WHO AFRO Outbreaks and Other Emergencies, Week 16: 15 - 21 April 2017 (Data as reported by 17:00, 21 April 2017)
This weekly bulletin focuses on selected public health emergencies occurring in the WHO African region. WHO AFRO is currently monitoring 42 events: three Grade 3, six Grade 2, two Grade 1, and 31 ungraded events.
This week, two new events have been reported: monkeypox outbreaks in Sierra Leone and Central African Republic. In addition, two events have been graded: the acute watery diarrhoea/cholera outbreak and the humanitarian crisis in Ethiopia have been elevated to grade 3 emergency while the meningitis outbreak in Nigeria has been graded as level 2 emergency. The bulletin also focuses on key ongoing events in the region, including the grade 3 humanitarian crisis in South Sudan, the grade 2 cholera outbreak in Democratic Republic of Congo and the meningitis outbreak in Niger.
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 report with information on all public health events currently being monitored in the region.
Major challenges to be addressed include:
• Timely laboratory confirmation of disease outbreaks in order to implement appropriate control measures.
• The prompt availability of sufficient doses of vaccines in order to implement effective reactive vaccination campaigns.
A single case of monkeypox has been confirmed in Pujehun district in the southern region of Sierra Leone. The putative index case, a 35-year old peasant farmer from Kpaku village, Galliness Perri chiefdom, Pujehun district, developed ill-health on 14 March 2017. He presented to a local health facility on 16 March 2017 with fever, body pains, malaise, dysphagia, and enlarged cervical lymph nodes; and was presumptively treated for malaria and sore throat as an out-patient. On 17 March 2017, he developed generalized vesicular skin eruptions in addition to the initial constitutional clinical features. The case-patient was admitted to Pujehun district hospital on 25 March 2017. Biological samples including blood and vesicular swabs were collected on 28 March 2017 and shipped to the National Reference Laboratory in Freetown. The samples were then transported to the Institut National de Recherche Biomedicale (INRB) in Kinshasha, the Democratic Republic of Congo. Laboratory results from INRB relayed on 17 April 2017 to Sierra Leone indicated that the vesicular swab tested positive for Orthopox virus by polymerase chain reaction (PCR) assay and monkeypox virus by GeneXpert technique. Based on these results, the Sierra Leone Ministry of Health notified WHO on 17 April 2017 of the outbreak of monkeypox. Part of the samples have been shipped to the Centres for Diseases Control and Prevention (CDC) in Atlanta, United States for further analysis.
Thirteen close contacts to the index case were listed and are being followed up. None of them have developed any febrile illness and/or skin lesions in the first 21 days since the last exposure.
The contacts are still being monitored for additional 21 days (twice the maximum incubation period of monkeypox). No other significant exposure risks have been identified except for the fact that the index case, being an occasional hunter, caught a squirrel (a known vector of the monkeypox virus) in the preceding days of his illness for domestic consumption.