H5N1

WHO: Deaths from DR Congo measles outbreak top 6000

WHO AFRO has published Deaths from Democratic Republic of the Congo measles outbreak top 6000.

Kinshasa, 7 January 2020 – With the death toll from the world’s worst measles epidemic in the Democratic Republic of the Congo (DRC) surpassing 6000, the World Health Organization (WHO) is calling for more funding to stop the outbreak.  

Under the leadership of the DRC Ministry of Health, WHO, Gavi, the Vaccine Alliance, and other partner aid agencies vaccinated more than 18 million children under five across the country in 2019. However, in some areas, routine vaccination coverage remains low and 25% of the reported measles cases are in children over the age of five, who are the most vulnerable. 

“We are doing our utmost to bring this epidemic under control. Yet to be truly successful we must ensure that no child faces the unnecessary risk of death from a disease that is easily preventable by a vaccine. We urge our donor partners to urgently step up their assistance,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. 

Since the start of 2019, around 310 000 suspected measles cases have been reported. The epidemic has been aggravated by low vaccination coverage among vulnerable communities, malnutrition, weak public health systems, outbreaks of other epidemic-prone diseases, difficult access by vulnerable populations to health care and insecurity that has hampered response in some areas.  

Lack of funding remains a huge impediment to successfully curbing the outbreak. So far, US$ 27.6 million have been mobilized. However, a further US$ 40 million are required for a six-month plan to extend the vaccination to children between six and 14 years and to reinforce elements of the outbreak response beyond vaccination, including improving treatment, health education, community engagement, health system strengthening, epidemiological surveillance and response coordination.  

“We recognize the Government’s engagement in the efforts to end the outbreak and we are grateful for the generosity of our donors. But we still need to do more,” said Dr Amédée Prosper Djiguimdé, Officer in charge of WHO office in the DRC. “Thousands of Congolese families need our help to lift the burden of this prolonged epidemic from their backs. We cannot achieve this without adequate finances.” 

The European Civil Protection and Humanitarian Aid Operations, Gavi, the Vaccine Alliance, Médecins du Monde, Médecins Sans Frontières, United Nations Children’s Fund, WHO and other partners have been supporting the Government to bring the long-running epidemic under control. In December 2019, WHO trained 60 health professionals from the Ministry of Health to conduct a range of services, including community engagement, health education and surveillance. These health professionals are being deployed this week as part of the response.

Samoa measles: Update, January 6

Thanks to @drfixus for tweeting the link to this ReliefWeb report from the government of Samoa: National Emergency Operation Centre: Update on the measles outbreak, January 6, 2020 - Samoa.

January 6th, 2020; The Ministry of Health confirms a cumulative total of 5,697 measles cases have been reported to the Disease Surveillance Team, since the outbreak started. 

Currently the outbreak is declining with 30 new cases reported between December 29, 2019 and January 5, 2020. 

As of 8.30am January 5th 2020, there were 16 measles currently admitted at the Tupua Tamasese Meaole Hospital (TTMH) including 4 critically ill children in ICU/HDU. 

The total number of measles cases admitted to all hospitals recorded for the outbreak to date is 1,860. Of that, 1,761 (95%) patients have recovered and been discharged. 

To date, 83 measles related deaths have been recorded. There were 2 fatalities (one infant and one adult) between December 29, 2019 and January 5, 2020.  

There are currently no travel restrictions or vaccination requirement for those travelling to Samoa. Additionally, proof of MMR vaccination is not currently required for Samoans travelling to Australia, New Zealand, or the United States. 

Only travelers to American Samoa are required to provide proof of vaccination for MMR.

The history of measles: From a 1912 genome to an antique origin

Via bioRxiv: The history of measles: from a 1912 genome to an antique origin. Abstract:

Many infectious diseases are thought to have emerged in humans after the Neolithic revolution. While it is broadly accepted that this also applies to measles, the exact date of emergence for this disease is controversial. Here, we sequenced the genome of a 1912 measles virus and used selection-aware molecular clock modeling to determine the divergence date of measles virus and rinderpest virus. This divergence date represents the earliest possible date for the establishment of measles in human populations. 

Our analyses show that the measles virus potentially arose as early as the 4th century BCE, rekindling the recently challenged hypothesis of an antique origin of this disease.

See this excellent article by Kai Kupferschmidt in Science for a discussion of the study.

Samoa measles: December 29 update

Via ReliefWeb, a release from the government of Samoa: National Emergency Operation Centre: Update on the measles outbreak (Press Release 43) December 29, 2019 - Samoa.

The Ministry of Health confirms a total of 5,667 measles cases have been reported to the Disease Surveillance Team, since the outbreak started. 

There were 12 recorded in the last 24 hours for Upolu (0 new cases for Savaii).  

