1

Disease Last

Update

2019

Cases

Con-

firmed Deaths

Notes and References (R 1, 2, 3)

*[Disease] = new since previous outbreak list

New York City

Measles

5-Aug 642 642 0

As of July 22, 2019, there have been 642 confirmed measles cases identified in New York City (NYC) since October

2018. Most were members of the Orthodox Jewish community in Brooklyn. On April 9, the NYC Health Commis-

sioner declared a public health emergency, ordering all unvaccinated adults and children in certain Brooklyn ZIP codes

to be vaccinated. Persons found unvaccinated or non-immune in these ZIP codes have been subject to fines.

Measles incidence has dropped dramatically in recent weeks. R 1

*Shigellosis 6-Aug 32 32 0

On July 19, the Health Department identified a cluster of shigellosis among residents of Queens, NY associated with

recreational water exposure at Flushing Meadows Corona Park in Queens, NY. As of August 6, a total of 32 NYC

residents diagnosed with shigellosis have reported visiting Flushing Meadow Corona Park since mid-July. The majority

of case-patients are children who reported exposure to a splash pad or fountain in Flushing Meadows Corona

Park. The NYC Department of Parks and Recreation sanitized splash pads/spray showers at various playgrounds

within the park and closed, drained, and disinfected the Unisphere (globe) fountain. The Unisphere fountain remains

closed. These areas are no longer a risk for Shigella transmission. The investigation is ongoing.

United States

Hepatitis A 2-Aug

>23,500

(2018-

19)

>23,500

(2018-19)

233 (1%)

The sustained 2018-19 outbreak of hepatitis A (HAV) has persisted in multiple eastern, southern, and midwestern

states. Of the >23,500 nationwide cases reported as of July 19, >14,000 (60%) have been hospitalized. Twenty-seven

states continue to report cases (AZ, CO, LA, AL, NM, AR, MO, MI, IL, OH, WV, KY, IN, TN, VA, NC, SC, FL, GA,

NH, MA, ID, NJ, PA, WA, MS, and MN). Risk factors continue to be homelessness and IV drug use. On October 24,

the Advisory Committee on Immunization Practices (ACIP) recommended HAV vaccination for homeless persons >1

year old. R 1, 2

Measles 1-Aug 1,172 1,172 —

As of August 1, a total of 1,148 measles cases, including 124 hospitalizations have been reported from 30 states —

WA, TX , OK, NJ, NY, PA, CA, CO, CT, IL, KY, TN, NH, OR, GA, FL, IN, MD, MA, MI, MO, IA, NV, AZ, VT, RI, VA,

ID, AK, and OH. This is the greatest case load in the US since 1992. The majority of cases have been in NYC and

nearby NYS counties. Over the past month, there has been a downward trend in incidence. R 1

E. coli 0103

and 0121 16-Jul 21 21 0

PulseNet identified an outbreak of Shiga toxin-producing E. coli 0103 and 0121. As of July 16, a total of 21 cases have

been reported from 7 states (CT, FL, MI, MO, NJ,NY, and PA). Eight have been hospitalized and there have been no

cases of hemolytic uremic syndrome or deaths. Epidemiologic and traceback information identified a strong associa-

tion with consumption of bison burgers. Northfork Bison Distributions, Inc. (Quebec) has recalled ground bison and

bison patties produced between February 22 and April 30. R 1

Hantavirus 25-Jun 2 2 1 A second person from McKinley County, New Mexico died of hantavirus pulmonary syndrome (HPS). This is the sec-

ond HPS case reported in 2019 in New Mexico. R 1 2

Current Infectious Disease Outbreaks for On-Call MDs

August 9, 2019

2

Disease Last

Update

2019 Cas-

es

Con-

firmed Deaths Notes and References (R 1, 2, 3)

United States

Legionnaires’

disease 22-Jul 63 12 1 (2%)

A Legionnaires’ disease (LD) outbreak in Atlanta has been linked to the Sheraton Atlanta. As of August 9, a total of 63

suspected cases, including 12 confirmed by the Georgia Department of Public Health (GDPH). have been reported;

one (2%) has died. LD cases have been confirmed in persons who stayed at the hotel from June 12—July 15. R 1 2

Rat lungworm 10-Jul 6 6 0

The Hawaii Department of Health reported a sixth case of infection with the rat lungworm, Angiostrongylus cantonensis

on the island of Hawaii’s western half. Half of the infections have been in visitors to the island from the mainland who

were unaware of the risk when consuming fresh produce. R 1

Salmonellosis 19-Jul 768 768 2 (0.2%)

