miércoles, 25 de septiembre de 2019

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Published Date: 2019-09-25 11:40:57
Subject: PRO/AH/EDR> Ebola update (92): Congo DR (NK,IT,SK) cases, summaries, response
Archive Number: 20190925.6692867
EBOLA UPDATE (92) DEMOCRATIC REPUBLIC OF CONGO (NORTH KIVU, ITURI), SOUTH KIVU CASES, SUMMARIES, RESPONSE
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A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this updates:
[1] Case update
- CMRE (Comite Multisectoriel de la Riposte a la maladie a virus Ebola) update 23 Sep 2019
- WHO/AFRO Ebola dashboard 24 Sep 2019
[2] Outbreak summaries
- CIDRAP (Center for Infectious Disease research and Policy) 24 Sep 2019
- CIDRAP: 2nd vaccine
[3] Response
- ALIMA

******
Case update
[1] Case update
- Mon 23 Sep 2019
[CMRE (Comite Multisectoriel de la Riposte a la maladie a virus Ebola), in French, machine trans., abridged, edited]
https://crofsblogs.typepad.com/h5n1/2019/09/drc-ebola-cmre-update-september-23.html

CMRE now publishes its daily updates in web-accessible format: Situation épidémiologique au 23 septembre 2019.

Excerpt from the Google translation:

Epidemiological situation in the provinces of North Kivu and Ituri on 22 Sep 2019:
- Since the beginning of the epidemic, the cumulative number of cases is 3168, of which 3057 are confirmed and 111 are probable. In total, there were 2118 deaths (2007 confirmed and 111 probable) and 975 people cured;
- 343 suspected cases under investigation;
- 4 new confirmed cases, including: 1 in North Kivu in Butembo; 3 in Ituri, including 2 in Mandima and 1 in Mambasa.
- 3 new deaths of confirmed cases, including: 2 community deaths, -- 1 in North Kivu in Butembo and 1 in Ituri in Mambasa; 1 confirmed death in Ituri in Mandima.
- No health worker is among the new confirmed cases. The cumulative number of confirmed/probable cases among health workers is 160 (5% of all confirmed/probable cases), including 41 deaths.

News
----
Start of training of trainers in Goma on good clinical practices related to the 2nd Ebola vaccine
- The Ebola Virus Disease Response Information Management Coordinator, representing the Technical Secretariat, Mathias Mossoko, launched Mon 23 Sep 2019 in Goma training of trainers that runs from 23-28 Sep 2019 on good clinical practices (GCP) related to the 2nd vaccine against the Ebola virus.
- This training benefits from the expertise of CVD's Malians on the transmission of notions about good clinical practice. It aims to provide participants with the standards applicable to the design, conduct, monitoring, and stopping of studies, to teach them the activities of audit, analysis, reporting, and documentation with the guarantee that these studies rely on sound scientific and ethical principles. It is also intended to introduce participants to the correct documentation of the clinical properties of the vaccine tested or evaluated.
- The Response Information Management Coordinator called the attendance participants to demonstrate better actors for the implementation of good practice in this 2nd vaccine.
- For its part, the chairman of the Immunization Committee, Stéphane Hans, said that this 5-day training announces the forthcoming launch of the 2nd vaccine that will come at any time in the targeted health zones. "We welcome this supplementary vaccine very positively compared to the 1st vaccine. This 2nd vaccine has the advantage of preventing all strains of the Ebola virus. It is therefore positive for the population that will receive it," he said while inviting all communities targeted by this vaccination to take ownership of this activity, once launched.
- The training on good clinical practice will revolve around several presentations on different topics, among others, the Ebola virus disease, the responsibilities of the INRB for the QA system, study vaccines (storage, management, chain cold and accounting), inclusion and follow-up of pregnant women, community involvement and informed consent, etc.
- This training was organized for the different actors involved in this project, including doctors, epidemiologists, clinicians, and pharmacists. A total of 25 people from Kinshasa, including the INRB, UNIKIN, CUK, and specialized programs and North Kivu, including the Provincial Health Inspectorate (IPS), the Provincial Division of health (DPS), and the health zones coordination Offices (BCZS) participate in these foundations.

