1. Epidemiological Update on Public Health Emergencies
WHO Country Office, Liberia 10 August 2018

2. Content Ebola Virus Disease: DRC Guinea Worm: South Sudan
Cholera: Niger
Hepatitis E: Namibia
Other Events Under Follow - up

3. Public Health Emergencies (AFR)
10 Humanitarian Crises
47 Outbreaks 2
Grade 3 events 4
Grade 1 events 36
Ungraded events 3
Grade 2 events
Health
EMERGENCIES
Program

4. Ebola Virus Disease: DRC
On 1 August 2018: the MoH of DRC notified WHO of a new outbreak in North Kivu Province, in the eastern part of the country
hosts over 1 million displaced people.
shares borders with Rwanda and Uganda with cross border movement due to the trade activities
The announcement was issued little more than a week after the MoH declared the end of an outbreak in Equateur Province some 2500 km from North Kivu
Since 28 July 2018: a total of 43 suspected cases including 34 deaths (CFR -79%) reported
16 tested positive for EVD
27 probable
31 suspected
A total of two health workers have been affected with CFR of 50%
Geographical distribution of EVD cases, DRC, 28 July - 3 August 2018
Geographically, all the cases are currently localized to five health zones in North Kivu Province
Current Risk Assessment:
National Level : High
Regional Level: High
Global Level: Low
Ebola virus disease – Democratic Republic of the Congo
Disease outbreak news
9 August 2018
On 1 August 2018, the Ministry of Health of the Democratic Republic of the Congo declared a new outbreak of Ebola virus disease in North Kivu Province, in the eastern part of the country. North Kivu is among the most populated provinces in the country, shares borders with Uganda and Rwanda, and experiences conflict and insecurity, with over one million internally displaced people and migration of refugees to neighboring countries.
The Ministry of Health, WHO and partners are continuing to strengthen activities across all key response pillars. As of 7 August 2018, 44 Ebola virus disease cases (17 confirmed and 27 probable), including 36 deaths, have been reported in North Kivu and Ituri provinces. This includes sporadic, antecedent deaths in affected communities since May 2018, which were identified from clinical records and tentatively classified as probable cases pending further investigations. Two healthcare workers (one confirmed and one probable) have been affected, of which one has died. Confirmed or probable cases are localized to five health zones in North Kivu, and one neighboring health zone in Ituri Province. The majority of cases (13 confirmed, 21 probable) have been reported from Mabalako Health Zone (Figure 1). An additional 47 suspected cases are currently pending laboratory testing to confirm or exclude Ebola virus disease.
On 6 August 2018, the Institut National de Recherche Biomédicale (INRB) confirmed by genetic sequencing that this latest outbreak is caused by the Zaire ebolavirus species, and is not related to the recent outbreak in Équateur Province.
For more information, see:
Ebola situation reports: Democratic Republic of the Congo
Figure 1: Confirmed and probable Ebola virus disease cases by health zone in North Kivu and Ituri provinces, Democratic Republic of the Congo, 7 August 2018
Public health response
The Ministry of Health has initiated response mechanisms in North Kivu and Ituri provinces with support from WHO and partners. Priorities include the establishment and strengthening of surveillance, contact tracing, laboratory capacity, infection prevention and control (IPC), clinical management, vaccination, risk communication and community engagement, safe and dignified burials, response coordination, cross-border surveillance, and preparedness activities in neighbouring provinces and countries.
On 2 August 2018, the Minister of Health of the Democratic Republic of the Congo, the WHO Representative and representatives of several partner agencies visited Mabalako Health Zone (the epicentre of the outbreak) and Beni to assess and support the local response.
The Ministry of Health and WHO have deployed Rapid Response Teams to the affected health zones to initiate response activities. As of 7 August, WHO has deployed 30 technical and logistics specialists to support response activities. Global Outbreak Alert and Response Network (GOARN) partner institutions continue to support the WHO response to Ebola virus disease in the Democratic Republic of the Congo, as well as ongoing readiness and preparedness activities in non-affected provinces of the Democratic Republic of the Congo and in nine bordering countries.
On 8 August, the vaccination of frontline health care workers started, followed by the vaccination of community contacts and their contacts. There are currently 3220 doses of rVSV-ZEBOV Ebola vaccine available in Kinshasa. A clinical team with therapeutics arrived on 7 August.
Ebola treatment centres have been established in Mangina and Beni, with the support of international partners. The deployment of experienced clinicians to support partners in caring for patients is in process.
On 3 August 2018, two GeneXpert machines were set up in Beni to facilitate the timely diagnosis of suspected cases. The establishment of additional laboratory capacity elsewhere is being explored, including additional GeneXpert machines in Mangina, Goma and other areas as needed. The INRB is working to deploy additional diagnostic capacities in Mangina, including conventional polymerase chain reaction (PCR), serology, haematology and biochemistry.
The International Federation of Red Cross and Red Crescent Societies is supporting the Democratic Republic of the Congo Red Cross to establish systems to ensure safe and dignified burials throughout the affected zones. Currently, two teams are operating from Beni and are covering the affected areas.
The WHO Regional Emergency Director for Africa has informed neighbouring countries (Rwanda, Uganda, Burundi, and South Sudan) of the outbreak and emphasized the need for heightened surveillance and preparedness actions in the respective countries, particularly along the border with North Kivu.
Thirty-two key points of entry have been identified in which to strengthen capacity to rapidly detect and respond to potential new Ebola virus disease cases and to engage communities along border areas to improve knowledge of Ebola virus disease and its prevention.
Activities to sensitize communities to the outbreak began in affected communities through the Social Mobilization Commission, and in neighbouring Uganda and Rwanda. WHO and partners have held a series of briefings with community and neighbourhood leaders, teachers, religious leaders, journalists, and community groups to raise awareness about Ebola, including information on the current outbreak and preventive measures.
As of 8 August, three charter cargo planes from Mbandaka arrived in Beni with a total of 23 tonnes of supplies. A further charter is scheduled to depart Dubai with sets of viral haemorrhagic fever Personal Protective Equipment (PPE) and sets of standard PPE.
WHO risk assessment
This latest outbreak of Ebola virus disease is affecting north eastern provinces of the Democratic Republic of the Congo, which are in close proximity to Uganda. Potential risk factors for transmission of Ebola virus disease at national and regional levels include the transportation links between the affected areas, the rest of the country, and neighbouring countries; the internal displacement of populations; and displacement of Congolese refugees to neighbouring countries. The country is concurrently experiencing several epidemics and a long-term humanitarian crisis. Additionally, the security situation in North Kivu may hinder the implementation of response activities. Based on this context, the public health risk is considered high at the national and regional levels and low globally.
WHO advice
As investigations continue to establish the full extent of this outbreak, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities. WHO will continue to work with neighbouring countries and partners to ensure health authorities are alerted and are prepared to respond.
WHO advises against any restriction of travel and trade to the Democratic Republic of the Congo based on the currently available information. WHO continues to monitor travel and trade measures in relation to this event.
WHO recommendations for international travellers
Ebola virus disease fact sheet
2018 IHR Emergency Committee for Ebola virus diseas

