News Scan for Feb 07, 2019

Ebola in the DRC
More measles in Washington state outbreak
Measles in Europe and the Philippines
UK acute flaccid paralysis rise

Ebola infects 2 more in the DRC

The Democratic Republic of Congo (DRC) health ministry today reported two more Ebola cases, one from Butembo and the other from Kyondo. In addition, 189 suspected cases are under investigation.

Also, officials said four more people died from their infections. They include one from Butembo and one from Kyondo who died in the community, an occurrence known to increase the risk of virus spread. The two others died in Katwa's Ebola treatment center.

Today's developments lift the outbreak total to 791 cases, including 737 confirmed and 54 probable. The fatality count has reached 492.

In its daily update, the health ministry addressed messages circulating on social media that allege that women have been victims of sexual advances in exchange for work on the Ebola response. It notes that though local women's groups have denounced some of the messages as rumors designed to tarnish the image of women working on the outbreak response, the health ministry is taking the allegations seriously. It asked people who have been victims or witnesses of such incidents to report them confidentially.

The ministry emphasized that all outbreak services are free and that anyone offering services for payment in kind or cash should be reported. It also urged women to take safety steps when responding to outbreak response recruitment and employment.
Feb 7 DRC update


Four more measles cases confirmed in Washington state outbreak

Four more measles cases have been reported in an outbreak in the Vancouver, Wash., area, including three in Oregon's Multnomah County and one in Washington's Clark County, according to official updates.

The three new case-patients in Oregon all had close contact with Multnomah County's first confirmed case, which was reported on Jan 25. The Oregon Health Authority (OHA) said yesterday that the three people have remained at home and are in regular contact with county health officials. The initial case-patient is part of a larger outbreak in Washington's Clark County.

Meanwhile, Clark County has confirmed one new case, raising its total to 50. In an update yesterday, Clark County Public Health said 11 suspected cases are still under investigation. All but two of the cases involve children younger than 18. Of those with measles, 43 were unvaccinated, 6 had unverified immunization status, and 1 had been vaccinated.

In a related development, demand for measles, mumps, and rubella (MMR) vaccine is surging in Clark County, even among people who had avoided vaccination, Kaiser Health News (KHN) reported yesterday. Orders were up nearly 500% in January compared with the same month last year. According to the report, health officials had worried about the potential for a measles outbreak in the region, given that only 76.5% of kindergarteners had received all recommended shots for the 2017-2018 school year.
Feb 6 OHA press release
Feb 6 CCPH update
Feb 6 KHN story


Report details Europe's 2018 measles surge; Philippines declares outbreak

New data for 2018 released today by the World Health Organization (WHO) European regional office shows the highest number of cases in a decade, but that more children than ever before have been vaccinated.

In a statement today, the WHO said the numbers point to uneven progress within countries, leaving pockets of people unprotected. In 2018, 82,596 people in 47 of the region's 53 countries had measles, and 72 died from the disease. Nearly two-thirds of people infected with measles were hospitalized. The total for 2018 was the highest this decade—three times higher than in 2017 and 15 times the record low reported in 2016.

However, the WHO said the surge followed a year (2017) that marked the highest ever estimated coverage (90%) for the second dose of measles vaccine. Coverage of first-dose vaccination also reached a high of 95% in 2017.

The WHO said achievements at the national level can mask gaps at the subnational level, which aren't often recognized until outbreaks occur. It notes that most countries struggling with suboptimal immunization coverage are middle-income countries and that the office is working with them to implement targeted strategies to improve vaccine coverage.
Feb 7 WHO Europe statement

In other international measles developments, the Philippines Department of Health yesterday declared a measles outbreak in the National Capital Region of Luzon island, with 196 cases reported through the first half of January, compared with 20 reported in the area for the same period in 2018. The region includes Manila and has 16 cities and 1 municipality.

In an update today, the health department expanded the outbreak declaration to other regions, including other parts of Luzon and the Central and Eastern Visayas (Visayan Islands). As of Jan 26, the country had recorded 575 cases, 9 of them fatal. Health Secretary Francisco Duque, MD, said in the statement, "We are expanding the outbreak from metro Manila to the other regions as cases have increased in the past weeks and to strengthen surveillance of new cases and alert mothers and caregivers to be more vigilant."
Feb 6 Philippines DOH statement
Feb 7 Philippines DOH statement


UK task force describes 40 recent acute flaccid paralysis cases

The United Kingdom Acute Flaccid Paralysis Task Force today reported 40 cases between Jan 1, 2018, and Jan 21, 2019, up from 28 reported in December by Public Health England.

Writing in Eurosurveillance, the group said the task force was formed in November after PHE began to receive AFP reports and that today's report spells out their early findings.

Of the 40 cases, 9 involve acute flaccid myelitis (AFM) and 9 patients were positive for enterovirus D68 (EV-D68). Tests excluded poliovirus in all but two cases, and investigations are still underway. Aside from the 9 confirmed AFM cases, 7 more are classified as probable and further testing is pending to classify 19 of the other cases. Half of the patients and most of those with EV-D68 infections are children ages 5 and younger.

Clinically, 22 of the patients had experienced a recent acute respiratory illness. Half had paralysis symptoms in all four limbs. Fifteen patients were admitted to intensive care units, including 12 who needed assisted ventilation. Three of the children still have considerable neurologic problems.

The authors said the UK situation is very similar to the pattern seen in the United States, with the increase in polio-like syndrome cases tracking with EV-D68 circulation.
Feb 7 Eurosurveill report
Dec 19, 2018, CIDRAP News scan "Public Health England notes 28 cases of acute flaccid paralysis"

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