H5N1

Progress toward regional measles elimination — worldwide, 2000–2021

Via MMWR: Progress Toward Regional Measles Elimination — Worldwide, 2000–2021. The summary:

What is already known about this topic?  

Progress toward measles elimination experienced setbacks in 2020 during the COVID-19 pandemic.  

What is added by this report?  

During 2000–2021, measles vaccination prevented an estimated 56 million deaths worldwide. In 2021, only 81% of children received their first dose of measles containing vaccine (MCV), the lowest coverage reported since 2008, leaving 25 million children vulnerable to measles. Measles surveillance continues to be suboptimal, and large and disruptive outbreaks were reported in 22 countries.  

What are the implications for public health practice?  

Reaching all children with 2 doses of MCV and strengthening measles surveillance is critical to close immunity gaps, prevent outbreaks, and recover progress lost during the pandemic.

Ebola in Mbandaka: Death of a 4th confirmed case

Via Radio Okapi: Ebola in Mbandaka: death of a 4th confirmed case. The Google translation, with my bolding:

The fourth confirmed case of the Ebola virus disease died on Friday May 20 in Mbandaka. This is the fourth recorded since the outbreak of the epidemic on April 21. He was discovered on Thursday in the Maman Balako health area, Wangata health zone and commune.  

Only 24 hours after his discovery, the patient died, after having dragged around the community for a long time without proper care.  

Medical sources claim that the victim was a 12-year-old child in the Maman Balako health area. Since May 14, he had been developing symptoms of Ebola, including fever, fatigue, blackish vomit.  

For five days, he was cared for at home, until Thursday, May 19; date on which he was taken to a medical center in the Mbandaka II district. The results of the analysis of the samples taken on the same day from the child were found to be positive for the Ebola virus disease.  

But the family resisted and brought the child home on Thursday evening, where he passed away on Friday morning.  

Sources add that another 9-year-old child died with the same symptoms, in the same neighborhood, on May 6 and buried, without post-mortem collection or a dignified and secure burial. This raises fears of a multiplication of cases.  

The response teams are preparing for the decontamination of different places, through which the deceased child passed. They seek the cooperation of the populations around the case and in the health area concerned.  

They also invite the inhabitants to appropriate all the preventive measures recently enacted by the provincial authority, in order to avoid a large-scale spread of the disease. Among these measures, there is a compulsory post-mortem sample before any burial of bodies in the city.

Joint ECDC-WHO Regional Office for Europe Hepatitis of Unknown Origin in Children Surveillance Bulletin

ECDC and WHO have published Joint ECDC-WHO Regional Office for Europe Hepatitis of Unknown Origin in Children Surveillance Bulletin. The surveillance summary:

This report provides an overview of the cases of hepatitis of unknown origin in children aged 16 years and below reported to ECDC and the WHO Regional Office for Europe through The European Surveillance System (TESSy) hosted at ECDC.  

As of 13 May 2022, 232 cases of acute hepatitis of unknown aetiology in children aged 16 years or below have been reported, of which 229 were classified as probable and three as epidemiologically linked, by 14 countries (Belgium (12), Cyprus (two), Denmark (six), Greece (two), Ireland (six), Italy (24), the Netherlands (six), Norway (five), Poland (one), Serbia (one), Slovenia (one), Spain (26), Sweden (nine), and the United Kingdom (131)).  

Of the 229 probable cases, 122 have recovered, while 18 remain under medical care.  

The epicurve shows cases by the date of onset of first symptoms of disease. An increase in the number of cases has occurred from week 9. As severe hepatitis can take some time to develop after the onset of the first symptoms and as investigations take time, there may be a delay in the reporting of cases. The recent decrease in cases is therefore challenging to interpret.  

The majority (75.9%) of cases are <5 years of age.  

Of 143 cases with information, 22 (15.4%) were admitted to an intensive care unit. Of the 98 cases for which this information was available, six (6.1%) have received a liver transplant. There has been one death associated with this disease.  

Overall, 151 cases were tested for adenovirus by any specimen type, of which 90 (59.6%) tested positive. The positivity rate was the highest in whole blood specimens (68.9%).  

Of the 173 cases PCR tested for SARS-CoV-2, 20 (11.6%) tested positive. Serology results for SARS-CoV-2 were only available for 19 cases, of which 14 (73.7%) had a positive finding. Of the 56 cases with data on COVID-19 vaccination, 47 (83.9%) were unvaccinated.

