H5N1

New threats put wildfire fighters’ health on the line

Via The New York Times: New Threats Put Wildfire Fighters’ Health on the Line. This will be a serious issue for the rest of the century. Excerpt:

SANTA ROSA, Calif. — As fires spread across Northern California last year, Capt. Matt Alba and Strike Team 2253A found themselves wading through a smoldering jungle of plastic and metal in search of bodies.  

As they worked through charred auto shops and trailers, Mr. Alba kept thinking about the poisons they were kicking up, and that they did not have a single mask or hazmat suit among them. 

Wildfire fighting had changed. 

For generations, firefighters fought mostly in desolate forests, where most of the dangers were fatigue and falling trees. But a confluence of modern factors — namely America’s rapid suburban expansion into the wilderness, combined with the growing ferocity of wildfires — is posing a host of new health threats to the men and women who fight these blazes. 

While burning wood poses some threat to lungs, man-made products and the gases and particles they produce when burned are far more dangerous.  

In the last three years, California has seen a record number of devastating fires, and thousands of firefighters have been exposed to chemicals they had not previously encountered in such high volumes.

Unlike urban firefighters dealing with structural blazes, these wildfire responders do not wear heavy gear that filters air or provides clean air because the gear is unwieldy and too limited to allow the kind of multi-hour, high-exertion efforts demanded on the front lines of these large outdoor infernos.  

But some think more needs to be done to keep wildland firefighters safe.  

Mr. Alba, who has been with the San Francisco Fire Department for 18 years, spent 11 days working in Paradise, Calif., last year, in a smog so thick it burned his lungs. As he picked his way through the wreckage, he said, his crew began to fall sick: severe headaches, brutal coughs. 

“I was just thinking about 9/11,” he said of the many firefighters who fell ill after the 2001 terrorist attacks. “I asked myself: Is history repeating itself here?”

DRC Ebola: CMRE update, October 31

CMRE has published Situation épidémiologique du 31 octobre 2019. Excerpt from the Google translation and then a comment:

EVOLUTION OF THE EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI AS AT OCTOBER 30, 2019   

Thursday, October 31, 2019   

Since the beginning of the epidemic, the cumulative number of cases is 3,272, of which 3,155 are confirmed and 117 are probable. In total, there were 2,183 deaths (2066 confirmed and 117 probable) and 1052 people healed. 

• 503 suspected cases under investigation; 

• 3 new confirmed cases in Ituri in Mandima; 

• 1 new confirmed death at CTE in Ituri in Mambasa; 

• 4 people cured out of ETCs in North Kivu, including 3 in Mabalako and 1 in Beni; 

• No health workers are among the newly confirmed cases. The cumulative number of confirmed / probable cases among health workers is 161 (5% of all confirmed / probable cases), including 41 deaths; 

• Continued search for the patient confirmed on 23 October 2019 in Mandima in Ituri and fleeing into the community.

 

The data presented in this table are subject to change after extensive investigation and after redistribution of cases and deaths in their respective health areas.

NEWS  

Closing of the mid-term review of SRP4 for Ebola Virus Disease in Goma 

- The Minister of Health, Dr. Eteni Longondo, closed this Thursday, October 31, 2019 in Goma, capital city of North Kivu, the Mid-term Review of the fourth Operational Plan of the Integrated Strategy for Disease in Ebola virus. 

- Dr. Eteni Longondo, urging the teams of the response, gave some recommendations, notably related to the alignment of the national and international partners behind the SRP4 and to the Human Resources management of the response and financial allocated to the State Congolese ; 

- "  We recommend that the management of funds made available to the Congolese State be done transparently. The technical secretariat of the CMRE and state institutions need to know what is being done with these funds. Given the current trend of the 10 th epidemic of MVE evoking the disappearance of the epidemic, we must begin to redirect funds to finance the strengthening of the system ";  

-  He also insisted on impunity in the management of human resources, where one notices the swelling of payroll listings; 

- Five major recommendations were formulated in this workshop, including the establishment by the general coordination of the Ebola Virus Epidemic response of an ad hoc committee to follow up on the recommendations of the review and the plan. post-Ebola discharge and the implementation of the Zero Transmission Strategy modalities; 

