H5N1

The cost of insecurity: From flare-up to control of a major Ebola virus disease hotspot during the outbreak in the Democratic Republic of the Congo, 2019

Eurosurveillance has published a rapid communication: The cost of insecurity: from flare-up to control of a major Ebola virus disease hotspot during the outbreak in the Democratic Republic of the Congo, 2019. The abstract:

The ongoing Ebola outbreak in the eastern Democratic Republic of the Congo is facing unprecedented levels of insecurity and violence. We evaluate the likely impact in terms of added transmissibility and cases of major security incidents in the Butembo coordination hub. We also show that despite this additional burden, an adapted response strategy involving enlarged ring vaccination around clusters of cases and enhanced community engagement managed to bring this main hotspot under control.

DR Congo: Red Cross volunteers attacked during Ebola burial

Via ReliefWeb, a report from the IFRC: DR Congo: Red Cross volunteers attacked during Ebola burial.

Goma/Nairobi/Geneva, 15 January 2020 – Two volunteers from the Democratic Republic of Congo (DR Congo) Red Cross were seriously injured following an attack during a safe and dignified burial of a suspected Ebola case near Mambasa, in eastern DR Congo on Monday, 13 January. The volunteers are now in hospital, receiving medical care and psychosocial support. 

DR Congo Red Cross teams have faced incidents of violence and aggression from communities resisting safe and dignified burial protocols since the start of the Ebola outbreak in North Kivu and Ituri. In this most recent attack, the family had consented to the burial but rumours and panic quickly spread among the community resulting in a violent assault against the Red Cross team. 

Grégoire Mateso Mbuta, President of the DR Congo Red Cross Society said: 

“This incident is a stark reminder of the serious risks our volunteers face when they carry out the dangerous task of safe and dignified burials. While we deplore any violence towards our volunteers or staff, we understand first hand, the fear and frustration that communities harbour and shall continue to render the needed services to the affected populations.” 

The current Ebola outbreak, which began on 1 August 2018, is unfolding in an area affected by a two decades-long conflict that has claimed countless lives and raised fear and hostility towards responders. 

Building community trust and acceptance has been at the core of the Red Cross’ Ebola response operations. This investment has paid off. Since the beginning of the outbreak nearly 20,000 successful safe and dignified burials have been conducted with a consistently high success rate. 

Red Cross volunteers continue to work within affected communities, listening to concerns and gathering feedback that is then analysed and used to provide improved support to people in need. As a result, community resistance for safe and dignified burials has drastically declined over the course of the operation.  

Nicole Fassina, Ebola Operations Manager for the International Federation of Red Cross and Red Crescent Societies (IFRC) said: 

“While we experienced an overall improvement in community’s acceptance of burials, this attack underscores why we cannot become complacent. The Red Cross will continue to engage and involve communities in the Ebola response if we want to bring this outbreak to end.”

DRC Ebola: CMRE update, January 13

CMRE has published Situation épidémiologique du 13 Janvier 2020. Excerpt from the Google translation:

EVOLUTION OF THE EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI ON JANUARY 12, 2020    

Monday, January 13, 2020   

• Since the start of the epidemic, the cumulative number of cases is 3,398, of which 3,280 are confirmed and 118 probable. In total, there were 2,235 deaths (2,117 confirmed and 118 probable) and 1,123 were recovered; 

• 410 suspected cases under investigation; 

• 3 new confirmed cases in North Kivu at Mabalako; 

• No new deaths among the confirmed cases, of which: o No community death was recorded; 

o No death among the confirmed cases; 

• 1 healed person leaving the CTE in North Kivu in Butembo;  

• No health worker is among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 164 (approximately 5% of all confirmed / probable cases), including 41 deaths.

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  

Ebola response teams attacked by the community in the Bandibwame health area

• Teams of the response to the #Ebola virus disease were attacked this Monday, January 13, 2020 in the Bandibwame health area in Lolwa in the province of Ituri by the community; 

• The incident left 4 people injured, 2 of whom were brought back to Lolwa General Hospital and 2 to Mambasa. Among the victims, there is an APS and a response agent committed to dignified and secure burial; 

• In addition, there is community reluctance in the health areas of Biakato Mines and Lwemba in Mandima in Ituri, as well as in those of Aloya, Bingo and Mangina in Mabalako in the province of North Kivu; 

• This reluctance leads to a low participation of people in vaccination. Nevertheless, 6 vaccination teams committed to the Aloya and Bingo health areas in North Kivu were able to vaccinate 82 people around the confirmed cases from December 26, 2019 to January 6, 2020 in these two health areas. 

