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From 1 through 31 October 2019, the National IHR Focal Point of Saudi Arabia reported 15 additional cases of Middle East respiratory syndrome (MERS-CoV) infection and six associated deaths. The cases were reported from Assir (5 cases), Al-Qassim (3 cases), Riyadh (6 cases), and Taif (1 case) regions. Of the 15 cases reported, four were linked to two separate clusters. Cluster 1 involved a patient (case #1) and a health care worker (case #5) in Assir region. Cluster 2 involved a patient (case #12) and a health care worker (case #15) in Riyadh region.

The link below provides details of the 15 reported cases:
Nine new confirmed cases were reported from 27 November to 3 December in the ongoing Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces. The confirmed cases in this week were reported from Mandima (56%, n=5) and Mabalako (44%, n=4) Health Zones.

In the past two weeks, violence, widespread civil unrest, and targeted attacks have severely disrupted the Ebola response and restricted access to affected communities in multiple locations. As a result, several key activities of the response experienced diminished performance, including the volume of reported and investigated alerts and the number of contacts registered and followed (Figure 1, Figure 2). The volume of alerts from health zones affected by insecurity is lower than usual, and this has led to an overall reduction in the average number of alerts reported in the last seven days. Of the 3346 alerts reported, 96% were investigated within 24 hours.
On 6 November 2019, the Spanish authorities reported a likely sexual transmission of dengue between two men who have sex with men (MSM) in the municipality of Madrid in central Spain.
Outbreaks of circulating vaccine-derived poliovirus type 2 (cVDPV2) have been reported in several countries in West Africa, central Africa and Horn of Africa (for more information, please see the disease outbreak news published on 31 July 2019(2005)). This report provides a situational update on current cVDPV2 outbreaks in newly affected countries in Africa. No wild poliovirus has been detected on the continent since September 2016.

In West Africa and the Lake Chad sub-region, a cVDPV2 outbreak originating from Jigawa state, Nigeria, continues to spread. Following detection of this outbreak in Cameroon, Ghana, Benin and the Republic of Niger earlier this year and in 2018, the virus has now been detected in Chad, Togo and Côte d’Ivoire.
Sierra Leone health officials, supported by WHO, US Centers for Disease Control and Prevention (CDC) and other partners, are responding to an outbreak of Lassa fever.

On 20 November 2019, WHO was informed by The Netherlands’ International Health Regulations (IHR) National Focal Point of one imported case of Lassa fever from Sierra Leone. The patient was a male doctor, a Dutch national who worked in a rural Masanga hospital in Tonkolili district, Northern province in Sierra Leone.
Six new confirmed cases were reported between 20 to 26 November in the ongoing Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces.
Through national disease surveillance, an outbreak of circulating vaccine-derived poliovirus type-2 (cVDPV2) has been confirmed in Pakistan in 2019. Between 7 July and 3 November 2019, 11 children have been paralysed from cVDPV2 in Pakistan – four in Diamir district, Gilgit-Baltistan province, three in Kohistan, two in Torghar and one in Charsadda, Khyber Pakhtunkhwa (KP) province, and one in Metropolitan Corporation Islamabad. The median age for these cases was 22 months ranging from 8 to 66 months .

The virus was also isolated in stool samples from two contacts of one patient from Diamir, one contact of one patient from Torghar, as well as from 16 healthy children from Diamir, Kohistan and Rawalpindi districts. In addition, the virus was also isolated in seven environmental samples collected between 21 August and 25 October 2019 in Rawalpindi and Lahore districts, Punjab province; Diamir and Gilgit districts, Gilgit-Baltistan province; and Site Town, district West, Karachi, Sindh province.
Many countries around the world are experiencing measles outbreaks. As of 5 November 2019, there have been 440,263 confirmed cases reported to WHO through official monthly reporting by 187 Member States in 2019.

Data Source: IVB Database - This is surveillance data, hence for the last month(s), the data may be incomplete.
On 10 October 2019, the Sudan International Health Regulations (IHR) National Focal Point (NFP) notified WHO of 99 suspected cases of dengue fever in Kassala State. The first reported case presented to the health facilities on 8 August 2019 with symptoms including high-grade fever, headache, and joint pain, with or without vomiting.

From 8 August through 4 November 2019, a total of 1,197 suspected cases of dengue fever including five deaths have been reported from seven states: Kassala (1,111 cases; 3 deaths), West Darfur (43 cases; 1 death), North Darfur (29 cases; 1 death), Red Sea (9 cases; 0 deaths), South Darfur (3 cases; 0 deaths), Gadarif (1 case; 0 deaths) and North Kordofan (1 case; 0 deaths).
On 13 November 2019, the Venezuela International Health Regulations (IHR) National Focal Point (NFP) and the Venezuela PAHO/WHO Country Office shared information about a confirmed case of yellow fever in Bolivar State. The case-patient is a 46-year-old male resident of the municipality of Gran Sabana, Bolivar State. He was in the locality of Uriman municipality of Gran Sabana within the 19 days prior to the onset of symptoms. Symptom onset was on 14 September 2019, and included fever, chills, nausea, vomiting, epistaxis, petechiae, and diarrhoea. On 26 September 2019, he visited a public hospital in the municipality of Heres where his condition deteriorated, with moderate dehydration, bleeding from the gums, jaundice, choluria, abdominal pain, and hepatomegaly. As of 13 November 2019, the patient remains hospitalized with chronic renal failure and moderate anaemia.

