Month: May 2018

Health Experts at the World Health Assembly in Geneva agree the next few weeks will be crucial in determining whether the Ebola outbreak in Democratic Republic of Congo can be contained and prevented from spreading to highly-populated urban areas.

Two weeks have elapsed since the first laboratory-confirmed case of Ebola was discovered in the remote, rural town of Bikoro in DR Congo’s northwestern Equateur Province.

Soon after the Ebola outbreak was declared May 8, World Health Organization Director General Tedros Adhanom Ghebreyesus and several associates went to the region to assess the situation.

Tedros said he was pleased by the government’s quick response.

“The government had already triggered the community committees so that communities can take the ownership and contribute, and they are going house to house to identify cases and to identify contacts.Starting from the Government leadership, everything is triggered,” he said. “We are watching it around the clock, 24/7, and we hope it will have a better outcome.”

This rapid response to the current emergency is a sea change from the way the WHO and other agencies reacted to the West African Ebola epidemic.More than 11,000 people were killed before it was brought under control in 2016.

This is the 9th Ebola outbreak in DRC since the disease was simultaneously discovered in DRC and South Sudan in 1976. In the eight previous outbreaks, Ebola occurred in either isolated rural areas or in small towns where the disease remained largely confined.

Peter Salama, WHO Deputy Director-General, Emergency Preparedness and Response, said the current outbreak has features of two previous typologies — a combination of rural villages, and larger towns and cities. These factors “have given us concern that the outbreak has the potential to expand,” he said.

“First is the involvement of a town — Mbandaka — which is the capital of the Equateur Province in that region with a population of more than 1 million people,” he added. “Secondly, that town is on the Congo River and its tributaries, which ultimately connects this outbreak potentially to Kinshasa and also to surrounding countries such as the Republic of Congo and the Central African Republic.”

He said five health care workers in Mbandaka have been infected with the virus, which is a potential signal for further amplification. He noted there are 58 confirmed and suspected cases of Ebola, including 27 deaths.He said health agencies and the government are actively following 600 contacts to learn the specific locations of the outbreak.

“It is really the detective work of epidemiology that will make or break the response to this outbreak,” he said. “It is documenting how people are getting infected and, therefore, managing control, the control of transmission. … We are following three separate chains of transmission, and each one has the potential to expand, if not controlled.”

One potentially powerful tool for containing the spread of Ebola is an experimental, protective vaccine that was not available during the West African epidemic. More than 7,500 doses of the vaccine have been sent to DRC.

Salama said a ring vaccination program began Monday in Mbandaka.

“This is not mass immunization,” he noted. “This is highly targeted ring vaccination where concerned or probable cases are identified and then each and every contact is traced and vaccinated, and then the contacts of those contacts are then traced and vaccinated, forming protective rings around that case — to protect the people themselves — the contacts, but also to prevent further community transmission.”

Salama said this is the same approach used in the 1970s for the elimination of smallpox.

Regional risk

On a regional level, the World Health Organization has designated nine neighboring countries, which share porous borders with DRC at high risk of Ebola. Those most at risk are the Republic of Congo and Central African Republic.The others include Angola, Burundi, Rwanda, South Sudan, Tanzania, Zambia and Uganda.

WHO Regional Director for Africa, Matshidiso Moeti, said WHO is helping these countries scale up preparedness so they can detect, investigate, and manage the disease.

“We are helping countries to pre-position the supplies that they will need, including personal protective equipment, infra-red thermometers, rapid diagnostic test kits and other critical supplies,” said Moeti. “We are working with members states and partners at all levels to scale up surveillance, detection, case management at the border areas surrounding the Democratic Republic of the Congo.”

Salama said the exceptionally rapid, robust response to the outbreak and strong multi-partner effort bodes well for the work ahead.

“It is not over yet,” he cautioned. “We are really just at the beginning … we are on the epidemiological knife-edge of this response.The next few weeks will really tell if this outbreak is going to expand to urban areas or if we are going to be able to keep it under control.”

The World Health Organization is appealing for $26 million to keep the operation going for the next six months.It says strong, continued international support is essential for combating this deadly disease.
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Two infected patients who fled from an Ebola treatment center in a Congo city of 1.2 million people later died, an aid group said Wednesday while asserting that “forced hospitalization is not the solution to this epidemic.”

As the number of suspected Ebola cases continued to rise, experts emphasized that more community engagement is needed to prevent the spread of the deadly virus.

Three patients left of their own accord from the isolation zone of the Wangata hospital in Mbandaka city between Sunday and Tuesday, said Henry Gray, emergency coordinator for Medecins Sans Frontieres.

