Vaccines help battle cholera outbreak in Malawi

Lilongwe, Malawi – In late 2022 staff at Tukombo health centre, a stone’s throw away from the shores of Lake Malawi, were stretched to the limit. The small facility in northern Malawi had been repurposed to serve as a cholera treatment centre to care for hundreds of patients as cases surged amid the country’s worst outbreak.

At the peak of the infection wave, Tukombo area (in Nkhata Bay District) accounted for 60% of the 1500 cases recorded then in the whole of Malawi’s Northern Region. “We had to work double shifts. It was a stressful situation,” recalls Dyson Tchuwa, a health surveillance assistant at the health centre.

Now operations at Tukombo have almost returned to normal after several hectic weeks, thanks in part to a vaccination campaign in November 2022 that helped stem the tide of infections.

Since the onset of the cholera outbreak in Malawi in March 2022, World Health Organization has supported the country to access 4.9 million doses of oral cholera vaccines from the International Coordinating Group—the body that manages emergency supplies of vaccines— with funding from Gavi, the Vaccine Alliance. To date, vaccines have been deployed in 21 out of Malawi’s 29 districts. In May and June 2022, 1.95 million doses were administered during a campaign in nine of the most affected districts, in the country’s Southern region. A second batch of 2.9 million doses arrived in October and WHO together with UNICEF supported a vaccination campaign in 14 more districts. In Nkhata Bay District, the number of news cases decreased from 381 in October 2022 to only 43 in December 2022.

For both campaigns, only one dose was administered instead of two, due to the global shortage in oral cholera vaccines.

“I know the dark side of cholera”

“I almost lost my life,” says Jones Chinula, a fisherman in Tukombo, as he shows his vaccination certificate. “I spent five days in hospital fighting for my life. I know the dark side of cholera, and this is why I am happy that the vaccine has been made available in my area.”

Since March 2022, Malawi has reported over 44 500 cases and nearly 1440 deaths. The first cholera cases were reported in the country’s south following floods. A total of 10 districts were affected as of July 2022. The disease then quickly spread to the north of the country and by the end of October 2022 all 29 districts were affected. The government declared the outbreak as a national public health emergency on 5 December 2022.

Cholera is an acute intestinal infection caused when someone consumes food or water contaminated with the bacterium Vibrio cholerae. Untreated, cholera can kill within hours. People living in places with poor sanitation and unsafe drinking water are most at risk.

“The trend of cholera changed significantly in the Southern region after the oral cholera vaccination campaign, and this helped the government to focus on other aspects of rebuilding the health system post-floods,” says Dr Charles Mwansambo, Secretary for Health in the Ministry of Health. In Nsanje, one of the most affected districts in the Southern region, cholera cases dropped from an average of 10 cases a day to less than three cases a day between May and December 2022. Despite the rainy season, which saw an upsurge of cases in a number of districts, Nsanje is still reporting low case numbers.

Cholera vaccination is crucial in outbreak control but should be complemented by measures to address the triggers of the disease. In Malawi, cases continue to increase in many districts, including some where cholera cases are usually not reported as the rainy season continues.

Multi-sectoral interventions

“Oral cholera vaccination should be used in conjunction with improvements in water and sanitation to control cholera outbreaks and for prevention in targeted areas known to be at high risk for cholera,” says Dr Neema Kimambo, WHO Representative in Malawi. “We will continue to engage with partners and donors to ensure that if a need for additional oral cholera doses arise, we are well prepared and support the Ministry of Health accordingly.”

A surge in cholera outbreaks globally has strained the supply of cholera vaccines, prompting the International Coordinating Group to temporarily suspend the standard two-dose vaccination regimen in cholera outbreak response campaigns, using instead a single-dose approach.

“Vaccine is an additional tool for the response, and in the absence of it, we are working with the Ministry of Health and partners to employ multi-sectoral interventions to effectively control cholera,” says Dr Kimambo.

