Congolese cross-border trader’s Ebola death fuels Uganda outbreak fears

FILE PHOTO: A Congolese health worker prepares to administer Ebola vaccine, outside the house of a victim who died from Ebola in the village of Mangina in North Kivu province of the Democratic Republic of Congo, August 18, 2018. REUTERS/Olivia Acland/File Photo

By Tom Miles

GENEVA (Reuters) – A Congolese woman who died of Ebola this month vomited four times in a Ugandan market after crossing the border days earlier to sell fish, the WHO said, fuelling fears that the virus may be spreading beyond the Democratic Republic of Congo.

The current outbreak of the highly infectious disease has been all but confined to Congo, killing 1,673 people there – more than two-thirds of those who contracted it – over the past year, and three in Uganda last month.

A World Health Organization panel is debating whether to declare the outbreak “of international concern”, a designation that the agency’s head suggested a case this month in the large Congolese city of Goma had made more likely.

The fisherwoman traveled across the border to Mpondwe market on July 11, according to a Ugandan Health Ministry report published on Wednesday by the WHO.

It said 19 fishmongers were listed as having had possible contact with her while another 590 could be targeted for vaccination.

The health response to the virus relies on tracking down and testing people who may have been exposed to it and vaccinating them and anybody they have had contact with.

Ugandan and Congolese officials were working to find people who might have been put at risk by the dead woman, who appeared to have used an illegal border crossing, health ministry spokesman Emmanuel Ainebyona said.

So far “no one has been found to be positive of the Ebola virus. The team is still monitoring the tested traders,” he said.

The report said health workers had not established where the fishmonger spent nights, who transported her merchandise and who cleaned up her vomit.

The Ministry and the WHO said there were currently no confirmed Ebola cases in Uganda.

The WHO’s emergency committee of international experts were meeting on Wednesday for a fourth time to consider if the 11-month outbreak constituted a “public health emergency of international concern” (PHEIC), and will announce their decision at 1700 GMT.

A PHEIC declaration would be just the fifth in WHO history and include recommendations for international action. It could also help unlock sorely needed funds.

Last month the committee decided the potential disruption of declaring one risked causing economic harm while achieving nothing.

But WHO chief Tedros Adhanom Ghebreyesus said this week that the case in Goma was a potential game-changer since it meant Ebola might now spread among the urban population and into neighboring Rwanda.

A separate WHO report cited a very high risk for Uganda’s Arua district, which borders a Congolese area where an Ebola patient died after having had contact with over 200 people. Two deaths in Arua were under investigation.

(Reporting by Tom Miles and Nairobi newsroom; Editing by Gareth Jones and John Stonestreet)

First Ebola patient in eastern Congo’s main city dies, fears of epidemic spreading

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

GOMA, Democratic Republic of Congo (Reuters) – The first Ebola patient in eastern Democratic Republic of Congo’s largest city, Goma, has died, the government said on Tuesday.

The spread of the virus to Goma, a city of roughly 1 million people on the border with Rwanda, has raised fears the outbreak, which is already the second deadliest Ebola epidemic ever, could spread more widely.

The patient was a priest who became infected during a visit to the town of Butembo, one of the epicenters of the outbreak, before taking a bus to Goma, according to Congo’s health ministry.

He was being driven from Goma to a clinic in Butembo on Monday to receive treatment when he died, North Kivu province’s Governor Carly Nzanzu told an Ebola response meeting.

The World Health Organization (WHO) said on Monday that health officials had identified 60 people who had come into contact with the pastor since he was taken ill and that half of them had been vaccinated.

Goma, a lakeside city more than 350 kilometers (220 miles) south of where Ebola was first detected a year ago, is the largest city to be affected by the outbreak, which has infected more than 2,500 people and killed nearly 1,700.

Three Ebola cases which originated in Congo were confirmed in neighboring Uganda a month ago, but no new cases have since been registered in that country.

(Reporting by Stanis Bujakera and Djaffar Al Katanty, Writing by Anna Pujol-Mazzini, Editing by Ed Osmond)

Eroding trust in vaccines leaves populations vulnerable, global study finds

FILE PHOTO: A vial of measles, mumps and rubella vaccine and an information sheet is seen at Boston Children's Hospital in Boston, Massachusetts February 26, 2015. REUTERS/Brian Snyder/File Photo

By Kate Kelland

LONDON, June 19 (Reuters) – Trust in vaccines – one of the world’s most effective and widely-used medical products – is highest in poorer countries but weaker in wealthier ones where skepticism has allowed outbreaks of diseases such as measles to persist, a global study found on Wednesday.

