H5N1

Migration and outbreaks of vaccine-preventable disease in Europe: A systematic review

Via The Lancet Infectious Diseases: Migration and outbreaks of vaccine-preventable disease in Europe: a systematic review. The summary:

Migrant populations are one of several underimmunised groups in the EU or European Economic Area (EU/EEA), yet little is known about their involvement in outbreaks of vaccine-preventable diseases. This information is vital to develop targeted strategies to improve the health of diverse migrant communities. 

We did a systematic review (PROSPERO CRD42019157473; Jan 1, 2000, to May 22, 2020) adhering to PRISMA guidelines, to identify studies on vaccine-preventable disease outbreaks (measles, mumps, rubella, diphtheria, pertussis, polio, hepatitis A, varicella, Neisseria meningitidis, and Haemophilus influenzae) involving migrants residing in the EU/EEA and Switzerland. 

We identified 45 studies, reporting on 47 distinct vaccine-preventable disease outbreaks across 13 countries. Most reported outbreaks involving migrants were of measles (n=24; 6496 cases), followed by varicella (n=11; 505 cases), hepatitis A (n=7; 1356 cases), rubella (n=3; 487 cases), and mumps (n=2; 293 cases). 19 (40%) outbreaks, predominantly varicella and measles, were reported in temporary refugee camps or shelters. Of 11 varicella outbreaks, nine (82%) were associated with adult migrants. Half of measles outbreaks (n=11) were associated with migrants from eastern European countries. 

In conclusion, migrants are involved in vaccine-preventable disease outbreaks in Europe, with adult and child refugees residing in shelters or temporary camps at particular risk, alongside specific nationality groups. Vulnerability varies by disease, setting, and demographics, highlighting the importance of tailoring catch-up vaccination interventions to specific groups in order to meet regional and global vaccination targets as recommended by the new Immunisation Agenda 2030 framework for action. 

A better understanding of vaccine access and intent in migrant groups and a greater focus on co-designing interventions is urgently needed, with direct implications for COVID-19 vaccine delivery.

DR Congo: Government declares meningitis epidemic in Tshopo

Via Radio Okapi: DRC: Government declares meningitis epidemic in Tshopo. The Google translation:

The Deputy Minister of Health, Hygiene and Prevention, Véronique Kilumba Nkulu, declared Tuesday, September 7 in Kinshasa, the meningitis epidemic in the province of Tshopo. At least 267 cases, including 129 deaths already linked to the meningitis epidemic, have been recorded in the Banalia health zone. The most affected age group is over 15, she said.  

“Nineteen cerebrospinal fluid samples were collected and sent to the Pasteur Laboratory in Paris, France. The first results were released on September 6, 2021 and confirm the presence of Neisseria Miningitidis serogroup W. Several actions were undertaken in the field already before the confirmation, in particular: strengthening of epidemiological and laboratory surveillance, isolation and case management and community awareness,” said Véronique Kilumba.   

She also announced a series of government measures to deal with this epidemic:   

“A team from the central level is already hard at work on the ground to support the province. A second team is preparing to strengthen technical support from the central level. A response plan is being developed by the Ministry of Health with its support partners. In view of the standards and recommendations of the International Health Regulations (IHR 2005), on September 7, 2021, we are declaring the epidemic of meningococcal meningitis in the Banalia health zone, in the province of Tshopo.”    

This Nigerian doctor might just prevent the next deadly pandemic

Via Nature News & Comment: This Nigerian doctor might just prevent the next deadly pandemic. Excerpt:

Chikwe Ihekweazu tried to steel himself as he surveyed people writhing in pain beneath ramshackle tents in the deserts of northern Nigeria. A deadly epidemic of meningitis had swept through the region in 2017, debilitating so many people that clinics had run out of space.  

