H5N1

DR Congo: Imminent hunger crisis threatens Ebola-stricken North Kivu

Via ReliefWeb, a report from the Norwegian Refugee Council: DR Congo: Imminent hunger crisis threatens Ebola-stricken North Kivu. Excerpt:

An average of 87 per cent of displaced people are living on just over a meal a day in areas already plagued by conflict and Ebola in Congo’s North Kivu. Families affected by the deadly virus have lost access to food and are on the brink of malnutrition. Ebola cannot be eradicated if people are left starving, warns the Norwegian Refugee Council. 

“Fighting Ebola should not make the world forget that millions of Congolese cannot find enough to eat,” warns NRC DR Congo Country Director, Maureen Philippon. “This is due to conflict and insecurity, displacement, a series of poor harvests and upset economic activities. The current Ebola crisis further worsens these conditions.” 

An unintended consequence of the outbreak has been its adverse effect on the economy of upper North Kivu. People infected or suspected of Ebola infection have been forced to abandon their work when they are incubated.  

According to recent data collected by the United Nations, several areas in upper North Kivu—including areas affected by the Ebola outbreak— are experiencing major spikes in hunger rates. During the first three months of year, the province experienced between a 31 and 66 per cent increase in hunger among displaced families and the communities hosting them. 

“We are deeply concerned that the international community is sacrificing one crisis for another, rather than looking at the whole picture, and now the population is suffering further as a result,” warned Philippon. “We must rethink how we address these needs.” 

Upper North Kivu’s territories have been insecure for years with massive inter-communal and inter-ethnic conflicts causing the majority of farming families to flee and abandon their fields. This has led to instances of crop failure and a decline in markets. Low humanitarian funding has also had a crippling effect on the people in need within these areas. Several aid agencies have had to close operations in the beleaguered province between 2017 and 2018. 

“People are much less likely to seek treatment or be treated successfully for Ebola if their basic needs are not being met,” said Philippon. “If we continue on this course, we will face a double wave of sickness and loss of life much sooner than we think.”

Liberia post Ebola: Ready for another outbreak?

Via The Lancet, an excellent report: Liberia post Ebola: ready for another outbreak? Excerpt:

Comfort Gbainsay is huddled on a bed under a mosquito net at the CB Dunbar Maternity Hospital in Gbarnga, a small city about a 3 hours' drive from Liberia's capital Monrovia. A few days ago, she started feeling weak. She had stomach cramps and was breathing fast. At the hospital, she was diagnosed with stomach ulcers and typhoid fever. The 37-year old is 3 months' pregnant. 

The ward is veiled in darkness. With a torch in one hand and a spoon in the other, Gbainsay is eating her dinner from a plastic container. There are not enough funds to run the hospital generators 24 h a day, so electricity is scheduled. This will be her third child, says Gbainsay. Her large eyes look exhausted, her voice is muted. She gave birth to her other two children at CB Dunbar, but back then, she says, she did not have to pay for any of her medication. 

CB Dunbar is a government hospital and therefore drugs and services should be free. The National Health and Social Welfare Policy 2011–2021 focuses on an essential package of health services, and the country has set itself the goal of reaching universal health coverage. However, the coverage index for essential health services lies at 34, the target value being 100. Gbainsay has already spent more than LRD3000, or around US$18, on medication during her stay, a third of her monthly income as a teacher. 

“The drugs that were here, they gave me; the ones that were not here, they told me to go out and buy”, she says. One of the prescribed medicines is out of stock at all pharmacies in Gbarnga and she had to send her husband to Monrovia to buy it. 

“Everything is becoming very difficult because of, I don't know, the economic condition or because of the new president”, she says. “Over the past year, things that we easily used to do just can't be done easily nowadays. If you don't have money, things don't work for you.” 

The new president Gbainsay is referring to is ex-footballer George Weah, who was sworn in as head of state in January, 2018. Voters had high expectations and hoped he would rein in corruption, kick-start the economy, alleviate poverty, and rebuild the health system after the Ebola outbreak of 2014–15, which killed 4810 people in Liberia, including almost 180 health workers. When the haemorrhagic fever struck, the health sector was on a slow path to recovery after years of brutal civil war that had ended in 2003. 

