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Online Discussion: Tracking new emerging diseases and the next pandemic

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: February 02 2019 at 9:01am
HEALTHCENTRE SUPERSPREADERS?

Many cases in DRC Ebola outbreak coming from health centers
February 1, 2019
Matshidiso Moeti, MBBS, MSc
Matshidiso Moeti

Six months into the 10th and largest Ebola virus outbreak in the Democratic Republic of the Congo, or DRC, officials said many confirmed cases are coming from health care centers.

“As we look back on the 6 months, we can see the strategies that have been successful in controlling the outbreak in some areas ... though we continue to see flare ups and outbreaks in other areas,” Matshidiso Moeti, MBBS, MSc, WHO regional director for Africa, said during a news conference.

Strategies that have worked to control the outbreak, she said, have involved engaging with communities, especially with women and religious groups, and case investigation and contact tracing. Widespread use of an investigational vaccine and investigational drugs also have aided the response.

However, as Moeti explained, transmission remains a problem, with one in every five confirmed cases reporting contact with a health center before the onset of the disease.

According to WHO, the outbreak in Katwa and Butembo health zones is partly being driven by nosocomial transmission in health centers. WHO said 86% of cases in these areas since Dec. 1 reported having visited or working in a health care facility before becoming ill. Additionally, in the past 3 weeks, 49 health structures were identified where confirmed cases were hospitalized and eight new infected health workers were reported.

“In order to strengthen infection prevention and control practices, we prioritize facilities according to risk, we train health workers and monitor their progress and we also provide incentives to encourage best practices,” Moretti said. “In addition, we work closely with facilities and the community to ensure that they report all deaths and have safe and dignified burials.”

Moeti said strengthening the health system is crucial to fight outbreaks, including an ongoing malaria outbreak in Beni. Officials had to deploy additional WHO teams to work along with the Ebola response teams to get control of that outbreak.

“Ultimately, this outbreak has put into even sharper focus the weaknesses and the gaps in the health care system and reinforced our ultimate message — stronger health systems are the only way to rapidly detect, respond to, and eventually, end outbreaks,” Moeti said.

The case count in the Ebola outbreak has reached 759, including 705 confirmed cases and 414 confirmed deaths. So far, more than 70,000 people have been vaccinated in the DRC, and 2,600 health care workers in bordering Uganda and South Sudan also have been vaccinated. Moeti said preparing bordering countries is a priority in controlling the outbreak, although an international public health emergency of international concern has not been declared.

“I feel optimistic that in the places where we started with a combination of interventions, that we have been able to bring the situation there almost under control,” Moeti said. “We’ve seen a change in our engagement with communities, we’ve invested a lot in it, and we have been very pleased with the support from local leaders who have been able to work with us to carry the message and engage the community.”

However, she added there is still a lot to be done to stabilize and bring the situation under control. – by Caitlyn Stulpin

Source:   https://www.healio.com/infectious-disease/emerging-diseases/news/online/%7B1914c63f-ccca-4478-be05-3818387d56f9%7D/many-cases-in-drc-ebola-outbreak-coming-from-health-centers
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Dutch Josh Quote  Post ReplyReply Direct Link To This Post Posted: February 02 2019 at 10:56pm
Techno; thank you for the Ebola-updates.

With this many diseases in the region several risks;
-The symptoms may be related to the wrong disease (so people could spread ebola because their disease could be mistaken for cholera at first-as an example)
-A "melting pot" for virusses, bacteria etc. (not only in humans but also other species) could-maybe-produce a new virus/bacteria (or add to a flu-virus ???) wich would worsen the healthcrises even further.

DJ-In my opinion this outbreak (with the mix of climate change, enviromental problems) is not getting enough attention (and thus money).
It is like a "small fire" going on for a longer period suddenly exploding.
There are at present to many countries with failed/weak governments, to many extremists willing to use bio-weapons-for now ebola is a central-africa problem, but "a new disease" may develop and could turn into a major global health risk.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: February 03 2019 at 4:02am
Ebola has never really been considered a threat to us in the West. Consequentially it is usually underfunded, Josh.

Things are slowly improving and the main problems in this case are the remoteness of the location and the lack of previous funding for research (for instance: there is a vaccine but it does not travel well).

But at least some attention is being paid to it now. Here is another bit of recent research, this time on the infection control measures:

Protecting those on the frontline from Ebola

Date:
    February 2, 2019
Source:
    Medical University of South Carolina
Summary:
    Online training has increased the knowledge of health care workers about effective prevention of Ebola up to 19 percent and reduced critical errors to 2.3 percent in a small cohort. These findings suggest that the program could improve protection of health care workers from Ebola and, because it will be easily accessible via the Internet, could be especially useful in low-resource settings.
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FULL STORY

In a world where we can travel the globe by jet, diseases that were once thought to plague faraway places can now strike close to home.

The U.S. had to learn this the hard way. In 2014, a patient harboring Ebola returned home to Dallas, Texas from Liberia. Within 15 days of this person's arrival, the Centers for Disease Control and Prevention (CDC) had confirmed two secondary cases in nurses who were treating the infected patient.

Ebola virus is very easily contracted from body fluids -- a mere ten viral particles will do it -- and people who get it have up to a 78 percent chance of dying. Health care workers are among the most vulnerable.

According to a 2015 report by the World Health Organization, health care workers can have an infection rate up to 32 times higher than the general population in certain parts of the world. Infected health care workers can unknowingly spread the disease, and once sick, are unable to care for patients.

