H5N1

Branswell: Ebola response suffers another setback, as WHO evacuates some staff

Via STAT, Helen Branswell writes: Ebola response suffers another setback, as WHO evacuates some staff. Excerpt:

The World Health Organization has evacuated 16 people working to contain the Ebola outbreak in the Democratic Republic of the Congo following a rebel attack near the area where they were staying, Director General Tedros Adhanom Ghebreyesus said Saturday.  

The decision marks another violence-related setback for the response to the outbreak, but Tedros said in an interview with STAT that he hoped containment operations could resume as normal soon. 

Overall, the response team in the area comprises more than 200 health workers and others, he said. 

The attack appears to have targeted a camp used by United Nations peacekeeping forces in Beni, a city in northeastern Congo that is currently a hot spot for Ebola transmission. The camp is located near a hotel where some Ebola responders are staying. 

Tedros said leaders of the response operation called him to inform him an attack was underway on Friday night, and he could hear heavy gunfire over the phone.  

“They called me immediately and the gunfire was very close to them,” he said. 

After Friday night’s violence subsided, several members of the Ebola response team “were exhibiting some distress,” Tedros said, and a decision was made to pull them back to Goma, a city south of Beni, so that they could get a few days of rest and counseling. Others insisted on staying in Beni, he said, calling them “very courageous people.”  

Friday’s violence was the latest in a string of attacks in the region. Earlier in the week eight peacekeepers and at least 12 Congolese soldiers died in an ambush on their joint operation aimed at routing out a stronghold of the rebel group Allied Democratic Forces near Beni. A number of rebels were captured in the exchange.  

That event again prompted the U.N. to call for a halt to the violence in the region, suggesting attacks on the peacekeepers may be deemed war crimes under international law. 

The Ebola outbreak response has been struggling because of the violence in the region and the distrust it fosters among people in the region who have lived with these conditions for years. 

Repeated bouts of violence have hampered the ability of the response teams to do their work, and the virus has taken advantage of their limitations. 

As of Saturday there have been 358 confirmed and probable cases in this outbreak, and 213 of those people have died. It is the third largest Ebola outbreak on record and the largest in Congo’s long history with Ebola outbreaks.

EBOLA DRC - Evolution of the response to the Ebola epidemic in North Kivu and Ituri on Saturday, 17 November 2018

The Ministry of Health has published EBOLA DRC - Evolution of the response to the Ebola epidemic in North Kivu and Ituri on Saurday, 17 November 2018. The news is not good, given the nearness of Friday's Beni attack to the Ebola emergency response center. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Saturday, November 17, 2018   

The epidemiological situation of the Ebola Virus Disease dated November 16, 2018:   

• Since the beginning of the epidemic, the cumulative number of cases is 358, of which 311 are confirmed and 47 are probable. In total, there were 213 deaths (166 confirmed and 47 probable). 

• 57 suspected cases under investigation.  

• 6 new confirmed cases, including 4 in Beni, 1 in Katwa and 1 in Kalunguta.  

• 3 new confirmed deaths, including 2 in Beni and 1 in Katwa.    

 /! \ Cleaning the current database   

Remarks: 

• To avoid that the total number of cases varies (up or down) daily, the suspect cases have been placed in a separate category. Thus, suspect cases with positive laboratory tests will be added to the confirmed category, while negative ones (non-cases) will be removed from the table. 

• The category of probable cases includes all reported deaths for which it was not possible to obtain biological samples for laboratory confirmation. The investigations will determine whether these deaths are related to the epidemic or not. 

• A community death is a death in the community, outside of a licensed health center. 

News of the response 

Security 

• On the evening of Friday, November 16, 2018, an armed group made an incursion into Boikene neighborhood, Rwenzori commune, in the city of Beni, with the intention of attacking one of the bases of MONUSCO. The peacekeepers reacted immediately, pushing the rebel group after several hours of clashes, a few meters from the Ebola Response Emergency Operations Center and hotels in which several teams from the response were lodged.  

• This Saturday, November 17, 2018, all field activities were suspended, and the Emergency Operations Center remained closed. All the teams stayed in their respective hotels. 

