1

Disease Last

Update

2019

Cases

Con-

firmed Deaths

Notes and References (R 1, 2, 3)

*[Disease] = new since previous outbreak list

United States

Vaping-

related lung

injury

13-Nov 2,172 2,172 42

(1.9%)

In August, clusters of severe vaping-related lung injury were investigated by public health authorities in WI and IL, in

collaboration with CDC. All patients reported recent exposure to e-cigarettes containing nicotine and/or tetrahydro-

cannabinol (THC), the psychoactive compound in marijuana. As of November 13, a total of 2,172 cases of “e-

cigarette, vaping, or product use-associated lung injury (EVALI)” have been identified in 49 states (not Alaska); 42

(1.9%) have died. Sixty-eight percent have been male, 15% less than 18 years old, and 62% between 18 and 34 years

old. On November 8, CDC announced that vitamin E acetate, an additive in some THC-containing products, had been

found in all BAL specimens from 29 EVALI cases. R 1 2 3 4

Hepatitis A 15-Nov

>27,200

(2018-

19)

>27,200

(2018-19)

261

(0.9%)

The sustained 2018-19 outbreak of hepatitis A (HAV) has persisted in multiple eastern, southern, and midwestern

states, though incidence has decreased substantially. Of the >27,200 nationwide cases reported as of November 15,

>16,400 (60.3%) have been hospitalized and >261 (0.9%) have died. Incidence has decreased over recent weeks. Risk

factors continue to be homelessness and IV drug use. On October 24, 2018, the Advisory Committee on Immuniza-

tion Practices (ACIP) recommended HAV vaccination for homeless persons >1 year old. R 1 2

Coccidioides 19-Nov 8,970 8,970 ??

As of November 19, a total of 8,970 cases of coccidioidomycosis had been report to public health authorities in Ari-

zona in 2019, compared with 7,478 in all of 2018. Increased incidence of Coccidiodes infection can be attributed to

increased reporting practices, climate change (drought and increasing temperatures), dust storms, soil disturbance

caused by increased construction activity, and host factors. No longer a fungal disease limited to the southwest, Coc-

cidioides spp. have been detected in recent years as far north as eastern Washington State. R 1 2 3

EEE 19-Nov 36 36 13

(36.1%)

No further Eastern equine encephalitis (EEE) cases have been reported since November 5, as the transmission season

has come to the end in the Northeast and Midwest. As of November 19, a total of 36 cases have been reported by

MA (12), MI (10), RI (3), CT (4), NJ (4), NC (1) IN (1) and TN (1); 13 (37.1%) have died. This has been a very active

EEE transmission season in the US. R 1 2

Salmonella

Dublin 19-Nov 11 11 1 (10%)

As of November 19, a total of 11 cases of Salmonella Dublin cases in 7 states (CA, CO, KS, IA, OK, WA, and TX)

have been linked by whole genome sequencing. Illness has been more severe than typical for salmonellosis, with 8

hospitalizations and one death. As is common for Salmonella Dublin, all diagnoses were made from blood cultures.

Illness onsets occurred from August 8 to September 22. Contaminated ground beef produced by Central Valley Meat

Co. in Hanford, CA is the suspected source. R 1

*E. coli

O157:H7 20-Nov 17 17 0

As of November 18, a total of 17 cases of E. coli O157:H7 infections, including 7 hospitalizations and no deaths, have

been detected in 8 states (MD, WI, MT, ID, CO, AZ, CA, WA). E. coli O157:H7 has been detected in an unopened

package of Ready Pac Foods Bistro Chicken Caesar Salad, which some cases reported eating. R 1

Current Infectious Disease Outbreaks for NYC Providers

November 22, 2019

2

Disease Last

Update

2019

Cases

Con-

firmed Deaths Notes and References (R 1, 2, 3)

United States

*Scombroid 15-Nov 47 47 0

As per the Food and Drug Administration (FDA), 47 cases of scombrotoxin fish poisoning have been reported by pub-

lic health authorities, with onsets from August 8 to October 15. Traceback investigations have implicated Truong Phu

Xanh Co. Ltd. a Vietnamese company that has refused to recall their fish from the US market. In return, the FDA has

blocked incoming shipments from this company. R 1 2

Canada

Salmonella

Litchfield 23-Oct 12 12 0

As of October 23, 12 cases of salmonellosis have been linked to consumption of Filicetti brand Italian Style mild, dry

cured sausage, from which Salmonella Litchfield was isolated. All cases have been in Ontario (10) and Quebec (2). R 1

*Creutzfeldt-

Jakob disease 12-Nov 3 3 ??

