H5N1

330,000 Rohingyas and host community to get cholera vaccine in Cox’s Bazar

Via ReliefWeb, a report from the govenment of Bangladesh, WHO, and UNICEF: 330,000 Rohingyas and host community to get cholera vaccine in Cox’s Bazar. Excerpt:

Cox’s Bazar, Bangladesh, 17 November 2018: Nearly 330,000 Rohingyas refugees and Bangladesh host community will be vaccinated against cholera in a month-long campaign beginning today in the refugee camps in Cox’s Bazar and its nearby areas, to protect vulnerable population against the deadly disease amidst increased risk of flooding in the ongoing cyclone season.  

Led by the Ministry of Health and Family Welfare, with support of the World Health Organization, UNICEF, and partners such as Gavi, the vaccine alliance, the campaign aims to reach people who missed some or all previous cholera vaccination opportunities.  

“Despite the progress and efforts made by humanitarian agencies to improve water and sanitation conditions in Rohingya camps, cholera remain a concern. Oral cholera vaccination is the most effective way to protect such a large section and reduce the risk of disease outbreak,” says Dr Bardan Jung Rana, WHO Representative in Bangladesh.  

Nearly 2.2 million doses of oral cholera vaccines have been dispensed among Rohingya refugees and their host population through three massive vaccination campaigns since November 2017.

Fighting a polio outbreak in Papua New Guinea

Via The Lancet: Fighting a polio outbreak in Papua New Guinea. Excerpt:

After a long morning of organised chaos inside a crowded government compound in Papua New Guinea's capital Port Moresby, hundreds of health workers and volunteers are finally wrangled into teams, issued with instructions, and piled into a fleet of hard-worn four-wheel drives. 

As the first of four mass vaccination waves scheduled over October and November begins to push out across the Pacific nation, emergency teams are rolled out in the capital. The vehicles are loaded up with loud hailers and ice boxes full of oral polio vaccine. Before they head into the surrounding settlements, posters are hastily taped to the windows and doors: Stop Polio in PNG. 

An outbreak of vaccine-derived polio has been playing out across Papua New Guinea since June. It has been something of an embarrassment to the country's leaders, who have put millions of PNG kina into preparing the capital to host world leaders for the Asia-Pacific Economic Cooperation (APEC) summit, which began on Nov 12. After 30 years of international effort, the ambition of global polio eradication seemed tantalisingly close when it reached a record low of 118 cases last year. But cases are tracking higher than in 2017, with Papua New Guinea now accounting for 21 of 109 cases reported so far this year. 

This outbreak can be blamed on “the steady breakdown of the health system”, Anup Gurung, WHO's acting officer in charge of the polio response, said at a press conference in September. 

Circulating vaccine-derived outbreaks of polio occur when a population is seriously under-immunised and the live attenuated virus that replicates inside vaccinated children mutates and escapes into the environment. There have been 82 such cases recorded globally to date this year compared with 27 cases of wild poliovirus, which is endemic in only three countries—Pakistan, Afghanistan, and Nigeria. 

Given the erosion of routine vaccination coverage in Papua New Guinea, falling as low as 30% in some parts of the country over recent years, this was a situation that experts had long warned was inevitable, Gurung acknowledged. Just half of Papua New Guinea's more than 8 million people have access to clean water and less than one fifth to a toilet that disposes of waste in a way that it does not pose a disease risk. 

Genetic analysis of stool samples taken from the victims reveals the virus has been circulating undetected for more than 2 years, Gurung said. “If you have one case, there would be 200, maybe 500 000 people circulating the virus.”

Norovirus at several Camp Fire shelters

Via the Chico Enterprise-Record: Norovirus at several Camp Fire shelters. Excerpt:

CHICO — Close quarters make for the easy spread of sickness, which explains a norovirus outbreak at the Camp Fire evacuation centers.  

Lisa Almaguer of Butte County Public Health said as of Thursday morning there were 21 individuals at the Neighborhood Church confirmed with norovirus out of the 179 evacuees at the center. 

Symptoms included fever, vomiting, diarrhea and stomach pain. She said that symptoms have been seen at the other evacuation centers, but the center managers have isolated the individuals, who are being cared for separately by other public nurses.  

Those ill have separate areas for washing hands and using the restroom, with “limited” in and out access. 

“Other shelters have people who are ill. We didn’t wait to confirm through lab tests (what they had). They are in separate parts of the shelters,” she said.  

Thursday morning there were 10 sick of the 352 at the Oroville Nazarene Church; nine of the 142 at the Butte County Fairgrounds; and one of 200 at the East Avenue Church.  

