H5N1

DRC Ebola: CMRE update, September 27

CMRE has published its September 27 update, with data as of September 26. Excerpt from the Google translation:

EVOLUTION OF THE EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI AS AT SEPTEMBER 26, 2019
 
The Epidemiological Situation of Ebola Virus Disease on September 26, 2019
 
Friday, September 27, 2019
 
• Since the beginning of the epidemic, the cumulative number of cases is 3,183, of which 3,069 are confirmed and 114 are probable. In total, there were 2,128 deaths (2014 confirmed and 114 probable) and 989 people healed.

• 416 suspected cases under investigation;

• 2 new probable cases in Ituri, including 1 in Komanda and 1 in Mambasa;

• 3 new confirmed cases, including:

• No cases in North Kivu;

• 3 in Ituri, including 1 in Lolwa, 1 in Mambasa and 1 in Mandima;

• No new confirmed deaths have been recorded;

• 8 Cured people released from CTEs, including 6 in Ituri in Komanda and 2 in North Kivu in Beni;

• No health worker is among the new confirmed cases. The cumulative number of confirmed / probable cases, including 41 deaths.

The data presented in this table is subject to change after extensive investigation and after redistribution of cases and deaths in their respective health areas.

NEWS

Mambasa Ebola Virus Cure Insertion Ceremony in the community

• Immediately after their exits from CTE in Komanda, the cured were accompanied by the teams of the response to Mambasa, their respective health zone, where a festive atmosphere awaited them.

• They were greeted by a motorized caravan from the Fitter Control Point in Mputu-Mambasa center taking the direction of Mambasa main artery and passing through the Ambient Street 100 meters to land at the office esplanade Mambasa territory, where the official insertion ceremony took place.

• The Deputy Coordinator-General of the Ebola Response, Dr. Justus Nsio Mbeta, who welcomed these healers to the site of the protest, emphasized that the reintegration of the cured is an expression of hope and guarantee for the entire population of Mambasa called for Ebola Virus Disease to be a curable disease if the person gets to CTE early;

• "Ebola can reach everyone, it is important that the entire population, not only of Mambasa, but also of the surrounding or distant, can be as one man get involved by appropriating the activities of the response to put end this 10th epidemic," insisted Dr. Nsio, calling the population to respect preventive measures, including regular hand washing and vaccination;

• The WHO coordinator at the Mambasa sub-coordination, Dr. Freddy invited the six healers to remain ambassadors of the response in their respective communities, while testifying about the management of CTE and the the effectiveness of the drugs used to treat Ebola patients;

• For UNICEF, these cures are living proof that you can go to CTE and get out of bed.

Ceremony Certificate Ceremony for the MVE healers in Mambasa

• The Mambasa sub-coordination teams, the Technical Secretariat of the Multisectoral Committee for the Ebola Virus Disease Response (CMRE), the Ministry of Health, the local political-administrative authorities, the National Police as well as the partners, proceeded to the delivery of the certificates to the various cures;

• Long before the certificate ceremony, the Deputy General Coordinator of the response greeted the healed by shaking hands to show that they are truly and completely healed. He recommended to the community to receive these cures like everyone else, because they are no longer infected;

• In addition, the administrator of the territory of Mambasa,Mr.. Idriss Koma Tokodila, called on his constituents to appropriation of the fight against the Ebola Virus Disease and the activities of vaccination, which he says allows to quickly break the chain of transmission. "I refuse Ebola in our territory and with the will of all of you, we can stop this epidemic in our territory and in neighboring territories," said Idriss Koma before urging his constituents to avoid spreading the disease by fleeing into other territories, but rather to stay in place to fight the epidemic;

• This ceremony was also marked by the testimonies of the cured and some members of the cured family;

• To reintegrate them into the community, the psychosocial committee accompanied them each to his home with family members who came to greet him with a few survival kits, including food and hygiene kits.

