1. Epidemiological Update on Public Health Emergencies WHO Country Office, Liberia 27 October 2017

2. Content Public Health Emergencies 1 2 3 4 5 5
Marburg Virus Disease : Uganda 2
Dengue: Burkina Faso 3
Monkey Pox: Nigeria 4
Pneumonic Plague: Madagascar 5
Cholera: AFR Region 5
Other Events Under Follow-up
Public Health Emergencies

3. Public Health Emergencies (AFRO)
12 Humanitarian Crises
33 Outbreaks 2
Grade 3 events 10
Grade 1 events 7
Grade 2 events 23
Ungraded events
Source: WHO Health Emergencies AFRO week 42 bulletin on outbreaks and public health emergencies

4. Marburg Virus Disease : Uganda
17 October 2017: Uganda’s Ministry of Public Health notified WHO of an outbreak of Marburg virus disease in Kween District, central part of the country
Index case: death of a 50-year-old woman who became ill on 3 October 2017 and was initially admitted to a local health facility (Kaproron Health Centre IV) on 5 October 2017 with fever and bleeding diathesis. She died on 11 October and was buried on 13 October 2017 under local cultural customs.
(RT-PCR positive for Marburg Virus at the Uganda Virus Research Institute (UVRI) in Entebbe on 17 October 2017.
Chronologically, the first case (probable) : 30 year-old male, who worked as a game hunter and lived near a cave with heavy presence of bats.
On 20 September 2017, he was admitted to Kaproron Health Centre IV with high fever, vomiting and diarrhoea, which did not respond to antimalarial.
Geographical distribution of cases of Marburg virus disease cases in Uganda, October 2017
Further investigations established that the index case had nursed and participated in the burial rituals of her brother, who is considered the primary (first) case in this outbreak.
Source: WHO AFRO Situation Report No. 1: Marburg Virus Disease in Uganda

5. Marburg Virus Disease : Uganda
As his condition deteriorated and was transferred to Kapchorwa Hospital on 25 September where he died with no laboratory specimens collected. He was given a traditional burial on 27 September 2017, which was attended by an estimated 200 people.
The third (probable) case is the brother of the first two cases, who transported his sister (the index case) to the hospital and subsequently became symptomatic.
On 19 October 2017, health authority in Kapchorwa Hospital detected a fourth suspected case in a 2-year-old child admitted with similar symptoms.
As of 19 October 2017, four (4) suspected cases including two (2) deaths (CFR – 50%) of Marburg virus disease:
one confirmed,
two probable and one suspect
To date, 41 contacts have been identified and are being followed up.
Public Health Response
National Task Force has been reactivated and (IMS) established
The District Task Force established and an emergency response plan is being developed.
A rapid response team deployed to Kween and Kapchorwa Districts
The Minister of Health held a press conference to inform the public of the outbreak,
alley anxiety and disseminate preventive messages.
Active surveillance has been initiated
Training of Healthcare workers on (IPC protocols, safe and dignified burial, Case mgt)
Source: WHO AFRO Situation Report No. 1: Marburg Virus Disease Outbreak in Uganda

6. Geographical distribution of cases of monkey pox cases in Nigeria,
Monkey Pox: Nigeria
On 26 September 2017: Nigeria Centre for Disease Control (NCDC) notified WHO of a suspected outbreak of monkey pox in Yenagoa Local Government Area (LGA), Bayelsa State.
The initial cluster of cases: two brothers, and their uncle including a neighbor developed fever and generalized skin rash over a period of 6 weeks.
Their illnesses were self-limiting apart from one case, an 11-year-old male, who additionally developed painful swelling of the jaw and presented to a local private hospital.
A differential diagnosis of chickenpox or impetigo was made before the child was transferred to Niger Delta University Teaching Hospital.
Suspicion of monkey pox prompted the collection of laboratory specimens, as well as field investigations which established that there was a captured monkey in the neighborhood, that young boys regularly played with, before it was killed and eaten about a month prior to onset of illness.
Geographical distribution of cases of monkey pox cases in Nigeria,
26 September - 19 October 2017
Source: WHO AFRO Situation Report No. 6: Monkey Pox in Nigeria

