Global & Disaster Medicine

Archive for the ‘WHO’ Category

Cholera in Somalia: The cumulative total of cases is 6394, including 42 associated deaths (case-fatality rate 0.7%) since the beginning of the current outbreak in December 2017

WHO

Outbreak update – Cholera in Somalia, 4 October 2018

04 October 2018 – The Ministry of Health of Somalia has announced 30 new cases of cholera and no deaths for week 38 (17 to 23 September) of 2018. Since week 28, there has been a decreasing trend in the number of cholera cases reported. The cumulative total of cases is 6394, including 42 associated deaths (case-fatality rate 0.7%) since the beginning of the current outbreak in December 2017. Of 276 stool samples collected since the beginning of this year and tested in the National Public Heatlh Laboratory in Mogadishu, 80 tested positive for Vibrio cholerae, serotype O1 Ogawa.
The cholera outbreak started in December 2017 in Beletweyne along river Shabelle and has spread to Jowhar, Kismayo, Afgoye Merka and Banadir. Over the past five weeks, there has been a decrease in the number of cases reported in Banadir and Lower Jubba, while during week 38 active transmission was reported in Kismayo district of Lower Jubba, and 7 districts of Banadir region (Darkenly, Daynile, Hodan, Madina, Waberi, Hamarjabjab, and Heliwa districts).
During week 38, Banadir accounted for 90% (27) of the newly reported cases. Banadir also has the highest concentration of IDPs living with limited safe water and sanitation. Among the new cases, 44% are children below 5 years old. The oral cholera vaccination campaign that was implemented in 11 high risk districts in 2017 and 2018 across Somalia has greatly contributed to the reduction in the number of new cholera cases compared to the same period in 2017. All cases reported for week 38 had not received vaccination before.
WHO provides leadership and support for activities with the Ministry of Health (MoH) to respond to this outbreak. Coordination meetings were held in the flood-affected districts with MoHs at Federal and State levels including Health Cluster partners for effective collaboration on the outbreak response.
WHO has continued to support clinical care delivery, including building capacity for health care workers. On-the-job trainings on case management were conducted at cholera treatment centers (CTCs) in Kismayo, Farjano, Banadir and Marka. Disease surveillance data was collected through the early warning alert and response network (EWARN) with support from WHO, contributing to early detection of new cases and a prompt response to outbreaks.
WHO worked with WASH cluster partners on chlorination of water sources in cholera-affected areas, including Hnati-wadaaq, Bulo-sheikh, Allenley and Fanole, to ensure safe water in the communities.  1500 hygiene kits were distributed in villages in Kismayo, and hygiene promotion for cholera prevention and control is on-going in Farjano, Allanley, Gulwada, Shaqalaha and Kismayo district.

WHO: Prioritizing Emerging Infectious Diseases in Need of Research and Development

The World Health Organization R&D Blueprint aims to accelerate the availability of medical technologies during epidemics by focusing on a list of prioritized emerging diseases for which medical countermeasures are insufficient or nonexistent. The prioritization process has 3 components: a Delphi process to narrow down a list of potential priority diseases, a multicriteria decision analysis to rank the short list of diseases, and a final Delphi round to arrive at a final list of 10 diseases.

A group of international experts applied this process in January 2017, resulting in a list of 10 priority diseases. The robustness of the list was tested by performing a sensitivity analysis. The new process corrected major shortcomings in the pre–R&D Blueprint approach to disease prioritization and increased confidence in the results.

