H5N1

Mother whose son died of the flu says she’s become a target of anti-vaccine groups on Facebook

Via The Globe and Mail, yet another reason I'm glad I got the hell off Facebook (and why you should too): Mother whose son died of the flu says she’s become a target of anti-vaccine groups on Facebook. Excerpt and then a comment:

A Canadian who became a vaccination advocate after the death of her son says she has been subjected to hundreds of online attacks in recent days from an anti-vaccination Facebook group, highlighting what she says is the social-media giant’s failure to curb false and dangerous information about immunization.  

Jill Promoli started the advocacy group For Jude, For Everyone after her two-year-old son Jude died as a result of the flu in 2016. Last week, Ms. Promoli created a post on the group’s Facebook page to mark the start of National Immunization Awareness Week. In the post, she explained that her son received a flu shot, but failed to develop immunity and died after contracting the virus. 

She wrote that if more people were vaccinated, it would reduce the incidence and spread of such illnesses. The post was shared on an anti-vaccination Facebook group, and the For Jude, For Everyone page was inundated with posts that blamed Ms. Promoli for the death of her child and claimed that she was lying about the cause of his death.  

“It was very aggressive,” said Ms. Promoli, who lives in Mississauga. “It became sort of a mob mentality.” 

The case shows that groups can still spread false messages and attack vaccine advocates despite efforts by social-media companies to shut them down. Vaccination opponents have even used Facebook’s mechanism for reporting objectionable material to have Ms. Promoli’s page blocked.  

The attacks seemed to come from members of a closed anti-vaccination Facebook group called Vaccine Education Network: Natural Health Anti-Vaxx Community. The group has a public page and a closed group that only members can view. A member of the closed group told Ms. Promoli her Facebook post was shared on that page and to expect negative comments. The administrator of the public group did not respond to a request for comment. 

Ms. Promoli said she likes to promote conversations about vaccines, but felt compelled to remove many of the comments because of their misleading and hurtful content. She said that only seemed to embolden members of the anti-vaccination group, who continued to write on her page.  

Ms. Promoli said this is the latest of several co-ordinated attacks from anti-vaccination groups, and that Facebook failed to take action each time. In fact, Facebook has blocked her advocacy page and her business page several times after anti-vaccination users reported them, saying they contained malicious content. 

Ms. Promoli said she has learned it is common for large numbers of anti-vaccination users to report pro-vaccination pages to get them blocked or removed. She added that after this happens, it is difficult to get the pages reactivated.  

Ms. Promoli said she got her pages unblocked only after contacting a friend of a friend who worked at Facebook, and that many other pro-vaccination users have to start from scratch. She said this happens because no one at Facebook appears to be paying close attention.

By now it should be clear that most social media in general, and Facebook in particular, are hazards to public health. Twitter is pretty messed up, but it at least offers Flublogia a venue to swap news and information. 

Facebook, however, seems beyond redemption. If it's not stealing your country, or selling you useless shit, it's compounding the misery of those who survive avoidable illnesses. Unless it's nationalized, and its senior staff are consigned to Guantanamo for the rest of their natural lives, Facebook has no redeeming value. 

'Attacking the Ebola response endangers the republic': Dr. Nestor Lubi

Via Radio Moto Butembo-Beni: 'Attacking the Ebola response endangers the republic': Dr. Nestor Lubi. The Google translation:

The rise in positive cases of Ebola patients in Butembo and surrounding areas continues to raise several concerns. According to Dr. Nestor LUBI contacted from Brussels in Belgium, attacking experts, doctors, nurses, health services who deal with this disease is endangering not only our population but also the republic.  

The outbreak of confirmed cases is sometimes due to the resistance for some people to observe certain prevention rules. For Dr Nestor LUBI, a Congolese doctor and teacher living in Brussels, Belgium, the public must take the threats of this disease seriously. Disease is endangering the population of the region. For this doctor, the population must combine its efforts in the fight against this disease.  

"We must not be dispersed before this epidemic. The disease exists. And the Ebola virus kills. If we do not pay attention, it will continue to kill. If there was a group of Mai-Mai behind the attacks of the Ebola treatment centers, they must understand that at this level they are irresponsible. If they were manipulated by a politician, they need to ask the politician what type of solution he is going to propose immediately to the people of our country to avoid illness. Because destroying health centers, attacking experts, doctors, nurses, health services who deal with this disease is endangering not only our population but also the republic. We may end up in quarantine."

DR Congo: Ebola virus disease - External Situation Report 39

Via ReliefWeb, WHO has published Democratic Republic of Congo: Ebola Virus Disease - External Situation Report 39.

