WHO EMRO Weekly Epidemiological Monitor: Volume 10, Issue 53 (31 December 2017)
Current major event
Health threats reported in 2017
In 2017, a variety of emerging and reemerging infectious disease threats were reported in the Eastern Mediterranean Region (EMR). Most of the threats began in 2016, including chikungunya in Pakistan, or were already endemic in the country, for example, Crimean-Congo hemorrhagic fever (CCHF) in Afghanistan. However, new threats, such as diphtheria in Yemen, have also been observed this year.
Several countries of the EMR have been facing severe humanitarian emergencies in the past few years. This, coupled with ongoing conflicts and insecurities in the region, has increased the risk of emergence and active transmission of infectious disease threats in a number of countries in the Region. The increasing number of internally displaced people living in over crowded conditions with little access to health services and/or damage to water and sanitation systems, as the case in Yemen, Iraq and Somalia have augmented this risk manifold. The cholera trend continues to dramatically increase in Yemen, whereas the cholera situation in Somalia was well controlled and the number of cases dropped significantly throughout this year, possibly following introduction of mass vaccination campaign with oral cholera vaccine (OCV).
An increase in cases of zoonotic infections was also observed this year. Pakistan was most affected as it suffered from an increase in chikungunya, dengue and CCHF cases. In Afghanistan, the number of CCHF cases in 2017 exceeded those reported in previous years. In addition, MERS cases increased in United Arab Emirates (UAE) and Oman this year. Avian influenza (H5N1) continues to circulate in Egypt, with a total of 349 cases reported so far.
Other ongoing outbreaks, such as Polio in Afghanistan and Pakistan and dengue in Yemen, continue to pose perennial threats in the Region. On the other hand, due to the collapse of healthcare infrastructure and routine vaccination programme, new infections have re-emerged such as meningitis in Yemen. Diphtheria is another vaccine preventable disease which has been reported in increasing number in recent time.
As conflict-affected countries are disproportionally affected by infectious disease threats, establishing and strengthening an early warning system for disease outbreaks in those countries is imperative.
This system would allow rapid identification and response to outbreaks when routine surveillance system remains fragile or dysfunctional. Implementing such a system would require continuous collaboration and commitment from all agencies and partners working with the ministries of health of high risk countries. Early detection and control of outbreaks is a crucial component of global health security efforts and it remains a shared responsibility.