In addition to a human toll, Ebola also exacts an economic one. Treatment of an Ebola patient in the U.S. can range from $30,000-$50,000 per day, limiting the number of hospitals who can treat it, and making its spread a very costly problem

The best hope for controlling this lethal foe is to prevent it. Researchers at the Medical University of South Carolina (MUSC) have created an online software package via the SmartState spin-off company, SimTunes, LLC, to train health care workers using simulation in safe Ebola disease response. They report promising findings in a small cohort of MUSC health care workers in an article published in the December 2018 issue of Health Security.

"This training program takes information from multiple resources, including the CDC, the National Ebola Training and Education Center and the European Network for Infectious Diseases," says Lacey MenkinSmith, M.D., assistant professor of Emergency Medicine at MUSC and first author of this article.

"What makes the program unique is that it combines all that information into one training program that is widely distributable."

"The entire course, including background material and hands-on simulation practice, is delivered over the Internet, so people can be trained immediately," adds Jerry G. Reves, M.D., distinguished professor and emeritus dean of the College of Medicine at MUSC and principal investigator of the CDC-funded study.

The software package includes a self-study component, a "hands-on" simulation workshop and a data-driven performance assessment toolset. A post-test evaluates trainees' knowledge of Ebola treatment, and software tracks and scores individual and team performance in Ebola treatment scenarios.

This training package aims to reduce the number of critical errors and risky actions committed when treating an Ebola patient. Critical errors put an individual at risk of infection or contaminate the clean zone. Risky actions increase the chance of committing a critical error.

The researchers tested the usefulness of their software package in 18 health care workers at MUSC, a state treatment center for Ebola. The health care workers were divided into two groups based on their experience level with treating high-risk infectious disease. The software package increased the knowledge of both groups about effective prevention by up to 19 percent.

Both groups also performed extremely well in simulation scenarios, with only 2.3 percent of 341 total steps flagged for critical errors in both groups. These scenarios included cleaning up spills, putting on a biosuit correctly and properly responding to a needle stick. Practicing all of these scenarios helps to reduce the risk of infection of the health care workers treating the Ebola patient.

These results validate this software package as a way to streamline and adequately educate health care workers on proper techniques to reduce infection when treating an Ebola patient.

The MUSC team plans next to test their training program in other health care settings relevant to Ebola. These include community hospitals, where Ebola patients might first be seen, or intermediary hospitals, which would care for them until they could be sent to a treatment center like MUSC.

MenkinSmith, who specializes in global emergency medicine, would also like to test the program in developing countries, and is planning to use the course in Uganda.

"I want to see how we can adapt what we have to a place that is a low-resource health care setting, such as a site like Uganda that I am set to visit," says MenkinSmith. Uganda's neighbor, the Democratic Republic of Congo, is currently experiencing an Ebola outbreak.

"Instituting this training at various universities and hospitals across the world will take time and adjustments" says Reves. "However, this represents the beginning of a concrete way to ensure that health care workers are protected from Ebola with just-in-time training anywhere in the world."

Story Source:

Materials provided by Medical University of South Carolina. Note: Content may be edited for style and length.

Journal Reference:

    Lacey MenkinSmith, Kathy Lehman-Huskamp, John Schaefer, Myrtede Alfred, Ken Catchpole, Brandy Pockrus, Dulaney A. Wilson, J. G. Reves. A Pilot Trial of Online Simulation Training for Ebola Response Education. Health Security, 2018; 16 (6): 391 DOI: 10.1089/hs.2018.0055

Medical University of South Carolina. "Protecting those on the frontline from Ebola." ScienceDaily. ScienceDaily, 2 February 2019. <www.sciencedaily.com/releases/2019/02/190202171849.htm>.


Source:   https://www.sciencedaily.com/releases/2019/02/190202171849.htm
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Experts are calling for a declaration of a public health emergency
Cases rise to 785


Lisa Schnirring | News Editor | CIDRAP News| Feb 04, 2019



© UNICEF / Herrmann

Over the weekend and through today, the Democratic Republic of the Congo's (DRC's) health ministry reported 22 more cases, many from the current hot spot Katwa, but seven other areas also reported new cases.

In other developments, a group of experts today urged the World Health Organization's (WHO's) emergency committee to meet again to consider declaring a public health emergency, and clinical experts pushed for more use of renal replacement therapy to prevent kidney failure in critically ill Ebola patients.
Latest case details

Of the 22 new cases, the health ministry announced 11 of them in its update today. Among those lab-confirmed cases, 10 are in Katwa, with the following areas also reporting cases: Kyondo (4), Butembo (2), Kalunguta (2), Mabalako (1), Mangurujipa (1), Mutwanga (1), and Vuhovi (1). The increase lifts the outbreak's overall total to 785 cases, 731 of them confirmed and 54 listed as probable.

Health officials are still investigating 165 suspected Ebola infections.

In its latest updates the health ministry said 13 more people have died from their infections, 7 in community settings and 6 in Ebola treatment centers. Locations for community deaths, a factor that increases the risk of virus transmission, include Mangurujipa, Mutwanga, Mabalako, Kyondo, Katwa, and Vuhovi.

In a promising development, the ministry said contacts identified in Komanda have completed their 21-day follow-up period. And the number of people immunized with the experimental VSV-EBOV vaccine has risen to 73,309, roughly half of them in Beni and Katwa.
Experts call for global alert

Writing in a Lancet commentary today, several global health experts called for the WHO to reconvene its Ebola emergency committee and consider declaring a public health emergency of international concern (PHEIC) to address the threat of cross-border spread and to trigger more high-level support for the response. Several of the international experts are from Georgetown University's O'Neill Institute for National and Global Health Law and Johns Hopkins' Center for Health Security.

