Welcome to this press briefing of the Information Service in Geneva.
Today is Friday, the 22nd of December.
We have a quite a straightforward agenda today and I will start immediately with our colleagues of WHO.
Tariq is here with us today and he has brought brought us Doctor Diana Rojas.
Alvarez was the team leader on arbour of viruses at The Who.
So Doctor Rojas or Tariq, who would like to start?
Just a quick, quick note.
We give the floor to Doctor Rojas.
We have sent what we call disease outbreak News.
On a global dengue situation this morning.
So journalists already got this, this this note has a detailed description of of the current situation with dengue.
But it's it's always good to hear from our experts and give opportunity to reporters to ask questions.
Remarks made by Doctor Rojas will also be sent shortly to to report.
So it is Doctor Rojas, please deploys yours.
Thank you very much, Tariq, and good morning, everybody.
So let me start with having a a brief description of what dengue is.
So dengue is the most common viral infection transmitted to humans through bite of infected mosquitoes.
And it's mostly found in urban areas within tropical and subtropical climates worldwide.
However, because mosquitoes can thrive in more countries because of increasing temperatures due to climate change, many more countries are reporting cases.
About 4 billion people are at risk of becoming infected with dengue virus, but most of the people won't get any symptoms.
But for those who do, they will recover within one to two weeks.
There is currently no specific treatment for dengue and severe dengue, so the early detection and the access to proper medical care would lower the probability to die due to severe dengue.
Since the beginning of this year, over 5 million cases and about 5000 deaths of dengue have been reported worldwide and close to 80% of those cases have been reported in the Americas, followed by Southeast Asia and the Western Pacific.
The distribution of the mosquitoes that transmit dengue and other mosquito borne viruses have changed in the last few years due to several social and environmental factors and in 2023 Helena phenomenon have resulted in more detection of dengue in previously dengue free countries.
It is also concerning that dengue outbreaks are occurring in fragile and conflict affected countries in the Eastern Mediterranean region such as Afghanistan, Pakistan, Sudan, Somalia, Yemen, because these countries are facing simultaneously sorry outbreaks of infectious diseases, mass population movements, pool water and sanitation infrastructure and recurring natural disasters.
This is also the case for the African region where the evidence of dengue circulation has been detected in local populations and also among travellers from about 30 African countries in the In Europe, dengue is not endemic and the majority of the cases are usually travel related.
But this year limited clusters of our doctor knows dengue transmission have been reported in in Europe, in France, in Italy and Spain.
So considering all these factors and this current situation, WHO has assessed the risk of dengue as **** globally, which with what it means is that it requires the maximum attention and response from all levels of the organisation to support countries around the world controlling the current dengue outbreaks and also preparing for the countries to respond to the upcoming dengue season.
WHO is currently actively supporting the countries to plan and implement priority multi sectorial interventions because this is a complex disease that requires a multi sectorial approach to control the spread of dengue through strengthening surveillance of cases or strengthening their reporting and and early reporting of detection and reporting of cases.
Conducting a certification of countries to be able to prioritise the actions where the transmission is occurring.
Providing support through our global expert networks.
We're updating guidance and also supporting training for clinical early detection and clinical management of dengue cases, strengthening environmental and mosquito surveillance to guide vector control and reducing the the densities of these mosquitoes, reinforcing risk communications and also engaging the community who play a very important role in daily control.
WHO is also leading the Global Auto Virus initiative, which is an integrated strategic plan to tackle emerging and re emerging auto viruses with epidemic and pandemic potential will then get E part of.
So for advice for the country's partners and the community, let's all work together, be alert and prepared to detect transmission of dengue and other mosquito borne viruses such as Zika, Chikungunya, which are transmitted by the same mosquito on tropical areas globally and now especially the Southern hemisphere where the summer is starting and the dengue seasons are also about to start.
And for the general population, you can lower your risk and your family's risk of dengue by avoiding mosquito bites by using mosquito repellent, especially during the day because these mosquitoes bite mostly during the day and supporting the communities to reduce the risk by eliminating the mosquito breeding sites in and around the homes.
