H5N1

You don't want to be #1 on the Fragile States Index

A very illuminating site about the most and least sustainable of the world's countries: Fragile States Index for 2018. It's worth exploring in some detail, especially the comparative analysis, which among other things shows conditions generally improving in Canada and generally worsening in the US. 

Finland is most sustainable at #178, followed by Norway at #177 and Switzerland at #176.

 

We in Canada rank #172, with Australia even more sustainable at #174. (Denmark is #175.) The US ranks #153; the UK is #155. 

At the top of the Fragility Index: Yemen, #1; Somalia, #2; South Sudan, #3. Syria, #4; DR Congo, #5. It's not a coincidence that these countries also deal with serious problems in public health.

India: H5N1 bird flu detected in Cuttack

Via The Times of India: Bird flu detected in Cuttack.

Cuttack: A team of veterinary doctors and experts culled more than 600 ducks and 66 chickens on Sunday following confirmation of bird flu (H5N1) in the city. 

An outbreak of bird flu was suspected after death of ducks in the Duck Breeding Centre and Dairy Farm at Khapuria . On March 23, as many as 13 ducks died on the day in the farm. District veterinary office investigated into the incident and sent blood samples to National Institute of High Security Animal Diseases (NIHSAD) in Bhopal. 

“The samples tested positive for the H5N1 or avian Influenza virus,” informed chief district veterinary officer Premananda Rout. 

“Following the test report, we culled ducks and chickens. Moreover, 3.6 quintal of foodgrains were destroyed as well. Carcasses of culled birds were buried in 10-foot dip pits. Bleaching powder and other disinfectants were sprinkled while filling up the pits to prevent spread of H5N1 virus,” added Rout. 

All the poultry farms in one-km radius of the breeding centre have been banned for the time being. The farms will remain closed for next six months according to guidelines, added Rout.

Ebola at the end of March

The Ministry of Health has published EBOLA DRC - Evolution of the response to the Ebola outbreak in the provinces of North Kivu and Ituri to Sunday, March 31, 2019. The news continues to be bad. Excerpt from the Google translation and then a comment:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Sunday, March 31, 2019   

The epidemiological situation of the Ebola Virus Disease  dated March 30, 2019: 

• Since the beginning of the epidemic, the cumulative number of cases is 1,082, of which 1,016 confirmed and 66 probable. In total, there were 676 deaths (610 confirmed and 66 probable) and 331 people cured. 

• 279 suspected cases under investigation; 

• 13 new confirmed cases, including 5 in Katwa, 3 in Vuhovi, 2 in Mandima, 1 in Masereka, 1 in Musienene and 1 in Beni;  

º The case initially notified in the health zone of Mambasa in the bulletin of March 30, 2019 was reclassified in the health zone of Mandima where the symptoms of the patient began.  

• 11 new confirmed case deaths, including

º 8 community deaths, including 4 in Katwa, 2 in Vuhovi, 1 in Mandima and 1 in Masereka;

º 3 deaths at CTE, including 2 in Butembo and 1 in Beni; 

• 2 new patients recovered from Butembo CTE. 

/! \  The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

News of the response 

The voice of the community 

• The community dialogue initiated by coordinating the response to Ebola treatment attacks in late February has given community members a voice in the ongoing response to Ebola at home.  

• In general, the three main objectives achieved in these community dialogues were to discuss social and development issues of importance to communities, the establishment of local response committees, and the signing of a trust agreement between communities and response teams. Some of the communities' concerns can be realized in the immediate future while others will require more in-depth consultations with the technical and financial partners for their implementation.  

• The communities demanded that the Government and international partners also invest in improving the overall living conditions of the population, especially by improving sanitation facilities, increasing access to drinking water, improving the road network, to create jobs for young people and to build modern public markets.  

• In addition, the establishment of local response committees has already begun in several neighborhoods. These committees allowed the community to own and feel responsible for the success of the response activities in their neighborhood.  

