H5N1

Australia: Crackdown on avian influenza in Victoria

Via ABC News, a slightly confusing report: Crackdown on avian influenza in Victoria. Excerpt:

Victorian authorities are tracing all poultry movements from two duck farms where avian influenza has been found. 

The low pathogenic strain of the disease was discovered on Friday afternoon and 10,000 ducks have already been destroyed. 

The two farms are north west of Melbourne and under one ownership. 

Veterinarian Dr Peter Scott, who advises the egg industry, says this is not bird flu, but is a local disease carried by wild waterfowl.

The Chief Vet of Victoria, Dr Andrew Cameron, says it is not as contagious or harmful as the H5N1 strain that is affecting poultry and people in Asia. 

He says there is no risk to human health from this outbreak.

So it's avian influenza but it's not bird flu, and it's "not as contagious or harmful as the H5N1 strain." What are we dealing with here? 

I think it's low-path H5N1, which is far more widespread than the high-path strain. But the Australian Broadcasting Corporation missed a chance to explain the difference by garbling the vets' explanations.

The 1918 pandemic: Why so many deaths among young adults?

The February issue of Emerging Infectious Diseases is now online, and this article caught my eye: Pathogenic Responses among Young Adults during the 1918 Influenza Pandemic. The abstract, re-paragraphed:

Of the unexplained characteristics of the 1918–19 influenza pandemic, the extreme mortality rate among young adults (W-shaped mortality curve) is the foremost. Lack of a coherent explanation of this and other epidemiologic and clinical manifestations of the pandemic contributes to uncertainty in preparing for future pandemics. 

Contemporaneous records suggest that immunopathologic responses were a critical determinant of the high mortality rate among young adults and other high-risk subgroups. 

Historical records and findings from laboratory animal studies suggest that persons who were exposed to influenza once before 1918 (e.g., A/H3Nx 1890 pandemic strain) were likely to have dysregulated, pathologic cellular immune responses to infections with the A/H1N1 1918 pandemic strain. The immunopathologic effects transiently increased susceptibility to ultimately lethal secondary bacterial pneumonia. 

The extreme mortality rate associated with the 1918–19 pandemic is unlikely to recur naturally. However, T-cell–mediated immunopathologic effects should be carefully monitored in developing and using universal influenza vaccines.

UK: Could TDR-TB hit Birmingham?

Via the Sunday Mercury: Deadly drug-resistant strain of Tuberculosis could hit Britain says Birmingham consultant. Excerpt:

Health chiefs have told how the deadly drug-resistant strain of Tuberculosis which has claimed three lives in India could strike in the Midlands. 

And Dr Martin Dedicoat, a consultant in infectious diseases at Heartlands Hospital in Birmingham, said precautions have been taken to safeguard against a breakout. 

But the medic stressed the risk of contracting the “totally drug resistant” form of TB in Britain was “only small” – despite rates of the disease more than doubling over the last two decades in the region. 

Currently around 1,000 people contract TB every year in the West Midlands and around half of these live in Birmingham. 

Experts say the increase is due to immigration from countries such as India and former Soviet states where TB is endemic. 

Dr Dedicoat, aged 44, spent a decade working with TB sufferers in the townships of South Africa. 

He said: “There is a small chance that someone could bring the drug-resistant form of TB into the UK without them knowing it, before it re-awakens in their body at a later date and is spread on. 

“We have strong links with countries like India and that is part of the reason why we have seen such an increase in TB in the last two decades. “As many as two billion people in the world today are carrying TB and many won’t know it. 

“But in Birmingham we have some of the best screening labs in the country so if the drug resistant form of TB is identified, which it would be very quickly, plans are already in place on how to respond to the situation. 

“The individual involved would be immediately quarantined, and as their condition would most likely be terminal, we would have to isolate them as quickly as possible.”

Philippines: Health officer reveals rise in dengue cases in Zamboanga City

Via Sun.Star: Health officer reveals rise in dengue cases in Zamboanga City. Excerpt: 

City health officer Dr. Rodelin Agbulos cited the need to step-up public vigilance to avert potential epidemic as he reported an increase in dengue cases in Zamboanga City. 

Agbulos said from 27 reported cases of dengue on the first week of January, the number climbed to 69, doubling the first mentioned record in two weeks. 

Based on the trend, Agbulos believes the number of dengue cases may exceed than that of last year’s with 81 victims. 