Multicriteria scores of diseases considered in the 2017 prioritization exercise for the development of the World Health Organization R&D Blueprint to prioritize emerging infectious diseases in need of research and development. A) Disease final ranking using the geometric average of the comparison matrices. B) Disease final ranking using the arithmetic average of the raw data. Error bars correspond to SD, indicating disagreement among experts. C) Disease final ranking using the SMART Vaccines

Multicriteria scores of diseases considered in the 2017 prioritization exercise for the development of the World Health Organization R&D Blueprint to prioritize emerging infectious diseases in need of research and development. A) Disease final ranking using the geometric average of the comparison matrices. B) Disease final ranking using the arithmetic average of the raw data. Error bars correspond to SD, indicating disagreement among experts. C) Disease final ranking using the SMART Vaccines prioritization tool (56). P1, Ebola virus infection; P2, Marburg virus infection; P3, Middle East Respiratory Syndrome coronavirus infection; P4, severe acute respiratory syndrome; P5, Lassa virus infection; P6, Nipah virus infection; P7, Rift Valley fever; P8, Zika virus infection; P9, Crimean-Congo hemorrhagic fever; P10, severe fever with thrombocytopenia syndrome; P11, South American hemorrhagic fever; P12, plague; P13, hantavirus infection.

Si Mehand M, Millett P, Al-Shorbaji F, Roth C, Kieny MP, Murgue B. World Health Organization methodology to prioritize emerging infectious diseases in need of research and development. Emerg Infect Dis. 2018 Sep [date cited]. https://doi.org/10.3201/eid2409.171427


WHO: Cholera and Conflict

WHO

Crisis-driven cholera resurgence switches focus to oral vaccine

Oral rehydration was once the mainstay of treatment for cholera, but today’s cholera outbreaks fuelled by conflict and instability require a new approach. Sophie Cousins reports.

Bulletin of the World Health Organization 2018;96:446-447. doi: http://dx.doi.org/10.2471/BLT.18.020718

Residents queue up to receive the oral cholera vaccine in he city of Nampula in Mozambique during the vaccination campaign in 2016.

WHO/L. Pezzoli

On a hot, humid afternoon at the world’s largest diarrhoeal disease hospital, dozens of patients are filing in, many being carried in the arms of loved ones, frail and barely alive.

Inside the Cholera Hospital – as it is commonly known – in Dhaka, at the icddr,b (formerly the International Centre for Diarrhoeal Disease Research, Bangladesh or ICDDR, B), hundreds of patients receive rehydration treatment.

Up to 1000 patients can be admitted each day at this time of the year, as the rains peak and temperatures soar. Outside the hospital, the ward has extended into circus-size tents in the car park. Most patients recover quickly and go home within 24 hours.

“We don’t say no to anyone and we don’t charge anyone,” says Dr Azharul Islam Khan, who is the chief physician and head of hospitals at the icddr,b.

The bacterium Vibrio cholerae has wreaked havoc for hundreds of years. Originating in the Ganges delta in India, the first recorded cholera epidemic started in 1817 and travelled along trade routes through Asia and to the shores of the Caspian and Mediterranean seas. Since then, regular outbreaks across the world have killed millions of people.

Cholera is an acute diarrhoeal infection caused by ingesting food or water contaminated with Vibrio cholerae. If left untreated, the infection can kill within hours. Each year between 1.3 to 4 million cases, and up to 143 000 deaths are reported to the World Health Organization (WHO). But the true burden of cholera is unknown.

“Reporting of cholera is not reliable. The number of cholera cases reported to us is considered to be the tip of the iceberg,” says Dr Dominique Legros, from WHO’s health emergencies programme.

There are many reasons for this, he says. For one, it’s difficult to confirm cases in large outbreaks where diagnostic capacity is limited. Second, the symptoms of less severe cholera are similar to those of other diarrhoeal diseases. Third, some countries may be reluctant to report cases of cholera for fear this will affect trade or tourism, Legros adds.

Bangladesh, an impoverished country of 162 million people, where cholera is endemic, has been at the forefront of the global fight against this ancient disease.

In the past 30 years, oral rehydration solution (ORS) – a mixture of salt, sugar and clean water – has saved an estimated 50 million lives worldwide, particularly those of children who are most vulnerable to diarrhoea-related dehydration.

The simple and inexpensive mixture was first formulated to treat cholera by researchers at the icddr,b in Dhaka and their colleagues at the Johns Hopkins Center for Medical Research and Training in Kolkata, India in the late 1960s.

