Weekly Bulletin on Outbreaks and other Emergencies: Week 6 - 30 January to 5 February 2022

(2) Algeria Mali Chad Niger Angola EthiopiaNigeria South Africa Namibia Mauritania Zambia Kenya Democratic Republic of the Congo Mozambique Botswana Congo Madagascar South Sudan Cameroon Zimbabwe Gabon Ghana Guinea United Republic of Tanzania Uganda Central African Republic Côte d'Ivoire Senegal Burkina Faso Benin Eritrea Liberia Malawi TogoSierra Leone Lesotho Burundi Rwanda Eswatini Guinea-Bissau Gambia Equatorial Guinea Mauritius Comoros Cape Verde Sao Tome and Principe Seychelles 0 820410 Kilometers ¤ Health Emergency Information and Risk Assessment Graded events † 40 Ungraded events Protracted 3 events 2 Protracted 2 events 0 Protracted 1 event 1 WEEKLY BULLETIN ON OUTBREAKS AND OTHER EMERGENCIES Ongoing events 1423 Humanitarian crises 20 Outbreaks 125 Protracted 3 events 2 5 Protracted 1 events 0 Grade 1 events 2 Grade 3 events 5 25 Grade 2 events New events Week 6: 30 January to 5 February 2023 Data as reported by: 17:00; 5 February 2023 17 355 285 244 37 3 243 3 255 0 751 1 3 134 12 273 873 513 0 5 114 0 763 7 13 934 71 426 0 4 982 46 142 0 31 0 024 7 797 85 266 463 3 155 124 295 1 965 4 056 701 102 595 22 025 396 15 367 113 25 070 388 87 981 833 95 586 1 463 74 143 1 423 499 592 7 572 48 980 306 8 062 294 63 436 997 170 724 4 088 133 090 1 468 50 665 172 42 664 846 9 510 315 7 652 194 10 189 103 294 915 1 044 105 184 1 931 341 573 4 049 263 083 5 659 232 510 2 236 63 227 413 67 842 1 420 170 305 3 630 342 785 5 688 12 586 372 8 947 176 32 780 743 271 376 6 881 329 494 2 800 53 492 15 88 503 2 686 7 760 126 18 393 138 34 490 706 8 992 161 3323 259 39 356 290 6 280 77 17 186 183 019 46738 224 88 900 1 968 27 989 163 2 200 000 15 164 303 767 4 146 438 1 846 137 21 1 174 0 2 311 7 2 147 10 01 117 3 3 581 41774 067 22 38 566 1 254 186 0 984 0 6 912 132 3 315 31 14 153 32 148 5 68 3 08 1 180 8 7 743 707 2 0 121 4 171 112 1 462 3 0 2 137 31 5 0 1 485 3 392 2 17 0 02 204 0 127 70 53 24 013 1 068 28 20 768 498 49251 6 0 1 000 000 84 0 1 0 4 186 78 3 156 0 8 3 31 0 034 06 4 0 115 1 2 0 1 0 64 0 1 882 391 16490 580 838 1 1 2 000 000 481 463 1 200 000 3 400 000 6 100 000 4 104 16 22 000 000 12 000 000 4 500 000 6 310 000 9 400 000 118 1 90 810 33 39 1 16490 2 0 144 0 Legend Malaria Floods, Cyclonic Humanitarian crisis Dengue fever Yellow fever Countries outside WHO African Region WHO Member States with no reported events Not applicable Countries reported in the document Chikungunya Plague Leishmaniasis Crimean-Congo haemorrhagic fever Hepatitis E Monkeypox Cholera Lassa fever Measles Deaths Cases Acute Food Insecurity cVDPV2 Anthrax COVID-19 Meningitis Typhoid fever Malnutrition crisis Ebola virus disease Sudan virus disease Drought Influenza like illness Rift Valley fever Acute kidney injury “The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate borderlines for which there may not yet be full agreement.” Emergency Preparedness and Response Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 1 Overview Ongoing events IDRS Report All events currently being monitored This Weekly Bulletin focuses on public health emergencies occurring in the WHO African region. This week’s articles cover:  Cyclone CHENESO in Madagascar  Lassa fever in Nigeria  Mpox in the WHO African Region For each of these events, a brief description, followed by public health measures implemented and an interpretation of the situation is provided. A table is provided at the end of the bulletin with information on all new and ongoing public health events currently being monitored in the region, as well as recent events that have been controlled and closed. Major issues and challenges include:  Since 19 January 2023, Madagascar is responding to cyclone CHENESO which has currently left around 500 000 people without access to health care services, in almost half of the 114 districts across the country. Many roads and bridges have been cut or made impassable, many health care facilities are now inaccessible, hence complicating the provision of care and humanitarian assistance to affected communities. There is urgent need for resource mobilization, in a context of extreme precarity and poverty, weak and fragile health system, and lack of qualified human resources. In addition, there are concomitant and resource-consuming emergencies including a protracted malnutrition crisis in southern and south-eastern parts of the country, the COVID-19 pandemic, resurgence of malaria and plague, and an outbreak of circulating vaccine derived poliovirus-2.  There is an ongoing seasonal Lassa fever outbreak in Nigeria for which the number of suspected and confirmed cases as well as the number of the affected Local Government Areas (LGA) and States increased compared to that reported for the same period for the previous two years. While the increased number of cases reported may be considered as result of improved surveillance activities, more effort is needed to further reduce the fatality of the disease and limit its geographical extension. Additional resources are also required for the country to be able to respond to others ongoing emergencies including other disease outbreaks (cholera, Covid-19, meningitis, etc.) and mitigate the impact of the volatile security situation in the affected areas. Contents Overview 1 8 9 2 - 7 Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 2 EVENT DESCRIPTION Madagascar, located in the South-West basin of Indian Ocean, is the African country most prone to seasonal cyclones running from November to April. For the recent cyclonic season, Madagascar has been hit by four consecutive tropical storms and cyclones between January and April 2022 including Ana, Batsirai, Dumako and Emnati. A cumulative of 945 727 people had been affected including 172 339 displaced persons and 204 fatalities. In addition, 148 health care facilities had been damaged. While the country was still struggling to recover from these previous shocks, on 19 January 2023 at 10:45am, a new cyclonic system called CHENESO landed in Madagascar by its northwest coast, precisely in the north of Antalaha district in Sava region, with an average wind speed of 90 km/h and gusts up to 120 km/h. From the latest information on its position received on 28 January at 9:00am, the system was 282 km southwest of Toliara district in Atsimo Andrefana region, with an average wind speed of 120 km/h and gusts up to 170 km/h near the centre. It was moving southeast at a speed of 13 km/h. At this moment, the danger seemed averted. However, the system has caused an accumulation of precipitation with consequential torrential rains that are persistently falling in several regions of Madagascar. These heavy rains have led to rising water levels, overflooding of rivers, and landslides. Indeed, the three main rivers of Grand Tana - which hosts the capital city of the country - have been overflooded, including the Sisaony river whose dike broke on 27 January leading to extensive overflooding of southern Antananarivo plains. As of 31 January 2023, preliminary reports indicate that CHENESO has overflooded 26 403 houses and completely destroyed 1 073 others, in 18 (78.3%) of the 23 regions and 53 (46.5%) of the 114 districts of the country. A total of 90 780 people representing 20 980 households have been directly impacted, including 34 114 people forced to displacement and resettled in 115 shelters of which 66 had already been evacuated by 17 766 returnees. At the same time, 33 fatalities have already been recorded and 20 people were still missing. Damages on infrastructures are also important, the magnitude of which varies across districts and regions affected. Although a thorough assessment has not yet been undertaken, many administrative buildings have been partially or totally damaged, roads and/or bridges have been cut or become impassable as a result of cumulative rainfall and heavy flooding that accompany the cyclone. For the health sector, preliminary data reveal that nearly 64 health care facilities (25 level 1 basic health centres, 34 level 2 basic health centres, and three district reference hospital centres) have been partially or totally destroyed, and 19 administrative buildings or accommodations have been damaged. Consequently, approximately 470 998 people are likely to be deprived of basic health care services. 157 Madagascar Cyclone CHENESO Go to overview Go to map of the outbreaks PUBLIC HEALTH ACTIONS  A multisectoral coordination mechanism has been put in place, under the leadership of the National Office for the Management of Risks and Disasters. Regular meetings are being held both at national and regional levels.  The President of the Republic, and other political and administrative authorities have visited some of the affected areas, and provided comfort and assistance to victims.  An Incident Management system has been activated at the level of WHO.  A national strategic preparedness and response plan has been elaborated.  A multisectoral rapid risk assessment for the health sector has been completed.  Efforts are underway to conduct a thorough assessment of damages, particulary to the health sector.  Surveillance activities have been reinforced in affected areas through daily collection and analysis of data.  Various medical equipment, materials and kits have been dispatched in affected and at-risk areas.  Health care services including vaccination are being delivered to affected populations. As of 31 January, 115 shelters had been settled, of which 66 had already been evacuated.  Populations living in at-risk zones have been evacuated. The whole population is being educated and sensitized on preventive and/or mitigative measures relating to the cyclone and related health risks. SITUATION INTERPRETATION Madagascar is at very high risk of being affected by cyclones, with an INFORM rank score of 7.4 for this 2023 cyclonic season. Many of the currently affected areas were still struggling to recover from the previous cyclonic season during which four consecutive cyclones and tropical storms have occurred between January and April 2022. This situation has direly aggravated the vulnerability of a population already living in very precarious conditions and extreme poverty. It is worsening a protracted malnutrition crisis that has been ongoing for more than 40 years in the “Grand Sud” regions of the country and has now extended to some of the “Grand Sud-Est” regions as well as a result of previous cyclones. There is crucial need to increase surveillance activities in affected areas due to the increased risk of water-borne (cholera, typhoid fever, shigellosis, etc.) and vector-borne (malaria, plague) disease outbreaks, as well as vaccine-preventable disease outbreaks (measles, meningitis, poliomyelitis). 