Current major event

Diphtheria in Sudan

Federal Ministry of Health (FMOH) Sudan reported an outbreak of diphtheria, starting from epidemiologic week 33. Till the reporting date (week 49), a total of 63 suspected diphtheria cases with 11 associated deaths (CFR 17.46%) are reported from six states (See graph). Out of these, 57 cases with 9 deaths are reported from Al-Sunta locality of South Darfur state alone. 83% of the total (52) were not vaccinated against Diphtheria. One out of six samples collected was laboratory confirmed through PCR on November 28, 2019 .

Editorial note

Diphtheria is a highly contagious bacterial disease that primarily infects the throat and upper airways, and produces a toxin affecting other organs. The disease has an acute onset and can result in low grade fever, difficulty in breathing, swollen glands in the neck and the toxin, in severe cases, may cause heart failure, paralysis, and even death. Transmission occurs from person to person through close respiratory and physical fluid contact. Diphtheria is fatal in 5-10% of the cases, with a high mortality rate in young children. Vaccinations are available and recommended for its prevention.

Sudan has a very high immunization coverage for DPT3 93% - 2018 (See table ) and it has never reported such number of diphtheria cases in the past. But the reporting of cluster cases from Al-Sunta locality South Darfur (56 cases with 09 associated deaths) is an alarming sign as most of the cases from the locality were un-vaccinated, whereas the national average for DPT3 coverage is significantly high from last five years (>92%).

Majority of the cases (97%) aged from <1 to 44 years of age and 77% cases were less than 15 years old and all deaths occurred in this age group. Most of the cases presented with low grade fever, difficulty in swallowing, neck swelling, lymph node enlargement and typical greyish membrane.

Highlights

• In November 2019, the Ministry of Public Health and Population of Yemen reported a total 49 403 suspected cholera cases including 16 related deaths (case fatality rate: 0.03%), from 22 governorates.

• The cumulative number of suspected cholera cases reported in Yemen since October 2016 to November 2019 is 2 236 570 including 3886 related deaths, with a case fatality rate of 0.17%. The country experienced a second wave of this outbreak from 27 April 2017. The total number of suspected cholera cases reported during the second wave were 2 210 743 including 3757 related deaths with a case fatality rate of 0.17%.

• Since January 2019, a total of 9656 stool specimens were tested. Out of these, 5292 were laboratory confirmed for Vibrio cholerae.

• The 5 governorates with the highest cumulative attack rate per 10 000 are Amran (1680.76), Al Mahwit (1578.22), Sana’a (1467.65), Al Bayda (1176.89) and Al Hudaydah (1026.21). The national attack rate is 784.86 per 10 000. The Governorates with high numbers of deaths are Hajjah (577), Ibb (501), Al Hudaydah (402) and Taizz (328).

The number of cholera cases decreased globally by 60% in 2018, the World Health Organization (WHO) announced in a report that points to an encouraging trend in cholera prevention and control in the world's major cholera hotspots, including Haiti, Somalia and the Democratic Republic of the Congo.

"The decrease we are seeing in several major cholera-endemic countries demonstrates the increased engagement of countries in global efforts to slow and prevent cholera outbreaks and shows the vital role of mass cholera vaccination campaigns," said WHO Director-General Dr Tedros Adhanom Ghebreyesus. "We continue to emphasize, however, that the long-term solution for ending cholera lies in increasing access to clean drinking water and providing adequate sanitation and hygiene."

There were 499 447 cases of cholera and 2990 deaths in 2018, according to reports from 34 countries. While outbreaks are still ongoing in various countries, the case load represents a significant downward trend in cholera transmission that has continued into 2019, according to data collected by WHO.

"The global decrease in case numbers we are observing appears to be linked to large-scale vaccination campaigns and countries beginning to adopt the Global Roadmap to 2030 strategyin their national cholera action plans," said Dr Dominique Legros, who heads WHO's cholera programme in Geneva. "We must continue to strengthen our efforts to engage all cholera-endemic countries in this global strategy to eliminate cholera."

Nearly 18 million doses of Oral Cholera Vaccine (OCV) were shipped to 11 countries in 2018. Since the OCV stockpile was created in 2013, almost 60 million doses have been shipped worldwide. Gavi, the Vaccine Alliance, has provided funding for purchase of the vaccine and financial support for the global vaccination drives.

The Global Task Force on Cholera Control launched the Global Roadmap strategy for effective long-term cholera control and elimination in October 2017. The Global Roadmap aims to reduce cholera deaths by 90% and to eliminate transmission in up to 20 countries by 2030. The strategy provides a framework for national action plans that emphasize three main axes of cholera control:

• early detection and rapid response to contain outbreaks
• a multisectoral approach integrating strengthened surveillance, vaccination, community mobilization and water, sanitation and hygiene to prevent cholera in hotspots in endemic countries
• An effective mechanism of coordination for technical support, resource mobilization and partnership at the local and global levels

"The Global Roadmap provides clear guidance for how to prevent and, ultimately, to eliminate cholera. Every death from cholera is preventable with the tools we have today," said Dr Tedros.

The new report shows several countries, including Zambia, South Sudan,United Republic of Tanzania, Somalia, Bangladesh, and Nigeria have made significant progress in developing national action plans within the framework of the Global Roadmap strategy.

"We are seeing the results of countries reporting -- and acting -- on cholera. And these countries are making remarkable gains in cholera control and prevention," said Dr Legros.

WHO, in collaboration with partners, provides support to ministries of health in countries affected by cholera to implement immediate, long-term cholera control, including surveillance, outbreak response and preventive measures such as OCV and risk communication.

In 2018, WHO country offices worked with governments to respond urgently to major outbreaks in the Democratic Republic of the Congo, Nigeria, Uganda, Yemen, Zambia and Zimbabwe. WHO also worked with countries to transition from outbreak response to longer-term cholera control and elimination, in Haiti, United Republic of Tanzania (Zanzibar) and Zambia.

Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. Cholera affects both children and adults and can kill within hours if left untreated. WHO estimates that each year cholera infects 1 million to 4 million people and claims up to 143 000 lives.

Note to Editors:

About the estimates

The total number of cholera cases in 2018 includes 371 326 cases reported from Yemen, where reporting has been imprecise, according to the report.

The Weekly Epidemiological Record (WER) serves as an essential instrument for the rapid and accurate dissemination of epidemiological information on cases and outbreaks of diseases under the International Health Regulations and on other communicable diseases of public health importance, including emerging or re-emerging infections.

