Vaccines and Global Health: The Week in Review :: 30 November 2019

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Executive Director
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UNICEF delivers over 260,000 vaccines and medical supplies to fight measles outbreaks in Samoa, Fiji and Tonga :: 4,500 children under the age of five died from measles in the Democratic Republic of the Congo so far this year :: Measles – Global situation

Milestones :: Perspectives :: Research



UNICEF delivers over 260,000 vaccines and medical supplies to fight measles outbreaks in Samoa, Fiji and Tonga
Delivers 115,500 doses of measles vaccines to worst-affected Samoa
SUVA, 28 November 2019: UNICEF is supporting the Governments of Samoa, Fiji and the Kingdom of Tonga to respond to the current measles outbreak in the Pacific region. As of 28 November, almost 300,000 vaccines and medical supplies have been delivered to reach those populations most at-risk in Samoa, Fiji, the Kingdom of Tonga, Vanuatu, Cook Islands, Nauru, Niue, Tokelau and Tuvalu.

UNICEF is responding to the outbreak together with the World Health Organisation (WHO) and other partners. UNICEF’s response is being conducted with the support of the Australian Department of Foreign Affairs and Trade (DFAT) and New Zealand’s Ministry of Foreign Affairs and Trade (MFAT).

The Government of Samoa officially declared a state of emergency on 15 November 2019. UNICEF has delivered a total of 115,500 doses of measles vaccines to Samoa since 1 October, including the required diluent, syringes and safety boxes, as well as sufficient supplies of Vitamin A.

The national Measles Vaccination Campaign began on 20 November 2019 with mobile outreach vaccination sites and teams, and special vaccine booths. Since the launch of the campaign, the Ministry of Health has successfully vaccinated more than 33,500 individuals in both Upolu and Savai’i.

UNICEF has delivered six 42 sqm tents, which will be used as vaccination sites or isolation wards for patients with measles. Six specially designed refrigerators and three emergency trolleys will also be provided to the Ministry of Health, to ensure the cold chain is maintained and vaccines are effective when given at vaccination sites.

Fiji declared a measles outbreak on 7 November 2019. Since 1 October, UNICEF has delivered a total of 135,000 doses of measles vaccines with required diluent, syringes and safety boxes. An additional 200,000 vaccines are en route to Fiji.

A measles outbreak was also declared in the Kingdom of Tonga on 24 October 2019. Since 1 October, UNICEF has delivered a total of 12,000 measles vaccines including required diluent, syringes and safety boxes, to Tonga. Two refrigerators, for the vaccine cold chain, will also be provided along with an additional 6,000 doses of vaccines.

UNICEF and WHO have jointly prepared a communication toolkit and resources to be used for measles prevention, which has been shared with all Pacific Island governments, including Samoa, Fiji and the Kingdom of Tonga. The toolkit is a regional resource, which countries can use and adapt to their country’s needs. It includes a range of communication products targeting three main audiences: travellers, general public and health workers.



4,500 children under the age of five died from measles in the Democratic Republic of the Congo so far this year
Statement by UNICEF Representative in the DRC Edouard Beigbeder
KINSHASA, 27 November 2019 – “Since the beginning of the year, more than 5,000 people have died due to measles, over 90 per cent of them children under the age of five.

“While the Ebola outbreak, which has claimed more than 2,000 lives in the Eastern DRC, has commanded sustained international attention, measles, which has claimed more than twice as many lives, continues to be underreported.

“Violence and insecurity, lack of access to healthcare and shortages of vaccines and medical kits in the worst-affected areas have meant that thousands of children have missed out on vaccinations, with potentially deadly consequences. Cultural beliefs and traditional healthcare practices also often get in the way of vaccinating children against measles and treating those with symptoms.

“Despite the many challenges, we have the tools and the knowledge to prevent measles with a safe, effective and affordable vaccine. The key is to reach every single child, no matter where they are.