So that's it from my side.
Happy to answer any questions.
Thank you very much, Doctor.
And I see there are in the chats.
Yeah, and and Tariq has answered about your notes.
So let's see who would like to ask.
The first question is from Peter Kenny, our correspondent of All African Media.
Peter, you have the floor.
Yeah, thanks for the briefings.
Could you elaborate on the African countries?
That are affected by dengue and also is the rise.
Can this be partly attributable to the non?
Deadly pesticides that were used to eliminate mosquitoes.
Thank you very much for your question.
So in the African region, we had about 170,000 dengue cases reported this year and about 700 people passed away due to dengue.
There were reported outbreaks in 15 countries of the 47 of the African Region including Benin paper, the Chad Code Boa, Ethiopia, Ghana, Guinea, Mali, Nigeria but the country that was most affected was Putina Faso with almost 150,000 cases.
I think the African region has a lots of experience in battling malaria and other vector borne diseases and they.
As this is a mosquito that lives inside the house, so it the the anorphous mosquito are the ones that transmit malaria and this is a different type of mosquito and they behave differently.
So some of the activities that are used to tackle malaria transmission might not be useful to tackle a dengue transmission or 80s eighties mosquito per SE.
So they but what we can learn from what what has been used for several decades in malaria control is the integrated approach.
Because here you need not just the insecticides, but also because you need to control the the water form of the mosquito, which are the larvae.
And that's used with with larvae sites or there are many other strategies to control the larvae.
Also the adult mosquitoes that there are, those are the ones that usually are targeted by the insecticide.
Then the community, because as as this, this mosquito lives inside the household, in the water pots, in the flower pots, in any artificial container that has clean water.
So we know where the mosquito lives.
So the community and everybody should be putting effort in eliminating those breeding sites where so we can, we can control the mosquito densities.
So the, the African region is when we the, the real burden of disease in the region is not really well understood.
But we are working with, with partners to try to establish which is the, the set of prevalence or the level of exposure to dengue in the, in the region.
So there are there are many, many things that we can do right now to prevent further spread and also further outbreaks in, in this region.
Paula Dupras from Geneva Solution.
Yes, well, actually I have one couple of questions regarding dengue, but then regarding another issue that I was wondering whether WHA could respond to.
Why don't we start with dengue so that we can the doctor and then eventually I'll come back to you for for the other questions, maybe Tarek can pick them up.
First of all, I'm sorry, I, I signed in perhaps a minute or so after you started, but just wondering what the most affected countries are.
You mentioned that 80% of those cases are in the Americas.
So would you have some data that you could share regarding the worst affected in terms of population and then also in terms of response?
Just wondering, but whether efforts to combat dengue may have been affected by the, the, the impact that health health that health services were hit with, you know, during COVID-19, whether that may affect the, the response to Dania to this outbreak.
Thank you very much for your questions.
So they they done that was distributed early in the morning has very little information on the on all the countries and with the where the highest burden is.
But in the in the Americas, the largest number of cases is reported from Brazil, Peru and Mexico, which are also a very highly populated areas.
And the highest incidents which are in based on the population are mostly in the islands of the Caribbean because they have no populations.
And they also have had they had they were heat during the this second semester due to due to dengue.
They about the impact of health services during the COVID-19 pandemic.
So people were locked down in their households.
Usually for dengue control, there is a house to house visit where the the the public health officers, they go to the, to each of the house, they knock on the door and they check if there are reservoirs and how much larvae and mosquitoes are available.
So all that all, all those actions were not able to be performed during the, during at least the first year or, or the first year and a half of the COVID-19 pandemic.
Also the healthcare services were fully responding to to the COVID-19 pandemic and the healthcare workers.
And so that also decreased a little bit the surveillance of of arboviruses, not just dengue and other diseases.
It was not just just dengue, we we saw an impact on the healthcare services for immunisation for and for many other types of infectious diseases and and issues.
