1. Epidemiological Update on Public Health Emergencies WHO Country Office, Liberia 28 July 2017

2. Content Public Health Emergencies 1 2 3 4 5 6
Dengue Fever: Ivory Coast 2
Crimean-Congo Hemorrhage Fever: Senegal 3
Aflatoxicosis – Tanzania 4
Hepatitis E: Nigeria
Cholera: AFRO Region 5
Other Events Under Follow-up 6
Public Health Emergencies

3. Public Health Emergencies (AFRO)
11 Humanitarian Crises
31 Outbreaks 3
Grade 3 events 7
Grade 1 events 6
Grade 2 events 26
Ungraded events
Source: WHO Health Emergencies AFRO week 29 bulletin on outbreaks and public health emergencies

4. Dengue: Ivory Coast 4 – 11 July: 142 new suspected cases
As of 11 July: 623 suspected cases with 2 deaths
136 cases confirmed
Type 2 dengue positive: 127
Type 3 dengue positive: 55
Type 1 dengue Positive: 10
Ninety (90) samples are IgM + of which 68 cross-reactions yellow fever
Public Health Measures
End of the mosquito control campaign in Cocody and Bingerville
Destruction of breeding sites
70,608 farms were treated and 4,126 tires disposed of.
Control of adult mosquitoes by thermal fogging
continuation of campaign in the municipality of Marcory
Geographical distribution of confirmed cases of dengue per commune, Ivory Coast, Week 17 – 28, 2017
Evolution of suspect and positive cases of dengue epidemic, Ivory Coast, Week 17-28, 2017
The weather conditions and coastal location including urban and semi-urban settings, as well as the high entomological indices observed during the initial rapid assessment validated the potential risk for dengue outbreak in the country. The low case fatality rate shows adequate case management but strengthening education of health care workers, vector control, laboratory and surveillance interventions is imperative to contain this outbreak

5. Crimean-Congo hemorrhagic fever: Senegal
A single case, 10-year old young shepherd, detected in Fatick District, Kamsaté, Senegal
29 June 2017: developed fever, headache, arthralgia, muscle pain and vomiting
13 July 2017: The Institute Pasteur Dakar confirms diagnosis
Possible source: two cows purchased from a city market <3mths prior to event.
High prevalence of ticks observed within the implicated herd
21 contacts of the case and of the implicated animals were identified
None have shown any sign of illness at day 17 of follow-up
Public Health Measures
Multi-sectoral investigation
Active case search; case management
Geographical distribution of Crimean-Congo hemorrhagic fever cases, Senegal, 29 June - 15 July 2017
This is the fourth case of CCHF reported by the Senegal Ministry of Health in 2017 to date, but the first locally-acquired infection. Three unrelated cases were previously documented in persons seeking healthcare from Nouakchott in Mauritania. Previous seroprevalence studies have highlighted that CCHF is focally endemic throughout Senegal and neighbouring countries. But this is highly variable in time and space, with the virus not known to circulate in the Fatick District, where this case occurred. Epidemics are typically correlated to the relative abundance of Hyalomma ticks; the reservoir and vector for the CCHF virus. Sporadic human infections may be expected in people with regular contact with livestock in endemic areas, but these are preventable through use of repellents, protective clothing and gloves to prevent tick bites, and avoiding contact with blood and body fluids of livestock.

6. Aflatoxicosis: Tanzania
Between 15 June and 13 July 2017, two unrelated clusters involving 8 cases with 4 deaths in Kiteto District, northern Tanzania.
1st cluster: 5 children aged between 3-9 years with 3 deaths
Affected children consumed maize that was harvested and left in the field for some time.
2nd cluster: 3 cases with 1 death
children reportedly consumed maize stored improperly
Public Health Measures
Multi-sectoral emergency response team convened
food and blood samples collected for further analysis
collecting a detailed food consumption history
Geographical distribution of Aflatoxicosis cases in Tanzania, 15 June - 19 July 2017
Aflatoxin is a fungal toxin that commonly grows on maize and other types of grains. People are often exposed through home-grown foods, when inadequate harvesting and storage techniques allow for the growth of aflatoxin-producing fungi. Children are particularly susceptible, and at lower doses or over a long duration, the toxin can lead to chronic disease and conditions such as stunted growth, delayed development, liver damage, and liver cancer. Acute, high-level exposure can result in aflatoxicosis, which manifests as severe acute hepatic failure with vomiting, abdominal pain and jaundice, often associated with high fatality rates.

7. Hepatitis E: Nigeria
As of 15 July 2017 Borno State: 426 suspected cases with 4 deaths (CFR: 1.3%); 42 positives
Ngala: 43 pregnant women with four deaths (CFR = 9.3%).
164 samples collected and 66 have been analysed
42 (64%) tested positive
Public Health Measures
Prepositioned medicines and supplies in high-risk LGAs and health facilities
Trucking of safe drinking water, disinfection and chlorination of water points are ongoing in refugee camps and villages
implementing risk communication activities  
Geographical distribution of hepatitis E cases in Nigeria, 18 June - 15 July 2017

8. Cholera – AFRO Region Burundi: 6 cases with zero deaths
Tanzania (15 Aug 2015 – 16 Jul 2017): 25,542 cases with 401 deaths (CFR:1.6%)
Kenya (2017): 1,216 cases with 14 deaths (CFR:1.2%)
Democratic Republic of Congo (2015 – 2 July 2017): 44,415 cases with 1,244 deaths (CFR: 2.8%)
Angola (4 Jan – 28 June 2017): 455 cases with 24 deaths (CFR: 5.3%)
South Sudan (20 Feb – 17 Jul 2017): 17,617 cases with 320 deaths (CFR: 1.8%)
Nigeria (7 – 30 June 2017): 1,558 cases with 11 deaths (CFR: 0.7%)
Geographical distribution of cholera cases in Kenya,
July 2017
Geographical distribution of cholera cases in Tanzania, 15 August July 2017

9. Other Events Under Follow-up
AWD in Ethiopia:
39,046 cases with 801 deaths (CFR- 2.1%)
Necrotising cellulitis/fasciitis in Sao Tome
1,802 cases with zero deaths
Meningitis in Niger:
3,292 cases with 189 deaths (CFR 5.7%)
Hepatitis E in Chad:
1,658 suspected/confirmed cases with 18 deaths (CFR-1.1%)
Hepatitis E in Niger:
1,096 suspected/confirmed cases with 34 deaths (CFR-3.1%
Measles in Ethiopia:
2,342 suspected cases

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