Communicable Diseases Communiqué

Transcription

1 Communicble Diseses Communiqué JULY 2018, Vol. 17(7) CONTENTS Pge 1 ZOONOTIC AND VECTOR-BORNE DISEASES An updte on rbies in South Afric 2 b An updte on humn cses of Rift Vlley fever on frm in the Jcobsdl re, Free Stte Province 2 c A cluster of leptospirosis cses in Bushbuckridge, Mpumlng Province 3 2 FOOD-AND WATER-BORNE DISEASES An updte on the outbrek of Listeri monocytogenes, South Afric 3 b Foodborne outbrek mongst stff t hospitl in Guteng Province 5 c A cse of heptitis E in the Western Cpe Province 6 3 INTERNATIONAL OUTBREAKS OF IMPORTANCE Ebol virus disese outbrek, Democrtic Republic of Congo 7 4 SEASONAL DISEASES Influenz 7 5 AN OUTBREAK OF NECROTISING ENTEROCOLITIS AT A HOSPITAL IN GAUTENG PROVINCE An updte on the outbrek of necrotising enterocolitis of unknown etiology in bbies dmitted to neontl unit in Guteng Province, Mrch July SURVEILLANCE FOR ANTIMICROBIAL RESISTANCE Crbpenemse-resistnt Enterobctericee n updte 9 7 BEYOND OUR BORDERS 10 8 WHO-AFRO: OUTBREAKS AND EMERGENCIES 11 1

2 1 ZOONOTIC AND VECTOR-BORNE DISEASES An updte on rbies in South Afric A cse of rbies ws confirmed in n eight-yer-old boy from Cnzibe, Estern Cpe Province. A history of possible contct with rbid dog, six weeks before onset of illness, ws reported but the detils could not be verified. The child presented to n Estern Cpe hospitl with strnge violent movements, vomiting, hiccups, spsms nd hydrophobi. A single sliv ws collected for testing before the ptient demised. The smple tested positive for rbies by PCR nd sequencing. A totl of ten humn rbies cses hs been confirmed in South Afric for 2018 to dte. This includes five cses from KwZulu-Ntl nd five cses from the Estern Cpe (including the cse reported here) provinces. In ddition, two probble cses of rbies were reported from the Estern Cpe Province. These cses could not be confirmed through lbortory testing, but fulfilled the clinicl cse definition of rbies nd both cses hd history of exposure to likely rbid niml. The rise in the number of humn cses reported from the Estern Cpe nd KwZulu-Ntl coincides with the outbrek of rbies in dogs (nd cts) experienced in the two provinces. Rbies cn be prevented by ensuring vccintion of dogs nd cts, nd through prompt post-exposure prophylxis following possible exposure to rbid niml. For more informtion regrding rbies postexposure prophylxis, visit the NICD website: Source: Centre for Emerging Zoonotic nd Prsitic Diseses, NICD-NHLS; jnuszp@nicd.c.z b An updte on humn cses of Rift Vlley fever on frm in the Jcobsdl re, Free Stte Province Cses of Rift Vlley fever (RVF) were reported on 16 My 2018 in 250 sheep on frm in the Jcobsdl re of Free Stte Province by the Deprtment of Agriculture, Forestry nd Fisheries (DAFF). The disese cuses flu-like illness in most humns, but could progress in minority to either retinitis with permnent blindness, or severe forms like encephlitis or bleeding mnifesttions tht my led to deth. Initil epidemiologicl investigtion nd testing of humns living on the ffected frm, who were involved in hndling of potentilly infected nimls, reveled four confirmed cses of RVF, nd four probble cses, s reported in the June 2018 Communiqué. Further lbortory testing led to the confirmtion of RVF in the four probble cses. Retrospective testing of whole blood reveled the presence of RVF virl nucleic cid in three of the initil four cses. Sequencing studies hve been concluded nd further phylogenetic nlyses re underwy to determine the virl linege responsible for the 2018 outbrek. Six of the eight individuls confirmed to hve been infected with RVF virus reported history of mild flu-like illness. All confirmed cses underwent n ophthlmic