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United Republic of Tanzania | Presumptive positive case of Ebola virus disease
On 10 September 2019, WHO received unofficial reports of a suspected EVD case in Dar es Salaam, United Republic of Tanzania. In accordance to Article 10 of IHR, WHO sent a formal verification request to the United Republic of Tanzania for which receipt should have been acknowledged within
https://extranet.who.int/ihr/eventinformation/print/event/2019-e000391 Page 1 of 3
United Republic of Tanzania (the) | Ebola virus disease 13/09/2019, 00)21
24 hours and available public health information on the status of the event provided within a further 24 hours. To date no acknowledgement nor reply have been received by WHO. However, as EVD is a notifiable disease under the IHR and because of the potential public health significance of such an event, WHO is issuing this report to Member States. The below report is gathered from sources in the United Republic of Tanzania and investigation conducted by Ugandan health authorities. WHO and partners are continuing to engage with the National authorities to obtain the additional information required to adequately assess the risk posed by this event.
Event Description
On 10 September 2019, WHO received unofficial reports of a suspected EVD case in Dar es Salaam, United Republic of Tanzania. The suspected case, a 34 years old female, Tanzanian national, was studying in Uganda.
She arrived in Uganda from the United Republic of Tanzania on 08 August 2019. From 08 to 22 August, she stayed in the Central region of Uganda, in a private hostel near Kampala (Central Region). She visited health facilities in the same area as she developed her research concept for her post- graduate training. No EVD case has been reported in Kampala, nor in the Central Region of Uganda.
On 22 August 2019, she returned to the United Republic of Tanzania. She travelled to Mwanza (in the north of the country), then she went to Dar es Salaam (in the east of the country) and subsequently travelled to the South-West of the country (Mtwara or Songea). She became symptomatic on 28 August (headache, fever, rash, bloody diarrhoea) and sought medical attention at a private clinic where she was first diagnosed with malaria. She had an adverse reaction and the treatment was discontinued. On 5/6 September, she travelled back to Dar es Salaam, where she was hospitalized on 7 September at one of the regional referral hospitals. Following a suspicion of viral haemorrhagic fever, she was transferred to an isolation unit in another referral hospital -Temeke ETU- for further management, and samples were collected. On 8 September 2019, the patient died, and a supervised burial was performed on the same day.
On 11 September 2019, according to informal sources, a RT-PCR test performed at the Tanzanian National Health Laboratory was positive for EVD. To date, this information has not been confirmed nor ruled out by national authorities. As EVD has never been confirmed in the United Republic of Tanzania, re-testing by a viral haemorrhagic fever reference laboratory is strongly recommended to confirm the diagnosis and to determine the Ebola specie. WHO has provided Tanzanian authorities with this advice.
Contact tracing activities have been reported unofficially as being initiated and contacts have been “quarantined.” No additional information is available. The places where contact tracing is being performed are not documented.
On 11 September 2019, WHO received unofficial reports regarding a businessman from Mwanza who presented EVD like symptoms. He had travel history to DRC (dates and itinerary not documented). He reportedly had no contact with the presumptive positive case reported in Dar es Salaam. According to unofficial reports, this patient tested negative for EVD. However, no official confirmation from the United Republic of Tanzania has been received. In addition, re-testing at an international viral haemorrhagic fever reference laboratory must be considered.
On 12 September 2019, WHO received unofficial reports regarding a 27-year-old female suspected of EVD presented at Muhimbili hospital (Dar es Salaam) on 11 September. She was transferred to Temeke ETU on 12 September. No information is available regarding laboratory test and results nor description of the symptoms. No official information from the United Republic of Tanzania regarding this suspicion has been received.
In the eventuality that the presumptive case would be confirmed by a reference laboratory as being a viral haemorrhagic fever, the following will be of significant concern:
The case travelled when symptomatic, leading potentially to a high number of contacts.
The case visited at least three health care facilities increasing the risk of nosocomial transmission.
The likely source of exposure is not documented; it may be associated with i) the ongoing EVD outbreak in DRC, or ii) a distinct -and yet non-identified- source.
Public Health Response
WHO and partners are continuing to engage with national authorities to obtain the additional information required to adequately assess the risk posed by this event
WHO strongly recommends re-testing by a viral haemorrhagic fever reference laboratory to confirm the presumptive diagnosis.
WHO is deploying a multidisciplinary rapid response team to the United Republic of Tanzania to expand response capacity in the WHO country office and provide further technical assistance to the national officials in their investigation should this be requested.
In preparation for vaccination of frontline health workers, a protocol is being reviewed by the Tanzanian ethical committee (provisional approval granted on 11 September, final approval expected by 13 September 2019).
Since May 2018, as part of the recommended Ebola preparedness activities, an Ebola treatment centre (ETC) has been established in Dar es Salaam, a public health emergency operation centre (PHEOC) has been operationalized, training of three rapid response teams has been conducted, and key EVD messages have been developed and translated to local languages with ongoing EVD sensitization in both radio and print media.