“UNICEF and partners are conducting measles vaccination campaigns in the worst-affected areas and supplying clinics with medicine to treat symptoms. So far, we have distributed 1,317 medical measles kits – containing antibiotics, rehydration salts, Vitamin A and other medicines – to affected health zones to treat children with complications.

“Yet these measures can only ever be a short-term solution, as significant investment in strengthening DRC’s national vaccination programme and wider health care systems is crucial to guarantee the health and wellbeing of the country’s children.”



Measles – Global situation
Disease outbreak news = WHO
27 November 2019
Many countries around the world are experiencing measles outbreaks. As of 5 November 2019, there have been 440,263 confirmed cases reported to WHO through official monthly reporting by 187 Member States in 2019.

The following is a brief update on the global measles situation based on information shared by Member States with WHO. Note that this is an evolving situation and data is constantly updated. Data below are based on the latest information available to WHO.


African Region
Large measles outbreaks are being reported in several countries in the region. Outbreaks are ongoing in Madagascar and Nigeria ; although the rate of new cases is decreasing, cases are still being reported weekly. As of 17 November 2019, a total of 250,270 suspected cases with 5,110 associated deaths have been reported by the Democratic Republic of the Congo, an increase in more than 8,000 cases compared to the previous week. All provinces are affected, and a national outbreak response vaccination campaign is ongoing in phases and should be completed by the end of the year. As of 13 November, Guinea had 4,690 suspected measles cases, 1,091 of which were confirmed. Outbreak vaccination response activities are underway. As of 17 November 2019, Chad had reported 25,596 suspected cases in 94% of their districts; outbreak response vaccination is planned.


Eastern Mediterranean Region
From 1 January through 17 November 2019, Lebanon reported 1,060 confirmed cases of measles1 (For more information, please see Disease Outbreak News (DON) published on measles in Lebanon on 22 October 2019). As of 8 November 2019, current outbreaks of concern include Yemen with 5,847 confirmed cases, Sudan with 3,659 confirmed cases, Somalia with 2,795 cases, Pakistan with 1,978 confirmed cases, Tunisia with 1,367 cases, and Iraq with 1,222 cases of measles.


European Region
Many countries in Europe experienced large outbreaks in 2019. From 1 January through 5 November 2019, Ukraine has reported 56,802 cases, followed by Kazakhstan with 10,126 cases, Georgia with 3,904 cases, Russian Federation with 3,521 cases, Turkey with 2,666 cases, and Kyrgyzstan with 2,228 cases of measles. Some of these outbreaks (e.g. Georgia, Russian Federation, Turkey) have resolved.


Region of the Americas
From 1 January through 9 November 2019, Brazil reported 11,887 confirmed cases of measles, with the majority of cases in Sao Paulo. A vaccination response is underway.

During the same time, Venezuela reported 520 measles cases with no new case being reported in the last 14 weeks. Colombia has reported 215 cases which were likely acquired in Venezuela. In the United States, two large sustained outbreaks in New York State have also been declared over; however, small outbreaks are still occurring in other states within the United States. 2


South-East Asia Region
From 1 January through 18 November, Bangladesh has reported 4,181 confirmed cases of measles. Much of the current, growing outbreak is centered in Rohingya refugee camps in Cox’s Bazaar; vaccination efforts continue. Myanmar has had 5,286 cases though their outbreak appears to be resolving after two rounds of outbreak response immunization. A nationwide vaccination campaign for children aged 9-65 months is ongoing. There is a need to also vaccinate previously unreached adults to stop the current ongoing transmission.

During the same time, Thailand reported 4,852 cases, and a vaccination campaign targeting children between 1-12 years of age is ongoing; however, there is a need to conduct vaccination campaigns for susceptible populations born between 1984 to 2000 as well as migrant populations in industrial areas, people participating in travel and tours company and such other establishments.


