Weekly Bulletin on Outbreak and other Emergencies: Week 2: 04 - 10 January 2021

(2) Algeria Mali Chad Niger Angola EthiopiaNigeria South Africa Namibia Mauritania Zambia Kenya Democratic Republic of the Congo Mozambique Botswana Congo Madagascar South Sudan Cameroon Zimbabwe Gabon Ghana Guinea United Republic of Tanzania Uganda Central African Republic Côte d'Ivoire Senegal Burkina Faso Benin Eritrea Liberia Malawi TogoSierra Leone Lesotho Burundi Rwanda Eswatini Guinea-Bissau Gambia Equatorial Guinea Mauritius Comoros Cape Verde Sao Tome and Principe Seychelles 0 820410 Kilometers ¤ REGIONAL OFFICE FOR Africa WHO Health Emergencies Programme Health Emergency Information and Risk Assessment Graded events † 2 Ungraded events Protracted 3 events 2 Protracted 2 events 0 Protracted 1 event 1 WEEKLY BULLETIN ON OUTBREAKS AND OTHER EMERGENCIES Ongoing events 1190 Humanitarian crises 13 Outbreaks 106 Protracted 3 events 3 3 Protracted 1 events 49 Grade 1 events 0 Grade 3 events 19 4 Grade 2 events New event Week 2: 3-10 January 2021 Data as reported by: 17:00; 10 January 2021 18 504 301 10 114 66 1 195 244 3 112 249 183 0 795 2 8 717 41 5412 59 0 14420 1 952 87 6 231 203 305 7 1 488 6 1 873 916 2 464 1 711 13 71 0 38 397 1 124 17 28 676 137 1 868 13 42 079 14 728 257 35 0 25 0 105 0 862 0 133 0 010 07 879 351 22 2 0 178 1 7 2 52 14 626 2 100 087 1 358 1 698 27 21 245 465 27 336 451 1 231 597 33 163 3 304 44 8 082 89 4 973 63 7 160 112 23 254 138 19 158 610 11 435 295 128 316 1 994 9 694 66 55 772 336 1 800 83 15 512 384 28 259 254 9 630 120 525 1 509 21 3 877 126 2 537 107 1 556 6 539 10 18 193 407 27 728 469 21 477 507 21 939 192 12 392 114 18 001 267 37 742 301 98 271 1 770 3 857 125 2 447 45 055 030 7 600 298 102 144 2 807 16 051 48 1 019 2 8 575 225 2 834 77 3 649 63 989 0 2 577 50 7 0 1 0 1 184 25 130 55 1 349 5 1 1 3 1 198 5 16450 36 13 146 053 036 3 957 72 1 066 17 5 289 86 017 8113 942 071 3 0 6 0 567 0 67 2Legend 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 West Nile fever Rift Valley fever Skin disease of unknown etiology Hepatitis E Monkeypox Cholera Lassa fever Measles Deaths Cases cVDPV2 Anthrax COVID-19 “The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate borderlines for which there may not yet be full agreement.” Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 1 Overview Ongoing events Summary of major issues, challenges and proposed actions All events currently being monitored This Weekly Bulletin focuses on public health emergencies occurring in the WHO African Region. The WHO Health Emergencies Programme is currently monitoring 119 events in the region. This week’s main articles cover the following events:  Coronavirus disease 2019 (COVID-19) in South Africa  Cholera in Togo 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:  A major surge in cases in South Africa, the most affected country in the region, is of grave concern. There are reports that hospitals are under pressure in the most affected provinces, with oxygen requirements greater than were seen in the first wave. Although there are signs that Eastern Cape and Western Cape provinces may have reached a peak in new cases, the trajectory in Gauteng and KwaZulu-Natal is still rising. The recent holiday season saw significant movement of people around the country, the effects of which remain to be seen, as does the effect of the recent return to an adjusted level 3 lockdown across the country.  Cholera is endemic in Togo. The current cholera outbreak is occurring in an area that is known to have poor access to safe water supplies and inadequate sanitation. The outbreak is currently small and localised, although affecting a fishing area that often becomes busy, with the consequent risk of transmission to other areas. Authorities need to address these issues urgently to bring this outbreak to a rapid close and prevent geographical extension. Contents Overview 1 6 2 -5 7 Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 2 157 South Africa 2.7% CFR REGIONAL SUMMARY The WHO African Region remains one of the least affected by the COVID-19 pandemic accounting for 2.5% (2 147 369) of cumulative reported cases, and 2.5% (48 273) of cumulative deaths globally (case fatality ratio 2.3%). The Region observed a sustained decline in case incidence from mid-July 2020, and then a marginal increase from early October until mid-December 2020, after which cases across the region started rising rapidly, with a high proportion of cases reported in South Africa, Nigeria, Ethiopia, Namibia and Zimbabwe in the past four weeks. Currently, heterogeneous transmission patterns with established community transmission are seen in 42 countries. The top five countries (South Africa, Ethiopia, Algeria, Nigeria and Kenya) account for 82% of total cases and 83% of total deaths. As of 10 January 2021, a total of 1 701 489 (79%) case-patients reported from all 47 countries in the Region have recovered, with Côte d’Ivoire (98.3%) and Central African Republic (98.2%), experiencing the highest recovery rate, and Lesotho (56.4%) and Angola (63.0%) the lowest, which could be attributed to under reporting of recoveries in these countries. Infections among health workers have been gradually increasing, and account for 67 482 (3.1%) infections reported in 46 countries. Only Eritrea has not reported any healthcare worker infections. As the region faces this resurgence (since early October 2020), WHO can never stress enough the need for countries to provide better, timely and more accurate COVID-19 outbreak data, to enable improved response from enhanced epidemiological analysis and understanding of COVID-19 in the region as mandated under the International Health Regulations (IHR 2005). EVENT DESCRIPTION South Africa continues to record the highest number of COVID-19 cases and deaths on the continent and the sustained increase in cases that has been observed since 19 November 2020, continues. The surge in cases initially started in Nelson Mandela Bay in Eastern Cape, which then spread along the coastal areas of the Western Cape, also affecting the City of Cape Town. However, both KwaZulu- Natal and Gauteng provinces are now also experiencing significant increases in case numbers and deaths. As of 10 January 2021, the overall incidence of COVID-19 in the country is 2 066/100 000 population. In the 24 hours up to this date, there were 63 046 tests conducted, with a positivity rate of 27.64%. 1 231 597 33 163 Cases Deaths Go to overview Go to map of the outbreaks Ongoing events Coronavirus disease 2019 Geographical distribution of cumulative number of cases of coronavirus disease 19 in South Africa as of 10 January 2021. As of 10 January 2021, the cumulative total of confirmed cases is 1 231 163, with 33 163 deaths (case fatality ratio 2.7%). Gauteng Province remains the most affected, at 333 842 cases (27.1%), followed by KwaZulu-Natal with 252 115 (20.5%) cases. Western Cape (241 001; 19.6%) and Eastern Cape (180 689; 14.7%) follow. Case numbers continue to rise in the less populous provinces, with 66 760 cases in Free State Province, 46 451 cases in North West Province, 45 894 cases in Mpumalanga Province, 37 197 cases in Limpopo and 27 648 cases in Northern Cape. Eastern Cape has the most reported deaths (8 739; 26.4%), followed by Western Cape (8 187; 24.7%), Gauteng (6 170; 18.6%), KwaZulu-Natal (5 241; 15.8%) and Free State (2 295; 7.0%). The remaining provinces have reported 2 531 (7.6%) of deaths between them. KwaZulu-Natal The distribution of confirmed COVID-19 cases and deaths in South Africa, 28 February 2020 to 11 January 2021. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 3 Province has the highest number of active cases, at 92 634 (40.0%), followed by Western Cape (46 411; 20.0%) and Gauteng Province (46 272; 20.0%). The number of active cases in the other provinces ranges from 10 067 in Limpopo, to 3 675 in Northern Cape. The total number of active cases among known confirmed cases across the country is 232 066. The number of recoveries stands at 966 368 (78.5%). The reported number of health worker infections is 35 404 (3.0%). As of 10 January 2021, a total of 7 183 893 Polymerase Chain Reaction (PCR) tests has been carried out, of which 57% have been carried out in the private sector and 43% in the public sector. Sentinel surveillance carried out in selected public and private hospitals by the National Institute for Communicable Diseases (NICD) shows that weekly hospital admissions have been rising steadily since week 44 (week ending 31 October 2020). As of 1 January 2021, there was a total of 14 994 patients admitted, with 2 054 in ICU of which 745 were ventilated. Gauteng had the highest number of patients admitted, with 4 128, of which 862 are in ICU and 247 ventilated. KwaZulu-Natal had 3 713 patients admitted, of which 452 were in ICU and 143 ventilated; Western Cape had 3 323 patients admitted, of which 374 were in ICU and 138 ventilated; and Eastern Cape had 1 702 patients admitted, of which 141 were in ICU and 75 ventilated. The other provinces had admissions ranging from 617 in North West, to 253 in Northern Cape. PUBLIC HEALTH ACTIONS  On 28 December 2020, South Africa moved back into lockdown level 3 (adjusted), with a curfew from 21:00 to 06:00 daily, alcohol sales banned completely, and gatherings limited to 50 persons indoors and 100 persons outdoors, with public parks now closed.  