H5N1

DRC Ebola: 19 new cases, 18 deaths (8 in community)

The Ministry of Health has published EBOLA DRC - Evolution of the response to the Ebola outbreak in the provinces of North Kivu and Ituri on Wednesday, May 22, 2019. Note the very interesting news that staff at a hospital in Munzumbaye had been resisting efforts of the Ebola response, but have now agreed to work with it. And they're not the only resisters among healthcare workers. Excerpt from the Google translation:

EVOLUTION OF THE EBOLA EPIDEMIC  IN THE PROVINCES OF NORTH KIVU AND ITURI 

Wednesday, May 22, 2019 

The epidemiological situation of the Ebola Virus Disease  dated 21 May 2019: 

• Since the beginning of the epidemic, the cumulative number of cases is 1,866, of which 1,778 are confirmed and 88 are probable. In total, there were 1,241 deaths (1,153 confirmed and 88 probable) and 490 people healed. 

•307 suspected cases under investigation; 

• 19 confirmed new cases, including 8 in Butembo, 5 in Katwa, 2 in Beni, 2 in Mabalako, 1 in Mandima and 1 in Kalunguta; 

• 18 new confirmed deaths, including 

º 8 community deaths, including 4 in Butembo, 2 in Mabalako, 1 in Katwa and 1 in Kalunguta; 

º 10 deaths at CTE, including 5 in Mabalako, 2 in Butembo, 2 in Katwa and 1 in Beni;  

• 3 new healings from the CTE Mabalako.

    

/! \  The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

NEWS   

Operations of the response

• The sub-coordination of the Ebola response officially handed over a batch of 40 mattresses to the Baraka Hospital Center located in Munzambaye, in the Butembo Health Zone, on Wednesday, May 22, 2019. Two health workers from CH Baraka / Munzambaye, known as "Chez Bambuti" (pygmy note), representing their colleagues, received symbolically one of 40 mattresses.  

• It should be noted that this donation is the result of the partnership concluded between CH Baraka and the teams of the response which, formerly, had difficulties to carry out their preventive health actions within CH Baraka. After realizing that their resistance to the teams of the response in their health facility posed a threat to the peaceful population, the medical staff of the latter ended up doing its "mea culpa" by radically changing its position and engaging in a perfect collaboration with the teams of the response. CH Baraka's health-care workers called on other health facilities that continue to resist following the Ebola outbreak in the Butembo Health Zone.

FIGURES OF THE RESPONSE  

121,868 vaccinated persons   

• 666 people vaccinated on 21/05/2019. 

• Of those vaccinated, 33,385 are high-risk contacts (CHR), 59,649 are contacts of contacts (CC), and 28,834 are front-line providers (PPL). 

•  Persons vaccinated by health zone: 32.192 in Katwa, 24.884 in Beni, 15.259 in Butembo, 9.397 in Mabalako, 6.033 in Mandima, 4.319 in Kalunguta, 3.070 in Goma, 3.048 in Komanda, 2.569 in Oicha, 1.980 in Kayna, 1.972 in Lubero 1,945 at Masereka, 1,935 at Vuhovi, 1,817 at Kyondo, 1,587 at Karisimbi, 1,558 at Musienene, 1,487 at Bunia, 1,025 at Biena, 1,012 at Mutwanga, 690 at Rutshuru, 557 at Rwampara (Ituri), 527 at Nyankunde, 496 at Mangurujipa, 494 to Alimbongo, 420 to Mambasa, 355 to Tchomia, 342 to Kirotshe, 333 to Lolwa, 250 to Mweso, 245 to Kibirizi, 161 to Nyiragongo, 97 to Watsa (Haut-Uélé) and 13 to Kisangani. 

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

DRC Ebola: 21 new cases (1 HCW), 5 deaths

The Ministry of Health has published EBOLA DRC - Evolution of the response to the Ebola outbreak in the provinces of North Kivu and Ituri to Tuesday, May 21, 2019. Excerpt from the Google translation:

EVOLUTION OF THE EBOLA EPIDEMIC  IN THE PROVINCES OF NORTH KIVU AND ITURI 

Tuesday, May 21, 2019 

The epidemiological situation of the Ebola Virus Disease  dated May 20, 2019: 

• Since the beginning of the epidemic, the cumulative number of cases is 1,847, of which 1,759 are confirmed and 88 are probable. In total, there were 1,223 deaths (1,135 confirmed and 88 probable) and 487 people healed. 

