DR Congo: 2019/2020 Measles - 7,000+ deaths - outbreak over

[Shiloh]

Source: https://mobile.nation.co.ke/news/afr...87z/index.html

2 Hours Ago
Hundred children die in DR Congo measles outbreak
KINSHASA

More than a hundred children in Democratic Republic of Congo have died of measles since the start of the year, an outbreak that has added to deadly epidemics of cholera and Ebola, the UN said on Wednesday.

Health officials in the southeast provinces of Lualaba and Lomami recorded 7,175 cases of measles in January, "at least 137 of which were fatal," the UN's MONUSCO peacekeeping mission said.

More than 80 percent of the fatalities were children aged under five, it said.

Experts have blamed lack of vaccination, poor medical facilities and malnutrition among the young.

[Shiloh]

Source: http://outbreaknewstoday.com/drc-mea...-update-67255/

DRC: Measles up 700 percent, Ebola update
by News Desk
June 10, 2019
By NewsDesk
Measles

Health officials with the Democratic Republic of the Congo (DRC) report since the beginning of 2019, a total of 87,000 suspected measles cases (1.8 % CFR) through May 18.

This represents an increase of more than 700 percent, compared to the epidemiological situation for the same period in 2018.

For the whole of 2018, the country had notified 65,098 suspected cases of measles, of which 2,908 cases were investigated, of which 961 were confirmed with a lethality of 1.3 percent.

Vaccination rates in DRC is bad with less than half of all children being fully immunized...

[Shiloh]

Source: https://www.africanews.com/2019/08/1...es-in-the-drc/
Measles claims over 2500 lives in the DRC
Eric Oteng with AFP 16 hours ago
Democratic Republic Of Congo

A measles epidemic has caused more than 2,700 deaths between January and early August in the DRC, killing more people in seven months than Ebola in one year, M?decins Sans Fronti?res (MSF) reported in a tweet read on Saturday.

?The measles epidemic declared on June 10 is the deadliest that the Democratic Republic of Congo (DRC) has known since 2011-2012 Between January and early August 2019, it infected more than 145,000 people and resulted in 2,758 deaths? , according to the MSF-DRC tweet dated Friday.

?Despite the magnitude of the measles epidemic in the DRC, there is an alarming lack of actors and funds.With $ 2.5 million mobilized out of the $ 8.9 million required for the response plan, the contrast with the urgency #Ebola, which attracts hundreds of millions of dollars, is striking, ?adds the humanitarian medical organization...

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Outbreaks and Emergencies Bulletin, Week 37: 9 - 15 September 2019
...
Measles Democratic Republic of the Congo

179 477 Cases

3 559 Deaths

2.0% CFR

EVENT DESCRIPTION

The measles outbreak in Democratic Republic of the Congo continues
to evolve with an increasing trend in the number of cases in recent
weeks and a geographical spread of cases to new areas. Since our
last report on 4 August 2019 (Weekly Bulletin 31), 72 607 additional
suspected cases and 1 744 additional deaths have been reported
across the country and there are 29 newly affected health zones.

Since the beginning of the year, there have been two peaks in the
case incidence, during weeks 17 and 30. Following a decline in case
numbers during week 31, the weekly incidence has been gradually
increasing with 7 286 suspected cases, including 141 deaths (CFR
1.9%) reported during week 35 (week ending 1 September 2019)
compared to an average weekly incidence of 6 403 cases over the
preceding four weeks (weeks 31 to 34). Twenty-four out of 26
provinces reported cases during week 35, with most of the cases
originating from the provinces of Kwilu (1 142), Kasai (869), Kasai
central (650), and Kinshasa (603), together accounting for 45% of
the cases.

From 1 January to 1 September 2019, a total of 179 477 suspected
measles cases including 3 559 deaths (CFR 2.0%) have been
reported from 484 (93%) out of 519 health zones across all 26
provinces of the Democratic Republic of the Congo. The outbreak
has been laboratory confirmed in 188 (36%) health zones. Of 4 388
cases sampled, 1 810 tested IgM-positive for measles virus infection
at the National Institute of Biomedical Research (INRB) in Kinshasa.

Among these laboratory-confirmed cases, 63% had not been
previously vaccinated or had unknown vaccination status. Children
less than five years old are the most affected, accounting for 76% of
all suspected cases and 88% of measles-associated deaths.

