H5N1

WHO: Local leaders help turn the tide on Ebola

A news release from WHO AFRO: Local leaders help turn the tide on Ebola. Excerpt:

Butembo, Democratic Republic of the Congo – Joseph Kakule, the community leader of the Vighole area, has become one of the most committed social mobilizers in a region ravaged by the ongoing outbreak Ebola in the Democratic Republic of the Congo.  

Kakule, 47, is a native of Butembo. He is one of the local leaders who are working to mobilize community engagement to combat Ebola. "Listening to my community, sharing its anxieties and trying to find a solution – that's what motivates me," he says. 

Kakule and his deputy, 30-year-old Gervais Muhindo, form a duo resolutely determined to break the silence about the disease, and to end mistrust of Ebola health workers. 

This week, they both feel happy that they have done their duty. They managed to persuade people who had come in contact with the most recent confirmed cases of Ebola to agree to be vaccinated. Located southwest of Butembo, Vighole is part of the Katwa health zone, which is considered one of the strongholds of community resistance. People here have turned a deaf ear to attempts to raise awareness of an epidemic that has continued to spread. 

Every day for the past ten months, Ebola cases have been reported in Butembo – a city of more than one million inhabitants – and its immediate surroundings, including Binone, Kabondo, Kavisa, Kirimbere and Vuhunga. So far there have been more than 2 008 cases in the provinces of North Kivu and Ituri, including 1 900 confirmed and 94 probable, with more than 1 340 deaths. 

To make sure that vaccination teams from the Ministry of Health and the World Health Organization could safely arrive on site to administer the Ebola vaccine, Kakule and Muhindo first toured the alleys of Vighole, meeting community members. Their goal was to conduct an in-depth door-to-door awareness campaign so that a vaccination site could be set up. They were targeting first and second degree contacts with people who had been diagnosed with the virus. 

“It has been a long time since an Ebola response team could set foot here," Kakule says, “but we are mobilizing against misinformation and lack of trust within our community, which itself is plagued by doubt and anger at the insecurity caused by armed groups.”  

During the first six months of 2019, the Katwa area and the Butembo urban agglomeration experienced several attacks attributed to armed groups. These attacks included the looting and destruction of Ebola treatment centres, during which some health responders at the frontline and security forces repelling the attackers lost their lives. 

Kakule remembers that, after difficult weeks of bitterness and misunderstanding following these violent incidents, he and Muhindo simply decided to organize community meetings to explain that the Ebola virus disease was a serious danger that threatened everyone without exception.  

"Those who die of this deadly virus are our brothers and sisters. We cannot give up and watch the situation continue to deteriorate like this without doing anything," Kakule says. The Vighole area was recently in uproar after a series of deaths occurred within a single family. First came the death of a 17-year-old boy suspected of having contracted Ebola, followed by the deaths of both his parents a few days later.  

"I told myself that talking about Ebola to members of our neighbourhood is not a crime, even if other residents treat us like sell-outs bought by the response teams," says Muhindo. 

Muhindo says he often uses "the testimonies of those who are already healed from Ebola as a powerful argument to sweep away the doubt" of his neighbours in the Vighole area. He also talks about the importance of vaccinating or decontaminating affected households to prevent the disease from spreading further.

Sudan doctors: Death toll now at 113

Via Radio Dabanga: Sudan doctors: Death toll now at 113.

The Sudan Doctors Central Committee announced the deaths of five protesters in Port Sudan and Khartoum on Thursday, bringing the total number of dead since the violent dispersal of the Khartoum sit-in on Monday to 113. 

The committee said in a statement that four people were killed in Port Sudan while the fifth died in intensive care in Khartoum from wounds received during the Monday massacre.  

Residents in Ed Babikir, Mayo, El Kalakla, and El Jereif districts in the capital Khartoum have denied reports of an attack by criminal gangs on citizens and the looting of their property. 

They told Radio Dabanga that these were mere rumours, saying that any suspects arrested for housebreaking were handed over to the armed forces. 

The Sudanese Professionals Association (SPA) declared categorical rejection of the calls, which were launched through loudspeakers of some mosques, to bring out edged weapons to resist the gangs.  

In its statement, the SPA accused the military junta of bringing these gangs and arming them, considering it a plan by the military junta to terrorise and intimidate people in order to provoke them to violence and abandonment of peace. 

Witnesses  

Witnesses and victims have given detailed accounts of Monday’s massacre in Khartoum. 

An activist who called herself Sarah revealed in a live broadcast on Facebook, that she and her colleague were subjected to repeated rape attempts by members of the Rapid Support Forces (RSF) militia. 

