H5N1

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 outbreak in DRC - Sitrep 62

WHO AFRO has published Ebola Virus Disease Outbreak in DRC - Sitrep 62: 08 October 2019. Excerpt:

In the past week, from 30 September to 6 October, 14 new confirmed Ebola virus disease (EVD) cases, with an additional nine deaths, have been reported from seven health zones in two affected provinces in the Democratic Republic of the Congo. Although the decline in the number of new cases is encouraging, the recent fluctuations in case numbers per week must be interpreted with caution, as case reporting is contingent upon the level of access and security. 

During mid-September, serious security incidents in Lwemba Health Area, Mandima Health Zone, stalled outbreak response activities for more than two weeks. Response activities have since resumed but remain limited. Last week, an open forum for discussion and reconciliation was held in Lwemba with partners and civil society to dispel mistrust and enhance engagement in future response activities. Improved access may result in enhanced case finding and an increase in the number of reported cases from the area. 

In the 21 days from 16 September to 6 October, 28 health areas in 11 health zones reported new cases. During this period, a total of 73 confirmed cases were reported, with the majority coming from the health zones of Mambasa (30%; n=22 cases), and Mandima (23%; n=17 cases). In the past 21 days, 10 cases were reported from Komanda and Oicha Health Zones with links to cases from Beni and Mambasa health zones. Issues with under reporting are possible in the Oicha Health Zone, as poor access and security constraints limit response activities. The occurrence of transmission along a major road in from Komanda and Mambasa also poses greater risk of spread westward to other major cities in the Democratic Republic of the Congo (e.g. Kisangani). 

As of 6 October 2019, a total of 3205 EVD cases were reported, including 3091 confirmed and 114 probable cases, of which 2142 cases died (overall case fatality ratio 67%). Of the total confirmed and probable cases, 59% (1796) were female, 30% (909) were children aged less than 18 years, and 5% (162) were healthcare workers. 

As of 4 October 2019, 1000 people have survived EVD in this outbreak. Of the approximately 1555 confirmed cases admitted to Ebola treatment centers, 1000 of them, or nearly two thirds, have survived. The reintegration of survivors into community can create opportunities to discuss their experiences and strengthen the participation of local communities in the response. Many survivors are working within the response, and are an important part of caring for the sick and reaching out to communities. A programme is in place to monitor survivor health and support them in the year after they leave care. 

Under Pillar 1 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$120-140 million for WHO. As of 8 October 2019, US$60.4 million has been received by WHO, with additional funds committed or pledged. Further resources are needed to fund the response through to December 2019 and into Q1 2020. 

Under Pillar 5 Regional Preparedness, the funding requirement for all partners is US$66 milllion, of which WHO requires US$ 21 million. As of 8 October 2019, WHO has received US$ 1.6 million. While some additional pledges are in the pipeline, increased funding for preparedness in neighbouring countries is urgently needed. WHO is appealing to donors to provide generous support. A summary of funding received by WHO since the start of this outbreak can be found here.

DRC Ebola: CMRE update, October 4

CMRE has published Situation épidémiologique Ebola du 04 Septembre 2019. Excerpt from the Google translation:

EVOLUTION OF THE EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI AT OCTOBER 03, 2019   

Friday, October 04, 2019   

Since the beginning of the epidemic, the cumulative number of cases is 3,201, of which 3,087 are confirmed and 114 are probable. In total, there were 2.139 deaths (2025 confirmed and 114 probable) and 999 people cured. 

• 451 suspected cases under investigation; 

• 3 new confirmed cases, including: 

º 1 in North Kivu in Beni; 

º 2 in Ituri, including 1 in Mambasa and 1 in Mandima; 

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

• 4 people healed from the CTE in North Kivu in Beni; 

• 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. 

• 18th day without response activities in the health area Lwemba to Mandima in Ituri.