In Tukombo, where health surveillance assistant Tchuwa and his colleagues expended huge efforts to vaccinate the population, the fight is not over. “Apart from the vaccination, we have intensified chlorine distribution in households for water purification and we are engaging fishing villages on water, hygiene and sanitation to ensure that we contain the cholera outbreak,” he says.

Source: World Health Organization

UNICEF Malawi Humanitarian Flash Update No. 7 (Cholera): 13 February 2023

The situation in Numbers (Cumulative)

• 8 million people at risk of contracting cholera, including more than 9 million children

• 42,427 Cases

• 1,384 Deaths

• 3.26% Case Fatality Rate (CFR)

• 11,500 Children Cases

• 188 Children Deaths

• 29 Districts Affected

Source: Ministry of Health’s press statement on Cholera update as of 12th February 2023.

Highlights

• As of 12 February, 42,427 cholera cases and 1,3841 deaths have been registered in Malawi. A total of 11,500 children’s cases and 188 deaths were reported as of the last update of 05 February 2023.

• During the reporting week, 3,861 cases and 130 deaths were reported. There were 4,958 cases and 161 deaths in the previous week.

• The cumulative case fatality rate stands at 3.26 per cent, with the highest Case Fatality Rate (CFR) of 5.86 in Lilongwe and the lowest CFR of 0.42 in the Mzimba North district.

• To establish a Cholera Treatment Unit (CTU), UNICEF provided four high-performance tents and supplies in Balaka, Machinga, and Lilongwe districts to respond to the high need for additional spaces for treating cholera patients.

• UNICEF actively supports all clusters and pillars of the humanitarian coordination team and participates in weekly meetings as a co-lead for the Education, Nutrition, WASH, Protection, and Risk Communication and Community Engagement (RCCE).

Source: UN Children’s Fund

ISS Crew to Remain on Orbital Outpost for an Extra Six Months

Two Russian cosmonauts and an American astronaut will remain aboard the International Space Station for an extra six months because of damage to their Russian spacecraft.

Sergey Prokopyev, Dmitry Petelin and Frank Rubio were set to end their six-month stay aboard the ISS in late March, but the Russian space agency Roscosmos said Tuesday the trio will have to remain on the orbital outpost until September.

The Soyuz MS-22 capsule that carried the crew to the ISS last September has been leaking coolant since mid-December, which both Roscosmos and the U.S. space agency NASA have blamed on a micrometeoroid, or space rock, that struck the capsule.

Russia had planned to send an unmanned Soyuz capsule to the ISS earlier this month to bring the crew home, but the launch of that spacecraft was postponed because a Russian Progress MS-21 cargo ship docked at the station was also leaking coolant. That leak has been blamed by officials on an “external impact.”

Prokopyev, Petelin and Rubio were joined on the ISS in October by four astronauts brought by a SpaceX capsule: two Americans, a Russian and a Japanese. The space station will become even more crowded next week when another four person crew, including an astronaut from the United Arab Emirates, is set to arrive.

Source: Voice of America

Supreme Court Weighs Google’s Liability in IS Terror Case

The Supreme Court is taking up its first case about a federal law that is credited with helping create the modern internet by shielding Google, Twitter, Facebook and other companies from lawsuits over content posted on their sites by others.

The justices are hearing arguments Tuesday about whether the family of an American college student killed in a terrorist attack in Paris can sue Google for helping extremists spread their message and attract new recruits.

The case is the court’s first look at Section 230 of the Communications Decency Act, adopted early in the internet age, in 1996, to protect companies from being sued over information their users post online.

Lower courts have broadly interpreted the law to protect the industry, which the companies and their allies say has fueled the meteoric growth of the internet and encouraged the removal of harmful content.

But critics argue that the companies have not done nearly enough and that the law should not block lawsuits over the recommendations, generated by computer algorithms, that point viewers to more material that interests them and keeps them online longer.

Any narrowing of their immunity could have dramatic consequences that could affect every corner of the internet because websites use algorithms to sort and filter a mountain of data.

“Recommendation algorithms are what make it possible to find the needles in humanity’s largest haystack,” Google’s lawyers wrote in their main Supreme Court brief.