As of July 19, a total of 768 cases of salmonellosis have been reported from 48 states, following contact with chicks

and ducklings in backyard flocks from multiple hatcheries. One hundred twenty-two cases were hospitalized; 2 have

died. Onset dates range from January 1 to May 24. Infections have been with many Salmonella serotypes: Braenderup,

Montevideo, Agona, Anatum, Infantis, Newport, Alachua, Enteritidis, Manhattan, Muenchen, and Oranienburg. R 1

Salmonellosis 31-Jul 127 127 0

PulseNet identified an outbreak of multi-drug resistant salmonellosis due to serotypes 1 4,[5],12:i:-, Infantis, Newport,

and London. As of July 31, total of 127 cases from 33 states have been reported, including 26 hospitalizations and no

deaths. Epidemiologic, laboratory, and traceback information indicates that exposure to pig ear dog treats is the likely

cause of the outbreak. Pet Supplies Plus recalled pig ear dog treats stocked in open bins. R 1

*Cyclosporiasis 23-Jul 580 580 0

As of July 23, a total of 580 Cyclospora cayetanensis infections had been reported, including 38 hospitalizations. On May

30, only two states (SC, CT) had reported cases. As of July 23, A total of 30 states had reported cases (VT, NH, CT,

MA, NY, NJ, PA, MD, DC, VA, NC, SC, GA, FL, LS, MO, IA, MN, WI, IL, MI, IN OH, NE, CO, NM, TX, AZ, UT, CA).

Multiple clusters involving multiple restaurants are being investigated. One outbreak has been linked to basil imported

from Siga Logistics de RL de CV of Morelos, Mexico. R 1

Caribbean, Central America, and South America

Dengue 3-Aug >1,590,000 >846,000 658

In 2019 as of August 3, a total of >1,590,000 dengue cases, including >846,000 laboratory-confirmed, and 658 deaths,

have been reported to the Pan American Health Organization (PAHO). Brazil ( >1,356,000), Colombia (>69,000),

Nicaragua (>49,000), Mexico (>39,000), and Honduras (>26,000) have reported the most cases. Cases have been

confirmed in all Central and South American countries except Uruguay. Most dengue cases in the Caribbean (>8,700)

have been reported by the Dominican Republic and Jamaica. Guadeloupe, Martinique, Antigua/Barbuda,

Trinidad/Tobago, and 10 other islands also have reported cases. R 1

Chikungunya 8-Jun >39,000 —

15

In 2018, >80,000 chikungunya cases were reported in the Americas and the Caribbean. In 2019 as of June 8, Brazil

has reported 38,000 cases (Rio de Janeiro, Minas Gerais, Tocantins, Pará and Acre regions); Colombia reported >300

cases; and Peru reported >125 cases. To date in 2019, chikungunya cases also have reported in Paraguay, El Salva-

dor, Mexico, and Nicaragua. R 1 2

Zika 3-Aug ~10,800 2,865 —

As of August 3, a total of ~10,800 Zika cases have been reported to PAHO in 2019. . In addition to Brazil’s 8,287 and

Peru’s 1,205 reported cases, countries throughout Central America, Mexico, Bolivia, Colombia, Paraguay,

Argentina, and Venezuela, have reported Zika cases. No Caribbean countries have reported to PAHO. R 1 2

3

Disease Last

Update

2019

Cases

Con-

firmed Deaths Notes

Measles 27-Jul >14,000 2,389 —

In 2018, of the >16,000 reported measles cases in the Americas and Caribbean, >60% and 34% were reported in Bra-

zil and Venezuela, respectively. So far in 2019, most of the >14,000 suspected cases have been reported by Brazil,

Mexico, Cuba, and Columbia. Confirmed cases also have been reported in Argentina, Venezuela, Chile, Peru,

Costa Rica, and the Bahamas. R 1 2 3

Haiti

Cholera 6-Jul 458 — 3 (0.6%)

As of March 13, a total of 218 cholera cases, including 3 deaths, have been reported in 2019. In comparison, 3,786

cholera cases were reported in 2018 and 13,681 cases in 2017. Since the outbreak began in 2010, Haiti has reported

819,963 suspected cases and 9,792 deaths (1.2%). R 1 2 3 4

Diphtheria 1-Jun 70 6 1 (8.2%)

In 2018, a total of 375 probable cases were reported, including 105 confirmed and 14 (13.3%) deaths. The highest inci-

dence has been in children 6-14 years old followed by 1-5 year olds. As of June 1, a total of 70 diphtheria cases have

been reported in Haiti in 2019, including 6 confirmed and one death (8.2%). R 1

Argentina

*Hantavirus 24-Jul 18 18 1 Once again, hantavirus cases have been occurring in Jujuy province, as 3 additional cases were reported by health au-

thorities. Most cases have originated from Palma Sola and San Pedro. R 1

Brazil

Yellow fever 9-Jun 82 82 14(17%)

