H5N1

Madagascar: More than 10,000 cases of measles in 20 Tana regions

Via Midi Madagasikara: Epidemics: More than 10,000 cases of measles in 20 Tana regions also in rubella epidemic. Excerpt from the Google translation:

44 districts, 20 regions and 10,294 affected subjects. The measles epidemic has reached its peak and begins a decreasing curve. The districts of Antananarivo Renivohitra and Ambato Boeny are the most affected. As the stock of vaccine is exhausted - except for infants up to 9 months old and already scheduled to be vaccinated in health facilities according to the vaccination schedule - an import of new vaccine doses is underway. 

The milestone of 10,000 cases, all age groups, has now been crossed. The measles epidemic affecting children, adolescents and adults hit a large part in the Antananarivo district with 5971 cases, and that of Ambato Boeny where 782 cases were recorded. In total, 44 districts in Madagascar are affected by this epidemic, which started about three months ago. With 20 out of 22 affected regions, the epidemic has spread across the island with the exception of two regions that are currently untouched. These are the Ihorombe and Anosy regions.  

This resurgence of measles cases is explained by the gaps in vaccination, deplore the officials within the Ministry of Public Health. Indeed, the number of children vaccinated at 9 months (the age indicated for vaccination against measles in Madagascar) has been steadily decreasing if one refers to the figures that go back to the health facilities of the various regions. 

"As the measles virus continues to circulate, its meeting with the unvaccinated, more vulnerable organisms is at the root of the highly contagious disease development," says Dr. Manitra Rakotoarivony, Director of Promotion of Health.  

Out of stock. 

Thus, as the number of vulnerable or unvaccinated organisms is high, so is the risk of people developing the disease. Since the beginning of the current epidemic, nearly 70% of measles cases are children and adolescents aged 1 to 14 years. Among them, vaccinated or unvaccinated persons, with a clear predominance of unvaccinated, in the age group of less than one year.  Similarly, 55% of all cases are unvaccinated or unknown vaccination status. 

"It's only in the face of this growing epidemic that people are realizing the importance of immunization. And yet routine vaccination has for years included that against measles from 9 months. Similarly, Mother and Child Health Week (MSM) is an opportunity to carry out catch-up vaccination," says Dr. Manitra Rakotoarivony. Completely free vaccines in public health facilities, are accessible to every child from 9 to 11 months.

Ebola DRC: Bad news, but a miracle baby (updated)

I posted this item but found Typepad's editing function wasn't working. So here is the complete post, with today's table and a very nice photograph.

The Ministry of Health has published EBOLA RDC - Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Jeudi 13 décembre 2018. The bad news: Ten new cases and seven deaths—six of them in the community. The good news: A baby whose Ebola-positive mother died in childbirth has recovered. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Thursday 13 December 2018   

The epidemiological situation of the Ebola Virus Disease  dated December 12, 2018:   

• Since the beginning of the epidemic, the cumulative number of cases is 515, of which 467 are confirmed and 48 are probable. In total, there were 303 deaths * (255 confirmed and 48 probable) and 179 people cured. 

• 96 suspected cases under investigation.  

• 10 new confirmed cases, including 4 in Kyondo, 2 in Mabalako, 2 in Komanda, 1 in Kalunguta and 1 in Beni.  

º The new case confirmed Mabalako reported in the bulletin of 12 December 2018 lives in the health area near Biena, where he began to have symptoms of Ebola. The patient was contaminated by a confirmed case who lived in Aloya City, Mabalako Health Zone, and died at the Ebola Treatment Center on December 3, 20018.  

• 7 new confirmed deatha, including 2 in Kyondo, 2 in Katwa, 1 in Beni, 1 in Mabalako and 1 in Komanda. All are community deaths, except that of Beni.  

• 4 new healed people, including 3 exits from the CTE of Beni and 1 from the CTE of Butembo.  

*  Review of the list of confirmed cases of death in Beni in progress.  

 

/! \  The data presented in this table is subject to further changes after thorough investigation and after redistribution of cases and deaths in their health areas.