One patient had been about to be discharged, he said.

“The two others were helped to leave the hospital by their families in the middle of the night on Monday. One of the men died at home and his body was brought back to the hospital for safe burial with the help of the MSF teams; the other was brought back to the hospital yesterday morning and he died during the night,” Gray said in a statement.

Hospital staff made every effort to convince the patients and their families not to leave and to continue treatment, Gray said.

Three Ebola deaths have been confirmed since Congo’s health ministry announced the current outbreak of the often lethal hemorrhagic fever on May 8. It was not immediately clear if the two deaths reported by MSF were confirmed Ebola ones.

Congo’s health ministry on Wednesday announced six new suspected cases in the rural Iboko health zone in the country’s northwest and two in Wangata. There are now 28 confirmed Ebola cases, 21 probable ones and nine suspected. Overall the death toll stands at 27.

“We’re on the epidemiological knife’s edge of this response. The next few weeks will really tell if this outbreak is going to expand to urban areas or if we’re going to be able to keep it under control,” Dr. Peter Salama, the World Health Organization emergencies chief, told a World Health Assembly session Wednesday.

Worrying factors include the spread of confirmed cases to Mbandaka city and the fact that five health workers have been infected, signaling “a potential for further amplification,” he said. Front-line workers are especially at risk of contracting the virus, which spreads in contact with the bodily fluids of infected people, including the dead.

Finally, Salama said, the outbreak has “three or four separate epicenters,” making it more challenging to contain. “It’s really the detective work of epidemiology that will make or break the response to this outbreak. It’s documenting how people are getting infected and therefore managing to control the transmission,” he said.

“We are following three separate chains of transmission,” he said. “One associated with a funeral that took place in a neighboring town of Bikoro; one associated with a visit to a health care facility more than 80 kilometers (50 miles) away in the small village of Iboko and one where we’re still gathering data on that’s related to a church ceremony.”

WHO is accelerating efforts with nine countries neighboring Congo to try to prevent the Ebola outbreak from spreading beyond the border.

The top two priorities are Central African Republic and the Republic of Congo near the epicenter of the outbreak, Matshidiso Moeti, WHO’s director for Africa, told the WHA session. The other countries are Angola, Burundi, Rwanda, South Sudan, Tanzania, Zambia and, to a lesser extent, Uganda.

WHO began vaccinations this week and is using a “ring vaccination” approach, targeting the contacts of people infected or suspected of infection and then the contacts of those people. More than 600 contacts have been identified, WHO said.

There is no specific treatment for Ebola. Symptoms include fever, vomiting, diarrhea, muscle pain and at times internal and external bleeding. The virus can be fatal in up to 90 percent of cases, depending on the strain.

The UK on Wednesday pledged another 5 million pounds ($6.6 million) to help combat the outbreak.

WHO Director-General Tedros Adhanom Ghebreyesus said simply: “We are watching it around the clock, 24-7.”
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In this arid stretch of Kajiado County, where worsening heat and drought have been tough on livestock farmers, Arnold Ole Kapurua is experimenting with a hot new crop: chilis.

Ole Kapurua, 29, a farmer and agronomist, now grows two acres of the fiery pods — and is training other farmers to do the same — as a way to protect their incomes in the face of harsher weather linked to climate change.

“With time we realized that we weren’t making good money as our livestock income stagnated,” he said. “During drought we lost our herds to hunger and diseases while during the rainy season we lost some to floods making us live on a lean budget.”

But after a bit of research, “I realized that chilis had climate friendly features,” he said.

While some farmers still rely entirely on livestock in the region, a growing number are now concentrating their energy on farming chili, which can be grown with limited amounts of water, said Samuel Ole Kangangi, another new chili farmer.

Over the last five years, more than 100 farmers in the region have begun growing chili, most after trying other crops, including maize and beans, that didn’t cope as well with drought and brought in little money, the farmers said.

Well-managed chili farms can produce an ongoing harvest over six months, with an acre of land producing up to two tons of peppers a week, Ole Kapurua said.

That level of harvest can bring as much as 80,000 Kenyan shillings ($800) a season, he said.

“That cannot be compared to livestock rearing as one cannot afford to be selling a cow every week, thus making chili farming a better option,” said the farmer.

Solomon Simingor, another farmer in Kajiado County, said a farmer with at least two acres of land can earn as much as three times more with chili than with cattle, in his experience.

To provide enough water to keep their plants irrigated, farmers in the region are turning to building small dams to catch water in the rainy season.