“ORS is the mainstay in the prevention of dehydration,” Khan says. “Bangladesh has come a long way in terms of promoting ORS and raising awareness about how to treat cholera.”

ORS has helped Bangladesh to make huge strides in improving child health in recent decades. From 1988 to 1993, diarrhoea was the cause of almost one in five deaths among children under the age of five years. Between 2007 and 2011, only 2% of these deaths were related to diarrhoea, according to the Bangladesh Demographic and health survey 2011.

Today the United Nations Children’s Fund distributes around 500 million ORS sachets a year in 60 low and middle-income countries at a cost of around US$ 0.10 each.

Yet, while ORS has saved millions of lives, cholera shows no sign of waning, even in the region where it originated. Cholera still persists for very simple reasons: a lack of access to safe water, and poor sanitation and hygiene.

For Munirul Alam, senior scientist at the Infectious Diseases Division at the icddr,b, people living in conditions of overcrowding, poor hygiene and lack of access to safe water risk contracting cholera.

Around the world, as wars, humanitarian crises and natural disasters, such as flooding and droughts, uproot millions of people, destroy basic services and health-care facilities, cholera is surging.

Cholera broke out in conflict-torn Yemen almost two years ago. It has since claimed almost 2500 lives and infected about a million people in the country of 30 million. In Nigeria, three cholera outbreaks have already been declared this year in the country’s north-east, where millions have been displaced by conflict.

If ORS is so effective in preventing death, why are people still dying of cholera? “It’s the problem of access to care,” Legros says. “Cholera starts as acute diarrhoea and can quickly become extremely severe.”

“In emergency situations, where hospitals have been destroyed, are inaccessible or lack the basic resources, people with severe dehydration do not always receive intravenous rehydration treatment that they need.”

Severely dehydrated people need the rapid administration of intravenous fluids plus ORS during treatment, along with appropriate antibiotics to reduce the duration of diarrhoea and reduce the V. cholerae in their stool.

In Yemen, Dr Nahla Arishi, paediatric co-ordinator at Alsadaqah Hospital in Aden, a port city in the south of the country, is treating up to 300 cholera cases a day.

Last year the Yemeni paediatrician travelled to Dhaka’s icddr,b to participate in a week-long training on cholera and malnutrition case management and take back the skills and knowledge to her country.

Arishi, one of a team of 20 doctors and nurses from Yemen, learnt about the assessment of dehydration, food preparation, severe acute malnutrition and observed how the Cholera Hospital manages patients.

“They will be acting as good master trainers,” Khan says, adding that the icddr,b regularly deploys its experts to assist WHO and governments with the response to diarrhoeal diseases in emergencies.

While Arishi brought knowledge home with her, there are limits in applying these lessons. Battling cholera in Yemen is extremely challenging and the situation differs from that in Bangladesh.

Alsadaqah Hospital has ORS and intravenous fluids but the provision of these simple services is constantly disrupted – disruptions that can mean a matter of life and death, she says. “Electricity is on and off and is worse in summer, [it’s the] same with water [supplies].”

In emergencies such the one in Yemen, the oral cholera vaccine is playing an increasingly important role.

Currently there are three WHO pre-qualified oral cholera vaccines, two of which are used in areas experiencing outbreaks. They require two doses at least 14 days apart and can provide protection for up to five years.

In the last five years the use of these vaccines has increased exponentially, Legros says. The reason being that the vaccine is available, easy to use, well tolerated and addresses “a disease which people fear a lot.” “If you come with a vaccine, people will take it,” he says.

Rohingas in Cox Bazaar in south eastern Bangladesh receive the oral cholera vaccine in 2017.

WHO/W. Owens

In 2013, WHO established a stockpile of two million doses of oral vaccine financed by Gavi, the Vaccine Alliance, to respond to cholera outbreaks and to reduce the risk of outbreaks in humanitarian crises.

