Global & Disaster Medicine

2018-2019 Influenza Season Week 6 ending February 9, 2019: Influenza activity continues to increase in the United States.

CDC

national levels of ILI and ARI

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INFLUENZA Virus Isolated

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DRC: Ebola cases climb to 835

WHO

Ebola virus disease – Democratic Republic of the Congo

Disease outbreak news: Update
14 February 2019

Despite slightly fewer cases reported during the past week (Figure 1), current epidemiological indicators highlight that the Ebola virus disease (EVD) outbreak is continuing with moderate intensity. Katwa and Butembo remain the major health zones of concern, while simultaneously, small clusters continue to occur in various geographically dispersed regions. During the last 21 days (23 January – 12 February 2019), 97 new cases have been reported from 13 health zones (Figure 2), including: Katwa (59), Butembo (12), Beni (7), Kyondo (4), Oicha (4), Vuhovi (3), Biena (2), Kalunguta (2), Komanda (1), Manguredjipa (1), Mabalako (1), Masereka (1), and Mutwanga (1).1 The recent case reported in the Komanda health zone was a resident of Katwa who was exposed to the virus, and subsequently travelled to both Bunia and Komanda. This case comes one month after the last reported case in Ituri Province; underscoring the high risks of reintroduction to previously affected areas, as well as the potential for spread to new ones.

As of 12 February, 823 EVD cases2 (762 confirmed and 61 probable) have been reported, including 517 deaths (overall case fatality ratio: 63%). Cumulatively, cases have been reported from 118 of 287 health areas across 18 health zones, of which 37 health areas have reported a case in the last 21 days. Thus far, 283 people have been discharged from Ebola Treatment Centers (ETCs) and enrolled in a dedicated monitoring and support programme. One new health worker infection was reported in Katwa. To date, a total of 68 health workers have been infected.

Main challenges this past week primarily pertain to community mistrust, particularly in Katwa, and the difficulty in encouraging community members to be more proactive in reporting suspected cases, presenting early to ETCs for treatment, and participating in community-based prevention and response efforts. However, in the face of these protracted challenges, response strategies have demonstrated to be effective in curtailing the spread of EVD. Fostering greater community trust by strengthening engagement with its members remains a top priority for response teams.

On 13 February, the Ministry of Health (MoH) launched the Strategic Response Plan 3 (SRP 3). The plan lays out the response strategy, objectives and budget requirements for the MoH, WHO, and all implementing partners for the next six months (February through July 2019). SRP 3 takes into account recommendations from operational reviews, and builds on a series of new strategic directions that capitalize on lessons learned under the scope of SRP 2. Activities laid out aim to stop the transmission of EVD in North Kivu and Ituri provinces, and prevent its spread to other provinces and neighbouring countries.

WHO remains confident that this outbreak can be successfully brought to an end through strategies outlined in SRP 3. To achieve the goals set out by the plan, MoH, WHO, and partners are appealing for US$ 148 million. WHO and partners count on the continued support of the international community to provide the required funding in order to stop this outbreak.

Figure 1: Confirmed and probable Ebola virus disease cases by week of illness onset, data as of 12 February 2019 (n=822)

Figure 2: Confirmed and probable Ebola virus disease cases reported between 22 January and 11 February by place of residence, North Kivu and Ituri provinces, Democratic Republic of the Congo (n=101)*

*Map based on the latest available detailed line lists (data as of 11 February 2019), and excludes cases reported after this date, as well as cases with delayed/missing village or health area details. Categorization of cases by health zone may differ from the reported place of residence.

Public health response

For further information about the public health response actions by the MoH, WHO, and partners, please refer to the latest situation reports published by the WHO Regional Office for Africa:

WHO risk assessment

WHO continuously monitors changes to the epidemiological situation and context of the outbreak to ensure that support to the response is adapted to the evolving circumstances. The last review conducted on 7 February 2019, outlines the high risk the EVD outbreak poses at the national and regional levels, though global risk levels remain low. This EVD outbreak is affecting primarily the north-eastern provinces of the Democratic Republic of the Congo bordering Uganda, Rwanda, and South Sudan. There is a potential risk for transmission of EVD at the national and regional levels due to extensive travel between the affected areas, the rest of the country, and neighbouring countries for economic and personal reasons, as well as due to insecurity. The country is concurrently experiencing other epidemics (e.g. cholera, vaccine-derived poliomyelitis, malaria), and a long-term humanitarian crisis. Additionally, the fragile security situation in North Kivu and Ituri, further limits the implementation of response activities.

As the risk of national and regional spread is very high, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities. The International Health Regulations (IHR 2005) Emergency Committee has advised that failing to intensify these preparedness and surveillance activities would lead to worsening conditions and further spread. WHO will continue to work with neighbouring countries and partners to ensure that health authorities are alerted and are operationally prepared to respond.

WHO advice

International traffic: WHO advises against any restriction of travel to, and trade with, the Democratic Republic of the Congo based on the currently available information. There is currently no licensed vaccine to protect people from the Ebola virus. Therefore, any requirements for certificates of Ebola vaccination are not a reasonable basis for restricting movement across borders or the issuance of visas for passengers leaving the Democratic Republic of the Congo. WHO continues to closely monitor and, if necessary, verify travel and trade measures in relation to this event. Currently, no country has implemented travel measures that significantly interfere with international traffic to and from the Democratic Republic of the Congo. Travellers should seek medical advice before travel and should practice good hygiene.

