Niger + 12 more

WHO AFRO Outbreaks and Other Emergencies, Week 15: 8 - 14 April 2017 (Data as reported by 17:00, 14 April 2017)

Situation Report
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This weekly bulletin focuses on selected public health emergencies occurring in the WHO African region. WHO AFRO is currently monitoring 41 events: two Grade 3, six Grade 2, two Grade 1, and 31 ungraded events.

This week, one new event has been reported: an outbreak of hepatitis E in Niger.

The bulletin also focuses on key ongoing events in the region, including the grade 3 humanitarian crisis in South Sudan as well as outbreaks of Lassa fever in 5 West African countries, measles in Guinea, acute watery diarrhoea/cholera in Ethiopia, and the food insecurity crisis in the Horn of Africa.
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:

• Cross border spread of diseases and the need to build and maintain strong collaboration and corporation among State Parties, in line with provisions of the International Health Regulations (IHR 2005).

• Deliberate investment in preparedness activities in order to strengthen disease surveillance for early detection, verification and response to public health events; and minimize their impacts.

New event

Hepatitis E
72 Cases 17 Deaths
24% CFR

Event description

The Niger Ministry of Health notified WHO on 12 April 2017 of an outbreak of hepatitis E in Diffa region located in the east of the country. The outbreak emerged on 09 January 2017 when clinicians at the Centre Mere-Enfant de Diffa started admitting pregnant women with acute jaundice syndrome. The initial case-patients presented with headaches, vomiting, fever, conjunctivitis, pelvic pain, and memory loss. The initial differential diagnosis was yellow fever, however, hepatitis E was later considered in light of the preponderance of pregnant mothers to the disease and the ongoing outbreak of hepatitis E in neighbouring Chad.

According to the Regional Director of Public Health in Diffa, 72 cases of acute jaundice syndrome including 17 deaths (case fatality rate of 23.6%) were reported by 10 April 2017. All 17 deaths occurred among pregnant mothers. Over 70% (52/72) of the case-patients and 100% of the deaths were reported from the Centre Mere-Enfant de Diffa while 20 case-patients and zero death came from Diffa district health care.

On 11 April 2017, the WHO Country Office in Niger relayed laboratory results from the Institut Pasteur Dakar (IPD). The results indicated that 14 samples obtained from the initial cases of acute jaundice syndrome in Diffa tested negative for yellow fever virus while 4 samples tested positive for hepatitis E virus. These results led to the formal declaration of hepatitis E outbreak by the Ministry of Health on 12 April 2017.

Detailed outbreak investigation and risk assessment are currently being conducted and the findings will be provided in the next bulletin.