This is the beginning of yellow fever season. As of June 9, a total of 82 confirmed cases (all presumed to be sylvatic)

have been reported in the southern states of São Paulo (68), Parana (13), and Santa Catarina (1) This may indicate the

emergence of a 3rd wave of yellow fever expansion into south and southeastern Brazil. Epizootics among non-human

primates have been confirmed in both of the two southern states. Travelers to Brazil are advised to get vaccinated

more than 10 days before travel. R 1

Mexico

*Cyclosporiasis 2-Aug 14 14 0 Fourteen British tourists to Riveria Maya and Cancun have been diagnosed with cyclosporiasis. R 1

Venezuela

Diphtheria 22-Jun 324 — 15

(4.6%)

A diphtheria outbreak that began in 2016 has continued in Venezuela. As of June 22, a total of 324 cases and 15 deaths

have been reported in 2019. This compares with 1,102 cases and 50 (13.6%) deaths in 2018. With Venezuela’s collaps-

ing healthcare system, childhood vaccination has been affected. R 1 2

*Malaria 20-Jul 10 — — At least 10 cases of malaria were reported in Venezuela’s Anzoategui State (Barcelona). Malaria has re-emerged in

Venezuela over the past few years as mosquito control programs have stopped functioning there. R 1

4

Disease Last

Update

2019

Cases Confirmed Deaths Notes

Europe

West Nile

virus 8-Aug 46 46 3

The West Nile virus season has begun in Europe. As of August 1, Greece (34), Romania (4), Italy (3), Hungary (2),

Cyprus (2), and France (1) have reported cases, including 3 deaths in Greece and one in Romania.. Seven equine out-

breaks have been reported in Greece (6) and Romania (1). R 1 2

Measles 1-Aug >76,000 >76,000 25

Between January 2018 and January 2019, an estimate of >73,700 measles cases were confirmed throughout WHO’s

European Region. So far in 2019, measles outbreaks have occurred in all regions of Europe. A total of >56,861 cases,

including 18 deaths, were reported in Ukraine alone as of July 15. Outbreaks have been reported in most European

countries, including Serbia (5,798), North Macedonia (1,879), Romania (2,333), France (2,313), Poland (1,338),

Bulgaria (1,122), Italy (1,334), Lithuania (794), Czech Republic (579), Germany (455), the United Kingdom

(522), Switzerland (208), Slovakia (194), Spain (238) and Austria (136) R 1 2 3

Denmark

*Campylobact

eriosis 26-Jul 50 50 0

At least 50 people have been diagnosed with campylobacteriosis, though health authorities suspect that many more

people have been sickened after eating chicken meat. R 1

France

Salmonellosis 20-Jul >80 >80 0

More than 80 persons in France have been infected with Salmonella Typhimurium; 13 were hospitalized. Illness has

been linked to consumption of Italian capocollo, a pork cold cut, produced by Di Vittorio with ingredients from France

and Germany. The product has been recalled. R 1

*Salmonellosis 3-Aug 49 49 0 In northern France, 49 people were diagnosed with S. enterica serovar Typhimurium following consumption of cheese

made from unpasteurized, raw sheep milk by the French firm, GAEC Froidevaux Cornuet. R 1

Latvia

*Tick-borne

encephalitis 30-Jun >90 >90 —

Latvian health authorities have reported a 33% increase in tick-borne encephalitis (TBE) in the first half of 2019, com-

pared to the same period in 2018. The Baltic countries have the highest rates of TBE in Europe. R 1

Sweden

*Tularemia 7-Aug 50 50

An outbreak of tularemia appears to be occurring in northern, central, and eastern counties in Sweden. Norbotten,

Dalarna, and Gavleborg counties have reported 5, 12, and 33 cases, respectively. F. tularensis subspecies holarctica is

found throughout northern Europe and can be transmitted by tick and mosquito bites and via direct contact with in-

fected animal tissue. R 1

Arabian Peninsula and Middle East

Yemen

Cholera 21-Jul >885,500

(2018-19) 4,018

1,259

(0.1%)

As of July 8, at least 440,000 suspected cases of cholera have been reported in Yemen in 2019, which already is more

than all reported cases in 2018. More than 3,500 cases have been culture-confirmed. Most cases have been reported

from Governates in the western areas. Yemen’s water, sanitation, electricity, and health care infrastructures have

been decimated by the civil war raging there since 2014. R 1 2 3

5

Disease Last

Update

2019

Cases Confirmed Deaths Notes

Saudi Arabia

MERS-CoA 4-Aug 167 167 41

(24.6%))

In 2019, as of August 4, the Ministry of Health (MOH) has reported a total of 167 cases of MERS-CoA infection. Over-

all, the incidence tempo has slowly considerably since a large nosocomial outbreak in March, though cases continue to

be reported in geographically dispersed locations. The past 5 weeks, cases have been reported from the central Al-

Qassim Region (Ar Rass, Buraidah), Riyadh City, and in the south (Najran). Over the past few months, cases have been

reported from across the country.