7. Monkey Pox: Nigeria
On 19 October 2017, a total of 22 suspected cases were reported
from Bayelsa State, with seven cases admitted.
Cumulatively, 86 cases have been reported from 10 states:
Akwa Ibom, Cross River, Delta, Ekiti, Enugu,
Federal Capital Territory, Imo, Lagos,
Nasarawa, and Rivers.
The majority of cases are male (77%) and aged years.
however, a recovering patient has reportedly committed suicide – issues surrounding the death are being investigated.
Samples collected from 83 cases of the 86
3 (3.6%) have been confirmed by either RT - PCR
All three confirmed samples were from Yenagoa LGA, Bayelsa State.
Public Health Response
Multi-sectoral national response coordination committee established under the leadership of the Nigerian Centres for Disease Control (NCDC) and the Federal Ministry of Health
Rapid response teams deployed
Case investigations are ongoing to identify the primary source(s) of infection.
Active case search at the community and health facility levels in the affected areas.
Training of healthcare workers - diagnosis, contact tracing and clinical management
Risk communication activities are ongoing
SITUATION INTERPRETATION Monkeypox is a relatively rare zoonosis that occurs sporadically in remote parts of Central and West Africa, often near tropical rainforests. While most cases are self-limiting within days, severe disease is more common among children and may be fatal. Confrmation of this outbreak has, however, been challenged by long delays in the collection, referral and testing of samples. Nonetheless, now that the circulation of monkeypox virus has been confrmed (at least in Bayelsa State), there is greater impetus for local authorities and international partners to investigate and control this event. Equally concerning is the observation of exaggerated and incorrect public perception about the cause, risk and severity of disease; reports of stigmatisation of cases which hinders sample collection and other patient-centred response activities; and the unethical use of patient’s photographs on social media, leading to further stigmatization and concealment. Community engagement activities must be strengthened to counter these perceptions. Geographical distribution of monkeypox cases in Nigeria, 26 September - 19 October Cases 0 0% Deaths CFR Go to overview Go to map of the outbreaks Health Emergency Information and Risk Assessment 0
Source: WHO AFRO Situation Report No. 6: Monkey Pox in Nigeria

8. Dengue: Burkina Faso
Geographical distribution of Dengue cases in Burkina Faso as of 17 October 2017
The outbreak of dengue fever in Burkina Faso is rapidly evolving, with a dramatic increase in weekly incidence
Week 42: 1,130 new suspected cases and no deaths were reported across the country
Cumulatively, 4,098 suspect cases, including 11 deaths (CFR - 0.3%) have been reported.
Epidemic declare on 28/09/2017
92% (12) of the country’s 13 health regions, with 65.4% of cases reported in the central region, particularly in the city of Ouagadougou.
To date, 205 samples have been sent.
110 (54%) positive for dengue on RT - PCR
Further characterization of 72 samples has identified three dengue virus serotypes: DENV-2 (58 positive), DENV-3 (12 positive) and DENV-1 (2 positive).
Public Health Response
Weekly change in the attack rate of suspected and probable cases of dengue in the city of Ouagadougou from Week 1 to Week 42, 2017

