COVID-19 associated with SARS-CoV-2 ±Multi-country (World) 2020

Latest update: 20 May 2020 Epidemiological summary

Since 31 December 2019 and as of 20 May 2020, 4 861 456 cases of COVID-19 (in accordance with the applied case definitions and testing strategies in the affected countries) have been reported, including 322 483 deaths.

Cases have been reported from:

Africa: 91 365 cases; the five countries reporting most cases are South Africa (17 200), Egypt (13 484), Algeria (7 377), Morocco (7 023) and Nigeria (6 401).

Asia: 833 437 cases; the five countries reporting most cases are Turkey (151 615), Iran (124 603), India (106 750), China (84 065) and Saudi Arabia (59 854).

America: 2 186 907 cases; the five countries reporting most cases are the United States (1 528 568), Brazil (271 628), Peru (99 483), Canada (79 101) and Mexico (54 346).

Europe: 1 740 551 cases; the five countries reporting most cases are Russia (299 941), the United Kingdom (248 818), Spain (232 037), Italy (226 699) and Germany (176 007).

Oceania: 8 500 cases; the five countries reporting most cases are Australia (7 068), New Zealand (1 153), Guam (154), French Polynesia (60) and Northern Mariana Islands (21).

Other: 696 cases have been reported from an international conveyance in Japan.

Deaths have been reported from:

Africa: 2 903 deaths; the five countries reporting most deaths are Egypt (659), Algeria (561), South Africa (312), Morocco (193) and Nigeria (192).

Asia: 25 417 deaths; the five countries reporting most deaths are Iran (7 119), China (4 638), Turkey (4 199), India (3 303) and Indonesia (1 221).

America: 129 680 deaths; the five countries reporting most deaths are the United States (91 921), Brazil (17 408), Canada (5 912), Mexico (5 666) and Peru (2 914).

Europe: 164 349 deaths; the five countries reporting most deaths are the United Kingdom (35 341), Italy (32 169), France (28 022), Spain (27 778) and Belgium (9 108).

Oceania: 127 deaths; the four countries reporting deaths are Australia (99), New Zealand (21), Guam (5) and Northern Mariana Islands (2).

Other: 7 deaths have been reported from an international conveyance in Japan.

EU/EEA and the UK:

As of 20 May 2020, 1 324 183 cases have been reported in the EU/EEA and the UK: United Kingdom (248 818), Spain (232 037), Italy (226 699), Germany (176 007), France (143 427), Belgium (55 791), Netherlands (44 249), Sweden (30 799), Portugal (29 432), Ireland (24 251), Poland (19 268), Romania (17 191), Austria (16 257), Denmark (11 044), Czechia (8 647), Norway (8 257), Finland (6 399), Luxembourg (3 958), Hungary (3 598), Greece (2 840), Bulgaria (2 292), Croatia (2 232), Iceland (1 802), Estonia (1 791), Lithuania (1 562), Slovakia (1 495), Slovenia (1 467), Latvia (1 012), Cyprus (918), Malta (560) and Liechtenstein (83).

As of 20 May 2020, 158 134 deaths have been reported in the EU/EEA and the UK: United Kingdom (35 341), Italy (32 169), France (28 022), Spain (27 778), Belgium (9 108), Germany (8 090), Netherlands (5 715), Sweden (3 743), Ireland (1 561), Portugal (1 247), Romania (1 126), Poland (948), Austria (632), Denmark (551), Hungary (470), Czechia (302), Finland (301), Norway (233), Greece (165), Bulgaria (116), Luxembourg (109), Slovenia (104), Croatia (96), Estonia (64), Lithuania (60), Slovakia (28), Latvia (21), Cyprus (17), Iceland (10), Malta (6) and Liechtenstein (1).

EU: As of 20 May 2020, 1 065 223 cases and 122 549 deaths have been reported in the EU.

Public Health Emergency of International Concern (PHEIC): On 30 January 2020, the World Health Organization declared that the outbreak of COVID-19 constitutes a PHEIC. On 11 March 2020, the Director-General of the WHO declared the COVID-19 outbreak a pandemic. The Third International Health Regulations (IHR) Emergency Committee meeting for COVID-19 was held in Geneva on 30 April 2020. This committee concluded that the COVID-19 pandemic continues to constitute a PHEIC.

