Global & Disaster Medicine

Yellow fever – Brazil: From December 2018 through January 2019, 361 confirmed human cases, including eight deaths, have been reported in 11 municipalities of two states of Brazil.


Disease outbreak news
11 February 2019

Brazil is currently in the seasonal period for yellow fever, which occurs from December through May. The expansion of the historical area of yellow fever transmission to areas in the south-east of the country in areas along the Atlantic coast previously considered risk-free led to two waves of transmission (Figure 1). One during the 2016–2017 seasonal period, with 778 human cases, including 262 deaths, and another during the 2017–2018 seasonal period, with 1376 human cases, including 483 deaths.

From December 2018 through January 2019, 361 confirmed human cases, including eight deaths, have been reported in 11 municipalities of two states of Brazil. In the southern part of São Paulo state, seven municipalities:El dorado (16 cases), Jacupiranga (1 case), Iporanga (7 cases), Cananeia (3 cases), Cajati (2), Pariquera-Açu (1), and Sete Barras (1) reported confirmed cases. In the same state, additional cases in Vargem (1) and Serra Negra (1) municipalities were confirmed on the border with Minas Gerais State. Additionally, two cases have been confirmed in the municipalities of Antonina and Adrianópolis, located in the eastern part of Paraná State. These are the first confirmed yellow fever cases reported since 2015 from Paraná, a populous state with an international border. Among these confirmed cases, 89% (32/36) are male, the median age is 43 years, and at least 64% (23/36) are rural workers.

Human cases reported so far during the current 2018–2019 period (July 2018 to Jan 2019) in nine municipalities in São Paulo State, as well as the confirmation of human cases and epizootic due to yellow fever in the state of Paraná, mark the beginning of what could be a third wave and a progression of the outbreak towards the Southeast and South regions of the country (Figure 2). While too early to determine if this year will show the high numbers of human cases observed in the last two large seasonal peaks, there is indication that the virus transmission is continuing to spread in a southerly direction and in areas with low population immunity.

Measles in the Philippines: from 1 January to 9 February this year, a total of 4,302 measles cases have been reported, with 70 deaths.

Philippines DOH

measles, outbreak, vaccines, immunization

The Department of Health (DOH) today points to vaccine hesitancy as one of the reasons for the recent measles outbreak in some regions of the country.
Validated data from different regions of the country by the Epidemiology Bureau of DoH revealed that from 1 January to 9 February this year, a total of 4,302 measles cases have been reported, with 70 deaths.
Ages of cases ranged from 1 month up to 75 years old with 1 to 4 years old (34%) followed by less than 9 months old (27%) as the most affected age-groups.  Sixty-six percent of them had no history of vaccination against measles.
Of the total deaths, ages ranged from one month to 31 years old. Notably, 79% of those who died had no history of vaccination.
Regions with high reported cases are NCR (1,296 cases and 18 deaths) CALABARZON (1,086 cases and 25 deaths), Central Luzon (481 cases with 3 deaths), Western Visayas (212 cases and 4 deaths) and Northern Mindanao (189 cases and 2 deaths).
Eastern Visayas, MIMAROPA, CALABARZON, Central Visayas and Bicol are regions that have shown increasing trend as to reported cases for this week.  
Vaccine hesitancy refers to delay in acceptance or refusal of vaccines despite availability of vaccination services.
The causes of measles outbreak involved a number of factors or elements. Loss of public confidence and trust in vaccines in the immunization program brought about by the Dengvaxia controversy has been documented as one of many factors that contributed to vaccine hesitancy in the country. This refers to mothers who became hesitant to have their children vaccinated with vaccines that were long proven to be effective.
 On October 2018, the World Health Organization conducted a study in selected areas in Metro Manila to identify reasons for not bringing their children for immunization. The top reasons are the following: fear due to Dengvaxia, and the lack of time among households.
Moreover, results of the vaccine confidence project in 2015 against 2018 by London School of Hygiene and Tropical Medicine on the respondents’ views that vaccines are important decreased from 93% to 32%; safe and effective from 82% down to 21% and vaccine confidence dropped from 93 to 32% respectively.
DOH has been conducting vaccination activities against measles such as Outbreak Immunization Responses (ORI) in several regions. This was followed by a nationwide Supplemental Immunization Activity (SIA) for 6 to 59 months old which was conducted in 2 phases – in April 2018 (NCR and Mindanao) and in September 2018 (other parts of Luzon and Visayas).  Despite the efforts of health workers, the SIA campaign had achieved a coverage of 69% during Phase 1 of implementation and 29% in Phase 2.
“I appeal to the public to rebuild your trust and confidence in vaccines that were long proven to be effective, and I am quite sure that all of us sometime in our lives have been recipients of these vaccines which had protected us from various diseases,” Health Secretary Francisco T. Duque III concluded.

