H5N1

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

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

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

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

DRC Ebola: CMRE update, November 19

CMRE has published Situation épidémiologique du 19 novembre 2019. Excerpt from the Google translation:

EVOLUTION OF THE EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI AS AT 18 NOVEMBER 2019   

Tuesday, November 19, 2019  

Since the beginning of the epidemic, the cumulative number of cases is 3,296, of which 3,178 are confirmed and 118 are probable. In total, there were 2,197 deaths (2079 confirmed and 118 probable) and 1074 people healed. 

• 544 suspected cases under investigation; • No new confirmed cases; 

• 1 new death of confirmed cases, including: 

o No new community deaths have been recorded; 

o 1 new death of confirmed case in the CTE in North Kivu in Beni; 

• 4 people healed from CTE in North Kivu in Mabalako;  

• No health worker is among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 163 (5% of all confirmed / probable cases), including 41 deaths;

 

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  

Closing in Goma of the leadership capacity building workshop for the actors involved in the epidemic response to #Ebola Virus Disease

• The general coordinator of the epidemic response to #Ebola Virus Disease in the provinces of North, South Kivu and Ituri, Prof. Steve Ahuka Mundeke closed a workshop in Goma on Tuesday 19 November 2019 on capacity building for the actors involved in this response; 

• The teacher, Ahuka Mundeke, said that this workshop was more beneficial to participants who are expected to use all the concepts learned to improve the work of the response and their personal lives. "Now that we know the types of leadership, when to apply them, to be leaders to oneself, to manage oneself and others," he said; 

• These notions, he said, are very important for crisis management. To this end, he asked the participants in this workshop to use these learned concepts, because, he insisted, knowledge is only useful when it is used; 

• He took the opportunity to thank not only all the participants for their attendance, but also all the partners who contributed to the success of this training, in particular WHO, CDC, DFID and Ukaid, not to mention the trainers who attended. moved from Geneva to Goma to equip the Ebola response team of the Ministry of Health and WHO with the Ebola response to the epidemic; 

• For WHO, this workshop is productive for all the response teams who will be able to use it all their lives; 

• This training ended with the delivery of the certificate and as "To the Lord all honor", the first certificate was given to the general coordinator of the response, the Prof. Steve Ahuka Mundeke. 

VACCINATION  

• 243 people were vaccinated with the 2nd Ad26.ZEBOV / MVA-BN-Filo vaccine (Johnson & Johnson) in the two health zones of Karisimbi in Goma; 

• Since the start of vaccination on August 8, 2018 with the rVSV-ZEBOV vaccine,   254,151 people have been vaccinated; 

• Approved October 22, 2019 by the Ethics Committee of the School of Public Health of the University of Kinshasa and October 23, 2019 by the National Ethics Committee, the second vaccine, called Ad26.ZEBOV / MVA-BN -Filo, is produced by Janssen Pharmaceuticals for Johnson & Johnson; 

• This new vaccine complements the first, the rVSV-ZEBOV, vaccine used until then (since August 08, 2018) in this epidemic manufactured by the pharmaceutical group Merck, after approval of the Ethics Committee on May 20, 2018. It has recently been approved. 

MONITORING AT ENTRY POINTS  

• Since the beginning of the epidemic, the total number of travelers checked (temperature rise) at the sanitary control points is 118,357,153 ;  

• To date, a total of 109 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.

A new twenty-first century science for effective epidemic response

Thanks to Mary Marshall for sending the link to this Nature article: A new twenty-first century science for effective epidemic response. The abstract:

With rapidly changing ecology, urbanization, climate change, increased travel and fragile public health systems, epidemics will become more frequent, more complex and harder to prevent and contain. 

Here we argue that our concept of epidemics must evolve from crisis response during discrete outbreaks to an integrated cycle of preparation, response and recovery. This is an opportunity to combine knowledge and skills from all over the world—especially at-risk and affected communities. Many disciplines need to be integrated, including not only epidemiology but also social sciences, research and development, diplomacy, logistics and crisis management. 

This requires a new approach to training tomorrow’s leaders in epidemic prevention and response.

WHO AFRO: Review of the Strategic Response Plan for the Democratic Republic of the Congo

WHO AFRO has published Review of the Strategic Response Plan for the Democratic Republic of the Congo.

“The response to Ebola has required enormous resources. Let us put the emphasis on using this crisis as a means of strengthening the health system. The implications go far beyond the Democratic Republic of the Congo (DRC); the world is watching us.” 

This was the core message from Dr Eteni Longondo, Minister of Health of the DRC, to the participants of the Mid-Term Review of the Strategic Response Plan 4 for Ebola, which took place in Goma this past week.   

