H5N1

Uganda: Kampala, Wakiso at Ebola risk- Ministry of Health

Via PML Daily: Kampala, Wakiso at Ebola risk- Ministry of Health. Excerpt:

KAMPALA  – Dr. Henry Mwebesa, the Director General, Ministry of Health has revealed that Uganda is at a very high risk of catching the deadly Ebola virus that is ravaging and has claimed lives in Eastern Democratic Republic of Congo.  

Mwebesa explained: “The latest information is that we have 344 cases of Ebola in DR Congo and this is a place that is very close to our borders. Initially, we were talking about 100kms, but of late it has come even closer to 50kms from our border and in fact, recently, we had two people that died exactly at the landing site of L. Albert on the other side of Congo.” 

He made the remarks today during the third Grande Annual Doctors Conference held at Imperial Royale Hotel, Kampala. 

While detailing the Ebola risk Uganda faces, Mwebesa pointed at Ugandans close to the Congo border, but warned that this shouldn’t make those far away from the border relaxed, as experts haven’t ruled out the risk those people in Kampala and Wakiso stand at contracting the virus, calling for more vigilant campaigns to avert the risk. 

“Ebola doesn’t know borders so as a country we are at a very high risk. We had 202 deaths [in Congo] as of Thursday which is about 59%,” Mwebesa noted.  

He stated that the Ministry has embarked on vigorous preventive measures to ensure Ebola doesn’t make its way into Uganda and assured Ugandans that on top of putting up treatment centres, the health teams have the ‘capacity’ to treat any Ebola case. 

Mwebesa added: “We must develop a very high degree of suspicion because we may be focusing at the borders, but you know the airport is open and this puts areas of Kampala and Wakiso at a very high risk too. So you [doctors] may at any time be confronted by a case and you may be treating malaria when it’s actually Ebola.”  

The Director-General also said that although the country has witnessed numerous false Ebola alerts since its outbreak in Congo, he deemed all these threats are ‘fake news’ asserting that the Ministry has tested over 300 cases, but all these have turned out as negative and no case has been registered in Uganda.

Branswell: Ebola response suffers another setback, as WHO evacuates some staff

Via STAT, Helen Branswell writes: Ebola response suffers another setback, as WHO evacuates some staff. Excerpt:

The World Health Organization has evacuated 16 people working to contain the Ebola outbreak in the Democratic Republic of the Congo following a rebel attack near the area where they were staying, Director General Tedros Adhanom Ghebreyesus said Saturday.  

The decision marks another violence-related setback for the response to the outbreak, but Tedros said in an interview with STAT that he hoped containment operations could resume as normal soon. 

Overall, the response team in the area comprises more than 200 health workers and others, he said. 

The attack appears to have targeted a camp used by United Nations peacekeeping forces in Beni, a city in northeastern Congo that is currently a hot spot for Ebola transmission. The camp is located near a hotel where some Ebola responders are staying. 

Tedros said leaders of the response operation called him to inform him an attack was underway on Friday night, and he could hear heavy gunfire over the phone.  

“They called me immediately and the gunfire was very close to them,” he said. 

After Friday night’s violence subsided, several members of the Ebola response team “were exhibiting some distress,” Tedros said, and a decision was made to pull them back to Goma, a city south of Beni, so that they could get a few days of rest and counseling. Others insisted on staying in Beni, he said, calling them “very courageous people.”  

Friday’s violence was the latest in a string of attacks in the region. Earlier in the week eight peacekeepers and at least 12 Congolese soldiers died in an ambush on their joint operation aimed at routing out a stronghold of the rebel group Allied Democratic Forces near Beni. A number of rebels were captured in the exchange.  

That event again prompted the U.N. to call for a halt to the violence in the region, suggesting attacks on the peacekeepers may be deemed war crimes under international law. 

The Ebola outbreak response has been struggling because of the violence in the region and the distrust it fosters among people in the region who have lived with these conditions for years. 