VACCINATION  

• 5,684 people were vaccinated, until January 10, 2020, with the 2nd vaccine Ad26.ZEBOV / MVA-BN-Filo (Johnson & Johnson) in the two health areas from Karisimbi to Goma; 

• Since the start of vaccination on August 8, 2018 with the rVSV-ZEBOV vaccine 265,309 people have been vaccinated; 

• 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 the firm Janssen Pharmaceuticals for the company 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. was recently pre-qualified for certification.

ENTRY POINT SURVEILLANCE

• Since the start of the epidemic, the total number of travelers checked (temperature taken) at health checkpoints is 138,206,316 ;

• To date, a total of 109 entry points (PoE) and health control points (PoC) have been established in the provinces of North Kivu and Ituri in order to protect the country's major cities and avoid the spread of the epidemic in neighboring countries.

DRC Ebola: CMRE update, January 4

CMRE has published Situation épidémiologique du 04 Janvier 2020. Click to enlarge the table below to see how many health zones have gone weeks and months without a case. The DRC is agonizingly close to shutting down this outbreak altogether, but the violence keeps pushing the response back and condemning more to illness and death. Excerpt from the Google translation:

EVOLUTION OF THE EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI ON JANUARY 03, 2020     

Saturday, January 04, 2020   

• Since the start of the epidemic, the cumulative number of cases is 3,386, of which 3,268 are confirmed and 118 probable. In total, there were 2,233 deaths (2,115 confirmed and 118 probable) and 1,114 people healed; 

• 523 suspected cases under investigation; 

• 1 new confirmed case in North Kivu at Butembo; 

• 1 new death from confirmed cases, of which: 

o No community death was recorded; 

o 1 death from confirmed cases in North Kivu in Katwa; 

• No healed person has left the CTE;  

• No health worker is among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 164 (approximately 5% of all confirmed / probable cases), including 41 deaths.

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  

The General Coordinator of the response to the Ebola virus disease epidemic intervenes at the 28th ethics day in Kinshasa 

 • The general coordinator of the response to the Ebola virus disease epidemic, Prof. Steve Ahuka Mundeke, intervened this Saturday, January 04, 2020 at the twenty-eighth ethics day of Kinshasa organized by the urban council of the Order of physicians (CUOM) under the theme "Medical ethics and ethics, the foundation of practice the art of healing” in the Agora Amphitheater of the Bel Campus University in Kinshasa; 

• For Prof. Ahuka, there is a link between managing the epidemic and ethics in medical practice. The Ebola crisis, he said, concerns all health personnel, particularly doctors, recalling that doctors must intervene in this crisis while respecting the ethics as intended by this day; 

• "There are many aspects of deontology and ethics in medical practice and in the management of Ebola. Lack of hospital hygiene is one of the major factors in the spread of the disease. To this is added the lack of prevention and control of infection in Congolese hospitals. This is an important element of which doctors must be aware, "said the general coordinator of the response during the 28th ethics day in Kinshasa; 

• The intervention of the general coordinator of the response to the Ebola virus disease epidemic at these meetings focused on the communication on the current situation of the Ebola virus disease epidemic; 

• This day ended with the presentation of a diploma of merit to a few doctors and pharmacists for their distinction and commitment to their profession. The diploma of Professor Jean-Jacques Muyembe Ntamfum was symbolically awarded to Prof. Ahuka. 

VACCINATION  

• 4,551 people were vaccinated, until December 2, 2020, with the 2nd vaccine Ad26.ZEBOV / MVA-BN-Filo (Johnson & Johnson) in the two health areas from Karisimbi to Goma; 

• Since the start of vaccination on August 8, 2018 with the rVSV-ZEBOV vaccine, 261,027 people have been vaccinated; • 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. was recently pre-qualified for certification. 

ENTRY POINT SURVEILLANCE  

• Since the start of the epidemic, the cumulative number of travelers checked (temperature taken) at health checkpoints is 134.802.696 ;  

• To date, a total of 109 entry points (PoE) and health control points (PoC) have been established in the provinces of North Kivu and Ituri in order to protect the country's major cities and avoid the spread of the epidemic in neighboring countries.

