H5N1

'For God's sake, vaccinate your children': Measles survivor still feels the effects after 69 years

Via CBC News: 'For God's sake, vaccinate your children': Measles survivor still feels the effects after 69 years. Excerpt:

Brenda Shaw spent a month in hospital when she contracted measles as a four-year-old in 1950. The infection burst her eardrum, leaving her deaf in her right ear and causing complications that still trouble her today.  

Shaw's best friend also got sick during the outbreak that year, and suffered permanent damage to her eyes. Another classmate lost their hearing in both ears.   

There was no vaccine for measles at the time.  

Shaw, who lives in Oliver, B.C., says this first-hand knowledge of just how serious measles can be has left her feeling exasperated about the news of another outbreak in Vancouver, linked to one family with three unvaccinated children. 

"I can't say enough times: For God's sake, vaccinate your children. It does not cause autism," Shaw told CBC News on Monday.

Much of the hysteria around a possible link between vaccines and autism stems from a discredited 1998 study written by Dr. Andrew Wakefield. The study was retracted by the medical journal The Lancet in 2010 and described as an "elaborate fraud" by other researchers.  

'I was in extreme pain' 

Today, despite two eardrum transplants over the years, Shaw is still deaf in her right ear and often suffers from vertigo and nausea.  

She still has vivid memories of the illness that would shape her childhood, especially the pain of her burst eardrum. 

"I remember waking up that morning and my pillow case was covered in pus and blood. I was in extreme pain and screaming for Mom," said Shaw, now in her 70s.

"Dad just picked me up in his arms and drove to the hospital and that's where I stayed."

WHO AFRO: External Situation Report 29: 19 February 2019

WHO AFRO has published Situation Report: Democratic Republic of Congo Ebola Virus Disease Outbreak External Situation Report 29: 19 February 2019. The summary:

The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces, Democratic Republic of the Congo, continues to prove challenging to contain as ongoing security incidents and pockets of community mistrust hamper response efforts. Following our last report on 12 February 2019, 24 new EVD cases have been reported, including 20 confirmed and four probable cases. The four probable cases were all deaths that occurred in November and December 2018 in Komanda Health Zone, with a clinical history consistent with EVD but without the opportunity to be tested.

From the beginning of the outbreak to 17 February 2019, a total of 840 EVD cases, including 775 confirmed and 65 probable cases, were reported from 19 health zones in the North Kivu and Ituri provinces. A total of 537 deaths were reported (overall case fatality ratio 64%), including 472 deaths among confirmed cases. To date, 294 people have been discharged from Ebola Treatment Centres (ETCs) and enrolled in a dedicated monitoring and support programme. Of confirmed and probable cases with reported age and sex, 57% (481/841) were female, and 30% (253/842) were children aged less than 18 years. No new cases among healthcare workers were reported in the last week, leaving the number of healthcare workers infected to 68 with 21 deaths.

Thirteen (13) of the 19 affected health zones have active virus transmission, reporting at least one confirmed case in the last 21 days (28 January to 17 February 2019). Over this period, a total of 88 confirmed cases were reported from Katwa (55), Butembo (15), Kyondo (4), Vuhovi (4), Kalunguta (2), Biena (1), Komanda (1), Mabalako (1), Manguredjipa (1), Masereka (1), Mutwanga (1), Oicha (1), and Bunia (1) – a newly affected health zone. The major urban centres of Katwa and Butembo remain notable areas where most cases were reported, with 80% (70/88) of cases reported in the last three weeks. Beni did not report cases in the last three weeks and dropped off the list of health zones with active transmission. Overall, cases have been reported from 119 of 309 (39%) health areas (a subdivision of health zones) across 19 health zones. Thirty-five health areas have reported at least one case in the last 21 days. Trends in case incidence show that the outbreak is continuing, with lower transmission intensity across these geographically dispersed areas.

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. To date, all reported alerts outside the outbreak affected areas have been investigated or laboratory tested to rule out EVD.

Measles outbreak leads to 136 deaths in the Philippines

Via CBC News, a report by The Associated Press: Measles outbreak leads to 136 deaths in the Philippines. Excerpt:

The Philippine health secretary said Monday that 136 people, mostly children, have died of measles and 8,400 others have fallen ill in an outbreak blamed partly on vaccination fears.  