However the new president has other priorities, as he highlighted in his second annual message in January, of this year. “…I have set my eyes on roads as my administration's path to delivering a better living condition for the Liberian people”, he said and added that good road connectivity will, among other things, “reduce travel times to schools and hospitals”. Health care was otherwise barely touched upon.

DR Congo: 'Ebola is spreading faster, and many people are no longer seeking care'

Via ReliefWeb, a report from the IFRC: DR Congo: “Ebola is spreading faster, and many people are no longer seeking care”.

Nairobi/Geneva, 11 April 2019 –The deadly Ebola outbreak in the Democratic Republic of the Congo is worsening as trust in the response effort falters, says the International Federation of Red Cross and Red Crescent Societies.  

This warning follows confirmation of 18 new Ebola cases on Tuesday (9 April) – the highest single day figure in the now eight month-long outbreak. DR Congo’s Health Ministry also reported that 10 died people from Ebola on Tuesday, including eight who died in their communities having not sought treatment and support. 

“This is a very distressing development,” said Emanuele Capobianco, IFRC’s Director of Health and Care. “The bottom line is that Ebola is now spreading faster, and many people are no longer seeking care. It is clear that some vulnerable communities do not trust Ebola responders.”  

Redoubling efforts to engage with these communities is critical, according to Capobianco. 

“Trust can be built by going community to community, working with local leaders and villagers, listening to their concerns with empathy, and incorporating their feedback and preferences into how we work,” he said. 

In-depth community engagement is central to the Red Cross operation in North Kivu and Ituri provinces in eastern DR Congo, where more than 700 Red Cross volunteers from Ebola-affected communities are at work. They have reached more than 1 million people with locally adapted information and have collected more than 130,000 “pieces” of community feedback. 

“Our research and experience show that when in-depth community engagement takes place, acceptance of outside assistance improves significantly,” said Capobianco.  

For example, intense community outreach and engagement in and around the city of Butembo has had a direct and significant impact on the willingness of communities to welcome, and in some cases, request Red Cross ‘safe and dignified burial teams’. The safe burial of people who have died from Ebola is a critical intervention in preventing disease spread, as dead bodies are particularly infectious. 

The efforts of the Red Cross and other responders are also hampered by considerable funding shortfalls. Last month, the International Red Cross and Red Crescent Movement – IFRC, and the International Committee of the Red Cross – launched a revised emergency appeal for 31.5 million Swiss francs to support response activities in DR Congo as well as preparedness activities in neighbouring countries. So far, only 11.1 million Swiss francs have been received.

The scary shortage of infectious-disease doctors

Via The New York Times, an op-ed: The Scary Shortage of Infectious-Disease Doctors. Is this also true of countries with reasonable health-insurance systems? Excerpt:

Many have heard of the rise of drug-resistant infections. But few know about an issue that’s making this threat even scarier in the United States: the shortage of specialists capable of diagnosing and treating those infections. 

Infectious diseases is one of just two medicine subspecialties that routinely do not fill all of their training spots every year in the National Resident Matching Program (the other is nephrology). Between 2009 and 2017, the number of programs filling all of their adult-infectious-disease training positions dropped by more than 40 percent. 

This could not be happening at a worse time. Antibiotic-resistant microbes, known as superbugs, are pinballing around the world, killing hundreds of thousands of people every year. The Times recently reported on Candida auris, a deadly new fungus that has infected hospital patients in Illinois, New Jersey and New York. 

Everyone who works in health care agrees that we need more infectious-disease doctors, yet very few actually want the job. What’s going on?  

The problem is that infectious-disease specialists care for some of the most complicated patients in the health care system, yet they are among the lowest paid. It is one of the only specialties in medicine that sometimes pays worse than being a general practitioner. At many medical centers, a board-certified internist accepts a pay cut of 30 percent to 40 percent to become an infectious-disease specialist. 

 This has to do with the way our insurance system reimburses doctors. Medicare assigns relative value units to the thousands of services that doctors provide, and these units largely determine how much physicians are paid. The formula prioritizes invasive procedures over intellectual expertise.

