1 Epidemiology and Response Datapack 27 July 2016
2 Zika Virus Yellow Fever Other Events
3 Epidemiology Zika Virus Highlights In Spain, the first baby born with microcephaly linked with in-utero Zika infection has been reported. This microcephaly case was posted on the Situation Report published on 26 May 2016. It was first diagnosed at the mother s 20-week scan and she decided to continue with the pregnancy. One country and one territory have reported mosquito-borne Zika virus transmission. These are Antigua and Barbuda and Turks and Caicos (an overseas territory of United Kingdom). 2 non travel-related Zika infections, and therefore possibly mosquito-borne, are currently being investigated in Florida, USA. 1 case of Zika virus infection whose mode of transmission is currently being investigated was reported in the USA. She is a family contact of an elderly man who died in June. The latter s blood was found to have high amounts of Zika virus, more than 100 000 times higher than what can be found from samples of infected people.* 3 samples were confirmed for Zika virus in Guinea-Bissau, and an additional sample from a symptomatic case was sent to IPD for gene sequencing (total: 4 samples). 2 suspect cases of GBS are under investigation in Grenada laboratory confirmation for Zika is still pending and historical data for GBS has been requested by NFP. 1 suspect case of GBS is also under investigation in Saint Vincent and the Grenadines. 1 additional case of microcephaly associated with Zika virus is under investigation in El Salvador. 4 microcephaly cases and 2 GBS are under investigation in Guatemala. Risk assessment: overall no change Issues and next steps A WHO assessment mission to Guinea-Bissau to identify priority activities to strengthen response capacity is planned.
4 Zika Virus Situation Summary As of 27 July 2016, 67 countries and territories have reported evidence of vector-borne Zika virus transmission since 2007 (64 of these countries and territories have reported evidence of vector-borne Zika virus transmission since 2015): Mosquito-borne transmission: 50 countries and territories countries and territories with a first reported outbreak from 2015 onwards 4 countries are classified as having possible endemic transmission or have reported evidence of local vector-borne Zika infections in 2016. 13 countries and territories reported evidence of local vector-borne Zika infection before 2015, but without documentation of cases in 2016, or with outbreak terminated Person-to-person transmission: 11 countries and territories have reported evidence of person-to-person transmission of Zika virus, probably via a sexual route. 13 countries and territories have reported microcephaly and other fetal malformations potentially associated with Zika virus infection or suggestive of congenital infection (infections occurred in 13 countries and territories). 15 countries and territories worldwide have reported an increased incidence of Guillain-Barré syndrome (GBS) and/or laboratory confirmation of a Zika virus infection among GBS cases, in the context of Zika virus circulation.
5 Definitions Category 1: Countries with a first reported outbreak from 2015 onwards A laboratory confirmed, autochthonous, vector-borne case of Zika virus infection in an area where there is no evidence of circulation of the virus in the past (prior 2015), whether it is detected and reported by the country itself or by another state party diagnosing returning travellers OR A laboratory confirmed, autochthonous, vector-borne case of Zika virus infection in an area where transmission has been previously interrupted. The assumption is that the size of the susceptible population has built up to a sufficient level to allow transmission again; the size of the outbreak will be a function of the size of the susceptible population OR An increase of the incidence of laboratory confirmed, autochthonous, vector-borne Zika virus infection in areas where there is on-going transmission, above two standard deviations of the baseline rate, or doubling the number of cases over a 4- week period. Clusters of febrile illnesses, in particular when epidemiologicallylinked to a confirmed case, should be microbiologically investigated. Category 2: Countries with possible endemic transmission or evidence of local vector-borne Zika infections in 2016 with the reporting period beginning in 2007 Category 3: Countries with evidence of local vector-borne Zika infections in or before 2015, but without documentation of cases in 2016, or outbreak terminated with the reporting period beginning in 2007 Countries or territories that have reported an outbreak with consistent presence of laboratory confirmed, autochthonous, vector-borne cases of Zika virus infection 12 months after the outbreak OR Countries or territories where Zika virus has been circulating for several years with consistent presence of laboratory confirmed, autochthonous, vector-borne cases of Zika virus infection or evidence of local vector-borne Zika infections in 2016. Reports can be from the country or territory where infection occurred, or from a third party where the case is first recorded according to the International Health Regulations (IHR 2005). Countries with evidence of infection prior to 2007 are listed in http://www.who.int/bulletin/online_first/16-171082.pdf Absence of confirmed cases over a 3-month period in a specific geographical area with climatic conditions suitable for year-round arbovirus transmission, or over a 12-month period in an area with seasonal vector activity.