Vaccination
-----------
Opening of an enlarged ring of vaccination around 2 confirmed cases on 19 and 21 Sep 2019 in the health area of Madidi in Mambasa in Ituri.
Another satellite ring was opened at the Kitatumba General Referral Hospital in Butembo health zone in North Kivu around the case notified on 22 Sep 2019. This case started the illness in the Kasindi health area in Mutwanga, North Kivu.
- The Expanded Program of Vaccines has received 4320 doses of vaccine at the national level;
- Since vaccination began on 8 Aug 2018, 226 722 people have been vaccinated;
- The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 20 May 2018.

Monitoring at Entry Points
--------------------------
- High-risk contact was intercepted at Kangote PoC in Butembo, North Kivu. This is a 28-year-old unvaccinated woman on the 14th day (D14) follow-up who was listed around a confirmed case in the Katwa Health Zone. During her interception, this woman presented some signs related to the #Ebola Virus Disease. She was sent to the Butembo ETC for treatment.
- Kituku PoC providers in Goma, North Kivu, were assaulted by about 20 onlookers called "Maibobo" who were avenging one of their drowned during the night of 20 -- 21 Sep 2019. These providers feel insecure and ask to be supported by officers of the National Police (PNC) or FARDC.
- Since the beginning of the epidemic, the total number of travelers checked (temperature measurement) at the sanitary control points up to 22 Sep 2019 is 96 998 860;
- To date, a total of 111 entry points (PoE) and sanitary control points (PoCs) have been set up in the provinces of North Kivu and Ituri to protect the country's major cities and prevent the spread of the epidemic in neighboring countries.

--
Communicated by:
Mary Marshall
<mjm2020@googlemail.com>
and
ProMED-mail
<promed@promedmail.org>

- Mon 23 Sep 2019
WHO/AFRO Ebola dashboard
[WHO/AFRO, edited]
https://who.maps.arcgis.com/apps/opsdashboard/index.html#/e70c3804f6044652bc37cce7d8fcef6c

3171 cases of which 3059 confirmed
128 cases in last 21 days
979 survivors
2119 deaths
9900 contacts being followed out of 11 000 identified.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

******
[2] Outbreak summaries
- Tue 24 Sep 2019. WHO: Multiple DRC Ebola hot spots 'grave concern'
[CIDRAP (Center for Infectious Disease research and Policy), abridged, edited]
http://www.cidrap.umn.edu/news-perspective/2019/09/who-multiple-drc-ebola-hot-spots-grave-concern
[Byline: Stephanie Soucheray]

In the past week, officials in the Democratic Republic of the Congo (DRC) confirmed 48 new cases and 25 new deaths in an ongoing Ebola outbreak in 3 of the DRC's eastern provinces.

According to the World Health Organization's (WHO's) African regional office's weekly update on the 13-month-long outbreak, the principle virus hot spots in September [2019] have been Mambasa (25% of new cases), Mandima (19%), Kalunguta (18%), and Beni (11%).

"8 health zones, namely Mambasa, Komanda, Mandima, Beni, Katwa, Kayna, Kalunguta, and Biena have reported new confirmed cases in the past 7 days and remain points of attention," the WHO said. "The persistence of hot spots and the shift in transmission intensity between the main hotspots remains of grave concern, as does continued sporadic transmission in other health areas."

Today [24 Sep 2019] the WHO recorded 2 more cases and 3 fatalities on its online Ebola dashboard, raising outbreak totals to 3171 cases and 2118 deaths. There are 342 suspected cases under investigation.

In an update issued late yesterday [23 Sep 2019], the DRC's multisector Ebola committee (CMRE) said that the 4 cases confirmed yesterday were in Butembo, Mandima (2 cases), and Mambasa.

