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Friday, August 29, 2014

Ebola cases in DR Congo

As per our discussion group in International Society of Travel medicine, here are the latest figures for the Ebola cases in DRC

Original Message:
Sent: 28-08-2014 16:31
From: Barry Wecker
Subject: Ebola in the DRCongo

I just received word from the Ministry of Health of the Democratic Republic of Congo that the Ebola situation in the DRC is as follows:
Equateur -- 68 cases of haemorrhagic fever, 8 confirmed Ebola serologies, 55 patients quarantined and 13 deaths.
Lubumbashi -- 113 cases of haemorrhagic fever, 3 confirmed serologies, 104 patients being quarantined and 9 deaths
North Kivu -- 16 cases of haemorrhagic fever, no confirmed serologies, 15 patients quarantined and 1 death.

All immigration and customs officers at points of entry are required to glove and mask and all persons arriving in the DRC regardless of country of origin must submit to a temperature evaluation and will be refused entry if they have a fever. 

Barry Wecker, MD MPH DTM&H

Here is a related article 

International aid organizations, already stretched to the limit by the biggest Ebola outbreak on record, are facing a second, probably unrelated cluster of cases in the Democratic Republic of the Congo (DRC). DRC’s Ministry of Health yesterday notified the World Health Organization (WHO) of the outbreak in the north of the country. It said 13 of the 24 people suspected to have contracted Ebola have died.
“At this time, it is believed that the outbreak in DRC is unrelated to the ongoing outbreak in West Africa,” says a WHO statement issued today. None of the patients had traveled to the regions in West Africa where Ebola is now spreading or had contact with persons from those regions. Early results from a lab in DRC also indicate that the disease was not caused by Ebola-Zaire, the virus species causing the outbreak in West Africa. Since December, Ebola-Zaire has sickened at least 2615 people in Liberia, Sierra Leone, Guinea, and Nigeria and killed 1427 them. It is the biggest Ebola outbreak on record.
While that outbreak is the first in that region, the new outbreak in DRC comes in a region more used to dealing with the virus. “This is the country that has the most experience of dealing with the virus and that gives me some hope,” says Stephan Günther, a virologist at the Bernhard Nocht Institute for Tropical Medicine in Hamburg, Germany, who is currently working in a mobile lab in Nigeria. DRC (formerly Zaire) has seen seven outbreaks including the first one on record in 1976.
“It is important to understand that this outbreak has come to the attention of the government quite early and is being dealt with by a group of people who know how to control an Ebola outbreak,” says David Heymann, an epidemiologist at the London School of Hygiene & Tropical Medicine. At the same time, Heymann adds, “It’s impossible to know at this point what the country will request and what they can do on their own.”
According to WHO, the index case of the new outbreak was a pregnant woman in the Ikanamongo Village in northern DRC. She was probably infected when she butchered a bush animal given to her by her husband. Jonathan Epstein, a veterinary epidemiologist at EcoHealth Alliance in New York City, calls it “almost a classic case.” It is known that chimpanzees, bats, and other animals can carry the deadly Ebola virus, and the pathogen often spills over into the human population when people eat infected animals. The new outbreak shows “that we also need to pay attention to the broader situation,” Epstein says. “There is a need for more outreach and education.” Reducing risky behavior like eating bushmeat is an important public health goal, Heymann agrees. “It’s a sign that we need to really look seriously at how to prevent these outbreaks from occurring,” he says.
The infected woman was treated in a private clinic in Isaka Village and died on 11 August. A doctor and two nurses who treated the woman, as well as the hygienist and a ward attendant, infected themselves at the hospital and all later died. “Other deaths have been recorded among the relatives who attended the index case, individuals who were in contact with the clinic staff, and those who handled the bodies of the deceased during funerals,” the WHO statement notes. Some 80 people who have had contact with the patients are being monitored, and more contacts are being traced.
Samples from the current outbreak in DRC are being tested at a WHO collaborating center in Gabon and the results are expected later today, according to a WHO representative. Apart fromZaire ebolavirus, there are four other species of Ebolavirus: Sudan, Reston, Bundibugyo, and Taï Forest.
Of those four, Sudan is by far the most common. Reston virus infection has been documented in humans without causing illness, and the only case of Taï Forest virus infection in a human is a scientist who had conducted an autopsy on an infected chimpanzee. Sudan ebolavirus, on the other hand, has caused several outbreaks and sickened close to 800 people since it was discovered after an outbreak in Sudan in 1976.  About half the patients died.
The only other Ebola virus that has caused large outbreaks is Bundibugyo ebolavirus. It was first discovered in an outbreak in Uganda that started in December 2007 and killed 37 people. Two years ago, it caused an outbreak in DRC.
Posted in AfricaHealth Ebola