Three cases of Creutzfeldt-Jakob disease (CJD) have been confirmed in residents of Moncton in southeastern New

Brunswick. All cases had cataract surgery at the Moncton Hospital. R 1

Caribbean, Central America, and South America

Dengue 2-Nov >2.84

million

>1.23

million 1,256

In 2019 as of November 2, a total of >2,.84 million dengue cases, including >1.23 million laboratory-confirmed, and

1,256 deaths, have been reported to the Pan American Health Organization (PAHO). Cases have been confirmed in all

Central and South American countries except Uruguay. Brazil ( >2,070,000), Colombia (>108,000), Nicaragua

(>172,000), Mexico (>227,000), and Honduras (>98,000) have reported the most cases. Most dengue cases in the

Caribbean (>28,000) have been reported by the Dominican Republic, Jamaica, and Cuba. Guadeloupe, Marti-

nique, Antigua/Barbuda, Aruba, Trinidad/Tobago, and 11 other islands also have reported cases. R 1

Chikungunya 22-Sep >120,000 —

72

In 2018, >80,000 chikungunya cases were reported in the Americas and the Caribbean. In 2019 as of September 22,

Brazil alone has reported 119,000 cases (Rio de Janeiro, Minas Gerais, Bahia, Rio Grande do Norte, Pernambuco, and

Pará regions). To date in 2019, chikungunya cases also have reported in Peru, Colombia, Paraguay, Venezuela, El

Salvador, Costa Rica, Mexico, Bolivia, and Nicaragua. R 1 2 3

Zika 26-Oct >29,100 >4,560 —

As of October 26, a total of >29,100 Zika cases have been reported to PAHO in 2019. In addition to Brazil’s

>25,300 and Peru’s 1,370 reported cases, countries throughout Central America, Mexico, Bolivia, Colombia,

Paraguay, Argentina, and Venezuela, have reported <1,700 Zika cases apiece. In 2019, only 52 cases have been

reported from the Caribbean, with all but one coming from Puerto Rico. R 1

Measles 2-Nov >66,200 10,288 —

In 2019 as of October 26, >66,200 measles cases have been reported, with >50,700 (76.5%) coming from Brazil,

>4,575 (6.9%), >2,055 (3.1%), >2,397 (3.6%) reported by Mexico, Colombia, and Cuba, respectively. Cases also

have been reported from all South and Central American countries. R 1

3

Disease

Last

Up-

date

2019

Cases

Con-

firmed Deaths Notes and References (R 1, 2, 3)

Caribbean, Central America, and South America

Haiti

Cholera 5-Oct 636 — 3 (0.5%)

As of October 5, a total of 636 cholera cases, including 3 (0.5%) deaths, have been reported in 2019. In comparison,

3,786 cholera cases were reported in 2018 and 13,681 cases in 2017. Since the outbreak began in 2010, Haiti has re-

ported 820,413 suspected cases and 9,792 deaths (1.2%). R 1 2 3

Diphtheria 7-Sep 151 17 5 (29.4%)

*

As of September 7, a total of 151 probable diphtheria cases have been reported in Haiti in 2019, including 17 con-

firmed and 5 deaths (29.4%) in confirmed cases. This represents an increase of 67 probable cases in the last 6 report-

ing weeks. In 2018, at the same time, 269 suspected cases had been reported. The highest incidence in confirmed cas-

es has been children 6-14 years old, followed by 1-5 years old. R 1 * Case-fatality rate is of confirmed cases only

Venezuela

Diphtheria 21-Sep 407 — 16 (3.9%)