--
Communicated by:
Mary Marshall
<mjm2020@googlemail.com>

- Mon 23 Sep 2019. 2nd vaccine
[CIDRAP (Center for Infectious Disease Research and Policy) abridged, edited]
http://www.cidrap.umn.edu/news-perspective/2019/09/who-pushes-tanzania-suspected-ebola-cases-drc-oks-use-2nd-vaccine
[Byline: Lisa Schnirring]

In DRC developments, government officials announced plans to use a 2nd experimental vaccine, a 2-dose regimen made by Johnson & Johnson, the WHO said today [23 Sep 2019] in a statement. The vaccine, known as Ad26.ZEBOV/MVA-BN, is a prime-boost product given 56 days apart and is designed to provide longer lasting protection against the virus.

In April [2019], a WHO vaccine advisory group recommended adding Ad26.ZEBOV/MVA-BN as a way to increase supply and test the effectiveness of a 2nd vaccine, but the country's former health minister pushed back against mounting international pressure to use it, because it could complicate vaccine messaging and post logistical challenges in delivering the 2nd dose.

In its statement, the WHO said health officials will introduce the vaccine in the middle of October [2019], targeting at-risk population in areas that don't have active Ebola transmission.

Matshidiso Moeti, MBBS, who directs the WHO's regional office for Africa, said, "The evaluation of the 2nd Ebola vaccine will help ensure that we have potentially an additional tool to prevent the expansion of the outbreak and also a potential tool to protect populations before outbreaks hit areas at risk."

The WHO said at the current number of cases being reported, supplies of the current VSV-EBOV vaccine are sufficient. Merck, the vaccine's maker, has provided the WHO with 245 000 doses and built a stockpile of 190 000 doses that are ready to send to the DRC. Also, the WHO said Merck's goal is to release 650 000 doses over the next 6-18 months.

--
Communicated by:
Mary Marshall
<mjm2020@googlemail.com>

[Also see
https://crofsblogs.typepad.com/h5n1/2019/09/who-second-ebola-vaccine-to-complement-ring-vaccination-given-green-light-in-drc.html

Excerpt of statement from WHO:
"The Johnson & Johnson vaccine will complement the current vaccine (rVSV-ZEBOV-GP, manufactured by Merck), which has proven highly effective and safe, and which has helped protect thousands of lives. The Merck vaccine will continue to be provided to all people at high risk of Ebola infection including those who have been in contact with a person confirmed to have Ebola, all contacts of contacts, and others determined to be at high risk of contracting Ebola. To date over 223 000 people have received this vaccination during the current outbreak.

"In May 2019, WHO's Strategic Advisory Group of Experts on Immunization (SAGE) reviewed use of vaccines in the ongoing Ebola outbreak and issued recommendations. These included adjusting the dose of the Merck vaccine, evaluating a second vaccine under appropriate protocols, changing strategies when insecurity makes it difficult to reach people - such as providing pop-up vaccination stations -- and increasing the number of people vaccinated within communities with ongoing transmission, sometimes vaccinating whole villages.

"In everything we do, we are driven by science," Dr Tedros said. "The advice we were given by SAGE in May has been applied, always taking into account community needs and preferences, as we know this will make the approach more effective. The changes made have saved thousands of lives in this outbreak."

"New therapeutics and better use of treatment protocols have also saved many lives. "To date, 973 people have been successfully treated and released from Ebola treatment centres, and we expect that the 1000th survivor will return to his or her community in the coming weeks," Dr Moeti said.

"Innovative vaccine strategies
------------------------------
"The introduction of the 2nd experimental vaccine is in line with the SAGE recommendations as are a number of other innovations.

"The main vaccination strategy used with the rVSV-ZEBOV-GP vaccine is a 'ring strategy' where all people who have come into contact with someone with a confirmed case of Ebola are given the vaccine. Where people are stigmatized or feel under threat protected, temporary 'pop-up', vaccination sites are set up, often at health posts, rather than near the homes of individuals infected with Ebola. This allows people to come for vaccination at a safe, more anonymous site, but also increases protection for vaccinators in areas where there is ongoing conflict and insecurity.

