H5N1

Haiti: PIH staff brief US Congress on cholera

Via Partners in Health: In Washington D.C., PIH staff participate in Congressional briefing on cholera in Haiti. Buried under a list of Very Important Bureaucrats who took part in the event, we get this:

PIH’s representatives came with a clear message. Efforts to combat cholera should be redoubled with a focus on working with the Government of Haiti and local partners to: 

•Strengthen water and sanitation infrastructure:  The international cholera response must prioritize major investments in Haitian-developed plans for improving access to safe drinking water and sanitation. 

•Identify and treat all those with cholera symptoms:  Resources are needed to train and retain public health workers and equip them with the supplies necessary for aggressive case finding and treatment. 

•Roll out a safe, affordable, and effective cholera vaccine:  Under the leadership of the Ministry of Health in Haiti, PIH and GHESKIO are rolling out a cholera vaccination campaign as part of a comprehensive approach to slowing cholera in Haiti. 

•Strengthen Haiti’s public health system:  Rather than creating private, parallel systems that drain resources from the public sector, NGOs should work with the Government of Haiti to make comprehensive medical care affordable and accessible for all Haitians.  

•Improve effectiveness of foreign assistance to Haiti:  Foreign assistance, if rooted in human rights and aid effectiveness principles, can save lives and strengthen local government approaches to breaking the cycle of disease and poverty.

Philippines: Dogs in Cagayan de Oro contract leptospirosis too

Via Inquirer News: Dogs in Cagayan de Oro contract leptospirosis too. Excerpt:

The city veterinarian’s office is vaccinating dogs against leptospirosis after 15 canines were found to have contracted the potentially deadly ailment in the aftermath of the December 17 floods here. 

Nine of the infected animals have died,  veterinarian Lucian Anthony Acac said. 

The city health office conducted a similar vaccination campaign for humans after nearly 200 people were found to have contracted the ailment, caused by the  leptospira bacteria, which can be found in the feces and urine of rats and other animals and thrive in floodwaters. 

The bacteria enter the human body through breaks in the skin, or wounds, that come in contact with contaminated water. Death is caused by massive organ failure. 

Acac said that the vaccine given to dogs is different from that for humans. 

Acac said free vaccination of dogs was being done in the barangays of Macasandig, Consolacion, Balulang, Kauswagan, and the Calaanan Tent City, which houses many families displaced by the floods. 

“This is part of a campaign to prevent the spread of leptospirosis in the city,” he said. 

Like rats, which are the common carriers of the leptospira bacteria, dogs can also transmit the illness to humans, Acac said. 

Acac said close contact with infected dogs and other animals could cause a person to catch the illness.

CIDRAP: News scan for January 27

Via CIDRAP: NEWS SCAN: H5N1 invasion of CNS, low-path H5 in Australia, viral co-evolution, E coli O104 in Turkey. Excerpt:

A French woman who returned home from a tour of Turkey last September with hemolytic uremic syndrome (HUS) was infected with a strain of Shiga toxin–producing Escherichia coli (STEC) O104:H4 similar to the one that caused a widespread outbreak in France and Germany earlier in 2011, according to a report in Eurosurveillance. 

The earlier outbreak was attributed to contaminated fenugreek sprouts. The French traveling group comprised 22 people; eight experienced diarrhea, including two hospitalized with HUS on their return. No common food source could be traced, but no one in the group reported eating sprouts before or during the trip. The timing of the cases suggested the illnesses were acquired in Turkey. 

Both HUS cases showed positive serology for STEC O104:H4. One, which showed the same resistance profile as the strain in the European outbreak, was compared by pulsed-field gel electrophoresis with cases from the earlier outbreak. It was similar but not identical, showing differences in two bands for the gene Xbal and in three bands for Notl. 

The authors conclude from these and several cases that occurred from 2004 through 2009 that STEC O104 circulates in Turkey and certain other countries, such as Egypt and Tunisia, and that the strain should be considered in travelers who return from these areas with HUS.

Congo-Kinshasa: Spike in cholera cases

Via allAfrica.com, an AFP report from Radio Netherlands Worldwide: Congo-Kinshasa: Spike in Cholera Cases - UN.