Two new probable cases validated in Ituri in the health zones of Komanda and Mambasa

For the probable case of Komanda notified on September 10, 2019:

• It is about a little boy, infant of 7 months, died in the Area Idohu health center in Ndimo village Antenna in Komanda, Ituri province. This infant has not been listed as contact and has not been vaccinated;

• The date of onset of the signs dates back to September 07, 2019, with the date of exposure from August 21 to September 3, 2019, by fever;

• From 07 to 10 September, this baby was cared for at Rwenzori Health Station, where he was diagnosed with malaria. He died on September 10, 2019 and the alert was issued on the death by the health care staff of this center;

• The body was taken by his father before the arrival of the investigative team, resulting in a failed and secure buccal discharge and burial;

• This child was an unlisted contact of his cousin, confirmed on August 24, 2019 and died at the Ebola Treatment Center (ETC) on August 25, to whom he had visited with his mother at Rohi Health Station from August 20 to August 23, 2019;

• 11 contacts are listed around this case, including 5 family members, 2 co-patients and 4 care providers, all vaccinated.

For the probable case of Mambasa, notified on August 29, 2019:

• This is a 28-year-old man who died in the Salama Health Area in Madidi district of Mambasa in Ituri province. It has not been listed as a contact and has not been vaccinated;

• The date of onset of the signs is 21 August 2019, with exposure date from 04 to 17 August 2019, fever, headache, chills and polyarthralgia;

• From August 21st to 27th, this man was hospitalized at Saint-Pierre Health Center with no improvement. The patient came out of this center at his own request that same day to be brought for prayer sessions at the Assembly of Saints Church until his death on August 29, 2019;

• That same 29th of August, the body of the deceased was moved from the church to his home, located in a district of the Boyomais, very reluctant to the response activities. The body was buried on August 30, 2019 without oral sampling (Swab) or dignified and secure burial (EDS);

• Before his illness, two of his family members died in a manner reminiscent of Ebola Virus Disease. This is his son, who died on August 18, 2019, and his father, whose date of death was not specified, all of whom did not benefit from either swab or DHS;

• After his death, his brother, who had accompanied him to the health center and to the church, also participating in the funeral, had died and confirmed MVE on September 12, 2019 with the date of the beginning of the signs on September 03, 2019.

UK: Babies exposed to air pollution have greater risk of death - study

Via The Guardian: Babies exposed to air pollution have greater risk of death. Excerpt:

Babies living in areas with high levels of air pollution have a greater risk of death than those surrounded by cleaner air, a study has found. 

It is not the first study to investigate the link between air pollution and infant mortality , but thestudydrew particular focus on different pollutants and its analysis at different points in babies’ lives.  

Dr Sarah Kotecha , a researcher at Cardiff University, said the results were difficult for pregnant women and their families to do much about.

“You live where you live and you can’t avoid pollution day in day out,” she said, adding that it was down to policymakers to reduce pollution levels and for researchers to unpick how pollutants affect health. “If you can find out some of the mechanisms you can look at potential interventions,” she added. 

A growing body of research has revealed links between different components of air pollution and health issues, including lung problems, heart disease, mental health problems, dementia and low birthweight. 

The latest study, yet to be peer-reviewed or published, will be presented at the European Respiratory Society international congress in Madrid. 

Kotecha said the research was based on data for almost 8 million live births in England and Wales between 2001 and 2012.  

The team divided England and Wales into 35,000 areas, each containing approximately 1,500 residents, and looked at the annual death rates for babies up to one-year-old, together with the average annual levels for three pollutants. These were particulate matter known as PM10, which comes from sources including vehicles and waste incineration, nitrogen dioxide (NO2), and sulphur dioxide (SO2), which is released through burning of fossil fuels in power stations and refineries as well as metal extraction. 

For each pollutant the team compared the death rate for babies in the worst fifth of polluted areas with those in the best fifth.  

Once factors such as maternal age, deprivation level for the area and birthweight were taken into account, the team said that babies aged up to one year had a greater chance of dying living in areas with the worst air pollution compared with areas with the cleanest air. 

