H5N1

DRC Ebola: 23 new cases today, 10 deaths

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, April 26, 2019. Not only do we have the most cases in a day since the outbreak began, but we have ten deaths—eight of them in the community—and a total of 900 since August 1. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Friday, April 26, 2019   

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

• Since the beginning of the epidemic, the cumulative number of cases is 1,396, of which 1,330 are confirmed and 66 are probable. In total, there were 900 deaths (834 confirmed and 66 probable) and 394 people healed. 

• 260 suspected cases under investigation; 

• 23 new confirmed cases, including 9 in Katwa, 4 in Mandima, 3 in Musienene, 2 in Butembo, 2 in Kalunguta, 1 in Vuhovi, 1 in Komanda and 1 in Mabalako;  

• 10 new confirmed cases, including 

º 8 community deaths, including 5 in Katwa, 1 in Musienene, 1 in Kalunguta and 1 in Mabalako; 

• 2 deaths at Katwa 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     

Vaccination  

• Since the beginning of vaccination on 8 August 2018, 105,757 persons have been vaccinated , including 28,279 in Katwa, 23,004 in Beni, 12,826 in Butembo, 6,874 in Mabalako, 4,662 in Mandima, 3,180 in Kalunguta, 3,070 in Goma, 2,669 in Komanda, 2,569 in Oicha, 1,845 in Vuhovi, 1,819 in Masereka, 1,689 in Kyondo, 1,630 in Kayina, 1,487 in Bunia, 1,357 in Karisimbi, 1,233 in Lubero, 1,027 in Musienene, 1,025 in Biena, 772 in Mutwanga, 690 in 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.

DR Congo: Over 18,000 persons died of malaria in 2018

Via mediacongo.net: WMD 2019: Over 18,000 dead of malaria in 2018. Excerpt from the Google translation:

On the occasion of the commemoration of the 12th JMP 2019, the Minister of Public Health announced that the DRC has recorded more than 18 million cases of malaria in 2018, of which more than 16 million cases of simple malaria and 1.8 million cases of severe malaria. Of this number, 18 thousand people died. 

Placed this year under the theme "Zero Malaria. I commit myself ", the 12th World Malaria Day (JMP 2019) was celebrated yesterday Thursday, April 25th by the international community. In Kinshasa, the Minister of Public Health and the actors of the fight against malaria met on the campus of the Academy of Fine Arts (ABA), in Kinshasa / Gombe, to commemorate and prepare the state of play against the scourge of malaria in the DRC. On this occasion, the Minister of Public Health declared that the celebration of this 12th JMP reminds the suffering conveyed by malaria with its cohort of expenses and deaths unacceptable, because avoidable.  

Malaria, he said, is the leading cause of morbidity, hospitalization and mortality in the country. Thus, this pathology killed silently during the year 2018, more than 18 thousand people in the DRC on more than 18 million cases of malaria, including 16 million cases of simple malaria and more than 1.8 million severe malaria, or nearly 10%. These figures are staggering and must appeal to the national community. 

It is therefore in this sense that we must inscribe the manifestation of the day that encourages awareness and urgent action. It is precisely because of the need to act against this pathology that the Government of the Republic has committed, through the Ministry of Health, to guarantee universal access to key interventions in the fight against malaria for all inhabitants. from the country.

Cyclone Kenneth kills one, leaves trail of destruction across Mozambique

Via Thomson Reuters: Cyclone kills one, leaves trail of destruction across Mozambique. Excerpt:

JOHANNESBURG/LUANDA, April 26 (Reuters) - Cyclone Kenneth killed at least one person and left a trail of destruction in northern Mozambique, destroying houses, ripping up trees and knocking out power, authorities said on Friday. 

The cyclone brought storm surges and wind gusts of up to 280 km per hour (174 mph) when it made landfall on Thursday evening, after killing three people in the island nation of Comoros. 

It was the most powerful storm on record to hit Mozambique's northern coast and came just six weeks after Cyclone Idai battered the impoverished nation, causing devastating floods and killing more than 1,000 people across a swathe of southern Africa. 

The World Food Programme warned that Kenneth could dump as much as 600 millimetres of rain on the region over the next 10 days - twice that brought by Cyclone Idai. 

One woman in the port town of Pemba died after being hit by a falling tree, the Emergency Operations Committee for Cabo Delgado (COE) said in a statement, while another person was injured.

In rural areas outside Pemba, many homes are made of mud. In the main town on the island of Ibo, 90 percent of the houses were destroyed, officials said. Around 15,000 people were out in the open or in "overcrowded" shelters and there was a need for tents, food and water, they said.  

There were also reports of a large number of homes and some infrastructure destroyed in Macomia district, a mainland district adjacent to Ibo.  

