Public Health Emergency of International Concern (PHEIC)

Polio this week as of 19 July 2017 [GPEI]
:: The first report of the Transition Independent Monitoring Board (TIMB) has now been published, following the group’s first meeting last month.  The TIMB has been established at the request of the Polio Oversight Board (POB) to independently monitor and guide the polio transition process, especially in the 16 countries prioritized for transition planning.  The group’s next meeting will be held in London, United Kingdom, on 2-3 November.  More.

:: Five country-wide vaccination campaigns have been held in Pakistan since October 2016, preparing for the 2017 high season for poliovirus transmission, which runs from June until September. Read more about what the high season means for eradication.

:: Read the latest polio update from WHO Afghanistan to see information on cases, surveillance and vaccination campaigns for the month of June.

:: Summary of newly-reported viruses this week:  Pakistan – six new wild poliovirus type 1 (WPV1)-positive environmental samples


WHO-UNICEF: Syria cVDPV2 outbreak Situation Report # 6   25 July 2017
Key highlights
:: No new cVDPV2 cases reported this week. The total number of cVDPV2 cases remains 27 (26 cases are from Mayadeen district, Deir Ez-Zor governorate, and 1 case from Tell Abyad district, Raqqa governorate).

:: The first mOPV2 vaccination round in Deir Ez-Zor started on 22 July. A total of 59,051 children under the age of five were vaccinated on the first day of the campaign.

:: Given high temperatures, WHO has arranged for local ice-cream factories to assist in the daily freezing of ice packs.

:: Community mobilization activities continue throughout the campaign. Household visits have focused on addressing vaccine refusal through use of community influencers.

:: In addition to administering mOPV2, vaccination teams are searching for AFP cases during campaign days. An AFP case detected during vaccination visits in Mayadeen district is under investigation.

:: The total number of acute flaccid paralysis (AFP) cases detected in Deir Ez-Zor governorate since the beginning of 2017 is 89 (67 from Mayadeen, 10 from Deir Ez-Zor, and 12 from Boukamal districts). Raqqa governorate has reported 14 AFP cases (6 from Raqqa, 7 from Tell Abyad, and 1 from Thawra districts).


WHO Grade 3 Emergencies  [to 29 July 2017]
::  The life and death struggle against cholera in Yemen   25 July 2017
Cholera continues to spread in Yemen, causing more than 390 000 suspected cases of the disease and more than 1800 deaths since 27 April.
WHO and its partners are responding to the cholera outbreak in Yemen, working closely with UNICEF, local health authorities and others to treat the sick and stop the spread of the disease…

The Syrian Arab Republic
:: Read the latest WHO & UNICEF cVDPV2 outbreak situation report  25 July 2017
[See Polio above for more detail]

South Sudan – No new announcements identified.
Iraq  – No new announcements identified.
NigeriaNo new announcements identified.
WHO Grade 2 Emergencies  [to 29 July 2017]
Myanmar  No new announcements identified
Cameroon  No new announcements identified
Central African Republic  – No new announcements identified. 
Democratic Republic of the CongoNo new announcements identified
EthiopiaNo new announcements identified.
LibyaNo 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. 
:: Iraq: Mosul Humanitarian Response Situation Report No. 40 (12 to 26 July 2017)
:: Almost 1 million people fled from western Mosul and western Ninewa Governorate as of 26 July, surpassing humanitarians’ ‘worst-case’ estimates. Beyond Mosul, sustained efforts are now needed to support more than 700,000 people who lost everything.
:: Protection remains a top priority, especially for minority groups, women and children. The targeting of these groups is a particularly disturbing feature in Ninewa Governorate and in other areas of the country.
:: While the battle for Mosul is declared over, other areas remain under the Islamic State in Iraq and the Levant’s (ISIL) control. This means civilians continue to be in danger as induced displacement, mostly from Ba’aj and Telafar, continues.
:: Outside of camps and in Mosul city water issues remain critical. This is mainly due to the logistical challenges caused by the temporary closure of Qayyarah bridge and lack of funding.

Syrian Arab Republic
:: 28 Jul 2017  2017 Regional Refugee & Resilience Plan – 3RP (all agencies) – Funding snapshot as of 27-Jul-17
:: Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, Stephen O’Brien Statement to the Security Council on the Humanitarian Situation in Syria
New York, 27 July 2017

:: Key messages on cholera (23 July 2017)
[No reference to vaccination, immunization, OCV]
:: Joint Cholera Response Plan – Yemen – July 2017
[Excerpts referencing vaccination/OCV]
4) Oral Cholera Vaccine [p.8, 9]
Conduct risk assessment to determine locations and population eligible for vaccination,
explore availability of the vaccine globally, discuss with MoPHP and other stakeholders
the feasibility of a cholera vaccination campaign in high risk areas eligible to receive
the vaccine…

ANNEX 6: Funding Requirements for Health and WASH Response – budget breakdown [p.29]
…Community awareness
Social mobilization and communication for OCV campaign $500,000

Editor’s Note:
We continue to monitor how OCV is being factored into response strategies in the Yemen context. We note that the Joint Cholera Response Plan document above does not include any reference to the “much larger preventive campaign” noted below from last week’s WHO situation report.
::  [WHO] Yemen cholera situation report no. 4   19 JULY 2017
Highlights [Excerpt]
:: A cholera vaccination campaign originally planned for July 2017 has been postponed at the request of the health authorities, in favour of a much larger preventive campaign next year targeting millions of Yemenis at risk of the disease.