The problem is that infectious-disease doctors don’t really do procedures. It is a cognitive specialty, providing expert consultation, and insurance doesn’t pay much for that. 

For example, I recently diagnosed a case of fungal pneumonia. To arrive at this diagnosis took hours: first, speaking with the patient’s primary care doctor and pulmonologist, followed by a long stretch reviewing chest X-rays and other imaging studies with a radiologist, before examining the cells in the patient’s lung tissue under a microscope to confirm the diagnosis and report back to the anxious patient and family. Most of this work was done free. 

A generation ago, most well-rounded doctors knew what to do when a patient developed a fever. Not anymore. New threats like Candida auris pop up all the time, and to identify a deadly pathogen, we often have to use a sophisticated technique called matrix-assisted laser desorption ionization time-of-flight mass spectrometry. As the name suggests, it requires a bit of expertise.

Back in the day, there were only a handful of reliable antibiotics to choose from. But as more bugs have emerged, and more have become resistant to standard treatments, we’ve had to develop new drugs to fight them. The good news is that in 2018, the Food and Drug Administration approved a cadre of new antibiotics to confront the rising threat of superbugs, including eravacycline, plazomicin and omadacycline, and we can expect even more this year. But very few physicians know how to use these powerful new drugs. Many don’t even know how to pronounce them.  

Infectious-disease specialists are often the only health care providers in a hospital — or an entire town — who know when to use all of the new antibiotics (and when to withhold them). These experts serve as an indispensable cog in the health care machine, but if trends continue, we won’t have enough of them to go around. 

The terrifying part is that most patients won’t even know about the deficit. Your doctor won’t ask a specialist for help because in some parts of the country, the service simply won’t be available. She’ll just have to wing it.

Ebola response in Beni: 30 neighborhood leaders demand six months of arrears from their premiums

Via Radio Moto Butembo-Beni: Ebola response to BENI: 30 neighborhood leaders demand six months of arrears from their premiums. This sounds depressingly like what happened in West Africa: people fighting Ebola on the ground get little or nothing while their income vanishes somewhere higher up the food chain. The Google translation:

To claim their rights, 30 heads of Beni neighborhoods accompanied by their deputies held a sit-in at the office of Beni health zone on Monday, April 8, 2019. They say claim six months of arrears of their premium with the coordination of response activities.  

In a memorandum, they state that they are divorcing from any activity related to the response to the Ebola response. 

"All the chiefs are active. When it comes to money, these people refuse to pay us. Since the month of August, they have paid only one month. Even the units, the leaders do not receive. If all the leaders rise up, it's because of that. We resigned en bloc. While they continue with their IT ... If there are games of pulls and resistances, we raise our hands. We come to claim our right, but they run away from us and do not want to reach a consensus with us," said one of these leaders while the other said: "We live in risks. That is finally the population understood that the disease really exists. So we who have made efforts in this direction, they should not abandon us like that. See, for example, you die in this work ... They do not even come to sympathize ... Not even a reward to the family?" 

Until the evening of this Monday, April 8, 2019, no member of the coordination of the response team has pronounced on this subject.

Nigeria mulls healthcare fund for Lassa fever patients

Via Xinhua: Nigeria mulls healthcare fund for Lassa fever patients. Excerpt:

Nigerian health authorities have said the country will soon launch a healthcare fund to cater for patients with confirmed cases of Lassa fever and ensure that money does not become a hindrance in accessing treatment.  

The Nigeria Center for Disease Control (NCDC) confirmed this in a statement reaching Xinhua in Abuja on Monday, saying this process is at the heart of discussion at all levels of government in the country at the moment. 

"We are making plans through the Basic Primary Healthcare Provision Fund, the new funding instituted by the federal government, to cover the cost of treatment of confirmed cases of Lassa fever patients," said the statement by Chikwe Ihekweazu, head of the NCDC. 

"The aim is to make sure that ability to pay is not a barrier to accessing the treatment for public health diseases such as Lassa fever," the disease control chief said.  

Pending the take-off of the healthcare fund, the Nigerian government is working to reduce the burden of Lassa fever treatment on patients, he said. 