This past week saw a continued increase in the number of new Ebola virus disease (EVD) cases reported in the North Kivu and Ituri provinces of the Democratic Republic of the Congo, with a total of 126 new confirmed cases reported. Most of these cases originated primarily from several geographically-limited, hotspot areas within Katwa, Mandima, Butembo, Mabalako and Musienene health zones. 

During the last 21 days (8-28 April 2019), a total of 297 confirmed cases were reported from: Katwa (141), Butembo (33), Mandima (33), Vuhovi (23), Mabalako (19), Beni (14), Musienene (14), Kalunguta (10), Masereka (5), Biena (1), Kyondo (1), Mutwanga (1), Oicha (1), and Komanda (1). During this period, 70 health areas in 14 health zones reported new cases; 45% of the 156 health areas affected to date (Table 1 and Figure 2). 

As of 28 April 2019, a total of 1466 EVD cases, including 1400 confirmed and 66 probable cases, were reported. A total of 957 deaths were reported (overall case fatality ratio 65%), including 891 deaths among confirmed cases. Of the 1466 confirmed and probable cases with known age and sex, 56% (815) were female, and 28% (416) were children aged less than 18 years. The number of healthcare workers affected has risen to 92, including 33 deaths. 

Risk Communication and Community Engagement (RCCE) teams on the ground have been working closely with Infection Prevention and Control (IPC) teams this week in support of the Safe Injection Campaign, an initiative aimed at encouraging the safer use of needles and injections in homes as a means of reducing EVD transmission risks. The campaign will commence on 5 May 2019, alongside activities for the World Hand Hygiene Day. 

As part of the continued efforts to empower communities to be more actively engaged in the EVD response, requests received from the numerous dialogues with local residents are being reviewed to aid the transfer of the response ownership back to the community. Further plans are currently being drafted on who will deliver this feedback to the communities in a timely manner. 

Lastly, RCCE teams are also working closely with other WHO partners to bring about a new mass communications campaign to comprehensively promote key messages to the affected communities from all outbreak response pillars.

DRC Ebola: 14 new cases, 13 deaths (6 in community/hospital)

The Ministry of Health has a long update today: EBOLA DRC - Evolution of the response to the Ebola outbreak in the provinces of North Kivu and Ituri to Tuesday, April 30, 2019. We could see 1,000 deaths before the end of the week. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Tuesday, April 30, 2019   

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

• Since the beginning of the epidemic, the cumulative number of cases is 1,480, of which 1,414 are confirmed and 66 are probable. In total, there were 970 deaths (904 confirmed and 66 probable) and 412 people cured. 

• 279 suspected cases under investigation; 

• 14 new confirmed cases, including 6 in Katwa, 2 in Musienene, 2 in Butembo, 1 in Mabalako, 1 in Beni, 1 in Kayna and 1 in Kalunguta;  

• 13 new confirmed case deaths, including 

º 6 community / hospital deaths, 2 in Katwa, 2 in Musienene, 1 in Kayna and 1 in Beni; 

º 7 CTE / CT deaths, including 4 in Butembo and 3 in Katwa; 

• 1 new healed from the CTE of Butembo.    

 /! \  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   

Establishment of multisectoral Ebola Response Committee 

• Considering the persistence of the Ebola epidemic in the provinces of North Kivu and Ituri and on the instructions of the President of the Republic at the meeting of 27 April 2019, Prime Minister Bruno Tshibala Nzenzhe and the Minister of Health, Dr. Oly Ilunga Kalenga, signed on Tuesday, April 30, 2019, the decree establishing, organizing and operating the multisectoral committee for the response of the Ebola virus disease in the Democratic Republic of Congo. 

• This Committee's mission is to: 

1. Oversee the multi-sectoral response to the current Ebola virus disease in the provinces of North Kivu and Ituri; 

2. Formulate the necessary measures to be taken at government level; 

3. Collaborate with institutions at central, provincial and decentralized territorial entities to prevent the spread of the epidemic;  

4. Propose the allocation of resources needed for the response to end the epidemic;  

5. Ensure an optimal link between the overall response strategy and sectoral policies. 

• The Committee meets once a week and whenever necessary, when convened by its Coordinator. He reports to the President of the Republic, once a week, and keeps him fully informed of the work, interventions and evolution of the epidemic.  

• The Committee is composed of the Prime Minister, who is the Coordinator, the Deputy Prime Minister, Minister of the Interior and Security, the Minister of the Budget, the Minister of Defense, the Minister of Finance, the Minister of Health who is the Secretary of the Committee, the Minister of Communication and Media, the Minister of Humanitarian Action and National Solidarity, the Minister of Social Affairs, and a representative of the Cabinet of the President of the Republic. Each member of the Committee is responsible for the response in their area of ​​activity. 