News of the response 

The miraculously young Beni 

Credit: DRC MOH

• The youngest Ebola healed came out of the Beni Ebola Treatment Center this Wednesday, December 12, 2018. This miraculously young, born October 31, 2018, was admitted at the age of 6 days to CTE after her mother , a confirmed case of Ebola, died during childbirth. Throughout his hospitalization, pediatricians, resuscitators and nannies of CTE took turns at his bedside 24 hours a day to give him every chance to survive. Nannies are former CTE patients who have recovered from Ebola and are able to care for sick children by wearing lighter protective gear. They play a fundamental role in caring for sick children who need more attention and a reassuring presence at their side during treatment.   

Vaccination 

• Continued wide-belt vaccination (or ring plus) in Otomaber (in Komanda Health Zone) and Aloya (in Mabalako Health Zone). Since the start of vaccination on 8 August 2018, 45,647  people have been vaccinated , including  18,726 in Beni, 8,084 in Katwa, 4,950 in Mabalako, 4,276 in Butembo, 2,108 in Kalunguta, 1,663 in Mandima, 791 in Vuhovi, 750 in Masereka, 700 in Lubero, 633 in Komanda, 627 in Oicha, 599 in Mutwanga, 434 in Bunia, 381 in Kyondo, 355 in Tchomia, 314 in Musienene, 63 in Alimbongo, and 13 in Kisangani.

Update: The little girl is named Benedicte, and The Washington Post has more details about her story. 

Branswell: Developmental delays persist as Brazil’s Zika babies grow up

Via STAT, Helen Branswell writes: Developmental delays persist as Brazil’s Zika babies grow up. Excerpt:

The Zika virus has faded from the world’s headlines. But the damage the strange mosquito-borne virus inflicted on some children whose mothers were infected during pregnancy very much remains.  

A new study, published Wednesday in the New England Journal of Medicine, reports that in a group of Zika babies from Brazil who are being followed to assess their progress, 14 percent had severe developmental problems.  

This was higher than previous studies have suggested, said Dr. Karin Nielsen-Saines, one of the authors. 

These children scored unusually low scores on testing of their cognition, motor, or language skills, or they had visual or hearing impairment.  

“It was either both things or one or the other,” explained Nielsen-Saines, a professor of pediatric infectious diseases at the David Geffen School of Medicine at the University of California, Los Angeles. 

Nielsen-Saines and her co-authors, a number of whom are from Brazil’s Oswaldo Cruz Foundation, wanted to chart what Zika would do over the long term to children born to mothers infected during pregnancy. So they followed a cohort of 182 children. 

Of those, 131 were brought in by their parents for follow-up testing that involved at least one of the following: brain imaging, eye examinations, hearing tests, and a standardized test used to assess the development of children in the first few years of life. The test is called the Bayley Scales of Infant and Toddler Development, or Bayley-III. 

The testing was done in the second year of life for these young children, between the ages of 12 to 18 months in most cases. Nielsen-Saines said the work is ongoing and the group is currently assessing later data from these children, who they plan to study until at least the age of 7. 

Of the total, 94 of the children underwent both imaging and the Bayley-III assessment; 63 percent of them had scores that were in the normal range for cognition, motor, and language skills. But 14 percent had severe neurodevelopmental delays.

Six of the children had microcephaly and were so profoundly impacted that in essence the Bayley test could not be conducted, Nielsen-Saines said. Another roughly 15 percent had moderate developmental delays, she said.

DR Congo: Ebola virus disease - External Situation Report 19

Via ReliefWeb, a WHO AFRO report: Democratic Republic of Congo: Ebola Virus Disease - External Situation Report 19. The situation update:

The Ministry of Health (MoH), WHO and partners continue to respond to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo. By using proven public health measures as well as new tools at hand (immunization and therapeutics), WHO remains confident the outbreak can be contained and brought to an end, despite multifaceted challenges.  

During the reporting period, 4 December – 10 December 2018, cases continued to be reported in several health zones of North Kivu and Ituri Provinces, including in Mandima, a health zone in Ituri Province that last reported cases 102 days ago. During the reporting period, 39 new confirmed cases were reported from Katwa (12), Butembo (8), Beni (6), Mabalako (4), Oicha (3), Komanda (1), Kyondo (1), Vuhovi (1) and Mandima (1). Three healthcare workers were reported among the confirmed cases. A total of 21 deaths occurred during the reporting period.  