6 Classification of Zika virus transmission in countries where cases have been reported since 2007 Classification Category 1: Countries with a first reported outbreak from 2015 onwards WHO Regional Office Country / territory / area Total AFRO Cabo Verde; Guinea-Bissau 2 Anguilla; Antigua and Barbuda; Argentina; Aruba; Barbados; Belize; Bolivia (Plurinational State of); BONAIRE, SINT EUSTATIUS and SABA Netherlands*; Brazil; Colombia; Costa Rica; Cuba; Curaçao; Dominica; Dominican Republic; Ecuador; El Salvador; AMRO/PAHO French Guiana; Grenada; Guadeloupe; Guatemala; Guyana; Haiti; Honduras; Jamaica; Martinique; Mexico; Nicaragua; Panama; 42 Paraguay; Peru; Puerto Rico; Saint Barthélemy; Saint Lucia; Saint Martin; Saint Vincent and the Grenadines; Sint Maarten; Suriname; Trinidad & Tobago; Turks and Caicos; United States Virgin Islands; Venezuela (Bolivarian Republic of) WPRO American Samoa; Fiji; Marshall Islands; Micronesia (Federated States of); Samoa; Tonga 6 Subtotal 50 Category 2: Countries with possible endemic SEARO Indonesia; Thailand 2 transmission or evidence of local vector-borne WPRO Zika infections in 2016 Philippines; Viet Nam 2 Subtotal 4 Category 3: Countries with evidence of local vector-borne Zika infections in or before 2015, but without documentation of cases in 2016, or outbreak terminated AFRO Gabon 1 PAHO/AMRO Isla de Pascua-Chile** 1 SEARO Bangladesh, Maldives 2 WPRO Cambodia; Cook Islands**; French Polynesia**; Lao People s Democratic Republic; Malaysia; New Caledonia; Papua New Guinea; Solomon Islands; Vanuatu Subtotal 13 Total 67 *This includes confirmed Zika virus cases reported in BONAIRE Netherlands and SINT EUSTATIUS Netherlands. ** These countries and territories have not reported Zika virus cases in 2015 or 2016. 9
7 Countries reporting non vector-borne Zika virus transmission Classification WHO Regional Office Country/ territory/ area Total Countries with evidence of Argentina, Canada, Chile, Peru, United States of AMRO/PAHO person-to-person America 5 transmission of Zika virus, EURO France, Germany, Italy, Portugal, Spain 5 other than mosquito-borne transmission WPRO New Zealand 1 Total 11
8 Month first reported Likely timing of increased incidence of microcephaly in countries and territories first reporting Zika Virus infection Country / territory Countries or territories that have previously reported microcephaly cases (Month of 1 st case of microcephaly reported) Likely timing of increased incidence of microcephaly cases Jan-15 New Caledonia Jul-15 Feb-15 Brazil, Solomon Islands Brazil (Aug-15) Aug-15 Apr-15 Vanuatu Oct-15 May-15 Papua New Guinea Nov-15 Jul-15 Fiji, Samoa Jan-16 Oct-15 Cabo Verde, Colombia Cabo Verde (Mar-16) Colombia (Jan-16) Apr-16 Nov-15 Venezuela (Bolivarian Republic of) (May- El Salvador, Guatemala, Mexico, Paraguay, Suriname, Venezuela 16) (Bolivarian Republic of) El Salvador (June-16) May-16 Martinique (Mar-16) Dec-15 French Guiana, Honduras, Martinique, Panama, Puerto Rico Panama (Mar-16) Puerto Rico (May-16) French Guiana (Jun-16) Jun-16 Jan-16 Barbados, Bolivia (Plurinational State of), Costa Rica, Dominican Republic, Guadeloupe, Maldives, Nicaragua, Saint Martin, United States of Virgin Islands Jul-16 Feb-16 American Samoa, Aruba, BONAIRE - Netherlands, Curaçao, Ecuador, Guyana, Haiti, Jamaica, Marshall Islands, Peru, Saint Vincent and The Grenadines, Sint Maarten, Tonga, Trinidad and Tobago Haiti (June 16) Marshall Islands (April-16) Aug-16 Mar-16 Cuba, Micronesia (Federated States of), Philippines, Viet Nam Sep-16 Apr-16 Belize, Saint Barthélemy, Saint Lucia Oct-16 May-16 Argentina, Grenada Nov-16 June-16 Anguilla Dec-16 Jul-16 Guinea-Bissau, SINT EUSTATIUS - Netherlands Jan-17