The provinces of Tshopo (32 832), Kasai (29 476), Haut-Lomami
(14 632) and South-Kivu (9 870) account for 48% of the cumulative
cases reported since the beginning of 2019. Densely populated
urban areas in the capital city Kinshasa are also affected, with 5 608
suspected cases reported across all 35 health zones of the city. Two
of the provinces, North-Kivu and Ituri, are concomitantly affected
by the ongoing Ebola outbreak. These provinces reported 3 016
cases (CFR 0.3%) and 7 765 cases (CFR 0.7%), respectively since
the beginning of 2019. The weekly incidence has been on a gradual
increase in both provinces, with averages of 175 cases (North-Kivu)
and 297 cases (Ituri) per week reported in the past three weeks.

Between 19 and 23 April 2018, a responsive vaccination campaign
was conducted in 63 health zones prioritised based on their
epidemiological situation. The weekly case incidence in these health
zones has been on a steady decline since week 17.

PUBLIC HEALTH ACTIONS

A National Measles Coordination Committee has been
established at Ministry level as part of incident management
structure.

On 10 September 2019, a third advocacy meeting with donors
and NGOs was held in order to mobilize additional funds for
the response.

With support from WHO, and using Measles and Rubella
Initiative (MRI) funds, a responsive vaccination campaign was
conducted from 26 to 30 August 2019 in 328 health areas of 28
out of 35 health zones in Kinshasa.

M?decins Sans Fronti?res has been supporting case management and
vaccination interventions since the beginning of the year in 28 health zones.

UNICEF is supporting the preparation of a vaccination campaign in five health
zones in Central Kasai.

SITUATION INTERPRETATION

The massive resurgence of measles in Democratic Republic of the Congo is likely
due to an accumulation of measles-susceptible children which were not vaccinated
against the virus due to suboptimal routine immunization coverage and inadequate
implementation of supplementary immunization activities (SIA). Furthermore, the
under-performance of case-based surveillance has impaired rapid detection of
suspected measles cases, which is necessary to guide timely and effective outbreak
response interventions. To achieve the regional goal towards measles elimination,
the country should also accelerate the process of implementing the second dose of
the measles vaccine (MCV2), strengthen routine immunization and SIA efforts as well
as improve monitoring indicators for case-based surveillance.

https://www.afro.who.int/node/11740

https://apps.who.int/iris/bitstream/handle/10665/327408/OEW37-0915092019.pdf

[Shiloh]

Source: https://www.thestar.com/news/world/a...this-year.html

Measles outbreak has killed more than 4,000 in Congo this year, UNICEF says
By Carley PeteschThe Associated Press
Wed., Oct. 9, 2019

DAKAR, Senegal—More than 4,000 people have died in Congo this year in the world’s largest measles outbreak, the United Nations children’s agency said Wednesday.

The Central African nation is also battling an Ebola outbreak that has killed about half that number since August 2018.

Since January, more than 200,000 cases of measles have been reported across Congo, UNICEF said. More than 140,000 involve children under 5, who also make up nearly 90 per cent of deaths.

“We’re facing this alarming situation because millions of Congolese children miss out on routine immunization and lack access to health care when they fall sick,” said the UNICEF country representative, Edouard Beigbeder. “On top of that, a weak health system, insecurity, community mistrust of vaccines and vaccinators and logistical challenges all contribute to a huge number of unvaccinated children at risk of contracting the disease.”

Health officials are facing many of the same challenges in the Ebola outbreak in eastern Congo that has killed more than 2,000 people. Multiple armed groups have been fighting over the mineral-rich land for decades and threatening residents. The insecurity has led to mistrust of authorities, including health workers...

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https://en.wikipedia.org/wiki/Kwango

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Translation Google

More than 400 deaths out of 650 measles cases reported in Kwango province

By TopCongo FM 88.4 Useful Frequency October 24, 2019 91 0 2 Minutes Read

"All 14 health zones in Kwango province are affected. The disease also affects adults. We continue to advocate for a mass vaccination campaign against measles, especially in border health zones with Angola. There, one records daily new cases and deaths are reported " , explains, on TOP CONGO FM, the president of the consultation framework of the civil society of Kwango. In total, he says, more than 650 cases and more than 421 deaths since October 14 to this day.

