Democratic Republic of Congo: Cholera vaccination campaign targets 1.2 million

Phase 2 of the biggest ever oral vaccination campaign against cholera is scheduled to take place from 3-8 July 2019 in 15 health districts in the four central provinces of the Democratic Republic of the Congo (DRC) – Kasaï, Kasaï Oriental, Lomami et Sankuru.

The second dose of vaccine confers lasting immunity against cholera, and is being targeted at 1 235 972 people over 1 year of age. The 5-day, door-to-door campaign will involve 2632 vaccinators recruited mainly from local communities, whose job it is to administer the oral cholera vaccine, fill in vaccination cards and tally sheets, and compile a daily summary of the teams’ progress.

In parallel, 583 community mobilizers have been selected – 1 mobilizer for every 3 teams in urban areas and 1 mobilizer for every 2 teams in rural districts.

Their job is to alert local people that vaccinators will visit their homes. They will use loudspeakers to spread the message, particularly in the early evening.

The campaign is organized by the Ministry of Health with technical, logistic and financial support from WHO, Gavi, the Vaccine Alliance and the Global Task Force on Cholera Control (GTFCC).

It is the second such campaign in this central region of the DRC. 1 224 331 people over 1 year of age were vaccinated during the first round in late December 2018.

The purpose of the vaccination campaign is to contain the serious epidemic which resulted in 9154 presumed cases and 458 deaths (case-fatality rate of 5%) in the 5 affected provinces in Kasaï region between January and December 2018.

This cholera vaccination campaign marks the intensification of our response in the DRC,” said Dr Matshidiso Moeti, WHO Regional Director for Africa, “WHO and our partners are working with national authorities to rollout the vaccine, which comes in addition to multiple interventions introduced since the beginning of the cholera epidemic, including sanitation and water quality control in the affected areas, many of which have little access to a safe water supply.”

Right now, with the second dose, the preventive campaign for which 1 235 972 doses of oral vaccine have been laid in will ensure coverage of all at-risk areas in this central region of the DRC. The vaccines have been provided from global cholera vaccine stocks managed by Gavi, the Vaccine Alliance.

“This vaccination campaign will play a key role in bringing this cholera outbreak under control,” said Dr Seth Berkley, CEO of Gavi. “The DRC is currently going through an unprecedented combination of deadly epidemics, with Ebola and measles outbreaks also causing untold misery across the country. It is vital that the global effort to control these outbreaks continues to receive support: we cannot allow this needless suffering to continue.”

In 2018 the DRC reported a cumulative total of 29 304 suspected cholera cases and more than 930 deaths (case-fatality rate 3.17%). Since the start of 2019 and up to epidemiological week 23 (3-9 June), at least 12 247 suspected cases of cholera and 279 deaths (case-fatality rate 2.2%) have already been reported in 137 health districts in 20 of the 26 provinces of the DRC. Cholera is a highly contagious communicable disease transmitted via contaminated water or food. It causes severe diarrhoea and dehydration which must be treated immediately to avoid death after only a few hours and to stop the disease from spreading on a massive scale throughout an environment at risk.

“This cholera vaccination campaign in the 4 central provinces of the DRC is crucial to stop the disease from gaining a permanent foothold in the target areas of Kasaï, Lomami and Sankuru. The vaccinators will visit every household, even in the remotest areas, to administer the second dose vital for ensuring long-term protection against cholera,” explains Dr Deo Nshimirimana, Acting WHO Representative in the DRC.

“We must not forget that oral cholera vaccine works in conjunction with other effective prevention measures such as improvement of sanitary conditions, individual and collective hygiene including regular hand-washing (with soap) after going to the bathroom or before meals, and lobbying authorities to improve access to drinking water.”

Former Liberia president, Ellen Johnson Sirleaf, and three others appointed WHO new goodwill ambassadors

Ellen Johnson Sirleaf

WHO Director-General Dr Tedros Adhanom Ghebreyesus in his speech to open the 72nd World Health Assembly in Geneva announced that former Liberia president, Ellen Johnson Sirleaf, is WHO Goodwill Ambassador for Health Workforce.