Western Pacific Region
Outbreaks in the Philippines and Viet Nam earlier in 2019 drove the increase in cases in the Region, but new cases are decreasing in these countries. As of 20 November 2019, current outbreaks include New Zealand with 2,084 confirmed cases, of which 80% are in the Auckland region 3 ; Cambodia has 490 cases with cases occurring in all provinces.

From 1 January through 23 November 2019, multiple countries in the Pacific Islands are experiencing outbreaks including Tonga (310 cases), Fiji (10 cases)4 , and American Samoa (2 cases). As of 26 November, the Samoa Ministry of Health confirmed a total of 2,437 cases and 32 associated deaths, with 243 new cases reported within the last 24 hours 5 . These islands are conducting outbreak response activities and mitigation measures, including vaccination campaigns.


Public health response
WHO and partners coordinate their support to Member States for the following activities:
:: Enhancing preparedness for measles outbreak response
:: Strengthening public trust in vaccines
:: Strengthening surveillance, risk assessment and outbreak investigations
:: Improving clinical management of measles cases
:: Implementing outbreak response immunization activities
:: Evaluating outbreak response activities

WHO has established a measles outbreaks Incident Management Support system to coordinate its support to affected countries.


WHO risk assessment
Measles is a highly contagious viral disease which affects susceptible individuals of all ages and remains one of the leading causes of death among young children globally, despite the availability of safe and effective measles-containing vaccines. It is transmitted via droplets from the nose, mouth, or throat of infected persons. Initial symptoms, which usually appear 10–12 days after infection, include high fever, usually accompanied by one or several of the following: runny nose, conjunctivitis, cough and tiny white spots on the inside of the mouth. Several days later, a rash develops, starting on the face and upper neck and gradually spreads downwards. A patient is infectious four days before the start of the rash to four days after the appearance of the rash. Most people recover within 2–3 weeks.

Even with implementation of routine immunization, measles continues to circulate globally due to suboptimal vaccination coverage and population immunity gaps. Any community with less than 95% population immunity is at risk for an outbreak. If an outbreak response is not timely and comprehensive, the virus will find its way into more pockets of vulnerable individuals and potentially spread within and beyond the affected countries.

The impact on public health will persist until the ongoing outbreaks are controlled, routine immunization coverage is continuously high (≥ 95%) and immunity gaps in the population are closed. As long as measles continues to circulate anywhere in the world, no country can be assured to avoid importation. However, countries can protect their populations through high vaccine coverage achieved primarily through routine immunization programmes, and where necessary through supplemental immunization activities designed to assure that susceptible individuals are vaccinated.


WHO advice
Immunization is the most effective preventive measure against measles. Two doses of measles-containing-vaccine are recommended to ensure immunity.

While there is no specific antiviral treatment for measles,prompt provision of vitamin A is recommended by WHO for all children infected with measles. It is critical to quickly recognize and treat complications of measles in order to reduce mortality and severity of disease.


WHO urges all Member States to do the following:
:: Maintain high measles vaccination coverage (≥ 95%) with two doses of measles-containing-vaccine, in every district;
:: Offer vaccination to individuals who do not have proof of vaccination or immunity against measles, and who are at risk of infection and transmission of the virus, such as healthcare workers, people working in tourism and transportation, and international travelers;
:: Strengthen epidemiological surveillance for cases of ‘fever with rash’ for timely detection of all suspected cases of measles in public and private healthcare facilities;
:: Ensure that collected blood samples from suspect measles cases appropriately tested by laboratories within five days;
:: All countries need to provide a rapid response to imported measles cases to prevent the establishment or re-establishment of endemic transmission;
:: Recognize complications early and provide comprehensive treatment to reduce the severity of disease and avoid unnecessary deaths.
:: Administer vitamin A supplementation to all children diagnosed with measles to reduce the complications and mortality (two doses of 50, 000 IU for a child less than 6 month of age, 1,00,000 IU for children between 6 and12 months of age or 2,00,000 IU for children 12-59 months, immediately upon diagnosis and on the following day.
:: Ensure health care workers are vaccinated in order to avoid infections acquired in a health care setting.

