H5N1

MSF withdraws staff as security in Ebola-affected Biakato deteriorates

A statement from MSF.org: MSF withdraws staff as security in Ebola-affected Biakato deteriorates.

On 4 December 2019, Medecins Sans Frontières (MSF) took the painful decision to temporarily withdraw our staff from the Biakato region of Ituri province, Democratic Republic of Congo. After months of working extremely closely with the community to address the health needs in the region, MSF is saddened to have made this decision.  

In the early morning of 3 December, a group of people armed with sticks and machetes entered Biakato health centre. They didn’t reach the Ebola Treatment Centre which is located within the health centre, and no one was injured.  

During the same night, a group of people also armed with sticks and machetes attempted to enter the MSF compound in Biakato Mines. Rocks were thrown at the compound for a brief period, but no one was injured.  

These events follow the deadly attack against Ebola responders in Biakato during the night of 27/28 November. In the days after the attack, MSF remained in the area to provide medical care in local health centres, as well as in the Biakato Mines Ebola Treatment Centre, in collaboration with the Ministry of Health. As many Ebola responders and organisations had evacuated the area, and access to healthcare was extremely limited for people, the situation became challenging over a couple of days. 

MSF has been providing healthcare in the Biakato region since 2016. During the current Ebola outbreak, we have worked closely with the Biakato community to identify and help respond to the Ebola and non-Ebola health priorities in the region, including the rehabilitation of wells and the construction of a paediatric ward.  

In support to the Ministry of Health, we have also provided access to free primary healthcare and inpatient paediatric care. In November 2019, still in cooperation with the Ministry of Health, MSF built and managed an Ebola Treatment Centre in Biakato. 

MSF cannot work if the security of our staff and patients is not ensured. It is not clear yet who was responsible for the attempted intrusion on the compound or into the health centre, nor are the motivations behind those actions clear.  

As we are not currently able to guarantee that the necessary security conditions to work have been met, MSF decided to temporarily withdraw our staff from the Biakato region. The decision to leave this community, with whom we have worked very closely over the past few years, was extremely hard to take. 

Prior to departure, we ensured that the necessary materials were given to the Ministry of Health, to enable them to continue the activities we had been undertaking in collaboration, to ensure the community continues to have access to the medical care they need. MSF will re-assess the situation and we hope to be able to return to Biakato soon.

MSF opens trauma hospital amid Haiti’s deepening health crisis

Via MSF.org: MSF opens trauma hospital amid Haiti’s deepening health crisis. Excerpt:

PORT-AU-PRINCE, HAITI — A deepening political and economic crisis is putting a severe strain on all aspects of medical care in Haiti, Médecins Sans Frontières (MSF) said today as we announced the opening of a hospital in Port-au-Prince for patients with traumatic injuries. 

The hospital, which opened on 27 November in the Tabarre area of Port-au-Prince, specialises in treating patients with life-threatening injuries, including open fractures and gunshot wounds. In its first five days of operations, the hospital admitted 21 patients, about half of whom had injuries from violence.  

"We are responding to a vital need with the opening of the Tabarre emergency trauma hospital, but this will not be enough," said Jane Coyne, MSF head of mission in Haiti. "The country is undergoing a severe economic and political crisis, and hospitals are struggling to stay open." 

MSF originally opened a hospital in Tabarre in 2012 to provide emergency care to people with traumatic injuries in the years following the Haitian earthquake. The hospital, named "Nap Kenbe," progressively reduced its services in recent years and admitted its last patient in late 2018.  

Since September, when Haiti's economic and political crisis deepened, MSF has decided on a new initiative to care for patients with life-threatening injuries, which the Haitian medical system now struggles to treat. 

Working in the same location in Tabarre, the new MSF hospital currently employs 170 medical personnel, including eight surgeons. After opening with 25 beds, the hospital is preparing to increase its capacity to 50 beds. 

As economic troubles and political tensions have intensified, medical facilities, including those operated by MSF, have struggled to meet the needs of patients. Since September, streets have regularly been blocked by barricades made of burning tyres, cables and even walls built overnight. These have made it more difficult for ambulances to move and for medical facilities to receive fuel, oxygen, blood, medicines and other supplies.

MSF's medical facilities in Haiti are seeing a high level of need amid the current crisis. So far in 2019, MSF's emergency stabilisation centre in the Martissant area of Port-au-Prince has received an average of 230 patients per month with gunshot wounds, lacerations or other injuries from violence. MSF's hospital in the Drouillard area of Port-au-Prince saw a peak in activity in September, when it admitted a total of 141 patients with severe burns, primarily caused by accidents. 

