H5N1

In worsening Ebola outbreak, many Congolese are shunning Canadian-developed vaccine

Via The Globe and Mail, an excellent report by Geoffrey York: In worsening Ebola outbreak, many Congolese are shunning Canadian-developed vaccine. Excerpt:

New data show that the experimental Ebola vaccine, developed at Winnipeg’s microbiology laboratory, has been remarkably effective in preventing the virus. About 100,000 doses of the vaccine have been administered in the latest outbreak, and it has had a 97.5-per-cent protection rate among those who took it, the data released by the World Health Organization show.  

But a “huge portion” of the Ebola infections are among those who refuse to take the vaccine, and nearly 10 per cent of those who could be exposed to the virus are refusing to take the vaccine, according to Michael Ryan, executive director of the WHO’s health emergencies program.

“There have been, tragically, some refusals among even health workers to be vaccinated,” Dr. Ryan told a media briefing on Friday in Geneva. “We have to get the message to communities that this vaccine is highly effective.”  

There is mounting concern that health workers and government officials have been unable to dispel the suspicion and fear among communities where Ebola is spreading, in the North Kivu and Ituri provinces of eastern Congo. 

Because of mistrust of the medical system and the government, many people are refusing to seek treatment when they become ill, and many die without any treatment, which can further spread the virus. Over the past week, about 40 per cent of newly detected cases were among people who died in their communities before their virus was detected.  

The mistrust is largely because of a decades-long history of neglect, poverty, armed conflict and traumatization in the region. More than 20 armed groups are active in the two provinces. Much of the region was excluded from Congo’s election in December because of the Ebola outbreak, adding to the sense of alienation and resentment. Five Ebola treatment centres in the region have been attacked and damaged, and many health workers have been assaulted. Police and soldiers have been deployed to protect health workers or to compel people to comply with health measures, causing more mistrust and pushing some people into hiding when they become ill.  

A survey in the region, published in the medical journal Lancet, found that nearly half of respondents believed that Ebola didn’t exist or was invented to destabilize the region or to make money. People with those beliefs were far less likely to seek Ebola treatment. And about one-third of all respondents were unwilling to take the Ebola vaccine. 

“More than eight months into the outbreak, the situation is alarming,” said a statement by Médecins sans frontières (Doctors Without Borders). “It is clear that the outbreak is not under control.”

MSF is calling for urgent changes. The Ebola response should be integrated into local health centres, allowing people to choose health care in their own communities, instead of requiring them to travel to a formal Ebola treatment centre, MSF said.  

The International Red Cross Federation, which has 700 volunteers working in the Ebola zone, has issued a warning about the rising number of Ebola deaths among those who don’t seek care. “This is a very distressing development,” said Emanuele Capobianco, director of health and care at the Red Cross federation.  

“The bottom line is that Ebola is now spreading faster, and many people are no longer seeking care. It is clear that some vulnerable communities do not trust Ebola responders.”

DR Congo: 'Ebola is spreading faster, and many people are no longer seeking care'

Via ReliefWeb, a report from the IFRC: DR Congo: “Ebola is spreading faster, and many people are no longer seeking care”.

Nairobi/Geneva, 11 April 2019 –The deadly Ebola outbreak in the Democratic Republic of the Congo is worsening as trust in the response effort falters, says the International Federation of Red Cross and Red Crescent Societies.  

This warning follows confirmation of 18 new Ebola cases on Tuesday (9 April) – the highest single day figure in the now eight month-long outbreak. DR Congo’s Health Ministry also reported that 10 died people from Ebola on Tuesday, including eight who died in their communities having not sought treatment and support. 

“This is a very distressing development,” said Emanuele Capobianco, IFRC’s Director of Health and Care. “The bottom line is that Ebola is now spreading faster, and many people are no longer seeking care. It is clear that some vulnerable communities do not trust Ebola responders.”  

Redoubling efforts to engage with these communities is critical, according to Capobianco. 

“Trust can be built by going community to community, working with local leaders and villagers, listening to their concerns with empathy, and incorporating their feedback and preferences into how we work,” he said. 

In-depth community engagement is central to the Red Cross operation in North Kivu and Ituri provinces in eastern DR Congo, where more than 700 Red Cross volunteers from Ebola-affected communities are at work. They have reached more than 1 million people with locally adapted information and have collected more than 130,000 “pieces” of community feedback. 

“Our research and experience show that when in-depth community engagement takes place, acceptance of outside assistance improves significantly,” said Capobianco.  

For example, intense community outreach and engagement in and around the city of Butembo has had a direct and significant impact on the willingness of communities to welcome, and in some cases, request Red Cross ‘safe and dignified burial teams’. The safe burial of people who have died from Ebola is a critical intervention in preventing disease spread, as dead bodies are particularly infectious. 