US: Measles Cases in 2019


Measles Cases in 2019

From January 1 to February 7, 2019, 101** individual cases of measles have been confirmed in 10 states.

The states that have reported cases to CDC are California, Colorado, Connecticut, Georgia, Illinois, New Jersey, New York, Oregon, Texas, and Washington.

Trends in Measles Cases, 2010-2019

*Cases as of December 29, 2018. Case count is preliminary and subject to change.
**Cases as of February 7, 2019. Case count is preliminary and subject to change. Data are updated weekly.

Measles Outbreaks in 2019

Five outbreaks (defined as 3 or more cases) have been reported in 2019 in the following jurisdictions:

These outbreaks are linked to travelers who brought measles back from other countries such as Israel and Ukraine, where large measles outbreaks are occurring. Make sure you are vaccinated against measles before traveling internationally.

Spread of Measles

  • The majority of people who got measles were unvaccinated.
  • Measles is still common in many parts of the world including some countries in Europe, Asia, the Pacific, and Africa.
  • Travelers with measles continue to bring the disease into the U.S.
  • Measles can spread when it reaches a community in the U.S. where groups of people are unvaccinated.

Measles Outbreaks

In a given year, more measles cases can occur for any of the following reasons:

  • an increase in the number of travelers who get measles abroad and bring it into the U.S., and/or
  • further spread of measles in U.S. communities with pockets of unvaccinated people.

Reasons for an increase in cases some years:

  • 2018: The U.S. experienced 17 outbreaks in 2018, including three outbreaks in New York State, New York City, and New Jersey, respectively. Cases in those states occurred primarily among unvaccinated people in Orthodox Jewish communities. These outbreaks were associated with travelers who brought measles back from Israel, where a large outbreak is occurring. Eighty-two people brought measles to the U.S. from other countries in 2018. This is the greatest number of imported cases since measles was eliminated from the U.S. in 2000.
  • 2017: A 75-case outbreak was reported in Minnesota in a Somali-American community with poor vaccination coverage.
  • 2015: The United States experienced a large (147 cases), multi-state measles outbreak linked to an amusement park in California. The outbreak likely started from a traveler who became infected overseas with measles, then visited the amusement park while infectious; however, no source was identified. Analysis by CDC scientists showed that the measles virus type in this outbreak (B3) was identical to the virus type that caused the large measles outbreak in the Philippines in 2014.
  • 2014: The U.S. experienced 23 measles outbreaks in 2014, including one large outbreak of 383 cases, occurring primarily among unvaccinated Amish communities in Ohio. Many of the cases in the U.S. in 2014 were associated with cases brought in from the Philippines, which experienced a large measles outbreak.
  • 2013: The U.S. experienced 11 outbreaks in 2013, three of which had more than 20 cases, including an outbreak with 58 cases. For more information see Measles — United States, January 1-August 24, 2013.
  • 2011: In 2011, more than 30 countries in the WHO European Region reported an increase in measles, and France was experiencing a large outbreak. These led to a large number of importations (80) that year. Most of the cases that were brought to the U.S. in 2011 came from France. For more information see Measles — United States, January-May 20, 2011.
  • 2008: The increase in cases in 2008 was the result of spread in communities with groups of unvaccinated people. The U.S. experienced several outbreaks in 2008 including three large outbreaks. For more information see Update: Measles — United States, January–July 2008.

