H5N1

Ebola fight ongoing amid evidence of ‘several massacres’ in DR Congo’s Ituri province

Via UN News: Ebola fight ongoing amid evidence of ‘several massacres’ in DR Congo’s Ituri province. This helps to explain why Bunia Actualité, in the capital of Ituri province, is scarcely reporting on Ebola; the violence is far more serious. Excerpt:

The vital work of tracing people infected with deadly Ebola virus disease in north-east Democratic Republic of the Congo (DRC) is progressing, despite evidence of “several” massacres in the affected area earlier this month, the UN said on Friday.  

In an update on the situation in Ituri and North Kivu provinces, nearly 11 months after the outbreak began, the World Health Organization (WHO) reported 2,284 cases of infection so far, and 1,540 deaths.  

At the same time, the UN human rights office, OHCHR, announced that a “robust” probe found that 117 people had been killed in “several massacres” involving multiple villages in gold-rich Ituri, between 10 and 13 June.  

Victims beheaded in scorched-earth policy to prevent returns 

“The investigative team confirmed that at least 94 people had been killed in Djugu territory and 23 in Mahagi territory, including an as yet undetermined number of women and children,” OHCHR spokesperson Marta Hurtado said. “Some of the victims were beheaded. Homes and warehouses were burned down after being looted. The ferocity and scorched-earth nature of the attacks suggests the assailants intended to prevent survivors from being able to return to their villages.” 

 Most of the victims belonged to the Hema community, while the remainder were Alur people, Ms. Hurtado said. The attackers were reportedly from the Lendu community, she added, her comments echoing an earlier alert from the UN refugee agency, UNHCR, that thousands of people displaced by violence had arrived in Uganda this month, with an average of 311 people crossing the border daily, double the number for May.  

Despite the insecurity, WHO insisted that frontline workers were doing all they can to tackle Ebola in north-east DRC.  

“We had 637 people who survived the disease, and I think this is important”, said Dr. Ibrahima Soce Fall, WHO Assistant Director-General for Emergency Response.  

Briefing journalists in Geneva, he noted that around 90 people are currently receiving treatment for Ebola virus disease infection, while new cases have dropped from 106 two weeks ago, to 79 last week. 

Towns seeing only ‘sporadic’ infections, rural areas a serious concern 

Major urban centres of Butembo and Katwa were now seeing only “sporadic” cases of infection, thanks to full access, Dr. Fall explained, before cautioning that in Beni, a large town in North Kivu, Ebola had claimed nine lives since Monday.  

Contact tracing there and other preventative work was slowed earlier this week, he added, amid attacks by taxi drivers who were upset about the death of a colleague who sought help too late.  

Turning to remote areas, Dr. Fall confirmed that the “very volatile” security situation had complicated the WHO’s work to tackle “a new hotspot” in Mabalako and Mandima. 

“The outbreak started there last year and spread to other regions,” he said, “so it’s important to break the vicious cycle, to contain very quickly the situation in Mabalako and Mandima, where we have more than 55 per cent of the cases coming from.” 

For the first time in the current outbreak, Ebola has also reached small forest-based villages such as Alima, where access is “more challenging”, thanks to the presence of armed groups from DRC and neighbouring Uganda, Dr. Fall said.

DRC Ebola: 13 new cases, 13 deaths (4 in community), 4 recoveries

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 Friday, June 28, 2019. Excerpt from the Google translation:

EVOLUTION OF THE EBOLA EPIDEMIC  IN THE PROVINCES OF NORTH KIVU AND ITURI 

Friday, June 28, 2019 

The epidemiological situation of the Ebola Virus Disease  dated June 27, 2019: 

• Since the beginning of the epidemic, the cumulative number of cases is 2,297, of which 2,203 are confirmed and 94 are probable. In total, there were 1,553 deaths (1,459 confirmed and 94 probable) and 641 people healed. 

• 364 suspected cases under investigation; 

• 13 new confirmed cases, including 7 in Beni, 3 in Masereka, 1 in Mabalako, 1 in Biena and 1 in Kulunguta; 

• 13 new confirmed case deaths:  

º 4 community deaths, including 3 in Beni and 1 in Biena; 

º 9 deaths in CTEs, including 3 in Beni; 2 in Mabalako, 2 in Butembo and 2 in Katwa; 

• 4 people recovered from ETCs, including 3 in Beni and 1 in 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

Consensus Meeting and Consensus on Immunization in the EVD Epidemic in North Kivu and Ituri

• The Minister of Health, Dr. Oly Ilunga Kalenga, chaired, on Friday, June 28, 2019, the meeting of consensus and consensus on vaccination in the context of the tenth epidemic of the Ebola virus disease that has been raging since the 1st August 2018 in the provinces of North Kivu and Ituri.