• Health Minister Oly Ilunga Kalenga deplores the violence that has once again wounded the people of Beni and is slowing the efforts of the response teams to end the Ebola outbreak. The epidemic remains dangerous, especially in Beni. As a result, national and international teams continue to work alongside the population to end the epidemic.  

Vaccination 

• Since the start of vaccination on August 8, 2018, 31,713  people have been vaccinated , including  15,901 in Beni, 4,544 in Mabalako, 3,292 in Katwa, 1,663 in Mandima, 1,615 in Butembo, 1,602 in Kalunguta, 732 in Masereka, 434 in Bunia, 355 in Tchomia, 330 in Vuhovi, 292 in Mutwanga, 241 in Kyondo, 240 in Komanda, 210 in Musienene, 178 in Oicha, and 34 in Alimbongo.

Twelve Congolese soldiers killed in clashes this week in Ebola-hit east

Via Reuters: Twelve Congolese soldiers killed in clashes this week in Ebola-hit east.

Twelve Congolese soldiers were killed alongside seven U.N peacekeepers in clashes with militias on Wednesday in Democratic Republic of Congo’s Ebola-hit east, government spokesman Lambert Mende said. 

The casualties, incurred during a joint operation against the Ugandan Islamist group Allied Democratic Forces (ADF), make this week one of the deadliest for troops in Congo’s volatile eastern borderlands since a rebel attack in early 2018.

And that is why the local media pay more attention to the ongoing violence than to Ebola: the violence has killed far more people.

Looking for Brazilian public health resources

Since the end of the yellow fever outbreak, I've lost touch with many of my Brazilian sources of health news. Now, with the impending inauguration of Jair Bolsonaro on January 1, such sources will be increasingly important. 

A quick search for Brazilian health bloggers has turned up very few active blogs, and I doubt the Ministry of Health website and blog will be very helpful. I'm also aware that Brazilian bloggers on political topics sometimes get shot—and I have no desire to see that happen to anyone else.

Still, if you know of any individuals, groups, or agencies that are familiar with Brazil's public health issues, working online in or out of the country, I'd be grateful for the links.

 

CIDRAP: Armed rebels kill UN peacekeepers in Ebola hot spot

Via CIDRAP, Lisa Schnirring writes: Armed rebels kill UN peacekeepers in Ebola hot spot. Excerpt:

A joint operation yesterday against armed rebels near the Democratic Republic of the Congo (DRC) Ebola hot spot in Beni killed seven United Nations peacekeepers, as officials confirmed one more infection in the outbreak. 

Action targeted ADF stronghold 

The action against the armed rebels, who have been responsible for several attacks against civilians in Beni that have stymied response activities, involved the UN mission known as MONUSCO and government armed forces. Their target was the Allied Democratic Forces (ADF). 

Forces killed in the clash included one Tanzanian and six Malawian "blue helmets," or UN soldiers, according to a UN report. Ten other peacekeepers were wounded, and another is missing. Several government soldiers and an unknown number of ADF fighters were also killed or wounded.  

According to a New York Times report, the joint forces came under attack while trying to remove rebel fighters from a stronghold in Kididiwe near Beni. UN officials speaking anonymously told the Times that the mission was successful, and a number of rebels were taken. 

In a statement, UN Secretary-General Antonio Guterres condemned the killing of the UN peacekeepers and called on armed groups to disarm and stop their destabilizing activities, which hurt the local population and complicate the Ebola outbreak response. 

He also urged the DRC's government to keep taking steps to apprehend those responsible for attacks on civilians, government forces, and UN peacekeeping troops. 

Beni has been the scene of several violent attacks since the Ebola outbreak began in August, including one in September that resulted in a public mourning period that temporarily halted response operations.  

The joint mission push against the ADF forces in the area comes a week after a high-level visit by UN and World Health Organization (WHO) officials to address the security problems, which have been fueled by the DRC's longstanding failure to protect citizens against armed groups in the eastern part of the country. 

One confirmed case, more probable illnesses 

Meanwhile, the DRC's health ministry today reported one new case, which involves a patient from Katwa. Officials have been cleaning up their case database, which has resulted in the addition of seven probable cases in Kalunguta. 