The tragic scene laid bare the challenges ahead for Ihekweazu, who had just been appointed director of the nation’s first agency tasked with tracking and responding to outbreaks, the Nigeria Centre for Disease Control (NCDC). Local health workers either didn’t know to report cases, or reporting lagged behind because they lacked electricity to charge mobile phones and laptops. Samples of spinal fluid spoilt before they reached the NCDC’s microbiology laboratory in Abuja, which made it impossible to confirm diagnoses — a requirement for unlocking access to international stockpiles of vaccines. As the agency struggled to count cases, the outbreak wore on, eventually infecting more than 14,000 people and killing almost 1,200. 

“That’s when it became clear how quickly things can fail,” says Ihekweazu. 

Nigeria is Africa’s most populous nation and its biggest economy, but it is also the world’s poorest, as measured by the number of people living in extreme poverty. It is routinely battered by infectious diseases: meningitis, measles, cholera and newly emerging threats that plague communities and raise alarms around the world. 

Ever since the Ebola crisis of 2014–16 — from which Nigeria was largely spared — global-health leaders have been fretting about the possibility of an epidemic exploding in Lagos and spreading to London, New York, Mumbai or Beijing. Many argue that the best hope of mitigating such a catastrophe will come from the capacity of African nations to catch outbreaks early and stem their spread. Ihekweazu had written about this necessity long before it was in vogue — but he never imagined leading the effort himself.  

Yet just two years after his appointment, he has more than doubled the size of the NCDC staff, set up a network of molecular-biology labs across the country and become the steward of multimillion-dollar grants intended to diffuse the threat that an epidemic in Nigeria poses for the rest of the world. On his watch, the nascent agency has battled about a dozen outbreaks, which have infected more than 70,000 people (see ‘Keeping tabs’). “We are building the ship while we are sailing,” Ihekweazu says. Now he has another two years to transform the NCDC into an organization that will operate successfully long after he’s gone.  

Many have faith that he can do so, because he’s proved to be an agile leader in a fragile part of the world. Furthermore, they hope that his strategies in Nigeria might be repeated elsewhere on the African continent, such as in the Democratic Republic of the Congo. 

“Chikwe is showing that Africa can do what is needed, when it’s needed,” says David Heymann, an epidemiologist at the London School of Hygiene and Tropical Medicine. “He is leading the way in how things can be done.”

NCDC: Intensifying outbreak preparedness

The Nigeria Centre for Disease Control has published Intensifying outbreak preparedness. Excerpt:

Nigeria usually experiences an increase in the number of Lassa fever and Cerebrospinal Meningitis (CSM) cases during the dry season. Ahead of the start of the dry season, the Nigeria Centre for Disease Control (NCDC) has increased the intensity of outbreak preparedness, at various levels. 

Following the large outbreak of Lassa fever in 2018, the National Technical Working Group has developed a five-year strategy, with the goal to reduce the case fatality ratio of Lassa fever. In addition, an Emergency Preparedness and Response Plan for Cerebrospinal Meningitis has been developed. 

Risk communications is a key component of these strategies. As part of this, an advocacy meeting with members of the Media and Civil Society Organizations (CSO) was held on 21st November, 2018 in Abuja. 

The meeting aimed at strengthening collaboration between NCDC, the media and CSOs. Importantly, discussions involved opportunities to work together to limit misinformation, and utilise various channels to enlighten and educate the public on how to protect themselves and their communities from these infectious diseases.  

In addition, NCDC has begun a weekly radio programme, aired every Monday at 5:30pm (WAT) on Radio Nigeria across states in the country. This is targeted at members of the public especially in rural areas, to educate them on prevention against outbreaks. Newspaper adverts on Lassa fever prevention have also been published in major dailies. 

The Nigeria Centre for Disease Control will continue to prioritise risk communication, and work with stakeholders to protect the health of Nigerians. For more information on preparedness activities, kindly visit: ncdc.gov.ng.

MMWR: West Nile virus and other nationally notifiable arboviral diseases — United States, 2017

MMWR has published West Nile Virus and Other Nationally Notifiable Arboviral Diseases — United States, 2017. The summary:

What is already known about this topic?  

