Communicable disease threats report, week 32, 7-13 August 2016

Publication series: Communicable Disease Threats Report (CDTR)
Time period covered: 7 - 13 August 2016

​The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiolgists and health professionals on active public health threats. This issue covers the period 7-13 August 2016 and includes updates on Zika virus, yellow fever in Angola, polio, MERS CoV and West Nile virus.

Executive summary

This issue covers the period 6 to 13 August 2016 and includes updates on West Nile virus, Zika virus infection, yellow fever outbreak, MERS CoV, measles cases among refugees in Germany and poliomyelitis.​

West Nile virus

During the past week, six new cases of West Nile fever have been reported in the EU Member States: Italy has reported two confirmed cases in Bologna, one confirmed case in Modena and one confirmed case in Ferrara. Romania has reported one confirmed case in Ialomita and one confirmed case in Ilfov. In countries neighbouring the EU: Serbia has reported one confirmed case in  Belgrade and Russia has reported one confirmed case in Saratov.

During the June to November transmission season, West Nile fever cases in humans are shown in ECDC’s weekly updated West Nile fever maps. This informs blood safety authorities of West Nile fever (WNF)-affected areas and enables them to identify significant changes in the epidemiology of the disease.

Zika virus infection

Between 4 August and 11 August 2016, the Florida Department of Health has reported ten additional non-travel related cases in Miami-Dade County. The Department of Health still believes that active transmission is only taking place in this previously identified one-square-mile area in Miami-Dade County. As of 11 August, the Florida Department of Health has reported 404 travel-related and 25 non-travel-related Zika infections and 57 infections in pregnant women. Media are reporting that three cases are being investigated that do not have a clear link with the one-square-mile area in Miami-Dade County, including one recent case in Palm Beach county.

A field trial for genetically-modified mosquitoes engineered to reduce Aedes aegypti populations in Florida has been approved by the Food and Drug Administration (FDA). However, all other local, state, and federal requirements should be met before conducting the proposed field trial. If approved, the mosquitoes will be released in Key Haven, Florida.

On 9 August, a Zika-related infant death of an infant born with birth defects including microcephaly in Texas received media attention as it was the first Zika-associated-death in Texas.

On 10 August, the Cayman Islands reported the first two cases of locally-acquired Zika virus.

ECDC publishes an epidemiological update every Friday together with maps with information on countries or territories which have reported confirmed autochthonous cases of Zika virus infection. A Zika virus infection Atlasis also available.

Yellow fever outbreak

According to WHO, the yellow fever epidemic in Angola appears to be declining, with no new cases confirmed in the last six weeks. According to ECHO, as of 8 August, there were 2 269 suspected cases and 74 confirmed cases reported in the Democratic Republic of Congo (DRC).

An outbreak of yellow fever in Angola started in December 2015 in the municipality of Viana, Luanda province, and has spread to all 18 provinces of Angola.

Middle East respiratory syndrome – coronavirus (MERS CoV)

Between 14 July 2016 and 11 August 2016, Saudi Arabia has recorded seven new cases and five deaths in previously reported cases. The cases have occurred in Najran (1), Buraidah (1), Jubail (2), Hafof (1), Almodhannab (1) and Hurayima (1). Five of the seven cases are male, one is female and one is of unknown gender. One of the cases in Jubail is a healthcare worker. Three of the cases had direct or indirect contact with camels.

Since April 2012 and as of 11 August 2016, 1 815 cases of MERS, including 698 deaths, have been reported by health authorities worldwide. The source of the virus remains unknown, but the pattern of transmission and virological studies point towards dromedary camels in the Middle East as being a reservoir from which humans sporadically become infected through zoonotic transmission. Human-to-human transmission is amplified among household contacts and in healthcare settings.

Measles cases among refugees in Germany

On 8 August 2016, the Robert Koch Institute in Berlin published an overview of measles cases reported from asylum seeker centres in Germany over the period of January to July 2016, showing a marked increase in reports of measles cases since mid-May.

From mid-May to 20 July 2016, 53 measles cases were reported from asylum seeker centres, compared to only three in the period January-April. According to the German authorities this increase seems to be concomitant with the arrival in Germany of groups of asylum seekers from Chechnya.

These 53 cases of measles were reported from 11 different asylum seeker centres across eight Federal states. All cases were in children aged 0–13 years, with the exception of two adults aged 21 and 22 years. Cases had travelled from Chechnya to Germany using different routes crossing Poland, Russia or Belarus. The initial case among Chechen asylum seekers was reported on 10 May 2016, a few days after arrival at a centre, suggesting infection was acquired while travelling. Similarly, symptoms appeared within a few days of arrival at the asylum seeker centres for several other cases, suggesting that the infection was likely to have been acquired while travelling to Germany. Typing pointed towards a strain that has been circulating in the Caucasus. Secondary cases were reported among residents and staff at the centres.

ECDC published an epidemiological update on the issue, highlighting the potential for measles outbreaks in structures hosting migrants and asylum seekers and the need for staff working in migrant reception centres to be vaccinated against measles.



On 10 August 2016, WHO reported that wild poliovirus type one (WPV1) has been detected from Borno state in Nigeria during the month of July in two children with acute flaccid paralysis. Nigeria had been polio-free for two years before the detection of these two new cases. Pakistan and Afghanistan have not recorded additional cases this week.