H5N1

DRC Ebola: CMRE update, January 17

CMRE has published Situation épidémiologique du 17 Janvier 2020. Excerpt from the Google translation:

EVOLUTION OF THE EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI ON JANUARY 16, 2020   

Friday, January 17, 2020   

• Since the start of the epidemic, the cumulative number of cases has been 3,411, of which 3,292 have been confirmed and 119 are probable. In total, there were 2,237 deaths (2,119 confirmed and 119 probable) and 1,133 people healed; 

• 516 suspected cases under investigation; 

• 1 new confirmed case in North Kivu in Beni; 

• 1 new probable case was validated in North Kivu at Mabalako; 

• No new deaths among the confirmed cases, of which: 

o No community death was recorded; 

o No death among the confirmed cases of CTE; 

• No healed person has left the CTE;  

• No health worker is among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 165 (approximately 5% of all confirmed / probable cases), including 41 deaths.

The data presented in this table are likely to change later, after in-depth investigations and after redistribution of cases and deaths in their respective health zones.

NEWS  

Visit by the Canadian Minister for International Development to the General Coordination of the Response to the Ebola Virus Disease Epidemic in Goma 

 • The General Coordinator of the response to the Ebola virus disease epidemic, Prof. Steve Ahuka Mundeke received this Friday, January 17, 2020 in Goma in the presence of the provincial Minister of Health for North Kivu, a Canadian delegation led by the Canadian Minister for International Development, Ms. Karina Gould; 

• This visit is justified by the interest, for the Canadian Minister for International Development, of meeting with the response teams on the ground in order to absorb the current situation of the Ebola virus disease; 

• To this end, Karina Gould congratulated the experts on the ground, announcing that her country, Canada is providing financial support to the Democratic Republic of the Congo as part of the fight against the humanitarian crisis in the country; 

• '' Canada has always been very involved in the response to Ebola in different pillars. This visit is part of its support for the response and the action taken by Canada consolidates the actions we are carrying out here. For us, this is a good intervention that will help end the epidemic of Ebola virus disease in the DRC," said the general coordinator of the response, Prof Steve Ahuka Mundeke; 

• For the provincial Minister of Health of North Kivu, Canada has always been by the side of the DRC during difficult times, as currently when epidemics are wiping out the country. He believes that Canada's support is timely and will further strengthen the health system, not only in North Kivu, but throughout the DRC; 

• At the end of their meeting, the Canadian Minister for International Development visited the various offices of the General Coordination of the response to the Ebola virus disease epidemic.

Arrival of the Technical Secretary of the Multisectoral Committee for the Fight against Ebola on Friday in Beni

• The Technical Secretary of the Multisectoral Committee for the Response to the Ebola Virus Disease epidemic, Prof. Jean-Jacques Muyembe Ntamfum, carried out a field trip this Friday, January 17, 2020 in Beni in the province of North Kivu;

• He went not only to assess the efforts made by the response teams in this territory, but also to comfort them while urging them to be able to end this tenth epidemic if only the population strengthened their support for them;

• As for the resurgence of Ebola cases in Beni, the Technical Secretary wished to see these cases die out as soon as possible. Currently, he said, the province of Ituri remains the epicenter of this tenth epidemic that has been raging in the Democratic Republic of the Congo since August 1, 2018.

VACCINATION

• 6,554 people were vaccinated with the 2nd vaccine Ad26.ZEBOV / MVA-BN-Filo (Johnson & Johnson) in the two health areas from Karisimbi to Goma;

• Since the start of vaccination on August 8, 2018 with the rVSV-ZEBOV vaccine 268,252 people have been vaccinated;

• Approved on October 22, 2019 by the Ethics Committee of the School of Public Health at the University of Kinshasa and on October 23, 2019 by the National Ethics Committee, the second vaccine, called Ad26.ZEBOV / MVA-BN -Filo, is produced by Janssen Pharmaceuticals for Johnson & Johnson;

• This new vaccine complements the first, rVSV-ZEBOV, a vaccine used until then (since August 08, 2018) in this epidemic manufactured by the pharmaceutical group Merck, after approval by the Ethics Committee on May 20, 2018. It was recently pre-qualified for certification.

