H5N1

DRC: Free education or free Ebola in schools?

Via Habari RDC, which aggregates Congolese blog posts: Free education or free Ebola in schools? The Google translation:

In the city of Goma, few schools are fighting Ebola. Reason advanced: lack of resources because of free education. Students, teachers and even their directors do not observe the handwashing rule. I find it risky in a context where the Ebola epidemic continues to rage in North Kivu. The free school is likely to be "free of Ebola".  

I visited several schools to see if Ebola hygiene measures are being followed. What was not my surprise! Most do not have a handwashing device. Students and teachers come from home and go directly to classrooms without washing their hands. No temperature sampling either. This letting go is in my opinion very dangerous and can facilitate contamination. 

The fight against Ebola is everyone's business. You, school authorities, must take care of hygiene measures. "The problem we have in our school is the lack of resources to put in place the health system. It's a big challenge. We do not want to register any confirmed cases of Ebola in our school. Unfortunately, we can not afford prevention, "says Jean-Pierre Viholo Lusambia, head of a primary school run by the Eglise Lumière.  

Schools do not have money because of free education 

In other schools, teachers force parents to buy disinfectants for their children to eliminate germs. This is because schools can not afford wash basins and flash thermos for temperature sampling. 

"We are waiting for the State, which has decreed free education, to provide us with hygiene kits. We do not have money to take care of us. Here everything is free. We do not even have liquid soap for hand washing, we do not have pumps to get water, not even cisterns," explains the prefect Hubert Kahasha Badera. 

At Biahi Primary School in Nyiragongo territory, hygiene measures do not exist. During recess, students play in the yard, shake hands, eat together, kiss each other ... Others come out of the bathroom without washing their hands.  

In these circumstances, I fear that the Ebola outbreak will spread more.

DRC: 11 NGOs warn of 'catastrophic' situation of hundreds of thousands of displaced people in Ituri

Via Actualite.cd: DRC: 11 NGOs warn of "catastrophic" situation of hundreds of thousands of displaced people in Ituri. The Google translation:

Humanitarian Action Against Hunger, AVSI, Danish Refugee Council, Intersos, Mercy Corps, Norwegian Refugee Council, Oxfam, Solidarity International, Tearfund, Trócaire and Welthungerhilfe have issued an alert on the need for funding to meet the needs of many hundreds of thousands of people affected by the resurgence of violence in the Djugu and Mahagi territories in Ituri province.

These 11 organizations report that most people who have fled the violence live in appalling conditions lacking clean water, medicines and sanitation.   

Others spend the night cramped in public places, such as churches and schools, or try to survive in overcrowded makeshift camps exposed to heavy rains and life-threatening diseases.  

In some cases, 500 people have to share a single toilet.   

These living conditions also increase the risk of sexual violence against women and girls.    

"The situation is catastrophic. Many children are malnourished. Most people lost everything and witnessed the worst atrocities. Now they are facing a terrible dilemma: finding themselves with nothing to eat or risking their lives by returning to their fields," confirms Corinne N'Daw, country director Oxfam in the DRC.    

According to Benjamin Vienot, Country Director of Action Against Hunger in the DRC, humanitarian organizations have not had sufficient funding to cover needs and they still face insecurity in this part of the country.   

"Humanitarian organizations have not been able to reach all those who needed help during the last crisis in 2018 due to lack of funding and insecurity, which made access to the people extremely difficult. We are now faced with an equally dark picture," he added.   

Ten months after the beginning of 2019, DR Congo received only 35% of the necessary funds, in a country where 15.6 million people are affected by severe food insecurity.   

Other parts of the country are also beset by the humanitarian crisis. These are the provinces of South Kivu, Tanganyika and Kasai.  

International travel as source of a hospital outbreak with an unusual methicillin-resistant Staphylococcus aureus clonal complex 398, Denmark, 2016

Eurosurveillance has published International travel as source of a hospital outbreak with an unusual meticillin-resistant Staphylococcus aureus clonal complex 398, Denmark, 2016. The abstract:

In May 2016, an unusual outbreak with the Panton-Valentine leukocidin-positive human variant of methicillin-resistant Staphylococcus aureus (MRSA) clonal complex 398 occurred among mothers and infants in the maternity unit of a Danish hospital. MRSA sharing genotypic and phenotypic characteristics was confirmed in 36 cases, including 26 patients, nine household members and a healthcare worker (HCW) who had contact with all the patients. The national MRSA database contained 37 seemingly unlinked MRSA cases whose isolates shared the same genotypic and phenotypic characteristics as the outbreak strain. 

