H5N1

UK: London nurseries to get air purifiers after toxic air concerns

Via The Guardian: London nurseries to get air purifiers after toxic air concerns. Excerpt:

A group of state-run nurseries in London are to be given air filtration systems as concern grows about the impact of the UK’s toxic air on some of the capital’s youngest and most vulnerable residents.  

Five nurseries have been selected for the purifiers in the first wave, with 20 nurseries being audited to measure the extent of toddlers’ exposure to the potentially deadly particles from vehicles. 

The move follows a report earlier this year for the mayor of London which found that air pollution was worse inside school buildings than in the surrounding streets, with potentially stark consequences for children’s health and cognitive ability. 

The London mayor, Sadiq Khan, who is rolling out the filtration systems and audits, said it was unacceptable that a generation of youngsters were having their health and ability to learn affected by air that was dangerous to breathe.  

“It is completely inexcusable that the youngest and most vulnerable in our city face a daily threat to their health from the toxic air they breathe,” Khan told the Guardian. “This ongoing threat to public health from polluted air outdoors and indoors must be addressed.” 

There is growing concern about air pollution in and around schools and the long-term impact on children’s health. 

Earlier this year the Guardian reported that primaries across the country were trying to ban the school run to reduce pollution, while others have managed to close down roads outside their schools at the beginning and end of the day. 

The paper also found that a growing number were installing air purifiers in an effort to protect children from the worst effects of air pollution. It reported on one school which found that particulate pollution exceeded WHO guidelines in every classroom, with two more than three times over the limit.  

The new nursery audits will target sources of indoor and outdoor pollution, with five of the 20 nurseries trialling new air filtration systems to test their effectiveness at reducing indoor pollution.  

The audits will focus on reducing NO2, PM10 and PM2.5 – the most dangerous particulate – as research shows children exposed to these smaller pollution particles and gases are more likely to grow up with lung problems and develop asthma. 

The UK has the worst level of asthma in Europe and there were a record number of deaths from the condition last year.  

Air pollution, which is linked to 40,000 premature deaths a year in the UK, can also cause a range of debilitating lifelong conditions from heart disease and strokes to dementia and Alzheimer’s.

Ebola DRC - Evolution of the response to the Ebola epidemic in North Kivu and Ituri on Saturday January 5 2019

The Ministry of Health has published Ebola DRC - Evolution of the response to the Ebola epidemic in North Kivu and Ituri on Saturday January 5 2019. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Saturday, January 5, 2019   

The epidemiological situation of the Ebola Virus Disease  dated January 4, 2019:   

• Since the beginning of the epidemic, the cumulative number of cases is 614, of which 566 are confirmed and 48 are probable. In total, there were 374 deaths (326 confirmed and 48 probable) and 214 people healed * . 

• 127 suspected cases under investigation. 

• 1 new case confirmed in Katwa. 

• 3 new confirmed deaths, including 2 in Butembo and 1 in Beni. 

• 2 new people healed out of Butembo CTE. 

* Reclassification of cases and deaths by health zone after update of the database.

    

 /! \  The data presented in this table is subject to further changes after thorough investigation and after redistribution of cases and deaths in their health areas.

News of the response 

Medical care 

• A new 16-bed Ebola treatment center (ETC) opened in Katwa health zone on 3 January 2019. The Beni transit center is operational again after material damage has been repaired. replacement of stolen equipment during the events of 27 December 2018.   

Vaccination 

• Since vaccination began on August 8, 2018, 55,676  people have been vaccinated , including 19,546 in Beni, 11,088 in Katwa, 6,319 in Butembo, 5,452 in Mabalako, 2,273 in Kalunguta, 1,663 in Mandima, 1,534 in Komanda, 1,172 in Oicha, 1,016 to Goma, 791 to Vuhovi, 750 to Masereka, 700 to Lubero, 659 to Kyondo, 599 to Mutwanga, 558 to Karisimbi, 434 to Bunia, 394 to Musienene, 355 to Tchomia, 167 to Nyankunde, 70 to Biena, 63 to Alimbongo, 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.

Poll: Many in Finland want financial penalties for vaccine refusal

Via Yle Uutiset: Poll: Many in Finland want financial penalties for vaccine refusal.