• The two-day meeting aimed to create a consultative framework to transparently share the latest scientific and technical information on existing experimental Ebola vaccines to facilitate the Ministry of Health's decision-making on their use in the framework of the current epidemic or possible clinical trials in the margins of the current response. At the 72nd World Health Assembly, the Minister of Health made a commitment to hold a meeting on vaccination against Ebola to Kinshasa to discuss the latest SAGE recommendations.

• The Ministry of Health invited its partners and producers of these different experimental vaccines, including Merck, Johnson & Johnson, Cansino Biologics Inc. and Rospotrebnadzor, to submit to the national regulatory authorities the relevant technical data concerning their product.

• Several bodies of the Ministry of Health also made presentations at the meeting, in particular the Directorate General for Disease Control (DGLM), the Expanded Program on Immunization (EPI), and the National Program for Communication and Promotion of Health (PNCPS).
Dr. Oly Ilunga Kalenga solicited the contributions of all national and international participants during these meetings, so that together they could make relevant recommendations to the national regulatory authorities empowered to make the final decision. These authorities are the Directorate of Pharmacy and Medicine (DPM) and the National Ethics Committee.

• It should be noted that the vaccination against Ebola in this tenth epidemic was launched on 08 August 2018, less than 8 days after the declaration of the epidemic.

More than 8,000 teachers briefed on their role in fighting Ebola

• More than eight thousand (8,000) teachers from Butembo and Katwa have been briefed on their role in fighting Ebola.

• The aim of this training was to make these teachers ambassadors for the fight against EVD in the community during the school holidays in order to get rid of this epidemic at the beginning of the school year.

• It is done before the end of the school year in order to encourage teachers, as well as students and their parents, to adopt measures to prevent and combat EVD during school holidays.

No cause identified for death of children in Bihar, India

Via The Lancet: No cause identified for death of children in Bihar, India. Excerpt:

Since June 1, Bihar in eastern India, known for its lush lychee orchards, has been in the news because almost 150 children in Muzaffarpur and adjoining districts have died from an illness that many experts call acute encephalitis syndrome, a blanket term for several neurological manifestations. 

There is no definitive epidemiological diagnosis of these deaths as yet, but local reports suggest that several factors could be responsible, including a toxin that can be found in lychees, extreme heat and humidity, child malnutrition, and an ill-equipped public health system that could not offer timely treatment. The children who died were from very poor families, and most deaths have been attributed to hypoglycaemia. 

Bouts of recurring acute encephalopathy have been reported in Bihar since 1995. A Lancet Global Health study found that these outbreaks are “associated with both hypoglycin A and [methylenecyclopropylglycine] toxicity from lychee consumption” and that “this illness is also associated with absence of an evening meal”. 

“Muzaffarpur is a poor district with a cluster of significant risk factors for widespread child undernutrition—the available data from the National Family Health Survey highlights this very clearly”, Purnima Menon, a senior research fellow at the International Food Policy Research Institute's Poverty, Health and Nutrition Division, told The Lancet. “While we await the epidemiological diagnoses, at this point in time, it seems very much like this cluster of child deaths is very similar to what occurred in the same district in previous years.” 

T Jacob John, a retired virology professor from the Christian Medical College, Vellore, Tamil Nadu, who, along with colleagues, had investigated the disease in Muzaffarpur during outbreaks in 2012, 2013, and 2014, says the children would not have died had they not gone to sleep on an empty stomach. 

“The lychee is not the primary cause”, John told The Lancet. “You have to fix the primary health-care system and the gross malnutrition. No child from a well-to-do family has ever suffered because he or she ate lychees.”

Uganda Ebola update: No new cases for the past 13 days

Via New Vision: Ebola Update: No New Cases For The Past 13 Days. Excerpt:

KAMPALA - As the Ebola virus disease continues to ravage Democratic Republic Congo (DRC), particularly the Beni region, 50km from the Ugandan border, Uganda has not registered new cases of the disease for the past 13 days, according to the ministry of health spokesperson Emmanuel Ainebyoona. 

“In addition to the absence of new cases of Ebola, there is currently no patient in the isolation unit as well. So far, 14 people who have been under isolation but have all tested negative,” Ainebyoona told New Vision. 

Uganda, which has been on high alert for Ebola following an outbreak in DRC registered a case of the disease on June 11 in Kasese district, after a five-year-old Allan Bwambale returning to Uganda from DRC through Bwera border post  tested positive of Ebola. 

