H5N1

DR Congo: Launch of national immunization days against polio and measles

Via mediacongo.net, a Radio Okapi/MCP report: Launch of National Immunization Days against Poliomyelitis and Measles. The Google translation:

National Polio Vaccination Days combined with the measles response in sixty-three health zones were launched this Thursday, April 18 in Kinshasa. 

These campaigns mobilize more than 230,000 actors from the Ministry of Public Health and partners. They target 19,466,557 children aged 0 to 59 months for polio vaccination and 2,200,772 children aged 6 to 59 months for measles immunization.  

During his speech, the WHO representative in the DRC, Deo Nshimirimana, said that humanity is at a turning point in the eradication of polio, which is now set for 2023. As such, he continued, the strategic polio eradication plan and the final phase focuses on strengthening the routine immunization system and confining poliovirus in the laboratories.  

He notes that in the DRC, the situation of measles is very worrying. 

"At the 14th week of 2019, the country reached 73% of the reported cases during the same period in 2018 with 13 times more deaths. The Government of the Republic has requested and obtained funding from the Measles and Rubella Initiative to respond to ongoing epidemics. These responses are technically supported by partners including MRI, WHO, UNICEF and MSF, but there is a need to mobilize additional resources to respond to all epidemic health zones, "said Deo Nshimirimana. 

Involvement of all  

The operating costs of these campaigns are estimated at USD $9,273,865. 

The Interagency Coordinating Committee expects full commitment from parents by hosting vaccinators in their households and sending the children to the vaccination sites that will be installed in the 63 health zones to receive an injection of measles vaccine. 

It also calls on community leaders, religious leaders and policymakers to become involved in eradicating polio and eliminating measles, by encouraging people to massively adhere to this campaign and other activities aimed at vaccinating children. 

Campaign partners include MRI and UNICEF for the measles response and WHO, UNICEF, Rotary International, National Philanthropic Trust for polio NIDs.

Donkeys deliver vaccines in Mali as diseases spike with violence

Via Thomson Reuters: Donkeys deliver vaccines in Mali as diseases spike with violence. Excerpt:

DAKAR, April 17 (Thomson Reuters Foundation) - With spiralling ethnic violence exposing more children in Mali to fatal diseases, health workers are using donkeys and boats to deliver life-saving vaccines, charities said on Wednesday. 

In the central Mopti region - where 157 people died in one attack last month - suspected measles cases rose five-fold in one year to 98 in 2018, U.N. children's agency UNICEF said, due to a four-fold jump in unvaccinated children to 70,000.  

Motorcycles, which health workers used to reach remote villages, have been banned to reduce militant activity, forcing them to use traditional means like horses, it said. 

"The problem of vaccination is directly linked to the current conflict," said Patrick Irenge, medical coordinator for the charity Medecins Sans Frontieres (MSF), which is using cars and boats as mobile clinics to reach cut off communities.  

"If there is a lull in the violence, a small window that opens, we organise a vaccination campaign." 

Last month's massacre was the deadliest to date in a conflict between Dogon hunters and Fulani herders which has displaced tens of thousands of civilians in the West African country since it escalated last year.  

Pneumonia is one of the top killers of children in Mali and it can be prevented with vaccines - as can measles - but it is too dangerous for many parents to venture out with children.

Ebola survivors comfort sick and frightened in Congo outbreak

Via Thomson Reuters: Ebola survivors comfort sick and frightened in Congo outbreak. Excerpt:

BENI, Democratic Republic of Congo, April 17 (Reuters) - W earing a disposable gown and gloves for protection, Jeanine Masika cradles a 2-year-old Ebola patient and offers the listless toddler teaspoons of brown soup. 

Most health care workers need a surgical mask, goggles, hooded coveralls, an apron, rubber boots and two pairs of gloves to avoid catching the virus that typically kills around half those it infects. 

The outfits are hot, and in the stifling tropical temperatures of eastern Democratic Republic of Congo this limits the time they can spend with patients fighting for their lives in isolation units. 

