HHS-CDC-ATSDR

Secretary Price Appoints Brenda Fitzgerald, M.D., as CDC Director and ATSDR Administrator

 

WHO

Meningococcal septicaemia associated with attending a funeral – Liberia

This is an update to the Disease Outbreak News “Unexplained cluster of deaths – Liberia” published on 5 May 2017 and update published on 10 May 2017.

On 25 April 2017, the Ministry of Health (MoH) of Liberia notified WHO and partners of a cluster of sudden deaths of unknown aetiology in Sinoe County. The event started on 23 April 2017, when an 11-year-old female had been admitted to hospital presenting with diarrhoea, vomiting, and mental confusion after attending the funeral of a religious leader on 22 April 2017. The child died within one hour of admission.

Between 23 April and 7 May, a total of 31 cases including 13 deaths, and one case with neurological sequelae of an unknown disease associated with attending a funeral were reported from three counties (Sinoe, Grand Bassa, and Montserrado). The majority of cases did not present with fever, but did present with abdominal pain, diarrhoea, vomiting, and mental confusion. Some patients presented with purpura and/ or petechiae. Most of the cases were related to each other either socially, through family or school. All but two cases attended the funeral, who were subsequently identified as contacts of the index case.

On 8 May 2017, MoH informed partners and the public that specimens taken from patients tested positive for Neisseria meningitidis serotype C at the United States Centers for Disease Control and Prevention (CDC). The outbreak was therefore classified as a meningococcal disease outbreak. A total of 14 cases out of 31 cases were later confirmed with presence of Neisseria meningitidis C by PCR in clinical specimens conducted at the National Reference Laboratory in Liberia or clinically diagnosed due to the presence of purpura fulminans. Laboratory results were further confirmed by the National Institute for Communicable Diseases (NICD) and the National Institute of Occupational Health (NIOH) in Johannesburg, South Africa, in addition to serological results of three cases that were tested at Institute Pasteur in France. The temporal characteristics of this outbreak are unusual raising the hypothesis of the presence of a co-factor.

Additionally, on 8 May 2017, the MoH informed partners and the public that toxicological investigations conducted by CDC on urine samples from three cases did not suggest that intoxication was the cause of the outbreak. The samples were tested for pesticide metabolites and toxic metals.

On 20 June 2017, the MoH was notified that results of toxicological investigations carried out at the Center for Analytical Chemistry in Vienna, Austria, on food samples, water and a soft drink that were consumed during the funeral, were not suggestive of intoxication. The samples were tested for more than 600 fungal and bacterial toxins and these were either not detected or were within regulatory limits.

Public health response

The MoH supported by the WHO, CDC, Africa Field Epidemiology Network (AFENET), and other partners started on-site investigations one day after the alert. No disease was identified at the start of the outbreak and Ebola virus disease (EVD) was ruled out within 24 hours of the alert.

The National Public Health Institute of Liberia was activated to lead the response. WHO, CDC, UNICEF, and MSF reinforced the field response, and international coordination and information sharing was supported though the Global Outbreak Alert and Response Network (GOARN). The following response activities were implemented:

• Most of the cases from Sinoe were managed in the local hospital in Greenville, the capital of Sinoe County and received treatment as per EVD protocol.
• Infection, prevention, and control measures were implemented in the local hospital.
• Active case searching was conducted and identified attendees of the funeral and close contacts of the cases were followed up for 21 days.
• Autopsies were conducted on two patients.
• Approximately 70 specimens (58 clinical specimens and 12 food samples) were collected for laboratory testing and sent to the national reference laboratory in Margibi County, the United States, France, South Africa, and Austria.
• Chemoprophylaxis was distributed to all attendees, contacts of the cases, health workers, and burial personnel.
• A meningitis C vaccination strategy was discussed but not implemented due to the lack of secondary transmission.
• Social mobilization was implemented with the support of UNICEF.

WHO risk assessment

In the absence of clear understanding of the epidemiology of this outbreak , the risk of recurrence cannot be excluded. However, based on current understanding of the epidemiology of meningococcal disease, the risk is considered low.

The efficient and timely implementation of the response to this event is a result of the expertise developed in Liberia following the large outbreak of EVD in 2014. This led to the quick identification of the event, testing and ruling out EVD as the cause of the outbreak, identification of contacts and their follow-up and the collaboration of the country with partners to perform laboratory testing of human and environmental specimens, which led to the identification of the cause of the disease.

WHO advice

WHO does not recommend any restriction on travel and trade to Liberia on the basis of the information available on the current event.

WHO recommends the inclusion of meningococcal septicemia in routine surveillance in Liberia as an epidemic prone disease together with meningitis due to Neisseria meningitidis.

FEMA

These capabilities are referenced in many national preparedness efforts, including the National Planning Frameworks. The Goal grouped the capabilities into five mission areas, based on where they most logically fit. Some fall into only one mission area, while some others apply to several mission areas.