Experts say the cost of Lassa treatment is very high. Ribavirin, a potent antiviral medication, is known to be a very expensive drug in the country.  

"But we want to ensure that every confirmed case gets the drug free," Ihekweazu said. "No matter how accessible you can make the treatment of Lassa, it is always cheaper to prevent it."

EBOLA DRC - Evolution of the response to the Ebola outbreak in North Kivu and Ituri on Saturday April 6 2019

The Ministry of Health has published EBOLA DRC - Evolution of the response to the Ebola outbreak in the provinces of North Kivu and Ituri on Saturday, April 6, 2019. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Saturday, April 6, 2019   

The epidemiological situation of the Ebola Virus Disease  dated April 5, 2019: 

• Since the beginning of the epidemic, the cumulative number of cases is 1,130, of which 1,064 are confirmed and 66 are probable. In total, there were 714 deaths (648 confirmed and 66 probable) and 342 people cured. 

• 284 suspected cases under investigation; 

• 13 new confirmed cases, including 7 in Katwa, 3 in Butembo, 1 in Beni, 1 in Vuhovi, and 1 in Oicha; 

• 12 new confirmed deaths, including 

º 6 community deaths including 3 in Butembo, 2 in Katwa, and 1 in Beni; 

º 6 CTE deaths, 2 in Beni, 2 in Mangina (Mandima patients), 1 in Butembo and 1 in Katwa; 

• 3 new people healed out of Butembo CTE.

 /! \  The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

News of the response 

Butembo Rapid Impact Operations 

• Recent community dialogues in Butembo town and surrounding areas revealed that part of the community's reluctance was due to the willingness of the population to see the Government and partners invest more in the development of the region and improvement of the general living conditions of the population.  

• The Minister of Health, Dr. Oly Ilunga Kalenga, had initiated discussions with the Government's technical and financial partners in order to establish a medium and long-term development plan to restore the region socially and economically.  

• Thus, capitalizing on the ongoing investments in the region and in order to be able to pose immediate and visible actions for the community, the World Bank is committed to support the financing of Fast Impact Operations through the Stabilization project. East of the DRC for Peace (STEP) with the support of the Social Fund of the DRC (FSRDC).  

• The STEP project is being implemented in seven provinces of the country, including North Kivu, since 2014. Its three components are community support, livelihoods and job creation, as well as capabilities. Created in 2002, the FSRDC is the Government Executing Agency whose mission is: 

º To improve the living conditions of the Congolese population and their access to social services through the rehabilitation and reconstruction of community economic and social infrastructures; 

º To create income and employment in rural and urban areas through the implementation or implementation of income-generating micro-projects to alleviate poverty and promote economic and social development. 

• The first phase of the quick-impact operations, which began this week, involves the recruitment of 1,000 people for labor-intensive public works for road maintenance in the Butembo and Katwa districts. The second phase, currently being prepared by the FSRDC and the technical services of the town hall and the Office of Roads and Drainages (OVD), will include the recruitment of an additional 1,000 people and will start in May 2019. The recruitment procedure aims to maximize the use of local skills and resources for both labor and equipment purchases to ensure greater redistribution within the community. 

Vaccination  

• Since the start of vaccination on 8 August 2018, 95,658 people have been vaccinated , including 23,814 in Katwa, 21,485 in Beni, 11,668 in Butembo, 6,109 in Mabalako, 3,934 in Mandima, 3,070 in Goma, 3,005 in Kalunguta, 2,370 in Oicha, 2,317 to Komanda, 1,729 to Masereka, 1,630 to Kayina, 1,552 to Vuhovi, 1,487 to Bunia, 1,433 to Kyondo, 1,357 to Karisimbi, 1,193 to Lubero, 1,025 to Biena, 958 to Musienene, 772 to Mutwanga, 690 to Rutshuru, 557 in Rwampara (Ituri), 527 in Nyankunde, 496 in Mangurujipa, 420 in Mambasa, 355 in Tchomia, 333 in Lolwa, 342 in Kirotshe, 254 in Alimbongo, 250 in Mweso, 245 in Kibirizi, 161 in Nyiragongo, 97 in Watsa (Haut-Uélé) and 13 in Kisangani.  