• Each member of the Committee invites the experts and partners in the work of his sector of activity whenever necessary. These experts and partners will be able to integrate the technical commissions and take part in the work of each sector of activity. 

• As a reminder, for the health pillar of the Ebola response, the Ministry of Health has created nine commissions, each led by a Ministry program or directorate. These nine commissions are:  

1. Surveillance (General Directorate for Disease Control, DGLM) 

2. Port of Entry Surveillance (National Hygiene Program at the Borders, PNHF) 

3. Medical care (National Program of Emergencies and Humanitarian Actions, PNUAH, and the National Institute of Biomedical Research, INRB) 

4. Logistics 

5. Vaccination (Expanded Program on Immunization, PEV, and INRB) 

6. Laboratory (INRB) 

7. Infection Prevention and Control (Health Directorate of the DGLM) 

8. Psychosocial care (National Mental Health Program) 

9. Communication and Community Engagement (National Program for Communication and Health Promotion) 

World Health Organization High-Level Mission in Butembo 

• WHO Director-General Dr Tedros Adhanom Ghebreyesus and WHO Regional Director for Africa Dr Matshidiso Moeti concluded their visit to Butembo on Tuesday, 30 April 2019. This high-level visit took place only ten days after the murder of Dr. Richard Mouzoko, a WHO epidemiologist from Cameroon.  

• Click here to read the WHO communiqué on this mission.

Vaccination

• Since the beginning of vaccination on August 8, 2018, 108,175 people have been vaccinated , including 29,182 in Katwa, 23,177 in Beni, 13,355 in Butembo, 6,973 in Mabalako, 4,862 in Mandima, 3,335 in Kalunguta, 3,070 in Goma, 2,729 in Oicha, 2,699 at Komanda, 1,915 at Vuhovi, 1,889 at Masereka, 1,748 at Kyondo, 1,630 at Kayina, 1,487 at Bunia, 1,357 at Karisimbi, 1,313 at Lubero, 1,047 at Musienene, 1,025 at Biena, 772 at Mutwanga, 690 at Rutshuru, 557 in Rwampara (Ituri), 527 in Nyankunde, 496 in Mangurujipa, 420 in Mambasa, 355 in Tchomia, 342 in Kirotshe, 333 in Lolwa, 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.

WEEKLY SUMMARY OF EPIDEMIOLOGICAL DATA

Week 17 (April 22-28, 2019)

For the week of April 22-28, 2019, we recorded:

• 1,588 suspected cases investigated and tested in the laboratory

• 126 new confirmed cases :

• The city of Butembo remains the main focus of the epidemic. Together, the two areas of the city, namely Butembo and Katwa, reported half of the new cases (64 cases out of 126, or 50.8%).

• 83 deaths of confirmed cases:

• The town of Butembo is also the main focus of confirmed case fatalities reported last week. The health zones of Butembo and Katwa together reported 53 of the 83 new confirmed case deaths, or 63.9%;

• Of the 83 deaths, 47 were community deaths, or 56.6%, and 36 occurred in an ETC.

• 24 new healed people left the CTE.

Ugandan health workers fatigued: Ebola simulation report

Via The Independent in Kampala: Ugandan health workers fatigued-Ebola simulation report. Excerpt:

Health workers on Ugandan borders are tired of the endless state of Ebola preparedness, an Ebola Simulation exercise carried out early this month has revealed. 

The results were disseminated during an international Ebola Virus Disease meeting that begun in Kampala on Monday. The Simulation exercise was carried out in Wakiso and Kasese, which are part of the 22 high Ebola risk districts. 

The exercise showed that health workers at different border posts are tired of being on standby. Uganda has been in a state of Ebola preparedness since August 2018 when the disease broke out in North Kivu in DRC. 

Dr. Yonas Tegegn Woldermariam, the Country Representative World Health Organisation, says the exercise was an eye opener because it revealed gaps that need to be filled.  

Health Minister, Dr. Ruth Aceng attributed the reports of fatigue on the part of health workers to the unfamiliar working environment.  

She said there is for financial assistance to make sure that the country bridges the existing gaps. “There’s a need for financial help as the numbers of people suffering of Ebola in DRC increases,” she said. 

Uganda’s first Ebola preparedness budget totaled up to Shillings 4 trillion while the next stood at Shillings 3 trillion, according to the health ministry. 