Planning

Public Information and Warning

Operational Coordination

Forensics and Attribution

Intelligence and Information Sharing

Interdiction and Disruption

Screening, Search, and Detection

Access Control and Identity Verification

Cybersecurity

Physical Protective Measures

Risk Management for Protection Programs and Activities

Supply Chain Integrity and Security

Community Resilience

Long-term Vulnerability Reduction

Risk and Disaster Resilience Assessment

Threats and Hazards Identification

Critical Transportation

Environmental Response/Health and Safety

Fatality Management Services

Fire Management and Suppression

Infrastructure Systems

Logistics and Supply Chain Management

Mass Care Services

Mass Search and Rescue Operations

On-scene Security, Protection, and Law Enforcement

Operational Communications

Public Health, Healthcare, and Emergency Medical Services

Situational Assessment

Economic Recovery

Health and Social Services

Housing

Natural and Cultural Resources

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USGS

WHO

Director-General Dr Tedros takes the helm of WHO: address to WHO staff

Dr Tedros Adhanom Ghebreyesus
Director-General of the World Health Organization

Today it is my pleasure and privilege to join and stand before you as the new Director-General of the World Health Organization. Our World Health Organization.

Let me start with the moral centre of our work, with this simple but crucial statement: WHO’s work is about serving people, about serving humanity. It’s about serving people regardless of where they live, be it in developing or developed countries, small islands or big nations, urban or rural settings. It’s about serving people regardless of who they are. Poor or rich, displaced or disabled, elderly or the youth. Most importantly, it’s about fighting to ensure the health of people as a basic human right. Health is a basic human right, that you fully understand.

It’s about a child who gets to see adulthood or about a parent who watches their child survive and thrive. It’s about a community living disease-free or an entire country or region that’s better prepared for health emergencies or for climate change.

Without health, people have nothing. Without health, we have nothing as humanity.

That’s why our work here at the World Health Organization is so important. WHO’s work is about helping people to protect and to improve their health. This is our collective vision: a world where everyone can achieve healthy and productive lives no matter who they are or where they live.

My transition, as you know, has been very short, just over four weeks, but also very busy. I have been listening intensely and appreciated all the advice I have received from you and others.

Let me outline, for today, three areas that I will focus on.

• Implementing leadership priorities and measuring results.
• Delivering results, value for money, efficiency and earning trust.
• Reinforcing a talented, motivated and engaged staff.

I’ll start with number one: implementing leadership priorities and measuring results.

During the transition, I met with the United Nations Secretary-General António Guterres who emphasized WHO’s opportunity and responsibility to lead on health and the Sustainable Development Goals. As you know, I ran with four clear substantive priorities plus a promise to transform WHO. These priorities came from WHO Member States. I was elected with an overwhelming mandate. I feel obliged by this clear mandate to implement the priorities.

These priorities are:

• universal health coverage
• health emergencies
• women’s, children’s and adolescents’ health
• health impacts of climate and environmental change

Of this, universal health coverage is at the centre.

I have said many times during the campaign that all roads lead to universal health coverage. For me, the key question of universal health coverage is an ethical one. Do we want our fellow citizens to die because they are poor? Universal health coverage, as I said earlier, is a human rights issue. And the responsibility of national governments. It’s not only a technical matter but even more so a political one. Countries should compare their results to their peers and learn from each other.

About 400 million people have no access, as you know, to even basic health care. Many more have access but will endure financial hardship. During the coming weeks, we will be looking at how best to implement the relevant Sustainable Development Goal, achieving universal health coverage, including financial risk protection, access to quality essential health care services, and access to safe, effective, quality and affordable essential medicines and vaccines for all.

Health emergencies will also be the litmus test for WHO. This topic is also closely related to universal health coverage because our goal is to prevent outbreaks from becoming epidemics at their roots. And this happens at the country level, based on strong health systems which robustly implement the International Health Regulations. Universal health coverage and health emergencies are cousins, two sides of the same coin.

We learned important lessons from Ebola. The task is now to make sure these lessons are effectively implemented. The next outbreak can occur tomorrow and WHO needs to be prepared. We have a new programme in health emergencies which is integrated into headquarters and the regions and country offices. I had the chance to observe the recent Ebola response in the Democratic Republic of the Congo and gained confidence that WHO is implementing its reforms. But we need to do more. If you read the report of the Independent Oversight and Advisory Committee prepared for the World Health Assembly, you will see that they think WHO has made progress in implementing reforms, but they also think that it’s not fast enough. We mustn’t let this happen. I have met with the leaders of the Health Emergencies Programme and I am committed to making sure the world is prepared for the next epidemic.