But Masika has antibodies in her system after she won her own battle against Ebola last year, and she now has immunity.  

The 33-year-old mother of six can spend entire days with patients at a treatment centre in the North Kivu town of Beni, offering a comforting presence among a crowd of faceless figures with names written on their suits in marker pen.  

Masika is one of dozens of survivors who are providing care - and much-needed human contact - to some of the littlest victims of the second-worst Ebola epidemic on record.  

Of the more than 1,260 confirmed and probable Ebola cases, 28% are children, according to figures from the World Health Organization. More than 800 people, including at least 248 under the age of 18, have died since the outbreak began in August. 

The outbreak is surpassed only by one in West Africa in 2013-16, which is believed to have killed more than 11,000 people. 

FIGHTING BACK  

Masika lost 10 relatives to the virus; four of those infected in her family survived. 

"It was as if Ebola had chosen my family," she said.  

She was admitted to the same treatment centre where she now works in September and stayed there for 21 days, battling horrific symptoms. 

"It's like suffering from all the diseases of Congo at the same time," she said. "I felt bad all over my body: headache, stomach ache, diarrhoea, vomiting, tiredness." 

Masika's experience inspired her to join the fight against Ebola, comforting sick and frightened children who have to be isolated from their families and familiar surroundings to avoid infecting others. She is one of at least 23 former patients employed at the centre in Beni, which is run by the Alliance for International Medical Action (ALIMA). 

When Reuters visited in late March, Masika was spending most of her time in a clear plastic isolation cube. She rocked and fanned Furaha, a little girl who rarely stirred or cried. The cubes allow patients to see relatives during treatment, albeit through thick plastic walls. 

When the needle attached to Furaha's intravenous drip had to be replaced, Masika gently lifted the girl and carried her to the back of the cube so a medic in full protective gear could find a new vein. Furaha slipped a skinny arm around Masika's neck and leaned her head against the woman for support.  

"My goal is to make her happy," Masika said of her small charge, the youngest of five family members who were being treated at the centre. "I treat the child like she's my own, so she's at ease even while she's away from her parents."

WHO: DRC Ebola External Sitrep 37

Via ReliefWeb, a WHO AFRO report: Democratic Republic of Congo: Ebola Virus Disease - External Situation Report 37. Excerpt:

This past week saw the continued rise in the number of Ebola virus disease (EVD) cases in the North Kivu and Ituri provinces of the Democratic Republic of the Congo, with a total of 110 new confirmed cases. Documented transmission, however, remains geographically confined, with the majority of recent cases reported from the health zones of Katwa, Mandima, Butembo, and Vuhovi. 

During the last 21 days (25 March to 14 April 2019), 55 health areas within 11 health zones reported new cases; 38% of the 144 health areas affected to date (Table 1 and Figure 2). During this period, a total of 238 confirmed and probable cases were reported from Katwa (119), Vuhovi (41), Mandima (27), Beni (20), Butembo (14), Oicha (7), Mabalako (5), Kalunguta (1), Masereka (1), Musienene (1), and Lubero (1). 

As of 14 April 2019, a total of 1264 EVD cases, including 1198 confirmed and 66 probable cases, were reported. A total of 814 deaths were reported (overall case fatality ratio 64%), including 748 deaths among confirmed cases. 

Of the 1264 confirmed and probable cases with reported age and sex, 56% (712) were female, and 28% (355) were children aged less than 18 years. The number of healthcare workers affected has risen to 89, including 32 deaths, with four new health workers confirmed in the last week; all from community health centres within hotspot areas.

WHO: New measles surveillance data for 2019

WHO has published New measles surveillance data for 2019. Excerpt:

15 APRIL 2019, GENEVA - Measles cases have continued to climb into 2019. Preliminary global data shows that reported cases rose by 300 percent in the first three months of 2019, compared to the same period in 2018. This follows consecutive increases over the past two years. 