Sources: Wuhan Municipal Health Commission | China CDC | WHO statement | WHO coronavirus website | ECDC 2019-nCoV website | RAGIDA | WHO ECDC assessment Information on the COVID-19 situation and a risk assessment can be found on the ECDC website.

Actions

ECDC activities related to COVID-19 can be found on the ECDC website.

Poliomyelitis ±Multi-country (World) ±Monitoring global outbreaks

Epidemiological summary

Between 7 and 13 May 2020, eight cases of polioviruses (WPV1 and cVDPV2) were reported; additional positive environmental samples were reported in five countries (Afghanistan, Pakistan, Chad, Cote d'Ivoire and Somalia):

 - Five WPV1 acute flaccid paralysis (AFP) cases were reported in Afghanistan (1 case) and Pakistan (4 cases)

 - Thirteen WPV1 in environmental samples in Pakistan - Three cVDPV2 AFP cases in Chad (2 cases) and Cote d'Ivoire (1 case)

 - Three cVDPV2 in environmental samples in Somalia

Summary:

Wild poliovirus: In 2020, and as of 13 May, 61 cases have been reported in endemic countries: Pakistan (49) and Afghanistan (12).

Circulating vaccine-derived poliovirus (cVDPV): Overall, 105 cases have been reported in 2020, as of 13 May. These cases have been reported in Pakistan (44), Chad (13), Ethiopia (10), Ghana (8), Togo (6), Cote D´Ivoire (4), Democratic Republic of the Congo (4), Cameroon (3), Afghanistan (2), Angola (2), Burkina Faso (2), Central African Republic (1), Niger (1), Nigeria (1), and Philippines (1).

Global guidance from WHO recommends temporarily postponing preventive immunisation campaigns where there is no active outbreak of a vaccine-preventable disease. Operationally, polio vaccination campaigns are incompatible with physical distancing recommendations. The guidance calls for countries to prioritise routine immunisation of children in essential service delivery. Therefore, the Global Polio Eradication Initiative (GPEI) has taken the decision to temporarily delay immunisation campaigns. In the GPEI programme, surveillance activities will continue to the extent possible to monitor the evolution of the situation. In addition, comprehensive, context-specific plans to resume efforts are being developed, to be launched whenever and wherever the situation allows.

Sources: Global Polio Eradication Initiative | ECDC | ECDC Polio interactive map | WHO DON | WPV3 eradication certificate

ECDC assessment

 The WHO European Region has remained polio-free since 2002. Inactivated polio vaccines are used in all EU/EEA countries. The risk of reintroduction of the virus in Europe exists as long as there are non- or under-vaccinated population groups in European countries and poliomyelitis is not eradicated. According to WHO, one EU/EEA country (Romania) and two neighbouring countries (Bosnia and Herzegovina, and Ukraine) remain at high risk of a sustained polio outbreak. According to the same report, an additional 15 EU/EEA countries are at intermediate risk of sustained polio outbreaks, following wild poliovirus importation or emergence of cVDPV due to suboptimal programme performance and low population immunity. The continuing circulation of wild poliovirus type 1 (WPV1) in three countries shows that there is a continued risk of the disease being imported into the EU/EEA. Furthermore, the worrying occurrence of outbreaks of circulating vaccine-derived poliovirus (cVDPV), which only emerge and circulate due to lack of polio immunity in the population, shows the potential risk for further international spread.

To limit the risk of reintroduction and sustained transmission of WPV and cVDPV in the EU/EEA, it is crucial to maintain high vaccine coverage in the general population and increase vaccination uptake in the pockets of under-immunised populations.

ECDC endorses WHO´s temporary recommendations with regard to EU/EEA citizens who are resident in or long-term visitors (> 4 weeks) to countries with potential risk of international spread.

ECDC links: ECDC comment on risk of polio in Europe | ECDC risk assessment

Actions

ECDC provides updates on the polio situation on a monthly basis. ECDC monitors polio cases worldwide through epidemic intelligence in order to highlight polio eradication efforts and identify events that increase the risk of wild poliovirus being reintroduced into the EU/EEA.

ECDC maintains an interactive map showing countries that are still endemic for polio and have ongoing outbreaks of cVDPV.

Source: European Centre for Disease Prevention and Control (ECDC)