H5N1

Samoa measles: 87 new cases but no new deaths

A tweet from the Government of Samoa:

Latest update: 4,819 measles cases have been reported since the outbreak with 87 recorded in the last 24 hours. There were no fatalities in the last 24 hours and the death toll remains at 70.  

VACCINATION UPDATE: As of 8 Dec, 91% of population have been vaccinated.

No tables yet, but I'm grateful for the good news.

Samoa measles: Rate of new cases may have peaked - NZ doctor

Via RNZ News: Rate of new measles cases in Samoa may have peaked - NZ doctor. Excerpt:

A doctor leading New Zealand's medical response to the measles epidemic in Samoa says the virus is still taking children's lives but he's hopeful the mass vaccination programme is beginning to help. 

The death toll from Samoa's measles epidemic yesterday reached 70, with 87 percent of those killed aged four years or younger. 

The government ordered a shutdown of the nation on Thursday and Friday to try to cope with the epidemic. 

Samoa's government said on Sunday it had vaccinated about 90 percent of the population. 

Hawke's Bay's Alan Wright is the Clinical Team Leader for the New Zealand Medical Assistance Team 'Bravo', the second rotation to help in Samoa with the outbreak.  

Dr Wright is running the response at Leulumoega Distric Hospital, with all other patients diverted for treatment to a smaller clinic near Faleolo Airport on Upolu. 

There was now a flattening off in severity of presentations and while there were still daily deaths from measles, the rate of new cases appeared to have peaked, he said.  

However, some of the children presenting for treatment had been desperately sick for several days with serious infections.  

"It's overwhelming pneumonia. There are bugs around in the community that are great opportunists. 

"And if you get a child that's debilitated by the measles virus between the age of one and four, when their immune system's not flash anyway and their nutritional status may not be perfect, then they're just sitting targets. And once the infections take hold, it's pretty hard. You're chasing your tail trying to catch up with them." 

New foreign medical teams will relieve exhausted doctors, nurses 

New Zealand, the UK and Israel are sending dozens more nurses and doctors to Samoa to assist with the epidemic.  

There have been nearly 4700 cases of measles diagnosed since October.  

The UK government said in a statement 14 medics will arrive on Sunday, to relieve a team that arrived two weeks ago.  

"The medical system here is under the most enormous amount of strain, with the hospital operating far, far beyond its usual capacity," said Becky Platt, a paediatric nurse with the UK Emergency Medical Team. 

"The local staff have been working around the clock for weeks and weeks on end, many of them without proper breaks or any days off. Some of them are absolutely on their knees."

Distraught parents taking kids with measles out of hospitals in Samoa

Via RNZ News: Distraught parents taking kids with measles out of hospitals in Samoa. Excerpt:

Some parents of children with measles in Samoa appear to be panicking over the care their infants are receiving, with at least three families reportedly taking their children out of hospital against medical advice.

New Zealand Red Cross nurse Karen Page, who has been based in Apia assisting with the measles epidemic for the past two weeks, said she had heard reports of three families discharging their children in more than one location. 

In some cases the families returned to hospital several days later when their children's health had seriously deteriorated, Ms Page said. 

"We also went to the hospital west of Apia where the New Zealand Medical Assistance Team are working and one of the Samoan doctors there told us exactly the same thing - it's the young mothers, the young parents - that are taking their kids out to access traditional healers," she said. 

"And it's just a shame, a real shame that's happening."  

Ms Page said she and her colleagues had not come across any 'anti-vaxxers' in Samoa. 

"Some of us have been going door to door as part of the mobile vaccination thing. No one, not one person, has declined. 

"We get the odd person who is scared of the needle, which you do everywhere, and they take a lot of convincing."  

Ms Page said it would take at least two weeks for the two day mass vaccination effort to have a significant impact.  

The measles vaccine can take about two weeks to provide immunity to the disease. 

The death toll from Samoa's measles epidemic has reached 70, with two deaths recorded in the past 24 hours.

Butembo: More than 120,594 children expected to be vaccinated against measles

Via Radio Moto Butembo-Beni: Butembo: More than 120,594 children expected to be vaccinated against measles. The Google translation:

More than 120 thousand 594 children are expected in a vaccination campaign against measles in Butembo town. Officially launched by the Mayor of Butembo town, Maitre Mbusa Kanyamanda Sylvain, this Monday, December 9, 2019 at KAVITERO CASOP health center, this campaign will extend over a period of five days from 10 to 15 December. 

The Acting Zone Chief Medical Officer of the Butembo Health Zone, NZANZU SALITA EUGENE, presented the characteristics of this disease in an interview with the RMBB on Monday after launch.  

"It's a feverish disease. After that you can have a cough, and the child has a run in the nose, in the eyes, and the eyes can turn red. There are rashes on the child's skin. That's what makes measles. And these eruptions there which. It becomes as if a layer leaves that skin there," he said. 

The Acting Chief Medical Officer adds that the choice of the vaccination site is focused on the health centers following the health situation characterized by the Ebola virus disease.  

"We proceed by an injection. It's difficult to go door-to-door giving injections. We must be in a secure environment, especially since we are in an epidemic. Therefore, all precautions must be taken at last not to transmit another disease to the child. That's how the strategy is fixed. So depending on the children to cover, we can move the site. But these are the usual vaccination sites where moms know they are bringing children to routine immunization, "he added.  

Breastfeeding women at these activities are calling on parents to prepare children to prevent this contagious disease.

Samoa measles: 112 new cases, 70 total deaths

A tweet from the Government of Samoa. They are not out of this mess yet:

Latest update: 4,693 measles cases have been reported since the outbreak with 112 recorded in the last 24 hours. To date, 70 measles related deaths have been recorded. 

