Tag Archives: Outbreak

Explainer: Low vaccination rates, global outbreaks fuel U.S. measles spread

A measles poster is seen at Venice Family Clinic in Los Angeles, California February 5, 2015. REUTERS/Lucy Nicholson

By Steve Gorman

(Reuters) – A measles outbreak that has stricken at least 225 people in New York state since October began with a traveler who visited Israel during the Jewish high holidays and returned to a predominantly ultra-Orthodox Jewish neighborhood of Rockland County.

A similar pattern unfolded three months later and nearly 3,000 miles (4,800 km) away when a person who visited Eastern Europe returned to a community with strong ties to a local church group in Vancouver, Washington. More than 50 people fell ill there.

In both instances, U.S. travelers picked up measles in foreign countries where the highly contagious disease was running rampant and brought it back to places where vaccination rates were too low by U.S. public health standards, setting off the worst outbreaks seen in those states in decades.

The U.S. Centers for Disease Control and Prevention says New York’s outbreak marks the highest tally of imported cases since measles was declared eradicated in the United States in 2000.

The two outbreaks appear to be winding down, health officials say, after concerted efforts to pinpoint the origins and isolate and inoculate those who were exposed but unprotected and educate parents who had resisted vaccines.

The disease has spread mostly among school-age children whose parents declined to get them vaccinated. Most cited philosophical or religious reasons, or concerns – debunked by medical science – that the three-way vaccines against measles, mumps and rubella (MMR) could cause autism, authorities said.

New York State Health Commissioner Dr. Howard Zucker said another key factor was mere “complacency” in an age where the potential ravages of measles are unfamiliar to parents who came of age after the vaccine was introduced in 1957.

In Rockland County, the suburb north of Manhattan accounting for the bulk of cases, the state has vaccinated 15,000 children since the outbreak began there last autumn, Zucker said. The Brooklyn borough of New York City was another hot spot.

Still, officials say the measles crisis in New York and Washington states offer a lesson about the importance of maintaining a minimum level of “herd” immunization against dangerous, preventable diseases such as measles.

It also highlights the global nature of disease control, in which a hot spot of infection in one country can ignite a distant outbreak in an immunization-weak spot of another, said Dr. Scott Lindquist, Washington’s top epidemiologist.

Here are some key facts about measles and immunization, according to public health experts and the CDC.

WHAT IMMUNIZATION RATES ARE IDEAL?

A 95 percent rate of immunization is required to provide sufficient “herd” protection in a given population. Rates as low as 60 percent were found in parts of New York where measles spread, Zucker said.

HOW BAD CAN MEASLES GET?

Symptoms typically include high fever, cough, runny nose and watery eyes, followed by tiny white spots inside the mouth and a red rash that can cover the body.

Serious and potentially fatal complications, especially in young children and pregnant women, can include pneumonia and swelling of the brain. Ear infections occur in about 10 percent of children with measles and can lead to permanent hearing loss.

One rare but fatal complication is subacute panencephalitis (SSPE), which can attack the central nervous system seven to 10 years after a person has recovered from measles.

HOW CONTAGIOUS IS MEASLES?

Measles is spread through casual contact with the virus, which can linger and remain infectious in the air of an enclosed space for up to two hours after it is breathed out by someone carrying the disease. The rate of transmission from an infected person to another individual nearby who lacks immunity is about 90 percent.

ORIGINS OF LATEST OUTBREAKS?

Health authorities say the strain of the virus identified in Washington state matches the one circulating widely in Ukraine since last year. The New York outbreak has been tracked back to separate flare-ups of measles in Israel and in Eastern Europe.

(Reporting by Steve Gorman in Los Angeles; Editing by Bill Tarrant and Peter Cooney)

Congo records one-day record for confirmed Ebola cases

FILE PHOTO: Healthcare worker carry a coffin with a baby suspected of dying of Ebola during the funeral in Beni, North Kivu Province of Democratic Republic of Congo, December 18, 2018. REUTERS/Goran Tomasevic/File Photo

KINSHASA (Reuters) – Democratic Republic of Congo on Wednesday confirmed 14 new cases of Ebola virus in its eastern borderlands, the largest one-day increase since the current outbreak was declared in August.

The outbreak of the haemorrhagic fever in the eastern provinces of North Kivu and Ituri is already the second-largest in history with 713 confirmed and probable cases and 439 deaths.

It is surpassed only by the 2013-2016 outbreak in West Africa, which involved over 28,000 cases and 11,000 deaths and led to substantial investments in a vaccine and treatments for the virus.

Health officials have struggled to bring the current outbreak, Congo’s tenth since 1976, under control, largely due to widespread militia violence in eastern Congo which has hampered the response.