Bwambale was from Masambu in the DRC where he had gone with his mother to attend his grandfather’s burial in Beni. His grandfather was suspected to have died of Ebola. On return, Bwambale started feeling fever and abdominal pain, joint pains, and vomiting. The temperature on admission was high and the tests for Ebola turned positive. 

He was admitted and isolated at Bwera Hospital Ebola Treatment Unit but passed on shortly after. 

Although there have been numerous previous alerts, this was the first confirmed case in Uganda during the Ebola outbreak on-going in DRC.

DRC: A political exile comes home to fight Ebola

Via Actualite.cd: "I can not decline the outstretched hand of those who have the power, when it is necessary to try to find solution to the problems of Ebola which decimates us": Mbusa. The Google translation:

Mbusa Nyamwisi arrived this Friday, June 28, 2019 in Butembo. During a rally in front of thousands of people at VGH Square, an important crossroads of the city, he explained the reasons for his involvement in the response to the deadly Ebola epidemic that has already killed more than 1,300 people in North Kivu and Ituri since early August 2018. 

"When I accepted the extended hands of new authorities, I mentioned the security of the region but especially Ebola. Because we often see people burn vehicles, Ebola treatment centers, they even kill doctors, it's very dangerous because only one contaminated person can exterminate us all and even the whole nation " he explained.  

Influential personality of the Beni-Butembo region, Mr. Mbusa wants to give his contribution to overcome the disease.  

"I must be clear. I did not come to finish Ebola, because I do not have the competence because I am neither a doctor nor an expert. But have come to my contribution to raise awareness and awareness of those who believe in me to facilitate the activities of the Ebola response to overcome this disease. Of course, not everything is rosy in the response, but please, the most important for now is to support the response to stop the deaths," said the president of the RCD / KML.  

This is the first stage of his visit to the Great North (Beni, Butembo and Lubero), his main stronghold, which he finds after nearly seven years of political exile. Antipas Mbusa Nyamwisi has said he will end his political exile to join Felix Tshisekedi's regime in his efforts to fight insecurity and Ebola disease in the region. 

Challenges, not the least. For insecurity for example, it remains fueled by local militias, of which nearly 132 remain active in North and South Kivu, according to a count of the Security Barometer Kivu, a joint project of the Study Group Congo (GEC) and Human Rights Watch (HRW).

DRC Ebola: 13 new cases, 50 this week, 2,297 total

The MoH/WHO AFRO Ebola DRC KIVU 2018 Dashboard report 13 new cases on June 27, making 50 cases so far this week, 253 in the past 21 days, and 2,297 since the outbreak began. Out of 18,100 contacts, 1,900 are not being traced.

WHO: Ebola virus disease – Democratic Republic of the Congo

WHO has published its weekly update: Ebola virus disease – Democratic Republic of the Congo. Excerpt:

The Ebola virus disease (EVD) outbreak in the North Kivu and Ituri provinces continues at a stable pace this week. Although response operations were temporarily interrupted in Beni following two days of insecurity in the surrounding areas, operations have largely resumed. However, in the town of Musienene, violent threats persist against healthcare workers (HCW) and local security forces providing assistance to the response efforts. Furthermore, response activities in Kambau health area, Manguredjipa health zone were also suspended following security incidents. 

Of growing concern this week, are the current hotspots of Mabalako, particularly the Aloya health area, and Mandima (Figure 1), which were the first health zones to report EVD cases in August/September 2018. Sporadic reintroduction events in areas such as Vuhovi, which had not reported any new cases in the past 24 days, further compound the evolving situation. Other areas experiencing a similar resurgence in EVD cases after a period of prolonged absence include Komanda and Masereka.  

In the 21 days, between 5 to 25 June 2019, 67 health areas within 19 health zones reported new cases, representing 10% of the 664 health areas within North Kivu and Ituri provinces (Figure 2). During this period, a total of 252 confirmed cases were reported, the majority of which were from the health zones of Mabalako (35%, n=88), Beni (17%, n=43), Mandima (12%, n=30), Butembo (5%, n=13) , Musienene (5%, n=13) , Kalunguta (5%, n=12), and Katwa (5%, n=12). As of 25 June 2019, a total of 2277 EVD cases, including 2183 confirmed and 94 probable cases, were reported (Table 1). A total of 1531 deaths were reported (overall case fatality ratio 67%), including 1437 deaths among confirmed cases. Of the 2277 confirmed and probable cases with known age and sex, 57% (1287) were female, and 29% (663) were children aged less than 18 years. Cases continue to rise among health workers, with the cumulative number infected rising to 129 (6% of total cases). 