WHO Risk Assessment
The absence of communication from the Tanzanian authorities represents a major challenge for assessing the risk posed by this event. If confirmed, this would be the first EVD outbreak reported in the United Republic of Tanzania. Despite preparedness activities, there remains a lack of experience and capacity in addressing such an outbreak.
Since 1 August 2018, there have been thousands of alerts of suspected EVD cases in the world, eleven of which were reported in the United Republic of Tanzania. To date, cases were only exported from DRC to Uganda.
Since the beginning of the EVD outbreak in DRC in August 2018, WHO has advised and worked with neighbouring countries to reinforce their preparedness measures. The United Republic of Tanzania began implementing these in May 2018 when DRC was facing an earlier EVD outbreak.
Nevertheless, considering i) the high risk for human health posed by EVD if confirmed; ii) the fact that the presumptive case extensively travelled within the United Republic of Tanzania including to Dar es Salaam and areas bordering Uganda and bordering Malawi; iii) the absence of communication from the Tanzanian health authorities, the risk at national level has to be considered as very high. Likewise, the risk at regional level shall be considered as high due to potential cross-border travels and significant population movements as well as potential unknown transmission chains. The risk at the global level is considered low.
The risk assessment shall be reviewed once further information becomes available.
Update
2019-
09-12
https://extranet.who.int/ihr/eventinformation/print/event/2019-e000391 Page 2 of 3
United Republic of Tanzania (the) | Ebola virus disease 13/09/2019, 00)21
WHO Recommendations
WHO advises against any restriction of travel and trade to the United Republic of Tanzania based on the currently available information. Entry screening in the neighbouring countries has been recommended following the declaration of the EVD outbreak in the DRC as a Public Health Emergency of International Concern under the IHR. The United Republic of Tanzania is already implementing entry screening at major international airports. WHO continues to monitor travel and trade measures in relation to this event, and currently there are no restrictions of the international traffic in place.
For more information on Ebola virus disease, please see the links below:
Ebola fact sheet: https://www.who.int/en/news-room/fact-sheets/detail/ebola-virus-disease
SAGE recommendations: https://www.who.int/immunization/po...terim_ebola_recommendations_may_2019.pdf?ua=1 Statement on the meeting of the IHR Emergency Committee: https://www.who.int/ihr/procedures/statement-emergency-committee-ebola-drc-july- 2019.pdf
On 10 September 2019, WHO received unofficial reports of a suspected EVD case in Dar es Salaam, United Republic of Tanzania. In accordance to Article 10 of IHR, WHO sent a formal verification request to the United Republic of Tanzania for which receipt should have been acknowledged within
https://extranet.who.int/ihr/eventinformation/print/event/2019-e000391 Page 1 of 3
United Republic of Tanzania (the) | Ebola virus disease 13/09/2019, 00)21
24 hours and available public health information on the status of the event provided within a further 24 hours. To date no acknowledgement nor reply have been received by WHO. However, as EVD is a notifiable disease under the IHR and because of the potential public health significance of such an event, WHO is issuing this report to Member States. The below report is gathered from sources in the United Republic of Tanzania and investigation conducted by Ugandan health authorities. WHO and partners are continuing to engage with the National authorities to obtain the additional information required to adequately assess the risk posed by this event.
Event Description
On 10 September 2019, WHO received unofficial reports of a suspected EVD case in Dar es Salaam, United Republic of Tanzania. The suspected case, a 34 years old female, Tanzanian national, was studying in Uganda.
She arrived in Uganda from the United Republic of Tanzania on 08 August 2019. From 08 to 22 August, she stayed in the Central region of Uganda, in a private hostel near Kampala (Central Region). She visited health facilities in the same area as she developed her research concept for her post- graduate training. No EVD case has been reported in Kampala, nor in the Central Region of Uganda.
On 22 August 2019, she returned to the United Republic of Tanzania. She travelled to Mwanza (in the north of the country), then she went to Dar es Salaam (in the east of the country) and subsequently travelled to the South-West of the country (Mtwara or Songea). She became symptomatic on 28 August (headache, fever, rash, bloody diarrhoea) and sought medical attention at a private clinic where she was first diagnosed with malaria. She had an adverse reaction and the treatment was discontinued. On 5/6 September, she travelled back to Dar es Salaam, where she was hospitalized on 7 September at one of the regional referral hospitals. Following a suspicion of viral haemorrhagic fever, she was transferred to an isolation unit in another referral hospital -Temeke ETU- for further management, and samples were collected. On 8 September 2019, the patient died, and a supervised burial was performed on the same day.
