Circulating vaccine-derived poliovirus type 1 – Indonesia

On 12 February, a circulating vaccine-derived poliovirus type 1 (cVDPV1) has been confirmed in Papua province, Indonesia. Two genetically-linked VDPV1 viruses were isolated from a child with acute flaccid paralysis (AFP) with onset of paralysis on 27 November 2018 and in a healthy community contact, a child whose stool sample was collected on 24 January 2019. The location of this healthy child, with the VDPV isolation, is in a remote village, approximately 3–4 km away from the AFP case with onset of paralysis on 27 November 2018. Even though this province shares a border with Papua New Guinea, this outbreak is not linked to the cVDPV1 outbreak currently affecting its neighbouring country.

WHO and partners are supporting the Ministry of Health (MoH) and local public health authorities in conducting a field investigation, a thorough risk assessment and planning an outbreak response. The exact extent and timing of the outbreak response is being finalized. Initial outbreak response immunization (ORI) has been conducted in Yahukimo district and 5718 children under 15 years of age have been immunized with bivalent oral polio vaccine (bOPV). Disease surveillance, including conducting retrospective and active searches for additional acute flaccid paralysis (AFP) cases, has been further strengthened in community health centres, hospitals and other health facilities including all districts and cities in Papua province. Surveillance has also been strengthened at entry and exit ports and monitoring notification and reporting through the Early Warning, Alert, and Response System (EWARS) has been reinforced. Other provinces have been alerted to improve immunization and AFP surveillance.

Middle East respiratory syndrome coronavirus (MERS-CoV) – The Kingdom of Saudi Arabia

On 6 February 2019, the National IHR Focal Point of The Kingdom of Saudi Arabia notified WHO of an ongoing outbreak of MERS-CoV infection in Wadi Aldwasir city and one of its hospitals (referred to as Hospital A). Between 29 January and 13 February 2019, 39 cases of MERS-CoV infection, including four deaths, were reported. At the time of writing, this outbreak remains ongoing. Human-to-human transmission has occurred between the index patient and health care workers, patients in the emergency department and intensive care unit (ICU) of Hospital A, and from patients to household contacts. As of 13 February, nine health care workers have been infected. Descriptions of the outbreak are based on information WHO has received as of 13 February 2019; further updates will be provided as they become available.

Details regarding each of the cases are provided in the file linked below.

Circulating vaccine-derived poliovirus type 1 – Papua New Guinea

On 26 June 2018, an outbreak of circulating vaccine-derived poliovirus type 1 (cVDPV1) was declared in Papua New Guinea following laboratory confirmation of cVDPV1 isolation in two healthy community contacts of the index case. Since the declaration, a total of 26 confirmed cVDPV1 cases have been reported in the following nine provinces: Eastern Highlands (six), Enga (five), East Sepik (four), Madang (three), Morobe (three), Jiwaka (two), Gulf (one), Southern Highlands (one), and National Capital District (NCD) (one). The last laboratory-confirmed case reported having experienced the onset of paralysis in late October 2018. Environmental surveillance continues on a bimonthly basis in Port Moresby and Lae to complement active acute flaccid paralysis (AFP) case search efforts.

To date, there have been five rounds of Supplementary Immunisation Activities (SIA) conducted from July to December 2018. Consultants from WHO and UNICEF have been deployed to provide technical support during pre-campaign preparations and implementation to ensure high quality SIAs and improve AFP case detection. The first round of SIA targeted children under five years of age in three high-risk provinces. The second round included children under five years of age in all nine provinces. The third and fourth rounds of SIA included National Immunisation Days (NIDs) which were aimed at children less than 15 years of age and achieved a coverage of 93% and 97% respectively. The fifth round of SIA was a sub-national campaign conducted in four priority provinces (NCD, Central, Enga, and Angoram district in East Sepik province). Planning is currently ongoing for additional NIDs in 2019.

Lassa Fever – Nigeria

From 1 January through 10 February 2019, 327 cases of Lassa fever (324 confirmed cases and three probable cases) with 72 deaths (case fatality ratio = 22%) have been reported across 20 states and the Federal Capital Territory, with the majority of cases being reported from Edo (108) and Ondo (103) States.

Yellow fever – Brazil

Brazil is currently in the seasonal period for yellow fever, which occurs from December through May. The expansion of the historical area of yellow fever transmission to areas in the south-east of the country in areas along the Atlantic coast previously considered risk-free led to two waves of transmission (Figure 1). One during the 2016–2017 seasonal period, with 778 human cases, including 262 deaths, and another during the 2017–2018 seasonal period, with 1376 human cases, including 483 deaths.

From December 2018 through January 2019, 361 confirmed human cases, including eight deaths, have been reported in 11 municipalities of two states of Brazil. In the southern part of São Paulo state, seven municipalities:El dorado (16 cases), Jacupiranga (1 case), Iporanga (7 cases), Cananeia (3 cases), Cajati (2), Pariquera-Açu (1), and Sete Barras (1) reported confirmed cases. In the same state, additional cases in Vargem (1) and Serra Negra (1) municipalities were confirmed on the border with Minas Gerais State. Additionally, two cases have been confirmed in the municipalities of Antonina and Adrianópolis, located in the eastern part of Paraná State. These are the first confirmed yellow fever cases reported since 2015 from Paraná, a populous state with an international border. Among these confirmed cases, 89% (32/36) are male, the median age is 43 years, and at least 64% (23/36) are rural workers.