H5N1

BUTEMBO: Two Ebola CTEs burned in the space of four days—complicity or negligence?

Via Radio Moto Butembo-Beni: BUTEMBO: Two CTEs burned in the space of four days--complicity or negligence? The Google translation:

In connection with this mission of the National Minister of Health, the Mayor of Butembo explained the incident of Wednesday, February 27, 2019. A question of complicity or negligence? The question was put to master MBUSA KANYAMANDA Sylvain. In response, the urban authority argues that the threat was strong.  

MBUSA KANYAMANDA Sylvain talks about terrorist actions by attackers who targeted this site while the city was calm. The mayor of Butembo indicates that the perpetrators of the fire have links with militiamen. However, the mayor of Butembo welcomes the fact that the police have displayed resistance that has allowed some patients to escape.  

"It's not a small question that will have to be overlooked. There was still resistance. Our elements did something. They protected the generators, they also protected the sites of care of the patients. The patients escaped from this center there to avoid having shots. There are those who are beginning to identify themselves, they are beginning to call coordination. They are civilians supervised with May-May. Because if they were civilians, they would not have guns. There are even those who have bulletproof vests," said the mayor. 

According to him, the attackers, some of whom will be arrested soon, are high-risk people, since they would have reached dangerous sites in CTE Butembo. About the fate of the sick, the latter were transferred to the transit center of Katwa pending the reconstruction work that begins this Friday, promises the mayor. 

No organization has yet made official mention of its withdrawal  

With regard to the announced withdrawal of Médecins Sans Frontières experts who co-managed the Ebola treatment centers in Butembo, the mayor replied that no organization has yet made any official mention of its withdrawal.  

"The partners are here. There are some who have done 1 month, 2 months, 6 months. There are some who cannot handle stress related to these attacks. For them, you can not deny them the right to rest, to be able to reconstitute themselves. But no one has yet declared the departure, because those who are gone, it is surely for a small leave pending that they reconstitute themselves and return. On site, their office remains functional " he said.  

As a reminder, CTE Butembo was attacked on Wednesday night at ITAV Butembo. The mayor deplores the death of a police officer during the exchange of fire that took place between law enforcement officials and attackers.

DRC: Police officer killed in attack on Ebola treatment center in Butembo

Via Actualite.cd: DRC: Police officer killed in attack on Ebola treatment center in Butembo. The Google translation:

A police officer was killed on Wednesday, February 28, in the evening, during an attack by gunmen on another Ebola treatment center (ETC) in Butembo town. The attackers set fire to the center, which housed some 30 patients, police said.  

Colonel Richard Mbambi, commander of the police in Butembo, indicates that the policeman killed was committed to the protection of the CTE, erected in the concession of the Institute of agricultural and veterinary techniques (ITAV), Lumumba district, in the commune of Kimemi, and assigned to the organization Doctors Without Borders (MSF). 

"This is an indicator to answer those who falsely accuse the authorities of not having taken measures to protect the ETCs. We have lost a valiant policeman, among the members of the section affected there. Our investigations are continuing to identify perpetrators whose identity remains unclear," said Colonel Richard Bambi. 

Police authorities attribute the attack to militia Mai-Mai Mazembe. They also report several material damage, namely a vehicle, seven motorcycles and a generator set on fire.  

Another CTE, erected in the concession of the Protestant community in Kirimavolo, Katwa district, in the municipality of Mususa, and managed by the NGO Médecins Sans Frontières (MSF), was burned three days ago by Mai Mai militiamen, according to the authorities of Butembo.

DRC: MSF suspends medical activities after Ebola Treatment Center attack

Via Doctors Without Borders USA: DRC: MSF suspends medical activities after Ebola Treatment Center attack.

NEW YORK/BUTEMBO, FEBRUARY 28, 2019—The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) has put on stand-by its medical activities in the epicenter of the Ebola epidemic in the Democratic Republic of the Congo (DRC), following an attack on an Ebola Treatment Center (ETC) in Butembo on February 27. 

Unidentified assailants set some of the compound’s facilities and vehicles on fire. The blazes were contained and no staff or patients were harmed, but the teams were forced to immediately cease patient care. At the time of the attack, there were 57 patients admitted in the ETC—which was run alongside the Ministry of Health—including 15 who were confirmed to have Ebola. All patients still in the ETC were transferred to a transit center.  

This incident comes only days after another Ebola treatment facility—also supported by MSF teams in the neighboring district of Katwa—was attacked on February 24, also forcing its suspension. MSF has evacuated staff from the area for their safety pending a thorough analysis of the risks associated with continuing to provide medical care there.  