 

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  

The 10th epidemic Ebola virus disease in DRC reached its 1000th cured 

- The thousandth cured of the Ebola Virus Disease came out Friday of the Mangina CTE in Mabalako in North Kivu Province;    

- Indeed, this 1000th cured is one of four healed Friday of this CTE. It is about a woman, quarantine gone, case contact of her nephew in the Health Zone of Lwemba with Mandima in Ituri. As soon as she felt the fever, she went to the Health Center, where she was detected as a suspected case and transferred directly to the CTE. She was confirmed and followed her treatment until recovery. She advises the population to go quickly to the Health Center and not fear the CTE to cure Ebola Virus Disease;    

- Among these four cures, there is also a health provider. This is an ambulance hygienist, the 1001st healed, who was contaminated during the unloading of his personal protective equipment (PPE). He recommended a lot of protection and precautions to all hygienists when removing PPE. And in case of possible contamination, do not panic, but rather go quickly to the Health Center for appropriate treatment;    

- For the Ebola Epidemic Epidemic Response Coordinator, Dr. Faustin Bile Saka, these healers will be the ambassadors for the response in their respective communities and testify that when we arrive early we have the chance to come out healed like them. He handed out the certificates of release to the cured, with the various partners of the response, WHO and IMC to the 1000th, 1001st, 1002nd and 1003rd cures of the Ebola Virus Disease in the DRC; 

- As a miracle, the 10th epidemic of the Ebola Virus Disease began around the end of July 2018 and declared in early August 2019 in Mangina and it is still in Mangina, where came the 1000th cured. 

VACCINATION   

-  Since vaccination began on August 8, 2018, 232,725 people have been vaccinated; 

- 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 20 May 2018.   

MONITORING AT ENTRY POINTS  

- Since the beginning of the epidemic, the total number of travelers checked (temperature measurement ) at the sanitary control points is 102,092,950 ; 

- 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.

WHO: Ebola weekly update, October 3

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

The Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo continues this week with 20 new confirmed cases reported in North Kivu and Ituri provinces from 25 September to 1 October 2019, versus 29 in the previous week. This decrease in the number of cases should be interpreted with caution, as operational and security challenges in certain health zones make it difficult to undertake case detection and response functions. 

With over half (55%) of cases in the past week coming from Mambasa and Mandima Health Zones, there is a clear shift in the hot spots of the outbreak from high density, urban settings, such as Butembo, Katwa, and Beni, to more rural areas with a lower population density. This results in a change in the transmission dynamics, with more community-based transmission and less possible transmission in healthcare facilities. 

Conversely, this may introduce new issues in terms of accessibility and logistical challenges to reach affected villages, especially as we enter the rainy season.  

In Mambasa Health Zone, delays in raising EVD awareness and involving the community and civil society in the response have led to community mistrust. To strengthen the participation of local communities in the response, WHO is working with the community, civil society, and partners in Mambasa Health Zone to engage women’s groups and enhance community-based surveillance. 

While in Lwemba, within Mandima Health Zone, poor EVD awareness compounded with armed conflict has led to heightened tensions between local communities and Ebola response teams. This has resulted in difficulties in investigating community deaths. Therefore, it is likely that the number of cases and community deaths in this area is under reported.  

During the past 21 days (from 11 September through 1 October 2019), a total of 106 confirmed cases were reported from 13 health zones (Table 1, Figure 2), with the majority of cases from Mandima (26%, n=27), Mambasa (25%, n=26), Kalunguta (15%, n=16), and Komanda (12%, n=13) health zones. 

As of 1 October, a total of 3197 EVD cases were reported, including 3083 confirmed and 114 probable cases, of which 2136 cases died (overall case fatality ratio 67%). Of the total confirmed and probable cases, 56% (1790) were female, 28% (906) were children aged less than 18 years, and 5% (161) were health workers. 

Under Pillar 1 of the current Strategic Response Plan, the estimated funding requirement for all partners for the period July to December 2019 is US$ 287 million, including US$ 120-140 million for WHO. As of 2 Oct 2019, to US$ 61 million have been received by WHO, with further funds committed or pledged. Further resources are needed to fund the response through to December 2019 as well as into Q1 2020. WHO is appealing to donors to provide generous support.

