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EBOLA DRC - Evolution of the response of the Ebola outbreak to Thursday, May 31, 2018

The Ministry of Health has published EBOLA DRC - Evolution of the response of the Ebola outbreak to Thursday, May 31, 2018. Encouragingly, the case count keeps falling. We're now down to 50 cases. Excerpt from the Google translation.

EPIDEMIOLOGICAL SITUATION  

Thursday, May 31, 2018   

The epidemiological situation of the Ebola Virus Disease dated May 30, 2018: 

• A total of 50 cases of haemorrhagic fever have been reported in the region, of which 37 confirmed, 13 probable and 0 suspect. 

• 3 negative tests, including 1 in Wangata and 2 in Iboko 

• 1 new positive case in Iboko 

• No new suspicious cases 

• No new deaths reported this day. However, at the close of the database, deaths from confirmed cases increased from 5 to 6 for Bikoro and from 4 to 3 for Iboko.   

Epidemiological analyses have identified contacts living in nearby health areas in Bikoro and Iboko. These contacts are followed and advised to limit their movements during the entire follow-up period of 21 days.     

Remarks 

• Negative tests are systematically removed from the summary table. 

• The category of probable cases includes all reported deaths for which it was not possible to obtain biological samples for laboratory confirmation. 

News from the Ebola response     

Vaccination 

• Since the launch of the vaccination on May 21, 682 people have been vaccinated, including 499 in Mbandaka, 113 in Bikoro and 70 in Iboko.

Uganda: DR Congo pilgrims to be screened for Ebola

Via New Vision: DR Congo Pilgrims To Be Screened For Ebola.

All pilgrims arriving from Democratic Republic of Congo (DRC) are undergoing screening for Ebola, according to a statement from the ministry of health.   

The screening is taking place at both the border districts and in Namugongo before entrance into the shrines.   

This comes after the Health Ministry in the DRC the declared the ninth outbreak of Ebola virus in the country, in early May.   

According to the World Health Organisation, as of May 21, 2018, a cumulative total of 58 cases, including 27 deaths had been reported from three health zones in Equateur Province.   

The ministry of health in Uganda has set up an isolation unit at the China-Uganda Friendship hospital, Naguru.   

“An expert team of 10 medical personnel will conduct screening of Ebola Viral Hemorrhagic fevers at Namugongo,” reads the statement.  

Additionally, the ministry has designated 150 workers, led by Tororo diocese at the Catholic shrine while 60 health workers led by Kigezi diocese will be deployed at the Anglican shrine alongside 40 emergency care officers.   

Some of the personnel shall be positioned among the pilgrims, wearing reflector jackets with tags for easy identification and timely provision of first aid incase need arises.   

Seven fully equipped ambulances, two stationed inside the premises and five along the road have been availed until 4th June

Compulsory vaccinations in Italy: The impact on vaccination coverage

Via Eurosurveillance: Introduction of new and reinforcement of existing compulsory vaccinations in Italy: first evaluation of the impact on vaccination coverage in 2017. Excerpt from the discussion:

An encouraging increase in VC[vaccination coverage] was observed following the decree-law 73/2017. Vaccination was mandatory for all children, not only those who were due to be vaccinated at the time. Therefore, a catch-up campaign was necessary with a main limitation being the capacity of the vaccination services to perform all the immunisation required by the law. Due to this, the effect of the law is likely underestimated as its implementation only began in the second part of 2017. The requirement of a regular immunisation to attend preschool facilities and screening of certificates of vaccination at school most likely drew the attention of the parents on the importance of the vaccination. 

The increase in VC between 2016 and 2017 (ranging from 0.9% for vaccination against tetanus at 24 months to 4.4% for MMR vaccination at 24 months) was most likely a result of the decree-law being brought into force and supported by the related communication campaign, which was amplified by the media. These probably increased the awareness of the population on the importance of vaccines and vaccination. Parents’ reasons for their adherence to the vaccination should be evaluated in detail in further studies. 

However, there is still a small group of parents threatening a lawsuit against the law or are trying to delay the vaccination, making the normal process of active calling and pre-vaccination counselling longer and more difficult with a higher number of people not turning up at the appointment or bringing an exaggerated list of questions.  

Results of a recent survey conducted in Italy estimated that 83.7% of parents were positive towards vaccination, 15.6% were hesitant and 0.7% were against vaccination. This should be kept in consideration for further adjustment to the organisation of the vaccination services, because the number of hesitant parents that could be convinced to vaccinate is relevant and could positively impact the VC.