Cholera cases have soared in the Democratic Republic of Congo in recent weeks, the UN said on Friday, bringing the number of people infected in the year-long outbreak to 22,000 with 584 deaths. 

Aid agencies have been trying to halt the spread of the water-borne disease that has ravaged eight of the country's 11 provinces since January 2011. 

"There has been a spike in cases" since mid-December, with figures on the rise in the capital Kinshasa in particular, the UN Office for the Coordination of Humanitarian Affairs (OCHA) said. 

Cholera, a contagious intestinal infection, has taken its heaviest toll on eastern regions however, with a quarter of all cases reported in Sud-Kivu province. 

The UN Central Emergency Response Fund has allotted $4.4 million to children's aid agency UNICEF and $4.7 million to the World Health Organisation to help combat its spread.

Richard Horton on WHO on Twitter

Maryn McKenna has kindly Storified Richard Horton on WHO on Twitter. This is one of the most surprising and worrying series of health tweets I've ever seen, and I look forward (if that's the term I want) to seeing Horton's comments expanded and documented.

Dr. Carroll on cholera and blame in Haiti

A few days ago Dr. John Carroll posted a column in the Peoria Journal Star about his experiences in Pestel. Then he withdrew the column and I deleted my excerpt and link to it. Evidently the problem has been sorted out and he's re-posted Cholera and Blame in Rural Haiti. Excerpt:

During the last several weeks I have lived with very poor Haitians in the mountains of Pestel and I felt filthy. I didn’t take a real shower in 10 days. But I had fairly clean water to drink…which is a luxury that tens of thousands of Haitians surrounding me in the mountains do not have. 

And if all of this doesn’t sound bad enough, some of the Haitian nurses staffing cholera treatment units in Pestel had not received a salary from the Haitian government since September, 2011. I would not think that would encourage their spirits. But these nurses came to work anyway. Taking good care of a sick cholera patient is difficult nursing work. 

And these Haitian nurses make a grand total of 300 dollars US per month. Why were they not paid? The Haitian doctor in charge of the whole Pestel Commune was pleading that his nurses get paid. And so we went to bat for the Haitian nurses at a “high level” and the salaries they were owed for the last three months was paid to them almost immediately. I wonder what the problem was? 

And how about the Haitian hospital in the village of Pestel? It is a Haitian government hospital. And it is absolutely horrible. It is an embarrassment. There are five broken down beds serving about 80,000 people in the Pestel area. There are a couple of Haitian doctors and one Cuban doctor that staff the outpatient clinic at the hospital. The head doctor shook his head and showed me the ancient rusty green oxygen tanks that don’t function in the corner of the room where our newly admitted 58-year-old lady in florid heart failure died in front of us. 

And the cholera tent is despicable at the Pestel hospital. I don’t have adequate words to describe its filth and the misery inside of it. 

And even if I had “adequate words” to describe the misery on the ground in Pestel, I started to have uninvited visitors at night asking me where my documented permission was that stated I could work in Pestel. And I was told my posts on the internet needed to be read by the powers that be BEFORE I posted them. And I was told NOT to take more photographs. 

So along with the poor Haitians who don’t wash their hands in clean water, the messenger in the mountains became a problem too. 

With cholera in Haiti, someone always needs to be blamed.

India: TDR-TB in Bangalore

Via DNA India: TDR-TB in Bangalore: Where’s the committee, Mr SA Ramdas? Excerpt:

The three-member committee which was supposed to have been formed to probe into Totally Drug-Resistant Tuberculosis (TDR-TB) cases in Bangalore, has not yet been formed despite two such clinically-tested confirmed cases coming to light. One of the patients is still absconding. 

Following the reports published in DNA on January 11 about the two confirmed cases of TDR-TB, SA Ramdas, the minister for medical education, health and family welfare, had said a three-member committee would be formed to probe into the matter. 

However, no such committee has been formed to date, which shows just how seriously the state government is taking this disease caused by the bacteria Mycobacterium tuberculosis with a new strain. There is no drug anywhere in the world to stop this evolved bacterium. The committee was supposed to probe and submit a report on the status of TB in Karnataka.

CDC planning trial for mysterious nodding syndrome

Via The Lancet: CDC planning trial for mysterious nodding syndrome. Except:

A mysterious illness affecting mostly children called nodding syndrome is spreading across wide swaths of northern Uganda and South Sudan, stumping investigators who have failed so far to determine what is causing the disease that gives young people epileptic-like seizures and impairs their cognition. 