The emergency committee last met in October 2018, and its members said they didn't consider the event at that time to be a PHEIC. WHO emergency committees typically meet every 3 months or sooner, if needed.

The authors of the commentary said cases have more than tripled since then, with illnesses detected in 18 health zones and less than 20% of cases coming from known contact lists. They also said a widening outbreak could destabilize the region, especially in South Sudan, where tenuous peace is haunted by continued violence and predicted famine.

Declaring a PHEIC could specify proactive measures that are needed to shore up the response and send a clear signal that UN leadership and high-level political, financial, and technical support are urgently needed.

The expert commenters acknowledged that a PHEIC might escalate conflict by raising the international response's profile. "Like any complex multilateral negotiation, cultural competence and smart diplomacy are required. Outsiders are unlikely to be privy to all on-the-ground realities and risks," the team wrote, adding that problems—if they happen—would require urgent reform of the process.

"WHO has shown leadership and operational endurance, working tirelessly to combat the DRC Ebola epidemic. But WHO and partners cannot succeed alone," they wrote, noting that the WHO and United Nations will likely increasingly be called on to response to complex humanitarian crises.
Supportive care, reporting delays

In other medical literature developments:

    Experts from Canada and Africa writing in The Lancet today pushed for higher standards for supportive care for patients in Africa's outbreaks. Pointing out the role of renal failure in critically ill patients whose conditions deteriorate, they said that, although conventional dialysis isn't always feasible in many field settings, renal replacement therapy is an option when sterile water is scarce. They wrote that the bags are sealed until use, the approach is feasible, and the treatment would give patients time to recover from Ebola and associated acute renal failure.
    Georgia State University scientists who analyzed reporting dates in the DRC's current outbreak in the journal Epidemics yesterday described a two-wave pattern early in the outbreak, with the one surge in the first half of August and the other in late September, likely linked to local armed conflict. They said reporting delays have shown an 81.1% decline and that the epidemic appears to have reached a steady state, averaging about 35 cases a week during the 8 weeks preceding Jan 15.

Source:   http://www.cidrap.umn.edu/news-perspective/2019/02/drc-ebola-cases-surge-785

Feb 4 Lancet commentary on public health emergency declaration:   https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30243-0/fulltext#%20

PDF:   https://www.printfriendly.com/p/g/KNWht5
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: February 05 2019 at 1:48am

The Ebola outbreak in Eastern Congo is moving toward a major city. That’s not good.


With at least 680 cases, it’s already the second-largest Ebola outbreak in history.

By Julia Belluz@juliaoftorontojulia.belluz@voxmedia.com Updated Jan 22, 2019, 1:13pm EST


At least 680 people have been infected with the Ebola virus in the Democratic Republic of Congo. It’s the second-largest Ebola outbreak in history, with 414 deaths so far, and the first Ebola outbreak in an active war zone, DRC’s eastern North Kivu and Ituri provinces.

But it could get worse: Health officials are concerned that Ebola appears to be spreading in the direction of Goma, a major population center in DRC.

Last week, DRC’s health ministry confirmed four cases of the deadly virus in Kayina, a town in North Kivu, where fighting among rebel and militia groups has repeatedly interrupted the painstaking work of health workers who are responding to the outbreak.

Kayina happens to be halfway between Butembo, currently one of the outbreak’s most worrisome hotspots, and Goma, where a million people live. Two of the patients died, and two were traveling to Goma when they were picked up at a checkpoint en route and sent back to Kayina for treatment.

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So far, the outbreak has not affected DRC’s biggest cities. But Ebola in Kayina “raises the alarm” for Ebola reaching Goma, Peter Salama, the head of the new Health Emergencies Program at the World Health Organization, told Vox on Friday.

Goma is a major transportation hub, with roads and highways that lead to Rwanda. “These are crossroad cities and market towns,” Salama added. People there are constantly on the move doing business, and also because of the insecurity in North Kivu. Ebola in Goma is a nightmare scenario WHO and DRC’s health ministry are scrambling to prevent.

Together, they’ve deployed a rapid response team, including a vaccination team, to Kayina. And if the virus moves on to Goma, Salama says Ebola responders are ready. They’ve already mobilized teams there, set up a lab, and prepared health centers where sick people can be cared for in isolation.

But as Ebola expert Laurie Garrett wrote in Foreign Policy last week, Ebola in Goma could also trigger a rare global public health emergency declaration by WHO, escalating the severity of an already dangerous outbreak.

An Ebola vaccine has been no match for DRC’s social and political chaos
WHO

When Ebola strikes, it’s like the worst and most humiliating flu you could imagine. People get the sweats, along with body aches and pains. Then they start vomiting and having uncontrollable diarrhea. They experience dehydration. These symptoms can appear anywhere between two and 21 days after exposure to the virus. Sometimes patients go into shock. In rare cases, they bleed.

The virus is spread through direct contact with the bodily fluids, like vomit, urine, or blood, of someone who is already sick and has symptoms. The sicker people get, and the closer to the death, the more contagious they become. (That’s why caring for the very ill and attending funerals are especially dangerous.)

Because we have no cure for Ebola, health workers use traditional public health measures: finding, treating, and isolating the sick, and breaking the chains of transmission so the virus stops spreading.