On 26 September 2019, the first serum sample was sent to the National Reference Laboratory, the National Institute of Hygiene “Rafael Rangel” per its acronym in Spanish, IHRR1 , in Caracas. On 13 November 2019, the sample tested positive for yellow fever by reverse-transcriptase polymerase chain reaction (RT-PCR), and negative for dengue on 14 November 2019 by RT-PCR. On 10 October 2019, a second serum sample was taken and sent to the IHRR; for which the results are still pending.
Seven new confirmed cases were reported in the past week (13 to 19 November) in the ongoing Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces.
Health authorities in Pakistan are responding to an ongoing outbreak of dengue fever. This outbreak was first reported on 8 July 2019 by the Khyber Teaching Hospital in Peshawar, Khyber Pakhtunkhwa (KP) province. Since then, three other provinces (Punjab, Balochistan, and Sindh), as well as Islamabad Capital Territory (ICT), and Azad Jammu and Kashmir (AJK; one of the two autonomous territories) have also reported cases of dengue fever.

From 8 July to 12 November 2019, a total of 47,120 confirmed cases of dengue fever, including 75 deaths, were reported from the four provinces (KP, Punjab, Balochistan, and Sindh), Islamabad, and AJK.
Six new confirmed cases were reported in the past week (6 to 12 November) in the ongoing Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces.
On 10 October 2019, the National IHR Focal Point for Sudan notified WHO of 47 suspected cases of Rift Valley Fever (RVF), including two deaths in Arb’aat Area, Towashan Village, in El Qaneb locality, Red Sea State. The suspected cases presented with high-grade fever, headaches, joint pain, vomiting. There were no hemorrhagic signs or symptoms observed. The first case presented to the health facility on 19 September 2019.

On 28 September 2019, a total of 14 samples were sent to the National Public Health Laboratory in Khartoum, and 5 tested positive for RVF by Immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) and reverse-transcriptase polymerase chain reaction (RT-PCR). These samples were also tested for malaria and were found negative.
Fifteen confirmed cases were reported in the past week (30 October – 5 November) in the ongoing Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces
On 9 October 2019, the French authorities reported an autochthonous Zika virus (ZKV) case in Hyeres, Var department, France. The case had reported symptom onset on 29 July 2019. No travel history to Zika endemic countries was reported for the patient or partner. Since this notification, French authorities reported an additional two probable autochthonous ZKV cases, identified through active case finding, in Hyeres, in the same area and same timeframe (symptom onsets of the three cases from 6 to 15 August 2019). All three patients have recovered.

Epidemiological and entomological field investigations by French authorities are still ongoing to determine the possible route(s) of transmission for these cases, prevent further spread and detect possible associated cases.
On 7 October 2019, the National IHR Focal Point of the United Arab Emirates (UAE) notified WHO of one laboratory-confirmed case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection.

The patient is a 44-year-old male non-national farmer from Al Ain city, Abu Dhabi region, UAE. He developed fever, runny nose, headache, vomiting, productive cough and shortness of breath on 25 September 2019, and was admitted to hospital on 29 September. A nasopharyngeal aspirate was collected and tested positive for MERS-CoV by reverse-transcriptase polymerase chain reaction (RT-PCR) on 3 October at the Shiekh Khalifa Medical Center laboratory. The patient has underlying comorbidities including diabetes mellitus, hypertension and hyperlipidemia. He has a history of close contact with dromedary camels and sheep at nearby farms during the 14 days prior to the onset of symptoms. He has no history of recent travel and has not been involved in the slaughtering of animals. As of 14 October, the patient is in stable condition and is currently in an intensive care unit (ICU).
The ongoing Ebola virus disease (EVD) outbreak in the North Kivu and Ituri provinces saw a stabilization in the number of new cases this past week, with 19 confirmed cases reported in the past week (23–29 October), essentially equivalent to the 20 confirmed cases the week before.
On 27 September 2019 , a circulating vaccine-derived poliovirus type 1 (cVDPV1) has been confirmed in environmental samples in Philippines. The virus has been isolated from ten environmental samples, all genetically related, which were collected from one sewage collection site and its tributary pumping stations in Manila, between 1 July and 23 September 2019. This sewage collection site in the city of Manila has a catchment area of over 600,000 people.

Vaccine-derived polioviruses are rarely occurring forms of the poliovirus that have genetically changed from the attenuated (weakened) virus contained in oral polio vaccine. They only occur when the vaccine virus is allowed to pass from person to person for a long time, which can only happen in places with limited immunization coverage and inadequate sanitation and hygiene. Over time, as it is passed between more unimmunized people, it can regain the ability to cause disease. When the population is fully immunized with both oral polio vaccine and inactivated polio vaccine, this kind of transmission cannot take place. The gut immunity in people immunized with oral polio vaccine stops the virus from being passed on. Full immunization therefore protects against both vaccine-derived and wild polio viruses.
The number of confirmed cases of Ebola virus disease (EVD) remains relatively low this week, with 21 new confirmed cases reported in North Kivu and Ituri provinces during the epidemiological week of 14 – 20 October.

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