H5N1

Ebola in the DRC: Situation report, July 2

CMRE has published Ebola : Situation épidémiologique du 02 Juillet 2020. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCE OF ECUADOR ON JULY 01, 2020  

Thursday, July 02, 2020  

• Since the start of the epidemic declared on June 01, 2020, the cumulative number of cases has been 36, including 33 confirmed and 3 probable. In total, there were 14 deaths (11 confirmed and 3 probable) and 3 winners (one healed or a survivor); 

• 2 new confirmed cases, including 1 Bikoro in Mbuli and 1 in Mbandaka in Ipeko;  

• No new deaths among the confirmed cases;

• No one came out cured.    

 /! \ The data presented in this table are likely to change later, after in-depth investigations and after redistribution of cases and deaths in their respective health zones. 

VACCINATION 

•  7,759 people already vaccinated with the rVSV-ZEBOV-GP vaccine.

Willingness to vaccinate against COVID-19 in Australia

Via The Lancet Infectious Diseases: Willingness to vaccinate against COVID-19 in Australia.

More than half of the world's population faces long-term restrictions as the new normal to prevent the spread of COVID-19. If a vaccine becomes available, it might be possible to develop herd immunity and protect those who are most vulnerable to serious consequences of COVID-19. The population coverage required to achieve herd immunity through vaccination varies across diseases and is dependent on the basic reproduction number (R0). Modelling estimates R0 to be around 2·5 for severe acute respiratory syndrome coronavirus 2 when no restrictions or physical distancing measures are in place, and R0 reached almost 4·0 in Wuhan in early-mid January, 2020. Vaccination uptake for herd immunity would need to be at least 67% with an R0 of 3·0. In their Comment, the COCONEL Group reported that 26% of French adults would not accept a COVID-19 vaccine. We similarly explored this question among a diverse sample of Australian adults. 

We conducted an online survey of 4362 Australians aged 18 years and older during April 17–21, approximately 4 weeks after lockdown measures had been activated in Australia and at a time when potential deaths and health system capacity were still of great concern. We asked participants about actions or intentions toward the flu vaccine (“I have or I will get the flu vaccine this year”) and a potential COVID-19 vaccine (“If a COVID-19 vaccine becomes available, I will get it”).  

In this sample, 630 (14·4%) participants said they would not get the flu vaccine this year, 394 (9·0%) were indifferent, and 3338 (76·5%) said they have or will get the flu vaccine this year. For a COVID-19 vaccine, 213 (4·9%) said they would not get the vaccine, 408 (9·4%) were indifferent, and 3741 (85·8%) said they would get the vaccine if it became available. 

Individuals who said they would not get a COVID-19 vaccine were more likely to believe the threat of COVID-19 has been exaggerated (43·7% [93/213]) than those who said they would get the vaccine if it became available (11·5% [429/3741]) and those who were indifferent (19·9% [81/408]). Inadequate health literacy and lower education level were significantly associated with a reluctance to be vaccinated against both influenza and COVID-19 (p<0·001; appendix). Notably, a high proportion overall were confident in the state (75·4% [3288/4362]) and federal (65·2% [2845/4362]) government's response. 

In Australia, attitudes towards a COVID-19 vaccine appear to be more positive than reported in France in late March, which might in part reflect greater confidence in the government. However, our data show efforts are needed to target vaccine education to those with lower education and health literacy. 

It remains to be seen whether Australia's high intentions towards vaccine uptake will remain when restrictions are relaxed and the immediate perceived threat diminishes.

Dr. Tedros on COVID-19: 'This is not even close to being over'

A WHO transcript: WHO Director-General's opening remarks at the media briefing on COVID-19 - 29 June 2020. Excerpt:

WHO will continue to do everything in our power to serve countries with science, solidarity and solutions. The critical question that all countries will face in the coming months is how to live with this virus. That is the new normal.  

Many countries have implemented unprecedented measures to suppress transmission and save lives. These measures have been successful in slowing the spread of the virus. But they have not completely stopped it.

Some countries are now experiencing a resurgence of cases as they start to re-open their economies and societies. Most people remain susceptible. The virus still has a lot of room to move.

We all want this to be over. We all want to get on with our lives.  But the hard reality is: this is not even close to being over.  Although many countries have made some progress, globally the pandemic is actually speeding up.

We’re all in this together, and we’re all in this for the long haul. We will need even greater stores of resilience, patience, humility and generosity in the months ahead.  We have already lost so much – but we cannot lose hope.