- We also note the signature by the Minister of Health of an order on the scale setting the premium of the service providers and the functions used in the response, the availability by the partners concerned of the financial report of the SRP4 for the period from July to September 2019 to submit to the World Bank, the development by the technical secretariat of a communication plan adapted to promote the implementation of the second vaccine in the community and the finalization by the sub-coordination of the response of inventories of equipment and equipment acquired during the response and the means of their maintenance after redeployment; 

- The technical secretary of CMRE, Prof. Jean-Jacques Muyembe Ntamfum, announced in collaboration with the partners of the Ministry of Health, a workshop on strengthening the health system and preparing for the end of transmission of the Ebola virus;

- This ceremony, which benefited from the support of the PDSS, ended in the presence of the United Nations Coordinator for the emergency response of the Ebola epidemic in the DRC, the Deputy Director General of the WHO, the Provincial Minister of Health representing the Governor of the Province of North Kivu, the Provincial Ministers in charge of Health of North Kivu, South Kivu and Ituri, the Inspector General for Health, the Heads of Service, executives and experts from the central and provincial levels, the mayors of the cities of Butembo and Beni. Among the UN agencies and non-governmental organizations, both national and international, there were Unicef, IOM, MSF, Red Cross, Alima, CDC Atlanta and the World Bank. 

VACCINATION  

- Since vaccination began on August 8, 2018, 245,520 people have been vaccinated; 

- 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 20 May 2018. 

MONITORING AT ENTRY POINTS  

- Since the beginning of the epidemic, the total number of travelers checked (temperature rise) at the health control points is 111,795,227; 

- To date, a total of 111 entry points (PoE) and sanitary control points (PoCs) have been set up in the provinces of North Kivu and Ituri to protect the country's major cities and prevent the spread of the epidemic in neighboring countries.

The search for the escaped patient in Mandima has been going on for the better part of a week. The person must by now be gravely ill if not dead, and some of those sheltering him could be starting to show symptoms.

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 ongoing Ebola virus disease (EVD) outbreak in the North Kivu and Ituri provinces saw a stabilization in the number of new cases this past week, with 19 confirmed cases reported in the past week (23–29 October), essentially equivalent to the 20 confirmed cases the week before. The majority (63%) of newly confirmed cases link back to chains of transmission in Biakato Mine Health Area, Mandima Health Zone, including a further three cases detected outside of Mandima in individuals who recently travelled from Biakato.  

Onward local transmission has been observed in a limited number of towns and villages within family/social networks or health centers where cases visited prior to their detection and admission to treatment. 

In Mabalako, seven new cases were reported, of which two were linked to Biakato, two reported local family contact, and two were contacts within local health facilities, suggesting possible nosocomial exposure; investigations are ongoing for the remaining case. 

In Mambasa Health Zone, one additional case was reported, linked to a large cluster of cases. In Butembo, after over 21 days with no cases, two were reported this week. Both were residents of Kalunguta Health Zone where they were likely exposed. Thus far, there is no evidence of onward transmission in Butembo; nonetheless, these events demonstrate the high risks of reintroduction and resurgence in previously cleared health zones. 

During the past 21 days (from 9 – 29 October), 59 confirmed cases were reported from eight active health zones in North Kivu and Ituri provinces (Figure 2, Table 1) with the majority reported in three health zones: Mandima (49%, n=29), Mabalako (20%, n=12), and Mambasa (10%, n=6). As of 29 October, a total of 3269 EVD cases were reported, including 3152 confirmed and 117 probable cases, of which 2182 cases died (overall case fatality ratio 67%). Of the total confirmed and probable cases, 56% (n=1841) were female, 28% (n=926) were children aged less than 18 years, and 5% (n=163) were health workers.

Stealing tongues: Miscommunication in the time of Ebola in DR Congo

Thanks to Mary Marshall for sending the link to this RFI.fr report: Stealing tongues: miscommunication in the time of Ebola in DR Congo. Excerpt (but read the whole article):

The second-largest Ebola epidemic continues in North Kivu, DRC, as health responders continue to battle the disease. The outbreak has raged for more than a year, but numbers have begun dropping as those at its epicentre begin to feel more confident about how to deal with the virus. 

In Part 3 of RFI’s focus on issues surrounding the Ebola crisis, Laura Angela Bagnetto speaks to experts in the region about how cultural misunderstandings and miscommunication affected the Ebola response in the North Kivu. 