9 Geographical spread of mosquito-borne Zika virus infection Data as of 27 July 2016
10 Countries, territories and areas reporting microcephaly Reporting country or territory Number of microcephaly cases suggestive of congenital infections or potentially associated with a Zika virus infection Probable location of infection Brazil 1709* Brazil Cabo Verde 9 Cabo Verde Colombia 21** Colombia El Salvador 2 El Salvador French Guiana 2 French Guiana French Polynesia 8 French Polynesia Marshall Islands 1 Marshall Islands Martinique 8 Martinique Panama 5 Panama Puerto Rico 1 Puerto Rico Slovenia 1*** Brazil Spain 2 United States of America 18 # Colombia, Venezuela (Bolivarian Republic of) Brazil; Mexico, Belize or Guatemala (undetermined); Haiti *http://portalsaude.saude.gov.br/index.php/cidadao/principal/agencia-saude/24544-mais-de-60-dos-casos-suspeitos-de-microcefaliaestao-cominvestigacao-concluida **http://www.ins.gov.co/boletin-epidemiologico/boletn%20epidemiolgico/2016%20bolet%c3%adn%20epidemiol%c3%b3gico%20semana%2027.pdf *** http://www.nejm.org/doi/pdf/10.1056/nejmoa1600651 http://www.invs.sante.fr/publications-et-outils/points-epidemiologiques/tous-les-numeros/antilles-guyane/2016/situation-epidemiologique-du-virus- Zika-aux-Antilles-Guyane.-Point-au-21-juillet-2016 #http://www.cdc.gov/zika/geo/pregnancy-outcomes.html
11 Countries, territories and areas reporting Guillain-Barré Syndrome (GBS) Classification Country/ Territory/ Area Total Reported increase in incidence of GBS cases, with at least one GBS case with confirmed Zika virus infection No increase in GBS incidence reported, with at least one GBS case with confirmed Zika virus infection Brazil, Colombia, Dominican Republic, El Salvador*, French Guiana, French Polynesia, Honduras, Jamaica, Martinique, Suriname, Venezuela (Bolivarian Republic of) Guadeloupe, Haiti, Panama, Puerto Rico 4 Total 15 11 *GBS cases with previous history of Zika virus infection were reported by the International Health Regulations (2005) National Focal Point in United States of America.
12 *Lao People s Democratic Republic has reported autochthonous transmission from blood samples collected from 2012 to 2015. Awaiting further confirmation of report date. **ISLA DE PASCUA - Chile is not displayed in the map with the given uncertainty in the start date. ***Thailand s circulation started before 2013. Data as of 27 July 2016
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14 Zika Virus Yellow Fever Other Events
15 YF Virus Highlights DRC: No comprehensive data about confirmed/discarded cases since late June. DRC continue to report suspect cases, mostly from Kinshasa. The back log testing is ongoing: 7 New confirmed cases including: 2 in Kwango (Kajiji and Kisandji) 4 in Kinshasa: 2 in Ndjili, 1 in Kingasani (1 st confirmed) + 1 in Massima I (2 nd confirmed) 1 in Kangu a non-immunised Kongo central HZ (1 st reported and confirmed) Angola: as of 24 July The number of new cases remains low, with no confirmed cases being reported in July thus far. Date of onset of last confirmed case 23/06/2016 : Cunene province A case from June was the first to be documented as local transmission in Cambambe (Cuanza Norte) = local transmission in 45 districts/12 provinces.