Recently, some cases isolated at home with mild or no illness may have progressed to serious disease requiring hospi-

talization. This might be worth keeping in mind when evaluating patients with possible MERS. (See epidemic curve,

map, and nosocomial transmission diagram on p. 13 of this report.) R 1

Asia

Dengue 14-Jul ~365,000 — —

Dengue is endemic throughout Asia. Already in 2019, the Philippines, Vietnam, Malaysia, Sri Lanka, and Thai-

land have reported >92,000, >81,100 >69,700, >28,000, and >40,400 dengue cases, respectively. Cambodia

(>20,500), Singapore (>7,400) the Maldives (>2,800), Laos (>8,000), India (>5,500), Bangladesh (4,500), Indo-

nesia (>1,000), Nepal (1,500), Pakistan (2,500), Timor-Leste,and Taiwan also have reported cases. R 1 2 3

*MDR falcipa-

rum malaria 22-Jul — — —

Dihydroartiminisin-piperaquine (DHA-PQP), frontline treatment for falciparum malaria, and which has been adminis-

tered throughout SE Asia and in many regions of Africa the last decade, is no longer efficacious in large swaths of these

areas. Studies published in Lancet Infectious Disease indicate that DHA-PQP resistance is now prevalent in eastern

parts of SE Asia. Continued spread of this P. falciparum lineage has the potential for becoming a global public health

emergency. R 1

Chikungunya 22-Jun >6,000 — —

So far in 2019, Thailand has reported ~4,500 chikungunya cases, most of which are in its southern districts near Ma-

laysia. The Maldives and Malaysia (largely in Kuala Langat District) have reported >1,296 and >200 cases, respec-

tively. India (Tamil Nadu) and Indonesia (Depok, West Java) also have reported cases. R 1 2 3

India

Acute en-

cephalitis

syndrome

27-Jul ~1,600 ?? ??

Since April, >1,560 cases of acute encephalitis syndrome (AES) have been reported in the northern Indian state of As-

sam, south of Tibet. Of them, ~440 have been confirmed as Japanese encephalitis, a vaccine-preventable disease. Cases

also have been reported in Nagaland, Meghalaya, and in Manipur states, southeast of Bangladesh. R 1

Iran

*Brucellosis 31-Mar >16,000 >16,000 ?? More than 16,000 brucellosis cases were diagnosed from March 2018 to March 2019, and especially in western, north-

western, and northeastern provinces. R 1

Pakistan

*Crimean-

Congo HF ~32 ~30 20

~16

(50%)

Since July, there have been ongoing reports of Crimean-Congo hemorrhagic fever cases (CCHF) in Sindh (Karachi) and

Balochistan provinces. The estimated numbers of CCHF cases in Pakistan clearly are undercounts. R 1

6

Disease Last

Update

2019

Cases Confirmed

Death

s Notes

Pakistan and Afghanistan

Polio

(WPV1) 7-Aug 60 60 —

Already in 2019, a total of 48 infections with wild poliovirus type 1 (WPV1) have been reported in Pakistan (12 cases

in 2018). Environmental samples have yielded WPV1 from two provinces (Sindh and Balochistan). In Afghanistan, a

total of 12 WPV1 infections have been reported in 2019, compared with 21 in 2018. No new cases were reported

over the past week. R 1

Philippines

Falsified

rabies PEP 26-Jul — — —

WHO and the FDA of the Philippines announced that counterfeit and falsified rabies vaccine (Verorab, Speeda, and

Rabipur) and anti-rabies serum (EquiRab) are in commercial circulation. If a patient presents with a history of animal

bite and post-exposure prophylaxis (PEP) in the Philippines, providers can consider this information. R 1

Taiwan

Japanese en-

cephalitis 10-Jul 12 12

1

(8.3%)

Twelve cases of Japanese encephalitis (JE), a vaccine-preventable disease, have been confirmed in Kaohsiung City and