She said that officers of the Sudanese Armed Forces (SAF) intervened and protected her and her colleague from the militiamen. 

She said that the force that carried out the massacre consisted of RSF, and public and student security staff. 

She recounted the excessive violence that the RSF used against the protesters, as well as the blatant abuse, insults, obscenities, racism, and harassment.

DRC: Ebola epidemic in North Kivu and Ituri is the most complex in world history (Ministry of Health)

Via Radio Okapi: DRC: Ebola epidemic in North Kivu and Ituri is the most complex in world history (Ministry of Health). The Google translation:

The Ebola epidemic in North Kivu and Ituri is the most complex in world history because of the high mobility of the population and the security context with more than one million displaced people in North Kivu, Health Minister Oly Ilunga said at a press conference Saturday (June 8th) in Kinshasa.  

Ten months after its appearance, Ebola passed the milestone of 2000 and caused 1,340 deaths, said Minister of Health Oly Ilunga. 

The security context, characterized by the presence of at least one hundred armed groups and armed attacks in most of the affected areas, does not facilitate the response. And the consequences are considerable.  

"Eight months after the beginning of the epidemic, 33 weeks after the declaration of the epidemic, we were only 1000 cases. In 10 weeks between March and June, the number of cases doubled. This rapid increase is directly related to the armed attacks against the teams and the operations of the riposte in Butembo and Katwa," Oly Ilunga argued.  

Despite this, some positive actions have been taken by the teams in the field, including the cantonment of the epidemic. 

But according to Dr. Oly Ilunga, there are still challenges in controlling the epidemic. These are epidemiological surveillance to break the chain of transmission, the prevention and control of infections and the high rate of community deaths.

DRC: 1,000 cases of Ebola due to armed violence in North Kivu and Ituri

Via Actualite.cd: DRC: 1000 cases of Ebola due to armed violence in North Kivu and Ituri. The Google translation: 

Armed violence targeting the Ebola response teams in the North Kivu provinces and in Ituri prevented the successful response activities between March and May, causing 1000 new cases appear in 10 weeks, according to the Ministry of Health. 

The consequence of this armed violence is that "1000 new cases have been registered during the last 10 weeks while the milestone of the first 1000 cases has been reached in 33 weeks (8 months)," said Saturday the health authority. 

"Each armed attack targeting the response and each suspension of activities led to an increase in Ebola cases, the next 10-15 days," the same source added. 

Declared in August 2018, this epidemic has already passed the 2000 mark for 1,381 deaths, according to official figures, as of June 7, 2019. 

The Democratic Republic of Congo (DRC) is facing its 10th Ebola outbreak, a first in its eastern facade infested with a hundred armed groups. If since the first epidemic in 1976 the DRC regularly manages to contain easily Ebola, the prevailing insecurity in the region explains the persistence of the present outbreak. Armed groups destroy Ebola treatment centers and kill health workers. Last April, a Cameroonian doctor deployed by the World Health Organization (WHO) perished in Butembo, in an attack perpetrated by the Mai-Mai militia, while he was meeting with his colleagues. 

"The virus spreads when the teams are unable to perform their activities for various reasons (family refusal, insecurity, flight of the patient, etc.)," explains the ministry. 

"In order to break the chain of transmission of the Ebola virus, a series of activities must be carried out around each Ebola patient," adds the same institution that orchestrates the response. 

The Congolese authorities have been pleased to have managed to contain the epidemic geographically in only two provinces of the DRC while, over the same period, "the epidemic of West Africa had reached 9 countries." 

To date, 11 of the 22 affected health zones have no longer reported cases of Ebola for more than 21 days. The neutralization of armed groups is imperative for an effective response to Ebola in the DRC. 

During a meeting in Kinshasa on 5 and 6 June, the heads of the intelligence services of the four countries of the subregion African Great Lakes (Rwanda, Uganda, DRC and Tanzania) announced Friday, "regional action coordinated and concerted" against rebellions and armed groups active in eastern DRC.  

North Kivu-Ebola: Altercation between the population and the response team this Saturday in Cantine

Via 7sur7.cd: North Kivu-Ebola: Altercation between the population and the response team this Saturday in Cantine. The Google translation:

The situation remained hectic this Saturday in Mangato district, Cantine-Aloya locality in Beni territory. 

Indeed, it was reported an uprising of the population against Ebola response teams that came from Mangina to fight against this virus in this part of the territory of Beni where many positive cases are currently recorded.  

According to Mangina's civil society, despite the sensitization, the population of Cantine persists in their doubts about the existence of this epidemic in the eastern part of the country.  

Unfortunately, he laments, patients who flee this locality come again to contaminate the city of Mangina where the virus is more and more contained by the response for some months now.