Insecurity affects health care workers as well. For months, the national Haitian ambulance service has experienced repeated incidents affecting its ability to respond to medical emergencies. 

To keep MSF's health facilities functioning during the tensions of recent months, MSF has needed to transport hundreds of staff to work each day in MSF vehicles. 

"Thanks to the positive reputation of MSF in Haiti, our vehicles are generally respected and are able to pass through the barricades," said Ella Lambe, MSF project coordinator in the town of Port-à-Piment. "However, some health centre where we have referred our patients have been looted, and some of our vehicles have been hit with stones."

Ebola fight in Beni: MSF renews its commitment to support the population

Via Radio Moto Butembo-Beni: Ebola fight in Beni: MSF renews its commitment to support the population. The Google translation:

Médecins Sans Frontières (MSF), an NGO, is responding to the threats that Ebola response teams are facing these days. The organization advocates for the safety of health care workers so that they can effectively contribute to the Ebola response and the care of several other patients in the framework of free healthcare.   

MSF remains in Beni at the request of the population. Regardless of ADF threats, it remains active. Despite the departure of other NGOs, this organization is resisting.  

"MSF is still in Beni. I think the people of Beni still need it. And we are still in contact with this population because if MSF is there it is to support the population of Beni by offering care ... We felt it was important that we still stay in Beni to support this population in distress," said the MSF coordinator in Beni city.  

MSF also promises to strengthen donations of medicines that can treat the wounded in six health centers and carry out other actions of Beni's general reference hospital. 

"In Beni we support some health centers where people can access quality primary health care in a free way. This is the first activity we have in Beni. And apart from that, our teams promise to strengthen the response to the care of the wounded, if necessary. And for prevention measures, MSF is preparing a donation of dressing pledges for injuries to at least 6 health centers while working with Beni General Hospital, " said Pamphyle BASHIMBE.

DRC Ebola: In one week more than 245 people have already received the Johnson & Johnson vaccine in Goma

Via provinces26rdc.net: DRC-Ebola: in one week more than 245 people have already received the Johnson & Johnson vaccine in Goma. Excerpt from the Google translation:

50,000 people are affected by this vaccination which will last 4 months. Until Monday, November 18, 245 people are already vaccinated including 172 adults including 50 women and 23 children aged 5 to 18 years. 

The NGO Doctors Without Borders (MSF), responsible for the implementation of the study Johnson & Johnson Clinic, notes with satisfaction the ownership of this study by the Kahembe and Majengo health area population in Goma, North Kivu. The campaign to introduce this new vaccine into the Ebola response started on Thursday, November 14th.  

"It's going very well. People come slowly and gradually, which is still quite interesting for us. And then, we avoid a large crowd that can not be vaccinated. And everything happens in a calm and very respectful way. I am very happy with this start of vaccination. For the moment, no incidents. People who come have a desire to get vaccinated because it's voluntary. So, those who do not agree do not come. For the moment, it is going very pleasantly and cordially," explains Véronique Urbaniak, coordinator of the Ebola vaccination project at MSF. 

Vaccination is performed by muscle 0.5 ml, in the deltoid muscle of the forearm. Monitoring the safety of the vaccine regimen in completed or ongoing studies has not revealed any safety concerns. 

"Our community engagement teams have been active in the neighborhoods for over a month. Now, meeting people, associations that are influential in the neighborhoods, explaining, going door-to-door, doing meetings to answer all the questions, the public could have and try to bring them the answers the more transparent possible," adds Véronique Urbaniak. 

The early onset of the immune response occurs after the first dose. It is after the second dose, given 56 days after the first, that the substantial increase in antibody response develops. ELISA data (an immunoassay technique that allows the detection and measurement of antibodies) show the persistence of antibodies up to two years after the second dose. 

This vaccination is made with the vaccine Ad26.ZEBOV / MVA-BN-Filo, produced by the firm Janssen Pharmaceuticals for Johnson & Johnson. It was approved on 22 October 2019 by the Ethics Committee of the School of Public Health of the University of Kinshasa and, on 23 October 2019, by the National Ethics Committee.

DRC Ebola: CMRE update, November 14

CMRE has published Situation épidémiologique du 14 novembre 2019. Excerpt from the Google translation: 

EVOLUTION OF THE EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI AT NOVEMBER 13, 2019 

Thursday, November 14, 2019 • Since the beginning of the epidemic, the cumulative number of cases is 3,292, of which 3,174 are confirmed and 118 are probable. In total, there were 2,193 deaths (2075 confirmed and 118 probable) and 1067 people cured. 