exmintion but hd no signs of eye complictions. The outbrek remined limited to one frm, unlike the widespred epidemic which occurred in southern Afric during There is neither tretment nor vccine for people. The frmers in the re hve been dvised by DAFF to vccinte nimls to prevent further outbreks in the coming 2018/19 summer period. Individuls cn prevent exposure by wering protective clothing nd equipment (prons, gloves, msks, goggles) while working with infected nimls, or void hndling of nimls ll together during outbreks. Helthcre worker guidelines nd RVF cse investigtion forms re vilble from the NICD website, Source: Centre for Emerging Zoonotic nd Prsitic Diseses, NICD-NHLS (jnuszp@nicd.c.z) c A cluster of leptospirosis cses in Bushbuckridge, Mpumlng Province In 2012, study to identify zoonotic etiologies for cute dult febrile illness in the Mnisi community of Bushbuckridge, Mpumlng Province, ws initited within NICD. Adults over the ge of 18 yers presenting to three locl community clinics with fever were enrolled nd tested for number of zoonotic diseses, including leptospirosis. This surveillnce recently identified three cses of leptospirosis. The first ws identified in lte April 2018, subsequently, two more cses were identified in the month of June They presented with fever nd mlise. The dignosis ws confirmed on serology on ll three cses. All three responded well to ntibiotics nd there were no complictions. All the cses live in the sme villge in modertely close proximity to ech other. The sudden spike of positive cses nd the geogrphicl proximity cused concern, thus prompting n investigtion. Leptospirosis is zoonotic disese spred through the infected urine of nimls such s rodents, cttle, dogs nd pigs (Figure 1). In res where people nd nimls live in close proximity, the possibility for trnsmission of zoonotic diseses such s 2

3 leptospirosis is high. A 2015 systemtic review of leptospirosis in Afric found tht the prevlence in humns rnged from 2.3% to 19.8% in hospitl ptients with febrile illness. In South Afric, cses re spordic, with the most recent outbrek occurring in prison in Given the rrity of leptospirosis outbreks s well s the niml origin of disese, One Helth pproch to the investigtion ws undertken. The pproch integrtes humn, niml nd environmentl role plyers in coordinted, collbortive, multidisciplinry nd cross-sectorl pproch to ddress potentil or existing risks tht originte t the niml-humn-ecosystems interfce (Figure 2). The One Helth investigtive tem trvelled to the households of the cses in Bushbuckridge, with the im of collecting risk fctor nd environmentl exposure dt. A review of the households reveled opportunities for humn exposure to leptospirosis through niml contct, in prticulr rodents nd domestic nimls such s cttle nd dogs. Blood smples tken from household members of cses, nd nimls in their immedite environment s well s wter smples from their yrds were, however, negtive for leptospires. Regrdless of these results, wreness mong community members nd helthcre workers on the prevention nd recognition of zoonoses, including leptospirosis continues, to be provided. Source: Centre for Emerging Zoonotic nd Prsitic Diseses, Division of Public Helth Surveillnce nd Response, Mpumlng Provincil Epidemiology, NICD -NHLS; University of Pretori Fculty of Veterinry Science, nd Mpumlng Provincil CDC (johnf@nicd.c.z) Figure 1. Leptospirosis trnsmission cycle Figure 2. The One Helth trid 2 FOOD-AND WATER-BORNE DISEASES An updte on the outbrek of Listeri monocytogenes, South Afric The number of lbortory-confirmed listeriosis cses reported per week hs decresed since the outbrek source ws identified nd the implicted redy-to-et processed met products