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WHO EMRO Weekly Epidemiological Monitor: Volume 12, Issue no 52; 29 December 2019

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Disease outbreaks in Eastern Mediterranean Region (EMR), January to December 2019

In 2019 alone, eight countries in the Eastern Mediterranean Region (EMR) experienced major outbreaks of high threat pathogens. Some of these outbreaks started during previous year (s) and can not be contained while others emerged exclusively during 2019.

Editorial note

During 2019 alone, countries in the region experienced several major outbreaks from emerging and re-emerging infectious diseases, with some of these turning into explosive outbreaks. The infectious diseases that have been reported in the EMR in 2019 include cholera, Crimean-Congo hemorrhagic fever (CCHF), chikungunya, chicken pox (Varicella), dengue fever, diphtheria, extensive drug-resistant typhoid fever, Hepatitis A, HIV, measles, Middle East respiratory syndrome (MERS), poliomyelitis, and Rift Valley fever (See map).

Sudan remained the epicenter of outbreaks during 2019. The country experienced outbreaks of six different infectious diseases simultaneously (Cholera, Chikungunya, Dengue fever, Diphtheria, malaria and Rift Valley Fever), the highest number than any other country in the region and all were declared during second half of 2019. The country announced for the first time the cholera outbreak and reported 346 cases, including 11 deaths (See table). The cases remained relatively low as compared to previous outbreaks due to timely detection and response.

Pakistan was the second most affected country with outbreaks of infectious diseases and it experienced HIV, Dengue fever, extensive drug resistance (XDR) typhoid, Crimean Congo Hemorrhagic Fever, Poliomyelitis and chicken pox outbreaks during 2019. HIV outbreak was reported in April 2019 from Ratodero Taluka in Sindh province and till end of 2019, a total of 1 211 people tested positive among 3,8009 screened voluntarily. Around 80% of the cases were children less than 11 years old and the reporting of new cases continued till end of year. Dengue fever re-emerged this year in Pakistan with more cases across country with cumulative cases of 53,600 with 95 deaths. Most affected cities were Islamabad and Rawalpindi (39% of total cases) and Karachi (29 % of total cases). Although this outbreak started declining during week 46 but sporadic cases were reported till end of year.

Middle East respiratory syndrome coronavirus (MERS-CoV) has continued to circulate since 2012. This year, a total of 203 cases were laboratory confirmed and among them 199 cases with 48 deaths were reported in Saudi Arabia. The rest of the cases were reported in United Arab Emirates (1 cases) and Qatar (3 cases).

Other countries in the region that reported outbreaks during 2019 are; Somalia (Cholera; 9735 cases and 50 deaths), Yemen (Cholera; 794,741 cases an 1007 deaths) Afghanistan (CCHF; 583 cases (63 deaths), Dengue fever; 14 cases (1 death) and Poliomyelitis; 26 cases), Lebanon (Measles; 1064 cases, Hepatitis A; 418 cases).

The emergence and rapid transmission of high-threat pathogen diseases has increased due to acute or protracted humanitarian emergencies, rapid urbanization, climate change, weak surveillance and limited laboratory diagnostic capacity, and increased human–animal interaction. Its important to scale up the prevention, timely detection and response to any infectious disease threats among such vulnerable populations in emergency settings. In the region at large, WHO/ EMRO has started the implementation of a holistic strategy to minimize the impact of emerging infectious disease outbreaks, which is focusing on strengthening early warning surveillance systems for rapid detection, and improving capacities for field investigation and laboratory confirmation of emerging and re-emerging infectious disease outbreaks as well as enhancing rapid response capacities for early damage control.