H5N1

Brazil: Mato Grosso reports one case of yellow fever

Thanks to Viki Hansen-Landis for sending the link to this report from the Mato Grosso state government: Secretariat of Health confirms a case of yellow fever in Mato Grosso. Edited excerpt from the Google translation:

The State Health Department (SES / MT), through the State Epidemiological Surveillance, confirms a case of yellow fever in a human in the state. The patient is from Primavera do Leste, works as a grain sorter and is responding well to treatment.

In the face of this case, the Health Surveillance of the municipality, with the support of the Regional Health Office (ERS) of Rondonópolis, triggered the actions of prevention and control of the disease beginning with an emergency strategic meeting between the two teams, followed by investigation of the positive case and of the site of possible infection.

A technical note signed by the Management of Diseases and Endemic Diseases and Coordination of Epidemiological Surveillance informs that it also carried out the investigation of possible infected monkeys in the region, active search for patients with possible symptoms of yellow fever in the health units of the municipality, and vaccination blockade of the population without vaccine registration.

The case continues under investigation, because during the interview the patient reported that in the period before the onset of the symptoms of the disease he had traveled to several rural areas of the municipalities of Primavera do Leste, Itiquira, Campo Verde and Alto Taquari.

In view of this report, the ERS team in Rondonópolis needed to extend the actions to the other municipalities, holding an expanded meeting to prepare the response plan. The four have already prepared their respective plans and in all there is forecast of a D-Day to pass information to the population and immunization of those who have not yet been vaccinated.

SES requested the National Immunization Program (PNI) for sufficient doses of vaccine for these four municipalities. Mato Grosso is an endemic area for the disease and in the period from 2010 to 2017, 44 suspected cases were reported and none of these confirmed. The last confirmed case in the state was in 2009, in the municipality of Feliz Natal.

Major donor nixes effort to combat tuberculosis crisis in North Korea

Via Science: Major donor nixes effort to combat tuberculosis crisis in North Korea. Excerpt:

By all accounts, malaria control efforts in North Korea have been a clear success. Cases have fallen from 13,500 in 2010 to 2719 in 2016. The Global Fund has provided enough mosquito nets and antimalarial drugs to see the country through the 2018 malaria season, says spokesperson Seth Faison, who is based in Geneva. 

But TB remains a stubborn and worsening problem. A quarter-century ago, North Korea’s TB prevalence—around 50 cases per 100,000 people—was approximately one-third of South Korea’s. But after a severe, prolonged famine in the North in the mid-1990s, the TB bacterium spread rapidly among malnourished survivors. According to WHO, North Korea’s TB incidence, or number of new cases, per 100,000 people shot up from under 200 in 2000 to 513 in 2016 (global incidence in 2016 was 140). An MPH survey carried out in 2015 and 2016—which outside experts laud for its rigor—pegged North Korea’s TB prevalence, or total cases, at 640 per 100,000 people. 

Most North Korean TB patients now under medical care are taking drugs purchased under Global Fund grants. The Eugene Bell Foundation is providing drugs to treat about 1200 North Koreans with multidrug resistant (MDR) TB each year. That represents about 10% to 15% of each year’s new MDR cases, Seung says. MPH had proposed carrying out a drug-resistance survey in the next tranche of money from the Global Fund, he says, but that won’t happen now. 

In announcing its decision last February to end grants to the Democratic People’s Republic of Korea (DPRK)the Global Fund cited its concern that the country’s “unique operating environment” prevented the group from providing “the required level of assurance and risk management” for its grants. 

Humanitarian groups and medical researchers criticized the decision in letters to The Lancet and in other forums. They implored the Global Fund to reconsider, noting that transparency concerns and challenging operating environments exist in many countries with high TB burdens. The Global Fund “has not modified its decision” to close the grants, Faison says. However, he says, “We hope to re-engage with DPRK when the operating environment allows the access and oversight required.”  

Still, “the public outcry did have an effect,” Park says. The Global Fund recently agreed to allow leftover funds from its North Korea grants to be spent on a buffer stock of medications and diagnostics “sufficient to provide for continued treatment for TB patients [through] June 2019,” Faison says. There appear to be enough drugs on hand not only to treat existing patients, but also to enroll new patients through December, Park says. 