Hot spot areas have been designated across the country, including in the less populous provinces of Limpopo and North West, which are subject to further restrictions, with restaurants closing at 20:00; beaches, dams, lakes and rivers closed; and social and faith-based gatherings prohibited for two weeks from 28 December 2020.  Cloth masks are mandatory in public places, including outside areas. Family and social visits in homes are now permitted.  Schools will re-open on 27 January 2021, subject to full COVID-19 measures being in place. Go to overview Go to map of the outbreaks SITUATION INTERPRETATION South Africa remains the most affected country in the African Region and has shown a clear resurgence in case numbers. Media reports suggest that hospitals across the country are under pressure, with much larger oxygen requirements being reported across the country than was reported in the first wave of the virus, and increasing numbers of health workers being affected. The holiday season is now largely over, with schools returning in 10 days and most businesses open again, which means that there is significant movement of people around the country. The effects of this on infection levels will be seen in the next 10 days to two weeks. A consistent testing strategy, with localized contact tracing and isolation of cases, is urgently required, with continued risk assessment and community engagement to encourage people to continue to adhere to all COVID-19 preventive measures. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 4 EVENT DESCRIPTION The cholera outbreak in Lomé, Togo declared on 19 November 2020, is ongoing. From 11 November 2020 to 28 December 2020, a total of 67 suspected cholera cases, presenting with diarrhoea and vomiting, including two deaths, a case fatality ratio of 3.0%, were reported from the municipalities Golfe 1 and Golfe 6 in Lomé, Togo. A total of four health areas (Katanga, Adakpamé, Gbétsogbé in Golfe 1, and Kangnikopé in Golfe 6) in the affected municipalities reported at least one case. On 17 November 2020, cholera was confirmed by culture in the laboratory of the National Institute of Hygiene (INH) in Lomé, Togo. From 11 November to 28 December 2020, a total of 17 stool samples (out of 41 tested) were tested positive for Vibrio cholerae O1 serotype Ogawa by culture. The daily number of cases peaked on 16 November 2020 with six cases, including one death, , then after a drop, the number of daily cases again peaked with six cases reported on 16 and 22 December 2020. Cases with symptom onset between 11 to 15 November 2020 were found retrospectively by active case searches in health facilities from consultation registers. Of the 67 cases, 19 (28%) were fishermen with high mobility in Togo and neighbouring countries (especially Ghana, Benin, and Nigeria). The sex ratio is 1.5 male / female (40 males and 27 females) with an average age of 24 years. PUBLIC HEALTH ACTIONS  Implementation of the outbreak response plan is in progress.  Active surveillance and case search is in place, as well as briefing of health workers and community workers.  Infection prevention and control is being strengthened in health facilities.  Additional human resources have been allocated to the Katanga health district.  Free patient care and case management with fluids is ongoing in the clinic in Katanga.  Homes of cases are being disinfected.  Chlorine tablets are being distributed in Katanga and Gbétsogbé for water treatment.  Medicines and medical equipment are being prepositioned in Katanga.  Cholera awareness messages are being disseminated across all media.  Water samples are being taken for biochemical and bacteriological analysis. SITUATION INTERPRETATION Cholera is endemic in Togo, with the main focus in the capital, Lomé. There are usually two epidemic peaks a year, in the dry season (January to March) and in the rainy season (July to October). In the past five years, Katanga has experienced three cholera outbreaks. The area has poor access to drinking water and poor sanitation. Challenges exist around sufficient equipment for case management and the lack of permanently available safe drinking water, which requires deep boreholes, as well as better sanitation. Given that Togo has experienced ten cholera outbreaks in the past 15 years, these problems need urgent attention. National authorities and partners need urgently to implement acute responses to the current outbreak to ensure that it is rapidly brought under control without spread to other areas and at the same time address the long-term issues around safe drinking water and sanitation that are driving the constant outbreaks. Go to overview Go to map of the outbreaks Geographical distribution of cholera cases in Lomé, Togo as of 28 December 2020. 157 Cholera Togo 4.3%CFR 67 2 Cases Deaths Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 5Go to overview Go to map of the outbreaks Major issues and challenges  South Africa’s second surge in COVID-19 cases is of grave concern, with the previously relatively unaffected rural areas of the Western Cape now seeing significant increases in cases, along with Eastern Cape Province. However, most active cases are now in Gauteng and KwaZulu-Natal provinces, with suggestions that their peaks of infections are still to come. The country is returning to work, with major population movement across the country as a result. The effect of this, and of gatherings during the recent festive season, are yet to be seen.  The current cholera outbreak in Togo, although relatively small, is in an area that attracts large numbers of people from different areas of Lomé and from neighbouring towns to buy fish. The affected area is known for inadequate access to safe water supplies and poor sanitation and is, in any cases, an endemic area. Proposed actions  Authorities in South Africa need urgently to implement a consistent testing and tracing policy, as well as strengthen risk communication and community engagement activities throughout the country in order to bring this second surge of the disease under swift control.  Authorities in Togo need to continue urgent response to the cholera outbreak in one commune in Lomé, including provision of safe water supplies and distribution of chlorine tablets, as well as active case search, case management and follow-up to rapidly bring the outbreak to a close before there is geographical spread. Summary of major issues, challenges and proposed actions Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 6Go to overview Go to map of the outbreaks All events currently being monitored by WHO AFRO Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Ongoing Events Algeria COVID-19 Grade 3 25-Feb-20 25-Feb-20 10-Jan-21 102 144 102 144 2 807 2.7% From 25 February 2020 to 10 January 2021, a total of 102 144 confirmed cases of COVID-19 with 2 807 deaths (CFR 2.8%) have been reported from Algeria. A total of 69 212 cases have recovered. Angola COVID-19 Grade 3 21-Mar-20 21-Mar-20 10-Jan-21 18 193 18 193 416 2.3% The first COVID-19 confirmed case was reported in Angola on 21 March 2020. As of 10 January 2021, a total of 18 193 confirmed COVID-19 cases have been reported in the country with 416 deaths and 13 872 recoveries. Angola Measles Ungraded 4-May-19 12-Dec-19 4-Nov-20 1 349 1 028 5 0.4% From 4 January 2020 to 4 November 2020, Angola reported a total of 1 349 suspected cases that have been notified and investigated of which 1 028 have been confirmed. There was a total of 5 deaths reported from 1 January to 1 July 2020 in 14 provinces across Angola; there is no further information regarding deaths for this current period. 