H5N1

Ebola DRC - Evolution of the response to the Ebola epidemic in North Kivu and Ituri on February 27 2019

 

First, apologies for being so silent on a very bad day for Ebola; Canada today is undergoing a Watergate-level political crisis that could see the government fall, or Prime Minister Justin Trudeau replaced.

 

The Ministry of Health has published Ebola DRC - Evolution of the response to the Ebola epidemic in North Kivu and Ituri on February 27 2019. The attack on Butembo's ETC is a disaster. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Wednesday, February 27, 2019   

The epidemiological situation of the Ebola Virus Disease  dated February 26, 2019:   

• Since the beginning of the epidemic, the cumulative number of cases is 879, of which 814 are confirmed and 65 are probable. In total, there were 553 deaths (488 confirmed and 65 probable). 

• 229 suspected cases under investigation; 

• 4 new confirmed cases, including 3 in Katwa and 1 in Butembo;  

2 new confirmed deaths, 1 in Katwa and 1 in Butembo, all are community deaths. 

/! \  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     

Attack on Butembo Ebola Treatment Center 

• On the evening of Wednesday, February 27, 2019, unidentified gunmen attacked the Butembo CTE co-managed by Médecins Sans Frontières and the Ministry of Health. This attack took place only three days after the arson attack of the Katwa CTE, the neighboring health zone.  

• At the time of the attack, 38 suspected patients and 12 confirmed patients were treated at the CTE. Of the suspected patients, 32 fled. And among the confirmed cases, 8 were found in their single rooms. Research is underway to find the 4 confirmed fugitives. All the patients found, as well as the medical staff, are safe and unharmed. The patients were temporarily transferred to the Butembo Transit Center operationalized by Alima.  

Workshop on the implementation of the 3rd  Strategic Plan Response 

• On Tuesday, February 26, 2019, the Minister of Health, Dr Oly Ilunga Kalenga, opened in Goma, the workshop on the implementation of the third strategic plan for response to the Ebola epidemic (SRP 3) in provinces of North Kivu and Ituri. This workshop brought together all the national and international actors of the response, including all the health authorities of the different health zones of the region.  

• The purpose of the two-day workshop was to explain the PSR 3 to all local health authorities, senior staff of strategic coordination and sub-coordination as well as to gain ownership of the plan to ensure better Implementation.  

• This new plan focuses on three important areas: 

1. The anchoring of the response in the local health system: The leadership and the expertise of the response belong to the specialized teams while the optimization of the functioning of the health system is the responsibility of the actors of the local health system (Provincial Division of Health). Health, Health Zone and Health Area).  

2. Establishment of an information management system: The information management mechanism has been strengthened to improve data collection and analysis at all levels. 

3. The importance of accountability: An important addition in SRP 3 is the accountability framework for each stakeholder involved in the response, both local providers and international partners. This accountability framework clearly identifies the roles and responsibilities of each organization in the response to assess their performance on the ground.   

Vaccination  

• Since the beginning of vaccination on 8 August 2018, 84,094 persons have been vaccinated , including 21,504 in Katwa, 20,679 in Beni, 10,486 in Butembo, 6,109 in Mabalako, 2,839 in Kalunguta, 2,590 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, 590 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.

North Korea’s silent health crisis

As Kim and Trump meet in Vietnam (a situation unthinkable three years ago), IRIN reports on North Korea’s silent health crisis. Excerpt:

North Korea is frequently portrayed as an unknowable, impenetrable land. However, a substantial amount of data on health indicators is readily available. While it must be treated with caution – malnutrition figures, for example, don’t include political prisoners languishing in camps – the data can be useful for showing longer-term trends.  

When it comes to the effects of malnutrition, the data shows an improvement in the two decades since the famine ended – but also clear indications of a continuing problem. In 1998, a UNICEF survey found evidence of child stunting – when a child’s height falls considerably below what would be expected at that age. About 62 percent of children younger than seven years of age showed stunted growth, while 60 percent were considered underweight. In 2017, UNICEF’s Multiple Indicator Cluster Survey – drawn from household survey data – reported that roughly 19 percent of children were stunted, while about 9.3 percent were underweight.  