Chiayi City, indicating that the JE transmission season has started in Taiwan. One has died. The Culex mosquito vector

is abundant in Taiwan. R 1

Australia and the Pacific

Dengue 2-Jul >4,900 — —

Already, 2019 promises to record significant dengue incidence. As of June 28, New Caledonia has reported 3,700

cases (DENV-2). Australia has reported 87% more cases by July 2 (700) than at the same time last year. In French

Polynesia, 500 cases have been reported as of June 30 in Moorea, Raiatea, Bora Bora, Palau, Rangiroa, Vana-

tu, the Cook Islands, Wallis and Fortuna, and Tahiti, including 106 cases due to DENV-2 on Tahiti (for the first

time since 2000), Moorea, Bora Bora and Nuku Hiva. R 1 2 3

Africa

Polio

(cVDPV) 7-Aug 40 40 —

So far in 2019, compared with 80 cases in 2018, a total of 39 cases of circulating vaccine-derived poliovirus (cVDPV)

infection have been reported in Nigeria (13), Somalia (3), Niger (1), Ethiopia (1), DRC (15), Central African

Republic (4) and Angola (3). In 2018, outbreaks of cVDPV persisted in Nigeria, (Jigawa, Katsina, Borno, and Sokoto

states). Somalia (Lower Juba), DRC (Haut Katanga, Haut Lomami, Mongala, and Maniema Provinces), Niger (Zinder

province) and Mozambique (Zambézia province). R 1

Measles 2-Jul >325,000 >5,000 —

The most severe outbreak has been in Madagascar, with >145,000 cases in 2019. DRC, Nigeria, and Chad have

reported >137,000; >30,000; and >23,000 cases, respectively, in 2019. To a lesser extent, Angola, Cameroon, Cen-

tral African Republic, Niger, Liberia, Sierra Leone, Mauritius, Ethiopia, South Sudan, Mali, Guinea,

Uganda, Kenya, and Tunisia also have reported cases. R 1 2 3

Dengue 9-Jul >54,000 >17,000 —

In 2019 and as of July 9, a total of >54,000 cases of dengue have been reported in Côte d’Ivoire (1,853), Tanzania

(6,089), Kenya, and on Mauritius (123) and the island of Réunion (47,000), where incidence may have started to

decrease, yet 17,000 confirmed cases of both DENV-1 and DENV-2 have been reported as of Jul 9. R 1 2 3

7

Disease Last

Update

2019

Cases Confirmed Deaths Notes

Leishman-

iasis 23-Jun >7,000 — —

In February, >6,000 cutaneous leishmaniasis cases were reported in North Africa over the past 6 months. Most have

been diagnosed along the Mediterranean coast (west of Tripoli) of Libya (>5,000), followed by central and southwest-

ern Tunisia (~1,300) and in the Ghardaia Province of Algeria (~400). A major kala-azar outbreak with >1,700 cases

has been ongoing in Kenya since April. Leishmaniasis also can be found in South Sudan and Somalia. R 1 2

Angola

*Measles 30-Jun 3,127 85 64

(2.0%)

On May 4, Angola health authorities reported a new measles outbreak. As of June 30, a total of 3,127 cases have been

identified, including 85 confirmed and 64 (2%) deaths. Most cases have been in Lunda Sul and Moxico provinces,

though 16 more have reported cases. R 1

Burundi

Malaria 21-Jul 5,738,661 — 1,801

(0.03%)

Burundi currently has epidemic levels of malaria throughout the country. In 2019, as of May 26, more than 5.7 million

suspected cases of malaria have been reported. In the week ending July 21, >152,000 cases and 65 deaths were report-

ed which is >50% more than at the same time in 2018. Health authorities are hampered by a lack of resources to

mount a comprehensive, nationwide malaria prevention campaign. R 1 2

Cameroon

*Cholera 26-Jul 313 81 18

(5.8%)

A new wave of cholera has been reported from the North and Far North Regions. A total of 313 suspected cholera

cases have been reported since March 1, as of July 26, including 81 confirmed and 18 (5.8%) deaths. Eighty-three per-

cent of reported cases have been from the North Region. R 1

Central African Republic

*Measles 28-Jul 278 13 2 (0.7%)

On July 9, the Ministry of Health announced a measles outbreak in the district of Nana-Gribizi. As of July 28, a total of

278 cases were reported, including 13 confirmed and 2 (0.7%) deaths, both in children <5 years old. Vaccine coverage

for the first vaccine dose is only 49%. R 1

Côte d’Ivoire

Dengue 30-Jul 2,919 302 2 (0.1%)