However, with the with the COVID-19 pandemic, they were also capacities that were billed for diagnosis.
So now we have molecular diagnosis capacities that were used to diagnose COVID and can be used also to do diagnosis of dengue and other Alba viral diseases.
So we can leverage in some of the lessons learned during the COVID-19 pandemic to respond to these dengue outbreaks and other threats that might be might be coming.
But definitely the the COVID-19 pandemic impacted the the healthcare services and also the training of the doctors.
There was a lot of rotation.
So that's it from my side.
And as I said, I come back to you for the other questions.
So let's go to Christian Erich, our correspondent of the German news agency DPA.
Doctor Romas, can you elaborate a little bit on the situation in Europe, the cases?
And just to understand, do these larvae survive the winter?
Do we have populations of those mosquitoes resident in Europe now?
And what is The Who projection in the future?
So Europe currently is in is in winter, but during 2023, Italy reported 82 cases out of Turnus cases that were transmitted in Italy, in France, 43 cases were reported and in Spain 3 cases were reported.
So usually Europe reports imported cases from the from the Americas, from the Western Pacific, from the endemic regions.
But this this year we saw limited clusters of out of Turnus transmission.
As we know the the summers are getting warmer and the there are two main vectors of these of these virus 1 is Ed Salvopictus, which is widely distributed in in Europe and is called the tiger mosquito.
And then the other one is said it's a Jeep type which is a better mosquito to transmit dengue, which is a currently established in Cyprus, Madeira and and in Portugal since 2022 and in other areas.
So the cold winters will prevent year long transmission as we saw as we see in in other tropical areas.
However, the eggs are the ones that can can stay during the winter, hibernate and then once spring comes and when the temperature goes up up to 2020° and the egg gets in contact with water, they will hatch and then they will they will increase the mosquito density.
So they say this mosquito has well the eggs.
They lay the eggs in, in, in, in places where there is clean water.
And once the eggs hatch, you will have a larvae and then two to three days the, the adult mosquito will start flying.
So there is a, there is a full cycle of these mosquitoes and the eggs are the ones that can stay hibernating during, during the winter and once temperature gets up, then they, they will have.
So this is a this is a gold opportunity for Europe to start controlling the mosquito before dengue becomes a real ****** and becomes a well now there is transmission, but with the with the summers getting longer and the temperatures going higher, higher, these might become a seasonal disease in Europe.
So this is the time to control this vector given that the the the temperature and the seasonality is being is in favour of the region.
Christian has a follow up.
Can you just repeat or write in the chat to the second mosquito, the Tiger 1 you mentioned, the second one you mentioned because I didn't get that.
I will write it in the chat.
Maybe, maybe Tarek can do it while you're answering the other questions.
So Lisa Schlein has been asking for the flu, but her hand doesn't work apparently.
So I don't know if my colleagues can open her mic.
Lisa Schlein was of America.
It's not on the screen so.
Anyway, here I am with my voice.
Yeah, just a couple of quick questions.
Surge in Africa unusual because it it doesn't seem to be a.
Region that is really principally or greatly affected by by the by.
To climate change, whether you could talk about the.
Relationship if there is.
Such between the surge in dengue and climate change.
Thank you very much for your question.
So in the it's not just climate change.
So the main drivers of dengue transmission are mostly social and environmental factors.
So unplanned urbanisation, population growth and other factors that are related with the globalisation process are part of the transmission dynamics of dengue.
The climate change has an impact in dengue transmission because it increases rainfall, humidity and temperature.
So these mosquitoes are very sensitive to temperature and temperature regulates how fast they grow, how fast they incubate the virus inside them.
And they are going to have an impact in in the in the transmission per SE.
So climate change has definitely an impact because the warmer temperatures create the conditions for the mosquitoes carrying the infection through spread.
So what we are seeing with climate change is in, in many, in many ways or let's say with the increasing temperatures.
So one is what we, what we are seeing in, in Europe and in temporary regions where the mosquito was not present few, few years ago and now it's widely distributed.
