Family sent back to DR Congo after two die of Ebola in Uganda

A health worker checks the temperature of a woman as she crosses the Mpondwe border point separating Uganda and the Democratic Republic of Congo as part of the ebola screening at the computerised Mpondwe Health Screening Facility in Mpondwe, Uganda June 13, 2019. REUTERS/Newton Nabwaya

By Elias Biryabarema

KAMPALA (Reuters) – Authorities repatriated the relatives of two people who died of Ebola in Uganda back to the Democratic Republic of Congo on Thursday, including a 3-year-old boy confirmed to be suffering from the disease, the Ugandan health minister said.

The cases marked the first time the virus has crossed an international border since the current outbreak began in Congo last August. The epidemic has already killed 1,390 people in eastern Congo.

The family sent home on Thursday had crossed from Congo to Uganda earlier this week and sought treatment when a 5-year-old boy became unwell. He died of Ebola on Tuesday. His 50-year-old grandmother, who was accompanying them, died of the disease on Wednesday, the ministry said.

They were the first confirmed deaths in Uganda in the current Ebola outbreak.

The dead boy’s father, mother, 3-year-old brother and their 6-month-old baby, along with the family’s maid, were all repatriated, the minister’s statement said.

The 3-year-old has been confirmed to be infected with Ebola. His 23-year-old Ugandan father has displayed symptoms but tested negative, Ugandan authorities said.

“Uganda remains in Ebola response mode to follow up the 27 contacts (of the family),” the statement said.

Three other suspected Ebola cases not related to the family remain in isolation, the ministry said.

The viral disease spreads through contact with bodily fluids, causing hemorrhagic fever with severe vomiting, diarrhea and bleeding.

UGANDA PRECAUTIONS

Authorities in neighboring Uganda and South Sudan have been on high alert in case the disease spreads.

On Thursday, Uganda banned public gatherings in the Kasese district where the family crossed the border. Residents are also taking precautions, local journalist Ronald Kule told Reuters.

“They are a little alarmed now and they realize that the risk of catching Ebola is now real,” he said.

“Hand washing facilities have been put in place, with washing materials like JIK (bleach) and soap. There’s no shaking of hands, people just wave at each other.”

At the border, health workers checked lines of people and isolate one child with a raised temperature, a Reuters journalist said.

Uganda has already vaccinated many frontline health workers and is relatively well prepared to contain the virus.

The World Health Organization (WHO) sent 3,500 doses of a Merck experimental vaccine to Uganda this week, following 4,700 initial doses.

Dr. Mike Ryan, head of WHO’s emergencies program, said that he expected Uganda to approve the use of experimental therapeutic drug treatments, to be shipped “in coming days”.

Monitoring and vaccination had been stepped up, but there had been “no panic reaction” so far to the cases there.

The WHO has said it will reconvene an emergency committee on Friday to decide whether the outbreak is an international public health emergency and how to manage it.

Authorities have struggled to contain the disease partly because health workers have been attacked nearly 200 times this year in conflict-hit eastern Congo, the epicenter of the outbreak.

(Reporting by Elias Biryabarema; Writing by Omar Mohammed and Katharine Houreld; Editing by Angus MacSwan)

WHO issues warning as measles infects 34,000 in Europe this year

FILE PHOTO: A vial of the measles, mumps, and rubella (MMR) vaccine is pictured at the International Community Health Services clinic in Seattle, Washington, U.S., March 20, 2019. REUTERS/Lindsey Wasson/File Photo

By Kate Kelland

LONDON (Reuters) – More than 34,000 people across Europe caught measles in the first two months of 2019, with the vast majority of cases in Ukraine, the World Health Organization said on Tuesday as it urged authorities to ensure vulnerable people get vaccinated.

The death toll among 34,300 cases reported across 42 countries in the WHO’s European region reached 13, with the virus killing people in Ukraine – which is suffering a measles epidemic – as well as in Romania and Albania. The risk is that outbreaks may continue to spread, the WHO warned.