Le nombre de cas de choléra a diminué de 60 % en 2018 a annoncé l’Organisation mondiale de la Santé (OMS) dans un rapport qui souligne les tendances encourageantes enregistrées en matière de prévention et de lutte dans les principaux points chauds, notamment en Haïti, en Somalie et en République démocratique du Congo.

Comme l’a indiqué le Directeur général de l’OMS, le Dr Tedros Adhanom Ghebreyesus, « Le recul du choléra auquel nous assistons dans plusieurs pays d’endémie témoigne de l’engagement accru des pays en faveur des efforts mondiaux visant à ralentir et à éviter des flambées et montre le rôle vital joué par les campagnes de vaccination anticholérique de masse. Nous continuons cependant à souligner que la solution à long terme pour mettre fin au problème du choléra consiste à améliorer l’accès à l’eau potable et à offrir des moyens d’assainissement et d’hygiène adéquats. »

Sur la base des rapports fournis par 34 pays, on arrive à un total de 499 447 cas de choléra pour 2018, dont 2 990 mortels. Si des flambées subsistent dans différents pays, on observe une tendance significative à la baisse de la transmission, qui s’est maintenue en 2019 d’après les données recueillies par l’OMS.

Pour le Dr Dominique Legros qui dirige le programme de lutte anticholérique de l’OMS à Genève, « la diminution du nombre de cas que nous observons semble liée aux campagnes de vaccination à grande échelle et au fait que les pays commencent à adopter la stratégie de la feuille de route mondiale jusqu’à 2030 dans leur plan d’action national. Nous devons continuer à renforcer nos efforts pour associer tous les pays d’endémie à la stratégie mondiale d’élimination du choléra. »

Près de 18 millions de doses de vaccin anticholérique oral (VCO) ont été envoyées à 11 pays en 2018. Depuis la constitution du stock de VCO en 2013, près de 60 millions de doses ont été envoyées au total dans le monde entier. L’Alliance Gavi a assuré le financement des achats de vaccins et apporté un appui financier aux efforts de vaccination mondiaux.

Le Groupe spécial mondial de lutte contre le choléra a lancé la stratégie de la feuille de route pour la lutte anticholérique à long terme et l’élimination de la maladie en octobre 2017. La feuille de route mondiale vise à réduire la mortalité cholérique de 90 % et à éliminer la transmission dans jusqu’à 20 pays d’ici à 2030. La stratégie offre un cadre pour des plans d’action nationaux mettant l’accent sur trois grands axes de lutte :

• détection précoce et intervention rapide contre les flambées

• approche multisectorielle intégrant une surveillance renforcée, la vaccination, la mobilisation communautaire et l’eau, l’assainissement et l’hygiène pour prévenir le choléra dans les points chauds des pays d’endémie

• mise au point d’un dispositif efficace de coordination de l’appui technique, de mobilisation des ressources et de partenariat aux niveaux local et mondial.

« La feuille de route mondiale indique clairement les orientations à suivre pour prévenir et, à terme, éliminer le choléra », a ajouté le Dr Tedros. « Tous les décès dus au choléra sont évitables grâce aux outils dont nous disposons aujourd’hui. »

Il ressort du nouveau rapport que plusieurs pays, notamment la Zambie, le Soudan du Sud, la République-Unie de Tanzanie, la Somalie, le Bangladesh et le Nigéria ont fait des progrès significatifs en vue de la mise au point d’un plan d’action national dans le cadre de la stratégie de la feuille de route mondiale.

Comme l’a dit le Dr Legros, « Nous constatons aujourd’hui les résultats obtenus grâce aux données notifiées et aux mesures prises par les pays concernant le choléra. Et ces pays ont beaucoup progressé en matière de prévention et de lutte. »

En collaboration avec ses partenaires, l’OMS apporte un appui au ministère de la santé dans les pays touchés par le choléra pour la mise en œuvre de mesures immédiates de lutte à long terme – concernant la surveillance, la riposte aux flambées et les interventions préventives comme la vaccination par le VCO et la communication sur les risques.

En 2018, les bureaux de pays ont collaboré avec les gouvernements pour répondre d’urgence aux flambées majeures survenues au Nigéria, en Ouganda, en République démocratique du Congo, au Yémen, en Zambie et au Zimbabwe. L’OMS a aussi collaboré avec les pays dans le cadre de la transition de la riposte aux flambées vers la lutte anticholérique à plus long terme et l’élimination, en Haïti, en République-Unie de Tanzanie (à Zanzibar) et en Zambie.

Le choléra est une infection intestinale aiguë provoquée par l’ingestion d’aliments ou d’eau contaminés par le bacille Vibrio cholerae, qui frappe l’adulte aussi bien que l’enfant et qui en l’absence d’un traitement peut être mortelle en quelques heures. Selon les estimations de l’OMS, on compte annuellement 1 à 4 millions de cas et jusqu’à 143 000 décès dus à la maladie.

Note à l’intention des rédacteurs :

Concernant les estimations

Le nombre total de cas de choléra en 2018 comprend 371 326 cas signalés par le Yémen, pays pour lequel le rapport indique que la notification est imprécise.

Le Relevé épidémiologique hebdomadaire (REH) est un instrument essentiel pour la diffusion rapide et précise de données épidémiologiques sur les cas et les flambées de maladies à notifier au titre du Règlement sanitaire international et sur les autres maladies transmissibles importantes pour la santé publique, y compris les infections émergentes ou réémergentes.

Contacts pour les médias

Tarik Jasarevic
Chargé de communication
OMS
Téléphone: +41227915099
Portable: +41793676214
Email: jasarevict@who.int

Despite serious challenges, there’s been plenty of good global health news in 2019. These are just a few of the brightest spots.

Ensuring health for all

World leaders from 193 countries adopted the broadest-ever set of health commitments globally. The political declaration on universal health coverage aims to ensure that everyone, everywhere can access quality healthcare, and that no one is pushed into poverty by health costs.

With WHO support Greece, India, Kenya and the Philippines took decisive steps towards expanding health coverage in 2019.

Egypt is defying worrying global trends relating to Hepatitis C— with 57 million people screened and 1 million treated between October 2018 and April 2019.

More women and children are surviving childbirth than ever before thanks to improved access to affordable, quality health services.