“The hope is that will buy enough time” to find a successor to the Global Fund, says Heidi Linton, executive director of Christian Friends of Korea, a nonprofit in Black Mountain, North Carolina, that a few years ago helped establish a National Tuberculosis Reference Laboratory in Pyongyang.

Outbreak of Ebola virus disease in the Democratic Republic of the Congo, April–May, 2018: An epidemiological study

Via The Lancet: Outbreak of Ebola virus disease in the Democratic Republic of the Congo, April–May, 2018: an epidemiological study. The summary:

Background 

On May 8, 2018, the Government of the Democratic Republic of the Congo reported an outbreak of Ebola virus disease in Équateur Province in the northwest of the country. The remoteness of most affected communities and the involvement of an urban centre connected to the capital city and neighbouring countries makes this outbreak the most complex and high risk ever experienced by the Democratic Republic of the Congo. We provide early epidemiological information arising from the ongoing investigation of this outbreak. 

Methods 

We classified cases as suspected, probable, or confirmed using national case definitions of the Democratic Republic of the Congo Ministère de la Santé Publique. We investigated all cases to obtain demographic characteristics, determine possible exposures, describe signs and symptoms, and identify contacts to be followed up for 21 days. We also estimated the reproduction number and projected number of cases for the 4-week period from May 25, to June 21, 2018. 

Findings 

As of May 30, 2018, 50 cases (37 confirmed, 13 probable) of Zaire ebolavirus were reported in the Democratic Republic of the Congo. 21 (42%) were reported in Bikoro, 25 (50%) in Iboko, and four (8%) in Wangata health zones. Wangata is part of Mbandaka, the urban capital of Équateur Province, which is connected to major national and international transport routes. By May 30, 2018, 25 deaths from Ebola virus disease had been reported, with a case fatality ratio of 56% (95% CI 39–72) after adjustment for censoring. This case fatality ratio is consistent with estimates for the 2014–16 west African Ebola virus disease epidemic (p=0·427). The median age of people with confirmed or probable infection was 40 years (range 8–80) and 30 (60%) were male. 

The most commonly reported signs and symptoms in people with confirmed or probable Ebola virus disease were fever (40 [95%] of 42 cases), intense general fatigue (37 [90%] of 41 cases), and loss of appetite (37 [90%] of 41 cases). Gastrointestinal symptoms were frequently reported, and 14 (33%) of 43 people reported haemorrhagic signs. Time from illness onset and hospitalisation to sample testing decreased over time. 

By May 30, 2018, 1458 contacts had been identified, of which 746 (51%) remained under active follow-up. The estimated reproduction number was 1·03 (95% credible interval 0·83–1·37) and the cumulative case incidence for the outbreak by June 21, 2018, is projected to be 78 confirmed cases (37–281), assuming heterogeneous transmissibility. 

Interpretation 

The ongoing Ebola virus outbreak in the Democratic Republic of the Congo has similar epidemiological features to previous Ebola virus disease outbreaks. Early detection, rapid patient isolation, contact tracing, and the ongoing vaccination programme should sufficiently control the outbreak. The forecast of the number of cases does not exceed the current capacity to respond if the epidemiological situation does not change. The information presented, although preliminary, has been essential in guiding the ongoing investigation and response to this outbreak.

Yemen: 1,113,140 cholera cases as of June 27

WHO's Cholera Response Dashboard reports 1,113,140 cases and 2,307 deaths as of June 27. That is an increase of 1,918 cases and one death in a week.

Health experts believe Pakistan very close to becoming polio-free

Via The News: Health experts believe Pakistan very close to becoming polio-free. Excerpt:

PESHAWAR: The bottom line of speeches delivered by health experts in the two-day media workshop was that Pakistan for the first time is very close to become a polio-free country provided the state, the nation, parents and the media continued their commitment in efforts against eradication of poliovirus from the country. 

The National Emergency Operation Centre for Polio Eradication (NEOC) had organised the event in collaboration with the Unicef and World Health Organisation (WHO). 

The journalists covering health-related issues were invited to the workshop from the four provinces and erstwhile Fata. 

The speakers said national and international organisations handling poliovirus in the country were still facing numerous serious challenges in reaching each and every child during the polio drive owing to a host of reasons.  