Repeated bouts of violence have hampered the ability of the response teams to do their work, and the virus has taken advantage of their limitations. 

As of Saturday there have been 358 confirmed and probable cases in this outbreak, and 213 of those people have died. It is the third largest Ebola outbreak on record and the largest in Congo’s long history with Ebola outbreaks.

California Woolsey fire near nuclear accident site

Via the Bulletin of the Atomic Scientists: California fire near nuclear accident site. Excerpt:

Call it another sad chapter in the long and depressing book of governmental failures to properly clean up after nuclear research and production efforts. Last week, the Woolsey Fire—one of three major, climate change-charged conflagrations now afflicting California—apparently started on the grounds of the Santa Susana Field Laboratory, located just south of Simi Valley and west of Los Angeles. 

Closed in 1996, the lab site was home to rocket engine and nuclear reactor research; one of the nuclear efforts—the Sodium Reactor Experiment—led to the partial melt-down of a reactor in 1959 and the release of radioactive material. But as the Los Angeles Chapter of Physicians for Social Responsibility noted, the Santa Susana site is contaminated in a variety of ways: 

“Decades of nuclear and rocket-engine testing activity, including nuclear reactor accidents and other toxic spills and releases, have resulted in widespread contamination throughout [lab’s] 2,850-acre facility.”  

The California Department of Toxic Substances Control (DTSC) quickly announced that it didn’t believe the fire had released significant amounts of toxins. “Our staff were able to access the site Saturday morning and assess damage caused by the fire,” a Tuesday press release said. 

“We confirmed that the [lab] facilities that previously handled radioactive and hazardous materials were not affected by the fire. Over the weekend our multi-agency team took measurements of radiation and hazardous compounds, both on the site and in the surrounding community. The results from this initial round of testing showed no radiation levels above background levels, and no elevated levels of hazardous compounds other than those normally present after a wildfire.” 

Safecast, an international, volunteer-centered organization formed in the wake of the Fukushima Daiichi nuclear disaster, reported Wednesday that it “had no survey data from the immediate [lab] area prior to the fire, but we had a fair amount of data from nearby communities which showed it to be at normal background levels. Our real-time radiation and particulate sensors in the Southern California region, the closet of which is 30km (about 18 miles) away from [the site], have shown no measurable increases in radiation. Safecast volunteers are on the way to the site, however, so hopefully we will have new data to share soon. Though CalFire indicates that the fire danger in the [lab] area has passed, many roads are still closed, making access difficult.” 

Local activists were not shy about voicing in their disbelief in governmental pronouncements about contamination and the fire. “We can’t trust anything that DTSC says,” West Hills resident Melissa Bumstead said. “DTSC repeatedly minimizes risk from [the lab] and has broken every promise it ever made about the [lab] cleanup. The public has no confidence in this troubled agency.” 

Should it? The Santa Susana Field Laboratory closed 22 years ago, and cleanup efforts remain in the planning stages.

EBOLA DRC - Evolution of the response to the Ebola epidemic in North Kivu and Ituri on Saturday, 17 November 2018

The Ministry of Health has published EBOLA DRC - Evolution of the response to the Ebola epidemic in North Kivu and Ituri on Saurday, 17 November 2018. The news is not good, given the nearness of Friday's Beni attack to the Ebola emergency response center. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Saturday, November 17, 2018   

The epidemiological situation of the Ebola Virus Disease dated November 16, 2018:   

• Since the beginning of the epidemic, the cumulative number of cases is 358, of which 311 are confirmed and 47 are probable. In total, there were 213 deaths (166 confirmed and 47 probable). 

• 57 suspected cases under investigation.  

• 6 new confirmed cases, including 4 in Beni, 1 in Katwa and 1 in Kalunguta.  

• 3 new confirmed deaths, including 2 in Beni and 1 in Katwa.    