For more information, see:


1 Excludes newly probable cases from Katwa (7) and Komanda (5), who died in November and December 2018 and were reported during the period of 21 January to 10 February following a retrospective re-classification of cases.

2 Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning – trends during this period should be interpreted cautiously.


Five people have died following a workplace shooting in Aurora Friday afternoon. The suspect, identified as Gary Martin, was shot dead

CBS2

 


Aurora, IL: Four police officers were injured as were a “number of civilians” in a mass shooting at a company shop. Possibly 1 death.

CNN

  • “What happened: A gunman opened fire at the Henry Pratt Company in Aurora, Illinois, a manufacturing plant southwest of Chicago.
  • The suspect: Aurora police said the alleged shooter is in custody.
  • Victims: An Aurora city official says four police officers were struck along with a number of civilians….”


North Macedonia: A bus carrying workers crashed into a ravine outside Skopje Wednesday, killing 14 people and injuring about 30

Daily Mail

“…………Venko Filipce, the newly renamed European nation’s health minister, said seven people were pronounced dead at the scene and the rest died after being taken to a hospital. Six of those injured had life-threatening conditions…..

The bus was carrying about 50 people when it veered off a highway linking Skopje with…. Tetovo and plunged 10 meters (30 feet) into a small ravine, landing upside down. The cause of the crash…wasn’t yet known…..”


Allegedly: A third man suspected of involvement in the nerve agent poisoning of former Russian spy Sergei Skripal in England last year is a high-ranking Russian military intelligence agent

Reuters

‘……Bellingcat [investigative website] said it had identified a third Russian agent who was also in Britain at the time and was suspected of being involved.

“Bellingcat can now reveal the true identity and background of this GRU officer, who operated internationally under the cover persona of Sergey Vyachaeslavovich Fedotov,” it said.

“In fact, this person is Denis Vyacheslavovich Sergeev, a high-ranking GRU officer and a graduate of Russia’s Military Diplomatic Academy.”…..’


Kashmir: An attack on a convoy of Indian soldiers killed 37 and wounded five

CNN

 


Parkland, 2/14/2018: 17 dead, 17 injured

NYT

The five bullet wounds he took as he barricaded a classroom door to protect other students have healed, remarkably. But his recovery is far from over. And the prospect of being asked to testify in court looms in the future……..

Now a sophomore, she was inside the freshman building where the shooting took place. Her lab partner, Alyssa Alhadeff, was killed. So were two of her creative-writing classmates. During the interview, loud squawks from birds flying overhead made her jumpy……..

The Coral Springs police officers — who have been friends for more than 25 years — were among the first emergency personnel to enter the freshman building. Their counterparts at the Broward Sheriff’s Office were criticized for failing to try to confront the gunman……..

The 2017 Stoneman Douglas graduate co-founded the March for Our Lives organization after the shooting, though he is not among the group’s well-known leaders. He left college to help with merchandising, but became the organization’s creative director after he designed a T-shirt that could be scanned with a cellphone to register someone to vote…….

She’s a senior whose boyfriend, Joaquin Oliver, known as Guac, was killed in the shooting, months before he was expected to graduate. Only in December did she take what she considered the first step toward healing: planting a memorial garden at the school to commemorate the lives lost. She keeps the flowers Joaquin gave her last Valentine’s Day—his “last act of love,” she calls them— in a vase. ………

Like many other parents, Joaquin Oliver’s mother and father have become dedicated activists since their son’s death. One of them was elected to the local school board. While the families don’t all share the same political views, they stay in touch and occasionally meet, knowing they are bound by the pain of losing a child…….

An English and journalism teacher and yearbook adviser at Stoneman Douglas, she compiled stories from shooting survivors into a book. Two of her students, Jaime Guttenberg and Meadow Pollack, were killed…….”

 


An enhanced-delivery anthrax vaccine formulation

Weir GM, MacDonald LD, Rajagopalan R, et al. Single dose of DPX-rPA,
an enhanced-delivery anthrax vaccine formulation, protects against a
lethal _Bacillus anthracis_ spore inhalation challenge. npj Vaccines,
Abstract
——–
Anthrax is a serious biological threat caused by pulmonary exposure to
aerosolized spores of _Bacillus anthracis_. Biothrax® (anthrax
vaccine adsorbed (AVA)) is the only Food and Drug
Administration-licensed vaccine and requires 5 administrations over 12
months with annual boosting to maintain pre-exposure prophylaxis. Here
we report the evaluation of a single intramuscular injection of
recombinant _B. anthracis_-protective antigen (rPA) formulated in the
DPX delivery platform. Immune responses were compared to an alum-based
formulation in mice and rabbits. Serological analysis of anti-rPA
immunoglobulin G and toxin neutralization activity demonstrated higher
responses induced by DPX-rPA when compared to rPA in alum. DPX-rPA was
compared to AVA in rabbits and non-human primates (NHPs). In both
species, DPX-rPA generated responses after a single immunization,
whereas AVA required two immunizations. In rabbits, single injection
of DPX-rPA or two injections of AVA conferred 100% protection from
anthrax challenge. In NHPs, single-dose DPX-rPA was 100% protective
against challenge, whereas one animal in the 2-dose AVA group and all
saline administered animals succumbed to infection. DPX-rPA was
minimally reactogenic in all species tested. These data indicate that
DPX-rPA may offer improvement over AVA by reducing the doses needed
for protective immune responses and is a promising candidate as a
new-generation anthrax vaccine.

A truck bomb attack on a bus carrying members of Iran’s Islamic Revolutionary Guard Corps, killed 27 Guards and wounded 13

NPR


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