This is clearly an improvement. But one in five children are still considered stunted. The children in the 1998 survey are now in their 20s, many likely with children of their own. Today, the World Food Programme estimates that 10.9 million people are undernourished – about 43 percent of the population. And undernourishment is a common denominator for many of the health problems afflicting North Koreans.  

Undernourishment in pregnant women 

Indicators gauging maternal health in North Korea vary widely. The maternal mortality ratio estimates the proportion of women who die during pregnancy – essentially the risk associated with pregnancy in a given country. World Bank data suggests the maternal mortality ratio in North Korea has fallen steadily since a peak in 1999. However, data from North Korea’s own Central Bureau of Statistics says the maternal mortality ratio has fluctuated and even risen in recent years: from 72 per 100,000 live births, to 62.7 in 2014, then a notable jump to 82 in 2015. 

Even using the World Bank’s more optimistic figures, North Korea’s maternal mortality ratio still hasn’t reached pre-famine levels – estimated at 56 deaths per 100,000 live births in 1992. And it’s still far off the mark set by South Korea, where the ratio is 11.  

Current indicators suggest cause for concern. According to UNICEF, nearly one in three women of reproductive age are undernourished, and nearly one in four are underweight. And the UN agency says it couldn’t distribute nutritional supplements to 95 percent of pregnant and lactating women during a nationwide child health campaign last year, due to funding shortfalls. 

Tuberculosis trouble ahead 

There is a funding crisis for tuberculosis treatment in North Korea, and the disease may be killing people at an increasing rate. World Health Organisation estimates for tuberculosis deaths in North Korea are on the rise: from a low of 42 deaths per 100,000 people in 2015, to 63 in 2017. 

The Global Fund – the donor agency financing treatment for HIV, tuberculosis, and malaria around the world – pulled funding for tuberculosis and malaria programmes last year citing oversight concerns in North Korea’s ”unique operating environment”. The decision was met with worried opinion pieces, open letters, and pleas of concern from the medical community.

With the impact of sanctions and the Global Fund’s withdrawal, there are fears this upward trend may continue. In an open letter published in the British medical journal The Lancet, the director of the Korean American Medical Association, which works on tuberculosis treatment programmes in North Korea, warned that medicine rationing triggered by drugs shortages could fuel the ”rapid creation of drug-resistant TB strains”.

Canada: Mandatory vaccine reporting could be in place for September, BC health minister says

Via CBC News: Mandatory vaccine reporting could be in place for September, B.C. health minister says. Excerpt:

It could become mandatory for parents to report their child's vaccination status in time for the start of the new school year in September, according to B.C.'s health minister. 

"That's our goal," Adrian Dix told reporters on Tuesday.  

Mandatory reporting of vaccinations would help public health officials assess the scope of immunization and respond to outbreaks more effectively.  

The model was recommended in 2014 by then B.C. Chief Medical Health Officer Dr. Perry Kendall, after 343 measles cases were reported in B.C.

Dix said the model has been under consideration since then and would be more effective than mandatory immunizations.   

"That we don't try to litigate these questions in the courts or make children the sort of middle of fights between authorities and parents, but that we take actions that are going to raise immunization rates which are really important for everybody — but are especially important for children who themselves can't be immunized for medical reasons," he said.  

Dix said he's also considering an expansion of mobile vaccination clinics to make it more convenient for people to get immunized. 

14% of B.C. children not immunized 

More than a dozen cases of the measles have been confirmed in the Lower Mainland in recent weeks, after a family whose children were not vaccinated travelled to Vietnam. 

In B.C., 14 per cent of children haven't been immunized against measles.

BUTEMBO: Mayor pledges double efforts to secure Ebola Treatment Centers

Via Radio Moto Butembo-Beni: BUTEMBO: Mayor pledges double efforts to secure Ebola Treatment Centers. The Google translation:

Master MBUSA KANYAMANDA Sylvain said this Tuesday, February 26, 2019 to the local press. The Mayor of Butembo says the Security Council has taken this step to provide double efforts for securing Ebola Treatment Centers to prevent what happened on Sunday February 24 in his city from happening again.  