These settings include refugee camps, such as those for the Rohingyas in south-eastern Bangladesh, where two vaccination campaigns were completed between October and November 2017 and in May of this year.

The oral cholera vaccine has also been deployed in outbreaks in Haiti, Iraq and South Sudan, and recently in Malawi and Uganda.

“We’ve just started using the vaccine as a first stop for sustainable cholera control, followed up with water, sanitation and hygiene (WASH) interventions,” Legros says, referring to WASH measures that include improved water supply and sanitation, provision of safe drinking water and handwashing with soap.

But, Firdausi Qadri, a vaccine scientist and acting senior director of icddr,b’s Infectious Diseases Division, warns there aren’t enough vaccines stockpiled.

Last year an ambitious strategy to reduce cholera deaths by 90% by 2030 was launched by the Global Task Force on Cholera Control, a partnership of more than 30 health and development organizations including WHO, established in 2011.

According to Ending cholera: a global roadmap to 2030, which targets 47 countries, prevention and control can be achieved by taking a multisectoral approach and by combining the use of oral cholera vaccines with basic water, sanitation and hygiene services in addition to strengthening health-care systems and surveillance and reporting.

The roadmap also calls for a focus on cholera “hotspots,” places that are most affected by cholera – like the high risk areas in Bangladesh – that play an important role in the spread of cholera to other regions.

Bangladesh now has plans for a more systematic prevention and control of cholera, in line with the global strategy. To boost oral cholera vaccine supplies in the country, a local company is producing a vaccine, via technology transfer from India, and this could result in up to 50 million doses a year for the country, Qadri says.

But she recognizes that greater reliance on the vaccine will come at the expense of investing in water and sanitation hygiene services.

“Water, sanitation and hygiene interventions are what we need,” she says. “We have to change the whole environment and we have to educate people.”

Dr Khairul Islam, country director of WaterAid Bangladesh, agrees.

“No one would disagree that water, sanitation and hygiene interventions are ultimately the best way to prevent cholera and other water-borne gastrointestinal diseases,” he says.


WHO’s latest research: Heat-stable carbetocin is as safe and effective as oxytocin in preventing postpartum haemorrhage.

WHO

WHO study shows drug could save thousands of women’s lives

27 June 2018

News Release
Geneva
A new formulation of a drug to prevent excessive bleeding following childbirth could save thousands of women’s lives in low- and lower-middle-income countries, according to a study led by the World Health Organization (WHO) in collaboration with MSD for Mothers and Ferring Pharmaceuticals.
Currently WHO recommends oxytocin as the first-choice drug for preventing excessive bleeding after childbirth. Oxytocin, however, must be stored and transported at 2–8 degrees Celsius, which is hard to do, in many countries, depriving many women of access to this lifesaving drug. When they can obtain it, the drug may be less effective because of heat exposure.

The study, published today in the New England Journal of Medicine, has shown an alternative drug – heat-stable carbetocin – to be as safe and effective as oxytocin in preventing postpartum haemorrhage. This new formulation of carbetocin does not require refrigeration and retains its efficacy for at least 3 years stored at 30 degrees celsius and 75% relative humidity.

“This is a truly encouraging new development that can revolutionize our ability to keep mothers and babies alive,” says Dr Tedros Adhanom Ghebreyesus, Director-General of WHO.

Approximately 70 000 women die every year because of post-partum haemorrhage – increasing the risk that their babies also die within one month.

The clinical trial, the largest of its kind, studied close to 30 000 women who gave birth vaginally in 10 countries: Argentina, Egypt, India, Kenya, Nigeria, Singapore, South Africa, Thailand, Uganda and the United Kingdom.

Each woman was randomly given a single injection of either heat-stable carbetocin or oxytocin immediately following the birth of her baby. The study found that both drugs were equally effective at preventing excessive bleeding after birth.

Since both drugs in the study were kept in at the temperatures required to ensure maximum efficacy of oxytocin, the trial may underestimate the benefit expected with heat-stable carbetocin use in real-life settings where oxytocin may have degraded due to exposure to higher temperatures.