The results held across all three pollutants, with the odds of death 7% worse for NO2, 4% worse for PM10 and 19% worse for SO2. Further analysis suggested that of the three pollutants, only SO2 was associated with deaths within a baby’s first 28 days. 

The study was unable to prove whether high levels of air pollution were to blame for the increased risk of death in those areas. It also did not take into account levels of indoor air pollution.

DRC Ebola: CMRE update, September 6

It's not quite 5:00 a.m. on Saturday morning here in Helsinki, almost 7:00 p.m. Friday in Vancouver, but jet lag has ensured an early return to blogging.

The CMRE has emailed its daily update for September 6, with data for September 5. Excerpt from the Google translation:

SUBJECT: EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI AS AT SEPTEMBER 05, 2019

Date: Friday, September 06, 2019

Since the beginning of the epidemic, the cumulative number of cases is 3,069, of which 2,958 are confirmed and 111 are probable. In total, there were 2,057 deaths (1,946 confirmed and 111 probable) and 918 people cured.

• 415 suspected cases under investigation;

• 2 new probable cases in North Kivu, including 1 in Butembo and 1 in Biena;

• 13 new confirmed cases, including:

º 10 in North Kivu, including 4 in Kalunguta, 2 in Beni, 2 in Kayna, 1 in Butembo and 1 in Katwa;
º 3 in Ituri, including 2 in Mandima and 1 in Mambasa.

• 3 new confirmed deaths in North Kivu:
º 2 community deaths in North Kivu, including 1 in Kalunguta and 1 in Katwa;

º 1 death in the CTE in North Kivu in Mabalako.

• 4 people cured out of ETCs in North Kivu, including 3 Beni and 1 in Butembo.

• No health workers are among the newly confirmed cases. The cumulative number of confirmed / probable cases among health workers is 156 (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.

DESCRIPTION OF PROBABLE CASES

• The case of Butembo is a girl, 2 weeks old infant, who died on March 20, 2019 at the "Everything is Grace" Hospital Center in the Vuvatsi Area (Vuthawa / Matembe) in Butembo, North Kivu. She was contacted by her mother, not followed for refusal and not vaccinated, who was confirmed EVD on March 14, 2019 and died on March 15, 2019 at CTE. This child was hospitalized at CH "Tout est Grâce" on March 19, 2019 following the occurrence of fevers, but without success. The alert was launched the same day by Community Relays (ReCo). There is reluctance for dignified and secure burial (EDS). 25 contacts, including 16 family members, 3 CH and 6 others were listed around this case;

• The case of Biena is a 22-year-old woman, unvaccinated, who died on December 16, 2018 at the home of a traditional healer, who was followed on an outpatient basis, but without success since December 09. This is an unlisted contact of her mother, confirmed Ebola case on November 24, 2018. The 22-year-old woman, accompanied by her older brother, had traveled by motorbike on December 10 to Biena. She remained in Biena until December 15 and her condition worsened with haemorrhagic signs. The alert was launched by the Vuvo IT, while the body was already buried before the arrival of the investigation team and EDS. 10 contacts, all members of his family, were listed around this case.

VACCINATION

• Since the beginning of vaccination on August 8, 2018, 213,814 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, until 04 September 2019, is 91,667,203;

• To date, a total of 98 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.

Air pollution and infant mortality: Evidence from Saharan dust

Via the National Bureau of Economic Research: Air Pollution and Infant Mortality: Evidence from Saharan Dust. The abstract:

Accurate estimation of air quality impacts on health outcomes is critical for guiding policy choices to mitigate such damages. Estimation poses an empirical challenge, however, because local economic activity can simultaneously generate changes in both air quality and in health impacts that are independent of air quality, confounding pollution-health estimates. 

To address this challenge, we leverage plausibly exogenous variation in local particulate matter exposure across sub-Saharan Africa due to dust export from the Bodele Depression, a remote Saharan region responsible for a substantial share of global atmospheric dust. Large scale transport of this dust is uncorrelated with local emissions sources and allows us to isolate the causal impact of air quality on infant mortality across Sub-Saharan Africa. 

