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Between January 22 and 28, 2024 (week 4), 18 countries reported their meningitis epidemiological data.

Epidemics: 

• Mali: Gao region
  
• Nigeria: Jigawa State
  

Warnings: 

• Benin: Littoral region (Cotonou district)
  
• Ghana: Upper West Region 
  
• Nigeria: Yobe State and Bauchi State
  

Previous epidemics and warnings can be found at www.healthytravel.ch.

Seasonal meningitis epidemics occur in sub-Saharan Africa mainly during the dry season, usually from December to June. They decline rapidly with the onset of the rains. In general, the meningococcal serogroups A, C, W and X are responsible for these outbreaks. The disease spreads from person to person by droplets. If symptoms (high fever, severe headache and vomiting) occur, a doctor should be consulted immediately and antibiotic therapy started, as the disease can lead to life-threatening conditions within hours. Vaccination against the most important meningitis strains is available as prophylaxis for adults and children over 1 year of age.

According to Médecins Sans Frontières (MSF), 3,965 patients were treated for measles in Borno State in Nigeria from October to December 2023. The increase in the number of cases could be due to the fact that public health actors were unable to achieve the 95% vaccination rate due to the uncertain situation in the region. In addition, the interruption of routine childhood vaccinations during the COVID-19 pandemic contributed to the increase in cases.

On February 12, 2024, the Centres for Disease Control and Prevention (CDC) published the top 10 countries with measles outbreaks (data refer to the period July - December 2023):

1. Yemen 18,464
   
2. Azerbaijan 13,721
   
3. Kazakhstan 13,195
   
4. India 12,301
   
5. Ethiopia 10,060
   
6. Russian Federation 7,720
   
7. Iraq 7,601
   
8. Pakistan 7,027
   
9. Kyrgyzstan 5,777
   
10. Indonesia 3,205
    

Measles outbreaks are reported when the number of reported cases in an area is higher than the expected number of cases.

In the 2nd and 3rd week of 2024, 21 countries have reported their epidemiological data on meningitis:

Epidemic:

• Ethiopia: Jinka Town (since week 1/2024)
  

Warning:

• Benin: Littoral Region (Cotonou District)
  
• Ghana: Upper West Region (Jirapa and Nandom districts) and Northern Region (Zabzugu district)
  
• Nigeria: Bauchi State (Damban District) and Jigawa State (Biriniwa District)- D.R. Congo: Haut-Uele and North Kivu
  
• Chad: Mandoul region (Goundi district)
  

Previous epidemics and warnings can be found at EpiNews or at www.healthytravel.ch.

Seasonal meningitis epidemics occur in sub-Saharan Africa mainly during the dry season, usually from December to June. They decline rapidly with the onset of rainfall. In general, the meningococcal serogroups A, C, W and X are responsible for these outbreaks. The disease spreads from person to person by droplets. If symptoms (high fever, severe headache and vomiting) occur, a doctor should be consulted immediately and antibiotic therapy started, as the disease can lead to life-threatening conditions within hours. Vaccination against the most important meningitis strains is available as prophylaxis for adults and children over 1 year of age.

In 2023, 171 cases of leptospirosis were recorded in Reunion Island, more than 70% of which occurred between January and June.

Leptospirosis is a bacterial disease that occurs worldwide, particularly frequently in tropical countries during the rainy or flooding season. It is transmitted through contact between small skin lesions and water contaminated with urine (mainly from infected rats, dogs, pigs, cows, etc.). The risk of infection increases when camping or during water-related activities (swimming, kayaking, wading through watercourses). The disease can be treated with antibiotics if diagnosed in time.

Since the beginning of 2023 and up to January 11, 2024, a total of 777 Zika virus infections (ZIKV) have been reported in Thailand. These have been registered in 36 provinces, with the central and northern regions being the most affected. According to the government, 758 people tested positive (including 33 pregnant women), compared to only 190 in 2022 and 63 in 2021. It is currently unclear whether the case numbers in 2023 are due to an increase in awareness and/or diagnostic capacity or an increase in ZIKV circulation.

In December 2023, three Zika cases were imported to Europe after a stay in Thailand.

The outbreak of Streptococcus suis infections in Thailand continues: 137 infections and 8 deaths have been reported within the last three weeks. The increase in infections is linked to the consumption of raw or undercooked pork, sausages and raw pork blood salad.

Infection with Streptococcus suis is usually asymptomatic in pigs. Humans can become infected by eating contaminated raw or undercooked pork and fresh blood or through direct contact with infected pigs or pork products. Symptoms include high fever, severe headache and dizziness, vomiting, diarrhea, neck stiffness, intolerance to light, decreased level of consciousness and hearing loss.