For Lucien Lufutu, the epidemiological situation is worrying. "We exchanged with the authorities. We, the civil society, had gone with the provincial minister of health in Popokabaka. But so far, the measles vaccine is not available in sufficient quantities. We invite government authorities to see how to respond to Kwango measles. "

The provincial health minister confirms the facts.

"We are in an epidemic. Especially in Kenge Health Zone. Only the Popokabaka health zone has vaccinated against measles with the support of the World Health Organization, but in the other 13, the response has not yet been organized due to lack of logistics, " he said. TOP CONGO FM, Dr. Laman Ngafula.

She added that thanks to routine immunization activities, the children were able to be cared for.

"What you have to do is initiate a mass vaccination campaign. We are asking partners to help us, " she concluded.

http://topcongofm.net/plus-de-400-deces-sur-650-cas-de-rougeole-notifies-dans-la-province-du-kwango/

[Shiloh]

Source: http://outbreaknewstoday.com/dr-cong...to-date-38239/

DR Congo measles epidemic continues rise: Nearly 223K cases to date
by News Desk
November 4, 2019

Approximately 12,000 additional measles cases have been reported in the worlds largest outbreak in the Democratic Republic of the Congo (DRC) in the past two weeks.
Image/CDC

Through October 20, officials report 222,939 measles cases, up from 209,211 cases on Oct. 6. In addition, the measles fatalities have risen to 4,435, more than double the deaths reported in the Ebola Virus Disease (EVD) outbreak (2185)...

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WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES
Week 45: 4 November – 10 November 2019
Data as reported by: 17:00; 10 November 2019
...
Measles Democratic Republic of the Congo

233 337 Cases
4 723 Deaths
2% CFR

EVENT DESCRIPTION

Cases of measles continue to be reported across all 26 provinces
of the Democratic Republic of the Congo, five months after the
outbreak’s official declaration by the Ministry of Public Health in
June 2019. After the last peak observed in case incidence in week
39 (week ending 27 September 2019), with more than 6 900 cases
recorded, there has been a fluctuating trend from week 40 to week
43 of 2019. Since our last report on 15 September 2019 (Weekly
Bulletin 37), 53 860 additional suspected cases and 1 164 additional
deaths have been reported, with 42 more health zones declared in
epidemic phase.

In week 43 (week ending 27 October 2019), 7 421 suspected cases
and 146 deaths were reported, with 4 468 cases (60%) reported from
five provinces, namely Mai-ndombe (1 377), Kwilu (1 194), SouthKivu (699), Kongo Central (696) and Ecuador (502). The highest
case fatality ratios were recorded in Sankuru (16.7%), North-Ubangi
(12.5%), Bas-Uele (4.6%), Haut-Lomami (4.4%), Tshuapa (3.9%)
and Kasai Central (3.2%).

From 1 January to 27 October 2019, a cumulative total of 233 337
suspected measles cases with 4 723 deaths (CFR 2%) have been
reported. A total of 230 (44%) out of 519 health zones across the
26 provinces of the country are in epidemic phase, with 16 health
zones newly affected between week 40 and week 42 (week ending
20 October 2019), and no newly affected health zone in week 43.
Cases continue to be reported from Ituri and North-Kivu provinces,
concomitantly affected by the ongoing Ebola outbreak, with 9 809
cases (CFR 0.6%) and 4 777 cases (CFR 0.3%) reported respectively,
between January and October 2019.

PUBLIC HEALTH ACTIONS

The government continues to lead the management of
the outbreak through the National Measles Coordination
Committee.

WHO continues to coordinate partners supporting the
government, through organizing regular coordination meetings
with all partners involved in the outbreak response.

The follow-up measles vaccination campaign that started on
30 October 2019 in 7 provinces, namely, Lomami, Tanganyika,
Sankuru, Kasai, Ituri, North-Ubangi and Tshopo is ongoing.
Preliminary results of the post-campaign evaluation survey
revealed that, of the targeted 4 493 694 children aged 6 to 59
months, 2 134 516 (47.5%) have been vaccinated.

Alterations have been made to the planning of the upcoming
campaigns with the campaign originally planned for February
2020 now being conducted in December 2019.

Microplanning for the second follow-up campaign that will be
conducted at the end of November 2019 is ongoing.
Go to overview Go to map of the outbreaks

The systematic investigation of new cases, and sample collection and shipment
to the National Institute of Biomedical Research (INRB) in Kinshasa are ongoing
in the affected health zones.