Some 43 percent of respondents said they wanted pediatric vaccinations to become mandatory, according to a survey commissioned by local news conglomerate Uutissuomalainen. 

A quarter of those polled said Finland’s national insurer Kela should suspend monthly child benefit payments to parents of unvaccinated children. This group also wanted to refuse unvaccinated kids from entering publicly funded daycare.

Another 20 percent said they would like to see financial support, such as an extra child benefit payment, for parents whose kids’ immunisations are up to date. About half of those favouring the idea of compulsory vaccinations were over the age of 45. 

Carrot vs stick 

When news emerged that a young unvaccinated child in the Finnish region of Ostrobothnia had contracted measles at the end of last year, Finland's Minister of Education Sanni Grahn-Laasonen proposed making children's vaccination a condition for the payment of state child and family benefits, saying the country had to find more effective ways to secure proper vaccine coverage.  

In some western coastal areas, only 75 percent of the population has received the MMR vaccine against measles, mumps and rubella, significantly below the required 95 percent needed for herd immunity. 

Minister of Family Affairs and Social Services Annika Saarikko has, however, argued that making immunisations obligatory would likely increase ideological opposition to vaccinations.  

Pollster Tietoykkönen interviewed 1,000 people last month. The poll's margin of error is +/- 3 percent.

WHO: Ebola virus disease – Democratic Republic of the Congo

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

The response by WHO and partners to the ongoing Ebola virus disease (EVD) outbreak continues despite disruptions to key services due to security incidents taking place in Beni and Butembo during the recent election on 30 December 2018. In order to ensure the safety of all staff deployed, as a precautionary measure, operations were scaled back for a few hours on election day. All normal operations have been fully restored as of 1 January 2019. 

After an intensification of field activities in early December, notable improvements can be observed in many areas, notably a decrease in cases in Beni. However, hard-earned progress could still be lost to rebound levels of transmission resulting from prolonged periods of insecurity hampering containment efforts.  

During the reporting period (27 December 2018 – 2 January 2019), 16 newly confirmed cases were reported from Beni (two), Butembo (five), Katwa (three), Komanda (one), Mabalako (one), and Oicha (four) health zones (Figure 1). As of 2 January 2019, there have been a total of 609 EVD cases1 (561 confirmed and 48 probable, Figure 2), including 370 deaths and 208 people having recovered. Overall, cases are occurring in localised hotspots within 16 health zones found in North Kivu and Ituri. 

Amongst confirmed and probable cases, the case load has been highest in females aged 15-49 who are eligible for vaccination (i.e. non-pregnant), and also females aged 50 years and older (Figure 3). Amongst confirmed and probable cases, 61% (374/609) were female (median age = 28) and were predominantly older than male cases (median age = 25.5). 

Of note, 16% (96/607) of cases were among children less than five years old, and 7% (41/607) were infants less than one year old. Most of the cases among children aged five years old or more were from Beni, 48% (46/96). There were 29 cases among pregnant women, of which 14 were from Beni. Fifteen of the 29 cases were reportedly breastfeeding women.  

As of 2 January, a total of 86 cases of nosocomial infection were reported in patients from the general public, primarily from Beni (34), Butembo (13), Katwa (11) and Mabalako (eight). There have been no new cases in healthcare workers during this reporting period. To date, there have been a total of 55 EVD cases involving healthcare workers, of which 18 have died and eight were hospitalised as patients. Of the healthcare workers with available clinical information, 36% (18/50) died. Eleven healthcare workers were reportedly infected in a general hospital while the other 30 health facilities reported between one to three cases each during the entire outbreak period. It should be noted that 22% (133/609) of all cases had history of exposure to a hospital 1-21 days prior to the onset of their illness. 

Thorough contact tracing during initial case investigations remains difficult in light of continued community resistance and the deteriorating security situation in the field during the recent elections. This resulted in a number of new confirmed cases not being identified as potential contacts. Of all cases, 66% (327/495) had known contact with a case, and 37% (177/478) had attended a funeral. A sizeable proportion of cases, 34% (155/451), had both these exposures.  