Regulating Medicines in a Globalized World: The Need for Increased Reliance Among Regulators

Milestones :: Perspectives :: Research



Regulating Medicines in a Globalized World: The Need for Increased Reliance Among Regulators
National Academies of Sciences, Engineering, and Medicine;
Alastair Wood and Patricia Cuff, Editors
November 2019 :: 160 pages
Open Access – PDF:
Globalization is rapidly changing lives and industries around the world. Drug development, authorization, and regulatory supervision have become international endeavors, with most medicines becoming global commodities. Drug companies utilize global supply chains that often include facilities in countries with inconsistent regulations from those of the United States, perform pivotal trials in multiple countries to support registration submissions in various jurisdictions, and subsequently market their medicines throughout most of the world. These companies operate across borders and require individual national regulators to ensure that drugs authorized for use in their countries are safe and effective, and appropriate for their health care system and their population. This process involves significant resources and often duplicative work. It is important to consider how this process can be improved in order to better allocate resources, time, and efforts to improve public health.
Regulating Medicines in a Globalized World: The Need for Increased Reliance Among Regulators considers the role of mutual recognition and other reliance activities among regulators in contributing to enhancing public health. This report identifies opportunities for leveraging reliance activities more broadly in order to potentially impact public health globally. Key topics in this report include the job of medicines regulators in today’s world, what policy makers need to know about today’s regulatory environment, stakeholder views of recognition and reliance, as well as removing impediments and facilitating action for greater recognition and reliance among regulatory authorities.



Ebola – DRC+
Public Health Emergency of International Concern (PHEIC)

Ebola Outbreak in DRC 69: 26 November 2019
Situation Update
In the week of 18 to 24 November 2019, seven new confirmed EVD cases were reported from four health zones in two affected provinces in Democratic Republic of the Congo. The majority of the confirmed cases in this week came from Mabalako Health Zone (57%; n=4).

Violence and civil unrest in the week have led to the suspension of Ebola response activities in some areas of Beni, Butembo, and Oicha health zones. On 26 November 2019, some response personnel were temporarily relocated from Beni, though most remain in place to continue responding. The immediate focus will be on maintaining the safety and welfare of response personnel while preserving essential response activities in these places.

The disruptions to the response and lack of access to Ebola-affected communities is threatening to reverse recent progress. As seen previously during this outbreak, such disruptions limit contact tracing, surveillance, and vaccination efforts, and they often result in increased transmission…


Dead and injured following attacks on Ebola responders in the Democratic Republic of the Congo
Attacks in eastern Democratic Republic of the Congo
28 November 2019 News release
Two attacks in eastern Democratic Republic of the Congo (DRC) have killed 4 workers responding to the Ebola outbreak and injured 5 others.
The attacks occurred overnight on a shared living camp in Biakato Mines and an Ebola response coordination office in Mangina.
We are heartbroken that people have died in the line of duty as they worked to save others,” said Dr Tedros Adhanom Ghebreyesus, World Health Organization Director-General. “The world has lost brave professionals.”
The dead include a member of a vaccination team, two drivers and a police officer. No WHO staff are among those killed, one staff member was injured.
“My heart goes out to the family and friends of the first responders killed in these attacks,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “We are doing everything possible to bring the injured and front-line workers in the impacted areas to safety. These constant attacks must stop. We will continue to work with the DRC Government, partners and MONUSCO to ensure the security of our staff and other health workers.”…