The health ministry said in a daily bulletin that nine of the new cases were in the health zone of Katwa, just outside Butembo, a city of several hundred thousand people near the Ugandan border that has emerged as the outbreak’s new epicenter. One other case was in Butembo.

The ministry also announced six new deaths of confirmed cases as well as the recovery of one patient.

(Reporting By Stanis Bujakera and Fiston Mahamba; Writing by Aaron Ross; Editing by William Maclean and Peter Graff)

Yemen sterilizes Sanaa water supplies as cholera outbreak picks up again

Girls wait next to a charity tap where people collect drinking water amid fears of a new cholera outbreak in Sanaa, Yemen November 5, 2018. Picture taken November 5, 2018. REUTERS/Khaled Abdullah

SANAA (Reuters) – Authorities in the Houthi-held Yemeni capital Sanaa are sterilizing water supplies at wells, distribution networks and houses to help stem the world’s worst outbreak of cholera.

Nearly four years of war between a Saudi-led coalition and the Iranian-aligned Houthi group have crippled healthcare and sanitation systems in Yemen, where some 1.2 million suspected cholera cases have been reported since 2017, with 2,515 deaths.

The World Health Organization (WHO) warned in October that the outbreak is accelerating again with roughly 10,000 suspected cases now reported per week, double the average rate for the first eight months of 2018.

Most cases have been reported in areas held by the Houthi movement, which controls most population centers after ousting the internationally recognized government from Sanaa in 2014.

“We receive information of reported cases of cholera from the Ministry of Health, then the team sterilizes the house and 20 houses around it,” Nabeel Abdullah al-Wazeer, the Houthis’ minister of water, told Reuters in Sanaa.

“We worked from house to house and on sterilizing water wells. We also worked on bus-mounted tanks, which transport water in the private sector to the citizens, as well as sterilizing local institutions which distribute water.”

Adel Moawada, director general of technical affairs at Sanaa’s main water sanitation plant, said there are currently 20 automated chlorination units installed in wells directly linked to the capital’s water distribution network.

Cholera, which is spread by consuming contaminated food or water, is a diarrheal disease and can kill within hours. While previous outbreaks may have helped build immunity in the population, other diseases and widespread malnutrition can weaken resilience.

The United Nations says about 14 million people, or half of Yemen’s population, could soon face famine. Some 1.8 million children are malnourished, according to UNICEF.

Children account for 30 percent of cholera infections.

Pediatrician Mohammed Abdulmughni administers intravenous fluids to children in WHO tents in Sanaa. Their beds rest on gravel and flies circle their faces.

“With winter’s arrival we expected the numbers would decrease, yet the cases have been coming in at the same pace,” he said. “We expected positive (diagnoses) cases to decrease but the cases remain high.”

If caught early, acute diarrhea can be treated with oral hydration salts, but more severe cases require intravenous fluids and antibiotics.

More than 250,000 cases of cholera have been recorded in Yemen since the beginning of 2018, with 358 associated deaths, UNICEF representative Meritxell Relano told Reuters.

“We have prevented an outbreak at the scale of 2017,” Relano said. “But the risk is still there.”

(Reporting by Reuters team in Yemen, additional reporting by Julie Carriat in Paris; Writing by Tuqa Khalid; Editing by Ghaida Ghantous and Raissa Kasolowsky)

Don’t eat romaine: U.S., Canada warn on E.coli in lettuce

FILE PHOTO - Romaine lettuce grows near Soledad, California, U.S., May 3, 2017. REUTERS/Michael Fiala

(Reuters) – Public health officials in the United States and Canada on Tuesday warned against eating romaine lettuce while they investigate an outbreak of E. coli that has sickened 50 people in the two countries, including 13 who were hospitalized.

The alerts, issued as millions of Americans plan their Thanksgiving Day menus, covered all forms of romaine, including whole heads, hearts, bags, mixes and Caesar salad.

Officials were uncertain of the source of the tainted lettuce.

“Consumers who have any type of romaine lettuce in their home should not eat it and should throw it away, even if some of it was eaten and no one has gotten sick,” the U.S. Centers for Disease Control said in its food safety alert.

Refrigerator drawers and shelves where romaine lettuce had been stored should be sanitized, the CDC said.

The Public Health Agency of Canada, which is investigating 18 of the E. coli cases, directed its romaine lettuce alert at consumers in Ontario and Quebec.

In the United States, the CDC said the outbreak affected 32 people in 11 states between Oct. 8 and 31. No deaths have been reported, it said.