Spreading illness 

Norovirus spreads through touching contaminated surfaces like door handles, food, objects or other people or their body fluids. Just being close to someone physically can spread the virus too, Almaguer said. 

The sickness lasts one to three days, and Almaguer said people are still contagious for two days after symptoms disappear.  

“They should go home, stay home, not run errands, don’t go to work.” 

The virus had been reported in the community before the fire, she said, and this is the time of year normally when it pops up. 

Last year, evacuees from the Oroville Dam spillway crisis wrestled with the condition as well at the fairgrounds.  

Almaguer said there is no medication or treatment to cure the virus. It just has to run its course. Prevention is important. Wash hands with soap and water, and use bleach-based products to clean all areas touched by persons with nausea, vomiting and diarrhea.  

Almaguer said additional medical staff is being assigned to the shelters, and evacuees are being instructed in how to prevent norovirus.

DR Congo: The difficult fight against a growing cholera epidemic

Via mediacongo.net: Cholera epidemic: the difficult fight against a growing cholera epidemic.The Google translation:

The Democratic Republic of the Congo is currently experiencing a tenth Ebola epidemic in the east of the country, killing 180 people, and many cases of polio and measles.  

The country is also facing a cholera epidemic that began in 2017. Since the beginning of the year and until mid-October, the Congolese Ministry of Health has registered more than 880 people who died of this disease over 25,000 cases reported. Almost all provinces are affected, according to the country's authorities who have begun to implement a health response. But halting this cholera outbreak will be complicated.  

Already 22 provinces affected of the 26 in the DRC. Everyone recognizes today that the cholera epidemic has progressed geographically, even though the authorities claim to have been able to contain it in terms of the number of its victims. In question, lack of resources, inherent weaknesses in the health system or even insalubrity.  

The authorities also point to the emergence of a new Ebola outbreak, particularly in the north-east of the country. 

"This year was the moment when we wanted to focus energy to organize the response to Ebola. This has mobilized resources and even staff to organize the fight," said Dr. Aruna Abedi, Director of Epidemiological Surveillance in the DRC.  

The government and WHO assure that they are doing everything in their power to stem the cholera outbreak, even though, as it stands, it will be difficult to completely defeat dirty hands, "as it is called. 

"The problem of cholera is multi-sectoral. As long as people do not have clean water, as long as people do not have access to sanitation, it will be difficult to control cholera in the DRC," says Dr. Gervais Folesack, emergency coordinator for the DRC.

In the meantime, WHO has just proposed to the government the vaccination of some 6 million people at risk. This is a new strategy to fight cholera alongside those that have already been proven elsewhere such as the adoption of hygiene measures.

MSF in Central African Republic: More than 10,000 seek refuge in Batangafo hospital

Via MSF.org: Central African Republic: More than 10,000 seek refuge in Batangafo hospital. Excerpt:

Following clashes between armed groups that took place on Wednesday, 31 October 2018 in the north and centre of the Central African Republic (CAR), more than 10,000 people fled to seek refuge in the compound of a hospital supported by Médecins Sans Frontières (MSF). 

In Batangafo, in northern Central African Republic, violent clashes between armed groups led to the burning of three camps for internally displaced people, numerous homes and a marketplace. More than 10,000 people sought refuge in the compound of the MSF-supported hospital, while several hundred others fled to the bush. 

In Bambari, in the centre of the country, MSF teams on the ground responded to treat 12 wounded following further violent clashes, while in Batangafo MSF received 20 patients, including ten requiring emergency surgery. Among these victims, two patients died as a result of severe burns.

To meet the initial needs of these displaced populations, and to fight against diseases such as diarrhoea and respiratory infections related to precarious living conditions, MSF has set up additional sanitary facilities such as latrines and showers at Batangafo hospital. A medical team continues to work to provide care to those in need. 

"The situation in Batangafo and Bambari remains very tense. The protection of the population and the medical mission remain our primary concerns," says Omar Ahmed Abenza, MSF head of mission in CAR. "We managed to treat the wounded who arrived, but the tensions in these two cities are still very much in evidence. We call for the continued cooperation of all parties to the conflict to provide assistance to all those who need it.  

"The humanitarian situation in the Central African Republic remains worrying and this latest outbreak of violence is likely to further threaten the already extremely precarious displaced communities that today lack food, shelter and other basic necessities,” Abenza adds.