New England Journal of Medicine
Online November 27, 2019
DOI: 10.1056/NEJMoa1910993
Original Article
A Randomized, Controlled Trial of Ebola Virus Disease Therapeutics
Sabue Mulangu, M.D., Lori E. Dodd, Ph.D., Richard T. Davey, Jr., M.D., Olivier Tshiani Mbaya, M.D., Michael Proschan, Ph.D., Daniel Mukadi, M.D., Mariano Lusakibanza Manzo, Ph.D., Didier Nzolo, M.D., Antoine Tshomba Oloma, M.D., Augustin Ibanda, B.S., Rosine Ali, M.S., Sinaré Coulibaly, M.D., Adam C. Levine, M.D., Rebecca Grais, Ph.D., Janet Diaz, M.D., H. Clifford Lane, M.D., Jean-Jacques Muyembe-Tamfum, M.D., and the PALM Writing Group for the PALM Consortium Study Team*
Although several experimental therapeutics for Ebola virus disease (EVD) have been developed, the safety and efficacy of the most promising therapies need to be assessed in the context of a randomized, controlled trial.
We conducted a trial of four investigational therapies for EVD in the Democratic Republic of Congo, where an outbreak began in August 2018. Patients of any age who had a positive result for Ebola virus RNA on reverse-transcriptase–polymerase-chain-reaction assay were enrolled. All patients received standard care and were randomly assigned in a 1:1:1:1 ratio to intravenous administration of the triple monoclonal antibody ZMapp (the control group), the antiviral agent remdesivir, the single monoclonal antibody MAb114, or the triple monoclonal antibody REGN-EB3. The REGN-EB3 group was added in a later version of the protocol, so data from these patients were compared with those of patients in the ZMapp group who were enrolled at or after the time the REGN-EB3 group was added (the ZMapp subgroup). The primary end point was death at 28 days.
A total of 681 patients were enrolled from November 20, 2018, to August 9, 2019, at which time the data and safety monitoring board recommended that patients be assigned only to the MAb114 and REGN-EB3 groups for the remainder of the trial; the recommendation was based on the results of an interim analysis that showed superiority of these groups to ZMapp and remdesivir with respect to mortality. At 28 days, death had occurred in 61 of 174 patients (35.1%) in the MAb114 group, as compared with 84 of 169 (49.7%) in the ZMapp group (P=0.007), and in 52 of 155 (33.5%) in the REGN-EB3 group, as compared with 79 of 154 (51.3%) in the ZMapp subgroup (P=0.002). A shorter duration of symptoms before admission and lower baseline values for viral load and for serum creatinine and aminotransferase levels each correlated with improved survival. Four serious adverse events were judged to be potentially related to the trial drugs.
Both MAb114 and REGN-EB3 were superior to ZMapp in reducing mortality from EVD. Scientifically and ethically sound clinical research can be conducted during disease outbreaks and can help inform the outbreak response. (Funded by the National Institute of Allergy and Infectious Diseases and others; PALM number, NCT03719586. opens in new tab.)