A dengue outbreak in Côte d’Ivoire was first reported on February 15. As of July 30, a total of 2,919 cases have been

reported, including 302 laboratory-confirmed and 2 (0.1%) deaths. The trend in reported cases has been decreasing

since mid-June. The outbreak has been located in the upscale suburbs of the capital city, Abidjan. DEN-1 is the pre-

dominant serotype, though DEN-3 also has been identified. R 1 2 3

Chad

Measles 21-Jul 23,265 133 225

(1.0%)

As of July 21, a total of 23,265 measles cases have been reported in 2019, including 225 (1.0%) deaths, as the epidemic

continues to spread geographically. Of the country’s 126 districts, 118 (94%) have now been affected. Sixty percent of

cases are <5 years old., of whom 77% were not vaccinated. R 1 2 3

8

Disease Last

Update

2019

Cases Confirmed Deaths Notes

Congo

Chikungunya 07-Jul 11,050 148 0

A chikungunya outbreak was declared on February 2. As of July 7, a total of 11,050 cases, including 148 confirmed,

have been reported by health authorities. A downward trend in incidence has been seen. Cases have been reported in

9 of 12 departments: Kouilou (most affected), Pool., Bouenza, Pointe-Noire, Plateaux, Niari, Lékoumou, Brazzaville,

and Cuvette. Aedes albopictus, a competent mosquito vector, was found during investigations. R 1 2 3

Democratic Republic of Congo

Cholera 7-Jul 13,743 — 280

(2.0%)

As of July 7, a total of 13,743 cholera cases have been reported in the DRC in 2019, including 280 (2.0%) deaths. Out-

breaks have been reported in 20 (77%) of the 26 DRC provinces. Approximately 90% of the cases have been reported

from eastern provinces where cholera is now considered endemic: Tanganyika, Upper Katanga, Upper Lomami,

North Kivu and South Kivu. R 1 2 3

Measles 21-Jul 137,154 1,308 2,581

(1.9%)

As of July 21, a total of 137,154 measles cases have been reported in DRC in 2019, including 2,581 deaths (1.9%). In

the week ending July 21, >5,600 cases and 116 deaths were reported from 20 provinces across the country. Seventy–

seven percent of all reported cases and 90% of measles-associated deaths have been children <5 years old. More than

80% of cases in 2019 have been from Tshopo, Lualaba, Kasai, South Kivu, Upper Lomami, Tanganyika, Kasai-Central,

Ituri, and Kasai-Oriental provinces. Measles vaccination coverage remains low in the DRC. R 1 2 3

Monkeypox 7-Jul 2,733 — 58

(2.1%)

In 2019 and as of July 7, a total of 2,733 cases of monkeypox have been reported, including 58 (2.1%) deaths. In the

week ending in July 7, there were 106 suspected cases reported, with most occurring in Sankuru (69%) or Mai-

Ndombe provinces. North and South Ubangi also have reported cases in recent months. R 1 2 3

Ebola 7-Aug 2,787 2,693 1,867

(66.8%)

The last month has seen a worsening of the Ebola virus disease (EVD) outbreak in northeastern DRC’s North Kivu

and Ituri provinces, including a dramatic increase in transmission within Beni and from there into surrounding health

areas. Violence and community unrest continued to interfere with response activities; 2 public health workers were

murdered in Beni. As of August 7, a total of 2,787 EVD cases, of whom 149 (5%) were health workers, have been re-

ported, including 2,693 confirmed and 94 probable; 1,867 (66.8%) have died. Fifty-seven percent of cases have been

female and 28% (787) have been children <18 years old. In the 21 days from July 15 to August 4, a total of 68 health

areas within 16 health zones reported new cases, representing 10% of the 664 health areas with North Kivu and Ituri

provinces. During this period, a total of 260 confirmed cases were reported, the majority of whom were from the

health zones of Beni (46%; n=120), Mandima (21%; n=54), and Mabalako (5%; n=12). Of concern, as many as 50% of

EVD may be going undetected. More than 180,000 Ebola vaccinations have been administered as of July 21.

EVD continues to be confined to the DRC. Two introductions of EVD into Goma, the provincial capital of North Kiva

<1 mile from the Rwandan border and a city of 1-2 million people, have resulted in 2 secondary cases in family mem-

bers of the second case. Three days after the first Goma case was confirmed, WHO declared a Public Health Emer-

gency of International Concern. See epidemic curve and maps on p. 14 of this report.) R 1 2 3 4

9

Disease Last

Update

2019

Cases

Con-

firmed Deaths Notes

Democratic Republic of Congo

*cVDPV 7-Aug 15 15 0

In the past week, 4 cases of acute flaccid paralysis following infection with circulating vaccine-derived poliovirus 2

(cVDPV2) were reported in the DRC. So far in 2019, 15 cVDPV2 cases have been reported (20 in 2018). Most recent-

ly, cases were reported in the following provinces: West Kalonda, Nyanga, Kasai, Tshumbe, and Sankuru. R 1

Egypt

Shiga toxin-

producing E.

coli (STEC)

30-Jul 51 20 0

Public Health England and Germany health authorities have determined that 20 and 31 persons, respectively, were

infected with a Shiga toxin-producing E. coli (STEC) during travel to Egypt. A source(s) has not been determined yet.