A team of scientists from the US Centers for Disease Control and Prevention will be travelling to the region in mid-February for their fourth such exploration; this time, they hope to lay the groundwork for a clinical trial to test treatments for the disease. 

“It is a devastating disease from the patient's point of view and the villagers' point of view”, said Scott Dowell, director of CDC's Division of Global Disease Detection and Emergency Response, and the lead investigator on nodding syndrome. “It's been so difficult to figure out what is causing it and what should be done about it.” 

In northern Uganda, the current cases are in the districts of Kitgum, Pader, and Gulu. Ugandan officials say that in Pader District alone nodding syndrome is the cause of death for 66 children. They have diagnosed roughly 1000 cases between August and December, 2011. There is no known cure for the disease, and investigators do not know if it is communicable. 

Researchers have been examining several possible causes for nodding syndrome, a name given because those infected often nod their heads when food is put in front of them. They have found an unexplained association with Ochocerca volvulus, a parasite that can cause river blindness; tests have shown that high numbers of those with nodding syndrome also have antibodies in their system for Ochocerca. Nearly all the children live near rivers or fast-moving streams. The disease also is associated with malnourished children or young adults who have a vitamin B6 deficiency. 

Some epidemiologists have suggested that climate change could have played a part, especially if the disease is definitively linked to the parasite causing river blindness and the range of the parasite is expanding. 

But Dowell said many questions remain. One question is if that parasite is connected to the epidemic, why has it in the past attacked people's corneas, while now it is attacking the brain.

Australia: Low-path avian flu detected in Victoria

Via The Age: Bird flu detected in Victoria. Excerpt:

Bird flu has been detected at two locations northwest of Melbourne. 

The Department of Primary Industries has quarantined two commercial duck farms operated by the same owner, after birds at both properties tested positive to low pathogenic avian influenza (LPAI). 

DPI Chief Veterinary Officer, Dr Andrew Cameron, on Friday said analytical tests carried out at the Australian Animal Health Laboratory at Geelong, Victoria, had given a positive response to low pathogenic H5 subtype avian influenza virus, prompting authorities to act immediately. 

The cases were detected during routine testing for other conditions. 

"Avian influenza, also referred to as AI or bird flu, is a contagious disease that affects birds. The transmission of the AI virus from birds to humans is a rare event," Dr Cameron said in a statement. 

This low pathogenic subtype of avian influenza is not the highly pathogenic H5N1 virus affecting poultry and humans throughout much of Asia, and the wider community is not at risk, he said.

Low-path flu can be a disaster for the poultry industry, as we learned here in British Columbia  when H7N3 broke out in 2004.

Indonesia: Tangerang man positive for H1N1 swine flu: Health Ministry

Via The Jakarta Post: Tangerang man positive for swine flu: Health Ministry. Excerpt:

The 18-year-old man in Tangerang, who was suspected of being infected with bird flu and who died on Wednesday, tested positive for swine flu, the Health Ministry said. 

The ministry’s head of research and development, Trihono, told The Jakarta Post on Thursday that the man, known as R, had contracted H1N1, which caused a pandemic in 2009. 

Trihono said, however, that it was unlikely that the man had died of swine flu. “While swine flu was deadly in 2009 and 2010, it is no longer a harmful disease.” 

He added that the disease is a lot like a more common seasonal flu. “The sufferer does not even need to be isolated,” he said. 

 The World Health Organization announced in 2010 that the H1N1 swine-flu pandemic had passed, but made clear that “this does not mean that the H1N1 virus has gone away”. 

Trihono suspected that the patient might have suffered from another, deadlier disease, which led to his death. “That disease killed him rather than the swine flu.” 

Officials from Tangerang General Hospital and the regency’s health authority declined to comment on the swine-flu infection, telling the Post that only Health Ministry officials were authorized to make such comments. 

The hospital’s spokesman, Achmad Muchlis, had earlier said that R had died from respiratory problems. The man, a resident from Panongan district in Tangerang, died after being treated for five days.