This is a time for renewing our commitment to empowering communities, suppressing transmission, saving lives, accelerating research and political and moral leadership. 

But it’s also a time for all countries to renew their commitment to universal health coverage as the cornerstone of social and economic development – and to building the safer, fairer, greener, more inclusive world we all want. 

Could MMR vaccine protect against COVID-19 sequelae?

Via mBio: Could an Unrelated Live Attenuated Vaccine Serve as a Preventive Measure To Dampen Septic Inflammation Associated with COVID-19 Infection? The abstract:

We propose the concept that administration of an unrelated live attenuated vaccine, such as MMR (measles, mumps, rubella), could serve as a preventive measure against the worst sequelae of coronavirus disease 2019 (COVID-19). 

There is mounting evidence that live attenuated vaccines provide nonspecific protection against lethal infections unrelated to the target pathogen of the vaccine by inducing “trained” nonspecific innate immune cells for improved host responses against subsequent infections. Mortality in COVID-19 cases is strongly associated with progressive lung inflammation and eventual sepsis. Vaccination with MMR in immunocompetent individuals has no contraindications and may be especially effective for health care workers who can easily be exposed to COVID-19. 

Following the lead of other countries conducting clinical trials with the live attenuated Mycobacterium bovis BCG (BCG) vaccine under a similar concept, a clinical trial with MMR in high-risk populations may provide a “low-risk–high-reward” preventive measure in saving lives during this unprecedented COVID-19 pandemic.

Ebola in the DRC: June 14

CMRE has published Ebola : Situation épidémiologique du 14 Juin 2020. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI ON JUNE 13    

Date: Sunday, June 14, 2020 

• Since the start of the epidemic, the cumulative number of cases has been 3,463, of which 3,317 have been confirmed and 146 are probable. In total, there were 2,280 deaths (2,134 confirmed and 146 probable) and 1,171 winners (healed persons, or survivors);  

• 398 suspected cases under investigation; 

• No new confirmed cases were recorded for the 47th consecutive day; 

• No confirmed case hospitalized in the CTE since the resurgence of the epidemic in Beni on April 10, 2020.     

* EPIDEMIOLOGICAL SITUATION IN THE PROVINCE OF EQUATEUR ON JUNE 13, 2020  

• Since the start of the epidemic declared on June 01, 2020, the cumulative number of cases has been 17, including 14 confirmed and 3 probable. In total, there were 11 deaths (8 confirmed and 3 probable); 

• No new confirmed cases;  

• No new deaths among the confirmed cases.    

/! \ The data presented in this table are likely to change later, after in-depth investigations and after redistribution of cases and deaths in their respective health zones.

NEWS  

NOTHING TO REPORT 

VACCINATION  

•  9,560 people were vaccinated, from February 14 to April 10, 2020, with the second dose of the 2nd Ad26.ZEBOV / MVA-BN-Filo vaccine (Johnson & Johnson) in the two health areas from Karisimbi to Goma;  

•  20,339 people were vaccinated, until February 29, 2020, with the 2nd vaccine d26.ZEBOV / MVA-BN-Filo (Johnson & Johnson) in the two health areas from Karisimbi to Goma; 

• A total of 2,129 people were vaccinated from April 11 to May 20, 2020 around the resurgent cases of Beni; 

• Since the start of vaccination on August 8, 2018 with the rVSV-ZEBOV vaccine 303,905  people have been vaccinated until May 20, 2020; 

• Approved on October 22, 2019 by the Ethics Committee of the School of Public Health at the University of Kinshasa and on October 23, 2019 by the National Ethics Committee, the second vaccine, called Ad26.ZEBOV / MVA-BN -Filo, is produced by Janssen Pharmaceuticals for Johnson & Johnson; 

• This new vaccine complements the first, rVSV-ZEBOV, a vaccine used until then (since August 08, 2018) in this epidemic manufactured by the pharmaceutical group Merck, after approval by the Ethics Committee on May 20, 2018. It was recently pre-qualified for certification. 

ENTRY POINT SURVEILLANCE  

• Since the start of the epidemic, the total number of travelers checked (temperature measurement) at the anitary checkpoints, until June 13, 2020 is 179,635,921 ;  

• To date, a total of 50 entry points (PoE) and health control points (PoC) are operational out of the 109 set up in the provinces of North Kivu and Ituri in order to protect large cities in the country and to avoid the spread of the epidemic in neighboring countries.

Fauci: COVID-19 pandemic that ‘took over the planet’ is far from over

Via The Guardian: Fauci: coronavirus pandemic that ‘took over the planet’ is far from over.