• 527 suspected cases under investigation; 

• 1 new case confirmed in North Kivu in Mabalako; 

• No new deaths of confirmed cases have been recorded; 

• No cured person has emerged from ETCs;  • 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

Ebola Virus Disease Comprehensive Response Coordination Announces Three Road Traffic Accident in Bunia, Ituri

• Overall Coordination of Epidemic Response to Ebola Virus Disease in North, South Kivu and Ituri was informed this Thursday, November 13, 2019 of the tragic accident of road traffic between two motorcycles, one of which carried three agents of the response;

• These three officers, who work for the Epidemiological Surveillance Commission at the Point of Entry and Control, were returning from Bunia to Mambasa, where they are respectively delivering;

• This accident occurred around Marabo in Bunia on the evening of Wednesday 13 November 2019;

• The balance sheet reports an officer who died at the scene and two others who were seriously injured, including one in a coma. The two wounded were taken to the Nyakunde Reference General Hospital in Ituri for appropriate care;

• The overall coordination of the response sends its deepest condolences to the grieving family and expresses all its compassion and solidarity to the injured officers, while wishing them a quick recovery.

Effective start of Johnson & Johnson vaccination in two Goma health areas

• Ebola vaccination with the Ad26.ZEBOV / MVA-BN-Filo vaccine, produced by Janssen Pharmaceuticals for Johnson & Johnson, started on Thursday 14 November 2019 in two Karisimbi health areas in the city of Goma, North Kivu province;

• The Epidemic Response Coordinator for Ebola Virus Disease in North, South Kivu and Ituri, Prof. For this purpose, Steve Ahuka Mundeke visited the vaccination sites to inquire about the evolution of activities in the field. He was satisfied with the work of the teams;

• He took the opportunity to invite the population of the targeted areas to be vaccinated in order to protect themselves from the resurgence of the Ebola virus;

• Several people were present in Majengo and Kahembe health areas to get vaccinated. The first person to be vaccinated is a Kahembe community leader who has been protected against the Ebola virus today and also in case of a possible new outbreak of Ebola. This community leader has appealed to all residents of his community and sites targeted to come take this second vaccine. "This is an opportunity not to be missed, because it is said that prevention is better than cure, " he said;

• The logistics of this vaccination are provided by the international non-governmental organization Médecins Sans Frontières of France (MSF / France).

• 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, this 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, the vaccine used until then in this epidemic. Manufactured by the pharmaceutical group Merck, after approval of the Ethics Committee on May 20, 2018, it was recently approved.

Closing of the training workshop for media professionals in Beni on the role and responsibility of journalists during public health crises

• The Deputy Mayor of the city of Beni, Muhindo Bakwanamaha Modeste, closed this Thursday, November 14, 2019 in Beni in the province of North Kivu the training of media professionals on the role and responsibility during public health crises;

• The coordinator of the Beni Ebola Ebola response, Dr Pierre Adikey, on behalf of the Coordinator of the Response, Prof. Steve Ahuka, wished to see these kinds of trainings be organized, not only in other sub-Coordination of the response, but also throughout the Democratic Republic of Congo so that journalists from all over the country are ready to face any possible epidemic crisis;

• This training, he said, is part of the zero-case Ebola strategy and strengthening the health system of tomorrow;

• The focal point of Beni's journalists, Moustapha MULONDA, reaffirmed the commitment of journalists to combat Ebola Virus Disease through various programs and publications disseminated and published by their respective media thanks to the new tools acquired during this period. training;

• This training was organized by the Ministry of Health in collaboration with the World Health Organization and benefited from the facilitation of the overall coordination of the response, UNICEF, CDC Africa and MSF.

VACCINATION

• Since the start of vaccination on August 8, 2018 with the rVSV-ZEBOV vaccine, 251,637 people have been vaccinated;

• Vaccination with the second Ad26.ZEBOV / MVA-BN-Filo vaccine, produced by Janssen Pharmaceuticals for Johnson & Johnson, began on Thursday November 14, 2019 in Goma. This vaccine was approved on 22 October 2019 by the decisions of the Ethics Committee of the School of Public Health of the University of Kinshasa and 23 October 2019 of the National Ethics Committee;

• Until then, only one vaccine was used in this outbreak. This is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, after approval of the Ethics Committee in its decision of 20 May 2018 and which has recently been approved.

MONITORING AT ENTRY POINTS

• A 27-year-old woman from Butembo for Goma, an escaped suspect from Makasi Hospital in Butembo, North Kivu, was intercepted at the Kanyabayonga checkpoint in Kayna. When she was intercepted, she experienced signs such as fever at 38.4°C, severe asthenia, abdominal pain and vaginal bleeding. She was sent to the KAYNA Transit Center.