“If outbreak response is not timely and comprehensive, the virus will find its way into more pockets of vulnerable individuals and potentially spread to additional countries within and beyond the region,” it said in a statement.

“Every opportunity should be used to vaccinate susceptible children, adolescents and adults.”

Measles is a highly contagious disease that can kill and cause blindness, deafness or brain damage. It can be prevented with two doses of an effective vaccine, but – in part due to pockets of unvaccinated people – it is currently spreading in outbreaks in many parts of the world including in the United States, the Philippines and Thailand.

In Europe, the majority of measles cases so far in 2019 are in Ukraine, which saw more than 25,000 people infected in the first two months of the year.

There is no specific antiviral treatment for measles, and vaccination is the only way to prevent it, the WHO said. Most cases are in unvaccinated or under-vaccinated people.

It added that even though the region had its highest ever estimated coverage for the second dose of measles vaccination in 2017 – at around 90 percent – some countries have had problems, including declining or stagnating immunization coverage in some cases, low coverage in some marginalized groups, and immunity gaps in older populations.

The WHO called on national health authorities across the region to focus efforts on ensuring all population groups have access to vaccines.

“The impact on public health will persist until the ongoing outbreaks are controlled,” it said, adding that health authorities should “identify who has been missed in the past and reach them with the vaccines they need.”

A report by the United Nations children’s fund UNICEF last month found that more than 20 million children a year missed out on measles vaccines across the world in the past eight years, laying the ground for dangerous outbreaks.

(Reporting by Kate Kelland; Editing by Mark Heinrich)

Congo Ebola death toll nears 1,000, new vaccine planned -WHO

Mike Ryan, Executive Director of the World Health Organisation (WHO) attends a news conference on the Ebola outbreak in the Democratic Republic of Congo at the United Nations in Geneva, Switzerland May 3, 2019. REUTERS/Denis Balibouse

By Stephanie Nebehay

GENEVA (Reuters) – The World Health Organization said on Friday it feared continued “intense transmission” of Ebola virus in the Democratic Republic of Congo, where deaths from a nine-month-old epidemic stood at 994 and were expected to exceed 1,000 within hours.

The WHO plans to expand vaccination with an unlicensed new Ebola vaccine made by Johnson & Johnson, in addition to a Merck vaccine already being used, said Dr. Michael Ryan, executive director of WHO’s Health Emergencies Programme.

“We are anticipating a scenario of continued intense transmission,” Ryan told a news briefing.

“We haven’t exceeded the 1,000 (deaths) as of this morning but we will likely exceed that today when we see the numbers later this evening. We want to use every tool in the tool box.”

Security incidents continue to plague the response to the outbreak, with 119 since January alone, Ryan said. This curtails access and thereby slows efforts to vaccinate more than 900 people a day as well as daily checks on some 12,000 people potentially exposed to the virus, he said.

“We still face major issues of community acceptance and trust,” Ryan added.

There was a would-be assault on an Ebola treatment facility in Butembe on Thursday, he said, adding that nobody was injured and the assailants were captured.

(Reporting by Stephanie Nebehay; Editing by Mark Heinrich)

Ebola spread concentrated in Congo, not a wider emergency: WHO

FILE PHOTO: Health workers carry a newly admitted confirmed Ebola patient into a treatment centre in Butembo in the eastern Democratic Republic of Congo, March 28, 2019. REUTERS/Baz Ratner

By Stephanie Nebehay and Kate Kelland

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 signaled that greater resources and international coordination are needed.

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

It had not spread across borders to Uganda, Rwanda or South Sudan, but neighboring 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 epicenters of Butembe, Katwe and Vuhovi, said Mike Ryan, head of the WHO’s health emergencies program.

“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 centers 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.

(Reporting by Stephanie Nebehay and Kate Kelland Additional reporting by Aaron Ross in Dakar; Editing by Hugh Lawson and Frances Kerry)

Battle against Ebola being lost amid militarized response, MSF says

FILE PHOTO: A mother of a child, suspected of dying from Ebola, cries outside a hospital during the funeral in Beni, North Kivu Province of Democratic Republic of Congo, December 17, 2018. REUTERS/Goran Tomasevic

By Tom Miles

GENEVA (Reuters) – The battle against Ebola in Democratic Republic of Congo is failing because ordinary people do not trust health workers and an overly militarized response is alienating patients and families, the medical charity MSF said on Thursday.