On 11 September 2019, according to informal sources, a RT-PCR test performed at the Tanzanian National Health Laboratory was positive for EVD. To date, this information has not been confirmed nor ruled out by national authorities. As EVD has never been confirmed in the United Republic of Tanzania, re-testing by a viral haemorrhagic fever reference laboratory is strongly recommended to confirm the diagnosis and to determine the Ebola specie. WHO has provided Tanzanian authorities with this advice.
Contact tracing activities have been reported unofficially as being initiated and contacts have been “quarantined.” No additional information is available. The places where contact tracing is being performed are not documented.
On 11 September 2019, WHO received unofficial reports regarding a businessman from Mwanza who presented EVD like symptoms. He had travel history to DRC (dates and itinerary not documented). He reportedly had no contact with the presumptive positive case reported in Dar es Salaam. According to unofficial reports, this patient tested negative for EVD. However, no official confirmation from the United Republic of Tanzania has been received. In addition, re-testing at an international viral haemorrhagic fever reference laboratory must be considered.
On 12 September 2019, WHO received unofficial reports regarding a 27-year-old female suspected of EVD presented at Muhimbili hospital (Dar es Salaam) on 11 September. She was transferred to Temeke ETU on 12 September. No information is available regarding laboratory test and results nor description of the symptoms. No official information from the United Republic of Tanzania regarding this suspicion has been received.
In the eventuality that the presumptive case would be confirmed by a reference laboratory as being a viral haemorrhagic fever, the following will be of significant concern:
The case travelled when symptomatic, leading potentially to a high number of contacts.
The case visited at least three health care facilities increasing the risk of nosocomial transmission.
The likely source of exposure is not documented; it may be associated with i) the ongoing EVD outbreak in DRC, or ii) a distinct -and yet non-identified- source.
Public Health Response
WHO and partners are continuing to engage with national authorities to obtain the additional information required to adequately assess the risk posed by this event
WHO strongly recommends re-testing by a viral haemorrhagic fever reference laboratory to confirm the presumptive diagnosis.
WHO is deploying a multidisciplinary rapid response team to the United Republic of Tanzania to expand response capacity in the WHO country office and provide further technical assistance to the national officials in their investigation should this be requested.
In preparation for vaccination of frontline health workers, a protocol is being reviewed by the Tanzanian ethical committee (provisional approval granted on 11 September, final approval expected by 13 September 2019).
Since May 2018, as part of the recommended Ebola preparedness activities, an Ebola treatment centre (ETC) has been established in Dar es Salaam, a public health emergency operation centre (PHEOC) has been operationalized, training of three rapid response teams has been conducted, and key EVD messages have been developed and translated to local languages with ongoing EVD sensitization in both radio and print media.
WHO Risk Assessment
The absence of communication from the Tanzanian authorities represents a major challenge for assessing the risk posed by this event. If confirmed, this would be the first EVD outbreak reported in the United Republic of Tanzania. Despite preparedness activities, there remains a lack of experience and capacity in addressing such an outbreak.
Since 1 August 2018, there have been thousands of alerts of suspected EVD cases in the world, eleven of which were reported in the United Republic of Tanzania. To date, cases were only exported from DRC to Uganda.
Since the beginning of the EVD outbreak in DRC in August 2018, WHO has advised and worked with neighbouring countries to reinforce their preparedness measures. The United Republic of Tanzania began implementing these in May 2018 when DRC was facing an earlier EVD outbreak.
Nevertheless, considering i) the high risk for human health posed by EVD if confirmed; ii) the fact that the presumptive case extensively travelled within the United Republic of Tanzania including to Dar es Salaam and areas bordering Uganda and bordering Malawi; iii) the absence of communication from the Tanzanian health authorities, the risk at national level has to be considered as very high. Likewise, the risk at regional level shall be considered as high due to potential cross-border travels and significant population movements as well as potential unknown transmission chains. The risk at the global level is considered low.
The risk assessment shall be reviewed once further information becomes available.
Update
2019-
09-12
https://extranet.who.int/ihr/eventinformation/print/event/2019-e000391 Page 2 of 3
United Republic of Tanzania (the) | Ebola virus disease 13/09/2019, 00)21
WHO Recommendations
WHO advises against any restriction of travel and trade to the United Republic of Tanzania based on the currently available information. Entry screening in the neighbouring countries has been recommended following the declaration of the EVD outbreak in the DRC as a Public Health Emergency of International Concern under the IHR. The United Republic of Tanzania is already implementing entry screening at major international airports. WHO continues to monitor travel and trade measures in relation to this event, and currently there are no restrictions of the international traffic in place.
For more information on Ebola virus disease, please see the links below:
Ebola fact sheet: https://www.who.int/en/news-room/fact-sheets/detail/ebola-virus-disease
SAGE recommendations: https://www.who.int/immunization/po...terim_ebola_recommendations_may_2019.pdf?ua=1 Statement on the meeting of the IHR Emergency Committee: https://www.who.int/ihr/procedures/statement-emergency-committee-ebola-drc-july- 2019.pdf