A diphtheria outbreak that began in 2016 has continued in Venezuela. As of September 21, a total of 407 suspected

cases and 16 deaths have been reported in 2019. Given the breakdown in the public health and healthcare infrastruc-

ture, this probably is an underestimate. This compares with 1,102 cases and 50 (13.6%) deaths in 2018. . R 1

Europe

West Nile

virus 14-Nov 462 462

50

(10.8%)

The 2019 West Nile virus season has slowed in Europe over the past month As of November 14, a total of 461 cases

were confirmed. Greece (223), Romania (66), Italy (53), Hungary (36), Serbia (27), Cyprus (16), Israel (10), Turkey

(9), North Macedonia (6), Bulgaria (5), Austria (4), France (2), Germany (4), and Slovakia (1) have reported cases, in-

cluding 50 (10.8%) deaths in Greece (34), Romania (8), Italy (4), Cyprus (1), Bulgaria (1), North Macedonia (1), and

Serbia (1). Eighty-eight equine outbreaks were reported in Germany (30), Greece (21), France (13), Italy (8), Hungary

(7). ), Austria (4), Spain (4) and Portugal (1). Germany also has reported 53 avian outbreaks. R 1 2 3

Measles 31-Oct >74,000 — —

In 2019 and as of October 31, a total of >74,000 measles cases have been reported throughout WHO’s European

Region. A total of >58,200 cases, including 20 deaths, were reported in Ukraine alone as of October 3. Outbreaks

have been reported in most European countries. Regional incidence has declined in the past 2 months. R 1 2 3

Germany

XDR Klebsiel-

la pneumoni-

ae

21-Oct 17 17 —

An outbreak of extensively drug-resistant (XDR) Klebsiella pneumoniae sequence type ST307 has been detected, involv-

ing 4 medical facilities in Mecklenburg-West Pomerania. As of October 21, 6 infections (sepsis, pneumonia, and urinary

tract infection) and 11 carrier states have been identified. The OXA-48 and NDM-1 carbapenemase-containing strain

is resistant to all penicillins, cephalosporins, carbapenems, quinolones, aminoglycosides, fosfomycin, and colistin. It is

susceptible to chloramphenicol and has limited susceptibility to tigecycline. A contaminated endoscope may have

played a role in the outbreak. R 1 2

4

Disease Last

Update

2019

Cases

Con-

firmed Deaths Notes

Europe

Switzerland

*Tickborne

encephalitis 31-Oct 255 255 ??

Switzerland’s Federal Office of Public Health reported that 255 cases of tickborne encephalitis have been reported in

2019. Hikers and campers in forested areas up to an altitude of 1,500 meters (4,920 feet) are at-risk. R 1 2

Arabian Peninsula and Middle East

Saudi Arabia

MERS-CoA 18-Nov 199 199 53

(26.6%))

As of November 18, a total of 199 cases, including 53 (26.6%) deaths have been reported in 2019. For the past 6

weeks, cases were confirmed in these Regions: northcentral Al-Qassim (Buraidah, Unaizah, Uyun al Jawa), central Najd

(Wadi ad-Dawasir), Bisha (Bisha), the Eastern Region (Al Hofuf), southwestern Aseer (Abha, Khamis Meshait), Mecca

(Jeddah, Taif, Al Khurma), and in the central Riyadh Region (Riyadh City, Al-Muzahmiya).

Some MERS cases who have been isolated at home with mild or no illness may have progressed to serious disease

requiring hospitalization. This might be worth keeping in mind when evaluating patients with possible MERS. (See

epidemic curve, map, and nosocomial transmission diagram on p. 11 of this report.) R 1 2

Yemen

Cholera 13-Nov 785,000 5,165 1,004

(0.13%)

Yemen continues to suffer through the worst cholera outbreak of modern times. More than 785,000 suspected cases

have been identified in 2019 as of November 13, including 5,165 confirmed and 1,004 (0.13%) deaths. Since the out-

break began in April 2017, more than 2,178,000 suspected cases have been identified, including 3,737 (0.17%) deaths.

