Health WHO Disease outbreak Updates!

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No new confirmed cases of Ebola virus disease (EVD) have been reported in Ituri, North Kivu and South Kivu Provinces of the Democratic Republic of the Congo since 27 April 2020 (Figure 1). While this is a positive development, there remains a risk of re-emergence of EVD. It is critical to maintain surveillance and response operations in the period leading up to the declaration of the end of the outbreak, as well as after the declaration – as outlined in the WHO recommended criteria for declaring the end of the EVD outbreak .

From 11 to 16 June 2020, an average of 2939 alerts were reported per day, of which 2788 (about 95%) were investigated within 24 hours. Of these, an average of 453 alerts were validated as suspected cases each day, requiring specialized care and laboratory testing to rule-out EVD. The number of reported and validated alerts has remained stable in recent weeks. Timely testing of suspected cases continues to be provided from eight laboratories. From 8 to 14 June 2020, 3219 samples were tested including 2513 blood samples from alive, suspected cases; 324 swabs from community deaths; and 382 samples from re-tested patients. Overall, the number of samples tested by the laboratories increased by 3% compared to the previous week.

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[Ninja]

On 25 June 2020, the Minister of Health of the Democratic Republic of the Congo declared the end of the Ebola Virus Disease (EVD) outbreak in North Kivu, Ituri and South Kivu Provinces . In accordance with WHO recommendations, the declaration was made more than 42 days after the last person who contracted EVD in this outbreak tested negative twice and was discharged from care.

The outbreak was declared on 1 August 2018 following investigations and laboratory confirmation of a cluster of EVD cases in North Kivu Province. Further investigations identified cases in Ituri and North Kivu Provinces with dates of symptom onset from May to August 2018. In 2019, the outbreak subsequently spread to South Kivu Province, and on 17 July 2019, the WHO Director-General declared the outbreak a Public Health Emergency of International Concern. In the Democratic Republic of the Congo, 11 outbreaks have been recorded since the first recognized outbreak in 1976. The 10th EVD outbreak in North Kivu, Ituri and South Kivu Provinces was the country's longest EVD outbreak and the second largest in the world after the 2014–2016 EVD outbreak in West Africa.

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Between 1 April and 31 May 2020, the National IHR Focal Point of Saudi Arabia reported nine new cases of MERS-CoV infection, including five deaths. The cases were reported from Riyadh (seven cases), Assir (one case) and Northern (one case) Regions. Most cases were and ages of the reported cases ranged from 40 to 96 years.

Of the cases reported in Riyadh six were from a hospital outbreak in the region between 21 and 31 May 2020: an index case who was a newly admitted patient, and five secondary cases identified through contact tracing. One of the secondary cases was a health care worker and the other four were in-patients admitted due to other health conditions. All four in-patients were bedridden and above 75 years of age. All reported cases had comorbidities with the exception of the healthcare worker.

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On 22 June 2020, the International Health Regualtions (IHR) Focal Point (FP) of Brazil shared a preliminary report with the Panamerican Health Organization, the WHO Regional Office for the Americas of a human infection with Influenza A(H1N2) variant virus (A(H1N2)v). According to the report, the patient, a 22-year-old female, with no comorbidities, worked in a swine slaughterhouse in Ibiporã Municipality, Paraná State, and developed an influenza-like illness on 12 April 2020. The patient initially sought medical care on 14 April and a respiratory specimen was obtained on 16 April as part of routine surveillance activities. The patient was treated with oseltamivir, was not hospitalized and has recovered.

A real-time RT-PCR test conducted at the public health laboratory identified a non-subtypable influenza A virus. In May 2020, the specimen was forwarded to the Laboratory of Respiratory Virus and Measles, Oswaldo Cruz Institute (FIOCRUZ per its acronym in Portuguese), a national influenza reference laboratory, in Rio de Janeiro. On 22 June, genetic sequencing characterized this virus as an influenza A(H1N2)v virus.

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[Ninja]

The health zone of Rethy in Ituri province, the Democratic Republic of the Congo, has seen an upsurge of plague cases since June 2020. The first case, a 12-year-old girl, reported to a local health centre on 12 June experiencing a headache, fever, cough, and an enlarged lymph node. She died on the same day and further deaths from the community due to suspected cases of plague were subsequently reported.

From 11 June though 15 July, six out of 22 health areas have been affected within Rethy health zone (11 villages), with a total of 45 cases including nine deaths (case fatality rate: 20%). All nine (9) cases who died presented with signs of headache, high fever, and painful nodes; four (4) out of the nine (9) cases had cough.

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On 23 July 2020, the France IHR National Focal Point reported a confirmed autochthonous (locally acquired) case of yellow fever in a 14-year-old male in French Guiana. On 17 July 2020, the case was laboratory confirmed at the French National Reference Centre for arboviruses, Institute Pasteur Cayenne.

The case-patient had severe disability, and developed dengue-like symptoms on 12 July. On 16 July, he was hospitalized in an intensive care unit in Cayenne, French Guiana, with consciousness disorders and acute liver failure, and died on 19 July.

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On 9 August 2020, the Federal Ministry of Health, Sudan notified WHO of the detection of a

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[Ninja]

Three months after the declaration of the eleventh Ebola virus disease (EVD) outbreak in Equateur Province, Democratic Republic of the Congo, the number of confirmed cases continues to increase, and the geographic spread of the outbreak continues to expand.

As of 1 September 2020, 110 cases (104 confirmed and six probable) including 47 deaths (case fatality ratio 43%) have been reported from 36 health areas in 11 health zones. In the past 21 days (12 August – 1 September 2020), 24 confirmed cases have been reported in 15 health areas across eight health zones. To date, three healthcare workers have been affected, making up 3% of all cases. In addition, 48 people have recovered from EVD to date.

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On 28 August 2020, the National IHR Focal Point of Chad notified WHO of an outbreak of chikungunya in Abéché, eastern Chad.

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From 1 January through 13 September 2020, a total of 4,594 suspected cases of monkeypox, including 171 deaths (case fatality ratio 3.7%), have been reported in 127 health zones from 17 out of 26 provinces in the Democratic Republic of the Congo. The first epidemic peak was observed at the beginning of March 2020 (epi week 10), with 136 cases reported weekly (Figure1). From 1 January through 7 August, the Institut National de Recherche Biomédicale (INRB) received 80 samples from suspected cases of monkeypox, of which 39 samples were confirmed positive by polymerase chain reaction. Four out of the 80 specimens were skin lesions (crusts/vesicles), the remaining samples were blood. There is no further information at this time regarding the outcome of these 80 patients whose samples were tested. Confirmatory testing remains ongoing.

During the same period in 2019, 3,794 suspected cases and 73 deaths (CFR 1.9%) were reported in 120 health zones from 16 provinces while a total of 2,850 suspected cases (CFR 2.1%) were reported in 2018.

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