The US’s top infectious disease expert Dr Anthony Fauci warned on Tuesday that the coronavirus pandemic was far from over, calling Covid-19 his “worst nightmare”. 

“In a period of four months, it has devastated the whole world,” Fauci said, speaking to executives at a conference of the Biotechnology Innovation Organization. “And it isn’t over yet.” 

About 7 million people have been infected with the coronavirus and 400,000 people are known to have died. Many countries, including the US where more than 110,000 have died, are now relaxing quarantine rules despite rising rates of infection in some areas. 

“That’s millions and millions of infections worldwide. And it isn’t over yet. And it’s condensed in a very, very small time frame,” said Fauci. 

In a videotaped discussion Fauci said he had known that an outbreak like this could occur but he was surprised by how “rapidly it just took over the planet”. Fauci attributed the rapid spread to the contagiousness of the virus and extensive world travel by infected people. 

The top White House infectious disease adviser said the coronavirus pandemic differed significantly from other recent public health crises including Ebola and HIV. 

“I mean, Ebola was scary. But Ebola would never be easily transmitted in a global way,” he said. “HIV, as important as it is, was drawn out over an extended period of time. I mean, I think the ultimate impact of Aids almost certainly will be greater than anything we’re talking about now.”  

The coronavirus just “took over the planet,” he said.  

Fauci described research on the disease as “a work in progress” and said there were still questions about whether or not survivors who were seriously ill would fully recover. The disease has been shown to have a wide range of effects on people – leaving some without symptoms while others suffer lung damage, strokes, clotting disorders and severe immune responses. 

Fauci was speaking after the World Health Organization (WHO) rolled back guidance that it was “very rare” for the disease to be transmitted by people who have the virus but no symptoms. 

“Oh my goodness,” Fauci said. “Where is it going to end? We’re still at the beginning of it.”  

But Fauci said he was “very heartened” by the pharmaceutical industry, which he said, “stepped up to the plate”. There are more than 124 Covid-19 vaccines under development as of 2 June, according to the WHO, and Fauci said he was “almost certain” that more than one would be successful. 

“The industry is not stupid. They figured it out,” Fauci said. “There’s going to be more than one winner in the vaccine field because we’re going to need vaccines for the entire world. Billions and billions of doses.”

COVID-19 vaccine could be ready for emergency use within months, says Chinese expert Zhong Nanshan

Via the South China Morning Post: Coronavirus vaccine could be ready for emergency use within months, says Chinese expert Zhong Nanshan. Excerpt:

China could have a Covid-19 vaccine for use in emergencies as early as this autumn, according to the country’s top respiratory expert, Zhong Nanshan. 

Zhong’s estimate echoed last month’s comments by Gao Fu, head of the Chinese Centre for Disease Control and Prevention, that it was drafting guidelines to determine who would be eligible to receive the vaccine, when to take them, and what would constitute emergency use. 

The head of the US National Institute of Allergy and Infectious Diseases, Antony Fauci, has made similar comments, saying 100 million doses might be ready by the end of the year even before the end of clinical trials. 

Zhong said herd immunity without intervention could not be achieved without a high death toll, making inoculation the only feasible means of gaining herd immunity. 

“Natural immunity needs 60 to 70 per cent of a country’s population to be infected by the novel coronavirus, which could cause a death toll of 30 to 40 million,” Zhong told a live event hosted by tech giant Baidu. “The [only] solution is still mass vaccination.”  

“[Herd immunity] still depends on the development of vaccines. Large-scale vaccination will take one to two years. The new vaccine can be used in an emergency as early as this autumn or the end of the year.” 

Five vaccines developed by Chinese scientists are undergoing human trials, according to a government white paper published on Sunday. 

One of the candidate vaccines, developed by the Beijing Institute of Biological Products, published its preclinical data on the journal Cell on Saturday.  

The data shows that in macaques the vaccine, which uses an inactivated pathogen, induced high levels of antibodies that defend the body and provided a highly efficient protection against Sars-CoV-2, the virus that causes Covid-19. 

The macaques were immunised twice on day zero and day 14, while a placebo group was given saline. 

On day 24, all the macaques were exposed to Sars-CoV-2. 

The placebo group maintained a high viral load throughout the seven-day evaluation period after the exposure, but swabs taken from the vaccinated macaques showed that their viral load peaked on the fifth day and was significantly lower by day seven. 

