Authors: Martha Powell, Future Science Group
As we head into 2020, we review the biggest outbreaks of 2019 and the impact they had – from growing cases of measles across the globe to the outbreaks as a result of ongoing instability in Yemen – read on to find out more.
Cholera in Yemen
Yemen continues to be in the throes of a humanitarian crisis. The 4-year conflict has forced 4.3 million individuals to leave their homes and an estimated 24 million individuals – 80% of the population – are in need of humanitarian assistance . Extreme shortages of food, safe water, sanitation and healthcare have therefore led to outbreaks, including one of the largest in modern history.
The cholera outbreak began in October 2016, and between then and November 2019 2,236,570 suspected cases have been reported, including 3886 related deaths . This year, cases increased from week eight to week 14, peaking at 29,500 cases in 7 days. The trend is now considered stable, however, in 2019 the outbreak affected 22 of the 23 governorates and 311 of the 333 districts of Yemen. Moreover, children under 5 years old represent 26% of the total suspected cases .
2019 has also seen relatively large cholera outbreaks in the Democratic Republic of Congo (DRC; 25,001 suspected cholera cases, including 445 deaths, as of November 3), Kenya (4708 cases, including 37 associated deaths, as of November 10) and Somalia (8871 suspected cholera cases, including 46 associated deaths, as of November 3) .
Measles in the DRC, the Pacific and Europe
This year has once again seen growing measles cases, and not just across Europe. The WHO have had 413,308 confirmed cases reported to them by 187 Member States across the globe in 2019, as of 5 November .
Many countries in Europe experienced large outbreaks in 2019. Approximately 90,000 cases were reported in the European Region in the first 6 months of 2019 – exceeding the number of cases reported in the entirety of 2018 (82,596) . From 1 January through 5 November 2019, Ukraine has reported 56,802 cases, followed by Kazakhstan with 10,126 cases and Georgia with 3,904 cases . In addition, it was reported in August that four European countries – Albania, the UK, Czech Republic and Greece – had lost their elimination status.
In Africa, outbreaks are ongoing in Madagascar and Nigeria but the DRC has once again been hit hardest, seeing a total of 250,270 suspected cases with 5110 associated deaths as of 17 November 2019. As a result of this, in September the Congolese government and the WHO launched an emergency vaccination program, aiming to inoculate over 800,000 children [6,7].
However, the most recent concern regarding measles has been surrounding outbreaks in the Pacific, where the last declared outbreak of the measles occurred in 2014. In late 2019, following outbreaks in neighboring nations and significant population movements, confirmed measles outbreaks were reported in Fiji, Samoa and Tonga.
Tonga has seen 485 cases of confirmed or suspected measles, and Fiji has seen 18 confirmed cases , however, the situation was most severe in Samoa. The Samoa Ministry of Health declared a measles outbreak on 16 October, and the Government declared a State of Emergency on 15 November. As of 17 December, a total of 5371 cases have been reported, comprising over 2% of the Samoan population, with 76 related deaths . It has been reported that approximately 52% of cases are children aged below 5 years . The positive news is is that 94% of population have now been vaccinated, compared with 31% at the start of the outbreak.
Dengue in Yemen, Bangladesh and Pakistan
Alongside the burden of cholera currently in the country, Yemen has seen an escalation in dengue cases and a flare-up of malaria . In November this year the International Committee of the Red Cross reported a new outbreak of dengue fever in Yemen, with thousands of cases and several dozen deaths. Specifically, the European Commission’s humanitarian aid operation reported an estimated 7970 cases of dengue fever in Taiz, Yemen’s third-largest city .
In addition, Pakistan’s health officials have reported that they are battling one of the worst dengue outbreaks the country has experienced. It was reported by the WHO that one city hospital in Rawalpindi admitted more than 2000 dengue patients in a single weekend in October . Moreover, it has been estimated that over 45,000 people in Pakistan have been infected with the dengue virus in 2019 (as of early November).