Whole genome sequencing showed that three of these isolates clustered together with the 36 outbreak isolates, suggesting spread outside the hospital. The HCW and 21 of 37 cases from the national MRSA database had links to south-eastern Asia, where the outbreak strain is endemic. These findings suggest that the HCW acquired the outbreak strain while travelling in south-eastern Asia and then introduced it into the hospital; from there, it spread within the patients’ households and into the community. 

Screening of travellers returning from countries with high levels of MRSA could be an important intervention to prevent spread of these bacteria into hospitals via patients or HCWs.

WHO AFRO: Ebola virus disease outbreak in DRC - Sitrep 63 (2019)

WHO AFRO has published Ebola Virus Disease Outbreak in DRC - Sitrep 63 (2019). Excerpt:

In the past week, from 7 to 13 October, 15 new confirmed Ebola virus disease (EVD) cases were reported from five health zones in two affected provinces in the Democratic Republic of the Congo. While it is encouraging to see another week of relatively low numbers of newly confirmed cases, these are occurring in a concentrated area where limited access and insecurity pose challenges for the response. In such environments, risks of resurgence remain very high, as do the risks of re-dispersion of cases. For example, this past week, several people who were eventually confirmed as positive for EVD sought healthcare in health zones which are no longer experiencing ongoing transmission, such as Beni. 

The proportion of confirmed cases listed as contacts has decreased in the past week from 57% to 13%, the lowest since mid-January. The majority (87%) of confirmed cases in the past week had links to the Biakato Mines Health Area in the Mandima Health Zone, with the remaining confirmed cases linked to the Mambasa Health Zone. Insecure environments in both Mandima and Mambasa Health Zones can diminish response activities related to disrupting transmission chains such as contact tracing, linkage of cases, safe and dignified burials, decontamination of affected residences, and vaccination rings. 

In the 21 days from 23 September to 13 October, the number of affected health areas has decreased, with 22 health areas and 10 health zones reporting new cases. During this period, a total of 49 confirmed cases were reported, with the majority coming from the health zones of Mandima (43%; n=21 cases), Mambasa (12%; n=6 cases) and Oicha (12%; n=6 cases). 

As of 13 October 2019, a total of 3220 EVD cases were reported, including 3106 confirmed and 114 probable cases, of which 2150 cases died (overall case fatality ratio 67%). Of the total confirmed and probable cases, 56% (1806) were female, 28% (915) were children aged less than 18 years, and 5% (162) were healthcare workers. 

Following the declaration of the Ebola outbreak in the Democratic Republic of the Congo as a public health emergency of international concern (PHEIC) on 17 July 2019, the Director-General will reconvene the Emergency Committee under the International Health Regulations (IHR) on 18 October to review and potentially update the Temporary Recommendations made, and determine if the event still constitutes a PHEIC. 

Under Pillar 1, the public health pillar of the Strategic Response Plan, the estimated funding requirement for all partners for the period July to December 2019 is US$ 287 million, including US$ 140 million for WHO. As of 15 October 2019, US$ 65.8 million has been received by WHO, with additional funds committed or pledged. 

Further resources are needed to fully fund the response through to December 2019 and into Q1 2020. Under Pillar 5, the Regional Preparedness pillar, the funding requirement for all partners is US$ 66 million, of which WHO requires US$ 21 million. As of 15 October 2019, WHO has received US$ 3.8 million. While some additional pledges are in the pipeline, increased funding for preparedness in neighboring countries is urgently needed. WHO is appealing to donors to provide generous support.

More than 18 million children in Uganda to be immunized against measles, rubella and polio in mass campaign

Via WHO AFRO: More than 18 million children in Uganda to be immunized against measles, rubella and polio in mass campaign.

Kampala, 15 October 2019 – Uganda is set to immunize more than 18 million children against measles and rubella, which amounts to 43% of the country’s population. Among them, 8.2 million children younger than 9 months, or 20.5% of the population, will also receive the oral polio vaccine. 

Uganda has experienced measles outbreaks across numerous districts in the past three years. At the same time, polio remains a daunting threat, given evidence of vaccine-derived strains circulating in neighbouring countries. 

