MEDICAL ALERT 27th June 2018

Congo (DRC): Ebola outbreak in Bikoro

Since the beginning of April, more than 50 suspected, probable or confirmed cases have been identified in Bikoro, Iboko, Ntondo and Wangata (an area in the city of Mbandaka) health zones in Equateur province.


Of the total, over 35 cases have been confirmed. Five of them are healthcare workers. At least 25 people have died in this outbreak. Over 900 contacts in Bikoro, Iboko and Mbandaka are under surveillance


A coordinated response with Medecins Sans Frontieres, local and international health authorities is underway. Ebola is spread by contact with the blood or other bodily fluids (especially vomit and diarrhoea) of infected or dead people. Healthcare workers, household members and people participating in traditional funeral practices (touching the body) are at high risk

Angolan authorities will increase surveillance of persons crossing into Luanda Sul province.
Kenya is screening all travellers at Jomo Kenyatta International Airport, Busia and Malaba border points for fever.
Nigerian authorities have also stepped up screening measures at all airports and land border points. All incoming travellers will be screened, particularly those from DRC and its neighbouring countries.

Ebola is persistently present in the DRC. This is the ninth outbreak recorded since the discovery of the virus in 1976.


 Nigeria: Lassa Fever

An outbreak of Lassa fever, which began in December 2016, continues. Although the number of new cases is declining, at least 10 states are still affected. Contacts remain under monitoring in other states. Lassa fever is a viral haemorrhagic fever. Humans can be infected via contact with excretions from infected rodents. During outbreaks, the disease can spread to people who have direct contact with the body fluids of an infected person.

Cases accelerated alarmingly in the beginning of 2018, affecting at least 21 states at peak. The southern states of Edo, Ondo and Ebonyi have reported most of the cases this year. Lassa fever case management centres are operational in all three of those states. Some cases have been exported from Nigeria and have been identified in Benin.

The Nigerian Centre of Disease Control (NCDC) is assisting several states in their response and surveillance activities. The Ministry of Health has implemented a rapid response and raising awareness in healthcare workers to use appropriate infection control procedures.


Congo (DRC): Polio cases

More than 20 cases of polio  Polio cases due to a strain of “circulating vaccine-derived poliovirus” (cVDPV) continue to be detected. The outbreak has been ongoing since February 2017, cases have been confirmed in Haut Katanga, Haut Lomani, Maniema and Tanganika provinces. The cVDPV strain can emerge in under-vaccinated populations.


On 13 February, the Ministry of Health declared a national public health emergency for the ongoing cVDPV2 outbreak. Surveillance has been increased and polio vaccination campaigns are being conducted in at risk health districts to limit the spread of disease


Polio is a contagious viral illness that causes paralysis and death. The infection is spread through ingestion of contaminated food or water, or directly from an infected person


United States, Canada: Multistate E. Coli Outbreak

Since March, over 140 cases of E. coli O157:H7 have been identified in more than 25 states: Alaska, Arizona, California, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota,Mississippi, Missouri, Montana, New Jersey, New York, North Dakota, Ohio, Pennsylvania, South Dakota, Tennessee, Texas, Utah, Virginia, Washington and Wisconsin. Pennsylvania and California have recorded the highest number of cases. Around half of all cases have required hospitalisation and at least seventeen people developed “haemolytic uraemic syndrome” (HUS), a severe complication with kidney failure. One death has been reported from California

The United States Centers for Disease Control and Prevention (CDC) has advised consumers to avoid any romaine lettuce from Yuma, Arizona. (Initially only chopped romaine lettuce from the Yuma, Arizona region was considered the likely source.) To date, no specific grower, supplier, distributor, or brand has been identified however, investigations are continuing. The CDC are advising people in the United States to discard of store-bought romaine lettuce or salad mixes containing romaine lettuce if they do not know its origins. Ensure lettuce bought at a store, or eaten at a restaurant, does not originate from the Yuma, Arizona growing region


Kiribati: Dengue Fever

An increase in dengue-like illness has been noted in the island nation. Dengue is known to occur in Kiribati. The disease is spread by mosquitoes, and is present in both rural and urban areas. Dengue can cause a range of symptoms and has no particular treatment.


Costa Rica: malaria

A traveller from the United States was infected with malaria while visiting Costa Rica in April. Historically, Costa Rica has been considered lower risk for malaria infections. None were reported between 2013-2016, and then just 13 cases were reported 2016-2017. All of those were the less serious P. vivax strain of the disease, and occurred in northern Costa Rica. This recent case was the more serious P. falciparum strain, and occurred in the Osa Peninsula, an area in the southern part of Puntarenas province


Preventative malaria medication is now recommended for travel to that area. Previously, the recommendation had been to avoid mosquito bites and be aware of malaria symptoms – both of which remain important even when travellers are taking malaria medicines. Malaria is spread through mosquito bites and can be fatal unless promptly treated


 Japan: Measles outbreak

A measles outbreak that began in late March has now infected at least 95 people in Okinawa. A few cases in Nagoya are linked to this outbreak and at least one in Tokyo. Measles is caused by a highly contagious virus that spreads from person-to-person via infectious droplets.