“I welcome President Ellen Johnson

Alisson Becker

Sirleaf, Cynthia Germanotta, Alisson Becker and Natália Loewe Becker as WHO’s new Goodwill Ambassadors and look forward to working with them over the coming years,” said Dr Tedros. “Each of our new ambassadors are champions in their own right, from helping their communities rebuild and develop sustainably, to fighting for better mental health and well-being, to being role models for healthier living.”

Dr Natália Loewe Becker

Cynthia Germanotta

Alisson Becker, goalkeeper of the Brazilian national and Liverpool football teams, Cynthia Germanotta, President of Born This Way Foundation, which was co-founded with her daughter Lady Gaga, as WHO Goodwill Ambassador for Mental Health; and Dr Natália Loewe Becker, medical doctor and health advocate from Brazil, as WHO Goodwill Ambassadors for Health Promotion.

WHO Director-General warns civil unrest in the DRC could affect fight against Ebola

The WHO Director-General Dr Tedros Adhanom Ghebreyesus has said efforts to end the outbreak are continuing after recent disruptions, but further interruptions could have serious consequences, he warned.

Dr. Ghebreyesus was in the Democratic Republic of the Congo (DRC) over the New Year to Ebola-affected areas to review the response at this critical phase.

Civil unrest resulted in vandalism to an Ebola transit centre in Beni and several other health facilities last week. The insecurity slowed down vaccinations and epidemiological surveillance and follow-up for several days.

“I’m concerned about the impact of the recent disruptions at this critical moment. This outbreak is occurring in the most difficult context imaginable. To end it the response needs to be supported and expanded, not further complicated. Ebola is unforgiving, and disruptions give the virus the advantage,” said Dr Tedros.

On the three-day mission (31 December 2018 – 2 January 2019) to Beni, Butembo and Komanda, Dr Tedros took stock of the outbreak, spent time with affected communities, and personally thanked responders for their dedication. WHO has 380 response staff in North Kivu and Ituri working together with hundreds more from the Ministry of Health and partners. 

WHO/L. Mackenzie
On the three-day mission (31 December 2018 – 2 January 2019) to Beni, Butembo and Komanda, Dr Tedros took stock of the outbreak, spent time with affected communities, and personally thanked responders for their dedication.

“The Ebola responders are sacrificing a lot,” said Dr Tedros. “They’ve worked flat-out for months, away from their families, to combat one of the world’s deadliest viruses in a risky environment. I’m proud of them, and I wanted to tell them that personally over the New Year holiday.”

Director of the Wellcome Trust and Chair of WHO’s Research and Development Blueprint Dr Jeremy Farrar joined the mission to see the outbreak first-hand.

“I came away humbled by the dedication of the Ebola responders, but worried by the immense challenges they face in such a complex environment. This outbreak is in a critical phase. It is vital the international community recognizes this and ensures the DRC and WHO have the support needed to ensure this outbreak does not spiral out of control,” Dr Farrar said.

Since the outbreak began in August 2018, there have been 608 cases and 368 deaths in North Kivu and Ituri provinces. To date, more than 54,000 high-risk contacts and frontline responders have been vaccinated, and almost every new patient receives one of four investigational treatments, something which was never previously possible during an Ebola outbreak. 

The main challenges are the security environment, pockets of mistrust among affected populations, and poor infection prevention and control in many public and private health facilities. Under the government’s leadership and working collaboratively with UN and NGO partners, WHO is committed to addressing these challenges and ending the outbreak.

Article published courtesy of the WHO

More than 90% of the world’s children breathe toxic air every day

Every day around 93% of the world’s children under the age of 15 years (1.8 billion children) breathe air that is so polluted it puts their health and development at serious risk.

Tragically, many of them die: WHO estimates that in 2016, 600,000 children died from acute lower respiratory infections caused by polluted air.

A new WHO report on Air pollution and child health: Prescribing clean air examines the heavy toll of both ambient (outside) and household air pollution on the health of the world’s children, particularly in low- and middle-income countries. The report is being launched on the eve of WHO’s first ever Global Conference on Air Pollution and Health. 

It reveals that when pregnant women are exposed to polluted air, they are more likely to give birth prematurely, and have small, low birth-weight children. Air pollution also impacts neurodevelopment and cognitive ability and can trigger asthma, and childhood cancer. Children who have been exposed to high levels of air pollution may be at greater risk for chronic diseases such as cardiovascular disease later in life.