The efforts of the Red Cross and other responders are also hampered by considerable funding shortfalls. Last month, the International Red Cross and Red Crescent Movement – IFRC, and the International Committee of the Red Cross – launched a revised emergency appeal for 31.5 million Swiss francs to support response activities in DR Congo as well as preparedness activities in neighbouring countries. So far, only 11.1 million Swiss francs have been received.

MSF: Rwandan genocide 25 years on

Via MSF.org: Rwandan genocide 25 years on. Excerpt:

During the period 1994 to 1997, MSF teams providing assistance against a background of extreme violence and wholesale slaughter in the Great Lakes region found themselves faced with a succession of unprecedented situations. Before then, the teams had been mainly working in refugee camps and health centres some distance from the fighting and massacres. As the genocide against the Rwandan Tutsis was set into motion, our teams in Kigali and other places across the country witnessed the first executions. Almost 200 members of our Rwandan staff were murdered, some of them in front of their colleagues. 

When MSF teams finally succeeded in assembling the resources required for an aid operation—in this case, a surgical programme—patients were either killed before their very eyes or a few hours after they left.   

After their military defeat in mid-1994, the perpetrators of the genocide retreated to Zaire (now known as Democratic Republic of Congo), taking the same route as hundreds of thousands of Rwandan Hutus fleeing the country because they had been threatened or feared reprisals from the rebellion. MSF staff members not only had to contend with a health disaster brought on by the combined effects of cholera and dysentery, but also the violence meted out by militiamen who seized control of the camps.

In 1995, seeing that humanitarian aid was being diverted to the benefit of the perpetrators of the genocide, we took the decision to suspend our work in the camps in Zaire. These camps then came under attack from the recently formed Rwandan army and its Congolese allies. Hutu refugees were hunted down, often over hundreds of kilometres, and then executed. Our teams, who became more and more vocal in denouncing these atrocities, at times unwittingly served as bait to incite the refugees to come out of the forests where they were hiding.   

Under these conditions, and faced with genocide and mass crimes, how did our teams react? We called for military intervention, condemned an unacceptable situation, stayed put in camps where aid was misappropriated, and assessed the risks involved in helping people threatened with death… 

These were the many issues that MSF teams had to grapple with, as much in the field as during the internal discussions which gripped the whole organisation.

MSF in Yemen: Medical admissions in Aden suspended after patient kidnapped and killed

Via MSF.org: Medical admissions in Aden suspended after patient kidnapped and killed. Excerpt:

• We have put on hold the admission of all patients to Al Sadaqah hospital in Aden following the kidnapping and killing of a patient. 

• The latest incident follows a series of threats and security incidents involving patients and staff. 

• We are very worried about the deteriorating security situation during an extremely busy period for the hospital. 

On the morning of 2 April 2019, a group of armed men threatened guards and medical staff at Médecins Sans Frontières’ (MSF) emergency trauma hospital in Aden, Yemen before entering the building and kidnapping a patient who had been admitted the previous day and was due to undergo surgery. Later the same day, the patient was found dead on a street in the city’s Al Mansoura district.   

This incident follows a number of threats and security incidents, involving both patients and staff, which have occurred since the start of the year at our hospital in Aden. It comes at a time when the hospital is particularly busy as a result of escalating violence in Aden.

“Following this incident, we have no choice but to suspend the admission of patients until further notice,” says Caroline Seguin, MSF’s programme manager for Yemen. “Over recent weeks, the hospital has been functioning at full capacity, particularly the emergency room and intensive care unit, following an escalation of violence in the city.”  

“This suspension comes at a critical time for patients and their families from Aden, as well as patients from Hodeidah and Taiz governorates, from where we receive war-wounded in need of urgent surgical care on a daily basis,” says Seguin. 

“We are extremely worried by the deteriorating security situation inside Aden and its consequences for our medical activities, as incidents like these endanger the lives of both patients and staff.”  

As Congo Ebola cases pass 1,000, growing calls to listen to locals when responding

Via The New Humanitarian: As Congo Ebola cases pass 1,000, growing calls to listen to locals when responding. Excerpt:

As the world’s second-deadliest Ebola outbreak ever continues to ravage communities in the Democratic Republic of Congo, international aid groups are reconsidering the way they respond after a string of attacks by armed assailants on health centres.  

Five Ebola treatment centres have been attacked in quick succession in recent weeks, as Congo struggles to contain an eight-month epidemic in the restive eastern provinces of North Kivu and Ituri, where mistrust is reportedly growing among local communities.  