“Dengue can be countered effectively if cleanliness and the necessary preventive measures are observed without complacency,” Agbulos said. 

Of the 20 villages where the dengue cases originated, Talon-Talon village has the highest number of cases with seven, followed by the villages of San Roque with six, Tetuan with five and Tumaga with four.

India: Kolkata investigates its crow deaths

Mike Coston at Avian Flu Diary has a fascinating post on The Kolkata Crow Mystery, reporting that the city authorities are finally looking into local crow deaths.

I confess that I love health stories from Kolkata and West Bengal in general, because politics is invariably right under the surface and the local media treat health and politics with truly operatic style, like last night's report on infant deaths in Behrampore Hospital: government denial with attacks on the previous Communist state government, grieving parents, and the promise of an ongoing scandal. About the only topic never discussed is how such tragedies might be prevented in future.

Nigeria: Two fatal cases of lassa fever

Arkanoid Legent has a new report via allAfrica.com: Nigeria : Rivers Records Two Cases of Lassa Fever. Excerpt:

The Rivers Commissioner for Health, Dr Sampson Parker, on Wednesday announced an outbreak of lassa fever in the state. 

He said in Port Harcourt that two persons, including a female youth corps member, had been reported dead from the disease. 

Parker explained that the victims were serving in the state, but travelled to their homes in Edo and Ebonyi during the Christmas celebration, where they developed symptoms of the fever and eventually died.

Ecuador controls dengue lethality

Via Prensa Latina: Ecuador controla letalidad por dengue. [Ecuador controls dengue lethality] Excerpt, with my translation:

El plan de contingencia implementado por el gobierno de Ecuador logró controlar hasta hoy la letalidad por dengue en la actual temporada invernal, que reporta una muerte a causa de la variante hemorrágica del virus.   

The Ecuadorian government's contingency plan has so far controlled dengue lethality during the current winter season, with just one death from the hemorrhagic variant of the virus.

José Dávila, Coordinador Nacional de Epidemiología, confirmó a la agencia Andes la existencia de 360 casos en los primeros 25 días del mes de enero, cifra que puso en alerta a las autoridades sanitarias. 

José Dávila, National Coordinator of Epidemiology, confirmed to the Andes news agency the existence of 360 cases in the first 25 days of January—a statistic that put health authorities on alert.

Dávila resaltó que el Ejecutivo dispuso unos siete millones de dólares solo para la prevención y el control de la epidemia, que azota con más fuerza a las provincias ecuatorianas de Guayas, Los Ríos, Esmeraldas y Manabí, con un clima tropical favorable para la reproducción del aedes aegypti, agente transmisor. 

Dávila emphasized that the Executive has some 7 million dollars dedicated to the prevention and control of the epidemic, which has hit with most force in the provinces of Guayas, Los Ríos, Esmeraldas and Manabí, whose tropical climate favours the Aedes aegypti, the vector of the disease.

El funcionario señaló que de los cuatro serotipos del dengue, en los últimos años no habían circulado en Ecuador el dos y el cuatro, pero en octubre pasado se presentaron pacientes en Esmeraldas, lo cual podría incrementar los casos clínicos que podrían derivar en la variante grave de la enfermedad.

The official said that of the four dengue serotypes, Ecuador has not seen types 2 and 4 in recent years. But last October patients in Esmeraldas presented with them, which could increase the number of severe cases of the disease.

H5N1 controversy: The New York Times debate

The New York Times has published an editorial: The Missing Bird Flu Report. The NYT supports redaction of the reports before they're published.

You'll also find a debate among the experts, including comments from Flublogia's own Dr. Philip Alcabes and Dr. Vincent Racaniello. Neither supports redaction.

Superbugs found in Antarctic seawater

Via New Scientist: Superbugs spied off the Antarctic coast. Excerpt:

Bacteria that can resist nearly all antibiotics have been found in Antarctic seawater. 

Björn Olsen of Uppsala University in Sweden and colleagues took seawater samples between 10 and 300 metres away from Chile's Antarctic research stations, Bernardo O'Higgins, Arturo Prat and Fildes Bay. A quarter of the samples of Escherichia coli bacteria carried genes that made an enzyme called ESBL, which can destroy penicillin, cephalosporins and related antibiotics (Applied and Environmental Microbiology). 