Saturday, August 23, 2014

Chikungunya Fever Outbreak Possible, Scientists Warn

Chikungunya outreak
A map showing probable places that Chikugunya can spread in the US
Scientists warn that aside from the Corona virus and Ebola virus outbreaks, there's one more virus that people should worry about: Chikungunya fever.
Chikungunya is an infection that causes long period of joint paints lasting years. It starts with an acute fever that can last for two to five days which is followed by joint pains.
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Research shows the disease is transmitted to humans by the Aedes mosquito, the mosquito responsible for dengue fever.
It also said the Chikungunya virus that once spread to the U.S. from the Caribbean came from an Aedes Aegypti mosquito endemic to subtropical and tropical areas in Southeast Asia.
Researchers now believe Chikungunya could mutate, creating an Aedes Albopictis vector that was once responsible for Yellow Fever.
They said a worldwide spread of the Chikungunya virus is higher than the risk of widespread dissemination of the Corona and Ebola virus.
They predict that the number of Chikungunya victims in the Americas and Europe might increase immeasurably.
Remi Charel, one of the researchers who studied the Chikugunya virus, said this isn't a question if it will happen because it will happen.
Researchers believe there is a need for funding surveillance systems and developing countermeasures against the virus.
Previous chikugunya patients like Pete Pedersen said he didn't expect that he'd contract the virus in Haiti. He said he couldn't move even his finger from four to five days because of the disease.
Pederson compared having the virus to having a broken back where you feel like dying.
He said his pain was equivalent to a nine on what he called the "Richter Scale of Pain," It was that painful.

Friday, August 22, 2014

Doctors given experimental drug for Ebola infection - recovering

Three doctors in Liberia with Ebola who started taking an experimental drug last Thursday are showing remarkable signs of improvement, a minister says.
ZMapp was first given earlier this month to two US aid workers, who were flown home for treatment from Liberia.
Ebola has no cure but the World Health Organization (WHO) has ruled that untested drugs can be used in light of the scale of outbreak in West Africa.
Since the beginning of the year, 1,229 people have died of the virus.
It is transmitted by direct contact with the body fluids of an infected person. Initial flu-like symptoms can lead to external haemorrhaging from areas such as eyes and gums, and internal bleeding which can cause organ failure.
The outbreak began in Guinea and has since spread to Liberia, Sierra Leone and Nigeria.
Health officials in Guinea say the country has suffered a setback in its fight against the epidemic, seeing a resurgence of cases in the town of Macenta.
The BBC’s Alhassan Sillah in Guinea says the town had not had any cases for two months, and the authorities had dismantled all Ebola facilities in that area.
Public awareness campaigns are being stepped up across the region as some people believe Ebola is a hoax
Public awareness campaigns are being stepped up across the region as some people believe Ebola is a hoax
The health authorities believe that Guineans returning from neighbouring Liberia are carrying the virus.
In Liberia, Information Minister Lewis Brown said the government only received a small number of ZMapp doses and gave them to one Nigerian and two Liberian doctors who had caught Ebola whilst helping save the lives of other victims of the virus.
Two US missionaries who received doses of the medicine are also reportedly recovering, but a 75-year-old Spanish priest who contracted Ebola in Liberia died in Spain last week despite being given the drug.
The US pharmaceutical company that makes the drug says it has for now run out of it, so the only way to stop the current outbreak is to isolate the victims and those who have come into contact with them.
Mr Brown also said 17 suspected Ebola patients who went missing after a health centre in the capital was attacked have been found.
In Nigeria, which has had four fatal Ebola cases, health officials say five people have now recovered from the virus and have been discharged from hospital in Lagos. Another three are still being treated.
Since the outbreak spread to Nigeria in July, when a person infected with Ebola flew from Liberia to Lagos, several airlines have stopped flights to the worst-affected countries.
Kenya’s ban on people from Guinea, Liberia and Sierra Leone entering the East African nation comes into force on Wednesday – and Cameroon has closed its land, sea and air borders with Nigeria.

Wednesday, August 20, 2014

Rabid dog bites more than 25 people in Goa

A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Mon 18 Aug 2014
Source: NDTV, Press Trust of India report [edited]

At least 25 people were bitten by a rabies-infected dog at South Goa's Cansaulim village, 30 km [18.6 mi] from [Panaji] following which they were hospitalised, sources said today [18 Aug 2014]. The incident occurred last evening [17 Aug 2014] when the stray dog went on a rampage, biting passers-by. The canine was later killed by villagers.