They mount vigorous public health awareness campaigns to remind people to wash their hands; that touching and kissing friends and neighbors is a potential health risk; and that burial practices need to be modified to minimize the risk of Ebola spreading at funerals.

They also employ a strategy called “contact tracing”: finding all the contacts of people who are sick, and following up with them for 21 days — the period during which Ebola incubates.

In this outbreak, there’s also an additional tool: an effective experimental vaccine. Since the outbreak was declared in August, more than 61,000 people have been vaccinated. But while the vaccine has tempered Ebola’s spread, it hasn’t overcome the social and political chaos in DRC, which has been called the world’s most neglected crisis.

“The brutality of the conflict is shocking,” Jan Egeland, head of the Norwegian Refugee Council, told the Thomson Reuters Foundation, “the national and international neglect outrageous.”
Presidential elections have “ratcheted up” the tension in an already tense situation

On December 30, after years of delays, voters went to the polls to elect a new president. In the days leading up to the election, tensions in North Kivu “ratcheted up,” Salama said. Protesters stormed Doctors Without Borders treatment centers in Beni, a recent outbreak hotspot, shutting them down for several days.

In January, the country’s electoral commission announced interim election results suggesting opposition leader Felix Tshisekedi had likely won the election. But leaked data and external analyses show there are irregularities with the voter count that point toward election fraud.

“All the outside observers — the African Union, the European Union, the Catholic Church — say the results of the election have been rigged,” and the people actually voted in Martin Fayalu for president, said Severine Autesserre, a political science professor at Barnard College, and author of the book The Trouble with the Congo. When the final results are announced in the coming days, more protests and riots are likely to follow.

But though the political instability isn’t making the Ebola response any easier, the war in Congo’s eastern provinces is a far bigger challenge. The 25-year-long conflict has displaced more than a million people, and made the already dangerous work of an Ebola response even more deadly, Autesserre said.

Between August and November, Beni had experienced more than 20 violent attacks, which put the outbreak response there on pause for days at a time. That meant cases had gone uncounted, and Ebola continued to spread.

There’s also some more encouraging news, according to Salama: The outbreak of more than 200 people in Beni, a North Kivu town marred by decades of violence, has been brought under control.

“Many people would have been extremely skeptical that the outbreak in Beni could be controlled as quickly given force of infection we were seeing in November and December, and the fact that we’ve had nothing but volatility and insecurity since then,” Salama said. “But the fact that Beni has had only one confirmed case in two weeks is giving us a lot of hope and optimism.”

As of Friday, the two biggest hotspots in the outbreak were Butembo, with 51 cases, and a neighboring city, Katwa, with 119 cases. But the outbreak is geographically dispersed. There are active Ebola cases in 12 of the country’s “health zones,” the districts around which the DRC’s health system is organized. Because of the insecurity and difficulty reaching people, only 30 to 40 percent are coming from known contact lists, Salama said. That means the virus might already be in places no one’s discovered yet.

Source:   https://www.vox.com/science-and-health/2019/1/18/18188199/drc-ebola-outbreak
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: February 05 2019 at 9:57am

Long-running Ebola outbreak is now an international health emergency, say experts

Anne Gulland, Global health security correspondent

5 February 2019 • 10:38am

The current outbreak of Ebola in the Democratic Republic of Congo (DRC) is now so severe it should be declared an international health emergency, experts have warned.

In an article in the Lancet medical journal a group of international lawyers has urged the World Health Organization to declare the situation a public health emergency of international concern, which they hope would shine an international spotlight on the outbreak, currently the second largest in history.

Since the outbreak was declared last August there have been 774 cases of the disease and 481 deaths, and emergency responders have had to contend with outbreaks of violence and high levels of mistrust among the affected communities.

WHO’s emergency committee last met in October but since that time the number of cases of the disease have tripled, the outbreak has expanded into 18 health zones and governments have withdrawn personnel “fearing for their safety”, the Lancet warns. And the risk of the disease spreading across the border to Uganda, Rwanda and South Sudan is also high.

Mark Eccleston-Turner, one of the authors of the Lancet paper and a law lecturer at Keele University, said that declaring an international health emergency would not give WHO any more funding but he added: “Its main function is as a signal to the international community that this outbreak is serious, it requires more effort, more resources and a coordinated international response."

At the beginning of the 2014-15 Ebola outbreak in West Africa, which eventually led to nearly 30,000 cases including 11,000 deaths, the WHO came in for heavy criticism for being slow to grasp its severity and to declare an international emergency.

Dr Eccleston-Turner said that when an international health emergency was finally declared in August 2014 it triggered the involvement of the United Nations which described the outbreak as a threat to global peace and security.

He added: “WHO has learned some of the lessons of the West Africa outbreak and seems to be in a much better position now. But we cannot have complacency or hesitancy at WHO.”

But the situation in the summer of 2014 was very different: Ebola was spreading like wildfire in three countries, there was concern it would spread beyond Africa and there was no clear strategy for dealing with the disease. There was also no vaccine to control the spread of the disease or treatments for those infected.

By contrast today, international agencies have at their disposal a vaccine, four experimental treatments for patients as well as a tried and tested containment strategy.

The Lancet paper states that declaring a public health emergency would be "a clarion call to galvanise high-level political, financial, and technical support... It would provide a clear signal from the world's global health body that UN leadership is urgent.”

Tarik Jasarevic, a WHO spokesman, said: “WHO and our partners in DRC and neighbouring countries are watching carefully to detect any signs that we might need to call an expert committee... If and when we see those signs, the director general will call a meeting.”