A massive immunization drive that started last week in hard-hit Manila and four provincial regions may contain the outbreak by April, Health Secretary Francisco Duque III said. President Rodrigo Duterte warned in a TV message Friday of fatal complications and urged children to be immunized.  

"No ifs, no buts, no conditions. You just have to bring your children and trust that the vaccines ... will save your children," Duque said by telephone. "That's the absolute answer to this outbreak." 

Infections spiked by more than 1,000 per cent in metropolitan Manila — the densely packed capital of more than 12 million people — in January compared to last year, health officials said. 

About half of the 136 who died were children aged one to four, and many of those who perished were not inoculated, the officials said. 

Vaccine hesitancy 

Duque said a government information drive was helping restore public trust in the government's immunization program, which was marred in 2017 by controversy over an anti-dengue vaccine made by French drugmaker Sanofi Pasteur which some officials linked to the deaths of at least three children.  

The Philippine government halted the anti-dengue immunization drive after Sanofi said a study showed the vaccine may increase the risks of severe dengue infections. More than 830,000 children were injected with the Dengvaxia vaccine under the campaign, which was launched in 2016 under then-President Benigno Aquino III. The campaign continued under Duterte until it was stopped in 2017. 

Sanofi officials told Philippine congressional hearings that the Dengvaxia vaccine was safe and effective and would reduce dengue infections if the vaccination drive continued. 

"It seems the faith has come back," Duque said of public trust on the government's immunization drive, citing the inoculation of about 130,000 of 450,000 people targeted for anti-measles vaccinations in metropolitan Manila in just a week.

DRC: Tanganyika province reports measles and cholera

Via mediacongo.net: Tanganyika: measles and cholera reported to Mpyana and Manono. The Google translation:

Cholera and measles have raged in the cities of Manono and Mpyana in Tanganyika province for two weeks, said territory administrator Pierre Mukamba on Monday (18 February). According to him, this situation is worrying because of the lack of drugs. Children are the most affected by these epidemics, which cause the death of six to seven children per day. 

Pierre Mukamba also reports the deployment of an MSF-Spain team in the area to try to find a solution. Apart from measles and cholera, malaria is also reported in these two areas.

UNICEF Executive Director Henrietta Fore: Update on Ebola in the DRC and beyond

Jemima, an Ebola survivor, cares for a child at a UNICEF-supported crèche in Beni, in eastern Democratic Republic of Congo. Credit: UNICEF/Hubbard

Via UNICEF: UNICEF Executive Director Henrietta Fore's remarks at Munich Security Conference: Town Hall Event: “Update on Ebola in the DRC & Beyond”.

Munich, Germany, 16 February 2019 -  "Once again, we’re facing an outbreak of Ebola — the 10th in the DRC.  

"And once again, we face familiar challenges — and more. An unforgiving disease that requires 100 per cent of cases to be controlled and isolated. A high-density, mobile population. A lingering mistrust of aid. More children and women among those infected and dying of the disease. And a new, unexpected threat: security concerns and direct attacks that impede access. 

"In some ways, we’re in a better place than 2014. Building on what we’ve learned from previous outbreaks, we’re now working as a tightly co-ordinated team, using a common Strategic Response Plan. 

"Since the beginning of the epidemic, UNICEF and our partners have deployed more than 650 staff members to the effort. All under the excellent leadership of the Ministry of Health, which is well-trained and experienced from previous outbreaks. 

"Together, we’re providing drinking water to more than 1.3 million people. We’re providing sanitation and hygiene kits — and emergency nutritional care for Ebola patients. We’re directly assisting 950 affected families. We’re supporting orphans and unaccompanied children. And we’ve reached more than 10 million people with information on preventing this disease and reducing transmission — including in schools.  

"We’re also deploying innovative approaches — isolation cubes for treatment, new vaccines, experimental therapeutics, and big-data analysis to track the spread of the outbreak.

"Our protection teams are doing intense-contact follow-up work, to ensure well-being within communities and to prevent spread to non-affected areas.   

"We’re putting a renewed emphasis on risk communication and community engagement, to improve trust in — and uptake of — vital health and prevention services.  