ECDC epidemiological update: Hepatitis of unknown aetiology in children

ECDC has published Epidemiological update: Hepatitis of unknown aetiology in children. Excerpt:

Since the first alert launched by the United Kingdom (UK) on 5 April 2022, probable cases of hepatitis of unknown aetiology in children have been reported from several countries worldwide. It is not yet clear whether the cases identified following the alert are part of a true increase compared to the baseline rate of hepatitis of unknown aetiology in children.  

The aetiology and pathogenetic mechanisms of disease are still under investigation. A possible association with current adenovirus infection has been found in cases in the UK in particular but other hypotheses and possible co-factors are under investigation. Most cases continue to be reported as sporadic un-linked cases.  

This report presents an update of probable cases identified in the European Union/European Economic Area (EU/EEA) and worldwide. Whereas cases detected in the EU/EEA have been reported according to the ECDC/WHO case definition, worldwide cases are collected through screening of official websites and media sources and therefore different case definitions could have been used. 

Case definition used in EU/EEA: 

• Confirmed: N/A 

• Probable: A person presenting with an acute hepatitis (non-hepatitis viruses A, B, C, D and E*) with aspartate transaminase (AST) or alanine transaminase (ALT) over 500 IU/L, who is 16 years old or younger, since 1 October 2021.  

• Epi-linked: A person presenting with an acute hepatitis (non-hepatitis viruses A, B, C, D and E*) of any age who is a close contact of a probable case since 1 October 2021.  

Cases of hepatitis with known aetiology such those due to specific infectious diseases, drug toxicity, and metabolic hereditary, or autoimmune disorders should not be reported under this protocol.    

In EU/EEA countries, approximately 106 cases have been identified in 14 EU/EEA countries as of 10 May 2022. 

Worldwide update

United Kingdom: As of 3 May 2022, the UKHSA has identified a total of 163 children, aged under 16 years, with acute hepatitis of unknown aetiology. Of these cases, 11 children have received a liver transplant. A second detailed technical briefing on the investigations among the UK cases was published by the UKHSA on 6 May 2022. 

Outside of EU/EEA and the United Kingdom: as of 10 May 2022, there are at least 181 cases of acute hepatitis among children. Cases have been reported by Argentina [8], Brazil [16], Canada [7], Costa Rica [2], Indonesia [15], Israel [12], Japan [7], Panama [1], Palestine* [1], Serbia [1], Singapore [1], South Korea [1] and the United States [at least 109].  

The total number of cases reported worldwide is approximately 450, including 11 deaths reported from Indonesia [5], Palestine [1], and the United States [5].  

On 3 May 2022, the media quoting public health authorities reported a death of an eight-year-old child with acute hepatitis of unknown aetiology in Palestine*. It is currently unclear whether this is the same child who was diagnosed in the previous week. Confirmation of this case is pending.

Jakarta health agency talks of mysterious acute hepatitis

Via Tempo, an Indonesian news site: Jakarta Health Agency Talks of Mysterious Acute Hepatitis. Excerpt:

Jakarta Health Agency Head Widyastuti said the agency is still studying the clinical criteria and epidemiology of the mysterious acute hepatitis or liver inflammation. She said the government has not yet dared to conclude the pattern of the disease.  

“It is a mysterious [disease] that surely needs investigation. We are not in haste to conclude what it is,” she said at City Hall, Central Jakarta, Monday, May 9, 2022.  

Previously reported, the Health Ministry stated that three child patients at Dr. Cipto Mangunkusumo Central National Hospital (RSCM) died of suspected mysterious hepatitis. They were treated for two weeks starting April 30, 2022. The cause remains unknown.  

Widyastuti said hepatitis was not a new disease as there have been hepatitis types A-E. Thus, early vigilance has been practiced from the beginning. “So of course, we all must stay vigilant,” she remarked.

Kwilu: 286 children died in 3 months from an unknown disease

Kwilu province, DR Congo. Gungu is in the south-central part of the province. Google Maps.