Health authorities are warning people to protect themselves after a case of Japanese encephalitis virus (JEV) infection was detected in New South Wales (NSW).  Following the persistently wet and warm weather over the vacation period, mosquito populations in NSW are currently thriving.

In 2022, there was one outbreak of JEV in Australia with 45 cases detected mainly in the Murray Valley in New South Wales.

According to the Thai Ministry of Health, there has been a significant increase in Zika virus cases, with around 100 new cases are reported every month.

Around 660 cases have been registered since June 2023, mainly in the northern and central areas. Cases of Zika virus have also been detected in people who had recently returned from Thailand. Zika is endemic in Thailand and other parts of the world, but a current outbreak (epidemic) is not currently recorded in Thailand, according to the US Center of Disease Control and Prevention (CDC) (see CDC map).

After a three-week trip to southern Thailand (Krabi, Khao Sok, Koh Phangan, Koh Samui), two German tourists in Tübingen were diagnosed with Zikainfection.

Although the CDC does not classify Thailand as a country with a current outbreak (see CDC map), Zika is endemic in Thailand.

The WHO's annual malaria report highlights the growing threat of climate change. In 2022, there were an estimated 249 million malaria cases worldwide in 85 malaria-endemic countries and territories - significantly more than the estimated number of cases before the COVID-19 pandemic. The main countries contributing to the increase in 2022 were Pakistan, Ethiopia, Nigeria, Uganda and Papua New Guinea.  The WHO African region accounted for about 94% of cases worldwide. The number of deaths amounted to an estimated 608,000. In addition to the disruption caused by COVID-19, the global malaria response is facing a growing number of threats: Drug and insecticide resistance, humanitarian crises, resource scarcity, climate change impacts and delays in program implementation, particularly in countries with a high burden of the disease.

Details can be found at WMR LINK.

In October 2023, the following countries reported meningitis outbreaks:

Epidemic: 

• Nigeria: Nangere LGA (Yobe State) 
  

Warning:

• Nigeria: Machina LGA (Yobe State), Garawa LGA and Gumel LGA (Jigawa State)
  
• Ghana: Bole District (Savannah Region)
  
• Chad: Goundi district (Manoul region)
  

Seasonal meningitis epidemics occur in sub-Saharan Africa mainly during the dry season, usually from December to June. They decline rapidly with the onset of the rains. In general, the meningococcal serogroups A, C, W and X are responsible for these outbreaks. The disease spreads from person to person by droplets. If symptoms (high fever, severe headache and vomiting) occur, a doctor should be consulted immediately and antibiotic therapy started, as the disease can lead to life-threatening conditions within hours. Vaccination against the most important meningitis strains is available as prophylaxis for adults and children over 1 year of age.

On the World AIDS Day on December 1, here is a look back at the extent of the pandemic:

In 2022:

• 39 million people are living with HIV worldwide 
  
• 1.3 million people were newly infected with HIV 
  
• 630,000 people died from AIDS-related illnesses
  
• 29.8 million people received access to antiretroviral therapy 
  

Since the beginning of the epidemic:

• 85.6 million people have been infected with HIV and 40.4 million people have died from AIDS-related illnesses.

In Denmark, whooping cough (pertussis) cases have increased significantly during the spring and summer, with the authorities now reporting a figure more than ten times higher than normal. In the 37th week alone (up to September 16), 200 cases of whooping cough were detected (normally an average of around 20 cases per week).

Whooping cough is a respiratory infection that is characterized by a course lasting up to three months with severe coughing fits, often accompanied by howling breathing and vomiting immediately after the attacks.

An 8-year-old girl died of rabies in Agra, Uttar Pradesh, on October 25, 2023, after being bitten by a stray dog two weeks earlier. The child did not inform anyone in her family except her mother about the incident, and she was only given some home remedies instead of the necessary rabies vaccine. The family only contacted the Community Health Center when the girl developed symptoms after 15 days. 

According to officials, as many as 5000 cases of dog bites are reported every month in both rural and urban Agra.

Ethiopia has faced malaria outbreaks in numerous regions since early 2023. The regions most affected include Gambela, Southwest Ethiopia (SWEPR), Afar, and Ahmara. 

In addition to malaria, Ethiopia faces other health crises, including cholera, measles, dengue fever, and COVID-19, as well as a variety of natural disasters such as droughts, recurrent floods, food insecurity, and locust infestations, as well as man-made challenges such as conflict, internal displacement, and the effects of the Sudan conflict. These factors combined have significantly increased the country's need for health and humanitarian assistance.

In the Indian state of Assam (north-eastern part of the country), 432 cases of Japanese encephalitis (JE) were reported by the end of August, 24 of which were fatal. Cases have increased almost tenfold since the beginning of August 2023.

