public health emergencies and responses …...complex humanitarian crisis in kasai burkina faso,...

03/11/2017

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PUBLIC HEALTH EMERGENCIES AND RESPONSES IN

WEST AND CENTRAL AFRICA

Regional Health Working Group

(RHWG)

Dakar, 03 November 2017WHO/AFRO – Dakar Hub

RHWG, 03 November 20172

CONTENTS

I. Overview of public health emergencies in the African region

II. Public Health and emergencies in the West and Central African countries

▰UGANDA: Marburg Hemorragic Fever (HF)

▰DR CONGO:

� Cholera outbreak

� Complex Humanitarian crisis in Kasai

▰BURKINA FASO, SENEGAL, COTE D’IVOIRE : Dengue

▰CABO VERDE: Malaria outbreak

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Public health emergencies in the African region, 2017, Week 43

More info on the WHO AFRO website

http://www.afro.who.int/en/clusters-a-

programmes/whe/outbreaks-and-other-emergencies-

updates.html

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UGANDA: Marburg HF | Grade 2 | Situation as of 31/10/2017

Key figures : Confirmed cases : 2 ; Probable cases: 1; Deaths: 3 CFR: 100%

Location of affected districts

SITUATION � On 17th October 2017, the Uganda Virus Research Institute confirmed by PCR a positive case

of Marburg Virus Disease from a sample obtained from Kween District, Eastern Uganda.

� 19th October 2017 : Declaration of an outbreak of Marburg was officially declared by the Ministry of Health.

� The index case is believed to have been an adult male, aged about 35 years, who was a herdsman with frequent hunting missions to the area of Kaptum where there are caves heavily

infested with bats.� As of the 30th of October 2017, there are 3 cumulative cases; one (01) probable, two (02)

confirmed and no (0) suspect cases, CFR is 100%.� No health workers among the cases� 3 alerts are being investigated including the wife and child of the second confirmed case and

another contact in Kapchorwa

� 260 number of contacts listed, 135 contacts under follow-up, 79 total contacts that completed 21 days

� Traditional healer in Kenya is being isolated, blood samples result from KEMRI is negative.

� Kenya WCO supporting investigation in Kitale and 2nd sample will be collected from traditional

by the joint WHO/MOH team currently on investigation

Cases by date of onset

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Transmission Chain

Case distribution by age


Distribution of cases



Line list

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Public health response

Partners in the field


Human resource deployed by all partners

Area Number of staff

Surveillance and Lab 23

Case management 14

Social mobilization 7

Psychosocial support 3

Logistics 2

Total 48



Public health response� Healthcare workers have been orientated in case management and infection

prevention and control (IPC) protocols.

� Marburg treatment centres have been setup in Kapchorwa Hospital and Kaproron Health Centre IV.

� Burial teams have also been trained in both sites.

� Community engagement and awareness campaigns are ongoing, aimed to reduce stigma, encourage reporting and early healthcare seeking behaviours, and prevention measures.

� Various international partners have been engaged to support the responses : UNICEF is assisting with communication activities, and MSF is supporting case management in the treatment centres.

� Psychosocial Support : A counselling session conducted for the discharged patient (CE).

� The Ugandan Ministry of Health continues to respond to the outbreak with support from WHO and partners.

� WHO has deployed additional staff, six viral haemorrhagic fever kits and additional funding to support and scale up the response, including case management and facilitating specimen transport.

� Active surveillance activities are ongoing, including active case search, contact tracing and monitoring within the affected communities and healthcare centres.

� Cross-border surveillance activities have been initiated with the Kenyan uthorities. Alert desks have been set up and are currently operational in Kween and Kapchorwa Districts.