In response, the lawyers for the victim’s family questioned the prediction of dire consequences. “There is, on the other hand, no denying that the materials being promoted on social media sites have in fact caused serious harm,” the lawyers wrote.

The lawsuit was filed by the family of Nohemi Gonzalez, a 23-year-old senior at Cal State Long Beach who was spending a semester in Paris studying industrial design. She was killed by Islamic State group gunmen in a series of attacks that left 130 people dead in November 2015.

The Gonzalez family alleges that Google-owned YouTube aided and abetted the Islamic State group, also known as the Islamic State of Iraq and Syria, or ISIS, by recommending its videos to viewers most likely to be interested in them, in violation of the federal Anti-Terrorism Act.

Lower courts sided with Google.

A related case, set for arguments Wednesday, involves a terrorist attack at a nightclub in Istanbul in 2017 that killed 39 people and prompted a lawsuit against Twitter, Facebook and Google.

Separate challenges to social media laws enacted by Republicans in Florida and Texas are pending before the high court, but they will not be argued before the fall and decisions probably won’t come until the first half of 2024.

Source: Voice of America

Infected in the First Wave, They Navigated Long COVID Without a Roadmap

When COVID-19 hit in 2020, Ghenya Grondin of Waltham, Massachusetts, was a postpartum doula – a person charged with helping young couples navigate the first weeks of their newborn child’s life at home.

Grondin, now aged 44, was infected with SARS-CoV-2 in mid-March of that year – before there were tests, before social distancing or masks, and many months before the medical community recognized long COVID as a complication of COVID-19.

She is part of a community of first-wave long-haulers who faced a new disease without a roadmap or support from the medical establishment.

Three years later, at least 65 million people worldwide are estimated to have long COVID, according to an evidence review published last month in Nature Reviews Microbiology. More than 200 symptoms have been linked to the syndrome – including extreme fatigue, difficulty thinking, headaches, dizziness when standing, sleep problems, chest pain, blood clots, immune dysregulation, and even diabetes.

There are no proven treatments but research is underway.

People infected later in the pandemic had the benefit of vaccination, which “protects at least to some degree” from long COVID, said Dr. Bruce Levy, a Harvard pulmonologist and a co-principal investigator of the National Institute of Health’s $1.15 billion U.S. RECOVER trial, which aims to characterize and find cures for the disease.

“The initial variant of the virus caused a more severe illness than we’re seeing currently in most patients,” he said.

According to the University of Washington’s Institute of Health Metrics and Evaluation, in the first two years of the pandemic women were twice as likely as men to develop long COVID, and 15% of all of those affected at three months continued to experience symptoms beyond 12 months.

An analysis of thousands of health records by the RECOVER trial found that non-Hispanic white women in wealthier areas were more likely than others to have a long COVID diagnosis. Researchers said that likely reflected disparities in access to health care, and suggests that many cases of long COVID among people of color are not being diagnosed.

Grondin grew concerned when she continued to have symptoms three months after her initial infection – but there was no name for it then.

“I just kept saying to my husband, something isn’t right,” she said.

Like her fellow long-haulers, she has experienced a host of symptoms, including fatigue, sleep apnea, pain, cognitive dysfunction, and in her case, a brain aneurysm. She described a frightening moment when she was driving a car with her toddler in the back and had a seizure that left her in the path of oncoming traffic.

She has since been diagnosed with long COVID and can no longer work.

“It just feels like a constant punch in the face,” said Grondin.

Scientists are still working out why some people infected with COVID develop long-term symptoms, but syndromes like this are not new. Other infections such as Lyme disease can result in long-term symptoms, many of which overlap with long COVID.

Leading theories of the root causes of long COVID include the virus or viral proteins remaining in the tissues of some individuals; the infection causing an autoimmune response; or the virus reactivating latent viruses, leading to inflammation that damages tissue.

Kate Porter, 38, of Beverly, Massachusetts, a project manager for a financial services company, believes she was infected on a flight back from Florida in late March of 2020.