• 292 suspected cases under investigation; 

• 21 new confirmed cases, including 5 in Beni, 5 in Kalunguta, 4 in Butembo, 4 in Musienene, 2 in Mabalako and 1 in Masereka: 

• 5 new deaths of confirmed cases, including 

º 3 community deaths, 2 in Butembo and 1 in Musienene; 

º 2 deaths at the CTE of Beni;  

• 3 new healed CTE patients, 2 in Butembo and 1 in Katwa; 

• One health worker in Masereka, vaccinated, is among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 104 (5.6% of all confirmed / probable cases), including 34 deaths. 

/! \  The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas. 

NEWS   

Operations of the response

• On the sidelines of the 72nd World Health Assembly (WHA) in Geneva, the Minister of Health, Dr. Oly Ilunga, the WHO Director General, Dr Tedros Adhanom Ghebreyesus, and the Director of the WHO Regional Office in Africa (AFRO), Dr Matshidiso Moeti, reported on the evolution of the Ebola outbreak and regional preparedness activities at a meeting of AMS Committee A on Tuesday 21 May 2019. 

• All stakeholders recognized that the main barrier to ending this epidemic is the security context and violence against the response teams. The Minister of Health recalled that, from the point of view of public health, Ebola virus disease is not a particularly difficult disease to contain, especially since the country currently has a diagnostic, therapeutic medical arsenal and comprehensive preventive for the first time in the history of the virus. He recalled that to break the chain of transmission, it is enough to do a series of important activities around the confirmed cases, dead or alive, in particular the sensitization, the epidemiological investigations, the disinfection of the household, the vaccination and the follow-up of the contacts, and funerals worthy and secure. All these activities are available but teams are sometimes prevented from doing them because of insecurity or mistrust of the population. The Director of WHO emphasized that the Ebola epidemic in the DRC is still ongoing, not because the teams do not have the means or the skills but because they can not get regular access to the sick in the communities. If the security environment improves and access to communities is guaranteed, the response teams will be able to put an end to this epidemic, not because the teams do not have the means or the skills but because they can not get regular access to the sick in the communities. If the security environment improves and access to communities is guaranteed, the response teams will be able to put an end to this epidemic. not because the teams do not have the means or the skills but because they can not get regular access to the sick in the communities. If the security environment improves and access to communities is guaranteed, the response teams will be able to put an end to this epidemic.  

• While welcoming the work of the Congolese Government in containing the Ebola outbreak, the Director of WHO-AFRO presented the progress of regional preparedness in case the Ebola outbreak spreads outside the DRC. To date, no cases of Ebola have been detected in DRC's neighboring countries thanks to the efforts of the Government and partners, who have examined more than 50 million travelers at the various health checkpoints located east of the DRC. country. As part of the regional preparedness plan, the nine countries bordering the DRC now have an emergency plan, 16 Ebola treatment centers have been built in neighboring countries, 270 technical experts have been deployed to support the efforts of border countries.

FIGURES OF THE RESPONSE

121,202 vaccinated persons

• 564 people vaccinated on 20/05/2019.

• Of those vaccinated, 33,118 are high-risk contacts (CHR), 59,281 are contacts of contacts (CC), and 28,803 are front-line providers (PPL).

• Persons vaccinated by health zone: 32,126 in Katwa, 24,788 in Beni, 15,069 in Butembo, 9,208 in Mabalako, 6,021 in Mandima, 4,235 in Kalunguta, 3,070 in Goma, 3,048 in Komanda, 2,569 in Oicha, 1,980 in Kayna, 1,972 in Lubero , 1,945 to Masereka, 1,935 to Vuhovi, 1,817 to Kyondo, 1,487 to Bunia, 1,558 to Musienene, 1,357 to Karisimbi, 1,025 to Biena, 1,012 to Mutwanga, 690 to Rutshuru, 557 to Rwampara (Ituri), 527 to Nyankunde, 496 to Mangurujipa, 494 to Alimbongo, 420 to Mambasa, 355 to Tchomia, 342 to Kirotshe, 333 to Lolwa, 250 to Mweso, 245 to Kibirizi, 161 to Nyiragongo, 97 to Watsa (Haut-Uélé) and 13 to Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

