Public Health Emergency of International Concern (PHEIC)
Polio this week as of 6 September 2017 [GPEI]
:: Summary of newly-reported viruses this week: Pakistan: one new wild poliovirus type 1 (WPV1) case from Karachi (pre-notified last week) and four environmental WPV1-positive samples.


WHO Grade 3 Emergencies  [to 9 September 2017]
Weekly epidemiology bulletin, 28 August–3 September 2017
Country and Governorate level (cumulative)
– The cumulative total from 27 April 2017 to 3 September 2017 is 612,009 suspected cases and 2,047 associated deaths (CFR 0.33). 25,883 suspected cases and 11 associated deaths were reported in W35.
– The national attack rate is 215 per 10,000. The five governorates with the highest cumulative attack rates per 10,000 remain Amran (540), Al Mahwit (504), Al Dhale’e (482), Abyan (388) and Hajjah (288).
– Children under 5 years old represent 24% of total suspected cases.
– In total, 11,414 rapid diagnostic tests (RDT) have been performed which represents 18.7% coverage. The coverage for culture is 16.9%.
Conclusions and actions taken
– WHO is on full alert and is following the evolution of the outbreak each day in close collaboration with local health authorities.
– Initial investigations began on 31 August. A key objective is to determine whether the numbers are accurate and whether the increase in suspected cases is, in fact, caused by cholera, another diarrhoeal disease, or another reason.
– Three teams of international medical experts and epidemiologists are conducting investigations in Aden, Al-Hudaydah and Ibb governorates.
– These teams are traveling out to the worst-affected districts in these three governorates, visiting local health authorities and health facilities to determine the reason for this sudden escalation in suspected cases.

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. 
Syrian Arab Republic
:: 8 Sep 2017  Children caught up in the aftermath of violence in Syria and Iraq need immediate protection and assistance


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.
:: Nigeria – North-East Flash Update No. 2 – Cholera Outbreak, 6 September 2017

:: Key Messages: Ethiopia humanitarian context , 8 September 2017
Third consecutive poor/failed rains exacerbate drought conditions in Ethiopia: Southern and eastern Ethiopia continue to battle the impact of drought caused by the Indian Ocean-related weather systems in 2016, exacerbated by below average spring rains this year – the third consecutive poor/failed rains in the southern and eastern regions. The drought conditions are compounded by disease outbreaks, large scale loss of livelihood assets and displacement.

The number of people requiring food assistance has increased by 3 million: At least 8.5 million people require relief food assistance in the second half of 2017, up from 5.6 million at the beginning of the year. In addition, 3.6 million moderately malnourished children and pregnant and lactating mothers will require supplementary feeding, at least 376,000 children are expected to become severely acutely malnourished and some 10.5 million people will not have regular access to safe drinking water until the end of 2017. Separately, some 4 million Public Works clients of the Productive Safety Net Program (PSNP) will require sustained assistance to the end of 2017. Although not formally included in the Mid-Year Review of Ethiopia’s 2017 Appeal, the financial requirements are estimated at US$300 million.

International partners scaling-up operations in support of the Government-led response: The UN and NGO partners have scaled-up response and further strengthened leadership and coordination functions in support of the Government-led response. With available, albeit quickly depleting resources, operational partners are pushing forward with the integrated, adaptable and scaled-up response in response to the rapidly changing humanitarian context and priorities.

Growing needs are outpacing the level of funding: with Government and donor contributions and commitments in 2016 and 2017, the initial projected requirement for Ethiopia’s humanitarian response was well funded. But an increase in those needing assistance following the Mid-Year Review means that there will at least be an outstanding gap of US$417.6 million for the rest of the year. Additional funding is urgently needed, especially at this critical juncture where any further delay in food assistance will have a domino effect on levels of malnutrition, and associated health complications particularly amongst children and the internally displaced.

The impact of back to back droughts underscores the need to prioritize development programming: The Government and its international partners are also investing in long-term development cooperation programs to reduce vulnerability to drought, including through accelerated urban development and industrial transformation. Ethiopia’s investments in basic services, including health, education and agriculture extension services, have helped make the poorest and most food insecure more resilient but much remains to be done. Increased joint planning between humanitarian and development systems is essential. Studies have shown that every dollar spent on resilience programming saves three dollars in humanitarian assistance.

:: 4 Sep 2017  Ethiopia Humanitarian Bulletin Issue 35 | 21 August – 3 September 2017


[See WHO Grade 3 Emergencies – Yemen above]
WHO issues updated cholera vaccines position paper
29 August 2017
In an updated position paper on cholera vaccines published in the August edition of the Weekly Epidemiological Record, WHO incorporates recent developments in the field of cholera and provides revised guidance on the target populations for immunization.
Joint Press Release – Sierra Leone Ministry of Health and Sanitation, WHO, UNICEF, Gavi
Sierra Leone to begin cholera vaccination drive in disaster-affected areas
More than 1 million doses of Gavi-funded cholera vaccines heading to Sierra Leone after severe flooding and landslides
FREETOWN, 5 September 2017 – Half a million people in Sierra Leone will be able to access the life-saving cholera vaccine within weeks, the country’s Ministry of Health and Sanitation announced.