470 998 33 people affected Deaths Ongoing events Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 3Go to overview Go to map of the outbreaks Emergency Response Coordination Centre (ERCC) – DG ECHO Daily Map | 27/01/2023 Madagascar | Tropical Cyclone CHENESO update M A D A G A S C A R INDIAN OCEAN Mozambique Channel COMOROS Mayotte (FRANCE) La Réunion (FRANCE) *The speed in the boxes represent the 10-min sustained winds. **Rainfall over La Réunion and Mauritius is due to a different low pressure system (source: MeteoFrance, Mauritius MetService). ©European Union, 2023. Map produced by the JRC. The boundaries and the names shown on this map do not imply official endorsement or acceptance by the European Union. MAURITIUS MOZAMBIQUE 18 Jan 0:00 UTC 63 km/h 27 Jan 06:00 UTC 106 km/h* International Disaster Charter activation (795) Activation time: 24 Jan Copernicus EMS Rapid Mapping activation (EMSR645) Activation time: 25 Jan INDIAN OCEAN ATLANTIC OCEAN Region boundary Densely populated area Source: GHSL Flooded area over 22-27 Jan Source: JRC GloFAS GFM, Copernicus EMSR645 50-100 100-250 500-750 >750 Rainfall accumulation** (mm) over the entire track (18-31 Jan) Source: GDACS, ECMWF 250-500 Tropical Cyclone Source: GDACS, MeteoFrance Past track Forecast track C urrent position î 63–118 km/hT ropical Storm D < 63 km/hT ropical Depression î 119–179 km/hT ropical Cyclone C ompleted P lanned Copernicus EMSR645 A rea of Interest (AoI) 19 Jan 06:00 UTC 106 km/h 20 Jan 0:00 UTC 53 km/h 23 Jan 06:00 UTC 53 km/h 26 Jan 18:00 UTC 116 km/h 28 Jan 06:00 UTC 158 km/h 28 Jan 179 km/h 30 Jan 137 km/h 31 Jan 116 km/h 21 Jan 0:00 UTC 53 km/h 22 Jan 12:00 UTC 63 km/h 24 Jan 18:00 UTC 116 km/h 26 Jan 0:00 UTC 169 km/h 19 Missing person 26 000 Displaced people 55 000 Affected people 13 350 Damaged houses Impact overview (Madagascar) Source: BNGRC ~ 2.5 Million Potential exposed population (Madagascar) to rainfall > 500 mm Source: GDACS 16 Fatality 18 Damaged medical centres Source Clicanoo Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 4 EVENT DESCRIPTION From week 1 through week 3, 2023, a total of 244 new confirmed cases of Lassa fever, including 37 deaths with a case fatality ratio of 15.2%, have been reported in 16 states. The highest number of cases was reported in Ondo (90) and Edo (89) states, followed by Bauchi (13), Taraba (10), Benue (9), Ebonyi (9), Nasarawa (7), Plateau (5), Kogi (4), Anambra (2), Delta (1), Oyo (1), Adamawa (1), Enugu (1), and Imo (1) states; one case was reported from the Federal Capital Territory (FCT) (1). About 79% of all confirmed Lassa fever cases were reported from three states (Ondo, Edo, and Bauchi), while 21% were reported from 13 states. Of the 79% of confirmed cases, Ondo reported 37%, Edo 36%, and Bauchi 5%. In total for 2023, 16 States have recorded at least one confirmed case across 50 Local Government Areas. Of the reported cases, the predominant age group affected is 21-30 years (range: 1 to 79 years) and the Median age is 30 years. The male-to-female ratio for confirmed cases is 1:0.9. Five confirmed cases and one death were reported among health workers. In week 3 alone, the number of new confirmed cases increased from 77 in week 2, 2023 to 137 cases and the number of deaths from six in week 2 to 18 in week 3. These cases were reported from Ondo, Edo, Taraba, Benue, Nasarawa, Bauchi, Ebonyi, Plateau, Kogi, Anambra, Delta, FCT, Adamawa, and Enugu states. A total of two confirmed cases among health Care workers were reported in the reporting week. Compared to the previous year 2022, from week 1 to week 3, the number of confirmed cases has increased from 170 cases in 2022 to 244 cases in 2023. A total of 12 states and 37 Local Government Areas (LGAs) were affected in 2022 against 16 states and 50 LGAs in 2023. However, the case fatality ratio was higher in 2022 (18.8%, 32/170) compared to 2023 (15.1%, 37/244) for the same period. Regarding suspected cases reported, a total of 939 were reported for the three epidemiological weeks of 2023 among which 244 were confirmed (30.0%),the number of suspected cases reported increased compared to that reported for the same period in 2021 (354) and 2022 (759). A cumulative number of 700 contacts were listed since the beginning of this year and 518 are under follow up, 183 completed follow up, four contacts developed symptoms and no contact tested positive for Lassa fever. A total of 226 cases were managed at the treatment centre. 157 NigeriaLassa Fever Go to overview Go to map of the outbreaks PUBLIC HEALTH ACTIONS  At national level, the Nigeria Centre for Disease Control and Prevention (NCDC) activated the National Multisectoral Emergency Operations Center for Lassa Fever at Level 2 to coordinate and strengthen the ongoing response activities in the country, following a risk assessment carried out on 20 January 2023.  A workshop to validate the five-year Strategic plan for Lassa fever was organized.  The dissemination of the reviewed case management and safe burial practices guidelines has been done.  The mortality review of Lassa fever deaths as well as in- depth investigation of healthcare worker infections were performed.  The preparation of the External Quality Assurance panel for all testing laboratories is ongoing.  The distribution of response commodities to the affected states and treatment centers was conducted, these included: personal protective equipment (PPEs), Ribavirin (injection and tablets), body-bags, thermometers, hypochlorite hand sanitizers and IEC materials  The implementation of Nigeria Lassa fever epidemiological Study is ongoing.  The Multi-sectoral Public Health Emergency Operation Centers (PHEOC) were activated in affected states. SITUATION INTERPRETATION Lassa fever is endemic in Nigeria with seasonal outbreaks reported and the number of cases typically increases between December and March, which coincides with the dry season in the country. For the past five- year’s period, from week 1 through week 3 of each year, except in 2021, the trend in number of suspected and confirmed cases has been increasing as well as the number of the affected Local Government Areas and States, however the case fatality ratio is decreasing since 2021. This may be considered as the positive impact of the strengthened surveillance and case management response activities. Lassa fever is one of diseases linked to poor environmental health conditions. 15.2% CFR 244 37 cases Deaths Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 5Go to overview Go to map of the outbreaks Confirmed Lassa fever cases in Nigeria from epidemiological week 48, 2022 to week 3, 2023 Trend of confirmed cases of Lassa fever in Nigeria from 2019 to 2023 Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 6Go to overview Go to map of the outbreaks Distribution of confirmed cases and deaths of Lassa fever in affected States in Nigeria, as of epidemiological week 3, 2023 @WHO/AFRO Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 7 EVENT DESCRIPTION Six newly confirmed mpox cases were reported in Africa in the past week as the cases reported in 2023 increased from 118 in week 3 (23 -29 January 2023) to 124 within the past week. The cases were reported from the Central African Republic (CAR), Liberia and Nigeria. One new death was retrospectively reported from Nigeria. The number of mpox cases in CAR has increased from 20 to 22 as the country reported two new cases from four suspected cases in the past week. Liberia also reported the first case in 2023, making a total of seven cases since the outbreak in 2022. The three new cases reported in Nigeria in the past week have increased the number of mpox cases to 26 in 2023. Nigeria has reported a cumulative total of 789 cases from 1 January 2022 to 5 February 2023. Between 1 January 2022 and 05 February 2023, 1 365 laboratory- confirmed cases have been reported from 13 African countries, including Nigeria (789), the Democratic Republic of the Congo (DRC) (370), Ghana (121), CAR (22), Cameroon (18), Sudan (18), Liberia (7), Congo (5), South Africa (5), Benin Republic (3), Morocco (3), Egypt (1), and Mozambique (1). Three countries (CAR, DRC, and Nigeria) reported sporadic mpox cases in 2023. The top three countries with the highest number of confirmed cases include Nigeria (58.8% n = 789), DRC (27.7%; n = 370), and Ghana (9.0%; n = 121). Together, the three countries accounted for 94.5% (n = 1 341) of all confirmed cases. Seven countries that have not reported new mpox cases for more than ten weeks include Benin, Cameroon, Congo, Mozambique, Morocco, South Africa, and Sudan. Egypt in six weeks and Ghana in five weeks. Seventeen (17) deaths have been reported in the African region since 2022 from Nigeria (8), Ghana (4), Cameroon (3), Mozambique (1), and Sudan (1). 157 Multiple Countries Mpox Go to overview Go to map of the outbreaks PUBLIC HEALTH ACTIONS  Workshop for harmonizing response pillar tools was concluded in the Democratic Republic of the Congo from 26 - 30 January 2023  Ongoing technical support for the countries to identify target groups for mpox vaccination  WHO AFRO continues to support countries in strengthening Mpox surveillance, laboratory capacity, information management, and genomic sequencing SITUATION INTERPRETATION Six new mpox cases were reported from Central Africa Republic, Liberia, and Nigeria in the past week, with no new deaths. Africa has been reporting weekly new mpox cases since January 2023. Four countries have reported new cases in 2023, including the Central Africa Republic, the Democratic Republic of the Congo, Liberia, and Nigeria. 1.2% CFR 1 365 17 cases Deaths @WHO/AFRO Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 8Go to overview Go to map of the outbreaks Distribution of cases of Mpox in Africa, as of 5 February 2023 Sub region and country 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 Burundi Cameroon Central African Republic Chad Congo Democratic Republic of Congo Equatorial Guinea Eritrea Ethiopia Gabon Kenya Rwanda Sao Tome and Principe South Sudan Uganda United Republic of Tanzania Angola Botswana Comoros Eswatini Lesotho Madagascar Malawi Mauritius Mozambique Namibia Seychelles South Africa Zambia Zimbabwe Algeria Benin Burkina Faso Cabo Verde Côte d'Ivoire Gambia Ghana Guinea Guinea-Bissau Liberia Mali Mauritania Niger Nigeria Senegal Sierra Leone Togo Central and Eastern Africa Southern Africa Western Africa Please, refer to the calendar below to submit your IDSR data on a weekly basis : Veuillez-vous référer au calendrier ci-dessous pour soumettre vos données de la SIMR sur une base hebdomadaire : afrooutbreak@who.int afrgoeprhir@who.int Reminder : Upcoming deadlines for weekly data submission Rappel : Dates limites prochaines de soumission des données hebdomadaires All the correspondences related to this document should be directed to/ Toutes les correspondances relatives à ce document doivent être adressées à: Dr Etien Luc Koua, HIR Programme Area Manager (kouae@who.int) Emergency Preparedness and Response, WHO Regional Office for Africa Integrated Disease Surveillance and Response Weekly data submission report Health Emergency Information Management & Risk Assessment Programme Week 3 Week 4 Week 5 Week 6 Start date 16-Jan-2023 23-Jan-2023 30-Jan-2023 06-Feb.-2023 End date 22-Jan-2023 29-Jan-2023 05-Feb-2023 12-Feb.-2023 Deadline / Date limite 25-Jan-2023 01-Feb-2023 08-Feb-2023 15-Feb.