Mulch around the plants — usually grass or plastic — also helps hold onto limited water and keep down weeds.

Kenyan farmers have been growing and exporting chilies to Britain, Germany, Norway and France for about 10 years. Chili is also sold in local markets and supplied to supermarkets.

Many of the new farmers also have turned to eating the vitamin-rich peppers at home — often fried with onions and meat — in a dietary change for families in the region.

Now, “when children are asked to fetch vegetables from the farm, they also fetch chili as to them it is part and parcel of their diet,” Ole Kapurua said.

Paul Rangenga, a chili farming expert who has been advising farmers on taking up the crop and who runs a produce company, said he believes chlli can provide a workable alternative for herders dealing with worsening drought stress.

“Chili farming is a long-term form of investment and the risks involved are minimal, as the crops are drought resistant and well adapted to arid regions,” he said.
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The last thing Lizabeth Loud, a month from giving birth, wanted was to be forced into treatment for her heroin and prescription painkiller addiction.

But her mother saw no other choice, and sought a judge’s order to have her committed against her will. Three years later, Loud said her month in state prison, where Massachusetts sent civilly committed women until recent reforms, was the wake-up call she needed.

“I was really miserable when I was there,” the 32-year-old Boston-area resident said. “That was one bottom I wasn’t willing to revisit again.”

An Associated Press check of data in some key states has found that the use of involuntary commitment for drug addiction is rising. And in many places, lawmakers are trying to create or strengthen laws allowing authorities to force people into treatment.

But critics, including many doctors, law enforcement officials and civil rights advocates, caution that success stories like Loud’s are an exception. Research suggests involuntary commitment largely doesn’t work and could raise the danger of overdose for those who relapse after treatment.

And expanding civil commitment laws, critics argue, could also violate due process rights, overwhelm emergency rooms and confine people in prison-like environments, where treatment sometimes amounts to little more than forced detox without medications to help mitigate withdrawal symptoms.

At least 35 states currently have provisions that allow families or medical professionals to petition a judge, who can then order an individual into treatment if they deem the person a threat to themselves or others. But the laws haven’t always been frequently used.

Wisconsin Gov. Scott Walker signed a law last year allowing police officers to civilly commit a person into treatment for up to three days. In Washington state, legislation that took effect April 1 grants mental health professionals similar short-term emergency powers. In both states, a judge’s order would still be required to extend the treatment.

Related bills have also been proposed this year in states including Pennsylvania, New Jersey and Massachusetts, where involuntary commitment has emerged as one of the more controversial parts of Republican Gov. Charlie Baker’s wide-ranging bill dealing with the opioid crisis.

Massachusetts already allows for judges to order people to undergo up to three months of involuntary treatment, but lawmakers are considering giving some medical professionals emergency authority to commit people for up to three days without a judge’s order.

Burden on hospitals?

The proposal is a critical stopgap for weekends and nights, when courts are closed, said Patrick Cronin, a director at the Northeast Addictions Treatment Center in Quincy, who credits his sobriety to his parents’ decision to have him involuntarily committed for heroin use almost 15 years ago.

But giving doctors the ability to hold people in need of treatment against their will, as Massachusetts lawmakers propose, will burden emergency rooms, which already detain people with psychiatric problems until they can be taken to a mental health center, said Dr. Melisa Lai-Becker, president of the Massachusetts College of Emergency Physicians, an advocacy group.

“We’ve got a crowded plane, and you’re asking the pilots to fly for days waiting for an open landing strip while also making sure they’re taking care of the passengers and forcibly restraining the rowdy ones,” Lai-Becker said.

Baker’s administration stressed the proposal wouldn’t take effect until 2020, providing time to work out concerns.

Rising numbers

Even without the state legislative efforts, use of involuntary commitment for drug addiction is rising, according to information the AP obtained from states that have historically used it the most.

Florida reported more than 10,000 requests for commitment in both 2016 and 2015, up from more than 4,000 in 2000, according to court records.

Massachusetts reported more than 6,000 forced commitments for drug addiction in both fiscal years 2016 and 2017, up from fewer than 3,000 in fiscal year 2006.

In Kentucky, judges issued more than 200 orders of involuntary commitment for alcohol or drug abuse in the last calendar year, up from just five in 2004, according to court records. The state has so far reported nearly 100 such commitments this year.

But researchers caution there hasn’t been enough study on whether forced treatment is actually working. And many states don’t track whether people are being civilly committed multiple times, let alone whether they get sober for good, the AP found.

