What were the biggest outbreaks of 2018?

We take a look back at some of the largest outbreaks from 2018 and their impacts, from an unexpected outbreak of listeria in South Africa to the ongoing devastation by cholera in Yemen, read on to find out more.

Cholera in Yemen

Cholera continues to have a devastating impact globally, with the outbreak in Yemen being considered the largest and fastest-spreading in modern history. The disease first appeared in the country in April 2017 reaching a count of 994,751 suspected cholera cases and 2226 deaths by the end of the year [1]. The cases continued into 2018 with an additional 311,288 cases and 401 associated deaths between January 1 and November 25 2018 – bringing the total cases for this outbreak to over 1.2 million. Children under 5 years of age are estimated to make up 32% of the suspected cases [2].

The WHO have reported that cases currently appear stable at country level, however, there are seven governates where cases are increasing, in addition, a surge in cases was reported in September and October – a worrying trend [2,3]. Organizations have raised concerns about malnutrition and famine worsening the present situation, moreover, ongoing instability and conflict have been a hinderance to relief operations throughout this outbreak [4].

2018 also saw cholera outbreaks in Somalia, with 6669 cases and 45 associated deaths since December 2017, and Zimbabwe, with 8340 infections 50 reported deaths as of October 2018 [5,6].

Listeria in South Africa

In South Africa an outbreak of listeriosis – a serious foodborne infection – has been reported as one of the worst outbreaks of this disease. The epidemic had been ongoing since the beginning of 2017; in this time 1060 cases were reported by the National Institute for Communicable Diseases (Johannesburg), including 216 deaths [7].

The outbreak was brought under control in the summer – the last case was reported in the first week of June – with the source being traced to a ready-to-eat processed meat plant in Polokwane, Limpopo.

Australia has also seen cases of listeriosis this year, with 20 cases – leading to seven deaths – being traced to the consumption of rockmelons from a single grower in March [8].

Ebola in the Democratic Republic of Congo (DRC)

The DRC has seen two Ebola outbreaks this year. The first outbreak in May was controlled swiftly [9]; however, the second (ongoing) outbreak has faced challenges with the security and safety of healthcare workers owing to the instability of the area.

This outbreak, which was declared on August 1, is the second largest reported Ebola outbreak, only smaller than the West African epidemic (2014), which claimed over 11,000 lives [10]. As of December 26 the ongoing DRC outbreak has comprised a total of 591 cases reported from two neighboring provinces – North Kivu and Ituri. Overall, 357 cases have died, a case fatality rate of 60%.

The WHO have warned that ongoing instability in the region has disrupted operations, for example, on December 27 protests at government buildings in Beni spilled over to an Ebola transit center [11]. This has been the major challenge in controlling this epidemic, particularly in administering ring vaccination and other interventions.

Measles in Europe

Measles has had a huge number of cases across Europe in 2018; the monthly surveillance reports from the ECDC (Stockholm, Sweden) report a total of 10,530 cases of measles across the European Union and European Economic Area (EU/EAA) between January and October. Greece, France and Italy are among the countries with the highest number of cases in this region and the ECDC suggest that the vaccination rate has dropped below 95% in most countries. The ECDC also reported a total of 33 measles-associated deaths in EU countries in 2018 [12].

The WHO European region – which covers a larger area than the EU/EEA – has reported record highs for measles this year. In the first 6 months of 2018, over 41, 000 children and adults in the WHO European Region were infected with measles – this number exceeds the 12-month totals for every other year this decade [13].

The continued circulation of measles in the region stresses the importance for vaccination, in addition, the WHO have reported that severe and protracted outbreaks across the globe are a result of gaps in vaccination coverage [14].

Hepatitis A in the USA

Since March 2017 the Centers for Disease Control and Prevention (CDC; GA, USA) has been aiding state and local health departments with hepatitis A outbreaks spread via person-to-person contact. Cases have primarily been among homeless individuals, individuals who use injection and non-injection drugs, and the close contacts of these groups [15].