Indonesia to produce H5N1 vaccine by 2013

Via The Jakarta Post: RI to produce bird-flu vaccine by 2013. Excerpt:

Indonesia is aiming to manufacture its first, locally produced vaccine to combat the H5N1 avian influenza virus by 2013, with state-owned pharmaceutical company PT Biofarma working to prepare its facilities for developing the vaccine for mass production, a minister says. 

Health Minister Endang Rahayu Sedyaningsih said that Biofarma was currently working on an initial stage of the vaccine, a process that could lead the way for its mass production in 2013. 

“It takes a long time to manufacture the bird-flu vaccine on a large scale. If the budget is available this year, then we will be able to have the facilities ready by the end of 2013,” Endang told reporters after witnessing the signing of an agreement between the Health Ministry and the Research and Technology Ministry on vaccine research and development. 

The government has developed a research consortium to develop the bird-flu vaccine to deal with any outbreaks. The consortium, led by the University of Indonesia’s (UI) School of Medicine, involves several other institutions, including the Eijkman Institute, Health Research and Development Agency at the Health Ministry, the Indonesian Agency for the Assessment and Application of Technology (BPPT), UI’s School of Engineering, Biofarma and the University of Airlangga in Surabaya, East Java.

A WHO re-education

Get out of here and go read the sequence of tweets posted by Dr. Richard Horton (richardhorton1) on Twitter just a little while ago. Dr. Horton is the editor of The Lancet, and he's been tweeting the key points of an interview with "a senior WHO scientist." Horton begins: "My WHO re-education began tonight. You may not agree with what follows. But these are the sincere views of one senior WHO scientist."

What follows is alarming, and if documented in the coming days it will be much worse than alarming.

H5N1 controversy: Lessons of the lambda

Via The New York Times: In Real Time, a Virus Learns a New Way to Infect. Excerpt:

Viruses regularly evolve new ways of making people sick, but scientists usually do not become aware of these new strategies until years or centuries after they have evolved. In a new study published today in the journal Science, however, a team of scientists at Michigan State University describes how viruses evolved a new way of infecting cells in little more than two weeks. 

The report is being published in the midst of a controversy over a deadly bird flu virus that researchers manipulated to spread from mammal to mammal. Some critics have questioned whether such a change could have happened on its own. The new research suggests that new traits based on multiple mutations can indeed occur with frightening speed. 

The Michigan researchers studied a virus known as lambda. It is harmless to humans, infecting only the gut bacterium Escherichia coli. Justin Meyer, a graduate student in the biology laboratory of Richard Lenski, wondered whether lambda might be able to evolve an entirely new way of getting into its host. 

The standard way for lambda to get into a cell is to latch onto its outer membrane, attaching to a particular kind of molecule on the surface of E. coli. It can then inject its genes and proteins into the microbe. 

Mr. Meyer set up an experiment in which E. coli made almost none of the molecules that the virus grabs onto. Now few of the viruses could get into the bacteria. Any mutations that allowed a virus to use a different surface molecule to get in would make it much more successful than its fellow viruses. “It would have a feast of E. coli,” Dr. Lenski said. 

The scientists found that in just 15 days, there were viruses using a new molecule — a channel in E. coli known as OmpF. Lambda viruses had never been reported to use OmpF before.  

Mr. Meyer was surprised not just by how fast the change happened, but that it happened at all. “I thought it would be a wild goose chase,” he said. 

To see if this result was just a fluke, Mr. Meyer ran his experiment over again, this time with 96 separate lines. The viruses in 24 of the lines also evolved to use OmpF.  

The researchers then sequenced the genomes of the evolved viruses and were surprised to find that this transformation always required four mutations. In all the lines that could grab OmpF, those four mutations were identical, or nearly so. No single mutation could allow the viruses to start latching onto OmpF. Even three out of four mutations brought no change. Only after they developed all four mutations could the viruses make the switch.  

The results from the experiment suggest that the mutations initially help the viruses do a better job of hooking onto the original molecules after they became scarce. “When you put all four together, you get this entirely new function,” Mr. Meyer said.

A shaky future for Hispaniola

Via Nature News & Comment, a discouraging report: A shaky future for Hispaniola. Excerpt:

The magnitude-7 quake that devastated Haiti in January 2010 may have been the opening salvo in a decades-long period of increased seismicity, a study suggests. 