There are currently 45 measles cases who are in-patients at all health facilities. Of this, 37 are at the Tupua Tamasese Meaole Hospital (TTMH), 2 at Poutasi District Hospital, 1 at Lalomanu District Hospital, 4 at Foailalo District Hospital and 1 in Sataua. Admissions include 9 critically ill children and 1 adult in ICU/HDU, 1 pregnant woman admitted to TTMH in maternity ward and 1 pregnant woman in Poutasi District Hospital. 

The total number of measles cases admitted to all hospitals recorded for the outbreak to date is 1,846. Of that, 1,720 (93%) patients have been discharged. 

To date, 81 measles related deaths have been recorded. There were no fatalities in the last 24 hours. 

VACCINATION UPDATE:  

As of December 28, 2019, approximately 95% of all eligible people in Samoa have been vaccinated against measles.

Samoa measles: 12 new cases on December 28, no new deaths

An encouraging tweet from the Government of Samoa:

Just 12 cases, compared to 21 the day before, and no new deaths. This shows what a government can do when it gets serious about a public health problem. 

See also this Reuters report in The Guardian for details about the lifting of the emergency in Samoa.

Samoa lifts measles state of emergency

Via RNZ News: Samoa lifts measles state of emergency.

At today's meeting, Cabinet unanimously approved the cancellation of the State of Emergency Orders in place. 

In its decision, Cabinet has approved the State of Recovery for Samoa to commence immediately. 

For the Recovery Phase, the Ministry of Health and the Ministry of Foreign Affairs are tasked with the preparations of the Recovery Plan to be tabled for Cabinet's consideration in two weeks from today. 

Cabinet has also instructed that all works which were centralised and conducted by the National Emergency Operation Center, during the crisis are to be referred to the Health Emergency Operation Center for continuation. 

And finally, the Public Appeal supported by the United Nations will continue with the UN's Resident Coordinator working together in close collaboration.  

No new measles deaths in past 24 hours 

Samoa's Ministry of Health says the death toll from the measles epidemic in the country remains at 81 with no fatalities in the last 24 hours.  

There are 46 measles cases in hospital, nine of that number are critically ill children; another critical patient is a pregnant woman.  

It said twenty-one measles cases were recorded in the last 24 hours. 

The Ministry confirms that 5,655 measles cases have been reported to the Disease Surveillance Team, since the outbreak started.  

The total number of measles cases admitted to all hospitals recorded for the outbreak to date is 1,844. Of that, 1,717 patients have been discharged.  

The Ministry said as of December 27, 2019, approximately 95 percent of all eligible people in Samoa have been vaccinated against measles.

Samoa measles: 21 cases on December 27, no new deaths, 95% vaccination rate

A tweet from the Government of Samoa:

Samoa measles: 22 new cases on December 26, no new deaths

A tweet from the Government of Samoa:

From seniors’ care to opioids, eight critical public health issues for 2020

The Tyee has published my article From Seniors’ Care to Opioids, Eight Critical Public Health Issues for 2020. Excerpt:

Canada has plenty of domestic public health problems, and an infectious disease outbreak anywhere in the world is just one airline passenger away from Toronto or Vancouver.

As the year winds down, here are eight incredibly pressing public health problems — and some solutions — we’re likely to deal with in 2020. 

The slow end of the Ebola outbreak. Time and again, extremist political violence and distrust of the Kinshasa government in the northeast Democratic Republic of Congo have halted the response to the Ebola crisis that has killed more than 2,200 people. We now have two effective Ebola vaccines, but getting them to people at risk will be a problem well into the new year.  

The outbreak won’t be considered over until 42 days have passed since the last confirmed case. Given the violence, we won’t likely experience those 42 days for months. 

Continued spread of measles. The World Health Organization estimates that 144,000 people died of measles in 2018. It’s killed more people in the DR Congo than Ebola. Encouragingly, Samoa recently shut down the country for two days to vaccinate 90 per cent of the population — and hit that target.

Social media attacks on measles vaccine have helped keep immunization rates low in countries that should know better, like the U.S. and Canada. We should learn from the Samoans.  

Opioids and their collateral damage. It’s been over three years since Dr. Perry Kendall declared a public health emergency in B.C. over opioid overdoses and deaths. Deaths are trending down, but overdoses seem to have stabilized at an intolerable 22,000 a year. 

It’s intolerable partly because survivors of multiple overdoses may end up with lifelong brain damage, and partly because first responders — fire and rescue and paramedics — must deal with the stress and mental health problems caused by saving the same people again and again. In 2020, we may start thinking about why people get on opioids in the first place.

Samoa measles: 9 new cases, 1 new death on Christmas Day

A bittersweet tweet on Christmas Day from the Government of Samoa:

Just 9 cases is a triumph that vindicates Samoa's decisive response to the epidemic. But to lose yet another life must be especially painful when the Samoans are so close to suppressing the outbreak altogether.