Thanks to @BojoBodean for alerting me to this Radio Okapi report: Kwilu: 286 children died in 3 months from an unknown disease. The Google translation:

The head of the provincial health division of Kwilu, Dr Jean-Pierre Basake, told Radio Okapi on Monday, November 8 that two hundred and forty-six children whose age varies between 0 and 5 years had died since the end of the month. of August 2021 of an illness of unknown origin, in the health zone of Mukedi, in the territory of Gungu, in the province of Kwilu.  

According to him, this figure was drawn from the cumulative amount of 4,881 cases including 286 registered deaths. "The cases are still there. Children have a fever with abdominal pain, vomiting, some lead to a picture of anemia. We are at 4,481 cases and 286 cumulative deaths," said Dr Basake.  

He also said that the province and some partners had provided material and financial support to strengthen the response:  

"We brought in medical, material and technical support. The drugs we used did not have the right active principle. We nevertheless obtained the support of the provincial government on the recommendation of the provincial assembly, five million francs. Congolese (US $ 2,450) taken out of the provincial fund and drugs. The partners also made available antimalarials, therefore ACTs and inputs of nearly US $28 to 29,000. From the weekend to this day, this 'was $33 to 34,000 USD. Drugs and inputs. We have with us here a biologist technician who takes the samples, we will send nationally to the INRB."

DR Congo: In less than two months, nearly 90 children aged 0 to 5 died from an unknown disease in Gungu (Kwilu)

Via Actualite.cd: DRC: in less than two months, nearly 90 children aged 0 to 5 died from an unknown disease in Gungu (Kwilu). The Google translation:

Nearly 90 children aged 0 to 5 have died since the end of August as a result of a hitherto undetermined illness, authorities alert. According to the head of the provincial health division in Kwilu, Jean-Pierre Basake, the affected children show signs of fever causing anemia. He indicates that the health authorities were not seized of the matter in time.

“In places, like in Lonzo Munene village, two to three children die. It already dates from the end of August. And when we add up, we are around 90 children. The team was not warned in time because the families were going to the private community more, the state structures were not informed. It is malaria with fevers that reduce blood hemoglobin, so that by lack of transfusion and good management to minimize fevers, there is anemia,” said Jean-Pierre Basake. 

He adds: “Also because of their habits and customs, we don't like transfusing. Now is the time for us to see how we can combine actions to have a possibility of installing the blood bank in large cities.”  

In society, these numerous cases of child deaths call for an investigation to determine the nature of the disease.  

“Children die every day, especially in the rural commune of Mukedi and the surrounding villages. There is fever, loss of blood, there is also diarrhea which manifests itself especially in children from 0 to 5 years old who are targeted by this epidemic which still lacks a name. We ask that there be a descent of a team of health experts who can come to the aid, to see if it is exactly what,” pleaded journalist René Kinenga, director of programs at Radio Fraternité by Mukedi.  

According to information collected from some residents, this is the third time that these repeated deaths have been observed for three years, still at the start of the rainy season.

DR Congo: Ebola resurfaces in North Kivu

Via 7sur7.cd: DR Congo: Ebola resurfaces in North Kivu. The Google translation:

The Minister of Health, in a statement made this Friday, October 8, 2021, announced the resurgence of the Ebola epidemic in the east of the Democratic Republic of the Congo.   

According to Dr. Jean-Jacques Mbungani Mbanda, this is a case that has been identified in the territory of Beni in North Kivu.   

"The Democratic Republic of Congo, our country has just recorded a new case of Ebola virus on October 8, 2021. This new resurgence of the Ebola virus in the east of the Democratic Republic of Congo has occurred in the health zone of Beni, territory of Beni in the province of North Kivu," indicated the Minister of Health.  

In the process, the Minister of Health specifies that this case concerns a 3-year-old male child hospitalized and died on October 6 in a local health establishment in a hemorrhagic picture following which a sample was taken the next day by the Beni civil protection team.  

"The sample sent to Goma for analysis was found to be positive for the Ebola virus," added the Minister of Health.  

According to Jean-Jacques Mbungani Mbanda, the teams of the Provincial Health Division and the health zone are already hard at work in the field to carry out response activities, in particular the listing and follow-up of around 100 contacts to date and the decontamination of health facilities.  

"Thanks to the experience acquired in the management of the Ebola virus disease during previous epidemics, we are assured that the response teams in the province, supported by the central administration, will be able to control this epidemic as soon as possible," reassured the Minister of Health.  