In response to a rapidly evolving Ebola outbreak, the Ministry of Health, the United Nations and other partners launched Strategic Response Plan 4 on 1 July 2019, which calls for scaling up the Ebola response around five pillars: 

• strengthening the public health response to the Ebola outbreak; 

• strengthening political commitment, security and operational support; 

• strengthening support for communities; 

• strengthening financial planning, monitoring and reporting; and 

• strengthening preparedness.   

The plan covers the period of 1 July to 31 December 2019.    

During the three-day meeting, some 200 participants representing partners involved in the fight against Ebola evaluated the ongoing response activities. In addition to identifying the impediments and challenges to an efficient response, working groups focused on how to optimize the synergies between the five pillars of the plan; the reorganization of local responses; preparations needed for risk areas and other provinces; and the strategy for getting to zero transmission of the Ebola virus disease. The participants also reviewed funding allocations to determine if they need to be revised.   

The World Health Organization (WHO) is leading the public health operations and regional preparedness pillars of the response. In recent weeks, the number of new Ebola cases has experienced a downward trend.   

“This meeting served as an opportunity to take a critical look at what has been done so far and to propose an ambitious plan to get to zero cases,” said Dr Michel Yao, Emergency Operations Manager in the WHO Regional Office for Africa. “The progress we have made is due not only to our consolidated efforts but also because we have incorporated lessons learned along the way.”   

The principal recommendation arising from the meeting is to move forward with a “zero-transmission” strategy, which involves ensuring high-quality interventions in current outbreak hot spots and preventing the return of the disease in areas where it has been controlled. Other recommendations include: ensure the transfer of skills to local and national experts; assist the DRC in “building back better” and in strengthening its health system; and develop a transition plan while maintaining current response capacity.    

The country’s tenth Ebola outbreak was declared on 1 August 2018. The previous Strategic Response Plans guided the deployment of the resources needed to support the Government and its partners. An operational review of the response was organized in June 2019 to assess appropriateness with the evolution of the epidemic, which led to this latest plan and its validation in September 2019.

The world is flunking in the fight against disease

Via The Washington Post, an editorial that will not come as news to regular readers of this blog: The world is flunking in the fight against disease.

The threat of a disease disaster has arisen in the past two decades in an unfortunate cycle of panic followed by neglect. The panics have been real: the anthrax letters; severe acute respiratory syndrome and Middle East Respiratory syndrome, both coronaviruses; the swine flu pandemic; the Ebola virus disease outbreaks in Africa, taking thousands of lives. These events should be taken as warnings, but they have not been.  

That is the conclusion of a globe-spanning survey of 195 nations, looking closely at their readiness to combat infectious disease outbreaks, either natural or man-made, including those of high consequence, meaning they could overwhelm the national and international capacity to manage them. 

The study, the Global Health Security Index, was carried out by the Nuclear Threat Initiative and the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, with help from the Economist Intelligence Unit. It plumbed each country with 140 questions about readiness in the fields of disease prevention, detection and reporting, rapid response, adequacy of existing health systems, meeting international standards and the overall risk situation.  

The world flunked. The index shows that “no country is fully prepared for epidemics or pandemics. Collectively, international preparedness is weak.” The average national score was 40.2 of a possible 100. Only 19 percent of countries received top marks for detection and reporting; fewer than 5 percent of the nations scored in the highest tier for being ready to respond rapidly to an epidemic. 

The United States ranked at the top overall, with a score of 83.5, but fell to 19th place in the category of overall risk environment and vulnerability to biological threats. This was the first year of the index; hopefully it will spur progress that will show up in future editions.  

National boundaries don’t stop infectious disease, but how nations are governed remains an important factor in preparing and fighting sickness, and there are a host of reasons that they fall down on the job. The most significant is a lack of political will and a failure to make preparedness a priority, including by chronically underfunding public health. 

But the problem does not stop there. The current Ebola outbreak is being fought with an effective experimental vaccine and with benefit of lessons drawn from the 2014 outbreak, yet the struggle faces new hurdles, such as how to overcome fear, suspicion and distrust in a war zone. Nations need to prepare for old problems, and new ones. They need to not lapse back into neglect after each panic.

A link to the Global Health Security Index is now in the Key Sites list.

ECDC: Health emergency preparedness for imported cases of high-consequence infectious diseases

ECDC has published Health emergency preparedness for imported cases of high-consequence infectious diseases. The executive summary:

Preparedness planning is essential in order to respond effectively to outbreaks, including single cases of high consequence infectious diseases (HCID), such as the importation of a viral haemorrhagic fever case. 