So it puts the population at risk.
And now there is also transmission of the virus because it was introduced from, it could be somewhat the travel, because the ones who carry the virus around are the humans, the mosquitoes.
They don't fly more than 200 metres around the house or around where they, where they, where they hatch their eggs.
And so this is what we are seeing in, in, in Europe, even in, in the South part of North America and even in the southern Hemisphere.
This year we had cases in, in Uruguay, which is in the, in the South, in Buenos Aires, in Argentina.
So, so this is the, this is one of the of the impacts of the mosquito going up in latitude.
And also down in latitude.
But also we are seeing in endemic countries changes in spatial and seasonal patterns.
So for example, in Nepal, they are seeing dengue in areas with more than 2000 metres above the sea level that before these mosquitoes they used to survive just up to 16,000 metres above the sea.
Yeah, 16,000 metres above the sea level.
Or for example, with the unusual rainfalls, if there are, if there are a potential breeding size that with the rain they are going to be filled with water that might also increase the mosquito densities.
And that's what we saw in Bangladesh after the monsoon season in Oman, in Saudi Arabia that this unusual rainfalls lead to an increased number of mosquitoes and increased number of transmission.
Also in areas in Latin America in in countries like Colombia, which also have a mountains, the mosquito is found even higher and higher.
And that brings population that was previously completely naive and unexposed to dengue to be at risk for, for this kind of viruses.
So your question about the African region, I think it's a combination of multiple factors.
1 is that now there is a more capacity to do diagnosis.
So probably there are more, there is more detection of these arboviruses but but also like what we saw in Burkina Faso around 150,000 cases that that's significant and there is still a large amount of population that might be susceptible.
As I mentioned before, we are currently working with partners to set up prevalence surveys to understand a little bit better which is the the real burden of disease of dengue in the in the African region.
So we can we can target a little bit better our interventions over.
Thank you very much, Gabriela Sotomayor, Processor Hola.
Hola, Alessandra, thank you very much.
My question is in Mexico, in Acapulco dengue.
Hit Acapulco so the port was devastated and it's still flooded with garbage.
So are you observing this situation?
Are you worried about this situation in Mexico especially?
Apparently, the government is underestimating.
If you can elaborate also on the.
And I see that the name of the mosquito has been put in the chart, the CGPT.
You very much so so, but Mexico is endemic for for dengue since a couple of decades they they are hyper endemic.
So they have Co circulating the four different stereotypes as I mentioned this before, but dengue has four different serotypes.
So people can get infected up to four times in their life and the second infection is the one that might lead to severe to severe dengue.
So in Mexico, they have the Co circulation of all the serotypes since several years ago.
This year they reported about almost 230,000 cases and that is about 180 cases per 100,000 population.
So the South is is mostly affected.
So the Yucatan and as you were mentioning in in Acapulco.
But I know that the Pan American Health Organisation is being coordinated with the country office and with the Ministry of Health in the, in Mexico to address the situation.
Because now with all the these unusual a, a climate events such as the Hurricanes, also the floods and, and, and they will lead to more mosquito densities and, and **** transmission.
So I'm sure they are, they are working on it.
There is there is risk and we have it on, on on the list.
So they, I know the Pan American Health Organisation and the and the MOH in, in Mexico are are are aware of the situation and they are acting accordingly in a with a multi sectorial plan and and trying to to control the transmission of of dengue and potentially other threats.
Thank you, Nina Larson, AFP.
Thank you for taking my question.
I was wondering if you could say a little bit.
About the situation in North America I.
Think you said it is similar to Europe.
A similar development there.
And also if you could say something about.
You know you're talking about a disease.
Where most people will recover after.
Of this illness, if it becomes more endemic or if it spreads more widely.
What the death toll might be or also.
Thank you very much for your question.
So in, in North America, there were some cases reported in, in, in Florida and of course in, in Puerto Rico.
Puerto Rico is endemic for, for dengue in the, in the US and the 80 sample pictures, which is one of the vectors is getting getting more and more space in the South of the US.