• Since the beginning of the epidemic, the total number of travelers checked (temperature rise) at the sanitary control points is 116,622,388 ;

• To date, a total of 112 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.

DRC Ebola: The Johnson & Johnson vaccine actually administered on Thursday in two health areas in Goma

Via Actualite.cd: DRC-Ebola: The Johnson & Johnson vaccine actually administered on Thursday in two health areas in Goma. Excerpt from the Google translation:

The Ebola vaccination campaign with the second vaccine, Johnson & Johnson, began this Thursday in Goma (North Kivu). It concerns, initially, two districts located to the north of the city, namely Majengo and Kahembe. 50,000 adults and minors are targeted. Pregnant and lactating women are also eligible for this vaccine, with a particularity, they will be followed until three months after delivery. 

"We are very pleased that starting today, immunization activities with the second vaccine can begin to contribute to the Ebola response. The importance of this vaccine for which we ask all the interested population to come to receive is that it complements the first vaccine that has been used since the beginning of the epidemic and for which we know that the effectiveness is good. We want to supplement it in areas where there is no contamination and continue to immunize or protect a large number of our fellow citizens," said Professor Steve Ahuka, coordinator of the Ebola response. 

MSF is responsible for the field implementation of the clinical study. For several weeks, Médecins Sans Frontières (MSF) community engagement teams have been on the ground to inform and answer questions from community members in the Majengo and Kahembe health districts. These districts have been identified in collaboration with the health authorities as the first areas to be vaccinated.  

"The people of Goma are really interested in this vaccination campaign. We do not force anyone to come. We are just trying to inform as objectively as possible about the advantages and disadvantages of participating in this study. Today, two sites have been opened. One in Majengo, one in Kahembe. The idea is that in the coming weeks to open six sites in these two health areas to have a full vaccination capacity. Afterwards, we will go elsewhere in the province according to the evolution of the epidemic," said Dr Véronique Urbaniak, coordinator of the Ebola vaccination project at MSF.

Rollout of Johnson & Johnson Ebola vaccine begins in Congo

Via Reuters: Rollout of Johnson & Johnson Ebola vaccine begins in Congo. Excerpt:

GOMA, Congo (Reuters) - Health authorities in eastern Congo have introduced a new Ebola vaccine produced by Johnson & Johnson, aid group MSF said on Thursday, to help combat the world’s second-worst outbreak of the virus on record.

New tools including vaccines have helped contain the outbreak, second only to the 2013-16 West African outbreak that killed more than 11,300, despite public mistrust and conflict affecting the response in parts of the region.  

The new vaccine, which has passed clinical trials but has never been tested in a real-world setting, will be administered to 50,000 people in Goma, a city of two million on the Rwandan border, Médecins Sans Frontières (MSF) said in a statement. 

The vaccine, which requires two injections eight weeks apart, will be rolled out alongside another manufactured by Merck, which only requires a single shot. The Merck vaccine has been administered to over 250,000 people since the start of the outbreak in August 2018. 

“The introduction of a second vaccine is not meant to replace [Merck’s] vaccine, but to complement it and hopefully provide us with an additional tool in the fight against future Ebola outbreaks,” said John Johnson, who is leading the project for MSF.

Yemen: MSF hospital partially destroyed in Mocha attack

Via MSF.org: Yemen: MSF hospital partially destroyed in Mocha attack.

Thursday, November 7, 2019 — Sana’a / Paris / London – A hospital run by Médecins Sans Frontières in Mocha, in southwestern Yemen, was partially destroyed on Wednesday evening when an attack hit the surrounding buildings including a military warehouse. 

At the time of the attack, around 30 patients and 35 staff were present in the hospital. Fortunately, no casualties were reported among them. Everyone was rapidly evacuated. The majority of stable patients were able to leave the area on their own, while some critical patients, including two new-born babies, were transferred by MSF teams to another hospital in Mocha.

The MSF hospital was severely damaged by the explosions and the fire which followed the attack which hit a nearby military warehouse. The pharmacy was burnt and the office buildings were destroyed, while damage has still to be assessed on some technical buildings including the one housing the power generator. The windows of the hospital wards were shattered by the force of the blasts. 

Medical activities in the hospital are currently suspended and a part of the medical team will be relocated to Aden. Given the risk of unexploded devices on the site, demining will be needed before any activity can restart.  

The location of the hospital had previously been communicated to all warring parties and authorities and was well known by all warring parties in the area since the hospital opened in 2018.  