"Another approach being used to offer vaccination for people at high risk of contracting Ebola is 'targeted geographic vaccination'. This strategy involves vaccinating everyone in the neighbourhood, or village, rather than vaccinating only the known contacts and contacts of contacts. Targeted geographic vaccination was used successfully when the outbreak spread to Chowe in South Kivu.

"Over 90 percent of people who are offered vaccination accept it. Since the start of the outbreak WHO and partners have worked to recruit and train Congolese nationals from within Ebola-affected communities as vaccinators to increase community acceptance and also transfer skills to the region. Now, the majority of ring vaccination team members are trained healthcare workers, doctors and medical students from affected communities who speak local languages and understand community concerns."

--
Communicated by:
Mary Marshall
<mjm2020@googlemail.com>

******
[3] Response
Date: Mon 23 Sep 2019
Source: ALIMA (Alliance for International Medical Action) [abridged, edited]
https://www.alima-ngo.org/en/drc-more-than-60-of-patients-cured-within-alima-s-ebola-treatment-center


DRC: More than 60% of patients cured within ALIMA's Ebola Treatment Center
--------------------------------------------------------------------------
After more than a year of caring for Ebola patients at the Ebola Treatment Center (ETC) in Beni, Democratic Republic of the Congo, ALIMA (The Alliance for International Medical Action) is transferring the management of the center to Doctors Without Borders/Medecins Sans Frontieres (MSF). Thanks to the quality of care provided at the ETC, more than 60% of patients with Ebola virus disease have recovered.

Nearly 4000 people, including 600 confirmed Ebola patients, were treated by ALIMA teams. Thanks to the innovative CUBE (a Biosecure Emergency Care Unit for Outbreaks), the quality of care compared to previous outbreaks has greatly improved. Today, it is possible to provide intensive care, resuscitate patients, perform wireless and sonic ultrasounds, transfusions, and perform certain surgical procedures such as cesarean sections. In addition, ALIMA participated very extensively in a clinical trial that identified 2 treatments (REGN-EB3 and mAB114), which are the 1st drugs to clearly show a significant decrease in mortality in people with the Ebola Virus. Today, our teams continue to operate at the Ebola Treatment Center in Katwa, with the same quality of care.

As the management of the Beni ETC is handed over to MSF, 3 members of the ALIMA team reflect on their experience and work at the centre. - [read their accounts at the source URL above]

--
Communicated by:
Mary Marshall
<mjm2020@googlemail.com>

[Maps of Congo DR: http://goo.gl/DM2AT8 and http://healthmap.org/promed/p/194]