� As of 24 October 2017, 185 contacts had been listed (120 from Kween and 65 from Kapchorwa) and 90 (49%) of these completed the follow-up period


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Operational challenges and gaps

� Contact tracing is still hampered by a hostile community

� Traditional healer in Bokou still not located

� All contacts of the second confirmed case have not been traced

� Funding :

� Required: USD 2,122,000

� Secured: USD 500,000

� Gap: USD1,162,000 (76%)



DRC: Cholera outbreak | Situation as of 30/10/2017

Sud

Kivu

Nord

Kivu

Key Figures: Cholera cases: 40,444 Deaths: 794 CFR: 1.9%.

Cholera

• Week 42: 2,039 cases, 67 deatths (CFR=3.4%).

• Weeks 1-42: 40,444 cases, 794 deaths (CFR = 1.9%);

• Most important peak during Week 39 with 2,516 cases

• Overall cholera trend: decreasing since Week 40.

• Cases reported in Lomami : 16 cases during Week 42 and 7

deaths (CFR: 43,7%).

-2.00%

3.00%

8.00%

13.00%

18.00%

0

1000

2000

3000

S1

S5

S9

S13

S17

S21

S25

S29

S33

S37

S41

Léta

lité

Nb

re c

as

Cas létalité


• Continued support to response coordination andcases management;

• Early response to new zones affected in Kasai and

Lomami: deployment of Cholera Kits and Staff.

• Reinforcement of preparedness activities in Mwene-

Ditu and Kisangani.

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DRC: | Situation as of 30/10/2017

SITUATION UPDATE

Key figures :

Complex Humanitarian crisis in Kasai

IDPs: 762,000 ; Returnees: 710 000; Severe malnutrition: 280,000 children.

• Dynamic of populations return continues;• 710 returnees in Kasai central, Kasai oriental and

Lomami;• Remaining IDPs: 762 000;• 31,370 refugees in Angola;• Population covered by humanitarian assistance: 425,414• 280,000 children with severe malnutrion;• Cholera cases reported in 3 health zones of Kasai ( Ilebo,

Mushenge and Mikobe) and One Health Zone in Lomami.

PUBLIC HEALTH RESPONSE

• Direct support to 8 health zones inreplacement of ONG ADRA;

• Contract with ALIMA for 3 Health Zones inLomami in final stage.

• Support to the MoH in the implementation ofNational forum recommendations

OPERATION CHALLENGES AND GAPS

• No more funds in-country to support the response

• Delay in the delivery of Emergency kits for theKasai response

• Finalize the agreement process with ALIMA NGO.• Closely follow-up the delivery process of

Emergencies kits. • Conduct in rapid assessment in other Provinces

affected by armed conflicts (Tanganyika and South Kivu).

ACTIONS


SENEGAL: Dengue fever | Situation as of 30/10/2017

SITUATION UPDATE

� On 28 September 2017, first confirmed cases of dengue fever (DF)

reported through routine sentinel surveillance system, in Louga

region, through the Santhiaba Sentinel Health Post.

� On 24 October, Ministry of health notified WHO of the DF epidemic.

� As of 30 October : 232 suspected including 36 confirmed cases

reported and 0 deaths

� All of the confirmed cases are DENV-1 serotype.

Key figures : Suspected cases : 232, Confirmed cases 36, Deaths 0

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Public health response� Since 23 October, deployment of a multidisciplinary investigation team led by the Centre for Emergency

Health Operations.

� Since 30 October, mobile response support team deployed in Louga. The team includes two field epidemiologists (FELTP), infectious disease doctor, biologists, entomologist and communication specialist.

� Since 26 October, first insecticide spraying to reduce vector density was carried out.

� Ministry of Health started to communicate by press release, first one released on October.

� Health facilities are provided with the case management guideline and two referral hospital identified for DF case management .

� Mass communication led by MOH through radio and television ongoing.