• Finally, trust contracts were established between the community and the actors of the response in neighborhoods where the greatest number of attacks had been recorded. By signing this contract of trust, the communities commit themselves to facilitate the work of the teams of the response and to guarantee their safety when they carry out actions in their district. In return, the response teams are committed to always listening to communities and ensuring that response interventions respect community desires and local customs. Following the signing of these contracts of confidence in several neighborhoods of Butembo, the coordination has agreed to reduce the use of law enforcement to secure the movement of agents of the response,   

Vaccination  

• Since the beginning of the vaccination August 8, 2018, 93,613 p eople have been vaccinated , of which, 23,206 in Katwa, 21,270 in Beni, 11 372 in Butembo, 6109 at Mabalako, 3498 at Mandima 3.005 to Kalunguta, 2970 in Goma, 2333 to Oicha, 2317 in Komanda, 1630 at Kayina, 1629 to Masereka, 1499 at Vuhovi, 1466 in Bunia, 1413 at Kyondo, 1357 at Karisimbi, 1193 in Lubero, 1025 at Biena, 936 Musienene, 772 Mutwanga, 690 in Rutshuru, 557 Rwampara (Ituri), 527 to Nyankunde 496 to Mangurujipa, 355 for Tchomia 333 to Lolwa, 342 to Kirotshe, 280 to Mambasa 254 Alimbongo, 250 to Mweso, 245 to Kibirizi 161 to Nyiragongo 97 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.

By comparison, here's the MoH update for March 1, just one month ago. The case count has risen from 888 to 1,082, an increase of 194. The death toll has risen from 557 to 676, up 119. Recoveries have risen from 302 to 331, just 29. And this despite 8,973 new vaccinations. No doubt the disruption of the response by the attacks on ETCs is responsible for much of this increase; MSF pulled out of its ETCs on March 1. Whatever the reasons, control of the outbreak is clearly weakening.

Guyana: Chinese national dead, seven quarantined after mystery breakout at manganese mine

Thanks to Mike Coston and FluTrackers for finding this story. Via Kaieteur News: Chinese national dead, seven quarantined after mystery breakout at manganese mine. Excerpt:

One of several afflicted manganese workers is now dead, after exhibiting symptoms of a viral influenza, yesterday. The other seven, who are also Chinese nationals, are currently being treated at the Georgetown Public Hospital Corporation (GPHC). 

A team of medical personnel was deployed to Matthews Ridge yesterday, from the Mabaruma Hospital after the members received these reports. 

The seven men were airlifted to Eugene F. Correia International Airport, Ogle, and transported to GPHC for treatment. 

A medical practitioner on the team informed this publication that the team has been extremely cautious, both, in its transport of the patients and with the level of care they’re currently receiving. 

This publication was informed that two floors of the Male Medical Ward of GPHC were cleared and restricted yesterday, to quarantine the victims of the undetermined illness. 

 The seven workers had initially been taken to Pakera Hospital, Matthews Ridge, for treatment. The medical personnel at the hospital have been running a battery of tests. Further testing is expected to be done to ascertain the exact nature of the illness. One doctor involved has dismissed speculation that swine flu is the cause of the symptoms. 

The workers were reportedly stationed at a manganese mine owned by Guyana Manganese Inc. (GMI), a subsidiary of Chinese company, Bosai Minerals Group Guyana Company Limited, when they began showing signs of respiratory discomfort, rash and high fever-like temperatures. 

Just Friday, Ministers of Natural Resources and Public Affairs, Raphael Trotman, and Dawn Hastings-Williams, visited the mine to inspect it, since operations there are expected to restart soon.

BUTEMBO: Civil society calls on MPs to engage in Ebola response

Via Radio Moto Butembo-Beni: BUTEMBO: Civil society calls on MPs to engage in Ebola response. The Google translation:

The urban coordination of Butembo's civil society organized this Saturday, March 30, 2019 an "Ebola truth dialogue" for the candidate deputies to the provincial and national legislatures. Selected setting, the SYDIP meeting room. Among the objectives of this dialogue: to trigger an integrative process of opinion of the political actors for a participative, inclusive and representative response in Butembo city. 