Speaking to the Telegraph last week Mike Ryan, WHO assistant director general for emergencies, said the current strategy was working as the outbreak is being brought under control in the affected areas.

But while the outbreak has been largely contained in the cities of Beni and Mangina it has now moved "like a bush fire" to the city of Katwa, which has seen around two thirds of the new cases of the disease over the last month.

“The real challenge is containing the disease before it moves on to the next city. We know that’s been the pattern in the past - this is a highly mobile population which means there’s a high risk that cases will move to another city or region,” said Dr Ryan.

He added: “From the air the outbreak looks like a conflagration but it’s more like a series of bush fires.”

This is the 10th outbreak of the disease in DRC, after being identified in what was then Zaire in 1976. But it is the first time that Ebola has been in the North Kivu region in the north east of the country.

Dr Ryan said that there was much distrust of the international community and even some health workers have refused the vaccine.

He said: “Participation of the community is crucial, without it tension and misunderstanding come in. The vast majority of the responders are local and we’re doing a tremendous amount of training.”

He added that standards of care had much improved during this outbreak thanks to the work of agencies such as Médecins Sans Frontières (MSF) and US-based Alliance for International Medical Action (Alima).

"Credit to MSF and Alima - standards of care are definitely rising. We have intensive care specialists embedded in treatment centres and they provide extra assistance with managing patients. There is now improved hydration and monitoring of blood chemistry - the centres are more like intensive care units now," he said.


Source:   https://www.telegraph.co.uk/news/0/long-running-ebola-outbreak-now-international-health-emergency/
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Post Options Post Options   Thanks (0) Thanks(0)   Quote EdwinSm, Quote  Post ReplyReply Direct Link To This Post Posted: February 05 2019 at 10:37pm
Unlike the West African outbreak which suddenly explode across a region, this Congo outbreak seems to be very slow moving. But, sadly, it is moving in the wrong (outward) direction.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: February 09 2019 at 12:12pm
DR Congo Ebola death toll passes 500 —Health ministry

Published February 9, 2019


More than 500 people have died from the latest outbreak of Ebola in DR Congo, but a vaccination programme has prevented thousands more deaths, the country’s health minister told AFP.

“In total, there have been 502 deaths and 271 people cured,” said a health ministry bulletin published late on Friday, reporting on the outbreak in the east of the country.

But Health Minister Oly Ilunga Kalenga said that, for the first time, a vaccination programme had protected 76,425 people and prevented “thousands” of deaths.

“I believe we have prevented the spread of the epidemic in the big cities” in the region, he said.

“The teams also managed to contain the spread of the epidemic to neighbouring countries,” he added.

“The biggest problem is the high mobility of the population,” the minister added.

The outbreak started last August in the North Kivu region, which borders Uganda and Rwanda.

The Spanish wing of the aid agency Doctors Without Borders reported on Twitter Saturday that there had been a surge in cases since January 15.

Rwanda, Uganda and South Sudan, further north, were all now on alert, it added.

The security situation in the east of the country, where armed rebels have terrorised the population for years, has made treating the disease difficult.

Source:   https://punchng.com/dr-congo-ebola-death-toll-passes-500-health-ministry/
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https://www.climatestotravel.com/climate/democratic-republic-congo

Flooding could worsen the situation in the area. March-May could be wet.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: February 12 2019 at 2:49am
[I have so many comments, I don't know where to start.]


Ebola vaccine offered in exchange for sex, say women in Congo

As experts urge global warning over outbreak, women and girls in Beni report alleged exploitation
Global development is supported by
Bill and Melinda Gates Foundation

Kate Holt in Beni and Rebecca Ratcliffe

Tue 12 Feb 2019 07.00 GMT
Last modified on Tue 12 Feb 2019 07.02 GMT

An unparalleled Ebola vaccination programme in the Democratic Republic of the Congo has become engulfed in allegations of impropriety, amid claims that women are being asked for sexual favours in exchange for treatment.

Research by several NGOs has revealed that a deep mistrust of health workers is rife in DRC and gender-based violence is believed to have increased since the start of the Ebola outbreak in August.

The research, presented at a national taskforce meeting in Beni, follows calls by international health experts urging the World Health Organization to consider issuing a global alert in relation to the outbreak. The experimental vaccine has been described by the WHO as “highly, highly efficacious” and hopes have been pinned on it controlling the outbreak.
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In one study cited, multiple respondents raised concerns over individuals offering Ebola-related services, such as vaccinations, in exchange for sexual favours.

The risk of exploitation by frontline Ebola workers was also mentioned by several focus groups.

Concerns were raised over a reported increase in stigma and violence facing women. Some women are blamed for failing to prevent the spread of the disease, according to the research by the International Rescue Committee (IRC), whose study was cited in the presentation.

Women, who are responsible for caring for the sick and ensuring that children wash their hands, faced a rising workload, with many feeling traumatised and exhausted, the recent meeting was told. One participant in a focus group said women are isolated during their periods, and are being accused of having the virus.

The IRC has since said those claims were based on preliminary findings. The charity, which consulted more than 30 focus groups, added in a statement that it is still analysing research: “We will take the findings and work with partners to address concerns raised and ensure that women and girls are protected.”

Trina Helderman, senior health and nutrition adviser for Medair’s global emergency response team, said the Ebola response should have established a higher standard of protection for women.