ENTRY POINT SURVEILLANCE

• Since the start of the epidemic, the total number of travelers checked (temperature taken) at health checkpoints has been 139,794,443 ;

• To date, a total of 109 entry points (PoE) and health control points (PoC) have been established in the provinces of North Kivu and Ituri in order to protect the country's major cities and avoid the spread of the epidemic in neighboring countries.

DRC: Unknown disease kills 5 in Kiri, Mai-Ndombe province (updated)

Google Maps

Via Actualite.cd: DRC: Unknown disease kills lives in Kiri, 5 dead. The Google translation:

An unknown disease has already killed 5 people at Kiri General Hospital, in the province of Mai - Ndombe, in the west of the Democratic Republic of Congo (DRC), according to the authorities.   

The provincial minister of public health has said that all measures are underway to detect the mysterious disease.   

"Admittedly, there was an abnormal situation, but however the situation is manageable because we have just raided this health facility and we have tried to carry out investigations. My collaborators and I took some samples which are already quickly sent to the National Institute for Biomedical Research (INRB) in Kinshasa for the appropriate medical examinations which can give us an accuracy on this abnormal situation ", declared the minister Jean Claude Bola.   

At first, added the same official, "it is not about the Ebola epidemic contrary to the rumor which circulates in the territory of Kiri and in the social networks".   

In an exclusive interview with actualité.cd , the provincial authority also confirmed the deaths. "However, I warn all those who broadcast through the various media and social networks that there is Ebola in Mai-Ndombe while they have neither quality nor competence, because the only authority having jurisdiction in the provinces to declare an epidemic it is only the provincial governor ”, declared Paul Mputu Boleilanga.    

"Severe and disciplinary sanctions will be reserved for usurpers of power," he threatened. According to provincial authorities, a team from the National Institute of Biomedical Research (INRB), a team is expected in the territory of Kiri for the “rapid” management of all patients and to determine the disease underlying deaths in this region.

Update: While I found and posted another news story about the outbreak (saying 3 have died), I'm finding very little about the province of Mai-Ndombe itself. Wikipedia is terse. The governor has an inactive Twitter account. I haven't yet found a local radio station or newspaper, much less a provincial website. Kiri may have a general hospital, but all I can find is another brief Wikipedia entry.

I do know Mai-Ndombe has a population of about 1.7 million, and the capital, Inongo, has about 45,000 people. Kiri has about 15,000. That suggests the province is mostly rural. While it's not far from Kinshasa, Kiri is in the north of the province. It doesn't even seem to have a road connection to Inongo.

Whereof we do not know, thereof we should not speak. Until I know more, I'll shut up about this outbreak.

Wuhan Municipal Health Committee: January 17 nCov2019 update

The Wuhan Municipal Health Committee has published its nCov2019 update for January 17. The Google translation:

At 04:00 on January 16, 2020 , 3 patients were discharged and no new deaths were reported. After comprehensive research and judgment on the clinical manifestations, epidemiological history, and laboratory test results of the national, provincial and municipal expert groups, four new cases of pneumonitis with new coronavirus infection have been added to our city. 

At present, the new cases have been arranged for transfer to Wuhan. All cases were treated at Jinyintan Hospital. All the patients were in stable condition without critical illness. The onset time of the cases was concentrated from January 5th to 8th. Related epidemiological investigations and close contacts search were being carried out.  

In addition, Thailand and Japan each reported a case of pneumonia with a new coronavirus infection from Wuhan. Currently, Thai diagnosed cases are being hospitalized; Japanese diagnosed cases have recovered and discharged. Close contacts in the country are conducting follow-up and medical observations.  

Up to now, 45 cases of pneumonitis with new-type coronavirus infection have been reported in our city, 15 cases have been cured and discharged, 5 cases are being treated as severe cases, and 2 cases have died. A total of 763 close contacts have been tracked, 665 medical observations have been lifted, and 98 people are still receiving medical observations. Among the close contacts, no related cases were found.