Most cases have been reported from Governates in the western areas. Yemen’s water, sanitation, electricity, and

health care infrastructures have been decimated by the civil war raging there since 2014. R 1

Asia

Dengue 15-Oct >900,000 — —

Dengue is endemic throughout Asia. Already in 2019, the Philippines, Vietnam, Malaysia, Thailand, Sri Lanka,

and Cambodia, have reported >322,000, >124,000, >104,950, >98,000, >54,700, and ~56,000 dengue cases, respec-

tively. Singapore (>12,600) the Maldives (>3,700), Laos (>30,600), Bangladesh (>81,800), Indonesia (>1,000),

Nepal (5,095), India (>5,500), and Pakistan (>3,800). Timor-Leste and Taiwan also have reported cases. Except

for Pakistan, and Sri Lanka, 2019 incidence is dramatically increased over 2018. R 1 2 3

Chikungunya 6-Oct >10,360 — —

So far in 2019, Thailand has reported ~8,100 chikungunya cases, most of which are in its southern districts near Ma-

laysia. The Maldives and Malaysia (largely in Kuala Langat District) have reported >1,400 and >470 cases, respec-

tively. India (Tamil Nadu) and Indonesia (Depok, West Java) also have reported cases. R 1 2 3 4

China

*Plague 12-Nov 2 2 0

Two patients from Inner Mongolia have been diagnosed with pneumonic plague in Beijing. They reportedly became

symptomatic 10 days before transfer, suggesting that their illnesses began as bubonic plague that then resulted in sec-

ondary pneumonic plague. R 1

5

Disease Last

Update

2019

Cases

Con-

firmed Deaths Notes

Asia

India

Malaria 1-Nov 535 ?? ??

According to news sources, 76 malaria cases have been reported in suburban areas of Delhi this week, and 535 in all

of 2019. Whereas malaria is endemic in other cities (Kolkata, Mumbai), Delhi has not been considered one of them.

The report does not indicate to what extent the malaria cases were imported from other areas. Plasmodium falcipa-

rum accounts for ~40% of malaria cases in India. R 1 2

Japan

Rubella 27-Oct 2,245 2,222 —

The rubella outbreak in Japan that was publicized earlier in 2019 has continued. As of October 27, a total of 2,245

cases have been confirmed in all prefectures except for Aomori and Kochi, with most in Tokyo (840), Kanagawa (286),

Chiba (195), Saitama (195), and Osaka (126). There have been 3 cases of congenital rubella syndrome. CDC updated a

Level 2 Travel Alert on August 7 warning non-immune women who are pregnant not to travel to Japan until the out-

break has ended. Incidence has been declining over the past month. R 1 2 3

Myanmar

Polio

(cVDPV) 6-Nov 6 6 0

In 2019 as of November 6, a total of 6 cVDPV1 infections have been identified in Myanmar (Kayin province). R 1

Pakistan and Afghanistan

Polio

(WPV1) 13-Nov 102 102 —

Polio remains endemic. Already in 2019, a total of 82 infections with wild poliovirus type 1 (WPV1) have been report-

ed in Pakistan (12 cases in 2018) in Punjab, Sindh, Balochistan, and especially southern Khyber Pakthunkwa provinces.

More than 5 million children were vaccinated in July campaigns. In Afghanistan, a total of 20 WPV1 infections have

been reported in 2019, compared with 21 in 2018. Cases have occurred in Kandahar, Himand, Uruzgan, Kunar, and

Paktika provinces. Vaccination efforts continue in the affected districts. R 1

Philippines

Polio

(cVDPV) 13-Nov 3 3 0

On September 19, the first polio case since 2000 was announced by health authorities. As of November 13, a total of

3 cases have been confirmed on the island of Mindanao and in the Laguna area near Manila. All illnesses have been due

to infection with cVDPV2. Only two of viruses are genetically linked. R 1

Australia and the Pacific

Dengue 14-Oct >6,400 — —

Already, 2019 promises to record significant dengue incidence. As of September 26, New Caledonia has reported

3,898 cases (DENV-2). Australia has reported nearly twice as many cases (1,107) by August 27 than at the same time

last year. In French Polynesia, 1,488 cases have been reported as of October 14 in Moorea, Raiatea, Bora Bora,

Palau, Rangiroa, Vanatu, the Cook Islands, Wallis and Fortuna, and Tahiti, including 106 cases due to DENV