“This region of DRC has a long history of sexual violence and exploitation of women and girls. Though shocking, this is an issue that could have been anticipated,” said Helderman. “Humanitarian actors should have been more prepared to put safety measures in place to prevent this from happening.”

On Thursday, the health ministry urged people to report anyone offering services such as vaccinations or other treatment in exchange for money.

The ministry said it was aware of separate rumours, spread on social media, that women working on the Ebola response had been given jobs in exchange for sexual favours. In a statement, it said it took such claims seriously, and advised that women should only meet with recruiters wearing an official badge.

The warnings come as international health experts urged the WHO to consider issuing a global alert in relation to the outbreak. Writing in the Lancet, they said the response had been complicated by a “storm of detrimental factors”, including political instability, conflict and large numbers of people on the move.

Since August, there have been 811 Ebola cases, and 510 deaths as a result of the virus. The WHO has warned that there is a very high risk of the outbreak spreading not only across DRC but to Uganda, Rwanda and South Sudan. There are also concerns that the source of transmission is unclear in one in five cases.

Suspicion of authorities and health agencies has further hampered efforts to contain the response, said Eva Erlach, of the International Federation of Red Cross and Red Crescent Societies. The agency has analysed feedback from thousands of people living in Ebola-affected areas.

“Across all locations there are lots and lots of people who do not think that Ebola is real, that it is just a way for humanitarian organisations to make money, or that it was just used to postpone elections,” said Erlach.

Last week, agencies were urged to work closely with women’s groups and local community leaders to build trust in services.

Tarik Jasarevic, a spokesman for the WHO, which supports the Ebola response, said most community engagement activities are already led by national DRC experts who work closely with local networks. There are around 20 dialects spoken in North Kivu and Ituri, he added.

“Together, we continually adapt and work to improve our response to adjust to local challenges in this delicate social, political, economic context,” he said.

Jasarevic added that sexual exploitation is a grave concern, and said the agency continually monitors its services.

“A large part of the communication effort with communities is to inform them that all Ebola services are free,” he said. “We will continue to check and improve measures we have in place to prevent, monitor and report on any such incidents. More can always be done.”

Source:    [url]https://www.theguardian.com/global-development/2019/feb/12/ebola-vaccine-offered-in-exchange-for-sex-say-women-in-congo-drc]
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: February 13 2019 at 9:42am

Ebola outbreak in violence-plagued DRC a worst-case scenario
Author
Dr. Theodore Karasik
February 13, 2019 15:36

Recently, several rebel militia members fighting over the northeastern corner of the Democratic Republic of the Congo (DRC) died of Ebola. Rebels dying from Ebola is a development that merits deeper examination.
The fact that Ebola, which has killed more than 500 people in this outbreak, is now truly mixing with the country’s violent landscape is a complicating factor, as international health care officials are developing an inoculation ring in Rwanda, Uganda and South Sudan that began in mid-January. In effect, a program of spatial containment is being instituted.

This Ebola outbreak is the second worst case so far. Luckily, experimental vaccination programs are working, but administering these programs in violence-prone areas is difficult at best. DRC Health Minister Oly Ilunga Kalenga said that the vaccination program had been administered to 76,425 people and had prevented “thousands” of deaths by stopping the spread of Ebola to “big cities.” The vaccine is not 100 percent effective as it is still experimental. International health authorities are concerned that the disease can still spread.

The DRC security situation is most problematic in the east of the country, where dozens of armed militias struggle over resources such as gold, diamonds, copper and coltan for profit and power. The area is home to the vast majority of the country’s 70 armed groups, all pursuing shifting local and national agendas. Most of them are small, numbering less than 200 fighters, but the havoc they have wreaked over decades, especially in North and South Kivu, have made eastern DRC the epicenter of deadly violence and humanitarian crises. This mix makes treating Ebola problematic, as this is the first time that an Ebola outbreak is occurring in an area with daily violence. The DRC’s ongoing instability caused by militia activity is creating mistrust in the population toward health workers.

For international aid organizations, this is a worst-case scenario, where victims carrying a deadly disease are unable to be treated because of attacks by machete-carrying rebels with heavy caliber weaponry. An attack by the Allied Democratic Forces (ADF) late last year killed 18 people in the town of Beni, halting local efforts to contain the spread of Ebola through this unstable area.

The DRC’s ongoing instability caused by militia activity is creating mistrust in the population toward health workers.

Armed militias that target DRC civilians and foreign aid workers make it difficult, if not impossible, for response teams to reach and work in the nation’s most isolated areas — a serious issue since the beginning of this outbreak. The ADF militia was initially created by rebels to oppose Ugandan President Yoweri Museveni, but the rebel group has also focused operations on the DRC’s North Kivu province.

This part of Central Africa is where 2.5 million people, mostly civilians, were killed between 1998 and 2002, especially involving ethnic hatred between the Hutu and the Tutsi people, which had formed the basis of the 1994 Rwandan genocide. One cannot overstate the complex landscape of ethnic identities and shifting alliances that occur between these groups. Throwing a deadly disease on top of this rebel instability makes for a combustible situation. An attack by any one of the dozen or so militias in an Ebola outbreak area collapses the ability to conduct safe practices. In the chaos, village mobs are known to try to bury their dead who died from Ebola by trying to steal the corpse, in a complete break of protocol.