“The development of a drug to prevent postpartum haemorrhage that continues to remain effective in hot and humid conditions is very good news for the millions of women who give birth in parts of the world without access to reliable refrigeration,” says Dr Metin Gülmezoglu, from the Department of Reproductive Health and Research at WHO.

The next step is regulatory review and approval by countries.

WHO will ask its Guideline Development Group to consider whether heat-stable carbetocin should be a recommended drug for the prevention of postpartum haemorrhage.

About the study

This WHO study, also referred to as the CHAMPION (Carbetocin HAeMorrhage PreventION) trial, was funded by MSD for Mothers. Heat-stable carbetocin was provided by Ferring Pharmaceuticals, the product innovator and oxytocin was provided by Novartis for the study. The study was conducted under a collaborative arrangement between WHO, MSD for Mothers and Ferring Pharmaceuticals. Following the positive results from the trial, the parties will now work to advance affordable access to this lifesaving drug in countries that have a high burden of maternal deaths.

WHO: Ebola outbreak in Congo is stabilizing

WHO

 


WHO: List of Blueprint priority diseases (i.e. diseases and pathogens to prioritize for research and development in public health emergency contexts)

WHO

2018 annual review of the Blueprint list of priority diseases

For the purposes of the R&D Blueprint, WHO has developed a special tool for determining which diseases and pathogens to prioritize for research and development in public health emergency contexts. This tool seeks to identify those diseases that pose a public health risk because of their epidemic potential and for which there are no, or insufficient, countermeasures. The diseases identified through this process are the focus of the work of R& D Blueprint. This is not an exhaustive list, nor does it indicate the most likely causes of the next epidemic.

The first list of prioritized diseases was released in December 2015.

Using a published prioritization methodology, the list was first reviewed in January 2017.

February 2018 – Second annual review

The second annual review occurred 6-7 February, 2018. Experts consider that given their potential to cause a public health emergency and the absence of efficacious drugs and/or vaccines, there is an urgent need for accelerated research and development for*:

  • Crimean-Congo haemorrhagic fever (CCHF)
  • Ebola virus disease and Marburg virus disease
  • Lassa fever
  • Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS)
  • Nipah and henipaviral diseases
  • Rift Valley fever (RVF)
  • Zika
  • Disease X

Disease X represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease, and so the R&D Blueprint explicitly seeks to enable cross-cutting R&D preparedness that is also relevant for an unknown “Disease X” as far as possible.

A number of additional diseases were discussed and considered for inclusion in the priority list, including: Arenaviral hemorrhagic fevers other than Lassa Fever; Chikungunya; highly pathogenic coronaviral diseases other than MERS and SARS; emergent non-polio enteroviruses (including EV71, D68); and Severe Fever with Thrombocytopenia Syndrome (SFTS).

These diseases pose major public health risks and further research and development is needed, including surveillance and diagnostics. They should be watched carefully and considered again at the next annual review. Efforts in the interim to understand and mitigate them are encouraged.

Although not included on the list of diseases to be considered at the meeting, monkeypox and leptospirosis were discussed and experts stressed the risks they pose to public health. There was agreement on the need for: rapid evaluation of available potential countermeasures; the establishment of more comprehensive surveillance and diagnostics; and accelerated research and development and public health action.

Several diseases were determined to be outside of the current scope of the Blueprint: dengue, yellow fever, HIV/AIDs, tuberculosis, malaria, influenza causing severe human disease, smallpox, cholera, leishmaniasis, West Nile Virus and plague. These diseases continue to pose major public health problems and further research and development is needed through existing major disease control initiatives, extensive R&D pipelines, existing funding streams, or established regulatory pathways for improved interventions. In particular, experts recognized the need for improved diagnostics and vaccines for pneumonic plague and additional support for more effective therapeutics against leishmaniasis.