See also: The Surveillance Manual chapter on measles that describes case investigation, outbreak investigation, and outbreak control for additional information.

An enormous blaze broke out at a fully occupied hotel in central New Delhi on Tuesday morning, killing at least 17


MERS-CoV cases announced from Wadi al-Dawasir

Saudi MOH

03/02/2019 19-1793
MERS in Riyadh city: 75-year-old male in Riyadh city, Riyadh region Contact with camels: No Case classification: Primary, community acquired Current status: Hospitalized
ﻣ ﺔﻣزﻼﺘ قﺮﺸﻟا ﻂﺳوﻷا ﺔﻴﺴﻔﻨﺘﻟا ﻦﻣ ﺔﻨﻳﺪﻣ اﻟﺮﻳﺎض: ﻣﻨﻄﻘﺔ اﻟﺮﻳﺎض ، ﻋﺎ ًﻣﺎ ﻦﻣ ﺔﻨﻳﺪﻣ اﻟﺮﻳﺎض 75 ﻞﺟر ﻳ ﻎﻠﺒ ﺔﻄﻟﺎﺨﻣ ﻞﺑﻺﻟ ﻻ: ﻣﻜﺘﺴﺒﺔ ﻓﻲ اﻟﻤﺠﺘﻤﻊ ، ﻒﻴﻨﺼﺗ ﺔﻟﺎﺤﻟا أ:ﺔﻴﻟو ﺔﻟﺎﺣ اﻟﻤﺮﻳﺾ :مﻮﻨﻣ ﻲﻓ اﻟﻤﺴﺘﺸﻔﻰ
03/02/2019 19-1794
MERS in Wadi Aldwasir city: 55-year-old male in Wadi Aldwasir city, Riyadh region Contact with camels: Yes Case classification: Secondary, healthcare-acquired Current status: Hospitalized
ﻣ ﺔﻣزﻼﺘ قﺮﺸﻟا ﻂﺳوﻷا ﺔﻴﺴﻔﻨﺘﻟا ﻦﻣ ﺔﻨﻳﺪﻣ يداو ، ﻋﺎ ًﻣﺎ ﻦﻣ ﺔﻨﻳﺪﻣ يداو اﻟﺪواﺳﺮ 55 اﻟﺪواﺳﺮ: ﻞﺟر ﻳ ﻎﻠﺒ ﺔﻘﻄﻨﻣ اﻟﺮﻳﺎض ﺔﻄﻟﺎﺨﻣ ﻞﺑﻺﻟ :ﻢﻌﻧ ﻣﻜﺘﺴﺒﺔ ﻓﻲ ﻣﻨﺸﺄة ﺔﻴﺤﺻ ، ﻒﻴﻨﺼﺗ ﺔﻟﺎﺤﻟا :ﺔﻳﻮﻧﺎﺛ ﺔﻟﺎﺣ اﻟﻤﺮﻳﺾ :مﻮﻨﻣ ﻲﻓ اﻟﻤﺴﺘﺸﻔﻰ
03/02/2019 19-1795
MERS in Wadi Aldwasir city: 40-year-old male in Wadi Aldwasir city, Riyadh region Contact with camels: yes Case classification: Secondary, household contact Current status: Hospitalized

Hooch in Uttar Pradesh: The death toll of the hooch tragedy climbed up to 92 on Saturday

India Today

“……So far, 39 people were arrested in Saharanpur while 35 cases have been registered in the area….. The police conducted raids on illegal liquor shops across the state……”

2 Men Die from Hooch

Methanol Poisoning Information:

Latest research: “End-of-season influenza vaccine efficacy for the 2017-2018 flu season was a mediocre 38% (95% CI 31%-43%), but flu shots were still estimated to have prevented 7 million illnesses and 8,000 deaths…”

Effects of Influenza Vaccination in the United States during the 2017–2018 Influenza Season