A local group, the Friends of Pemba Association, had earlier reported that they could not reach people in Muidumbe, a district further inland.  

Mark Lowcock, United Nations under-secretary-general for humanitarian affairs, warned the storm could require another major humanitarian operation in Mozambique.  

"Cyclone Kenneth marks the first time two cyclones have made landfall in Mozambique during the same season, further stressing the government's limited resources," he said in a statement.

ECDC: CDTR, week 17

ECDC has published Communicable Disease Threats Report, 21–27 April 2019, week 17. The summary:

The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals on active public health threats. This issue covers the period from 21–27 April 2019 and includes updates on influenza A(H7N9), chikungunya and dengue, dengue, Ebola virus disease, influenza, Rift Valley fever and risks of communicable diseases related to Cyclone Idai.

UCLA statement on measles case

From the University of California at Los Angeles: UCLA statement on measles case.

UCLA was notified Monday, April 22, by the Los Angeles County Department of Public Health that one of our students had contracted measles. UCLA immediately identified and contacted students, faculty and staff with whom the student may have come into contact or who may have otherwise been exposed.  

On Wednesday, April 24, the Department of Public Health decided to quarantine 119 students and eight faculty members until their immunity could be determined. As of Thursday afternoon, UCLA has established proof of immunity for and released from quarantine 43 of those 119 students, and two of the eight faculty members, reducing the total number still under quarantine to 82. We expect the trend to continue as more people provide proof of immunization or are shown by tests to have immunity to measles. 

The quarantine is expected to last between 24 and 48 hours for most of the people who were identified, until their proof of immunity can be established. A few may need to remain in quarantine for up to seven days. We have arranged for students to be cared for at UCLA while they are quarantined.

Measles eradication: A goal within reach, slipping away

An editorial in The Lancet: Measles eradication: a goal within reach, slipping away.

Prior to the introduction of the measles, mumps and rubella vaccine (MMR) in 1963, an estimated 3 to 4 million people in the USA contracted measles annually. As of April 22, 626 children in the USA have become infected with the virus so far in 2019. This fact has led to urgent Congressional hearings, understandably alarmed national news coverage, and the introduction of legislation to address the outbreak. Measles was declared eliminated in the USA in 2000, but the resurgence of the disease and its continued prominence globally are causes for great concern. 

In the past 5 years, 75% of measles cases in the USA have occurred within more closed, religious communities such as the Amish in the Midwest and Somali migrants in Minnesota. According to the US Centers for Disease Control and Prevention, 91% of US children between the ages of 19 and 35 months receive MMR vaccinations. But within New York's ultra-Orthodox Jewish community, for example, the rate is as low as 60%. These communities tend to be extremely close knit, have large families and young populations, and are fairly isolated from their surrounding communities. 90% of unvaccinated people exposed to measles will become infected, and, in communities such as these, even a small rate of vaccination hesitancy could potentially pose an enormous risk for a larger epidemic. 

The current measles outbreak has become a major political issue in America. In New York City, Mayor Bill de Blasio controversially ordered mandatory vaccinations for specific areas of Williamsburg, Brooklyn—areas with heavily Orthodox Jewish populations—with a threat of a US$1000 fine. So far, six states have introduced legislation that would limit or eliminate the ability to claim religious or personal exemptions from vaccination for children. 

In the USA, anti-vaccine views don't align neatly with political poles. But the fact that views seem to be hardening is an ominous echo of the political divisions that have prevented the near-unanimous scientific consensus on global climate change from being more broadly accepted in the USA. The science on vaccines is just as reliable, and the prospect of vaccination becoming another front in a political cold war could presage incalculable harm. 

Global measles deaths have declined by over 80% since 2000—from 550 100 deaths to 89 780 deaths in 2016. But, according to WHO, there have been over 112 000 confirmed measles cases globally to date in 2019—nearly half of these in Africa, an increase of 700% over the same period in 2018. Europe has also seen a 300% increase in measles infection, with the German state of Brandenburg ordering mandatory vaccination at kindergartens. In 2018, 85% of children had received one dose of the two-dose MMR vaccine, while only 67% had received both. 

WHO reports that vaccine-hesitant parents often find misinformation online, and engagement, listening, and information provided by medical professionals are often the best ways to address concerns. While conflict and infrastructure are also major drivers of the current outbreak in Venezuela, Madagascar, and other nations, WHO called vaccine hesitancy one of its top ten threats to global health in 2019. 

Removing vaccine exemptions for non-medical reasons has proven effective in the past. In 2015, California outlawed non-medical vaccination exemptions for school admissions and the vaccination rate rose to greater than 95%. And while we must carefully balance the needs of public health with religious rights, vaccine hesitancy isn't just a personal issue. With a condition as contagious as measles, the choice not to vaccinate leaves the immunocompromised and children too young to be vaccinated at risk of infection. 