Investigational Drugs Reduce Risk of Death from Ebola Virus Disease – NIH
Study Leaders Publish Results from NIH-DRC-WHO Clinical Trial of Four Experimental Therapies.
November 27, 2019
The investigational therapeutics mAb114 and REGN-EB3 offer patients a greater chance of surviving Ebola virus disease (EVD) compared to the investigational treatment ZMapp, according to published results from a clinical trial conducted in the Democratic Republic of the Congo (DRC). The new report also shows that early diagnosis and treatment are associated with an increased likelihood of survival from EVD.
The results appear online this week in the New England Journal of Medicine. An announcement made on August 12, 2019, noted that the study leaders halted the trial early, on August 9, 2019, as recommended by an independent data and safety monitoring board based on its review of preliminary data from 499 study patients. The preliminary analysis found that both mAb114 and REGN-EB3 performed better than ZMapp. The fourth drug, remdesivir, performed similarly to ZMapp. Today’s publication provides a comprehensive analysis of the full dataset from nearly 200 additional patients enrolled in the clinical study.
The clinical trial known as PALM, short for “Pamoja Tulinde Maisha,” a Kiswahili phrase that translates to “together save lives,” was organized by an international research consortium coordinated by the World Health Organization (WHO). It is led and funded by the DRC’s National Institute for Biomedical Research (INRB) and Ministry of Health, and the National Institute of Allergy and Infectious Diseases (NIAID), part of the U.S. National Institutes of Health. Professor Jean-Jacques Muyembe-Tamfum, M.D., Ph.D., director-general of the INRB and head of the DRC’s Ebola response, and Richard T. Davey, Jr., M.D., deputy director of NIAID’s Division of Clinical Research, are co-principal investigators for the study.
“Response teams have faced unprecedented challenges in ongoing efforts to save lives and control the outbreak of Ebola in a highly insecure region of the Democratic Republic of the Congo,” said NIAID Director Anthony S. Fauci, M.D. “Although effective treatments alone will not end this outbreak, the PALM study findings identify the first efficacious treatments for Ebola virus disease and therefore mark a significant step forward in improving care for Ebola patients. We thank the study team for their extraordinary efforts to conduct this landmark trial.”
The study enrolled 681 people with Ebola virus disease between November 2018 and August 2019 at four Ebola treatment centers (ETCs) in the cities of Beni, Butembo, Katwa and Mangina. Staff from The Alliance for International Medical Action (ALIMA), International Medical Corps (IMC), Médecins Sans Frontières/Doctors Without Borders (MSF) and the DRC Ministry of Health implemented the trial at the ETCs with support from Congolese staff, the World Health Organization, the Frederick National Laboratory for Cancer Research and The Mitchell Group.
The study was designed to compare mortality among patients who received one of three investigational Ebola drugs with that from a control group of patients who received the investigational monoclonal antibody cocktail ZMapp, developed by Mapp Biopharmaceutical, Inc. The other therapies were mAb114, a single monoclonal antibody product developed for clinical use by NIAID’s Vaccine Research Center and the INRB and licensed to Ridgeback Biotherapeutics and Mapp Biopharmaceutical; REGN-EB3, a monoclonal antibody cocktail developed by Regeneron Pharmaceuticals, Inc.; and remdesivir, an antiviral drug developed by Gilead Sciences, Inc. The Biomedical Advanced Research and Development Authority (BARDA), part of the U.S. Department of Health and Human Services, also has provided support for the development of REGN-EB3, ZMapp and mAb114.
The four therapies are administered as intravenous infusions. REGN-EB3 and mAb114 are administered as single infusions and ZMapp and remdesivir are administered as infusions over multiple days. Study participants also received optimized supportive care, including oral and/or intravenous fluids, electrolyte replacement, monitoring of oxygen levels and blood pressure (with supportive measures as needed), blood transfusions, pain management, and antibiotics and antimalarials as indicated….
All four study drugs were generally well tolerated. There were a total of four serious adverse events that were judged to be potentially related to the experimental drugs. Three of these were in two of the patients who received ZMapp. One was in a patient who received remdesivir.
The authors note that despite encouraging findings regarding mAb114 and REGN-EB3, approximately one-third of patients who received these therapeutics died, highlighting the potential to improve upon these results, whether through further optimization of supportive care, combination therapy using agents with complementary mechanisms of action or other strategies.
“Despite unprecedented challenges — including an unstable electrical power grid and evacuations of staff and patients from treatment centers due to violent attacks — the PALM trial demonstrates that scientifically rigorous and ethically sound clinical research can be conducted during disease outbreaks,” said H. Clifford Lane, M.D., NIAID deputy director for Clinical Research and Special Projects. “We thank the patients and the medical staff in the field and at the treatment sites for their participation and exceptional commitment to the trial.”


Public Health Emergency of International Concern (PHEIC)

Polio this week as of 20 November 2019
:: A four-day regional emergency preparedness workshop is currently underway in Lomé, Togo, for senior public health officials to strengthen the capabilities within West African countries to respond to polio outbreaks. Read more about the workshop.
:: “It was good to know that a country like India could eradicate polio. It gives us hope that Pakistan can do it too, and we will soon be polio free.” These are the words of Aziz Memon, a Rotarian who has dedicated his life to fight polio in Pakistan. Read about his journey.