The implementation of a set of spatial protocols that, from the start of the current Ebola outbreak, quickly identified areas of disease activity with the goal of preventing diffusion is now expanding instead of shrinking. Disease infection rates among the militia groups are unknown and, given their population, these groups could act as not only an incubator but also a transmitter into more distant areas. The number of fighters and their supporting infrastructure is likely to number in the tens of thousands. These rebels fall outside any international Ebola protocols, unless they are capable of stealing the medicine and then administering it themselves in highly unstable conditions, which would lay the foundation for further infections. These militias have access to medical facilities and possess a particular level of capability and capacity, yet are clearly unprepared for a disease such as Ebola.
Other military actors on the ground matter too. Naturally, the DRC’s military is actively engaged against the militias. The DRC military’s role in the Ebola crisis is focused on securing supply lines, but it frequently needs to concentrate on other internal issues. The Congolese army receives support from the UN’s Organization Stabilization Mission in the Democratic Republic of the Congo (MONUSCO), which has helped in the Ebola response since the beginning of the outbreak through the provision of logistical support, office facilities, transportation, communication and security.

Meanwhile, the DRC’s military engagement with these militias is now also being influenced by Russian advisers. Let us also recall that Russia’s private military company, Wagner Group, is involved across several sectors of the country. Finally, the US is nearby in Gabon. How these actors respond to the next chapter of this outbreak of Ebola in a violent, rebel-infested zone will most likely be determined by a highly uncoordinated effort among security actors.
A deadly disease such as Ebola being carried through rebel communities and their networks is an issue that needs urgent attention from government authorities, in addition to a communication plan to educate those who may be assisting such networks. Add in the terrain, corruption and crime and the ability for authorities to address the spread of the disease is severely weakened. The ability for militias to transmit Ebola unchecked is a public health and national security concern.

    Dr. Theodore Karasik is a non-resident senior fellow at the Lexington Institute and a national security expert, specializing in Europe, Eurasia and the Middle East. He worked for the RAND Corporation and publishes widely in the US and international media.
Disclaimer: Views expressed by writers in this section are their own and do not necessarily reflect Arab News' point-of-view

Source:   http://www.arabnews.com/node/1451516
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Post Options Post Options   Thanks (0) Thanks(0)   Quote EdwinSm, Quote  Post ReplyReply Direct Link To This Post Posted: February 14 2019 at 3:03am
If more fighters die, will that change the dynamics to allow health care workers access?

Or will we have to see enough deaths in various groups so that most of them can no longer function? With 70 or so armed groups that would need a terrible death rate
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: February 14 2019 at 12:45pm
Ebola infects 4 more in DRC as death prompts testing in Uganda

Lisa Schnirring | News Editor | CIDRAP News | Feb 13, 2019


UNMEER, Martine Perret / Flickr cc

In the latest developments in the Democratic Republic of the Congo (DRC) Ebola outbreak, the health ministry reported four new cases, as details emerged about a suspected Ebola death that triggered a swift response in Uganda, where the man's samples tested negative for the virus.

The new cases signal continued activity in some of the outbreak's current main hot spots, and the close-call in Uganda shows how fear of cross-border spread has prompted intensive tracking of contacts.
New cases in 2 hot spots

The newly confirmed Ebola cases in the DRC include two patients in Katwa and two in Butembo. Also, health officials are still investigating 177 suspected illnesses.

One more person died from Ebola, a patient who was being treated at Katwa's Ebola treatment center.

The new cases lift the outbreak total to 823 cases, which includes 762 confirmed and 61 probable cases. So far, 517 deaths have been reported.

In the VSV-EBOV immunization campaign, 79,464 people have been vaccinated since Aug 8, 2018, more than half of them in Beni, Katwa, and Butembo.

A family's transport of a Ugandan man who died on Feb 8 in the DRC's outbreak region across the border and back into Uganda sparked intensive contact tracing, location of the body, and sample testing, according to a statement yesterday from the World Health Organization (WHO) African regional office.

The 46-year-old man was a construction worker who had been living and working the DRC for the past 8 years. He was first admitted to the hospital in Bunia, one of the towns in Ituri province that has reported Ebola cases, in November 2018 with symptoms that included chest pain and a sometimes-bloody cough.

Over the past week his condition worsened and he died at Bunia Hospital, where staff issued a death certificate and released his body to relatives, which included a group of 13 people from Tororo in Uganda. The group used the death certificate to cross the border and other checkpoints with the body. According to the statement, the death certificate said the man's cause of death was cardiac failure and pulmonary tuberculosis.

After learning of the incident, Uganda's health ministry—with support from the WHO—intercepted the man's relatives and the vehicle with the dead body in it before they reached their village in Tororo district. A ministry burial team and surveillance officer took oral swabs, conducted a verbal autopsy, and made plans to conduct a safe and dignified burial.

Yonas Tegegn Woldermariam, MD, the WHO's Uganda representative, said in the statement, "The immediate reporting by UMA and quick action by health workers as exhibited last night in this particular incident is what determines how quickly we respond and contain Ebola. I urge other Ugandans to take this as an excellent example as we prepare for a possible importation of EVD cases."

Uganda's health ministry said on Twitter that its teams conducted a dignified burial of the man in Tororo and that all people who were in close contact with the body have been quarantined. It added that samples taken from the dead man were sent to the Uganda Virus Research Institute, where they tested negative for Ebola. It emphasized that there are no confirmed Ebola cases from Uganda.

As part of preparedness efforts for possible spread of the virus across the border, Uganda has been vaccinating healthcare and front-line workers in high-risk districts since Nov 7. So far 3,587 have been immunized, the health ministry said.