They noted that the biggest challenge until 2014 was inaccessibility to thousands of children in the tribal areas, particularly in North Waziristan and South Waziristan, where local Taliban leaders had banned polio vaccination. They recalled that the militants had linked polio immunisation to an end to drone strikes in Waziristan by the CIA-operated spy aircraft.  

A senior Unicef communication official, Ban Al-Dhayi, however, admitted that suffering of polio workers particularly started after May 2, 2011 when the CIA conducted a fake immunisation campaign that led to the US Navy SEALs attack on a three-story compound in Abbottabad in which Osama bin Laden was killed.  

It was learnt later that the CIA had used a Pakistani physician, Dr Shakil Afridi in conducting the fake hepatitis-B immunisation drive to collect DNA and trace bin Laden.  

It was the American CIA that sabotaged the global health initiative by using this noble profession for spying purposes and putting the lives of humanitarian and health workers in danger. 

The meaningful silence of WHO and Unicef to clarify that it was in fact hepatitis-B campaign and not anti-polio drive caused harm to the global efforts for polio eradication. 

Some health experts said violence against polio workers in Pakistan first started in 2007, but the Abbottabad operation proved a turning point and militant groups then began target killing of polio workers and also security personnel deployed on security duty during the campaign. According to officials, 41 people who were mostly polio workers lost their lives in target killings. 

For national and international health organisations, 2014 was the most frustrating year when Pakistan alone reported 306 polio cases. 

Dr Rana Muhammad Safdar, coordinator of NCEOP, informed the participants about efforts being made at the national level against polio eradication.  

He said the entire pattern of programme was changed after 2014 and innovative ideas were incorporated that helped them achieve maximum goals in the fight against polio.

MSF: European government policies condemn people to be locked up in Libya or drown at sea

Via MSF.org: European government policies condemn people to be locked up in Libya or drown at sea. Meanwhile CBC News reports another 100 migrants are believed drowned today.

European governments must come to their senses and end policies which trap extremely vulnerable people in Libya or leave them to die at sea, said Médecins Sans Frontières (MSF), as governments gather for the European Council Summit today.  

Last week was the deadliest so far this year on the Mediterranean, as at least 220 people drowned. These were avoidable tragedies. European governments have blocked non-governmental search and rescue operations, while turning over responsibility for rescues to the Libyan coastguard. 

European governments are financing, training and equipping the Libyan coastguard to intercept boats in distress and return them to Libya, where they are held in inhumane conditions. In an unprecedented development, some 2,000 people were returned to Libya over the course of last weekend. Upon arrival they were sent to arbitrary detention, with no due legal process. 

The same European governments that were just a few months ago strongly condemning reports of slave markets in Libya, seem today to have no hesitation in escalating policies that will increase the suffering of people trapped there. People whose only ‘crime’ is that they flee conflict, violence or poverty.  

“EU member states are abdicating their responsibilities to save lives and deliberately condemning vulnerable people to be trapped in Libya, or die at sea,” said Karline Kleijer, MSF head of emergencies. “They do this fully aware of the extreme violence and abuses that refugees and migrants suffer in Libya.” 

“MSF urges European governments to show some basic decency and remember that we are talking about human lives and human suffering. They can start by committing to search and rescue, and facilitate swift disembarkation in places of safety. This does not mean Libya”.  

People trapped in Libyan detention centres are largely without any assistance. Access is severely limited for international humanitarian organisations, including MSF, as well as for the UN, affecting the ability to monitor and provide protection. Over the last month, however, MSF has conducted over 3,300 medical consultations in four detention centres. Medical teams found that the main health issues are linked to poor living conditions, including overcrowding, and lack of sufficient water or sanitation.  

Meanwhile, despite the overwhelming need for search and rescue, an orchestrated campaign against non-governmental search and rescue operations is reaching breaking point. Independent search and rescue missions are increasingly obstructed from carrying out rescues in international waters and are denied access to local ports. This weekend the Aquarius was one of the only three dedicated search and rescue vessels in the central Mediterranean.  

“Saving lives at sea is not a crime,” continued Kleijer. "Yet, the message from European governments is loud and clear: humanitarian assistance is not welcome. Scapegoating NGOs is a tactic to distract from the real issues: lack of solidarity or vision in the EU, and a broken asylum system. These actions block and obstruct us from doing the work EU governments are failing to do, all the while dehumanising people in need. Any deaths caused by this are now at their hands.”