Combining detailed information on nearly 1 million births with satellite measures of aerosol particulate matter, we find that a 10mg/m3 increase in local ambient PM2.5 concentration driven by distant dust emission causes a 22% increase in infant mortality across our African sample (95% CI: 10-35%), an effect comparable to quasi-experimental pollution-infant mortality estimates from wealthier countries. 

We also show that rainfall over the Bodele is a significant control on PM2.5 export and thus child health, and that future climate-change driven changes in Saharan rainfall could generate very large impacts on African child health through this pathway alone. 

We calculate that seemingly exotic proposals to pump and apply groundwater to the Bodele to reduce dust emission could be cost competitive with leading interventions aimed at improving child health.

MSF: Mothers and children left to die in Yemen without access to medical care

Via MSF.org: Mothers and children left to die in Yemen without access to medical care. Excerpt:

AMSTERDAM/BARCELONA/SANA’A – Many expectant mothers experiencing complications in childbirth and parents of sick children are unable to reach medical care in Yemen in a safe and timely manner, often with deadly consequences, a report by Médecins Sans Frontières (MSF) has found.

MSF’s new report, Complicated delivery: The Yemeni mothers and children dying without medical care, outlines the impact of the war on pregnant women, new mothers and children under 15 – who are some of the most neglected and vulnerable people in Yemen – as observed by MSF medical teams working in Taiz and Hajjah governorates.

Four years into the conflict, the warring parties in Yemen and their international backers have brought about the effective collapse of the country’s public health system, which cannot meet the needs of Yemen’s 28 million people.

Between 2016 and 2018, 36 mothers and 1,529 children died – 1,018 of whom were new-borns – in MSF’s Taiz Houban hospital, in Taiz governorate, and the MSF-supported Abs hospital, in Hajjah governorate. Of the deaths in Taiz Houban, almost one-third were children and new-borns who were dead on arrival. Many new-borns brought to MSF for care had a low birthweight or were born prematurely, at home or in small private clinics. The most common causes of deaths in neonates were prematurity, birth asphyxia and severe infection (sepsis). 

The high numbers of deaths are linked to a number of factors, with most being from a direct result of the war. These include the lack of functioning health facilities in Yemen, people’s difficulties in reaching them, and their inability to afford alternatives. Many people have to cross frontlines, pass through no-man’s land or negotiate their way through multiple checkpoints in order to reach a hospital that is still functional.

Eleven premature babies die in less than a day in Tunisian hospital, sparking outrage

Via The New York Times: 11 Premature Babies Die in Less Than a Day in Tunisian Hospital, Sparking Outrage. Excerpt:

TUNIS — Outrage grew in Tunisia this past week after 11 premature babies died in less than 24 hours from infections acquired in the same hospital as doctors and patients expressed frustration over the country’s struggling public health care system. 

The babies died recently at the Rabta hospital maternity ward in central Tunis, the country’s capital, after nosocomial, or hospital-acquired, infections led to deadly septic shocks, the health ministry said. 

Four more babies died later, and two of those deaths were also linked to the infection, said officials at a news conference at the health ministry on Friday.  

After the deaths, Abderraouf Cherif, the health minister, who had been nominated just months ago, quickly resigned. Several top health officials were fired. 

 Sonia Ben Cheikh, the interim health minister, called the deaths a “national disaster” and said officials suspected a problem with the sterile room where hospital staff members prepare the premature babies’ nutrients, which were delivered intravenously.

“We have doubts on the sterilization of the room and of the tools, which may have led to the infection,” she said at a news conference on Monday, adding later on local television that the department where the newborns died was short on workers, with only three doctors for 40 beds.  

The public outcry was worsened by the hospital’s handling of the deaths. 

Local television showed families holding the bodies of their newborns in cardboard boxes that had been handed to them by hospital staff members, sparking indignation on social media, especially after an official from the health ministry said on television it was not an “unusual practice” because “it can be less traumatizing than giving them in a simple blanket.”  