To date, 4 persons in England have been hospitalized. In England and Germany, hemolytic uremic syndrome (HUS) was

confirmed in one and 5 persons, respectively. R 1

Ethiopia

Measles 21-Jul 7,043 59 —

In Ethiopia as of July 21, a total of 7,043 measles cases have been reported in 2019, including 59 laboratory-confirmed.

The impacted areas have been Oromia, Amhara, and Solami regions. Half of cases are children <5 years old. A vaccina-

tion campaign is being planned to target 6.7 million displaced children aged 6 months to 14 years. R 1

*Cholera 21-Jul 1,005 33 11

(1.1%)

Since May 12 and as of July 21, a total of 1,005 cholera cases were reported by Ethiopian health authorities. Cases have

been reported in the following regions: Afar, Amhara, Oromia, Somali, Tiray, Addis Ababa, and Dire Dawa. R 1

Guinea

Measles 21-Jul 3,349 773 27

(0.8%)

As of July 21, a total of 3,349 measles cases, including 27 (0.8%) deaths have been reported, compared with 1,863 total

cases in 2018. Of 1,352 specimens tested, 773 (57.2%) have been positive. Disease transmission currently is most

acute in Matoto, Ratoma, Dixinn, Labé, Matam, ,Dubreka, Coyah, Maferinyah, Kegneko, and Manéah. R 1 2 3

Liberia

Measles 7-Jul 1,120 110 5 (0.4%) As of July 7, a total of 1,120 measles cases from across the country, including 110 confirmed. Bong, Margibi, and Lofa

Counties have been hard-hit. R 1 2 3

Kenya

Leishmani-

asis 21-Jul 1,789 420

24

(0.7%)

As of July 21, a kala-azar outbreak in Marsabit, Wajir, and now Garissa counties has led to 1,789 suspected cases, in-

cluding 420 confirmed with rapid diagnostic testing and 24 deaths (0.7%). R 1 2 3

Cholera 21-Jul 3,465 141 24

(0.7%)

A cholera outbreak that began in early January has been contained in Nairobi and Narok. As of July 14, a total of 3,433

cases have been reported, including 141 confirmed and 24 (0.7%) deaths. Cases continue to be reported from Kajiado,

Mali

Measles 14-Jul 1,068 281 0 As of July 14, a total of 1/068 measles case were reported in Mali, including 211 confirmed. Cases have been reported

recently in the following health districts: Koulikoro, Segou, Kayes, Mopti, Bamako, Kidal, and Babamba. R 1 2 3

10

Disease Last

Update

2019

Cases Confirmed Deaths Notes

Mozambique

Cholera 25-Jun 7,052 — 8 (0.1%)

Tropical Cyclones Idai and Kenneth, hitting Mozambique in March and April, caused widespread flooding, crop loss,

and devastation to infrastructure. As of June 25, a total of 7,502 cholera cases have been reported in central Sofala

(especially Beira district) and northern Cabo Delgado provinces. However, the situation may have stabilized, which

Sofala not reporting any cases for nearly 3 weeks. Due to severe damage to healthcare, sanitation, and water facilities

and infrastructure, affected areas will remain especially vulnerable to waterborne and vectorborne disease. Wide areas

of the coastal regions remain without utilities and with severely damaged roads. R 1 2 3

Namibia

Hepatitis E 14-Jul 5,711 1,185 48 (0.8%)

The hepatitis E outbreak that started nearly one year ago has persisted, become protracted, and has continued to in-

tensify. The outbreak, which at first was restricted to the Windhoek district in the Khomas Region (still the most af-

fected region), spread to 11 other regions: Erongo, Omusati, Oshana, Omaheke, Ohangwena, Otjozondjupa, Oshiko-

to, Kavango, Karas, Kunene, and Hardap. As of July 14, a total of 5,711 hepatitis E cases had been identified. Forty-

eight (0.8%) cases have died, of whom 21 (44%) were either pregnant or post-partum women. R 1 2 3 4

Niger

Measles 27-Jul 9,706 0 51 (0.5%)