In Massachusetts, where fatal overdoses dropped for the first time in seven years in 2017, state public health officials don’t credit increased use of civil commitment, but rather better training for medical professionals, tighter regulations on painkillers, more treatment beds, wider distribution of the overdose reversal drug naloxone, and other initiatives.

A review published in the International Journal of Drug Policy in 2016 found “little evidence” forced treatment was effective in promoting sobriety or reducing criminal recidivism.

Another 2016 study by Massachusetts’ Department of Public Health found the involuntarily committed were more than twice as likely to die of an opioid-related overdose than those who went voluntarily, but those findings shouldn’t be viewed as an indictment of the process, argues Health and Human Services office spokeswoman Elissa Snook.

“Patients who are committed for treatment are among the sickest, most complex and at the greatest risk for an overdose,” she said. “Involuntary commitment is an emergency intervention, to help individuals stay alive until they are capable of entering treatment voluntarily.”

Most states send the civilly committed to treatment facilities run or contracted by public health agencies. The costs generally fall on patients, their families or insurance providers.

Minimum-security prison

Massachusetts stands out because, until recently, it sent those civilly committed for drug addiction to prisons. That decadeslong practice ended for women in 2016, but many men are still sent to the Massachusetts Alcohol and Substance Abuse Center, which is housed in a minimum-security prison in Plymouth, near Cape Cod.

Patients wear corrections-issued uniforms and submit to prison regulations like room searches and solitary confinement. They also aren’t given methadone or buprenorphine to help wean off heroin or other opioids, as they might in other treatment centers.

Michelle Wiley, whose 29-year-old son David McKinley killed himself there in September after he asked her to have him civilly committed for the third time, said she isn’t opposed to expanded use of the practice as long as those with addiction aren’t sent to places like Plymouth.

In the days before he hanged himself in his room, Wiley said, her son had complained to her about dirty conditions, poor food and not enough substance abuse counselors while he went through withdrawal.

“You think it’s going to be helpful until you hear what it’s like,” she said. “If I had to do it over, I wouldn’t send him to that place.”

The corrections department has since taken steps to improve conditions, including more frequent patrols by prison guards and extended hours for mental health professionals, department spokesman Jason Dobson said.

As for Loud, the Massachusetts woman civilly committed while pregnant, she said she has found peace.

After briefly relapsing following her son’s birth, she has been sober for about a year and a half. She focuses her energies on raising her son, attending regular support meetings and pursuing a passion sidelined by her addiction: competitive Muay Thai fighting. Her fourth bout is in July.

Loud has also reconciled with her mother. The two now live together, along with her son. 

“It took me a long time to understand what she was going through,” Loud said. “She was just trying to save her daughter.”
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Health officials in Nigeria say 12 people have died from cholera in recent days.

More than 100 people have been sickened in the outbreak located in the Mubi district in the northeastern state of Adamawa.

Cholera is a bacterial disease spread by contaminated food or drinking water. It causes severe diarrhea and subsequent dehydration, and can kill within hours if not treated.
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Preparations are under way for a mass Ebola vaccination campaign in the Democratic Republic of Congo as the Ministry of Health and international aid agencies hold a second day of inoculations in northwestern Equateur Province. The latest World Health Organization estimates report 51 cases of Ebola, including 27 deaths.

The World Health Organization said 33 people, most of them front-line health care workers, were vaccinated against Ebola on Monday in Mbandaka, a city of more than one million people. It said a few high-risk people from the community also were vaccinated during the first day of the campaign.

More than 7,500 doses of the Ebola vaccine have been shipped to the Democratic Republic of Congo. WHO spokesman Tarik Jasarevic told VOA he expects the campaign to accelerate and ultimately reach thousands of people.

He said a lot of work has to be done before this complex operation can hit its stride. For example, he said transporting the vaccines and storing them in freezers in affected areas is a major challenge.

“You need to have vaccination teams to be trained so they know exactly what they need to do, how to get a consent, how to define eligibility of a contact and contacts of contacts,” he added. “So, all of that has to be done in a very, very short period of time under very difficult conditions.”

Jasarevic said a team from Doctors Without Borders will begin vaccinations later in the week in Bikoro, the remote rural town in northwestern Equateur Province, where the deadly Ebola virus was discovered two weeks ago.

The Ebola vaccine is not licensed, but a major trial in 2015 in Guinea showed it gave a high rate of protection against the disease. A so-called ring vaccination strategy is being applied. It relies on tracing all the contacts and extended contacts of a recently confirmed case as soon as possible. More than 600 contacts have been identified.
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