The five-day mass immunization campaign, funded by the Government of Uganda; GAVI, the Vaccine Alliance; the United Nations Children’s Fund; and the World Health Organization (WHO); intends to tackle these three public health challenges. 

The campaign, to be conducted in schools for the first three days and in communities for the last two days, targets all children younger than 15 years, whether previously immunized or not, in order to interrupt circulation of these diseases. The campaign will be a launch pad to introduce the measles-rubella vaccine into the country’s routine immunization schedule. 

“This campaign does NOT replace the routine immunization schedule. Parents, caregivers and all concerned must ensure that all children receive and complete all the vaccines specified on our immunization schedule after the campaign,” said Dr Jane Ruth Aceng, Uganda Minister of Health.  

The mass campaign provides opportunity to intensify sensitization of communities on measles, rubella and polio as well as disease surveillance and to investigate any unreported but suspected cases of these diseases. This is particularly important because of the declining trend in routine immunization coverage in the country.  

“This is an extremely important exercise,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “It represents an impressive level of commitment to health care that we need more than ever across the African Region to prevent deaths, disease and suffering and to avoid unnecessary expenditure when caring for people who are sick.” 

The Government of Uganda acknowledges the importance of immunization against various diseases to attain Sustainable Development Goal 3, which underlines the need for good health and well-being.  

“We appeal to all parents, caregivers and guardians to take your children younger than 15 years for immunization against measles, rubella and polio during this mass exercise. The Ministry of Health has approved the vaccines to be used, and they are safe, free and effective,” said Dr Yonas Tegegn Woldermariam, WHO Representative in Uganda.  

During the campaign, teams of health workers will set up vaccination service delivery posts across the country, with the objective of attaining more than 95% immunization coverage, which is needed to interrupt the transmission of measles, rubella and polio.

WHO: Cholera – Republic of the Sudan

A WHO DON: Cholera – Republic of the Sudan. Excerpt:

On 8 September, Sudan’s Federal Ministry of Health (FMoH) notified WHO about a cholera outbreak in four localities in the Blue Nile State (BNS), south-eastern Sudan, bordering Ethiopia and South Sudan. The first case was detected on 28 of August 2019.  

From 28 August through 12 October 2019, a total of 278 suspected cholera cases, including 8 deaths (case fatality ratio: 2.88 %), have been reported from four localities in Blue Nile State including Al Roseries (113), Ad Damazin (55), Wad Almahi (3) and Baw (5), and five localities in Sinnar State including Abu Hugar (80), Singa (4), Alsoky (14), Aldaly wa Almzmom (3) and Sennar (1) . One hundred seventy two cases were female (62%), and 238 (93.1%) were over 5 years of age.

As of 2 October, 28 out of 42 (67%) samples tested from affected States were confirmed by culture as Vibrio cholerae O1 Ogawa in the National Public Health Laboratory.  

Public health response 

The following public health response measures have been implemented:  

• With the support of WHO, the Federal Ministry of Health (FMoH) activated the national Cholera Task Force on 10 September; 

• WHO has deployed a technical team to assist FMoH with coordination of response and development of response strategy on the ground; 

• Surveillance and reporting system have been strengthened by the distribution of case definitions and case investigation forms, active case finding and maintaining the line list; 

• Activation of 14 Cholera Treatment Centres by MoH, 4 in Blue Nile State and 10 in Sinnar State, and standardization of case management protocols; 

• FMoH, WHO, and partners have provided cholera kits (enough to treat 200 people) with three additional kits (enough to treat 300 people) in the pipeline; 

• WHO is supporting the water quality surveillance system, water sampling, and testing, and infection prevention & control activities; 

• State Ministry of Health in Blue Nile State, with the support of partners, is implementing the water chlorination activities and health promotion in the affected areas; 

• WHO,with the support of Global Alliance for Vaccines and Immunization (GAVI), has launched an Oral Cholera Vaccine (OCV) campaign with an aim to target 1.6 million people in Senner and Blue Nile State. Doses of OCV have been released from the WHO global stockpile. 

