Public Health Emergency of International Concern (PHEIC)
Polio this week as of 31 May 2017
:: Delegates to the World Health Assembly discussed how to finish the job and address the challenges of the post-polio world last week in Geneva.
:: After a polio outbreak, how do experts make sure that the virus is gone for good? Find out more about finding that needle in the haystack.
:: In May, the Emergency Committee of the International Health Regulations removed Lao People’s Democratic Republic from the list of polio-infected countries after a comprehensive outbreak response.
:: Summary of newly-reported viruses this week: one new environmental sample positive for wild porelates to response to the situation in Soth Sudan.
Poliovirus type 1 (WPV1) from Pakistan.


Editor’s Note:
We include below a joint statement from WHO and UNICEF, and additional New York Times coverage, as part of coverage of the health emergency in South Sudan.

Statement regarding findings of joint investigation of 15 deaths of children in Nachodokopele village, Kapoeta East County in South Sudan
1 June 2017
An investigation into the cause of the death of 15 children in rural and remote Nachodokopele village, Kauto County in South Sudan by the National Adverse Events Following Immunization (AEFI) Committee, supported by WHO and UNICEF Vaccine safety experts has concluded that severe sepsis / toxicity resulting from the administration of a contaminated vaccine caused the event.

Ministry of Health, WHO and UNICEF express our deep regret and sadness at the passing of the children. This tragic event could have been prevented by adhering to WHO immunization safety standards.

The report presented to the Minister of Health by the AEFI committee stated that the team that vaccinated the children in this tragic event were neither qualified nor trained for the immunization campaign.

Evidence gathered by the investigators indicates that the vaccination team did not adhere to the WHO-approved immunization safety standards. A single reconstitution syringe was used for multiple vaccine vials for the entire four days of the campaign instead of being discarded after single use. The reuse of the reconstitution syringe causes it to become contaminated which in turn contaminates the measles vaccine vials and infects the vaccinated children.

The report also stated that the vaccination team did not follow the cold chain protocols as specified in the Measles Supplementary Immunization Activities guidelines. The vaccines were stored in a building with no cold chain facilities for four days. This means that the vaccines were not maintained at the recommended temperature ranges to preserve their quality.

About 300 people were vaccinated against Measles in Nachodokopele Village during the campaign. Thirty-two other children suffered similar symptoms of fever, vomiting and diarrhoea but recovered.

The Ministry of Health has commissioned a multiagency administrative committee to review the AEFI report and give appropriate recommendations for further actions to improve immunization service delivery.

Vaccination is one of the most basic and critical health needs in emergencies to protect populations from the risk of contracting deadly but preventable diseases.
The risk of measles and other Vaccine Preventable Diseases in South Sudan remains extremely high because of the challenges being faced by the health system. The country has experienced significant measles outbreaks among unprotected population caused by a backlog of unvaccinated children in areas of insecurity.

The measles vaccine has been used all over the world to protect more than 2 billion children against measles. When used according to WHO-approved immunization safety standards, the measles vaccine is safe and effective.  In South Sudan, this is the fifth follow up vaccination campaign. The past campaigns were successfully implemented and the safety of the vaccine was assured.

Mishandled Measles Vaccine Kills 15 Children in South Sudan
New York Times   June 02, 2017 – By JACEY FORTIN
Contaminated vaccines in a rural village in South Sudan killed 15 children last month and endangered dozens more, according to a statement [above] from the World Health Organization, Unicef and the health ministry of South Sudan…
…And children were recruited to help organize the efforts; one even administered injections, the W.H.O. representative to South Sudan, Dr. Abdulmumini Usman, said in a phone interview.
The vaccination campaign, which was officially run by South Sudan’s government and supported by the W.H.O. and Unicef, lasted for four days, and about 300 people in the village were inoculated. The children who died were all injected on the same day and from the same vial, Dr. Usman said…


WHO Grade 3 Emergencies  [to 3 June 2017]
South Sudan
:: Read the latest cholera situation report pdf, 315kb  30 May 2017
Oral cholera vaccination
As part of the ongoing cholera response, cholera vaccines have been deployed in Leer, Bor
PoC, Malakal Town, Bentiu PoC, Mingkaman IDP settlement, and Aburoc IDPs. All these sites
are not reporting cholera cases with the exception of Aburoc. In 2017, a total of 228,551 doses
of the vaccine have been deployed targeting individuals aged one year and above. WHO has
secured a total of 544,140 doses of oral cholera vaccines in 2017 and the current balance in
the National Vaccine store stands at 78,684 doses….

