Date: Sun 9 Dec 2018
Source: WHO Weekly Epidemiological Monitor. Issue no 49.Volume 11 [edited]
<http://www.emro.who.int/surveillance-forecasting-response/weekly-epidemiological-monitor/>

As of [30 Nov 2018], the Ministry of Health of Tunisia reported 377 suspected cases of West Nile fever (WNF). Out of these, 65 cases are probable and 49 cases are laboratory confirmed. Two related deaths have also been reported.

Editorial note
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West Nile Virus (WNV) is a member of the flavivirus genus and belongs to the Japanese encephalitis antigenic complex of the family _Flaviviridae_. WNV infection is a non-contagious disease, primarily transmitted by the bite of infected mosquitoes of the genus _Culex_.

WNV is endemic in Tunisia. Since 1997 till 2012, 3 major upsurge of WNV cases were reported in the country. From the beginning of 2018 till last week of November [2018], a total of 377 suspected cases of West Nile fever were reported of which 49 were confirmed by RT-PCR with two related death.

In comparison with the previous years, the number of suspected and confirmed cases reported in 2018 already exceeded previous year's number (Please see table [in PDF of the URL]). This increased number of reported, suspected and confirmed cases compared to previous years, confirms the intensified circulation of WNV in the country.

This upsurge of the cases can also be explained by the risk factors including increased temperatures and early and heavy rainfall during the summer and autumn of 2018, that provided favourable conditions to the amplification of the vector and as well as the intensification of WNV circulation in the country.

The current trend shows a decline in the number of reported cases. The epidemic peak has been observed during the 1st week of October, but confirmed cases continue to be recorded till the week of reporting of the current year [2018] (Please see graph [in PDF of the URL]).

Climatically changed environment favour the establishment of the vector in the country which also facilitates the circulation of the virus; this has lead to the concern that the outbreak may also spread to other areas. The key public health measures that should be rapidly scaled up to contain the current surge and stop the transmission include aggressive vector control such as emptying and cleaning water reservoirs (breading sites), targeted indoor spraying, ensuring the use of bed nets and repellents and risk communication to reduce the risk of infection at the source. At the same time, surveillance systems should be enhanced ensuring early detection of the spread of the infection to other areas.
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[The first human West Nile disease (WND) epidemic in Tunisia occurred in 1997. Since 2010, sporadic human meningoencephalitis cases have been reported in different regions of Tunisia almost every year. The last epidemic WNV human meningitis and meningoencephalitis was recorded in 2012, with 86 cases and 6 deaths  (<http://www.izs.it/vet_italiana/2017/53_3/VetIt_1181_6565_2.pdf>).

In 2015 and for the first time, WNV was isolated and detected in Culex pipiens mosquitoes in Tunisia. Phylogenetic analysis showed that WNV strains belong to lineage 1 and are closely related to the 1997 Human Tunisian strain (Wasfi F, Dachraoui K, Cherni S, et al. West Nile virus in Tunisia, 2014: first isolation from mosquitoes. Acta Trop. 2016 Jul;159:106-10; abstract available at  <https://www.sciencedirect.com/science/article/abs/pii/S0001706X16301486?via%3Dihub>).

It is important to set up continuous entomological surveillance as an early alert system. Timely detection of WNV should prompt vector control to prevent future outbreaks. In addition, education of people to protect themselves from mosquito bites is of major epidemiological importance as preventive measure against WNV infection. - ProMED Mod.UBA]

[HealthMap/ProMED map available at:
Tunisia: <http://healthmap.org/promed/p/71>]
Date: Thu, 22 Nov 2018 14:06:16 +0100

Tunis, Nov 22, 2018 (AFP) - Tunisian civil servants staged the biggest general strike in five years on Thursday after their powerful trade union failed to secure wage hikes in tense negotiations with the government.   More than 3,000 people gathered outside parliament, responding to calls from the Tunisian General Labour Union (UGTT) for demonstrations.   "The wage increase is not a favour" and "Tunisia is not for sale", protesters chanted, also employing a popular slogan of the country's 2011 revolution -- "work, freedom, national dignity".    The UGTT is demanding 673,000 state employees receive salary bumps equal to those granted this year to public companies, which range from 15 to 30 euros ($17-34) a month.    Bouali Mbarki, UGTT deputy secretary, told AFP the wage increase "had not been taken into account in the 2019 state budget".

Thursday's strike, the biggest since 2013 and the first civil servant walkout over wages in decades, according to UGTT, included staff from ministries, hospitals and public schools.    The demands for wage hikes are tied to "an unprecedented rise in prices, a deterioration of citizen purchasing power.... and a degradation of daily life," Mbarki said.   Donors keeping Tunisia afloat have called on the government to control civil service salaries to avoid pushing up the public deficit.   But Mbarki said the government "must find a solution without being subjected to the instructions of the International Monetary Fund (IMF)-- even if it has made commitments with it -- and preserve social stability".    Mbarki said the union was "not negotiating with (head of the IMF) Christine Lagarde) but with the head of the Tunisian government", Prime Minister Youssef Chahed. 