WHO risk assessment 

Sudan is facing a continuous surge of suspected cholera cases since 2016. The current outbreak was reported following recent severe rainstorms and flooding in 15 out of 18 States. With the ongoing flooding and widespread damage to infrastructure, there is a concern that cases may further increase. Although Blue Nile State shares borders with Ethiopia and South Sudan, there is currently no evidence of cross-border spread of the outbreak. However, the risk of spread is of more concern in the areas situated down the river Nile (including Khartoum). The Government swiftly responded to the detection of cases and necessary control measures are being implemented by national authorities, with support from partners, to contain the outbreak

Mambasa: Young people attack Ebola response team after child's death

Via Radio Okapi: Mambasa: Young people attack Ebola response team after child's death. The Google translation:

Calm returned on Monday (October 14th) to Lolwa-center, after a strong tension recorded Sunday in this village located 64 kilometers north of Mambasa on the national road number 4. This tension was due to the anger of the population, who protested against the death of a child at the general hospital of the place.  

For the protesters, the staff caring for Ebola in this medical facility are the cause of this death. In particular, they ransacked all the handwashing devices there.  

This happened around 4 pm local time. It all started with the death of a three-year-old child who was suffering from malaria. The latter was admitted to the Lolwa General Hospital to receive care. 

Local civil society sources report that the parents of this child first removed it from the health facility, considered a transit center for Ebola patients. Some time after his death, they again returned to the same hospital because he had a high fever. And he gave up the ghost. 

This death was not well perceived by local youth. They accused health care workers of the Ebola outbreak of being responsible for the death. 

In their anger, they ransacked the handwashing and isolation posts of suspected Ebola cases. Military personnel stationed in this area intervened to restore order.  

Political and notable actors in Mambasa condemned these acts. Among them, the former governor of Ituri, Jefferson is not Abdallah Pene Mbaka. The latter requested that the perpetrators of these acts be arrested for their actions.

IOM: First families cross into Iraq after crisis in north eastern Syria

Via ReliefWeb, a report from IOM: First Families Cross into Iraq After Crisis in North Eastern Syria. Excerpt:

Duhok Governorate - On Saturday night (12/10) almost 200 Syrian Kurds started crossing the border into Iraq’s Kurdistan Region (KRI) to escape bombardments in North Eastern Syria. The families crossed unofficial entry points into KRI, through the villages of Masaka and Sahela. 

A day after their entry into Iraq, 182 Syrians were brought by local security forces to a processing center near the Sahela border in Duhok, KRI’s northernmost governorate. 

IOM deployed Rapid Assessment and Response Teams (RART) in Sahela, to receive the Syrian families and evaluate their fitness to travel further. 

Three medical professionals, including one psychologist, were on-site to carry out emergency health assessments. Roughly 30 patients sat for consultations; children were mostly found to be suffering from upper respiratory tract infections, tonsillitis and the flu; while among adults some of the health issues examined by the doctors were post-surgery complications, hyperthyroidism, and asthma. 

The medical team also assisted two pregnant women, who were found to be in stable condition.  

All patients were examined and given the necessary treatment where available. For cases that could not be treated immediately, follow up care will be organized.  

At the processing centre, IOM has also provided food and drinks for the families. All individuals were then transferred by bus to Domiz 1 - a refugee camp in Duhok Governorate.

DRC Ebola: CMRE update, October 11

CMRE has published Situation épidémiologique du 11 octobre 2019, with data for October 10. Excerpt from the Google translation:

EVOLUTION OF THE EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI AS OF OCTOBER 10, 2019   

Friday, October 11, 2019   

Since the beginning of the epidemic, the cumulative number of cases is 3,210, of which 3,096 confirmed and 114 probable. In total, there were 2,146 deaths (2032 confirmed and 114 probable) and 1028 people healed. 

• 422 suspected cases under investigation; 

• 2 new cases confirmed at CTE in Ituri in Mandima; 

• 2 new confirmed deaths, including 1 in North Kivu in Mabalako and 1 in Ituri in Mandima; 

• 1 person healed out of CTE in Ituri in Mambasa; 

• 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. 

