Hantavirus disease – Republic of Panama

The Panama Ministry of Health has reported an increase in cases of hantavirus infection in Los Santos Province, Republic of Panama, to the Pan American Health Organization / World Health Organization (PAHO/WHO). Between 1 January and 22 December 2018, a total of 103 confirmed cases of hantavirus have been reported at the national level, 99 of which were reported in Los Santos Province. In Los Santos Province, 51 cases were classified as hantavirus fever1 (HF) without pulmonary syndrome and 48 cases were classified as hantavirus pulmonary syndrome2 (HPS), including four deaths.

Cases were confirmed by serology and polymerase chain reaction (PCR)3. Sequencing determined that the type of virus associated with this outbreak is Choclo virus. It was first isolated in 1999 in the western Republic of Panama.

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

From 31 October through 30 November 2018, the International Health Regulations (IHR 2005) National Focal Point of Saudi Arabia reported eight additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including two deaths. Details of these cases can be found in a separate document (see link below).

From 2012 through 30 November 2018, the total number of laboratory-confirmed MERS-CoV cases reported globally to WHO under IHR (2005) is 2274 with 806 associated deaths. The total number of deaths includes the deaths that WHO is aware of to date through follow-up with affected member states.

Typhoid fever – Islamic Republic of Pakistan

Pakistan Health Authorities have reported an ongoing outbreak of extensively drug resistant (XDR) typhoid fever that began in the Hyderabad district of Sindh province in November 2016. An increasing trend of typhoid fever cases caused by antimicrobial resistant (AMR) strains of Salmonella enterica serovar Typhi (or S. Typhi) poses a notable public health concern. In May 2018, the case definitions for non-resistant, multi-drug resistant (MDR) and XDR typhoid fever were formally agreed by the Regional Disease Surveillance and Response Unit (RDSRU) in Karachi, following a review by an expert group of epidemiologists, clinicians and microbiologists from Pakistan. All typhoid fever cases reported from 2016 to 2018 were reviewed and classified according to these case definitions (see Table 1).

From 1 November 2016 through 9 December 2018, 5 274 cases of XDR typhoid out of 8 188 typhoid fever cases were reported by the Provincial Disease Surveillance and Response Unit (PDSRU) in Sindh province, Pakistan. Sixty-nine percent of cases were reported in Karachi (the capital city), 27% in Hyderabad district, and 4% in other districts in the province (Table 2). The circulating XDR strain of S. Typhi haplotype 58 was resistant to first and second-line antibiotics as well as third generation cephalosporins. Informal reports of XDR typhoid cases occurring in other parts of Pakistan were made and required further verification.

Yellow Fever – Kingdom of the Netherlands

On 22 November 2018, the World Health Organization (WHO) was informed by Dutch authorities of a laboratory-confirmed case of yellow fever. The case-patient is a 26 year-old male who visited Gambia from 3 through 17 November 2018, with a three day trip to Senegal from 12 through 14 November. He had no history of vaccination for yellow fever prior to the trip. On 18 November 2018, the case-patient developed symptoms including fever, nausea and vomiting. On19 November 2018 he was hospitalized with symptoms of acute liver failure and he is still in hospital as of 10 December.

The International Health Regulations National Focal Point (IHR NFP) from the Netherlands has notified counterparts in Gambia and Senegal about the case, and about the exact locations visited by the patient. There have been no other reports of confirmed yellow fever cases from Senegal, Gambia or The Netherlands at this time.