See Also

Ebola update (91): Congo DR (NK,IT,SK) cases, summaries, response, Uganda 20190920.6684164
Ebola update (90): Congo DR (NK,IT,SK) cases, summaries, response, Tanzania, story 20190918.6680252
Ebola update (89): Congo (NK,IT) Tanzania case update, NOT Ebola 20190914.6674377
Ebola update (88): Congo DR (NK,IT) cases, summaries, front line, response 20190914.6673644
Ebola update (87): Congo DR (NK,IT,SK) Uganda, summaries, response, therapeutics 20190908.6662930
Ebola update (86): Congo DR (NK,IT,SK) Uganda, summaries, response, reading 20190905.6659380
Ebola update (85): Congo DR (NK, IT) Uganda, cases, summaries, response 20190901.6652681
Ebola update (84): Congo DR (NK,IT,SK) cases, Uganda, summaries, response 20190830.6649635
Ebola update (83): Congo DR (NK,IT,SK) cases, summaries, response 20190827.6644258
Ebola update (82): Congo DR (NK,IT,SK) cases, response 20190823.6636225
Ebola update (81): Congo DR (NK,IT,SK) cases, summaries, response 20190820.6630575
Ebola update (80): Congo DR (NK,IT,SK) cases, summaries, therapeutics, response 20190816.6624873
Ebola update (79): Congo DR (NK, IT) therapeutics, response, research 20190813.6620807
Ebola update (78): Congo DR (NK, IT) cases, summary, WHO, response, research 20190811.6616470
Ebola update (77): Congo DR (NK,IT) cases, WHO, response, vaccine, research 20190807.6609574
Ebola update (76): Congo DR (NK, IT) cases, WHO, summary, response, vaccine 20190803.6604404
Ebola update (75): Congo DR (NK, IT) cases, WHO, summary, response, research 20190802.6601434
Ebola update (74): Congo DR (NK, IT) cases, WHO, response 20190801.6599231
Ebola update (73): Congo DR (NK, IT): case update, summary, vaccine 20190731.6597142
Ebola update (72): Congo DR (NK,IT) case update, summary, response, research 20190729.6594431
Ebola update (71): Congo DR (NK,IT) summary, WHO, preparedness, response, clarif. 20190726.6588573
Ebola update (70): Congo DR (NK, IT) case update, WHO, PHEIC, vaccine, MoH 20190724.6584623
Ebola update (69): Congo DR (NK, IT): cases, WHO 20190721.6579520
Ebola update (68): Congo DR (NK, IT) cases, WHO, Uganda 20190718.6574479
Ebola update (67): Congo DR (NK, IT) cases, WHO, Goma 20190717.6571650
Ebola update (66): Congo DR (NK, IT) case update, Goma, media advisory 20190715.6568141
Ebola update (65): Congo DR (NK, IT) case update, summaries, opinion 20190713.6566907
Ebola update (64): Congo DR (NK,IT) update, WHO, summaries, challenges, vaccines 20190712.6565357
Ebola update (63): Congo DR (NK, IT) case update, summaries 20190706.6555278
Ebola update (62): Congo DR (NK, IT) case update, summaries, education 20190703.6550730
Ebola update (61): Congo DR (NK,IT) case update, summaries, leadership, response 20190629.6543844
Ebola update (60): Congo DR (NK, IT) case update, WHO, summaries, response 20190627.6540134
Ebola update (59): Congo DR (NK,IT) case update, summaries, WHO, vaccine 20190625.6536477
Ebola update (58): Congo DR (NK, IT) case update, summaries, spread, treatment 20190620.6530882
Ebola update (57): Congo DR (NK,IT) case updates, summary, borders, research 20190618.6525334
Ebola update (56): Congo DR (NK,IT) updates, no PHEIC, Merck vaccine, Africa CDC 20190615.6521868
Ebola update (55): Congo DR (NK,IT) Uganda (KS) ex DRC, case updates, summaries 20190614.6519943
Ebola update (54): Congo DR (NK,IT) Uganda (KS) ex DRC, case updates, summaries 20190613.6517597
Ebola update (53): Uganda (KS) ex Congo DR (NK) 1st cross-border cases, MOH, WHO 20190612.6516605
Ebola update (52): Congo DR (NK, IT), new UN emergency Ebola coordinator 20190609.6511167
Ebola update (51): Congo DR (NK, IT) cases, summary, support, response 20190606.6507016
Ebola update (50): Congo DR (NK, IT) cases, preparedness, response, vaccine 20190603.6501486
Ebola update (49): Congo DR (NK,IT) cases, WHO, response 20190531.6494013
Ebola update (48): Congo DR (NK, IT) cases, summary, WHO, response 20190525.6486623
Ebola update (47): Congo DR (NK, IT) cases, summary, situation, research 20190520.6476709
