Emerging and re-emerging viral diseases in the

WHO Eastern Mediterranean Region

Dr Gabriele Riedner (WHO)Endemic and Emerging Viral Diseases of Priority in MENA: A Scientific Workshop to Promote Research Collaboration

26th - 29th May 2014Doha, Qatar

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OutlineOutline

Emerging infectious diseases in the region:– Background and overview– Polio– Avian influenza– Dengue Haemorrhagic Fever – MERS-CoV

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BackgroundBackground

In the past 20 years, the incidence of emerging infectious diseases has increased globally

A large proportion (over 60%) of these new infections are caused by novel viruses

Many of these new pathogens are zoonotic in origin; (HIV; Ebola; Crimean-Congo HF; Rift Valley Fever, A/H5N1, A/H1N1; A/H7/N9; SARS-CoV, MERS-CoV etc.)

This trend has also been observed in the WHO Eastern Mediterranean Region

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Emerging & re-emerging diseases reported in the WHO EMR: 1994- 2014

P H1N1 2009

Polio

Plague

Anthrax

A(H5N1)

MERS-CoV

CCHF

Dengue

Ebola

Rift Valley fever

Yellow Fever

Al Khurma

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Polio

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Polio‐Paralyzed Children, 2013International Spread of Polio, 2013

Syria re‐infected

Horn of Africa re‐infected

Cameroon re‐infected

, Palestine, Egypt Israel(isolation from sewage)

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Poliovirus type 1 affected districtspast 6 months: 21 Nov 2013 – 20 May 2014

Poliovirus type 1 affected districtspast 6 months: 21 Nov 2013 – 20 May 2014

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Declaration of public health emergency of international concern

Declaration of public health emergency of international concern

On 5 May 2014, the DG of the WHO declared the international spread of wild poliovirus (WPV) a public health emergency of international concern (PHEIC).

Temporary Recommendations are made under the IHR (2005) to reduce the international spread of polio to those states that

– are currently still exporting Wild Poliovirus (Pakistan, Syria, Cameroon)

– are infected with Wild Poliovirus but not currently exporting(Afghanistan, Equatorial Guinea, Ethiopia, Iraq, Israel, Nigeria, Somalia)

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Avian influenza (H5N1)

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Number of confirmed H5N1 cases by country and month of onset (as of 15 May 2014)

Number of confirmed H5N1 cases by country and month of onset (as of 15 May 2014)

Iraq

Last case Egypt

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Dengue

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Current Dengue Situation in EMRCurrent Dengue Situation in EMR

Kingdom of Saudi Arabia, Yemen, and Pakistan:– Repeated outbreaks in the last two decades in urban settings;– Becoming a leading cause of hospitalization/death (children and

young adults);– Fatal hemorrhagic cases have been reported; and– Little or no evidence that the disease is spreading to rural areas

Sudan, Djibouti and Somalia:– Small outbreaks of the disease are becoming more frequent; – Multiple virus serotypes are co-circulating; and – Disease is gradually expanding geographically within the country

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Dengue outbreaks in the EMR

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MERS CoV

as of 17 May 2014

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Epidemic CurvesEpidemic Curves

Confirmed cases by outcome

Many cases were not reported with a symptom onset (onset estimated) or were asymptomatic (n=129)

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Characteristics of primary cases over timeCharacteristics of primary cases over time

Symptom onset date 2012 to 28 Feb 2014

1 March to 17 May 2014

Total number of primary cases 70 34

Median age in years (range) 58.5 (2-83) 55.5 (13-90)

% of male cases 78.6% (55/70) 87.9% (29/33)

% of cases with one or more underlying condition reported 79.4% (50/63) 96.3% (26/27)

% of cases classified as fatal 53.6% (37/69) 38.2% (13/34)

% Severe 94.2% (65/69) 73.5% (25/34)

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TransmissionTransmission

Zoonotic transmission from camels to humans– Exposures to camels resulting in infection are unknown;

Human-to-human transmission in the community:– Very little human-to-human transmission is occurring among family

members in household settings

Nosocomial transmission– Nosocomial transmission is occurring in health care workers and

patients; health care setting outbreaks– Transmission via contact and/or fomite?

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Thank you!

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Geographic distribution of serologic evidence for MERS-CoV or MERS like CoV in camels

Geographic distribution of serologic evidence for MERS-CoV or MERS like CoV in camels

Source: Reusken, Messadi et al. 2014 EID 20, 8 – Jul 2014.

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Pakistan, 2013 & 2014*> 500,000 children unreached with OPV

82% of Cases in FATA and KP*As of May

92% of Cases in FATA and KP

20142013• North & South

Waziristan - Ban on Vaccination since June 2012

• Peshawar & Karachi -Attacks on health workers since July 2012

• 2013: 93 polio cases (58 in 2012)

• 2014: 66 cases to date (13 at the same date in 2013)

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Middle East Polio Outbreak Polio, AFP cases & SIAs (campaigns) in Syria,

April 2013 – March 2014

Syria: 36 WPV cases (35 in 2013, 1 in 2014)

Iraq:2 WPV cases in 20142nd case onset on 7 April