5. Ebola Virus Disease: DRC
The majority of the cases are in the Mangina health area:
an active conflict zone.
The major barrier will be safely accessing the affected population
As of 5 August 2018, 966 contacts have been registered and follow up
A total of 28 key PoEs have been identified to strengthen surveillance capacity to rapidly detect and respond to potential new Ebola cases
There are 3,220 doses of vaccine available in Kinshasa and the MOH started vaccination of contacts and front-line workers on 8 August 2018
WHO recommends
Strengthening multi-sectoral coordination of the response,
Enhanced surveillance (active case finding, Case investigation, Contact tracing and surveillance at Points of Entry)
IHR travel measures and cross border health
WHO advises against any restriction of travel and trade to the DRC based on the currently available information
As investigations continue to establish the full extent of this outbreak, it is important for neighboring

6. Guinea Worm: South Sudan
On 23 July 2018, the South Sudan MoH declared the outbreak in Western Lakes State, located in the central part of the country
Between May and July 2018: 3 out of 25 worm specimens tested positive for Guinea Worm at US CDC Laboratory
The confirmed cases, two females and one male aged 14, 17 and 25 years, respectively, are all cattle keepers by occupation
Until this event, the last case of Guinea worm in South Sudan was confirmed in December 2016
Geographical distribution of GW disease cases South Sudan, 27 May - 23 Jul 2018
The Ministry of Health is working closely with partners including WHO, the Carter Center and UNICEF to respond to this Guinea worm outbreak.
The South Sudan Guinea Worm Eradication Program (SSGWEP) has deployed a rapid response team to identify and investigate contacts of the three confrmed
cases.
Countrywide surveillance for suspected Guinea worm cases is ongoing, with priority in the affected areas and the surrounding villages and counties.
Mapping of all the open water sources visited by the confrmed cases is being carried out to ensure Abate® (a larvicide) is applied to inactivate the cyclops.
Efforts to improve access to safe drinking water have commenced, including promoting the use of LifeStraw water pipes, water flters and water bottles, and
drilling of hand pumps in the long-term.
Sensitization of the public about the Guinea worm cash reward for reporting suspected Guinea worm cases has been intensifed in the affected areas and their
surroundings. In October 2017, South Sudan launched the cash reward campaign “It pays to report Guinea worm”. The goal of the campaign is to increase
nationwide awareness for reporting suspected Guinea worm cases
Detailed investigations are ongoing to ascertain the
source of disease, close contacts
and the open water sources visited by the cases after the worms emerged