Sources in Goa Medical College (GMC) said that 15 people were administered anti-rabies injection in their hospital while rest were treated at cottage hospital Chicalim and Hospicio hospital at Margao.

Communicated by:
ProMED-mail from HealthMap Alerts

[For a map of India, go to http://www.mapsofindia.com/images2/india-map.jpg. Goa is the small state in the middle of the west coast of India. Cansaulim can be located on the map at http://healthmap.org/promed/p/954. Panaji is at http://www.fallingrain.com/world/IN/33/Panaji.html; Chicalim athttp://www.fallingrain.com/world/IN/33/Chicalim.html; Margao at http://www.fallingrain.com/world/IN/33/Madgaon.html.

There has not been time for the results from any canine brain pathology, so we can presume that there was a logical presumption of canine rabies. - Mod.MHJ]

Tuesday, August 19, 2014

Ebola virus fear comes to India: Kolkata sex workers asked to stay away from African customers

KOLKATA: As the spreading of Ebola virus grows the sex workers of Sonagachi are cautioned regarding choosing of customers. In an advice sent to the sex workers in the largest red-light area in Kolkata, it has been said that the sex workers need to be careful while choosing about choosing their customers from Africa, who are regular visitors to the place. 

Durbar Mahila Samannay Committee — the NGO that works with nearly 13,000 sex workers of the area are closely monitoring the situation and are training the girls so that they can understand the symptoms, problems and threat of this disease. "We have requested the sex workers not to entertain people from African nations as it can be a life risk for them if they get infected by the highly contagious Ebola virus which is causing havoc in some West African countries," a member of DMSC said. 

Ebola virus (EBOV, formerly designated Zaire ebolavirus) is the sole member of the Zaire ebolavirus species, and the most dangerous of the five known viruses within the genus Ebolavirus. Four of the five known ebolaviruses cause a severe and often fatal hemorrhagic fever in humans and other primates, known as Ebola virus disease. "Though the disease yet to reach Kolkata but this is an easy way through which the disease be spread and so we are taking all steps to check all measures so that it can be checked before it arrives," the member said. Samarjit Jana of DMSC is presently engaged in training and providing lessons to sex workers to identify the signs of the Ebola disease. 
According to WHO guidelines, transmission of the virus requires close contact with body fluids such as sweat, saliva and the cough of an infected person, and also body contact. "So we are training the sex workers on how to identify the symptoms," the member said.

All you wanted to know about Ebola - by CDC

Thanks for asking. The Ebola team is reworking that page and we hope to have it and some smaller modules from that page ready by early next week. 

In the meantime these seven pages have been added to the collection. 






http://www.cdc.gov/vhf/ebola/treatment/index.html ‬


We will update you all next week as we have more info. Keep the requests coming!

Wednesday, August 13, 2014

Govt of India high commission in Abuja, Nigeria advisory on ebola virus


Advisory regarding Ebola virus disease, August 8th, 2014

The Liberian born US national Patrick Sawyer who died in Lagos on July 25, 2014 was the first Ebola casualty in Nigeria and also outside Guinea, Sierra Leone and Liberia in this year’s outbreak, in which 1700 people have been infected and over 900 have died since March. The World Health Organization, after a two day emergency meeting in Geneva, Switzerland, has declared the spread of Ebola in West Africa an International Health Emergency

2.           In Nigeria, there have been 7 confirmed cases of Ebola as on date including late Sawyer. 6 others are Nigerian doctors, nurses and airport staff. One nurse died three days ago. There are 70 primary and secondary contacts including 48 passengers who landed in Lagos and airport & immigration personnel and hospital staff who attended on late Sawyer are under surveillance.  

3.            At a briefing given to the diplomatic corps in Abuja b y the Nigerian Minister for Health Prof. Onyebuchi Chukwu, (i) Nigeria has declared Ebola outbreak a national emergency and is taking steps to contain its spread, (ii) All State governments are to take proactive measures including training of medical personnel to mitigate possible complications, (iii) A centre has been set up in Lagos comprising a six-member inter-agency team drawn from the National Primary Health Care Development Agency, the US CDC (Centre for Disease Control),  WHO, UNICEF and the Bill & Melinda Gates Foundation to work on Ebola in Nigeria, (iii)  Authorities emphasize personal hygiene at homes and outside as an important precautionary measure. (iv) Isolation wards have been provided in hospitals in all States and Federal Capital Territory. (v) Government has not yet decided to close its borders with neighboring countries but considers the situation in Nigeria as ‘not yet critical’, but one of alert.   (vi) Ministry of Health has launched a website – www.ebolaalert.org and a 24&7 toll free number - 0800EBOLAHELP to provide information on Ebola. (vii) Authorities have conveyed that if advance information can be provided to them of incoming delegations, special care will be taken of such delegations. -