That official was fired a few days later. 

Prosecutors have opened an investigation, and the health ministry has asked a committee of doctors and pharmacists to investigate the deaths and the possible human errors that led to them.

Two babies die after contracting infection at Glasgow hospital

Via The Guardian: Two babies die after contracting infection at Glasgow hospital. Excerpt:

Two premature babies have died after contracting a bloodstream infection at a Glasgow hospital, the third infection-control crisis to hit the city’s health service within two weeks.  

NHS Greater Glasgow and Clyde confirmed on Wednesday night that it was investigating three cases in the neonatal unit at the Princess Royal maternity hospital. It said the infection was “one of a number of contributing causes” in the deaths of two “extremely premature” babies, and that a third had required treatment and was in a stable condition. 

On Tuesday Scottish prosecutors confirmed they were investigating the deaths of two patients, a 10-year-old boy and a 73-year-old woman, who contracted an infection connected to pigeon droppings at Queen Elizabeth university hospital in Glasgow. Another patient at that hospital remains seriously ill after contracting a separate fungal infection called mucor.

Dr Barbara Weinhardt, an infection control doctor, said a number of measures had been taken at the Queen Elizabeth university hospital, including a deep clean, isolation and barrier nursing, safety briefings to all staff and infection control advice to all visitors.  

She said: “Our thoughts are with the families affected. Results have confirmed that the three cases of Staphylococcus aureus are linked and our investigations continue into how they are linked.”

Syria: WHO concerned over critical health situation in Al-Hol camp, Al-Hasakeh

WHO EMRO has published WHO concerned over critical health situation in Al-Hol camp, Al-Hasakeh. Excerpt:

31 January 2019, Damascus, Syria – The World Health Organization is extremely concerned about the deteriorating humanitarian situation in Al-Hol camp in Al-Hasakeh governorate, and calls on all parties to the conflict to provide unhindered humanitarian access to people in need of life-saving aid.  

Over the last 2 months, approximately 23 000 people, mainly women and children fleeing hostilities in rural areas of neighbouring Deir-ez-Zor, have arrived in the camp. Many of them have walked or travelled in open trucks for several days and nights in the bitterly cold winter weather. Their journeys have been delayed en route by lengthy security screening procedures in an exposed field, and their ordeal has not ended on arrival to the camp. Thousands of new arrivals have been forced to spend several nights in the camp’s open-air reception and screening areas, without tents, blankets or heating. At least 29 children and newborns are reported to have died over the past 8 weeks, mainly from hypothermia, while travelling to the camp or shortly after arrival. 

The situation in the camp is now critical. Its population has tripled in size (from 10 000 to almost 33 000 people) in less than 2 months. The authorities are overwhelmed and struggling to cope with the sheer numbers of people. Many new arrivals are malnourished and exhausted following years of deprivation living under the control of the Islamic State of Iraq and the Levant. 

The camp is unheated and there are shortages of health care services, tents, latrines and sanitation facilities. Humanitarian access to the camp and surrounding roads is hampered by bureaucratic obstacles and security constraints. 

Since the beginning of January, WHO has delivered over 35 000 treatment courses to support the work of 2 mobile clinics donated by WHO, as well as 4 mobile health teams currently operating in the camp. WHO-supported teams are working round the clock to screen new arrivals and refer them to hospitals when required. Severely malnourished children are being referred to a WHO-supported hospital in Al-Hasakeh.

Why couldn’t my Ebola treatment center save this baby?

Via The New York Times, an opinion piece by Karin Huster, a field coordinator with MSF: Why Couldn’t My Ebola Treatment Center Save This Baby? Excerpt (but read the whole article):

That day when the mother and baby came to our center, I was standing on the other side of a fence that isolates the possibly contagious from the rest of us. I watched the young mother for a while, but I couldn’t catch her gaze. She appeared lost in her thoughts. 