7. Cholera: Niger
Geographical distribution of cholera cases in Niger, 5 July - 5 August 2018
On 13 July 2018, the Niger MoH notified WHO of a cholera outbreak in Madarounfa District, Maradi Region at the border with Nigeria
In epi-week 31 (ending 5 August 2018), 129 new suspected cases were reported compared to 322 including two deaths during week 30, 2018
Since 5 July 2018: a total of 739 suspected cases Including 11 deaths (CFR - 1.5%) have been reported.
54% of the suspected cases are between 2 and 14 years, while 46% are 15 years and above.
The outbreak has remained localized to Madarounfa District
The initial case-patients were found to have epidemiological links to Nigeria
PUBLIC HEALTH ACTIONS
Active surveillance has been strengthened
Management of cholera cases in different CTUs
WASH & IPC practices are have been initiated in affected communities

8. Hepatitis E: Namibia
The outbreak of hepatitis E in Namibia continues to evolve, with one new region being affected
In epi-week 31 (ending 5 August 2018), 520 new suspected cases with one death reported
As of 29 July 2018: a total of 2,435 suspected cases Including 20 deaths (CFR - 0.8%) have been reported
Of the 2, 435 cases, 250 have been laboratory confirmed by IgM ELISA.
Of the 20 deaths, 50% occurred in women during pregnancy or post-delivery
Four regions are currently experiencing the disease outbreaks
Geographical distribution of hepatitis E cases in Namibia, 27 May - 18 July 2018
PUBLIC HEALTH ACTIONS
Active case search ongoing in affected regions
Health education materials and case management posters have been distributed.
Repair of water taps and sanitation facilities is ongoing

9. Lassa Fever: Nigeria During week 31 (ending August 5, 2018)
Geographical distribution of confirmed Lassa fever cases in Nigeria as of 5 August, 2018
During week 31 (ending August 5, 2018)
nine new confirmed cases were reported with two new deaths
From January – 5 August 2018:
a total of 2,334 s suspected cases have been reported from 22 states
Of these: 481 were confirmed including 123 deaths (CFR – 25.6%),
10 are probable,
1844 negative
39 health care workers have been affected
Ten patients are currently being managed at treatment Centres
A total of 6,383 contacts have been identified
439(6.9%) are being followed up, 5846 (91.6%) have completed 21 days
88 symptomatic contacts of which 30 (34%) have tested positive
PUBLIC HEALTH ACTIONS
Lassa fever TWG continues to coordinate the response activities at all levels
Enhanced surveillance scaled up across the country
Harmonization of laboratory and surveillance data ongoing
In week 31 (week ending 5 August 2018), a total of 129 new suspected cholera cases (and no deaths) were reported in Madarounfa district, compared to 322 cases and four deaths reported
in week 30. Since the beginning of the outbreak on 5 July 2018, a total
of 739 suspected cholera cases, including 11 deaths (case fatality ratio
1.5%) have been reported. Fifty-four percent (389) of the suspected
cases are between 2 and 14 years, while 46% are 15 years and above.
Fifty-four percent of the cases are females.
The outbreak has remained localised to Madarounfa District. One
new health area, Safo, has reported a case during the reporting week,
bringing to nine the number of health areas that have reported at least
one cholera case since the beginning of the outbreak.
On 13 July 2018, the Niger Ministry of Public Health notifed WHO of a
cholera outbreak in Madarounfa District, Maradi Region at the border
with Nigeria. Three stool specimens had tested positive for Vibrio
cholerae O1 inaba by culture at the Centre for Medical and Health
Research (CERMES) in Niamey on 12 July The initial case-patients
were found to have epidemiological links to Nigeria. The outbreak was
formally declared on 15 July 2018.

10. Other Events Under follow -Up
Monkey Pox: CAR:
Cumulatively, since 2 March 2018:
29 cases of Monkeypox including one death (CFR -3.4%) have been reported 11 cases laboratory confirmed
RVF and CCHF: Uganda
As of 9 July 2018, 8 suspected cases of RVF,
4 laboratory confirmed including 2 deaths (CFR - 50%)
cVDPV2: DRC
A cumulative total of 29 confirmed cVDPV2 cases have been reported from six provinces, with no death
Dengue : Ethiopia
since 19 January, A total of 125 cases have been reported. The outbreak was due in Gode Zone of Somali Region
Measles : Mali:
Since week 1 of 2018, a total of 1,136 suspected cases with zero deaths have been reported
Of these, 265 have been confirmed (IgM-positive)
cVDPV2: Nigeria:
From 30 January through 23 May 2018: ten environmental samples collected from two collection sites tested positive for genetically-related VDPV2 viruses
Nipah virus: India:
As of 17 July 2018: a total of 19 Nipah virus (NiV) cases, including 17 deaths, were reported from Kerala State.
Cholera: Nigeria
As of 18 July 2018: a total of 16,892 suspected cases Including 201 deaths (CFR - 1.2%) have been reported from 17 states

11. THANK YOU