The vaccines will be received from the Gavi-funded global stockpile and will target areas particularly affected by August’s floods and deadly landslide, which resulted in over 500 confirmed deaths. Hundreds more people were reported missing in the wake of the disaster, according to the Office of National Security, while thousands were displaced from their homes.
“Cholera is a devastating disease which spreads quickly and kills fast, and risks can increase after severe flooding,” said Dr. Brima Kargbo, Chief Medical Officer at the Ministry of Health and Sanitation. “The oral cholera vaccine is an important tool to better protect the country and affected communities against the disease, which will ultimately save lives.”

Two rounds of vaccination are planned to run from September and will be delivered in 25 affected communities by the Government of Sierra Leone with support from Gavi Alliance, the World Health Organization (WHO), UNICEF, the UK Government and other health partners.

“The devastating floods and landslides which ravaged Sierra Leone throughout August have left the country dangerously vulnerable to water-borne disease outbreaks,” said Dr. Seth Berkley, CEO of Gavi Alliance. “Access to safe water and sanitation is limited, and the public health system, still recovering after the 2014 Ebola outbreak, is stretched. These lifesaving vaccines, alongside urgent support to improve safe water and sanitation, have the potential to prevent a cholera outbreak before it has the chance to bring more misery to a country that has already suffered enough.”

The decision to send cholera vaccines from the global stockpile was taken quickly on 31st August by the International Coordinating Group (ICG) for Vaccine Provision following the deployment of a WHO specialist to the country. The full quantity of the vaccine (1,036,300 doses for two rounds) is set to arrive in Freetown on 7th September through UNICEF’s global Supply Division.

WHO recommends that vaccination against cholera be considered in emergencies and other high-risk scenarios where there are increased threats of outbreaks, when combined with standard prevention and control measures for the disease. These measures include readiness to provide adequate testing and treatment, steps to ensure access to safe water and sanitation, and community mobilization to engage the public in preventing infection.

Sierra Leone’s last major cholera outbreak, in 2012, killed 392 people and infected more than 25,000 others.

Gavi, WHO, UNICEF and partners are working with the Ministry of Health and Sanitation to help plan and implement the campaign, which will make the vaccine available free-of-cost to disaster-affected populations, while supporting ongoing cholera prevention and preparedness.

UNICEF  [to 9 September 2017]
Selected News Releases
Growing concern for nearly 1.4 million internally displaced people living in cholera ‘hotspots’ as outbreak spreads in northeast Nigeria
MAIDUGURI/DAKAR/NEW YORK 7 September 2017 – There is growing concern for the health and wellbeing of 1.4 million displaced people, including 350,000 children under the age of five, living in cholera ‘hotspots’ in northeast Nigeria, UNICEF warned today.
The outbreak occurs as ongoing violence and military efforts against insurgents in the region have displaced more than 1.7 million people and left over 3.6 million without adequate access to basic water services.
An estimated 28 people have died from cholera, while 837 are suspected to have been infected with the disease, including at least 145 children under the age of five. The outbreak was first identified in the Muna Garage camp for the displaced in Maiduguri, the state capital of northeast Nigeria’s Borno state. The outbreak spread quickly to as many as six other locations across the state. UNICEF and partners have rapidly scaled up their response to the cholera outbreak, as heavy rains multiply the risk of disease and malnutrition for conflict affected children.
“Cholera is difficult for young children to withstand at any time, but becomes a crisis for survival when their resilience is already weakened by malnutrition, malaria and other waterborne diseases,” said UNICEF Deputy Representative in Nigeria, Pernille Ironside. “Cholera is one more threat amongst many that children in northeast Nigeria are battling today in order to survive.”
A cholera preparedness plan has been in place since before the rains began. Religious leaders, community heads and local volunteers have been mobilised to encourage good hygiene practices and help refer suspected cases to health facilities. Water
is chlorinated at access points in the camps and across host communities in an effort to curb the spread of disease as the rainy season continues.
Since the outbreak was confirmed there has been a closely coordinated water, sanitation and hygiene (WASH) and health rapid response, driven by the Borno State Government with support from WHO, UNICEF and international non-governmental organisations, including the setup of a cholera treatment centre at the Muna Garage Camp.
As the impact of the rains is felt, UNICEF has also scaled up its nutrition and child health programmes across the three northeast Nigerian states most affected by conflict. So far this year, UNICEF has treated over 110,000 children suffering from severe acute malnutrition, distributed nearly 120,000 mosquito nets and provided emergency primary health care services to over three million people in these states. The response continues despite increased security concerns, reduced access because of floods and a heavily damaged health system.
Even in the face of a deadly cholera outbreak, the WASH sector remains critically underfunded. To date, UNICEF has only received 49% of funding needed to provide two million people with access to clean water, one of the main interventions that can protect children from deadly waterborne diseases and offer some protection against the threat of malnutrition.