Diabetics in low and middle-income countries will soon have better and more affordable access to treatment thanks to the launch of a WHO pilot programme to prequalify insulin.

WHO has also prequalified its first biosimilar medicine to increase worldwide access to life-saving breast cancer treatment.

The fight against polio has achieved a major milestone for humanity with the eradication of the second of three strains of wild poliovirus worldwide.

Although malaria still kills over 400,000 people each year, pregnant women and children in sub-Saharan Africa are better protected, Algeria and Argentina are officially declared malaria-free, and the world’s first malaria vaccine has been piloted in Ghana, Kenya and Malawi.

The Food and Agriculture Organization, the World Organisation for Animal Health and the WHO have launched a dedicated funding vehicle to accelerate global action against Antimicrobial Resistance, the AMR Multi-Partner Trust Fund.

By 2023, WHO aims to ensure that one billion more people benefit from universal health coverage.

Protecting from emergencies

In 2019, substantial gains were made in responding to the world’s second largest Ebola epidemic on record in the Democratic Republic of the Congo.

The spread of Ebola has slowed within DRC, and the virus has not taken root in neighbouring countries. WHO prequalified an Ebola vaccine in record time, and landmark advances were made in care and treatment.

WHO also supported vaccination campaigns for children across the country as DRC battled the world’s most severe measles outbreak.

WHO investigated 440 events and responded to 51 emergencies in 40 countries and territories in 2019 — including the Rohingya crisis, cyclone Idai in Mozambique, and conflict and disease outbreaks in Yemen, Syria, Nigeria and South Sudan. We also responded to floods in Iran and an earthquake in Albania, as well as supported Sudan in responding to six different outbreaks, including yellow fever.

New insect birth control techniques are offering opportunities to control mosquito-borne diseases such as Chikungunya, Dengue and Zika.

By 2023, WHO aims to ensure that one billion more people are better protected from health emergencies.

Enabling healthier populations

We are witnessing a powerful shift in the global tobacco epidemic, as the number of males using tobacco begins to decline worldwide for the first time. WHO projects that there will be 5 million fewer male tobacco users globally by 2025.

The international food and beverage industry has committed to align with the WHO target to eliminate industrially produced trans fat from the global food supply by 2023.

The UN Climate Conference COP25 marked 5 key actions to tackle the health risks of climate change. This included the launch of the Clean Air Fund and more than 50 countries and 80 cities signing up to WHO’s Air Quality Guidelines through the Clean Air Initiative.

Healthcare providers and policymakers can now refer to new WHO guidelines on adopting a healthy lifestyle to reduce the risk of dementia.

WHO is working to ensure that one billion more people are enjoying better health and well-being by 2023.

A fit-for-purpose WHO

In 2019, WHO announced the most wide-ranging reforms in the Organization’s history. Our goal is clear: a modern WHO that works seamlessly to make a measurable impact for people’s health.

Aligned with the Sustainable Development Goals and the wider United Nations reform agenda, the 13th General Programme of Work (2019–2023) guides our work over the next five years to promote health, keep the world safe and serve the vulnerable.

Current major event

Arbovirus diagnostics EQAP

In 2016, the World Health Organization (WHO) initiated a global external quality assessment program (EQAP) for arbovirus diagnostics to determine proficiency in countries to adequately detect the priority arboviruses, dengue virus (DENV), yellow fever virus (YFV), Zika virus (ZIKV), and chikungunya virus (CHIKV). Here we summarize the performance of WHO Eastern Mediterranean Region (EMR) laboratories in the first (2016) and second (2018) rounds of the EQAP. 　

Editorial note

Arboviruses spread by Aedes mosquitos, particularly DENV, YFV, ZIKV and CHIKV, are major threats to human health worldwide. Outbreaks caused by one or more of these viruses have been reported in the EMR countries of Djibouti, Egypt, Oman, Pakistan, Saudi Arabia, Somalia, Sudan and Yemen in the past 14 years alone. While Zika virus disease is yet to be reported in the EMR, Aedes vectors are present in the countries mentioned and suitable habitat may be found in several of the region’s other countries.

Laboratory detection and characterization of arboviruses is key to diagnosis, clinical and environmental intervention, and epidemiological study. WHO has developed an EQAP for arbovirus diagnostics to determine the proficiency of national public health laboratories to adequately detect DENV, YFV, ZIKV and CHIKV by polymerase chain reaction (PCR). Weak points revealed though the program offer laboratories (and WHO, as needed) the opportunity to implement corrective actions to improve the quality of testing available.

The first two rounds of the EQAP were implemented in 2016 and 2018 by the Royal College of Pathologists of Australasia Quality Assurance Programs, Australia. Testing panels consisted of 12 specimens of inactivated, lyophilized arboviruses, including DENV, YFV (optional), ZIKV and CHIKV. Two of the specimens were double-spiked to simulate coinfection. Panels were distributed to participating national-level public health laboratories between October and December, and confidential performance reports were sent in March of the following year.

In the 2016 round, 96 laboratories participated globally, including 9 laboratories from 7 countries in the EMR. Of these EMR laboratories, 5/5 (100%) correctly identified YFV (optional), 6/6 (100%) identified CHIKV and 7/8 (88%) identified DENV and ZIKV. PCR diagnostics for the 4 arboviruses were available in 5 laboratories. A single laboratory was responsible for 3/4 reported errors.

In the 2018 round, 107 laboratories participated globally. Thirteen, including 5 repeat participants, represented 11 EMR countries. Of EMR laboratories, 6/6 (100%) correctly identified YFV (optional) , 11/11 (100%) identified CHIKV, 11/13 (85%) identified DENV and 10/13 (77%) identified ZIKV. Six laboratories had PCR diagnostics for the 4 arboviruses. Of the 5 repeat participants, all accurately detected CHIKV in both rounds, 75% accurately detected DENV and ≥60% accurately detected ZIKV. The 3 repeat participants that tested YFV in both rounds did so correctly. Most errors (4/6) were reported in a single DENVZIKV double-spiked specimen. The laboratory that had made the most errors in 2016 demonstrated error-free testing in 2018.

While the EMR laboratories participating in the 2016 and 2018 rounds of the EQAP demonstrated good proficiency, they represent only half of the countries in the region, providing an incomplete picture of national capacities for arbovirus diagnostics. In addition, few countries with arbovirus outbreaks have consistently, or ever, participated. For some this is due to conflict and the commensurate difficulty in sourcing the necessary reagents. WHO will assist where it can to help countries obtain the necessary reagents as well as encourage the enrolment of others in the program.