Civil society reports that it was the inhabitants of Cantine, in collusion with the Mai-Mai, who forced the response teams to turn back and that the worst would be lived if the police did not intervene in time. 

"It has been a week since Ebola cases are being registered at the Mangina Ebola treatment centers, and most of these cases come from Cantine and Mabalako. The population has risen against the response teams, all the teams have returned to the base, and we learn at the last minute that it is the mixed population of the Mai-Mai," said the civil society. 

Other sources report that a lady was hit by a bullet during this tug.

Polio: Statement of the Twenty-first IHR Emergency Committee

Via ReliefWeb, a May 30 WHO report: Polio: Statement of the Twenty-first IHR Emergency Committee. Excerpt:

The twenty-first meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) regarding the international spread of poliovirus was convened by the Director-General on 14 May 2019 at WHO headquarters with members, advisers and invited Member States attending via teleconference, supported by the WHO secretariat.  

The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine derived polioviruses (cVDPV). The Secretariat presented a report of progress for affected IHR States Parties subject to Temporary Recommendations. The following IHR States Parties provided an update on the current situation and the implementation of the WHO Temporary Recommendations since the Committee last met on 19 February 2019: Afghanistan, DR Congo, Indonesia, Nigeria, Pakistan and Somalia.  

The committee commended all countries that presented on the quality of information provided, and the transparency with which countries discussed their challenges. 

Wild poliovirus 

The Committee is gravely concerned by the significant further increase in WPV1 cases globally in 2019, particularly in Pakistan where 15 cases have already been reported. In Pakistan transmission continues to be widespread, as indicated by the number of positive environmental isolates in many areas of the country, and the proportion of samples that detect WPV1 is rising. 

The recent cluster of cases in Lahore also indicates that vulnerabilities still exist outside the high-risk corridors. Notably, the increased rate of infection during what is usually the low season may herald even higher rates of infection in the coming high season unless urgent remedial steps are taken. The committee was very concerned about attacks on vaccinators and on the police protecting them. The increasing refusal by individuals and communities to accept vaccination also needs to be actively addressed. While the committee understood that the recent elections and political transition may have adversely affected delivery of the polio program, it is now essential that the new government renews its efforts, noting that the eradication program in the country is no longer on-track.  

Highlighting these concerns, the committee noted the recent detection of WPV1 in sewage in Iran in an area close to the international border with Pakistan. Based on genetic sequencing, the virus is most closely linked to viruses found recently in Karachi, Pakistan. 

While there is no evidence currently that transmission has occurred in Iran and routine immunization coverage is high there, this finding together with the resumption of WPV1 international spread between Pakistan and Afghanistan suggests that rising transmission in Pakistan correlates with increasing risk of WPV1 exportation beyond the single epidemiological block formed by the two countries. The Iran event is the first such exportation detected since 2014 and signals that the hard fought gains of recent years can easily be reversed.  

In Afghanistan, the critical issue of access is seriously hampering progress towards global eradication and needs to be resolved. Inaccessible and missed children particularly in the Southern Region mean there is a large cohort of susceptible children in this part of Afghanistan. Environmental surveillance has found an increased proportion of positive samples in 2019. The security situation and access will need to significantly improve for eradication efforts to progress.

Branswell: WHO sees progress in Ebola response, but others see a grimmer reality

Via STAT, Helen Branswell writes: WHO sees progress in Ebola response, but others see a grimmer reality. Excerpt:

Efforts to contain the 10-month-old Ebola outbreak in the Democratic Republic of the Congo appear to be bearing fruit, with a decline in cases over the past two weeks and a shrinking of the geographic footprint of the zones of transmission, the World Health Organization said Thursday.  

The cautious notes of optimism were in contrast to messages from earlier in the week from other partners in the response, including the Centers for Disease Control and Prevention.  

The CDC’s director, Dr. Robert Redfield, warned Tuesday that the world needs to prepare for the possibility the epidemic could drag on for another year or two. And Tariq Riebl, an emergency response director for the International Rescue Committee, said the sharp rise in case in cases this spring, at a time when an outbreak ought to be coming under control, suggested drastic changes are needed. “This response requires a total and complete reset,” Riebl said. 

The WHO’s Dr. Mike Ryan, who is executive director of the global health agency’s emergencies program, said Redfield’s estimation was a worst-case scenario. But he said other possibilities include halting spread in the Congolese provinces of North Kivu and Ituri much sooner than that.

“The outcome is effort related,” Ryan said. “Are we prepared to make immediate, sustained, comprehensive effort to bring this disease under control? And if we are, I believe the timelines can be much shorter than the ones stated.” 