"And the UN peacekeeping force is providing a welcome security umbrella for all that we’re doing.  

"Thanks to this work, we’ve controlled the outbreak in Equateur, and in many spots in North Kivu, including Beni. We’ve also succeeded in preventing the outbreak from spreading to other regions and countries.  

"But the outbreak remains active. There is a serious risk of it reaching major urban centres, like Goma. 

"Our staff members — across all of our organizations — are stretched thin. They’re facing continued community resistance — and new security threats.  

"In this uncertain environment, we will be strained to control new outbreaks in DRC — or even respond to other health emergencies like cholera or polio that might emerge in neighbouring countries. 

"We must find ways to stay one step ahead of Ebola. 

"And we can do it. The excellent work of Uganda and Rwanda to prepare has made all the difference in preventing an outbreak. 

"Which is why — in addition to our immediate response — UNICEF is working with our partners with a new urgency to strengthen health systems and local response capabilities over the long-term.  

"This includes bolstering immunization stocks and capacity.  

"It includes scaling-up surveillance and isolation capabilities, especially in urban areas — so important in controlling the Lagos outbreak in 2014. 

"And it includes investing in stronger communication efforts with communities, and new prevention and control efforts in health facilities and schools. This includes a new team of anthropologists and communication for development specialists to improve our research and assessment efforts.    

"In the meantime, we must make the most of a key window of opportunity, before the Strategic Response Plan ends in July 2019. We must continue raising the alarm on this emergency to summon more funds, recruit more staff, and be strategic about where — and when — we deploy current staff. 

"Throughout, we must work closely with the new government to reduce security threats, strengthen health systems for the future, and gain access to every child and community affected. 

"Ebola is unforgiving — but it’s not unbeatable. 

"Let’s draw inspiration — and learn lessons — from our successes so far, and act now, before the outbreak spreads to Goma or crosses the border. Thank you."

WHO AFRO: Madagascar measles update, week 6

WHO AFRO has published its Weekly Bulletin on Outbreaks and Other Emergencies for week 6 (February 4-10). It includes an update on measles in Madgascar. Excerpt:

The measles outbreak in Madagascar is still of grave concern as the full picture of the outbreak is established. Detailed epidemiological
investigations showed a much higher magnitude, including mortality, with the overall outbreak situation worsening since week 1 of 2019.

In week 5 (week ending 3 February 2019), 4 079 measles cases were reported compared to 6 971 cases reported in week 4 (week ending
27 January 2019). The number of cases reported in week 5 is likely to increase as data comes in.

From 3 September 2018 to 5 February 2019, a total of 53 459 measles cases were recorded, of which 676 were laboratory confirmed
(immunoglobulin M (IgM) positive)) and 52 783 cases were epi-linked. A total of 312 deaths (case fatality ratio 0.6%) were reported from 106
health districts, of which 182 health facility deaths were retrospectively reported after investigation in 21 health districts. Most, 84%, of the
deaths occurred in children aged less than 9 months. A total of 7 333 serious cases were hospitalized. A total of 56% of registered cases are
either not vaccinated or of unknown vaccination status. More than half (64.5%) of cases are in children aged 1-14 years. Of these cases, 7% are
in children less than 9 months, 3.5% from 9-11 months, 24.5% from 1-4 years, 40% from 5-14 years and 25% aged 15 and over. The sex ratio is
nearly equal, with 50.1% of cases in males.

Seventy-five percent (86/114) of the health districts have been affected, with a national attack rate of 1 499 cases/1 000 000 inhabitants –
demonstrating the scale and rate of spread of the virus. Six regions of the island, (Androy, Anosy, Analamanga, Sava, Vakinankaratra and Boeny)
have 100% of districts in epidemic state. The highest attack rates are recorded in three urban health districts; Mahajanga 1, Ambatoboeny and
Antanarivo Renivohitra. Cases epidemiologically linked to the outbreak in Madagascar have been reported in Reunion Island and Mayotte.

Canada: Father at centre of measles outbreak didn't vaccinate children due to autism fears

Via CBC News: Father at centre of measles outbreak didn't vaccinate children due to autism fears. Excerpt:

The man whose family is at the centre of a measles outbreak in Vancouver said he didn't vaccinate his children because he distrusted the science at the time. 