reclled on 04 Mrch 2018 (Figure 3). Since the recll, totl of 87 cses hs been reported. As of 20 July 2018, totl of lbortoryconfirmed listeriosis cses hs been reported to NICD since 01 Jnury Most cses hve been reported from Guteng Province (58%, 614/1 060) followed by Western Cpe (13%, 136/1 060) nd KwZulu-Ntl (8%, 83/1 060) provinces. Cses hve been dignosed in both public (64%, 680/1 060) nd privte (36%, 380/1 060) helthcre sectors. Outcome is known for 808/1 060 (76%) ptients of whom 217 (27%) hve died (Figure 4). Femles ccount for 56% (577/1 035) of cses where gender is reported. Where ge ws reported (n=1 039), ges rnge from birth to 93 yers (medin 18 yers) Figure 5. Neontes ged 28 dys ccount for 43% (443/1 039) of cses. Of neontl cses, 95% (423/443) hd erly-onset disese (birth to 6 dys). Although outbrek-relted cses hve declined shrply, spordic cses (i.e. not epidemiologiclly linked) continue to be reported, s expected. Therefore, helthcre workers re encourged to continue providing risk reduction guidnce to persons t high risk for developing listeriosis (pregnnt women, neontes 28 dys of ge, persons >65 yers of ge, nd persons with immunosuppression (due to HIV infection, cncer, dibetes, chronic renl disese, chronic liver disese, trnsplnttion nd immunosuppressive therpy)). Such guidnce 3

4 includes dvice on food hygiene (the World Helth Orgniztion s five keys to sfer food is useful resource for generic food hygiene dvice) nd voidnce of t-risk foods. Additionlly, the WHO dvises tht pregnnt women protect themselves ginst L. monocytogenes infection by: Avoiding high-risk foods, which re not cooked prior to eting. This includes smoked nd lightly preserved fish or sefood, unpsteurised milk nd its products (e.g. soft cheeses), pâté, nd prepred slds from stores; Cooking met nd poultry products, including rw, processed (e.g. hm, vienns, polony nd cold mets) nd leftovers thoroughly; nd Avoiding perishble foods tht re pst their consume before dtes. The joint WHO/RSA listeri incident mngement tem continues to co-ordinte ctivities to control nd end the listeriosis outbrek, nd to strengthen systems to prevent further outbreks. To dte, just under 900 environmentl helth prctitioners (EHPs) hve been trined in fctory inspection procedures, including specimen collection. A totl of 146 of 158 fcilities cross the country tht produce redy-to-et processed met products hs been inspected. Environmentl swbs were collected t 132 fcilities nd re being tested. Following the publiction of three importnt pieces of legisltion pertining to food sfety, plnning for the following ctivities is underwy including; ) publiction of terms of reference for food scientist nd legl expert; b) stkeholder workshop to gree on listeri levels; c) trining of EHPs in the hzrd nlysis nd criticl control points (HACCP) nd revised legisltion; nd d) survey of L. monocytogenes levels in redy-to-et foods to support proposed legisltion. Risk communiction ctivities continue to tke plce. Phse 3 of the Emergency Response Pln hs commenced with reporting nd consolidtion of helth system strengthening ctivities. Further resources on listeriosis cn be found on the NICD website t Diseses A-Z, under listeriosis Source: Centre for Enteric Diseses, nd Division of Public Helth Surveillnce nd Response, NICD Provincil Epidemiology Tems; NICD-NHLS; Provincil CDCs; (junot@nicd.c.z; outbrek@nicd.c.z) Figure 3. Epidemic curve of lbortoryconfirmed listeriosis cses by dte of clinicl specimen collection (n = 1 060) nd sequence type (ST) (n = 637) South Afric, 01 Jnury 2017 to 20 July Figure 4. Outcome of lbortoryconfirmed listeriosis cses by ge group South Afric, 01 Jnury 2017 to 20 July 2018 (n = 808, where outcome is known). 4