HCIDs can include diseases such as: Ebola virus disease, Crimean Congo haemorrhagic fever, Marburg virus disease, highly pathogenic avian influenza, pneumonic plague, severe acute respiratory syndrome, to name a few. Patients with such diseases typically develop severe symptoms and require a high level of care. Moreover, case-fatality rates can be high.   

Several HCIDs are transmissible from person to person and therefore require healthcare workers to take precautions to prevent transmission. 

The ECDC preparedness checklist describes the system elements that need to be planned, and the required organisational competencies in order to effectively manage the threat. It has been developed for public health planners.   

The content of the ECDC checklist is based on work performed during the Ebola virus disease outbreak in West Africa (2013–2016) and a specific protocol used in the peer-review visits to three EU member states. Enhanced with a number of references, it may be seen as complementary to broader preparedness checklists published by other international organisations.

Effect of economic recession and impact of health and social protection expenditures on adult mortality

Via The Lancet Global Health, an important study: Effect of economic recession and impact of health and social protection expenditures on adult mortality: a longitudinal analysis of 5565 Brazilian municipalities. The summary:

Background 

Economic recession might worsen health in low-income and middle-income countries with precarious job markets and weak social protection systems. Between 2014–16, a major economic crisis occurred in Brazil. We aimed to assess the association between economic recession and adult mortality in Brazil and to ascertain whether health and social welfare programmes in the country had a protective effect against the negative impact of this recession. 

Methods 

In this longitudinal analysis, we obtained data from the Brazilian Ministry of Health, the Brazilian Institute for Geography and Statistics, the Ministry of Social Development and Fight Against Hunger, and the Information System for the Public Budget in Health to assess changes in state unemployment level and mortality among adults (aged ≥15 years) in Brazil between 2012 and 2017. Outcomes were municipal all-cause and cause-specific mortality rates for all adults and across population subgroups stratified by age, sex, and race. 

We used fixed-effect panel regression models with quarterly timepoints to assess the association between recession and changes in mortality. Mortality and unemployment rates were detrended using Hodrick–Prescott filters to assess cyclical variation and control for underlying trends. We tested interactions between unemployment and terciles of municipal social protection and health-care expenditure to assess whether the relationship between unemployment and mortality varied. 

Findings 

Between 2012 and 2017, 7 069 242 deaths were recorded among adults (aged ≥15 years) in 5565 municipalities in Brazil. During this time period, the mean crude municipal adult mortality rate increased by 8·0% from 143·1 deaths per 100 000 in 2012 to 154·5 deaths per 100 000 in 2017. An increase in unemployment rate of 1 percentage-point was associated with a 0·50 increase per 100 000 population per rter (95% CI 0·09–0·91) in all-cause mortality, mainly due to cancer and cardiovascular disease. 

Between 2012 and 2017, higher unemployment accounted for 31 415 excess deaths (95% CI 29 698–33 132). All-cause mortality increased among black or mixed race (pardo) Brazilians (a 0·46 increase [95% CI 0·15–0·80]), men (0·67 [0·22–1·13]), and individuals aged 30–59 years (0·43 [0·16–0·69] per 1 percentage-point increase in the unemployment rate. 

No significant association was identified between unemployment and all-cause mortality for white Brazilian, women, adolescents (aged 15–29 years), or older and retired individuals (aged ≥60 years). In municipalities with high expenditure on health and social protection programmes, no significant increases in recession-related mortality were observed. 

Interpretation 

The Brazilian recession contributed to increases in mortality. However, health and social protection expenditure seemed to mitigate detrimental health effects, especially among vulnerable populations. This evidence provides support for stronger health and social protection systems globally.

Worst global health news of the year

Via the UN, Secretary General António Guterres has published his Remarks to the Fifth Committee of the General Assembly on the Proposed Programme Budget for 2020. Excerpt, with my bolding, and then a comment:

Earlier this year, I proposed measures to resolve the financial crises facing our Organization.  

You have responded positively to some of the proposals for the peacekeeping budget, which will reduce, but not cancel completely, the debt to troop- and police-contributing countries – for which I am grateful.  

But we have not yet addressed the regular budget crisis, and the situation continues to deteriorate. 

This month, we will reach the deepest deficit of the decade. We risk exhausting the closed peacekeeping cash reserves, and entering November without enough cash to cover payrolls. 

This situation would have been much worse if I had not worked since January to curtail spending, align our real vacancy rate with the approved rate, and manage cash on a month-by-month basis. Without these steps, we would not have had, I repeat, we would not have had the liquidity to support the opening of the General Assembly debate and the mandated high-level meetings last month. 

