Measles – Burundi

Burundi has been experiencing an increase in the number of confirmed cases of measles since November 2019. This outbreak initially started in a refugee transit camp (Centre de transit de Cishemere, Cibitoke Health district), whose inhabitants had arrived from measles-affected provinces of the Democratic Republic of Congo. Refugees spend 21 days in the Transit Camp of Cishemere before they are sent to permanent camps in Nyankanda and Bwagiriza refugee camps in Butezi, Kavumu camp of Cankuzo, Garsowe camp of Muyinga and Mulumba camp at Kiremba.

The outbreak was identified when suspected measles cases had been reported by the local residents in the surrounding areas, highlighting pockets of under-vaccinated populations. According to WHO/UNICEF 2018 estimates, measles first dose vaccination coverage is relatively high (88%), and slightly lower for the second dose (77%). However, this does not reflect the vaccination coverage of incoming refugees.

Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia

From 1 through 31 March 2020, the National IHR Focal Point of Saudi Arabia reported 15 additional cases of MERS-CoV infection, including five associated deaths. The cases were reported from Riyadh (7 cases), Makkah (4 cases), Najran (3 cases), and Al Qassim (1 case) regions.

The link below provides details of the 15 reported cases.

Measles – Mexico

Mexico is experiencing a measles outbreak. Between 1 January and 2 April 2020, 1,364 probable1cases of measles were reported, of which 124 were laboratory confirmed, 991 were discarded and 328 remain under investigation. The age of the confirmed measles cases ranged from three months to 68 years (median=20 years), and 59% were male. Analysis conducted by the National Reference Laboratory (InDRE) identified the genotype D8 (similar to other countries in the Region), linage MVs/GirSomnath.IND/42.16/ for 17 of the confirmed cases.

Of the 124 confirmed cases, 105 were in Mexico City, 18 in Mexico State, and one in Campeche State; the following is a summary of the epidemiological situation in each:

Yellow fever – Ethiopia

On 3 March 2020, the Ethiopian Public Health Institute (EPHI) reported three suspected yellow fever cases in Enor Ener Woreda, Gurage zone, SNNPR. The three reported cases were members of the same household (father, mother and son) located in a rural kebele. Two of three samples tested positive at national level by reverse transcriptase-polymerase chain reaction (RT-PCR) and were subsequently confirmed positive by plaque reduction neutralization testing (PRNT) at the regional reference laboratory, Uganda Viral Research Institute (UVRI) on 28 March 2020.

In response to the positive RT-PCR results, the EPHI and Ministry of Health performed an in-depth investigation and response, supported by partners including WHO.

Yellow fever – Republic of South Sudan

On 3 March 2020, the Ministry of Health of South Sudan reported two presumptive positive cases of yellow fever in Kajo Keni county, Central Equatoria State, South Sudan. Both the cases were subsequently confirmed positive by plaque reduction neutralization testing (PRNT) at the regional reference laboratory, Uganda Viral Research Institute (UVRI) on 28 March.

The cases were identified through a cross-border rapid response team investigation mounted in response to the recently declared outbreak in bordering Moyo district, Uganda. During the investigation, the team collected 41 blood samples from five villages which were in close proximity to the bordering Moyo district, Uganda. Of the 41 individuals whose samples were collected, nine (22%) had history of fever, but none had history of jaundice. The individuals represented a spectrum of occupations typical for the area (farming, forestry, homemaker, soldier). Most of the individuals investigated were between 20-45 years of age, and 18 (44%) of these individuals were female.

Dengue fever – French Territories of the Americas – French Guiana, Guadeloupe, Martinique, Saint-Martin, and Saint-Barthélemy

On 12 February 2020, the European Centre for Disease Prevention and Control (ECDC) reported an increase in the number of cases of dengue infection in French Guiana, Guadeloupe, Martinique, and Saint-Martin. In January 2020, health authorities in the region declared a dengue epidemic in Guadeloupe and Saint-Martin and indicated that Martinique is also at-risk of an epidemic.

Dengue epidemics in these territories usually occur when there is a shift in the predominant circulating DENV serotype, and non-immune populations (e.g., tourists, new immigrants, or people not previously exposed to the circulating serotypes) are exposed to the new serotype through human movements within the territories or across neighboring countries. Local transmission occurs through the Aedes mosquito vector present on the islands and in French Guiana.

Ebola virus disease – Democratic Republic of the Congo

From 19 to 25 February, no new confirmed cases of Ebola virus disease (EVD) were reported. This was the first time since the beginning of the response that no new confirmed cases were reported over a seven-day period (Figure 1). The most recent case was reported in Beni Health Zone, North Kivu Province on 17 February. While the lack of new confirmed cases reported in the last seven days is a major achievement, the outbreak remains active and risk of additional cases emerging remains high. In the past 21 days (5 to 25 February 2020), four confirmed cases were reported from two health areas in Beni Health Zone in North Kivu Province (Figure 2, Table 1). Even with strengthened surveillance operations, transmission of Ebola virus outside of groups currently under surveillance cannot be excluded. Ebola virus also persists in some survivors’ body fluids, with potential to infect others. In at least one instance during this outbreak, relapse – in which a person who has recovered from EVD develops symptoms again – was observed, sparking a new chain of transmission which has taken several months to interrupt. To mitigate a potential resurgence of the outbreak, it is critical to maintain response capacities to rapidly detect and respond to any new cases, and to prioritize survivor support and monitoring and the maintenance of cooperative relationships with the survivors’ associations.

Substantial surveillance, pathogen detection, and clinical management activities are currently ongoing, including validating alerts, following remaining contacts who were potentially exposed to the virus, supporting rapid diagnostics of suspected cases, and working with community members to strengthen surveillance on people who pass away in the communities. As of 25 February, 510 contacts are currently under surveillance, of which 97% were followed daily in the last seven days. In the last seven days, more than 5100 alerts per day were reported and investigated, of which over 400 alerts (including ~70 community deaths) were validated as suspected EVD cases; requiring laboratory testing and specialized care within the established Ebola treatment and transit centres. On average, suspect cases stay in these facilities for three days before EVD can be definitively ruled out (i.e. after two negative polymerase chain reaction tests 48 hours apart), while care is provided for their illness under isolation precautions. Timely testing of suspected cases continues to be provided across 11 operational laboratories deployed in cities that have been affected by the outbreak. From 17 to 23 February, more than 3600 samples were tested.