 The challenge of North Kivu is that it is linguistically diverse French and Kiswahili are two official languages spoken in the region, along with Kinande, a local language. When the Ebola epidemic hit the region in August 2018, an emergency response was mobilised with Francophone speakers – either from the African continent or Western countries.  

With the danger and severity of the outbreak, less attention was paid “to make sure that the information actually being shared on how to prevent Ebola, and how to treat and cure the disease, in a language that people could actually understand”, says Mia Marzotto of Translators Without Borders, a group that aims to close the language gaps that hinder humanitarian efforts worldwide. 

North Kivu is a restive region containing some 70 different armed militias, in an environment where large portions of the population, particularly women and old people, have not had the opportunities to study French, making the a language literally out of reach for many in the region. 

And while Kiswahili was the second language responders used for posters and information campaigns, it is not standardised Kiswahili, but changes from city to city, town to town, says Marzotto, speaking to RFI in Goma, DRC.  

“Health centre, or centre de santé in French is kituoa kya afia in Congolese Swahili, and ku dawa in local Swahili in Beni,” she says, giving one example. 

And if that complicates issues, Kinande also contains hyper-local variations. Only 44 kilometres separates the town of Beni and the city of Butembo.  

“Medical check-up is erilevya muviri in Kinande in Beni, and erisuvakolania ovulwere in Kinande in Butembo,” she adds.  

Lost in translation  

While some variation of Kinande eventually became the go-to language for the local response, health workers in the region created specialised medical terms that had never been used in a health context before. The terms were created for health workers and communications staff to educate people on the deadly disease, such as cas suspect in French, that is a suspected case of Ebola. 

“The word cas in Kinande spoken in Beni is a diminutive. So when people hear cas, you’re diminishing them,” says Marzotto, which creates confusion and negative connotations.  

The term vainqueur, or ‘winner’ in French, is given to people who have been cured of Ebola. Translators Without Borders finds this term problematic, too. 

“In people’s minds they associated this with conflict or some kind of violence that they won,” says Marzotto. 

“One thing that we heard from people we spoke to in Beni in our recent language assessment is that using this term vainqueur is as if saying somebody suspected -- a police term--  of having Ebola was brought to the treatment centre where he had a fight with the doctor and won,” she adds.  

The term health officials use for the strategy of vaccinating people who have come into contact with an Ebola sufferer is ‘ring de vaccination’, or vaccination ring, a word in French borrowed from English.  

Marzotto says that when they carried out their research in Beni, one of the Ebola hotspots in North Kivu, local people thought of this as a boxing ring. “Vaccination is linked to some violent conflict or confrontation between two people or more, and not necessarily as something that can protect you and make sure that you and your family can be safe,” she says.

Maxmen: California biologists are using wildfires to assess health risks of smoke

Via Nature News & Comment, Amy Maxmen writes: California biologists are using wildfires to assess health risks of smoke. Excerpt:

As the skies above the San Francisco Bay Area in California filled with smoke last week from wildfires ripping through nearby Sonoma County, Kari Nadeau and Mary Prunicki sprang into action.  

The pair, scientists at Stanford University in the Bay Area, began calling in hundreds of people who had signed up to participate in their study of the long-term health effects of wildfire smoke. Previous research has linked air pollution from wildfires to surges in hospital visits for asthma and strokes. But it’s not clear whether exposure to wildfire pollution has lasting consequences — something that Nadeau, director of Stanford’s Sean N. Parker Centre for Allergy & Asthma Research, and Prunicki, a pollution biologist, hope to find out. 

In early October, before the first large wildfires of the year sparked in northern California, their team assessed the circulatory, respiratory and immune systems of people enrolled in the study. The scientists began calling participants back to their lab on 28 October to undergo the same tests, which they’ll repeat in three months after the smoke has cleared. Nadeau and Prunicki have approval to continue assessments until 2037 and ultimately hope to enrol as many as 2,000 people — amassing a trove of data on how a person’s body responds over time to wildfire smoke.

Answers are sorely needed. Wildfires burned a record-breaking 760,000 hectares last year in California, destroying an area larger than the US state of Delaware. Almost 100 people died and hundreds of thousands of others breathed in sooty air for days. And climate models predict these blazes will grow larger and more frequent in the coming decades. The area burned in California each year will increase by 77% by the end of the century if greenhouse-gas emissions continue to rise, according to the state’s most recent climate-change assessment. 