While this data is provisional and not yet complete, it indicates a clear trend. Many countries are in the midst of sizeable measles outbreaks, with all regions of the world experiencing sustained rises in cases. Current outbreaks include the Democratic Republic of the Congo, Ethiopia, Georgia, Kazakhstan, Kyrgyzstan, Madagascar, Myanmar, Philippines, Sudan, Thailand and Ukraine, causing many deaths – mostly among young children.  

Over recent months, spikes in case numbers have also occurred in countries with high overall vaccination coverage, including the United States of America as well as Israel, Thailand, and Tunisia, as the disease has spread fast among clusters of unvaccinated people. 

Measles is one of the world’s most contagious diseases, with the potential to be extremely severe. In 2017, the most recent year for which estimates are available, it caused close to 110 000 deaths. Even in high-income countries, complications result in hospitalization in up to a quarter of cases, and can lead to lifelong disability, from brain damage and blindness to hearing loss.  

The disease is almost entirely preventable through two doses of a safe and effective vaccine. For several years, however, global coverage with the first dose of measles vaccine has stalled at 85 percent. This is still short of the 95 percent needed to prevent outbreaks, and leaves many people, in many communities, at risk. Second dose coverage, while increasing, stands at 67 percent.  

With governments and partners such as the Measles & Rubella Initiative, Gavi, the Vaccine Alliance, UNICEF and others, response operations are underway to bring country outbreaks under control, strengthen health services, and increase vaccine coverage. 

• After conducting emergency vaccination campaigns targeting 7 million children from 6 months through 9 years of age, Madagascar is now seeing overall declines in measles cases and deaths. 

• In the Philippines, over 3 890 000 doses of the measles and rubella vaccine have been given to children aged under 5 years. 

• In the Democratic Republic of the Congo, the country is preparing to launch a combined response with polio vaccine. 

• In collaboration with local health authorities, WHO and UNICEF conducted a nationwide measles and rubella vaccination campaign in Yemen reaching more than 11.6 million (90%) children aged 6 months–16 years across the country.

Madagascar measles epidemic kills more than 1,200 despite desire for vaccinations

Via CBC News, a report by The Associated Press: Madagascar measles epidemic kills more than 1,200 despite desire for vaccinations. Excerpt:

Babies wail as a nurse tries to reassure mothers who have come to vaccinate their children. They fear a measles epidemic that has killed more than 1,200 people in this island nation where many are desperately poor. 

As Madagascar faces its largest measles outbreak in history and cases soar well beyond 115,000, there is poor vaccine coverage caused, not by resistance to vaccinating children, but by lack of access to health resources.  

Measles cases are rising in the United States, Canada and other parts of the world, in part the result of misinformation that makes some parents balk at a crucial vaccine. British Columbia, the Northwest Territories and parts of Ontario have all had confirmed cases, while New York City is trying to halt a measles outbreak by ordering mandatory vaccinations in one Brooklyn neighbourhood.  

In Madagascar, many parents would like to protect their children but face immense challenges, including the lack of resources. 

Just 58 per cent percent of people on Madagascar's main island have been vaccinated against measles, a major factor in the outbreak's spread. With measles one of the most infectious diseases, immunization rates need to be 90 to 95 per cent or higher to prevent outbreaks. 

According to UNICEF, Madagascar has reported more than 118,000 cases of measles in the past six months, and there have been 1,688 reported deaths.

Beni: Polio vaccination campaign postponed to April 19 in Mutwanga health zone

Via mediacongo.net, a reminder that Ebola isn't the only problem in North Kivu: Beni: polio vaccination campaign postponed to April 19 in Mutwanga health zone. The Google translation:

Initially planned for this Thursday, April 11, 2019, the beginning of the polio vaccination campaign in the health zone of Mutwanga, is postponed for April 19 next, said on Thursday the health authorities in this part of the Ruwenzori sector in the territory of Beni.  

Reason: inputs are not yet available.  

The nurses of the Lubiriha and Kangahuka health areas in the Basongora group call on the parents of this area to wait for this date, which promises to be very promising for children from 0 to 5 years old.  

