Ebola Spread Concentrated in Congo, Not a Wider Emergency - WHO, April 2019

GENEVA/LONDON (Reuters) - An outbreak of Ebola in the Democratic Republic of Congo (DRC) that has killed more than 700 people and is continuing to spread does not constitute an international emergency, the World Health Organization said on Friday.

Declaring the epidemic a "public health emergency of international concern" would have signalled that greater resources and international coordination are needed.

The WHO's independent Emergency Committee, which analysed the latest data, said the disease was entrenched in several epicentres in the northeast and was being transmitted in health care settings.

It had not spread across borders to Uganda, Rwanda or South Sudan, but neighbouring countries should shore up their preparedness, the experts said.

"It was an almost unanimous vote that this would not constitute a PHEIC (public health emergency of international concern) because we are moderately optimistic that this outbreak can be brought into control - not immediately, but still within a foreseeable time," panel chairman Professor Robert Steffen told a news conference.

Dozens of new cases reported this week have been mainly in the epicentres of Butembe, Katwe and Vuhovi, said Mike Ryan, head of the WHO's health emergencies programme.

"It's quite a focused amplification of disease in a very specific geographic area," Ryan said.

"But the disease there has risen because of lack of access to that community, we've fallen behind in starting vaccination rings," he said, referring to attacks on health centres by armed groups in February that cut-off hotspot areas.

"Vaccine is proving to be a highly effective way of stopping this virus but if we can't vaccinate people we cannot protect them," he added, noting that nearly 100,000 people have been vaccinated.

Experts have declared four emergencies in the past decade: the H1N1 virus that caused an influenza pandemic (2009), a major Ebola outbreak in West Africa (2014), polio (2014) and Zika virus (2016).

Some experts expressed concern that the Emergency Committee was too narrowly interpreting WHO guidelines.

"This is a deeply concerning event, due to the pathogen itself, the total number of cases, the increase in cases just this week, and the difficulty of coordinating the response due to conflict - that needs to receive the appropriate level of attention," health experts Rebecca Katz and Alexandra Phelan of Georgetown University in Washington D.C. said in a statement.

The Ebola outbreak - by far the biggest Congo has seen, and the world's second largest in history - was declared by national authorities in August. It is concentrated in Congo's North Kivu and Ituri provinces.

It has already infected at least 1,206 people, of whom 764 have died - giving a death rate of 63 percent.

They include 20 new cases reported by the health ministry on Thursday, another one-day record after 18 on Wednesday. Two workers at the Butembo airport tested positive, it said.

Reuters Health Information © 2019 

Cite this: Ebola Spread Concentrated in Congo, Not a Wider Emergency - WHO - Medscape - Apr 12, 2019.

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Singapore tightens entry regulations to prevent yellow fever, June 2018

Singapore (VNA) – The Singaporean Ministry of Health is considering adjustments to the Infectious Disease Act’s articles, especially those on denied entry to the country to prevent yellow fever virus.

The Southeast Asian country has listed Congo, Ethiopia, Paraguay, Brazil, Argentina and Peru among 42 African and South American countries in the endemic areas of the yellow fever virus.

Accordingly, all passengers, comprising children from one year old, from those nations, or international tourists once residing and transiting through the 42 countries for more than 12 hours in the latest six days, have to show up proof of yellow fever vaccination, or else they will be denied entering the country.

The ministry said that although there are yet no reported cases of yellow fever in Singapore, any importation of the disease to the nation will make it soon become an epidemic there due to the presence of Aedes mosquito vector.

Yellow fever is a mosquito borne acute viral haemorrhagic disease caused by the yellow fever virus. It is transmitted by the bite of an infected Aedes aegypti mosquito.

 

The disease, which is popular in African and South American countries, is characterised by high fever, nausea and jaundice. It can become more serious, causing heart, liver and kidney problems along with bleeding. Up to 50 percent of people with more-severe form of the fever die.-VNA 

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A Global Guide For Leery Travelers - Goats and Soda by NPR

With its tropical beaches and a memorable national park, Venezuela was a popular destination for American tourists a decade ago. But years of political and economic turmoil have left its tourism industry in tatters.