29 December 2019 – In Yemen, a country torn apart by war, those seeking medical help often struggle to receive proper and effective treatment. One reason is that much hospital equipment needs replacing. For example, in the central sterile supply department of Al-Thawra hospital, Sana'a, the equipment was until recently so old that the sterilization of instruments would take hours instead of minutes, causing the delay or cancellation of critical surgical operations. But thanks to the support given by the World Bank to the Emergency Health and Nutrition Project, Al-Thawra hospital now has the updated sterilization equipment it so desperately needed.

“The number of patients in Al-Thawra hospital benefiting from this support is 3000 to 4000 beneficiaries on a monthly basis. With approximately 120 to 130 operations a day in 26 medical departments, some of these operations need to go through the sterilization process in 16 minutes, but the sterilization equipment was very old, resulting in the delay or cancellation of operations. The new sterilization equipment can sterilize in 16 minutes, saving lives through the performance of urgent surgeries without delay”, says Mansor Kuhazah, manager of the central sterile supply department of Al-Thawrah hospital.

Without proper sterilization, patients are at risk of infection. Millions of patients are harmed each year due to unsafe health care worldwide resulting in 2.6 million deaths annually in low-and middle-income countries alone. Most of these deaths are avoidable.

“Now the central sterile supply department of Al-Thawra hospital is in a position to sterilize plastic and instruments rapidly due to the modern sterilization equipment provided by WHO through the Emergency Health and Nutrition Project”, says Engineer Mohammed Nofal, responsible for the rehabilitation of the central sterile supply department of the hospital.

Through the Emergency Health and Nutrition Project, WHO and UNICEF, with the support of the World Bank, are meeting health needs and expectations in Yemen. The Project is a cross-cutting initiative, providing essential health and nutrition services throughout the country. In the midst of the ongoing war, the Project is protecting Yemen's health system, supporting 72 hospitals with a package of essential life-saving health services. WHO, UNICEF and the World Bank are also working closely together to strengthen the referral system from the primary and secondary health care levels to the tertiary level. In addition, the Project supports public health programmes and the response to disease outbreaks such as cholera and diphtheria.

14 January 2020 - The Ministry of Public Health and Population of Yemen reported 11 531 suspected cases with four associated deaths during epidemiological week 46 (11 – 17 November) of 2019 with 11% of the cases reported as severe. The cumulative total number of suspected cholera cases from 1 January 2018 to 17 November 2019 is 1 165 823, with 1511 associated deaths (case-fatality rate of 0.13%). Children under five represent 26.1% of the total suspected cases during 2019. The outbreak has affected 22 of the 23 governorates and 311 of the 333 districts of Yemen.

Suspected cholera cases at the country level started to be increasingly reported from week eight of 2019 and the trend continued until week 14 when the number of cases reached more than 29 500, the highest number of cases reported so far in a single week. The number of suspected cases fluctuated over the following period with the trend now considered as stable during the past three weeks based on the average number of cases calculated between weeks 44 and 46.

The governorates reporting the highest number of suspected cases of cholera during 2019 are Al Hudaydah (122 717), Amanat Al Asimah (102 058), Sana’a (98 683), Hajjah (72 288), Ibb (71 344), Dhamar (63 542) and Amran (48 387).

Of a total of 102 595 samples tested at the central public health laboratories since January 2019, 5207 have been confirmed as cholera-positive by culture. During this reporting period the governorates reporting the highest number of positive cultures were Amanat Al Asimah (1410), Taizz (1372) and Sana’a (470).

WHO continues to provide leadership and support for activities with health authorities and partners to respond to this ongoing cholera outbreak including case management; surveillance and laboratory investigations; hotspot mapping and oral cholera vaccine (OCV) campaign planning; water, sanitation and hygiene (WaSH); and risk communication.

The Ministry of Public Health and Population of Yemen reported 10 787 suspected cases with two associated deaths during epidemiological week 48 (25 November – 1 December) of 2019 with 12% of the cases reported as severe. The cumulative total number of suspected cholera cases from 1 January 2018 to 1 December 2019 is 1 189 757, with 1513 associated deaths (case-fatality rate of 0.13%). Children under five represent 26.1% of the total suspected cases during 2019. The outbreak has affected 22 of the 23 governorates and 313 of the 333 districts of Yemen.

Suspected cholera cases at the country level started to be increasingly reported from week eight of 2019 and the trend continued until week 14 when the number of cases reached more than 29 500, the highest number of cases reported so far in a single week. The number of suspected cases fluctuated over the following period with the trend now considered as stable during the past three weeks based on the average number of cases calculated between weeks 46 and 48.

The governorates reporting the highest number of suspected cases of cholera during 2019 are Al Hudaydah (126 934), Amanat Al Asimah (104 952), Sana’a (102 294), Hajjah (73 984), Ibb (73 786), Dhamar (65 179) and Amran (49 381).

Of a total of 104 005 samples tested at the central public health laboratories since January 2019, 5292 have been confirmed as cholera-positive by culture. During this reporting period the governorates reporting the highest number of positive cultures were Amanat Al Asimah (1459), Taizz (1384) and Sana’a (478).

WHO continues to provide leadership and support for activities with health authorities and partners to respond to this ongoing cholera outbreak including case management; surveillance and laboratory investigations; hotspot mapping and oral cholera vaccine (OCV) campaign planning; water, sanitation and hygiene (WaSH); and risk communication.

Disease outbreaks in Eastern Mediterranean Region (EMR), January to December 2019

In 2019 alone, eight countries in the Eastern Mediterranean Region (EMR) experienced major outbreaks of high threat pathogens. Some of these outbreaks started during previous year (s) and can not be contained while others emerged exclusively during 2019.

Editorial note

During 2019 alone, countries in the region experienced several major outbreaks from emerging and re-emerging infectious diseases, with some of these turning into explosive outbreaks. The infectious diseases that have been reported in the EMR in 2019 include cholera, Crimean-Congo hemorrhagic fever (CCHF), chikungunya, chicken pox (Varicella), dengue fever, diphtheria, extensive drug-resistant typhoid fever, Hepatitis A, HIV, measles, Middle East respiratory syndrome (MERS), poliomyelitis, and Rift Valley fever (See map).