Lisa Miller, an immunologist at the University of California, Davis, says the Stanford study is one of the first to monitor wildfires’ health effects in a diverse group of people over several years. By understanding who is most affected by wildfire and why, Miller says researchers can create evidence-based guidelines for mitigating risk. She is particularly worried that smoke exposure could damage children’s lungs as they develop in ways that lead to chronic health problems.  

“We have to be better prepared for these events,” she says. “Last year was everyone’s wake-up call that we need to be ready for the next big fire to happen — because it will happen again.”

US: Release of Vaxxed sequel prompts fears dangerous propaganda will spread again

Via The Guardian: Release of Vaxxed sequel prompts fears dangerous propaganda will spread again. Excerpt:

Anti-vaccination campaigners are preparing to release the sequel to Vaxxed, the highly contentious film that has been used to spread the unfounded claim that vaccines cause autism and other developmental problems.  

Vaxxed II: The People’s Truth will be premiered on 6 November in 50 venues across America. Its producers, led by Robert F Kennedy Jr, are keeping locations secret with tickets sold quietly in advance in the hope of foiling efforts to block the movie.  

From 7 November, the film will be taken on the road in the same “Vaxxed” bus that was deployed in 2016 to disseminate the original film, traveling more than 50,000 miles from coast to coast of the US. The movie was a powerful propaganda tool for the anti-vaccination movement, which has seen a surge in recent years within certain religious communities and among parents worried about scientifically unproven so-called “vaccine injuries”.  

Vaxxed II lands at a particularly anxious time in the US, where several states including California and Washington have been battling against localised outbreaks of measles. The worst affected state, New York, only recently succeeded in bringing the disease under control. 

Official figures compiled by the Centers for Disease Control and Prevention (CDC) show that in the first nine months of this year some 1,249 measles cases were reported in the US – the largest incidence of the disease in almost 30 years. Of those, one in 10 were hospitalized.  

The explosion of cases of an illness once considered eliminated from the US has alarmed medical experts. They predict children will die unless anti-vaccination fears among parents are assuaged. 

“If that level rises to 2,000 or 3,000 cases a year we will start to see children dying of measles once again. That’s the dangerous game that is being played here,” said Dr Paul Offit, a vaccine expert at the Children’s Hospital of Philadelphia. 

Running to 92 minutes, Vaxxed II bears many of the hallmarks of the original Vaxxed movie. The film, which the Guardian has previewed, is slickly produced and carries considerable dramatic punch – making its message all the more potent.

WHO, Congo eye tighter rules for Ebola care over immunity concerns

Via Reuters, alarming news: Exclusive: WHO, Congo eye tighter rules for Ebola care over immunity concerns. Excerpt:

The World Health Organization and Congolese authorities are proposing changes to how some Ebola patients are cared for, new guidelines show, after a patient’s death challenged the accepted medical theory that survivors are immune to reinfection.

There are many unanswered questions surrounding the circumstances of the woman’s death in Democratic Republic of Congo, which has not previously been reported.  

But it has raised concerns because the woman, whose name has not been released for confidentiality reasons, was thought to have had immunity after surviving infection, but fell ill again with Ebola and died.  

“That was a big red flag event for all of us,” said Janet Diaz, who leads the World Health Organization’s clinical management team for the epidemic in Congo.  

Congo’s Ebola outbreak has infected over 3,000 people and killed more than 2,000 since August last year. It is the second-worst outbreak after one in West Africa between 2013 and 2016 that killed more than 11,000 people.  

The woman was working as a caregiver in the high-risk “red zone” of a treatment center in Beni, eastern Congo, according to health officials familiar with her case. 

She was one of dozens of people assigned to care for Ebola patients because it was assumed they would not get sick as Ebola survivors, although some researchers have considered reinfection to be at least a theoretical possibility. 

Their presumed immunity allowed for closer contact with sufferers, many of them children. 

Alima, the medical charity that co-ran the Beni center where she worked, said she tested positive for Ebola and died in July before she could be readmitted for treatment. 

 But it is not yet known whether the woman received a false positive result the first time she was tested, experienced a relapse or was reinfected, health officials say.