Canadian scientists create stable, affordable way to transport fragile vaccines

Via The Globe and Mail: Canadian scientists create stable, affordable way to transport fragile vaccines. Excerpt:

A breakthrough by researchers at McMaster University could save lives around the world by making it easier and far cheaper to deliver fragile vaccines for deadly viruses such as Ebola and influenza to remote communities in developing countries.  

The innovation is almost as easy “as stirring milk and sugar into coffee,” said Matthew Miller, an assistant professor in McMaster’s biochemistry department, who was part of the interdisciplinary team that worked on the project. The process involves combining sugars used for other purposes with the drugs, turning the temperature-sensitive vaccine into a lightweight sugary gel that can travel for long periods through harsh climates.  

Globally, nearly 20 million children are vulnerable to preventable diseases because they don’t get vaccines, with one-quarter living in three countries: Afghanistan, Nigeria and Pakistan. 

Transporting and storing vaccines is complicated because they need to be kept at low temperatures to remain viable – a system of constant refrigeration known as the “cold chain.” Warm weather and rough roads don’t just increase the risk the vaccines will fail, they also raise the price tag – in some cases, transportation alone accounts for 80 per cent of the cost of a vaccine program, Dr. Miller said. 

Solar-powered, mini-refrigerators that can travel on the back of camels or wagons, have been one solution, says Vincent Leung, a chemical engineer at McMaster and the lead author of the paper published today in the journal Scientific Reports. But these are expensive and heavy, the units break down and they can only carry so much of the vaccine. 

At McMaster, a team of engineers and infectious-diseases scientists decided to look for a lighter, more travel-friendly solution. They had one already: an edible coating that had been previously created by chemical engineers at the university to extend the shelf life of fruit.  

As researchers discovered, the same two ingredients – a pair of sugars called trehalose and pullulan, which are used to make the jelly coating on breath strips – could do the same for a delicate vaccine. Combine, stir and dry, and their work suggests that a vaccine would be able to travel safely and relatively cheaply in the sugary gel, protected from the heat for months.  

“It is extremely simple,” said Dr. Miller, using the coffee milk-and-sugar analogy. The process, he said, can be easily adopted by any facility that can manufacture vaccines. Upon arrival at the destination, saline water would be added to restore the vaccine to a liquid state so that it can be administered.  

To make sure they were on the right track, the team at McMaster tested their theory with two of the hardest vaccines to transport, one for the herpes virus, and another for influenza A. “This was the extreme end of testing,” Dr. Miller said. “Now that we know it works there, it can be employed with any vaccine.” 

For instance, he said, it could work with the Ebola vaccine created by a lab in Winnipeg, which is difficult to transport to hot spots in remote parts of Africa. Being able to transport vaccines more easily will also help eradicate “smouldering fires” of preventable illnesses such as polio in regions that are difficult to reach.

DRC Ebola: 10 cases, 9 deaths (4 in community)

The Ministry of Health has published EBOLA DRC - Evolution of the response to the Ebola outbreak in the provinces of North Kivu and Ituri at Monday, May 20, 2019. Excerpt from the Google translation:

EVOLUTION OF THE EBOLA EPIDEMIC  IN THE PROVINCES OF NORTH KIVU AND ITURI 

Monday, May 20, 2019  

The epidemiological situation of the Ebola Virus Disease dated 19 May 2019: 

• Since the beginning of the epidemic, the cumulative number of cases is 1,826, 1,738 confirmed and 88 probable. In total, there were 1,218 deaths (1,130 confirmed and 88 probable) and 484 people healed. 

• 245 suspected cases under investigation; 

• 10 new confirmed cases, including 3 in Mabalako, 3 in Kalunguta, 2 in Beni 1 in Katwa and 1 in Butembo;  

9 new confirmed deaths, including 

º 4 community deaths, 2 in Kalunguta, 1 in Mabalako and 1 in Beni; 

º 5 deaths at CTE, including 3 in Butembo, 1 in Mabalako and 1 in Katwa;  

• 2 new healed from the CTE of Butembo. 