Last week, I was forced to introduce extraordinary measures to cope with the record-level shortage of cash. Vacant posts cannot be filled, travel will be limited to essential travel only, meetings may have to be canceled or deferred, webcasting of non-mandated events will not be available, and support to meetings will have to be adjusted. The Secretariat will no longer be able to support any non-mandated events after 6 p.m. These steps will affect our operations in New York, Geneva, Vienna and Nairobi and at the regional commissions. 

Our work and our reforms are at risk. 

As I introduce the 2020 programme budget proposals, I reiterate my call on you to recommit to paying your financial obligations on time and in full. I thank those Member States that have done so. I also thank those that continue to make every effort to do so, notwithstanding the difficult economic conditions they face. I equally urge you to consider measures to ease the structural impediments preventing us from managing the resources more effectively. 

The full and efficient implementation of our programme of work depends on the financial support of Member States through the adoption of realistic budget levels and the provision of timely contributions to ensure a stable financial situation throughout the year. 

I look forward to your full and enthusiastic support.

This is not just the Ebola response that's running out of money—it's the whole UN. The health consequences scarcely bear thinking about: shelter, food security and basic nutrition and education among refugees, internally displaced people, and disaster survivors; surveillance and response to countless outbreaks around the world; long-term studies of population health. 

You can add to this list. A major factor appears to be the nonpayment of UN dues by the United States, but a quick scan of today's major American media shows little or no mention of the shortfall, let alone the Trump administration's responsibility for it. 

 

The repercussions will be felt all over the world.

Fomeka-Beni mental health center: More than 60 patients in a space designed for 23 people

Via Radio Moto Butembo-Beni, a reminder that not all Ebola casualties actually contract the disease: FOMEKA-BENI mental health center: more than 60 patients in a space designed for 23 people. The Google translation:

Built for a capacity of 23 patients, the Psycho-Clinical and Pastoral University Center FOMEKA-Beni currently has about sixty patients. One room even contains two to three patients for lack of space.  

This concern was presented to Radio Moto Butembo-Beni this Friday, October 4, 2019 by KAMBALE KAHUNDE Jean Louis, psychologist at the FOMEKA-BENI mental health center.  

Monthly, more than 600 people attend this health facility for consultations. Faced with this situation and to save the lives of men, KAMBALE KAHUNDE Jean Louis appealed to the good will to support the psycho-clinical and pastoral center FOMEKA-Beni. 

"I will appeal to anyone of goodwill who listens to me that there is an emergency. Within its means, a partner who may be interested in the war trauma, which may be interested in trauma related to Ebola virus disease in any case it would be nice to try to help a little community," he said. 

Despite the proximity that is observed in this mental health institution because of the lack of space, the psychologist KAMBALE KAHUNDE Jean Louis is pleased that no case of Ebola virus disease has ever been recorded in this center of care since the outbreak of this epidemic in the Beni region. 

"Since the epidemic began, we are meeting the minimum of standard measures. Which means that as I speak, there has never been a case that has been recorded at our center, and that would have come out positive. So, whatever the behavior of our patients, we really try to respect the rules of hygiene," he said.  

It should be noted that some of the mentally ill persons currently in the Fomeka-Beni Mental Health Center have contracted mental illness because of the war in the Beni region. The others became ill after taking drugs.

Hong Kong: Protests affect delivery of health services

Via the Centre for Health Protection, an October 4 statement: DH announcement on service of dental clinics and chest clinics.

In light of possible mass gathering activities in some areas today (October 4), the Department of Health (DH) announced that the evening dental services of Wan Chai Dental Clinic, Yau Ma Tei Dental Clinic, Sheung Kwai Chung Government Dental Clinic and Pamela Youde Government Dental Clinic in Sha Tin have been suspended today.       

Meanwhile, the treatment service hours of DH‘s evening chest clinics have been suspended earlier at 6.30pm today. The concerned clinics are namely East Kowloon Chest Clinic, Kowloon Chest Clinic, Sai Ying Pun Chest Clinic, Shaukeiwan Chest Clinic, Shek Kip Mei Chest Clinic, South Kwai Chung Chest Clinic, Wanchai Chest Clinic, Yan Oi Chest Clinic, Yaumatei Chest Clinic, Yuen Chau Kok Chest Clinic and Yung Fung Shee Chest Clinic. 

Those with appointments will be given a new appointment.

Another statement advises that methadone clinics were to close early because of "mass gathering activities."