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The Ministry of Health (MoH), WHO and partners continue to respond to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo.
From 31 October through 30 November 2018, the International Health Regulations (IHR 2005) National Focal Point of Saudi Arabia reported eight additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including two deaths. Details of these cases can be found in a separate document (see link below).

From 2012 through 30 November 2018, the total number of laboratory-confirmed MERS-CoV cases reported globally to WHO under IHR (2005) is 2274 with 806 associated deaths. The total number of deaths includes the deaths that WHO is aware of to date through follow-up with affected member states.
Pakistan Health Authorities have reported an ongoing outbreak of extensively drug resistant (XDR) typhoid fever that began in the Hyderabad district of Sindh province in November 2016. An increasing trend of typhoid fever cases caused by antimicrobial resistant (AMR) strains of Salmonella enterica serovar Typhi (or S. Typhi) poses a notable public health concern. In May 2018, the case definitions for non-resistant, multi-drug resistant (MDR) and XDR typhoid fever were formally agreed by the Regional Disease Surveillance and Response Unit (RDSRU) in Karachi, following a review by an expert group of epidemiologists, clinicians and microbiologists from Pakistan. All typhoid fever cases reported from 2016 to 2018 were reviewed and classified according to these case definitions (see Table 1).

From 1 November 2016 through 9 December 2018, 5 274 cases of XDR typhoid out of 8 188 typhoid fever cases were reported by the Provincial Disease Surveillance and Response Unit (PDSRU) in Sindh province, Pakistan. Sixty-nine percent of cases were reported in Karachi (the capital city), 27% in Hyderabad district, and 4% in other districts in the province (Table 2). The circulating XDR strain of S. Typhi haplotype 58 was resistant to first and second-line antibiotics as well as third generation cephalosporins. Informal reports of XDR typhoid cases occurring in other parts of Pakistan were made and required further verification.
Responding to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo continues to be a complex challenge.
Responding to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo continues to be a complex challenge.
On 22 November 2018, the World Health Organization (WHO) was informed by Dutch authorities of a laboratory-confirmed case of yellow fever. The case-patient is a 26 year-old male who visited Gambia from 3 through 17 November 2018, with a three day trip to Senegal from 12 through 14 November. He had no history of vaccination for yellow fever prior to the trip. On 18 November 2018, the case-patient developed symptoms including fever, nausea and vomiting. On19 November 2018 he was hospitalized with symptoms of acute liver failure and he is still in hospital as of 10 December.

The International Health Regulations National Focal Point (IHR NFP) from the Netherlands has notified counterparts in Gambia and Senegal about the case, and about the exact locations visited by the patient. There have been no other reports of confirmed yellow fever cases from Senegal, Gambia or The Netherlands at this time.
The Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo is occurring in an unforgiving context. Non-engagement from communities and conflict continue to hamper response activities in some affected areas. Moreover, poor infection prevention and control (IPC) practices across numerous private and public health centers remain a major source of amplification of the outbreak and risk to health and other frontline workers.

Despite these challenges, substantial progress has been made on multiple fronts to address the situation, and daily successes are being observed in the implementation of proven public health measures alongside newer tools, such as vaccination and novel therapeutics. Together with the Ministry of Health (MoH) and our partners, WHO is further scaling up our response to the developing situation. WHO especially emphasizes the need to continuously improve quality, judiciously deploy new tools at our disposal, and sustain international commitment to response efforts well into 2019. Nonetheless, we remain confident the outbreak can be brought to a conclusion.
Responding to the Ebola virus disease (EVD) outbreak in north-eastern parts of the Democratic Republic of the Congo continues to be a multifaceted challenge. By utilising proven public health measures (contact tracing, engaging communities) as well as new tools at hand (vaccine and therapeutics), WHO remains confident the outbreak can be contained and brought to an end.

During the reporting period (28 November – 4 December 2018), 35 new cases were reported from nine health zones in North Kivu and Ituri provinces: Beni (8), Komanda (eight), Katwa (eight), Vuhovi (three), Kalunguta (two), Butembo (two), Mabalako (two), Masereka (one), and Mutwanga (one). Recent cases in Komanda and Mabalako health zones follow an extended period (exceeding two incubation periods) without detection of new cases; highlighting the risk of reintroduction of the virus, and the need to maintain enhanced surveillance. Cases in the Komanda originated from an infection of a mother and her children in Beni. While insecurity in Komanda will challenge the response activities, control measures including contact tracing and vaccination were initiated soon after the detection of cases.
As the Ebola virus disease (EVD) outbreak approaches five months since declaration, responding to the outbreak continues to be a challenge; nevertheless, in collaboration with the Ministry of Health (MoH) and partners, WHO remains focused on the ongoing containment efforts to end the outbreak.
Containing the ongoing Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo is a complex and challenging task but WHO remains confident that the outbreak can be successfully contained in collaboration with the Ministry of Health (MoH) and partners.
From 16 through 30 October 2018, the International Health Regulations (IHR 2005) National Focal Point of Saudi Arabia reported four additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including one death.
New measures to overcome obstacles in responding to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo are having a positive impact. The Ministry of Health (MoH), WHO and partners continue to be confident that, despite challenges, the outbreak can be contained.
As the Ebola virus disease (EVD) outbreak enters the fourth month since declaration, and case numbers surpass 300, substantial progress has been achieved in all aspects of the response.
From 17 September through 15 October 2018, the International Health Regulations (IHR 2005) National Focal Point of Saudi Arabia reported eight additional cases of MERS-CoV infection, including three deaths. Of the eight cases reported, three were hospital contacts from one hospital in Dammam and two were household contacts in Riyadh. Details of these cases can be found in a separate document (see link below).

From 2012 through 15 October 2018, the total global number of laboratory-confirmed MERS-CoV cases reported to WHO is 2262 with 803 associated deaths.
The increase over the past four weeks in confirmed case incidence (Figure 1), most notably in the city of Beni and communities around Butembo, is concerning.
From July through September 2018, six cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported from Niger, genetically linked to a cVDPV2 case in Jigawa and Katsina States, Nigeria. The virus was isolated from children with acute flaccid paralysis (AFP) from Zinder region, located in the south of Niger and on the border with Nigeria, with dates of onset of paralysis ranging from 18 July through 16 September 2018. This outbreak has also affected Jigawa, Katsina, Yobe, Gombe, and Borno states in Nigeria, with 17 cases reported since April 2018.

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