"We will start with the OPV campaign from the 19th until the 22nd. It will be the polio campaign for all children aged 0 to 5 and the relays will go door to door to vaccinate the children. So far we have no information because the vaccine comes from the WHO and at home no input is already available, "said Kangahuka health area nurse, Katembo Mahalaki Justin .

WHO: Ebola virus disease – Democratic Republic of the Congo

WHO has published its weekly update: Ebola virus disease – Democratic Republic of the Congo. We will likely hear much more from WHO tomorrow and over the weekend. Excerpt:

The rise in number of Ebola virus diseases cases observed in the North Kivu provinces of the Democratic Republic of the Congo continues this week. During the last 21 days (20 March to 9 April 2019), 57 health areas within 11 health zones reported new cases; 40% of the 141 health areas affected to date (Table 1 and Figure 2). During this period, a total of 207 probable and confirmed cases were reported from Katwa (83), Vuhovi (41), Mandima (29), Beni (21), Butembo (15), Oicha (8), Masereka (4), Lubero (2), Musienene (2), Kalunguta (1), and Mabalako (1).  

As of 9 April, a total of 1186 confirmed and probable EVD cases have been reported, of which 751 died (case fatality ratio 63%). Of the 1186 cases with reported age and sex, 57% (675) were female, and 29% (341) were children aged less than 18 years. The number of healthcare workers affected has risen to 87 (7% of total cases), including 31 deaths. To date, a total of 354 EVD patients who received care at Ebola Treatment Centres (ETCs) have been discharged.  

WHO Director-General Dr. Tedros Adhanom Ghebreyesus has convened the Emergency Committee for a meeting on 12 April, to consider whether the current EVD outbreak constitutes a public health emergency of international concern and to provide recommendations.  

Progress on the ground this week focused primarily on intensifying infection prevention and control (IPC) activities in and around outbreak hotspot areas. IPC teams are concentrating their efforts at addressing reluctance to decontamination activities amongst some local residents by actively engaging in regular direct dialogues with community leaders. 

Along with intensifying decontamination efforts, other IPC measures being undertaken include rapid evaluation of IPC practices in healthcare facilities and patients’ homes and identifying facilities at increased risk of contact with EVD cases. Results from these rapid evaluations demonstrated a range of IPC gaps depending on the type of facility, which were then promptly addressed through supplementary supervision. 

Reoccurring issues include limited knowledge of standard precautions, lack of triage and isolation capacity, insufficient supplies (e.g., of personal protective equipment), inappropriate waste management, and lack of capacity for decontaminating medical equipment. These findings highlight the importance of maintaining supportive supervision and mentorship at priority facilities throughout the response. WHO is confident that strengthening these IPC measures would be an integral means of slowing the spread of EVD in the outbreak areas. 

WHO and partners in Risk Communication and Community Engagement are continuing with activities to build and maintain a trusting relationship between communities and the Ebola response teams. 

Dialogues with community committees are ongoing in the hotspot areas of Butembo, Katwa, and Vuhovi, and form a key part of a larger increase ownership of the Ebola response by the communities. Information about community disquiet are systematically collected and monitored to ensure that any misunderstanding leading to reluctance, refusal, or resistance of the Ebola response is followed up with and resolved as quickly as possible. This has been made possible by feedback from the community members, received through ongoing dialogue and various research activities within both the Democratic Republic of the Congo, and neighbouring areas.  

In an effort to address the feedback received and specific concerns over the outbreak response, guided visits of the Ebola Treatment Centres (ETCs) in various affected areas have been organized. Students and community associations who attended these guided visits to the ETCs can see first-hand how EVD patients are treated and help stop the potential dissemination of misinformation surrounding EVD and the ongoing response efforts.  

The security situation has remained calm for the past week as well. Provisional results released on 9 April by the Commission Électorale Nationale Indépendante concerning the national and provincial legislative elections in Beni, Butembo city (North Kivu), and Yumbi territory (Mai-Ndombe) have caused no significant unrest or disruption to outbreak response activities.  