-2 on Tahiti (for the first time since 2000), Moorea, Bora Bora and Nuku Hiva. R 1 2 3

6

Disease Last

Update

2019

Cases

Con-

firmed Deaths Notes

Africa

Polio (cVDPV) 13-Nov 113 113 —

So far in 2019, compared with 80 cases in 2018, a total of 113 cases of circulating vaccine-derived poliovirus (cVDPV)

infection have been reported in DRC (52), Nigeria (17), Angola (16), Central African Republic (14), Somalia

(3), Ethiopia (3), Ghana (2), Benin (2), Chad (1), Niger (1), Togo (1), and Zambia (1). R 1

Measles 20-Oct >314,000 >8,400 —

The most severe outbreak was in Madagascar, but that has ended. DRC, Nigeria, and Chad have reported

>233,000; >55,400; and >25,400 cases, respectively, in 2019. To a lesser extent, Angola, Cameroon, Central Afri-

can Republic, Niger, Liberia, Sierra Leone, Mauritius, Ethiopia, South Sudan, Mali, Guinea, Uganda, Ken-

ya, and Tunisia also have reported cases. R 1 2 3

Dengue 15-Oct >59,000 >25,000 —

In 2019 and as of October 15, a total of >59,000 cases of dengue, including >25,000 confirmed, have been reported on

the island of Réunion (17,981), in Côte d’Ivoire (2,920), Tanzania (6,916), Sudan (135), Kenya, Mauritius (123),

Mayotte (80), and Benin (19). Incidence on Réunion has decreased dramatically. R 1 2 3 4

Leishmaniasis 6-Oct >8,700 — —

A major kala-azar outbreak with >2,757 cases has been ongoing in Kenya since April. Leishmaniasis also can be found

in South Sudan and Somalia. Earlier this year, >6,000 cutaneous leishmaniasis cases were reported in North Afri-

ca over a 6-month period. Most were diagnosed along the Mediterranean coast (west of Tripoli) of Libya, followed

by central and southwestern Tunisia and in the Ghardaia Province of Algeria. R 1 2 3 4

Burundi

Malaria 27-Oct >7.392,0

00 —

2,823

(0.03%)

Burundi currently has epidemic levels of malaria throughout the country. In 2019 as of October 20, more than 7.39

million suspected cases of malaria have been reported. In the week ending October 27, >150,000 cases and 66 deaths

were reported, which was a 54% increase compared with the same week in 2018. Health authorities are hampered by

a lack of resources to mount a comprehensive, nationwide malaria prevention campaign. R 1 2 3

Cholera 12-Nov 1,074 288 7 (0.7%) From June 1 to September 22, a total of 1,074 cholera cases, including 288 confirmed and 7 (0.7%) deaths, were re-

ported in 4 provinces: Bujumbura Mairie, Cibitoke, Bubanza, and Bujumbura. R 1 2

Cameroon

Cholera 10-Oct 667 98 32

(4.8%)

A new wave of cholera was reported from the North and Far North Regions following the onset of the rainy season in

May. A total of 667 suspected cholera cases have been reported since March 1 and as of October 10, including 98 con-

firmed and 32 (4.8%) deaths. Over 70% of reported cases have been from the North Region, where 57% of cases are

female. The incidence trend continues to be decreasing. R 1 2 3

Central African Republic

Measles 14-Oct 1,638 98 40

(2.4%)

On July 9, the Ministry of Health announced a measles outbreak in the Nana-Gribizi health district. As of October 14,

a total of 1,638 cases have been reported, including 98 confirmed and 40 (2.4%) death. Vaccine coverage for the first

vaccine dose is only 49%. R 1 2 3

7

Disease Last

Update

2019

Cases

Con-

firmed Deaths Notes

Africa

Chad

Measles 13-Nov 25,464 203 243

(1.0%)

As of November 13, a total of 25,464 measles cases have been reported in 2019, including 243 (1.0%) deaths. Forty-

seven percent of cases have been between 1 and 4 years. The tempo of the outbreak may be lessening. Of the coun-

try’s 126 districts, 118 (94%) have now been affected. Forty-seven percent of cases are between 1 and 5 years old and

