BEYOND OUR BORDERS
1. Cholera: Zimbabwe On 6 September 2018, a cholera outbreak in Harare was declared by the Ministry of Health and Child Care (MoHCC) of Zimbabwe and notified to WHO on the same day. A clinical sample tested positive for Vib ri o c h ole r a e serotype O1 Ogawa. The outbreak has intensified since it was first declared in September, with 54 reported deaths, more 10 000 suspected cases and over 200 confirmed cases to date. In October, the government said it would vaccinate 1.4 million people. The outbreak has exposed lack of maintenance of infrastructure with burst pipes and contaminated boreholes.
2. Salmonellosis: North America The Israeli Ministry of Health has reported almost 40 cases of Salmonella infection linked to tahini products, that has also caused illness in five people in the USA. Tahini is a paste made from raw sesame seeds and is exported from Israel to several countries. Other products made from sesame seeds include hummus and halvah. Tahini products packed under five brands were recalled in the USA last month (November 2018) because a sample tested positive for Salmonella Concord. The Ministry of Health found a possible connection between the Salmonella accumulation and tahini products made by Achdut Ltd. in Ari’el, Israel, with expiry dates 7 April 2019 to 21 May 2019. People have been told not to consume tahini of all weights and package variants, with those expiry dates that had been marketed to retail, institutional markets and restaurants.
3. Lassa Fever: Nigeria From 1 January to 2 December 2018, a total of 3 229 suspected cases has been reported. Of these, 581 were confirmed positive, 17 probable and 2 631 negative. Since the onset of the 2018 outbreak, there have been 147 deaths in confirmed cases and 17 in probable cases. Case fatality rate (CFR) in confirmed cases is 25.3%. This outbreak has been widespread, occurring in 23 states and 92 local government areas. It is not known whether the prevalence of Lassa fever virus has been increasing in populations of rodent hosts in these areas. A total of 9 193 contacts has been identified from 23 states. Of these, 303 (3.3%) are currently being followed up, 8 760 (95.3%) have completed 21-day-follow-up period, while 15 (0.2%) were lost to follow-up. Of the remaining 115 (1.3%) symptomatic contacts identified, 36 have tested positive from five states. Lassa fever national multi-partner, multi-agency Technical Working Group (TWG) continues to coordinate response activities at all levels.
4. West Nile fever: Tunisia West Nile fever is a mosquito-borne viral disease caused by the West Nile virus (WNV). It can affect birds, humans and horses, and can cause inapparent infection, mild febrile illness, meningitis, encephalitis, or death. WNV is endemic in Tunisia. Since 1997 till 2012, three major upsurges of WNV cases were reported in the country. From the beginning of 2018 till the last week of November 2018, 377 suspected cases of West Nile fever were reported, of which 49 were confirmed by RT-PCR, with two related deaths. In comparison with the previous years, the number of suspected and confirmed cases reported in 2018 already exceeded previous year's number. This increased number of reported, suspected and confirmed cases compared to previous years, confirms the intensified circulation of WNV in the country.
5. Yellow Fever: South Sudan The Ministry of Health in South Sudan declared a yellow fever (YF) outbreak on 29 November 2018 in Sakure, Nzara County, Gbudue state (formerly Western Equatoria state). Following the reported suspect case, the Ministry of Health, with support from WHO and partners, deployed a rapid response team for in-depth investigations as well as sample collection. The confirmation of the case automatically triggered the activation of the YF incident management system (IMS) with an incident manager designated to coordinate response to this event, including risk communication, surveillance, and disease control to prevent further spread of the disease. It is not clear if the yellow fever virus infection was acquired in South Sudan or in the Democratic Republic of the Congo (DRC). There is no indication if the DRC health authorities have been alerted, given that the case comes from Sakure, a border town between the two countries. A swift response to this single case is important to determine the risk of ongoing transmission. The general public was urged to be vaccinated against yellow fever to protect themselves from the risk of yellow fever virus, nevertheless, an organised vaccination campaign would be the most effective response. What is concerning is that, within the four months preceding the case, there were reports of fake YF vaccination certificates being sold in South Sudan.
6. Measles: Southeast Asia, Europe, Americas There have been multiple outbreaks of measles reported across the globe in the past months. These outbreaks have been driven by low levels of vaccination amongst those infected. In the Philippines, the incidence of measles in Western Visayas was 170 cases, and three suspected deaths recorded as of 6 December 2018. There has been an even bigger outbreak of measles among the Haredi, an ultra-Orthodox Jewish community in Israel, the UK and in the USA. This community is known to have lower immunisation coverage than the general public in all these countries. In Israel, more than 1 400 cases have been reported to date since October, with roughly 60% of those infected coming from the Haredi sector. In the UK, close to 70 members of London's Orthodox Jewish community have been infected since October 2018. In the USA, 70 cases have been reported in New York since October to date, and 18 cases have been reported in New Jersey, mostly affecting the Haredi communities in these areas. In the Americas as of 30 November 2018, a total of 16 766 confirmed measles cases, including 86 deaths, has been reported in 12 countries of the region. Incidence of measles has increased in the Americas, largely also due to low levels of vaccination and importation from countries where measles is more prevalent.
Communicated by: National Institute for Communicable Diseases