West Nile virus (WNV) is the leading cause of arboviral disease in the continental United States, but several other arboviruses cause sporadic cases and outbreaks of neuroinvasive disease.  

What is added by this report?  

In 2017, eastern equine encephalitis virus transmission via organ transplantation was reported for the first time. More cases of Jamestown Canyon and Powassan virus neuroinvasive disease were reported in 2017 than in any previous year. 

What are the implications for public health practice? 

Health care providers need to consider arboviral infections in the differential diagnosis of aseptic meningitis and encephalitis, obtain appropriate specimens for laboratory testing, and promptly report cases to public health authorities.

Pakistan: Outbreak of drug-resistant typhoid triggers level two alert

Via The News International: Outbreak of drug-resistant typhoid triggers level two alert. Excerpt:

Islamabad: An on-going outbreak of extensively drug-resistant (XDR) typhoid fever in Pakistan that has triggered the level two alert can be controlled by sensitizing public and health professionals on following preventive measures religiously and offering vaccination particularly to the population at risk. 

The US Centres for Disease Control and Prevention has already issued a travel alert saying anyone heading to Pakistan should take extra care of food and water and get vaccination against typhoid. The CDC said the XDR typhoid strain in Pakistan does not respond to many antibiotics. 

Typhoid or Enteric fever is a bacterial infection caused by Salmonella typhi. The faecal oral transmission is the commonest route infecting the healthy ones. Contaminated water and food are the main sources for the spread of the infection.  

Associate Professor of Pathology and Consultant Microbiologist at Al-Nafees Medical College Islamabad Dr Humaira Zafar expressed this while talking to The News on Sunday. 

She said the intestines are primary site of infection. The most common symptoms include continuous high grade fever, generalized weakness, blood stream infection and constipation or diarrhoea. If the infection prolongs either due to partial treatment, drug resistance or any other cause, a patient can land up to chronic phase along with the emergence of complications. The highlighted complications can be enlargement of the spleen, intestinal haemorrhage, perforation of the bowel and meningitis (inflammation of outer layers of brain), she explained.  

She added the mortality rate in untreated or drug resistant cases ranges from 12-30 per cent. “Despite the availability of effective antibiotics, about 200,000 people die annually while in successfully treated cases, the survival rate is 99%.” 

Typhoid fever is a treatable and curable infection provided accurately treated for proper duration after confirmed diagnosis by culture and sensitivity (blood, stool and bone marrow), she said.  

She said currently the biggest challenge is the emergence of drug resistant strain of Salmonella typhi bacteria. The antibiotics from penicillin, quinolones and cephalosporin groups are usually considered amongst the good treatment options but the challenge faced for public health concern was the emergence of resistant pattern to first line treatment (ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole) and the second-line option as well (fluoroquinolones). 

Due to this situation, ceftriaxone (third generation cephalosporin) is considered as the empirical treatment of choice for typhoid fever patients. However, now there is emergence of a strain that is also resistant to ceftriaxone. Thus giving this bug a label of extensively drug-resistant (XDR) typhoid, said Professor Humaira. 

She added the condition severely limits treatment options. The six months statistical data of National Institute of Health in Islamabad confirmed about 2000 cases of (XDR) Salmonella typhi in Pakistan. Emergence of such cases in Pakistan is becoming a global voice and has brought Pakistan in a lime light. The travellers and tourists visiting Pakistan are advised to take additional precautionary measures in order to not acquire infection, she said. 

The crisis in Pakistan represents the first known outbreak of an XDR strain and this state of affairs if not controlled may lead some researchers to warn that it could turn the clock 70 years back when surviving the disease was more a matter of luck than treatment, said Dr. Humaira.

NCDC epidemiological report, week 25

NCDC has published its Weekly Epidemiological Reports, Week 25.

