WHO & Regionals [to 28 June 2014]
Ebola: WHO to convene regional experts for comprehensive operational response
WHO Media Note –
26 June 2014 | GENEVA
The emergence of an Ebola virus disease outbreak in West Africa in 2014 has become a challenge to the 3 countries involved, as the Governments of Guinea, Liberia and Sierra Leone work intensively with WHO and other partners to ramp up a series of measures to control the outbreak.
Since March 2014, more than 600 cases of Ebola and over 390 deaths have been reported in Guinea, Liberia and Sierra Leone. While the number of suspected, probable and confirmed cases and deaths changes rapidly, the outbreak is causing concern among health authorities because the deadly disease is being transmitted in communities and in health-care settings, and it has appeared in cities as well as rural and border areas. The disease, which causes severe haemorrhaging and can kill up to 90% of those infected, is spread by direct contact with the blood and body fluids of infected animals or people….
…Recognizing that a coordinated regional response is essential, WHO is convening the leading health authorities from the affected and nearby countries in Accra, Ghana on July 2–3, to agree on a comprehensive operational response to control the Ebola outbreak. A wide range of partners have been invited, and Ministries of Health of Guinea, Liberia, and Sierra Leone will report on their preventive and control measures, contact identification and tracing; case management; infection and prevention control; social mobilization; and situation reports.
The countries are working to bring supportive care to the ill, inform affected communities of recommended practices, trace contacts of infected patients, control infections in health care settings, and taking other measures to control the outbreak. Despite their progress in implementing preventive and control measures, health authorities still face challenges in curbing the spread of the outbreak, and will discuss these at the Accra meeting….
…The latest numbers, which change as cases are discovered, investigated, or discarded, are:
:: Guinea has reported some 396 cases and 280 deaths
:: Sierra Leone has 176 cases and 46 deaths
:: Liberia reports 63 cases and 41 deaths.
WHO: Global Alert and Response (GAR) – Disease Outbreak News [to 28 June 2014]
:: Human infection with avian influenza A(H7N9) virus – update 27 June 2014
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update 26 June 2014
…Globally, 707 laboratory-confirmed cases of infection with MERS-CoV, including at least 252 related deaths have officially been reported to WHO.
Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for acute respiratory infections and to carefully review any unusual patterns. Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. It is not always possible to identify patients with MERS-CoV early because like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, health-care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be appliedhen performing aerosol generating procedures.
Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease from MERS‐CoV infection. Therefore, these people should avoid close contact with animals, particularly camels, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating. General hygiene measures such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to. Food hygiene practices should be observed. People should avoid drinking raw camel milk
or camel urine, or eating meat that has not been properly cooked.
WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update 26 June 2014
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update 25 June 2014
:: Update on polio in central Africa 25 June 2014
[Full text; Editor’s text bolding]
On 17 March 2014, WHO elevated the risk assessment of international spread of polio from central Africa, particularly Cameroon, to very high. A new exportation event from Equatorial Guinea demonstrates that the risk of international spread from central Africa remains very high (http://www.who.int/csr/don/2014_03_17_polio/en/). On 18 June 2014, Brazil reported that wild poliovirus type 1 (WPV1) had been detected in a sewage sample collected in March 2014 at Viracopos International Airport in Sao Paolo state. Genetic sequencing indicates that this virus is most closely related to the virus that is circulating in Equatorial Guinea.
Four wild poliovirus type 1 (WPV1) cases have been reported in Equatorial Guinea in 2014. The index case – Equatorial Guinea’s first case to be reported since 1999 – had onset of paralysis on 28 January 2014; the country’s most recent case occurred on 3 April 2014. Genetic sequencing indicates these cases are linked to an ongoing WPV1 outbreak in Cameroon (Cameroon’s most recent case was on 31 January 2014). Equatorial Guinea is implementing outbreak response activities, with three National Immunization Days (NIDs) with bivalent oral polio vaccine (OPV) in April and May, and plans for further NIDs in July and August. NIDs are deemed essential to stop the outbreak as an estimated 40% of children are fully immunized against polio through the routine immunization programme in the country.
No one in Brazil has been paralyzed by the virus nor is there evidence of transmission within the population of that country. This importation event in Brazil demonstrates that all regions of the world continue to be at risk of exposure to wild poliovirus until polio eradication is completed globally. It is important that all countries, in particular those with frequent travel and contacts with polio-affected countries and areas, strengthen surveillance for polioviruses (especially through the detection and investigation of Acute Flaccid Paralysis or AFP cases) in order to rapidly detect any new virus importations and to facilitate a rapid response. Uniformly high routine immunization coverage should be maintained at the district level to minimize the consequences of any new virus introduction.
An analysis of immunity levels across central Africa found important immunity gaps in most countries in 2014, prompting the large-scale polio immunization campaigns that are ongoing in the area. In Gabon, a nationwide immunization campaign was held in June (with a further round planned for July), and in the Republic of Congo, a nationwide activity was conducted in May (another round is planned for June). Polio vaccination campaigns have been conducted where possible in the Central African Republic (May to June), with another round planned for accessible areas in July.
There is no evidence to date that Brazil was re-infected by the poliovirus of Equatorial Guinea origin that was detected in a sewage sample collected in Sao Paolo State in March 2014; to date there has been no evidence of transmission of the virus in Brazil following this exposure.
Given Brazil’s high levels of population immunity, reflected in the high routine immunization coverage (>95%) and periodic vaccination campaigns, the lack of evidence so far of WPV1 transmission and the response being implemented, WHO assesses the risk of spread of this virus within or from Brazil as low.
WHO travel recommendations
WHO’s International Travel and Health recommends that all travellers to and from polio-affected areas be fully vaccinated against polio.