“We are extremely saddened by these attacks on our medical facilities. Not only did they endanger the lives of our staff members, but they also endangered the most vulnerable people at the heart of our response: the patients,” said MSF Emergency Desk Manager Hugues Robert. 

“In light of these two violent incidents, we have no choice but to suspend our activities until further notice. As medical responders, it is very painful to have to leave behind patients, their families, and other members of the community at such a critical time in the Ebola response.” 

Both attacks were traumatic for patients, relatives, and staff who were inside the centers at the time. In the Katwa attack, the caretaker of one patient died, reportedly when he tried to flee.  

Almost seven months after the beginning of the current Ebola outbreak in the provinces of North-Kivu and Ituri, there have been 879 confirmed cases of Ebola and 553 people have died.  

In North Kivu—in addition to the treatment centers in Butembo and Katwa—MSF manages Ebola-related activities in the towns of Kayna and Lubéru. MSF has also been supporting emergency preparedness in the city of Goma by reinforcing the surveillance system and ensuring there is adequate capacity to isolate suspected cases. In Ituri province, MSF runs two Ebola isolation facilities in the towns of Bwanasura and Bunia.

Ebola DRC - Evolution of the response to the Ebola epidemic on Thursday February 28 2019

The Ministry of Health has published Ebola DRC - Evolution of the response to the Ebola epidemic on Thursday February 28 2019. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Thursday, February 28, 2019   

The epidemiological situation of the Ebola Virus Disease  dated February 27, 2019:   

• Since the beginning of the epidemic, the cumulative number of cases is 885, of which 820 are confirmed and 65 are probable. In total, there were 555 deaths (490 confirmed and 65 probable). 

• 227 suspected cases under investigation; 

• 6 new confirmed cases, including 5 in Katwa and 1 in Kalunguta;  

º The new case confirmed in Kalunguta is a known contact of a confirmed case of Katwa who had refused follow-up and vaccination.  

• 2 new confirmed cases, including 1 in Katwa and 1 in Kalunguta (all community deaths);  

• 1 new person healed out of CTE de Beni. 

/! \  Cleaning databases in progress: Revision of the database of people cured. We will start sharing the number of cures as soon as the revision is complete. 

News of the response      

Minister's visit to Butembo 

• On Thursday, February 28, 2019, the Minister of Health, Dr. Oly Ilunga Kalenga, accompanied by the Representative of the WHO in the DRC, went to Butembo to inquire about the situation on the ground following the two arson that destroyed Ebola Treatment Centers in Katwa and Butembo.  

• These two incidents greatly disrupted the response teams. For several days, these teams have been the target of attacks and threats that have significantly slowed down the response activities, particularly the follow-up of contacts, the investigation of alerts, the vaccination of contacts, and the prevention and control activities. infections (PCI). Thus, it will be expected a significant upsurge of cases in health areas of Katwa and Butembo in the coming days. The Minister met with members of the sub-coordination and field teams to reassure them of the full support of the Ministry of Health.   

• With the mayor of the city and the coordinator of the Butembo sub-coordination, the Minister visited the sites of the two burned CTEs. The Minister urged the Mayor of Butembo that it will be impossible to control the epidemic in the city until the security of the agents of the response is assured.  

Vaccination  

• Since the beginning of vaccination on 8 August 2018, 84,361 persons have been vaccinated , including 21,662 in Katwa, 20,703 in Beni, 10,512 in Butembo, 6,109 in Mabalako, 2,839 in Kalunguta, 2,604 in Goma, 2,317 in Komanda, 2,084 in Oicha, 1,813 to Mandima, 1,357 to Karisimbi, 1,325 to Kyondo, 1,283 to Kayina, 1,094 to Bunia, 1,064 to Vuhovi, 920 to Masereka, 772 to Mutwanga, 769 to Lubero, 767 to Biena, 620 to Rutshuru, 583 to Musienene, 527 in Nyankunde, 496 in Mangurujipa, 426 in Rwampara (Ituri), 355 in Tchomia, 333 in Lolwa, 280 in Mambasa, 254 in Alimbongo, 207 in Kirotshe, 161 in Nyiragongo, 97 in Watsa (Haut-Uélé) and 13 in Kisangani.  

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

WHO expresses concern over damage to Ebola treatment facilities in the Democratic Republic of the Congo

A WHO AFRO news release: WHO expresses concern over damage to Ebola treatment facilities in the Democratic Republic of the Congo. 