On the seventh day after exposure to the virus, all animals were euthanised for pathological examination. 

No macaques in the low-dose and high-dose groups had a detectable viral load in the lung lobes, unlike the placebo group. 

“Taken together, all these results demonstrated that both low-dose and high-dose [vaccines] conferred highly efficient protection against Sars-CoV-2 in macaques without observed antibody-dependent enhancement of infection,” the researchers wrote.

WHO Director-General's opening remarks at the media briefing on COVID-19 - 03 June 2020

WHO has published WHO Director-General's opening remarks at the media briefing on COVID-19 - 03 June 2020. Excerpt:

WHO is continuing to respond to the new Ebola outbreak in the city of Mbandaka, in the Equateur province of the Democratic Republic of the Congo. 

So far, 8 cases have been detected. Four of those have died and the other 4 are receiving care.  To be clear, this outbreak is in the same area as a previous outbreak in 2018, which was stopped in just 3 months. However, it is on the other side of the country to the Ebola outbreak that WHO and partners have been fighting for almost 2 years in the provinces of North Kivu and Ituri, in eastern DRC. 

The latest person confirmed with Ebola attended the burial of one of the first cases, but was detected in the town of Bikoro, 150 kilometres away from Mbandaka. This means that two health zones are now affected.   

Today almost 50 responders from WHO and partners arrived in Mbandaka, plus 3600 doses of Ebola vaccine and 2000 cartridges for lab testing. The government is now sequencing the virus to see whether or not it is related to a previous outbreak.   

This is an important reminder that even as WHO focuses on responding to the COVID-19 pandemic, we continue to monitor and respond to many other health emergencies. 

===   

More than 100 000 cases of COVID-19 have been reported to WHO for each of the past 5 days.  

The Americas continue to account for the most cases. For several weeks, the number of cases reported each day in the Americas has been more than the rest of the world put together. We are especially worried about Central and South America, where many countries are witnessing accelerating epidemics.  

We also see increasing numbers of cases in the Eastern Mediterranean, South-East Asia and Africa, although the numbers are much smaller.  Meanwhile, the number of cases in Europe continues to decline. Yesterday saw the fewest cases reported in Europe since the 22nd of March. 

WHO continues to work through our regional and country offices to monitor the pandemic, to support countries to respond, and to adapt our guidance for every situation.

What the growing rift between the US and WHO means for COVID-19 and global health

Via Nature.com: What the growing rift between the US and WHO means for COVID-19 and global health. Excerpt:

Experts in health policy are contending with the real possibility that the United States will pull away from the World Health Organization (WHO), fracturing a relationship that began in the wake of the Second World War. 

They say that the repercussions could range from a resurgence of polio and malaria, to barriers in the flow of information on COVID-19. Scientific partnerships around the world would also be damaged, and the United States could lose influence over global health initiatives, including those to distribute drugs and vaccines for the new coronavirus as they become available, say researchers.  

A fissure between the US and the international health agency opened further last week, when US President Donald Trump tweeted a letter to WHO director-general Tedros Adhanom Ghebreyesus, threatening to make permanent the US freeze on WHO funding that began in April, unless the organization “can actually demonstrate independence from China” within 30 days. He added that he will reconsider the United States’ membership of the organization. “I don’t think this is an idle threat,” says Kelley Lee, a global health-policy researcher at Simon Fraser University in Burnaby, Canada. 

Proposals for new US-led initiatives for pandemic preparedness abroad do little to quell researchers' concerns. Some say these efforts might even add incoherence to the world's response to COVID-19, and global health more generally, if they're not connected to a fully-funded WHO. “It’s surreal to even be having this conversation, since it’s so hard to get one’s head around the massive implications,” says Rebecca Katz, director of the Center for Global Health Science and Security at Georgetown University in Washington DC. 

The acrimony is poorly timed, given the need for international coordination and cooperation to contend with the coronavirus. “In this pandemic, people have said we’re building the plane while flying,” Katz says. “This proposal is like removing the windows while the plane is mid-air.”  

Balance due 

Trump’s letter, which he tweeted on 18 May, alleges that the WHO intentionally ignored reports that COVID-19 was spreading between people in Wuhan, China, in December. “I cannot allow American taxpayer dollars to continue to finance an organization that, in its present state, is so clearly not serving America’s interests,” he wrote. A few of Trump's points were immediately debunked. For example, he claimed that the medical journal The Lancet had published on the new coronavirus in December. The next day, the journal issued a statement calling the claim factually incorrect because their first reports on COVID-19 were published on 24 January. The journal also refuted other allegations in the letter, concluding that the claims are "damaging to efforts to strengthen international collaboration to control this pandemic." 