We were all waiting on the medical team to see what was wrong with the baby. But moving, with Ebola, is frustratingly slow. Doctors and nurses must wear “Ebola armor” — plastic boots, two pairs of gloves, a face mask, goggles, a full-body impermeable plastic suit and a thick plastic apron. Because it’s as hot as a sauna inside it, they can’t wear the protective gear for very long. So every time a new patient arrives, a new team has to suit up.  

To partly remedy the problem, we are lucky to employ Ebola survivors to help in the triage area. Thanks to their acquired immunity to Ebola, they need much lighter protection, and so can be with patients much longer. They are the ones who spend the most time with patients as they are isolated for the three days it takes for testing. They are the ones who take care of the children and the babies who have to be separated from their mothers for this period. 

If the patients don’t have Ebola, they get to go home or to the hospital for further medical care. If they test positive, they will be transferred to the Ebola Treatment Unit just down the street, where they could remain isolated for weeks. 

Unlike us, unrecognizable in our scary spacesuits, survivors put a human touch to the frightening experience. And unlike us, they know what it feels like to be sick, unable to have your family at your side. 

They are the ones who started helping the mother and her baby while the medical team was suiting up. I watched as Chantal, a survivor who is also a nurse, began to carefully unwrap the baby in order to record its vital signs. 

She placed the baby in the hanging scale, carefully supporting its head. But something looked awfully wrong.  

“Lift the arm up and let go,” I said.  

The arm fell back, completely limp. I looked at Chantal, then looked at the mother. She didn’t seem to have noticed anything. Or if she did, she didn’t show it. The baby was carefully wrapped up again and the mother sat back down, waiting. A few minutes later, the medical team showed up, all dressed in their bright yellow suits.  

It was too late. The baby was dead. 

Perhaps the disease had progressed too quickly. Or perhaps the mother delayed coming. People often do, and it’s hard to blame them. There are rumors that Ebola is a business run by foreigners just to make money, and that the vaccine is a kind of poison. Such misinformation pushes people to seek care from traditional healers in hopes of avoiding the Ebola Treatment Units. Sometimes they even flee when an Ebola response team’s armada of SUVs, flanked by armed police officers, speeds toward their village.

Trends in infant mortality in Venezuela between 1985 and 2016

Via The Lancet Global Health: Trends in infant mortality in Venezuela between 1985 and 2016: a systematic analysis of demographic data. The summary:

Background 

Between the 1950s and 2000, Venezuela showed one of the most substantial improvements in infant mortality rates in Latin America. However, the recent economic crisis alongside an increase in infectious and parasitic diseases might be reversing previous patterns. Because no official updated mortality statistics have been published since 2013, the effect of these recent events has been difficult to assess accurately. We therefore aimed to estimate infant mortality rate trends and report the effect of the crisis. 

Methods 

We estimated infant mortality rates using direct methods (ie, death counts from Venezuelan Ministry of Health via yearbooks and notifiable diseases bulletins, and birth records published by the UN Economic Commission for Latin America and the Caribbean and the Venezuelan National Institute of Statistics) and indirect methods (using census data and a Living Conditions Survey ENCOVI 2016). We shaped yearly estimations using a semiparametric regression model, specifically a P-Spline model with a cubic thin plate base. The primary objective was to estimate infant mortality rate trends from 1985 to 2016. 

Findings 

Around 2009, the long-term decline in infant mortality rate stopped, and a new pattern of increase was observed. The infant mortality rate reached 21·1 deaths per 1000 livebirths (90% CI −17·8 to 24·3) in 2016, almost 1·4 times the rate of 2008 (15·0, −14·0 to 16·1). This increase represents a huge setback on previous achievements in reducing infant mortality. 

Interpretation 

Our conservative estimation indicates that Venezuela is in the throes of a humanitarian crisis. The increase in infant mortality rate in 2016 compared with 2008 takes the country back to the level observed at the end of the 1990s, wiping out 18 years of expected progress, and leaves the Venezuelan Government far from achieving the target of nine deaths per 1000 livebirths stated in the UN Millennium Development Goals.