Sudan remained the epicenter of outbreaks during 2019. The country experienced outbreaks of six different infectious diseases simultaneously (Cholera, Chikungunya, Dengue fever, Diphtheria, malaria and Rift Valley Fever), the highest number than any other country in the region and all were declared during second half of 2019. The country announced for the first time the cholera outbreak and reported 346 cases, including 11 deaths (See table). The cases remained relatively low as compared to previous outbreaks due to timely detection and response.

Pakistan was the second most affected country with outbreaks of infectious diseases and it experienced HIV, Dengue fever, extensive drug resistance (XDR) typhoid, Crimean Congo Hemorrhagic Fever, Poliomyelitis and chicken pox outbreaks during 2019. HIV outbreak was reported in April 2019 from Ratodero Taluka in Sindh province and till end of 2019, a total of 1 211 people tested positive among 3,8009 screened voluntarily. Around 80% of the cases were children less than 11 years old and the reporting of new cases continued till end of year. Dengue fever re-emerged this year in Pakistan with more cases across country with cumulative cases of 53,600 with 95 deaths. Most affected cities were Islamabad and Rawalpindi (39% of total cases) and Karachi (29 % of total cases). Although this outbreak started declining during week 46 but sporadic cases were reported till end of year.

Middle East respiratory syndrome coronavirus (MERS-CoV) has continued to circulate since 2012. This year, a total of 203 cases were laboratory confirmed and among them 199 cases with 48 deaths were reported in Saudi Arabia. The rest of the cases were reported in United Arab Emirates (1 cases) and Qatar (3 cases).

Other countries in the region that reported outbreaks during 2019 are; Somalia (Cholera; 9735 cases and 50 deaths), Yemen (Cholera; 794,741 cases an 1007 deaths) Afghanistan (CCHF; 583 cases (63 deaths), Dengue fever; 14 cases (1 death) and Poliomyelitis; 26 cases), Lebanon (Measles; 1064 cases, Hepatitis A; 418 cases).

The emergence and rapid transmission of high-threat pathogen diseases has increased due to acute or protracted humanitarian emergencies, rapid urbanization, climate change, weak surveillance and limited laboratory diagnostic capacity, and increased human–animal interaction. Its important to scale up the prevention, timely detection and response to any infectious disease threats among such vulnerable populations in emergency settings. In the region at large, WHO/ EMRO has started the implementation of a holistic strategy to minimize the impact of emerging infectious disease outbreaks, which is focusing on strengthening early warning surveillance systems for rapid detection, and improving capacities for field investigation and laboratory confirmation of emerging and re-emerging infectious disease outbreaks as well as enhancing rapid response capacities for early damage control.

Yemen’s Expanded Programme on Immunization (EPI) uses routine and specialized vaccination campaigns to protect children under one year of age from life-threatening diseases, including diphtheria, cholera and polio. More than 82% of targeted children under 1 year old were reached with various EPI vaccines. In total over 50 million doses of different vaccine, including oral cholera vaccine administered in 2019 through the EPI, with an average coverage of 80%, during the different campaigns conducted. Supplementary immunization activities are being implemented to mitigate a host of complexities brought on by the ongoing conflict, such as malnutrition, health care access challenges, population movement and changes in the transmission patterns of vaccine-preventable diseases.

With the support of local health authorities, WHO continues to remain vigilant through the disease detection and alert activities carried out by rapid response health teams. These mobile teams work to detect, assess, alert and respond to potential public health threats by investigating the situation and quickly supplying the appropriate public health response to reduce the risk of an outbreak.

Polio update

Polio is caused by a virus and is highly contagious. It affects people differently — some don't feel sick at all, others complain of sore throat, fever, stomach pain or vomiting, stiff neck or headache. OPV has been recommended for use globally since 1963.The success of the OPV in curtailing polio epidemics and reducing or even eliminating the disease in endemic countries provides overwhelming evidence of the effectiveness of polio vaccines, in particular OPV. Vaccine efficacy was estimated at 82% after one dose, 96% after two doses and 98% after three or more doses.

Yemen has been polio free since 2006. In December 2019, WHO and UNICEF conducted a 3-day nationwide polio campaign to protect over 4 million children under the age of 5. The recent campaign covered 317 out of 333 districts and all 22 governorates across the country.

• During the campaign, around 4 538 861 (85%) children under-5 years of age received polio vaccine with the help of 18 133 house-to-house vaccination teams.

• 2572 fixed teams deployed in health facilities.

• vitamin A supplementation was also administered to children 6 months to 5 years of age.

• These teams were supervised by 4667 close supervisors (one close supervisors for 3–5 mobile teams, 630 district supervisors (2 per district).

• 132 governorate supervisors (6 per governorate).

• 680 supervisors from local authorities (2 per district and 2 per governorate).

• In addition to these 41 independent supervisors were deployed by WHO in various high-risk areas to support the district/governorate in training and implementation of campaign.

An independent post-campaign assessment was carried out and the preliminary results indicate an overall coverage of 91% with the lowest coverage in Say’oun (68%), Mokala (78%), Aden (79%) and Sana’a city (84%).

Preliminary results for national polio campaign, December 2019

Outreach activities update

During December 2019, an integrated outreach round that was the fourth for the year, was conducted in the selected districts/ governorates to vaccinate the target children in the remote areas. A minimum package of “routine essential health and nutrition services provided to the target children and family planning/reproductive health services to women of childbearing age.

The services provided include:

• vaccinations: against 11 childhood vaccine preventable diseases
  
• Integrated Management of Child Illnesses; treatment of pneumonia, diarrhoea and malaria
  
• reproductive health; ante/postnatal care and family planning
  
• nutrition; screening for malnutrition, deworming, micronutrient supplementation referral services in case required.

Current major event

Emergence of novel Coronavirus (2019-nCoV) in China

On 31 December 2019, WHO was informed about the detection of a cluster of pneumonia of unknown etiology in Wuhan City, Hubei Province of China. A novel coronavirus (2019-nCoV) was identified as the causative virus on 7 January 2020.

Editorial note

Coronaviruses (CoV) are a large family of viruses that circulate in animals and few of them are known to affect humans causing mild to moderate lower-respiratory tract illnesses. However, if the virus is novel, more severe outcomes are expected. Before current events there were only two incidences where highly pathogenic coronaviruses had emerged: SARS-CoV in 2002 and MERSCoV in 2012. 2019-nCoV was identified by Chinese authorities on 7 January 2020. Investigations were triggered by the detection of a cluster of 27 pneumonia cases of unknown etiology in Wuhan City, Hubei Province of China on 31 December 2019. The source of infection is still unknown and under investigation. Some cases have reported a common exposure: a local seafood and animal market in Wuhan City. The market was closed on 1 January 2020 for environmental sanitation and disinfection. The Chinese authorities continue to perform intensive surveillance, take preventive measures and conduct further epidemiological investigations (see timeline of events).