Tedros has reiterated his commitment to a comprehensive and independent evaluation of the WHO's response to COVID-19, and an assessment of the organization's operations in the first part of 2020 is already public. But when reporters asked Tedros about additional, immediate investigations in response to Trump's allegations at a WHO press briefing, he said, “Right now, the most important thing is fighting the fire, saving lives.”

Trump does not need Congressional approval to withhold funds from the WHO, and global health researchers say the gap left by the US is a big deal. Last year, the US government gave the WHO roughly US$450 million. Nearly 75% of that was voluntary, and the other quarter was mandatory — a sort of membership fee expected from the 194 member countries, adjusted by the size of their economies and populations. 

The United States is the biggest donor, representing about 15% of the WHO budget. So far this year, it has paid about one-quarter — $34 million — of its membership dues, according to a WHO spokesperson. Voluntary funds are more complicated because a large portion were paid last year, however the spokesperson says that the freeze has put a hold on new agreements, meaning that the full-blown effects of the decision will be felt in 2021. 

The US government provides 27% of the WHO’s budget for polio eradication; 19% of its budget for tackling tuberculosis, HIV, malaria and vaccine-preventable diseases such as measles; and 23% of its budget for emergency health operations. If these initiatives shrink, researchers say, death and suffering will surge. David Heymann, an epidemiologist at the London School of Hygiene and Tropical Medicine, says this will also amount to squandered investment for the United States, particularly for polio. Gains won through vaccination campaigns that cost hundreds of millions of dollars would be lost, he says.

Safety, tolerability, and immunogenicity of a recombinant adenovirus type-5 vectored COVID-19 vaccine

Via The Lancet: Safety, tolerability, and immunogenicity of a recombinant adenovirus type-5 vectored COVID-19 vaccine: a dose-escalation, open-label, non-randomised, first-in-human trial. The summary:

Background 

A vaccine to protect against COVID-19 is urgently needed. We aimed to assess the safety, tolerability, and immunogenicity of a recombinant adenovirus type-5 (Ad5) vectored COVID-19 vaccine expressing the spike glycoprotein of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strain. 

Methods 

We did a dose-escalation, single-centre, open-label, non-randomised, phase 1 trial of an Ad5 vectored COVID-19 vaccine in Wuhan, China. Healthy adults aged between 18 and 60 years were sequentially enrolled and allocated to one of three dose groups (5 × 1010, 1 × 1011, and 1·5 × 1011 viral particles) to receive an intramuscular injection of vaccine. The primary outcome was adverse events in the 7 days post-vaccination. Safety was assessed over 28 days post-vaccination. Specific antibodies were measured with ELISA, and the neutralising antibody responses induced by vaccination were detected with SARS-CoV-2 virus neutralisation and pseudovirus neutralisation tests. T-cell responses were assessed by enzyme-linked immunospot and flow-cytometry assays. This study is registered with ClinicalTrials.gov, NCT04313127. 

Findings 

Between March 16 and March 27, 2020, we screened 195 individuals for eligibility. Of them, 108 participants (51% male, 49% female; mean age 36·3 years) were recruited and received the low dose (n=36), middle dose (n=36), or high dose (n=36) of the vaccine. All enrolled participants were included in the analysis. 

At least one adverse reaction within the first 7 days after the vaccination was reported in 30 (83%) participants in the low dose group, 30 (83%) participants in the middle dose group, and 27 (75%) participants in the high dose group. The most common injection site adverse reaction was pain, which was reported in 58 (54%) vaccine recipients, and the most commonly reported systematic adverse reactions were fever (50 [46%]), fatigue (47 [44%]), headache (42 [39%]), and muscle pain (18 [17%]. Most adverse reactions that were reported in all dose groups were mild or moderate in severity. No serious adverse event was noted within 28 days post-vaccination. 

ELISA antibodies and neutralising antibodies increased significantly at day 14, and peaked 28 days post-vaccination. Specific T-cell response peaked at day 14 post-vaccination. 

Interpretation 

The Ad5 vectored COVID-19 vaccine is tolerable and immunogenic at 28 days post-vaccination. Humoral responses against SARS-CoV-2 peaked at day 28 post-vaccination in healthy adults, and rapid specific T-cell responses were noted from day 14 post-vaccination. Our findings suggest that the Ad5 vectored COVID-19 vaccine warrants further investigation.