Wuhan pneumonia: Hong Kong widens net for suspected cases but medical workers fear already overstretched hospitals will suffer

Via the South China Morning Post: Wuhan pneumonia: Hong Kong widens net for suspected cases but medical workers fear already overstretched hospitals will suffer. Excerpt:

The strain on Hong Kong’s public hospitals, already overstretched by the peak flu season, could worsen after health authorities widened the net for suspected cases linked to the Wuhan pneumonia outbreak, medical workers fear. 

A representative of a health care workers’ union said increasing the turnover rate for hospital beds could be among the solutions to tackle the problem, while a medical expert urged local authorities to step up surveillance by introducing health declaration forms for passengers arriving on flights from Wuhan, which announced its second death of the outbreak on Thursday night. 

At least 41 people have been struck down in Wuhan, in central China’s Hubei province, with pneumonia caused by a new coronavirus, in an outbreak linked to a seafood market in the city. 

Japan on Thursday confirmed its first case of the disease and Thailand its second one on Friday. 

Hong Kong’s Centre for Health Protection announced on Thursday that criteria to report a suspected case of the coronavirus would be expanded. 

Initially, suspected cases were identified as those who had either fever and respiratory infection or pneumonia, and had been to Wuhan within 14 days of falling ill. 

Under the latest arrangements, which still include the initial criteria, people would be reported if they had those symptoms and had either visited a mainland hospital or had close contact with a patient confirmed to have the virus. 

Dr Arisina Ma Chung-yee, president of the Public Doctors’ Association, said: “If those who visited a hospital on the mainland will also be considered, it is likely the amount of suspected cases will much increase.”

She said that unlike in Hong Kong where patients with common ailments such as the cold or flu would go to a clinic, those seeking help on the mainland were more likely to visit a hospital’s outpatient department and be given intravenous fluids for even minor issues. 

Hong Kong’s public hospitals were already full as the city entered the peak flu season last week. Statistics on Thursday showed the overall occupancy rate for beds was 105 per cent.

2 more suspected Wuhan virus cases in Singapore; both isolated as precaution

Via The Straits Times: 2 more suspected Wuhan virus cases in Singapore; both isolated as precaution. Excerpt:

SINGAPORE - Two people who travelled to Wuhan have been diagnosed with pneumonia, said the Ministry of Health (MOH) on Friday evening (Jan 17).  

They are a 64-year-old male Chinese national and a 61-year-old female Singapore resident.  

"Both cases have been admitted for further assessment and treatment, and isolated as a precautionary measure," a ministry spokesman said. "They are in stable condition." 

 The two people did not visit the seafood wholesale market in Huanan, from where the new bug is thought to have emerged. 

Investigations are ongoing to establish whether their illnesses are linked to the Wuhan disease cluster, MOH said.  

These two cases bring the total number of people in Singapore who have been suspected of having the Wuhan virus to five.  

The first two were a three-year-old girl and a 26-year-old man, both of whom were Chinese nationals. They had visited Wuhan - the capital of central China's Hubei province - but subsequently were tested negative for the virus.  

The third case, reported on Thursday, is a 69-year-old Singaporean man who travelled to Wuhan but did not visit the seafood wholesale market in Huanan. The man has been tested negative for the virus. 

Hidden cameras capture misinformation, fundraising tactics used by anti-vaxx movement

Via CBC News, a report from the CBC program Marketplace: Hidden cameras capture misinformation, fundraising tactics used by anti-vaxx movement. Excerpt:

They came from across North America, paying $200 each to attend the ritzy event in Washington, D.C., hoping to snag selfies with some of the biggest names in the anti-vaccination movement.  

For the anti-vaccination activists gathered in the U.S. capital last November, it was also a chance to strategize on ways to further their cause.  

And they were more than willing to share those strategies with the undercover Marketplace journalists who attended the event, posing as activists trying to grow the movement in Canada. 

The Marketplace investigation provided a rare glimpse into the inner workings of the anti-vaxx movement, which experts say is largely to blame for a shift in mindset about vaccination. Nearly half of Canadians today have some concern about vaccine safety.   

"Take vaccines out of the name — that way you won't get flagged," said one Virginian woman attending the event. 

She was speaking about how to get around social media filters geared at weeding out anti-vaccination content.