All travellers should ensure they are fully immunised against measles


Most of the people infected in this outbreak are between 20 and 49 years old, and had either not been vaccinated or have an unknown vaccination status. Health officials are monitoring the situation and encouraging people to get vaccinated. The virus could spread further in Japan and beyond, particularly in the upcoming vacation “Golden Week” during which many people travel


United States: Volcanic activity

Activity at the Kilauea volcano, Big Island, has increased significantly since the beginning of the month. A local state of emergency has been declared and mandatory evacuation order issued for residents in Halekamahina Loop Road, Leilani Estates and Lanipuna Gardens Subdivisions in the Puna district. Vacation homes in lower Puna district have been closed. ‘Vog’ or visible haze caused by volcanic particles and gases released can cause health effects on eyes, throat, skin and respiratory system.


Dangerous levels of sulphur dioxide gas have been detected in affected areas which include – Kaupili, Kuhukai, Kupono, Leilani, Luana, Makamae, Malama and Mohala streets and Pohoiki road in Leilani Estates. The gas is emanating from fissures (cracks in the ground) and more such vents are likely to develop in the next few days. Frequent tremors continue to occur. Additionally, an eruption may occur at the summit of Kilauea volcano, sending boulders hurtling in the immediate vicinity and spewing ash over a 12 mile (19km) area. Most of the Hawaii Volcanoes National Park has been closed indefinitely.


Vanuatu: Volcanic activity

A state of emergency has been declared in Ambae Island after an increase in volcanic activity. Heavy ashfall has caused damage to infrastructure; water and food have also been affected. Volcanic ash and gases released can cause health effects on eyes, throat, skin and respiratory system.


The Volcanic Alert scale marks the activity at Level 3 on a scale of 5. A 3-km restricted zone around the active vent has been identified. The government has reportedly ordered the permanent relocation of Ambae’s 11,000 residents, likely to the neighbouring islands of Maewo and Pentecost (both Penama).


New Caledonia (France): Dengue fever outbreak

An outbreak of dengue fever was declared on 22 February. Since the start of 2018, more than 900 cases have been detected nationwide. Health authorities are taking action to reduce mosquito breeding grounds and educate the public

All areas are affected, including Noumea. The disease is spread by mosquitoes, and is present in both rural and urban areas.


Yemen: Diphtheria outbreak

Over 1,725 cases including at least 91 fatalities have been reported from 20 governorates since October 2017 in several provinces Most of the cases have been reported from Ibb followed by Al Hudaydah. Most of the infected are in the age group of 5-14 years. Diphtheria is a serious, potentially fatal, bacterial infection. The disease is highly contagious and spreads when infected people cough or sneeze droplets into the air. A booster vaccine is recommended every ten years as an adult or if travelling to an area where diphtheria is widespread. Prevention is by vaccination.


The World Health Organization is providing support to the Ministry of Public Health and Population (MoPHP), UNICEF and other health agencies.

Mali: Measles outbreak

An increase in measles activity has been reported in the country. The disease is caused by a highly contagious virus that spreads from person-to-person via infected droplets. Outbreaks occur frequently in under-vaccinated populations. Common symptoms include fever, cough and a characteristic rash. Measles can result in serious complications, particularly when very young children, the elderly or pregnant women are infected. All travellers should ensure they are fully immunised against measles

In the period between 1 January 2018 and 29 April 2018, more than 850 cases of measles were reported including at least 246 confirmed cases. Affected areas include Bougouni, Koutiala, Kolondieba in Sikasso; Tombouctou; Dioila and Kalabancoro in Koulikoro; and Taoudenit regions.


Réunion (France): Rise in dengue

An outbreak of dengue fever is underway. The disease is spread by mosquitoes, and is present in both rural and urban areas. Dengue symptoms include fever, headache, muscle aches and sometimes a rash. Some people, especially those who have been infected before, get a more severe form that can lead to fatal complications. Prevent infection by avoiding mosquito bites. Over 2,980 cases of dengue have been reported since the beginning of the year, more than half of which were recorded in the month of April. The cumulative total cases reported this year are already higher than the annual case counts seen in Reunion in recent years.

Although the majority of this year’s infections have been in the western parts of the island, risk exists island wide. Cases have been reported in more than half of the country’s cantons. The outbreak is expected to continue for several more months, as the weather is favourable for mosquito breeding and survival on the island, and it may expand to other areas. The most prevalent circulating virus is dengue type 2.

Authorities have raised their emergency level to increase mosquito-control efforts, expand communications with residents and healthcare workers, and mobilise additional resources


Somalia: Cholera outbreak

There is an ongoing cholera outbreak in the regions of Banadir, Hiran, Lower Juba, Lower Shabelle and Middle Shabelle. The Banadir region includes the city of Mogadishu, Somalia’s capital. Cholera is endemic in Somalia and spreads via contaminated food and water

Over 2,960 cases of cholera including at least 17 deaths have been reported since December 2017.  Due to lack of safe drinking water and uncontrolled movement of people, the outbreak, which began in the Beletweyne district of the Hiran region, has spread across 16 districts in the Banadir region. The Banadir region is highly populated and includes the capital city of Mogadishu. Cases have also been reported in the regions of Lower Juba, Lower Shabelle and Middle Shabelle.


