Public Health Emergency of International Concern (PHEIC)
Polio this week as of 13 March 2018 [GPEI]
::  New on www.polioeradication.org: For International Women’s Day, we highlighted the critical role that women play in global polio eradication efforts. Dr Adele Daleke Lisi Aluma works to reach children who have never been vaccinated, whilst in Somalia, women are the face of polio eradication. In Nigeria, dedicated female mobilizers are ending polio, one home at a time.
::  We also launched the Gender and Polio section of our website.
:: The Strategic Advisory Group of Experts on immunization (SAGE) Polio Working Group recently met in Geneva, Switzerland, to review global progress against polio. The group reviewed and endorsed the main elements of the Post-Eradication Strategy (PCS) currently being developed at the request of Member States, aimed at ensuring the availability of core functions to sustain a polio-free world after global certification (such as outbreak response capacity, surveillance, immunization and containment).  The PCS will be presented in April to the full SAGE, and to Member States at the World Health Assembly (WHA) in May. The group also reviewed current outbreak response protocols to vaccine-derived poliovirus, and agreed with a proposed plan to harmonize recommendations on immunization schedules in countries with Polio Essential Facilities (PEFs – facilities that will continue to handle poliovirus stock under appropriate containment).
Summary of newly-reported viruses this week:
Afghanistan: Advance notifications have been received of two new cases of wild poliovirus type 1 (WPV1), one occurring in Kunar province, and one in Kandahar province. Three new wild poliovirus type 1 (WPV1) positive environmental samples have been reported in Nangarhar province.
Pakistan: One new WPV1 positive environmental sample has been reported in Balochistan province.
Democratic Republic of the Congo: Two cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) reported, one from Tanganyika province, and one from Haut Lomami province.

WHO Grade 3 Emergencies  [to 17 March 2018]
:: Seven years of Syria’s health tragedy
News release       14 March 2018 | Geneva – After seven years of conflict in Syria, WHO has renewed its call for the protection of health workers and for immediate access to besieged populations.
Attacks on the health sector have continued at an alarming level in the past year. The 67 verified attacks on health facilities, workers, and infrastructure recorded during the first two months of 2018 amount to more than 50% of verified attacks in all of 2017.
“This health tragedy must come to an end,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Every attack shatters communities and ripples through health systems, damaging infrastructure and reducing access to health for vulnerable people. WHO calls on all parties to the conflict in Syria to immediately halt attacks on health workers, their means of transport and equipment, hospitals and other medical facilities.”…

:: Diphtheria vaccination campaign for 2.7 million children concludes in Yemen
SANA’A, YEMEN, 16 March 2018
[See Milestones/Perspectives above for more detail]

WHO Grade 2 Emergencies  [to 17 March 2018]
Bangladesh/Myanmar: Rakhine Conflict 2017 
:: Weekly Situation Report #17 – 13 March 2018
… The third round of 13-day Diptheria campaign has started on 10 March. By day 3, 86 497 (21%) children aged 6 weeks to 15 years have been vaccinated in Ukhiya and Teknaf Upazilas. 1479 humanitarian workers have also received Td vaccine at session sites during campaign days.
… A fixed site at Cox’s Bazar has started vaccinating humanitarian workers and will continue every Saturday henceforth.
… Routine EPI training was conducted in Teknaf and Ukhiya to reorient 270 vaccinators, supervisors, medical officers, and volunteers from Government and various NGOs who would be supporting EPI session sites in camps.
… Microplans for routine EPI in Rohingya refugee settings have been developed and EPI services at fixed sites are ongoing…

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. 
:: UN Humanitarian Chief and Dutch Minister call for urgent international support to meet spiralling humanitarian needs in DR Congo
(Kinshasa, 13 March 2018) UN humanitarian chief Mark Lowcock and Minister for Foreign Trade and Development Cooperation of the Kingdom of the Netherlands, Sigrid Kaag, today called on the international community to urgently address the crisis facing the Democratic Republic of the Congo (DRC) where humanitarian needs have doubled since last year.
More than 13 million people in DRC need humanitarian assistance and 4.5 million have been forced to flee their homes as a result of fighting. More than 4.6 million Congolese children are acutely malnourished, including 2.2 million cases of severe acute malnutrition. Epidemics are spreading, including the worst outbreak of cholera in 15 years.

Syrian Arab Republic
:: 16 Mar 2018   Update on the situation of children in Afrin and Eastern Ghouta