Last week Medecins Sans Frontres (Doctors Without Borders) suspended medical activities at the focal point of the epidemic after two of its facilities were torched by unidentified assailants.

MSF’s international president Joanne Liu said the outbreak, which has killed 569 people, would not be beaten unless the community trusted the authorities and were treated humanely.

“The existing atmosphere can only be described as toxic,” Liu told reporters in Geneva.

Ebola responders were increasingly seen as the enemy, with more than 30 attacks and incidents against the Ebola response in the past month alone, she said.

The epidemic is in a region of Congo that is prey to armed groups and violence where officials are prone to see threats through a security lens and to use force.

“There is a lot of militarization of the Ebola response,” she said. “Using police to force people into complying with health measures is not only unethical, it’s totally counterproductive. The communities are not the enemy.”

Involvement of security and police forces merely deepened suspicions that Ebola was being used as a political tool, she said.

A spokeswoman for Congo’s Health Ministry said there appeared to be confusion about the security forces’ role.

“The police and the army are not involved in Ebola response activities and their role has never been to enforce sanitary measures,” Jessica Ilunga said.

The Interior Ministry has been asked to guarantee security, as it is unacceptable for health officials to be threatened and attacked, or for the threat of violence to stop families burying their loved ones in a dignified and safe manner, she said.

MSF was insisting on security before it returned to its damaged facilities, she said. Local officials, unlike international staffers, did not have the privilege of being evacuated for security reasons, she said.

Liu said there were still signs the outbreak – the second worst ever – was not being brought under control.

Forty percent of deaths were outside medical centers, meaning patients had not sought care, and 35 percent of new patients were not linked to existing cases, meaning the spread of the disease was not being tracked.

“Ebola still has the upper hand,” Liu said.

Villagers saw fleets of cars racing to pick up a single sick person and vast amounts of money pouring in. Some were instructed to wash their hands but had no soap to do so.

“They see their relatives sprayed with chlorine and wrapped in plastic bags, buried without ceremony. Then they see their possessions burned,” she said.

 

(Reporting by Tom Miles, additional reporting by Giulia Paravicini in Kinshasa; Editing by Angus MacSwan)

China warns pig trade against African swine fever cover-ups as Taiwan concerns grow

Pork for sale is seen at a market in Beijing, China December 26, 2018. Picture taken December 26, 2018. REUTERS/Jason Lee

BEIJING/TAIPEI (Reuters) – China has warned the country’s pork industry that covering up cases of African swine fever is a crime, days after a dead pig was found on a Taiwanese beach prompting Taipei to claim Beijing was not sharing accurate information on the disease.

China’s animal husbandry and veterinary affairs bureau is stepping up investigation and punishment of illegal activity in the pig industry, said a statement published on the Ministry of Agriculture and Rural Affairs website on Friday.

Failing to report deaths and privately slaughtering and selling sick or dead pigs would be pursued under criminal law, it said, and compensation of 1,200 yuan ($175) for each pig culled was sufficient incentive for farmers to report the disease.

In the worst epidemic of the disease ever seen, China has confirmed about 100 cases of African swine fever across 23 provinces since August last year. The disease, for which there is neither cure nor vaccine, is deadly to pigs but does not harm people.

But many experts believe it is even worse than has been reported, and Taiwan President Tsai Ing-wen urged Beijing last month to “not conceal” information about the disease.

Tsai raised the issue again in a New Year’s speech after a dead pig was found on a beach on Taiwan’s Kinmen island, a half-hour ferry ride from the east coast of China. The pig has since been confirmed to have the African swine fever virus, while another dead pig was found on a nearby island on Friday, Taiwan’s official Central News Agency reported.

“During our recent efforts to prevent an African swine fever epidemic, China’s government has never followed the relevant agreements and provided Taiwan with accurate, real-time reports about the epidemic situation,” she said.