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

Venezuela: UN should lead full-scale emergency response

A news release from Human Rights Watch: Venezuela: UN Should Lead Full-Scale Emergency Response. Excerpt:

The combination of severe medicine and food shortages within Venezuela, together with the spread of disease across the country’s borders, amounts to a complex humanitarian emergency that requires a full-scale response by the United Nations secretary-general, researchers from Johns Hopkins Bloomberg School of Public Health and Human Rights Watch said in a report released today. The Venezuelan authorities during the presidency of Nicolás Maduro have proven unable to stem the crisis, and have in fact exacerbated it through their efforts to suppress information about the scale and urgency of the problems.

The 71-page report, “Venezuela’s Humanitarian Emergency: Large-Scale UN Response Needed to Address Health and Food Crises,” documents increased numbers of maternal and infant deaths; the unchecked spread of vaccine-preventable diseases, such as measles and diphtheria; and sharp increases in the transmission of infectious diseases such as malaria and tuberculosis in Venezuela. Available data shows high levels of food insecurity and child malnutrition, as well as of hospital admissions of malnourished children.  

“No matter how hard they try, Venezuelan authorities cannot hide the reality on the ground,” said Shannon Doocy, Ph.D., associate professor of International Health at Johns Hopkins Bloomberg School of Public Health, who conducted research at Venezuela’s border. 

“Venezuela’s health system is in utter collapse, which, combined with widespread food shortages, is piling suffering upon suffering and putting even more Venezuelans at risk. We need UN leadership to help end this severe crisis and save lives.”

Resurgence of vaccine-preventable diseases in Venezuela as a regional public health threat in the Americas

Emerging Infectious Diseases has published Ahead of Print - Resurgence of Vaccine-Preventable Diseases in Venezuela as a Regional Public Health Threat in the Americas. This is a long, important report. The abstract:

Venezuela’s tumbling economy and authoritarian rule have precipitated an unprecedented humanitarian crisis. Hyperinflation rates now exceed 45,000%, and Venezuela’s health system is in free fall. The country is experiencing a massive exodus of biomedical scientists and qualified healthcare professionals. 

Reemergence of arthropod-borne and vaccine-preventable diseases has sparked serious epidemics that also affect neighboring countries. 

In this article, we discuss the ongoing epidemics of measles and diphtheria in Venezuela and their disproportionate impact on indigenous populations. We also discuss the potential for reemergence of poliomyelitis and conclude that action to halt the spread of vaccine-preventable diseases within Venezuela is a matter of urgency for the country and the region. We further provide specific recommendations for addressing this crisis.

See also this article in The Guardian about the study.

Venezuela's humanitarian crisis, resurgence of vector-borne diseases, and implications for spillover in the region

Via The Lancet Infectious Diseases: Venezuela's humanitarian crisis, resurgence of vector-borne diseases, and implications for spillover in the region. The summary:

In the past 5–10 years, Venezuela has faced a severe economic crisis, precipitated by political instability and declining oil revenue. Public health provision has been affected particularly. In this Review, we assess the impact of Venezuela's health-care crisis on vector-borne diseases, and the spillover into neighbouring countries. 

Between 2000 and 2015, Venezuela witnessed a 359% increase in malaria cases, followed by a 71% increase in 2017 (411 586 cases) compared with 2016 (240 613). Neighbouring countries, such as Brazil, have reported an escalating trend of imported malaria cases from Venezuela, from 1538 in 2014 to 3129 in 2017. 

In Venezuela, active Chagas disease transmission has been reported, with seroprevalence in children (<10 years), estimated to be as high as 12·5% in one community tested (n=64).

Dengue incidence increased by more than four times between 1990 and 2016. 

The estimated incidence of chikungunya during its epidemic peak is 6975 cases per 100 000 people and that of Zika virus is 2057 cases per 100 000 people. 

The re-emergence of many vector-borne diseases represents a public health crisis in Venezuela and has the possibility of severely undermining regional disease elimination efforts. National, regional, and global authorities must take action to address these worsening epidemics and prevent their expansion beyond Venezuelan borders.