VACCINATION UPDATE: As of 8 Dec, 90% of population have been vaccinated (graphic attached).

Samoa measles: 121 cases, 3 deaths on December 7

A tweet from the Government of Samoa:

Latest update: 4,581 measles cases have been reported since the outbreak with 121 recorded in the last 24 hours. To date, 68 measles related deaths have been recorded. 

VACCINATION UPDATE: As of 7 Dec, 90% of population have been vaccinated (graphic attached).

Samoa measles: Vaccinators turned away by some families

Via Newsline Samoa: Vaccinators Turned Away By Some Families. Excerpt:

Vaccination teams were turned away by some of the families who did not accept the measles injections, during the Thursday and Friday house to house emergency immunisation campaign. 

The Chairman of the Disaster Advisory Committee, Ulu Bismarck Crawley, confirmed the rejections. 

Ulu was not quite sure why some people did not want to be vaccinated, despite the effort to ensure that everyone in the country is covered. 

“There were families and individuals who did not want the MMR injection when we met them,” said Ulu. “The whole purpose is to ensure that the whole country has been vaccinated but unfortunately some did not want it and we don’t know the reason. 

“However, our office will visit them again to conduct consultations and ask why they were against receiving the treatment.” 

Ulu made clear that they did not try to force the injections because they have the right as an individual to accept the injection or not.  

He felt it was a must for them to understand why it was necessary to be vaccinated especially during this time of the epidemic.  

“I understand their rights but our office needs to explain to them the risk they pose to others, especially the young children because of their anti vaccination stance.  

“We have to sit down with them and explain that this outbreak is not a joke and that those not being vaccinated is a risk. 

“They can easily become sick which means their family members as well as their children will surely catch the measles. 

“We have to find out their reasons for rejecting the injection because it may have something to do with their religion, maybe they don’t believe in injection or what not. 

“These are the things that we need to get from the people who rejected the injection and then we can explain why this is important. 

“Who knows maybe for some of them they don’t really understand the importance of getting vaccinated.  These are all the things that we need to do to ensure our people understand the purpose of all this.”  

Data collected from the two-day vaccination run should be ready by Monday, according to Ulu.  

National vaccination coverage is at 89 per cent of the population based on the latest Update 21 of the epidemic status. The percent may have expanded into 90 percent already or more after the emergency vaccination run during the week.

Two more deaths from measles in Samoa, toll now 65

Via RNZ News: Two more deaths from measles in Samoa, toll now 65. But see the post just below for the silver lining:

There are now 65 measles related deaths in Samoa following two more fatalities over the past 24 hours.

The government says there is also now at least 4460 measles cases since the outbreak began in October. 

There were 103 new cases recorded in the last 24 hours.  

165 people remain hospitalised including 18 critically ill children and three pregnant women. 

The new figures come after a two-day nationwide shutdown to enable vaccination teams to reach households where people still needed to be immunised. 

Prime Minister Tuilaepa Sailele Malielegaoi said the teams carried out more than 20,000 vaccinations on Thursday and Friday.

Samoa measles: 4,460 cases, 65 deaths—and 89% of population vaccinated

A tweet from the Government of Samoa that packs a hell of a punch in its last sentence. Public health experts around the world will take note, and take heart:

Latest update: 4,460 measles cases have been reported since the outbreak with 103 recorded in the last 24 hours. To date, 65 measles related deaths have been recorded. 

VACCINATION UPDATE: As of 6 Dec, 89% of population have been vaccinated (graphic attached).

WHO: Ebola virus disease – Democratic Republic of the Congo

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

Nine new confirmed cases were reported from 27 November to 3 December in the ongoing Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces. The confirmed cases in this week were reported from Mandima (56%, n=5) and Mabalako (44%, n=4) Health Zones.  

In the past two weeks, violence, widespread civil unrest, and targeted attacks have severely disrupted the Ebola response and restricted access to affected communities in multiple locations. As a result, several key activities of the response experienced diminished performance, including the volume of reported and investigated alerts and the number of contacts registered and followed (Figure 1, Figure 2). 

The volume of alerts from health zones affected by insecurity is lower than usual, and this has led to an overall reduction in the average number of alerts reported in the last seven days. Of the 3346 alerts reported, 96% were investigated within 24 hours.  

The overall average percentage of contacts under surveillance in the last seven days is 70%, which is below the average for November prior to these security events (Figure 2). This is due mainly to performance being suboptimal in some areas of Beni, Mabalako, and Oicha Health Zones, with only 82% of contacts followed in Beni, 68% in Mabalako, and 42% in Oicha. These numbers are improving slowly since the events, but fluctuations illustrate the continued impact that security events have on response activities. 

In the past 21 days (13 November to 3 December), 22 confirmed cases were reported from 10 of the 71 health areas within four neighbouring active health zones in North Kivu and Ituri provinces (Figure 3, Table 1): Mabalako (55%, n=12), Mandima (27%, n=6), Beni (9%, n=2), and Oicha (9%, n=2). The majority of the cases (91%, n=20) are linked to known chains of transmission. 

In the past 21 days, a higher proportion of cases (31%, n=8) have reported a funeral as their potential exposure to EVD compared to the average since January 2019 (7%); this is because of two separate community clusters in the health areas of Lwemba (six cases) and Bingo (two cases) linked to the burials of two probable cases. As of 3 December, a total of 3313 EVD cases were reported (Figure 4), including 3195 confirmed and 118 probable cases, of which 2207 cases died (overall case fatality ratio 67%). 

Of the total confirmed and probable cases, 56% (n=1866) were female, 28% (n=936) were children aged less than 18 years, and 5% (n=163) were health workers.