On behalf of the president of this citizen structure, Mr. CATHY FURAHA, third vice president of the active forces, outlined the objectives of this exchange. Among which trigger an integrative process of opinion of the political operators in favor of the response. 

"The first objective is to trigger an inclusive process of opinion of political actors for a participatory, inclusive and representative response in Butembo town. The second objective of our dialogue is to rethink through constructive criticism of the attitudes and behaviors of political actors and agents in the response to end the Ebola epidemic. The third objective is to facilitate local community response operations through community engagement," she said. 

A heated debate on Ebola and a set of questions took place. To eradicate the spread of Ebola in the region, some recommendations were made by the audience. This is for example the commitment of stakeholders to eradicate this epidemic.

"All stakeholders are making community commitments to raise awareness of the population to join the response in observing preventative measures and fighting Ebola," said one participant. 

Note that in their last statement, the forces of North Kivu advised the population to work with the response teams.

DRC Ebola: 13 new cases today, 65 this week, 1,082 total

The MoH/WHO AFRO Ebola DRC KIVU 2018 Dashboard has alarming news this morning: 13 new cases. The total for this week is now 65, the highest of the outbreak, and the total since August is 1,082.

Making matters worse, 1,000 Ebola contacts out of 6,500 are not being traced. It begins to look as if the response is losing the battle.

Nigeria: Containing the Lassa fever spread

Via Punch, an editorial: Containing the Lassa fever spread. Excerpt:

NIGERIA is once again at the receiving end of the yearly offensive of the deadly Lassa fever disease. But, working in close collaboration with the World Health Organisation and other experts already in the country, she is slowly but surely rolling back the spread of the current outbreak, which has already claimed scores of lives. Thereafter, there will be the usual lull before the storm, following which there will be an eruption of yet another round of the viral haemorrhagic fever, when deaths will be reported again in nearly all parts of the country. 

This has been the steady and unaltered pattern over the years. Since the disease was first described in the 1950s and the virus causing it identified in 1969 in Lassa town in Borno State, not much has been achieved in terms of halting its rampant spread. Rather, efforts have been concentrated mainly on the management of the sick, which has made it possible for the disease to continue to spread to new areas of the country. It has not come as a surprise that Lassa fever has become endemic in many parts of the country and beyond.  

This year alone, the outbreak has been reported in more than 33 states of the federation, according to the Nigeria Centre for Disease Control. This is barely short of overwhelming the entire country and it is difficult to say how far it would eventually go before grinding to a halt. States where cases have been reported so far include Ondo, Bauchi, Cross River, Kebbi, Ebonyi, Plateau, Delta Imo, Adamawa, Kwara and Benue. No official reason has been given for the alarming spread, but it may not be unconnected with the high rate of human mobility that occurred across the country as a result of the just-concluded elections. It is possible that some infected people may have taken it to other parts of the country as they travelled. 

An acute viral haemorrhagic fever, just like the deadly Ebola that is currently ravaging the Congo Democratic Republic, Lassa fever is primarily contracted through exposure to the urine or faeces of a species of rat called multimammate or Mastomys rat. It is also possible to be infected by coming in contact with the blood, urine, faeces and body secretions of an infected person. The outbreak is usually common in dry seasons when these rats find their way into people’s homes in search of food after human activities such as bush burning or clearing dislodge them from their natural habitat.   

Over time, the concerted efforts of humanity have led to the eradication of some very deadly diseases, especially smallpox, which used to be a prolific killer across the world, including Europe. Right now, the world is also on the cusp of ending the scourge of poliomyelitis, once a global child killer, whose presence has now been confined to just three countries, Pakistan, Nigeria and Afghanistan. Perhaps the same can be done of Lassa fever, a zoonotic disease that can also be spread from man to man. Even when it is not possible to completely eradicate it, a conscious effort should be made to limit its unbridled spread.  

Beyond Nigeria, Lassa fever is known to be endemic in the West African states of Benin, Ghana, Guinea, Liberia, Mali and Sierra Leone, among others. In fact, more countries are likely to start experiencing outbreaks if efforts are not shifted from mere treatment to possible eradication or rigorous containment. This can be done by focusing on the elimination of rats from homes and making it difficult for them to find their way back.  