In Mabalako, a total of 88 confirmed cases, with 61 concentrated in the Aloya health area, have been reported from 5-25 June. Multiple transmissions chains have been identified to be related to family connections, and 15 infections were associated with healthcare facility related infections. Currently, the main challenges present in Mabalako revolve around follow up of registered cases and the low number of alerts reported relative to the number of new EVD cases detected. 

In Mandima, as of 25 June, a total of 30 cases have been reported in the past 21 days, with the majority of the cases (22) originating from Biakato Mines, Biakato Mayi, and Alima health areas. Six chains of transmission have been identified over that time period, with new cases being primarily attributed to individuals having contact with an infected family member or other patients in healthcare facilities. Timely investigation of alerts in Mandima to date have been suboptimal due to lack of access and insecurity, with only 73% of alerts being investigated thoroughly within the first 24 hours. 

No new EVD cases or deaths have been reported in the Republic of Uganda since the previous EVD Disease Outbreak News publication on 13 June 2019. As of 26 June, 108 potentially exposed contacts have been identified and are under surveillance, including 13 who have completed followed up. Contacts will be visited daily for 21 days until the last contact completes follow-up on 3 July. All contacts remain asymptomatic to date. All 14 suspected cases reported to date have tested negative for EVD. On 26 June, ring vaccination of potential contacts was completed, with a total of 1063 individuals having consented and been successfully vaccinated, including 74 contacts (34 were not eligible for vaccination), 740 contacts of contacts, and 249 healthcare workers.

DRC Ebola: 7 new cases, 9 deaths (2 in community), 9 recoveries

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 Thursday, June 27, 2019. Excerpt from the Google translation:

EVOLUTION OF THE EBOLA EPIDEMIC  IN THE PROVINCES OF NORTH KIVU AND ITURI 

Thursday, June 27, 2019 

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

• Since the beginning of the epidemic, the cumulative number of cases is 2,284, of which 2,190 are confirmed and 94 are probable. In total, there were 1,540 deaths (1,446 confirmed and 94 probable) and 637 people healed. 

• 328 suspected cases under investigation; 

• 7 new confirmed cases, including 5 in Beni, 1 in Mabalako, 1 in Rwampara; 

• 9 new confirmed case deaths:  

º 2 community deaths in Beni; 

º 7 deaths in CTEs, including 4 in Mabalako, 2 in Butembo and 1 in Beni; 

• 9 people recovered from ETCs, including 7 in Mabalako and 2 in Katwa.

 

/! \  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   

Dialogue with the Madrandele community 

• On Thursday, June 27, 2019, a dialogue was held between the Madrandele health area community, the EVD response coordinator in Beni, the experts from the communication, psychosocial and epidemiological surveillance committees, as well as delegates from the WHO and UNICEF.  

• This dialogue led by the mayor of the city of Beni, Bakwanamaha Modeste, was held in Kalinda district of Madrandele where two teams of the response were attacked on June 23rd. A first meeting had already taken place with the families concerned by this incident on Wednesday, June 26, 2019.  

• Thursday's community dialogue aimed to better understand the concerns of the community in order to involve them more and to gain their support for all the actions of the Ebola response.

Mandatory vaccination: Suited to enhance vaccination coverage in Europe?

An editorial in Eurosurveillance: Mandatory vaccination: suited to enhance vaccination coverage in Europe? Excerpt:

Vaccines are one of the most successful medical measures that save millions of human lives every year. With the implementation of routine immunisation programs, high and maintained vaccination coverages for many vaccine-preventable diseases—such as those against poliomyelitis or diphtheria—have been reached in most European countries and many others. Although vaccine acceptance is often high within the general population, even in countries with high vaccination coverage a significant number of children and adults are not sufficiently vaccinated because of missed opportunities or various concerns and misperceptions. 

The reasons for this ‘vaccine hesitancy’ are multifactorial, complex and vary across vaccines, time and countries/regions, and are influenced by factors such as complacency (not perceiving disease as high risk and vaccination as necessary), convenience and constraints (practical barriers), and confidence (lack of trust in safety and effectiveness). As a result, vaccination coverages against highly contagious pathogens such as measles virus are not sufficient to prevent outbreaks and infectious disease spread in many countries today.  

Despite the World Health Organization (WHO)’s goal to eliminate measles, a constant increase in measles cases has occurred in recent years. In 2018, more than 82,500 people in 47 of the 53 countries in the WHO European Region were infected with measles, leading to 72 deaths. These numbers were the highest in a decade. They were three times higher than in 2017 and 15 times higher than in 2016, when numbers were at a record low. 

