H5N1

WHO: Middle East respiratory syndrome coronavirus (MERS-CoV) – The Kingdom of Saudi Arabia

WHO has published Middle East respiratory syndrome coronavirus (MERS-CoV) – The Kingdom of Saudi Arabia. Click or tap through to download the spreadsheet. Excerpt:

From 1 through 28 February 2019, the National IHR Focal Point of Saudi Arabia reported 68 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 10 deaths. Of the 68 MERS cases reported in February, 19 cases occurred in cities other than Wadi Aldwasir.  

This Disease Outbreak News update describes the 19 cases. Among these cases, fifteen were sporadic, and four were reported as part of two unrelated clusters. Cluster 1 involved two cases in Buridah city; and Cluster 2 involved two cases in Riyadh city. The link below provides details of the 19 reported cases. 

MERS-CoV cases reported from 1 February through 28 February 2019 xls, 116kb 

A separate Disease Outbreak News will provide an update on the outbreak in Wadi Aldwasir which affected 49 cases and resulted in seven deaths in February making a total of 52 cases since the onset of the outbreak.

 From 2012 through 28 February 2019, the total number of laboratory-confirmed MERS cases reported globally to WHO is 2374 with 823 associated deaths. The global number reflects the total number of laboratory-confirmed cases reported to WHO under IHR to date. The total number of deaths includes the deaths that WHO is aware of to date through follow-up with affected member states.

Butembo: Civil society calls on armed groups to stop attacking Ebola treatment centers

Via Radio Okapi: Butembo: civil society calls on armed groups to stop attacking Ebola Treatment Centers. The Google translation:

 The coordination of the civil society of North Kivu and the forces of the city of Butembo and the territory of Lubero call on the armed groups to stop the attacks of the Ebola treatment centers and the personnel engaged in the response of this disease.    

These civic structures launched this call Friday, March 29 in a statement issued from Butembo, the city considered as the current hotbed of the Ebola virus epidemic in North Kivu.  

According to them, these attacks caused large-scale contamination of populations in the Beni, Butembo and Lubero regions. 

"Ebola treatment center fire events, threats and popular resistance have caused large-scale contamination of people in the Beni and Lubero territories as well as in the cities of Beni and Butembo. These continual barbarities, perpetrated most often by malicious people, have added to the activities of the response and increased the number of cases. The coordination of North Kivu in collaboration with the coordinators of the civil society forces of Butembo and Lubero recommend to the population to abstain from the violence," recommends Georges Katsongo, general rapporteur of the civil society of North Kivu. 

The civil society of North Kivu also appeals to all those who "claim to be members of the armed groups or their collaborators and who prevent the actions of the response on the ground from ceasing to unnecessarily expose innocent people under the pretext of their protection".

Flu News Europe, week 12

Flu News Europe has published its week 12 (March 18-24) update. Excerpt:

• Of 45 countries reporting on geographic spread only 11, located in northern, southern, and western areas of the European Region, reported widespread activity. Specimens collected from individuals presenting with ILI or ARI to sentinel primary health care sites yielded an influenza virus positivity rate of 38%, similar to the rate of 39% in the previous week. 

• Of 45 countries reporting on intensity, 41 reported baseline or low intensity. No countries reported high intensity levels. 

• Influenza type A virus detections dominated with more A(H3N2) than A(H1N1)pdm09 viruses among sentinel and non-sentinel source specimens. Few influenza B viruses were detected. 

• Of the specimens from patients with severe acute respiratory infection (SARI) collected in week 12/2019 that were tested for influenza viruses, 21% were positive and almost all were type A. 

• Pooled data from 22 Member States and areas reporting to the EuroMOMO project indicated that the excess mortality observed in previous weeks has returned to normal levels.

DRC Ebola: Ten new cases today, 1,069 total

For some reason, the MoH/WHO AFRO Ebola DRC KIVU 2018 Dashboard keeps displaying an undercount on the total number of cases. Yesterday's total was 1,059; today's ten new cases make it 1,069. But as you can see, the dashboard has dropped nine cases. Yesterday's deaths total was 660; today's dashboard says it's 659.