SENEGAL: Dengue fever | Situation as of 30/10/2017

Key figures : Suspected cases : 232, Confirmed cases 36, Deaths 0


BURKINA FASO: Dengue fever | Situation as of 29/10/2017

SITUATION UPDATE� During week October 27, 2017, a total of 1010 new suspected cases and

no deaths were reported across the country.� Between 1 January and 27 October 2017, a cumulative total of 6699

(suspected, probable) cases and 13 deaths (case fatality rate 0.2%) werereported in the country

� Of the 6 699 suspected cases, 4 428 (66.1%) were probable after testingpositive on dengue rapid diagnostic tests (RDTs). Fifty-two percent of thecases were female.

Evolution of suspected and probable cases of dengue in Burkina Faso, W1 - W43, 2017

Key figures : Suspected cases : 6,699 Probable cases: 4428 Deaths: 13 CFR: 0.2%

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� The National Epidemic Management Committee has been activated to coordinate response activities.

� A preparedness and response plan (and budget) for dengue fever has been developed.

� An early warning system has been established, with daily notification in Ouagadougou and weekly in the other provinces.

� Provision of free medical care and treatment for severe cases in all hospitals is ongoing.

� A total of 10 000 rapid diagnostic tests (RDTs) have been procured, with the support of the World Bank, to facilitate early diagnosis.

� Development and dissemination of a national dengue management algorithm has been conducted.

� Delivery and dissemination of dengue awareness and key prevention measures through radio and television programs is ongoing.

� Periodic shipment of samples to the national VHF laboratory is being carried out.

BURKINA FASO: Dengue fever | Situation as of 29/10/2017

Key figures : Suspected cases : 6,699 Probable cases: 4428 Deaths: 13 CFR: 0.2%


CÔTE D’IVOIRE: Dengue fever | Situation as of 29/10/2017

SITUATION UPDATE� Since the beginning of the outbreak in April 2017, 1 281 cases (suspected, probable and confirmed) and 2

deaths (case fatality rate 0.2%) were reported

� A total of 311 cases have been confirmed at the Institut Pasteur de Côte d’Ivoire (IPCI) laboratory. Sixty-six percent (181/272) of the positive samples isolated dengue virus serotype 2 (DENV-2), while 78samples were DENV-3 and 13 samples DENV-1. In addition, 39 samples were confirmed IgM positive byserology.

� Abidjan city remains the epicenter of the outbreak, accounting for 95% of the total caseload. Fifty-fivepercent (55%) of the affected people are aged 30 years and above while 25% are between 15 and 29years. Female gender is the most affected with 54% of the cases.

Weekly trend of dengue fever cases in Côte d’Ivoire, weeks 17 - 42, 2017

Key figures : cases: 1,281, Deaths: 2, CFR: 0.2%

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CÔTE D’IVOIRE: Dengue fever | Situation as of 29/10/2017

Public health response� The Ministry of Health continues to coordinate implementation of outbreak control measures, with support of WHO and partners.

� There is ongoing active case search and collection of samples from suspected cases for laboratory confirmation, as well as field investigation around cases.

� The capacities of health personnel are being strengthened on disease surveillance, case management and vector control measures, in Abidjan and Bouake cities.

� Vector control interventions are being implemented, including fumigation and destruction of mosquito breeding sites.

� Sensitization of municipal authorities, religious and community leaders was conducted to enable them engage in public health education.

� Sensitization of population through local radios, national television, flyers and posters is ongoing;

� Case management of complicated dengue cases is provided free of charge in the Treichville University Hospital centre.

Key figures : cases: 1,281, Deaths: 2, CFR: 0.2%


CABO VERDE: Malaria outbreak | Situation as of 29/10/2017

SITUATION UPDATE� Cabo Verde is one of the few countries in the African Region that experiences very low malaria

incidence. � Malaria outbreak since 30 June 2017 (total cases=343, deaths=1, CFR=0.3%). � The risk assessment conducted on the 6th September 2017 concluded that overall risk at the

national level is high and that the risk is low at the regional and global levels

Daily trend of cases of malaria cases in Cabo Verde from weeks 1 – 42, 2017

Key figures : Total Cases: 396, Autochtones cases : 388, Deaths: 2

Geographical distribution of malaria cases in Cabo Verde

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