5 Figure 5. Age distribution of lbortoryconfirmed listeriosis cses by gender, South Afric, 01 Jnury 2017 to 20 July 2018 (n = 1 035, where gender is known). b Foodborne outbrek mongst stff t hospitl in Guteng Province On 30 My 2018, the NICD received n lert of suspected foodborne outbrek mongst stff t hospitl in Johnnesburg, Guteng Province. NICD crried out investigtions between 31 My - 04 June It ws estblished tht the reported illness my hve occurred s result of either stff lunch on 29 My or wter-cut t the hospitl from My A cse-control study ws conducted to determine the cuse nd source of the outbrek. Stff members completed cse investigtion form to estblish demogrphics, ny previous illness, ccess to drinking wter, bthroom usge nd detiled history of foods consumed t the stff lunch. Leftover food items nd self-dministered rectl swbs from cses were sent for microbiologicl testing. The City of Johnnesburg environmentl helth prctitioners conducted n environmentl investigtion. Of the 62 stff members who completed questionnire, 33 (53%) were identified s cses nd 29 (47%) stff members met the inclusion criteri s controls. The verge ge of the cses ws 38.4 yers (rnge: ). The mjority of cses (n= 26, 79%) were femles. From the epidemiologicl curve (Figure 6), the verge incubtion period ws 12.5 hours (rnge: 4-21). The most commonly reported symptoms mongst cses were dirrhoe (n=32, 96%) nd bdominl crmps (n=29, 90%) with illness selfresolving within hours. Logistic regression nlysis indicted tht stff who consumed beef lsgne were pproximtely 15 times more likely to develop symptoms compred to those tht did not consume beef lsgne [OR:14.8 (CI: )]. Microbiologicl testing of the food specimens indicted the presence of Clostridium perfringens in rosted vegetbles, enterotoxin-producing Bcillus cereus nd Pseudomons putid in threedish composite vegetble smple, C. perfringens nd non-dirrhoegenic Escherichi coli in beef stew nd C. perfringens nd Cronobcter skzkii in the beef lsgne. However, toxin screening ws not conducted on the C. perfringens. Microbiologicl investigtions on the self-dministered rectl swbs reveled no significnt findings, while environmentl investigtions were limited to only n inspection of the food preprtion fcility, which ws complint with ll regultions. Bsed on the epidemiologicl informtion (incubtion period, symptoms, durtion of illness), logistic regression nlysis nd food microbiology results, the source of the outbrek ws most likely indequtely reheted beef lsgne served t the lunch, with the custive pthogen the C. perfringens. Control mesures implemented included eduction of both the food hndlers nd hospitl mngement on the World Helth Orgniztion s five keys to sfer food with prticulr focus on reheting food to pproprite tempertures before consumption. Source: South Africn Field Epidemiology Trining Progrmme nd Division of Public Helth Surveillnce nd Response; NICD-NHLS (outbrek@nicd.c.z) 5

6 Notifiction According to the Ntionl Helth Act, 2003 (Act No. 61 of 2003), heptitis E is ctegory 2 notifible medicl condition nd should be notified through written or electronic notifiction to the Deprtment of Helth within 7 dys of dignosis by helth cre providers s well s privte nd public helth lbortories. Figure 6. Epidemic curve of foodborne outbrek mongst stff t hospitl in Johnnesburg, Guteng, Province, My 2018 (n=33) c A cse of heptitis E in the Western Cpe Province In July 2018, cse of heptitis E ws reported in the Western Cpe Province in 56-yer-old femle helthcre worker. She first presented on 07 June 2018 with vomiting nd bdominl pin. The dignosis of heptitis E virus (HEV) ws confirmed with serology. The ptient ws treted conservtively nd hs since