79% were not vaccinated. R 1 2 3

Congo

Chikungu-

nya 29-Sep 11,434 148 0

As of September 29, a total of 11,434 cases, including 148 confirmed, have been reported since the outbreak began in

February. The downward trend in incidence has continued. Cases have been reported in 9 of 12 departments: Kouilou

(most affected), Pool., Bouenza, Pointe-Noire, Plateaux, Niari, Lékoumou, Brazzaville, and Cuvette. R 1 2 3

Côte d’Ivoire

Dengue 24-Sep 3,201 281 2 (0.1%)

A dengue outbreak in Côte d’Ivoire was first reported on February 15. As of September 24, a total of 3,201cases have

been reported, including 281 laboratory-confirmed and 2 (0.1%) deaths. The trend in reported cases has been decreas-

ing since mid-June. The outbreak has been located in the upscale suburbs of the capital city, Abidjan. DEN-1 is the pre-

dominant serotype, though DEN-3 also has been identified. R 1 2 3

Democratic Republic of Congo

Measles 27-Oct 233,337 6,304 4,723

(2.0%)

As of October 27, a total of 233,337 measles cases have been reported in DRC in 2019, including 4,723 deaths (2.0%).

In the week ending October 27, there were 7,421 cases and 146 deaths were reported. Seventy–six percent of all re-

ported cases and 88% of measles-associated deaths have been children <5 years old. More than 80% of cases in 2019

have been from Tshopo, Lualaba, Kasai, South Kivu, Upper Lomami, Tanganyika, Kasai-Central, Ituri, and Kasai-

Oriental provinces. Densely populated areas in Kinshasa City also have been affected. Measles vaccination coverage

remains low in the DRC. R 1 2 3

Cholera 20-Oct 23,815 — 430

(1.8%)

As of October 20, the worst cholera outbreak since 1994 has led to a total of >23,800 suspected cholera cases in the

DRC in 2019, including 430 (1.8%) deaths. Outbreaks have been reported in 21 (81%) of the 26 DRC provinces. Ap-

proximately 88% of the cases have been reported from eastern provinces where cholera is now considered endemic:

Tanganyika, Upper Lomami, North Kivu and South Kivu. R 1 2 3

Monkey-

pox 13-Oct 4,374 —

87

(2.0%)

In 2019 and as of October 13, a total of 4,374 cases of monkeypox have been reported, including 87 (2.0%) deaths. In

the week ending in October 13, there were 144 and 9 deaths reported. Most cases occurred in Sankuru province. Mai

-Ndombe, North Ubangi, and South Ubangi provinces also have reported cases in recent months. R 1 2 3

cVDPV 15-Nov 52 52 0

In 2019 as of November 15, a total of 52 cases of acute flaccid paralysis following infection with circulating vaccine-

derived poliovirus 2 (cVDPV2) were reported in the DRC (20 in 2018). Separate cVDPV2 outbreaks ongoing in Haut

Katanga, Mongala, Sankuru, Tanganika, Tshuapa, Kasai, Kasai Central, and Haut Lomami (2) provinces. R 1

8

Disease Last

Update

2019

Cases

Con-

firmed Deaths Notes

Africa

Democratic Republic of Congo

Ebola 17-Nov 3,296 3,178 2,196

(66.6%)

After a dramatic loss of Ebola virus disease (EVD) containment during the spring and early summer, EVD incidence in

northeastern DRC’s North Kivu and Ituri provinces has decreased just as dramatically in the last 3 months. During the

21 days from October 28 to November 17, a total of 31 confirmed cases were reported from 12 health areas within 5

health zones, compared with 215 confirmed cases in 65 health areas within 18 health zones during the 21-day period

from July 29 to August 18. During this period, 45%, 29%, and 19% of cases were detected in the principal hot spots of

Mabalako (14), Beni (9), and Mandima (6).

As of November 17, a total of 3,296 EVD cases have been reported, including 3,178 confirmed, 118 probable, and

2,196 (66.6%) deaths; 162 (5%) cases were healthcare workers of whom 41 (25.3%) died. Fifty-six percent of cases

have been female and 28% have been children <18 years old. More than 253,545 Ebola vaccinations were adminis-

tered as of November 16.