She had daily fevers for seven months, muscle weakness, shortness of breath, and excruciating nerve pain.

“I don’t think people realize how brutal physically everything was,” she said. In one of her darker moments, Porter recalled, “I cried on the floor begging for something to take me peacefully. I’ve never been like that.”

Frustrated by the lack of answers from a list of 10 specialists she has seen, Porter has explored alternative medicine. “It has opened me up to other remedies,” she said.

Although her health is much improved now, she still suffers from near daily migraines and neck pain she fears may never go away.

Genie Stevens, 65, a director of climate education, got infected while traveling from her home in Santa Fe to Cape Cod in late March 2020 to visit her mother, and never left. “It completely upended my life,” she said.

She went to an emergency department seeking tests and was told there were none – the typical answer in the spring of 2020, when scientists were scrambling to understand the nature of the virus and tests were being rationed. She was sent home to manage on her own.

A lifelong practitioner of meditation, Stevens took solace there, finding it eased her symptoms.

Confined to her bed that spring, she focused on an ancient crabapple tree outside her room. “I watched every bud unfurl.”

Although largely recovered, Stevens still has flare-ups of brain fog, exhaustion and high-pitched ringing in her ears when she pushes too hard. “This is the astoundingly maddening part of the illness. I feel totally fine, and then bam.”


Source: Voice Of America

The United Nations and Humanitarian Partners Call for $45.3 Million to Provide LifeSaving Aid to People Devastated by the Cholera Outbreak in Malawi

(Lilongwe, 20 February 2023): The United Nations and humanitarian partners in Malawi today launched a Flash Appeal to assist 4 million people, including 56,000 refugees and asylumseekers, who have been hardest-hit by, and are at highest-risk of, cholera, in support of the Government-led response.

The appeal—which calls for US$45.3 million for the next five months—comes as the numbers of cholera cases and deaths in Malawi have increased exponentially since the beginning of January 2023, worsening what is already the deadliest cholera outbreak in the country’s history. “Despite all the efforts taken since the first cholera case was reported in Malawi nearly one year ago, the situation remains of grave concern. Every day, the number of cases increases, and more people die,” said the United Nations Resident Coordinator in Malawi, Rebecca Adda-Dontoh. “However, the good news is that, while cholera is highly transmissible, it is also easily treatable when cases are caught early and preventable when communities have access to clean water and good sanitation.”

The Malawi Cholera Flash Appeal—which is launched to coincide with Government of Malawi’s Cholera campaign—aims to address the most immediate needs of people impacted by the outbreak through an integrated response that brings together health and water, sanitation and hygiene (WASH), while ensuring communities are engaged, prepared and supported to respond to and reduce cholera. Acknowledging that the outbreak has taken a devastating toll on the hardest-hit communities, the Flash Appeal also calls for support to essential health, nutrition, education and protection services in affected and high-risk locations.

Remarking at the launch of the Flash Appeal, Ms. Adda-Dontoh said, “I had the privilege of joining His Excellency President Chakwera and Honorable Minister of Health in visiting three cholera treatment centres in Lilongwe last week, where I spoke with health-care workers who requested more support to treat the endless flow of patients they are receiving. When left untreated, cholera can kill in less than twelve hours, but with simple IV fluids, most patients are rapidly on the road to recovery. No one should die of cholera in 2023 and the world can, and must, step-up to help Malawians in their time of need.”

The current cholera outbreak, which started in March 2022, has affected all 29 districts of Malawi and is the largest outbreak in the country in the past two decades. The number of cases increased dramatically at the start of the rainy season in November 2022 and, as of 18 February 2023, nearly 45,000 cases had been reported, including nearly 1,450 deaths. Experts anticipate that, unless urgent, intensified action is taken to scale-up the response, between 64,000 and 100,000 cases could be reported in the next three months.

The UN and its partners in Malawi urgently call on donors to fund the Flash Appeal and enable them to work swiftly in support of the Government-led response to contain the outbreak and prevent further, avoidable, loss of life.

Source: UN Office for the Coordination of Humanitarian Affairs