 /! \ Cleaning the current database   

Remarks: 

• To avoid that the total number of cases varies (up or down) daily, the suspect cases have been placed in a separate category. Thus, suspect cases with positive laboratory tests will be added to the confirmed category, while negative ones (non-cases) will be removed from the table. 

• The category of probable cases includes all reported deaths for which it was not possible to obtain biological samples for laboratory confirmation. The investigations will determine whether these deaths are related to the epidemic or not. 

• A community death is a death in the community, outside of a licensed health center. 

News of the response 

Security 

• On the evening of Friday, November 16, 2018, an armed group made an incursion into Boikene neighborhood, Rwenzori commune, in the city of Beni, with the intention of attacking one of the bases of MONUSCO. The peacekeepers reacted immediately, pushing the rebel group after several hours of clashes, a few meters from the Ebola Response Emergency Operations Center and hotels in which several teams from the response were lodged.  

• This Saturday, November 17, 2018, all field activities were suspended, and the Emergency Operations Center remained closed. All the teams stayed in their respective hotels. 

• Health Minister Oly Ilunga Kalenga deplores the violence that has once again wounded the people of Beni and is slowing the efforts of the response teams to end the Ebola outbreak. The epidemic remains dangerous, especially in Beni. As a result, national and international teams continue to work alongside the population to end the epidemic.  

Vaccination 

• Since the start of vaccination on August 8, 2018, 31,713  people have been vaccinated , including  15,901 in Beni, 4,544 in Mabalako, 3,292 in Katwa, 1,663 in Mandima, 1,615 in Butembo, 1,602 in Kalunguta, 732 in Masereka, 434 in Bunia, 355 in Tchomia, 330 in Vuhovi, 292 in Mutwanga, 241 in Kyondo, 240 in Komanda, 210 in Musienene, 178 in Oicha, and 34 in Alimbongo.

Twelve Congolese soldiers killed in clashes this week in Ebola-hit east

Via Reuters: Twelve Congolese soldiers killed in clashes this week in Ebola-hit east.

Twelve Congolese soldiers were killed alongside seven U.N peacekeepers in clashes with militias on Wednesday in Democratic Republic of Congo’s Ebola-hit east, government spokesman Lambert Mende said. 

The casualties, incurred during a joint operation against the Ugandan Islamist group Allied Democratic Forces (ADF), make this week one of the deadliest for troops in Congo’s volatile eastern borderlands since a rebel attack in early 2018.

And that is why the local media pay more attention to the ongoing violence than to Ebola: the violence has killed far more people.

MSF expands care as Ebola outbreak spreads in DRC

Via MSF.org: MSF expands care as Ebola outbreak spreads in DRC. Excerpt:

In response to the worst Ebola outbreak ever recorded in Democratic Republic of Congo (DRC), Doctors Without Borders (Médecins Sans Frontières) is stepping up efforts to contain the epidemic.  

Just over three months since the declaration of the latest Ebola epidemic centered in North Kivu, DRC, the intervention still faces serious challenges. To date, 341 suspected Ebola cases have been identified, of which 303 have been confirmed.  

The epicenter of the Ebola outbreak has moved from the small town of Mangina to the larger city of Beni, where the number of new suspected and confirmed Ebola patients has risen steadily for weeks. MSF teams are increasingly busy with tracing suspected cases, as the epidemic has reached a new level. As many as 30 new suspected cases are identified every day and admitted to the Ebola treatment center in Beni. 

MSF has opened a new transit center in Beni in response to the growing needs. “The objective of this transit center is to boost the overall capacity for patient care in Beni. Since the city became the new focus of the outbreak in October, new confirmed cases have been frequently appearing in several neighborhoods,” says Marie Burton, MSF project coordinator.  

The new MSF transit center was built very close to an existing Ebola treatment center (ETC) that was operating at capacity. The proximity of the two facilities is intended to bring the various components of the Ebola response in Beni closer together. The MSF facility was built on a former football field measuring 8,000 square meters and required a week’s worth of fast-paced construction work.  