recovered fully from the episode. HEV Epidemiology nd trnsmission Heptitis E virus (HEV) cuses n cute heptitis syndrome. It is spred by the feco-orl route, typiclly through contminted wter, but incresingly lso through contminted food, nd in prticulr pork nd shellfish. Uncommon routes of trnsmission include bloodborne nd verticl trnsmission. Unlike heptitis A, person-to-person trnsmission is uncommon. People t risk include those whose work ctivities include hndling food, working in dult or child cre centres, s well s helthcre workers. Although HEV infections hve been reported worldwide, the highest incidence is in Asi, Afric, Middle Est nd Centrl Americ. In South Afric, two studies conducted in the 1990s described seroprevlence rtes of 10.7% nd 1.8%-2.6% of heptitis E, respectively. More recently, 2016 study done in the Western Cpe Province showed heptitis E seroprevlence of 27.9%, which is considerbly higher thn previously thought. In recent outbrek in Nmibi, which strted in December 2017, cses were confirmed in the cpitl Windhoek. Subsequently 15 people hve died, six of which were pregnnt women. An outbrek response review by the country s Ntionl Helth Emergency Ntionl Committee is scheduled for mid-july Clinicl fetures of HEV The incubtion period of HEV infection rnges from dys, with n verge of 5 6 weeks. Asymptomtic infection cn occur. Symptoms of cute HEV infection include fever, ftigue, jundice, nuse, dirrhoe, vomiting, bdominl pin nd heptomegly. HEV infection is cliniclly indistinguishble from disese cused by heptitis A virus. Usully the disese is self-limiting, but fulminnt heptitis in pregnnt women nd ptients with chronic liver disese cn occur. Dignosis nd clinicl mngement Dignosis is bsed on detecting ntibodies to heptitis E virus in serum through immunossys. In South Afric the Ntionl Helth Lbortory Service (Brmfontein lbortory nd the Tygerberg lbortory), s well few privte sector lbortories (including Lncet nd Pthcre) offer serologicl testing for heptitis E ntibodies (IgG nd IgM). The reverse trnscription polymerse chin rection (RT-PCR) test tht detects virl RNA cn be done t the Tygerberg virology lbortory, but it is generlly not routinely performed in the country. There is no specific tretment vilble for cute heptitis E, nd the infection usully resolves on its own. In severe cses, hospitlistion will be required. Specific ntivirl therpy my be considered in high risk ptients. Source: Division of Public Helth Surveillnce nd Response; NICD-NHLS (outbrek@nicd.c.z) 6

7 3 INTERNATIONAL OUTBREAKS OF IMPORTANCE Ebol virus disese outbrek, Democrtic Republic of Congo The Ebol virus disese (EVD) outbrek tht ws notified on 08 My 2018 in the Democrtic Republic of Congo (DRC), hs been declred over. On 24 July 2018, the Ministry of Helth of the DRC declred the end of the ninth outbrek of EVD in the country. The nnouncement comes 42 dys (two incubtion periods) fter blood smples from the lst confirmed Ebol ptient twice tested negtive for the disese. No new lbortory-confirmed EVD cses hve been detected since the lst cse developed symptoms on 02 June As of 24 July 2018, there hs been totl of 54 EVD cses (38 confirmed nd 16 probble), with illness onset between 05 April nd 02 June Of these cses, 33 died (overll cse ftlity rtio: 61%), including 17 deths mong confirmed cses. Cses were reported from three helth zones: Bikoro (n=21; 10 confirmed, 11 probble), Iboko (n=29; 24 confirmed, 5 probble) nd Wngt (n=4; ll confirmed). Seven cses were helthcre workers, of which two died. The WHO recommends the implementtion of proven strtegies for the prevention nd control of EVD outbreks. These include (i) strengthening the multi -sectorl coordintion of the response, (ii) enhnced