This week, the number of cases since the first – believed to be the unsafe burial on 25 July of a woman in the North Kivu town of Mangina – passed 1,000. At 634, the death toll is second only to the 2013-2016 epidemic in West Africa, which claimed more than 11,000 lives. 

After attacks on its facilities in late February and early March, Médecins Sans Frontières announced the suspension of activities at two clinics near the epicentre, in the North Kivu towns of Butembo and Katwa, where its infirmaries were destroyed.  

The attacks were a “wake-up call and need to be a game-changer for us,” Joanne Liu, international president of MSF, told The New Humanitarian on the sidelines of a press conference in Geneva earlier this month. 

“We (need to) take the time to reflect and ask: how did we get there, what did we get wrong, how are we going to change,” Liu said.  

At another Geneva press conference, World Health Organisation Director-General Tedros Adhanom Ghebreyesus applauded the commitment of local Ebola responders in North Kivu, which in March he visited for the second time. 

He acknowledged the importance of community engagement and local capacity-building, which he said were integrated into the WHO’s latest Strategic Response Plan for Ebola.  

After reports that some people in North-Kivu and Ituri can’t understand why they are only being helped now, Tedros sought to provide reassurances that the WHO would not leave the region as soon as the Ebola outbreak is over.  

“Our goal should be to help them not only with Ebola, but with the development of their health system,” he said. “That is what they are asking for, and that is what we should do.”

DR Congo registers record 15 new Ebola cases in one day

Via Reuters: Congo registers record 15 new Ebola cases in one day. Excerpt:

GOMA, Democratic Republic of Congo (Reuters) - Democratic Republic of Congo on Friday recorded 15 new confirmed cases of Ebola, the biggest one-day rise since the current outbreak was declared last August, the health ministry said.  

Coming a day after 14 new cases were confirmed, the number means the outbreak is on track to register one of its highest weekly case totals, despite health officials saying as recently as two weeks ago that it was largely contained and could be stopped by September. 

Health workers have brought new tools to the fight against the latest epidemic of the hemorrhagic fever, including a vaccine and several treatments, but community mistrust of first responders and militia violence have set back the campaign.

Five Ebola centers have been attacked since last month, sometimes by armed assailants. The violence led French medical charity Medecins Sans Frontieres (MSF) to suspend its activities at the epicenter of the outbreak last month.

Canadian Red Cross sends team of health workers to Mozambique amid humanitarian crisis

Via The Globe and Mail, Geoffrey York writes: Canadian Red Cross sends team of health workers to Mozambique amid humanitarian crisis. Excerp:

The Canadian Red Cross is sending an emergency field hospital and a team of 25 Canadian health workers to battle a growing humanitarian crisis in Mozambique after a devastating cyclone. 

There are fears of cholera outbreaks and rising malaria infections from the massive flooding in the wake of Cyclone Idai. Stagnant water stretches across 3,000 square kilometres of the country. Several hundred thousand people have lost their homes in the biggest humanitarian disaster in Mozambique’s recent history, and an estimated 1.8 million people need urgent aid, according to the United Nations. 

About 55 health centres in the country have been severely damaged, the World Health Organization said Tuesday. The WHO is sending 900,000 doses of cholera vaccines and 900,000 bed nets to Mozambique to prepare for an expected surge in cholera and malaria cases. Some cholera cases have already been reported.  

Senior UN officials have said the cyclone and flooding may have been the worst weather-related disaster ever to hit the southern hemisphere. The Red Cross has warned that the threat of water-borne diseases such as cholera and malaria is a “ticking bomb” for the region. 

The Canadian Red Cross field hospital, including 53,000 kilograms of medical supplies and three Land Cruisers for mobile health delivery, was flown out of Canada on a Boeing 747 cargo airplane Tuesday and will arrive in Mozambique on Wednesday, along with the 25 health workers and other aid workers. 

Their goal is to help restore medical care in a country where basic services have been drastically disrupted, many clinics do not have electricity and the threat of water-borne diseases is looming.  

“We want to prevent a second disaster from happening,” said Chiran Livera, operations manager at the Canadian Red Cross. 

Mozambique’s doctors and nurses have been working non-stop and are suffering a “tremendous strain,” the Red Cross said.

MSF in Yemen: Forty-nine wounded and two dead after four days of heavy fighting in Taiz city

Via MSF.org: Forty-nine wounded and two dead after four days of heavy fighting in Taiz city. Excerpt:

Four days of intense fighting in the Yemeni city of Taiz has left people unable to access healthcare, with at least one public hospital forced to close. Médecins Sans Frontières (MSF) warns that urban warfare in densely populated areas is having devastating consequences for civilians and is preventing war wounded from accessing lifesaving care in Taiz city.   