80% of the confirmed cases are <5 years of age; 14% are aged 5-9 years; 3% are 10-14 years of age. A total of 16 out of 18 provinces are affected. The most affected provinces are Cabinda (436), Bie (184), Malanje (108), Luanda (88), and Huambo (55). Angola Poliomyelitis (cVDPV2) Grade 2 8-May-19 1-Jan-19 6-Jan-21 133 133 0 0.0% No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There have been three cases reported in 2020 so far. The total number of cases reported in 2019 remain 130. These cases are from several outbreaks which occurred in 2019. Benin Cholera Ungraded 17-August-20 27-Sep-20 198 1 5 2.5% As of Week 39, Benin reported a total of 198 suspected cases of cholera. There were only 1 culture confirmed case and 5 deaths reported for 2020. Benin COVID-19 Grade 3 17-Mar-20 16-Mar-20 5-Jan-21 3 304 3 304 44 1.3% The Ministry of Health in Benin announced the first confirmed case of COVID-19 on 16 March 2020. As of 5 January 2021, a total of 3 304 cases have been reported in the country with 44 deaths and 3 185 recoveries. Benin Poliomyelitis (cVDPV2) Grade 2 8-Aug-19 8-Aug-19 6-Jan-21 10 10 0 0.0% No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. Two cases were reported in 2020, with 8 cases reported in 2019. These cases are all linked to the Jigawa outbreak in Nigeria. Botswana COVID-19 Grade 3 30-Mar-20 28-Mar-20 8-Jan-21 16 051 16 051 48 0.3% On 30 March 2020, the Minister of Health and Wellness in Botswana reported three confirmed cases of COVID-19. As of 8 January 2021, a total of 16 051 confirmed COVID-19 cases were reported in the country including 48 deaths and 12 927 recovered cases. Burkina Faso Humanitarian crisis Grade 2 1-Jan-19 1-Jan-19 30-Oct-20 - - - - Since 2015, the security situation in the Sahel and the East of Burkina Faso has gradually deteriorated as a result of attacks by armed groups. This has resulted in mass displacement leading to a total of 1 034 609 internally displaced persons registered as of 31 October 2020 in all 13 regions in the country. The presence of jihadist groups and self-defence units have created an increasingly volatile security situation. Presidential and legislative elections were successfully held on 22 November despite dire security conditions and widespread displacement across the country. The health system remains strongly impacted by the security situation in Burkina Faso. Attacks on the health system, intimidation and kidnapping of health workers, theft of medicines, continue to be reported. As of 30 September, 2020, according to the report from the Ministry of Health, 95 health facilities were closed, which is 7.5% of the health facilities in six regions affected by insecurity, and 199 other health facilities are working partially. Central Burkina Faso (particularly the Centre Region, including the area of the capital Ouagadougou, and the Centre-Nord Region) was affected by heavy rain since 5 September 2020, which trigered floods and resulted in casualties and damages. Burkina Faso COVID-19 Grade 3 10-Mar-20 9-Mar-20 9-Jan-21 8 082 8 082 89 1.1% Between 9 March 2020 and 9 January 2021, a total of 8 082 confirmed cases of COVID-19 with 89 deaths and 5 845 recoveries have been reported from Burkina Faso. Burkina Faso Hepatitis E Grade 1 7-Sep-20 17-Sep-20 23-Nov-20 450 10 16 3.6% From 8 September to 23 November 2020, there have been a total of 450 cases of febrile jaundice detected in Barsalogho health district, North Central Region of Burkina Faso. The outbreak has mainly affected internally displaced persons in the district, including 15 out of 16 deaths that were among pregnant or postpartum women. Hepatitis E has been confirmed in ten cases to date. Eight out of nine samples were IgM positive for hepatitis E at a hospital laboratory in Montpellier, France on 25 September 2020; three samples tested IgM positive for yellow fever and 1 sample was undetermined at the Laboratoire National de Référence des Fièvres Hémorragiques Virales (LNR-FHV) in Centre Muraz; a total of four samples were sent to IPD for confirmation. Results showed two samples tested PCR positive for Hepatitis E; seroneutralization results revealed 4 positive yellow fever results, however with very low titres; and 0 samples tested RT-PCR positive for yellow fever. In sum, this has now been confirmed as a hepatitis E outbreak. Burkina Faso Poliomyelitis (cVDPV2) Grade 2 1-Jan-19 6-Jan-21 55 55 0 0.0% No new cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported. There are now 56 cVDPV2 cases in the country. Burkina Faso is affected by different outbreaks, one linked to the Jigawa outbreak in Nigeria and one to the Savanes outbreak in Togo. Burundi COVID-19 Grade 3 31-Mar-20 18-Mar-20 10-Jan-21 1 019 1 019 2 0.2% On 31 March 2020, the Minister of Health in Burundi reported the first two confirmed cases of COVID-19. As of 10 January 2021, the total number of confirmed COVID-19 cases is 1 019, including two deaths and 804 recovered. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 7 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Burundi Measles Ungraded 23-Mar-20 4-Nov-19 2-Aug-20 989 989 0 0.0% Burundi has been experiencing measles outbreaks since November 2019 in camps hosting Congolese refugees and the disease has recently been spreading in the host community in the district of Citiboke. As of 9 August 2020, Burundi has reported a total of 989 confirmed measles cases of which 154 are lab-confirmed and the rest were clinically compatible cases and epidemiologically linked. The current outbreak is affecting the following districts: Bukinanyana (Cibitoke province), Ngozo (Ngozi province), Bujumbura Nord (Bujumbura province). There have been no deaths reported. Cameroon Humanitarian crisis (Far North, North, Adamawa & East) Protracted 2 31-Dec-13 27-Jun-17 17-Dec-20 - - - - Cameroon continues to face a humanitarian crisis in the Far North Region linked to the terrorist attacks by the Boko Haram group resulting in significant population displacement. The United Nations Department of Safety and Security (UNDSS) has identified 50 security incidents only for the month of October 2020. UNHCR protection monitoring through INTERSOS, reported 549 protection incidents in the same month. The incursions of the non-governmental armed group has resulted in numerous displacements of people within the region. In addition to the insecurity linked to armed group attacks, the Far-North region has experienced very heavy rains in September, resulting in large-scale floods, damaging and destroying houses, cultivated areas, roads and bridges and further reducing the access to services. According to data collected by the Cameroonian Red Cross (CRC) as of 20 October 2020, the floods affected around 162 300 people, killed 50 people and displaced 357 households in the Far North region. The multiple influxes of displaced people and the floods have worsened the problems of access to water, hygiene and sanitation in the region.The Minawao Refugee Camp in the Mokolo Health District continues to host Nigerian refugees. Cameroon Humanitarian crisis (NW & SW) Protracted 2 1-Oct-16 27-Jun-18 30-Oct-20 - - - - Conflict in the North-West and South-West regions continues to cause mass displacement, both internally and into neighboring Nigeria. As of 30 October 2020, a total of 711 056 internally displaced persons in the North-West and South-West region and a total 61 774 cameroon refugees in Nigeria were reported by UNHCR. Attacks on educational institutions and civilian populations continue to increase. On 3 November 2020, armed men kidnapped 11 teachers from a school in Kumbo and on 4 November 2020 students and teachers were tortured during an attack on a college in Limbe, and on the same day nine school children were kidnapped and later released in Fundong. Shelter, NFI (non-food Items), protection and food continue to be the most urgent needs of the displaced populations. Cameroon Cholera Ungraded 1-Mar-19 1-Jan-20 16-Dec-20 1 952 68 87 4.5% The cholera outbreak, which was notified on 1 April 2020, is ongoing, with fluctuating numbers of cases reported from Central, Littoral, South and South West regions. As of 16 December 2020, a total of 1 952 cases and 87 deaths were repored in centre (60 cases and 2 deaths), Littoral (962 cases and 53 deaths), south (798 cases and 25 deaths), and South Ouest (132 caes and 7 deaths) regions. Cameroon COVID-19 Grade 3 6-Mar-20 6-Mar-20 6-Jan-21 27 336 27 336 451 1.6% The Cameroon Ministry of Health announced the confirmation of the first COVD-19 case on 6 March 2020. As of 6 January 2021, a total of 27 336 cases have been reported, including 451 deaths and 26 252 recoveries. Cameroon Measles Ungraded 2-Apr-19 1-Jan-20 25-Aug-20 1 868 634 13 0.7% The measles outbreak is improving in Cameroon. Since 1 January 2020 to date, a total of 1 423 confirmed cases and 13 deaths have been reported in the country. Twenty- nine out of 79 health districts that were affected have not reported cases in the last four epidemiological weeks. A total of 13 deaths were reported to date in six districts, namely Kribi (4 cases), Gashiga (2 cases), Betaré Oya (1 case), Kolofata (2 cases), Awae (1 case), Ngaoundal (1 case), Ngong (1 case), Guidiguis (1 case). Fifty percent of cases are aged between 9 to 59 months. Cameroon Poliomyelitis (cVDPV2) Grade 2 1-Jan-20 1-Jan-20 6-Jan-21 7 7 0 0.0% No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There were seven cases reported in 2020. Cape Verde COVID-19 Grade 3 19-Mar-20 18-Mar-20 10-Jan-21 12 392 12 392 114 0.9% The first COVID-19 confirmed case was reported in Cape Verde on 19 March 2020. As of 10 January 2021, a total of 12 392 confirmed COVID-19 cases including 114 deaths and 11 733 recoveries were reported in the country. Central African Republic Humanitarian crisis Protracted 2 11-Dec-13 11-Dec-13 30-Oct-20 - - - - Civil unrest and food insecurity in most parts of the country, including major cities, continue to cause a complex humanitarian situation. The security situation remains tense with the persistence of inter-ethnic tensions within rival armed groups in the Northeast of the country, mainly in Ndele, Birao, Batangafo and Bria. Around 641 292 people are internally displaced in Central Africa and 626 838 persons are refugees in negbouring countries, namely, Cameroon, Democratic Republic of Congo (DRC), Republic of Congo, Sudan and South Sudan. Central African Republic COVID-19 Grade 3 14-Mar-20 14-Mar-20 2-Feb-21 4 973 4 973 63 1.3% The Ministry of Health and population announced the confirmation of the first COVID-19 case in the Central African Republic on 14 March 2020. As of 2 January 2021, a total of 4 973 confirmed cases, 63 deaths and 4 900 recovered were reported. Central African Republic Measles Grade 2 15-Mar-19 1-Jan-19 14-Oct-20 28 676 443 137 - As of 14 October 2020, a total of 28 676 suspected cases have been notified and 137 deaths within 22 affected districts. A total of 32 new cases and 0 deaths were reported as of epi week 40. The majority of cases are under five years of age, followed by the 5 to under 15 year old age group . Response activities are ongoing in the affected health districts. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 8 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Central African Republic Poliomyelitis (cVDPV2) Grade 2 24-May-19 24-May-19 6-Jan-21 25 25 0 0.0% No new cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There are 4 cVDPV2 cases reported in 2020 so far and 21 cases in 2019 from several outbreaks. Chad Chikungunya Grade 1 27-Aug-20 28-Aug-20 3-Dec-20 38 397 22 1 0.0% From 14 August to 3 December 2020, there have been 38 397 cases of chikungunya recorded and 1 death, 4 provinces are affected Ouaddai, Wadifira, Sila and Guera all in the central eastern part of the country. Cumulative cases number in Abéché (30 888), Biltine (7 233) and Arada (217), Abdi (1) et Goz beida (57), and Mongo (1). Since EW 47 no new cases have been reported. Chad COVID-19 Grade 3 19-Mar-20 19-Mar-20 10-Jan-21 2 537 2 537 107 4.2% The first COVID-19 confirmed case was reported in Chad on 19 March 2020. As of 10 January 2021, a total of 2 537 confirmed COVID-19 cases were reported in the country including 107 deaths and 1 965 cases who have recovered. Chad Measles Ungraded 24-May-18 1-Jan-19 27-Dec-20 8 717 547 41 - The measles outbreak in Chad continues to show a declining trend overall, although with a slight increase in cases in recent weeks. A total of 15 suspected cases were notified with no deaths in week 50 (week ending 12 December 2020). Chad Poliomyelitis (cVDPV2) Grade 2 18-Oct-19 9-Sep-19 6-Jan-21 105 105 0 0.0% One case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported in Mandoul. There are 94 cVDPV2 cases in 2020 from three different outbreaks. There were 11 cases reported in 2019. Comoros COVID-19 Grade 3 30-Apr-20 30-Apr-20 10-Jan-21 1 184 1 184 25 2.1% The first case of confirmed COVID-19 was notified on 30 April 2020 in Comoros. As of 10 January 2021, a total of 1 184 confirmed COVID-19 cases, including 25 deaths and 871 recoveries were reported in the country. Congo COVID-19 Grade 3 14-Mar-20 14-Mar-20 2-Jan-21 7 160 7 160 112 1.6% The Government of Congo announced the confirmation of the first case of COVID-19 in Congo on 14 March 2020. As of 2 January 2021, a total of 7 160 cases including 112 deaths and 5 846 recovered cases have been reported in the country. Côte d'Ivoire COVID-19 Grade 3 11-Mar-20 11-Mar-20 8-Jan-21 23 254 23 254 138 0.6% Since 11 March 2020, 23 254 confirmed cases of COVID-19 have been reported from Côte d'Ivoire including 138 deaths, and a total of 22 356 recoveries. Côte d'Ivoire Poliomyelitis (cVDPV2) Grade 2 29-Oct-19 29-Oct-19 6-Jan-21 71 71 0 0.0% Three cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported; one each in Gbeke, Belier and Agneby-Tiassa. There were 71 cVDPV2 cases reported in 2020. Democratic Republic of the Congo Humanitarian crisis Grade 3 20-Dec-16 17-Apr-17 22-Nov-20 - - - - The prolonged and complex humanitarian crisis in Democratic Republic of the Congo continues, with 5.5 million internally displaced persons (IDP), 15.6 million people food insecure and in need of emergency assistance, and 5.6 million people in need of emergency health assistance. The main provinces affected are Ituri, and North and South Kivu. Since the end of October 2020, an estimated 2 250 IDPs have been displaced in the Djili region, Ituri Province, as a result of clashes between government soldiers and armed insurgents. At the same time, several health zones in Ituri, notably Mangala, have been waiting for humanitarian assistance since March 2020, requiring non-food items, healthcare, nutrition and protection. This affects an estimated 21 000 people. In the Lita Health Zone, a further 11 890 IDPs are vulnerable, according to CARITAS and UNICEF, while in the Tchaka site 375 households have been assisted with non-food items by CARITAS. However, a futher 2 003 IDPs living outside the site have not been provided with assistance. In North Kivu, Beni is a hot spot for armed attacks against civilians, with instances of rape, looting and destruction of shelters, as well as killings. Around 30% of protection incidents documented in North Kivu were committed in Beni. Democratic Republic of the Congo Cholera Grade 3 16-Jan-15 1-Jan-20 5-Dec-20 18 504 - 301 1.6% The ongoing cholera outbreak in Democratic Republic of the Congo is on a declining trend compared to previous years, although there has been a recent increase in cases. Outbreaks continue to occur in the central, south-eastern and eastern parts of the country. As of 5 December 2020 there has been a cumulative total of 18 504 cases, including 301 deaths (case fatality ratio 1.6%) in 131 health zones in 18 provinces. This is in comparison to 27 883 cases and 487 deaths (case fatality ratio 1.8%) in 179 health zones in 24 provinces in the same period in 2019. However, outbreaks are expected to continue in affected provinces, with possible resurgences as a result of current high rainfall, population displacement, inadequate access to safe drinking water and poor sanitation. Democratic Republic of the Congo COVID-19 Grade 3 10-Mar-20 10-Mar-20 8-Jan-21 19 158 19 158 610 3.2% Since the start of the COVID-19 outbreak, declared on 10 March 2020, there have been 19 158 confirmed cases and one probable case, with 610 deaths reported. A total of 14 697 people have recovered. Democratic Republic of the Congo Monkeypox Ungraded n/a 1-Jan-20 18-Oct-20 6 231 39 203 3.3% During week 40 (week ending 18 October 2020), a total of 73 suspected cases of monkeypox with two deaths were reported across the country. Between week 1 and week 40, a total of 6 231 suspected cases including 203 deaths (CFR 3.3%) were reported in 127 health zones from 17 out of 26 provinces in the country. During the same period in 2019, 4 311 suspected cases and 87 deaths (CFR 2.0%) were reported in 124 health zones from 16 provinces. One major challenge to the current emergency includes acquiring the required funding to respond to all the multiple ongoing outbreaks in the country. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 9 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Democratic Republic of the Congo Plague Ungraded 12-Mar-19 1-Jan-20 4-Oct-20 124 - 17 13.7% Ituri province has notified an upsurge of plague cases in the health zone of Rethy. From 11 June to 9 August 2020, a total of 73 cases with 10 deaths (CFR 13.6%) were notified in 5 out of 22 health areas of Rety health zone. Plague is endemic in Ituri province. Since the beginning of 2020 to date, Ituri Province has reported a total of 124 cases and 17 deaths (CFR 18.7%) in 5 health zones, namely Aungba, Linga, Rethy, Aru, Logo and Kambala. In 2019, from week 1 to 52, a total of 48 cases of bubonic plague including eight deaths have been reported in the country. Democratic Republic of the Congo Poliomyelitis (cVDPV2) Grade 2 15-Feb-18 1-Jan-18 6-Jan-21 183 183 0 0.0% One case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported in Maindombe. There are 75 cases reported in 2020, while the 2019 case count remains 88. There were 20 cases reported in 2018. The country continues to be affected by several other genetically-distinct cVDPV2s (notably in Kasai, Kwilu, Kwango and Sankuru provinces). Equatorial Guinea COVID-19 Grade 3 14-Mar-20 14-Mar-20 7-Jan-21 5 289 5 289 86 1.6% The Ministry of Health and Welfare announced the first confirmed COVID-19 case on 14 March 2020. As of 7 January 2021, a total of 5 289 cases have been reported in the country with 86 deaths and 5 154 recoveries. Eritrea COVID-19 Grade 3 21-Mar-20 21-Mar-20 8-Jan-21 1 556 1 556 6 0.4% The first COVID-19 confirmed case was reported in Eritrea on 21 March 2020. As of 8 January 2021, a total of 1 556 confirmed COVID-19 cases with six deaths were reported in the country. A total of 803 patients have recovered from the disease. Eswatini COVID-19 Grade 3 13-Mar-20 13-Mar-20 10-Jan-21 11 435 11 435 295 - The first case of COVID-19 was confirmed in the kingdom of Eswatini on 13 March 2020. As of 10 January 2021, a total of 11 435 cases have been reported