surveillnce, including ctive cse finding, cse investigtion, contct trcing nd surveillnce t points of entry (PoE), (iii) strengthening dignostic cpbilities, (iv) cse mngement, (v) infection prevention nd control in helth fcilities nd communities, including sfe nd dignified burils, (vi) risk communiction, socil mobiliztion nd community enggement, (vii) psychosocil cre (viii) immuniztion of risk groups nd reserch response, nd (ix) opertionl support nd logistics. Current Risk ssessment The ltest WHO ssessment concluded tht the current Ebol virus disese outbrek hs been contined. Under the Consolidtion nd Stbilistion Strtegic Pln dopted by the Ministry for Helth, enhnced surveillnce, progrm for long-term Ebol survivor cre nd other response mechnisms remin in plce following the end of the outbrek declrtion, to mintin incresed vigilnce nd contribute to the strengthening nd resilience of the helth system. WHO considers the public helth risk ssocited with the recent Ebol virus disese outbrek to be low t ntionl, regionl nd globl levels. Ebol virus disese is, however, endemic in the DRC, nd my re-emerge t ny time. Sitution in South Afric As t 24 July 2018, there hve been no EVD cses in South Afric ssocited with the outbrek in the DRC. In ddition, there re no suspected cses of EVD in South Afric t present. More informtion bout the outbrek nd the ssocited continment efforts is vilble t Source: Division of Public Helth Surveillnce nd Response (outbrek@nicd.c.z); WHO: 4 SEASONAL DISEASES Influenz The 2018 influenz seson, which strted in week 18 (first week of My) continues, lthough the number of specimens per week submitted by Virl Wtch sites hs strted to decline. Since the beginning of April, totl of 373 influenz detections hs been mde, the mjority of which hve been influenz A(H1N1)pdm09 which ws detected in 353 (95%) of ptients. This ws the strin tht emerged globlly in 2009, nd which for the pst eight yers hs circulted sesonlly. Ptients infected with this strin should be treted like ny other sesonl influenz cse. There is no requirement to report or notify individul cses of this strin of influenz. In ddition, influenz A(H3N2) hs been detected in four nd influenz B in 13 ptients, nd three influenz A detections re unsubtyped, due to low virl lod. Although the seson hs strted to decline, it is never too lte to vccinte s long s influenz is still circulting in the community, nd individuls who hve not received influenz vccine for 2018, especilly those who re t risk of developing severe influenz illness or complictions, re encourged to get vccinted. Recommendtions on trget groups, dosges nd contrindictions for the 2018 influenz vccine, nd influenz ntivirl tretment re vilble in the 2018 influenz guidelines, vilble t April-2018.pdf Source: Centre for Respirtory Diseses nd Meningitis, NICD-NHLS; (cherylc@nicd.c.z) 7

8 Figure 7. Virl Wtch 2018: Number of positive smples by influenz types nd subtypes nd detection rte* *Only reported for weeks with >10 specimens submitted. Ptients known to hve cquired influenz brod or from contct with trvellers re not included in the epidemiologicl curve. 6 AN OUTBREAK OF NECROTISING ENTEROCOLITIS AT A HOSPITAL IN GAUTENG PROVINCE An updte on the outbrek of necrotising enterocolitis of unknown etiology in bbies dmitted to neontl unit in Guteng Province, Mrch July 2018 An outbrek of necrotising enterocolitis (NEC) in Guteng hospitl ws reported to the NICD in April 2018 [NICD Communiqué My nd June 2018]. The number of cses hs declined since June Four new cses including one deth hve been reported between 20 June to 20 July 2018 (Figure 8). The decline could be ttributed to the intervention mesures put in plce in mid-my following the