DRC Ebola: To declare the end of the epidemic, all outbreaks must exceed 42 days without a new infection

Via Koma Ebola: To declare the end of the epidemic, all outbreaks must exceed 42 days without a new infection (Dr Bibiche Matadi). The Google translation:

In recent weeks, the Ebola virus disease has clearly declined. Most outbreaks in the epidemic are recording fewer and fewer cases. Others count several weeks without new infection. Therefore, the population is impatient to know when the end of the epidemic will be declared. 

The question comes from the city of #Butembo where one constantly asks after how long without new case can declare the end of the epidemic. "All households need to spend 42 days without notifying new cases," says Dr. Bibiche Matadi, chair of the "monitoring" subcommittee of Beni's response in an interview with Koma Ebola on Wednesday.  

"As long as we still notify cases, we can not lower our guard, we must continue surveillance, we must continue vigilance until the last health zone that notifies a case follows the contacts during the 21 days. To this will be added another period of 21 days, which is 42 days," explained Dr. Matadi. 

According to her, during this period, the response teams and the community must increase vigilance. "It's a job that needs to be done in an efficient way and the monitoring has to be intensive to recover all the cases, to take care of all the cases and to reassure that there are actually zero cases of Ebola in our province, zero cases of Ebola in our country," she added.  

She acknowledges that several health zones have gone several days without notifying cases. But the end of the epidemic is not declared "because we are not out of business yet". Because there are also health zones that continue to report cases and "we all know that with Ebola, only one case is enough to declare the outbreak," said the head of surveillance at Beni.  

"Before we declare the end of the epidemic, we take care, we take every precaution to ensure that all cases of the disease have been found and isolated; this to cut the chain of transmission. And we have to work with the community," said Dr. Bibiche Matadi.  

Since the health zone of #Beni has recently reported a new case, there are suspicious cases at the Transit Center waiting for their laboratory results. "But we have patients at the Ebola Treatment Center," concluded the president of the "monitoring" subcommittee of Beni's response.

DRC Ebola: UN hails 'significant progress' in Ituri

Via Radio Okapi: Ebola: UN hails 'significant progress' in Ituri. The Google translation:

Significant progress has been made in the fight against the Ebola epidemic in Bunia (Ituri), the UN Deputy Coordinator for the Ebola Response, Abdou Dieng, announced on Wednesday (October 30th). 

This progress can be seen in the reduction of new positive cases. But, he thinks, much remains to be done for the eradication of this disease, which still persists in the localities of Biakato, Mandima and Mambasa-center.  

It also seeks the collaboration of the population to overcome resistance to Ebola and also to avoid the "militarization of the response."  

The UN Deputy Coordinator for the Ebola Response was speaking on his first visit to the region. 

Branswell: Second Ebola vaccine to be used soon in DRC outbreak

Via STAT, Helen Branswell writes: Second Ebola vaccine to be used soon in DRC outbreak. Excerpt:

The Democratic Republic of the Congo will begin using a second Ebola vaccine as early as next week, the company developing the experimental product, Johnson & Johnson (JNJ), said Thursday. J&J announced it is donating enough of the product to vaccinate up to 500,000 people.  

The vaccine will be used as part of a clinical trial, but the aim is as much to help extinguish the long-running outbreak in the country’s northeast as it is to gather data on the effectiveness of the vaccine, which does not yet have a brand name.  

“We are very excited to be able to contribute,” Dr. Johan van Hoof, global head of Janssen Infectious Diseases and Vaccines, J&J’s vaccines division, told STAT. “We see this as a significant milestone having worked so long on this that this is now going to be used.” 

In recent weeks the outbreak has appeared to be waning, with fewer cases in October than any month since September 2018. Should the outbreak end in the next couple of months, it’s not clear whether the trial will be able to determine if the vaccine is as protective as earlier studies would suggest. The company has tested the vaccine in primates — a good model for human infection — and has monitored both how high antibody levels rose and how long they remained elevated in people who were vaccinated in Phase 2 trials.  

“It’s very difficult to predict either way whether this will allow us to assess effectiveness for this particular outbreak,” van Hoof acknowledged, though he noted the outbreak is unpredictable and it’s far too soon to conclude it may soon end.  

“At the end of the day it’s only in this type of setting that we will able to assess effectiveness one day,” he said. “And hopefully we can do it now. But that’s not sure.”