DRC Ebola: CMRE October 2 update

CMRE has published Situation épidémiologique Ebola au 02 Octobre 2019. The situation in Lwemba, where response has been shut down for over two weeks, is a serious concern. Excerpt from the Google translation:

EVOLUTION OF THE EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI AS AT 01 OCTOBER 2019   

Wednesday, October 02, 2019   

Since the beginning of the epidemic, the cumulative number of cases is 3,197, of which 3,083 confirmed and 114 probable. In total, there were 2,136 deaths (2022 confirmed and 114 probable) and 994 people cured. 

• 430 suspected cases under investigation; 

• 3 new confirmed cases, including: 

º 1 in North Kivu, Katwa; 

º 2 in Ituri in Mandima; 

• No new confirmed deaths have been recorded; 

• 3 people cured out of ETCs, including 2 in Ituri in Komanda and 2 in North Kivu in Butembo; 

• 1 health worker, living and vaccinated, is one of the new confirmed cases of Mandima. The cumulative number of confirmed / probable cases among health workers is 161 (5% of all confirmed / probable cases), including 41 deaths. 

• 16th day without response activities in the health area Lwemba to Mandima in Ituri.  

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  

NOTHING TO REPORT  

VACCINATION 

- Since vaccination began on August 8, 2018, 231,594 people have been vaccinated; 

- 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 20 May 2018. 

MONITORING AT ENTRY POINTS  

- Launch of sanitary control activities at the MABOYA Checkpoint (PoC) in the health zone of Kalunguta in North Kivu; 

- Since the beginning of the epidemic, the total number of travelers checked (temperature measurement ) at the sanitary control points is 101,333,575 ; 

To date, a total of 111 PoEs and PoCs have been established in North Kivu and Ituri provinces prevent the spread of the epidemic in neighboring countries.

ITURI /Lwemba: Alerting community leaders about the risks of the suspension of health activities

Via Radio Moto Butembo-Beni: ITURI / Lwemba: Alerting community leaders about the risks of the suspension of health activities. The Google translation:

Health activities and the response remain suspended in the locality of LWEMBA. It is since the uprising of the inhabitants of this part of the chieftaincy of BABILA-BABOMBI face the teams of answer to EBOLA the night of Sunday 15 to Monday, September 16, 2019. More than ten days later, the community leaders of the area leave of their silence.  

Community leaders are calling for the urgent involvement of politico-administrative and health authorities to save the lives of people who are beginning to show signs of the disease. They fear that people who have manipulated the deceased EBOLA nurse's body during this popular uprising and considered high-risk contacts are spreading the disease in areas where the situation is calm. 

They say they started with the awareness so that the situation does not get worse as many people begin to show the signs of EVD and miss where to get treatment. These people tend to flee to stable environments, a serious situation they exclaim. 

"There are those who are escaping everywhere in the corners around the village of Lwemba, there are some who have gone to Beni, Butembo; everywhere in the Republic," said the leader, adding, "And we are calling them to come and see how to cut the chain of transmission of Ebola. We must know that there is not something more expensive than health." 

Recall that the population of LWEMBA had risen against the teams of the response after the death at CTE MANGINA Mr. ALLY Kasereka IMATHA. A death she had not digested. The toll of this popular uprising was heavy. Four health facilities next to about 20 community relay houses were set on fire by angry protesters. Since then, all health activities are suspended in this locality.

WHO: Ebola virus disease – DR Congo

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

The Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo continues this week with 29 new confirmed cases reported in North Kivu and Ituri provinces from 18-24 September 2019, versus 57 in the previous week. This decrease in the number of cases should be interpreted with caution, as operational and security challenges in certain health zones make it difficult to undertake case detection and response functions.  

There has been a recent increase in localized security or community-related incidents in several areas of operation. About a third of community incidents from August 2019, to date, occurred in Mambasa Health Zone. To strengthen the participation and engagement of local communities in this area, a WHO team of social scientists, community engagement, risk communication, and health promotion experts was set up to implement the Strategic Response Plan 4 (SRP4) approach and strategy together with La Commission Communication de Risque et Engagement Communautaire (CREC) sub-commission. The recent major security incident in Lwemba, within Mandima Health Zone, has halted response activities for the past nine days. This has limited contact tracing efforts, with 169 and 162 contacts lost to follow up in Lwemba and Mambasa, respectively. 