infection prevention nd control (IPC) udits nd environmentl helth ssessment recommendtions. The mesures implemented includes the isoltion of NEC cses in one isoltion room, eduction on hnd hygiene nd emphsis on strict dherence to IPC prctices by helth professionls, cleners nd the mothers, reduction of stff movement nd overcrowding in the wrd by reducing the number of rotting students, providing necessry resources needed for IPC dherence (e.g. hnd scrubs). As of 20 July 2018, cumultive totl of 41 NEC cses, including 37 (90%) premture nd four (10%) full-term bbies hs been reported, of which nine died (22%). The gesttionl ge (GA) t birth rnged from 26 to 40 weeks (medin: 32; IQR: 29-35). The ge of the cses t the dte of disese onset rnged from 2 to 59 dys (medin: 12; IQR: 7-21). Children under 1-month old (n=37) ccounted for 90% of the cses. Despite testing blood nd stool smples, the etiology of the outbrek hs not been identified. Milk formul testing reveled the presence of Bcillus nd Streptococcus species in mixed nd dry powder milk; however, toxin production tests were not done. Investigtions re ongoing to identify the source nd the etiology of this outbrek. Source: Division of Public Helth Surveillnce nd Response nd Centre for Helthcre-ssocited infections, Antimicrobil Resistnce nd Mycoses, NICD- NHLS; Clinicins t hospitl in Guteng Province; outbrek@nicd.c.z Figure 8. Epidemiologicl curve showing the number of NEC cses by dte of disese onset, 1 Mrch 20 July (*Where dte of onset ws not known, dte of dignosis ws used s proxy (n=1)). 8

9 6 SURVEILLANCE FOR ANTIMICROBIAL RESISTANCE Crbpenemse-resistnt Enterobctericee n updte The Antimicrobil Resistnce Lbortory nd Culture Collection (AMRL-CC) of the Centre for Helthcressocited infections, Antimicrobil Resistnce nd Mycoses (CHARM) t the NICD hs been testing referred isoltes of suspected crbpenemseproducing Enterobctericee (CPE) for the presence of selected crbpenemses. CPE hs become thret to helthcre nd ptient sfety worldwide by compromising empiric ntibiotic therpeutic choices nd incresing morbidity, hospitl costs nd the risk of deth. We re receiving cliniclly significnt isoltes from ll specimen types bsed on ntimicrobil susceptibility testing criteri for moleculr confirmtion. For the period Jnury-June 2018, totl of 839 Enterobctericee isoltes ws processed. Tble 1 shows brekdown per orgnism type nd genotype. The mjority of the isoltes were Klebsiell pneumonie (n=553, 66%) followed by Enterobcter cloce (n=131, 16%). Crbpenemeses were expressed in 723 (86%) isoltes nd the predominting crbpenemse ws OXA-48 nd its vrints (n=537, 64%). One hundred nd twentsix isoltes (15%) expressed combintion of crbpenemses s follows: OXA-48 nd its vrints nd NDM, n=113; OXA-48 nd its vrints nd VIM, n=3; OXA-48 nd its vrints nd GES, n=3; OXA-48 nd its vrints nd KPC, n=1; NDM nd VIM, n=4 nd NDM nd GES, n=2. Source: Centre for Helthcre-ssocited infections, Antimicrobil Resistnce nd Mycoses, NICD-NHLS; olgp@nicd.c.z Tble 1. Enterobctericee by orgnism nd crbpenemse type, Jnury -June 2018 Orgnism Type Number of isoltes per orgnism type OXA-48 & Vrints NDM VIM GES KPC Citrobcter mlonticus Citrobcter freundii Enterobcter erogenes Enterobcter sburie Enterobcter cncerogenus Enterobcter cloce Enterobcter kobei Enterobcter ludwigii Escherichi coli Klebsiell oxytoc Klebsiell plnticol Klebsiell pneumonie Klebsiell vriicol Leclerci decrboxylt Morgnell morgnii Proteus mirbilis Proteus vulgris Providenci rettgeri Roultell ornithinolytic Serrti mrcescens Totl GES: Guin extended-spectrum bet-lctmse; KPC: Klebsiell pneumonie crbpenemse; NDM: New Delhi metllo-bet-lctmse; VIM: Veron integron-encoded metllo-bet-lctmse; OXA: oxcillinsetype crbpenemse. The metllo-bet-lctmse, imipenemse (IMP) ws not expressed in ny of the isoltes. 9