The experts also noted that:

  • For many of the diseases discussed, as well as many other diseases with the potential to cause a public health emergency, there is a need for better diagnostics.
  • Existing drugs and vaccines need further improvement for several of the diseases considered but not included in the priority list.
  • Any type of pathogen could be prioritised under the Blueprint, not only viruses.
  • Necessary research includes basic/fundamental and characterization research as well as epidemiological, entomological or multidisciplinary studies, or further elucidation of transmission routes, as well as social science research.
  • There is a need to assess the value, where possible, of developing countermeasures for multiple diseases or for families of pathogens.

The impact of environmental issues on diseases with the potential to cause public health emergencies was discussed. This may need to be considered as part of future reviews.

The importance of the diseases discussed was considered for special populations, such as refugees, internally displaced populations, and victims of disasters.

The value of a One Health approach was stressed, including a parallel prioritization processes for animal health. Such an effort would support research and development to prevent and control animal diseases minimising spill-over and enhancing food security. The possible utility of animal vaccines for preventing public health emergencies was also noted.

Also there are concerted efforts to address anti-microbial resistance through specific international initiatives. The possibility was not excluded that, in the future, a resistant pathogen might emerge and appropriately be prioritized.

 

*The order of diseases on this list does not denote any ranking of priority.

 


Statement on the 1st meeting of the IHR Emergency Committee regarding the Ebola outbreak in 2018

WHO

18 May 2018

Statement

The 1st meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (IHR) (2005) regarding the Ebola Virus Disease (EVD) outbreak in the Democratic Republic of the Congo took place on Friday 18 May 2018, from 11:00 to 14:00 Geneva time (CET).

Emergency Committee conclusion

It was the view of the Committee that the conditions for a Public Health Emergency of International Concern (PHEIC) have not currently been met.

Meeting

Members and advisors of the Emergency Committee met by teleconference. Presentations were made by representatives of the Democratic Republic of the Congo on recent developments, including measures taken to implement rapid control strategies, and existing gaps and challenges in the outbreak response. During the informational session, the WHO Secretariat provided an update on and assessment of the Ebola outbreak.

The Committee’s role was to provide to the Director-General their views and perspectives on:

  • Whether the event constitutes a Public Health Emergency of International Concern (PHEIC)
  • If the event constitutes a PHEIC, what Temporary Recommendations should be made

Current situation

On 8 May, WHO was notified by the Ministry of Health of the Democratic Republic of the Congo of two lab-confirmed cases of Ebola Virus Disease occurring in Bikoro health zone, Equateur province. Cases have now also been found in nearby Iboko and Mbandaka. From 4 April to 17 May 2018, 45 EVD cases have been reported, including in three health care workers, and 25 deaths have been reported. Of these 45 cases, 14 have been confirmed. Most of these cases have been in the remote Bikoro health zone, although one confirmed case is in Mbandaka, a city of 1.2 million, which has implications for its spread.

Nine neighbouring countries, including Congo-Brazzaville and Central African Republic, have been advised that they are at high risk of spread and have been supported with equipment and personnel.

Key Challenges

After discussion and deliberation on the information provided, the Committee concluded these key challenges:

  • The Ebola outbreak in the Democratic Republic of the Congo has several characteristics that are of particular concern: the risk of more rapid spread given that Ebola has now spread to an urban area; that there are several outbreaks in remote and hard to reach areas; that health care staff have been infected, which may be a risk for further amplification.
  • The risk of international spread is particularly high since the city of Mbandaka is in proximity to the Congo river, which has significant regional traffic across porous borders.
  • There are huge logistical challenges given the poor infrastructure and remote location of most cases currently reported; these factors affect surveillance, case detection and confirmation, contact tracing, and access to vaccines and therapeutics.