During the past 21 days (from 18 September through 24 September 2019), a total of 126 confirmed cases were reported from 13 health zones (Table 1, Figure 2), with the majority of cases from Mambasa (25%, n=31), Mandima (18%, n=23), and Kalunguta (16%, n=20) health zones. Musienene Health Zone cleared 21 days without a new confirmed case of EVD. 

As of 24 September, a total of 3175 EVD cases were reported, including 3063 confirmed and 112 probable cases, of which 2122 cases died (overall case fatality ratio 67%). Of the total confirmed and probable cases, 56% (1778) were female, 28% (902) were children aged less than 18 years, and 5% (161) were health workers. The Democratic Republic of the Congo health authorities have endorsed the use of a second investigational Ebola vaccine with at-risk populations in areas that do not have active EVD transmission. Regular vaccination activities in EVD-affected areas will continue. 

The Merck/MSD vaccine will continue to be provided to all people at high risk of Ebola infection including those who have been in contact with a person confirmed to have Ebola, all contacts of contacts, and others determined to be at high risk of contracting Ebola. 

The Johnson & Johnson vaccine will be deployed by a consortium, including the Ministry of Health, Democratic Republic of the Congo National Institute for Biomedical Research, Coalition for Epidemic Preparedness Innovations, Médecins Sans Frontières (MSF), MSF Epicentre, United Kingdom Public Health Rapid Support Team, Wellcome Trust, and Janssen Vaccines & Prevention B.V. The Institut national de la santé et de la recherche médicale will coordinate the data safety and monitoring board.

WHO AFRO: Situation report 60, Ebola virus disease outbreak in DRC

WHO AFRO has published Situation Report - Ebola Virus Disease Outbreak in DRC - Sitrep 60 (2019). Excerpt:

In the past week, from 16 to 22 September, 39 new confirmed Ebola virus disease (EVD) cases, with an additional 22 deaths, have been reported from nine health zones in three affected provinces in the Democratic Republic of the Congo. 

 Pockets of insecurity in the affected areas, along with localised security incidents, continue to hinder response activities, including safe and dignified burials (SDB), vaccination, contact tracing and case reporting. For instance, a recent major security incident in Lwemba, within Mandima health zone is still preventing response activities in this area. Overall, these incidents underscore the need for continued and proactive engagement and sensitizing of local communities, especially in the high risk areas that may not currently be affected.

In the 21 days from 2 to 22 September 2019, 45 health areas in 13 health zones reported new cases. During this period, a total of 129 confirmed cases were reported, with the majority coming from the health zones of Mambasa (25%, n=32 cases), Mandima (19%, n=25 cases), Kalunguta (17%, n=22 cases) and Beni (11%, n=14 cases). 

As of 22 September 2019, a total of 3168 EVD cases were reported, including 3057 confirmed and 111 probable cases, of which 2118 cases died (overall case fatality ratio 67%). Of the total confirmed and probable cases with reported sex and age data, 56% (1772) were female, 28% (900) were children aged less than 18 years, and 5% (160) were healthcare workers. 

The Democratic Republic of the Congo health authorities have endorsed the use of a second investigational Ebola vaccine with at-risk populations in areas that do not have active EVD transmission. Regular vaccination activities in EVD-affected areas will continue. See the full update here (https://www.who.int/news-room/detail/23-09-2019-second-ebola-vaccine-to-complement-ring-vaccination-given-green-light-in-drc). 

Under Pillar 1 of the current Strategic Response Plan, the estimated funding requirement for all partners for the period July to December 2019 is US$ 287 million, including US$ 120-140 million for WHO. As of 24 September 2019, close to US$ 60 million have been received by WHO, with further funds committed or pledged. Currently available funds will close the financing gap up until the end of October 2019. Further resources are needed to fund the response through to December 2019, and WHO is appealing to donors to provide generous support.

Beni nurses pledge to avoid Ebola infections in health facilities

Via Koma Ebola: Beni nurses pledge to avoid Ebola infections in health facilities. The Google translation:

This Sunday, September 22, 2019, the Beni section of the National Order of Nurses organized a forum for care providers of private and public structures in the health zone of Beni. 