The total cases for this epidemiological week is 51, just one below last week's record 52. And of 6,200 contacts, one thousand are not being traced.

When medical workers behave badly during disease outbreaks, everyone suffers

When Dr. Pardis Sabeti and Lara Salahi speak up, I stop what I'm doing and listen. Via The Conversation, they write: When medical workers behave badly during disease outbreaks, everyone suffers. Excerpt (but read the whole story):

When a deadly infectious disease takes hold in a population, outbreak responders do their best to save lives and stamp out the contagion. No matter the disease or the location – whether AIDS in the U.S., SARS in China, or cholera in Yemen or Haiti – the public narrative of an outbreak often unfolds in a familiar way. An unruly and potentially fatal disease emerges and sets off a race against the clock to stop its spread, with limited or no certain treatment. 

Less widely known is the shared secret among outbreak responders: Bad behavior among their own ranks can consume undue energy amid an already frightening scenario. 

We’ve both seen firsthand different elements of disorder during disease outbreaks. One of us (Pardis) led a team working in Sierra Leone tracking genomic changes in the virus during the 2014 Ebola epidemic and experienced how off-the-charts stress led to a toxic setting. As a journalist, one of us (Lara) witnessed the ensuing chaos as the media and health agencies worked to communicate Ebola risk to a fearful public. Together, we decided to try to learn more about the irrational behaviors that occur in the midst of an outbreak. 

In a first attempt to move beyond open secrets to full transparency, we conducted an anonymous survey in 2015 of more than 200 local and foreign responders to the Ebola epidemic in West Africa. This was the largest and most widespread Ebola outbreak in history. Nearly 30,000 people were infected with the virus, and more than 11,000 people died in the three hardest-hit countries: Sierra Leone, Liberia and Guinea. We asked responders about their experiences during the height of the outbreak. 

What they told us led us to believe that a culture can form in this environment, created by individual actors and larger agents. It has little to do with the virus but can propagate its spread. As we describe in our new book Outbreak Culture, these dynamics dictate how the international community responds to a pathogen. Outbreak culture can inhibit efficient action and, in some cases, even make the epidemic worse.

DR Congo registers record 15 new Ebola cases in one day

Via Reuters: Congo registers record 15 new Ebola cases in one day. Excerpt:

GOMA, Democratic Republic of Congo (Reuters) - Democratic Republic of Congo on Friday recorded 15 new confirmed cases of Ebola, the biggest one-day rise since the current outbreak was declared last August, the health ministry said.  

Coming a day after 14 new cases were confirmed, the number means the outbreak is on track to register one of its highest weekly case totals, despite health officials saying as recently as two weeks ago that it was largely contained and could be stopped by September. 

Health workers have brought new tools to the fight against the latest epidemic of the hemorrhagic fever, including a vaccine and several treatments, but community mistrust of first responders and militia violence have set back the campaign.

Five Ebola centers have been attacked since last month, sometimes by armed assailants. The violence led French medical charity Medecins Sans Frontieres (MSF) to suspend its activities at the epicenter of the outbreak last month.

DRC Ebola: 15 new cases, eight deaths on March 29

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 Friday, March 29, 2019. With 29 new cases and 17 deaths in two days, the response seems to be in worsening trouble. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Friday, March 29, 2019   

The epidemiological situation of the Ebola Virus Disease  dated March 28, 2019: 

• Since the beginning of the epidemic, the cumulative number of cases is 1,059, 993 confirmed and 66 probable. In total, there were 660 deaths (594 confirmed and 66 probable) and 325 people healed. 

• 225 suspected cases under investigation; 

• 15 new confirmed cases, including 5 in Vuhovi, 4 in Katwa, 2 in Mandima, 2 in Oicha and 2 in Beni;

•  8 new confirmed case deaths, including 

º 4 community deaths, including 3 in Katwa and 1 in Vuhovi; 

º 4 deaths at CTE, 2 in Butembo and 2 in 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   

Vaccination  

• Since the start of vaccination on August 8, 2018, 92,868 people have been vaccinated , including 22,985 in Katwa, 21,208 in Beni, 11,315 in Butembo, 6,109 in Mabalako, 3,333 in Mandima, 3,005 in Kalunguta, 2,941 in Goma, 2,317 in Komanda, 2.309 to Oicha, 1.630 to Kayina, 1.629 to Masereka, 1.456 to Bunia, 1.399 to Kyondo, 1.373 to Vuhovi, 1.357 to Karisimbi, 1.159 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.