/! \  The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

NEWS   

Security situation

A vehicle from the response was slightly damaged and three policemen were slightly injured after a stone attack on a convoy of a dignified and secure burial team (EDS) at the Kanzunza cemetery in Butembo town on Sunday. May 19, 2019. In recent times, people living near certain public cemeteries are hostile to the EDS teams that are burying those who died of Ebola. The urban authorities and the coordination of the response organized a meeting on this subject on Monday, May 20, 2019.  

FIGURES OF THE RESPONSE  

120,638 vaccinated  persons   

• 986 people vaccinated on 19/05/2019. 

• Of those vaccinated, 32,964 are high-risk contacts (CHR), 58,917 are contacts of contacts (CC), and 28,757 are front-line providers (PPL).  

• Persons vaccinated by health zone: 32,010 in Katwa, 24,748 in Beni, 14,909 in Butembo, 9,138 in Mabalako, 6,006 in Mandima, 4,205 in Kalunguta, 3,070 in Goma, 3,048 in Komanda, 2,569 in Oicha, 1,980 in Kayna, 1,945 in Masereka , 1,935 in Vuhovi, 1,842 in Lubero, 1,814 in Kyondo, 1,558 in Musienene, 1,487 in Bunia, 1,357 in Karisimbi, 1,025 in Biena, 1,012 in Mutwanga, 690 in Rutshuru, 557 in Rwampara (Ituri), 527 in Nyankunde, 496 in Mangurujipa, 494 to Alimbongo, 420 to Mambasa, 355 to Tchomia, 342 to Kirotshe, 333 to Lolwa, 250 to Mweso, 245 to Kibirizi, 161 to Nyiragongo, 97 to Watsa (Haut-Uélé) and 13 to Kisangani. 

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

Dr. Tedros at WHA72 on the Ebola outbreak

From Dr. Tedros's speech to the World Health Assembly:

On this platform a year ago, I described my recent visit to the Democratic Republic of the Congo, where WHO was responding to an Ebola outbreak in the western province of Equateur. That outbreak was controlled in just 3 months. But shortly after it ended, another outbreak started, this time in the eastern part of DRC.

And as you know, it’s still going.

I would like to commend my brother Dr Oly Ilunga, the Minister of Health of DRC, and the government for their leadership and commitment to ending this outbreak. We can be proud of the fact that so far, the outbreak has not spread outside two provinces in DRC. But I emphasise “so far”. The risk of spread remains very high. Because this outbreak is one of the most complex health emergencies any of us have ever faced.

We are fighting one of the world’s most dangerous viruses in one of the world’s most dangerous areas. We are fighting with even better tools than we used to extinguish the Equateur outbreak in three months. So far we have vaccinated more than 120,000 people. And we now have evidence that the vaccine is more than 97% effective in preventing Ebola. We also have 4 experimental treatments that we’ve used to treat 800 patients.

But we are not just fighting a virus.

We’re fighting insecurity. We’re fighting violence. We’re fighting misinformation. We’re fighting mistrust. And we’re fighting the politicization of an outbreak.

Since January, there have been dozens of attacks on health facilities in North Kivu. Every attack disrupts our operations. Every attack makes it harder to reach communities. Every attack gives the virus an advantage, and a disadvantage to the responders. Every life lost is a tragedy.

But every life saved is a triumph.

This is Faustin Kalivanda, an Ebola survivor from Beni. Faustin lost his wife and his five-year-old daughter Ester to Ebola. Despite this tragedy, Kalivanda believes that as a survivor he has a duty to protect others. He now works at the Ebola treatment centre as a nurse assistant.

These are the stories of hope that keep us going.

When I visited DRC following Dr Richard Valery’s death, I discovered that our staff were shocked and shaken, but undeterred. They told me, “We’re here to save lives. We will not be intimidated by violence. We will finish the job.”

I have also met personally with His Excellency the President of DRC and opposition leaders to urge a bipartisan approach to ending this outbreak. Because Ebola does not take sides. It’s the enemy of everybody. Unless we unite to end this outbreak, we run the very real risk that it will become more widespread, more expensive and more aggressive.