:: Iraq: WHO and UNFPA scale up trauma and emergency obstetric response capacity to safeguard lives of newly displaced families from west Mosul
Baghdad, 31 May 2017 – The World Health Organization (WHO) and the United Nations Population Fund (UNFPA) are extremely concerned about the health conditions of about 180 000 men, women and children who are reportedly still trapped inside west Mosul’s old city where access to health care services has been limited.
:: Special health situation report from Mosul  27 May 2017
Under the leadership of the Ministry of Health Iraq and in collaboration with Ninawa, Erbil and Duhok Directorates of Health (DOHs), more than 60 700 children aged 0-59 months living in selected districts and internally displaced persons camps in the three governorates were vaccinated against polio…

:: Yemen: Jumbo jet lands in war-torn Yemen carrying 67 tons of cholera response supplies
25 May 2017 – A World Health Organization-chartered aircraft carrying intravenous fluids and cholera kits has successfully landed at Sana’a airport in Yemen. At 67 tons, it constitutes the largest planeload of medical goods WHO has brought into the country since the escalation of the conflict in March 2015.
[see UNICEF reports below]

NigeriaNo new announcements identified
The Syrian Arab Republic  – No new announcements identified

WHO Grade 2 Emergencies  [to 3 June 2017]
Cameroon  – No new announcements identified.
Central African Republic  – No new announcements identified.  [see UNICEF reports below]
Democratic Republic of the CongoNo new announcements identified.
EthiopiaNo new announcements identified.
LibyaNo new announcements identified.
MyanmarNo new announcements identified.
Niger  – No new announcements identified.
Ukraine  – No new announcements identified
UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
:: Mosul Humanitarian Crisis, 01 June 2017
…790,674 People cumulatively displaced since 16 October 2016 from Mosul city as of 1 June
…572,278 people remain displaced from western Mosul city as of 1 June – 42,246 people have returned to western Mosul city as of 30 May
…40,913 people remain displaced from eastern Mosul city as of 1 June – 135,237 people have returned to eastern Mosul city as of 30 May
…7,382 fully-serviced family plots available to shelter Mosul displaced people at 19 sites as of 1 …   6,400m³ of water trucked and distributed daily to Mosul city by humanitarian partners as of …   13,039 people transferred from frontline areas to hospitals for trauma injuries treatment as of 28 May
:: Iraq: Mosul Humanitarian Response Situation Report No. 35 (22 May to 28 May 2017) [EN/KU]

Syrian Arab Republic
:: Syria: Flash update on recent events – 1 June 2017
…898,374 displacements recorded by the CCCM Cluster in the last 12 months from affected areas of northern and southern Syria:
…..871,978 displacements from affected areas of northern Syria, including Aleppo (385,004), Ar-Raqqa (205,503), Hama (144,780), Idleb (101,634), Homs (21,005), Al-Hassakeh (5,294), Deir-Ez-Zor (7,717), Lattakia (1,041) governorates, northern Syria. This includes around 136,926 new displacements recorded in May 2017 alone, with the large majority from Ar-Raqqa Governorate (94,362).
….26,396 displacements from affected areas of Damascus, Rural Damascus, Sweida and Dar’a, southwestern Syria. This includes around 9,094 new displacements recorded in May 2017 alone.

:: Key messages on cholera (29 May 2017)  [No OCV mention]
[see UNICEF reports below]

UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
:: Humanitarian Bulletin Somalia May 2017 | Issued on 2 June 2017
:: Somalia: Drought Response – Situation Report No. 10 (as of 31 May 2017)

:: 31 May 2017  Ethiopia Weekly Humanitarian Bulletin, 29 May 2017

NigeriaNo new announcements identified

UNICEF  [to 3 June 2017]
2 June, 2017
Unprecedented spread of cholera in Yemen as health workers race against time to save children
SANAA/DJIBOUTI/AMMAN,– “I have just concluded a trip to Yemen to oversee UNICEF’s response to the unprecedented cholera outbreak that is gripping the country.

1.3 million children urgently need humanitarian assistance after storms batter Bay of Bengal
NEW YORK/BANGKOK/KATHMANDU, 1 June 2017 – At least 1.3 million children are in urgent need of humanitarian assistance across the Bay of Bengal region following severe weather over the past six days, UNICEF has warned. Devastation wrought by Cyclone Mora in Myanmar and Bangladesh, and torrential monsoon rains across Sri Lanka have left children homeless and in need of protection, nutrition and health services.