Nigeria: MSF Scales Up Efforts to Contain Cholera Outbreak in Maiduguri
September 01, 2017
NEW YORK/MAIDUGURI, NIGERIA, SEPTEMBER 1, 2017—The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) is scaling up treatment and prevention to curb the spread of cholera in Maiduguri in Borno State, Nigeria.

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 9 September 2017]
Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
6 September 2017
Between 13 and 30 August 2017, the National IHR Focal Point of Saudi Arabia reported 12 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV), including one death and, and one death from a previously reported case…

Yellow Fever  [to 9 September 2017]
30 August 2017
African Health Ministers pledge firm actions against yellow fever
Victoria Falls, Zimbabwe,:  African health ministers currently meeting for the 67th Session of the World Health Organization (WHO) Regional Committee in Zimbabwe have agreed on ten priority actions to guide countries to eliminate Yellow Fever (YF) epidemics by 2026…
Introducing the Framework for implementing the Global Strategy to Eliminate YF on behalf of the WHO Regional Director for Africa, Dr Matshidiso Moeti,  the Acting Director for the WHO Health Emergencies Programme, Dr Zabulon Yoti informed the ministers that low YF vaccination rates, limited vaccine supply and emergency stockpile, inadequate implementation of the International Health Regulations (IHR 2005), climate change, rapid urbanization are some of the factors that have put over 440 million people at risk. The World Health Organization estimates that in one of the worst outbreaks in 2013, there were about 170 000 severe YF cases in Africa that led to about 60 000 deaths. The massive pre-emptive vaccination of over 30 million people during the recent outbreak in Angola and DRC was a measure that averted an epidemic that could have been of similar magnitude to that of 2013.
“Yellow Fever is still a serious public health risk within and outside the Region. With a single dose of YF vaccine per person, elimination of YF epidemics is indeed a quick public health gain. Country ownership and leadership is critical to protect people at risk through preventive and routine vaccination,” he said…

Zika virus  [to 9 September 2017]
No new announcements identified.
Sanofi Statement on Zika Vaccine License
Sep 1, 2017
On August 17, 2017, Sanofi Pasteur was informed by The Biomedical Advanced Research and Development Authority (BARDA) within the Office of the Assistant Secretary for Preparedness and Response in the U.S. Department of Health and Human Services that they completed an assessment of all Zika-related projects they are funding and have decided to focus on a more limited set of goals and deliverables.

As a result of their review, Sanofi Pasteur has been notified of BARDA’s decision to “de-scope” its contract with Sanofi Pasteur to fund the manufacture and clinical development of an inactivated Zika vaccine and will limit its funding to a case definition and surveillance study as well as any activities required to advance our vaccine development to a point where development would be indefinitely paused but could be restarted if the epidemic re-emerges.
Consequently, Sanofi does not intend to continue development of, or seek a license from, the Walter Reed Army Institute of Research for the Zika vaccine candidate at this time.

We are proud of our contributions to the productive collaboration to date, which will result in significant contributions to science and to others who may continue pursuing licensure for an effective and safe Zika vaccine.

One of the ways Sanofi Pasteur will continue to contribute to the field of knowledge on Zika is by completing, with partial BARDA support, the ongoing case definition and surveillance study which will provide guidance on Zika epidemiology and diagnosis that can be applicable to any vaccine subsequently developed to prevent the disease.  The case-definition and surveillance study is currently being conducted in 4 countries—Colombia, Honduras, Mexico, and Puerto Rico—and we are looking to enroll 2,400 volunteers.

Given the evolving epidemiology of Zika, which has seen a profound reduction in the number of new Zika cases in the United States and around the world in 2017, as well as the results of the Phase I study, it was necessary to substantially extend our projected vaccine development timelines.  Therefore, we respect BARDA’s decision to re-purpose limited resources to meet their priorities.

In February 2016, Sanofi Pasteur urgently responded to the WHO’s declaration of a public-health emergency of international concern (PHEIC). In doing so, we assumed significant opportunity costs and delayed other internal pipeline priorities to lend our expertise to the Zika global public-health threat.  The epidemiology of the disease has changed significantly since that time, but we continue to believe that public-private partnerships are the right model to address these public health challenges and should continue to play a major role in response to emerging infectious diseases.