Table 3.

Details on outbreaks detected through formal notifications (n = 10)

ID	Country, area, date of onset (references)	Aetiologic agent	Onset to detection (days)	Comments
11	Guinea, Dinguiraye prefecture, Oct 2004 [34]	Yellow fever virus		In 2002 an African network of laboratories for the diagnosis of yellow fever was developed, leading to far greater testing of acute jaundice cases.
12	Guinea, Kissidougou district, Jun 2006 [35]	Yellow fever virus		A yellow fever vaccination campaign had been conducted in this district, with reported coverage of 93%. Only one case of yellow fever was identified. Close surveillance was to be maintained but a mass vaccination campaign was not considered necessary.
13	Guinea, Faranah health district, Dec 2008 [36]	Yellow fever virus	60	Two cases of yellow fever were initially reported through the yellow fever surveillance system. A further 21 suspected cases were recorded. A targeted mass reactive vaccination campaign was planned.
14	Liberia, Feb 2004 [34]	Yellow fever virus		42 cases of yellow fever were notified from eight of the country's fifteen counties.
15	Myanmar, Yangon, 2001 [37]	Dengue virus		Dengue is endemic in Myanmar. Outbreaks occur cyclically but this outbreak was the largest on record.
16	Republic of Congo, Mbomo and Kelle, Jan 2003 [38-40]	Ebola virus	(34)	In early January 2003, a WHO team arrived in the area to reactivate surveillance and reinforce hygiene promotion, following detection of a zootic among primates. A human outbreak was notified to the Ministry of Health and WHO 15 days later, 7 days after the index case was admitted to hospital. Control efforts were hampered by difficulties in communication and transport. Difficulties with community acceptance were also reported, including strong cultural objections to the collection of blood and post-mortem skin samples, delaying outbreak confirmation.
17	Sudan, Southern Sudan, 2000 [18]	Viral haemorrhagic fever	(7)	A local team from the southern Sudan EWARN detected and reported the case. Test results were available within 2 weeks of the reported onset.
18	Sudan, Torit County (Southern Sudan), May 2003 [41,42]	Yellow fever virus		A Norwegian NGO reported the suspected outbreak through the Southern Sudan EWARN system.
19	Sudan, South Kordofan state, Oct 2005 [43]	Yellow fever virus	(30)	A sentinel surveillance system of hospitals and clinics was in place. Jaundice cases were reported promptly by state health officers through the central surveillance system, but yellow fever was not initially considered and the outbreak was initially attributed to dengue. Laboratory investigation was not initially pursued. Confirmation and the start of control occurred more than a month after notification.
20	Sudan, Yambio county, Southern Sudan, May 2004 [44-47]	Ebola virus	21	Surveillance using haemorrhagic fever case definitions and a rapid response through EWARN contributed to a small number of cases. A concomitant measles outbreak complicated case identification, hampering control measures. On site laboratory facilities could have prevented this.

* Investigation revealed previously undetected or undiagnosed outbreaks; () indicates that dates were estimated.