in the country including 7 676 recoveries. A total of 295 associated deaths have been reported. Ethiopia Humanitarian crisis (Conflict in Tigray) Grade 2 4-Nov-20 4-Nov-20 2-Jan-21 - - - - Since conflict broke out on 4 November 2020, there have been significant population displacements in the region. As of 30 December 2020, more than 55 000 Ethiopians have fled to Sudan and 222 413 IDPs have been identified in the Tigray region, as well as displacements into neighbouring Amhara and Afar. The conflict has disrupted access to clean water, sanitation and health services, health supplies and commodities including essential drugs. Malaria, dysentery and typhoid have been reported, as well as SAM. Ethiopia Cholera Ungraded 14-May-19 12-May-19 31-Oct-20 14 728 257 1.7% In week 44 (week ending 31 October 2020), 48 new suspected cases with no associated death were reported. Most of the cases were reported from SNNP and Oromia. Ethiopia COVID-19 Grade 3 13-Mar-20 13-Mar-20 10-Jan-21 128 316 128 316 1 994 1.6% Since the confirmation of the first case on 13 March 2020, Ethiopia has confirmed a total of 128 316 cases of COVID-19 as of 10 January 2021, with 1 994 deaths and 113 374 recoveries. Ethiopia Measles Ungraded 14-Jan-17 1-Jan-19 31-Oct-20 1 873 - - As of week 44 (week ending 31 October 2020), the measles outbreak is still ongoing in the country. A total of 19 new suspected cases were reported during the week mainly from Oromia and Benishangul regions. Ethiopia Poliomyelitis (cVDPV2) Grade 2 24-Jun-19 20-May-19 6-Jan-21 35 35 0 0.0% No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. The total number of cVDPV2 cases reported is 35. Gabon COVID-19 Grade 3 12-Mar-20 12-Mar-20 8-Jan-21 9 694 9 694 66 0.7% On 12 March 2020, the Ministry of Health announced the confirmation of the first COVID-19 case in the country. As of 8 January 2021, a total of 9 694 cases including 66 deaths and 9 498 recoveries have been reported in the country. Gambia COVID-19 Grade 3 17-Mar-20 17-Mar-20 8-Jan-21 3 857 3 857 125 3.2% The first COVID-19 confirmed case was reported in the Gambia on 17 March 2020. A total of 3 857 confirmed COVID-19 cases including 125 deaths and 3 677 recoveries have been reported in the country. Ghana COVID-19 Grade 3 12-Mar-20 12-Mar-20 5-Jan-21 55 772 55 772 336 0.6% Since 12 March 2020, when the Ministry of Health announced the first confirmed COVID-19 cases in Ghana, a total of 55 772 cases including 336 deaths and 54 438 recoveries have been reported in the country. Ghana Poliomyelitis (cVDPV2) Grade 2 9-Jul-19 8-Jul-19 6-Jan-21 30 30 0 0.0% No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There were 12 cases reported in 2020, while the total number of 2019 cases remains 18. One cVDPV2 positive environmental sample was reported in the Eastern province. Guinea COVID-19 Grade 3 13-Mar-20 13-Mar-20 8-Jan-21 13 942 13 942 81 0.6% The Ministry of Health in Guinea announced the first confirmed case of COVID-19 on 13 March 2020. As of 8 January 2021, a total of 13 942 cases including 13 223 recovered cases and 81 deaths have been reported in the country. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 10 Country Event Grade Date notified to WCO Start of reporting period End of reporting period Total cases Cases Confirmed Deaths CFR Guinea Lassa Fever Ungraded 11-Jul-20 11-Jul-20 4-Aug-20 1 1 1 100.0% A case of Lassa fever was confirmed on 11 July 2020 by the Haemorrhagic Fever laboratory in Guéckédou. The case patient is a 28-year-old, female, 22 weeks of pregnancy, living in the village of Kondian, in the rural district of Koundou Lengo Bengou. She fell ill on 07 June 2020 with chest pain and no history of travel or being in contact with a foreigner a month before her illness. She consulted at Koundou health centre on 10 July 2020, with fever, cough, myalgia, diarrhoea, vomiting, sore throat, and chest pain. The malaria RDT performed was positive. She was treated for malaria and transferred to Guéckédou hospital the same day, where the diagnosis of haemorrhagic fever was made. A diagnostic test for haemorrhagic fever performed at the Haemorrhagic Fever laboratory in Guéckédou was positive for lassa fever. The patient died the next day. A dignified and secure burial was carried out by the Red Cross on 12 July 2020. Guinea Measles Ungraded 09-May-18 1-Jan-19 19-Oct-20 6 053 366 14 0.2% During week 41 (week ending 10 October 2020) there has been a total of 6 053 cases with 366 confirmed and 14 deaths in 2020. During week 44 of 2019 (week ending 3 November 2019), 127 suspected cases of measles were reported. From week 1 to 44 (1 January - 3 November 2019), a total of 4 690 suspected cases including 18 deaths (CFR 0.4%) have been reported. Of the 4 690 suspected cases, 1 773 were sampled, of which 1 091 tested positive for measles by serology. Three localities in three health districts are in the epidemic phase, namely, Wanindara in Ratoma health district, Dounet in Mamou health district and Soumpoura in Tougue health district. Guinea Poliomyelitis (cVDPV2) Grade 2 22-Jul-20 22-Jul-20 6-Jan-21 36 36 0 0.0% No new cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported this week. There are now 36 cVDPV2 cases in the country. Guinea Yellow fever Grade 2 19-Nov-20 6-Nov-20 15-Dec-20 52 0 14 26.9% A total of 48 suspected yellow fever cases have been notified in Guinea: 46 suspect cases from Koundara commune (northern part of Guinea), 1 suspect case from Kouroussa (center of Guinea), and 1 suspect case Dubreka (north of Conakry). Among the samples collected, there are 10 probable cases (IgM positive) tested by the Laboratoire des Fievres Hemorragiques Virales (LFHV) at Nongo, and are now en route to IP Dakar for confirmatory testing. Guinea- Bissau COVID-19 Grade 3 25-Mar-20 25-Mar-20 20-Dec-20 2 447 2 447 45 1.8% On 25 March 2020, the Ministry of Health of Guinea Bissau reported the first COVID-19 confirmed case in the country. As of 20 December 2020, the country has reported 2 447 confirmed cases of COVID-19 with 2 386 recoveries and 45 deaths. Kenya Cholera Ungraded 21-Jan-19 1-Jan-20 28-Aug-20 711 27 13 1.8% The outbreak is currently active in Garissa and Turkana counties. A cholera outbreak has been reported in five counties; Garissa, Wajir, Turkana, Murang’a and Marsabit since the beginning of 2020. Cumulative cases are 711 with 13 deaths (CFR 1.9%). The Wajir, Murang’a, Marsabit and Garissa outbreaks are now controlled. The outbreak is active in Turkana County. Turkana County is reporting the fourth wave of the outbreak this year, with 42 cases, so far and a total of 279 cases with 1 death (CFR 0.4%). Kenya COVID-19 Grade 3 13-Mar-20 13-Mar-20 10-Jan-21 98 271 98 271 1 710 1.7% On 12 March 2020, the Ministry of Health announced the confirmation of one new COVID-19 case in the country. As of 10 January 2021, 98 271 confirmed COVID-19 cases including 1 710 deaths and 80 875 recoveries have been reported in the country. Kenya Leishmaniasis Ungraded 31-Mar-19 3-Jan-20 15-Nov-20 305 272 7 2.3% Since 1 January 2020, a total of 430 visceral leishmaniasis cases have been reported in Marsabit, Garissa, Kitui, Baringo and West Pokot Counties. Marsabit County has reported 115 suspected cases out of which 62 tested positive by RDT (rk39) with four deaths (CFR 6.5%). Garissa County has reported 105 confirmed cases from Lagdera and Garissa sub-counties with three deaths. Kitui County has reported 79 cases from Mwingi North Sub County with no death, while Baringo County has reported 17 confirmed cases from Tiaty sub-county. West Pokot County, Pokot North sub-county, has reported 120 cases with 5 new cases reported from the county. Kenya Measles Ungraded 6-May-19 20-Oct-19 15-Nov-20 626 49 2 0.3% An outbreak of measles has been reported in nine sub-counties spread across five counties since the beginning of the year; West Pokot, Garissa, Wajir, Tana River and Kilifi. Total cases reported are 626 out of which 49 were confirmed and two deaths (CFR 0.3 percent). The outbreak is active in West Pokot County with 24 new cases reported in the last week. Lesotho COVID-19 Grade 3 13-May-20 13-May-20 22-Dec-20 2 577 2 577 50 1.9% Since the first confirmed COVID-19 case was reported in Lesotho on 13 May 2020, 2 577 cases of COVID-19 have been reported, including 1 454 recoveries and 50 deaths. Liberia COVID-19 Grade 3 16-Mar-20 16-Mar-20 23-Dec-20 1 800 1 800 83 4.6% From 16 March to 23 December 2020, a total of 1 800 cases including 83 deaths and 1 418 recoveries have been reported from all 15 counties of Liberia. Montserrado County, which hosts the country's capital city, remains at the epicenter of the outbreak. Liberia Lassa fever Ungraded 23-Jan-19 1-Jan-20 15-Nov-20 51 51 22 43.1% Two new confirmed cases were reported during week 46 (week ending 15 November 2020). Of 162 suspected cases reported across the country from 1 January to 15 November 2020, 51 were confirmed. A total of 22 deaths (CFR 43%) have been reported among the confirmed cases. Liberia Measles Ungraded 24-Sep-17 1-Jan-19 29-Nov-20 879 93 3 0.3% In week 48 (week ending 29 November 2020), 4 suspected cases were reported from Lofa (1), Grand Gedeh (1), Maryland (1) and Nimba(1) counties. Since the beginning of 2020, 879 cases with 3 associated deaths have been reported across the country, of which 93 are laboratory-confirmed, 228 are epi-linked, and 386 are clinically confirmed. Madagascar COVID-19 Grade 3 20-Mar-20 20-Mar-20 8-Jan-21 18 001 18 001 267 1.5% Madagascar Ministry of Health announced the confirmation of the first COVID-19 case on 20 March 2020. As of 8 January 2021, a total of 18 001 cases have been reported in the country, out of which 17 447 have recovered and 267 deaths reported. Malawi COVID-19 Grade 3 2-Apr-20 2-Apr-20 10-Jan-21 8 575 8 575 225 2.6% On 2 April 2020, the president of Malawi announced the first confirmed cases of COVID-19 in the country. As of 8 January 2021, the country has a total of 8 575 confirmed cases with 225 deaths and 5 824 recoveries. 