Ranchi district in Jharkhand state in northern India has also reported an increase in JE cases, although the numbers are still modest, with 12 cases in recent weeks.

According to media reports, a case of canine rabies has been reported in the city of São Paulo in Brazil. The infection was confirmed by the Pasteur Institute. This is the first case of canine rabies since 1983. 

The case is still under investigation and has already led to surveillance measures in the region and 367 animals have been vaccinated with rabies vaccine.

Since the first week of August and as of 11 September 2023, 19 locally acquired dengue fever cases have been detected in the Lombardy (14) and Lazio (5) regions in Italy. The cases are grouped in three clusters:

• in the province of Lodi, Lombardy region (14 cases)
  
• in the metropolitan city of Rome (3 cases) and 
  
• in the province of Latina (2 cases), Lazio region (Circero). 

All cases were laboratory confirmed by PCR and all cases have recovered or are improving.

A DENV-1 serotype virus was identified in the cases in Lombardy and in the metropolitan city of Rome, Lazio region. Epidemiological investigations have not identified any link between the cases in Lombardy and the cases identified in the Lazio region. 

A DENV-3 serotype was detected in the cluster of cases in the province of Latina, Lazio region, indicating that this outbreak is independent from the other two in Italy. 

Response and control measures are being implemented by Italian public health authorities. These include case finding, vector control activities, information to healthcare providers and the general public, and preventive measures for donors of substances of human origin (e.g. blood and organs). 

So far, 146 imported dengue cases have been registered in Italy in 2023, most of them in the Lombardy region (50 imported cases) and Lazio region (28 imported cases).

For more details of the outbreak in Italy, see Rapid Communication of Eurosurveilance.

An outbreak of 4 autochthonous (locally transmitted) cases of dengue fever was detected in Gardanne in the department of Bouches-du-Rhône. Symptoms of the cases occurred between the second half of July and early August 2023.

At least 47 autochthonous cases were recorded in France in 2022. The affected regions were Occitania (9 cases) and Provence-Alpes-Cote d'Azur (36 cases).

Officials observe that the downward trend in terms of chikungunya continues, with a weekly average of about 40 cases per week in the last 3 weeks, dengue cases still remaining at an average of 100 weekly cases. The high dispersion of the cases is also maintained, covering practically the entire national territory.

The head of Health Surveillance, Guillermo Sequera, stated that it is striking that at the end of July we still have cases of dengue and chikungunya (usually there are no cases at this time). He expressed his concern about this scenario, considering that the rainy season is approaching -in October-, to this is added the phenomenon of El Niño, which could portend a complicated epidemiological scenario for the next season.

A man has been hospitalized in Ulan Bator with bubonic plague after eating marmot meat. This was reported by the National Center for the Study of Zoonotic Infections of Mongolia. According to Xinhua News Agency, the hospitalized man and 5 other people who were in close contact with him have been isolated. 

While hunting marmots is illegal in Mongolia, many Mongolians regard the rodent as a delicacy and ignore the law. Of all the 21 Mongolian provinces, 17 are still at risk of the bubonic plague, urging the public not to hunt marmots or eat marmot meat.

According to the media, 8.64% of respiratory specimens handled by public laboratories tested positive for flu, higher than 8.57% recorded the week before, but below the baseline threshold level of 9.2%. The latest fatal case involved a 2-year-old boy who tested positive for influenza A and died on 28 July 2023.

Hong Kong has 2 flu seasons, one beginning in April and the second starting in August.

The ministries of health and agricultural development of the province have declared an epidemiological alert after the detection of cases of suspected trichinosis in the interior of Buenos Aires. So far, 29 people have been reported to have been exposed, 15 of whom developed symptoms; from the municipalities of Adolfo Alsina and Sallikelo, and the products included bacon and dried chorizo.

Samples of both products analyzed by the Applicant's laboratory tested positive for Trichinella spiralis. The sausages came from the plant "AGROINDUSTRIA LOS ANDRES SRL", with the trademark "Don Andrés" RPE No. 122-5 PAMS Exp No. 22500-39417/17 found in salami.
According to preliminary information, these products were distributed in the municipalities of Dayro, Hipólito Yrigoyen, Coronel Suárez, Saavedra, Tres Lomas, Trenque Lauquen, Puan, Rivadavia and Adolfo Alsina. Faced with this, medical teams were called in to strengthen the epidemiological surveillance of cases of trichinosis in the said municipalities, and the secretariats of health and food science departments of these areas were urged to continue the investigation.

So far this season (2023), 6 cases of Murray Valley Encephalitis (MVE) have been recorded, two of which were fatal. The Kimberley region has been particularly affected. This has been the worst season for MVE since 2012. Other arboviruses are also transmitted in Western Australia: dengue virus, Ross River virus, Japanese encephalitis virus, Barmah Forest virus, Kunjin virus, etc.