The Ministry of Health (MoH), WHO and partners continue to monitor and investigate all alerts in affected areas, in other provinces in the Democratic Republic of the Congo, and in neighbouring countries. Since the last report was published, alerts were investigated in several provinces of the Democratic Republic of the Congo as well as in Uganda. To date, EVD has been ruled out in all alerts outside of the above mentioned outbreak affected areas.

WHO: Hantavirus disease – Republic of Panama

WHO has published Hantavirus disease – Republic of Panama. Excerpt:

The Panama Ministry of Health has reported an increase in cases of hantavirus infection in Los Santos Province, Republic of Panama, to the Pan American Health Organization / World Health Organization (PAHO/WHO). Between 1 January and 22 December 2018, a total of 103 confirmed cases of hantavirus have been reported at the national level, 99 of which were reported in Los Santos Province. In Los Santos Province, 51 cases were classified as hantavirus fever (HF) without pulmonary syndrome and 48 cases were classified as hantavirus pulmonary syndrome  (HPS), including four deaths. 

• Of the 51 HF cases, 41% were female, 55% aged between 20-59 years, with 76% occurring between June 2018 and November 2018. 

• Of the 48 HPS cases, 56% were female, 67% aged between 20-59 years, with more than half of the cases occurring in February 2018 (17%) and between June 2018 and September 2018 (42%). 

• Four deaths were reported among HPS cases (two female, two male, all aged over 60 years). 

Cases were confirmed by serology and polymerase chain reaction (PCR)3. Sequencing determined that the type of virus associated with this outbreak is Choclo virus. It was first isolated in 1999 in the western Republic of Panama. 

Hantavirus cases have been reported in the Republic of Panama since 1999 (Figure 1). In the last five years, transmission has been documented in Los Santos, Herrera, Veraguas, and Cocle provinces. During 2018, cases have been reported in Los Santos (99 cases, Figure 2), Herrera (two cases), Cocle (one case) and Veraguas (one case) provinces (Figure 3). 

Since the reservoir for hantavirus is sylvatic rodents and transmission can occur when people come in contact with rodent habitats, the current increase in hantavirus cases in the Republic of Panama could be related to changes in the abundance and distribution of rodent species, as well as strengthened surveillance and laboratory capacity at the provincial level. Environmental and ecological factors affecting rodent populations can have a seasonal impact on disease trends.

Canada: Nine police officer suicides prompt review from Ontario's chief coroner

Via CBC News: Nine police officer suicides prompt review from Ontario's chief coroner. Excerpt:

Nine police officer suicides in 2018 have prompted Ontario's chief coroner to launch a review to determine what's contributing to the unusually high number.   

Chief Coroner for Ontario, Dirk Huyer, says some of the officer deaths were reported on and made public, but he heard from various sources there had been more. 

"When we looked deeper into the information that we have within our own database, we recognized that there were nine officers who had taken their lives during the year of 2018 and that's a significant number — greater than we see typically," he said in an interview Friday morning. 

"That prompted me to wonder, are there issues, patterns, themes, trends that society, those within the area of police service, [are] not identifying or recognizing that would provide potential intervention points or prevention points?"  

Huyer said he's working on finding people to make up a diverse expert panel to answer those questions. 

The panel could include a psychiatrist who understands mental wellness and diagnoses of mental health disorders, a psychologist who intersects with intersects with police service and supporting wellness in the service or a human resources lead, he said.

Huyer said the goal is to "have a panel that allows the ability to understand the concerns that arise … and then provide the knowledge and informed recommendations to try to reduce future deaths."  

Huyer is currently not naming the officers or where they worked. 

In August, the Ontario Provincial Police announced it was launching a review into suicide cases and attempts over the past five years. Huyer is assisting in that review.

ECDC: CDTR. week 1

ECDC has published Communicable disease threats report, 30 December-5 January 2019, week 1. 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 30 December-5 January 2019 and includes updates on poliomyelitis, Ebola virus disease, influenza and dengue.

Acute flaccid myelitis associated with enterovirus D68 in children, Argentina, 2016

Via Emerging Infectious Diseases: Acute Flaccid Myelitis Associated with Enterovirus D68 in Children, Argentina, 2016. The abstract:

After a 2014 outbreak of severe respiratory illness caused by enterovirus D68 in the United States, sporadic cases of acute flaccid myelitis have been reported worldwide. We describe a cluster of acute flaccid myelitis cases in Argentina in 2016, adding data to the evidence of association between enterovirus D68 and this polio-like illness.