PRIORITISING NIGERIA’S LASSA FEVER RESEARCH AND DEVELOPMENT ROAD-MAP 

Between January and May 2018, Nigeria experienced its largest reported outbreak of Lassa fever. In responding to the outbreak, critical questions were raised concerning the disease for which answers were either not readily available or required additional validation. 

In this regard, the Nigeria Centre for Disease Control (NCDC) has taken a leadership role to build a Research and Development (R&D) roadmap for Lassa fever in Nigeria.  

To bring the roadmap into reality, a National Lassa fever R&D Stakeholders meeting was convened between the 3rd and 4th of July 2018 in Abuja. The participants at this meeting included case management physicians from the various Lassa fever treatment centres, local and international researchers, partners including the World Health Organization and the host, NCDC. 

The meeting was aimed at identifying the key research areas for Lassa fever, developing research objectives and plans for each area and engaging partners for research implementation. The main areas of research cut across epidemiology of Lassa fever, case management, vector transmission, laboratory diagnosis and risk communications. 

The next few weeks will involve finalising the plans and mapping out resources for the research.  

The outcomes of these activities will help define the landscape with improved knowledge about Lassa fever, guide preparedness and response activities for future outbreaks and drive control/prevention measures for the disease. 

SUMMARY OF REPORTS 

In the reporting week ending on June 24, 2018: 

o There were 125 new cases of Acute Flaccid Paralysis (AFP) reported. None was confirmed as Polio. The last reported case of Polio in Nigeria was in August 2016. Active case search for AFP is being intensified as Nigeria has reinvigorated its efforts at eradicating Polio. 

o 828 suspected cases of Cholera were reported from 34 LGAs in 12 States (Adamawa – 29, Bauchi – 183, Borno – 27, FCT – 2, Gombe – 41, Jigawa – 13, Kaduna – 11, Kano – 110, Katsina – 45, Kogi – 4, Plateau - 24 & Zamfara - 339). Of these, nine were laboratory confirmed and nine deaths were recorded. 

o 24 suspected cases of Lassa fever were reported from nine LGAs in six States (Adamawa – 1, Edo – 9, Gombe – 1, Ondo – 8, Osun - 2 & Plateau – 2). Six were laboratory confirmed and two deaths were recorded.  

o There were 16 suspected cases of Cerebrospinal Meningitis (CSM) reported from 12 LGAs in eight States (Abia -1, Ebonyi – 1, Gombe – 1, Kaduna – 4, Katsina – 4, Oyo – 1, Taraba – 2 & Yobe - 2). Of these, two were laboratory confirmed and no death was recorded.  

o There were 222 suspected cases of Measles reported from 33 States. No laboratory confirmed and no death was recorded. 

In the reporting week, all States sent in their report except Taraba State. Timeliness of reporting remains 89% in both the previous and current weeks (week 24 & 25) while completeness also remains 99% at same period. It is very important for all States to ensure timely and complete reporting at all times, especially during an outbreak.

NCDC: Epidemiological report, week 22

NCDC has published its Weekly Epidemiological Report for week 22. Excerpt:

In the reporting week ending on June 3, 2018: 

o There were 187 new cases of Acute Flaccid Paralysis (AFP) reported. None was confirmed as Polio. The last reported case of Polio in Nigeria was in August 2016. Active case search for AFP is being intensified as Nigeria has reinvigorated its efforts at eradicating Polio. 

o 910 suspected cases of Cholera were reported from 16 LGAs in six States (Adawama – 423, Bauchi – 344, Borno – 20, Kano – 11, Plateau - 37 & Zamfara - 75). Of these, 12 were laboratory confirmed and six deaths were recorded.  

o Five suspected cases of Lassa fever were reported in the reporting week. One was laboratory confirmed and no death was recorded. 

o There were 27 suspected cases of Cerebrospinal Meningitis (CSM) reported from 18 LGAs in nine States (Borno – 1, Cross River – 1, Ebonyi – 2, Kaduna – 1, Katsina – 13, Nasarawa – 1, Ondo – 1, Taraba – 1, Yobe – 1 & Zamfara - 5). Of these, no was laboratory confirmed and two deaths were recorded.  

o There were 306-suspected cases of Measles reported from 31 States. No laboratory-confirmed and no death was recorded.  