India: Death toll from Nipah virus now 15 in Kerala

Via India TV: Death toll from Nipah virus rose to 15 in Kerala. Excerpt:

The death toll due to Nipah virus in the state rose to 15, with a 28-year-old man succumbing to the deadly virus here, a health department official said today.  

Akhil, a native of Karassery, who was undergoing treatment at the Kozhikode Medical college hospital (KMCH) since May 29, died last night, the official said.  

Two more persons, confirmed of having contracted the virus are being treated at KMCH, he said.   

Besides, 1,353 people who had been in contact with the affected persons before the confirmation of the disease, are under observation, the official said.

Yesterday, Madhusudhanan (55) of Nellikode in the district, who was undergoing treatment in a private hospital here also breathed his last.  He was working as a Senior superintendent in the Kozhikode District Court. 

Ebola: A war for life

Via the NGO blog ponabana, a report by Typhaine Daems, a UNICEF consultant: Ebola: a war for life. Excerpt from the Google translation:

Since Tuesday 8 May 2018, the DRC has faced its ninth epidemic of the Ebola virus disease. Since the declaration of the epidemic by the Minister of Public Health, the teams of the UNICEF office in Mbandaka have mobilised in order to organise the response alongside the Government and its partners. The Bikoro health zone, the epicentre of the epidemic, is only situated around a hundred kilometres from the city of Mbandaka.  

It was a few days after that I was asked to go to Mbandaka. I ask myself: is it really wise to go there? Is it really essential? After some moments of reflection (and after verifying my health insurance), the decision is made: I will go to Mbandaka. To depart for an affected zone is not a choice to be made without precaution: I had to bring a personal protection kit weighing almost 10 kilograms with me. Boots, gloves, biohazard suit, glasses and various medications will be my travel companions, without forgetting the hand sanitiser that will not leave my side for a single minute…  

Upon boarding the plane for Mbandaka, it was compulsory to apply gel on my hands. During the 90-minute flight, the word ‘Ebola’ was at the centre of every conversation. When we landed, security was reinforced: we had to pass through a laser thermometer and a thermal camera that displayed the temperature of the body. 

Peculiarly, when I left the airport to present myself at the UNICEF office, you could not tell that Ebola was not far away… apart from some UNICEF handwashing units and some posters, nothing led you to think of Ebola: public places were crowded; merchants travelled up and down the streets, and the taxi-motorbikes (and the taxi-bikes) were packed. Everyone went about their daily business. 

But since the famous Tuesday 8 May 2018, in the refuge of certain buildings in the city, a race against the clock was taking its course: it was necessary to implement a response plan to contain the epidemic as rapidly as possible. This is a war for life. In light of the emergency, offices and meeting rooms were transformed into crisis zones. 

When I arrive at the UNICEF office, I find that six people are meeting around a little table presided by a conference telephone: it is time for an update on the situation with the teams in Bikoro and in Kinshasa. From Kinshasa, Gianfranco Rotigliano, our Representative, facilitates the meeting and does not want to hear about anything other than results. Every moment counts and it is impermissible to lose time. Action must be quick for life to prevail and only results for the children count! 

At the end of the call, everyone moves. Doors closes, telephones ring and car motors start: everyone is on a war footing. Only one priority exists: to implement our response as rapidly as possible. Until the middle of the night, the UNICEF office in Mbandaka remains at boiling point. No one rests, some do not even have the time to drink a coffee or eat. 

A last meeting allows for an update on the day’s activities: logistics, education, protection, health, communication, transport, water and sanitation, etc. No one is set aside because everyone has a role to play in the response.

DR Congo: 561 vaccinated against Ebola so far

Via Actualite.cd: DRC-Ebola: Already 561 vaccinated, including drivers who had transported patients who had escaped. The Google translation:

Since the launch of the vaccination on May 21, 561 people have been vaccinated, including 444 in Mbandaka, 74 in Bikoro and 43 in Iboko, reports the Ministry of Health. Among those vaccinated in Mbandaka, there are motorcycle taxi drivers who have been in contact with confirmed cases of Ebola. They had transported patients who had escaped from Wangata General Hospital in mid-May.  

This Wednesday, May 30, 2018, the communication team of the Ministry of Health has sensitized more than 200 tolekists (cyclists) and motorcycle taxi drivers of the city on the precautionary measures to take to protect against the Ebola virus disease.  

"This is a priority target because bicycles and motorcycle taxis are the most popular means of transportation for the population in Mbandaka. When a person is sick, she is often transported by these tolekists or motorcycle taxis to the nearest health center. This is a real danger for the drivers themselves, but also for their future passengers," says the Ministry of Health.