The North African country is seen as having had a relatively smooth democratic transition since the January 14, 2011 toppling of President Zine El Abidine Ben Ali after 23 years in power.   At the same time price hikes, fuelled in particular by the fall of the Tunisian dinar, combined with tax increases and stubborn unemployment have spurred social discontent that escalated into riots across several cities in January.   In 2016, the IMF granted the North African country a 2.4-billion-euro loan over the span of four years in exchange for a promise to carry out economic reforms.    In recent months, political life in Tunisia has been paralysed by power struggles ahead of presidential elections set for 2019.
Date: Mon, 29 Oct 2018 14:30:30 +0100

Tunis, Oct 29, 2018 (AFP) - A strong explosion rattled the Tunisian capital on Monday, AFP journalists said.   Witnesses and a policeman at the scene said a woman had blown herself up close to police officers. Several ambulances and security personnel were at the scene.
Date: Thu, 18 Oct 2018 20:07:01 +0200

Tunis, Oct 18, 2018 (AFP) - Flash flooding in Tunisia has killed at least five people while a further two are unaccounted for, the interior ministry said on Thursday.   Two died in the northwestern region of Kef and another in Grombalia in the north, ministry spokesperson Sofiene Zaag told AFP.   On Wednesday a six-year-old child drowned in Sidi Bouzid in central Tunisia and a 40-year-old man was swept away by a seasonal river in the neighbouring province of Kasserine, the ministry said.   One person has been missing since Wednesday in Kasserine and another in Zaghouan in northeastern Tunisia, Zaag added.

The drownings come less than a month after torrential rains killed at least five people in the northeastern region of Cap Bon.   Water levels rose Thursday in several cities, including Tunis and its outskirts, where most schools were closed.   Some commuters parked their cars and took off their shoes as they navigated flooded streets to reach workplaces in the capital.   In some areas, floodwaters rose to nearly two metres deep during the night, devastating homes and shops.

In Mhamdia, a township 15 kilometres (nine miles) south of Tunis, families spent Wednesday night on the roofs of their homes to escape the floods.   "I slept with my three children on a floor under construction above my own home, exposed to the wind and the rain," one resident said. "I've lost everything".     In knee-deep mud, some residents tried to leave their homes in the crowded township with a few sodden possessions, an AFP photographer said.

People have lashed out at authorities for failing to maintain drainage systems or clear rubbish from seasonal riverbeds, despite frequent heavy rains in the autumn.   "This is the third time that this disaster has happened", said Abdelaziz Elkahbi, another Mhamdia resident.     "The authorities promise to do something, but nothing ever happens".   Schools remained closed in several areas including Kasserine and Sidi Bouzid, the cradle of Tunisia's revolution sparked by the December 2010 self-immolation of a fruit seller in protest at police harassment.   The interior ministry urged drivers to take care, as numerous roads across the country are impassable.
Date: Mon 1 Oct 2018
Source: Jawhara FM [in Arabic, trans. ProMED Mod.MM, edited]
<https://bit.ly/2QqYPZ1>

As of 30 Sep 2018, one case of death from West Nile virus infection was recorded from a total of 11 cases, 8 suspected and 3 confirmed, registered in Sousse-Masakin, and Kairouan governorates according to the director general of the centre of re-emerging diseases, MOH-Tunisia.
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[West Nile fever a mosquito-borne viral disease caused by the West Nile fever virus (WNV) which is a member of the genus _Flavivirus_ in the family Flaviviridae. The arbovirus is maintained in nature by cycling through birds and mosquitoes; numerous avian and mosquito species support virus replication.

The WNV has been reported across Tunisia especially in the coastal and Southern areas of the country. The 1st human West Nile disease (WND) epidemic in Tunisia was reported in 1997, but serological evidence of WNV circulation has been documented as early as 1968. A major WNV epidemic with cases of meningitis and meningoencephalitis was recorded in 2012, with 86 cases and 6 deaths.  (<https://www.ncbi.nlm.nih.gov/pubmed/29152704>).

Currently, surveillance in Tunisia is based on 3 components:
1. monitoring of human meningitis and meningoencephalitis cases (ONMNE 2013);
2. monitoring of clinical equine encephalitis cases based on the passive reporting of any suspicion of encephalitis within the framework of the integrated network monitoring of rabies (not systematic);
3. passive surveillance of the circulation of WNV in birds based on the monitoring of avian mortality integrated into the avian influenza surveillance network.

For the entomological component, no continuous monitoring is performed in the risk areas, with the exception of some investigations carried out after human outbreaks (<https://www.ncbi.nlm.nih.gov/pubmed/29152704>).

A multisectoral surveillance system for WNV is required, which should aim to provide early alerts to health authorities in order to adopt timely and effective measures to prevent the spread of the infection among animals and humans. - ProMED Mod.UBA]

[HealthMap/ProMED-mail map of Tunisia:
<http://healthmap.org/promed/p/71>]
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