The continuous efforts to review and reconcile case records in the database resulted in the addition of eight confirmed cases who had been admitted at the Ebola treatment Centre (ETC) of Beni during October 2018, and the identification of two former confirmed cases as being healthcare workers.  

As of 10 December 2018, a total of 500 EVD cases, including 452 confirmed and 48 probable cases, have been reported from 14 health zones in the two neighbouring provinces of North Kivu and Ituri. Of the total of 500 cases, 289 died (overall case fatality rate 58%), including 241 confirmed cases. As of 10 December 2018, 172 cases have recovered and been discharged from ETCs. Females account for 61% of all confirmed and probable cases, and children (<15 years of age) account for 25% of all confirmed and probable cases. The number of health workers affected is 49 (47 confirmed and 2 probable), including 15 deaths. 

Over the last 21 days (20 November to 10 December 2018), 100 confirmed and probable cases were reported from 12 health zones. The majority were reported from the major urban areas of Katwa (n=28), Beni (n=26), and Butembo (n=17); however, field teams are simultaneously pursuing the response activities around cases across Kalunguta, Komanda, Kyondo, Mabalako, Mandima, Masereka, Mutwanga, Oicha and Vuhovi.  

 The 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. Since the last report was published, alerts were investigated in several provinces of the Democratic Republic of the Congo as well as in South Sudan and Uganda. To date, EVD has been ruled out in all alerts outside of the abovementioned outbreak affected areas.

AFM, the polio-like illness, will be back

Via The Atlantic, a must-read by Ed Yong: AFM, the Polio-Like Illness, Will Be Back. Excerpt:

AFM isn’t new, but it rose to prominence (and gained its name) in 2014 when it afflicted 120 people in the United States—a record number. Doctors wondered whether that was a freak occurrence, but the condition came back in 2016, affecting 149 additional patients. And this year, it returned again, with 158 confirmed cases and more under investigation. The disease now seems to run on a biennial schedule, and although the third wave peaked in mid-fall, scientists, clinicians, and parents are anxiously looking ahead to a likely fourth surge in 2020.

Unlike many seasonal illnesses, which come, sicken, and leave without long-term consequences, AFM means lasting (if not lifelong) disability for those it touches. And that community grows with every new wave: A Facebook group for parents of children with AFM, which formed in January 2015, has swelled to more than 600 members. 

“We dread late summer,” wrote Bove in a recent opinion piece, co-authored with two other parents of children with AFM. “We grieve those final days when our still-normal children climbed their last playground structures or took their last runs down the block or their last independent breaths. We relive the trauma of the hospitalization, when at night we kissed our brave children, not knowing whether they would awaken stable, intubated, or unable to ever walk again. In addition, we fear the coming wave of new bewildered parents.” 

But Bove says that something was different this year. In 2014 and 2016, the affected families were still getting to grips with this strange and unfamiliar condition.

 “This year, when we saw many new parents join the Facebook group, it was like: Not this time!” she says. “It really galvanized the parent community to become more outspoken in their advocacy. They’ve plastered the news with stories.” 

In no small part because of their efforts, awareness of AFM has soared, including within the medical community. “We’re seeing a very appropriate amount of increased attention,” says Kevin Messacar, a pediatrician at Children’s Hospital Colorado.

North Kivu: Reported cholera in Nyakakoma village

Via Radio Moto Butembo-Beni, more trouble for North Kivu: RUTSHURU: Reported cholera in NYAKAKOMA village. The edited Google translation:

The lake village of Nyakakoma is facing the cholera epidemic, according to local sources. The care of the affected people becomes difficult because of their high number at the risk of the spread of the disease to other environments. For the Binza District Chief Medical Officer, it is not about cholera in Nyakakoma, but cases of diarrhea.  

Most of the sick are children. The chairman of the Nyakakoma Fishermen's Committee is worried about several factors that may allow the spread of this disease. 

"You know, Nyakakoma is landlocked. It is difficult to have pharmaceuticals. The health center of the place has a reduced capacity. It is difficult to take care of the cholera patient because we lack an isolation room. The cholera patients are lodged in corridors. Another thing, we lack prevention measures. We are unable to chlorinate the water of the lake before use," said Jeredi Kambasu. 