Coming back to Sunday's incident, the city authority mentions that the attackers have infiltrated CTE sites that expose to contamination. 

"We first had to cut the light so that we would be in the dark so that they could commit their crime without difficulty. After that, they had time to go to the shelter that served as the morgue. It is a space yet high risk and which no one can access without being protected. But they still did not consider this precautionary measure. They accessed it and set it on fire. 

"And this is where we regret that even where they went, they must be aware that they are already high-risk suspects ," worries the mayor, who adds: "The population will help us to find them to not only stop them, but first treat them to protect them from contamination and the spread of this epidemic."  

As a reminder, the Ebola Treatment Center of Katwa-KIRIMAVOLO was burned the night of Sunday 24 to Monday 25 February by strangers. The logistics of this center has been reduced to ash, motorcycles and a jeep burnt. A patient sick with the EBOLA virus disease was found dead in the river after trying to save himself from the fire.

Lubero Health Zone: A new health zone enters the Ebola epidemic

Google Maps

Via Radio Moto Butembo-Beni: Lubero Health Zone: A new health entity enters the Ebola epidemic. The Google translation: 

The health zone of Lubero is the new health entity that is entering the Ebola epidemic. Confirmation made Monday, February 25 by the doctor Chief of the health zone. A confirmed case of Ebola has indeed died at the reference general hospital of Lubero. The response teams are deployed on site to stop the threat.  

The first action by the WHO team and MSF presented at the Lubero General Referral Hospital is the dignified and secure burial of the confirmed case of death. The funeral took place on the evening of Saturday, February 23, 2019 in Ngeleza, East of Lubero-Center. On Sunday, the team of health professionals proceeded to identify the first contacts of the victim. According to medical sources, at least 86 contacts were identified this Monday, February 25. These first contacts of which the nursing members and the family members of the deceased began the vaccination, inform our sources. 

For the moment, the sensitization sessions are started in Lubero-Center and all over the health zone. The Lubero health area is the 6 th area affected by Ebola in the territory of Lubero.

Ebola: 'If the epidemic continues, it means that there are still gaps in the response'

Via Radio Okapi: Ebola: "If the epidemic continues, it means that there are still gaps in the response" (Oly Ilunga). The Google translation:

Fifty actors involved in the response to the Ebola virus disease since Tuesday reflect in Goma on the third plan to respond to this disease. The goal: to refocus the response strategy against the Ebola virus disease that has raged in North Kivu and Ituri for six months.   

"If the epidemic lasts, it simply means that in the implementation there are still gaps, so we must continue to track down these gaps," Health Minister Oly Ilunga said Tuesday in Goma at the opening of the meeting of the actors who fight against Ebola.  

Minister Ilunga believes that these shortcomings are not always related to the actors on the ground but also to the environment, the context. He called on speakers to circumvent these various difficulties and do their utmost to break the chain of transmission of the virus.    

Despite these difficulties, a significant reduction in transmission is observed in the initial outbreaks of the virus, particularly in Beni.

Canada: Anti-vaccine group launches billboard campaign in Toronto and surrounding area

Via The Globe and Mail: Anti-vaccine group launches billboard campaign in Toronto and surrounding area. Excerpt:

An anti-vaccine group has placed dozens of billboards in the Greater Toronto Area suggesting vaccines are risky and that children don’t need immunizations to attend school, a sign of the challenge facing public-health officials at a time when cases of measles are on the rise. 

The group, Vaccine Choice Canada, has four different images rotating on 50 digital billboards in Toronto and the surrounding area, according to the Facebook page of Ted Kuntz, the group’s vice-president. The billboards are in a number of locations around the city, including outside of Toronto’s Eaton Centre. Mr. Kuntz wrote that the advertising campaign, which began last week, will run for two weeks and will generate at least two million impressions. In the Facebook post, Mr. Kuntz thanked numerous donors who made the billboard campaign possible.  