China has repeatedly said that the disease has been effectively dealt with and is under control. The Ministry of Agriculture and Rural Affairs did not immediately respond to a fax seeking comment on Friday.

The dead animals found on the Taiwanese islands have stoked fears that Taiwan’s pigs could soon become infected with the disease.

Taiwan’s herd of 5.39 million pigs is tiny compared with China’s 700 million, but pork is the most popular meat in both places and domestic production in Taiwan reduces its need for imports of the staple meat.

(Reporting by Dominique Patton in BEIJING and Yi-Mou Lee in TAIPEI; Editing by Kenneth Maxwell)

Congo starts vaccinating health workers against Ebola

A Congolese health worker checks the temperature of a woman before the launch of vaccination campaign against the deadly Ebola virus near Mangina village, near the town of Beni, in North Kivu province of the Democratic Republic of Congo, August 8, 2018. REUTERS/Samuel Mambo

By Fiston Mahamba

MANGINA, Congo (Reuters) – Congolese officials and the World Health Organization began vaccinating health workers against the deadly Ebola virus on Wednesday, to try to halt an outbreak in Congo’s volatile east.

A Reuters witness on a visit to Mangina, the village in eastern Democratic Republic of Congo where the epidemic was declared, saw health workers in protective suits administering the injections.

So far 43 people are believed to have been infected in North Kivu and Ituri provinces, including 36 who have died, the health ministry said on Tuesday.

“We are putting all our energy and all our expertise to quickly control this epidemic,” Health Minister Oly Ilunga told journalists at the start of the vaccination campaign.

“All the measures of prevention are in place. The vaccination is the last phase. It will enable us to break the chain of transmission of this epidemic.”

More than 900 contacts of those infected have been identified for monitoring, although security is an issue in the area where militia groups operate, WHO said.

The disease, which causes fever, vomiting, and diarrhea, is spread through direct contact with body fluids.

“Around 40 health workers are expected to be vaccinated today; by end of the week, once all the necessary steps are in place, vaccination of community contacts and their contacts will commence,” WHO spokesman Tarik Jasarevic said.

WHO has said that analysis of genetic sequencing showed it was a separate outbreak from the one 2,500 km (1,500 miles) away in the northwest that ended less than two weeks ago after killing 33 people — but the same Zaire strain.

This is Congo’s 10th Ebola outbreak since the virus was first identified near northern Congo’s Ebola river.

“There is a huge fear among the local population,” Kaswera Mathumo, a medical worker at a clinic in Mangina, where the vaccinations were taking place, said.

The experimental vaccine being used, which is manufactured by Merck, proved successful during its first wide-scale usage against the previous outbreak in Equateur Province.

More than 3,000 doses remain in stock in the capital Kinshasa, allowing authorities to deploy them quickly to affected areas.

But they face security challenges in eastern Congo, a region bubbling with conflicts over land and ethnicity stoked by decades of on-off war.

Local authorities announced on Tuesday that 14 bodies had been discovered in the town of Tubameme, about 40 km (25 miles) northeast of the epicenter of the outbreak in the town of Mangina, suspected to have been killed by a militia group.

(Additional reporting by Tom Miles in Geneva; Writing by Tim Cocks and Stephanie Nebehay; Editing by Richard Balmforth)

Four ways to prevent loneliness from wrecking your retirement

A couple walks down the street in the Tverskaya district of Moscow August 17, 2013. REUTERS/Lucy Nicholson

By Chris Taylor

NEW YORK (Reuters) – When Monica Dwyer of West Chester, Ohio thinks of retirement, her mind wanders to her family friend Paul.

Paul had a wife and kids, and a good job at Procter & Gamble. But his wife died 15 years before he did, and, over time, his social circles started shrinking, along with his finances.

Eventually, Paul “barely had money to eat,” Dwyer said. He kept his thermostat at 55 Fahrenheit (13 Celsius), even in frigid Ohio winters. He could not drive, surviving on $1 McDonald’s hamburgers, and was alienated from his children, before he died.