Symptoms of the infection often include a moderate fever, severe stomach cramps, vomiting, and diarrhea, which is often bloody, the CDC said. Most people get better in five to seven days, but it can be life-threatening, it said.

The agency said the current outbreak is unrelated to another multi-state rash of E. coli infections related to romaine lettuce earlier this year that left five people dead and sickened nearly 200.

The U.S. Food and Drug Administration and the CDC traced the origin of that contamination to irrigation water in the Yuma, Arizona, growing region.

(Reporting by Peter Szekely in New York; Editing by David Gregorio)

WHO extremely concerned about Ebola ‘perfect storm’ in Congo

FILE PHOTO: A medical worker wears a protective suit as he prepares to administer Ebola patient care at The Alliance for International Medical Action (ALIMA) treatment center in Beni, North Kivu province of the Democratic Republic of Congo September 6, 2018. REUTERS/Fiston Mahamba/File Photo

By Tom Miles

GENEVA (Reuters) – The World Health Organization (WHO) said on Tuesday an Ebola outbreak in northeastern Democratic Republic of Congo could worsen rapidly because of attacks by armed groups, community resistance and the geographic spread of the disease.

At least 100 people have died in the outbreak, out of 150 cases in North Kivu and Ituri provinces.

“We are now extremely concerned that several factors may be coming together over the next weeks and months to create a potential perfect storm,” the WHO’s head of emergency response, Peter Salama, told a news conference in Geneva.

The response is at a critical juncture and, although the weekly number of new cases has fallen from about 40 to about 10 in the past few weeks and more than 11,700 people have been vaccinated, major obstacles remain ahead, Salama said.

Attacks by armed opposition groups have increased in severity and frequency, especially those attributed to the Alliance of Democratic Forces, most dramatically an attack that killed 21 in the city of Beni, where WHO’s operation is based.

The city has declared a “ville morte”, a period of mourning until at least Friday, obliging WHO to suspend its operations.

Overnight on Monday, unidentified assailants entered the town of Oïcha, about 20 km (12 miles) north of Beni, burned houses, killed one man and kidnapped 14 children and one woman, according to two local officials. Oicha has two confirmed cases of the virus and one probable case.

On Monday 80 percent of Ebola contacts — people at risk of developing the disease and so requiring monitoring — and three suspected cases in and around Beni could not be reached for disease monitoring.

EXPLOITATION

Pockets of “reluctance, refusal, and resistance” to accept Ebola vaccination were generating many of the new cases, Salama said.

“We also see a very concerning trend. That resistance, driven by quite natural fear of this terrifying disease, is starting to be exploited by local politicians, and we’re very concerned in the run-up to elections, projected for December, that exploitation… will gather momentum and make it very difficult to root out the last cases of Ebola.”

Some people were fleeing into the forest to escape Ebola follow-up treatment and checks, sometimes moving hundreds of kilometers, he said.

There was one such case to the south of Beni, and another to the north, close to the riverbanks of Lake Albert. Both were inaccessible for security reasons.

Neighboring Uganda was now facing an “imminent threat”, and social media posts were conflating Ebola with criticism of the DRC government and the United Nations and “a range of conspiracy theories”, which could put health workers at risk.

“We will not yet consider the need to evacuate but we are developing a range of contingency plans to see where our staff are best located,” he said.

“If WHO and its partners had to leave North Kivu … we would have grave concerns that this outbreak would not be able to be well controlled in the coming weeks or months.”

(Reporting by Tom Miles; Additional reporting by Fiston Mahamba in Goma,; Editing by Andrew Heavens, William Maclean)

Congo approves more experimental Ebola treatments as cases rise

FILE PHOTO: Congolese health workers prepare the Ebola treatment centre in the village of Mangina in North Kivu province of the Democratic Republic of Congo, August 18, 2018. REUTERS/Olivia Acland

KINSHASA (Reuters) – Democratic Republic of Congo has approved four more experimental treatments against the deadly Ebola virus, the health ministry said as it raced to contain an outbreak in its violence-torn east.

Health authorities last week started administering the U.S.-developed mAb114 treatment to Ebola patients, the first time such a treatment had been used against an active outbreak.

The health ministry said in a daily bulletin late on Tuesday that the 10 patients who received mAb114 since Aug. 11 have experienced a “positive evolution”, but the outbreak has continued to grow.

The four additional treatments approved by Congo’s ethics committee are Remdesivir, made by Israel’s Gilead Sciences; ZMapp, an intravenous treatment made by San Diego’s Mapp Pharmaceutical; Japanese drug Favipiravir; and one referred to as Regn3450 – 3471 – 3479.