The continued increase in cases this past week reflects the complex reality of conducting an effective outbreak response in a geographically difficult area with a highly fluid population, intermittent attacks by armed groups, and limited healthcare infrastructure. Despite these challenges, WHO and partners remain committed to limiting the spread of EVD amongst these vulnerable populations through the continued strengthening of our multi-faceted response efforts.

Children under 10 years of age were more affected by the 2018/19 influenza A(H1N1)pdm09 epidemic in Canada

Via Eurosurveillance: Children under 10 years of age were more affected by the 2018/19 influenza A(H1N1)pdm09 epidemic in Canada: ‎possible cohort effect following the 2009 influenza pandemic. The abstract:

Introduction 

Findings from the community-based Canadian Sentinel Practitioner Surveillance Network (SPSN) suggest children were more affected by the 2018/19 influenza A(H1N1)pdm09 epidemic. 

Aim 

To compare the age distribution of A(H1N1)pdm09 cases in 2018/19 to prior seasonal influenza epidemics in Canada. 

Methods 

The age distribution of unvaccinated influenza A(H1N1)pdm09 cases and test-negative controls were compared across A(H1N1)pdm09-dominant epidemics in 2018/19, 2015/16 and 2013/14 and with the general population of SPSN provinces. Similar comparisons were undertaken for influenza A(H3N2)-dominant epidemics.  

Results 

In 2018/19, more influenza A(H1N1)pdm09 cases were under 10 years old than controls (29% vs 16%; p < 0.001). In particular, children aged 5–9 years comprised 14% of cases, greater than their contribution to controls (4%) or the general population (5%) and at least twice their contribution in 2015/16 (7%; p < 0.001) or 2013/14 (5%; p < 0.001). Conversely, children aged 10–19 years (11% of the population) were under-represented among A(H1N1)pdm09 cases versus controls in 2018/19 (7% vs 12%; p < 0.001), 2015/16 (7% vs 13%; p < 0.001) and 2013/14 (9% vs 12%; p = 0.12). 

Conclusion 

Children under 10 years old contributed more to outpatient A(H1N1)pdm09 medical visits in 2018/19 than prior seasonal epidemics in Canada. In 2018/19, all children under 10 years old were born after the 2009 A(H1N1)pdm09 pandemic and therefore lacked pandemic-induced immunity. In addition, more than half those born after 2009 now attend school (i.e. 5–9-year-olds), a socio-behavioural context that may enhance transmission and did not apply during prior A(H1N1)pdm09 epidemics.

North Kivu: NGO sensitizes 300 street children against Ebola

Via Radio Okapi: North Kivu: NGO sensitizes 300 street children against Ebola. It's not clear from the Google translation whether 300 or 3,000 street children are involved. But this seems like a wise measure.

On April 9, the Union of Oppressed Women (UFO) launched an awareness campaign for 300 "street children" against the Ebola virus. Several sites in the communes of Goma and Nyiragongo have been targeted. 

The NGO UFO justifies this activity by the vulnerability of this social stratum in the city of Goma and the territory of Nyiragongo, with the outbreak of the epidemic that has already made more than a thousand people. 

"What motivates us to target this layer of the population is first and foremost their vulnerability. They are victims of many evils. And more than that, it is enough that one or two children are in contact with this virus [of Ebola, ed], it is the whole population which will pay the broken deposit," explained Gilbert Kubali, the in charge of the programs of this organization.  

Despite their vulnerable situation, these children do not hide their satisfaction.

"I'm happy with this awareness about Ebola. There are those who eat in the open air. And if one is caught, you sleep together, you will not know how you were affected; it is everyone who will be sick ... ", said one of the children. 

Jeanne Kamitiango, coordinator of the UFO, talks about the strategy to sensitize these children, most of whom can not read or write: "We have leaflets, we will show them signs, we will show them how to take care of their hands ..."  

This awareness campaign involves more than three thousand "street children" living in the two communes of Goma and the neighboring territory of Nyiragongo.

See also this March 26 report on street kids by two child reporters in the UNICEF blog Ponabana.