DR Congo + 26 more

WHO AFRO Outbreaks and Other Emergencies, Week 31: 29 July – 4 August 2019 Data as reported by 17:00; 4 August 2019

Situation Report
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This Weekly Bulletin focuses on selected acute public health emergencies occurring in the WHO African Region. The WHO Health Emergencies Programme is currently monitoring 72 events in the region. This week’s edition covers key new and ongoing events, including:

Measles in Democratic Republic of the Congo Ebola virus disease in Democratic Republic of the Congo Humanitarian crisis in Northeast Nigeria Measles in Central African Republic 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 new and ongoing public health events currently being monitored in the region, as well as recent events that have largely been controlled and thus closed.

Major issues and challenges include:

The number of cases in the ongoing measles outbreak in Democratic Republic of the Congo is on an increasing trend with new health zones reaching epidemic phase. The sustained transmission among a large cohort of susceptible individuals can be attributed to years of suboptimal immunization coverage. The outbreak is occurring in the context of a protracted humanitarian crisis, characterized by high levels of malnutrition, multiple outbreaks of other epidemic-prone diseases, including the ongoing Ebola outbreak, mass displacement of populations in conflict-affected areas, and a weak health system. Concurrent outbreaks of measles and Ebola in North Kivu and Ituri are of concern and response efforts could prove challenging in a setting with insecurity and mistrust from communities. While reactive campaigns have been mounted in some areas, response efforts continue to be challenged by inadequate capacities for surveillance, diagnosis, and case management, as well as insecurity, and logistical constraints. The government of Democratic Republic of the Congo, with support from partners, should invest more in the strengthening routine immunization activities to curb the high incidence of measles and prevent recurrent outbreaks. Investments in current EVD response could also be leveraged and integrated to support response efforts to the measles outbreak. 1 August 2019, marked one year since the declaration of the current outbreak of Ebola virus disease in Democratic Republic of the Congo. WHO and partners continue to support the government of Democratic Republic of Congo to adapt strategies in response to the evolving circumstances associated with this outbreak. The outbreak has remained largely confined to North Kivu and Ituri provinces with insecurity and pockets of community resistance challenging response efforts. The report of new confirmed cases including evidence of local transmission in Goma, capital of North Kivu, highlights the potential for spread within Democratic Republic of the Congo and to neighbouring countries. Operational readiness and preparedness activities in at-risk areas need to be sustained to ensure early detection and control of any future case. The concerted efforts of all stakeholders and partners, strategies should continue to remain dynamic and evidence-based to interrupt transmission and bring this outbreak to an end.

Measles continues to account for a high burden of morbidity and mortality in the African Region with several outbreaks ongoing including those of the Central African Republic and Democratic Republic of the Congo. The risk factors are well known – limited access to and utilization of immunization services – attributed to suboptimal performance of immunization programmes and weak health systems in general. While some progress has been made in the African region towards measles elimination, more investment is needed to ensure implementation of the five core strategies as articulated in the ambitious global measles and rubella elimination plan.