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.
:: Ethiopia Weekly Humanitarian Bulletin, 24 July 2017
Key Issues
:: The UN Humanitarian Coordinator allocated US$44.7 million through the OCHA managed Ethiopia Humanitarian Fund (EHF), to address the most life-saving and time critical needs. All eligible partners are encouraged to consult respective clusters and submit their project proposal online on the Grant Management System not later than 8 August 2017.
:: An estimated US$30 million required to assist the most vulnerable Ethiopian returnees from the Kingdom of Saudi Arabia.
:: Ethiopia continues to receive Somali and South Sudanese refugees fleeing conflict and food insecurity.

:: United Nations relief chief appeals for urgent funds for people in need in DR Congo
3.8 million people are now displaced within the Democratic Republic of the Congo
(Kinshasa/New York/Geneva, 21 July 2017): The United Nations Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, Stephen O’Brien, today wrapped up a four-day mission to the Democratic Republic of the Congo (DRC) by calling on the world “not to forget the DRC, where millions of girls, boys, women and men are suffering from violence, diseases, and malnutrition.”…

:: Trapped in displacement: Lessons and voices from internally displaced   Published on 21 Jul 2017
:: Somalia: Drought Response – Situation Report No. 15  Published on 24 Jul 2017
:: While extensive humanitarian operations are ongoing, with over three million people being reached monthly with lifesaving assistance, livelihoods support and protection services, humanitarian needs are expected to persist at current levels through the end of the year. As a result of below average Gu rains, pest infestation and reduced area cultivated, overall cereal production is expected to be 50-60 percent of average, according to the Post Gu Preliminary Assessment Results by Food Security and Nutrition Analysis Unit (FSNAU).
:: Results of nutrition surveys conducted by FSNAU indicate a critical nutrition situation (Global Acute Malnutrition (WHZ) prevalence of 15 per cent or higher) in 9 out of 12 displaced people’s settlements.
::The first ever Somalia Country Humanitarian Forum was held on 19 July, in Mogadishu. The forum will now serve as an information sharing and coordination platform with international humanitarian actors.
:: On 15 July, AMISOM handed over the Somali National University to the Federal Government. The handover of the last civilian learning facility occupied by armed actors comes after over 30 years of occupation and is an important step in expanding opportunities for youth.
:: The Humanitarian Coordinator for Nigeria condemns recent attacks on civilians in camps for internally displaced persons
Abuja, 25 July 2017 – The Humanitarian Coordinator for Nigeria, Edward Kallon, condemns in the strongest terms the deadly suicide attacks that took place in the Dalori I and Dalori II IDP camps in the outskirts of Maiduguri, the capital of Borno State, on 24 July 2017, which resulted in the deaths of several civilians, including women and children, and injured many others.
These suicide attacks are the latest in the recent accelerating trend of attacks against civilians in north-east Nigeria over the past few months…

Dashboard: International Coordinating Group (ICG) on Vaccine Provision on cholera 
[accessed 29 July 2017]
[No new request activity identified]

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

MERS-CoV [to 29 July 2017]
21 July 2017   WHO/MERS/RA
WHO MERS-CoV Global Summary and Assessment of Risk
Global summary
Between 2012 and 21 July 2017, 2040 laboratory-confirmed cases of Middle East respiratory syndrome-coronavirus (MERS-CoV) infection were reported to WHO, 82% of whom were reported by the Kingdom of Saudi Arabia (Figure 1). In total, cases have been reported from 27 countries in the Middle East, North Africa, Europe, the United States of America, and Asia (Table 1). Males above the age of 60 with underlying conditions, such as diabetes, hypertension and renal failure, are at a higher risk of severe disease, including death. To date, at least 710 individuals have died (crude CFR 34.8%)…

Overall, the epidemiology, transmission patterns, clinical presentation of MERS patients and viral characteristics reported since the last update are consistent with past patterns described in previous WHO risk assessments: MERS-CoV is a zoonotic virus that has repeatedly entered the human population via direct or indirect contact with infected dromedary camels in the Arabian Peninsula. Limited, non-sustained human-to-human transmission in health-care settings continue to occur, primarily in the Kingdom of Saudi Arabia,…

The continued importance of MERS-CoV in health-care settings
Since the last global update of 5 December 2016, approximately 31% of cases reported to WHO were associated with transmission in a health-care facility. These cases included health-care workers (40 cases), patients sharing rooms/wards with MERS patients, or family visitors.

Though not unexpected, these transmission events continue to be deeply concerning, given that MERS-CoV is still a relatively rare disease about which medical personnel in health-care facilities have low awareness. Globally, awareness for MERS-CoV is low and, because symptoms of MERS-CoV infection are non-specific, initial cases are sometimes easily missed. With improved compliance in infection prevention and control, namely adherence to the standard precautions at all times, human-to-human transmission in health-care facilities can be reduced and possibly eliminated with additional use of transmission-based precautions…