I have also briefed the Security Council twice on the outbreak. The Secretary-General and I have agreed on a further strengthening of the response across the entire UN system.

DRC Ebola: 15 new cases, 11 deaths (6 in community), and 16 recoveries

The Ministry of Health has published EBOLA DRC - Evolution of the response to the Ebola outbreak in the provinces of North Kivu and Ituri to Sunday, May 19, 2019.  We're still dealing with double-digit case numbers and deaths, but for once we've also got double-digit recoveries. Excerpt from the Google translation:

EVOLUTION OF THE EBOLA EPIDEMIC  IN THE PROVINCES OF NORTH KIVU AND ITURI 

Sunday 19 May 2019 

The epidemiological situation of the Ebola Virus Disease  dated May 18, 2019: 

• Since the beginning of the epidemic, the cumulative number of cases is 1,816, of which 1,728 are confirmed and 88 are probable. In total, there were 1,209 deaths (1,121 confirmed and 88 probable) and 482 people healed. 

• 291 suspected cases under investigation; 

• 15 new confirmed cases, including 4 in Butembo, 4 in Mabalako, 2 in Katwa, 2 in Beni, 1 in Musienene, 1 in Kalunguta and 1 in Mandima;  

• 11 new deaths of unconfirmed cases, including 

º 6 community deaths, 2 in Butembo, 2 in Mabalako, 1 in Katwa and 1 in Beni; 

º 5 deaths at CTE, including 4 in Butembo and 1 in Mabalako; 

• 16 new healers came out of CTE, including 12 in Butembo and 4 in Katwa.

 

/! \  The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

NEWS   

Epidemiological surveillance 

• Investigations continue around the first confirmed patient in the Alimbongo Health Zone. According to the initial results, the patient was contaminated after participating in an unsecured burial of a family member who died in Katwa.

FIGURES OF THE RESPONSE  

119,652 Vaccinated persons   

• 792 people vaccinated on 18/05/2019. 

• Of those vaccinated, 32,577 are high-risk contacts (CHR), 58,347 are contacts of contacts (CC), and 28,728 are front-line providers (PPL).  

• Persons vaccinated by health zone: 31,862 in Katwa, 24,585 in Beni, 14,829 in Butembo, 8,858 in Mabalako, 5,971 in Mandima, 4,169 in Kalunguta, 3,070 in Goma, 3,048 in Komanda, 2,569 in Oicha, 1,980 in Kayna, 1,945 in Masereka , 1,935 to Vuhovi, 1,814 to Kyondo, 1,712 to Lubero, 1,487 to Bunia, 1,444 to Musienene, 1,357 to Karisimbi, 1,025 to Biena, 1,012 to Mutwanga, 690 to Rutshuru, 557 to Rwampara (Ituri), 527 to Nyankunde, 496 to Mangurujipa, 494 to Alimbongo, 420 to Mambasa, 355 to Tchomia, 342 to Kirotshe, 333 to Lolwa, 250 to Mweso, 245 to Kibirizi, 161 to Nyiragongo, 97 to Watsa (Haut-Uélé) and 13 to Kisangani. 

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

DRC Ebola: 24 new cases, 21 deaths (13 in community)

The Ministry of Health has published EBOLA DRC - Evolution of the response to the Ebola outbreak in the provinces of North Kivu and Ituri on Saturday, May 18, 2019. More community deaths, and more community resistance to the response teams. Excerpt from the Google translation:

EVOLUTION OF THE EBOLA EPIDEMIC  IN THE PROVINCES OF NORTH KIVU AND ITURI 

Saturday, May 18, 2019  

The epidemiological situation of the Ebola Virus Disease dated May 17, 2019: 

• Since the beginning of the epidemic, the cumulative number of cases is 1,801, 1,713 confirmed and 88 probable. In total, there were 1,198 deaths (1,110 confirmed and 88 probable) and 466 people healed. 