In the reporting week, all States sent in their report except Delta State. Timeliness of reporting remains 89% in both the previous and current weeks (week 21 & 22) while completeness increases from 99% to 100% during the same period. It is very important for all States to ensure timely and complete reporting at all times, especially during an outbreak.

NCDC: Weekly epidemiological report, week 20

The Nigeria Centre for Disease Control has public its Weekly Epidemiological Report for week 20. Excerpt:

IMPROVING NIGERIA’S PREPAREDNESS FOR AN EBOLA OUTBREAK 

Since the declaration of the outbreak of Ebola virus disease (EVD) in the Democratic Republic of Congo (DRC), Nigeria has continued to improve the level of preparedness in the country. The Emergency Operations Centre at the Nigeria Centre for Disease Control (NCDC) remains on alert mode, closely monitoring the situation in the DRC. 

This week, preparedness activities in Nigeria were focused largely on strengthening screening measures at the major ports of entry, as well as capacity building of responders.  

The Port Health Services (PHS) of the Federal Ministry of Health which is responsible for the provision of health and related services at the National Ports of Entry (PoE) held a meeting, aimed at increasing awareness among ports of entry stakeholders. 

The screening processes for passengers were assessed at the Murtala Muhammed International Airport (MMIA), Lagos and Nnamdi Azikiwe International Airport (NAIA), Abuja. Staff at the PoEs were re-trained and mentored on how the appropriate screening processes should be carried out at the airports following the assessment. A training of Trainers was also carried out for PHS State Coordinators and heads of formations on improving surveillance activities. 

In the coming week starting on the 4th of June 2018, there will be a training of clinicians and other health workers, who have been identified as first responders in the event of an outbreak of EVD. A major outcome of the training is to build the capacity of a team of first responders who will be ready and prepared to respond to any infectious disease outbreak or public health event.  

The Nigeria Centre for Disease Control (NCDC) is committed to ensuring that all efforts are geared towards improving preparedness for all outbreaks/public health events as part of its mandate to protect the health of Nigerians. For more information on preparedness activities, kindly visit: www.ncdc.gov.ng 

SUMMARY OF REPORTS 

In the reporting week ending on May 20, 2018:  

o There were 164 new cases of Acute Flaccid Paralysis (AFP) reported. None was confirmed as Polio. The last reported case of Polio in Nigeria was in August 2016. Active case search for AFP is being intensified as Nigeria has reinvigorated its efforts at eradicating Polio. 

o 190 suspected cases of Cholera were reported from 11 LGAs in seven States (Adawama – 100, Bauchi – 22, Borno – 20, FCT – 1, Kaduna – 2, Kano – 44 & Zamfara - 1). Of these, 17 were laboratory confirmed and 17 deaths were recorded. 

o 11 suspected cases of Lassa fever were reported from ten LGAs in six States (Adamawa – 3, Anambra – 2, Edo – 1, Osun– 1, Plateau – 3 & Taraba - 1). Three were laboratory confirmed and one death was recorded.  

o There were 19 suspected cases of Cerebrospinal Meningitis (CSM) reported from 12 LGAs in five States (Borno – 5, Ebonyi – 2, Katsina – 10, Nasarawa – 1 & Yobe – 1). Of these, no was laboratory confirmed and no death was recorded. 

o There were 284-suspected cases of Measles reported from 29 States. No laboratory-confirmed and no deaths recorded.  

In the reporting week, all States sent in their report except Delta State. Timeliness of reporting remains 89% in both the previous and current weeks (week 19 & 20) while completeness increases from 99% to 100% at the same period. It is very important for all States to ensure timely and complete reporting at all times, especially during an outbreak.