See epidemic curve and maps on p. 12 of this report.) R 1 2 3 4

Plague 6-Oct 31 — 8

(25.8%)

From March 12 to October 3, a total of 31 bubonic plague cases, including 8 (25.8%) death, have been reported from

the Aru health zone in Iturui province. Since September 22, there have been 21 cases reported. hirty-one cases have

been reported in 2019, including 8 (25.8%) deaths. R 1

Ethiopia

Measles 10-Nov 8,841 59 57

(0.6%)

In Ethiopia as of November 10, a total of 8,841 measles cases have been reported in 2019, including 59 laboratory-

confirmed and 57 (0.7%) deaths. Cases have been reported from 4 regions: Oromia (5,192), Somali (2,340), Amhara

(703), and Afar (548). R 1 2 3

Cholera 10-Nov 1,894 57 11

(0.6%)

Since May 12 and as of November 10, a total of 1,894 cholera cases, including 57 confirmed, were reported largely by

Ethiopian health authorities in the following regions: Oromia (756), Afar (295), Somali (293), Amhara (191), Addis Ab-

aba (157). Incidence has been inclining in recent weeks. R 1 2 3

Chikungunya 10-Nov 53,238 29 0

An expanding outbreak of chikungunya has been taking place in the city of Dire Dawa since the week ending July 30.

A total of >53,200 suspected cases have been reported as of November 10, though some infections may be due to

dengue or malaria. Incidence has been on the decline since a peak in the week ending September 8. R 1 2

Guinea

Measles 11-Aug 4,573 969 13

(0.3%)

As of August 11, a total of 4,573 measles cases, including 13 (0.3%) deaths have been reported in 2019. Of 1,595 spec-

imens tested, 969 (57.2%) have been positive. Disease transmission currently is most acute in Matoto, Ratoma, Dixinn,

Labé, Matam, Dubreka, Coyah, Maferinyah, Kegneko, and Manéah. R 1 2 3 4

9

Disease Last

Update

2019

Cases

Con-

firmed Deaths Notes

Africa

Kenya

Leishmani-

asis 10-Nov 2,776 1,174

34

(1.2%)

As of November 10, a kala-azar outbreak in Mandara, Marsabit, Wajir, and Garissa counties has led to 2,776 suspect

cases, including 1,174 confirmed; 34 (1.2%) have died. In the week ending November 10, no new cases were report-

ed, compared with 232 cases for the week ending September 8. R 1 2 3

Cholera 10-Nov 4,708 221 37

(0.7%)

A cholera outbreak that began in early January has been contained in Nairobi and Narok. As of November 10, a total

of 4,708 cases have been reported, including 221 confirmed and 37 (0.8%) deaths. Cases continue to be reported in 3

counties: Garissa, Wajir, and Nairobi Counties. R 1 2 3

Liberia

Measles 10-Nov 1,523 229 5 (0.3%)

As of November 10, a total of 1,523 measles cases from across the country, including 229 confirmed and 5 (0.3%)

deaths. In the reporting week ending November 10, a total of 12 cases were reported. Nine of 15 counties have been

most affected, and especially in Bong, Margibi, and Lofa. R 1 2 3

Lassa fever 10-Nov 70 39 13

(18.6%)

Sporadic cases of Lassa fever continue to be reported in Liberia. As of November 10, a total of 70 suspect cases have

been reported in 2019, including 39 confirmed and 13 (18.6%) deaths. Confirmed cases have occurred in Bong, Nim-

ba, Grand Bassa, and Grand Kru Counties. R 1 2 3

Namibia

Hepatitis E 20-Oct 6,604 1,608 56

(0.8%)

After a steady decline in incidence, reported cases of hepatitis E have increased over the past two reporting weeks.

