point to measles, it has not been possible to confirm the aetiological agent of the disease by laboratory testing as the country did not have measles reagents. Zimbabwe Cholera G2 06-Sep-18 06-Sep-18 31-Mar-19 10 722 312 69 0.60% No new case has been reported across the country since 12 March 2019. A second round of oral cholera vaccine was recently concluded. Zimbabwe Floods/land slides G2 15-Mar-19 15-Mar-19 10-Apr-19 - - - - The Cyclone Idai hit 3 provinces neighboring Mozambique namely Manicaland, Masvingo and Masho- naland East provinces on 15 March 2019. The Government has reported that around 270 000 people are affected by the floods and cyclone, and 299 deaths, with 186 injuries have occurred. Chimanimani and Chipinge districts, in South Eastern Zimbabwe, are most affected, with at least half of the population impacted, with households needing shelter assistance also in Mutare, and Buhera districts. Zimbabwe Typhoid fever Ungraded - 01-Oct-17 19-Dec-18 5 159 262 15 0.30% There has been a resurgence of typhoid fever in Harare, the capital city of Zimbabwe, since mid-Sep- tember 2018. The increase started in week 37 (week ending 16 September 2018) when 61 suspected cases were reported, compared to 10 cases (which lies within normal range) in week 36. The weekly incidence eventually peaked in week 41 (week ending 14 October 2018), with 130 cases and has since been declining gradually. There were 34 suspected cases reported in week 49 (week ending 9 December 2018). Closed Events Kenya Rift Valley fever (RVF) Ungraded 01-Feb-19 18-Jan-19 04-Mar-19 169 16 0 0.00% A total of 169 human cases have been reported from Murang’a (22) and Nyandarua (147) Counties. The outbreak in Murang’a County has been brought under control while Nyandarua remains active. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 21 Country Event Grade Date notified to WHO Start of reporting period End of reporting period Total cases Cases Con- firmed Deaths CFR Comments Tanzania, Unit- ed Republic of Anthrax Ungraded 28-Feb-19 18-Feb-19 07-Apr-19 91 3 6 6.60% No new cases were reported in week 16 (week ending 21 April 2019). The cummulative number of cases re- ported is 91 with 6 associated deaths. Momba District in Songwe Region last reported a case on 7 January 2019 (total 81 cases, four deaths) while Moshi DC in Kilimanajro Re- gion last reported on 3 March 2019 (total 10 cases, two deaths). †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 22 © 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 Health Emergencies Programme 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. 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