UNICEF reaches children fleeing to Angola from violence in the Democratic Republic of the Congo
LUANDA, Angola 1 June 2017 – More than 9,000 children who have arrived at two temporary reception centres in Dundo, northern Angola, from the Democratic Republic of Congo (DRC) need urgent support, UNICEF said today. To date, more than 25,000 people have arrived in Angola, having fled violence in the Kasai province of the Democratic Republic of the Congo.

Central African Republic: Thousands of children and families in desperate need of humanitarian assistance as violence escalates
BANGUI/DAKAR/NEW YORK, 1 June 2017 – Two planes carrying vital supplies for thousands of families displaced by violence in the Central African Republic were finally able to land earlier today in Bangassou, UNICEF said, after weeks of intensified conflict had blocked the delivery of humanitarian assistance to the southeast.

Over 1,000 children seek treatment for watery diarrhoea daily as number of suspected cholera cases in Yemen soars – UNICEF
NEW YORK/SANA’A, 31 May 2017 – In the past 72 hours, the number of suspected cholera cases in Yemen has risen by 10,000 to a total of 65,300. Over 1,000 children suffering from acute watery diarrhoea have been reporting to health facilities every day. In just one month, cholera has claimed at least the lives of 532 people, including 109 children. These numbers represent only verified cases and actual figures are expected to be much higher.

Statement attributable to Geert Cappelaere UNICEF Regional Director on the spread of cholera in Yemen
AMMAN, 30 May 2017- “As the UN Security Council yet again holds consultations on the situation in Yemen, UNICEF is reporting an unprecedented increase in the number of suspected cholera cases across the country, many of those affected are children.
MSF/Médecins Sans Frontières  [to 3 June 2017]
Press release
South Sudan: Thousands at Risk of Cholera and Malnutrition After Fleeing Attacks in Yuai and Waat
JUBA, SOUTH SUDAN, JUNE 2, 2017—Malnutrition and suspected cases of cholera are e   scalating among people sheltering in the bush near Pieri, in northeastern South Sudan, putting the health of thousands of people at risk, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

Press release
Yemen: Cholera Outbreak Threatens to Spiral Out of Control
June 01, 2017
As cases of cholera and acute watery diarrhea rise across Yemen, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) warns that the outbreak is threatening to spiral out of control and calls for an urgent and appropriate response.


EBOLA/EVD  [to 3 June 2017]

Ebola Situation report: 02 June 2017
Situation update
WHO, UN Agencies, international organizations, non-governmental organizations (NGOs) and partners con­tinue to support the Ministry of Health (MoH) in the Democratic Republic of the Congo to rapidly investigate and respond to the outbreak of Ebola virus disease (EVD) in Likati Health Zone, Bas Uele Province in the north-east of the country.
On 01 June 2017, no new confirmed, probable or suspected EVD cases were reported. The last confirmed case was reported on 11 May 2017. There are currently a total of two confirmed, three probable and 8 sus­pected cases…

  • :: The protocol for a possible ring vaccination has been formally approved by the national regulatory author­ity and Ethics Review Board of the Democratic Republic of the Congo Vaccine.
  • :: International vaccine deployment and cold chain shipment to DRC is not advised at this point. Planning and arrangements should be in place for immediate deployment if necessary.
  • :: The government of the Democratic Republic of the Congo and MSF with support of WHO and other part­ners are working on detailed planning and readiness to offer access to the rVSV ZEBOV experimental/investigational vaccine, within the Expanded Access framework, with informed consent and in compliance with good clinical practice.
  • :: Planning and readiness should be completed urgently to be able to rapidly initiate ring vaccination should an EVD laboratory confirmed case be identified outside already defined chains of transmission. The vac­cine would be offered to contacts and contacts of contacts of a confirmed EVD case, including health care workers and field laboratory workers.
  • :: MOH, with support from WHO and partners continue active surveillance and response activities, including completing the contact follow-up period for already identified contacts, and conducting rapid laboratory evaluation of suspected cases as per WHO guidelines.

Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.

Zika virus  [to 3 June 2017]
[No new digest content identified]

MERS-CoV [to 3 June 2017]
[No new digest content identified]
Yellow Fever  [to 3 June 2017]
[No new digest content identified]