Remdesivir was administered to its first patient in the town of Beni on Tuesday, who is doing well, the ministry said in its bulletin.

Six new cases and four new deaths have been confirmed from the haemmorhagic fever, which causes vomiting and severe diarrhea, the ministry said.

That brings the total number of deaths to 59 and confirmed cases to 75 since last month.

Congo, whose heavily forested interior makes its a natural home for Ebola, is at the forefront of a global campaign to combat the virus, which killed more than 11,000 people when it swept through West Africa from 2013-2016.

The Central African country has experienced ten Ebola outbreaks since the virus was discovered in northern Congo in 1976 – more than twice as many as any other country – and 33 people died in a flare-up in the northwest that ended last month.

In addition, a vaccine manufactured by Merck, which proved effective against the earlier outbreak in northwestern Congo, has been administered to 1,693 health workers and contacts of Ebola patients.

Insecurity in Congo’s eastern borderlands with Uganda has continued to complicate the response, with some contacts of Ebola patients located in so-called “red-zones”, which are off limits to emergency responders due to militia activity.

Instead, local health workers in those areas are monitoring the contacts and no Ebola cases have yet been confirmed there.

(Reporting By Amedee Mwarabu and Fiston Mahamba; Writing by Aaron Ross; Editing by Andrew Heavens)

WHO says Ebola team arrives in Congo

FILE PHOTO: Medecins Sans Frontieres (MSF) workers talk to a worker at an isolation facility, prepared to receive suspected Ebola cases, at the Mbandaka General Hospital, in Mbandaka, Democratic Republic of Congo May 20, 2018. REUTERS/Kenny Katombe

By Tom Miles and Fiston Mahamba

GENEVA/GOMA (Reuters) – An international delegation has arrived in the town of Beni in Democratic Republic of Congo, 30 km (18 miles) from where an Ebola outbreak was declared, the World Health Organization and Congolese officials said on Thursday.

Officials from the United Nations, the World Bank, the WHO and Democratic Republic of Congo’s Ministry of Health, including Health Minister Oly Ilunga, will support a team already on the ground.

Congo declared the new outbreak on Wednesday, just days after another outbreak that had killed 33 people in the northwest was declared over.

Twenty people have died from haemorrhagic fevers in and around Mangina, a densely populated town in North Kivu province about 30 km (18 miles) southwest of the city of Beni and 100 km from the Ugandan border.

The ministry has not made public when the deaths occurred. Another six who are still living are showing signs of fever, of which four tested positive.

“The Government-Partner delegation is holding its first meeting to organize the response,” North Kivu governor Julien Paluku tweeted. “Already a … team from Kinshasa is installing a laboratory and a single coordination center.”

But eastern Congo is a tinderbox of conflicts over land and ethnicity stoked by decades of on-off war and this could hamper efforts to contain the virus.

About 1,000 civilians have been killed by armed groups and government soldiers around Beni since 2014, and the wider region of North Kivu holds over 1 million displaced people.

(Writing by Tim Cocks; editing by Matthew Mpoke Bigg)

CDC warns residents in eight U.S. states of cut-fruit Salmonella outbreak

Under a very high magnification of 12000X, this colorized scanning electron micrograph shows a large grouping of Gram-negative Salmonella bacteria. REUTERS/Janice Haney Carr/CDC/Handout

By David Shepardson

WASHINGTON (Reuters) – The head of the U.S. Food and Drug Administration on Sunday urged residents of eight U.S. states to check for recalled pre-cut melon that is linked to an outbreak of Salmonella.

The FDA and U.S. Centers for Disease Control are investigating an outbreak linked to 60 illnesses and at least 31 hospitalizations in five states. No deaths have been reported and the agencies urged residents in the eight states to throw out any melon that may have been recalled.

On Friday, Caito Foods LLC, a unit of SpartanNash Co, recalled fresh-cut watermelon, honeydew melon, cantaloupe and fresh-cut mixed fruit products containing one of those melons produced at a Caito Foods facility in Indianapolis.

The recalled products were distributed to Georgia, Illinois, Indiana, Kentucky, Michigan, Missouri, North Carolina, and Ohio and sold in clear, plastic containers at stores including Costco Wholesale Corp, Kroger Co, Payless, Owen’s, Sprouts, Trader Joe’s, Walgreens, Walmart Inc, and Whole Foods, a unit of Amazon.com Inc.

FDA Commissioner Scott Gottlieb in a Twitter post late on Sunday urged people in the eight states to check the “fridge and freezer for recalled pre-cut melon linked to Salmonella outbreak.”

Of the 60 cases reported to date, 32 were reported in Michigan.