Another factor to emphasize is that Nyakakoma opens on Kyavinyonge in the territory of Beni through Lake Edward. Contact is very frequent between these two agglomerations with three rotations per week. 

"This may also facilitate the spread of the disease, which may then be added to that of the Ebola virus," Kambasu said. For this, he calls for a large-scale response to stem the disease. 

Contacted, the chief physician of Zone Binza indicates that there are cases of diarrhea and that cholera is not confirmed yet. For him, it is necessary to make sufficient laboratory examinations for confirmation of cholera. Dr Bernard Kakule adds that the situation is being mastered by the medical staff in Nyakakoma.

Children account for more than one third of Ebola cases in eastern DR Congo

The Ministry of Health has told us almost nothing directly about the people who are actually contracting Ebola. Here is a little clarification. Via ReliefWeb, a UNICEF report: Children account for more than one third of Ebola cases in eastern Democratic Republic of the Congo. Excerpt:

KINSHASA, DAKAR, NEW YORK, GENEVA, 11 December 2018 – Children now account for more than one third of the Ebola cases in affected regions of the eastern Democratic Republic of the Congo (DRC), UNICEF said today. The UN children’s agency also reported that one in ten Ebola cases is under five-years-old, while children who contract the Ebola virus are at higher risk of dying from the disease than adults. 

“We are deeply concerned by the growing number of children confirmed to have contracted Ebola,” said UNICEF’s Regional Director for West and Central Africa, Marie-Pierre Poirier, returning this week from Beni, one of the current epicentres of the Ebola outbreak. “The earlier children infected with Ebola receive treatment in a specialized health facility, the greater their chances of survival. Community mobilization and public awareness activities are also crucial to ensuring early detection and quick referral of suspected cases to Ebola treatment centres.”  

Continued efforts are needed to raise awareness of prevention methods and promote early access to treatment which dramatically improves survival rates. 

The impact of the disease on children goes beyond those who have been infected. When parents or caregivers with the disease are taken to treatment centres or pass away, some children are left on their own. 

UNICEF and its partners have so far identified more than 400 children who have been orphaned or left unaccompanied because of the virus. The growing number of separated children is linked to the high caseload of patients in the Ebola treatment centres of Beni and Butembo, the current epicentres of the disease. UNICEF provides Ebola-infected children, orphans and unaccompanied children with appropriate assistance, including nutritional care and psychosocial and educational support. 

Together with its partners, UNICEF has opened a kindergarten next to the Ebola treatment centre of Beni to assist the youngest children whose parents are isolated in the centre. The creche has taken care of more than 20 separated infants and young children, aged up to eight years, since its opening early November.

Fears of measles outbreak in western Finland fade

Via Yle Uutiset: Fears of measles outbreak in western Finland fade. Excerpt:

Public health officials in western Finland say that no new cases of measles have been found since a child was diagnosed with the highly contagious illness in late November in the small town of Larsmo. Some patients have been tested for suspected cases, but the health centre in neighbouring Jakobstad says that there are no strong suspicions of new cases. 

However they warn that more cases are still possible, as the child had been in contact with many other people before being diagnosed on 29 November, and measles can have an incubation period of up to 21 days. 

The pre-school child contracted the virus while on a family trip to the Middle East, where there is an ongoing measles epidemic. 

Authorities were concerned that an epidemic could break out in Larsmo, where only about three quarters of small children have received the measles vaccine. The corresponding figure elsewhere in Finland is over 90 percent.  

According to the World Health Organisation (WHO), at least 93-95 percent of a population must be vaccinated to establish so-called herd immunity against measles. The illness can be fatal, especially to those with poor general immunity due to other serious illnesses. 

"Laestadian community does not generally oppose vaccinations" 

Larsmo is a mostly Swedish-speaking municipality of some 5,000 people, many of them members of fundamentalist religious communities. The child who fell ill is from a conservative Laestadian Lutheran family and had visited a prayer room where other unvaccinated children were present before being diagnosed. 

Local paediatric nurse Katarina Palo tells Yle that the Finnish Laestadian community does not generally oppose vaccinations, but that peer pressure had built up in the area spurred by the writings of an anti-vaccination blogger.  