Nigeria: Lassa fever kills nurse in Edo

Via Vanguard, a June 28 report: Lassa fever kills nurse in Edo.

An outbreak of Lassa fever has allegedly claimed the life of Mr Henry Ehimati, a male nurse working with Okomu Oil Palm Company staff clinic, located in Ovia South-West Local Government Area of Edo. 

The victim, said to be in his 30s and married with a child, works at the clinic, but lives with his family at Upper Sakponba area of Benin whenever he was off duty. 

A credible source told  Newsmen on Wednesday in Benin that a doctor in charge of the disease control at the clinic observed the victim. 

The source said the medical doctor observed that the deceased was unusually weak and with high fever last week.  

“By the time they admitted him at the clinic and run test on him, they detected that he had ‘2 plus’ malaria, with protein in his blood. 

“As the fever got worse by the day, they then decided to transfer him to a private clinic in Benin City, last Saturday, where they also conducted several tests on him. 

“When they suspected that he might be suffering from Lassa fever, they then decided to transfer him to the Lassa fever centre at Irrua Teaching Hospital.  

“But he died at the clinic even before they could finalise arrangements to take him there,’’ according the source. 

The State Commissioner for Health, Mr David Osifo, is yet to respond to calls and a text a message sent to his mobile phone. 

The Managing Director of Okomu Oil Palm Company Plc, Mr Graham Heife, also failed to respond to a text message sent and call put to his mobile phone.

EBOLA DRC - Special communication from the Minister of Health on the evolution of the ninth Ebola outbreak in the DRC

The Ministry of Health has published EBOLA DRC - Special Communication from the Minister of Health on the evolution of the ninth Ebola outbreak in the DRC.

Special statement by the Minister of Health on the evolution of the ninth Ebola outbreak in the DRC

This Thursday, June 28, 2018, all people who have been in contact with the last confirmed case of Ebola have completed their 21-day follow-up period without showing signs of contamination. This is an important step in the response to the Ebola outbreak as it marks the beginning of the countdown to the announcement of the end of the ninth Ebola outbreak in the Democratic Republic of Congo. The end of the epidemic will be declared when the country has spent 42 days, two incubation periods, without notifying a new confirmed case of Ebola.   

This epidemic was the most complex and difficult epidemic the country had to deal with, mainly because it started in two rural areas at the same time and quickly reached a city of more than one million people. inhabitants directly connected to Kinshasa, our capital where more than 12 million Congolese live. However, thanks to rapid national and international mobilization and the Government's leadership in coordinating the response, we managed to control this high-risk epidemic in just seven weeks.   

This is a real achievement of which we must all be proud. The key to our success is, first and foremost, the effectiveness of the national and international monitoring teams on the ground who have done, and continue to do, outstanding work. They managed to identify and follow 1,706 contacts who were among the first to benefit from the new Ebola vaccine.   

The use of vaccination in this response to Ebola has undeniably helped to break the chain of transmission and contain the virus faster. Since the start of the immunization microplan on May 21, 3,330 people have been vaccinated and immunized against the Ebola virus. So far, the results of the vaccination have been conclusive because none of the vaccinated people developed the disease nor experienced major side effects.     

Although we are heading towards the end of the epidemic, the work of the Ministry of Health does not stop there. Our priority now is to improve the resilience of the health system by starting with the expansion of our emergency operations centers in Mbandaka and Kinshasa. 

As Ebola is a virus whose natural reservoir is located in the equatorial forest, we must prepare for the 10th epidemic. In addition, because of the increasing mobility of the population, it is likely that other epidemics will occur in urban areas in the future. Therefore, we need to learn from this response and strengthen our health system so that it can detect and respond even more efficiently to the next epidemic.

White House wants to cut this public health service corps by nearly 40 percent

Via The Washington Post: White House wants to cut this public health service corps by nearly 40 percent. Excerpt and then a comment:

The White House is proposing to reduce by nearly 40 percent the uniformed public health professionals who deploy during disasters and disease outbreaks, monitor drug safety and provide health care in some of the nation’s most remote and disadvantaged areas.  