BRAZZAVILLE/28 February 2019 –The World Health Organization (WHO) is deeply concerned about the recent attacks on the Médecins Sans Frontières (MSF)-run Ebola treatment centres on 24 February in Katwa and on 27 February in Butembo in the Democratic Republic of the Congo. Such attacks are deplorable for their immediate impact on lives and for the risk of spreading the disease further. They are profoundly disrespectful of the dedicated work of local, regional and international responders.  

Following the most recent Butembo attack, WHO and partners are working to ensure the safety of the patients and staff. Patients have been transferred to the Katwa transit centre, which WHO is expanding to house and treat these additional patients. It is a priority of the response to ensure quality clinical care for the patients. Staff on the ground are also working to follow up with the four convalescent patients who sought shelter elsewhere during the violence.  

MSF reported that their staff were safe. Likewise, WHO staff in the area are all accounted for. However, security services did experience casualties. 

These attacks have occurred in areas with ongoing transmission of Ebola in the community and could lead to increases in transmission and result in more hardship for the local community. The violence and disruption to the treatment centres also make it difficult for Ebola responders to carry out field work. 

WHO teams on the ground continue to work tirelessly to respond to the challenges. WHO is working closely with our partners to determine appropriate action to ensure the overall Ebola response is maintained. Working with the Ministry of Health and our partners, our priority continues to be to end the outbreak.

Co-circulation of influenza A(H1N1)pdm09 and influenza A(H3N2) viruses, WHO European Region, October 2018 to February 2019

Eurosurveillance has published Co-circulation of influenza A(H1N1)pdm09 and influenza A(H3N2) viruses, World Health Organization (WHO) European Region, October 2018 to February 2019. The abstract:

In the World Health Organization European Region, the 2018/19 influenza season started in week 49 2018, crossing 10% virus-positivity in sentinel surveillance specimens. At week 5 2019, activity remained elevated with positivity rates at 55%. Both A(H1N1)pdm09 and A(H3N2) viruses circulated widely and detection levels in primary care and hospital settings were similar to past seasons. Hospitalisation data may suggest an increased susceptibility to A(H1N1)pdm09 virus in older age groups.

Butembo: Gunmen attack Ebola treatment center and kill guard

Via Radio Okapi: Butembo: Gunmen attack Ebola treatment center and kill guard. The Google translation:

Unidentified gunmen attacked the Ebola treatment center in Butembo town on Wednesday night and killed one of the policemen in charge of the center, the mayor said. All patients found, as well as the nursing staff are safe and sound, says Sylvain Kanyamanda. 

A statement from the Ministry of Health indicates that at the time of the attack, 38 suspected patients and 12 confirmed Ebola patients were being treated in the center. 

Of the suspected patients, 32 fled. Eight patients among the confirmed cases were found in their single rooms.  

The Ministry of Health is continuing research to find the other 4 confirmed Ebola patients on the run. For the moment, the patients have been provisionally transferred to the Butembo transit center. 

The Ebola treatment center in Butembo was attacked around 18:00 local time, three days after another community center in the Katwa district burned down.  

The security sources attribute these two attacks to a group of militiamen Mai Mai hitherto unidentified.   

Negative impact on the response  

"There are a lot of misconceptions, there are a lot of amalgams that have been made, pastors and healers who are involved and who claim to cure Ebola, you have to know that there is no pastor who can cure Ebola," said the minister, during a meeting to evaluate the response to Goma, from 26 to 27 February, before declaring that Ebola is a deadly, highly contagious disease that is far more dangerous than security problems. 

According to Oly Ilunga, in six months there have been more than 500 Ebola deaths.

Arsonists attack Ebola clinics in DRC as climate of distrust grows

Via The Guardian: Arsonists attack Ebola clinics in DRC as climate of distrust grows. Excerpt:

A second clinic serving patients affected by the escalating Ebola outbreak in the Democratic Republic of Congo has been set alight, as concerns mount over widespread distrust of health agencies. 

Seven months since the start of the outbreak, which has claimed 548 lives, experts warned that the virus is still not under control and said suspicion of agencies is severely undermining Ebola services. 

Médecins Sans Frontières, which runs treatment centres in Katwa and Butembo that were attacked, and is one of the agencies leading the wider Ebola response, said key partners needed to reconsider their approach. 

“Within the response, and ourselves, MSF, we need to think what more we could have done, because right now it’s clear that we do not have enough trust within the community,” said Pierre Van Heddegem, project coordinator of the Ebola response in Katwa, adding that all agencies needed to engage in greater consultation with communities.  

“In some neighbourhoods, you have to go back to square one, sit down, listen to people and not impose our views of how it [the response] should be organised,” said Van Heddegem. 