Micronesia: Mumps outbreak

An outbreak of mumps is ongoing in Chuuk state. Mumps is caused by a virus that spreads from person-to-person via infected droplets. It is highly contagious and nearly all cases occur among unvaccinated people


Vanuatu: Mumps

More than 460 cases have been reported across four provinces; Shefa, Sanma, Penama and Malampa.  Mumps is caused by a virus that spreads from person-to-person via infected droplets. It is highly contagious and nearly all cases occur among unvaccinated people

Health authorities have implemented awareness programmes in schools and communities


Venezuela: Deteriorating health infrastructure

The political and economic crisis affecting Venezuela has adversely affected Venezuela’s heath infrastructure and has led to Venezuela being classified as high medical-risk country. Both the public and private medical systems can now provide only basic medical care; moderate and severe medical conditions may require international evacuation.


In Venezuela supplies of electricity, clean water, medicines and medical equipment are now unreliable or in short supply. Social disruption can affect access to medical facilities. In addition, disease control programs are less effective. Typhoid, cholera, dengue fever and malaria may pose an increased threat.


India: Nipah virus cases in Kerala

To date, at least 15 confirmed and many suspected cases of Nipah virus infection have been reported. Over 10 fatalities have occurred, including a nurse who cared for Nipah patients. The cases have been reported mainly from the Kozhikkode district of Kerala. There are confirmed (and suspected) cases in the districts of Malappuram and Kozhikkode

Unconfirmed reports indicate that several other people who had contact with the nurse developed Nipah.

The cause of outbreak has not yet been established. Nipah is a viral disease transmitted by various species of fruit bats. The infection may also spread by direct contact with infected animals, infected humans and consumption of palm fruit or its juice contaminated by fruit bats

Cameroon: monkeypox cases

At least seven people in Cameroon are thought to have monkeypox, Cases have been reported in two different areas. Initial investigations show the first person infected in the current outbreak may have had contact with a gorilla before becoming ill. People can contract the virus from an infected animal. They may be bitten or come into contact with an infected animal’s skin, blood or body fluids. Infected people can pass on the disease to others. There is no monkeypox vaccine

Early investigation shows the index case, who works in a game park, may have handled a gorilla three weeks before becoming ill. Investigations are ongoing


Kenya: Cholera outbreak

The country has been experiencing a cholera epidemic since October 2016. However, there has been an increase in activity since January 2018, with over 3,200 cases and at least 60 deaths reported in 2018. Active transmission is ongoing in several parts of the country, including Garissa, Isiolo, Meru, Nairobi, Turkana and West Pokot counties


Seychelles: Dengue outbreak

Dengue is known to occur in Seychelles, but a significant uptick in transmission was noted since late April. Overall, around 5,000 cases have been recorded since the beginning of the outbreak of which at least 1,400 have been confirmed , All regions of the islands, Mahe, Praslin and La Digue have reported cases.


Nigeria: Meningitis cases

Nationally, more than 3,300 suspected cases of meningitis, including some confirmed, have been reported since September 2017. Approximately 70% of the country. Meningococcal meningitis is a serious bacterial infection that can be rapidly life-threatening. It spreads from person-to-person via infected droplets.

Much of Nigeria lies in the ‘meningitis belt’ of Africa, and outbreaks of meningococcal meningitis are common, especially during the dry season (December through to June).

Mauritius: Measles

Since March 2018, at least 40 cases of measles have been confirmed. Most of the cases have been reported from the north and north west of the island. Children between the ages of 0-15 years have been most affected

Measles is caused by a highly contagious virus that spreads from person-to-person via infected droplets


Nigeria: Cholera outbreak

In Borno, over 700 suspected cases of cholera have been reported and also in Adamawa, Bauchi, Borno and Yobe States, some of which have been confirmed on testing. Kukawa Local Government Area (LGA) is most affected. Half of all cases are in children under 5 years old. Authorities are responding by improving water supplies and sanitation, setting up treatment facilities, and educating the public on preventive measures.


Outbreaks of cholera. Cholera spreads via contaminated food and water


Tanzania: Cholera outbreak continues

A sharp increase in cases has been noted since mid-April.  The regions of Arusha, Rukwa and Songwe are affected, with a sharp rise in cases exacerbated by heavy seasonal rains. Zanzibar island has not had any cases in 2018 .Cholera spreads via contaminated food and water


Uganda: Anthrax outbreak

More than 80 suspected cases of cutaneous anthrax have been reported in Arua, Kiruhura, Kween and Zombo districts. The highest number of cases have been recorded in Kween district. In response, authorities are implementing measures to stop the spread and urging locals not to eat the meat of dead animals or handle skin carcasses. Anthrax is a potentially fatal bacterial disease that spreads to people through contact with infected animals or their products