The new developments bring the outbreak total to 352 cases, 305 of them confirmed and 47 listed as probable. One more death was reported, which involves a person from Katwa, lifting the fatality count to 210.

WHO AFRO Ebola update, week 45

WHO AFRO has published its Weekly Bulletin on Outbreaks and Other Emergencies for week 45. Excerpt:

The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces, Democratic Republic of the Congo continues to evolve. Since our last report on 2 November 2018 (Weekly Bulletin 44), 31 new confirmed EVD cases and 19 new deaths have occurred. Three new health zones have reported confirmed EVD cases during the reporting week: Mutwanga Health Zone close to Uganda border confirmed one new case on 7 November 2018 while Kyondo Health Zone close to Butembo reported one confirmed case on 8 November 2018. Musienene Health Zone (which had a probable case previously) reported a confirmed EVD case on 9 November 2018.

Insecurity persists, with an attack on a safe and dignified burial team by Mai-Mai at Mutembo village, on the road between Beni and Butembo.

As of 10 November 2018, there have been a total of 329 EVD cases, including 294 confirmed and 35 probable cases. To date, confirmed cases have been reported from 14 health zones: Beni (153), Mabalako (73), Butembo (34), Kalunguta (9), Masereka (4), Vuhovi (3), Oicha (2), Kyondo (2), Komanda (1), Musienene (1) and Mutwanga (1) in North Kivu Province; and Mandima (9) and Tchomia (2) in Ituri Province.

A total of 205 deaths were recorded, including 170 among confirmed cases, resulting in a case fatality ratio among confirmed cases of 57% (170/294). Two new health workers were affected on 9 November 2018, bringing the total number of health workers affected to 30, including 29 confirmed, and three deaths.

On 10 November 2018, 28 new patients were hospitalized, bringing the total number of patients admitted to 97, including 37 confirmed cases.

As of 9 November 2018, the number of patients cured and discharged back into the community is 98.

Beni and Butembo remain the main hot spots of the epidemic, reporting 65% and 20% of the 99 confirmed cases reported in the last 21 days, respectively. Contact tracing is still of concern due to insecurity and persistent community resistance. On 10 November 2018, the proportion of contacts followed was 94% (4476/4779), with the proportion varying between 90% and 100%.

Seven peacekeepers killed in clashes near Ebola-hit part of eastern DR Congo

Via Reuters: Seven peacekeepers killed in clashes near Ebola-hit part of east Congo. Excerpt:

GOMA, Congo (Reuters) - At least seven U.N. peacekeepers were killed in clashes with militias in an area that is at the center of the Democratic Republic of Congo’s worst Ebola epidemic, United Nations and diplomatic sources said on Thursday.  

“Our peacekeeping colleagues tell us that six peacekeepers from Malawi and one from Tanzania who are part of the U.N. peacekeeping operation in the DRC ... were killed yesterday, in Beni territory, in North Kivu,” U.N. spokesman Stephane Dujarric told reporters in New York. 

Eastern Congo has been plagued by banditry and armed insurrections for more than two decades since the fall of military ruler Mobutu Sese Seko, but the past year has seen a surge in violence around North Kivu. 

 Beni and the surrounding villages are also suffering an Ebola epidemic that has infected over 300 people and killed two-thirds of them.

Saudi-led coalition renews air strikes on Yemen's Hodeidah port

Via Thomson Reuters: Saudi-led coalition renews air strikes on Yemen's Hodeidah port. Excerpt:

ADEN, Nov 12 (Reuters) - The Saudi-led coalition resumed air strikes on Yemen's main port city of Hodeidah after a lull on Monday as Western allies pressed Riyadh to end a war that has left the impoverished country on the verge of starvation. 

Air strikes against the Iran-aligned Houthis' fortifications were halted for more than 12 hours on Monday and street battles, which had been raging for a week on the outskirts of the Red Sea city, trapping civilians and endangering hospitals, died down, residents said.  

Air strikes started again later on several areas in Hodeidah province, residents and aid groups said. The coalition's warplanes bombed the entrance of Hodeidah port two hours before the sunset killing three guards, a witness and Houthi media said.

The short lull coincided with a visit by British foreign minister Jeremy Hunt to Saudi Arabia to press for an end to the nearly four-year war that has killed more than 10,000 people.  