Women, children and adolescents are a central focus for universal health coverage and also the most vulnerable and at risk in health emergencies. Did you know that about half of the deaths of women and children are in a humanitarian context? WHO is fully committed to Every Woman Every Child and its areas of focus, including early child development, adolescent health and well-being. Quality, equity and dignity in services as well. Plus, sexual and reproductive health and rights, empowerment of women, girls and communities. And also, of course, humanitarian and fragile settings. While health emergencies hit quickly, climate change is a slow-motion disaster. WHO must play a strategic and decisive role not only in adaptation but also in mitigation.

Finally, for WHO to be effective in supporting countries, we need to have technical expertise in health challenges countries face: communicable diseases including polio, HIV, TB, malaria, hepatitis and neglected tropical diseases and noncommunicable diseases, including cardiovascular diseases, chronic pulmonary diseases, cancer, diabetes, mental health, addictions, accidents and injuries, you name it.

To single out just one vital example, this year, to date, we have had only 6 polio cases in the world. During my tenure, and together, we hope to meet the very last polio victim.

However, countries want holistic offerings from universal health care coverage that can be flexible to their needs. These individual areas of expertise are like the players on a football team. Each needs to be strong to win. But without teamwork, we will not win. Our team needs to work as one. Our team needs a captain. And universal health coverage is the captain of the team.

And the second of what I wanted to say today is on delivering results, value for money, efficiency and earning trust.

I said many times during my campaign that WHO must deliver value for money. This requires first and foremost that we develop a culture of results. We are very fortunate to have the Sustainable Development Goals. These indicators are the agreed results, the framework for the world, especially at the country level.

A key priority for me is to enhance our approach to resource mobilization among donors, old and new. And that has to start by building confidence among partners, that WHO will deliver results and impact. I want WHO to be synonymous with results. And that is doable. At the same time, we must recognize that WHO is the world’s platform for global health. It’s the only venue where all governments, along with other stakeholders, come together to discuss and decide fundamental issues in global health. If the platform did not exist, we would need to create it. This global governance function is the infrastructure of global health and the global public good.

WHO has a rightful role and is an undisputed leader in global health. When I met with the UN Secretary-General, he reinforced this role. However, I also want WHO to work with any partner, public or private, who can help improve health. We want to be the partner of choice and this has to go beyond our WHO brand to how we actually work together to improve outcomes for the poor.

I also fully understand from my experience that results happen at the country and local level. So I will be looking for ways to increase our emphasis on country level work in concert with the regions to meet the needs of countries and to optimize our results. We have to strengthen our country offices and need to ensure that heads of country offices are equipped not only with super technical capacity but also with political leadership and resource mobilization skills. In order to ensure our resources and efficiency, we need to have cohesion across all levels of the Organization: country offices, regional offices and headquarters. That’s why I will continue building upon the Global Policy Group in order to have shared vision and accountability at all levels.

We also need to become more efficient in our operations. Let me give you two examples that came to my attention during my interactions with WHO management and other stakeholders after my election. First, I was extremely surprised to learn that there are over 3000 separate grants managed by the World Health Organization. Just think about the transaction costs. This is unacceptable. I faced a similar situation in Ethiopia and developed the one plan, one budget and one report concept. I am cognizant that we cannot go from 3000 grants to one. I understand that. But it does illustrate how we need to radically overhaul and harmonize WHO’s business model and resource mobilization.

My second example from my engagement is, among a lot actually, the recent uproar over travel costs. I am reviewing the situation thoroughly and will ensure that our resources are used efficiently. We have to be good stewards of our resources. But I think the commitment of all of us will be necessary, but including our partners.

I have already started consultations with Member States, donors and partners on how to harmonize and modernize our resource mobilization. This will be a critical area I will be focusing on and I will ensure that WHO is adequately and appropriately funded with emphasis on expanding the donor base. From what we discussed so far I see positive developments that will really transform the way we mobilize resources. I hope through concrete actions on results, value for money and efficiency, WHO will earn trust among Member States, partners and donors, old and new, who will want to step up and not only increase their contributions for our collective live-saving work, but also become champions of our common cause.

And the third issue I would like to talk about today is reinforcing a talented, motivated and engaged staff. During the transition, I have focused first and foremost on WHO staff. My first meeting was actually with the WHO Staff Association.

If WHO is not healthy internally, then it will not be able to interact effectively externally.

In my acceptance speech in May, I promised staff, that I value you, and I will listen to you. And that’s what I did for the last four weeks. We have a amazing and dedicated staff. I have seen this in the last four weeks. And I believe that staff are our greatest asset more than even ever before. We should take pride in serving humanity.

And as I said earlier, my very first meeting after my election was with the representatives of the WHO Headquarters Staff Association Committee and I will be meeting their counterparts in the regions as well. I told them I will always listen. My answer will not always be “yes” but when it’s “no” I will give my reasons and I will engage them in the decision. But the 10 issues they raised, on many of them, we have the same position. And I was really happy to see that. I also told them that I will act on their concerns and started acting swiftly. And that we have on most of the issues a common position.

During the transition, I met each of the Regional Directors individually and collectively. I also met headquarters assistant directors-general and directors on several occasions to listen to their great ideas. I also got ideas for change from heads of WHO country offices. I appreciated when directors and heads of country offices consulted with their staff for the ideas they sent to me.

As you all know this was a unique election and the transition was also unique. I listened to staff for their views and opinions. I am so energized by their feedback and input as well as passion, dedication and commitment that I have seen so far.

When I met directors and assistant directors-general, I told them that I would be accessible and gave them my mobile phone number so they could reach me any time. We have to continue this candid discussion because candour is the best medicine for any organization.

I promise you this dialogue with WHO staff and the Staff Association will continue on a regular basis because we belong to the same team and we need to engage on a regular basis in order to be a winning team. I will continue to listen to and act upon staff concerns and ideas. Any enduring change at WHO will come from the staff outwards.

Let me also emphasize that I do not believe in perpetual reform and I think WHO staff are reformed out. I do believe in continuous improvement, however. Because our greatest asset is people, one core item in continuous improvement is how performance reviews are conducted and what coaching people receive. I would like to tie this much more closely to the results we seek to achieve.

My friends, talent is global, but opportunity is not. We will continue to conduct open recruitment, based on merit. However, we will ensure merit is seen from global or geographic and gender perspectives and the recruitment is done fairly and on an even playing field.

My door will always be open to the staff. In fact, I will set a regular time to meet with staff who wish to meet with me and I call upon all leaders and managers of WHO at all levels, starting from headquarters to the regions and to the country offices, starting from team leaders to the Deputy Director-General to do the same. Listening to our staff is a bottom line and builds our teams.

As a way forward, I would like to tell you that this has been a very holistic election. I have been given a decisive mandate and my vision and priorities for WHO have been endorsed by Member States. I have spent the last four weeks listening and engaging staff and conversing with partners. What we focus on in the next phase is going to be clearly articulating measurable outcomes and swiftly moving to implementation with a sense of urgency.

As you can imagine, the very short transition window has not given me enough time to identify the best and appropriate senior leadership team. I hope to complete forming my team in the next few months. That’s why I have asked the existing senior management to stay on their positions for few more months until I appoint my leadership team. As you know, I have asked for recommendations from all levels of the Organization and have received many excellent ideas. I have formed a committee of WHO staff to study these recommendations, composed of directors, and to identify which are the most important ones that would lead to a major paradigm shift in our WHO. I will ensure the full engagement and participation of staff in any change.

Again, let me emphasize that enduring change comes from the bottom up. Only change that’s owned by staff will succeed. As Tom Peters said, I quote, “change is a door that can only be opened from the inside”. So in order to fundamentally change WHO, first of all, we all need to individually open our minds for change. Because the mind is opened from inside. And two, we all need to collectively work together to open our organizations for change.

My friends, we have a historic opportunity to make transformational improvement in world health. Let’s do it. Let us do it for every woman and child who died when they didn’t have to die. And for every child who failed to reach her full potential. For every victim felled by an outbreak, for every small islander who is faced with the threat of climate change. Let us dedicate ourselves to them. Let us stand together for a healthier world.

Thank you so much. Merci beaucoup.

Global Health Now

“…..In India, ruthless and mercenary medical practitioners exploit vulnerable patients. Unnecessary procedures and avoidable surgical operations have become commonplace. Laboratories and doctors conspire to recommend unnecessary tests or manufacture false results (for example, a blood report with low vitamin levels) to extend the patient’s course of treatment—and payments.  Hospitals bent on boosting revenue compel or pressure doctors to order more tests, even though they may be unnecessary. Hospitals set targets for doctors to increase revenue, ranging from quotas to hospitalize a certain number of patients to sending a certain number for MRIs and CT scans…..”

 

ReliefWeb

“….Over the last months, Ukraine faced an outbreak of botulism – 76 cases recorded since the beginning of the year, 8 of them fatal. Ministry of Health of Ukraine faced a serious challenge fighting the current outbreak, as there are no botulism antitoxins registered in Ukraine since 2014. Moreover, there was no budget funding allocated for procurement of this kind.

International organizations were asked to help resolve the issue. United Nations Development Program reacted and expressed readiness to provide humanitarian response.

The antitoxin, which is produced only by a few manufacturers around the world, was sourced by UNDP within the shortest possible period. High-quality medicine manufactured in Canada arrived to airport in Kyiv today, from where it is being transferred to the specialized warehouse of the Ministry of Health.

Current shipment will allow to form the essential stock, which will be used to immediately cover new cases that might occur. Serums will be urgently provided in case of need…..”