“But … I think Dr. Redfield is really trying to wake the world up to the fact that this is a very complex situation and that if we keep operating at less than perfect efficiency, we may end up being around dealing with this outbreak for a very long time.”  

Ryan pushed back against the call for a total reset, saying that’s not an option available to the response. “Adapt, yes. Learn, yes. Change things, yes,” Ryan said. “I’ve been through a lot of Ebola and other outbreaks. There are no magic bullets. There are no unicorns. It’s just hard work and learning from what we do.”

One in four Ebola cases undetected in Congo: WHO

Via Reuters: One in four Ebola cases undetected in Congo: WHO. Excerpt:

Roughly a quarter of Ebola infections in eastern Congo are estimated to be going undetected or found too late, a World Health Organization (WHO) expert said on Thursday.

Some 2,025 cases and 1,357 deaths have been recorded since the epidemic began in August in the Democratic Republic of Congo’s North Kivu and Ituri provinces, said Dr. Mike Ryan, executive director of WHO’s Health Emergencies Programme.  

It is the second-worst outbreak of the virus on record.  

Some 88 infections have been detected each of the last two weeks, down from a peak of 126 weekly in April, and WHO teams are following up on 15,000 suspected contacts each day, a “huge number” who require checking for symptoms, he added. 

“We believe, let me be very cautious here, we believe we are probably detecting in excess of 75% of cases - we may be missing up to a quarter of cases,” Ryan told a news briefing in Geneva. 

There were “a lot of cases with very delayed detection”, he added. “We must get earlier detection of cases, have more exhaustive identification of cases.”  

The epidemic was not under control, he said, and was spreading fast in the rural area of Mabalako.

CDC director expects to run out of Ebola vaccine

Via Devex.com: CDC director expects to run out of Ebola vaccine. Excerpt:

WASHINGTON — The director of the Centers for Disease Control and Prevention predicts that responders in the Democratic Republic of the Congo will exhaust the current supply of the Ebola virus vaccine before the pharmaceutical company manufacturing them can produce more.

Robert Redfield, director at CDC, relayed that warning to U.S. lawmakers on Tuesday, just as new reports indicated the number of Ebola virus cases in eastern DRC has climbed past 2,000. While the Ebola vaccine has been helpful in this unprecedentedly difficult response effort, regulatory delays have stalled production of new vaccine stocks, Redfield said in a U.S. House of Representatives hearing.  

“Operationally, this isn’t really going as effectively as we’d like,” he said. “Vaccine supply is limited, and there’s a need to accelerate that supply,” he said. 

There is currently a global stockpile of about 145,000 doses of the vaccine, while roughly 130,000 people in DRC have been vaccinated so far, according to Redfield. That number of vaccinations represents only about 20% of the number of people that responders would like to be able to reach as they move toward broadening their vaccination plans, he said. 

The current approach is to vaccinate people in “rings.” The first ring includes anyone in contact with someone infected with Ebola. The second ring includes anyone in contact with someone in the first ring. 

“We actually want to vaccinate geographic areas where we can’t function because of the insecurity. Unfortunately, there’s going to be a six to 12-month lag before there’s adequate vaccine supply, so we do project that we are going to run out of vaccine,” Redfield said.

The problem is that the current vaccine’s manufacturer, Merck, closed its facility in Pennsylvania where the first lot of vaccines was produced. They have moved the production facility to Germany, but have been unable to secure the necessary validation for those plants that would allow production to proceed, Redfield told lawmakers. 

“We’re just waiting for the validation of the new plants … The clinical efficacy data, safety data is there. It’s just waiting to prove that the plant that’s going to make the vaccine is going to make it in a reliable way,” he said.

Insecurity in Beni: Bikers decree three days without a motorcycle taxi to put pressure on authorities

Via Actualite.cd: Insecurity in Beni: Bikers decree three days without a motorcycle taxi to put pressure on authorities. This strike may make it hard for suspected Ebola cases to reach help. The Google translation:

The motorcyclists' associations in Beni (North Kivu) have decreed three days without a motorcycle taxi on the whole city. According to the initiators, they are also spending time mourning six bikers killed in the recent massacres in Butanuka, southeast of Beni, on the night of Monday, June 3rd. They also call on the government to end the persistence of insecurity in Beni.

"We buried our colleagues killed by the ADF, so we have decided in collusion with all bosses to suspend work for three days from Thursday. We will see how our government is going to impose the security that taximen is now demanding. We will do three days of city without a motorcycle, " Kyatenga Arron, one of the initiators , told ACTUALITE.CD. 

This morning, the motorcycles are invisible in several streets of Beni. Some hunt down their colleagues who are trying to work in hiding.