In an exclusive interview with CBC News, Emmanuel Bilodeau said he and his then-wife were influenced by reports that linked the vaccine that prevents measles, mumps and rubella (MMR) with autism.

"We worried 10-12 years ago because there was a lot of debate around the MMR vaccine," said Bilodeau. "Doctors were coming out with research connecting the MMR vaccine with autism. So we were a little concerned."​​ 

The MMR vaccine prevents measles, mumps and rubella by helping the body make chemicals called antibodies to fight off the viruses. The BC Centre for Disease Control (CDC) recommends children receive two doses of the vaccine, one at 12 months of age and the second dose at five to six years of age. 

There is no scientific evidence linking the vaccine to autism, says the CDC. 

Bilodeau said he knows now the link between the MMR vaccine and autism has been debunked. "We're not anti-vaccination," he said. "We're just very cautious parents and we just tried to do it in the manner that was the least invasive possible on the child's health." 

"We were hoping we could find a vaccine that was given in a separate shot so it wasn't such a hit on the kid," he said.  

Family trip abroad 

Bilodeau believes one of his three sons contracted measles during a family trip to Vietnam earlier this year and that it has since spread at the French-language schools his children attend. 

Dr. Althea Hayden of Vancouver Coastal Health (VCH) said on Friday Vancouver was facing an "outbreak" of measles after confirming eight cases affecting students, staff and parents at École Jules-Verne and École Anne Hebert in South Vancouver and École Rose des Vent in Oakridge.​ 

Bilodeau said he brought his sons to a travel clinic on Broadway Street before their trip where they received other vaccinations, but not for measles. 

It was on the plane ride home that his 11-year-old son began experiencing symptoms, including fever. 

Bilodeau brought him to BC Children's Hospital on Jan. 21. He said medical staff were aware that the boy hadn't been vaccinated, but they ruled out measles and instead conducted tests for malaria and influenza. 

His other two sons started showing symptoms soon after, but it took several trips to the hospital before it was determined measles was the culprit although Bilodeau says he mentioned the possibility to doctors.

Canada: More measles cases confirmed in Vancouver

Via Vancouver Coastal Health: More measles cases confirmed in Vancouver. Excerpt:

A total of eight measles infections have been identified in Vancouver this week. Vancouver Coastal Health (VCH) Medical Health Officers determined that the first infection was acquired outside of North America. VCH is notifying people who were known to be in contact with the case, and is urging under-vaccinated or unvaccinated individuals among them to be immunized. 

Last week, another, unrelated case of measles was also confirmed, bringing the total number of cases to nine this month. 

One of the individuals visited the BC Children's Hospital Emergency Department while they were infectious. Those who were at the emergency department on the dates and times below could have been exposed. Most people in B.C. are immune to measles.  However, if you were at the emergency department during these times and do develop symptoms of measles, please contact your family doctor, or doctor at a walk-in clinic.    

• January 21, 2019 – 10am to 6:10pm  

• January 23, 2019 – 4:45pm to 11:10pm  

• January 24, 2019 - 8:13am to 11:40am  

• February 1, 2019 - 2:05pm to 6:55pm 

Measles is a highly infectious disease that spreads through the air. Close contact is not needed for transmission. The disease can also be spread through sharing food, drinks, cigarettes, or kissing an infected person.     

Symptoms of measles include fever, cough, runny nose, and red eyes, followed a few days later by a rash that starts on the face and spreads to the chest. Complications from measles can include pneumonia, inflammation of the brain (encephalitis), convulsions (seizures), deafness, brain damage, and death. An infected person can spread measles before knowing they have been infected. People are infectious to others from four days before to four days after the onset of rash. 

Since a number of cases have now been confirmed, there is an increased chance of unidentified exposures in the community. Those who are unimmunized or incompletely immunized are at highest risk. Two doses of measles vaccine are 99 per cent effective at preventing measles. Most cases now occur in those born after 1970 and who have had no doses or only one dose of measles vaccine.