The woman also pointed to another popular tactic: Challenging vaccination policies under the seemingly libertarian banner of "health freedom," "medical freedom," or "informed consent." 

Her own group is named Virginians for Informed Consent and has about 1,200 members. She's also gone a step further, making the group almost impossible for the public to find. 

"We're secret," she said. "You can't search our name [on Facebook]." 

'Spreading misinformation will create chaos' 

The VIP event attended by Marketplace followed a public rally on Washington's National Mall, where a number of anti-vaccination celebrities — Andrew Wakefield, Del Bigtree and Robert F. Kennedy Jr. — galvanized loyal activists, eager to speak out against what they claim is a coverup of a massive vaccine injury epidemic.

The movement persists despite a scientific consensus among medical professionals, vaccininologists and toxicologists that vaccines are safe and effective.  

"Their goal is to create noise, to create uncertainty," said Timothy Caulfield, a health law and policy expert and author of The Vaccination Picture, a book debunking anti-vaccination myths. 

"Spreading misinformation will create chaos — and that's exactly what they've done." 

Non-medical exemptions from vaccines have spiked in recent years, as have outbreaks from vaccine-preventable diseases, such as measles. 

Pneumonia in Ukraine 2020: 3 dead, over 50 hospitalized

Thanks to FluTrackers for posting this report from 24 Channel earlier today: Pneumonia in Ukraine 2020 - how many people died from pneumonia. The Google translation:

Ternopol hospitals recorded an outbreak of viral pneumonia. In the 2nd city hospital, there are more than 50 patients with viral pneumonia. Five people in intensive care, and three have already died.  

It is reported by TSN. It is noted that patients began to massively seek help in medical institutions after the New Year. Patients in hospitals have the same symptoms - at the beginning the temperature rises, which is difficult to bring down, and a cough appears.

Pulmonologist Alla Pasternak urges, at the first manifestations of the symptoms of pneumonia, to immediately consult doctors in order to start treatment on time. Without specialized help, a sick person can "burn out" in a few days.  

Previously, such pneumonia occurred in people when 10 years ago there was an epidemic of swine flu in Ukraine. 

In a commentary to UNIAN, the director of the city hospital No. 2 Rostislav Levchuk said the first patient died in mid-December, he was taken in serious condition from a district hospital. The man was 45 years old. Two more died in early January, both of working age. 

The director of the hospital added that patients who died were admitted to the hospital on the 5-10th day of the course of the disease with advanced forms.  

"Yesterday, a 36-year-old man came to us, he did not apply for qualified help for a month, you can imagine what condition he is in. Two doctors also came to us, in particular a midwife. They were also self-medicating,” added Rostislav Levchuk.  

Note that in Ukraine, from December 31 to January 14, 5 deaths from complications of swine flu have already been recorded! None of the dead were vaccinated. We emphasize that the best prevention of influenza is annual vaccination.

Estimating the number of nCoV cases in Wuhan City, China

Thanks to FluTrackers for tweeting the link to this report from the MRC Centre for Global Infectious Diseases Analysis: News / Wuhan Coronavirus | Faculty of Medicine | Imperial College London. Excerpt:

Background 

On the 31st December 2019, the World Health Organization (WHO) China Country Office was informed of cases of pneumonia of unknown aetiology in Wuhan City, Hubei Province, China. A novel Coronavirus (2019-nCoV) related to the Middle Eastern Respiratory Syndrome virus and the Severe Acute Respiratory Syndrome virus has since been implicated.  

As of 16th January 2020, 41 cases (including two deaths) have been confirmed in Wuhan City with three confirmed cases in travellers detected in Thailand (2 cases) and Japan (1 case). Most cases have been epidemiologically linked to exposure at a seafood market in Wuhan which has been closed since 1 January 2020 in efforts to contain the outbreak. Although both travellers have a history of travel to Wuhan City, they did not visit the seafood market implicated in the other cases. 

Using the number of cases detected outside China, it is possible (see Methods) to infer the number of clinically comparable cases within Wuhan City that may have occurred thus far.  