:: 13 Mar 2018  Yemen Humanitarian Update Covering 05 March – 11 March | Issue 6

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: Government and partners launch the humanitarian and disaster resilience plan (HDRP) for 2018  13 Mar 2018
US$1.66 billion urgently needed to address food and non-food needs for 7.88 million people
(Addis Ababa, 13 March 2018): The Government of Ethiopia and humanitarian partners today launched the Ethiopia Humanitarian and Disaster Resilience Plan (HDRP) for 2018. The HDRP seeks US$1.66 billion to reach 7.88 million people with emergency food or cash and non-food assistance, mainly in the southern and south-eastern parts of the country. “In the last two years, the Government of Ethiopia, with the support of international donors and humanitarian partners, was able to mount a robust drought response operation. Today, we need that partnership once again as continuing drought, flooding and conflict-related displacement has left 7.88 million vulnerable people in need of urgent assistance”, says Mr. Mitiku Kassa, Commissioner of the National Disaster Risk Management Commission (NDRMC). “The Government of Ethiopia has committed $138 million for drought response and rehabilitation of IDPs,” added the Commissioner…
:: UN allocates $9 million to support life-saving aid in north-east Nigeria
(Abuja, 15 March 2018): The United Nations, through the Nigeria Humanitarian Fund, has allocated US$9 million to provide life-saving aid to some 60,000 children, women and men recently displaced by ongoing hostilities in Borno State, including $2 million in support of the UN Humanitarian Air Service for frontline responders in north-east Nigeria.
The humanitarian crisis in the region remains one of the most severe in the world today, with at least 7.7 million people in need of humanitarian assistance in 2018 in the worst-affected states of Borno, Adamawa and Yobe states. About 80 per cent of them, 6.1 million, are targeted for humanitarian assistance…
Rohinga Refugee Crisis 
:: Joint Response Plan for the Rohingya crisis requests US$951M to provide life-saving assistance to 1.3M people
16 March 2018
A new Joint Response Plan for the Rohingya humanitarian crisis has been launched today in Geneva. It requests US$951 million to provide life-saving assistance to 1.3 million people, including Rohingya refugees who fled Myanmar to Bangladesh and local host communities.
The priority needs in the plan, which covers the March-December 2018 timeframe, include food, water and sanitation, shelter, and medical care…
:: ISCG Situation Report: Rohingya Refugee Crisis, Cox’s Bazar | 11 March 2018

:: Donors agree measures to prevent famine in Somalia in 2018   06 Mar 2018
In support of The Federal Government of Somalia, the United Kingdom and the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) convened an event in London on 6 March 2018 to draw urgent attention to the humanitarian crisis in Somalia and the need for a swift and substantial response…The event was attended by 31 Member States, UN Agencies, international organizations and non-governmental organizations committed to ensuring support for the humanitarian situation in Somalia for 2018…
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 17 March 2018]
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Oman  15 March 2018
Yellow Fever  [to 17 March 2018]
:: Yellow fever – Brazil  9 March 2018
…WHO risk assessment
The exponential increase in human cases and epizootics during January and February 2018, as indicated in Figure 1, is concerning due to the persistence of high viral circulation in at-risk areas and the spread to new areas, particularly near urban areas of large cities, such as São Paulo and Rio de Janeiro, and in municipalities that were previously not considered at-risk for Yellow fever.

The preliminary results of the mass vaccination campaign in São Paulo and Rio de Janeiro states indicate low vaccination coverage which suggests a significant number of persons remain at-risk and the necessity to intensify risk communications among high-risk groups.

Despite the significant efforts made to vaccinate large portion of the population, the increasing number of human cases and the persistence and geographical spread of epizootics among non-human primates illustrate the potential risk of further spread to new areas within Brazil that were not previously considered as at risk and where therefore yellow fever immunization coverage is low. The seasonality need also to be taken in to account as the outbreak is occurring the period of the year the most favourable for sylvatic yellow fever transmission.

The increasing occurrence of confirmed yellow fever infection also shows the potential of international spread. Although to date most imported cases have been reported in countries where the vector is absent (or absent during winter). These reports illustrate the importance of maintaining high levels of awareness especially for international travellers from areas with favourable ecosystem for yellow fever transmission.

To date, yellow fever transmission by Aedes aegypti has not been documented. The sylvatic yellow fever virus is transmitted to monkeys by forest dwelling mosquitoes such as Haemagogus and Sabethes spp. Humans who are exposed to these mosquitoes can become infected if they are not vaccinated. In entomological studies conducted during the 2016/2017 outbreak in some of the affected states, isolated Haemagogus mosquitoes were found to be positive for yellow fever indicating predominantly sylvatic transmission. More recently, an investigation conducted by the Evandro Chagas Institute reported by the Brazil Ministry of Health revealed the detection of yellow fever virus in Aedes albopictus mosquitoes captured in rural areas of two municipalities in Minas Gerais (Ituêta and Alvarenga) in 2017. The significance of this finding requires further investigation. The last documented outbreak of urban yellow fever in Brazil was recorded in 1942.

WHO continues to monitor the epidemiological situation and review the risk assessment based on the latest available information.

WHO advice
WHO encourage Member States to take all actions necessary to keep travellers well informed of risks and preventive measures including vaccination, and to inform them of the designated specific yellow fever vaccination centres within their territories, in accordance with Annex 7 of the International Health Regulations (2005). Travellers should also be made aware of yellow fever symptoms and signs and instructed to seek rapidly medical advice when presenting signs. Viraemic returning travellers may pose a risk for the establishment of local cycles of yellow fever transmission in areas where the competent vector is present.

Yellow fever can easily be prevented through vaccination. A single dose of WHO approved yellow fever vaccines, administered at least 10 days before travel, is sufficient to confer sustained immunity and life-long protection against the disease, and a booster dose of the vaccine is not needed.

WHO recommends vaccination of international travellers going to Brazil. The updated areas at risk for yellow fever transmission and the related recommendations for vaccination of international travellers were updated by WHO on 16 January 2018; the map of revised areas at risk and yellow fever vaccination recommendations is available on the WHO ITH website: Yellow fever vaccination recommendations in the Americas, 2018

WHO does not recommend that any general travel or trade restriction be applied on Brazil based on the information available for this event.
[See also: CDC Warns Of Deadly Outbreak of Yellow Fever in Brazil – Media Statement
Friday, March 16, 2018]