Bacteria with these genes can be even more dangerous than the better known superbug MRSA. That's because the genes sit on a mobile chunk of DNA that can be acquired by many species of bacteria, increasing the incidence of drug-resistant infections such as the E. coli outbreak last year in Germany. 

The type of ESBL they found, called CTX-M, is common in bacteria in people, and the Uppsala study found that concentrations of resistant bacteria were higher close to the sewage outfalls from the stations. Some Antarctic stations started shipping out human faeces for incineration after gut bacteria were found nearby. Chile's research stations have virtually no sewage treatment in place, says Olsen.

Thailand reflects on the need for disaster planning

Via The Nation: Kittiratt reflects on tough choices.

Governments will need to act with more far-sightedness if serious impacts from natural disasters such as the recent Thai floods are to be avoided, Deputy Prime Minister Kittiratt Na-Ranong told a gathering at the World Economic Forum. 

Speaking at a session on "Tough Choices in Times of Crisis" with a panel that included Carlos Ghosn, CEO of Renault-Nissan Alliance, Kittiratt said he had to make his toughest choice after an aerial survey of the flooding and saw the massive volume of water surrounding the country's economic zones.

"What should I do? Report to the public or the prime minister?" he said, referring to the magnitude of the expected devastation. 

"We had to make a decision that is not for ourselves but for the others," said Kittiratt, who is now also the finance minister. 

Kittiratt looked back at the Thai flooding situation and noted that reports were issued by the Japan International Cooperation Agency and others before the floods last year, recommending that something be done to avert serious damage from possible floods. But the reports were shelved and nothing was done. 

"I think we have to act with more far-sightedness ... [if we had done so] the devastation would have been avoided."

Last summer I proposed creation of a Foresight Party here in Canada to help prepare for natural disasters, climate change, and predictable economic pressures resulting from demographic shifts. But I wasn't surprised when no one picked up the idea.

India: Nine infants dead in last 48 hrs at West Bengal government hospital (updated)

Via IBNLive.in.com: Nine infants dead in last 48 hrs at West Bengal government hospital. The cause of the children's deaths isn't really made clear: Did they acquire pneumonia in hospital, or arrive with it? And was it really pneumonia in all cases? Excerpt:

After Malda, infant deaths were reported from the West Bengal state-run Behrampore Hospital in Murshidabad district, where nine babies have died during the last 48 hours. Sources said they were suffering from Pneumonia. 

Malda Sadar Hospital had reported 110 deaths between January 1 and January 27. The hospital's vice-principal, MA Rashid, told reporters on Saturday that of the 110 deceased, 87 were below one-year-old. 

According to him, the state health department has decided to open a 70-bed separate paediatric unit in the Malda Sadar Hospital within a month to cope with the situation. Besides, the number of doctors, nurses and para-medical staff would be increased shortly, he said. 

However, West Bengal Mamata Banjeree defended her government on January 19 in the case of several infants dying in Malda, blaming the media and criticising her party workers for blowing events out of proportion. 

Mamata had reiterated that in eight months of the Trinamool Congress (TMC) rule, crib deaths came down by 2 per cent and said that the government will bring it down by 25 per cent.

Update: The Statesman has more details on this story, and attributes the deaths to acute respiratory illness, malnutrition, and being underweght. Most of the infants were referred to the hospital from rural districts, and the hospital evidently lacks the surge capacity to handle so many. 

Could nodding disease in Africa have global implications?

Via The Star in Toronto: Could mysterious nodding disease in Africa have global implications? Excerpt:

Researchers had hypothesized it might be caused by a new viral encephalitis, but that didn’t bear any fruit. They also thought perhaps it was a prion disease — such as Creutzfeldt-Jakob disease — but they have ruled that out, as well. 

Now scientists are betting on the possibility that nodding syndrome is associated with river blindness. In all three CDC investigations so far, said Dowell, researchers have found an association. 

Children and adolescents with the disease are more likely to have antibodies against river blindness and were more likely to be exposed to it. But scientists don’t know how river blindness transforms itself into nodding syndrome. None of the children or adolescents who suffer from nodding syndrome recover. 

“Once they have it, it is forever,” said Dowell. It is very debilitating — they can’t eat, they are malnourished and they have cognitive problems, so they drop out of school and become totally dependent on their parents and the community, Dowell said. 

Currently, sufferers are being treated with anti-epileptic medications and family members report the children are experiencing some relief. 