Vinita Dubey, associate medical officer of health with Toronto Public Health, said the campaign is concerning and should prompt a discussion about banning advertisements that promote false or misleading messages. 

“There is legislation available to prevent tobacco companies from advertising,” Dr. Dubey said. “There is some precedent for being more legislative and proactive about messaging." 

The World Health Organization has declared vaccine hesitancy, or the refusal or reluctance to be vaccinated, as a top health threat in 2019. B.C. is dealing with a measles outbreak that has so far infected 13 people. Around the world, measles cases and deaths are on the rise and in many countries, it’s linked to falling vaccination rates.  

Dr. Dubey said the billboards use “half-truths” to lure people in. 

“They play on a truth that you may know, but they don’t quite give you the full story. That’s what gives you the seed of doubt and makes you question," she said. 

Natasha Crowcroft, chief of applied immunization research at Public Health Ontario, said the billboards were clearly designed so the casual observer wouldn’t know they were created by an anti-vaccine group. “It’s really poisonous in a really subtle way,” she said. 

Vaccine Choice Canada declined an interview request. In an e-mail, Mr. Kuntz said the aim of the campaign is to encourage people to become more educated about vaccines. He did not respond to questions about the group’s funding.

South Sudan: Nodding syndrome raises fear in Maridi state

Looking for local news reports of the suspected Ebola case in South Sudan, I can across this item from December 12 in the Juba Monitor: Nodding Syndrome raises fear in Maridi state. It's the first report I've seen on the syndrome in a long time. Excerpt:

“In one of every two families you find a case of nodding syndrome, some are very weak, they cannot help themselves, they are fed by family members, washed and taken for long call by family members,” Maridi state Minister of Health said.  

This information was released during the Neglected tropical disease Taskforce meeting held by the Ministry of Health, Amref, Health African and other health organisations on Saturday in Juba. 

The objective of the meeting was to make a plan to support the affected communities in order to improve understanding of nodding syndrome, Onchocercisasis-associated epilepsy in South Sudan. 

Maridi state Minister of Health and Environment, Dima Hosea Aburase said that children were being isolated even those who were in school were often sent back home because of the disease.  

“With the fear that nodding syndrome is communicable, that they will infect some or the rest of the children and they go home. Some are even chained because the parents find it difficult to manage them. Those who are already having mental disorder move anyhow so the situation is really devastating,” Aburase said.  

Aburase added that there were limited drugs in the market due to higher prevalence of nodding syndrome in the state.  

“There are some anti-Epileptic drugs like phinabaptol, Pagamazopil. Those are the ones we have in the country. These children are supposed to be put on these drugs but they are very limited among the drugs in the state. This family gets the drugs in the market since there is also high demand because the higher prevalence of nodding syndrome sometimes is not even there in the market,” he said. 

However, Peter Claver Olore Amref Stuff, highlighted that they carried out door to door house hold survey where they used some community clinical officers that were trained. 

“We went to eight study sites containing forty-four small villages which we went through together and we reached 2511 households. Our team was able to screen 17,652 individuals so out of these, we found almost 799 individuals who are suspected to be having Onchocerciasis associated epilepsy and we confirmed 92 percent of them. This means that the other eight percent are possibly people who had other forms of mental problems and epilepsy which could not be related with Onchocerciasis based on the questionnaire which was given to guide the team,” Olore said.

Ebola DRC - Evolution of the response to the Ebola epidemic in North Kivu and Ituri on Tuesday February 26 2019

The Ministry of Health has published Ebola DRC - Evolution of the response to the Ebola epidemic in North Kivu and Ituri on Tuesday February 26 2019. Excerpt from the Google translation: 

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Tuesday, February 26, 2019   

The epidemiological situation of the Ebola Virus Disease dated February 25, 2019:   

• Since the beginning of the epidemic, the cumulative number of cases is 875, of which 810 are confirmed and 65 are probable. In total, there were 551 deaths (486 confirmed and 65 probable). 