As a reminder, in May of the current year the Democratic Republic of the Congo officially declared the end of the 12th epidemic of the Ebola virus disease. It was almost 3 months after its resurgence in the province of North Kivu.

I don't find anything about this on the website of Radio Butembo-Beni, which is right in the region, and Actualite has a report claiming the case is a man in his 20s with no current details. But Reuters has a good report with some additional information. I'll keep checking.

New findings on pandemic kids. And what they really tell us

The Tyee has published my article: New Findings on Pandemic Kids. And What They Really Tell Us. Excerpt:

A new report by Children First Canada takes a long and detailed look at the state of our kids in this second year of pandemic. Even if you don’t have children, but hope for a decent and dignified old age, you’d better take note the findings of Raising Canada 2021 — and take appropriate action in this and future elections. 

The report finds that COVID-19 has aggravated ten major threats to our children. Those threats have been still more aggravated by “cross-cutting themes”: access to education and child care, access to health care and social services, inequity and inequality, and climate change. 

The report points to a host of threats to children that are also threats to us all. And those threats are unlikely to be blunted short of the kind of social transformation we usually call a revolution. 

Let’s look at the threats first. Some are simply intensified forms of the pre-pandemic status quo. Kids are coming into emergency departments with opioid and other poisonings, and cannabis ingestions. Their parents’ attempts to cope with stress don’t work with the kids either. 

Pre-pandemic Canada was stressful enough, but the report finds that “the effects of school closures have accelerated this threat,” leading to more eating disorders, substance misuse and suicide attempts among adolescents.

Systemic racism and discrimination stress racialized families, and the pandemic has only stressed them more. So it should be no surprise that “status First Nations, Métis, Inuit and Black children are disproportionately overrepresented in the child welfare system.” 

So stressed parents with no support are taking it out on their kids: “In some jurisdictions, clinicians have seen twice as many infants for maltreatment-related concerns, specifically fractures and head trauma.” 

More work for the health-care system 

Meanwhile, even less-stressed parents have skipped routine childhood vaccinations, ensuring more work for our health-care system when kids start coming down with measles and other preventable diseases. While many Canadian and U.S. states try to vaccinate their kids from age 12 and up, the report says, for those under 12 “vaccines may not be available until 2022.” Cuba is already testing its homegrown vaccines on kids as young as three. 

The pandemic has worsened childhood poverty, notably in a third of female lone-parent families, and “households with children are more likely to face food insecurity compared to households without children.” In other words, kids aren’t getting enough to eat. We are “ranked 37th out of 41 countries when it comes to providing healthy food for children.” Failing to nourish our children today will have consequences for the rest of the century. 

Well, not for those who die in infancy. The report says, “Canada’s infant mortality rate has increased. It is now the second highest among 17 OECD countries, at approximately 4.4 infant deaths per 1,000 live births. This is a marked change from 1960, when Canada ranked fifth lowest.”

Yemen: In a country stalked by disease, Covid-19 barely registers

Via The Guardian: Yemen: in a country stalked by disease, Covid barely registers. Excerpt:

On a ward in Ataq general hospital, in the dusty central province of Shabwa in Yemen, six-month-old Muna Bassam is lying on her back, eyes closed, her distended belly moving up and down with the labour of breathing.  

In the corridor outside her room, a poster shows before-and-after photos of several children admitted to the ward who have managed to recover from acute malnutrition – still painfully thin, but smiling and alert.  

Muna’s family have already taken her to hospital once before. Worried about being able to pay for her treatment and fuel to return to the village, their prayers for her this time around are even more urgent. 

“My wife and I had 20 children. Eleven of them died,” said the baby’s grandfather, Abdullah. “But that was a long time ago. This should not still be happening today.”

Elsewhere in the overwhelmed hospital, children are suffering with cholera, diphtheria and dengue fever, contagious diseases that have stalked Yemen since the outbreak of war six years ago. For patients and doctors here, in what the UN says is the world’s worst humanitarian crisis, coronavirus barely registers.  

“We don’t have a neurosurgeon. We don’t have a maternity ward. We treat 20 children a month for malnutrition and now we are admitting more and more people severely ill with complications from dengue fever – more than 3,000 cases so far this year. The generator doesn’t always keep the equipment on,” says Dr Ali Nasser Saeed, the hospital director. “Coronavirus is nowhere near our biggest problem.”