“Reports of illnesses linked to these products are under investigation, and Caito Foods is voluntarily recalling the products out of an abundance of caution,” the company said in a statement, adding it “has ceased producing and distributing these products as the company and FDA continue their investigation.”

Salmonella can result in serious illness and produce significant and potentially fatal infections in young children, frail or elderly people and others with weakened immune systems the company said.

The CDC said evidence suggested that melon supplied by Caito Foods “is a likely source of this multistate outbreak.”

The investigation is ongoing to determine if products went to additional stores or states, the agencies said.

(Reporting by David Shepardson; Editing by Peter Cooney)

WHO says Congo faces ‘very high’ risk from Ebola outbreak

FILE PHOTO: Congolese Health Ministry officials carry the first batch of experimental Ebola vaccines in Kinshasa, Democratic Republic of Congo May 16, 2018. REUTERS/Kenny Katombe/File Photo

By Tom Miles and Fiston Mahamba

GENEVA/KINSHASA (Reuters) – Democratic Republic of Congo faces a “very high” public health risk from Ebola because the disease has been confirmed in a patient in a big city, the World Health Organization (WHO) said on Friday, raising its assessment from “high” previously.

The risk to countries in the region was now “high”, raised from “moderate”, but the global risk remained “low”, the WHO said.

The reassessment came after the first confirmed case in Mbandaka, a city of around 1.5 million on the banks of the Congo River in the northwest of the country.

The case raised concerns that the virus, previously found in more rural areas, would be tougher to contain and could reach downstream to the capital Kinshasa, which has a population of 10 million.

It also followed the announcement by Congo’s health ministry of 11 newly confirmed cases in the smaller town of Bikoro, near the northwest village where the virus was first detected.

“The confirmed case in Mbandaka, a large urban center located on major national and international river, road and domestic air routes, increases the risk of spread within the Democratic Republic of the Congo and to neighboring countries,” the WHO said.

WHO Deputy Director-General for Emergency Preparedness and Response Peter Salama had told reporters on Thursday that the risk assessment was being reviewed.

“Urban Ebola is a very different phenomenon to rural Ebola because we know that people in urban areas can have far more contacts so that means that urban Ebola can result in an exponential increase in cases in a way that rural Ebola struggles to do.”

Later on Friday, the WHO will convene an Emergency Committee of experts to advise on the international response to the outbreak, and decide whether it constitutes a “public health emergency of international concern”.

The nightmare scenario is an outbreak in Kinshasa, a crowded city where millions live in unsanitary slums not connected to a sewer system.

Jeremy Farrar, an infectious disease expert and director of the Wellcome Trust global health charity, said the outbreak had “all the features of something that could turn really nasty”.

“As more evidence comes in of the separation of cases in space and time, and healthcare workers getting infected, and people attending funerals and then traveling quite big distances – it’s got everything we would worry about,” he told Reuters.

WHO spokesman Tarik Jasarevic said on Friday that Congo’s Ministry of Health had provided updated figures: 45 cases overall since April 4, including 14 confirmed, 10 suspected and 21 probable. There had been 25 deaths, but no new infections among healthworkers, Jasarevic told reporters.

The WHO is sending 7,540 doses of an experimental vaccine to try to stop the outbreak in its tracks, and 4,300 doses have already arrived in Kinshasa. It will be used to protect health workers and “rings” of contacts around each case.

The vaccine supplies will be enough to vaccinate 50 rings of 150 people, the WHO said. Each ring represents the number of people including health workers who may have come into contact with an Ebola patient.

As of 15 May, 527 contacts had been identified and were being followed up and monitored.

(This story corrects to clarify location of Mbandaka.)

(Additional reporting by Kate Kelland in London; Writing by Tom Miles and Edward McAllister; Editing by Matthew Mpoke Bigg)

WHO says 19 dead, 39 infected so far in Congo Ebola outbreak

A health worker is sprayed with chlorine after visiting the isolation ward at Bikoro hospital, which received a new suspected Ebola case, in Bikoro, Democratic Republic of Congo May 12, 2018. REUTERS/Jean Robert N'Kengo

GENEVA (Reuters) – Democratic Republic of Congo reported 39 suspected, probable or confirmed cases of Ebola between April 4 and May 13, including 19 deaths, the World Health Organization said on Monday.

It said 393 people who identified as contacts of Ebola patients were being followed up. Information about the outbreak in Bikoro, Iboko and Wangata health zones in Equateur province was still limited, the WHO said in a statement.

At present the outbreak did not meet the criteria for declaring a “public health event of international concern”, which would trigger the formation of an emergency WHO committee.

(Reporting by Tom Miles, Editing by William Maclean)