4.           The Mission would advise all Indian residents in Nigeria and those planning to undertake unavoidable travel to Nigeria to adhere to the dos and don’ts circulated by Ministry of Health and Family Welfare, government of India (Annexure). As the disease is not airborne and is transmitted only through contact with body fluids of the affected, personal hygiene is a critical preventive measure. For any assistance, following officials of the High Commission of India in Nigeria may be contacted:

Shri Sharad Srivastava, First Secretary (Consular)
Email: cons1.abuja@mea.gov.in, Tel: 00234-9021396919

Shri V.D.Choudhry, Second Secretary
Email: hoc.lagos@mea.gov.in , Tel: 00234-8128308752

Monday, August 11, 2014

Vaccinations for a splenectomized person traveling to Africa?

Here are a few things that we need to remember while immunizing people who have had a splenectomy
 Approximately 4% of patients undergoing splenectomy develop OPSI and in 1.7% of these patients death will follow.  Therefore, the administration of appropriate vaccinations, in conjunction with other therapeutic interventions, is critical to improve survival postsplenectomy.
The Centers for Disease Control and Prevention (CDC) have developed vaccination recommendations for asplenic patients.  For those patients undergoing an elective splenectomy, the CDC recommends vaccination with both the pneumococcal and meningococcal vaccines.  These vaccines should be administered at least 2 weeks prior to the scheduled surgery.  The pneumococcal vaccine should be readmininstered once after ≥ 5 years have elapsed since the initial vaccination.  Although the CDC does not recommend the routine administration of theHaemophilus influenza B vaccine prior to splenectomy, many providers will administer this vaccine as well.  An annual influenza vaccine is also recommended for asplenic patients.  In the event of an emergent splenectomy, it is recommended to administer the needed vaccinations after 2 weeks following the surgery.
The CDC recommends that asplenic travelers contact an international health clinic or the CDC (www.cdc.gov) to obtain information on disease risks within the intended country of travel. Asplenic travelers should be advised of the increased risk for Meningococcal meningitis and recommendation of the A and C vaccine for all asplenic individuals traveling to sub-Saharan Africa, India, and Nepal. 
Asplenic patients are susceptible to overwhelming sepsis with encapsulated bacterial pathogens. Although response to vaccines may be less than in people with a functioning spleen, many clinical guidelines recommend immunization against meningococcal, pneumococcal, and Haemophilus influenzae disease in these patients, regardless of travel plans.
  • Limited data show that vaccine response in people who have had a splenectomy was more impaired if splenectomy was performed because of hematologic malignancy rather than for splenic trauma.
  • The meningococcal A/C/Y/W-135 conjugate vaccine is indicated for both pediatric and adult populations at risk.
  • The polysaccharide-protein conjugate vaccine against disease due to H. influenzae type b (Hib conjugate vaccine) appears to elicit an increased immune response and duration of protection in vaccine recipients, and many experienced clinicians recommend a single dose for splenectomized patients.
  • Streptococcus pneumoniae vaccine is recommended for asplenic patients (Table 8-01).

ACIP Recommendations for PCV13 and PPSV23 Use
Adults with specified immunocompromising conditions who are eligible for pneumococcal vaccine should be vaccinated with PCV13 during their next pneumococcal vaccination opportunity.
Pneumococcal vaccine-naïve persons. ACIP recommends that adults aged ≥19 years with immunocompromising conditions, functional or anatomic asplenia, CSF leaks, or cochlear implants, and who have not previously received PCV13 or PPSV23, should receive a dose of PCV13 first, followed by a dose of PPSV23 at least 8 weeks later (Table). Subsequent doses of PPSV23 should follow current PPSV23 recommendations for adults at high risk. Specifically, a second PPSV23 dose is recommended 5 years after the first PPSV23 dose for persons aged 19–64 years with functional or anatomic asplenia and for persons with immunocompromising conditions. Additionally, those who received PPSV23 before age 65 years for any indication should receive another dose of the vaccine at age 65 years, or later if at least 5 years have elapsed since their previous PPSV23 dose.
Previous vaccination with PPSV23. Adults aged ≥19 years with immunocompromising conditions, functional or anatomic asplenia, CSF leaks, or cochlear implants, who previously have received ≥1 doses of PPSV23 should be given a PCV13 dose ≥1 year after the last PPSV23 dose was received. For those who require additional doses of PPSV23, the first such dose should be given no sooner than 8 weeks after PCV13 and at least 5 years after the most recent dose of PPSV23.
Here are the references for the same
The references below are NOT updated and do not reflect current recommended practices