The CDC has also recommended that they be treated for river blindness and malnutrition. 

Global Significance 

“Because we don’t know what causes it or its transmission routes, we don’t know what implications it may have for the rest of the world,” said Dowell. 

Some diseases in Africa are local and others turn out to be globally important. He cites as an example “slim disease” — a wasting disease in West Africa. “It turned out to have been caused by HIV before HIV was discovered.” 

In the case of nodding syndrome “we don’t know the implications of this for the rest of the world,” Dowell said. “It’s quite clear it has huge implications for those living in Kitgum district in Uganda, but it could turn out to have just as huge implications for the rest of the world.”

TDR-TB and the NTDS

This post appeared on January 19 on the blog End the Neglect, which deals with neglected tropical diseases, and which I promise I will stop neglecting: TDR-TB and the NTDS. It points to even more disturbing implications of total drug resistance. Excerpt:

Last week, the existence of a new form of TB hit the media. This new type, currently called totally drug resistant tuberculosis, or TDR-TB, is exactly what it sounds like. Doctors have not yet been able to identify a treatment for this TB that will work. As far as we can tell, it is resistant to all existing regimens. The WHO is looking into it, but this is a bad, bad, development for global health.  

So what does this have to do with neglected tropical diseases (NTDs)? 

Well, many NTDs are bacterial, which means they are treated with antibiotics, just like the treatment for TB. This means that they’re as much at risk for antibacterial resistance as TB is. In addition, TB has benefited from research, and the development of newer drugs. There has been less research into finding new treatments for NTDs. 

Trachoma, a bacterial infection that leads to blindness, has been controlled or eliminated in many countries through the use of the antibiotic azithromycin. Azithromycin is used extensively for everything from traveler’s diarrhea to STIs to pertussis, and in many countries it’s available over the counter. That’s pretty much a recipe for antibacterial resistance. Treatment for Leptospirosis, a bacterial disease that affects humans and animals, also depends on azithromycin. 

Leprosy (aka Hansen’s disease) is another NTD dependent on antibiotic treatment. Mycobacterium leprae, the bacteria that causes leprosy, responds well to Dapsone, Rifampin, and Clofazimine. Dapsone is one of the very oldest antibiotics, dating to the 1930s. In addition to treating leprosy, it’s a second-line TB drug. 

Rifampicin was created in 1959, and it’s commonly used as one drug in combination therapy for tuberculosis. (If you’re noticing a trend here, there’s a reason. Both Tuberculosis and leprosy are caused by mycobacteria, so they respond to similar drugs.) 

If it’s not used strictly in combination with other antibiotics, resistance to rifampin builds very quickly. This is a problem, since rifampin is also effective against chlamydia and gonorrhea, and therefore tends to be a hot property among people who are secretly self-treating. Clofazimine was first synthesized in 1954. It’s not used for much beyond leprosy. It has brutal side effects, and it doesn’t work on TB. 

So, if the TB drugs are beginning to see resistance – total resistance – it’s very likely we could see resistance in the antibiotics used for the NTDs as well.

Brazil: Type 4 dengue reaches northeastern São Paulo state

Via Folha.com: Tipo 4 da dengue chega à região de Ribeirão Preto (SP). [Type 4 dengue reaches Ribieirão Preto (São Paulo state). Excerpt, with my translation:

Após surgir em território paulista na região de São José do Rio Preto, norte do Estado, no primeiro semestre do ano passado, o tipo quatro da dengue chegou agora ao nordeste de São Paulo. 

After an outbreak early last year in the region of São José do Rio Preto, in the north of São Paulo state, type 4 dengue has now reached the northeast of the state.

A cidade de Serrana, na região de Ribeirão Preto (313 km da capital), confirmou nesta semana o primeiro caso da doença com esse sorotipo. A paciente é uma mulher de 30 anos, que já está curada, segundo a Prefeitura de Serrana. 

The city of Serrana, in the region off Ribeirão Preto (313 km from the capital), confirmed this week its first case of dengue of this serotype. The patient is a 30-year-old woman who has now recovered, the Serrana Prefecture said.

A Secretaria da Saúde da cidade trata o caso como "importado", já que a mulher mora em Serrana, mas esteve no Piauí entre os dias 20 e 31 de dezembro. 

The city's Secretariat of Health is treating the case as "imported," since the woman is a resident of Serrano but was in Piauí between December 20 and 31.