Now there's an even more pressing reason to stay out of the country. The Centers for Disease Control and Prevention (CDC) last month issued a rare "Level 3" warning, urging Americans to avoid nonessential travel to Venezuela. The CDC notes that the country is "experiencing outbreaks of infectious diseases, and adequate health care is currently not available in most of the country." Cases of measles, diphtheria and malaria have been reported.

"Venezuela's totalitarian regime has made health very tenuous, with many risks, both infectious and noninfectious," says Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.

While skipping Venezuela this summer seems like a no-brainer, other health dangers lurk in both mainstream and off-the-beaten-track destinations. Here are some of those threats, along with advice on how to check your destination in advance and take the proper precautions.

Is my destination too dangerous?

How do you know if your destination is too hazardous for your health? Checking the CDC's Travel Health Notices and the World Health Organization's Disease Outbreak News database will give you an overview of the global health problems this summer.

For popular tourist destinations, these include:

Yellow fever and malaria in Brazil. There's a large, ongoing outbreak of yellow fever in multiple states of Brazil, according to the CDC. The agency recommends vaccinations at least 10 days before travel to affected areas and urges you take precautions to ward off mosquito bites. The malaria warning is confined to the town of Wenceslau Guimarães, in Brazil's Bahia state.

Malaria and listeriosis in South Africa. U.K. health authorities in March reported cases of malaria in residents who had returned from the Waterberg district municipality of Limpopo Province. Malaria is most common along South Africa's borders with Zimbabwe and Mozambique. Listeriosis, a bacterial infection, is contracted by eating contaminated foods. The CDC has warned travelers to avoid certain foods, such as soft cheese made from unpasteurized milk, to reduce their risk of infection.

Zika in the Caribbean. The mosquito-borne Zika virus remains a problem in tourist hot spots like Antigua and Barbuda, Aruba, the British Virgin Islands, St. Martin, St. Vincent and the Grenadines, and Turks and Caicos. The CDC has warned travelers to take steps to protect themselves from mosquito bites.

For travelers headed to remote places, whether for business or adventure, there are significant warnings to consider. These include an Ebola Virus Disease outbreak in the Democratic Republic of the Congo, a cholera outbreak in Cameroon, and a danger of Middle East respiratory syndrome coronavirus infection, or camel flu, in Saudi Arabia.

A decision to travel is 'complicated'

An Ebola outbreak is a reason "for sure" to cancel a trip, says Robert Salata, chairman of medicine and an infectious-disease expert at University Hospitals Cleveland Medical Center. But it's not the only reason. If a place you're planning to visit this summer is on the warning list for cholera, other hemorrhagic fevers or Zika, you should strongly consider adding it to your no-visit list, says Salata.

"Don't just pay attention to the warnings about disease outbreaks," Salata adds. "Review any notices related to ongoing violence or natural disasters." Those can exacerbate a health problem at your destination by making it more difficult to obtain care.

Travelers should also consider their own health and other individual concerns, says Dan Strickman, a medical entomologist and a senior project officer at the Bill & Melinda Gates Foundation. (The Gates Foundation is a funder of NPR and its global health team.)

"It's complicated," he says.

Take Zika, for example. The mosquito-borne virus, which can cause birth defects, could be a reason to reconsider your travel plans. But if you aren't of childbearing age, it might not be, says Strickman. A few preventative measures — such as using mosquito repellent and wearing clothing with mosquito-repellent qualities — can substantially reduce the risk of infection.

How to protect yourself — and your vacation

If you're traveling this summer, it's vital to have a big-picture understanding of health and safety, says Louis Weiss, a professor of pathology at Albert Einstein College of Medicine in New York. For a primer on the subject, he recommends a section of the CDC site devoted to such risks. "Research the health risks and requirements for travel," he advises.

Another good resource is the U.S. Department of State website. Earlier this year, it overhauled its advisories to more clearly warn travelers of various dangers. (Afghanistan, the Central African Republic, Iran, and Iraq, for instance, rate "do not travel" warnings.)

"Travelers leaving the country should be well aware of any travel advisories for their intended destination," says Justin Tysdal, the CEO of Seven Corners, a travel insurance company. That includes popular destinations like England, France and Greece, each of which has its own CDC measles warnings.