MSF once again reminds that all parties to the conflict must proactively take all necessary measures to spare medical facilities.  

“It was only luck that no patients or staff were harmed in this attack; it could have been carnage,” said Caroline Seguin, manager of MSF programmes in Yemen. “As the hospital is currently out of commission, the people in the area are now without much-needed, often lifesaving, care.”  

MSF opened Mocha hospital in August 2018 to provide emergency surgical care for patients suffering from conflict-related injuries, as well as providing treatment of other surgical emergencies, such as caesarean sections for complicated deliveries.  

The 35-bed hospital is the only free-of-charge, civilian hospital providing these services in the Mocha area. 

Since the beginning of the year, a total of 1,787 patients were admitted to hospital, and 2,476 surgical procedures were performed, including 201 caesarean sections.

WHO scales up cholera vigilance in Khartoum, Sudan

WHO EMRO has published WHO scales up cholera vigilance in Khartoum, Sudan. Excerpt:

5 November 2019, Khartoum, Sudan -- To prevent a potential spread of the current cholera outbreak to Khartoum State – including to the country’s capital Khartoum City – and at the request of the Federal Minister of Health Dr Akram Eltom, WHO is working closely with health partners, nongovernmental organizations, and at-risk communities to ensure that suspected cases are quickly identified and responded to, and that people can effectively protect themselves from infection.   

“The risk of cholera spreading is very real. If not properly managed, this could have potentially serious consequences. More than 8 million people live in Khartoum State, where the public health system is impacted by the economic crisis, recent flooding, and ongoing outbreaks of infectious diseases,” said Dr Naeema Al Gasseer, WHO Representative in Sudan.  

As of 3 November, Sudan’s Ministry of Health reported 332 suspected cases of cholera, concentrated in Blue Nile and Sennar States. Two cases were confirmed in Khartoum State on 19 October.  

Together with the Ministry of Health, WHO has conducted initial risk mapping in Khartoum State to identify which areas are more likely to be at increased risk of an outbreak. This will allow for more informed planning to ensure high-risk areas, including Sharq Elnil and Ombada localities, are better prepared to respond as needed. 

Scaling up health capacities to detect and respond to cholera 

To ensure that health facilities and cholera treatment centres in Khartoum State are equipped to diagnose and treat suspected patients, WHO has delivered cholera medicines and supplies sufficient for 400 severely dehydrated patients, and 500 rapid diagnostic tests used for immediate detection and screening of cholera patients in health facilities.  

WHO is also supporting the establishing of 2 cholera treatment centres in Ombada and Bahri localities by providing additional cholera medicines, medical supplies, and rapid diagnostic tests.   

To strengthen disease surveillance in Khartoum State, WHO, with the support of MSF, is providing refresher training for 271 health staff and paramedics from all 7 localities on cholera detection and management. An additional 35 health staff are being trained to form rapid response teams who will be the first to respond to suspected cases at locality level.

Any let up in Ebola response could risk escalation of outbreak in DRC, warns IRC

Via the International Rescue Committee: Any let up in Ebola response could risk escalation of outbreak in DRC, warns IRC. Excerpt:

Goma, DRC, October 29, 2019 — As the daily number of reported Ebola cases continues to be in single digits, the International Rescue Committee (IRC) reaffirms that we must double down on our efforts to reach zero cases. Any let up in the response could risk a flare up of cases, and in turn prolong the outbreak. 

Dalia al-Awqati, Ebola Response Director in the Democratic Republic of Congo (DRC) at the IRC said: “Whilst we have seen the number of reported cases drop in the past weeks, cases continue to arise, and the challenges we face in controlling the spread are undiminished. We are walking on a tightrope. We know that it does not take much for cases in a new area to escalate quickly, as we have seen following previous lulls in cases in this outbreak. It only takes one infected person to travel to a new area to start a new transmission chain. Given the 21 day incubation period, the chances of this are relatively high.” 

Many of the areas in which the disease is now present represent a significant challenge to the response due to their remoteness and poor infrastructure, meaning curbing transmission continues to require significant effort. Increasingly we are working with small communities with pre-existing challenges such as lack of access to water and poor access to basic services.  

For example, to travel the 36km [22 miles] to Mayuwano from the small town of Mambasa in southwest Ituri province takes two hours on a good day. On a bad day the road is simply impassable. Once in Mayuwano, there is little infrastructure meaning that all materials for triages need to be brought along the increasingly damaged road, which the community also relies on. This example also brings to light the challenges that many people in North Kivu and southwest Ituiri face everyday, with or without an Ebola outbreak.