An Ebola treatment centre in Butembo, North Kivu province, was torched on Wednesday, the second attack on a clinic in a week. MSF was earlier forced to close one of its treatment centres in Katwa, also in North Kivu province, after it was attacked on Sunday night. Assailants threw stones at the centre before setting parts of the structure on fire. The brother of a patient died while reportedly trying to escape the scene, MSF said, though the exact circumstances of his death remain unclear. Medical wards and equipment were destroyed. 

On Tuesday, Tedros Adhanom Ghebreyesus, the World Health Organization’s director general, described the outbreak as unprecedented. “There has never been an Ebola outbreak in these conditions, with such a highly mobile population and with many gaps in the health system,” he said. 

Efforts to contain the outbreak have also been hampered by conflict and political instability. Suspicion and rumours – including that Ebola is not real, or that it is being used for financial gain – are also rife. 

Already health workers lack access to affected communities, and there are fears the outbreak could spread to more volatile areas. There are concerns that the use of police escorts in the Ebola response has worsened the situation for agencies who do not employ such protection, and added to fear among communities. 

“How can you work without escorts in a place where other activities are held with escorts? Then you put yourself in an extremely difficult position, and that comes from this militarisation of the response,” said Heddegem.

WHO: Ebola virus disease – Democratic Republic of the Congo

WHO has published Ebola virus disease – Democratic Republic of the Congo. Excerpt:

The Ebola virus disease (EVD) outbreak is continuing with moderate intensity. Katwa and Butembo remain the major health zones of concern, while simultaneously, small clusters continue to occur in various geographically dispersed locations. During the last 21 days (6 – 26 February 2019), 77 new cases have been reported from 33 health areas within nine health zones (Figure 1), including: Katwa (45), Butembo (19), Vuhovi (4), Kyondo (3), Kalunguta (2), Oicha (1), Beni (1), Mandima (1), and Rwampara (1).  

Although there are decreasing trends in case incidence (Figure 2), the high proportion of community deaths reported among confirmed cases and relatively low number of new cases who were known contacts under surveillance could increase the risk of further chains of transmission in affected communities. Response teams must maintain a high degree of vigilance across all areas with declining case incidence and contact tracing activity, as well as in areas with active cases, to rapidly detect new cases and prevent onward transmission. 

Following attacks this week on the treatment centres in Katwa and Butembo, WHO is working with partners to ensure the safety of the patients and staff. These incidents are disruptive to the response on many levels and can also hamper surveillance activities in the field. 

As of 26 February, 879 EVD cases (814 confirmed and 65 probable) have been reported, of which 57% (499) were female and 30% (264) were children aged less than 18 years. Cumulatively, cases have been reported from 119 of 301 health areas across 19 health zones. Overall, 553 deaths (case fatality ratio: 63%) have been reported and as of 19 February 2019, 257 survivors have been reported. There is ongoing cleaning of the case database to correct the number deaths and survivors discharged from Ebola Treatment Centres (ETCs).

DR Congo Ebola center set on fire after armed attack

Via Reuters: Congo Ebola center set on fire after armed attack. Excerpt and then a comment:

GOMA, Democratic Republic of Congo (Reuters) - Armed assailants attacked an Ebola treatment center in eastern Democratic Republic of Congo on Wednesday, setting off a fire and becoming embroiled in an extended gunbattle with security forces, health officials said.  

The identity and motive of the assailants were unclear. Aid workers have faced mistrust in some areas as they work to contain an Ebola outbreak.

Dozens of armed militias also regularly attack civilians and security forces in eastern Congo’s borderlands with Uganda and Rwanda, which has significantly hampered the response to the disease. 

The health ministry said in a statement that 38 suspected Ebola patients and 12 confirmed cases were in the center at the time of the attack. Four of the patients with confirmed cases fled and are being looked for, it said.  

None of the patients who have been accounted for were injured, nor were any staff members, the ministry added.   

French medical charity Medecins Sans Frontieres (MSF), which runs the center together with the ministry, condemned the “deplorable attack” and said its efforts were focused on the immediate safety of patients and staff.  

The attack in the city of Butembo was the second in Congo’s Ebola-hit east this week. On Sunday unidentified assailants set fire to a treatment center in the nearby town of Katwa, killing a nurse.

Two incidents like these imply a third within days. WHO is going to have to get a grip on itself and declare a Public Health Emergency of International Concern. Kinshasa's longstanding ineptitude in the northeast DRC shows it can't control the armed crazies of the Mai-Mai, ADF, and other lost souls in the region. Without serious military control of the crazies, Ebola will eventually spread across the DRC border. 

At that point, WHO's current polite request for $148 million will look like asking for spare change.