France has the least confidence of any country in the world in the safety and effectiveness of vaccines, with a third believing that vaccines are unsafe, according to the study.

While most parents do choose to vaccinate their children, varying levels of confidence expose vulnerabilities in some countries to potential disease outbreaks, the study’s authors said, recommending that scientists need to ensure people have access to robust information from those they trust.

Public health experts and the World Health Organization (WHO) say vaccines save up to 3 million lives every year worldwide, and decades of research evidence consistently shows they are safe and effective.

But to achieve “herd immunity” to protect whole populations, immunization coverage rates must generally be above 90% or 95%, and vaccine mistrust can quickly reduce that protection.

“Over the last century, vaccines have made many devastating infectious diseases a distant memory,” said Charlie Weller, head of vaccines at the Wellcome Trust health charity, which co-led the Wellcome Global Monitor study.

“It is reassuring that almost all parents worldwide are vaccinating their children. However, there are pockets of lower confidence in vaccines across the world.”

The spread of measles, including in major outbreaks in the United States, the Philippines and Ukraine, is just one of the health risks linked to lower confidence in vaccines.

In Afghanistan and Pakistan, false rumors about polio vaccines being part of a Western plot have in recent years hampered global efforts to wipe out the crippling disease.

The study, led by Wellcome and polling company Gallup, covered 140,000 people from more than 140 countries.

It found 6% of parents worldwide – equivalent to 188 million – say their children are unvaccinated. “The highest totals were in China at 9%, Austria at 8% and Japan at 7%.”

Seth Berkley, chief executive of the not-for-profit GAVI vaccine alliance, said the report showed a “worrying number of people” questioning vaccine safety. But by focusing on the “vocal minority” who refused to vaccinate, it was easy to forget that the vast majority trusted vaccines and the science that underpinned them.

The study also found that three-quarters of the world’s people trust doctors and nurses more than anyone else for health advice and that in most parts of the world, more education and greater trust in health systems, governments and scientists is a also sign of higher vaccine confidence.

In some high-income regions, however, confidence is weaker. Only 72% of people in North America and 73% in Northern Europe agree that vaccines are safe. In Eastern Europe, it is just 50%.

Heidi Larson, director of the vaccine confidence project at the London School of Hygiene and Tropical Medicine, worked with researchers on this study. She said it “exposes the paradox of Europe” which, despite being a region with among the highest income and education levels, also has the world’s highest levels of vaccine skepticism.

In poorer regions, trust levels tend to be much higher, with 95% in South Asia and 92% in Eastern Africa feeling confident that vaccines are safe and effective.

(Reporting by Kate Kelland; editing by John Stonestreet)

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)

East Libyan warplanes hit Tripoli government positions

Troops from eastern Libyan forces are seen in Ain Zara, south of Tripoli, Libya April 11, 2019. Picture taken April 11, 2019. REUTERS/Stringer

By Ulf Laessing and Ahmed Elumami

TRIPOLI (Reuters) – Eastern Libyan forces bogged down in street battles in a push to seize the capital Tripoli deployed warplanes on Friday to hit several government positions, as more civilians fled the fighting.

More than 1,000 people gathered in central Tripoli to demand that Khalifa Haftar stop the advance of his Libyan National Army (LNA) on the coastal city of about 1.2 million people.

Haftar launched the campaign a week ago, in the latest conflict in a cycle of anarchy since the 2011 overthrow of dictator Muammar Gaddafi.

But forces loyal to Prime Minister Fayez al-Serraj’s internationally recognized government have so far kept them at bay, with fierce fighting around a disused former airport about 11 km (7 miles) from the center.

On Friday, an LNA warplane bombed the camp of a force allied to Serraj in Zuwara, west of Tripoli toward the Tunisian border, an LNA military source and residents said.

Zuwara is near the Mellitah oil and gas plant, jointly operated by Italy’s ENI and state oil firm NOC, which supplies Italy with gas through the Greenstream pipeline.

An LNA warplane also attacked the only partly-functioning airport in Tripoli, Mitiga, where anti-aircraft opened fire in response, witnesses said. The extent of damage and possible casualties in both places was not clear.

A week of battles has killed 75 people – mainly fighters but also 17 civilians – and wounded another 323, according to latest U.N. tallies. Some 9,500 people have also been forced out of their homes.

As the sound of fighting echoed around their city, residents sought to maintain some normality on Friday.

Some families were eating in cafes next to the fish market where people were stocking up for the weekend.

“We have got used to wars. I fear only in God,” said Yamim Ahmed, 20, who works in a fast food restaurant.

More than 1,000 people staged a protest in Martyrs Square in central Tripoli to demand an end to the offensive, witnesses said. The turnout was bigger than last Friday.