“We are worried that wounded people are trapped between frontlines, and many of them are not able to reach health facilities inside or outside of the city,” said Caroline Ducarme, MSF Head of Mission in Yemen. 

“Across three MSF-supported facilities within Taiz city, medical teams have received 49 war wounded and two dead upon arrival over the last four days. However, we do not know the true total number of wounded in need of emergency assistance.”  

There have been reports of a hospital being damaged due to fighting nearby. Additionally, one of the public hospitals in Taiz has been forced to close due to fighting, making it even harder for people to access urgent medical care. 

In one MSF-supported public hospital, medical teams reported that a severely wounded patient was forcibly taken out of the operating theatre and prevented from receiving much needed medical care. This is simply unacceptable.

"We are worried that wounded people are trapped between frontlines, and many of them are not able to reach health facilities inside or outside of the city," said Caroline Ducarme, MSF Head of Mission in Yemen.

“There is a continued need for increased protection of health facilities,” said Ducarme. “Patients tell us that they can’t access hospitals due to clashes and roadblocks, and there is a fear that hospitals may be attacked. As a result of this fear, people are taking their relatives out of hospitals. Some medical staff have left their jobs as they are so afraid for their safety.” 

Millions of children at risk as death toll rises in Philippines measles outbreak

Via ReliefWeb, a report from the IFRC: Millions of children at risk as death toll rises in Philippines measles outbreak. Excerpt:

An estimated 3.7 million children under five in the Philippines are at risk during a measles outbreak that has already claimed 286 lives, most of them children or babies, the Red Cross is warning. 

Deaths from measles are already 42 per cent higher this year than for all of 2018, when 202 people died. It is estimated that 3.7 million children under five in the Philippines have never been vaccinated and have no protection to the highly contagious virus, which is still spreading. Health experts estimate that every person sick with the measles could infect up to 18 others. 

Philippine Red Cross Chairman Richard Gordon said: "We are in the grip of a measles outbreak that, tragically, is hitting the very young hardest. The Red Cross has been crucial in restoring people's confidence in vaccines, which makes it easier now to convince parents to get their children vaccinated. But we are aiming for a 100 per cent immunisation rate." 

Of 286 deaths so far this year, 110 have been of babies under nine months old. The median age of those who've died is just two years old.  

Since 10 February, the Philippine Red Cross, supported by the International Federation of Red Cross and Red Crescent Societies (IFRC), has been working with the Department of Health to support patients and their families. The Red Cross has set up tents with cots and bedding to reduce over-crowding and give care to measles patients. It has set up welfare desks, portable water and sanitation facilities, and hygiene equipment inside hospitals. 

The Red Cross has also called for volunteer doctors and nurses to help during a mass vaccination campaign. The aim is to ensure vaccination of all children aged six months to five years.

Branswell: Ebola response is working, WHO director-general says, amid criticism

Via STAT, Helen Branswell writes: Ebola response is working, WHO director-general says, amid criticism. Excerpt:

The director-general of the World Health Organization said Thursday that health officials are making progress against the Ebola outbreak in the Democratic Republic of the Congo and that the footprint of the outbreak zone is actually contracting.  

The cautiously hopeful remarks from Tedros Adhanom Ghebreyesus, who visited the outbreak zone last week, came just hours after the most recent attack on an Ebola treatment center, one in a series that has plagued efforts to bring this outbreak, now in its eighth month, to an end.  

As of Wednesday, there have been 927 cases in the outbreak and 584 deaths, making this the second largest Ebola outbreak on record. But Tedros, as he is known, said he is convinced the Congolese government and the international partners working on the response will get the job done. 

“Their dedication is unparalleled,” he said during a Geneva press conference. “The global community must stay the course.”

His optimism is not universally shared. Dr. Joanne Liu, international president of the medical group Doctors Without Borders, criticized the Ebola response efforts last week, insisting that the current approach was failing to bring the outbreak under control. The group withdrew its staff from two cities in the DRC, deeming it too dangerous to stay, after attacks last month on Ebola treatment centers that Liu’s organization was operating. 

“We’re not sure that if we keep doing what we’re doing [it] will lead us to the end of things,” Liu said during a press conference. 

Tedros did not mention Liu by name, but he did object to suggestions that the outbreak response is failing. He noted the average weekly case count has dropped from 50 in January to 25.  

The virus has not as yet spread to other parts of the Congo or to neighboring countries, which have prepared for that possibility by vaccinating health workers at facilities near the border they share with DRC. And within the outbreak zone, transmission has been contained in a number of locations, Tedros said, with Butembo and Katwa remaining as active hot spots.