MSF in DR Congo: Ebola update May 2018

Via MSF.org, a detailed report: Democratic Republic of Congo: Ebola update May 2018. Excerpt:

The outbreak is currently affecting the city of Mbandaka and the health zones of Bikoro (Bikoro and Ikoko villages), and Iboko (Itipo and Iboko villages). Bikoro, a small city where some Ebola cases have been detected, is approximately four hours’ drive from Mbandaka. Connections with Bikoro are also possible via Lake Tumba, which the local community uses to reach the Congo River. 

This is the ninth Ebola outbreak in DRC in the last 40 years[1]. So far, most of the previous outbreaks have occurred in relatively remote and isolated areas, with little spread of the disease. The last Ebola outbreaks in DRC occurred in Likati district in May 2017, with eight people infected, of whom four died, and in Boende (Thsuapa region) in 2014, with 66 people, of whom 49 died.  

Unlike in previous Ebola outbreaks in DRC, where cases have been concentrated in remote villages, patients have now been diagnosed in Mbandaka, a Congo River port city of more than one million inhabitants. While easy access to transport increases the risk of the virus spreading, surveillance is being reinforced, and as of 29 May 2018, only four lab confirmed patients have been identified in Mbandaka. 

For now, it’s important to emphasise that the epidemic has not spread widely within the city. With the correct intervention and careful monitoring of the situation, it is possible to limit the spread of the outbreak. 

During the past few weeks, MSF has been working closely with the Congolese Ministry of Health (MoH) and with other organisations on the ground to coordinate the response. The response is based on the ‘six pillars’ of Ebola intervention:  

1. Early care and isolation of people who present with symptoms 

2. Tracing and following up patient contacts 

3. Informing people about the disease, how to prevent it and where to seek care 

4. Supporting existing healthcare structures 

5. Temporarily adapting cultural behaviour to make funerals safe 

6. Outreach activities (pro-active case finding) 

If this intervention is well followed, an Ebola epidemic can often be contained in a relatively short period of time.  

For all these activities, building a good understanding with local communities is vital. Medical and health promotion teams are working hard to explain to the population what the symptoms of Ebola are, how to avoid contamination, the importance of coming to health structures as quickly as possible if they suffer from symptoms, and the importance of isolation measures to contain the disease. If patients are admitted and receive medical care quickly, the sooner their families are protected and there is a greater chance of limiting the spread of the epidemic. 

We have a lot of experience in working in Ebola epidemics and we currently have several teams working in four different locations – Mbandaka, Bikoro, Iboko and Itipo. Some of our most experienced staff is working on the ground.  

MSF and our research unit, Epicentre, are working with the local health authorities and the World Health Organization (WHO) to participate in the implementation of the Ebola vaccine rVSVDG-ZEBOV-GP, which is being used as part of the overall strategy to control the Ebola outbreak. 

Rather than launch a mass vaccination campaign, vaccines will be targeted at the contacts of confirmed Ebola patients (as well as the contacts of these contacts), and Ebola health workers in Bikoro. The vaccinations are voluntary and free-of-charge. 

This vaccine has not yet been licensed and is therefore being implemented through a study protocol, which has been accepted by the national authorities and the ethical review board in Kinshasa, as well as MSF’s ethical review board.

India: One more person dies of Nipah virus in Kozhikode

Via The Times of India: One more person dies of Nipah virus in Kozhikode. 

KOZHIKODE: One more person succumbed to Nipah virus here on Wednesday, taking the death toll in Kerala's Kozhikode and Malappuram districts to 14. 

Madhusudhanan (55) of Nellikode in Kozhikode district died on Wednesday night, according to health department sources.

He was undergoing treatment at a private hospital here, they said, adding that Madhusudhanan had tested positive of the virus. 

The number of confirmed Nipah virus cases has risen to 17 with the National Institute of Virology, Pune, finding its presence in the blood sample of a 28-year-old person from Karassery here, the sources said.

Meanwhile, The Times of India also reports that test results are still awaited for the Indian Army soldier who died in Kolkata last Friday with Nipah-like symptoms. He had recently returned from leave in Kerala.