• 285 suspected cases under investigation; 

• 24 new confirmed cases, including 5 in Butembo, 5 in Mabalako, 4 in Katwa, 3 in Beni, 2 in Musienene, 2 in Mandima, 1 in Kalunguta, 1 in Lubero and 1 in Mangurujipa; 

• 21 new confirmed cases, including 

º 13 community deaths, including 4 in Butembo, 2 in Beni, 2 in Mandima, 1 in Katwa, 1 in Kalunguta, 1 in Musienene, 1 in Mangurujipa and 1 in Mabalako; 

• 8 deaths at CTE, including 3 in Beni, 2 in Butembo, 2 in Mabalako and 1 in Katwa; 

• 3 new healings from the CTE, 2 in Beni and 1 in Katwa.

 

/! \  The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health area.

Security situation:

The Chief of the Dignified and Safe Burial (EDS) team of the Civil Protection has been assaulted by the family members of a person who died in Rwampara/Bunia who refused to let the EDS team take a sample from the body.  

• A Butembo EDS team was also assaulted on Friday, May 17, 2019 during the burial of four people who died at the CTE in Butembo. To facilitate their work, the EDS teams dig the graves beforehand. But, sometimes, some people cover the graves during the night to mark their opposition to burials. When the team arrived at the cemetery on Friday, the graves were covered and people threw stones at them, injuring an EDS officer.  

FIGURES OF THE RESPONSE  

118,826 Vaccinated  persons   

• 779 people vaccinated on 17/05/2019. 

• Of those vaccinated, 32,225 are high-risk contacts (CHRs), 57,888 are contacts of contacts (CC), and 28,713 are front-line providers (PPLs).  

• Persons vaccinated by health zone: 31,762 in Katwa, 24,426 in Beni, 14,679 in Butembo, 8,748 in Mabalako, 5,939 in Mandima, 4,073 in Kalunguta, 3,070 in Goma, 3,048 in Komanda, 2,569 in Oicha, 1,980 in Kayna, 1,945 in Masereka , 1,935 in Vuhovi, 1,791 in Kyondo, 1,712 in Lubero, 1,487 in Bunia, 1,357 in Karisimbi, 1,348 in Musienene, 1,025 in Biena, 1,012 in Mutwanga, 690 in Rutshuru, 557 in Rwampara (Ituri), 527 in Nyankunde, 496 in Mangurujipa, 434 in Alimbongo, 420 in Mambasa, 355 in Tchomia, 342 in Kirotshe, 333 in Lolwa, 250 in Mweso, 245 in Kibirizi, 161 in Nyiragongo, 97 in Watsa (Haut-Uélé) and 13 in Kisangani. 

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

DRC Ebola: 17 new cases, 16 deaths (9 in community)

The Ministry of Health has published EBOLA DRC - Evolution of the response to the Ebola outbreak in the provinces of North Kivu and Ituri to Friday, May 17, 2019. Excerpt from the Google translation:

EVOLUTION OF THE EBOLA EPIDEMIC  IN THE PROVINCES OF NORTH KIVU AND ITURI 

Friday 17 May 2019  

The epidemiological situation of the Ebola Virus Disease  dated May 16, 2019: 

• Since the beginning of the epidemic, the cumulative number of cases is 1,777, of which 1,689 are confirmed and 88 are probable. In total, there were 1,177 deaths (1,089 confirmed and 88 probable) and 463 people healed. 

• 333 suspected cases under investigation; 

• 17 new confirmed cases, including 5 in Butembo, 4 in Mabalako, 2 in Katwa, 2 in Beni, 1 in Vuhovi, 1 in Musienene, 1 in Biena and 1 in Kalunguta;  

• 16 new confirmed case deaths, including 

º 9 community deaths, including 3 in Butembo, 2 in Beni, 1 in Kalunguta, 1 in Musienene, 1 in Biena and 1 in Katwa; 

º 7 deaths at CTE, including 3 in Butembo, 2 in Katwa and 2 in Mandima; 

• 2 new healings from CTE Katwa.

 

 /! \  The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

FIGURES OF THE RESPONSE  

118,029 vaccinated  persons   

• 744 people vaccinated on 16/05/2019. 

• Of those vaccinated, 31,965 are high-risk contacts (CHR), 57,385 are contacts of contacts (CC), and 28,679 are front-line providers (PPL).  