As of 24 January 2020, a total of 846 confirmed cases have been reported of 2019-nCoV globally. Of them, 830 cases were reported from China including 375 cases confirmed from Hubei Province. Of the 830 cases, 177 have been reported as severely ill and 25 deaths have been reported. 16 healthcare workers were affected as well within China.

Since then, the virus has spread to three other administrative regions (5 cases) and six other countries (11 cases) (see table). Almost all reported 2019-nCoV cases outside China had a travel history to Wuhan. No confirmed cases of the new coronavirus have been reported in the WHO Eastern Mediterranean Region to date.

Epidemiological information available from China has confirmed human-to-human transmission, however, more epidemiological data is needed to understand the full extent of human-to-human transmission. Further investigations are ongoing to characterize transmission modes, reproduction interval and clinical spectrum resulting from infections to inform and refine strategies to prevent, control and stop the spread of 2019-nCoV.

Current evidence suggests transmission may be occurring through droplets, contact and fomites. WHO is recommending standard precautionary measures to prevent infection spread include regular hand washing, covering mouth and nose when coughing and sneezing, thoroughly cooking meat and eggs, as well as avoiding close contact with anyone showing symptoms of respiratory illness such as coughing and sneezing.

On 22 and 23 January, WHO DirectorGeneral convened an Emergency Committee under the IHR (2005). The committee has not declared the event as a PHEIC. WHO assessed the risk of this event to be very high in China, high at the regional level and moderate at the global level. WHO encourages all countries to continue enhancing preparedness and prevention activities. WHO advises against the application of any travel or trade restrictions based on the information available. If travellers develop respiratory illness before, during or after travel, they should seek medical attention and share travel history with their health care provider.

WHO has developed technical guidance, most of which was based on MERS experience in EMRO. The guidance is available on https://www.who.int/health-topics/ coronavirus. It is being continuously reviewed as new information becomes available.

Highlights

• In December 2019, the Ministry of Public Health and Population of Yemen reported a total 43 950 suspected cholera cases including 9 related deaths from 22 governorates (case fatality rate: 0.02%).

• The cumulative number of suspected cholera cases reported in Yemen from October 2016 to December 2019 is 2 280 585 including 3895 related deaths with a case fatality rate of 0.17%. During the second wave of this outbreak that started on 27 April 2017, the total number of suspected cholera cases reported were 2 254 758 including 3766 related deaths with a case fatality rate of 0.17%.

• Since January 2019, a total of 9694 stool specimens were tested. Out of these, 5298 were laboratory confirmed for Vibrio cholerae.

• The 5 governorates with the highest cumulative attack rate per 10 000 are Amran (1697.88), Al Mahwit (1599.41), Sana’a (1515.22), Al Bayda (1226.46) and Al Hudaydah (1049.29). The national attack rate is 800.48 per 10 000. The governorates with highest number of deaths are Hajjah (577), Ibb (503), Al Hudaydah (402) and Taizz (328).

3 February 2020, Sana’a/Amman — The UN Special Envoy for Yemen, Martin Griffiths, the UN Humanitarian Coordinator for Yemen, Lise Grande and the World Health Organization Representative for Yemen, Altaf Musani, welcomed today the launch of the medical air bridge operation that brought the first group of Yemeni patients in need of specialized medical assistance from Yemen to Jordan.

Today was the maiden voyage of the medical air bridge operation that brought a number of patients out of an initial group of 30 along with their respective travel companions from Sanaa to Amman. The remaining of the first group of 30 patients will travel in a second flight while more patients will follow on subsequent flights. The World Health Organization in collaboration with the local public health and population authorities coordinated these flights. The medical air bridge flights come as part of the United Nations’ ongoing humanitarian assistance in Yemen including providing support to the health care system.

The United Nations is grateful to the host countries, Egypt and Jordan but also to Saudi Arabia for their efforts in this humanitarian measure. The collaboration and commitment of both the Government of Yemen and Sana’a authorities made this operation possible.

Many United Nations entities and several governments in the Region and around the world collaborated to get these patients the treatment they need abroad, and we are grateful to them all. The United Nations will do what it can to ensure the continuation of the medical air bridge as a temporary solution to reduce the suffering of the Yemeni people until a more sustainable solution is reached in the near future.

For more infomation:

World Health Organization: Christine Cool, coolc@who.int (Yemen), Inas Hamam, hamami@who.int (Cairo), Tarik Jasarevic, jasarevict@who.int (HQ)

Office of the Special Envoy for Yemen: Mayy El Sheikh, mayy.elsheikh@un.org and Ismini Palla, palla@un.org

Office of the Humanitarian Coordinator for Yemen: Tapiwa Gomo, gomo@un.org

2019-nCoV - Public Health Emergency of International Concern (PHEIC)

The emergence of new deadly pathogen in China, 2019-nCoV, has been a significant global health challenge. Its rapid proliferation in China and global human-to-human transmission has necessitated convening the Emergency Committee by Director General and declare it as a PHEIC on 30 January 2020.

Editorial note

Coronavirus (CoV), a large group of viruses, is named due to the circular-shaped protein spikes that surround its genetic material in the centre. The new pathogen is a member of the family of Coronavirus; therefore, named as novel Coronavirus (2019-nCoV); other lethal siblings (viruses) are Severe Acute Respiratory Syndrome, SARS-CoV, first identified in China in 2002 and the Middle Eastern Respiratory Syndrome-MERS-CoV in Saudi Arabia in 2012. Different from both SARS-CoV and MERS-CoV that are transmitted by civet cats and dromedary camels respectively, the aetiology of the recent member of this family is still unknown. However, what is known are the commonalities of their symptoms, which includes cold, difficulty in breathing, and in severe cases pneumonia and kidney failure can also occur. Case fatality rate (CFR) frequently changes with the number of deaths caused by the virus but it is currently 2.1%. 2019-nCoV is spreading rapidly in China and has infected people globally, resulting global total to 14 545 confirmed cases out of which 14 411 cases are from China with 304 deaths as reported as of 02 February 2020.