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 Mali Humanitarian crisis Protracted 1 n/a n/a 30-Oct-20 - - - - The security situation continues to worsen as violence spreads from the north to the more populated central regions of the country.The persistent insecurity and deteriorating economic conditions due to the COVID-19 pandemic have caused a steep rise in trafficking of children, forced labour and forced recruitment by armed groups across the country. According to the latest report of the UNHCR led Global Protection Cluster, 220 cases of child recruitment were documented in the first half of 2020, compared to 215 cases in all of 2019. The country continues to record incidents targeting aid workers. Certain humanitarian operations in Timbuktu and Menaka regions were suspended as a result of violent security incidents. The country has had heavy rains since the end of June 2020, which have caused flooding in Mopti, Gao, Segou and Sikasso regions affecting over 13 200 people, including 5 400 IDPs. Mali COVID-19 Grade 3 25-Mar-20 25-Mar-20 10-Jan-21 7 600 7 600 298 3.9% On 25 March 2020, the Ministry of Health of Mali reported the first COVID-19 confirmed cases in the country. As of 10 Janvier 2021, a total of 7 600 confirmed COVID-19 cases have been reported in the country including 298 deaths and 5 291 recoveries. Mali Measles Ungraded 20-Feb-18 1-Jan-19 29-Nov-20 795 413 2 0.3% During week 48 (week ending 29 November 2020), 19 suspected cases of measles were reported from three regions in the country. Since 1 January 2020, 795 suspected cases, 413 of which were confirmed have been reported. Two associated deaths have been reported so far. Mali Yellow fever Ungraded 3-Dec-19 1-Jan-20 27-Dec-20 178 3 1 0.6% As of 27 December 2020, a total of 178 suspected cases have been reported including 3 confirmed cases and 1 death. 172 samples have been analyzed of which three (03) have been confirmed positive by IPD; 169 samples were deemed negative. The cumulative epidemiological situation in 2019 included 78 suspected cases including four 4 confirmed cases and three deaths (CFR 75%). Confirmed cases of yellow fever were reported from the Sikasso and Koulikoro regions. Mauritania COVID-19 Grade 3 13-Mar-20 13-Mar-20 10-Jan-21 15 512 15 512 384 2.5% The government of Mauritania announced its first confirmed COVID-19 case on 13 March 2020. As of 10 January 2021, a total of 15 512 cases including 384 deaths and 13 435 recovered cases have been reported in the country. Mauritania Dengue Ungraded 11-May-20 3-May-20 2-Nov-20 7 7 0 0.0% Between 16 to 24 October 2020, 5 cases of dengue fever have been suspected at Etewvigh Clinic in Tevragh Zeina district, and all have been confirmed by RT-PCR at the National Institute of Research in Public Health (INRSP). On 3 May 2020, two suspected cases of dengue fever were admitted to hospital in Mauritania. On May 4 2020, it was found that the majority of consultations at the hospital had a history of unexplained fever. Thus, samples from the two suspected cases were collected and sent to the National Institute of Research in Public Health (INRSP). On 5 May 2020 the 2 cases were confirmed by RT-PCR positive for Dengue virus with DENV-1 serotype. The cases were discharged from hospital and declared cured after symptomatic treatment. A rapid investigation was carried out at city level and a further 5 additional cases (4 women and 1 man) distributed in 4 districts of Atar (Atar, Tineri, Aghnemrite and Edebaye) were detected. Mauritania Rift Valley Fever Grade 1 9-Oct-20 4-Sep-20 28-Sep-20 36 36 13 36.1% The Ministry of Health notified the WHO of 8 cases, including 7 deaths, of Rift Valley Fever (RVF) (PCR positive) in breeders, which occurred between13 September 2020 and 1 October 2020, in several localities in the departments of Tidjikja and Moudjéria (Tagant region), Guerou department (Assaba region) and Chinguetty department (Adrar region). The 7 deaths occurred in the Tagant region (5) and in the Assaba region (2). All these deaths occurred among hospitalized cases with fever and haemorrhagic syndrome (petechiae, gingivorrhagia) and vomiting, in the 3 departments of the region. As of 5 October 2020, a total of 88 samples of suspected cases have been sent to the National Institute for Public Health Research (INRSP): 36 were positive (by PCR and Elisa), 46 were negative. Six sample result are still pending. Confirmed cases have been reported in 9 regions (Adrar, Assaba, Brakna, Hodh Elchargui, Hodh El Gharby, Tagant, Trarza, Gorgol et Noukchott Sud). The continuous surveillance of RVF at the animal level has confirmed the outbreaks in the Assaba, Tagant, Brakna, Trarza and Hodh Elgharbi regions. The results of 165 samples taken in the period from September 16 to 23, 2020, show that 33 camelids, 4 small ruminants and 6 cattle were positive. Mauritius COVID-19 Grade 3 18-Mar-20 18-Mar-20 6-Jan-21 539 539 10 1.9% The Republic of Mauritius announced the first three positive cases of COVID-19 on 18 March 2020. As of 6 January 2021, a total of 539 confirmed COVID-19 cases including 10 deaths and 514 recovered cases have been reported in the country. Mozambique Humanitarian crisis in Cabo Delgado Grade 2 1-Jan-20 1-Jan-20 30-Nov-20 - - - - Cabo Delgado Province passed one year and six months since it was hit by Tropical Cyclone Kenneth in April 2019 followed by deteriorating humanitarian situation due to consecutive climatic shocks, insecurity and violence, leading to significant displacement, disruption of livelihoods and poor access to basic services, as well as the occurrence of different disease outbreaks. The security situation continues to deteriorate due to frequent insurgency attacks. The province has been hit by a wave of violence since October 2017, which has escalated significantly since January 2020. Frequent attacks are happening in 8 districts (Quissanga, Mocimab, D parai, Muidembao, Nagadi, Melucu, Manocmia and Ibo) situated in the north part of the capital of the province resulting in destruction of government offices, and service providing facilities including health facilities. Of the total health facilities in the province 41 (32%) have been closed down due to vandalism or other reasons. Mozambique Cholera Ungraded 20-Feb-20 31-Jan-20 21-Oct-20 1 698 38 27 1.6% A cholera outbreak is ongoing in Mozambique. From 11 January till 21 October 2020, a total of 1 698 cases including 27 deaths (CFR 1.6 %) were reported in Cabo Delgado province. Five districts, namely Mocimboa de Praia, macomia, Ibo, Pemba city and Metuge are affected. Mozambique COVID-19 Grade 3 22-Mar-20 22-Mar-20 10-Jan-21 21 939 21 939 192 0.9% The first COVID-19 confirmed case was reported in Mozambique on 22 March 2020. As of 10 January 2021, a total of 21 939 confirmed COVID-19 cases were reported in the country including 192 deaths and 17 535 recoveries. Mozambique Measles Ungraded 25-Jun-20 1-Jan-20 22-Jul-20 862 140 0 0.0% There are measles outbreaks in six districts of Zambezia. The outbreak was declared in March 2020 at the Nauela Administrative Post, Alto Molócuè district. As of week 21, there were 862 suspected cases reported, 711 suspected cases tested, 140 IgM+ for measles, no epi-linked cases reported, and no deaths. So far there are 67 cases from Nampula, 18 from Cabo Delgado, 17 from Zambezia and 13 from Niassa provinces. 42% are <5 years old; 48% are aged 5-14 years. 