However, the Committee also noted the following:

  • The response by the government of the Democratic Republic of the Congo, WHO and partners has been rapid and comprehensive.
  • Interventions underway provide strong reason to believe that the outbreak can be brought under control, including: enhanced surveillance, establishment of case management facilities, deployment of mobile laboratories, expanded engagement of community leaders, establishment of an airbridge, and other planned interventions.
  • In addition, the advanced preparations for use of the investigational vaccine provide further cause for optimism for control

In conclusion, the Emergency Committee, while noting that the conditions for a PHEIC are not currently met, issued Public Health Advice as follows:

  • Government of the Democratic Republic of the Congo, WHO, and partners remain engaged in a vigorous response – without this, the situation is likely to deteriorate significantly. This response should be supported by the entire international community.
  • Global solidarity among the scientific community is critical and international data should be shared freely and regularly.
  • It is particularly important there should be no international travel or trade restrictions.
  • Neighbouring countries should strengthen preparedness and surveillance.
  • During the response, safety and security of staff should be ensured, and protection of responders and national and international staff should prioritised.
  • Exit screening, including at airports and ports on the Congo river, is considered to be of great importance; however entry screening, particularly in distant airports, is not considered to be of any public health or cost-benefit value.
  • Robust risk communication (with real-time data), social mobilisation, and community engagement are needed for a well-coordinated response and so that those affected understand what protection measures are being recommended;
  • If the outbreak expands significantly, or if there is international spread,  the Emergency Committee will be reconvened.

The Committee emphasized the importance of continued support by WHO and other national and international partners towards the effective implementation and monitoring of this advice.

Based on this advice, the reports made by the affected States Parties, and the currently available information, the Director-General accepted the Committee’s assessment and on 18 May 2018 did not declare the Ebola outbreak in the Democratic Republic of the Congo a Public Health Emergency of International Concern (PHEIC). In light of the advice of the Emergency Committee, WHO advises against the application of any travel or trade restrictions. The Director-General thanked the Committee Members and Advisors for their advice.

 


Ebola, the Democratic Republic of the Congo (DRC), and The WHO

WHO

The World Health Organization (WHO) and a broad range of partners are in the Democratic Republic of the Congo (DRC) working with the Government to contain an outbreak of Ebola virus disease (EVD) in Bikoro health zone, Equateur Province. The outbreak was declared three days ago.  WHO Director-General Dr Tedros Adhanom Ghebreyesus will travel to the DRC over the week-end to take stock of the situation and direct the continuing response in support of the national health authorities.

As of 11 May, 34 Ebola cases have been reported in the area in the past five weeks, including 2 confirmed, 18 probable (deceased) and 14 suspected cases. Five samples were collected from 5 patients and two have been confirmed by the laboratory. Bikoro health zone is 250 km from Mbandaka, capital of Equateur Province in an area of the country that is very hard to reach.

“WHO staff were in the team that first identified the outbreak. I myself am on my way to the DRC to assess the needs first-hand,” said Dr Tedros. “I’m in contact with the Minister of Health and have assured him that we’re ready to do all that’s needed to stop the spread of Ebola quickly. We are working with our partners to send more staff, equipment and supplies to the area.”

A multidisciplinary team including WHO experts, along with staff from the Provincial Division of Health and Médecins Sans Frontières (MSF), arrived in Bikoro on 10 May. This first group of responders is now gathering more data to understand the extent and drivers of the epidemic. The team will also set up an active case search and contact tracing, establish Ebola treatment units to care for patients, set up mobile labs, and engage the community on safe practices. WHO will also work with national authorities in planning further public health measures such as vaccination campaigns.

“WHO is supporting the Government of the Democratic Republic of the Congo in coordinating this response; this is the country’s ninth Ebola outbreak and there is considerable expertise in-country,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “However, any country facing such a threat may require international assistance. WHO and its partners including MSF, World Food Programme (WFP), UNICEF, International Federation of Red Cross and Red Crescent Societies (IFRC) and the Congolese Red Cross, UNOCHA and MONUSCO , US Centers for Disease Control and Prevention (US-CDC), the International Organization for Migration (IOM), are all stepping up their support.”