Since the beginning of 2019, 164 health zones have already benefited from
immunization campaigns. Advocacy meetings with donors to mobilize funds for
the implementation of vaccination campaigns in health areas that have not yet
been covered by vaccination are ongoing.

SITUATION INTERPRETATION

Although tremendous efforts are being made to mitigate the current outbreak of
measles in the Democratic Republic of the Congo, there are still some challenges on
the ground that are preventing the response from being fully effective. For instance,
some affected health zones in the Eastern part of the country remain inaccessible
due to armed conflicts and insecurity and available funds to conduct vaccination
campaigns in all affected health zones are insufficient. There is an urgent need to
address the challenges faced during the implementation of the response activities in
order to control this outbreak of measles.

https://apps.who.int/iris/bitstream/handle/10665/329898/OEW45-0410112019.pdf

https://www.afro.who.int/node/11976

[Shiloh]

Source: https://www.bbc.com/news/world-africa-50506743

[Shiloh]

Source: http://outbreaknewstoday.com/measles...-expand-35116/

Measles epidemic in DRC continues to expand
by News Desk
December 9, 2019

In a follow-up on the world’s largest measles outbreak, the World Health Organization (WHO) reports that the Democratic Republic of the Congo (DRC) measles outbreak continues to grow and expand.
Image/geralt

Since the beginning of the year through Dec. 2, a total of 269,079 suspected measles cases, including 5,430 deaths (CFR 2%) have been reported from all 26 provinces in Democratic Republic of the Congo.

Since Nov. 11, 53 new health zones have confirmed epidemics...

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WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES
Week 49: 2 - 8 December 2019
Data as reported by: 17:00; 8 December 2019
...
Measles Democratic Republic of the Congo

269 079 Cases
5 430 Deaths
2.0% CFR

EVENT DESCRIPTION

The protracted measles outbreak in Democratic Republic of
the Congo continues to expand, with increasing trends in
weekly incidence cases since week 27, when a short decline
was observed over a period of 10 weeks. Since our last report
on 11 November 2019 (Weekly Bulletin 45), 35 742 additional
suspected measles cases and 707 additional deaths have been
reported across the country, including in 53 new health zones
with confirmed epidemics. In week 47 (week ending 24 November
2019), a total of 7 230 suspected measles cases, including 136
deaths (case fatality ratio 1.9%) were reported, compared to
8 660 cases with 152 deaths reported in week 46. Two new
health zones in Haut-Uele province, Isiro and Niangara, attained
epidemic threshold during the reporting week. The most affected
provinces were Mai-Ndombe (n=1431), Equateur (n=982), Kwilu
(n=919) and South-Kivu (n=714), which contributed to 56% of
all cases reported during the week. Mortality was highest in the
provinces of Mai-Ndombe (n=44, CFR: 3%), Equateur (n=33,
CFR 3%) and Bas-Uele (n=30, CFR: 3%), accounting for about
80% of all deaths during the reporting week.

From 1 January to 2 December 2019, a total of 269 079
suspected measles cases, including 5 430 deaths (CFR 2%) have
been reported from all 26 provinces in Democratic Republic of
the Congo. The outbreak has been laboratory confirmed in 241
(46%) health zones. The provinces of Kasai (35 195), Tshopo
(33 419), Kwili (21 366) and Mai-Ndombe (20 250) account
for 41% of the cumulative cases reported since the beginning
of 2019. Cases continue to be reported from Ituri and NorthKivu provinces, which are concomitantly affected by the ongoing
Ebola outbreak, with 10 845 cases (CFR 0.6%) and 5 743 cases
(CFR 0.3%) reported respectively, since the beginning of the
year.

To date, vaccination campaigns have been conducted in 165
(31.8%) of the 519 health zones and a total of 5 277 827 children
were vaccinated. A decreasing trend in the weekly case incidence
has been observed in vaccinated areas.

PUBLIC HEALTH ACTIONS

The National Steering Committee sat on 3 December 2019 to
review, strategize and prepare for a vaccination campaign in
other provinces.

From 25 to 29 November 2019, WHO supported vaccination
campaigns in 14 hotspot and priority areas in six provinces.

