WHO AFRO Outbreaks and Other Emergencies, Week 19: 6 - 12 May 2017 (Data as reported by 17:00, 12 May 2017)
This weekly bulletin focuses on selected public health emergencies occurring in the WHO African region. WHO AFRO is currently monitoring 47 events: three Grade 3, six Grade 2, two Grade 1, and 36 ungraded events.
This week, three new events have been reported: outbreaks of Ebola virus disease in the Democratic Republic of Congo, dengue fever in Côte d’Ivoire and Crimean-Congo haemorrhagic fever in Senegal (imported from Mauritania). The bulletin also focuses on key ongoing events in the region, including the grade 3 humanitarian crises in Nigeria and South Sudan, the grade 2 humanitarian crisis in the Central African Republic and meningitis outbreak in Nigeria as well as the undiagnosed illness in Liberia.
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 public health events currently being monitored in the region.
Major challenges to be addressed include:
The unprecedented occurrence of acute public health events in the African Region, calling for full implementation of the IHR and the regional strategy on health security and emergencies in the African Region.
There are subtle public health emergencies in the region that require comprehensive response and actions including advocacy and multi-sector engagement
Ebola Virus Disease Democratic Republic of Congo
On 11 May 2017, the Ministry of Health of the Democratic Republic of Congo (DRC) notified WHO of an outbreak of Ebola virus dis- ease (EVD) in Likati health zone in Bas Uele province located in the north-eastern part of the country. The index case, a 39-year-old male, presented to the local health facility on 22 April 2017 with acute on- set fever, asthenia, vomiting, bloody diarrhoea, haematuria, epistaxis, and extreme fatigue. He was immediately referred to Likati health district facility but he died in transit. On 24 April 2017, a motorcycle rider (who transported the index case) and another person who supported the index case during transportation developed acute febrile illness. The motor cycle rider subsequently died on 26 April 2017.
Preliminary outbreak investigation carried out by the health team obtained 5 blood samples that were shipped to the Institut National de Recherché Biomédicale (INRB) in Kinshasa. Laboratory results re- leased on 11 May 2017 indicated that one of the five samples tested positive for Ebola virus Zaire subtype by polymerase chain reaction (PCR) assay.
As of 13 May 2017, a total of 11 suspected cases including 3 deaths (case fatality rate of 27.3%) have been reported. Detailed epidemiological investigation and risk assessment are being conducted and the findings will be communicated accordingly.
Public health actions
• The Ministry of Health convened an emergency meeting on 11 May 2017 involving various sectors of government and partners including CDC, MSF, WHO, etc. The meeting aimed to design response strategies, mobilize immediate resources needed and mount an effective response to the EVD outbreak.
• The Minister of Health, accompanied by the WHO Representative, held a press conference on 12 May 2017, intended to alert the general public to take necessary preventive measures while allaying anxiety and fear.
Preliminary outbreak investigation is being conducted by the national, provincial and health district teams, with support from WHO and other partners.
• The Provincial Government has mobilized initial funds to facilitate immediate operational activities in the field.
• WHO held a three-level teleconference on 12 May 2017 to review the situation, conduct risk assessment and guide the overall response to the outbreak. The potential risk of this outbreak was ranked as high at national and regional level.
• On 12 May 2017, WHO released a press statement to inform the global community on the EVD outbreak in DRC.
• The Regional Director of WHO AFRO is set to meet the national authorities on 13 May 2017 to reiterate the availability of WHO to closely work with the Ministry of Health and other sectors to rapidly contain the outbreak and avoid unnecessary interference with travel and trade. She will also be meeting with in-country partners to enhance partnership and coordination of response to this highly dangerous pathogen.
• WHO is deploying a surge team following the request from the government.
An outbreak of Ebola virus disease has been confirmed in the DRC, coming days after rumours of unexplained clusters of illness and deaths. The affected locality, situated in the north-eastern part of the country, is remote and isolated with limited transport and communication net- works including telephone connectivity. The locality is 350 km from Kisangani and cannot be access by car (has only 20 km of road). The public health infrastructure and health care system in the affected area is weak.
These circumstances, in addition to other factors, impeded the timely transmission of the information on this suspected outbreak. The delay to detect and con rm this outbreak may mean that the disease could have spread in the local communities. This therefore calls for a swift, extensive and rapid response in order to curtail further propagation and mitigate any impact and consequences.
The Ministry of Health has rapidly solicited for support from partners (in particular WHO), a call that we must respond to. Based on the lessons learnt from the West African EVD outbreaks, WHO calls for strong multi-sector collaboration and the support of global stakeholders to quickly bring this outbreak to an end. WHO is ready to provide the leadership and technical expertise required to mount a coordinated and effective response to the outbreak.