DRC Ebola: CMRE update, January 3

CMRE has published Situation épidémiologique du 03 Janvier 2020. Excerpt from the Google translation:

EVOLUTION OF THE EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI ON 02 JANUARY 2020    

Friday, January 03, 2020  

• Since the start of the epidemic, the cumulative number of cases is 3,385, of which 3,267 are confirmed and 118 probable. In total, there were 2,232 deaths (2,114 confirmed and 118 probable) and 1,114 people healed; 

• 389 suspected cases under investigation; 

• 3 new confirmed cases in North Kivu Butembo; 

• No new deaths from confirmed cases, including: 

o No community deaths have been recorded; 

o No death among the confirmed cases; • No healed person has left the CTE;  

• No health worker is among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 164 (approximately 5% of all confirmed / probable cases), including 41 deaths.

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  

Awareness around community watch in Mukulya in North Kivu  

• The Beni Sub-coordination, through its communication commission in collaboration with the commune of Bungulu organized in Mukulya in the South-West of Beni in the province of North Kivu a mass sensitization on community watch and on the rise of alerts, as part of the new campaign called "2020, new year without Ebola";  

• To this end, the assistant bourgmestre of the Bungulu commune, Mali Wa Singenda Hamza, congratulated the population in his jurisdiction for his behavior towards teams responding to the EVD and encouraged them to protect health structures; 

• He also explained the risk facing the Mukulya health area, close to the Kalunguta health zone, where Ebola positive cases have been reported in recent days; 

• At the end of this awareness raising, the population of Mukulya undertook to reinforce vigilance strategies around visitors and community engagement in the fight against Ebola; 

• In addition, at Biakato Mines in Ituri, an awareness day was organized on interpersonal communication on vaccination and on the dignified and secure burial protocol (EDS); 

• The fire of screening devices at the Biakato Mines Control Point was also reported on the night of January 2 to 3, 2020 by individuals not otherwise identified.

VACCINATION  

• 4,551 people were vaccinated with the 2nd Ad26.ZEBOV / MVA-BN-Filo vaccine (Johnson & Johnson) in the two health areas from Karisimbi to Goma; 

• Since the start of vaccination on August 8, 2018 with the rVSV-ZEBOV vaccine, 260,747 people have been vaccinated; 

• 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 the firm Janssen Pharmaceuticals for the company 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. was recently pre-qualified for certification. 

ENTRY POINT SURVEILLANCE  

• Since the start of the epidemic, the total number of travelers checked (temperature taken) at health checkpoints is 134,444,193 ;  

• To date, a total of 109 entry points (PoE) and health control points (PoC) have been established in the provinces of North Kivu and Ituri in order to protect the country's major cities and avoid the spread of the epidemic in neighboring countries.

Climate change, crime and political chaos: A deadly mix in Honduras dengue epidemic

Via The New York Times: Climate Change, Crime and Political Chaos: A Deadly Mix in Honduras Dengue Epidemic. Excerpt:

CHOLOMA, Honduras — More than 400 people died this year as one of the worst dengue epidemics on record swept through Central America — a type of outbreak that some scientists and public health officials are warning is likely to become more frequent and more widespread because of climate change.  

But while climate change is threatening to increase the spread of dengue worldwide by expanding the range of the mosquitoes that carry the virus, the disease has already found an especially fertile breeding ground in Honduras, for reasons that go beyond the environment.  

In Honduras, which accounted for more than 40 percent of the dengue deaths in Central America this year, according to the Pan American Health Organization, the effects of climate change have been compounded by government dysfunction, political tumult and public apathy. 

Dengue has hit the country hard. This year, it had more than 107,000 cases of the viral disease — more than 13 times the number recorded last year — and at least 175 deaths. In 2018, only three people in Honduras died from the disease, according to the Pan American Health Organization.

Honduras’s notorious criminality has worsened matters, too, as public health teams, already stretched thin by budget cuts and a lack of trained personnel, have been blocked by gangs from entering some of the most severely afflicted neighborhoods to educate residents and fumigate against mosquito infestations.  

Dengue is transmitted to humans by a type of mosquito called Aedes, which thrives in urban areas of the world’s tropical and subtropical regions. Tens of millions of cases occur each year in more than 100 countries, and symptoms may include fever, internal bleeding and shock. Inadequately treated, the illness can quickly kill. 