M?decins Sans Fronti?res supported the vaccination of
children aged 6-59 months in 9 out of 27 health areas of
the Koshibanda Health Zone. Overall 16 294 children were
vaccinated, representing a vaccination coverage of 109%.

M?decins Sans Fronti?res supported case management for
1 847 simple cases of measles and 91 cases of measles with
complications, in 9 out of 27 health areas in Koshibanda

The measles case management protocol has been
disseminated to improve case management and reduce
mortality.

The Emergency Medical Team has been deployed to hotspot
health zones since 27 December 2019 with support from
WHO.

WHO’s response interventions focusing on case management are carried
out jointly with other partners including M?decins Sans Fronti?res, Actions
Contre la Faim and M?decins du Monde.

Risk communication and community mobilization using various channels
such as religious fora, community radio stations, schools and NonGovernmental Organisations, have been strengthened to improve uptake of
the vaccination campaigns.

SITUATION INTERPRETATION

The measles outbreak in Democratic Republic of the Congo has become the world’s
largest and most severe measles epidemic. This outbreak has already caused more
deaths compared to the ongoing EVD outbreak. Sub-optimal routine immunization
coverages and high levels of malnutrition have contributed to the rapid expansion of
the measles epidemic and its associated high mortality rates. Furthermore, the underperformance of case-based surveillance has impaired rapid detection of suspected
measles cases, which is necessary to guide timely and effective outbreak response
interventions. In order to put an end to this outbreak, there is a need to strengthen
routine and reactive immunization activities, measles case-based surveillance and
case management.

https://apps.who.int/iris/bitstream/handle/10665/330076/OEW49-09122019.pdf

[Shiloh]

Source: http://outbreaknewstoday.com/drc-mea...k-cases-52038/


DRC measles outbreak grows to 280K cases
by News Desk
December 16, 2019

UN health officials reported nearly an additional 10,000 measles cases in week 48 this year, bringing the outbreak total to 280,677, the most cases reported in any single country this year.

During this week, most cases were reported from the provinces of Mai-ndombe (1459), Kwilu (1198), Tshuapa (1152) et Equateur (982).

In addition, the measles death toll has risen to 5,604, an increase in about 175 in one week...

[Shiloh]

Source: https://www.odt.co.nz/news/world/con...ths-reach-5700

Saturday, 28 December 2019
Congo measles deaths reach 5700

The measles epidemic in Democratic Republic of the Congo is still several steps ahead of the response, humanitarian group MSF says.

Since January 2019, more than 288,000 people have contracted measles in the Democratic Republic of Congo (DRC) and more than 5,700 have died from the disease, in the largest measles epidemic in the world today and the largest recorded in DRC for decades.

"Efforts have been made at national level, but more resources must be quickly committed and targeted to areas that are still suffering from this disease in order to stop this outbreak," Medi..

[Shiloh]

Source: https://reliefweb.int/report/democra...break-top-6000

Deaths from Democratic Republic of the Congo measles outbreak top 6000
Report from World Health Organization
Published on 07 Jan 2020

Kinshasa, 7 January 2020 - With the death toll from the world's worst measles epidemic in the Democratic Republic of the Congo (DRC) surpassing 6000, the World Health Organization (WHO) is calling for more funding to stop the outbreak.

Under the leadership of the DRC Ministry of Health, WHO, Gavi, the Vaccine Alliance, and other partner aid agencies vaccinated more than 18 million children under five across the country in 2019. However, in some areas, routine vaccination coverage remains low and 25% of the reported measles cases are in children over the age of five, who are the most vulnerable.

"We are doing our utmost to bring this epidemic under control. Yet to be truly successful we must ensure that no child faces the unnecessary risk of death from a disease that is easily preventable by a vaccine. We urge our donor partners to urgently step up their assistance," said Dr Matshidiso Moeti, WHO Regional Director for Africa.

Since the start of 2019, around 310 000 suspected measles cases have been reported. The epidemic has been aggravated by low vaccination coverage among vulnerable communities, malnutrition, weak public health systems, outbreaks of other epidemic-prone diseases, difficult access by vulnerable populations to health care and insecurity that has hampered response in some areas...

[Pathfinder]

WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES
Week 2: 6 – 12 January 2020
Data as reported by: 17:00; 12 January 2020
...