Table 8-01. Immunization of immunocompromised adults

AIDS) CD4 CELLS <200 br="" style="margin: 0px; padding: 0px;">mm3
Live Vaccines
Bacillus Calmette
Guérin (BCG)
Influenza, live attenuated (LAIV)XXXUXX
Measles-mumps-rubella (MMR)R1X1X1UUU
Typhoid, Ty21aXXXUUU
Varicella (adults)2UXXUUU
Yellow Fever3P3X3XUWW
Inactivated Vaccines
type b (Hib)
Hepatitis A6UUUUUU
Hepatitis B6U7U7U7U7R8U7
PCV13 followed by PPSV2311RRRRRC
Td or TdapRRRRRR
Typhoid, ViUUUUUU
Abbreviations: X, Contraindicated (per the Advisory Committee on Immunization Practices [ACIP]); U, Use as indicated for normal hosts; R, Recommended for all in this patient category; P, Precaution (per ACIP); W, Warning—medical conditions for which no data regarding YF vaccine exist but for which varying degrees of immune deficit might be present and could increase the risk of serious adverse events following vaccination; providers should carefully weigh vaccine risks and benefits before deciding to vaccinate such patients; C, Consider; PCV13, 13-valent pneumococcal conjugate vaccine; PPSV23, 23-valent pneumococcal polysaccharide vaccine.
1MMR vaccination should be considered for all symptomatic HIV-infected patients with CD4 counts ≥200/mm3 without evidence of measles immunity. Immune globulin may be administered for short-term protection of those facing high risk of measles and for whom MMR vaccine is contraindicated.
2Varicella vaccine should not be administered to people who have cellular immunodeficiencies, but people with impaired humoral immunity (including congenital or acquired hypoglobulinemia or dysglobulinemia) may be vaccinated. Immunocompromised hosts should receive 2 doses of vaccine spaced at 3-month intervals.
3See details in Chapter 3, Yellow Fever. YF vaccination is a precaution for asymptomatic HIV-infected people with CD4 cell counts of 200–499/mm3. YF vaccination is not a precaution for people with asymptomatic HIV infection and CD4 cell counts ≥500. YF vaccine is also considered contraindicated by ACIP for symptomatic HIV patients without AIDS and with CD4 counts ≥200/mm3.
4Also contraindicated by ACIP for symptomatic HIV patients without AIDS and with CD4 counts ≥200/mm3.
5Decision should be based on consideration of the individual patient’s risk of Hib disease and the effectiveness of the vaccine for that person. In some settings, the incidence of Hib disease may be higher among HIV-infected adults than among HIV-uninfected adults, and the disease can be severe in these patients.
6Routinely indicated for all men who have sex with men, people with multiple sexual partners, hemophiliacs, patients with chronic hepatitis, and injection drug users.
7Test for antibodies to hepatitis B virus surface antigen serum titer after vaccination, and revaccinate if initial antibody response is absent or suboptimal (<10 500="" a="" cd4="" cell="" counts="" course="" hiv-infected="" if="" may="" miu="" ml="" mm="" nonresponders="" react="" rise="" span="" style="bottom: 0.33em; margin: 0px; padding: 0px 3px 0px 0px; position: relative; vertical-align: baseline;" subsequent="" to="" vaccine="">3
 after institution of highly active antiretroviral therapy. See text for discussion of other immunocompromised groups.
8Use special double-dose vaccine formulation. Test for antibodies to hepatitis B virus surface antigen after vaccination and revaccinate if initial antibody response is absent or suboptimal (<10 br="" miu="" ml="" nbsp="" style="margin: 0px; padding: 0px;">9As with most inactivated vaccines, no safety or efficacy data exist regarding the use of Ixiaro in immunocompromised people. Immunocompromised people may have a diminished immune response to Ixiaro.
10Two doses ≥2 months apart for asplenic and HIV-infected patients.
11Previously unimmunized asplenic, HIV-infected, or immunocompromised adults aged ≥19 years should receive 1 dose of 13-valent pneumococcal conjugate vaccine (PCV13) followed by 1 dose of pneumococcal polysaccharide vaccine (PPSV23) ≥8 weeks later. People with these conditions previously immunized with PPSV23 should follow catch-up guidelines per ACIP.