Measles epidemics were common in Finland through the 1960s, breaking out every five to seven years, but the illness has been virtually eliminated in the country since 1970.

UK children face winter health crisis due to pollution, say doctors

Via The Guardian: UK children face winter health crisis due to pollution, say doctors. Excerpt:

Thousands of children are facing hospital this winter as cold weather and the UK’s air pollution crisis combine to create potentially deadly conditions for young people, doctors have warned. 

The Royal College of Paediatricians, the Royal College of Physicians and children’s charity Unicef say that the UK’s toxic air and cold weather will leave a huge number of children extremely vulnerable this winter, creating an “overlooked” emergency for an already stretched NHS.  

“Wards could soon be filled with wheezing, spluttering children, their lungs struggling to battle the double burden of cold weather and toxic air,” the groups state in a letter to the Guardian.  

Winter often sees spikes in acute air pollution as the cold weather results in both an increase in emissions from the heating of homes and offices, including the burning of wood or coal, and reduced dispersion in cold, still conditions.  

This, combined with freezing temperatures which weaken those with existing respiratory trouble, leaves thousands vulnerable to acute health problems.  

In the letter the doctors state that children are most at risk from this double threat. And they say that as the NHS prepares for a winter bed shortage, they have a “mandate to flag an issue that is continually overlooked”. 

“We know that the elderly are susceptible to ill health caused by the drop in temperatures, but the impact on young children with respiratory conditions, such as asthma, is often disregarded,” they say. 

They say the UK is home to more children suffering from respiratory conditions than anywhere else in Europe. “Admissions for people with respiratory conditions almost double during the winter – and the majority of those admitted are young children,” they say. 

“Emergency admissions and mortality rates linked to these conditions are also the highest: a child experiencing an asthma attack is admitted to hospital every 20 minutes.”  

Air pollution kills tens of thousands of people each year across Britain and affects the health of hundreds of thousands more. 

Last month, the UN warned that the UK government was endangering people’s health by denying their right to clean air, and Unicef told the Guardian it had refocused its British operation to tackle air pollution because of the scale of the “health crisis” facing young people in the country.  

In October, the World Health Organization (WHO) said air pollution was the “new tobacco”, causing 7 million deaths around the world and harming billions more. And a recent study published in the Lancet medical journal found that pollution from diesel vehicles was stunting the growth of children’s lungs, leaving them damaged for life.

WHO EMRO: Djibouti carries out mass immunization to protect children against polio, amid outbreaks in the Horn of Africa

WHO EMRO has published Djibouti carries out mass immunization to protect children against polio, amid outbreaks in the Horn of Africa. Excerpt:

Early analysis of campaign data points to a successful vaccination round in a polio-free country at risk of possible importation. 

In the last week of October, Djibouti’s Ministry of Health, working with WHO, UNICEF and other partners, successfully carried out the country’s first polio National Immunization Days (NIDs) since 2015. 

While Djibouti has not had a case of polio since 1999, the recent outbreak of polio in neighbouring countries in the Horn of Africa, and the low levels of routine immunization coverage in some areas in the country, are indications that Djibouti is still at risk if poliovirus spreads through population movements. Other countries in the Horn of Africa are already cooperating to control the existing outbreak and to reduce the risk of spread, and given that Djibouti is on a major migration route in the Horn of Africa, it makes a lot of sense for Djibouti to join this coordinated response. 

For Dr Ahmed Zouiten, the acting WHO Representative in Djibouti, this context demanded action. 

“I prefer to deal with a campaign for prevention than to have to deal with an outbreak of polio,” he said.  

With that in mind, an NID planned for 2019 was brought forward and carried out over 23–26 October. The target was 120 000 children under five years of age, a number suggested by Djibouti’s last census in 2009. Two strategies were proposed: one approach, where children would be vaccinated at fixed points (health facilities) and a complementary door-to-door approach using two-person teams (a vaccinator and a registration person). 

In the days and weeks before the NID, all partners, including the government, WHO and UNICEF, used a variety of communication channels – from outdoor signage to radio spots – to ensure that communities were informed not just of the risks of polio, but also of the importance of protecting children from vaccine-preventable diseases.