Furthermore, the transmission has been reported in 5 WHO regions (see table) involving 19 countries. In Eastern Mediterranean region (EMR), first 4 confirmed cases are reported from United Arab Emirates (UAE) on 29 January, 2020. All 4 cases belongs to the same family and have travel history to Wuhan, China- the epicenter of 2019-nCoV. Subsequently, it is more likely that other EMR countries may see the importation of new cases in the near future; thus, EMR Office has developed a Strategic Response Plan to scale up preparedness and operational readiness to prevent, early detect, and rapidly respond to the virus in the regional countries.
Keeping in view the global transmission of the new virus, WHO Director General convened an Emergency Committee under the IHR (2005) for three times in the last two weeks and finally agreed upon and announced the outbreak as a PHEIC on 30 January 2020. However, the committee further said that the announcement should be taken as a support to Chinese people and emphasized on global coordination to enhance preparedness in other regions which are in need of additional support.

Additionally, WHO has warned the international exportation of cases in any country; therefore, advised them to prepare for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread of the virus along with sharing full information with WHO. In addition WHO has developed interim guidance for laboratory diagnosis, clinical management, IPC in health care settings, home care for patients with suspected 2019-nCoV, risk communication and community engagement. Moreover, the R&D Blueprint has been activated as response to the outbreak to accelerate diagnostics, vaccines, and therapeutics for this novel coronavirus. Based on the similarity of 2019-nCoV with SARS-CoV and MERS-CoV, the public is advised similar measures to use facemasks, covering mouth and nose when coughing and sneezing, frequent handwashing after unprotected contact with farm animals and with the patients having respiratory illness and consuming thoroughly cooked animal products to reduce virus transmission.There are no travel or trade restrictions based on available information. However, travelers are advised to seek medical attention and share their travel history, if they have any respiratory illness.

Resurgence of Arboviruses in EMR

Epidemiology of Arthropod– borne viruses (Arboviruses) is changing in EMR. Emergence and resurgence observed trends of arboviruses could be attributed to several factors including viral mutation and recombination, urbanization, global population movements, trades and climate changes. In 2019, four arbovirus outbreaks were reported from 4 countries in the region.

Editorial note

Arboviruses are transmitted through bites of infected mosquitoes, ticks, or sand flies. (See table) Other mode of transmission is contact with body fluid of infected animal. Person to person transmission is un-common but can occur through blood transfusion, organ transplantation, health-care acquired and laboratory transmission. Vertical transmission and through breast milk are reported.

Arbovirus outbreaks exert a huge burden on population, health system and economy as well. There are more than 130 arboviruses are known to cause human disease. More than nine Arboviruses posed significant threat in EMR causing multiple outbreak in the past decade including; Dengue fever (DF), Rift Valley fever (RVF), Crimean-Congo haemorrhagic fever (CCHF), Chikungunya, Yellow fever (YF), West Nile fever (WNF), and Alkhurma fever.

DHF is currently the most widely spread mosquito-borne disease EMR. Dengue outbreaks were first reported in 1998 and have increased in frequency and spread ever since, with outbreaks occurring in Djibouti, Egypt, , Oman, Pakistan, Saudi Arabia, Somalia, Sudan, and Yemen.
Serological evidence of circulation of DV has been reported from Jordan recently.
All the four serotypes of DV have been circulated during the outbreak.

RVF was introduced to EMR in 1977, via infected livestock trade along the Nile irrigation system to Egypt. In 2000, RVF spread to Saudi Arabia and Yemen, marking the first reported occurrence of the disease outside the African continent. Then, subsequent outbreaks were reported from Egypt and Sudan.

In EMR, sporadic human cases and outbreaks of CCHF have been reported from Afghanistan, Islamic Republic of Iran, Iraq, Kuwait, Oman, Pakistan, Saudi Arabia, Sudan and the United Arab Emirates. So far, five genotypes of CCHF virus (genotype-1, 2, 3, 4 and 7) have been detected in region. In some countries, the trend of CCHF has been steadily increasing in recent years.

Chikungunya was first found during serological surveys in Pakistan in 1983. Huge outbreaks were reported from Yemen, Pakistan and Sudan as well. Sporadic cases were reported from Saudi Arabia. WNV is one of the most widely distributed arboviruses in the world. In EMR,
WNV is endemic in Tunisia. Since 1997 four major upsurge of WNV cases were reported in the country.

Alkhurma Haemorrhagic Fever (AHF) was initially isolated in 1995 from a patient in Saudi Arabia. Since then, several cases were reported from KSA.

Sudan is the only country in EMR in the Yellow Fever zone. Large epidemics have been reported in Sudan in 1940, 1959, 2003, 2005, 2012 and 2013. Apart from Sudan, serological evidence of circulation of Yellow Fever virus has been documented in Djibouti and Somalia.

The key to tackle Arboviruses resurge is strengthening the integrated one health initiative addressing public health, animal health and environmental aspects.

Diphtheria situation update: Sudan

Federal Ministry of Health (FMOH) Sudan reported an upsurge of diphtheria cases, starting from epidemiologic week 33-2019. Till the reporting date (week 02-2020), a total of 98 suspected diphtheria cases with 13 associated deaths (CFR 13.27%) are reported from six states.

Editorial note

The Federal Expanded Programme of Immunization (FEPI) data shows that, between 5 February 2019 and 31 October 2019; 12 sporadic suspected cases reported from East Darfur, North Kordofan, Khartoum, Gezira and White Nile states. Since November 1st 2019 an upsurge of cases has been reported from seven states of the country (See graph).

The most affected state is South Darfur , and the joint field investigation by the joint WHO and MOH mission (late November 2019) showed that 99% of the cases within South Darfur were from one locality (Al Sunta) and it was found that the immunization coverage in the locality was estimated around 35% due to lack of mobile immunisation teams. Further, the cold chain system that has been dysfunctional since last three years, was only recently corrected during May 2019.

Since early November 2019 to 12 January 2020 the Al Sunta locality reported 91 cases with 10 deaths with a CFR of 10.9% and cases from other areas of Sudan reported during this period were 7 with 2 associated deaths (See table). Reports of diphtheria cases from multiple states within Sudan despite high national DPT3 coverage shows that multiple hotspots exist with low vaccination coverage with potential for future outbreaks and due to lack of proper data collection and analysis, those areas are masked during national coverage estimates.