The warning arises from an analysis of historical records. Hispaniola — a Caribbean island now split between Haiti in the west and the Dominican Republic in the east — was one of the first places in the Western Hemisphere to be colonized by Europeans in the fifteenth century, so records of seismic activity there are arguably some of the longest in the region, says William Bakun, a seismologist with the US Geological Survey in Menlo Park, California. 

That long history makes Hispaniola’s strongest spate of seismic activity, a seven-decade-long cluster of four major quakes in the eighteenth century, stand out between two lengthy quiet periods. Because the population then was so sparse, however, researchers have been unsure about the strength and location of those shocks. 

So Bakun and his colleagues developed a mathematical technique to compare damage reports and other data gathered during the 2010 quake and its aftershocks with historical damage reports to improve those estimates. 

Historical data included descriptions of quake damage to cathedrals and government buildings — taken from reports made by colonial officials in order to receive funding for repairs — as well as accounts from letters and personal journals describing the intensity of ground motions. 

Data gathered during the 2010 quake and its aftershocks allowed Bakun and his team to determine how efficiently seismic energy is transmitted through rocks in the region, which, in turn, enabled the researchers to better interpret the patterns of damage and shaking reported during the eighteenth-century quakes. 

Their work is published in the February Bulletin of the Seismological Society of America. 

The first quake in the 70-year-long cluster along the Enriquillo Fault System, in November 1701, was a magnitude-6.6 event that struck western parts of the island, the team estimates. The trembler that struck in October 1751, hit eastern parts of the island and probably measured between 7.4 and 7.5. That was quickly followed by a magnitude-6.6 quake near Port-au-Prince about a month later. The final quake in the sequence struck west of Port-au-Prince in June 1770. From then until January 2010, says Bakun, the fault system had almost 240 years of seismic quiescence. 

“Most of the people living there had forgotten that they had a seismic hazard,” he says.

The February issue of the BSSA is not available online yet. But this finding should give the Haitian government and the UN some food for thought.

India: B2B H5N1 reappears in Tripura

Via IBN Live News, a report datelined Agartala: Bird flu reappears in Tripura. Tripura shares a long border with Bangladesh; India and Bangladesh enjoy blaming one another for bird flu outbreaks. Excerpt:

Bird flu has reappeared in Lembucherra area, about 45 km from here, official sources said today. Following reports of deaths of poultry birds in the area, blood samples were collected and examined and H5 strain of avian influenza virus was found, officials said. 

More than 2,000 ducks and birds would be culled tomorrow in the area. Meanwhile, the state administration has formed 16 rapid response teams to cull the ducks and birds in the area.

Oral vaccines cannot control Haiti cholera

Via Haiti Chery, a blog I've just discovered: Oral Cholera Vaccines Cannot Control Haiti Cholera: Rebuttal to an Article in Scientific American. Here's the whole editorial. Click through to read the article that inspired it.

Within less than two months of Haiti’s cholera outbreak, Paul Farmer began to promote an oral cholera vaccine for Haiti in the popular magazine Newsweek (3). Since then he has published a series of articles that are not peer-reviewed scientific papers describing original research, but rather, commentaries and viewpoints on cholera in Haiti. 

Some of these articles look as if they are peer reviewed, because they appear in journals that contain mostly peer-reviewed articles. For example, one article from May 2011, titled “Meeting Cholera’s Challenge to Haiti and the World: a Joint Statement on Cholera Prevention and Care,” and published in the journal PLoS Neglected Tropical Diseases, was really an opinion piece with Farmer as the lead author. 

Other articles and interviews from Paul Farmer, John Mekalanos, and others on cholera in Haiti have appeared in popular science journals like Scientific American and Science Watch. 

These articles had two things in common: 

•(1) They did not require a declaration of conflicts of interest, as is needed for serious articles in medical journals. 

•(2) They were not critically reviewed by independent scientists who study cholera. 

If declarations of conflict of interest had been required, Harvard University and most of the scientists from Harvard who wrote the PLoS Neglected Tropical Diseases article, for example, would have had to divulge that they hold substantial commercial interests in cholera vaccines. 

And if a critical review had been carried out, the articles would have come up against some devastating arguments, such as those raised below by Dr. Rashid Haider. 