In 2019, the situation seems to be even worse, indicating that current plans of action in the affected areas are insufficient to stop measles circulation. This is evidenced by the fact that the estimated coverage with the second dose of a measles-containing vaccine is far below the necessary 95% to achieve herd/population immunity in several European countries. 

In order to maintain or improve the population immunity acquired by vaccination, several countries are currently revisiting their strategies and discussing changes in vaccination policies, with a focus on either educating the population and giving individuals freedom of choice or implementing mandatory vaccination to ensure high coverage rates. 

With increasing calls to introduce mandatory vaccination programs, intense debates on their effectiveness have also started in several European countries. There are concerns that mandatory vaccination may lead to opposing attitudes and even less vaccine uptake, particularly in those with existing critical attitudes towards vaccines; nonetheless, other studies have disproved that implementation of compulsory vaccination led to opposing attitudes and/or had negative effects. 

However, it is indisputable that with any changes in vaccination policies, intensified information strategies are necessary to improve trust, rectify perceived risks and improve access and affordability of vaccines. Moreover, it is important to note that mandatory vaccination can follow different routes depending on a country’s specific social and cultural backgrounds, as well as epidemiological situations. 

Consideration of these factors can lead to implementing temporary or permanent vaccine mandates for certain vaccines (such as measles/measles-mumps-rubella (MMR) partial compulsory vaccination), for all vaccines included in a national vaccination program or for selected target groups, such as infants and children before entrance in educational settings or certain occupational groups, such as healthcare workers (HCW).  

For example, in France three mandatory vaccines (against diphtheria, tetanus and poliomyelitis (DTP)) co-existed with eight recommended vaccines (against MMR, pertussis, Streptococcus pneumoniae, hepatitis B (HepB), Neisseria meningiditis serogroup C (MenC) and Haemophilus influenza (Hib)) for routine childhood immunisation up until 2017. However, misperceptions in the population, i.e. that non-mandatory vaccines are less valuable, optional or not as safe and effective as the mandatory ones, resulted in insufficient and stagnating vaccine coverages of the recommended vaccines. This growing vaccine hesitancy, as well as large outbreaks and deaths from measles, led to a change in French policy to extend the mandates to all 11 childhood vaccines.  

Italy has had a similar situation, where four mandatory vaccines were in place already before 2017 (against poliomyelitis, tetanus, diphtheria and HepB). The coverage for vaccination against measles, mumps and rubella dropped country-wide from 90% to 87% between 2000–16. This, together with large measles outbreaks, led the government to extend the existing vaccine mandates to 10 mandatory vaccines (hexavalent vaccine against DTPert (pertussis)-poliomyelitis-Hib-HepB, as well as MMR and Varicella (V) vaccine) in 2017, whereas vaccination against Men C, S. pneumoniae and rotavirus remained recommended vaccines.  

The current issue of Eurosurveillance presents articles from France and Italy on approaches and experiences after the extension of mandatory vaccination. While an article in last week’s issue of Eurosurveillance by Mathieu et al describes the population’s general attitude towards mandatory vaccination shortly before implementation of extended vaccination mandates in France, the rapid communication by Lévy-Bruhl et al. in this issue evaluates the effects of mandatory vaccination on vaccine coverage 2 years after its implementation. D’Ancona et al., also in this issue, depict challenges in Italy in the year following the introduction of the new mandate and how these are being addressed.

Uganda: Government warns against mass immunisation sabotage

Via New Vision: Govt Warns Against Mass Immunisation Sabotage. Excerpt:

KAMPALA - The Government has warned cultural and religious leaders against sabotaging the upcoming mass immunisation exercise against measles and rubella, both caused by a virus. 

Health minister Dr Ruth Aceng, who voiced the warning, said culprits will be prosecuted. 

“Government will take action against cultural and religious leaders who will interfere with the mass immunisation exercise, according to the law. We have no choice but to implement the law,” she told a meeting of Resident District Commissioners (RDCs) in Kampala on Thursday. 

It was an engagement and sensitisation meeting on a planned campaign against meales and rubella, also known as German measles.  

Both are highly contagious diseases, transmitted in similar ways. Measles is spread through droplets from the nose, mouth or throat of infected persons while rubella is transmitted in airborne droplets when infected people sneeze or cough.    

President Yoweri Museveni assented into law the Immunization Act 2017, which makes it mandatory for every child to be immunised and a requirement for school enrolment.  

Dr. Aceng cited districts such as Kamuli, Kaabong and Napak, where in 2014, some of the cultural and religious leaders campaigned against a mass immunisation exercise against polio due to cultural and religious beliefs. 

She said there not be a repeat of that.  

The upcoming mass immusation exercise is scheduled for September in all the 136 districts for children between 9 months and 15 years of age.