-2023 57 % Completeness for weekly reporting 45 % Timeliness for weekly reporting 27 Countries out of 47, reported for week 03 Update on Reporting - Epidemiological Week 03: 16 – 22 Jan., 2023 Point du rapportage hebdomadaire – Semaine 03: 16 – 22 Jan., 2023 2022 Summary of Reporting - Frequency of weekly reports received at AFRO 2023 Received on time Received late Not Received Not applicable Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 9 Sub region and country 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 Burundi Cameroon Central African Republic Chad Congo Democratic Republic of Congo Equatorial Guinea Eritrea Ethiopia Gabon Kenya Rwanda Sao Tome and Principe South Sudan Uganda United Republic of Tanzania Angola Botswana Comoros Eswatini Lesotho Madagascar Malawi Mauritius Mozambique Namibia Seychelles South Africa Zambia Zimbabwe Algeria Benin Burkina Faso Cabo Verde Côte d'Ivoire Gambia Ghana Guinea Guinea-Bissau Liberia Mali Mauritania Niger Nigeria Senegal Sierra Leone Togo Central and Eastern Africa Southern Africa Western Africa Please, refer to the calendar below to submit your IDSR data on a weekly basis : Veuillez-vous référer au calendrier ci-dessous pour soumettre vos données de la SIMR sur une base hebdomadaire : afrooutbreak@who.int afrgoeprhir@who.int Reminder : Upcoming deadlines for weekly data submission Rappel : Dates limites prochaines de soumission des données hebdomadaires All the correspondences related to this document should be directed to/ Toutes les correspondances relatives à ce document doivent être adressées à: Dr Etien Luc Koua, HIR Programme Area Manager (kouae@who.int) Emergency Preparedness and Response, WHO Regional Office for Africa Integrated Disease Surveillance and Response Weekly data submission report Health Emergency Information Management & Risk Assessment Programme Week 3 Week 4 Week 5 Week 6 Start date 16-Jan-2023 23-Jan-2023 30-Jan-2023 06-Feb.-2023 End date 22-Jan-2023 29-Jan-2023 05-Feb-2023 12-Feb.-2023 Deadline / Date limite 25-Jan-2023 01-Feb-2023 08-Feb-2023 15-Feb.-2023 57 % Completeness for weekly reporting 45 % Timeliness for weekly reporting 27 Countries out of 47, reported for week 03 Update on Reporting - Epidemiological Week 03: 16 – 22 Jan., 2023 Point du rapportage hebdomadaire – Semaine 03: 16 – 22 Jan., 2023 2022 Summary of Reporting - Frequency of weekly reports received at AFRO 2023 Received on time Received late Not Received Not applicable Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 10Go to overview Go to map of the outbreaks All events currently being monitored by WHO AFRO Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR New Events Nigeria Meningitis Ungraded 1-Oct-2022 1-Oct-2022 31-Jan-2023 315 54 50 15.9% From 1 October 2022 to 31st January 2023, 44 wards, in 38 Local Government Areas drawn from 18 states reported 315 suspected meningitis cases, including 54 positive cases and 50 deaths (CFR: 15.9%). Twenty-five cases (Benue 5, Jigawa 13, Kebbi 1, Oyo 3, Plateau 1 and Yobe 1) were vaccinated against Meningitis. In Jigawa state, effective 1 October 2022 to 31st January 2023, 242 suspected cases (51 lab-confirmed) and 47 deaths (CFR: 19.4%) were reported in 12 LGAs within 43 wards. Of the confirmed cases, 50 cases were positive for Neisseria meningitidis serogroup C, and one was positive for Streptococcus pneumoniae. The positivity rate is 82%. South Africa Cholera Grade 3 3-Feb-2023 3-Feb-2023 3-Feb-2023 2 2 0 0.0% On 3 February 2023, the NCID of South Africa notified WHO of two imported cases of cholera. Both cases reported history of travel to Lilongwe, Malawi on 15 January to attend a funeral. Resided with relatives in Malawi and utilised municipal water. They travelled back to South Africa via bus on 29th January. Samples from both cases tested positive by PCR and further investigations are ongoing. Uganda Measles Ungraded 8-Dec-2022 2-Feb-2023 1-Feb-2023 144 12 0 0.0% A measles outbreak has been ongoing in Bunyoro Region of Uganda since 7 February 2023. As of 1 February 2023, a cumulative total of 144 suspect cases, 12 confirmed cases and no deaths have been reported since the onset of the outbreak. Ongoing Events Algeria COVID-19 Grade 3 25-Feb-2020 25-Feb-2020 29-Jan-2023 271 376 271 376 6 881 2.5% From 25 February 2020 to 29 January 2023, a total of 271 376 confirmed cases of COVID-19 with 6 881 deaths have been reported from Algeria, with 182 743 recovered. Algeria Poliomyelitis (cVDPV2) Grade 2 14-Jul-2022 11-Apr-2022 1-Feb-2023 2 2 - - According to Global Polio Eradication Initiative, no case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. The number of cases in 2022 remains two. Angola COVID-19 Grade 3 21-Mar-2020 21-Mar-2020 15-Jan-2023 105 184 105 184 1 931 1.8% The first COVID-19 confirmed case was reported in Angola on 21 March 2020. As of 15 January 2023, a total of 105 184 confirmed COVID-19 cases have been reported in the country with 1 931 deaths. Benin COVID-19 Grade 3 17-Mar-2020 16-Mar-2020 9-Jan-2023 27 989 27 989 163 0.6% The Ministry of Health in Benin announced the first confirmed case of COVID-19 on 16 March 2020. As of 9 January 2023, a total of 27 989 cases have been reported in the country, with 163 deaths and 27 823 recoveries. Benin Mpox Grade 3 14-Jun-2022 14-Jun-2022 1-Feb-2023 3 3 0 0.0% Three suspected cases of Monkeypox were notified to WHO by the Benin Ministry of Health on 3 June 2022. Two of the three suspected cases were from Nigeria, and one person was from the North of the country. Laboratory samples were taken and sent to the Institute Pasteur laboratory in Dakar, which confirmed the three samples positive on 14 June 2022. Benin Poliomyelitis (cVDPV2) Grade 2 8-Aug-2019 24-Aug-2019 1-Feb-2023 24 24 0 0.0% No cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported this week. There are 10 cases reported in 2022. Six cases were reported in 2021 and 2020, and 8 in 2019. No new cases were reported in 2023. Botswana COVID-19 Grade 3 30-Mar-2020 30-Mar-2020 24-Jan-2023 329 494 329 494 2 800 0.9% On 30 March 2020, the Minister of Health and Wellness in Botswana reported three confirmed cases of COVID-19. As of 24 January 2023, a total of 329 494 confirmed COVID-19 cases were reported in the country including 2 800 deaths. Burkina Faso Humanitarian crisis (Sahel Region) Grade 2 1-Jan-2019 1-Jan-2019 31-Jan-2023 1 882 391 - - - Since 2015, the security situation in the Sahel and East of Burkina Faso has gradually deteriorated due to attacks by armed groups. The humanitarian situation in the country remained a concern in January 2023. The government reported several security incidents and other restrictions that hampered humanitarian access, mainly in the Sahel, North-Centre, East and North regions. A total of 1 882 391 displaced persons are registered in Burkina Faso as of 31 December 2022. We observed a 4% increase in the total IDPs in December compared to November 2022. It is estimated that a total of 4.7 million people will need humanitarian aid in 2023. Access to health services remains a challenge for the population in affected areas. Burkina Faso COVID-19 Grade 3 10-Mar-2020 9-Mar-2020 9-Jan-2023 22 025 22 025 396 1.8% Between 9 March 2020 and 9 January 2023, a total of 22 025 confirmed cases of COVID-19 with 396 deaths and 21 596 recoveries have been reported from Burkina Faso. Burundi Cholera Grade 3 1-Jan-2023 1-Jan-2023 1-Feb-2023 118 66 1 0.8% An outbreak of cholera has been declared in Burundi on 1 January 2023. As of 1 February 2023, 118 suspected cases and one death (CFR 0.8%) have been reported, including more than 66 laboratory-confirmed cases. More than half of cases (n=61; 51.7%) are females. The most affected age group is the 21-30 years (28 cases; 23.7%); the under-five represent 20.3% of cases (n=24). Five new health areas have been affected, giving a total of 29 health areas that have reported one or several cases of cholera since the beginning of the outbreak, distributed in five districts including Budjumbura North (47 cases), Isale (36 cases), Cibitoke (30 cases), Bujumbura South (three cases) and Bujumbura Centre (two cases). Burundi COVID-19 Grade 3 31-Mar-2020 18-Mar-2020 28-Jan-2023 53 492 53 492 15 0.0% On 31 March 2020, the Minister of Health in Burundi reported the first two confirmed cases of COVID-19. As of 28 January 2023, the total number of confirmed COVID-19 cases is 53 492, including 15 deaths and 53 394 recovered. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 11 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Cameroon Humanitarian crisis (North, Adamawa & East) Protracted 2 31-Dec-2013 27-Jun-2017 16-Jan-2023 481 463 - As a result of the ongoing crisis in Far-Northern Cameroon and neighbouring countries, there has been a massive influx of internally displaced populations and refugees in Adamawa, North and East regions. For 2022, there is an estimated 481 463 refugees and asylum seekers in Cameroon, including more than 325 000 refugees coming from Central African Republic. Cameroon Humanitarian crisis (NW & SW) Protracted 2 1-Oct-2016 27-Jun-2018 16-Jan-2023 2 000 000 - - - The humanitarian situation in the NWSW regions remained dire, marked by continued violent attacks on schools and children, as well as on healthcare. Continued fighting between non-Sate armed groups (NSAGs) and State security forces (SSF) led to the killing and displacement of civilians. Parties to the conflict continue to attack or hamper healthcare services accusing health personnel of supporting either side. Civilians continue to be caught in crossfire due to frequent clashes between NSAGs and SSF as well as clashes between different NSAG factions competing for power and control over localities. Humanitarian activities continue to be hampered by roadblocks, theft of humanitarian supplies, bureaucratic impediments, and risk of IEDs in public spaces and roads used by humanitarians. Cameroon Humanitarian crisis (Sahel Region) Grade 2 31-Dec-2013 27-Jun-2017 16-Jan-2023 1 200 000 - - - The security situation in the Far-North region of Cameroon remains volatile. The Mayo-Sava department concentrates the greatest number of incidents in November. In the Mayo-Tsanaga department, attacks of NSAGs led to the displacement of more than 2 935 households (24 192 people) and for which humanitarian assistance remains insufficient. Moreover, as a consequence of flooding events that have occurred since mid-August 2022, more than 314 000 people (54 926 households) have been affected including more than 23 deaths and 113 324 internally displaced populations (17 348 households). In addition, more than 33 600 houses and 151 schools have been overflooded; 48 000 hectares of land have been destroyed and 10 566 animals have been lost in Mayo-Danay, Logone & Chari, and Mayo-Tsanaga departments. Cameroon Cholera Grade 3 31-Aug-2021 25-Oct-2021 26-Jan-2023 15 164 1 806 303 2.0% Between 20 and 26 January 2023, five new suspected cases of cholera with one death have been reported from Littoral (4 cases) and Centre (one case) regions. Ntui district in Centre region has started re-notifying cases of cholera. As of 26 January 2023, 15 164 suspected cases of cholera including 1 806 laboratory-confirmed cases and 303 deaths (CFR 2.0%) have been reported since October 2021, from eight Regions and 52 Districts of which five remain active in two regions. Patients’ ages range from 2 months to 103 years with a median of 27 years, and females remain twice less affected than males. Cameroon COVID-19 Grade 3 6-Mar-2020 6-Mar-2020 22-Jan-2023 124 295 124 295 1 965 1.6% The Cameroon Ministry of Health announced the confirmation of the first COVD-19 case on 6 March 2020. As of 22 January 2023, a total of 124 295 cases have been reported, including 1 965 deaths and 122 286 recoveries. Cameroon Measles Ungraded 2-Apr-2019 1-Jan-2022 31-Dec-2022 4 982 2 642 46 0.9% In 2022, from week 1 to week 52, a total of 4 982 suspected measles cases with 46 measles related deaths (CFR 0.9%), 2 642 total confirmed cases by: lab investigation (605 IgM+); epi-linkage (1 971) and measles compatible 66 cases have been reported. A total of 65 health distrcits have had outbreaks in the year ; 72% of confirmed cases (lab, epi link, compatible) are not vaccinated or unknown measles vaccination status. The number of deaths has been revised. Cameroon Mpox Grade 3 24-Feb-2022 1-Jan-2022 22-Jan-2023 117 18 3 2.6% From 2 to 22 January 2023 (weeks 1-3), two new suspected case of Mpox have been reported