When symptoms such as fever, general weakness, headache, sore throat, muscle and chest pains, nausea, diarrhoea, vomiting and abdominal pain are noticed, it is important to visit the hospital promptly, where proper diagnosis can be done. This will avoid its being mistaken for shigellosis, malaria, typhoid fever, Ebola virus disease and yellow fever, which all seem to share symptoms. Experts also recommend contact tracing, a common practice in tracking Ebola, to be able to limit the spread.

Pregnant Cathay Pacific flight attendants threaten to all go on sick leave after staff member becomes 33rd person in Hong Kong to catch measles this year

Hong Kongers don't mess around about infectious diseases. Via the South China Morning Post: Pregnant Cathay Pacific flight attendants threaten to all go on sick leave after staff member becomes 33rd person in Hong Kong to catch measles this year. Excerpt:

A group of pregnant Cathay Pacific flight attendants have said they will all take sick leave from Monday unless the Hong Kong-based airline improves its safeguards against the measles outbreak in the city. 

The threat came after the carrier had to disinfect part of its corporate headquarters after an office worker became the 33rd person to catch the disease in Hong Kong, and the 13th airport and airline employee to be affected. 

Vera Wu Yee-mei, chairwoman of the Cathay Pacific Airways Flight Attendants Union, said about 10 flight attendants, who had been transferred to ground duties in various departments at the company’s headquarters, were upset by what they viewed as insufficient measures to ensure staff safety. 

Wu wrote to the airline’s management on Saturday, urging them to temporarily allow the women to either work from home or to go on paid sick leave.

Wu also called for the whole of the airline’s headquarters to be disinfected, and said the company had until Monday to reply, or the flight attendants would call in sick. 

“We want the company to take a more proactive approaches to tackling the outbreak, not as passive as they appear to be now,” Wu said.

A spokeswoman from the airline said the company understood the concerns of pregnant colleagues who worked near the employee with measles. She said they were advised to see their doctor and follow their advice if they had concerns about their immunisation status or possible exposure. 

“We are also reaching out to those pregnant colleagues on work arrangements,” she added.

Jamaica: Three H1N1 deaths - Opposition raps government for failing to issue advisory on deadly flu

Thanks to Sean Smith for alerting me to this story. Via The Jamaica Gleaner: Three H1N1 deaths - Opposition raps Gov’t for failing to issue advisory on deadly flu. Excerpt:

The Ministry of Health has faced scathing criticism for failing to inform the public about the presence of the influenza H1N1 in the country, following yesterday’s revelation by broadcaster Alan Magnus that his late wife Karlene ‘Kerry’ Douglas died last Friday due to complications associated with the virus.  

“I have heard of several people dying from it. [For] Kerry’s death, the paper which we got from the hospital stated that that’s what she died from,” Magnus said while speaking on RJR 94 FM.  

Yesterday, Nicole Dawkins-Wright, acting director of emergency, disaster management and special services in the Ministry of Health, confirmed that three Jamaicans have died as a result of the H1N1 influenza virus in St Ann, Kingston, and St Catherine. It was also revealed that there were six confirmed and 110 suspected cases across the island since the start of the year.  

She also told The Gleaner that the H1N1 virus present in the island is not the swine flu strain.

Meanwhile, Sean Smith also tells me, Guyana is dealing with H1N1. Via INews Guyana: BREAKING NEWS: 1 dead, 8 suspected Swine Flu cases detected in Region 1.

The Guyanese Ministry of Public Health website doesn't have anything on flu, and I can't even access Jamaica's Ministry of Health.

EBOLA DRC - Evolution of the response to the Ebola outbreak in North Kivu and Ituri on Saturday March 30 2019

The Ministry of Health has published EBOLA DRC - Evolution of the response to the Ebola outbreak in the provinces of North Kivu and Ituri on Saturday, March 30, 2019. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Saturday, March 30, 2019   

The epidemiological situation of the Ebola Virus Disease  dated March 29, 2019: 

• Since the beginning of the epidemic, the cumulative number of cases is 1,069, of which 1,003 are confirmed and 66 are probable. In total, there were 665 deaths (599 confirmed and 66 probable) and 329 people cured. 