Summary 

We estimate that a total of 1,723 cases of 2019-nCoV in Wuhan City (95% CI: 427 – 4,471) had onset of symptoms by 12th January 2020 (the last reported onset date of any case). 

This estimate is based on the following assumptions: 

• Wuhan International Airport has a catchment population of 19 million individuals. 

• There is a mean 10-day delay between infection and detection, comprising a 5-6 day incubation period and a 4-5 day delay from symptom onset to detection/hospitalisation of a case (the cases detected in Thailand and Japan were hospitalised 3 and 7 days after onset, respectively). 

• Total volume of international travel from Wuhan over the last two months has been 3,301 passengers per day. This estimate is derived from the 3,418 foreign passengers per day in the top 20 country destinations based on 2018 IATA data, and uses 2016 IATA data held by Imperial College to correct for the travel surge at Chinese New Year present in the latter data (which has not happened yet this year) and for travel to countries outside the top 20 destination list. 

Caveats 

1. We assume that outbound trip durations are long enough that an infected Wuhan resident travelling internationally will develop symptoms and be detected overseas, rather than being detected after returning to Wuhan. We also do not account for the fact that international visitors to Wuhan (such as the case who was detected in Japan) might be expected to have a shorter duration of exposure and thus a lower infection risk than residents. Accounting for either factor correctly requires additional data but would increase our estimate of the total number of cases. 

2. We estimate the potential number of symptomatic cases with disease severity of a level requiring hospitalisation (both the cases detected in Thailand and Japan were moderately severe). Our estimates do not include cases with mild or no symptoms. 

3. The incubation period of 2019-nCov is not known and has been approximated with the estimates obtained for MERS-CoV and SARS. 

4. We assume that international travel is independent of the risk of exposure to 2019n-CoV or of infection status. If zoonotic exposure was biased towards wealthier people, travel frequency may be correlated with exposure. Also, some travel might be causally linked to infection status (to seek healthcare overseas) or the infection status of contacts in Wuhan (this may apply to the case detected in Japan). Accounting for either association would increase the probability of a case travelling and therefore reduce our estimates of the total number of cases.

Wuhan: 4 new nCoV cases reported

Thanks to MikeCoston and FluTrackers for catching this new report from the Wuhan Municipal Health Committee. The Google translation, with my bolding:

At 04:00 on January 16, 2020, 3 patients were discharged and no new deaths were reported. After comprehensive research and judgment on the clinical manifestations, epidemiological history, and laboratory test results of the national, provincial and municipal expert groups, four new cases of pneumonitis with new coronavirus infection have been added to our city. At present, the new cases have been arranged for transfer to Wuhan. All cases were treated at Jinyintan Hospital. All the patients were in stable condition without critical illness. The onset time of the cases was concentrated from January 5th to 8th. Related epidemiological investigations and close contacts search were being carried out. 

In addition, Thailand and Japan each reported a case of pneumonia with a new coronavirus infection from Wuhan. Currently, Thai diagnosed cases are being hospitalized; Japanese diagnosed case has recovered and been discharged. Close contacts in the country are conducting follow-up and medical observations. 

Up to now, 45 cases of pneumonitis with new-type coronavirus infection have been reported in our city, 15 cases have been cured and discharged, 5 cases are being treated in severe cases, and 2 cases have died. A total of 763 close contacts have been tracked, 665 medical observations have been lifted, and 98 people are still receiving medical observations. Among the close contacts, no related cases were found.

The cost of insecurity: From flare-up to control of a major Ebola virus disease hotspot during the outbreak in the Democratic Republic of the Congo, 2019

Eurosurveillance has published a rapid communication: The cost of insecurity: from flare-up to control of a major Ebola virus disease hotspot during the outbreak in the Democratic Republic of the Congo, 2019. The abstract:

The ongoing Ebola outbreak in the eastern Democratic Republic of the Congo is facing unprecedented levels of insecurity and violence. We evaluate the likely impact in terms of added transmissibility and cases of major security incidents in the Butembo coordination hub. We also show that despite this additional burden, an adapted response strategy involving enlarged ring vaccination around clusters of cases and enhanced community engagement managed to bring this main hotspot under control.