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! Rwanda: Outbreak of Marburg virus disease - update
On 27 September 2024, Rwanda reported its first Marburg virus disease outbreak (see EpiNews as of 3 Oct 2024). Updates as of 18.10.2024:
- As of 16 October 2024, 62 cases of MVD have been reported, including 15 deaths (case fatality rate: 24%); 9 patients are in isolation. So far, 38 patients have recovered. For updates, see LINK. Cases are reported from eight of the 30 districts. Health care workers continue to be disproportionately affected.
- Treatment trial: WHO announced the commencement of a randomized, controlled trial to test remdesivir and a monoclonal antibody designed specifically against MARV (derived from antibodies from a MVD survivor). Link to study with NHP model. Gilead donates remdesivir for emergency use to Rwanda.
- Vaccination: On 6 October 2024, vaccinations (provided by Sabin Vaccine Institute) for healthcare workers and high risk contacts started as part of a Phase 2 rapid response open-label study; as of 16.10.2024 a total of 856 doses have been administered. Link to phase 1 study of the cAd3-vector based vaccine (single-dose i.m.). Link to the Marburg virus vaccine consortium, MARVAC. Link to GAVI, Marburg-page.
- Rwanda continues implementing a number of control measures including: entry and exit screening at the airport, see EpiNews of 10.10.2024,
- Link to history of Marburg Outbreaks via CDC webpage, see LINK.
- CDC has put Rwanda on alert level 3 (Reconsider nonessential travel to the Republic of Rwanda).
- As of 14 October 2024, the US Department of Health and Human Services started public health entry screening for those entering the country after having been to Rwanda the past 21 days, see LINK.
China, Hong Kong: melioidosis, update
In urban districts of Hong Kong further cases of melioidosis were confirmed. Melioidosis is endemic in Hong Kong, though case numbers are low (18 so far in 2024). This serves as a reminder that this infection – though commonly associated with out-door and rural environments – is indeed also endemic in metropolitan surroundings.
Melioidosis is an endemic disease in Asia and Northern Australia. Cases have also been reported from Africa, the Caribbean basin, and the Americas. Cases may increase after hurricanes, heavy rain, typhoons, and other severe weather events.
Melioidosis mainly affects people who have direct contact with soil and water. Many have an underlying predisposing condition such as diabetes (most common risk factor), renal and liver disease, and others. Information on melioidosis: see CDC.
! Rwanda: Outbreak of Marburg virus disease - update
On 27 September 2024, Rwanda reported its first Marburg virus disease outbreak (see EpiNews as of 3 Oct 2024).
- As of 10 October 2024, 58 cases of MVD have been reported, including 13 deaths (case fatality rate: 22%); 30 patients are in isolation. So far, 12 patients have recovered. For updates, see LINK.
- The cases are reported from eight of the 30 districts in the country. Among the confirmed cases, over 80% are health care workers from two health facilities in Kigali. Contact tracing is underway and follow-up of more than 300 contacts is ongoing.
- On 6 October 2024, vaccinations for healthcare workers and high risk contacts started as part of a Phase 2 rapid response open-label study; vaccines have been provided by Sabin Vaccine Institute.
- Rwanda has been implementing a number of control measures including: entry and exit screening at the airport, measures in education settings and conferences, ban on patient visits to hospitals, strengthening infection prevention and control protocols in hospitals, and measures to limit contact with dead bodies.
- CDC has put Rwanda on alert level 3 (Reconsider nonessential travel to the Republic of Rwanda).
- On 7 October 2024, the US Department of Health and Human Services announced that on the week of 14 October 2024 US CDC will start public health entry screening for those entering the country after having been to Rwanda the past 21 days, see LINK.
Africa: Multi - country Mpox outbreak due to monkeypox virus clade I – update 06 October 2024
In 2024, as of 06 October 2024, 16 countries have reported 7’524 confirmed cases (+770 new confirmed cases within 1 week), including 32 deaths. The three countries with the majority of the cases in 2024 (all clades) are Democratic Republic of the Congo (6’169), Burundi, (n = 987), and Nigeria, (n = 84).
(Note: A significant number of suspected mpox cases that are clinically compatible with mpox remain untested due to limited diagnostic capacity in some African countries and therefore never got confirmed.)
In 2024, 15 countries have reported both 31’527 suspected and laboratory tested cases (+5’160 within 1 week, all clades), including 998 suspected and confirmed deaths (+2 within 1 week).
According to WHO, in 2024 as of 29 Sept 2024 the cumulative confirmed mpox cases (+ cases since last update 29 Sep 2024) were reported in the below mentioned countries (for updates, details, suspected cases, epidemic curves, see WHO LINK):
Clade Ia and b:
- D.R. Congo: according to WHO: 5’610 (+559 cases since 29 Sept 2024; note OV: in the week before the reported number was not conclusive)
Clade Ib
- Burundi: 987 confirmed cases (+134 cases since 29 Sept 2024, stable increase of confirmed cases) (plus hundreds of suspected cases)
- Uganda: 69 cases (+47 cases since 29 Sept 2024)
- Kenya: 12 cases (+4 since 29 Sept 2024)
- Rwanda: 6 cases (+0 cases since 29 Sept 2024)
- Outside Africa: Sweden (1 case, imported from Burundi), Thailand (1 case, imported from DRC), India (1 imported case)
Clade Ia:
- Republic of the Congo: 21 confirmed cases (+0)
- Central African Republic: 57 confirmed cases (+2)
- Cameroon: 6 cases (+0), including unknown number of cases with clade IIa and IIb
Clade II (a and/or b):
- Côte d’Ivoire: 67 cases (+15)
- Cameroon: 6 cases including unknown number of cases with clade 1a
- Ghana: 1 case
- Guinea: 1 case (+0)
- Morocco: 3 case (+1)
- Nigeria: 84 cases (+6)
- South Africa: 25 cases (+0)
In addition, mpox cases have been reported in Africa in 2024 without specification of the clade:
- Gabon: 2 cases (+0)
- Liberia: 14 cases (+1)
Epicurve for Ib clade cases as 6 October 2024:
Côte d’Ivoire: Rabies situation
At least 35 deaths due to rabies were reported in 2024. More than 50% of the victims are children under the age of 15.