Ebola update (46): Congo DR (NK, IT) cases, summary, response 20190515.6470579
Ebola update (45): Congo DR (NK, IT) cases, summaries, WHO, risk, response 20190512.6465801
Ebola update (44): Congo DR (NK, IT) cases, WHO, response, vaccine, research 20190509.6461476
Ebola update (43): Congo DR (NK, IT) cases, summary, WHO, preparedness, response 20190506.6457148
Ebola update (42): Congo DR (NK, IT) cases, summary, WHO, Uganda, vaccine 20190503.6453732
Ebola update (41): Congo DR (NK, IT) cases, summary, WHO 20190428.6445655
Ebola update (40): Congo DR (NK, IT) cases, summary, response, vaccine, crisis 20190425.6438898
Ebola update (39): Congo DR (NK, IT) cases, summary, response 20190420.6432252
Ebola update (38): Congo DR (NK, IT) cases, summary, WHO, response, research 20190417.6426205
Ebola update (37): Congo DR (NK, IT) cases, WHO, vaccine 20190414.6421230
Ebola update (36): Congo DR (NK, IT) cases, summaries, WHO, response 20190411.6417629
Ebola update (35): Congo DR (NK,IT) cases, setbacks, preparedness, personal acct 20190408.6409642
Ebola update (34): Congo DR (NK, IT) cases, summaries, spread, research 20190405.6406092
Ebola update (33): Congo DR (NK, IT) cases, summaries, response 20190402.6400473
Ebola update (32): Congo DR (NK,IT) cases, summary, WHO, public trust, economics 20190329.6393553
Ebola update (31): Congo DR (NK, IT) cases, summaries, opinions, research 20190324.6384785
Ebola update (30): Congo DR (NK, IT) cases, summaries, WHO, preparedness 20190321.6378400
Ebola update (29): Congo DR (NK,IT) cases, control 20190317.6372102
Ebola update (28): Congo DR (NK,IT) cases, law, research 20190314.6366412
Ebola update (27): Congo DR (NK, IT) cases, Butembo, summary, WHO, research 20190310.6360031
Ebola update (26): Congo DR (NK, IT) cases, summary, WHO, response 20190308.6356987
Ebola update (25): Congo DR (NK, IT) cases, summary, response, research 20190305.6350567
Ebola update (24): Congo DR (NK, IT) cases, attacks 20190303.6346910
Ebola update (23): Congo DR (NK,IT) cases, WHO, violence 20190301.6343087
Ebola update (22): Congo DR (NK,IT) cases, WHO, response 20190226.6336700
Ebola update (21): Congo DR (NK, IT) cases, summaries, vaccine, WHO, reading 20190223.6332712
Ebola update (20): Congo DR (NK, IT) cases, summary, vaccine, response 20190221.6328121
Ebola update (19): Congo DR (NK, IT) cases, summaries, news, UNICEF 20190218.6323083
Ebola update (18): Congo DR (NK, IT) cases, summaries, vaccine RFI, research 20190215.6319043
Ebola update (17): Congo DR (NK, IT) cases, summaries, research, response 20190213.6314580
Ebola update (16): Congo DR (NK, IT) cases, vaccine, South Sudan, local news 20190211.6310161
Ebola update (15): Congo DR (NK, IT) cases, summaries, local news 20190209.6307023
Ebola update (14): Congo DR (NK, IT) cases, summaries, WHO, Lancet 20190206.6299325
Ebola update (13): Congo DR (NK, IT) cases, summary, assessment, preparedness 20190202.6292000
Ebola update (12): Congo DR (NK, IT) cases, summaries, preparedness, treatment 20190131.6287934
Ebola update (11): Congo DR (NK,IT) cases, problems, education 20190128.6280966
Ebola update (10): Zaire ebolavirus detected, greater long-fingered bat, Liberia 20190124.6275982
Ebola update (09): Congo DR (NK, IT) cases, diagnostics, prevention, concerns 20190123.6273621
Ebola update (08): Congo DR (NK, IT) cases, prevention, spread, research 20190120.6268120
Ebola update (07): Congo DR (NK, IT) cases, summaries, prevention, research 20190118.6264739
Ebola update (06): Congo DR (NK, IT) cases, prevention, challenges 20190115.62596752018
Ebola update (05): Congo DR (NK, IT) cases, challenges, diagnostics, news 20190114.6256926
Ebola update (04): Congo DR (NK, IT) cases, WHO, travel, treatment 20190111.6252695
Ebola update (03): Congo DR (NK, IT) cases, summaries 20190109.6249090
Ebola update (02): Congo DR (NK, IT) cases, summaries 20190105.6243451
Ebola update (01): Congo DR (NK, IT) cases, summaries, Uganda 20190103.6241326
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