Measles Democratic Republic of the Congo
311 471 Cases
6 045 Deaths
1.9% CFR

EVENT DESCRIPTION

The measles epidemic in the Democratic Republic of the Congo
continues to evolve. Since our last report on 8 December 2019
(Weekly Bulletin 49), 42 392 additional suspected cases and 615
additional deaths have been reported across the country. While
the overall disease incidence trend has started declining in the
past weeks, the outbreak continues to expand, with nine additional
affected health zones in the last four weeks (week 49 to 52) of 2019.
From week 49 to week 52 of 2019 (week ending 29 December 2019),
the majority (71%) of cases were reported from Equateur (n=4
272), Tshuapa (n=4 218), Maindombe (n=2 973), Bas-Uele (n=2
969), Kongo Central (n=2 352), Kwilu (n=2 467) and Mongala (n=2
237) provinces. The highest case fatality ratios were recorded in
Tshopo (3.6%), Maindombe (3.2%), and Tshuapa (2%) provinces.
In week 52 of 2019, 5 792 suspected cases including 109 deaths
were reported (case fatality ratio 1.9%), and two new health zones
entered into epidemic phase, namely, Minova in South-Kivu province
and Katuba in Haut-Katanga province.

Between 1 January and 29 December 2019, a cumulative total of 311
471 suspected measles cases with 6 045 deaths (case fatality ratio
1.9%) have been recorded from 253 of 519 (48.7%) health zones
across the 26 provinces of the Democratic Republic of the Congo.
Of these 311 471 cases, 2 682 have been laboratory-confirmed
(IgM-positive) for measles infection, of which 28% are aged 5 years
and above and 63% are unvaccinated or have unknown vaccination
status.

Cases of measles continue to be reported from Ituri, North-Kivu
and South-Kivu provinces, which are concomitantly affected by the
ongoing Ebola virus disease outbreak. Between 1 January and 29
December 2019, these provinces have reported 11 043 cases (case
fatality ratio 0.6%), 7 488 cases (case fatality ratio 0.3%), and 3 537
cases (case fatality ratio 1.2%), respectively.

PUBLIC HEALTH ACTIONS

The National Measles Coordination Committee continues to
coordinate the response to the measles outbreak across the
country, working with the various sub-committees and supported
by WHO and partners.

The revised measles response plan, that covers the period January
to June 2020, has been validated on 7 January 2020 during the
weekly meeting of the Measles Coordination Committee.

A National Epidemiologic Data Analysis Cell has been put in place
with the support of WHO, UNICEF and CDC and the Cell activities
have been launched on 7 January 2020.

To date, the vaccine response has been organized in 179/253
(71%) health zones and a total of 5 789 008 children aged 6 to
59 months have been vaccinated.

WHO, M?decins Sans Fronti?res, Action Contre la Faim,
M?decins du Monde and other partners continue to support case
management.

The revised Integrated Disease Surveillance and Response
(IDSR) guideline has been approved by the Ministry of Public
Health and partners. It includes, inter alia, additional information
relating to community-based surveillance and a line list canvas
that should be used during a measles outbreak.

Multidisciplinary teams are being deployed in the 30 priority
health zones to support the response, with the financial and
technical support of the Humanitarian Fund, ECHO and WHO.
Each team deployed in the priority health zone is made up of
three experts in charge of surveillance, case management and
communication respectively.

SITUATION INTERPRETATION

The nationwide measles epidemic in the Democratic Republic of the
Congo continues to evolve. Although the weekly case incidence has
been on a decreasing trend following the implementation of vaccination
campaigns in affected health zones, the total number of cases and deaths
continue to increase with a cumulative total of over 6 000 deaths reported
as of the last week of December 2019. The continuous emergence of
cases is likely a result of persisting gaps in the vaccination coverage.
Indeed, the majority of confirmed cases are unvaccinated and children
aged five years and above have not been targeted during the reactive
mass vaccination campaigns, although they represent more than 25%
of the notified cases. This suggests that the ongoing response activities
need to be scaled-up accordingly, with comprehensive coverage, to
interrupt further propagation of the outbreak. Moreover, a funding gap
of over US$ 40 million needs to be filled urgently, in order to extend the
vaccination to children over 5 years old and to reinforce other outbreak
response activities beyond vaccination.

https://apps.who.int/iris/bitstream/handle/10665/330398/OEW02-0612012020.pdf