So now you can find it in the South of Texas and in in in Florida and and some of the southern states.
The risk for introduction is there as we saw as we have seen previously in other years with clusters that are controlled easily.
But the the risk is there.
The issue with this virus is that most of the infections are asymptomatic.
So you're going to have transmit silent transmission for a few weeks before you start seeing the the first case.
So it it's good to be aware of which are the, the vector that is in, in the area and then take action to reduce the the mosquito densities to also reduce the the risk of transmission in the population.
And your question about severe illness.
So this disease is as as I mentioned before, is mostly a mild.
However, around 10% of these of the of the patients can evolve to what we call severe dengue, which might involve severe bleeding and severe organ impairment, which will make them go to the to the ICU and can they can, they can die.
Dengue is a very, is an, A typical disease because usually the severity of the disease starts after the fever has gone away, which is very misleading because people are used that what if the fever is there, Then we need to be, we need to be checking the patient.
And then once the fever goes away, the the person is getting better.
In dengue, it's completely the opposite.
When the fever goes away, that is where the warning signs and the severe disease might present.
So the what is important here is that the population detects the warning signs which are intense of the abdominal pain, persisting vomiting, bleeding in the gums in the gastrointestinal system, a fluid accumulation.
They get sleepy and and also when the liver gets a little bit large.
But some of these thing are are detected in at the hospital.
So it is important for the population to be aware of these symptoms.
So they go to the healthcare facility and seek for for care if they if they if it's needed.
So with the proper care, which is mainly fluids, the person might we might prevent the that patient to evolve to severe dengue or if it has severe dengue, we might prevent that person from from dying because the treatment is just with with fluids as there is no specific treatment.
And the real burden of dengue is estimated that there are about 390,000,000 infections per year.
So what we get reported is just a fraction of what it was the of the of the real of the real infections.
The issue is that well it, it if you the case for is 10% will go to severe to a severe form of the disease and we are expecting less than 1% of case fatality rate, right.
So during outbreaks, for example, if you have an outbreak with 5 million cases, then the, the, the healthcare facilities get completely packed as we saw with, as you probably saw with the COVID-19 pandemic and it's very difficult to care and to follow up these patients.
So that might increase also the risk of death as we as we see with other infectious diseases.
So the, the, the, the burden of disease is estimated in almost 400 million infections per year.
So what we but as most of the infections are asymptomatic, we get just a proportion that were captured by the surveillance system and actually it made it to report.
That's why we are working with the countries in how to strengthen the surveillance of, of, of dengue and other our viruses to get more more cases reported and have a better view of the of the real burden of, of dengue.
Doctor Rochas, I think that was our last question to you, although I haven't forgotten, Paula, but thank you very much for this extensive briefing on this very important thing.
Is Paula, you had two questions for WHOI guess maybe for Tariq or yeah, I don't know if if Doctor Rojas can also add to to my question, but just wanted to know the concern that The Who may have regarding bird flu.
Last year we saw a very sharp spike in affecting animals, birds as well as I think sea lions and seals along Peru's Pacific Coast.
It seems that there have been outbreaks of bird flu in Europe as well.
Just just wondering you know what level of concern The Who may have regarding bird flow at?
I don't know if Paula, Dr Rochas or Tariq want to take the floor.
Doctor Rochas wants to say something, but Paula, I would really need to come back to you and look for the information.
I know that we have been, we haven't been looking into into bird flu globally, but I would need to get all the details and send it to you by e-mail.
Maybe Doctor Rochas, is there anything you would like to add on this?
No, we're I, I just wanted to add that we are monitoring not just word flu, but other sonosis all around the world.
So please get back to her with with the detailed information because it is available as we Daily Monitor these threats.
Thank you very much, but I keep tired because Emma has a question for you MFR writers.
It's it's on a different topic.
I'm hoping that The Who can respond to the fact that dual use items, including medical items, are being blocked from getting into Gaza at the moment.