EBOLA DRC - Evolution of the response of the Ebola outbreak to Wednesday, May 30, 2018

Via the Ministry of Health: EBOLA DRC - Evolution of the response of the Ebola outbreak to Wednesday, May 30, 2018. Excerpt and then a comment:

EPIDEMIOLOGICAL SITUATION  

Wednesday, May 30, 2018   

The epidemiological situation of the Ebola Virus Disease dated May 29, 2018:

• A total of 53 cases of haemorrhagic fever were reported in the region, including 36 confirmed, 13 probable and 4 suspected. 

• 3 new suspicious cases in Iboko 

• 1 negative test in Bikoro 

• 1 new case confirmed in Iboko 

• No new deaths   

Epidemiological analyses have identified contacts living in nearby health areas in Bikoro and Iboko. These contacts are followed and advised to limit their movements during the entire follow-up period of 21 days.     

Remarks 

• Negative tests are systematically removed from the summary table. 

• The category of probable cases includes all reported deaths for which it was not possible to obtain biological samples for laboratory confirmation. 

News from the Ebola response   

Minister of Health enlightening the National Assembly on the situation of the Ebola epidemic 

• Following the topical question of the Honorable National Deputy Bavon N'sa Mputu Elima on the Ebola outbreak, the Minister of Health, Dr. Oly Ilunga Kalenga, went to the National Assembly, this Wednesday, May 30, 2018, in order to enlighten the deputies on the evolution of the situation.  

• The questions addressed to the Minister focused on: the decision of the WHO Emergency Committee not to declare the epidemic a public health emergency of international concern; the concrete steps taken by the Government to effectively combat the disease; the epidemic, the nature and scope of the interventions of traditional multilateral partners in the health sector, the epidemiological situation to date, the nature and effectiveness of therapeutic treatments and vaccines administered to patients and caregivers .    

Raising awareness of Mbandaka cyclists and motorcyclists 

• This Wednesday, May 30, 2018, the communication team of the Ministry of Health has sensitized more than 200 tolekists (cyclists) and motorcycle taxi drivers of the city on the precautionary measures to take to protect against the Ebola virus disease. 

• This is a priority target because bicycles and motorcycle taxis are the most popular means of transport used by the population in Mbandaka. When a person is sick, she is often transported by these tolekists or motorcycle taxis to the nearest health center. This is a real danger for the drivers themselves but also for their future passengers. 

• In addition, patients who had left the treatment center had been transported with their families by these motorcycle taxis. Through this awareness session, the Ministry of Health team was able to identify five drivers who had been in contact with confirmed cases of Ebola. They are now monitored by the monitoring team. 

Vaccination 

• Following the sensitization of tolekists and motorcycle taxis, all drivers who have been in contact with confirmed cases of Ebola have voluntarily registered to benefit from vaccination. 

• Since the launch of the vaccination on May 21, 561 people have been vaccinated, including 444 in Mbandaka, 74 in Bikoro and 43 in Iboko. 

Psycho-social monitoring of students in Iboko 

• Following the Ebola outbreak, several schools in the Iboko Health Zone have decided to suspend school activities to protect children. The teams of the Ministry of Health in charge of psycho-social monitoring organized psycho-educational sessions in local primary schools as well as meetings with teachers and parents of pupils.

The DR Congo Ebola response does indeed seem to be evolving, and in a good way. The updates are reliable and increasingly detailed. The Congolese clearly know what they're doing, and so far the case and death counts suggest they're doing it well. Paying attention to children, parents, and teachers in Iboko is a wise step, especially since it's a hot spot with half of all cases.

The next wise step would be monitoring of survivors to identify and mitigate post-Ebola syndrome. 

Saudi Arabia: A family cluster of MERS in Najran

Google Maps

The KSA MOH Command and Control Center remains silent about MERS, but Mike Coston at Avian Flu Diary has been picking up rumours of a family cluster in Najran, almost on the border with Yemen. Via Khaberni.com: Khoraini: Corona belongs to Saudi Arabia. The Google translation:

Sources in the Kingdom of Saudi Arabia reported that 6 people from one family were infected with the "Corona" virus. The infection was diagnosed in Najran (south) and was transferred to Riyadh, according to the Ministry of Health.  

Sources told the local newspaper that the family's home was examined by the health authorities in Najran. It was found that a family member and his congregants had symptoms of the infection, which are 6 individuals. 

She added that the family had a farm in Najran, with a number of camels, while the Ministry of Environment, Water and Agriculture was informed to take preventive measures.  

The Corona virus has spread to several parts of Saudi Arabia and parts of the Gulf and the Middle East over the past years. 

The Corona virus broke out of the control of doctors and public health officials in Saudi Arabia for several months, wounded hundreds, and caused panic before the haj pilgrimage before it took over