from Bertoua district in East region and Batibo district in North-West region. Between 1 January 2022 and 22 January 2023, the country has notified 117 suspected cases of Mpox with three deaths (CFR 2.6%), from 23 districts across seven regions. A total of 18 cases have been laboratory-confirmed in nine districts of four regions. Males are slightly more affected than females (sex ratio M/F 3/2). Ages range from six months to 53 years with a median of 12.5 years; the under-five represent the most affected age group (n=21; 17.9%). Cameroon Poliomyelitis (cVDPV2) Grade 2 23-May-2019 1-Jan-2020 25-Jan-2023 13 13 0 0.0% No new case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week 3, 2023 (ending 22 January). There were three cases reported in 2022, three others reported in 2021, and seven cases reported in 2020. Cameroon Yellow Fever Ungraded 7-Feb-2021 4-Jan-2021 22-Jan-2023 3 243 83 3 0.1% From the beginning of the outbreak in February 2021 to 22 January 2023, 3 243 suspected cases of YF have been reported and investigated, including 83 laboratory- confirmed cases among whom three have died (CFR 3.6%). Of note, ten new suspected cases have been reported between weeks 1-3 (2-22 January 2023). A total of 29 districts are affected, in all ten regions of the country. Cape Verde COVID-19 Grade 3 19-Mar-2020 18-Mar-2020 26-Jan-2023 63 227 63 227 413 0.7% The first COVID-19 confirmed case was reported in Cape Verde on 19 March 2020. As of 26 January 2023, a total of 63 227 confirmed COVID-19 cases including 413 deaths and 62 754 recoveries were reported in the country. Central African Republic Humanitarian crisis Protracted 2 11-Dec-2013 11-Dec-2013 2-Feb-2023 3 400 000 - - - The humanitarian crisis in the Central African Republic (CAR) continues to deteriorate. As a result of violence against civilians and insecurity in areas outside urban centres, several million people are increasingly vulnerable and their livelihoods are eroding. Their access to food and basic services such as health care and water supply is drastically limited. In 2023, 3.4 million people will need humanitarian assistance and protection, an increase of 10% compared to 2022. Notwithstanding, humanitarian partners in CAR have provided life-saving multi-sectoral assistance to 1.5 million people during the first nine months of 2022, despite a volatile security context. A recent analysis for the period October 2022-August 2023 showed an expected 16% and 20% increase in the burden of acute malnutrition, respectively among under-five children and pregnant women as compared to last year projections. Central African Republic COVID-19 Grade 3 14-Mar-2020 14-Mar-2020 22-Jan-2023 15 367 15 367 113 0.7% The Ministry of Health and population announced the confirmation of the first COVID-19 case in Central African Republic on 14 March 2020. As of 22 January 2023, a total of 15 367 confirmed cases, 113 deaths and 15 200 recovered were reported. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 12 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Central African Republic Measles Ungraded 13-Mar-2022 1-Jan-2022 31-Dec-2022 1 485 148 3 0.2% In 2022, from week 1 through week 52 , a total of 1 485 suspected cases of measles and three deaths (CFR 0.2% ) were reported through Integrated Diseases Surveillance and Response (IDSR)system. Among cases reported, 148 are confirmed including 99 laboratory-confirmed and 49 by epidemiological link. A total of 10 districts confirmed measles outbreaks: Bangui 1 confirmed at week 33; Batangafo-Kabo at week 30, Ouango-Gambo at week 30, Bimbo at week 10, Kouango-Grimari at week 11, Alindao at week 14 , Haute-Kotto at week 20, Kembé-Satema at week 41, Bocaranga-Koui at week 43 and Mobaye-Zangba at week 46. About 97% of districts (34/35) investigated the outbreak and collected sample for at least one suspected measles case Central African Republic Mpox Grade 3 3-Mar-2022 4-Mar-2022 24-Jan-2023 774 20 0 0.0% From 1 January 2022 to 24 January 2023, Central African Republic has reported 20 laboratory-confirmed cases of monkeypox with no deaths. Sixteen confirmed and three probable cases were reported in 2022 while four confirmed cases have already been reported since the beginning of 2023. The last confirmed case was notified on 10 January in Bangassou district. Cumulatively, six districts have so far been affected: Sangha-Mbaéré, Bangui I, Alindao, Bimbo, Ouango-Gambo and Bangassou. Central African Republic Poliomyelitis (cVDPV2) Grade 2 24-May-2019 24-May-2019 25-Jan-2023 31 31 0 0.0% No new cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported this epiweek 3, 2023 (ending 22 January). There are six cases reported in 2022. Although no new cases were reported in 2021, 4 cVDPV2 cases were reported in 2020 and 21 cases in 2019 from several outbreaks. Central African Republic Yellow Fever Ungraded 17-Aug-2021 1-Apr-2021 8-Jan-2023 767 23 4 0.5% On 3 August 2021, an 18-month-old girl from Mala village in the Kemo district, Central African Republic, tested positive for yellow fever by plaque reduction neutralization. As of 8 January 2023, 767 suspected cases of YF have been reported including 6 probable and 23 lab-confirmed cases (14 cases in 2022). Two new suspected cases were reported in week 1 (ending 8 January). In total, five regions have so far been affected including RS1, RS2, RS3, RS4 and RS6; RS3 has reported 70% of confirmed cases. Chad Humanitarian crisis (Sahel region) Grade 2 11-Feb-2022 1-Mar-2016 15-Jan-2023 6 100 000 - - - The Lac Chad province is experiencing a double security and environmental crisis. Since 2015, the region is impacted by attacks of non-state armed groups (NSAG) which have forced local communities to flee their homes. The province experienced heavy rainfall which has affected some 229 000 people between October and December 2022, and has destroyed large surfaces of cropland, washed away more than 6 000 of cattle, and caused extensive damage to homes and schools. The floods added a new challenge to an already critical situation. Chad COVID-19 Grade 3 19-Mar-2020 19-Mar-2022 29-Jan-2023 7 652 7 652 194 2.5% The first COVID-19 confirmed case was reported in Chad on 19 March 2020. As of 29 January 2023, a total of 7 652 confirmed COVID-19 cases were reported in the country including 194 deaths. Chad Measles Ungraded 24-May-2018 1-Jan-2022 31-Dec-2022 3 134 194 12 0.4% From January through December 2022, a total of 3 134 suspected measles cases and 12 deaths ( 0.4%) were reported through Integrated Diseases Surveillance and Response system. A total of 13 districts with confirmed outbreaks. Among confirmed cases, 47.5% are below 5 years of age and only 17.5% known to have received the measles vaccine. Chad Poliomyelitis (cVDPV2) Grade 2 18-Oct-2019 9-Sep-2019 25-Jan-2023 142 142 0 0.0% No new case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week 3, 2023 (ending 25 January). A total of 27 cVDPV2 cases were reported in 2022. In addition, there were 106 cVDPV2 cases reported in 2020 from three different outbreaks, while nine other cases were reported in 2019. Chad Yellow Fever Ungraded 13-Nov-2021 1-Nov-2021 25-Dec-2022 2 311 30 7 0.3% On 13 November 2021, the Institut Pasteur in Dakar confirmed two samples from Mandoul district, Chad, positive for yellow fever. As of 25 December 2022, 2 491 suspected cases of yellow fever have been reported. Of these, 1 910 cases have been investigated, including 25 probable and 31 lab-confirmed cases. A total of 74 deaths have been reported (CFR 3.0%) including one among probable and six among confirmed cases. In 2022, 1 388 suspected cases were reported, including 12 probable and 12 lab- confirmed cases. A total of 27/126 districts in 10/23 provinces have been affected since the beginning of the outbreak. Comoros COVID-19 Grade 3 30-Apr-2020 30-Apr-2020 22-Jan-2023 8 992 8 992 161 1.8% The first case of confirmed COVID-19 was notified on 30 April 2020 in Comoros. As of 22 January 2023, a total of 8 992 confirmed COVID-19 cases, including 161 deaths were reported in the country. Congo COVID-19 Grade 3 14-Mar-2020 14-Mar-2020 29-Jan-2023 25 070 25 070 388 1.6% The Government of Congo announced the confirmation of the first case of COVID-19 in Congo on 14 March 2020. As of 29 January 2023, a total of 25 070 cases including 388 deaths and 24 006 recovered cases have been reported in the country. Congo Measles Ungraded 14-Mar-2022 1-Jan-2022 31-Dec-2022 6 912 6 717 132 1.9% From week 1 through week 52, 2022 (ending 1 January 2023), a total of 6 912 suspected measles cases were reported in Congo including 6 717 confirmed (6 385 through epi-link and 332 laboratory), about 132 deaths registered (CFR. 1.9%). A reactive measles vaccination campaign was organized from 4 to 11 August 2022. Three districts (Alima, Madingou, Makélékélé) experienced measles outbreak 28 days after the reactive campaign. The total number of confirmed cases have been revised Congo Mpox Grade 3 23-May-2022 1-Jan-2022 18-Jan-2023 68 5 3 4.4% From 1 January 2022 to 18 January 2023, the Republic of Congo has reported 68 suspected cases of monkeypox including five probable and five laboratory-confirmed cases, with three deaths among the probable (CFR 4.4%). The suspected cases have been reported from four Departments and nine Districts. Impfondo is the epicentre of the outbreak, with five probable and two confirmed cases. The other confirmed cases have been detected in Ouesso (2) and Ngoyo (1) Districts. Sixty percent of the probable and confirmed cases are females, and 40% are aged less than 10 years. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 13 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Côte d'Ivoire COVID-19 Grade 3 11-Mar-2020 11-Mar-2020 22-Jan-2023 87 981 87 981 833 0.9% Since 11 March 2020, a total of 87 981 confirmed cases of COVID-19 have been reported from Côte d'Ivoire including 833 deaths, and a total of 87 136 recoveries. Democratic Republic of the Congo Humanitarian crisis Protracted 3 20-Dec-2016 17-Apr-2017 30-Jan-2023 - - - - Since the beginning of 2022, more than 1.56 million people have been in a situation of internal displacement (IDPs) in the DRC. In North Kivu, approximately 521 000 people have been internally displaced towards the territories of Lubero, Masisi, Rutshuru, Nyiragongo and the city of Goma since March 2022 following the clashes between the rebels of the M23 movement and the Armed Forces of the Democratic Republic of Congo (FARDC). With various humanitarian partners, WHO continues to provide humanitarian support to the affected population in North Kivu by providing access to health care, strengthening epidemiological surveillance and responding to outbreaks of diseases with epidemic potential, particularly cholera. Democratic Republic of the Congo Cholera Grade 3 16-Jan-2015 3-Jan-2022 30-Dec-2022 17 355 1 356 285 1.6% From epidemiological week 1 to 51 (ending 24 December 2022), 17 355 suspected cholera cases, including 285 deaths (CFR: 1.6%), were recorded in 98 health zones across 17 provinces of the Democratic Republic of the Congo. Suspected cases have mostly been reported from South Kivu (5 707), Haut-Lomami (2 869), Tanganyika (3 114), and North Kivu (4 117). Karisimbi and Nyiragongo health zones are among the cholera hotspot sites in North Kivu province. The number of cholera cases increased in Nyiragongo and Karisimbi health zones from weeks 47 and 50 of 2022, respectively. Since then, there has been a steady weekly increase in the number of new cases in Nyiragongo Health Zone, up to 720 new cases at week 52 in 