I'm wondering what sort of items you're seeing blocked and, and how that's affecting your, your aid operations on the ground and, and how badly they're sort of needed within Gaza.
I'm, I'm really not aware of it.
So please send us e-mail and we will check with our colleagues on the ground.
Any other question for WHOI don't see other hands up.
And I would also ask if there's any other question for other colleagues who are connected.
And we have UNHCR and we have also Anguta, Denise M as a question for me.
It it, it's like a housekeeping 1.
Just one second, just one second.
Let me see if Christian has that because I I like to to let Doctor Rochas go if, if she's not on the grill anymore.
So let me just ask Christian if this is for WHO on any other question, on any other matter.
And then come to you, Emma.
This is for human rights.
So let me let me thank very much Tariq and Dr Rochas are various for this, for this extensive briefing and also for answering other question.
Let me see, I have something in the chat.
Doctor Rock has come back and, and, and update us on this situation, which it really is a needing of monitoring and, and attention.
And thanks Tarek for, for being with us today.
Well, Christian, you, you are already on.
And then I I give the floor to Emissary and Christian.
My question was on this incident, reported incident at the of, of summary executions in the Gaza Strip in the AL outer building.
I don't know whether there's anyone who can answer, because in the relief web there there is reference to some European monitoring organisation that I've never dealt with, and I wonder whether there are any actual facts that were gathered by the office.
Unfortunately HR is is not with us today and I wouldn't be able to answer on this.
Maybe you want to you want to send a message We have sent you the list.
Who are on on duty these days so maybe you want to to contact them and eventually come back to me if we need to dig more and now.
I'm sorry if I missed it, Alessandra.
An up to date list of spokespersons on duty during the holiday season And when was it sent out?
I, I some of you missed it indeed.
Maybe we, we can just Sarosh is listening to me.
Maybe we can send it again.
It was sent at least a couple of weeks ago and, and it basically covers the whole you and family in Geneva.
So I think you have there all the, all the people on duty.
I know that we've had some updates from WHO, including from WHO.
So maybe so long as you're, I know you're listening, maybe we can send it out again, making sure that the information about WHO is updated so that all the colleagues have it.
And and this gives me also the opportunity and and colleagues to remind you that of course, this is going to be our last briefing of 20, 23 unless something happens.
Then this case, of course, we will come back to you.
Otherwise we are going to post updates, messages sent you all the information that we received on news of the system.
Otherwise, we will reconvene for the next briefing on the 5th of January.
And it will be virtually again again because the parade stay close until the same of January.
So yeah, that let's let's maybe re circulate that list.
And yeah, it would probably be useful also for the others.
Any other question for me or for the other colleagues who are online?
So let me just inform you that the Secretary General will give a stick out today.
So short briefing today at 12:30, New York Times.
And of course you can follow this on the UN Web TV and I expect there will be quite a few points on the on the Middle East and you may want to to have that update.
Otherwise, we will distribute the transcript afterwards, of course, and I've told you about the arrangements.
I wanted to apologise for the information that we gave about the accesses to the pallet.
We have sent you an updated note, I hope everybody has received it, about the arrangements for the entrance from Penny Gate, whether you come by car, bike or foot from 8:00 in the morning to I think it's 5:00 in the afternoon, after which you can access through the National Gate with when you go by foot or again Penny by car and bike.
And of course, the same thing on holidays, on the, on the holiday days and, and on the weekends.
So sorry again for for the inconvenience that he does.
And yeah, that's what I, I had for you and I, I look at the platform, I don't see any end up.
And therefore, yeah, I'm left with the wishing you a very, very restful and hopefully more peaceful period of holidays with your families and dear ones, we'll see you in the new year.
And of course, again, don't hesitate to ask us if you have any questions.
It's not time for celebrating the news are are so terrible that we think of all the people who will be suffering during this.
But I still want to wish you all the very, very best for these holidays and of course, for the new year.
Let's hope it would be more peace on earth.
And I'll see you in 2024.