Nigeria: NCDC epidemiological update, week 12

Via NCDC: Improving laboratory response to future outbreaks. Excerpt:

The Lassa fever outbreak continued in Epi-week 12 with a total of 1,613 suspected cases reported across 12 states. Of this, 403 cases were classified as 394 confirmed case and 9 probable cases with 104 deaths (95 in Lab confirmed and 9 in probable) giving a case fatality rate of 24.1%.  

In this reporting week, two states (Osun and Gombe) each reported a confirmed case, bringing them back to the active phase of the outbreak. This was made possible through the ongoing surveillance in the inactive states, despite having exited from the active phase of the outbreak. Evidently, surveillance activities have increased across all affected states with a major outcome being the number of suspected cases identified and tested, despite leaving the peak period of the Lassa fever outbreak season. 

As the outbreak response is ongoing, the Laboratory pillar of the National Lassa fever emergency operations centre (LF-EOC) organized a 2day meeting to discuss issues arising in outbreak response with a view to improving laboratory processes with respect to sample management and diagnostics. Participants were Laboratory and case management experts drawn from the Nigeria Centre for Disease control (NCDC), World Health Organization (WHO), United States Centres for Disease Control and Prevention(US CDC), Public Health England (PHE), Bernard Nocht Institute for Tropical Medicine (BNITM) as well as the Laboratory scientists and key stakeholders from the Lassa fever testing Laboratories in Nigeria:-National Reference Laboratory (NRL) Gaduwa, Irrua Specialist Teaching Hospital (ISTH), Lagos University Teaching Hospital (LUTH) and Federal Teaching Hospital Abakaliki (FETHA). The outcome of this meeting includes: 

1. Development of a national diagnostic testing algorithm 

2. Development of principles for the implementation of operational research during emergency response  

3. Identifying key areas of collaboration to strengthen laboratory capacity 

In this outbreak, many lessons have been learnt in the course of diagnosing Lassa fever cases and the meeting, a first of its kind, was aimed at addressing challenges and preparing for the future in the area of Lassa fever diagnostics and research.  

SUMMARY OF REPORTS 

In the reporting week ending on March 18, 2018: 

o There were 164 new cases of Acute Flaccid Paralysis (AFP) reported. None was confirmed as Polio. The last reported case of Polio in Nigeria was in August 2016. Active case search for AFP is being intensified as Nigeria has reinvigorated its efforts at eradicating Polio. 

o 175 suspected cases of Cholera were reported from six LGAs in four States (Bauchi – 112, Borno – 40, Ebonyi – 21 & Kaduna – 2). Of these, 15 were laboratory confirmed and five deaths were recorded.  

o 18 suspected cases of Lassa fever were reported from ten LGAs in seven States (Bauchi – 2, Ebonyi – 3, Ekiti – 2, Gombe – 3, Ondo – 3, Plateau – 1 & Taraba - 4). Two were laboratory confirmed and one death was recorded. 

o There were 166 suspected cases of Cerebrospinal Meningitis (CSM) reported from 59 LGAs in 16 States (Adamawa – 2, Borno – 6, Cross River – 2, Ebonyi – 2, Gombe - 4, Jigawa – 5, Kaduna – 2, Kano – 4, Katsina - 58, Kebbi – 13, Niger – 1, Oyo – 2, Sokoto – 11, Taraba – 1, Yobe - 5 & Zamfara - 48). Of these, seven were laboratory confirmed and 13 deaths were recorded. Ongoing surveillance for CSM has been intensified in all the 26 States in the Nigeria meningitis belt and case-based surveillance commenced from 4th December 2017 

o There were 605 suspected cases of Measles reported from 36 States. None was laboratory confirmed and two death were recorded.  

In the reporting week, all States sent in their report. Timeliness of reporting remains 86% in both previous & current weeks (week 10 & 11, 2018) while completeness increases from 99% to 100% at the same period. It is very important for all States to ensure timely and complete reporting at all times, especially during an outbreak.