As of October 20, the nearly 2-year outbreak has led to 6,604 and 1,608 laboratory-confirmed cases respectively,

including 56 (0.8%) deaths, 24 (43%) of whom were either pregnant or post-partum women. Cases have been con-

firmed in 12 regions: Khomas (the most affected), Erongo, Omusati, Oshana, Omaheke, Ohangwena, Otjozondjupa,

Niger

Measles 18-Aug 9,741 0 53

(0.5%)

As of August 18, a total of 9,741 measles cases, including 53 (0.5%) deaths have been reported by Niger in 2019. Only

6 cases were reported in the last week. Most cases have occurred in Maradi and Tahoua regions, followed by Zinder,

Niamy, Tilaberi, Agadez, Diffa, and Dofo. R 1 2 3

Nigeria

Measles 30-Sep 55,476 2,150 275

(0.5%)

As of September 15, a total of 54,902 suspected measles cases have been reported in Nigeria’s massive 2019 measles

outbreak. The epidemic trend has been decreasing in the past two months. From August 31 to September 30, Katsi-

na, Borneo, Kano, Yobe, Ekiti, Lagos, and Sokoto States accounted for 59% of cases. R 1 2 3

Cholera 3-Nov 818 189 4 (0.5%)

On June 18, health authorities in Adamawa State declared a cholera outbreak in the northeast state. As of November

3, a total of 818 suspected cases have been reported, including 4 (0.5%) deaths. A declining trend in incidence has

continued. Most cases have been identified in Yola North, followed by Girei, and Yola South. R 1 2 3

10

Disease Last

Update

2019

Cases

Con-

firmed Deaths Notes

Africa

Nigeria

Yellow fever 31-Oct 3,620 144 150

(4.1%)

Since August 1, a large peak in yellow fever cases has been evolving in Nigeria’s northeastern Bauchi state. As of Octo-

ber 31, a total of 3,620 suspected cases have been identified, of whom 144 were confirmed; 150 (4.1%) have died.

Most recently, cases have been identified in 6 states: Katsina, Bauchi, Benue, Borno, Gombe, and Kano. R 1 2

South Sudan

Measles 30-Sep 3,632 163 23 (0.6%)

As of September 30, total of 3,632 suspected measles cases, including 163 confirmed and 23 (0.6%) deaths, have been

reported in 18 South Sudan counties: Juba, Pibor, Gogriel West, Gogriel East, Melut, Mayom, Tonj North, Awiel

South, Awiel West, Awiel East, Renk, Longochuk, and Jur River. R 1 2 3

Sudan

Rift Valley

fever 11-Nov 293 9 11(3.8%)

As of November 11, a total of 293 suspected Rift Valley fever (RVF) cases, including 9 confirmed and 11 (3.8%) deaths,

have been reported in 6 states: Red Seas (120), River Nile (168), Kassala (2), Al Qadarif (1), Khartoum (1), and White

Nile (1). Epizootics have been confirmed in sheep and goats in Red Sea and River Nile states, where vaccination efforts

have intensified. Saudi Arabia and Egypt have banned Sudanese livestock. R 1 2

Uganda

Measles 24-Sep 1,584 795 5 (0.3%) As of September 24, a total of 1,584 suspected measles cases have been reported in 2019, of whom 795 have been

confirmed. Children under 5 years old account for >64% of confirmed cases; all but one live in rural areas. R 1 2 3

Removed from last bi-weekly list:

Salmonella Oranienburg (US, Multistate)

Powassan virus encephalitis (US, CT)

Legionellosis (US, NC)

Salmonella Reading (Canada, Multistate)

Plasmodium cynomolgi (Denmark)

Listeriosis (Germany)

XDR Typhoid fever (Ireland)

MDR falciparum malaria (Asia, Multistate)

Leptospirosis (Philippines)

Enterovirus (Taiwan)

New outbreaks since last bi-weekly list

E. coli O157:H7 (US, Multistate)

Scombroid (US, Multistate)

Creutzfeldt-Jakob disease (Canada)

Tickborne encephalitis (Switzerland)

Plague (China)

11

Cholera MERS-CoV

Eastern Province Eastern Province

Najd

Al Qassim

Mekkah

Aseer

Riyadh

Bisha

12

Ebola virus disease outbreak,

North Kivu and Ituri Provinces,

Democratic Republic of Congo

As of November 17, 2019

13

14