Classification of global measles cases in 2013–17 as due to policy or vaccination failure

Via The Lancet Global Health: Classification of global measles cases in 2013–17 as due to policy or vaccination failure: a retrospective review of global surveillance data. The summary:

Background 

Despite improvements in reported coverage of measles-containing vaccine (MCV) and progress towards elimination of measles, 172 939 measles cases were reported worldwide in 2017. Questions have been raised about whether measles cases are due to failure of immunisation programmes or vaccine policy failure, which might require changes to vaccination schedules or number of doses. 

Methods 

This retrospective review of global surveillance data analysed case-based data for cases of measles occurring during 2013–17 submitted to WHO by its member states. Cases were classified as programmatically preventable (ie, did not receive the age-appropriate number of doses for that country) or programmatically non-preventable (ie, appropriately vaccinated as per national programme) on the basis of age at onset, year of birth, vaccination status, and eligibility for MCV doses in the country reporting the case. 

We grouped reasons why cases were non-preventable into four categories as follows: (1) received at least two doses of MCV; (2) too young for first dose; (3) received one dose but was too young to receive the second; or (4) was only eligible for one dose according to the national schedule. 

We analysed numbers and proportions of preventable and non-preventable cases of measles by region and year, reasons for non-preventable cases by year, preventable cases by age group, and preventable and non-preventable cases, including reasons for non-preventable cases, by measles elimination status of countries. 

Findings 

Between Jan 1, 2013, and Dec 31, 2017, 634 139 measles cases were reported; 7850 (1%) cases were excluded because they did not provide age at onset, so 626 289 were included in our analysis. 191 333 (31%) of these cases had unknown vaccination status. 275 754 (63%) of the 434 956 cases with available vaccination data were categorised as programmatically preventable, 213 461 (77%) of whom were aged 1 year to less than 15 years. 156 384 (36%) cases were categorised as non-preventable, of whom 38 677 (25%) were two-dose vaccine recipients, 74 438 (48%) were too young to receive their first MCV dose, 11 914 (8%) received their first dose and were too young to receive their second dose, and 31 355 (20%), mostly in the Africa region, were non-preventable because they were only eligible for one dose on the basis of the national immunisation programme. 

Interpretation 

Most measles cases during 2013–17 were programmatically preventable, highlighting the need for improving the effectiveness of immunisation programmes that already exist. Individual countries should do similar analyses to establish the changes needed in their country to decrease numbers of measles cases.

Canada: BC’s vaccination rate is too low to prevent diseases

Via The Globe and Mail: B.C.’s vaccination rate is too low to prevent diseases: officials. Excerpt and then a comment:

Certain pockets of British Columbia fall far short of the immunization coverage public health officials say ensures the best defence against serious diseases, and an outbreak across the border in Washington State should be a wake-up call. 

There have been 54 measles cases reported in reported in Washington State this month, and on Wednesday B.C. health officials confirmed three cases of measles. 

The B.C. cases are unrelated to those in Washington, but Monika Naus, medical director of communicable disease and immunization service at the B.C. Centre for Disease Control (BCCDC) said there’s a vulnerability in certain pockets of this province.  

“I think we have geographic parts of this province where if we had the introduction of measles, we could easily have the kind of outcome that they are seeing in Clark County,” said Dr. Naus said in an interview on Thursday. 

Measles are highly contagious and unvaccinated, young children are at highest risk. Complications from measles can include pneumonia and encephalitis, or inflammation of the brain. However, the Measles, Mumps and Rubella (MMR) vaccine is almost 100-per-cent effective if people are vaccinated properly, according to the BCCDC website. Children should typically be vaccinated at 12 months and for a second time between the ages of four to six.  

To make it difficult for the disease to spread, MMR immunization coverage ­– the percentage of people who receive one or more vaccines in relation to the overall population – should be at 95 per cent.  

However, vaccination data from 2017 data shows that 87.3 per cent of two-year olds received the first MMR vaccine in the province. 

In Clark County – where 53 of the 54 measles outbreaks occurred – only 67.7 to 79.3 per cent of kindergartners completed their required immunizations in the 2017-2018 school year.

Dr. Naus is very tactful about "geographic parts": At least one of them is within an hour's drive of Vancouver, in the Fraser Valley, where an anti-vaccination Dutch fundamentalist community was the source of a measles outbreak in 2014.