Summary of new viruses this week (AFP cases and ES positives):
:: Pakistan— five WPV1 cases, two cVDPV2 cases and one cVDPV2 positive environmental sample;
:: Democratic Republic of the Congo (DR Congo)- five cVDPV2 cases;
:: Benin – four cVDPV2 cases;
:: Ghana— four cVDPV2 cases and two cVDPV2 positive environmental samples;
:: Philippines – three cVDPV2 cases and five cVDPV2 positive environmental samples;
:: Togo – two cVDPV2 cases.


More than 3.1 million Iraqi children to be vaccinated against polio
Baghdad, 26 November 2019 – Health authorities in Iraq, in partnership with the World Health Organization (WHO) and UNICEF, have launched a campaign to reach more than 3.1 million children under-5 years of age with lifesaving polio vaccine.

The 5-day campaign aims to target children in 65 districts in the governorates of Baghdad, Babylon, Diwaniya, Diyala, Muthanna, Thi-Qar, Missan and Basra.

“Over the years, WHO, the Ministry of Health and UNICEF have worked hard to improve immunization coverage in the country. Therefore, it is important that we keep building on our work by making sure that children are vaccinated against childhood preventable diseases like polio and we keep Iraq polio free,” said Dr Adham Ismail, WHO Representative for Iraq. “During this second phase of the campaign, we want to reach all the children under 5 regardless of their previous vaccination status with oral polio vaccine leaving no one out no matter where they are,” added Dr Adham…


Editor’s Note:
WHO has posted a refreshed emergencies page which presents an updated listing of Grade 3,2,1 emergencies as below.

WHO Grade 3 Emergencies [to 30 Nov 2019]

Democratic Republic of the Congo
:: Dead and injured following attacks on Ebola responders in the Democratic Republic of the Congo 28 November 2019
:: Ebola Outbreak in DRC 69: 26 November 2019

Mozambique floods – No new digest announcements identified
Nigeria – No new digest announcements identified
Somalia – No new digest announcements identified
South Sudan – No new digest announcements identified
Syrian Arab Republic – No new digest announcements identified
Yemen – No new digest announcements identified


WHO Grade 2 Emergencies [to 30 Nov 2019]

Afghanistan – No new digest announcements identified
Angola – No new digest announcements identified
Burkina Faso [in French] – No new digest announcements identified
Burundi – No new digest announcements identified
Cameroon – No new digest announcements identified
Central African Republic – No new digest announcements identified
Ethiopia – No new digest announcements identified
HIV in Pakistan – No new digest announcements identified
Iran floods 2019 – No new digest announcements identified
Iraq – No new digest announcements identified
Libya – No new digest announcements identified
Malawi floods – No new digest announcements identified
Measles in Europe – No new digest announcements identified
MERS-CoV – No new digest announcements identified
Myanmar – No new digest announcements identified
Niger – No new digest announcements identified
occupied Palestinian territory – No new digest announcements identified
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified


WHO Grade 1 Emergencies [to 30 Nov 2019]

Chad – No new digest announcements identified
Djibouti – No new digest announcements identified
Kenya – No new digest announcements identified
Mali – No new digest announcements identified
Namibia – viral hepatitis – No new digest announcements identified
Tanzania – No new digest 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. 
Syrian Arab Republic – No new digest announcements identified
Yemen – No new digest announcements identified


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.
Editor’s Note:
Ebola in the DRC has bene added as a OCHA “Corporate Emergency” this week:
CYCLONE IDAI and Kenneth – No new digest announcements identified
EBOLA OUTBREAK IN THE DRC – No new digest announcements identified


WHO & Regional Offices [to 30 Nov 2019]