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 Namibia COVID-19 Grade 3 14-Mar-20 14-Mar-20 9-Jan-21 28 259 28 259 254 0.0% Namibia recorded its first confirmed case of COVID-19 on 13 March 2020. As of 9 January 2021, Namibia has a cumulative total of 28 259 COVID-19 cases, with 254 deaths. A total of 24 292 recoveries have been reported. Namibia Hepatitis E Protracted 1 18-Dec-17 8-Sep-17 4-Oct-20 10 114 10 114 66 0.7% In weeks 39 and 40 (21 September - 04 October 2020), a total of 12 HEV cases were reported country-wide. Since the beginning of the outbreak in December 2017, a cumulative total of 10 114 cases (2 069 laboratory-confirmed, 4 530 epidemiologically linked, and 1 378 suspected cases) including 66 deaths (CFR 0.8%) have been reported countrywide. Khomas Region remains the most affected region, accounting for 5 078 (50%) of reported cases, followed by Erongo 1 880 (19%) since the outbreak began. Niger Humanitarian crisis Protracted 1 1-Feb-15 1-Feb-15 30-Sep-20 - - - - Cabo Delgado has suffered frequent insurgent attacks from Non-State Armed Group (NSAG) which started in October 2017. Since the beginning of 2020, the frequency and area of attack has increased. The attacks are happening mainly in 8 districts situated in the North and Center of the Province. It has resulted in destruction of government service providing facilities (offices) including health facilities. Violent fighting has been reported in the areas around Mueda and Muidumbe districts. Niger COVID-19 Grade 3 19-Mar-20 19-Mar-20 10-Jan-21 3 877 3 877 126 3.2% From 19 March 2020 to 10 January 2021, a total of 3 877 cases with 126 deaths have been reported across the country. A total of 2 386 recoveries have been reported from the country. Niger Measles Ungraded 10-May-19 1-Jan-20 31-May-20 2 079 241 4 0.2% From week 1 to 22 of 2020, Niger reported a total measles suspected case count of 2 079 of which there were 241 lab confirmed (IgM positive) and 4 deaths in 8 regions: Agadez (50 cases, 0 deaths), Diffa: (4 cases, 0 deaths), Dosso (27 cases, 0 deaths), Maradi (101 cases, 2 deaths), Niamey (23 cases, 0 deaths), Tahoua (62 cases, 1 death), Tillaberi (67 cases, 0 deaths) and Zinder (167 cases, 1 death). In 2019 a total of 10 207 suspected measles cases were reported from eight regions in the country. So far, 24 districts have been affected by outbreaks in 2020. Nigeria Humanitarian crisis Protracted 3 10-Oct-16 n/a 30-Nov-20 - - - - The humanitarian crisis in the North-eastern part of Nigeria persists, with continued population displacement from security compromised areas characterized by overcrowding in many camps in the region. Health Sector partners are supporting the government led COVID-19 response across the three states, including support through joint resource mobilization activities, overall coordination and monitoring of the response in the northeast. Nigeria COVID-19 Grade 3 27-Feb-20 27-Feb-20 10-Jan-21 100 087 100 087 1 358 1.4% As of 10 January 2021, Nigeria is reporting a total of 100 087 confirmed cases of COVID-19 including 1 358 deaths and 80 030 recoveries. Nigeria Lassa fever Ungraded 24-Mar-15 1-Jan-20 27-Dec-20 1 195 1 181 244 20.4% A total of six new confirmed cases were reported from four states (Ondo, Edo, Bauchi and Ebonyi) in week 52 (week ending 27 December 2020). From 1 January to 27 December 2020, a total of 1 195 cases (1 181 confirmed and 14 probable) with 244 deaths (CFR 20.4%) have been reported from 131 Local Government Areas across 27 states in Nigeria. Nigeria Measles Ungraded 25-Sep-17 1-Jan-20 28-Oct-20 420 14 3.3% The measles outbreak in Nigeria is ongoing with multiple rounds of supplemental immunization activities (SIAs) ongoing in Kigo and Niger states. Nigeria Poliomyelitis (cVDPV2) Grade 2 1-Jun-18 1-Jan-18 6-Jan-21 59 59 0 0.0% No new cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported in Sokoto. There are seven cVDPV2 cases reported in 2020 and 18 cVDPV2 cases reported in 2019 and 34 in 2018. Nigeria Yellow fever Ungraded 1-Nov-20 25-Dec-20 3 112 109 249 8.0% As of 25 December 2020, there has been a cumulative total of 3 112 suspected cases of yellow fever, of which 109 cases have been confirmed, from 488 LGA (63%) across all states and the Federal Capital Territory (FCT). Laboratory results in-country show 70 cases confirmed by PCR, with 148 presumptive positive, 13 inconclusive and 1 526 negative. Laboratory results for 148 samples sent to Institut Pasteur Dakar show 41 (27.7%) confirmed, 16 negative and 91 pending. Rwanda COVID-19 Grade 3 14-Mar-20 14-Mar-20 10-Jan-21 9 630 9 630 120 1.2% The Rwanda Ministry of Health announced the confirmation of the first COVD-19 case on 14 March 2020. As of 10 January 2021, a total of 9 630 cases with 120 deaths and 6 973 recovered cases have been reported in the country. Sao Tome and Principe COVID-19 Grade 3 6-Apr-20 6-Apr-20 10-Jan-21 1 066 1 066 17 1.6% On 6 April 2020, the Ministry of Health of Sao Tome and Principe reported the country’s first case of COVID-19. As of 10 January 2021, a total of 1 066 confirmed cases of COVID-19 have been reported, including 17 deaths. A total of 988 cases have been reported as recoveries. Senegal COVID-19 Grade 3 2-Mar-20 2-Mar-20 10-Jan-21 21 245 21 245 465 - Since 2 March 2020, a total of 21 245 confirmed cases of COVID-19 including 465 deaths have been reported from Senegal. A total of 18 218 cases have recovered. Senegal Dengue Ungraded 1-Sep-20 7-Sep-20 7-Sep-20 1 1 0 0.0% A 36-year-old male tested positive for dengue serotype 2 (IgM) on 14 August 2020 by IP Dakar. Onset of symptoms began 10 July 2020 including fever, headaches, and arthralgia. Initial case investigations from the 1 June 2020 onward had found 6 suspect cases who then tested negative for dengue. No other cases have been reported as of 21 September 2020. Response actions include vector control entomological investigation and ongoing case identification. 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 Senegal Rift Valley Fever Ungraded 23-Oct-20 23-Oct-20 15-Nov-20 3 3 0 0.0% The Institut Pasteur of Dakar through the directorate of diseases prevention notified the district of Matam of two confirmed cases of Rift Valley fever (IgM positive) on 23 October 2020. It is a 20-year-old, male, living in Bokidiawé. He consulted at the health post on 13 October 2020 for an infectious syndrome without history of travel with an axillary temperature of 39.6 degree Celsius. The onset of symptoms is one day before the consultation date. The second case, is a 24 young man, living in Bokidiawé. he consulted the health post on 2 October 2020 for an infectious syndrome without notion of travel with an axillary temperature of 38.2 degree Celsius. The onset of symptoms is three days before the date of consultation. An additional case of confirmed Rift Valley fever was notified later. Senegal Skin disease of unknown aetiology Ungraded 17-Nov-20 12-Nov-20 22-Nov-20 567 0.0% As of 22 November 2020 a total of 567 cases of dermatosis of unknown origin had been seen and treated, including 336 in Mbao, 120 in Rufisque, 104 in Diamniado, six in Dakar Centre (CS Gaspard Camara) and one in Dakar West (CS Phillippe Senghor). All but one case were treated as outpatients. The age of the cases ranged from 10 to 59 years, with an average age of 23. Most cases (94; 34.4%) were in the age group 10-20 years. All had been to sea and all responded well to treatment. Cases are characterized by impetigo-like lesions with peri-laryngeal and peri-oral localization, with some papular lesions localized to the hand and feet and rarely to the external genitals. The eyes are affected with conjunctival redness and inflammation. Systemic features are headache and fever. Examinations to date do not suggest an infectious cause, with skin biopsy results suggesting dermatitis caused by some caustic external agent. Further investigations are ongoing. Senegal West Nile fever Ungraded 23-Oct-20 23-Oct-20 15-Nov-20 6 6 0 0.0% The Institut Pasteur of Dakar through the directorate of diseases prevention notified to the district of Matam of one confirmed cases of West Nile fever (IgM positive) on 23 October 2020. It is a 32-year-old lady living in Bokidiawe. She consulted at the health post of Bokidiawe on 7 October 2020 for an infectious syndrome without history of travel with axillary temperature of 38.2 degree Celsius. The symptoms occurred 2 days before the consultation. Five additional cases were notified later in Tambacounda, Matam, Dakar et Ziguinchor regions. Senegal Yellow fever Ungraded 17-Dec-20 7 7 2 28.6% From 29 October to 17 December 2020, there have been 7 cases confirmed (IP Dakar) with yellow fever in three regions of Senegal bordering Mauritania and Mali: 4 in Kidira health district (Tambacounda Region), 1 in Thilogne health district (Matam Region), 1 in Saraya district and 1 in Kedougou district (the latter two are both from Kedougou Region). Two deaths have been notified. Seychelles COVID-19 Grade 3 14-Mar-20 14-Mar-20 10-Jan-21 525 525 1 0.2% Since the first COVID-19 confirmed cases were reported in Seychelles 14 March 2020, 525 cases have been confirmed in total, including 267 recoveries and 1 death reported. Sierra Leone COVID-19 Grade 3 31-Mar-20 27-Mar-20 10-Jan-21 2 834 2 834 77 2.7% On 31 March 2020, the President of Sierra Leone reported the first confirmed COVID-19 case in the country. As of 10 January 2021, a total of 2 834 confirmed COVID-19 cases were reported in the country including 77 deaths and 1 983 recovered cases. South Africa COVID-19 Grade 3 5-Mar-20 3-Mar-20 10-Jan-21 1 231 597 1 231 597 33 163 2.7% Detailed update given above. South Sudan Floods Grade 1 1-May-20 1-May-20 30-Nov-20 - Flooding continues to displace and isolate people across Jonglei State. Flooding along the River