• Persons vaccinated by health zone: 31,632 in Katwa, 24,403 in Beni, 14,563 in Butembo, 8,459 in Mabalako, 5,905 in Mandima, 3,993 in Kalunguta, 3,070 in Goma, 3,048 in Komanda, 2,569 in Oicha, 1,980 in Kayna, 1,930 in Masereka , 1,915 to Vuhovi, 1,791 to Kyondo, 1,672 to Lubero, 1,487 to Bunia, 1,357 to Karisimbi, 1,348 to Musienene, 1,025 to Biena, 1,012 to Mutwanga, 690 to Rutshuru, 557 to Rwampara (Ituri), 527 to Nyankunde, 496 to Mangurujipa, 420 to Mambasa, 384 to Alimbongo, 355 to Tchomia, 342 to Kirotshe, 333 to Lolwa, 250 to Mweso, 245 to Kibirizi, 161 to Nyiragongo, 97 to Watsa (Haut-Uélé) and 13 to Kisangani. 

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

WHO: Ebola virus disease – Democratic Republic of the Congo

WHO has published its weekly update: Ebola virus disease – Democratic Republic of the Congo. Excerpt, with some important points bolded:

Although the security situation has subsided mildly into an unpredictable calm, the transmission of Ebola virus disease (EVD) continues to intensify in North Kivu and Ituri provinces with more than 100 confirmed cases reported this week. 

The main drivers behind the continued rise in cases stems from insecurity hampering access to critical hotspot areas, persistent pockets of poor community acceptance and hesitation to participate in response activities, and delayed detection and late presentation of EVD cases to Ebola Treatment Centres (ETCs)/Transit Centres (TCs).  

Of particular concern are the community deaths resulting from the culmination of these factors. Community deaths denote all EVD (confirmed and probable) cases who died outside of an ETC/TC. This includes cases who die at home, as well as those who die within public/private hospitals and other health centres. On average, community deaths comprise approximately 40% of cases reported each week. This proportion fluctuates on a weekly basis, ranging from 28% to 43% of cases since the beginning of April after peaking as high as 71% in February. Of the total deaths (1147) currently listed in surveillance systems, approximately two thirds (68%) occurred outside of ETCs. Many of the patients who arrive at ETCs, often do so in a severe condition with a poor prognosis, and subsequently die shortly after admission. 

Community deaths also pose a major transmission risk as these cases have spent more time in the community while symptomatic and remain highly infectious at the time of their death and thereafter; propagating EVD to other members of the community such as family members and healthcare workers. 

Despite the continued increase in EVD cases, it should be noted that transmission remains most intense in seven main hotspot areas: Katwa, Mabalako, Mandima, Butembo, Musienene, Kalunguta, and Beni. Collectively, these health zones account for the vast majority (93%) of the 350 cases reported in the last 21 days between 24 April – 14 May 2019 (Figure 1 and Table 1). A new case was also reported in the health zone of Alimbongo this week with links to cases deriving from Katwa.

Current transmission patterns also illustrate the challenges resulting from cases originating from hotpot health zones and re-introducing the virus to areas where transmissions have previously been successfully halted. During this period, new cases were reported from 91 health areas within 18 of the 22 health zones affected to date (Figure 2).  

As of 14 May, a total of 1739 confirmed and probable EVD cases have been reported, of which 1147 died (case fatality ratio 66%). Of the total cases with recorded sex and age, 56% (974) were female and 30% (514) were children aged less than 18 years. The number of healthcare workers affected has risen to 102 (6% of total cases). Of the EVD patients who received care at ETCs, 459 have been successfully discharged. 

Risk communication and community engagement teams continue to spread messages about the importance of seeking care early at healthcare facilities for an increased chance of survival. These messages have been particularly effective in Beni, where affected individuals have been reporting to the ETCs more frequently and more rapidly after onset of symptoms. 

The risk communication and community engagement actors have been instrumental in mediating instances of reluctance and resistance at the community level to ensure peaceful agreements are reached and that other pillars of the response such as vaccination, infection prevention and control (IPC), and safe and dignified burials (SDB) are able to carry out their respective response activities. 