Coalition spokesman, Colonel Turki al-Malki, said the offensive on the Houthi-held city was still on.

"The operation is still ongoing. It's not true that there is a ceasefire in Hodeidah," Malki told reporters in Riyadh.

EBOLA DRC - Evolution of the response to the Ebola epidemic in North Kivu and Ituri at Monday 12 November 2018

The MOH has published EBOLA DRC - Evolution of the response to the Ebola epidemic in the provinces of North Kivu and Ituri at Monday 12 November 2018. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Monday, November 12, 2018   

The epidemiological situation of the Ebola Virus Disease  dated November 11, 2018: 

• Since the beginning of the epidemic, the cumulative number of cases is 333, of which 295 are confirmed and 38 are probable. In total, there were 209 deaths (171 confirmed and 38 probable). 

º The investigations invalidated 11 historical deaths (probable cases) and identified 14 additional probable cases.   

º Following the clean-up of the confirmed case databases, the duplicates were removed and the confirmed cases were placed in their original health area and no longer in the Ebola Treatment Center (ETC) area. have been processed. 

• 49 suspected cases under investigation. 

• 2 new cases confirmed in Beni. 

• 1 new confirmed case fatality in Butembo.     

• 3 new people healed in Beni   

Remarks: 

• To avoid that the total number of cases varies (up or down) daily, the suspect cases have been placed in a separate category. Thus, suspect cases with positive laboratory tests will be added to the confirmed category, while negative ones (non-cases) will be removed from the table. 

• The category of probable cases includes all reported deaths for which it was not possible to obtain biological samples for laboratory confirmation. The investigations will determine whether these deaths are related to the epidemic or not. 

• A community death is a death in the community, outside of a licensed health center. 

News of the response   

• No vaccination activity could be carried out in Beni on Monday, November 11, 2018 because of the agitation of the population after the Boikene attacks that took place the previous night .   

• Since the start of vaccination on August 8, 2018, 28,991  people have been vaccinated , including 14,966 in Beni, 4,544 in Mabalako, 2,262 in Katwa, 1,663 in Mandima, 1,435 in Butembo, 1,337 in Kalunguta, 732 in Masereka, 434 in Bunia, 355 to Tchomia, 293 to Vuhovi, 258 to Mutwanga, 240 to Komanda, 178 to Oicha, 160 to Musienene, 100 to Kyondo, and 34 to Alimbongo.

DRC: Five killed, several children kidnapped in ADF attack on Mayimoya district of Beni

Via Actualite.cd, here are some details on the attack that Dr. Tedros tweeted about earlier today, as well as two other attacks: DRC: Five killed, several children kidnapped in ADF attack on Mayimoya district of Beni. The Google translation:

At least five civilians were killed in a new incursion by suspected Ugandan rebels of the Allied Democratic Forces (ADF) on Saturday (November 10th) in the Mayimoya locality, located on Nationale N ° 4, in the territory of Beni (North Kivu). reported Sunday, November 11, the local civil society. One person was shot and three children were abducted.    

"It was around 22 hours 35 minutes that we heard shooting in our locality, we directly believed the soldiers who were going to get drunk in the city, but it was the rebels who had just killed the people. 5 people were killed including one woman and four men, including a pastor and his child, one wounded and three missing children, three people were killed in their houses with guns and two others in the courtyard. but the intervention came a little late," said Mayimoya's civil society president, Patrick Musubao, joined by ACTUALITE.CD. 

Only the body of a victim was buried this afternoon in Mayimoya, other bodies will be supported by their families, according to the same source. Five people missed the call after this attack, they were kidnapped by the attackers.  

On the same Saturday, two people (one military and one civilian) were killed in two attacks in Boikene and Paida, neighborhoods of Ruwenzori commune in the city of Beni. The first attack was attributed to ADF rebels while the second, targeting a military camp, was attributed to suspected Mai Mai militiamen.

See this separate Actualite.cd report on the other attacks. Meanwhile, a confusingly translated report from Radio Moto Butembo-Beni indicates that the local government of Mayimoya blames the federal army for removing troops out of the area and leaving residents undefended.