As well as the humanitarian cost, the conflict threatens to disrupt oil supplies, increase migration across the Mediterranean to Europe, scupper a U.N. peace plan, and allow Islamist militants to exploit the chaos.

CITY STALEMATE

Haftar, 75, a former general in Gaddafi’s army who later joined the revolt against him, moved his troops out of their eastern stronghold to take the oil-rich, desert south earlier this year, before sweeping up to Tripoli at the start of April.

But Serraj’s government has managed to halt for now the advance, helped by forces with machine-guns on pickups and steel containers across the road into Tripoli. The Tripoli government says it has taken nearly 200 prisoners from Haftar’s forces.

The United Nations, which had hoped to organize a national conference this month bringing the rival eastern and western administrations together to organize an election, has called for a ceasefire. The United States, G7 bloc of wealthy nations and European Union have also urged the LNA to halt its offensive.

Tripoli-based Foreign Minister Mohamed Siyala urged the U.N. Security Council to call on Haftar to halt the advance.

The U.N. health agency said it fears outbreaks of tuberculosis, measles and diarrhea due to poor sanitation, especially among those displaced.

Five ambulances have been hit trying to extract wounded people from the conflict zone, World Health Organisation (WHO) representative Dr Syed Jaffar Hussain also told a Geneva news briefing from Tripoli.

The WHO said it had only two weeks of medical supplies available for Tripoli’s hospitals.

Haftar casts himself as a bulwark against Islamist militancy who wants to restore order to Libya. But opponents see him as a potential would-be new dictator like Gaddafi.

He has so far resisted U.N. pressure to accept a power-sharing settlement, using his leverage as an ally of the West in attempts to stem jihadists in North Africa.

About 1,500 refugees and migrants are trapped in detention centers, the head of the U.N. refugee agency said. “They must be urgently brought to safety. Simply put, this is a matter of life or death,” Filippo Grandi said in a statement.

Libya is a major transit point for migrants pouring into Europe in recent years, mostly trafficked by smuggling gangs.

(Additional reporting by Ayman al-Warfalli in Benghazi, Ahmed Salem in Tripoli, Tom Miles, Stephanie Nebehay in Geneva; Writing by Ulf Laessing; Editing by Kevin Liffey and Andrew Cawthorne)

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)

Deadly plague breaks out on Uganda-Congo border, WHO says

FILE PHOTO: A logo is pictured on the World Health Organization (WHO) headquarters in Geneva, Switzerland, November 22, 2017. REUTERS/Denis Balibouse

GENEVA (Reuters) – A deadly form of plague has broken out on Uganda’s border with Democratic Republic of Congo and several people are thought to have died of the disease, the World Health Organization said on Monday.

The agency praised Ugandan health workers for vigilance and prompt action in spotting a suspected outbreak of pneumonic plague, which the WHO says is usually fatal unless detected early and treated with antibiotics.

Uganda’s Health Ministry reported two probable cases of the illness in Zombo district on March 5 after a 35-year-old woman died and her 23-year-old cousin reported similar symptoms, the WHO said in a report.

Further investigation revealed the dead woman had lived in Atungulei village in Congo’s Ituri province, and her 4-year-old child had died days beforehand. Finding her sick at her child’s burial, her relatives took her to Uganda for treatment.

The cousin’s symptoms raised suspicions of plague and a preliminary rapid diagnostic test was positive for the disease. Results on additional specimens sent to Uganda’s Plague Laboratory in Arua were pending. The patient was steadily improving, the WHO report said.

Some 55 people, including 11 healthworkers and people who took part in the dead woman’s funeral, had been identified as high risk contacts and were being followed up.

Three other people reportedly died of similar symptoms in Congo, the WHO said, and Congolese authorities were investigating.

Plague is endemic in Democratic Republic of Congo, Madagascar and Peru, according to the WHO.

Congolese health authorities are already fighting a major outbreak of Ebola further south in Ituri and North Kivu provinces.

Pneumonic plague is caused by the Yersinia pestis bacteria, usually found in small mammals and their fleas. Humans can be infected through flea bites, unprotected contact with bodily fluids or contaminated materials and the inhalation of droplets or small particles from a patient with pneumonic plague.

(Reporting by Tom Miles; Editing by Frances Kerry)

World must prepare for inevitable next flu pandemic, WHO says

FILE PHOTO: A logo is pictured on the World Health Organization (WHO) headquarters in Geneva, Switzerland, November 22, 2017. REUTERS/Denis Balibouse

By Kate Kelland

LONDON (Reuters) – The world will inevitably face another pandemic of flu and needs to prepare for the potential devastation that could cause, and not underestimate the risks, the World Health Organization (WHO) said on Monday.