Nile and its tributaries continue to force communities in eleven counties of Jonglei State and the Greater Pibor Administrative Area (GPAA) to move to higher ground. At least 34 712 people affected by floods in Mundri West and Mundri East counties receive emergency assistance. On 26 October, FSL partners delivered 79 metric tons of emergency food assistance to 34 712 people affected by flooding. A total of 22 196 people in Mundri West County and 12 516 in Mundri East County were targeted. South Sudan Humanitarian crisis Protracted 3 15-Aug-16 n/a 30-Nov-20 - - - - The ongoing humanitarian response for over one million people affected by the flooding is considerably constrained by infrastructure damage, reduced physical accessibility, insecurity and limited resources. South Sudan COVID-19 Grade 3 5-Apr-20 2-Apr-20 9-Jan-21 3 649 3 649 63 1.7% On 5 April 2020, the Ministry of Health of South Sudan reported the country’s first case of COVID-19. As of 9 January 2021, a total of 3 649 confirmed COVID-19 cases were reported in the country including 63 deaths and 3 165 recovered cases. South Sudan Hepatitis E Ungraded - 3-Jan-19 22-Nov-20 412 41 5 1.2% The current outbreak in Bentiu UN Protection of Civilians (POC), which started at the beginning of 2019, has continued since the beginning of 2020 with 13 new cases reported in week 47 (week ending 22 November 2020). As of the reporting date, a total of 412 cases of hepatitis E including five deaths have been reported from South Sudan, in Bentiu POC. There is also a suspected outbreak of hepatitis E in Abyei region, with an increasing number of suspected cases reported on 16 November 2020. Further epidemilogical investigations about that outbreak are ongoing on the field. South Sudan Measles Ungraded 24-Nov-18 19-Sep-19 22-Jun-20 916 50 2 0.2% Between week 38 of 2019 to week 25 of 2020, a total of 916 suspected cases of measles of which 50 were laboratory-confirmed and 2 deaths (CFR 0.6%) have been reported. The outbreak has affected 6 counties (Tonj East, Magwi, Bor, Kapoeta East, Aweil East and Wau) and Bentiu Protection of Civilians Sites (POC). Tanzania, United Republic of COVID-19 Grade 3 16-Mar-20 16-Mar-20 20-Dec-20 509 509 21 4.1% 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 The Ministry of Health, Community Health Community Development, Gender, Elderly and Children in Tanzania reported the country’s first case of COVID-19 on 16 March 2020. As of 29 November 2020, a total of 509 cases have been reported in the country including 21 deaths. The last information on confirmed COVID-19 cases was shared by Tanzania mainland on 29 April 2020 and Zanzibar last shared information on on-going COVID-19 outbreak on 7 May 2020. Togo Cholera Ungraded 17-Nov-20 11-Nov-20 3-Jan-21 67 18 2 3.0% Detailed update given above. Togo COVID-19 Grade 3 6-Mar-20 1-Mar-20 10-Jan-21 3 957 3 957 72 1.8% 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 10 January 2021, a total of 3 957 cases including 72 deaths and 3 614 recovered cases have been reported in the country Togo Poliomyelitis (cVDPV2) Grade 2 18-Oct-19 13-Sep-19 6-Jan-21 17 17 0 0.0% No new case of cVDPV2 was reported during the past week. There have been nine cases so far in 2020 while the total number of cVDPV2 cases reported in 2019 remains eight. Togo Yellow Fever Ungraded 4-Feb-20 3-Feb-20 24-Aug-20 3 1 1 33.3% On 28 April 2020, WHO received information regarding a confirmed yellow fever case in Mango village, Oti district, Savanes region in the northern part of Togo. The results were confirmed at the yellow fever reference laboratory, Institut Pasteur in Dakar, Senegal by seroneutralisation. The case is a 55-year-old female with no travel or vaccination history for yellow fever. On 3 February 2020, she presented to a health facility with symptoms of fever with aches. The following day she developed jaundice and a blood sample was taken and transported to the national laboratory as yellow fever was suspected. The case-patient died three days later while receiving treatment. On 17 March, the sample tested IgM positive for yellow fever. On 22 March 2020, an in-depth multi-disciplinary investigation was conducted, and no additional case was detected. Uganda Humanitarian crisis - refugee Ungraded 20-Jul-17 n/a 30-Sep-20 - - - - Between 1 and 30 September 2020, a total of 2 786 new refugee arrivals crossed into Uganda from the Democratic Republic of the Congo. Uganda hosted 1 431 477 asylum seekers as of 30 September 2020, with 94% living in settlements in 11 of Uganda’s 128 districts and in Kampala. Most are women within the age group 18 - 59 years. Uganda Cholera Ungraded 11-May-20 29-Apr-20 7-Sep-20 1 488 17 6 0.4% As of 7 September 2020, we have 1 488 cases, 483 in Moroto , 543 in Nabilatuk, 72 in Napak, 390 in Kotido. On 11 May 2020, a cholera outbreak was confirmed in Moroto district. The index case was a 17-year-old male patient from Natapar Kocuc Village, Loputuk parish, Nadunget Subcounty who was seen on 29 April 2020 with acute watery diarrhoea and severe dehydration. On 4 May 2020 more cases with similar symptoms from the same location with the index case were seen and cholera was suspected. On 11 May 2020, CPHL confirming Vibrio cholerae serotype 01 Inaba detected in 7 out of 8 stool samples that were collected. As of 12 June 2020, the cumulative number of cases is 682 including 6 deaths. Uganda COVID-19 Grade 3 21-Mar-20 21-Mar-20 9-Jan-21 37 742 37 742 301 0.8% The first COVID-19 confirmed case was reported in Uganda on 21 March 2020. As of 9 January 2021, a total of 37 742 confirmed COVID-19 cases, 12 852 recoveries with 301 deaths. Zambia COVID-19 Grade 3 18-Mar-20 18-Mar-20 10-Jan-21 27 728 27 728 469 1.7% The first COVID-19 confirmed case was reported in Zambia on 18 March 2020. As of 10 January 2021, a total of 27 728 confirmed COVID-19 cases were reported in the country including 469 deaths and 20 598 recovered cases. Zambia Poliomyelitis (cVDPV2) Grade 2 17-Oct-19 16-Jul-19 6-Jan-21 2 2 0 0.0% No new case of circulating vaccine-derived poliovirus type 2 (cVDPV2) has been reported since the beginning of 2020. There were two cVDPV2 cases reported in 2019. Zimbabwe Anthrax Ungraded 6-May-19 6-May-19 1-Nov-20 464 1 0.2% The anthrax outbreak is ongoing in Zimbabwe. This outbreak started in week 36, 2019, affecting mainly Buhera and Gokwe North and South districts but a surge in cases started appearing in week 38 when cases were reported in some other areas. Thirteen new anthrax cases and no deaths were reported in week 44 (week ending on 1 November 2020). The reported cases were from Gokwe North District (2), Gokwe South District (9) in Midlands Province, Bikita District (1) in Masvingo Province and Hurungwe District (1) in Mashonaland West Province. The cumulative figures for anthrax are 464 cases and 1 death. Zimbabwe COVID-19 Grade 3 20-Mar-20 20-Mar-20 10-Jan-21 21 477 21 477 507 2.4% The first COVID-19 confirmed case was reported in Zimbabwe on 20 March 2020. As of 10 January 2021, a total of 21 477 confirmed COVID-19 cases were reported in the country including 507 deaths and 12 582 cases that recovered. †Grading is an internal WHO process, based on the Emergency Response Framework. For further information, please see the Emergency Response Framework: http://www.who.int/hac/about/erf/en/. Data are taken from the most recently available situation reports sent to WHO AFRO. Numbers are subject to change as the situations are dynamic. Health Emergency Information and Risk Assessment Health Emergency Information and Risk Assessment 15 © WHO Regional Office for Africa This is not an official publication of the World Health Organization. Correspondence on this publication may be directed to: Dr Benido Impouma Programme Area Manager, Health Information & Risk Assessment WHO Emergency Preparedness and Response WHO Regional Office for Africa P O Box. 06 Cité du Djoué, Brazzaville, Congo Email: afrooutbreak@who.int Requests for permission to reproduce or translate this publication – whether for sale or for non- commercial distribution – should be sent to the same address. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate borderlines for which there may not yet be full agreement. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization or its Regional Office for Africa be liable for damages arising from its use. 2Health Emergency Information and Risk Assessment REGIONAL OFFICE FOR Africa Editorial Team B. Impouma C. Okot B. Farham G. Williams J. Kimenyi E. Kibangou O. Ogundiran T. Lee D. Niyukuri T. Metcalf J. Nguna Production Team A. Bukhari T. Mlanda R. Ngom F. Moussana Contributors R. Nansseu (Democratic Republic of the Congo) Graphic design A. Moussongo Editorial Advisory Group Z. Yoti, Regional Emergency Director ai B. Impouma Y. Ali Ahmed N. Nsenga M. Djingarey Data sources Data and information is provided by Member States through WHO Country Offices via regular situation reports, teleconferences and email exchanges. Situations are evolving and dynamic therefore numbers stated are subject to change.