The simulation exercise also showed that Uganda needs to re-enforce its border health teams. Aceng says they are planning on hiring more health workers to feel the gaps.  

The Health Ministry is set to hire an additional 500 health workers in the 2019/2020 financial year.  Similar simulation exercises were also carried out in Tanzania, Sudan, Central Africa Republic, Rwanda, Zambia, South Sudan, Angola and Burundi. 

According to WHO, Uganda was not the only country that still falls short in some areas of Ebola preparedness.  

Dr. Zabulon York, the WHO Technical Coordinator of Health Emergencies programme who represented the WHO Director General, said results from other countries where the simulation exercise was carried out revealed existing gaps. 

He revealed that the countries were rated according to the level of community engagement, infection prevention and control, state of isolation facilities, capacity building and emergency response.

Killings of police and polio workers halt Pakistan vaccine drive

Via The Guardian: Killings of police and polio workers halt Pakistan vaccine drive. Excerpt:

A federal government campaign to vaccinate more than 40 million children under five against polio in Pakistan has been suspended following a series of attacks on workers and police over the past week.  

On 23 April a police officer responsible for protecting polio workers was gunned down in Bannu. The same day, a polio worker was injured with a knife in Lahore by a man refusing to allow his child to be vaccinated, citing a recent hoax video that claimed children were becoming ill after the immunisations.  

A second police officer was killed in Buner as he accompanied a polio team. 

A 35-year-old female polio worker was shot and killed on Thursday in Chaman, Balochistan, close to the border with Afghanistan. A 24-year-old colleague was also seriously wounded in the attack.  

Further attacks on staff in Sindh, Balochistan and Punjab have also been reported. 

The violence was preceded by a series of rumours intended to derail Pakistan’s campaign to eradicate the disease.  

On 22 April several thousand children were taken to hospital in the north-west of the country by panicked parents after a video circulated on Facebook in which a man attested that children were falling sick following vaccinations.

Hours later, a bizarre second video emerged, in which the same man attempted to show that children had fallen ill after the immunisations by ordering school boys to lie down in hospital beds and pretend to be unconscious. A mob went on to set fire to part of a government health facility. Thirteen people are being investigated over the incident.

The disruption has led to the suspension of the campaign’s “follow-up and evaluation”, earmarking children missed in the initial intensive vaccine drive.  

Vaccinators and police teams have previously been targeted in the country, where rumours have persisted about immunisation programmes being harmful or a cover for foreign interests. But a shift to recruiting local workers for the door-to-door campaigns – people known and trusted in their communities and with the right language skills and access – had led to better acceptance. 

Pakistan has seen a 96% reduction in polio cases since 2014. It is one of three countries that has yet to eliminate the disease, along with Afghanistan and Nigeria.  

Khalida Nasareen, 61, area supervisor in Orangi Town in the north of Karachi, said: “Absolutely, God willing, we will end polio soon, but unfortunately bad people try to run down our work. We have to face that propaganda head on. It hurts but it passes and we will bring it back to where we were. 

“If we can save the life of one child, I feel as though I’m contributing to saving humanity. Ours is a poor neighbourhood which lacks basic services and with poverty comes lack of awareness and education. It’s a cause I’m willing to die for.”

DRC Ebola: 14 new cases today, 1,480 total

The MoH/WHO AFRO Ebola DRC KIVU 2018 Dashboard reports 14 new cases today. The total for epidemiological week 17 is 126, and the total for the outbreak so far is 1,480. 

Out of 12,400 contacts, only 10,100 are being traced.

Canada: Patchy vaccination rates raise measles outbreak concerns in Ontario as US battles emergency

Via The Globe and Mail: Patchy vaccination rates raise measles outbreak concerns in Ontario as U.S. battles emergency. Excerpt:

Large numbers of children and teenagers in pockets of Ontario haven’t been vaccinated, creating the threat of a measles outbreak similar to the ones health officials are battling in the United States. 

This finding comes from a new analysis conducted by researchers at Public Health Ontario. It is the first official estimate of how many children in the province aren’t vaccinated, and provides important clues about who they are and where they live. 

“We have pockets where we know we’re not anywhere near where we need to be,” said Noni MacDonald, a vaccine expert based at Dalhousie University in Halifax, who was not involved in the study. 

The findings show that the percentage of students in the province with no record of receiving any vaccinations is as much as 2.9. It’s unclear whether all of those students were unvaccinated, or if some were up-to-date with their shots but hadn’t informed the local public-health unit. The study, published last week in the journal Vaccine, looked at children between the ages of 7 and 17, and was based on the 2016-17 school year.  