16 YF Virus Highlights Brazil: 1 fatal case of jungle YF in in the city of Goiánia, State of Goiás (Central Brazil). He had evidence for YF vaccine (1 dose) from 2008. Colombia: 1 confirmed fatal case of jungle YF in municipality of Carurú in the department of Vaupés. Area consider at risk for YF. Uganda, Guinea: suspected cases discarded Peru: situation stable Other countries: Republic of Congo, Ghana: no update
17 Data as of: DRC: 26 July Angola: 21 July
18 Angola Geographical distribution of cases New/ Total districts with confirmed cases 0 80 Districts with documented local transmission 1 45 New/ Total provinces with confirmed cases 0 16 Provinces with documented local transmission 0 12 Recent week Cumulative Cases and deaths (16 Jul 21 Jul) (5 Dec 21 Jul) Confirmed cases 0 879 Confirmed deaths Not available 119 Reported cases 66 3748 Reported deaths 3 364 Additional information Total number of districts 166 Total number of provinces 18 Population size 25 021 974 Data is as of most recent week for which data is available. These numbers are subject to change due to ongoing reclassification, retrospective investigation and availability of laboratory results. Source: Angola yellow fever situation report as of 4 July 2016, UNDP population data (https://esa.un.org/unpd/wpp/download/standard/population/)
19 National weekly number of probable and confirmed yellow fever cases in Angola, 5 Dec 2015 21 July 2016 Data for the last four weeks is incomplete due to lags between onset of symptoms and reporting. Source: Angola yellow fever situation report as of 24 July 2016
20 Data as of: DRC: 26 July Angola: 21 July
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22 YF vaccination coverage As of 24 July: Angola: Mass vaccination was completed in Capenda Camulemba, Cuilo and Cahungula (Lunda Norte province); Maquela de Zombo (Uige province); Cazengo (Cuanza Norte province); Cacuso (Malange province); Londuimbali and Longonjo (Huambo province); Bocoio and Chongoroi (Benguela province), Humpata and Gambos (Huila province). ICG approved 4,986,260 doses of vaccine, with immediate release of 1,490,902 doses for districts at the DRC border; 740,756 doses in districts with past proven transmission and high risk; as well as 817,047 doses for Lubango, the largest urban center on the south. Luanda vaccinated additional 105,149 people as part of a focused mop-up campaign Data as of: DRC: 28 June Angola: 24 July
23 Source: Angola yellow fever situation report as of 24 July 2016
24 YF Uganda As of 20 July: 5 suspect YF deaths reported in Bukomansimbi district (Central Uganda) during the one past week Symptoms: bleeding, yellowish discharge from the mouth, headache and high fever Death in three to four days Samples were sent to the Uganda Virus Research Institute Actions are being taken to sensitize the population in nearby districts to take precautionary measures
25 YF Brazil As of 20 July: 1 probable YF case (PCR +ve) reported in the city of Niteroi, state of Rio de Janeiro, in southeast Brazil. Symptoms: dyspnea, hematemesis, and sweating. Died on 2 April. The case was in Angola 8 days prior to the onset of symptoms. Sequencing of the viral genome and information on his travel and vaccination history is also pending. In 2016, one fatal yellow fever case was already reported in March. That was a sporadic sylvatic non vaccinated case reported form São Paulo state.
26 Zika Virus Yellow Fever Other Events
27 Cholera DRC Ethiopia Subset of events under follow up Rift Valley Fever first case in China imported from Angola E Coli STEC UK From 31 May to 22 July 2016, 160 cases, including 2 deaths with Shiga-toxin producing E coli (STEC) O157 infection in the UK. Investigation of source still ongoing. UK only country reporting and increase in STEC cases in EURO region. Aflatoxin food contamination - Tanzania 9 June to 26 July, total 53 cases, including 14 deaths. Food and blood samples collected showed high levels for aflatoxin. Investigation ongoing. Support to CO/MS in further laboratory tests and potential food replacement (with other UN partners) might be needed.