Suspected Ebola patients will be admitted to the MSF transit center pending confirmation of their laboratory analyses. MSF medical staff will provide immediate care according to a person’s clinical status; once the diagnosis is confirmed, patients who test positive for Ebola will be transferred to the nearby ETC while those who test negative will be transferred to other health facilities where further care will be provided. Until recently, both confirmed and suspected cases were admitted to the ETC, although the two wards were isolated.  

In the new MSF transit center, individual rooms were constructed to improve patient isolation. Partitions were fitted with large plexiglass windows to enable medical staff to more closely monitor patients, as well as make it easier for patients to see visiting family members and loved ones. The center’s initial capacity of 16 beds can be increased to 32, or up to 48 if needed.  

Since August 1 the Ebola virus has killed 215 people in DRC. More than 100 patients have been able to recover so far. Active conflict and insecurity in the affected areas are making it difficult for health workers to reach the local community.  MSF is working alongside several organizations to help contain the epidemic.  

“Since the [epicenter] of the epidemic moved from Mangina to Beni, the outbreak has become harder to control. We now observe an increasing number of new cases further south, in the even bigger city of Butembo. We fear the situation might become even harder to manage, unless the response in this area is significantly strengthened,” says Gwenola Seroux, emergency cell manager for MSF.

Eight more found dead; Camp Fire death toll rises to 71

Via kcra.com: 8 more found dead; Camp Fire death toll rises to 71. Excerpt:

At least 71 people have been killed in a wildfire burning in Butte County, officials said Friday. 

Butte County Sheriff Kory Honea said the bodies of eight people were found since Thursday evening. Of those, seven people were found in Paradise and one person was found in Magalia. 

The Camp Fire is the deadliest and most destructive wildfire in California history. 

The fire had charred 146,000 acres and was 50 percent contained as of Friday evening, Cal Fire said. The blaze ignited around 6:30 a.m. on Nov. 8 in the Camp Creek Road area near Highway 70 in the Feather River Canyon. 

At least 12,263 structures have been destroyed, including 9,844 homes, Cal Fire said. About 15,500 structures are still threatened by the blaze.  

Cal Fire said 47,200 people were forced to evacuate their homes and 1,164 are in evacuation shelters. 

 Those impacted by the Camp Fire are urged to sign up for FEMA disaster assistance online or to call 1-800-621-3362.  

More than 5,600 fire personnel from across the state and nation are battling the blaze. 

There are 1,011 people listed as missing or unaccounted for, Honea said. The Butte County Sheriff's Office is posting a list of the missing people's names. Honea said the list could contain duplicate names and the number of people missing is dynamic.

Looking for Brazilian public health resources

Since the end of the yellow fever outbreak, I've lost touch with many of my Brazilian sources of health news. Now, with the impending inauguration of Jair Bolsonaro on January 1, such sources will be increasingly important. 

A quick search for Brazilian health bloggers has turned up very few active blogs, and I doubt the Ministry of Health website and blog will be very helpful. I'm also aware that Brazilian bloggers on political topics sometimes get shot—and I have no desire to see that happen to anyone else.

Still, if you know of any individuals, groups, or agencies that are familiar with Brazil's public health issues, working online in or out of the country, I'd be grateful for the links.

 

CIDRAP: Armed rebels kill UN peacekeepers in Ebola hot spot

Via CIDRAP, Lisa Schnirring writes: Armed rebels kill UN peacekeepers in Ebola hot spot. Excerpt:

A joint operation yesterday against armed rebels near the Democratic Republic of the Congo (DRC) Ebola hot spot in Beni killed seven United Nations peacekeepers, as officials confirmed one more infection in the outbreak. 

Action targeted ADF stronghold 

The action against the armed rebels, who have been responsible for several attacks against civilians in Beni that have stymied response activities, involved the UN mission known as MONUSCO and government armed forces. Their target was the Allied Democratic Forces (ADF). 