• 293 suspected cases under investigation; 

• 10 new confirmed cases, including 3 in Vuhovi, 2  in Mandima,  2 in Katwa, 1 in Oicha, 1 in Mambasa and 1 in Beni; 

º New health zone potentially affected: A girl living in Mandima (Biakato Mine) was detected as a confirmed case in Mambasa (Ituri). It seems that she went there after getting sick to be cared for where her parents live. Further investigations will determine whether the case should be reclassified to Mandima.  

• 5 new deaths of confirmed cases, including 

º 2 community deaths, 1 in Katwa and 1 in Vuhovi; 

º 3 deaths at CTE, including 2 in Butembo and 1 in Beni; 

• 4 new cured patients, 2 of whom were from Butembo CTE and 2 from CTE de Beni. 

/! \  The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

News of the response 

Reopening of the Katwa Ebola Treatment Center 

• The Ebola Treatment Center in Katwa has been officially reopened since Saturday, March 30, 2019. After the attacks of the two CTEs in Butembo town in late February, a general feeling of fear had invaded both the communities and the response teams. The coordination then initiated community dialogues to listen to the community and rebuild trust so that the communities would accept the interventions of the response (CTE referencing, household decontamination, vaccination, dignified and secure burials, etc.).  

• Following the new wave of positive cases from Masereka, Katwa and Vuhovi since mid-March 2019, the Butembo CTE was full and the reconstruction of the Katwa CTE was becoming a real priority. Thus, in consultation with the district leaders of Vighole, Rughenda and Katwa, the communication teams of the response and the socio-anthropologists worked on a plan to rebuild the CTE that would promote the ownership of the CTE by the community.  

• Neighborhood leaders were pleased with this initiative as community women were concerned about the future of Ebola-infected patients in the community in the absence of an appropriate care structure for their care.  

• Socio-anthropologists have played an important role in defining the practical modalities for rebuilding the CTE and ensuring community ownership. They recommended that neighborhood leaders organize community meetings to ensure transparency in the recruitment of local workers. Then they asked that the traditional chiefs carry out rituals of appeasement of spirits in the presence of the district chiefs and all the members of the community recruited before initiating the cleaning and reconstruction work of the CTE. It was also important to sensitize all workers and the community at large about the importance of seeing the CTE as a community property where all members of this community can entrust their patients so that the experts take care of them with respect.  

• Management of the Katwa CTE is now provided by the Ministry of Health in collaboration with WHO and UNICEF. Dr Richard Kitenge, national coordinator of CTE and country leader in the management of Ebola Virus Disease (EVD), welcomed the rapid reopening of the Katwa CTE to relieve the congestion of the Butembo CTE. He recalled that the CTE is fully operationalized by local health workers and native Butembo territory. He invited the population to refer to the CTE as soon as possible any patient suspected of having Ebola to increase their chances of survival. According to patient data, 80% of patients (8 out of 10 patients) who were treated less than 3 days after onset of symptoms survived.  

Vaccination  

• Since the beginning of the vaccination on August 8, 2018, 93,206 persons have been vaccinated , including 23,047 in Katwa, 21,233 in Beni, 11,362 in Butembo, 6,109 in Mabalako, 3,425 in Mandima, 3,005 in Kalunguta, 2,961 in Goma, 2,333 in Oicha, 2,317 to Komanda, 1,630 to Kayina, 1,629 to Masereka, 1,456 to Bunia, 1,413 to Vuhovi, 1,399 to Kyondo, 1,357 to Karisimbi, 1,187 to Lubero, 1,025 to Biena, 936 to Musienene, 772 to Mutwanga, 690 to Rutshuru, 557 in Rwampara (Ituri), 527 in Nyankunde, 496 in Mangurujipa, 355 in Tchomia, 333 in Lolwa, 342 in Kirotshe, 280 in Mambasa, 254 in Alimbongo, 250 in Mweso, 245 in Kibirizi, 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.