In Honduras, health officials trace the start of the current epidemic to the fall of 2018. The number of incidents then rose sharply during the first half of 2019, hitting a peak this summer before falling off as the year ended. A nationwide health emergency declared in July by the administration of President Juan Orlando Hernández remains in effect.  

The outbreak struck during a time of political turbulence in Honduras, with violent street protests against Mr. Hernández and calls for his ouster. Some of the protests have been driven by fears the government planned to privatize the health and education sectors. 

The nation also suffers from high murder rates and widespread poverty, which have combined to drive tens of thousands of Hondurans in recent years to emigrate, with many trying to make it to the United States.  

The dengue outbreak has met little resistance from a public health system gutted by budget cuts and pervasive corruption, analysts and officials said.  

“It’s a collapsed system, an inefficient system,” said Ismael Zepeda, an economist with Fosdeh, a research group in Tegucigalpa, the capital.

From seniors’ care to opioids, eight critical public health issues for 2020

The Tyee has published my article From Seniors’ Care to Opioids, Eight Critical Public Health Issues for 2020. Excerpt:

Canada has plenty of domestic public health problems, and an infectious disease outbreak anywhere in the world is just one airline passenger away from Toronto or Vancouver.

As the year winds down, here are eight incredibly pressing public health problems — and some solutions — we’re likely to deal with in 2020. 

The slow end of the Ebola outbreak. Time and again, extremist political violence and distrust of the Kinshasa government in the northeast Democratic Republic of Congo have halted the response to the Ebola crisis that has killed more than 2,200 people. We now have two effective Ebola vaccines, but getting them to people at risk will be a problem well into the new year.  

The outbreak won’t be considered over until 42 days have passed since the last confirmed case. Given the violence, we won’t likely experience those 42 days for months. 

Continued spread of measles. The World Health Organization estimates that 144,000 people died of measles in 2018. It’s killed more people in the DR Congo than Ebola. Encouragingly, Samoa recently shut down the country for two days to vaccinate 90 per cent of the population — and hit that target.

Social media attacks on measles vaccine have helped keep immunization rates low in countries that should know better, like the U.S. and Canada. We should learn from the Samoans.  

Opioids and their collateral damage. It’s been over three years since Dr. Perry Kendall declared a public health emergency in B.C. over opioid overdoses and deaths. Deaths are trending down, but overdoses seem to have stabilized at an intolerable 22,000 a year. 

It’s intolerable partly because survivors of multiple overdoses may end up with lifelong brain damage, and partly because first responders — fire and rescue and paramedics — must deal with the stress and mental health problems caused by saving the same people again and again. In 2020, we may start thinking about why people get on opioids in the first place.

DRC Ebola: CMRE update, December 25

CMRE has published Situation épidémiologique du 25 décembre 2019. Excerpt from the Google translation:

EVOLUTION OF THE EPIDEMIC IN THE PROVINCES OF NORTH AND SOUTH KIVU AND ITURI AT 24  DECEMBER 2019   

Wednesday, December 25, 2019 

Since the start of the epidemic, the cumulative number of cases has been 3,366, of which 3,248 confirmed and 118 probable. In total, there were 2,227 deaths (2,109 confirmed and 118 probable) and 1,098 people recovered. 

• 392 suspected cases under investigation; 

• 3 new confirmed cases in North Kivu, including 2 in Kalunguta and 1 in Mabalako; 

• Kalunguta re-notified confirmed cases after 63 days of silence; 

• No new deaths among the confirmed cases, including: 

o No community death among the confirmed cases; 

o No death among the confirmed cases; 

• No healed person has left the CTE;  

• No health worker is among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 164 (approximately 5% of all confirmed / probable cases), including 41 deaths.

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  

Interception of two high-risk contacts at the Maboya checkpoint 

• Two high-risk contacts were intercepted at the Maboya checkpoint; 

• These are two men aged 47 and 14, from Cantine / Aloya bound for Butembo. They are the biker's contacts, confirmed case of December 16, 2019 in Aloya. The two subjects were sent to the Ebola Treatment Center (ETC) in Butembo; 

• In addition, at the Foner checkpoint in Mambasa in Ituri, there was theft of response materials during the night of December 23 to 24, 2019; 

• It is a hand washing device, including a tank with a capacity of 2000 liters carried by individuals not otherwise identified; 

• Assaults on two service providers at the Goma Public Port control point were also reported by the agents of the security firm GSA, because they demanded that they strictly observe the hygiene measures laid down at a control point.   