Bangladesh has also seen its worst dengue outbreak since the country first recorded an epidemic in 2000, with more than 92,000 reported cases. Although dengue is endemic in the country, this year has seen an unprecedented burden. Dhaka has been reported as the center of the outbreak, although cases have been seen across the country, and officials have blamed monsoon rains, which provide ideal breeding grounds for mosquitos .
Finally, it is also worth noting that the Philippines announced that the nation’s dengue outbreak was declared a national epidemic in August this year. This was following 162,000 cases and 622 associated deaths in the first 7 months of 2019 .
Ebola in the DRC
The outbreak of Ebola in the DRC has seen over 3348 cases and 2213 deaths (as of 16 December), since it first started in August 2018. The outbreak has seen many challenges including instability and violence, mistrust in the community and poor health infrastructure. Across 2019 the level of cases has waxed and waned – different health zones have seen flare-ups, for example, Katwa and Butembo in April and May this year, or Beni in June and July. Cases now seems to be falling; however, fluctuations illustrate the continued impact that security events have on response activities. For example, violence, widespread civil unrest and targeted attacks severely disrupted the Ebola response in late November, and this kind of disruption poses a constant threat to the outbreak’s control [14,15].
- The UN Refugee Agency. Yemen humanitarain crisis. unrefugees.org/emergencies/yemen/ (Accessed 19 December)
- Cholera situation in Yemen, November 2019. https://reliefweb.int/sites/reliefweb.int/files/resources/YEM-Chol-Nov-2019-eng.pdf (Accessed 19 December)
- Outbreak update – Cholera in Yemen, 10 November 2019. http://www.emro.who.int/pandemic-epidemic-diseases/cholera/outbreak-update-cholera-in-yemen-10-november-2019.html (Accessed 19 December)
- European Centre for Disease Prevention and Control. Cholera worldwide overview. ecdc.europa.eu/en/all-topics-z/cholera/surveillance-and-disease-data/cholera-monthly (Accessed 19 December)
- Measles – Global situation. www.who.int/csr/don/26-november-2019-measles-global_situation/en/ (Accessed 19 December)
- DR Congo measles: Nearly 5,000 dead in major outbreak. www.bbc.co.uk/news/world-africa-50506743 (Accessed 19 December)
- DR Congo: Vaccine campaign for world’s largest measles outbreak. www.bbc.co.uk/news/world-africa-49836280 (Accessed 19 December)
- Measles in Europe: record number of both sick and immunized www.euro.who.int/en/media-centre/sections/press-releases/2019/measles-in-europe-record-number-of-both-sick-and-immunized (Accessed 19 December)
- Measles outbreaks in the Pacific. https://www.who.int/westernpacific/emergencies/measles-outbreaks-in-the-pacific (Accessed 17 December)
- Government of Samoa. Twitter. https://twitter.com/samoagovt/status/1207092279082536962 (Accessed 19 December)
- Red Cross: Yemen faces new outbreak of dengue fever. www.aljazeera.com/news/2019/11/red-cross-yemen-faces-outbreak-dengue-fever-191126063404582.html (Accessed 19 December)
- WHO scales up response to worldwide surge in dengue. www.who.int/news-room/feature-stories/detail/who-scales-up-response-to-worldwide-surge-in-dengue (Accessed 19 December)
- Republic of the Philippines, Department of Health. DOH declares national dengue epidemic. www.doh.gov.ph/press-release/DOH-DECLARES-NATIONAL-DENGUE-EPIDEMIC
- Ebola Virus Disease, Democratic Republic of Congo, External Situation Report 72. https://apps.who.int/iris/bitstream/handle/10665/330215/SITREP_EVD_DRC_20191217-eng.pdf (Accessed 19 December)
- Ebola virus disease – Democratic Republic of the Congo www.who.int/csr/don/05-december-2019-ebola-drc/en/ (Accessed 19 December)