Measles continues to spread within the USA and internationally in isolated, under-resourced and conflict-riven areas. The USA spends around $2 billion on vaccination programmes annually, but further government investment and community engagement are required, in America and globally: from efforts to communicate the effectiveness of vaccination and the dangers of diseases parents may have no first-hand knowledge of, to making vaccination as easy as possible by providing the option of community and home vaccination for large families, families with limited means, or vulnerable populations. 

Fifty-six years ago, millions faced measles every year. Today, only a bare handful do, and that success should spur us to make the effort to engage, inform, and ensure that measles is controlled globally once and for all.

DRC Ebola: 23 new cases today, 1,396 total

April 25 was the worst day so far in the DR Congo's tenth Ebola outbreak. The MoH/WHO AFRO Ebola DRC KIVU 2018 Dashboard reports 23 new cases. The current week's total is 66, and the total for the outbreak is 1,396. 

We will learn more when the MoH publishes its daily update, which is usually around midnight Butembo time.

US: Measles outbreaks at UCLA and CSULA

A news release from the Country of Los Angeles Public Health: Public Health Collaborates with UCLA and Cal State LA to Prevent Spread of Measles. Excerpt:

LOS ANGELES – Los Angeles County Department of Public Health is working closely with health officials at University of California Los Angeles (UCLA) and California State University Los Angeles (Cal State LA) to institute a series of actions to limit the spread of measles based on its assessment of the previously identified measles cases. The goals are to build awareness among students, faculty and staff about the risks of measles after a potential exposure to measles, to confirm immunity to measles for those exposed, to provide instructions on what to do if you think you were exposed, and to offer measles immunizations to the broader university community. 

In this situation, for those exposed to a confirmed case of measles who could not provide evidence of two doses of measles immunizations or lab verified immunity to measles, a Health Officer Order for quarantine is being issued. Generally, a Health Officer Order (“Order”) mandates the exposed person to remain at their residence, to notify Public Health if they develop symptoms of measles, and to avoid contact with others until the end of their quarantine period or until they provide evidence of immunity. Quarantine for measles can be up to 21 days from the date of last exposure, at which time the exposed person is no longer a risk for developing the disease and spreading measles to others. 

Both universities are assisting with the implementation of quarantine orders and determining how best to support students who must be quarantined and who live on campus.  

Measles is highly contagious. It can stay in the air for up to two hours after a sick person coughs or sneezes and can also stay on surfaces for many hours. About 90% of people who are exposed and not immune to measles become ill 7-21 days after exposure. 

Schools are considered high-risk settings for exposure due to potentially frequent and prolonged contact. In accordance with the February 1, 2016, California Department of Public Health Immunization and Screening recommendations for college students, UCLA and CSULA require two doses of Measles, Mumps & Rubella (MMR) immunization OR positive titer (laboratory evidence of immunity to disease) for incoming students. 

Two doses of measles immunization are about 97% effective. Thus, getting immunized is the best way to prevent getting and spreading measles. Immunization protects not only the person who receives the immunization but also reduces the chance that measles will spread to family members, coworkers and friends.  

Public Health will continue to communicate with schools, health care providers, health plans, local governments, and elected officials to provide updates on the measles outbreak and actions they can take to help prevent the spread of measles and support the countywide response.

See also this article in The Guardian, and this one in The Washington Post.

Southern Africa: Tropical Cyclone Kenneth flash update no. 2 (25 April 2019)

Via ReliefWeb, an OCHA report: Southern Africa: Tropical Cyclone Kenneth Flash Update No. 2 (25 April 2019) - Mozambique. Excerpt:

SITUATION OVERVIEW

Tropical Cyclone Kenneth passed through the Comoros on 24 April, hitting the northern Ngazidja Island and reportedly causing three deaths, at least 20 injuries and extensive damage to houses across the archipelago. Preliminary estimates indicate that at least 1,000 people were displaced, most of them children. 

While assessments are ongoing, initial reports from the Comoros indicate that several villages were flooded due to sea surges and broken dykes, and that power was cut in multiple locations. Roads have reportedly been damaged and cut off by fallen trees, while telephone poles are down in multiple locations.  

On the evening of 25 April, Tropical Cyclone Kenneth made landfall between the districts of Macomia and Mocimboa da Praia. Although preliminary information on impact is still incoming, the storm’s cyclonic winds were expected to reach 180 kilometres per hour prior to landfall, according to the Mozambique National Institute for Meteorology (INM). 