To control the outbreak and provide treatment to the affected people, WHO provided assistance to the Government of Sudan for provision of adequate supplies of medicines (paracetamol, antibiotics etc.), diphtheria antitoxins (DAT) for the management of complicated cases, and for printing and distribution of IEC materials for public awareness. Targeted immunization campaign was launched within Al Sunta locality immediately and 1st round (November 25 - December 1) targeted 38 881 children aged < 15 years old; Penta vaccine for children under 7 years age and DT for 7-15 years old. The coverage during the campaign was high. Second round was administered from December 31 -January 6 with the same target population and vaccination coverage during this round was 80%. In addition to that, immunization drive through EPI was strengthened to vaccinate children less than 1 year old.

Although the outbreak is still on going but the number of new cases from the locality have reduced substantially since January 1, 2020. WHO is continuously monitoring the outbreak in coordination with MOH and is providing all possible support to control and eradicate the outbreak within the shortest possible time.

WHO recommends to develop a long-term strategy to enhance the immunization coverage in all areas and identification of hotspots through surveillance for taking timely corrective measures. Current diphtheria outbreak in Sudan can be used as a starting point to engage the state authorities to necessitate the sustained vaccination activities across the country to prevent such occurrences in future.

Sana’a, Amman – 9 February 2020 – A plane carrying Yemeni civilians who need medical treatment abroad landed in Jordan yesterday. The flight is the second to arrive this week as part of the United Nations/WHO medical airbridge operation.

“These are some of the first civilians to leave the country since the start of the crisis, signaling a new era of hope for Yemen and all Yemenis,” said Altaf Musani, WHO Representative in Yemen.

Earlier this week, 6 children were the first patients to be flown out of Yemen as part of the medical airbridge operation. Several have already had successful surgeries and are in good spirits, and optimistic about their future.

With today’s flight, they have now been joined by an additional 22 men, women and children, bringing the total number of Yemeni patients in Jordan to 28.

These patients are part of a special group of chronically ill Yemenis who cannot get the treatment they need inside the country. Many of them suffer from different types of cancers, kidney disease, congenital anomalies and other conditions.

A third flight is planned to Cairo, Egypt, scheduled to depart from Yemen in the coming weeks.

The medical airbridge operation was made possible through negotiations by the UN special envoy for Yemen, Martin Griffiths, and UN humanitarian coordinator for Yemen, Lise Grande, as well as the governments of Jordan, Egypt and Saudi Arabia.

Inside Yemen, WHO and partners continue to support the provision of aid for millions of people in need of basic and lifesaving health care services.

For more information, please contact:

Inas Hamam
Email: hamami@who.int
Cell: +201000157385
+962791815284 (temporary)

First cases of novel coronavirus (2019-nCoV) reported in WHO Eastern Mediterranean Region

On 29 January, WHO Eastern Mediterranean Region reported its first cases of 2019-nCoV following confirmation on the same day of four cases by the Ministry of Health and Prevention in the United Arab Emirates (UAE). An additional case was also reported on 30 January bringing the total number of reported cases to five in the UAE.

Editorial note

This has not been unexpected as WHO has assessed the risk of 2019-nCoV to be very high for China, high at the regional level and high at the global level (See table).

A report from the UAE Ministry of Health and Prevention dated 29 January 2020 indicated that four members of the same family from Wuhan City, China (63 year-old female, 38 year-old female, 36 year-old male and 10 year-old male) arrived in UAE on 4 and 16 January 2020, and were hospitalized on 25 and 27 January after testing positive for coronavirus. Two of the persons (both males) were asymptomatic. One additional case (male, 41 years old) was also reported following hospitalization on 30 January (See above).

WHO Regional Office for the Eastern Mediterranean (EMRO) is monitoring the trends of the disease and is working with Member States to ensure the highest degrees of readiness to detect and respond to potential cases. This is vital in controlling transmission and providing effective treatment to those who become ill.

Several priority actions have been taken to scale up country preparedness and operational readiness capacities to prevent, early detect and rapidly respond to 2019-nCoV as required under the International Health Regulations (IHR 2005) for the Region are being put in place. These actions include:

1- Providing leadership and coordination: An incident management system has been activated in EMRO and a regional plan to enhance preparedness and operational readiness of countries has been developed using a risk assessment approach.

2- Enhancing capacities required under IHR (2005) at international points of entry (PoE):
Regular communication takes place with the focal points for national IHR, surveillance and influenza. Active entry screening has also been established at PoE in most of the countries in the Region through temperature monitoring, assessing signs and symptoms, collecting primary information through a structured questionnaire and disseminating information to travellers.

3- Strengthening surveillance and reporting systems: This is done by disseminating 2019-nCoV standard guidelines and tools, the strengthening of event-based surveillance and case investigation, the follow up and reporting on suspected cases as well as the enhancement of existing national acute respiration infection surveillance systems.

4- Improving access to quality diagnostics testing and rapid turnaround of results: The testing capacity for 2019-nCoV in the Region was inadequate and EMRO has supported all regional Member States to enhance the 2019-nCoV laboratory testing capacity and sample referral system. As of today 20 out of 22 countries now have the capacity to detect 2019-nCoV in country.

5- Enhance national and health care facility infection, prevention and control (IPC) measures: Countries in the Region are identifying IPC surge capacity and undertaking risk assessment of IPC capacity at all the levels. The regional office has distributed personal protective equipment (PPE) kits for basic IPC for prioritized countries, and also disseminated WHO IPC guidance and materials on 2019-nCoV.

6- Improve case management: EMRO distributed case management guidelines for 2019-nCoV, and provided guidance to countries to strengthen their referral systems of suspected and confirmed cases, to designate referral facilities for case management and to map existing public/private health facilities at different levels of care/capacities for surge response.

7- Improving risk communication and community engagement (RCCE): EMRO is supporting the development of comprehensive national RCCE plans for 2019-nCoV, developing regular talking points and disseminating credible information and messages targeting different audiences in appropriate formats.

8- Strengthening rapid response capacities at national and subnational levels: This is done through the identification of members of multidisciplinary rapid response team(s) at the different administrative levels and ensuring the mechanism of activation and deployment of rapid response team(s) is in place, with the team(s) having the 2019-nCoV guidelines, SOPs and tools.

WHO expects further exported cases to appear in other countries and the possibility of other cases arriving in the Region. Countries will need to apply additional efforts to strengthen capacities for the early detection, investigation and rapid response to public health events.