10 7 BEYOND OUR BORDERS The Beyond our Borders column focuses on selected nd current interntionl diseses tht my ffect South Africns trvelling brod. Numbers correspond to Figure 9 on pge Rift Vlley fever: Ugnd An outbrek of Rift Vlley fever (RVF) hs been reported in the month of July in Ugnd. As of 17 July 2018, there hs been eight cses (six confirmed nd two suspected), including three deths (CFR: 42%). The six confirmed cses were reported from five different districts: one from Ksese, two from Isingiro, one from Ibnd, one from Mbrr nd one from Sembbule district. The disese rnges from mild flu-like illness to severe hemorrhgic fever tht cn be lethl mong humns. The outbrek my be relted to recent flooding nd stnding wter enbling higher number of mosquito eggs thn usul to htch nd thus incresed the potentil for RVF to spred mong people nd nimls. 2. Typhoid fever: Pkistn In the pst six months, more thn people in Pkistn hve been infected with extensively drugresistnt (XDR) Slmonell enteric serotype Typhi. The first report of cses occurred erly in Only one orl ntibcteril, zithromycin, works ginst the XDR strin, nd the other options, expensive intrvenous (IV) drugs, re imprcticl for widespred use in Pkistn nd other low-income ntions. There is concern regrding spill-over into neighbouring countries. A vccintion cmpign ws initited in Februry 2018 using recently pproved formultion tht works in young children nd triggers longer-lsting immunity thn older versions. 3. Choler: Nigeri, Cmeroon, Congo DR, Republic of the Congo The Centrl nd West Africn regions re fcing choler outbrek tht hs infected over people in Nigeri, Cmeroon, the Democrtic Republic of Congo (DRC), nd Congo-Brzzville (Republic of the Congo). Six people hve died in Cmeroon from the outbrek tht hs infected 43 people since My In Nigeri, 20 persons hve died in bout 181 cses recorded since choler outbrek hit some prts of Ktsin stte in the lst two weeks of July Mesles: EU/EEA According to the ltest Communicble Diseses Threts Report (CDTR), the outbrek of the mesles virus continues cross EU/EEA countries. Countries tht hve reported the highest number of mesles virus cses in 2018 include: Romni, 4 317; Frnce, 2 588; Greece, 2 238; nd Itly, Since the strt of the yer (2018), there hve been 31 reported deths cross the region due to mesles. There re only four EU/EEA countries tht hve mnged to rech the 95% trget for both the 1st nd 2nd doses, which hs shown tht more ction is needed to combt this growing issue of risk perception. 5. Influenz: Nmibi There hs been n increse in cses reported in Nmibi of the influenz A(H1N1) virus. The first cse ws reported in June Subsequently, 70 cses hve been lbortory-confirmed, 35 of which re from Windhoek; 24 from Okhndj; six from Rehoboth; two from Gobbis, nd one ech from Arnos, Ondngw, nd Ktim Mulilo. Of the 70 cses, 28 re children ged 5 yers nd younger; 10 re children ged between 5 nd 9 yers, nd 32 cses rnge between the ges of 10 nd 80. The best protection ginst H1N1 is the sesonl flu vccintion. Source: ( nd the World Helth Orgniztion ( Figure 9. Current outbreks tht my hve implictions for trvellers. Numbers correspond to text bove. The red dot is the pproximte loction of the outbrek or event. 10

11 Communicble Diseses Communiqué 8 JULY 2018, Vol. 17(7) WHO-AFRO: OUTBREAKS AND EMERGENCIES Figure 10. The W eek ly W HO Outbrek nd Em ergencies B ulletin focuses on selected public helth emergencies occurring in the WHO Africn Region. The Africn Region WHO Helth Emergencies Progrmme is currently monitoring 54 events, of which 45 re outbreks nd 9 humnitrin crises. For more informtion see link: 11