Clinical Infectious Diseases, ciz075,
02 February 2019
“…..We estimated that influenza vaccination prevented 7.1 million (95% CrI: 5.4 million–9.3 million) illnesses, 3.7 million (95% CrI: 2.8 million–4.9 million) medical visits, 109,000 (95% CrI: 39,000–231,000) hospitalizations, and 8,000 (95% CrI: 1,100–21,000) deaths. Vaccination prevented 10% of expected hospitalizations overall and 41% among young children (6 months–4 years)…..”
Research Paper

HIV, circumcision & Tanzanian members of Parliament


“A female MP in Tanzania has called for checks to determine whether or not her male colleagues have undergone circumcision – a procedure known to reduce the risk of HIV transmission……The World Health Organization (WHO) says circumcision reduces the risk of heterosexual men contracting HIV by around 60%……”


DRC and EBV: Outbreak totals now stand at 800 cases, including 502 deaths, and 178 suspected cases are still under investigation.


Vendredi 8 février 2019

La situation épidémiologique de la Maladie à Virus Ebola en date du 7 février 2019 :
  • Depuis le début de l’épidémie, le cumul des cas est de 800, dont 739 confirmés et 61 probables. Au total, il y a eu 502 décès (441 confirmés et 61 probables) et 271 personnes guéries.
  • 178 cas suspects en cours d’investigation.
  • 2 nouveaux cas confirmés, dont 1 à Oicha et 1 à Kyondo
  • 3 nouveaux décès de cas confirmés :
    • 1 décès communautaire à Kyondo
    • 2 décès au CTE, dont 1 à Butembo et 1 à Katwa
  • 7 nouveaux cas probables (décès historiques) validés à Katwa.
    • Plus d’informations à ce sujet seront fournis dans le bulletin du samedi 9 février 2019.
  • 4 nouvelles personnes guéries sorties du CTE de Butembo.

2018-2019 Influenza Season Week 5 ending February 2, 2019: Influenza activity increased in the United States.


Influenza activity increased in the United States. Influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B viruses continue to co-circulate. Below is a summary of the key influenza indicators for the week ending February 2, 2019

  • Viral Surveillance:The percentage of respiratory specimens testing positive for influenza viruses in clinical laboratories increased. Influenza A viruses have predominated in the United States since the beginning of October. Influenza A(H1N1)pdm09 viruses have predominated in most areas of the country, however influenza A(H3) viruses have predominated in the southeastern United States (HHS Region 4).
    • Virus Characterization:The majority of influenza viruses characterized antigenically and genetically are similar to the cell-grown reference viruses representing the 2018–2019 Northern Hemisphere influenza vaccine viruses.
    • Antiviral Resistance:The vast majority of influenza viruses tested (>99%) show susceptibility to oseltamivir and peramivir. All influenza viruses tested showed susceptibility to zanamivir.
  • Influenza-like Illness Surveillance:The proportion of outpatient visits for influenza-like illness (ILI) increased to 4.3%, which is above the national baseline of 2.2%. All 10 regions reported ILI at or above their region-specific baseline level.
    • ILI State Activity Indictor Map: New York City and 24 states experienced high ILI activity; Puerto Rico and 10 states experienced moderate ILI activity; the District of Columbia and 13 states experienced low ILI activity; and three states experienced minimal ILI activity.
  • Geographic Spread of Influenza: The geographic spread of influenza in Puerto Rico and 47 states was reported as widespread; two states reported regional activity; the District of Columbia and one state reported local activity; the U.S. Virgin Islands reported sporadic activity; and Guam did not report.
  • Influenza-associated Hospitalizations A cumulative rate of 20.1 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported. The highest hospitalization rate is among adults 65 years and older (53.0 hospitalizations per 100,000 population).
  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below the system-specific epidemic threshold in the National Center for Health Statistics (NCHS) Mortality Surveillance System.
  • Influenza-associated Pediatric Deaths: Four influenza-associated pediatric deaths were reported to CDC during week 5.

national levels of ILI and ARI

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INFLUENZA Virus Isolated

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