The activity focused on "the challenges of not integrating infection prevention and control measures" and brought together around 100 participants.

It is after they have understood the permanent risks to which they are exposed every day in their work that a hundred of health care providers present at this forum committed themselves in the fight against Ebola which has already made a lot of victims among health workers.  

"We have lost a lot of the population and nurses in this epidemic. As caregivers, we must respect preventive measures and protect ourselves, "said Moise Kambale Munyama, president of the National Order of Nurses of the Congo section of Beni, during the work.  

For this protection to be provided effectively, he referred to the personal protective equipment that health workers should use and the sterilization of this material. "We need to have complete equipment, change equipment for each patient, decontaminate everywhere, regardless of the signs that patients display. We believe that with this strategy, we will put an end to nosocomial infections (infection between patients in health centers) and to Ebola virus disease in our structures," he explained. 

Moise Kambale Munyama said that after more than a year of an epidemic, "it was a good time to get the health care providers on the ground and meet the challenges that are holding us back to effectively monitor infection prevention and control measures. Ebola virus disease in our structures and see why nosocomial infections come from our health facilities." 

The resolutions of this forum stress the application of preventive measures to limit any nosocomial infection that becomes recurrent in health care facilities. 

Recall that following the non-application of these prevention rules in health facilities, the current epidemiological situation shows that out of the total of 3053 cases confirmed since the beginning of the epidemic, 160 cases are health care providers.

Maxmen: Aid group says Ebola vaccine is not reaching enough people

Via Nature News & Comment, Amy Maxmen writes about today brouhaha: Aid group says Ebola vaccine is not reaching enough people. Excerpt:

The aid organization Médecins sans Frontiéres says that the World Health Organization (WHO) is not distributing Ebola vaccine widely enough in the Democratic Republic of the Congo (DRC). 

An epidemic of the virus in the DRC has sickened more than 3,100 people and killed roughly 2,100 since August 2018, according to the WHO. The agency, an arm of the United Nations, has been distributing the rVSV-ZEBOV vaccine in areas of the DRC where Ebola is spreading. 

The vaccine, made by Merck, is more than 97% effective, according to a preliminary analysis published in April by the WHO and DRC government researchers. Yet Médecins sans Frontiéres (MSF, also known as Doctors without Borders) says that “only a fraction of the eligible population” in the DRC has received the vaccine — roughly 225,000 of the 600,000 people that the group estimates should have received the shot. 

Health workers are among those who have been under-vaccinated, MSF says, noting that 160 have been infected with the virus. “In a hotspot of the outbreak such as Beni, almost a third of [health workers] reported they have not been vaccinated,” said Isabelle Defourny, MSF’s director of operations, who is based in Paris, in a statement on 23 September. Beni is a city in the eastern DRC and a hotspot of the epidemic.

The MSF’s criticisms came as the WHO said it will roll out a second Ebola vaccine in the DRC to combat the outbreak beginning in October. The WHO plans to give the vaccine, made by Johnson & Johnson, to people in the eastern DRC who live in areas free of Ebola. 

Ibrahima Socé Fall, the assistant director of WHO’s emergency response, rejects many of MSF’s claims — beginning with the group’s estimate that 600,000 people should have received the Merck vaccine. 

A tough task 

The WHO’s strategy has been to vaccinate people who have come in contact with a person who has been diagnosed with Ebola, along with the contacts of those contacts and health workers. Socé Fall argues that MSF has overestimated the number of people who should be vaccinated. The aid group based its projection on the average number of contacts per person diagnosed with Ebola — but in many cases, Socé Fall says, the contacts of people with Ebola overlap. This reduces the overall number of people who need to be immunized against the virus.

Socé Fall also disputes MSF’s estimate that a third of health workers haven’t been offered the vaccine. He says that [no] one knows the true number of health workers in the areas where Ebola is spreading, because the term includes traditional healers as well as doctors and nurses offering modern medical treatment — and others that mix both kinds of care. The WHO has struggled to find and vaccinate health workers that operate small, unregistered facilities scattered throughout the forests of the eastern DRC.