“He was a forgotten soul,” Dwyer said.

You might not hear of stories like Paul’s very often, but they are out there. A study https://www.cigna.com/newsroom/news-releases/2018/new-cigna-study-reveals-loneliness-at-epidemic-levels-in-america released last month by health services company Cigna found that nearly half of Americans report feeling lonely sometimes or always, which the study concluded is a national “epidemic.”

“We had been hearing from customers that they are feeling more disconnected and lonely, so we wanted to do some research to understand the state of loneliness across the U.S.,” said Dr. Doug Nemecek, Cigna’s chief medical officer for behavioral health. “What we found was astounding.”

The emotional impact of loneliness in retirement is obvious – feelings of being isolated and misunderstood, with social interactions that lack meaning. But loneliness turns out to have financial ramifications as well.

Take healthcare costs, for instance. “People who feel lonely are less healthy,” Nemecek said. “There are many studies linking loneliness to worsening heart disease, cancer, diabetes, depression and substance abuse. In fact, healthwise, loneliness is comparable to smoking 15 cigarettes a day.”

If you are strategic and determined, there are multiple defenses against social isolation as you get older. Here are four tips from financial planners.

MOVE TO A RETIREMENT COMMUNITY

Society likes to poke fun at retiree developments, like the elder Seinfelds buying their condo in Del Boca Vista. But at larger senior communities like The Villages and Sun City Center, both in Florida, “you could participate in a group activity nearly every hour of every day,” said Holly Donaldson, a financial planner in Seminole, Florida.

Retirement communities are a powerful alternative to retiring “in place” in your own home. Staying in your home may initially sound appealing because of the comfort level with your surroundings, but it could eventually leave you very alone indeed, especially if you are struggling with physical disability.

KEEP WORKING

If you enjoy working, and your employer does not have any mandated retirement age, then by all means keep showing up at the office. The first benefit is cognitive, keeping you alert and active and maintaining that social circle in the workplace.

The second benefit is financial: Just a couple of years of additional work means you are actively building up your 401(k) assets, not drawing anything down, and boosting your Social Security payments by delaying taking them. That alone is enough to create a robust retirement outlook.

VOLUNTEER

Volunteers live longer, have lower levels of disability and higher levels of well-being, according to data analysis by the Corporation for National & Community Service (CNCS), a federal agency. One surprising fact: volunteerism has a greater impact on well-being than other factors like income, education or marriage.

Volunteering also assembles a new social circle to hold you up in dark times. Intuitively, many seniors know this already: More than 21 million older Americans provide 3.3 billion hours of service every year, according to the CNCS.

CREATE SOCIAL CHECKS AND BALANCES

Retirees are highly susceptible to financial abuse, thanks to social isolation. The losses amount to an estimated $36.5 billion every year to fraud, scams and exploitation, according to a study by True Link Financial, a financial services company aimed at retirees, with the vast majority of financial abuse not even being reported.

The sad fact is that 90 percent of financial abuse comes at the hands of someone in a position of trust, like a family member, according to the non-profit National Adult Protective Services Association.

The best way to defend against being at the mercy of one person is by having multiple people in your corner. If you have church friends, childhood friends, extended family and volunteering friends – all looking out for you – it will be less likely you will be taken advantage of.

“I always recommend having duplicate financial statements sent to someone you trust,” advises Brett Anderson, a planner with St. Croix Advisors in Hudson, Wisconsin.

(Editing by Lauren Young and Frances Kerry)

Miami among cities at risk from yellow fever spread : study

FILE PHOTO: The downtown skyline of Miami, Florida is seen on Nov 5, 2015. REUTERS/Joe Skipper/File Photo

GENEVA (Reuters) – Miami is at risk of a deadly yellow fever outbreak because the disease could thrive there but the city has no checks on travelers arriving from endemic zones, a study to be published by the World Health Organization showed.

Yellow fever is spread by the same mosquito that causes Zika virus, which spread through the Americas after being detected in Brazil in 2015 and has been reported in southern Florida and southern Texas.