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  

President Félix-Antoine Tshisekedi Tshilombo submits to sanitary control for the prevention of #Ebola Virus Disease at Beni Airport 

- The Head of State, Coordinator of the Multisectoral Committee for the Ebola Virus Epidemic Response (CMRE), President Félix-Antoine Tshisekedi Tshilombo and his delegation were welcomed on Thursday, October 10, 2019 by the monitoring team at the entry points / sanitary control at Mavivi Airport in Beni, North Kivu Province. President Tshisekedi and his team have gone through all stages of health control at this point of entry to prevent Ebola Virus Disease; 

- The Ebola Virus Epidemic Response Coordination Team and a few members of the CMRE Technical Secretariat have been staying in Mambasa, Ituri province since Wednesday. It is in this part of the Democratic Republic of Congo that the last confirmed cases of #Ebola Virus Disease are concentrated; 

- This team, made up of the different experts in Ebola Virus Disease, has moved closer to Mambasa to coordinate closely the activities of the response; 

- Since they have been there, several activities have taken place, among which the release of 5 cured people from the CTE and a big meeting with all the partners of the response present in this sub-coordination. This meeting stems from the orientations to end the epidemic in this part of the DRC. 

VACCINATION   

- A  symbolic vaccination of the local chief resisting the vaccination of Butama in the health zone of Mambasa in Ituri. Also in Ituri, continued immunization around two confirmed cases from 07 and 08 August 2019 in Biakato mine in Mandima with low participation due to community reluctance; 

-  Immunization of front-line staff continued in the Kyondo and Kayna Reference Hospitals in North Kivu; 

-  Continuation of Local Polio Vaccination Days integrated with Vitamin A supplementation and Mebendazole deworming in 17 health zones at the Butembo antenna in North Kivu; 

- Since vaccination began on August 8, 2018, 236,772 people have been vaccinated; 

MONITORING AT ENTRY POINTS  

- Since the beginning of the epidemic, the total number of travelers checked (temperature measurement ) at the sanitary control points is 104,765,252; 

- 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.

MSF: Ebola response overshadows DRC's fragile health system

Thanks to Mary Marshall for sending the link to this important report from MSF.org: Ebola response overshadows DRC's fragile health system. Excerpt (but read the whole story):

For health centres and hospitals in the region, the scale-up of the internationally funded Ebola response can be a blessing or a curse. 

Where Ebola response teams and international organisations set up isolation and treatment facilities, they often improve infrastructure, pay extra staff, and support primary healthcare services. 

But the health workers needed in the response are almost exclusively hired from other health centres and hospitals in the area, which are now facing critical staff shortages.  

At the General Hospital in the main village of Mabalako, these gaps are strikingly evident. Over half of the doctors and nursing staff are missing, and no one has sufficient time to watch over patients in the four wards around the big courtyard.

As extra wages with the Ebola response tend to be higher and more reliable, many of the remaining staff are disappointed that they were not selected, and moral and motivation are low. 

In the hospital, the staff shortages, unavailable treatments, and missing salaries are a deadly mix.  

“We lost children in the paediatric ward because they were not put on the correct malaria treatment straight away – an error that could have been avoided with the right human resources and more vigilance,” said MSF doctor Brian Da Cruz, who is supporting the two remaining doctors in charge of an operating theatre, maternity department, paediatric clinic, and a regular ward with more than 40 beds. 

The hospital also has a basic isolation zone for patients with infectious diseases, but the small structure has no changing rooms, no decontamination zone, and there is no safe access for families to visit patients.  

As suspect Ebola patients are taken to another, better equipped structure, its rooms are currently used to observe four children with measles, a vaccine-preventable, but highly infectious disease leading to regular epidemics in the DRC. 

On the opposite side of the courtyard, MSF drilled a borehole and installed a water point, which is in permanent use by people living in the neighbourhood for clean drinking water.

While MSF’s support was mostly focused on improving infrastructure and working alongside the remaining staff in health centres and the regional hospital, the team is currently evaluating a different model, including a regular payment scheme to supplement staff salaries and offer bedside training. 

“We are discussing playing a stronger role in the hospital and the three health centres we support, by taking supervisory responsibility, offering training on the job, and ensuring patients have access to free care while staff are getting paid,” explained MSF project coordinator Amandine Colin. 

Back in Metale, MSF community outreach specialist Wivine Bokotogi hands a set of flashcards on malaria prevention and treatment to two local health promoters. 

Malaria is another major health burden at risk of being neglected as the attention and resources chase after the Ebola epidemic. In the DRC, malaria accounted for 13 per cent of deaths in children under five years old in 2016, and up to half of the people screened in Ebola treatment centres last year tested positive for malaria alone. 

“We train the local health promoters on key messages to prevent malaria, including instructions to cover stagnant water sources, use mosquito nets, and take children to the nearest health centres so they can be treated in time,” said Wivine.