Forces killed in the clash included one Tanzanian and six Malawian "blue helmets," or UN soldiers, according to a UN report. Ten other peacekeepers were wounded, and another is missing. Several government soldiers and an unknown number of ADF fighters were also killed or wounded.  

According to a New York Times report, the joint forces came under attack while trying to remove rebel fighters from a stronghold in Kididiwe near Beni. UN officials speaking anonymously told the Times that the mission was successful, and a number of rebels were taken. 

In a statement, UN Secretary-General Antonio Guterres condemned the killing of the UN peacekeepers and called on armed groups to disarm and stop their destabilizing activities, which hurt the local population and complicate the Ebola outbreak response. 

He also urged the DRC's government to keep taking steps to apprehend those responsible for attacks on civilians, government forces, and UN peacekeeping troops. 

Beni has been the scene of several violent attacks since the Ebola outbreak began in August, including one in September that resulted in a public mourning period that temporarily halted response operations.  

The joint mission push against the ADF forces in the area comes a week after a high-level visit by UN and World Health Organization (WHO) officials to address the security problems, which have been fueled by the DRC's longstanding failure to protect citizens against armed groups in the eastern part of the country. 

One confirmed case, more probable illnesses 

Meanwhile, the DRC's health ministry today reported one new case, which involves a patient from Katwa. Officials have been cleaning up their case database, which has resulted in the addition of seven probable cases in Kalunguta. 

The new developments bring the outbreak total to 352 cases, 305 of them confirmed and 47 listed as probable. One more death was reported, which involves a person from Katwa, lifting the fatality count to 210.

EBOLA DRC - Evolution of the response to the Ebola outbreak in North Kivu and Ituri at Friday, November 16, 2018

The Ministry of Health has published EBOLA DRC - Evolution of the response to the Ebola outbreak in the provinces of North Kivu and Ituri at Friday, November 16, 2018. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Friday, November 16, 2018   

The epidemiological situation of the Ebola Virus Disease dated November 15, 2018:   

• Since the beginning of the epidemic, the cumulative number of cases is 352, of which 305 confirmed and 47 probable. In total, there were 210 deaths (163 confirmed and 47 probable). 

• 90 suspected cases under investigation.  

• 1 new case confirmed in Katwa.  

• 1 new case death confirmed in Katwa.     

• 1 new person healed in Beni. 

/! \ Cleaning the current database 

• An additional 7 probable cases have been validated in Kalunguta. 

Remarks: 

To avoid that the total number of cases varies (up or down) daily, the suspect cases have been placed in a separate category. Thus, suspect cases with positive laboratory tests will be added to the confirmed category, while negative ones (non-cases) will be removed from the table. 

• The category of probable cases includes all reported deaths for which it was not possible to obtain biological samples for laboratory confirmation. The investigations will determine whether these deaths are related to the epidemic or not. 

• A community death is a death in the community, outside of a licensed health center. 

News of the response 

The National Association of Ebola Winners (ANVE) 

• The local committee of the ANVE of Beni was installed this Thursday, November 15, 2018. Two doctors having cured of Ebola were elected President and Vice-President of the cell of Beni by the other members.  

Vaccination 

• Closure of targeted geographic vaccination in Kanihunga Village, Kalunguta Health Zone. Targeted geographic vaccination, which is wider than conventional belt vaccination, consists of vaccinating several houses, or even a whole village or district, around a confirmed case when the security conditions do not permit the necessary investigations to be made to establish the list of contact.  

• Since the beginning of vaccination on August 8, 2018, 31,224  people have been vaccinated , including 15,729 in Beni, 4,544 in Mabalako, 3,062 in Katwa, 1,663 in Mandima, 1,615 in Butembo, 1,602 in Kalunguta, 732 in Masereka, 434 in Bunia, 355 to Tchomia, 293 to Vuhovi, 292 to Mutwanga, 241 to Kyondo, 240 to Komanda, 210 to Musienene, 178 to Oicha, and 34 to Alimbongo.