MMWR: Enterovirus D68–associated acute respiratory illness — New Vaccine Surveillance Network, United States, July–October, 2017 and 2018

MMWR has published Enterovirus D68–Associated Acute Respiratory Illness — New Vaccine Surveillance Network, United States, July–October, 2017 and 2018. The summary:

What is already known about this topic?  

A nationwide outbreak of enterovirus D68 (EV-D68), which is associated with acute respiratory illness (ARI), occurred in 2014. EV-D68 epidemiology is not fully understood because testing in clinical settings is limited and detections are not notifiable to CDC. 

What is added by this report?  

Based on active, prospective surveillance of ARI through the New Vaccine Surveillance Network, EV-D68 was detected in two (0.8%) patients in 2017 and 358 (13.9%) in 2018. Detections in 2018 peaked in September.  

What are the implications for public health practice? 

Continued active, prospective surveillance is needed to better understand trends in EV-D68 circulation.

DRC Ebola: 15 new cases today, 1,059 total

The MoH/WHO AFRO Ebola DRC KIVU 2018 Dashboard reports 15 new cases today, for a total of 1,059. (Once again the total given on the dashboard is an undercount.) The week's total is now 41. We'll have more details when the MoH releases its daily update in a few hours.

Epidemiological characteristics of an urban plague epidemic in Madagascar, August–November, 2017

Via The Lancet Infectious Diseases: Epidemiological characteristics of an urban plague epidemic in Madagascar, August–November, 2017: an outbreak report. The summary: 

Background 

Madagascar accounts for 75% of global plague cases reported to WHO, with an annual incidence of 200–700 suspected cases (mainly bubonic plague). In 2017, a pneumonic plague epidemic of unusual size occurred. The extent of this epidemic provides a unique opportunity to better understand the epidemiology of pneumonic plagues, particularly in urban settings. 

Methods 

Clinically suspected plague cases were notified to the Central Laboratory for Plague at Institut Pasteur de Madagascar (Antananarivo, Madagascar), where biological samples were tested. Based on cases recorded between Aug 1, and Nov 26, 2017, we assessed the epidemiological characteristics of this epidemic. Cases were classified as suspected, probable, or confirmed based on the results of three types of diagnostic tests (rapid diagnostic test, molecular methods, and culture) according to 2006 WHO recommendations. 

Findings 

2414 clinically suspected plague cases were reported, including 1878 (78%) pneumonic plague cases, 395 (16%) bubonic plague cases, one (<1%) septicaemic case, and 140 (6%) cases with unspecified clinical form. 386 (21%) of 1878 notified pneumonic plague cases were probable and 32 (2%) were confirmed. 73 (18%) of 395 notified bubonic plague cases were probable and 66 (17%) were confirmed. The case fatality ratio was higher among confirmed cases (eight [25%] of 32 cases) than probable (27 [8%] of 360 cases) or suspected pneumonic plague cases (74 [5%] of 1358 cases) and a similar trend was seen for bubonic plague cases (16 [24%] of 66 confirmed cases, four [6%] of 68 probable cases, and six [2%] of 243 suspected cases). 351 (84%) of 418 confirmed or probable pneumonic plague cases were concentrated in Antananarivo, the capital city, and Toamasina, the main seaport. All 50 isolated Yersinia pestis strains were susceptible to the tested antibiotics. 

Interpretation 

This predominantly urban plague epidemic was characterised by a large number of notifications in two major urban areas and an unusually high proportion of pneumonic forms, with only 23% having one or more positive laboratory tests. Lessons about clinical and biological diagnosis, case definition, surveillance, and the logistical management of the response identified in this epidemic are crucial to improve the response to future plague outbreaks.