2022. Democratic Republic of the Congo Cholera Grade 3 14-Dec-2022 1-Jan-2023 24-Jan-2023 4 104 16 0.4% An outbreak of cholera was officially declared in North Kivu province of DRC on 14 December 2022, following a massive influx of IDPs in Nyiragongo and Karisimbi health zones (HZs). Between outbreak inception on week 47, 2022 (21-27 November) and 27 January 2023, a cumulative of 4 104 suspected cases of cholera including 16 deaths (CFR 0.4%) have been reported, including 3 798 cases and 16 deaths (CFR 0.4%) in Nyiragongo HZ, and 306 cases and zero death (CFR 0.0%) in Karisimbi HZ. In Nyiragongo HZ, the health area of Kanyaruchinya is the epicenter of the outbreak, with 73.0% of cases, while in Karisimbi HZ, the most affected area is Methodiste with 64.1% of cases. The under-fifteen years of age represent 69% of all cases. An OCV campaign has been officially launched on 25 January 2023 and is scheduled from 26-30 January 2023. Democratic Republic of the Congo COVID-19 Grade 3 10-Mar-2020 10-Mar-2020 29-Jan-2023 95 586 95 584 1 463 1.5% Since the start of the COVID-19 outbreak, declared on 10 March 2020, a total of 95 584 confirmed cases and two probable case, including 1 463 deaths have been reported. A total of 84 273 people have recovered. Democratic Republic of the Congo Measles Ungraded 12-Oct-2021 1-Jan-2022 31-Dec-2022 146 438 2 852 1 846 1.3% In 2022, a total of 146 438 suspected measles cases and 1 846 measles-related deaths (CFR 1.3%) were reported , 6 740 of these cases have been investigated and 2 852 measles IgM positive, and 1 412 rubella IgM positive . About 62% of laboratory confirmed measles cases are children under five years of age, and only 35% have history of measles vaccination. Democratic Republic of the Congo Mpox Grade 3 30-Mar-2019 1-Jan-2022 25-Jan-2023 5 114 370 0 0.0% From 1 January – 25 January 2023, the Democratic Republic of the Congo (DRC) reported more than 5 114 suspected cases including 370 confirmed with no death among the confirmed cases. All confirmed cases belong to Clade I. Democratic Republic of the Congo Poliomyelitis (cVDPV1) Grade 2 27-Aug-2022 27-Aug-2022 1-Feb-2023 84 84 0 0.0% According to the Global Polio Eradication Initiative (GPEI), no case of circulating vaccine-derived poliovirus type 1 (cVDPV1) was reported this week. There are 84 cases reported in 2022.Outbreak response to both cVDPV1 and cVDPV2 is being intensified Democratic Republic of the Congo Poliomyelitis (cVDPV2) Grade 2 26-Feb-2021 1-Jan-2022 1-Feb-2023 255 255 0 0.0% According to the Global Polio Eradication Initiative (GPEI), no case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There are 255 cases reported in 2022. Outbreak response to both cVDPV1 and cVDPV2 is being intensified. Democratic Republic of the Congo Suspected meningitis Ungraded 31-May-2022 2-Jun-2022 23-Jan-2023 251 49 19.5% The suspected meningitis outbreak is still ongoing in the Banalia health zone, Tshopo province in the Democratic Republic of the Congo. From 2 June 2022 to 23 January 2023, a total of 251 suspected cases with 49 deaths (CFR 19.5%) have been reported. Three health areas are the hotspots: Mangi, Bongonza and Panga. Equatorial Guinea COVID-19 Grade 3 14-Mar-2020 14-Mar-2020 2-Jan-2023 17 186 17 186 183 1.1% The Ministry of Health and Welfare announced the first confirmed COVID-19 case on 14 March 2020. As of 2 January 2023, a total of 17 186 cases have been reported in the country with 183 deaths and 16 880 recoveries. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 14 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Eritrea COVID-19 Grade 3 21-Mar-2020 21-Mar-2020 30-Oct-2022 10 189 10 189 103 1.0% The first COVID-19 confirmed case was reported in Eritrea on 21 March 2020. As of 30 October 2022, a total of 10 189 confirmed COVID-19 cases with 103 deaths were reported in the country. A total of 10 085 patients have recovered from the disease. Eritrea Poliomyelitis (cVDPV2) Grade 2 2-Jun-2022 7-Jun-2022 25-Jan-2023 2 2 0 0.0% No new case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported in week 3, 2023 (ending 25 January). There has so far been one case reported in 2022 and another one reported in 2021. This latter one was however confirmed on 2 June 2022 by the Ethiopian National Polio laboratory. Eswatini COVID-19 Grade 3 13-Mar-2020 13-Mar-2020 5-Feb-2023 74 143 74 143 1 423 1.9% The first case of COVID-19 was confirmed in the kingdom of Eswatini on 16 March 2020. As of 5 February 2023, a total of 74 143 cases have been reported with 1 423 associated deaths. Ethiopia Drought/food insecurity Grade 3 17-Feb-2022 1-Jan-2022 18-Jan-2023 12 000 000 - - - Poor rainfall during the October-to-December dry rainy season marks the fifth consecutive below-average rainy season in the Horn of Africa, contributing to continued emergency-levels of humanitarian need for vulnerable populations across the region. In eastern and southern Ethiopia, the drought impact is expected to further worsen after January 2023 across the drought affected zones as the dry season is arriving. The humanitarian impact of the protracted drought is already devastating. It is estimated that more than 4.5 million livestock have died since late 2021, and at least 30 million weakened and emaciated livestock are at risk. At present, nearly 12 million people are estimated to be food insecure, and 8.6 million people are being targeted for water, sanitation and hygiene assistance across the drought-affected areas. Ethiopia Humanitarian crisis (Conflict in Tigray) Grade 3 4-Nov-2020 4-Nov-2020 18-Jan-2023 22 000 000 - - - Humanitarian partners have assisted more than 3.7 million people as of 4 January 2023, representing 68.5% of the total planned caseload of 5.4 million people in Tigray under the current round (Round 2) of food distribution. In Amhara Region, malnutrition levels are alarmingly high in conflict-affected zones, with acute malnutrition prevalence rates reaching almost 20% in some of these areas. In Afar Region, food assistance remains overall inadequate. Some areas of this Region remained inaccessible owing to insecurity and lack of roads. Meanwhile, the security situation in Oromia Region remains highly volatile with devastating humanitarian consequences. Hundreds of thousands of people continue to be uprooted from their homestead, with a consequential increase in humanitarian needs. Ethiopia Cholera Grade 3 17-Sep-2022 17-Sep-2022 2-Feb-2023 1 068 39 28 2.6% A cholera outbreak has been ongoing in Ethiopia since 27 August 2022. The index case was reported from Bekay Kebele, Oromia Region and the outbreak was confirmed on 9 September. As of 2 February 2023, a total of 1 068 suspected cases of cholera with 28 deaths (CFR 2.6%) have been reported, including 869 cases and 13 deaths (CFR 1.5%) from Oromia region and 199 cases and 15 deaths (CFR 7.5%) from Somali region. The attack rate is 100.7 per 100 000 population. A total of 39 of these cases were laboratory-confirmed through culture, and 144 cases were positive to cholera RDT. A total of 66 kebeles (villages) have so far been affected, distributed in ten woredas. Cholera outbreak in Somali region is controlled. Ethiopia COVID-19 Grade 3 13-Mar-2020 13-Mar-2020 2-Feb-2023 499 592 499 592 7 572 1.5% Since the confirmation of the first case on 21 March 2020, Ethiopia has confirmed a total of 499 592 cases of COVID-19 as of 2 February 2023, with 7 572 deaths and 486 726 recoveries. Ethiopia Measles Ungraded 13-Apr-2017 1-Jan-2022 31-Dec-2022 13 934 8 554 71 0.5% In 2022, a total of 13 934 suspected measles cases were reported in Ethiopia including 8 554 confirmed and 71 deaths (CFR 0.5%) , the number of deaths was revised. Ethiopia Poliomyelitis (cVDPV2) Grade 2 24-Jun-2019 20-May-2019 25-Jan-2023 64 64 0 0.0% No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week 3 of 2023 (ending 25 January). There was one case reported in 2022. In addition, ten cases were reported in 2021, 38 in 2020 and 15 in 2019. Gabon COVID-19 Grade 3 12-Mar-2020 12-Mar-2020 16-Jan-2023 48 980 48 980 306 0.6% On 12 March 2020, the Ministry of Health announced the confirmation of the first COVID-19 case in the country. As of 2 January 2023, a total of 48 980 cases including 306 deaths and 48 668 recoveries have been reported in the country. Gambia Acute kidney injury Grade 2 1-Aug-2022 27-Jun-2022 23-Dec-2022 127 82 70 55.1% On 1 August 2022, the Epidemic and Disease Control Unit of the Ministry of Health in The Gambia reported an unusual event detected at the main tertiary hospital in the country. The highest number of cases was among children under two years of age. The index case was traced to 4 July 2022. Patients presented with symptoms such as inability to urinate, fever, vomiting, and diarrhoea. Samples of medicines taken by these children were sent for toxicology testing, and four of the medicines were found to contain diethylene glycol and ethylene glycol. As of 23 December 2022, 127 cases were reported including 82 confirmed, six probable and 39 sespected cases. Of the confirmed cases, 70 deaths were recorded (CFR 85.4%). The last confirmed case was identified on 5 October 2022. Response activities are going on. Gambia COVID-19 Grade 3 17-Mar-2020 17-Mar-2020 4-Nov-2022 12 586 12 586 372 3.0% The first COVID-19 confirmed case was reported in The Gambia on 17 March 2020. As of 4 November 2022, a total of 12 586 confirmed COVID-19 cases including 372 deaths, and 12 189 recoveries have been reported in the country. Ghana COVID-19 Grade 3 12-Mar-2020 12-Mar-2020 23-Jan-2023 171 112 171 112 1 462 0.9% As of 23 January 2023, a total of 171 112 confirmed COVID-19 cases have been reported in Ghana. There have been 1 462 deaths and 169 640 recoveries reported. Ghana Mpox Grade 3 8-Jun-2022 24-May-2022 25-Jan-2023 121 121 4 3.3% On 8 June 2022, the Director General of the Ghana Health Service confirmed that five cases of monkeypox have been detected in the country. From 24 May-25 January 2023, there have been 121 confirmed and four deaths reported from 13 over 16 administrative regions, with the Greater Accra region reporting the most cases. Of the confirmed cases, 64 (62 %) are males. The age of confirmed cases ranges from 13 days to 67 Years (min-max). Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 15 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Ghana Poliomyelitis (cVDPV2) Grade 2 23-Aug-2019 23-Jul-2019 25-Jan-2023 34 34 - - According to Global Polio Eradication Initiative, no case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There are three cases in 2022. No cases were reported in 2021. In addition, 12 cases were reported in 2020, and 19 were reported in 2019. Ghana Yellow Fever Ungraded 25-Oct-2021 25-Oct-2021 29-Nov-2022 137 62 21 15.3% From 15 October 2021, suspected cases of yellow fever were reported mostly among nomadic settlers in the Savannah region, northwest Ghana (bordering Côte d'Ivoire). As of 29 November 2022, a total of 75 probable and 62 confirmed cases of yellow fever were reported from 13 regions in Ghana. Of the reported cases, nine deaths were recorded among probable cases and 12 deaths among confirmed cases. Guinea COVID-19 Grade 3 13-Mar-2020 13-Mar-2020 2-Jan-2023 38 240 38 240 467 1.2% The Ministry of Health in Guinea announced the first confirmed case of COVID-19 on 13 March 2020. As of 2 January 2023, a total of 38 240 cases, including 37 303 recovered cases and 467 deaths, have been reported in the country. Guinea Lassa Fever Ungraded 10-Dec-2022 8-Dec-2022 4-Jan-2023 1 1 0 0.0% One confirmed case of Lassa Fever was notified on 8 December 2022 in the Health District of Gueckedou. It is a female patient greater than 60 years old. A total of 27 contacts were identified and are being followed. Public health response activities are ongoing, including the in-depth epidemiological investigation to determine the source of infection. Since the notification of the first case on 8 December, no new case of confirmed Lassa fever was reported in the country, and the confirmed case was released from the hospital on 29 December 2022. The countdown to declare the end of this outbreak has started. Guinea Measles Ungraded 9-May-2018 1-Jan-2022 31-Dec-2022 23 259 432 33 0.1% Since the beginning of 2022 up to week 52 (ending 31 December), a total of 23 259 suspected measles cases with 432 confirmed and 33 death (CFR 0.1%) have been reported in Guinea through the Integrated disease surveillance and response. Guinea Yellow Fever Ungraded 6-Jan-2023 4-Jan-2023 4-Jan-2023 1 1 1 100.0% On 20 November 2022, a suspected case of yellow fever was reported from Dabola health district, Faranah health region, in Guinea. This is a 9-years-old child who died and whose yellow fever vaccination status is unknown. The sample collected on 22 November 2022 was positive for Enzyme-linked immunosorbent assay test (ELISA) and polymerase chain reaction (PCR) in Guinea (Conakry) on 2 December 2022. A confirmation test was conducted at the Dakar Institute Pasteur laboratory on 4 January 2023 and the results for ELISA and PCR received by the Ministry of Health on 6 January 2023 confirmed yellow fever infection. Guinea-Bissau COVID-19 Grade 3 25-Mar-2020 25-Mar-2020 18-Dec-2022 8 947 8 947 176 2.0% On 25 March 2020, the Ministry of Health of Guinea Bissau reported the first COVID-19 confirmed case in the country. As of 18 December 2022, the country has reported 8 947 confirmed cases of COVID-19 with 8 656 recoveries and 176 deaths. Kenya Drought/food insecurity Grade 3 17-Feb-2022 1-Jan-2022 12-Jan-2023 4 500 000 - - - The drought situation continued to worsen in twenty (20) of the 23 ASAL counties in Kenya. Seven (7) counties including Isiolo, Mandera, Samburu, Turkana, Wajir, Laikipia and Marsabit are in Alarm drought phase. Thirteen (13) counties including Embu, Garissa, Kajiado, Kitui, Makueni, Meru, Narok, Nyeri, Tharaka Nithi, Taita Taveta, Tana River, Kwale and Kilifi are in Alert drought phase. Drought is affecting about 4.5 million people, compared to 2.1 million in September 2021. Of these, approximately 2.14 million are children. Kenya Anthrax Suspected Ungraded 15-Jul-2022 30-Jun-2022 1-Jan-2023 204 - - Suspected anthrax outbreak is still ongoing in Kenya, with cases reported from different counties. During week 52 of 2022 ( ending 1 January 2023 ), one case was reported from Mwimbi sub county No deaths were reported in the week.The total suspected cases from week 1 through week 52 , 2022 are 204. Kenya Cholera Grade 3 19-Oct-2022 16-Oct-2022 5-Feb-2023 4 527 163 83 1.8% The outbreak has affected 15 counties: Garissa, Homa Bay, Kajiado, Kiambu, Kitui, Machakos, Mandera, Meru, Nairobi, Murang’a, Nakuru, Nyeri, Tana River, UasinGishu and Wajir counties. A total of 4 527 cases with 163 confirmed by culture and 83 deaths (CFR 1.8 %) have been reported as of 2 February 2023 . The outbreak has been controlled in Kitui, Machakos, Meru, Nakuru, Nyeri and UasinGishu. Kenya COVID-19 Grade 3 13-Mar-2020 13-Mar-2020 29-Jan-2023 342 817 342 817 5 688 1.7% On 12 March 2020, the Ministry of Health announced the confirmation of one new COVID-19 case in the country. As of 29 January 2023, 342 817 confirmed COVID-19 cases including 5 688 deaths and 337 095 recoveries have been reported in the country. Kenya Leishmaniasis (visceral) Ungraded 31-Mar-2019 3-Jan-2020 8-Jan-2023 2 147 1 965 10 0.5% Since January 2020, a total of 2 147 visceral leishmaniasis confirmed ( 1 965) and suspected (182) cases with 10 deaths (CFR 0.5%) , have been reported in nine counties namely: Baringo, Garissa, Isiolo, Kitui, Mandera ,Marsabit, Wajir, Tharaka Nithi and West Pokot. The outbreak is active in West Pokot County. Kenya Measles Ungraded 29-Jun-2022 26-Jun-2022 8-Jan-2023 392 85 2 0.5% The outbreak has affected six counties: Garissa, Mandera , Marsabit, Nairobi, Turkana and Wajir, Counties. A total of 392 cases with 85 confirmed and two deaths (CFR 0.5%) have been reported. Lesotho COVID-19 Grade 3 13-May-2020 13-May-2020 12-Sep-2022 34 490 34 490 706 2.1% Since the first confirmed COVID-19 case was reported in Lesotho on 13 May 2020, until 12 September 2023, a total of 34 490 cases of COVID-19 have been reported, and 706 deaths. Liberia COVID-19 Grade 3 16-Mar-2020 16-Mar-2020 24-Jan-2023 8 062 8 062 294 3.6% From 16 March 2020 to 24 January 2023, Liberia has recorded a total of 8 062 cases including 294 deaths and 7 766 recoveries have been reported. Liberia Lassa Fever Ungraded 3-Mar-2022 6-Jan-2022 1-Dec-2022 67 67 22 32.8% Since the beginning of 2022 up to 1 December 2022, a total of 67 confirmed cases of Lassa fever with 22 deaths (CFR 32%) have been reported from five out of 15 counties in Liberia. A total of 108 contacts are under follow up. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 16 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Liberia Measles Ungraded 3-Feb-2022 13-Dec-2021 30-Nov-2022 7 797 7 797 85 1.1% Since the measles outbreak started on 13 December 2021 as of 30 November 2022, a total of 8 338 suspected cases, including 7 797 confirmed and 85 deaths (CFR: 1%) were reported from 52 out of 93 health districts in 15 counties in Liberia. Among the confirmed cases, 6.1% (470) were laboratory confirmed, 7.2% (558) clinically confirmed and 86.7% (6 769) epidemiologically linked. Liberia Mpox Grade 3 21-Jul-2022 23-Jul-2022 18-Jan-2023 6 6 0 0.0% Liberia confirmed a case of Monkeypox on 23 July 2022 through the National Public health Reference Laboratory in the country. The case is a 43-year-old male who resides and works in Ebokayville Une, La Côte D’Ivoire but sought treatment at the Pleabo Health centre in Maryland County, Liberia where he was detected and isolated with 4 contacts being line-listed. As of 18 January 2023, six confirmed cases of monkeypox and 0 deaths were reported. Madagascar Cyclonic system CHENESO Grade 2 25-Jan-2023 19-Jan-2023 31-Jan-2023 90 810 33 On 19 January 2023 at 10:45 am, the cyclonic system CHENESO landed in Madagascar north of Antalaha district, SAVA region, with an average wind speed of 90 km/h and gusts up to 120 km. Last reports provided by the National Bureau for the Management of risks and catastrophes released on 31 January 2023 indicated that 33 people have died and 20 people were still missing. A total of 90 870 people (8 456 households) have so far been affected including 34 114 displaced people currently settled in 115 shelter sites. Nearly 26 403 houses have been overflooded while 1 073 others have been totally destroyed. Administrative buildings have also been partially or totally destroyed, roads and bridges have been cut or damaged due to high levels of waters in 18 regions and 53 districts. Madagascar Malnutrition crisis Protracted 2 1-Jul-2021 1-Jan-2021 20-Jan-2023 2 200 000 - - - Approximately 2.2 million people in the Grand Sud and Grand Sud-Est will likely experience Crisis—IPC 3—levels of acute food insecurity or worse between November 2022 and March 2023, according to a January 2023 IPC TWG analysis. This figure includes more than 250,000 people likely to face Emergency—IPC 4—levels of acute food insecurity. Madagascar COVID-19 Grade 3 20-Mar-2020 20-Mar-2020 5-Feb-2023 67 842 67 842 1 420 2.2% Madagascar Ministry of Health announced the confirmation of the first COVID-19 case on 20 March 2020. As of 5 February 2023, a total of 67 842 confirmed cases including 1 420 deaths have been reported in the country. Malawi Cholera Grade 3 3-Mar-2022 3-Mar-2022 5-Feb-2023 38 566 38 566 1 254 3.3% A total of 29 districts have reported Cholera cases since the confirmation of the first case in March 2022 in Machinga district. As of 5 February 2023, the cumulative confirmed cases and deaths reported since the onset of the outbreak is 38 566 and 1 254 respectively, with Case Fatality Rate at 3.3%. Malawi COVID-19 Grade 3 2-Apr-2020 2-Apr-2020 5-Feb-2023 88 503 88 503 2 686 3.0% On 2 April 2020, the president of Malawi announced the first confirmed cases of COVID-19 in the country. As of 5 February 2023, the country has a total of 88 503 confirmed cases with 2 686 deaths. Malawi Poliomyelitis (WPV1) Grade 2 31-Jan-2022 1-Feb-2022 1-Feb-2023 1 1 0 0.0% One positive case of wild WPV1 was detected in Lilongwe from a child with the date of onset of paralysis on 19 November 2021. No other cases have been reported. Malawi continues to participate in the multi-country, subregional outbreak response, to urgently stop the WPV1 outbreak affecting the area. Mali Humanitarian crisis (Sahel region) Grade 2 11-Sep-2017 20-Dec-2022 - - - - The humanitarian situation was recently marked by the flooding of more than 1 000 hectares in the commune of Alafia, Timbuktu region, which caused population movements. Overall, the number of internally displaced persons (IDPs) increased from 422 660 in August 2022 to 440 436 in September 2022, representing a 4% increase. The largest number of IDPs was in the Mopti region. Mali COVID-19 Grade 3 25-Mar-2020 25-Mar-2020 29-Jan-2023 32 780 32 780 743 2.3% On 25 March 2020, the Ministry of Health of Mali reported the first COVID-19 confirmed cases in the country. As of 29 January 2023, a total of 32 780 confirmed COVID-19 cases have been reported in the country including 743 deaths and 31 955 recoveries. Mali Measles Ungraded 20-Feb-2018 1-Jan-2022 11-Dec-2022 751 751 1 0.1% As of 11 December 2022, a total of 1 256 samples from suspected cases of measles were tested in Mali. Of these, 751 cases have been confirmed with one death. Mauritania COVID-19 Grade 3 13-Mar-2020 13-Mar-2020 22-Jan-2023 63 436 63 436 997 1.7% The government of Mauritania announced its first confirmed COVID-19 case on 13 March 2020. As of 22 January 2023, a total of 63 436 cases including 997 deaths and 62 437 recovered have been reported in the country. Mauritania Rift Valley fever Grade 1 31-Aug-2022 26-Aug-2022 25-Dec-2022 53 53 24 45.3% A new confirmed case of Rift Valley fever (RVF) was reported by the Mauritanian Ministry of Health on 29 August 2022. The index case is a 25-year-old male breeder from the Moughataa (district) of Tintane in Hodh El Gharbi region. He presented to a health facility with high fever and headache. On 26 August, he developed a haemorrhagic syndrome (epistaxis) with severe thrombocytopenia. He died on 29 August. As of 25 December 2022, a total of 53 cases have been confirmed with 24 deaths (CFR 45.3%). Response activities are underway including enhanced surveillance and investigations. Mauritius COVID-19 Grade 3 18-Mar-2020 18-Mar-2020 28-Jan-2023 294 915 294 915 1 044 0.4% The Republic of Mauritius announced the first three positive cases of COVID-19 on 18 March 2020. As of 28 January 2023, a total of 294 915 confirmed COVID-19 cases including 1 044 deaths have been reported in the country. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 17 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Mozambique Humanitarian crisis in Cabo Delgado Protracted 2 1-Jan-2020 1-Jan-2020 20-Jan-2023 - - - - The safety situation in Cabo Delgado remains unpredictable and volatile. Throughout 2022, various levels of authorities have announced “returns” of IDPs to some districts, such Mocimboa da Praia, Palma, Quissanga, Muidumbe and Macomia. The IOM DTM mapped a total of 1,028,743 IDPs and 352,437 returnees in 238 locations across Northern Mozambique as of November 2022. Mozambique Cholera Grade 3 14-Sep-2022 16-Nov-2022 3-Feb-2023 3 315 68 31 0.9% Cholera outbreak has been reported from Sofala and Zambezia provinces of Mozambique. From 14 September 2022 to 3 February 2023, a total of 3 315 cases and 31 deaths (CFR 0.9%) have been reported from seven districts;ago, Lichinga, Mecanhelas, Sanga, Chimbonila, Muembe and Mandimba. Mozambique COVID-19 Grade 3 22-Mar-2020 22-Mar-2020 22-Jan-2023 232 510 232 510 2 236 1.0% The first COVID-19 confirmed case was reported in Mozambique on 22 March 2020. As of 22 January 2023, a total of 232 510 confirmed COVID-19 cases were reported in the country including 2 236 deaths. Mozambique Mpox Grade 3 6-Oct-2022 7-Oct-2022 18-Dec-2022 1 1 0 0.0% The case was diagnosed Wednesday, 12 October 2022 in Maputo City in a man, Health minister Armindo Tiago said. As of 4 January 2023, no additonal case has been reported. Mozambique Poliomyelitis (cVDPV2) Grade 2 7-Dec-2018 1-Jan-2021 1-Feb-2023 6 6 0 0.0% According to the Global Polio Eradication Initiative, no case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. The number of cases in 2022 remains four. There were two cases reported in 2021. Mozambique Poliomyelitis (WPV1) Grade 2 17-May-2022 18-May-2022 1-Feb-2023 8 8 0 0.0% No wild poliovirus type 1 (WPV1) case was reported this week. There are eight cases reported in 2022. Intensified surveillance efforts continue across the country. Namibia COVID-19 Grade 3 14-Mar-2020 14-Mar-2020 22-Jan-2023 170 724 170 724 4 088 2.4% The first case of COVID-19 was detected in Namibia on the 14 March 2020. As of 22 January 2023, a total of 170 724 confirmed cases with 4 088 deaths have been reported. Niger Humanitarian crisis (Sahel region) Grade 2 1-Feb-2015 1-Feb-2015 16-Dec-2022 580 838 - - - Humanitarian access in Niger has deteriorated because of growing insecurity in Diffa, Maradi, Tahoua, and Tillabéri regions. Access to services such as education is challenging, particularly for people displaced in areas with limited humanitarian access. Niger hosts 580 838 people whose situation is of concern, of which 48% are internally displaced persons (IDPs), 43% refugees, 6% returnees, 2% asylum seekers and other people whose situation is worrying (mainly Burkinabés). Niger COVID-19 Grade 3 19-Mar-2020 19-Mar-2020 15-Jan-2023 9 510 9 510 315 3.3% From 19 March 2020 to 22 January 2023, a total of 9 510 cases with 315 deaths have been reported across the country. A total of 9 007 recoveries have been reported from the country. Niger Measles Ungraded 5-Apr-2022 1-Jan-2022 14-Jan-2023 14 153 722 32 0.2% From week 1 to week 52 (ending on 31 December ) of 2022, 14 127 cases and 32 deaths (CFR: 0.2%) have been reported. 94% (68/72) of the districts of Niger notified at least one suspected case of measles. In week 1 of 2023, 26 cases and zero deaths were notified in five regions, namely Dosso (7 suspected cases), Zinder (7 suspected cases), Diffa (6 suspected cases), Tahoua (7 suspected cases) and Maradi ( 2 suspected cases). Niger Meningitis Ungraded 7-Dec-2022 31-Oct-2022 15-Jan-2023 490 111 16 3.3% The first case of meningitis was reported on 31 October 2022 and confirmed on 23 November 2022 with Neisseria meningitidis identified as the causative agent. As of 15 January 2023, Zinder has reported 490 cases of meningitis including 111 laboratory confirmed cases and 16 deaths (CFR 3.3%). These cases were reported from six health districts (HD): Dungass (331 cases, 6 deaths), Gouré (1 case, 0 deaths), Magaria (28 cases, 4 deaths), Matamèye (83 cases, 3 deaths), Mirriah (46 cases, 2 deaths), and Zinder ville (2 cases, 1 death). A reactive vaccination campaign is underway in the region. Niger Poliomyelitis (cVDPV2) Grade 2 1-Jan-2020 1-Jan-2021 1-Feb-2023 31 31 0 0.0% No new cases were reported during this week. There are 13 cases reported in 2022. There were 18 cases reported in 2021. Nigeria Humanitarian crisis (Sahel region) Grade 2 10-Oct-2016 10-Oct-2016 13-Jan-2023 - - - - The conflict in northeastern, northwestern, and north central Nigeria affects 9.3 million people, including 5.7 million children. Of these, more than 2.9 million people are internally displaced, while one million live in inaccessible areas. Humanitarian crises caused by protracted armed conflict, armed violence, and community clashes between farmers and herders have resulted in alarming food insecurity and malnutrition, compounded by epidemics and childhood illnesses in the context of deteriorating water, sanitation, and hygiene conditions. Nigeria Cholera Grade 3 1-Jan-2022 27-Nov-2022 20 768 498 2.4% From 01 January to 27 November 2022 (EW 47), a cumulative 20,768 suspected cholera cases and 498 deaths (CFR 2.4%) have been reported from 258 Local Governmental Areas (LGAs), in 31 states, mainly in northwest and northeast of the country. Three states, namely Borno, Taraba and Yobe, have reported a combined total of 15,495 (75%) cases and 382 (77%) deaths with a CFR of 2.4%. Children under five years and age 5-14 years the most affected age groups (52.7%), and 47% of affected cases are males while 53% are females. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 18 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Nigeria COVID-19 Grade 3 27-Feb-2020 27-Feb-2020 6-Jan-2023 266 463 266 463 3 155 1.2% The first case of COVID-19 was first detected in Nigeria on 27 February 2020. As of 6 January 2023, a total of 266 463 confirmed cases with 259 850 recovered and 3 155 deaths have been reported. Nigeria Lassa Fever Grade 1 1-Jan-2021 1-Jan-2023 22-Jan-2023 244 244 37 15.2% Since the beginning of 2023 to 22 January 2023, a total of 244 confirmed cases of Lassa fever, including 37 deaths with a case fatality rate of 15.2%, have been reported in 16 states and the Federal Capital Territory (FCT). The highest number of cases was reported in Ondo (90) and Edo (89) states, followed by Bauchi (13), Taraba (10), Benue (9), Ebonyi (9), Nasarawa (7), Plateau (5), Kogi (4), Anambra (2), Delta (1), Oyo (1), Adamawa (1), Enugu (1), and Imo (1) states; one case was reported from the FCT (1). Of the reported cases, five cases and one death were among health workers. The Nigeria Centre for Disease Control and Prevention (NCDC) has activated the National Multisectoral Emergency Operations Center for Lassa Fever at Level 2 to coordinate and strengthen the ongoing response activities in the country, following a risk assessment carried out on 20 January 2023. Nigeria Mpox Grade 3 31-Jan-2022 1-Jan-2022 31-Dec-2022 763 763 7 0.9% From 1 January to 31 December 2022, Nigeria has reported 763 monkeypox confirmed cases with seven deaths. Nigeria Poliomyelitis (cVDPV2) Grade 2 1-Jun-2018 1-Jan-2018 11-Jan-2023 513 513 - - According to Global Polio Eradication Initiative, no case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There are 43 cVDPV2 cases reported in 2022. There were 410 cVDPV2 cases reported in 2021 and 513 cases since 1 January 2018. Rwanda COVID-19 Grade 3 14-Mar-2020 14-Mar-2020 22-Jan-2023 133 090 133 090 1 468 1.1% The Rwanda Ministry of Health announced the confirmation of the first COVD-19 case on 14 March 2020. As of 22 January 2023, a total of 133 090 cases with 1 468 deaths and 131 559 recovered cases have been reported in the country. Sao Tome and Principe COVID-19 Grade 3 7-Apr-2020 6-Apr-2020 29-Jan-2023 6 280 6 280 77 1.2% On 6 April 2020, the Ministry of Health of Sao Tome and Principe reported the country’s first case of COVID-19. As of 29 January 2023, a total of 6 280 confirmed cases of COVID-19 have been reported, including 77 deaths. A total of 6 202 cases have been reported as recoveries. Sao Tome And Principe Dengue Grade 2 11-Apr-2022 15-Apr-2022 22-Jan-2023 1 180 1 180 8 0.7% Sao Tome and Principe is experiencing its first ever documented dengue outbreak. From 15 April to 22 January 2023, a total of 1 180 cases and 8 deaths (CFR 0.7%) have been confirmed via RDT from: Água Grande (799, 67.3%), Mézôchi (180, 15.5%), Lobata (97, 8.3%), Cantagalo (47, 4.1%), Caué (23, 2.0%), Lemba (20, 1.6%), and RAP (14, 1.2%). During week 3 , there was 8 new case registered in the country. Água Grande's attack rate is by far the highest (94.8 per 10 000 inhabitants). Those aged 30-39 years are experiencing the highest attack rate at 73.1 cases per 10 000. Senegal COVID-19 Grade 3 2-Mar-2020 2-Mar-2020 29-Dec-2022 88 900 88 900 1 968 2.2% From 2 March 2020 to 29 December 2022, a total of 88 900 confirmed cases of COVID-19 including 1 968 deaths and 86 915 recoveries have been reported in Senegal. Senegal Dengue Ungraded 14-Nov-2022 1-Jan-2023 22-Jan-2023 4 4 0 0.0% Four dengue confirmed cases including two males and two females have been reported in Thilogne district from week 1 to week 3 of 2023. In 2022, 238 cases were recorded including 203 confirmed by PCR (85.3%) and 35 by IgM testing (14.7%). They were mostly concentrated in the first and last quarters of 2022. Eleven regions were affected. The Matam region had reported the highest number of cases (134 cases, 56.3%), followed by Dakar (41 cases, 17.2%), Kaffrine (17 cases, 7.1%) and Thies (17 cases, 7.1%). Senegal Measles Ungraded 4-Jul-2022 1-Jan-2023 22-Jan-2023 17 17 0 0.0% From epidemic week 1 to 3 of 2023 (ending 22 January 2023), 17 confirmed cases of measles with no deaths were reported from four regions in Senegal namely Diourbel (10 cases), Kédougou (4 cases), Louga (1 case), and Matam (2 cases). Almost all reported cases (16; 94.1%) were unvaccinated against measles. Seychelles COVID-19 Grade 3 14-Mar-2020 14-Mar-2020 31-Dec-2022 50 665 50 665 172 0.3% Since the first COVID-19 confirmed cases were reported in Seychelles on 14 March 2020 as of 31 December 2022, a total of 50 665 cases have been confirmed, including 50 440 recoveries and 172 deaths have been reported. Sierra Leone COVID-19 Grade 3 31-Mar-2020 27-Mar-2020 31-Jan-2023 7 760 7 760 126 1.6% On 31 March 2020, the President of Sierra Leone reported the first confirmed COVID-19 case in the country. As of 31 January 2023, a total of 7 760 confirmed COVID-19 cases were reported in the country, including 126 deaths and 4 898 recovered cases. Sierra Leone Measles Ungraded 1-Nov-2021 1-Jan-2022 31-Dec-2022 1 174 178 0 0.0% By 31 December 2022 (Week 52), 16 out of 16 districts reported a total of 1174 suspected measles cases, including 178 Laboratory confirmed measles cases. of the total suspected measles cases, 303 (26%) cases are above five years, The majority of cases (26%) were reported from Western Area Urban, followed by Kambia districts (17.8%). In December 2022, three districts, namely Western Area Rural, Western Area Urban and Karene districts reported more than 3 measles cases. Surveillance and immunisation activities have been intensified in all districts. South Africa COVID-19 Grade 3 5-Mar-2020 5-Mar-2020 5-Feb-2023 4 056 701 4 056 701 102 595 2.5% Since the start of the COVID-19 pandemic in South Africa through 5 February 2023, a cumulative total of 4 056 701 confirmed cases and 102 595 deaths have been reported. South Africa Measles Ungraded 17-Oct-2022 13-Oct-2022 2-Feb-2023 3 156 441 0 0.0% From 8 October 2022 to 2 February, 2023, a total of 441 laboratory-confirmed cases were reported from five provinces with declared measles outbreaks in Limpopo (158 cases), Mpumalanga (86 cases), North West (147 cases), Gauteng (30 cases), and Free State (20 cases). South Africa Mpox Grade 3 23-Jun-2022 23-Jun-2022 18-Jan-2023 5 5 0 0.0% From 22 June 2022 to 18 January 2023, there have been five unlinked laboratory-confirmed monkeypox cases in South Africa. The cases were reported from Gauteng (n = 1), Western Cape (n = 2), Limpopo (n = 1) and Johanesburg (n = 1)provinces. No new cases have been reported since October 2022. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 19 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR South Sudan Drought/food insecurity Grade 3 18-Dec-2020 5-Apr-2021 12-Jan-2023 6 310 000 - - - People across South Sudan have experienced critical needs in December 2022. An estimated 6.31 million people experienced high levels of acute food insecurity (IPC Phase 3/Crisis or above), with 33,000 people projected to be in IPC Phase 5/Catastrophe in Akobo and Fangak, Jonglei State; and Pibor County in the Greater Pibor Administrative Area (GPAA) in December 2022 - March 2023. Over 1.4 million children below the age of five are estimated to be acutely malnourished with 345 893 experiencing severe acute malnutrition (SAM) and another 1.1 million experiencing moderate acute malnutrition (MAM). South Sudan Floods Ungraded 7-Oct-2022 15-Jan-2023 1 000 000 Since July 2022, an estimated 1 million people were affected by severe flooding in 36 counties across South Sudan and in the southern part of the Abyei Administrative Area. People in Northern Bahr el Ghazal, Warrap, Unity and Western Equatoria states are the worst affected and 80 per cent of those affected were from Jonglei, Unity and Upper Nile states. People were forcibly displaced repeatedly due to multiple compounding shocks, both in areas of displacement and return. Floodwater levels remained high in Bentiu and Rubkona towns in Unity, impeding livelihood activities, exposing people to waterborne diseases and disrupting the provision of basic services. An assessment team found 17,000 newly displaced people sheltering in three locations in Pibor town, following armed clashes that broke out in Gumuruk area in Pibor County. South Sudan Humanitarian crisis Protracted 3 15-Aug-2016 15-Aug-2016 29-Dec-2022 9 400 000 - - - The long-standing and complex humanitarian crisis in South Sudan continues. In 2022, there were a total of 8.9 million people in need of humanitarian assistance and 2.23 million people internally displaced people as of 30 November 2022. Over the past three years, seasonal floods have caused thousands of people to be displaced as well as caused problems for water, sanitation, and hygiene conditions in formalized camps and informal settlements. Recent clashes in mid-November 2022, had already caused the displacement of civilians in Fashoda County, Upper Nile State. South Sudan Anthrax Ungraded 25-Apr-2022 13-Mar-2022 25-Dec-2022 148 8 5 3.4% Three new suspected cases of anthrax were reported in week 43, 2022 (ending 30 October), bringing the cumulative to 148 cases including five deaths (CFR 3.4%). Cases have been reported from 13 March to 25 December 2022, with eight samples that returned positive for Bacillus anthracis. The most affected age group remains the 5-9 years (33 cases; 22.3%), followed by the under five (32 cases; 21.6%). Females represent 54.1% of cases (n=80). Cases have been reported from eight Payams in Warrap state, the most affected of which are Kuac North (87 cases, two deaths) and Alek South (20 cases, two deaths). South Sudan COVID-19 Grade 3 5-Apr-2020 5-Apr-2020 30-Jan-2023 18 393 18 393 138 0.8% On 5 April 2020, the Ministry of Health of South Sudan reported the country’s first case of COVID-19. As of 26 December 2022, a total of 18 393 confirmed COVID-19 cases were reported in the country including 138 deaths and 18 115 recovered cases. South Sudan Hepatitis E Ungraded 3-Jan-2018 1-Jan-2019 22-Jan-2023 3 873 104 27 0.7% The current outbreak in the Bentiu IDP camp is ongoing. As of 22 January 2023, a total of 3 873 cases of hepatitis E including 27 deaths (CFR: 0.7%) have been reported since January 2019. Approximately 54% of cases are male. South Sudan Measles Ungraded 23-Feb-2022 1-Jan-2022 8-Jan-2023 3 581 310 41 1.1% Measles outbreaks were confirmed in 25 counties in 10 states since January 2022 to January 2023 with a cumulative of 3 581 cases including 41 deaths (1.14%). Recent outbreak confirmed in Tonj North County after confirmation of five samples IgM+ results in week 1, 2023. A total of 17 counties are still reporting cases and the outbreak is still active in 16 counties. Tanzania, United Republic of COVID-19 Grade 3 16-Mar-2020 16-Mar-2020 27-Jan-2023 42 664 42 664 846 2.0% The Ministry of Health, Community Health, Community Development, Gender, Elderly and Children in Tanzania reported the country’s first case of COVID-19 on 16 March 2020. As of 27 January 2023, a total of 42 664 confirmed cases have been reported in Tanzania Mainland including 846 deaths. Togo COVID-19 Grade 3 6-Mar-2020 1-Mar-2020 4-Feb-2023 39 356 39 356 290 0.7% On 6 March 2020, the Ministry of Health and Public Hygiene of Togo announced the confirmation of its first case of COVID-19. As of 4 February 2023, a total of 39 356 cases, including 290 deaths and 39 064 recovered cases, have been reported in the country. Togo Poliomyelitis (cVDPV2) Grade 2 18-Oct-2019 13-Sep-2019 1-Feb-2023 19 19 0 0.0% No case was reported this week. There were 2 cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) reported in 2022. No cases were reported in 2021. There were nine cases in 2020, while the total number of cVDPV2 cases reported in 2019 remains at eight. Uganda Drought/food insecurity Grade 3 17-Feb-2022 1-Jan-2022 6-Dec-2022 - - - - According to the Famine Early Warning Systems Network report covering projections from October 2022 to May 2023, Below-average crop production and high food and non-food inflation are to drive acute food insecurity in Uganda. In Karamoja, significantly below-average crop production (estimated to be only around half of normal levels) for a third consecutive season and localized insecurity continue to disrupt typical livelihoods and reduce income-earning. Given this and above-average prices, the number of households facing Crisis (IPC Phase 3) and Emergency (IPC Phase 4) outcomes remains atypically high for a postharvest period. Uganda COVID-19 Grade 3 21-Mar-2020 21-Mar-2020 21-Jan-2023 170 305 170 305 3 630 2.1% The first COVID-19 confirmed case was reported in Uganda on 21 March 2020. As of 21 January 2023, a total of 170 305 confirmed COVID-19 cases with 3 630 deaths were reported. Uganda Crimean- Congo haemorrhagic fever (CCHF) Ungraded 23-Oct-2022 12-Jul-2022 17-Jan-2023 8 8 3 37.5% From 23 June 2022 to 17 January 2023, eight cases of Crimean-Congo haemorrhagic fever (CCHF) have been confirmed in Uganda from Kanungu (2), Masaka (2), Amuru (1), Kaberamaido (1), Nakasongola (1) and Rakai (1) districts with three deaths. The last confirmed case was registered on 4 December 2022. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 20 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Uganda Yellow Fever Ungraded 7-Mar-2022 2-Jan-2022 25-Jan-2023 984 2 0 0.0% In 2022 and as of 13 January 2023, a total of 984 samples have been collected and tested for yellow fever (YF), of which 28 tested IgM+ for YF. Two cases were classified as laboratory-confirmed, including one in Masaka district and another one in Wakiso district. There are currently six cases under investigation, from five districts including Kasese (2), Buikwe (1), Buvuma (1), Masaka (1), and Wakiso (1). Zambia Cholera Ungraded 24-Jan-2023 20-Jan-2023 29-Jan-2023 39 19 1 2.6% On 21 January 2023, a male aged 22 from Kamtsekelo presented to Chikoma Health Centre (HC) with Acute Watery Diarrhea (AWD) and dehydration. On the same day, a 30-year-old female, presented to Chikoma Zonal Rural Health Centre with similar signs and symptoms to the index case. The female case had just returned to Vubwi from Mozambique to take care of her sick mother. As of 29 January, 39 suspect cholera cases, with 19 confirmed and one death have been reported. Zambia COVID-19 Grade 3 18-Mar-2020 18-Mar-2020 25-Jan-2023 341 573 341 573 4 049 1.2% The first COVID-19 confirmed case was reported in Zambia on 18 March 2020. As of 25 January 2023, a total of 341 573 confirmed COVID-19 cases were reported in the country including 4 049 deaths. Zambia Measles Ungraded 13-Jun-2022 13-Jun-2022 29-Jan-2023 2 137 288 31 1.5% A measles outbreak continues to evolve in Lusaka, North-western and Southern provinces affecting several districts. Cumulatively, the provinces have recorded 2 137 measles cases and 31 deaths as of 29 January 2023. WHO is supporting the Ministry of Health investing other cases with similar symptoms. Zimbabwe Anthrax Ungraded 20-Jan-2020 1-Jan-2022 24-Jan-2023 426 0 0 0.0% The anthrax outbreak is ongoing in Zimbabwe. In January 2023, 32 new cases have been reported from Midland province (30) and Masvingo province (2). As of 24 January 2023, the cumulative figures for anthrax are 426 cases and 0 deaths. Zimbabwe COVID-19 Grade 3 20-Mar-2020 20-Mar-2020 4-Feb-2023 263 083 263 083 5 659 2.2% The first COVID-19 confirmed case was reported in Zimbabwe on 20 March 2020. As of 4 February 2023, a total of 263 083 confirmed COVID-19 cases were reported in the country including 5 659 deaths. Zimbabwe Measles Ungraded 29-Apr-2022 19-May-2022 31-Dec-2022 7 743 355 707 9.7% A measles outbreak has been ongoing in Zimbabwe since 10 April 2022. As of 31 December 2022, A cumulative total of 7 743 suspect cases, 355 confirmed cases and 707 Deaths have been reported since the onset of the outbreak. Zimbabwe Typhoid fever Ungraded 17-Oct-2022 17-Oct-2022 27-Jan-2023 186 17 0 0.0% The Harare capital city of Zimbabwe is experiencing a typhoid fever outbreak since October 2022. As of 27 January 2022, a total of 186 cases with 17 confirmed have been reported. The age group of 1 – 4 years accounts for 16% of the total cases. Males account for 47% of all typhoid cases and females contribute 45% and 8% of the cases have no stated gender. All the tested samples were sensitive to Ciprofloxacin, Azithromycin, cefotaxime, and ceftriaxone and resistant to Ampicillin, cotrimoxazole and azithromycin †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 21 © WHO Regional Office for Africa This is not an official publication of the World Health Organization. Correspondence on this publication may be directed to: Dr Etien Luc Koua Programme Area Manager, Health Emergency Information and Risk Assessment Programme. WHO Emergency Preparedness and Response WHO Regional Office for Africa P O Box. 06 Cité du Djoué, Brazzaville, Congo Email: afrooutbreak@who.int Requests for permission to reproduce or translate this publication – whether for sale or for non- commercial distribution – should be sent to the same address. 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 REGIONAL OFFICE FOR Africa Editorial Team G. Sie Williams J. Nguna J. Kimenyi O. Ogundiran F. Kambale F. Sanni R. Mangosa Zaza J. Njingang Nansseu V. Mize C. Okot Production Team T. Mlanda R. Ngom F. Moussana M. Nzingou WCO Contributors Laurent MUSANGO (WR Madagascar), Gilbert KAYOKO (Madagascar) Walter KAZADI MULOMBO (WR Nigeria) Victor TUGUMIZEMU (Nigeria) A. Moussongo Editorial Advisory Group Dr. Salam Gueye, Regional Emergency Director E. Koua D. Chamla F. Braka Data sources Data and information is provided by Member States through WHO Country Offices via regular situation reports, teleconferences and email exchanges. Situations are evolving and dynamic therefore numbers stated are subject to change.