The U.S. Centres for Disease Control advises that yellow fever is found in tropical and subtropical areas of Africa and South America, and is a very rare cause of illness in U.S. travelers.

But the study, “International travel and the urban spread of yellow fever”, showed that almost 2.8 million people flew to the United States from endemic yellow fever areas in 2016.

Unlike some countries, the United States does not require travelers from such places to show proof of yellow fever vaccination.

“At a time when global yellow fever vaccine supplies are diminished, an epidemic in a densely populated city could have substantial health and economic consequences,” the researchers based in Canada, the United States and Britain wrote in the study.

Around 9.5 million people live in U.S. urban areas such as Miami that are ecologically suitable for an outbreak, they wrote in the study, issued online ahead of its publication in the Bulletin of the World Health Organization.

They said climate change, mobility, urbanization and a vaccine shortage had increased the risk of yellow fever globally and they called for a review of vaccination policies.

The study found 472 cities suitable for an outbreak in 54 countries, but many, such as New Delhi, Mumbai, Karachi, Manila and Guangzhou, required vaccination certificates on arrival from endemic countries.

WHO spokeswoman Fadela Chaib said the need for vaccination certificates was at each country’s discretion.

The researchers said a substantial proportion of the world’s yellow fever vaccine stocks had been used up by recent epidemics in Africa and Brazil, and further depleted by manufacturing difficulties. Preventive campaigns could cause shortages.

“Should another urban epidemic occur in the near future, vaccine demand could easily exceed the available supply,” they said.

Yellow fever, which can be hard to diagnose, causes symptoms including muscle pain, nausea and vomiting, and about 15 percent of cases lead to a more toxic phase within 24 hours, potentially experiencing jaundice, abdominal pain, deteriorating kidney function and bleeding from the mouth, nose, eyes or stomach.

Half of severe sufferers die within a week or two, but the rest recover without significant organ damage, according to WHO.

(Reporting by Tom Miles; Editing by Hugh Lawson)

U.S. life expectancy fell in 2016 as opioid overdoses surged: CDC

A used container of the drug Narcan used against opioid overdoses lies on the ground in a park in the Kensington section of Philadelphia, Pennsylvania, U.S. October 26, 2017. REUTERS/Charles Mostoller

NEW YORK (Reuters) – Life expectancy in the United States dipped in 2016 as the number of deaths due to opioid drug overdoses surged and total drug overdose deaths rose 21 percent to 63,600, the U.S. Centers for Disease Control and Prevention said on Thursday.

Life expectancy fell to 78.6 years, a decrease of 0.1 year from 2015, the second annual decline in a row and the first two-year decline since a drop in 1962 and 1963.

Opioid-related overdose deaths have been on the rise since 1999, but surged from 2014 to 2016, with an average annual increase of 18 percent, to become a national epidemic. From 2006 to 2014 the rise was only 3 percent annually on average and between 1999 to 2006 averaged 10 percent per year.

In 2016, 42,249 people died from opioid-related overdoses, up 28 percent from 2015, while the number of deaths from synthetic opioids other than methadone, such as fentanyl and tramadol, more than doubled to 19,413, the CDC said.

The 2016 rate of overdose deaths was up across all age groups but was highest rate among people aged 25 to 54.

West Virginia, Ohio, New Hampshire, the District of Columbia and Pennsylvania had the highest age-adjusted drug overdose death rates in 2016.

The number of drug overdose deaths involving natural and semisynthetic opioids, which include drugs like oxycodone and hydrocodone, was 14,487 in 2016.

As the U.S. opioid addiction epidemic has worsened, many state attorneys general have sued makers of these drugs as they investigate whether manufacturers and distributors engaged in unlawful marketing behavior.

President Donald Trump in October declared the opioid crisis a public health emergency, which senior administration officials said would redirect federal resources and loosen regulations to combat abuse of the drugs. However, he stopped short of declaring a national emergency he had promised months before, which would have freed up more federal money.

(Reporting by Caroline Humer; editing by Lisa Von Ahn and Jonathan Oatis)