DRC - Cholera: 23,166 suspected cases including 798 deaths since January (UN)

After resolving some technical problems with my blog display, I'm back in business. And just for a change, a non-Ebola story from Actualite.cd: DRC - Cholera: 23,166 suspected cases including 798 deaths since January (UN). Excerpt from the Google translation:

Some 798 people have died of cholera since January in the Democratic Republic of Congo (DRC) among 23,166 suspected cases, said Wednesday the UN mission for stabilization in the DRC (MONUSCO), linking this outbreak to the achievement of the Kasai region in October 2017 by the Cholera.  

"The situation of the cholera epidemic in the DRC remains very worrying From January to mid-October 2018, 23,166 suspected cases including 798 deaths have been reported", wrote the mission in an account which ACTUALITE.CD has a copy. 

Unlike previous situations where the majority of cases were reported in endemic areas in the east of the country, "it is almost all of the DRC, with 24 of the 26 provinces, which was affected this year" with reaching the provinces of the Kasai region "while the general trend was already trending downwards", explains the mission.    

This deadly outbreak can be explained by the late response to an outbreak of cases or the low quality of care for lack of resources, including trained providers, said the UN agencies.    

The trend has been "downward" in the Kasai region for a few weeks, while there is an increasing trend in the endemic areas of Tanganyika, South Kivu, Lomami and Kongo Central.  

"The current situation shows that the 2017 cholera epidemic has never subsided," concludes the UN.

Diarrhea in 195 countries: A systematic analysis for the Global Burden of Disease Study 2016

Via The Lancet Infectious Diseases: Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016. The summary:

Background 

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 provides an up-to-date analysis of the burden of diarrhoea in 195 countries. This study assesses cases, deaths, and aetiologies in 1990–2016 and assesses how the burden of diarrhoea has changed in people of all ages. 

Methods 

We modelled diarrhoea mortality with a Bayesian hierarchical modelling platform that evaluates a wide range of covariates and model types on the basis of vital registration and verbal autopsy data. We modelled diarrhoea incidence with a compartmental meta-regression tool that enforces an association between incidence and prevalence, and relies on scientific literature, population representative surveys, and health-care data. Diarrhoea deaths and episodes were attributed to 13 pathogens by use of a counterfactual population attributable fraction approach. Diarrhoea risk factors are also based on counterfactual estimates of risk exposure and the association between the risk and diarrhoea. Each modelled estimate accounted for uncertainty. 

Findings 

In 2016, diarrhoea was the eighth leading cause of death among all ages (1 655 944 deaths, 95% uncertainty interval [UI] 1 244 073–2 366 552) and the fifth leading cause of death among children younger than 5 years (446 000 deaths, 390 894–504 613). Rotavirus was the leading aetiology for diarrhoea mortality among children younger than 5 years (128 515 deaths, 105 138–155 133) and among all ages (228 047 deaths, 183 526–292 737). 

Childhood wasting (low weight-for-height score), unsafe water, and unsafe sanitation were the leading risk factors for diarrhoea, responsible for 80·4% (95% UI 68·2–85·0), 72·1% (34·0–91·4), and 56·4% (49·3–62·7) of diarrhoea deaths in children younger than 5 years, respectively. Prevention of wasting in 1762 children (95% UI 1521–2170) could avert one death from diarrhoea. 

Interpretation 

Substantial progress has been made globally in reducing the burden of diarrhoeal diseases, driven by decreases in several primary risk factors. However, this reduction has not been equal across locations, and burden among adults older than 70 years requires attention.

930 trucks lined up for Mexico City water service, but there are no guarantees

Via the Mexico News Daily, a story that deserves more attention: over seven million Mexico City residents will lose their water service from October 31 to as late as November 7: 930 trucks lined up for Mexico City water service, but there are no guarantees. Excerpt:

Private water distribution companies are not as confident as Mexico City authorities about the viability of supplying water via tanker trucks at the end of the month.  

The consensus among 20 such firms contacted by the newspaper Milenio was that they could not guarantee service to those requesting it.  

Water service will be suspended October 31 in 13 boroughs of the capital and 13 municipalities in México state to allow maintenance and repair work on the Cutzamala aqueduct. More than 7 million people will be affected.  

However, only two city boroughs — Cuauhtémoc and Miguel Hidalgo — will have their water completely cut off. The other 11 will see partial suspensions of service while three — Gustavo A. Madero, Milpa Alta and Xochimilco — will not be affected at all.  

In the state of México affected municipalities are Toluca, Metepec, Huixquilucan, Cuautitlán Izcalli, Ecatepec, Naucalpan, Tlalnepantla, Tultitlán, Coacalco, Nezahualcóyotl, Chimalhuacán México and La Paz.  