Murray Valley encephalitis virus is transmitted by mosquitoes. The risk of contracting and becoming ill is low, but the illness caused by the virus can be severe and possibly fatal.
Initial symptoms include fever, drowsiness, headache, stiff neck, nausea and dizziness. People who experience these symptoms should seek medical attention as soon as possible.

The Blitar District Health Office in East Java, Indonesia, reported 11 suspected diphtheria cases in the past 2 months, all of which required a stay in the intensive care unit of a hospital. 

Diphtheria is caused by bacteria that are common worldwide. The pathogen produces a powerful toxin that can permanently damage organs such as the heart and liver. There are two types of the disease: respiratory (breathing) and cutaneous (skin) diphtheria. The pathogen primarily affects the upper respiratory tract and produces a toxin that can lead to dangerous complications and late effects. Person-to-person transmission occurs through droplet infection (close physical contact, coughing, sneezing). It originates from a sick person or from someone who carries the bacterium without symptoms. Less commonly, infection occurs through contaminated objects or, in the case of cutaneous diphtheria, through direct contact. Effective vaccination protects against the disease.

In recent years, the world, and the Americas region in particular, has seen an exponential increase in international travel in search of medical care. While most patients seek this in the country in which they reside, there is a growing proportion of individuals who change countries for medical, dental or surgical treatment. This practice is referred to as medical and health tourism. For example, millions of Americans travel to other countries each year for medical care, especially to Mexico, Canada, and other countries in Central America, South America, and the Caribbean.

While there are few published studies on the number of people seeking medical care outside their country of residence, it is estimated that the annual number in the United States alone has increased from 750,000 to 1.4 million over a 10-year period (2007 to 2017). This number is expected to increase by 25% each year, both in the United States and globally. The main motivations for seeking outsourced medical care include lower costs, avoiding long waiting lists, the ability to access procedures that are not available in the country of residence, and the ability to combine health care with a vacation stay. Procedures related to cosmetic and aesthetic surgery account for the largest percentage of procedure types, followed by organ transplants, cardiac surgery, dental procedures, cancer treatment, joint treatments, bariatric surgery, and assisted artificial insemination techniques.

Health authorities in the Czech Republic report an increase in hepatitis E cases in the Moravian-Silesian region and throughout the country. In 2022, a total of 319 cases of hepatitis E were reported, and by the end of May 2023, 221 new cases had already been reported.

Doctors assume that it could be contamination from insufficiently cooked meat, especially pork.

Although monkeypox (MPOX) cases have declined significantly in recent months, it is important to remember that the virus is still circulating at low levels. Some WHO member states continue to report new cases, and the possibility of reintroduction, either from endemic areas or newly affected countries, is likely. 

Based on the findings of the current outbreak and the low number of new infections, the overall risk for MPOX remains moderate for men who have sex with men and very low for the general population. However, ECDC has warned of the possibility of an increase in cases next summer due to a series of celebrations such as Pride events and increased travel.

To kick off the summer festival season and Pride month, ECDC is releasing an updated fact sheet for health professionals. In addition, ECDC and the WHO Regional Office for Europe have provided a series of new infographics and social media maps on personal protective measures to consider for those at increased risk.

• Social media cards: learn more about MPOX before Pride events: LINK.
• Social media cards: MPOX - what you need to know: LINK
• Editable poster: Learn more about MPOX: LINK

MPOX is transmitted primarily through skin contact, including during sex, with someone who has Mpox, even before symptoms appear.

An increase in leishmaniasis cases in the north of the country has been reported in Honduras. In May of this year alone, 20 cases were registered. For the full year 2022, the number of cases was 84 (2021: 112 cases). 

An increase in cutaneous leishmaniasis was also observed in Nicaragua in the first months of the year, with 306 cases.

• As of 23 March 2023, 30 cases of botulism have been reported in Europe in Germany (27 cases), Austria (1 case), France (1 case), and Switzerland (1 case). All of the affected individuals underwent medical intervention in the form of injection of botulinum neurotoxin into the stomach to treat obesity in Turkey in February 2023.
• In addition, the National Focal Point for Turkey has reported 53 cases of botulism in individuals who underwent the same procedure at two private clinics in Istanbul (50 cases) and Izmir (3 cases).
  
• In 65 known cases, the procedure was performed at a single clinic in Istanbul, Turkey.
  
• At this time, it is unclear whether this event is a therapeutic or procedural problem at the affected hospitals or a problem with the product administered.
  

Outbreaks of botulism are very rare and may be associated with a natural, accidental, or possibly intentional source of infection.