WHO & Regional Offices [to 30 Nov 2019]
28 November 2019
News release
WHO launches Online Training on Climate and Health in the UN climate negotiations

28 November 2019
News release
Dead and injured following attacks on Ebola responders in the Democratic Republic of the Congo

28 November 2019
News release
5 Key Actions for COP25 to Bolster Global Health

28 November 2019
News release
Pollution Pods at COP25 show climate change and air pollution are two sides of the same coin

27 November 2019
News release
Innovative WHO HIV testing recommendations aim to expand treatment coverage
The World Health Organization (WHO) has issued new recommendations to help countries reach the 8.1 million people living with HIV who are yet to be diagnosed, and who are therefore unable to obtain lifesaving treatment.

“The face of the HIV epidemic has changed dramatically over the past decade,” said Dr Tedros Adhanom Ghebreyesus. “More people are receiving treatment than ever before, but too many are still not getting the help they need because they have not been diagnosed. WHO’s new HIV testing guidelines aim to dramatically change this.”

HIV testing is key to ensuring people are diagnosed early and start treatment. Good testing services also ensure that people who test HIV negative are linked to appropriate, effective prevention services. This will help reduce the 1.7 million new HIV infections occurring every year.

The WHO guidelines are released ahead of World AIDS Day (1 December), and the International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA2019) which takes place in Kigali, Rwanda on 2-7 December. Today, two thirds of all people with HIV live in the African Region.

The new “WHO consolidated guidelines on HIV testing services” recommend a range of innovative approaches to respond to contemporary needs…



Weekly Epidemiological Record, 29 November 2019, vol. 94, 48 (pp. 561–580)
:: Cholera, 2018
:: Global update on Middle East respiratory syndrome, 2019
:: Fact sheet on echinococcosis (updated May 2019)



WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: WHO, UNICEF help boost West Africa’s capacity to respond to polio outbreaks 27 November 2019

WHO Region of the Americas PAHO
:: Campaign encourages health workers and youth to have open conversations about HIV (11/27/2019)

WHO South-East Asia Region SEARO
:: Statement: Intensify action to eliminate violence against women 25 November 2019

WHO European Region EURO
:: WHO working with health authorities in European Region after outbreak of Lassa fever in Sierra Leone 29-11-2019
:: Gaps in access undermine universal health coverage across the EU 29-11-2019
:: Half of all women with HIV are diagnosed late in Europe 28-11-2019
:: Medical facilities coping well in Albania following earthquake 27-11-2019

WHO Eastern Mediterranean Region EMRO
:: Polio vaccination campaign targets more than 3.1 million Iraqi children 26 November 2019

WHO Western Pacific Region
No new digest content identified.

CDC/ACIP [to 30 Nov 2019]

CDC/ACIP [to 30 Nov 2019]


MMWR News Synopsis for Friday, November 29, 2019
Status of HIV Case-Based Surveillance Implementation — 39 U.S. PEPFAR-Supported Countries, May–July 2019
A new CDC study is one of the first global assessments of the pace and scale of human immunodeficiency virus (HIV) case-based surveillance (CBS) in 39 countries supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Twenty of the countries reported implementing CBS, and 15 others reported current planning for implementation. Closing gaps in policies and improving technical infrastructure are necessary steps towards implementing a comprehensive CBS system able to inform responses to end the HIV epidemic. HIV case-based surveillance is the systematic and continuous reporting of individual HIV cases to monitor HIV-positive patients throughout their clinical care and to facilitate rapid public health action. To date, few assessments have reported on the status of CBS implementation in countries on a global scale. Among 39 -PEPFAR-supported countries around the globe surveyed from May to July 2019, about half (20) reported implementing case-based surveillance. Among the remaining countries, 15 were planning for implementation. Despite this effort, gaps exist including patient-level unique identifiers to link data across systems, supportive national policy environments, and data security standards. The assessment identified critical barriers that must be addressed to implement CBS effectively and to better inform responses to end the HIV epidemic.