“Polluted air is poisoning millions of children and ruining their lives,” says Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This is inexcusable. Every child should be able to breathe clean air so they can grow and fulfil their full potential.”

One reason why children are particularly vulnerable to the effects of air pollution is that they breathe more rapidly than adults and so absorb more pollutants.  

They also live closer to the ground, where some pollutants reach peak concentrations – at a time when their brains and bodies are still developing.

Newborns and young children are also more susceptible to household air pollution in homes that regularly use polluting fuels and technologies for cooking, heating and lighting 

“Air Pollution is stunting our children’s brains, affecting their health in more ways than we suspected. But there are many straight-forward ways to reduce emissions of dangerous pollutants,” says Dr Maria Neira, Director, Department of Public Health, Environmental and Social Determinants of Health at WHO.

“WHO is supporting implementation of health-wise policy measures like accelerating the switch to clean cooking and heating fuels and technologies, promoting the use of cleaner transport, energy-efficient housing and urban planning. We are preparing the ground for low emission power generation, cleaner, safer industrial technologies and better municipal waste management, ” she added.

New global commitment to primary health care for all at Astana conference

Declaration of Astana charts course to achieve universal health coverage, 40 years since declaration on primary health care in Alma-Ata

Primary Healthcare in Sierra Leone. Photo credit: World Bank/ Dominic Chavez.

Countries around the world on Thursday agreed to the Declaration of Astana, vowing to strengthen their primary health care systems as an essential step toward achieving universal health coverage.

The Global Conference on Primary Health Care on 25-26 October in Astana, Kazakhstan, is co-hosted by WHO, UNICEF and the Government of Kazakhstan. Participants include ministers of health, finance, education and social welfare; health workers and patient advocates; youth delegates and activists; and leaders representing bilateral and multilateral institutions, global health advocacy organizations, civil society, academia, philanthropy, media and the private sector.

The Declaration of Astana reaffirms the historic 1978 Declaration of Alma-Ata, the first time world leaders committed to primary health care.

“Today, instead of health for all, we have health for some,” said Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO). “We all have a solemn responsibility to ensure that today’s declaration on primary health care enables every person, everywhere to exercise their fundamental right to health.”

While the 1978 Declaration of Alma-Ata laid a foundation for primary health care, progress over the past four decades has been uneven. At least half the world’s population lacks access to essential health services – including care for noncommunicable and communicable diseases, maternal and child health, mental health, and sexual and reproductive health.

“Although the world is a healthier place for children today than ever before, close to 6 million children die every year before their fifth birthday mostly from preventable causes, and more than 150 million are stunted,” said Henrietta Fore, UNICEF Executive Director. “We as a global community can change that, by bringing quality health services close to those who need them. That’s what primary health care is about.”

The Declaration of Astana comes amid a growing global movement for greater investment in primary health care to achieve universal health coverage. Health resources have been overwhelmingly focused on single disease interventions rather than strong, comprehensive health systems – a gap highlighted by several health emergencies in recent years.

“Adoption of the Declaration at this global conference in Astana will set new directions for the development of primary health care as a basis of health care systems,” said Yelzhan Birtanov, Minister of Health of the Republic of Kazakhstan. “The new Declaration reflects obligations of countries, people, communities, health care systems and partners to achieve healthier lives through sustainable primary health care.”

UNICEF and WHO will help governments and civil society to act on the Declaration of Astana and encourage them to back the movement. UNICEF and WHO will also support countries in reviewing the implementation of this Declaration, in cooperation with other partners.

Ebola outbreak in the DRC not a Public Health Emergency of International Concern

The Emergency Committee on the Ebola virus disease outbreak in the Democratic Republic of the Congo says a Public Health Emergency of International Concern (PHEIC) should not be declared at this time.

The meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (IHR) (2005) regarding the Ebola Virus Disease (EVD) outbreak in the Democratic Republic of the Congo took place on Wednesday, 17 October 2018.

The Committee however, remains deeply concerned by the outbreak and emphasized that response activities need to be intensified and ongoing vigilance is critical. The Committee also noted the very complex security situation.