Kalunguta Health Zone Reports Two Ebola Cases After 63 Days of Silence 

• The first case concerns a 7-year-old girl, alive, vaccinated in 2018 and not listed as a contact; 

• The beginning of the signs dates back to December 18, 2019 with the date of the exposure period from December 01 to 14, 2019 by fever, anorexia, physical asthenia, chills, abdominal pain and vomiting; 

• From December 18 to 24, this child was hospitalized at the Kasinga / Mbunduku health post. Her evolution was marked by the occurrence of gingivorrhagia and melaena on December 23, 2019; 

• This patient was transferred on 24 December by mototaxi to the Avo health post in the Kanyihunga health area. she was accompanied by her father and aunt. The alert was launched by the active research team and the child was transferred by ambulance to the Ebola Treatment Center in Butembo after validation as a suspect case. It was confirmed the same day; 

• The second confirmed case is a 5 year old girl, alive, unvaccinated and not listed as a contact. She is the sister of the first case; 

• The signs started on December 18, 2019 with the exposure period from December 01 to 14 as fever, anorexia and vomiting; 

• On December 19, 2019, this child was kept at home and without treatment. She was hospitalized and looked after by her mother at the Mbukudu dispensary from December 20 to 24 to be transferred on December 24 to the Avo health post in the Kanyihunga health area following the worsening of the signs and the occurrence of diarrhea, arthralgia and melaena. She was accompanied by her father and aunt on mototaxi; 

• She was transferred, after validation as a suspect case, by ambulance to the CTE of Butembo at the same time as her sister (the 7-year-old girl). She was confirmed Ebola the same day; 

• Investigations around these two cases are continuing to establish their source of contamination. A total of 15 contacts have already been pre-listed around these cases. 

VACCINATION  

• 2,938 people were vaccinated, until December 20, 2019, with the 2nd vaccine Ad26.ZEBOV / MVA-BN-Filo (Johnson & Johnson) in the two health areas from Karisimbi to Goma; 

• Since the start of vaccination on August 8, 2018 with the rVSV-ZEBOV vaccine, 259,276  people have been vaccinated; 

• 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 the firm Janssen Pharmaceuticals for the company 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. was recently pre-qualified for certification.

ENTRY POINT SURVEILLANCE

• Since the start of the epidemic, the total number of travelers checked (temperature taken) at health checkpoints has been 131,235,428 ;

• To date, a total of 109 entry points (PoE) and health control points (PoC) have been established in the provinces of North Kivu and Ituri in order to protect the country's major cities and avoid the spread of the epidemic in neighboring countries.

Ebola in Beni: The response committee calls for increased security for its agents

Via Radio Okapi: Ebola in Beni: the response committee calls for increased security for its agents. The Google translation:

The support committee for the response to the Ebola virus disease on Tuesday (December 24th) called in Beni to reinforce security for the agents and structures for the treatment of this disease. This committee says it deplores the threats and several attacks against health structures recorded recently in the territory of Beni (North Kivu) and Mambasa (Ituri).  

The president of the support committee for the response against Ebola, Me Omar Kavota, made this proposal to the FARDC General Staff:  

“We are currently advocating at the military level for a specialized unit to secure the response teams. We would like that, compared to the operational sector which is in Beni, as it is subdivided in axes according to certain commands, we would like that they are affected by the General Staff of the FARDC, a commander who will be able to manage units responsible for securing response teams." 

The structure believes that efforts must be made so that the care agents and structures are protected and secure in order to definitively overcome this disease.

“Alongside the ADF, we must realize that the other most formidable enemy is the Ebola virus epidemic. And as long as the medical professionals, as long as the medical structures are the object of attacks on behalf of the armed groups without there being specialized units at the level of the police force, at the level of the army to reassure these health professionals, we can tell ourselves that we still have a way to fight this epidemic,” continued Omar Kavota.

Samoa measles: 23 new cases in December 24, 1 new death, 95% vaccination rate

A Christmas Eve tweet from the Government of Samoa: