WHO

One million Rohingya refugees, host communities being vaccinated against cholera

Cox’s Bazar, 6 May 2018: A massive cholera vaccination campaign began today to protect nearly one million Rohingyas and their host communities living in and around the refugee camps in Bangladesh, to prevent any potential outbreak during the ongoing monsoon season.

This is a second cholera vaccination campaign being held for the Rohingyas and their host communities. Earlier 900,000 doses of oral cholera vaccine were administered to the vulnerable population in two phases in October – November last year.

“Considering the water and sanitation conditions in the overcrowded camps and the increased risk of disease outbreaks in the monsoon season, the health sector is taking all possible measures to prevent cholera and other water and vector borne diseases,” says Dr. Bardan Jung Rana, WHO Representative to Bangladesh.

As many as 245 mobile vaccination teams have been deployed to vaccinate all people over the age of one year in refugee camps and host communities in Ukhiya and Teknaf sub-districts during nearly week-long campaign led by the Ministry of Health and Family Welfare, with support of World Health Organization, UNICEF and icddr,b and other partners.

“We have managed to prevent the cholera outbreak since the first campaign in October last year, but flood water, heavy storms and landslides in the monsoon season could damage water and sanitation facilities in the camps, increasing the risk again of an outbreak of this dangerous disease. We have to take all initiatives to address the risk, including preventive measures through vaccination,” says Edouard Beigbeder, UNICEF Representative in Bangladesh.

The oral cholera vaccines have been made available through the Inter-Agency Coordinating Group with members from WHO, UNICEF, Médecins sans Frontières and International Federation of the Red Cross. The vaccines and supplies are financed by Gavi, the vaccine alliance.

“This vaccination campaign is a part of the ongoing efforts of the government and the health sector partners to protect nearly a million people, including at least 135,000 Bangladeshis, who have been affected by the influx since last year,” says Professor Dr. Abul Kalam Azad, Director General of Health Services (DGHS), Ministry of Health and Family Welfare, Government of Bangladesh.

In addition to vaccination, consistent efforts are being made to improve access to clean water and sanitation and promote hygiene. UNICEF has been scaling up interventions and communication on safe practices.

The World Health Organization has raised an early warning, alert and response emergency surveillance system, is monitoring water quality and working with the Department of Public Health Engineering to enhance local laboratory capacity.

Both WHO and UNICEF have prepositioned life-saving supplies to ensure rapid response to any outbreak.

The WHO-led Health Sector is supporting setting up of diarrhea treatment centres, including five supported by UNICEF and managed by icddr,b.

Editorial Note:

The Maternal Neonatal and Adolescent Health (MNC&AH) of Director General of Health Services (DGHS) is leading the oral cholera vaccination campaign through district and upazila level health managers and administration as well as DGHS Coordination Cell in Cox’s Bazar, Armed Forces, Refugee Relief and Repatriation Commission (RRRC), development partners, including UN agencies, and national and international non-government organizations.

NY Times

“…….In recent years, amid profound shortages of medicine coupled with widespread ignorance, H.I.V. has spread rapidly throughout the Orinoco Delta and is believed to have killed hundreds of the Warao indigenous people …..”

WHO

A spate of cholera outbreaks across Africa has prompted the largest cholera vaccination drive in history, with more than two million people across the continent set to receive oral cholera vaccine (OCV).

The vaccines, funded by Gavi, the Vaccine Alliance, were sourced from the global stockpile and are being used to carry out five major campaigns in Zambia, Uganda, Malawi, South Sudan and Nigeria. The campaigns, which will be completed by mid-June, are being implemented by the respective Ministries of Health supported by the World Health Organization (WHO) and partners of the Global Task Force on Cholera Control (GTFCC), and mostly in reaction to recent cholera outbreaks.

In the 15 years between 1997 and 2012 just 1.5 million doses of cholera vaccines were used worldwide. In 2017 alone almost 11 million were used, from Sierra Leone to Somalia to Bangladesh. In the first four months of 2018 over 15 million doses have already been approved for use worldwide.

“This is an unprecedented response to a spike in cholera outbreaks across Africa,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “We have worked hard to ensure there is now enough vaccine supply to keep the global stockpile topped up and ready for most eventualities. However with more and more people now succumbing to this terrible, preventable disease, the need for improved water and sanitation – the only long-term, sustainable solution to cholera outbreaks – has never been clearer.”

Through its Regional Office for Africa, WHO regularly provides technical and operational support to countries often affected by cholera in Africa. In particular, since the beginning of 2018 WHO has led on providing technical expertise and guidance, working closely with Ministries of Health in the five countries to plan and implement the campaigns with different partners. This is part of a global push to reduce cholera deaths by 90 percent by 2030.

“Oral cholera vaccines are a key weapon in our fight against cholera,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “But there are many other things we need to do to keep people safe. WHO and our partners are saving lives every day by improving access to clean water and sanitation, establishing treatment centres, delivering supplies, distributing public health guidance, training health workers, and working with communities on prevention.”

The burden of cholera remains high in many African countries. As of 7 May many countries are facing cholera outbreaks, with at least 12 areas or countries reporting active cholera transmission in sub-Saharan Africa. Recent developments in the use of OCVs show that the strong mobilisation of countries and partners can effectively tackle the disease when tools for prevention and control are readily available.

“Every rainy season, cholera springs up and brings devastation to communities across Africa,” said Dr Matshidiso Moeti, WHO’s Regional Director for Africa. “With this historic cholera vaccination drive, countries in the region are demonstrating their commitment to stopping cholera from claiming more lives. We need to build on this momentum through a multisectoral approach and ensure that everyone has access to clean water and sanitation, no matter where they are located.”

The five African campaigns are:

• Nigeria
  1.2 million doses will protect around 600,000 people to contain an emerging cholera outbreak in Bauchi state, where more than 1700 cases have been reported.
• MalawiOne million doses of cholera vaccine will protect over 500,000 people in Lilongwe to combat an outbreak which has infected more than 900 people across the country.
• Uganda360,000 doses of cholera vaccine have been shipped to Uganda to protect 360,000 people in Hoima District, Western Uganda, after an outbreak in Kyangwali refugee camp hospitalized more than 900 people. The country is also now engaging in long-term cholera control planning to vaccinate over 1.7 million people in the coming months.
• Zambia667,100 doses of cholera vaccine are being delivered as part of the second round of vaccination to the Lusaka slums after a major outbreak infected over 5700 people, killing more than 100. Zambia is also engaging on long term cholera control and planning vaccination in additional hotspots.
• South Sudan

113,800 doses have been shipped as a preventative measure ahead of the war-torn country’s rainy season. These extra doses will complement doses remaining from previous campaigns to target Panyijiar. Over 2.6 million doses of OCV have been administered in South Sudan since 2014.

Oral Cholera Vaccine is recommended to be given in two doses. The first gives protection for six months, the second for three to five years. All five campaigns should have completed their second round of vaccinations by mid-June.

A resolution on cholera will be proposed by Zambia and Haiti at this month’s World Health Assembly, calling for renewed political will and an integrated approached to eliminate cholera, including investment in clean water, sanitation and hygiene (WASH).

The global cholera vaccine stockpile is managed by the Global Task Force on Cholera Control (GTFCC), which decides on OCV use in non-emergency settings, and the International Coordinating Group (ICG), which decides on outbreak response and features representatives from WHO, UNICEF, the International Federation of the Red Cross and Red Crescent Societies (IFRC) and Medecins Sans Frontières (MSF). The stockpile is funded in full by Gavi, the Vaccine Alliance, which is a GTFCC partner and has an observer status on the ICG.

Situation On May 3, a lava flow broke to the surface in lower Puna on the Big Island of HI.

Since the onset of this eruption, a total of 12 fissures have emerged.

Multiple earthquakes/aftershocks of magnitude 2.5 or higher recorded in the past week; but earthquake activity has diminished by approximately 33% from May 6

Impacts

• Evacuations: 1,650 residents of Leilani Estates & Lanipuna Gardens (775 homes) under mandatory evacuation; Leilani Estates allowed limited, short-term reentry

• Shelters: 2 shelters open / 147 occupants (Region IX Update #5 as of 6:37 p.m. EDT May 7)

• Damage: 35 homes destroyed; no major damage to critical infrastructure (CIKR)

• Temporary Flight Restrictions for non-relief aircraft operations extended to May 15

• Pahoa-Pahoiki road closed from Highway 132 to Highway 137

State / Local Response

• HI EOC at Partial Activation

• Governor declared State of Emergency & activated HI National Guard

• State is working to restore water service to neighborhoods near the fissures

FEMA Response

• FEMA Region IX RWC & Pacific Area Watch at Steady State; continue to monitor

• Four FEMA Region IX LNOs deployed to HI EOC & Hawai‘i County Civil Defense

• N-IMAT East 1 at Region IX; deploying to Hawai‘i County over the next two days

• FEMA NWC is monitoring

CIDRAP

• “The more I learn about flu, the less I know,” said Michael Osterholm PhD, MPH, director of the University of Minnesota’s Center for Infectious Disease Research and Policy
• More people will die from the non-pandemic aspects of such a global health crisis.
• The US economy is so inextricably linked to other countries, especially China’s, that a pandemic would paralyze supply chains for both consumer and medical goods.
• A pandemic would bring “unprecedented employee absenteeism,” Osterholm said.
• Consider that 30 of the most common generic medicines currently used in the United States are wholly or partially manufactured in China. “Look at what happened with saline bags in Puerto Rico,” said Osterholm.
• Arnold Monto, MD, from the University of Michigan:  Modern tools, including the flu vaccine, would mean it’s unlikely the 1918 pandemic could ever be repeated.
• Luciana Borio, MD, of the White House National Security Council, confirmed that China is not currently sharing flu vaccine strain information nor any progress made on its development of a universal flu vaccine.
• Trust for America’s Health (TFAH’s) annual readiness report, “Ready or Not?” :  TFAH President and CEO John Auerbach, MBA, said no states were completely prepared for a pandemic (based on 11 criteria, and ranked from 1 to 10). Only five states had a preparedness ranking of 8 or 9, and half sat at a 5 or lower. The report was published in December.
• Dwindling public health department budgets are a problem
• Nancy Messonnier, MD, head of CDC’s National Center for Immunization and Respiratory Diseases, said that despite gaps in preparedness, the CDC is better equipped to handle a flu pandemic now than it was in 2009, when a novel H1N1 flu strain first emerged. Technologies, including mobile apps that help consumers find flu shots, and antivirals are putting the power to prevent and fight flu into patients’ hands.

https://nyti.ms/2KFFq4n

Elias, T., and Sutton, A.J., 2017, Volcanic air pollution hazards in Hawaii: U.S. Geological Survey Fact Sheet 2017–3017, 4 p., https://doi.org/10.3133/fs20173017.

“…..Noxious sulfur dioxide gas and other air pollutants emitted from Kīlauea Volcano on the Island of Hawai‘i react with oxygen, atmospheric moisture, and sunlight to produce volcanic smog (vog) and acid rain. Vog can negatively affect human health and agriculture, and acid rain can contaminate household water supplies by leaching metals from building and plumbing materials in rooftop rainwater-catchment systems. …..”

UPI

“……The victims had the same symptoms such as stomach ache, vomit, sore throat, fatigue, dizziness, and breathing difficulty…..adding that all the victims aged between 24 and 73 years old…..”

USA Today

On May 3, 2018, ash, lava, and gas erupted from Hawaii’s Kilauea volcano. Clouds have so far prevented NASA satellites from acquiring a natural-color image of the area. However, the plume contained sulfur dioxide (SO₂), a gas that was detected by the Ozone Mapper Profiler Suite (OMPS) on the Suomi-NPP satellite.

The map above shows concentrations of SO₂ as detected by OMPS at 1:30 p.m. local time (23:30 Universal Time) on May 3. Maximum gas concentrations reached 15 Dobson Units.

Sulfur dioxide is invisible to our eyes, but it can affect human health and Earth’s climate. The gas reacts with water vapor in the atmosphere to produce acid rain. It also can react with other gases to form aerosol particles that cause haze and, in extreme events, climate cooling.

According to the USGS Hawaiian Volcano Observatory, activity that continued on May 4 was primarily “lava spattering” from at least three small fissure vents in the Leilani Estates subdivision. News reports note that residents of the subdivision were ordered to evacuate.

• References and Further Reading

• USGS Volcano Hazards Program (2018, May 3) Hawaiian Volcano Observatory. Accessed May 4, 2018.
• USGS Volcano Hazards Program (2018, May 4) Hawaiian Volcano Observatory Daily Update. Accessed May 4, 2018.
• The Washington Post (2018, May 4) Hawaii’s Kilauea erupts. Evacuations underway as lava threatens communities. Accessed May 4, 2018.

NASA Earth Observatory image by Joshua Stevens, using OMPS data from the Goddard Earth Sciences Data and Information Services Center (GES DISC). Text by Kathryn Hansen.

USA Today

CNN