On June 11 2018 the CDC issued a Health Alert Network Advisory to public health departments, healthcare facilities, and public health programs with an update about the outbreaks and guidance to help identify and prevent new infections. However, the outbreak is ongoing, with the CDC reporting 10,582 cases in the USA as of December 15 [16].

Cases have been identified in Massachusetts, Michigan, Indiana, Kentucky, Ohio, Utah, Tennessee, and West Virginia, with Kentucky seeing over 3000 cases, and vaccination has been recommended for travelers [17].

Want to find out more?

  1. World Health Organization. Cholera Response: Weekly epidemiological bulletin December 11–17. emro.who.int/images/stories/yemen/Yemen_Cholera_Response_-_Weekly_Epidemiological_Bulletin_-_W50_2017_Dec_11-Dec_17.pdf?ua=1 (Accessed on January 3 2019).
  2. World Health Organization. Outbreak update – Cholera in Yemen, 20 December 2018. emro.who.int/pandemic-epidemic-diseases/cholera/outbreak-update-cholera-in-yemen-20-december-2018.html (Accessed on January 3 2019).
  3. Nebehay S. Yemen cholera outbreak accelerates to 10,000+ cases per week: WHO. 2 October (2018).
  4. Yemen conflict: A million more children face famine, NGO warns. www.bbc.co.uk/news/world-middle-east-45568669 (Accessed on January 3 2019).
  5. World Health Organization. Outbreak update – Cholera in Somalia, 20 December 2018 emro.who.int/pandemic-epidemic-diseases/cholera/outbreak-update-cholera-in-somalia-20-december-2018.html (Accessed on January 3 2019).
  6. World Health Organization. Cholera – Zimbabwe. Disease outbreak news: Update. who.int/csr/don/05-october-2018-cholera-zimbabwe/en/ (Accessed on January 3 2019).
  7. Whitworth J. South Africa declares end to largest ever Listeria outbreak . Food Safety News. 4 September (2018) .
  8. World Health Organization. Listeriosis – Australia, Disease outbreak news. who.int/csr/don/09-april-2018-listeriosis-australia/en/ (Accessed on January 3 2019).
  9. Infectious Diseases Hub. Ebola outbreak confirmed in the Democratic Republic of Congo: an update. id-hub.com/2018/05/17/ebola-outbreak-confirmed-democratic-republic-congo/ (Accessed on January 3 2019).
  10. Infectious Diseases Hub. id-hub.com/2018/11/30/ebola-outbreak-democratic-republic-congo-second-worst-ever-recorded/ (Accessed on January 3 2019).
  11. World Health Organization. Ebola outbreak in the Democratic Republic of Congo is second worst ever recorded. www.who.int/csr/don/28-december-2018-ebola-drc/en/ (Accessed on January 3 2019).
  12. European Centre for Disease Prevention and Control. Monthly measles and rubella monitoring reports. https://ecdc.europa.eu/en/measles/surveillance-and-disease-data/monthly-measles-rubella-monitoring-reports (Accessed on January 3 2019).
  13. Infectious Diseases Hub. Record high for measles cases in European Region. id-hub.com/2018/08/20/record-high-measles-cases-european-region/ (Accessed on January 3 2019).
  14. Infectious Diseases Hub. Measles resurgence due to vaccination coverage gaps, according to WHO. id-hub.com/2018/11/30/measles-resurgence-due-vaccination-coverage-gaps-according/ (Accessed on January 3 2019).
  15. Centers for Disease Control and Prevention. 2017 – Outbreaks of hepatitis A in multiple states among people who are homeless and people who use drugs. cdc.gov/hepatitis/outbreaks/2017March-HepatitisA.htm (Accessed on January 3 2019).
  16. Hackett DW. Hepatitis A outbreak reaches 10,582 cases during 2018. Precision Vaccines. 31 December (2018).
  17. International Association for Medical Assistance for Travelers. United States of America r recommended vaccinations: Hepatitis A iamat.org/country/united-states-of-america/risk/hepatitis-a (Accessed on January 3 2019).

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