As of July 27, a total of 9,706 measles cases, including 51 (0.5%) deaths have been reported by Niger in 2019. Most

have occurred in Maradi and Tahoua regions, followed by Zinder, Niamy, Tilaberi, Agadez, Diffa, and Dofo. A down-

ward trend in the case count has been seen in recent weeks. R 1 2 3

Nigeria

Lassa fever 14-Jul 639 622 140

(21.9%)

As of July 14, there have been a total of 622 laboratory-confirmed and 17 probable Lassa fever cases reported in 2019,

including 18 healthcare workers, two of whom died. One hundred thirty six (22.6%) deaths have occurred in con-

firmed cases. The steady decline seen in the past months has continued. Ninety-two percent of confirmed cases have

been from Edo, Ondo, Ebonyi, Bauchi, Taraba, and Plateau States. The emergency phase of the outbreak has been de-

clared over. R 1 2 3

Measles 25-May 30,669 1,476 91 (0.3%)

As of May 25, a total of 30,669 suspected measles cases have already been reported in Nigeria, including 1,862 in the

week ending May 19. Borneo State in northeast Nigeria, Yobe, and Katsina State in the north have accounted for 75%

of cases. Nigerian health authorities reported >17,000 suspected measles cases in 2018. R 1 2 3

Cholera 31-Jul 457 149 4 (0.9%)

On June 18, health authorities in Adamawa State declared a cholera outbreak in the northeast state. As of Jul7 31,, a

total of 457 suspected cases have been reported, including 4 (0.8%) deaths. Vibrio cholera classical O1 strain has been

confirmed. Most cases were reported in Yola North, Girei, Yola South, and Song. R 1 2 3

Sierra Leone

Lassa fever 16-Jun 7 7 5 (71%) Two confirmed Lassa fever cases were confirmed in the week ending May 26, increasing to 7 the total number of con-

firmed cases in 2019. Five (71%) have died. All were reported in Kenema district, an endemic area. R 1

11

Disease Last

Update

2019

Cases Confirmed Deaths Notes

South Sudan

Measles 9-Jun 1,187 72 7 (0.6%)

As of June 9, total of 1,187 suspected measles cases, including 72 confirmed, have been reported in 12 South Sudan

counties: Abyei, Juba, Pibor, Gogriel West, Gogriel East, Bor South, Melut, Mayom, Tonj North, Awiel South, Awiel

West, and Awiel Central. Three Protection of Civilian sites have been affected. R 1 2 3

Tanzania

Cholera 14-Jul 424 14 8 (1.9%)

In 2019, a new wave of cholera was reported in 9 Tanzanian Districts, including Longido, Handeni, and Pangani. In the

past reporting few reporting weeks, Dar es Salaam and Tanga regions reported cases. As of July 14, a total of 424 sus-

pected cases, including 8 deaths, have been reported by health authorities. R 1 2 3

Uganda

Measles 2-July 1,275 604 6 (0.5%) As of July 2, a total of 1,275 suspected measles cases have been reported in 2019, of whom 604 have been confirmed.

Children under 5 years old accounted for more 64% of confirmed cases; all but one live in rural areas. R 1 2

Zimbabwe

*Typhoid

fever 30-Jun 858 ?? ??

As reported earlier this year, the greater Harare area, and especially the suburbs of Glen View and Budiriro, had been

dealing with a typhoid fever. Zimbabwean authorities report 858 cases in the first half of 2019. Earlier, there also was a

cholera outbreak in Harare. R 1

12

Removed from last bi-weekly list:

Legionnaires’ disease (US, IL)

Salmonella Uganda (US, Multistate)

Q fever (Switzerland)

HIV (Pakistan)

Guillain-Barré syndrome (Peru)

Lassa fever (Liberia)

Rift Valley Fever (Mayotte)

Yellow fever (Uganda)

Ebola virus disease (Uganda)

New outbreaks since last bi-weekly list

Shigellosis (NYC)

Cyclosporiasis (US, Multistate)

Hantavirus (Argentina)

Cyclosporiasis (Mexico)

Malaria (Venezuela)

Campylobacteriosis (Denmark)

Salmonellosis (France)

Tick-borne encephalitis (Latvia)

Tularemia (Sweden)

MDR falciparum malaria (Asia, Multistate)

Brucellosis (Iran)

Crimean-Congo hemorrhagic fever (Pakistan)

Typhoid fever (Zimbabwe)

13

Cholera MERS-CoV

Najran

Al Qassim Riyadh

Medina

Mecca

14

Ebola virus disease outbreak,

North Kivu and Ituri Provinces,

Democratic Republic of Congo

As of August 6, 2019

15