Ebola response activities cautiously resume in Beni

Via Radio Moto Butembo-Beni: Ebola response activities cautiously resume in Beni. The Google translation:

On the ground, ambulances and other vehicles of the response are again in circulation. Also, the agents of various commissions are now at work, even those of the psychosocial commission. Some ransacked bases have been relocated from one place to another. Note that in some areas, this recovery is still shy. 

"It is in this context that the dignified and secure burials were carried out by the Red Cross of the DRC," confirmed Roger Mutanava, president of the Red Cross in the city and territory of Beni. At the same time, the vaccination operation was uneventful in Oicha, but the vaccination team went back and forth due to the security situation in the Beni region. 

In addition, Dr. Justus Nsio, which brought together grassroots leaders, leaders of some civil society organizations and community leaders from the city of Beni, announced community-based surveillance as a new Ebola response strategy that will be implemented. The community-based surveillance approach will involve sensitizing all households and identifying all households for referral to free care.  

All foreigners must also be identified because the outbreaks of contamination have expanded beyond Beni. And the health infrastructures that were actively involved in the response to Ebola will soon be redeveloped and equipped. This is the promise of Health Minister Oly ILUNGA who stayed in Beni city. He recalls that the fight against Ebola is effective only with the awareness of the entire population. 

"Everyone has to take ownership of the fight," Oly ILUNGA said.  

It should be noted that several Ebola response teams had also been vandalized along the Butembo-Beni, Beni-Oicha, Beni-Kasindi, Beni-Mangina and several agricultural services in the city and territory of Beni and in Butembo town. 

For the destroyers of these infrastructures, was a way to deplore the measure of the CENI having excluded them from the elections of December 30, 2018. The measure of the CENI had mentioned Ebola and the insecurity as reasons for the exclusion of the Congolese citizens of Beni and Butembo in the triple poll of Sunday, December 30, 2018. 

Since Thursday, December 27, 2018, there were no agents of response and thermo-flash to test the temperature of travelers, or chlorinated water for washing hands.

DR Congo: Free healthcare is doing well in different health facilities in Butembo

We often forget that even when a disease outbreak occurs, most people don't contract it—but they may well contract other diseases. If the healthcare system can't help them, the mortality rate from those diseases may well exceed that of the pandemic du jour.

The DRC Ministry of Health wisely declared that all healthcare in the Ebola hot zone would be free—creating an incentive for people to go on seeking healthcare rather than avoiding hospitals and clinics as Ebola death traps.

Via Radio Moto Butembo-Beni: Free healthcare is doing well in different health facilities in Butembo. The Google translation:

Statement made by Radio Moto Butembo-Beni this Thursday, January 3, 2019. At the Kitatumba Reference General Hospital, your reporter met the managing director of this health institution. In Matanda, Dr. NZANZU KALIMA indicated that the stock of drugs is always sufficient for the patients who frequent the structure. The sick continue to salute this act in these different structures. 

At the reference general hospital in Kitatumba we met the managing director of this health institution. Justin KWAMIRE confirms this free of charge. "The duration was estimated at 3 months. We are still in the free period. Maybe at the end of this month, the authorities will have to evaluate the work. It is now up to them to decide if the free will continue or stop as planned, " he said.  

At MATANDA General Hospital, this free treatment operation is also doing well. To the question of whether the stock of drugs is enough for the patients who attend the structure, Dr NZANZU KALIMA attending doctor at the Matanda hospital responded positively. At MIHAKE health center this free continues also. During this tour of RMBB in different health facilities in Butembo this Thursday, some patients continue to rejoice in this measure. 

"It's really free. In any case free. It is true we can do 3 days without being treated because of an exceptional craze in the hospital. We are happy, however, that in the end we will be treated," said a patient. 

Recall that the free care in some health institutions in Butembo health zones, Katwa, and Kalunguta Masereka began on 1st   November 2018 and will end January 31, 2019. During this time it is from the August 20 that this measure is in force in health zones of Beni, Mabalako and Oisha.