The Cyclone is forecasted to bring heavy rains, with over 500mm of rainfall expected from 24 to 30 April, and more than 750mm possible in some locations in Cabo Delgado. As the storm comes at the end of the rainy season, river levels are already high, and several rivers are projected to increase beyond the severe alert threshold after landfall, with peak flows most likely to occur on 29 April in the region around Pemba (Mozambique). There is a high risk of flash flooding and landslides.  

This is the first time in recorded history that two strong tropical cyclones have hit Mozambique in the same season, with Tropical Cyclone Kenneth following on the heels of Tropical Cyclone Idai, which made landfall on 14 March, leaving more than 600 people dead and an estimated 1.85 million people in need in Mozambique alone. 

Tropical Cyclone Kenneth is expected to become only the third satellite-era system to evolve to a moderate tropical storm stage or higher in the area north of the Mozambique Channel, according to Meteo France. The other two systems concerned, Elinah in 1983 and Doloresse in 1996, did not reach the African coast. Tropical Cyclone Kenneth therefore threatens an area where the population is not used to cyclones. 

Southern Tanzania and eastern Malawi are also expected to receive rains caused by the weather system. In Tanzania, an increase in cloud formation is already being witnessed, and an increase of rain is expected in Dar es Salaam, Tanga, Pemba, Lindi and Mtwara regions, the south coast of Tanzania and around Lake Victoria. 

PREPAREDNESS AND RESPONSE 

The Comoros has activated its National Contingency Plan with the establishment of a fixed command post within the General Directorate of Civil Security (DGSC). Ahead of the storm, people living in high risk areas were urged to evacuate to shelters in safe locations. Emergency stocks have been positioned for the health, education, nutrition and WASH sectors and the United Nations has deployed staff to support Government-led assessments.  

In Mozambique, the Government and Red Cross volunteers alerted communities in areas where the concern of flooding, erosion and landslides was particularly high and at least 30,000 people were evacuated from areas at highest-risk, according to the National Institute for Disaster Management (INGC). Flights to Pemba have been suspended and schools have been closed in the cyclone’s path. Schools are also being prepared by the government to host people displaced by the storm. 

An INGC team, led by the Director-General, has deployed to Pemba, which humanitarian partners are supporting. A joint World Food Programme (WFP)/International Organisation for Migration (IOM) team is pre-positioned in the northern part of the province to support the response. Humanitarian organizations have pre-positioned supplies and have additional teams on stand-by to deploy to the area. 

In Tanzania, the Government initially issued a warning saying people in the town of Mtwara should move to higher grounds. However, as the storm path shifted southwards, the warning was stood down, according to media reports. 

In Malawi, the Government has issued a statement saying it expects enhanced rainfall throughout the country and in particular along the lakeshore.

Polio vaccinator is shot and killed in Pakistan

Via The New York Times: Polio Vaccinator Is Shot and Killed in Pakistan. This is the third death this week. Excerpt:

ISLAMABAD — Two gunmen on motorcycle shot and killed a polio vaccinator in the southwestern Pakistani city of Chaman on Thursday, bringing the death toll among vaccinators working in the country’s anti-polio drive to at least three this week, officials said.  

The shooters opened fire on a group of vaccinators when they were at the front gate of a house in the remote village of Sultan Zai, near the border with Afghanistan, said Samiullah Agha, who is the assistant commissioner of Chaman.  

Two members of the vaccination team were hit: Nasreen Bibi, 35, was killed, and Rashida Afzal, 24, was critically wounded, Mr. Agha said in an interview. Vaccination was suspended for an indeterminate period of time in the Chaman area after the shooting.  

“The gunmen fled after the attack,” Mr. Agha added. “Security forces have launched a search operation in the area.”   

Polio vaccination teams have suffered several attacks since a countrywide vaccination drive began on April 23. Polio workers, volunteers and their guards are frequently targeted in the South Asian country. Islamist militants and hard-line clerics say the vaccination drive is a foreign plot to sterilize Muslim children and a cover for western spies.  

“These are unfortunate incidents,” said Babar Atta, who is the special adviser on polio to Imran Khan, Pakistan’s prime minister. “We have increased the security of vaccination teams across the country and are determined to end this crippling disease in Pakistan.” 

Hayat Khan, a resident of a tribal area bordering Afghanistan who runs a shop, said he is skeptical of the polio vaccine. Neither he nor his parents have taken the vaccine, which can be delivered orally as drops, and they are living a healthy life, he said. 

“We have doubts in our minds about this western vaccine,” he said. “Tribal people are not sure what they are giving to our children and what information they are collecting for spying. It’s a Western agenda, indeed.”

Two days ago, in separate events, two police officers who were protecting polio vaccination teams were shot and killed in the northern districts of Buner and Bannu. And a polio worker was injured in a knife attack this week in the eastern city of Lahore.