9. Pneumonic Plague: Madagascar
13 September 2017: Madagascar Ministry of Public Health notified WHO of an outbreak of pneumonic plague
death of a 47-year-old woman with respiratory disease in Soavinandriana Hospital, Antananarivo on 11 September 2017
RDT positive for plague at the Institut Pasteur de Madagascar triggered investigation
Index case: 31-year-old male from Tamatave, developed a malaria-like illness on 23 August 2017
Travelled by public transport on 27 August 2017 while symptomatic, and died on the way
Generated contacts who became secondary cases and onward transmission
Cumulative: 1,365 cases (suspected, probable and confirmed) with 106 deaths (CFR 7.8%); while 54 health workers have been affected
reported from 40 districts in 14 regions.
pneumonic plague: 915 cases (67%)
Bubonic plague: 275 (20.1%)
Septicaemic plague: One case
Unspecified: 174 cases
Geographical distribution of cases of plague in Madagascar as of 19 October 2017
Plague is endemic in Madagascar, especially in the central highlands, where a seasonal upsurge (predominantly the bubonic form) occurs each year, usually between August and September. There are three forms of plague infection, depending on the route of infection: bubonic, septicaemic and pneumonic
Source: WHO AFRO Situation Report No. 6: Pneumonic Plague Outbreak in Madagascar

10. Pneumonic Plague: Madagascar
On 27 October 2017, 70% (3467) of contacts were followed up and provided with prophylactic antibiotics.
141 contacts completed the 7-day follow up without developing symptoms.
A total of seven contacts developed symptoms and became suspected cases.
Of the 1365 cases,
Confirmed: 219 (PCR or RDT),
Probable: 520 and remain suspected: 626 (additional laboratory results are in process).
Eleven strains of Yersinia pestis have been isolated and were sensitive to antibiotics
Public Health Response
Multi-sectoral national response coordination committee established under the leadership of the Minister of Public Health
Rapid response teams deployed
Case investigations including the identification of potential exposures are being conducted.
Active case search at the community and health facility levels in the affected areas.
Training of healthcare workers - diagnosis, contact tracing and clinical management
Risk Assessment
National Level: High
Regional Level: Moderate due to frequent flights to neighboring Indian Ocean islands
WHO has classified the event as a Grade 2 emergency, based on its internal Emergency Response Framework.
About 70% (3467) of 4990 contacts identified have completed their 7-day follow-up and a course of prophylactic antibiotics. A total of seven contacts developed symptoms and became suspected cases. On 24 October 2017, 1165 out of 1239 (94%) contacts were followed up and provided with prophylactic antibiotics.
Source: WHO AFRO Situation Report No. 1: Pneumonic Plague Outbreak in Madagascar

11. Cholera – AFRO Region
Democratic Republic of Congo (2017): 38,154 cases with 702 deaths (CFR: 1.8%)
Tanzania (15 Aug 2015 – 16 Jul 2017): 30,719 cases with 483 deaths (CFR:1.6%)
South Sudan (20 Feb – 17 Jul 2017): 21,097 cases with 418 deaths (CFR: 2%)
Nigeria (7 – 30 June 2017): 7,052 cases with 149 deaths (CFR: 2.1%)
Kenya (2017): 3,244 cases with 60 deaths (CFR:1.8%)
Angola (4 Jan – 6 August 2017): 468 cases with 24 deaths (CFR: 5.3%)
Chad: 492 cases with 63 deaths (12.8%)
Geographical distribution of cholera cases in Tanzania,
week 32, 2017

12. Other Events Under Follow-up
AWD in Ethiopia:
47,340 cases with 859 deaths (CFR- 1.8%) 521 new cases reported in wk 41
Hepatitis E in Chad:
1,783 suspected/confirmed cases with 19 deaths (CFR-1.1%)
Hepatitis E in Niger:
1,610 suspected/confirmed cases with 38 deaths (CFR-2.4%)
Measles in Ethiopia:
3151 suspected cases: 382 new cases reported in wk 42
Dengue in Ivory Coast:
16 new cases in week 36 from Abidjan
1231 suspected cases with 2 deaths (CFR-0.2%)
Abidjan city remains the epicentre of this outbreak, accounting for 97% of the total reported cases. The main health districts affected include Cocody, Abobo, Bingerville and Yopougon. Of the cases confirmed, 181 were dengue virus serotype 2 (DENV-2), 78 were DENV-3 and 13 were DENV-1. In addition, 39 samples were confirmed IgM positive by serology.

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