It is anticipated that the rising case figures will continue within the hotspot areas in the coming weeks given the resumption of most major response activities, which will lead to the detection of more cases. The increased transmission rates witnessed recently continue to demonstrate a heightened risk of EVD spreading to other neighbouring provinces in the Democratic Republic of the Congo, and to surrounding countries.

MMWR: Measles outbreaks from imported cases in Orthodox Jewish communities — New York and New Jersey, 2018–2019

MMWR has published Notes from the Field: Measles Outbreaks from Imported Cases in Orthodox Jewish Communities — New York and New Jersey, 2018–2019.

On October 1, 2018, the Rockland County (New York) Department of Health (RCDOH) alerted the New York State Department of Health (NYSDOH) of an unvaccinated teenaged traveler with diagnosed measles. During the next 17 days, RCDOH learned of an additional six unvaccinated travelers with measles. 

On October 24, 2018, the Ocean County (New Jersey) Health Department alerted the New Jersey Department of Health (NJDOH) of a case of measles in an international traveler, with rash onset October 17. The unvaccinated travelers reported recent travel in Israel, where an outbreak of approximately 3,150 cases of measles is ongoing. 

Investigations during October 1, 2018–April 30, 2019, identified 242 laboratory-confirmed and epidemiologically linked measles cases in New York, excluding New York City, and during October 17, 2018–November 30, 2018, identified 33 in New Jersey (Figure). The cases of measles were primarily in members of orthodox Jewish communities. 

New York 

The 242 cases in New York (excluding New York City) included 206 in Rockland County and 36 in nearby counties. Most patients resided in orthodox Jewish neighborhoods with low school immunization rates. The median patient age was 5 years (range = 0 days* to 63 years). The 2017–2018 New York State School Immunization Survey measles vaccination rate for students in prekindergarten through grade 12 was 98%; however, documented measles vaccination coverage in schools in the outbreak area was only 77%. 

To prevent disease spread in schools, Rockland County and neighboring Orange County have excluded unvaccinated students from school for 21 days after a measles exposure. To further control spread after school exposures, in areas of Rockland County with measles cases, exclusions from school were expanded to include all nonimmune students at schools that had measles immunity rates of <95% as documented by 2 valid doses of measles-mumps-rubella vaccine (MMR) or serologic evidence of immunity. 

To provide opportunities for vaccination, approximately 20 community vaccination events open to all ages were held in Rockland County and two in Orange County. 

During October 1, 2018–April 30, 2019, Rockland County administered 19,661 MMR doses. NYSDOH, RCDOH, and private medical providers held nine informational events and distributed educational materials focused on measles prevention to 45,000 homes. A culturally appropriate and detailed vaccine education book was distributed to 15,000 Rockland County and 10,000 Orange County homes and medical providers. 

Orthodox Jewish leaders were engaged in the outbreak response, with rabbinical leaders supporting vaccination efforts and community groups advocating for vaccination. 

As of April 30, 2019, transmission was ongoing. This has been the largest measles outbreak in New York (outside New York City) since 1992 and, at 7 months, the longest documented outbreak in the United States since endemic measles was eliminated in 2000.  

New Jersey 

During October 17–November 30, 2018, 33 measles cases were confirmed in New Jersey, primarily in members of the orthodox Jewish community in Ocean County. The median patient age was 10 years (range = 6 months–59 years). In Ocean County, unvaccinated students were excluded from school for 21 days after a measles exposure. Some private schools excluded unvaccinated students for the duration of the New Jersey outbreak. NJDOH worked with local health officials and providers to facilitate delivery of >12,500 outbreak response doses of MMR vaccine to Ocean County medical providers. This outbreak was declared over on January 16, 2019. 

A second outbreak occurred in the same community in March 2019, with no identified connection to the first outbreak. 

In the New York outbreak, low community vaccination rates facilitated widespread measles transmission after introduction of imported measles in unvaccinated travelers. 

Educational efforts regarding risks associated with undervaccination should be increased in communities with low vaccination rates. Health departments and clinicians should be aware of multiple ongoing measles outbreaks globally, and travelers should have evidence of measles immunity. 

All U.S. communities should maintain ≥95% levels of age-appropriate vaccination coverage with 2 doses of MMR vaccine to ensure herd immunity (3).