The WHO was notified by the Ministry of Health of the Democratic Republic of the Congo of Ebola Virus Disease in North Kivu province on 1 August, cases were also subsequently found in Ituri Province. From 4 May to 15 October 2018, 216 EVD cases were reported, of which 181 are confirmed and 35 are probable; 139 total deaths have occurred, of which 104 are confirmed and 35 are probable. The global case fatality rate stands at 64% overall, and at 57% among confirmed cases.

Nine neighbouring countries have been advised that they are at high risk of spread and have been supported with equipment and personnel. Particular emphasis has been placed on Uganda, Rwanda, Burundi, and South Sudan in terms of preparedness activities.

After discussion and deliberation on the information provided, the Committee concluded that this Ebola outbreak is taking place in a particularly complex context and poses several important challenges:

• This outbreak is taking place in an active conflict zone amidst prolonged humanitarian crises. Approximately 8 major security incidents have occurred in the Beni area in the past 8 weeks. These factors have complicated contact tracing and other aspects of the response.
• Community mistrust, stemming from a variety of reasons, including the security situation, and people who avoid follow-up or delay seeking care, remain significant problems that require deepening engagement by community, national and international partners.
• New cases being identified without epidemiological links are of great concern and require further detailed epidemiological mapping.
• The assessment of the risk of spread is low at global level but it is very high at both national and regional levels. There has been no change to the risk assessment since 28 September.
• Ring vaccination efforts have achieved high coverage rates among eligible populations but rely heavily on highly performing contact tracing in DRC and all countries that may be affected.

WHO kicks off global initiative to treat children with cancer

WHO has announced a new Global Initiative for Childhood Cancer – with the aim of reaching at least a 60% survival rate for children with cancer by 2030, thereby saving an additional one million lives. This new target represents a doubling of the global cure rate for children with cancer.
Cancer is a leading cause of death for children, with 300,000 new cases diagnosed each year among children aged 0-19 years.

According to the International Agency for Research on Cancer (IARC) latest estimates on the global burden of cancer, the global cancer burden is estimated to have risen to 18.1 million new cases and 9.6 million deaths in 2018.

One in 5 men and one in 6 women worldwide develop cancer during their lifetime, and one in 8 men and one in 11 women die from the disease. Worldwide, the total number of people who are alive within 5 years of a cancer diagnosis, called the 5-year prevalence, is estimated to be 43.8 million – IARC

The GLOBOCAN 2018 database, accessible online as part of the IARC Global Cancer Observatory, provides estimates of incidence and mortality in 185 countries for 36 types of cancer and for all cancer sites combined.

An analysis of these results, published in CA: A Cancer Journal for Clinicians, highlights the large geographical diversity in cancer occurrence and the variations in the magnitude and profile of the disease between and within world regions.

The increasing cancer burden is due to several factors, including population growth and ageing as well as the changing prevalence of certain causes of cancer linked to social and economic development. This is particularly true in rapidly growing economies, where a shift is observed from cancers related to poverty and infections to cancers associated with lifestyles more typical of industrialized countries.

Cancer occurs in people of all ages and can affect any part of the body. It begins with genetic changes in a single cell that then grows out of control. In many cancers, this results in a mass (or tumour). If left untreated, cancer generally expands, invades other parts of the body and causes death.

According to the WHO, current data suggest that approximately 10% of all children with cancer have a predisposition because of genetic factors. Ongoing research is needed to identify factors impacting cancer development in children.

Unlike cancer in adults, the vast majority of childhood cancers do not have a known cause. Many studies have sought to identify the causes of childhood cancer, but very few cancers in children are caused by environmental or lifestyle factors. Cancer prevention efforts in children should focus on behaviours that will prevent the child from developing preventable cancer as an adult.

Some chronic infections are risk factors for childhood cancer and have major relevance in low- and middle-income countries. For example, HIV, Epstein-Barr virus and malaria increase the risk of some childhood cancers. Other infections can increase the child’s risk of developing cancer as an adult, so it is important to be vaccinated and other pursue other methods such as early diagnosis or screening to decrease chronic infections that lead to cancer, whether in childhood or later.