The proposal is part of a plan announced last week by the Office of Management and Budget to overhaul the federal government. It would cut the size of the U.S. Public Health Service Commissioned Corps from its current 6,500 officers to “no more than 4,000 officers.” Administration officials, who have said the officers are “more expensive” than equivalent civilians, want “a leaner and more efficient organization” better prepared to respond to public health emergencies. They have not offered projections on how much might be saved. 

All Corps members are officers who work as doctors, nurses, engineers and other public health professionals across the federal government. 

 The proposal would also create a Reserve Corps of government employees and private citizens, similar to that used by other uniformed services, to be mobilized in a public health emergency or to back-fill critical positions left vacant during regular Corps deployment. 

Jim Currie, executive director of the Commissioned Officers Association of the U.S. Public Health Service, said the reductions would greatly affect the Corps’ ability to respond to disaster sites as it routinely does now.  

“I don’t quite understand the animosity toward the Commissioned Corps,” he said. “These folks are doing day jobs” — at the Centers for Disease Control and Prevention, National Institutes of Health and elsewhere within the government — “and when they’re needed, they go and deploy and work their butts off for 12 to 14 hours a day.” 

The little-known U.S. Public Health Service Commissioned Corps, which dates back over two centuries, is part of the Department of Health and Human Services. It is one of the seven uniformed services; members receive military pay and benefits but are unarmed. They  wear uniforms that look like those of the Navy and Coast Guard except for the insignia. The service’s officers fought yellow fever, cholera and plague in the early years of the 20th century and examined immigrants at Ellis Island.  

The Corps has deployed to natural disasters, disease outbreaks and humanitarian crises. More than 1,460 officers were sent to respond to hurricanes Harvey, Irma and Maria, including more than 350 who deployed twice, said Kate Migliaccio Grabill, a commander and USPHS spokeswoman. Nearly 300 officers were sent to staff a U.S. field hospital in Liberia during the 2014 Ebola epidemic. 

When thousands of unaccompanied minors crossed into the United States from Mexico in 2014, triggering a humanitarian crisis, more than 350 officers were sent to the Southwest to provide a variety of services, including medical screenings and behavioral health support. During this current crisis involving migrant children separated from their parents at the border, the service is also being tapped to help, HHS Secretary Alex Azar said Tuesday.

I've read several parts of the plan, which sounds like a starry-eyed attempt to roll back American government to circa 1918. It offers few details and lots of banal "run government like a business" rhetoric: "streamline," "efficiencies," "lean," etc., which all translates as depriving citizens of services and putting them at risk of harm those services are supposed to protect them from. Worse yet, it describes Americans as the U.S. government's "customers," not as its citizen-proprietors.

The strategy, I suspect, is to swarm the opposition and provide so many targets that at least some of them will be enacted into law.

Eurosurveillance: Spatio-temporal patterns of highly pathogenic avian influenza virus subtype H5N8 spread, France, 2016 to 2017

Eurosurveillance has published Spatio-temporal patterns of highly pathogenic avian influenza virus subtype H5N8 spread, France, 2016 to 2017. The abstract:

Introduction 

France is one of Europe’s foremost poultry producers and the world’s fifth largest producer of poultry meat. In November 2016, highly pathogenic avian influenza (HPAI) virus subtype H5N8 emerged in poultry in the country. As of 23 March 2017, a total of 484 confirmed outbreaks were reported, with consequences on animal health and socio-economic impacts for producers. 

Methods: 

We examined the spatio-temporal distribution of outbreaks that occurred in France between November 2016 and March 2017, using the space–time K-function and space–time permutation model of the scan statistic test. 

Results: 

Most outbreaks affected duck flocks in south-west France. A significant space–time interaction of outbreaks was present at the beginning of the epidemic within a window of 8 km and 13 days. This interaction disappeared towards the epidemic end. Five spatio-temporal outbreak clusters were identified in the main poultry producing areas, moving sequentially from east to west. The average spread rate of the epidemic front wave was estimated to be 5.5 km/week. It increased from February 2017 and was negatively associated with the duck holding density. 

Conclusion: 

HPAI-H5N8 infections varied over time and space in France. Intense transmission events occurred at the early stages of the epidemic, followed by long-range jumps in the disease spread towards its end. Findings support strict control strategies in poultry production as well as the maintenance of high biosecurity standards for poultry holdings. Factors and mechanisms driving HPAI spread need to be further investigated.