For a popular-science journal like Scientific American or popular magazine like Newsweek, where science is presented as a form of entertainment, such standards are not needed, and it suffices to claim authority, based on the Harvard name. But the Harvard name does not impress us here at Haiti Chery. 

For public-health and medical workers interested in learning the truth about the oral cholera vaccines currently being pushed on Haiti, we provide below a thorough evaluation of these vaccines by Rashid Haider who is highly knowledgeable about the field trials on these vaccines. Haider’s article is also being sent to Scientific American in rebuttal to a January 12th article that extensively quoted Paul Farmer on the supposed high efficacy of cholera vaccines.

Egypt: Anti-bird flu campaign planned

Via IRIN Middle East: EGYPT: Anti-bird flu campaign planned. Excerpt:

A nationwide campaign to stop the spread of H5N1 avian influenza in Egypt is to be launched by the government in a few weeks, say officials, but details are still sketchy. 

The new plan, which will involve coordination between the Health Ministry, the Agriculture Ministry and poultry producers, requires close monitoring and various bio-safety measures. 

“These measures are just a small part of a more general plan to curb the spread of the virus in our country,” Saber Abdel Aziz, a senior official from the state-run General Organization for Veterinary Services, told IRIN. 

“We will also offer incentives to poultry growers to look for signs of illness in their animals, report sick ones, and practice bio-security.” 

H5N1 has infected 159 and killed 55 people in Egypt since 2006. 

The most recent fatalities occurred on 19 January 2012 - a two-year-old girl from Cairo, and a 31-year-old man from Fayoum Governorate in the Nile Delta. Epidemiological investigations indicated they had both been exposed to backyard poultry. 

Abdel Aziz and his colleagues at the General Organization for Veterinary Services say they will work hard to prevent this from happening again by applying bio-security prevention measures.

Indonesia: H5N1 deaths raise red flags

Via IRIN Asia: INDONESIA: Bird flu deaths raise red flags. Excerpt:

Two recent deaths from bird flu in Indonesia highlight the need for continued vigilance against a possible resurgence of the deadly virus, an official and health expert warned. 

On 16 January, a five-year-old girl from northern Jakarta died after being tested positive for the H5N1 bird flu virus. She was a relative of a 24-year-old man who died on 7 January, the World Health Organization (WHO) said, adding that the two had contact with the same pigeons in their neighbourhood. 

According to WHO, the latest fatalities brought the death toll from avian influenza in the country to 152, out of 184 confirmed cases since 2006. 

The Health Ministry's director-general of disease control and environmental health, Tjandra Yoga Aditama, said there was no evidence that human-to-human transmission was involved in the latest case. 

"As long as there are still birds carrying the virus, there will be cases of bird flu in humans from time to time," Aditama told IRIN. 

Of 60 bird flu cases detected last year in Indonesia, 11 were fatal, Aditama said.

Mr. Aditama might want to have a quiet word with WHO about those 60 H5N1 cases, because as far as WHO knows, Indonesia had just 12 cases in 2011, 10 of them fatal.

Dead goose in Hong Kong tests positive for H5N1 virus

Via Xinhua: Dead goose in Hong Kong tests positive for H5N1 virus. Excerpt:

The Hong Kong government said on Thursday a dead goose, found in the northwest part of the city, has been confirmed to be H5N1 positive after laboratory testing. 

The goose body was found and collected at Sham Tseng last Friday, said a spokesman for the Agriculture, Fisheries and Conservation Department (AFCD). 

"It was highly decomposed when found and required a series of tests before H5N1 avian influenza was confirmed." 

The spokesman said there were no poultry farms within three kilometers of where the dead goose was found. 

"AFCD staff have conducted inspections and found no evidence of any backyard poultry being kept there.

"AFCD will continue to monitor the situation and conduct inspections of the area," he added.

WHO: Latest update on confirmed H5N1 cases

On January 24, WHO posted its latest tally on the Cumulative number of confirmed human cases of avian influenza A(H5N1) reported to WHO. It's striking to see that in January alone, it's updated the table seven times.

When you click through to the January 24 table, you'll see that Cambodia has reported one case and one death. So have China, Indonesia, and Vietnam. Egypt has one reported case but no death. So we've seen (in a very small sample of five cases) a case fatality rate of 80 per cent.

I expect more updates soon.