Travel insurance may also be a worth considering. But you have to pore over the fine print before you buy. Medical evacuation coverage on travel insurance can be limited, so you might consider additional coverage through a medical-transport and travel-security membership program such as Medjet. Airfare, activities, or excursions booked through and prepaid to a travel supplier would generally be protected, as long as a health warning isn't already in effect in the destination.

But experts warn that if a health warning has already been issued, insurance usually won't cover an evacuation or cancellation.

"You might consider a 'cancel for any reason' policy, which addresses those types of concerns," says Beth Godlin, president of Aon Affinity Travel Practice, a travel insurance company. Those policies are typically more expensive than standard, named-exclusion insurance policies and will refund only a percentage of your vacation costs.

But whatever kinds of precautions you take, say the travel specialists, don't procrastinate. Once you've bought the tickets, getting a refund may not be possible.

Christopher Elliott is the founder of Elliott Advocacy, a nonprofit organization that empowers consumers to solve their problems and helps those who can't. Email him with your questions at chris@elliott.org.

Yellow fever: A new method for testing vaccine safety, June 2018

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IMAGE: THIS IS A BBB-MINIBRAIN TRICULTURE.view more 

CREDIT: © MARIE-CHRISTINE CUMONT AND MONIQUE LAFON - INSTITUT PASTEUR

Scientists from the Institut Pasteur, the CNRS and Sanofi Pasteur have recently developed a novel alternative method to animal testing that can be used to verify the safety of vaccines such as the yellow fever vaccine. This original approach is based on the development of an in cellulo device using a 3D culture model, the "BBB-Minibrain", to evaluate the safety of live vaccines for human use. The model was developed by the Institut Pasteur and a patent application has been filed by the Institut Pasteur and Inserm. It raises hopes for a reduction in the use of animals in quality control, especially in the tests carried out by the pharmaceutical industry to meet the requirements of regulatory authorities. The results of this research were published in the journal Biologicals in May 2018, and online on March 24th.

For several years now, following the adoption of EU Directive 2010/63/EU,1 the scientific community has been actively seeking to reduce the practice of animal testing. But in many cases, these efforts are hindered by a lack of acceptable alternatives that satisfy regulatory authorities. This is particularly the case for the regulatory testing required for live viral vaccines, such as the yellow fever vaccine; suppliers must demonstrate that the seed lots used to produce vaccine batches sold on the market do not represent a risk of neurotoxicity. These tests are currently performed on animals, which are monitored for the emergence of any clinical signs in the central nervous system that may suggest neurotoxic side effects.

Against this backdrop, Institut Pasteur scientists developed a 3D culture model mimicking the human blood-brain interface, the "BBB-Minibrain", in 2014. This model, formed of a blood-brain barrier (BBB) associated with a mixed culture of neurons, astrocytes and microglia (a "minibrain"), can be used to detect when viruses enter the brain through the BBB, their multiplication in the minibrain and the emergence of any neurotoxic effects. A patent application (WO2016038123) was filed for the model.

The scientists set out to test the BBB-Minibrain's ability to pinpoint and amplify any rare mutant particles with neuroinvasive and neurovirulent properties that are found in seed lots for live viral vaccines. They chose to use two yellow fever virus vaccine strains, including the strain currently used to produce the vaccine, which does not cause neurotoxicity.

Working with Sanofi Pasteur research teams, they demonstrated that the BBB-Minibrain can be used to identify any rare viral particles in vaccine preparations that have acquired the ability to enter the brain and multiply there. This test therefore paves the way for the rejection of any seed lots containing mutant viruses capable of entering the brain and becoming neurovirulent.

As Monique Lafon, lead author of the study and Director of the Virology Department at the Institut Pasteur, explains, "replacing animal testing is a major challenge for research. The BBB-Minibrain model is an ingenious tool that will facilitate our analysis of the basis for neurovirulence in these viruses, which colonize the brain via the bloodstream."

These findings represent a first proof of concept and feasibility for the development of an alternative test that complies with the "3Rs" principle. Work to develop this test is ongoing. The long-term aim is to secure approval for the new test from regulatory authorities.

The BBB-Minibrain model raises hopes for the development of an alternative method that can be used by the pharmaceutical industry to perform regulatory tests on live viral vaccines. The aim of this method is to reduce the use of animals while ensuring strict monitoring of any scientific benefits and breakthroughs in the area of human health.

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