Outlining a global plan to fight the viral disease and get ahead of a potential global outbreak, the WHO said the next influenza pandemic “is a matter of when not if”.

“The threat of pandemic influenza is ever-present,” Tedros Adhanom Ghebreyesus, the WHO’s director-general, said in a statement. “We must be vigilant and prepared; the cost of a major influenza outbreak will far outweigh the price of prevention.”

The world’s last flu pandemic was caused by the H1N1 virus, which spread around the world in 2009 and 2010. Studies of that pandemic found that at least one in five people worldwide were infected in the first year, and the death rate was 0.02 percent.

Global health experts and the WHO warn there is a risk that a more deadly flu virus will one day jump from animals to people, mutate and infect many hundreds of thousands of people.

Flu viruses are multiple and ever-changing, and they infect around a billion people every year around the world in seasonal outbreaks. Of those infections, around 3 to 5 million are severe cases, leading to between 290,000 and 650,000 seasonal flu-related respiratory deaths.

Vaccines can help prevent some cases, and the WHO recommends annual vaccination – especially for people working in health care and for vulnerable people such as the old, the very young and people with underlying illness.

The WHO plan – which it described as its most comprehensive to date – includes measures to try to protect populations as much as possible from annual outbreaks of seasonal flu, as well as prepare for a pandemic.

Its two main goals, the WHO said, are to improve worldwide capacities for surveillance and response – by urging all governments to develop a national flu plan, and to develop better tools to prevent, detect, control and treat flu, such as more effective vaccines and antiviral drugs.

(Reporting by Kate Kelland, editing by Gareth Jones)

Public mistrust after Congo election raises Ebola epidemic anxiety

FILE PHOTO: A healthcare worker sprays a room during a funeral of a person who is suspected of dying of Ebola in Beni, North Kivu Province of Democratic Republic of Congo, December 9, 2018. REUTERS/Goran Tomasevic/File Photo

By By, Kate, Kelland,, Health and and

LONDON, Jan 14 (Reuters) – Global health teams battling the world’s second largest Ebola epidemic in Democratic Republic of Congo fear an election dispute may deepen public mistrust and allow the epidemic to run out of control.

Fostering confidence in health authorities is essential when fighting a disease that can spread furiously through communities where local services are scant and patients are often scared to come forward to government or international response teams.

“When you have political instability, public health always suffers,” said Jeremy Farrar, an infectious disease expert who recently visited east Congo with a World Health Organization leadership team.

Without public trust, he said, the Congo epidemic could kill many hundreds more people.

The Dec. 30 election was supposed to mark Congo’s first uncontested democratic transfer of power after 18 years of chaotic rule by President Joseph Kabila.

But accusations of fraud and calls for a recount are threatening more volatility and violence after opposition leader Felix Tshisekedi was declared the winner.

“The worst case scenario is that political instability remains, mistrust grows … and then there’s nothing to stop the epidemic getting embedded into a big urban center and taking off as it did in West Africa,” said Farrar.

“GAINS COULD BE LOST”

Already, 385 people have been killed in the outbreak of Ebola in east Congo that began six months ago and has infected at least 630 people, according to WHO data. The death rate in this epidemic – by far the biggest Congo has seen, and the world’s second largest in history – is more than 60 percent.

Ebola spreads through contact with bodily fluids. It causes hemorrhagic fever with severe vomiting, diarrhea and bleeding. The outbreak is concentrated in North Kivu and Ituri provinces.

There are some signs case numbers in the North Kivu city of Beni may be leveling off, but WHO experts are cautious.

They say the apparent lull might be due to people getting ill but failing to seek proper diagnosis and treatment.

The West Africa Ebola outbreak Farrar referred to lasted for two years from 2014. It infected 28,000 and killed more than 11,300 people in an epidemic that devastated Sierra Leone, Liberia and Guinea and spread in sporadic cases to several other African countries as well as the United States and Europe.

The WHO says the risk of the disease spreading remains “very high” at national and regional levels and is working urgently with Congo and its neighbors – Uganda, Rwanda and South Sudan – to do everything to avoid that happening again.

WHO spokesman Tarik Jasarevic said 25 million people have already been screened for Ebola at border checks with Congo’s neighbors. Vaccination campaigns have also begun for health workers in Uganda and South Sudan.

Jasarevic also said multiple threats to response teams’ ability to find, treat and prevent cases of Ebola infection make the Congo situation particularly worrisome: “Gains could be lost if we suffer a period of prolonged insecurity,” he said.

(Reporting by Kate Kelland; Editing by Andrew Cawthorne)