Barbados: First detected human case of West Nile Virus
On 13 September 2024, the IHR NFP for Barbados notified WHO of one confirmed human infection with West Nile Virus (WNV) in a child. This marks the first detected human case of WNV reported from Barbados.
Additionally, no infections have been previously documented in birds or horses in this country, making this case both unusual and unexpected. However, the WNV has spread throughout the Caribbean, likely via infected migratory birds. It is possible that the virus is circulating in birds and horses undetected.
West Nile viruses belong to the flavivirus family and are transmitted by Culex mosquitoes. The main hosts are birds; humans are false hosts. Most cases are asymptomatic; clinically symptomatic cases develop fever and meningitis or encephalitis. Elderly persons, pregnant women and immunosuppressed persons are at higher risk for a neuroinvasive form of the disease.
India: Increasing number of leptospirosis in Kerala state
The number of people affected by leptospirosis and related deaths in Kerala is increasing. In the first 4 days of October 2024 alone, 45 people were diagnosed with the disease.
According to the Health Department, from 1 Jan to 4 Oct 2024, a total of 2’512 people have been diagnosed with leptospirosis, including 155 confirmed deaths. Additionally, 1’979 people sought treatment for symptoms related to the illness. Similarly, 131 deaths suspected to be caused by leptospirosis symptoms were also reported.
Health officials warn that the disease is now spreading during all seasons.
Italy: Locally acquired dengue cases
As of 3 October, 130 locally acquired dengue cases have been reported by the Italian National Public Health Authority. These are 63 more cases than reported in the previous week's update. The newly reported cases were from Marche (51 cases), Emilia Romagna (14 cases) and Lombardy (one case). According to local authorities in the Marche Region, there is a decreasing trend in case numbers reported from Fano.
For 129 cases NUTS2 regions were reported:
- Marche (102 cases)
- Emilia Romagna (19 cases)
- Lombardy (six cases)
- Tuscany (one case)
- Veneto (one case).
An additional case (onset of symptoms 18 August, DENV 2) was reported by the Abruzzo region. However, the place of infection is currently under investigation as the infection may have occurred in another region.
European Region: West Nile Virus - update
In 2024 and as of 2 October 2024, 18 countries in Europe have reported 1’202 locally acquired human cases of West Nile Virus (WNV) infection with known place of infection. The earliest and latest date of onset were respectively on 1 March 2024 and 26 September 2024.
Locally acquired cases were reported by Italy (422), Greece (202), Spain (114), Albania (102), Hungary (101), Romania (71), Serbia (53), Austria (34), Türkiye (30), France (27), Croatia (20), Germany (8), Slovenia (5), Kosovo (4), Slovakia (4), Bulgaria (2), North Macedonia (2) and Czechia (1).
In Europe, 88 deaths were reported by Greece (31), Italy (16), Albania (13), Romania (10), Spain (10), Bulgaria (2), Serbia (2), Türkiye (2), France (1) and North Macedonia (1).
Case numbers reported this year are above the mean monthly case count for the past 10 years. During the same period in 2023, 681 cases had been reported. However, numbers are lower than in 2018, when 1 728 cases had been reported by this time of year.
Distribution of locally acquired human West Nile virus infections in 2024 till 2 October 2024:
Of note, further regions of infection were reported in 2023.
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Updates of recommendations
Find out about the latest content updates on the websiteEntry requirements for yellow fever - update
The entry requirements for yellow fever have been updated for Bolivia, Malawi, Chad, Singapore and Thailand.
Mpox – updated informationen and recommendations
Following content has been updated by the Swiss Expert Committee for Travel Medicine: Mpox Factsheet, Infosheet, Map. See Health Risks - mpox.
Malaria – documents for health professionals
The country list (malaria recommendations in an alphabetical order) and the flyers for consultations have been updated.
Malaria – updates 2024
Content updates of prevention recommendation updates on world, regional and country maps with malaria prevention recommendations by country.
Polio – updated WHO temporary recommendations
The country pages have been updated to reflect the updated WHO temporary polio recommendations.
Dengue – ECTM statement on Qdenga
An updates version of ECTM statement on the dengue vaccine Qdenga is available, see LINK.
Marburg Virus Disease
A new factsheet on Marburg Virus Disease is available.
Yellow Fever Country List
The 'Yellow fever country list (vaccination recommendations and countries’ entry requirements) has been updated and is available on PRO Version -> yellow fever -> documents for professionals
Entry requirements for polio - update
The entry requirements for polio have been updated for Iraq and Jordan.