• 196 suspected cases under investigation; 

• 3 new confirmed cases, including 1 in Mandima, 1 in Vuhovi and 1 in Butembo;  

• 3 new deaths of confirmed cases, including 1 in Mandima, 1 in Vuhovi and 1 in Butembo, all are community deaths; 

• 1 new person healed out of Butembo CTE. 

/! \  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     

Revision of databases 

• The different databases are being revised to check and harmonize them. In discussion with the different partners involved in epidemiological surveillance, the decision was made to reclassify all cases in the health zone where they started the symptoms of the disease. Several questions arose as to the classification of some cases that had moved between two or even three health zones between the onset of symptoms and their death. In these particular cases, only thorough investigations can determine where the person has started to show signs of the disease, which may take several days. Pending the results of the investigations, some of these cases are tentatively classified in the health zone where they were detected.  

• These cases include the patient from Katwa who fled to Bunia with her family after falling ill in her area of ​​residence but whose body was found in Komanda. This patient was initially classified in Komanda but was reclassified to the Katwa Health Zone after completion of the in-depth investigation.   

• On Tuesday, February 26, 2019, Lubero District Chief Medical Officer said that a case of Ebola had been detected in the health zone of Lubero. This is a young woman from Katwa, who was known to be in contact with another confirmed case and who refused to be transferred to the Ebola Treatment Center when she became ill. She ran away from Katwa for Lubero. She died the next day at the Lubero General Referral Hospital from where the alert was launched. This patient was classified in the health zone of Katwa, where her first symptoms appeared.   

Vaccination  

• Since the start of vaccination on 8 August 2018, 83,813 people have been vaccinated , including 21,434 in Katwa, 20,673 in Beni, 10,367 in Butembo, 6,109 in Mabalako, 2,839 in Kalunguta, 2,590 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, 767 to Biena, 739 to Lubero, 590 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, 141 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.

MSF Ebola centre in North Kivu inoperative after violent attack

Via MSF.org: MSF Ebola centre in North Kivu inoperative after violent attack.

KATWA – Following a violent attack on an Ebola Treatment Centre in North Kivu, Democratic Republic of Congo (DRC), where the facility was partially burnt down, Médecins Sans Frontières (MSF) has decided to suspend activities at the centre. The suspension will severely limit access to essential health services. 

At 10pm on 24 February, unidentified assailants attacked the MSF-managed Ebola Treatment Centre in Katwa.  After throwing stones at the facility, they set parts of the structure on fire and destroyed wards and equipment. The brother of a patient died while reportedly trying to flee the scene. The exact circumstances of his death are still unclear.   

“This attack was traumatic for patients, their relatives and staff present inside the centre at the time,” said Emmanuel Massart, MSF’s Emergency Coordinator in Katwa. “We managed to relocate all four confirmed and six suspected patients to nearby treatment centres, but this attack has crippled our ability to respond to what is now the epicentre of the outbreak.” 

“Although the reasons behind the attack are unclear and such violence is unacceptable, what we know is that organisations involved in the Ebola response – MSF included – have failed to gain the trust of a significant part of the population,” said Meinie Nicolai, MSF’s General Director, who is currently visiting North Kivu. “All those involved in this response must change their approach and truly engage with the grievances and fears of the communities.” 

Previous Ebola outbreaks have demonstrated the importance of gaining the acceptance of the community. Without the communities’ trust, the sick and dead remain hidden and health workers risk being threatened or assailed.  

More than six months after the beginning of the Ebola outbreak in North Kivu and Ituri provinces, the epidemic is not under control with more than 870 confirmed patients and more than 540 deaths. After some successes in stopping transmission in the initial epicentres of Mangina and Beni, and some ancillary locations such as Tchomia, Mutwanga, and Masereka, the epidemic has spread from 4 to 19 health zones. People continue to die in the community, become infected in health centres, and the majority of new cases cannot be related to known Ebola cases. 

MSF activities in the Ebola outbreak response continue in Butembo, Bunia, Bwena Sura, Kayna and Biena.