The water will be turned off for three days (it was initially projected to be four) but full service is not expected to resume until November 7. In Mexico City, 930 trucks with capacity for 10,000 to 40,000 liters have been arranged for deliveries, but they expect long wait times at the locations where tanker trucks can load up, meaning they cannot guarantee deliveries to consumers.  

Nor can delivery be booked beforehand because the Mexico City water department, Sacmex, will control water distribution at the 450 locations where tankers will be supplied

‘We need answers’: Hurricane Michael leaves Florida residents desperate for aid

Via The New York Times: ‘We Need Answers’: Hurricane Michael Leaves Florida Residents Desperate for Aid. Excerpt:

PANAMA CITY, Fla. — It was two days after Hurricane Michael, and Eddie Foster was pushing his mother in a wheelchair down a thoroughly smashed street, his face creased with a concentrated dose of the frustration and fear that has afflicted much of the Florida Panhandle since the brutal storm turned its coast to rubble. 

He was in a working-class neighborhood called Millville, where many residents said they were becoming desperate for even basic necessities. Mr. Foster, 60, and his 99-year-old mother had no car, no electricity. The food had spoiled in his refrigerator. The storm had ripped off large sections of his roof. He had no working plumbing to flush with. No water to drink. And as of Friday afternoon, he had seen no sign of government help. 

“What can I do?” he said. “I’m not angry. I just want some help.”  

This was the problem that government officials were racing to solve on Friday, as desperation grew in and around Panama City under a burning sun. Long lines formed for gas and food, and across the battered coastline, those who were poor, trapped and isolated sent out pleas for help. 

It would take time to reach everyone. Yet the Panama City area, one of those hit hardest by Hurricane Michael, grew into a whirring hive of activity on Friday, as box trucks, military personnel, and rescue and aid workers flowed in from surrounding counties and states, struggling to fix communications and electrical systems that officials said were almost totally demolished. 

The death toll from the Category 4 storm rose to 16, stretching as far north as Virginia, where five people died, and it was expected to climb higher as search-and-rescue crews fanned out through rubble that in some cases spanned entire blocks. The toll also included the potential of millions of dollars in damage to aircraft, which were left behind during the storm at Tyndall Air Force Base.

For those waiting for relief supplies or the ability to return to their homes, Brock Long, the Federal Emergency Management Agency administrator, counseled patience. “Bottom line, it was one of the most powerful storms the country has seen since 1851,” he said. “It’s going to be a long time before they can get back.”

Health workers in Yemen reach more than 306,000 people with cholera vaccines during four-day pause in fighting

An October 5 news release from WHO and UNICEF: Health workers in Yemen reach more than 306,000 people with cholera vaccines during four-day pause in fighting. Excerpt:

More than 306,000 people in Yemen, including over 164,000 children under the age of 15, were vaccinated against cholera as part of a joint WHO-UNICEF campaign that concluded today. The number are expected to go up as reports of the final day of the campaign come in. The six-day vaccination effort, carried out by 3,000 health workers in three districts in Hudaydah and Ibb, was made possible by a pause in fighting – known as ‘Days of Tranquility’ – agreed by parties to the conflict.  

“The success of this vaccination campaign shows what we can collectively achieve for children and families in Yemen when the fighting stops and humanitarian access opens up,” said UNICEF Executive Director Henrietta Fore. “Yet the reality is that this is a quick fix. Only a comprehensive political resolution to the conflict can secure the wellbeing of children across the country over the long term.”  

“It is unacceptable for people to die from preventable diseases,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus. “We are grateful for the pause in fighting which enabled us to complete the cholera vaccination campaign. Vaccination is one of many health services people need. Ultimately, peace is the only road to health.” 

Since April 2017, there have been over 1.2 million suspected cholera cases and 2,515 associated deaths in the country – one of the worst outbreaks in recent history. The vaccination is critical to preventing further spread of the disease. This campaign aimed to reach 540,000 in the three districts.  

Before the end of the year, many more people will need to be vaccinated against cholera, and millions more children immunized against polio, measles, pneumonia and other preventable diseases. 

Immunization is a matter of life or death for millions of people in Yemen, especially children. A child dies every 10 minutes from preventable causes. The country’s health system is hanging by a thread: most health workers have not been paid in two years, medical equipment is in short supply, and attacks on or near critical infrastructure such as water points and health facilities continue to be a daily reality. Widespread acute malnutrition among children is making them more vulnerable to diarrhoeal diseases.