Nearly 1 per cent of the students with no vaccinations on record also had a non-medical exemption on file. Non-medical exemptions for reasons of conscience or religion can be granted to students whose parents object to vaccination in Ontario, where vaccinations are required for school attendance.

Sarah Wilson, a public-health physician at Public Health Toronto and lead author of the study, said it’s reasonable to assume that most or all of those students haven’t been vaccinated.  

Those students tended to have things in common. For instance, unvaccinated children with non-medical exemptions were more likely to go to private or religious school, or be home-schooled, live in a rural area or a community with a small- to medium-sized population and be located in the southwest and central west regions.  

The numbers of unvaccinated students were much higher in some parts of the province. For instance, in Oxford County, nearly 5 per cent of students were unvaccinated and had a non-medical exemption. In Elgin County, that number was 3 per cent. 

Dr. MacDonald said that while the percentages may seem small, they represent tens of thousands of students across the province. “This is not a denominator of 50 kids or 100 kids. This denominator is big … especially when they’re clustered together," she said.

Dr. Wilson said looking at these counties in more detail, such as by school or by neighbourhood, would likely reveal pockets where non-vaccination rates were even higher. And it illustrates why health officials are so concerned about the possibility of an outbreak.

Measles, mumps, rubella vaccination and autism

Via the Annals of Internal Medicine: Measles, Mumps, Rubella Vaccination and Autism. The abstract:

Background: The hypothesized link between the measles, mumps, rubella (MMR) vaccine and autism continues to cause concern and challenge vaccine uptake. 

Objective: To evaluate whether the MMR vaccine increases the risk for autism in children, subgroups of children, or time periods after vaccination. 

Design: Nationwide cohort study. 

Setting: Denmark.  

Participants: 657 461 children born in Denmark from 1999 through 31 December 2010, with follow-up from 1 year of age and through 31 August 2013. 

Measurements: Danish population registries were used to link information on MMR vaccination, autism diagnoses, other childhood vaccines, sibling history of autism, and autism risk factors to children in the cohort. Survival analysis of the time to autism diagnosis with Cox proportional hazards regression was used to estimate hazard ratios of autism according to MMR vaccination status, with adjustment for age, birth year, sex, other childhood vaccines, sibling history of autism, and autism risk factors (based on a disease risk score). 

Results: During 5 025 754 person-years of follow-up, 6517 children were diagnosed with autism (incidence rate, 129.7 per 100 000 person-years). Comparing MMR-vaccinated with MMR-unvaccinated children yielded a fully adjusted autism hazard ratio of 0.93 (95% CI, 0.85 to 1.02). Similarly, no increased risk for autism after MMR vaccination was consistently observed in subgroups of children defined according to sibling history of autism, autism risk factors (based on a disease risk score) or other childhood vaccinations, or during specified time periods after vaccination.  

Limitation: No individual medical charts were reviewed. 

Conclusion: The study strongly supports that MMR vaccination does not increase the risk for autism, does not trigger autism in susceptible children, and is not associated with clustering of autism cases after vaccination. It adds to previous studies through significant additional statistical power and by addressing hypotheses of susceptible subgroups and clustering of cases.

BENI: Second outbreak of Ebola at Mabuku Hospital

Via Radio Moto Butembo-Beni: BENI: 2nd outbreak of Ebola at Mabuku Hospital. The Google translation:

Second appearance of a case of Ebola virus disease in the Mabuku hospital center, in the rural health zone of Kalunguta in the territory of Beni Saturday, April 27, 2019. The patient had fled the health center MAMBOMBO in the health zone Mabalako. He then went to a health post in Mabuku where he spent a week before going to Mabuku Hospital where he died. 

"For me it's really bad because the patient really came to the last sigh. Just when we wanted to do first aid, it was already very serious. Just after, he arrived on April 27 at 1am. He is dead. Then, as in the habit, we must always take on the dead. When we took out, the result was positive Ebola return. Which worried us more; and in the frame, it was found that the patient came from Ngazi. It was there that he was treated a week ago to arrive here in Mabuku. That's how we got a second case here in Mabuku," said Dr. KAMOTO of Mabuku Hospital Center. 

Meanwhile, the vaccination went well at Mabuku Hospital. 20 people were vaccinated. The low participation of contacts or of some who have been denied has been noted. And Dr. KAMOTO is shocked. 

"Others who are also concerned are avoiding the vaccine and saying that it does not concern them, while the disease exists. People need to understand that the vaccine is there to prevent," he said.   

FARDC soldiers and suspected Mai-Mai militia have secured this vaccination campaign.