Source:   http://www.cidrap.umn.edu/news-perspective/2019/02/ebola-infects-4-more-drc-death-prompts-testing-uganda
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: February 15 2019 at 7:59am
EUROPEAN DISEASE CONTROL: RISK ASSESSMENT UPDATE

Rapid risk assessment: Ebola virus disease outbreak in North Kivu and Ituri Provinces, Democratic Republic of the Congo – third update risk assessment.


This is the third update of the rapid risk assessment published on the 9 August 2018. It addresses the public health risk associated with the current Ebola virus outbreak in the Democratic Republic of the Congo (DRC) and its implications for EU/EEA citizens. This update was triggered by the persistence of the Ebola virus disease (EVD) transmission in urban settings, the continuous increase in the number of reported cases during the last four weeks, the persistent occurrence of new cases among contacts unknown at the time of EVD diagnostics and current challenges for the prevention and control of EVD.

Executive summary

This epidemic in North Kivu and Ituri Provinces is the largest ever recorded in DRC and the second largest worldwide. As of 6 February 2019, the Ministry of Health of the Democratic Republic of the Congo has reported 791 Ebola virus disease cases, including 737 confirmed and 54 probable cases. A total of 492 deaths occurred during the reporting period, consisting of an overall case fatality rate of 62%.

As of 29 January 2019, 65 healthcare workers have been reported among the confirmed cases.

While the majority of the cases have been reported in urban settings, some have also been reported in rural health zones surrounding urban centres. This suggests that transmission is also ongoing in rural areas. The weekly number of cases has increased to approximately 40 for three consecutive weeks, indicating that the viral circulation in the community is persistent.

Persistence of Ebola virus circulation

Despite the impressive mobilisation of response actors, significant challenges remain in this complex setting marked by a long-term humanitarian crisis and an unstable security context. According to WHO, the persistence of Ebola virus circulation in the community is driven by the sub-optimal infection prevention and control practices in primary healthcare, incomplete contact tracing and follow-up, delays in detection and isolation of new cases and community deaths leading to potential exposure of relatives to EVD.

Efforts are on-going to strengthen community-led efforts to support key EVD prevention and control interventions. Outbreak response activities continue in order to offer high quality case management, perform ring vaccination campaigns, provide the community with safe and dignified burials and ensure Points of Entry screening.

New EVD cases are expected to be reported in the coming weeks. A geographical extension is still possible, given the prolonged humanitarian crisis in the region, the important crossborder population flows to and from neighbouring provinces and countries, and the observed adverse impact of security incidents and community reticence which is hindering the implementation of EVD prevention and control measures.
Risk to the EU

The probability that EU/EEA citizens living or travelling in EVD-affected areas of DRC will be exposed to the virus is low, provided they adhere to precautionary measures. There are no international airports in the affected areas with direct flights to the EU/EEA Member States, which limits the risk of the virus being introduced into these countries. The overall risk of introduction and further spread of Ebola virus within the EU/EEA remains very low. However, the risk can only be eliminated by stopping transmission at local level.


Source:   https://ecdc.europa.eu/en/publications-data/risk-assessment-ebola-virus-outbreak-north-kivu-and-ituri-third-update
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South Sudan conducts an Ebola Tabletop Exercise
Report
from World Health Organization
Published on 12 Feb 2019 — View Original

12 February 2019, Juba – South Sudan conducted an Ebola virus disease (EVD) Tabletop exercise (TTX) for National Rapid Response Team (NRRT) on 12 February 2019. The exercise aimed at enhancing NRRT’s operational readiness by familiarizing participants with the EVD Standard Operating Procedures (SOPs) on Rapid Response Team (RRT) activation, deployment and field investigation procedures. It also provided participants with an opportunity to evaluate current capabilities and resources for prompt deployment in response to any suspected EVD case.

A total of 70 participants drawn from eight teams comprising of epidemiologists, clinicians, risk communication experts, laboratory technicians, and infection prevention and control experts were engaged in the one-day TTX exercise. The scenario developed for the exercise allowed the participants to be tested on all the aspects of RRT activation, mobilization, deployment, and field investigation. During the simulation, the participants identified gaps in the current SOPs and proposed recommendations for improving the current guidelines.

As the EVD outbreak in DRC evolves, the risk of cross border spread remains high for South Sudan along with 3 other countries neighboring DRC. It is therefore important that the country attains and maintains operational readiness for prompt response to suspected EVD cases. A multi-disciplinary RRT that works to ensure rapid, coordinated detection, investigation, and response to outbreaks of disease are one of the key pillars of the EVD preparedness framework.

Mr Mathew Tut, the Director for Emergency Preparedness and Response and PHEOC Manager of the Ministry of Health said: “due to the history of previous EVD outbreaks, increasing global travel and proximity to DRC and the threat of cross-border spread, it is our responsibility to be prepared for effective alert management at any time”.

Although South Sudan has not confirmed any EVD case, the risk of Ebola importation from North Kivu and Ituri of the Democratic Republic of Congo (DRC) within the country and regionally is very high due to porous border, trade, IDPs and refugees coupled with insecurity, says Dr Olu Olushayo, WHO Representative for South Sudan.

We acknowledge our donors, the United States Agency for International Development (USAID), the Department for International Development (DFID), Canada, and Germany for supporting the ongoing efforts to strengthen the country’s preparedness capacities and mitigate the risk of EVD importation.

Source:   https://reliefweb.int/report/south-sudan/south-sudan-conducts-ebola-tabletop-exercise
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