The response plan to the outbreak includes surveillance, case investigation, and contact tracing; community engagement and social mobilization; case management and infection prevention and control; safe and dignified burials; research response including the use of ring vaccination and antivirals; and coordination and operations support.

“It is too early to judge the extent of this outbreak,” said Dr Peter Salama, WHO Deputy Director-General for Emergency Preparedness and Response. “However, early signs including the infection of 3 health workers, the geographical extent of the outbreak, the proximity to transport routes and population centres, and the number of suspected cases indicate that stopping this outbreak will be a serious challenge. This will be tough and it will be costly. We need to be prepared for all scenarios.”

In its latest Disease Outbreak News, WHO lists the risks to surrounding countries as moderate. WHO has however, already alerted those countries and is working with them on border surveillance and preparedness for potential outbreaks. WHO does not at this time advise any restrictions on travel and trade to the Democratic Republic of the Congo.

ENDS

Note to editors:

Current operations:

The first multidisciplinary team comprised of experts from WHO, Médecins Sans Frontières and the Provincial Division of Health arrived in Bikoro on 9 May to strengthen coordination and investigations. More deployments of epidemiologists, logisticians, clinicians, infection prevention and control experts, risk communications experts and vaccination support teams should arrive in Bikoro on Saturday.

WHO is working with Government and key partners – including Médecins Sans Frontières, World Food Programme, the International Federation of the Red Cross, UNICEF and US-CDC – to strengthen coordination of the EVD response at the national level and in the affected Bikoro health zone and is calling on its development partners to ensure a strong, comprehensive and rapid response to support the DRC Government to prevent and control the spreading of the disease.

Two mobile labs are planned to be deployed on 12 May.

Current bed capacity includes 15 beds in Bikoro. MSF is currently establishing isolation on site and has also deployed four mobile isolation units (5 beds each).

WHO is coordinating a major flight plan with UNHAS/WFP to deploy experts, equipment and materials to the field and is working closely with other health partners to prevent further geographical spread, improve surveillance data and reduce deaths by improving treatment of Ebola patients in Bikoro and the epicentre of Ikoko-Impenge.  The cost of the air bridge for 3 months is estimated at US$ 2.4 million.

A logistician is expected to arrive in Bikoro this afternoon/evening to arrange accommodation/staff logistics. Additional information on access, transportation, and logistics requirements will be communicated tomorrow.

WHO is in the process of sending (Saturday) medical supplies to Bikoro to support the Ebola response, including:

  • Personal Protective Equipment kits (PPE)
  • Interagency Emergency Health Kit (IEHK)
  • boxes for transportation
  • body bags

WHO is helping with surveillance of cases by setting up community-based data collection to complement information provided by health facilities.

WHO has alerted neighbouring countries and is supporting the Central African Republic and Republic of Congo to strengthen surveillance in case of cross-border spread of the outbreak.

Funding requirements

WHO released US$ 1 million from its Contingency Fund for Emergencies to kick start the rapid response. Based on current assessment and response needs the estimated budget for the international response is US$ 18 million for a 3-month operation. Wellcome Trust and UK Department for International Development (DFID) announced a commitment of up to £3 million to support a rapid response to the outbreak.


New anti-malarial netting: A long-lasting insecticidal net that incorporates a synergist piperonyl butoxide (PBO) and a long-lasting indoor residual spraying formulation of the insecticide pirimiphos-methyl.

NY Times

The Lancet

“……The PBO long-lasting insecticidal net and non-pyrethroid indoor residual spraying interventions showed improved control of malaria transmission compared with standard long-lasting insecticidal nets where pyrethroid resistance is prevalent……”

Health workers demonstrating the use of a LLIN in Kisumu, Kenya

“….The new nets contain pyrethroids, a class of chemicals used in nets for over a decade, along with the newer compound, piperonyl butoxide, which blocks mosquitoes’ ability to break down pyrethroids.….”

Net with Anopheles mosquito

 


Two million people in five African countries to be vaccinated against cholera

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.

 


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