"A contaminação aconteceu lá [no Piauí]", disse o diretor da Saúde de Serrana, Geraldo César Rosário. Segundo ele, a paciente procurou assistência no dia 8 com os sintomas, foi tratada como dengue "clássica" e já está fora de risco.

"The infection occurred there [in Piauí]," said the  Serrana director of health, Geraldo César Rosário. According to him, the patient sought help on January 8, was treated for classic dengue, and is now out of danger.

India: H5N1 culling begins in Tripura

Via The Assam Tribune Online: Bird flu: Culling begins in Tripura. Excerpt:

Culling operations have begun in avian flu affected gram panchayats of West Tripura district on Friday after confirmation from Bhopal based High Security Animal Disease Laboratory (HSADL). 

The State Government has already ordered culling of birds in three km radius of Lembucherra poultry farm as advised by the Centre. 

Twelve teams of Rapid Response Squad of Animal Resource Development Department (ARDD) have been pressed into the culling operation in the affected gram panchayats, said Manoranjan Sarkar, Director of ARDD here. 

He said though exact number of culled chicks and ducks could not be ascertained yet, the people engaged in the operation were asked to visit each house so that no chick or duck is left out of the operation. 

All necessary precautionary measures have been made to prevent fresh outbreak of bird flu in the State, Sarkar said adding that movement of poultry products had been banned in the affected areas.

Gates contributes $750 million to Global Fund

Via Vaccine News Daily.com: Gates contributes $750 million to Global Fund. Excerpt:

Bill Gates has contributed $750 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria in an effort to encourage other donors after the fund experienced problems with financial monitoring and extensive losses. 

The Microsoft founder said that the Bill & Melinda Gates Foundation’s donation to the Geneva-based fund comes in addition to the $650 million it has contributed to the fund in the past decade. 

Gates downplayed the reported losses of tens of millions of dollars to undocumented spending, corruption and misuse, the Associated Press reports. 

“These are tough economic times, but that is no excuse for cutting aid to the world’s poorest,” Gates said, according to the Associated Press. “If you’re going to do business in Africa, you’re going to have some losses.” 

Gates said that the public-private fund has improved the lives of the world’s poor in 150 countries, including providing 3.3 million people with antiretroviral treatment, giving 230 million bed nets to prevent malaria, and detecting and treating 8.2 million people with tuberculosis.

Drought in West Africa threatens millions

Via The Globe and Mail, a report by Geoffrey York: Drought in West Africa threatens millions. Excerpt: 

After thousands died needlessly because of the slow response to the Somalia famine last year, the world’s donor nations now face another crisis: a drought in West Africa where up to 500,000 are on the brink of starvation. 

Failed harvests and lack of rain are affecting millions of people in the Sahel region of eight countries in West Africa. The crisis is made worse by rising food prices and the return of 200,000 migrant workers to West Africa because of the civil wars in Libya and Ivory Coast. 

Now the question is whether the world’s wealthy nations will respond in time – or whether they will repeat the disaster of the Somalia famine, when early warnings were ignored for nearly a year before massive aid was finally sent. 

Among the countries suffering from the Sahel drought are Niger, Senegal, Mali, Mauritania, Chad, Cameroon, Burkina Faso and Nigeria. It’s a vast, sprawling, arid region, with villages often in remote and inaccessible places, making it difficult to distribute food to them. 

Unlike Somalia, the Sahel is not in the grip of war, and it is not controlled by a militant anti-Western group like al-Shabab, which has blocked aid from reaching much of Somalia. But there are security concerns in some parts of the Sahel, including Mali, where rebels roam the north, and Nigeria, where terrorist attacks have ravaged many districts. 

The United Nations children’s agency, Unicef, says it needs $100-million this year to save the lives of 500,000 children in the Sahel. It wants to provide food to a million people in the region, and so far it only has the resources to feed half of them. 

“We’re buying food as quickly as we can,” said David Gressly, the regional director of Unicef in West Africa. “Everyone has learned a lesson from the Horn of Africa famine. We’re acting much more quickly this time. We’re going to react in time and save a large number of lives.” 

The latest Unicef surveys have forecast that more than a million children will suffer acute malnutrition in the Sahel crisis. As many as 60 per cent of malnourished children can die in a food crisis, but the death rate in the Sahel could be higher than usual because the region has still not recovered from a serious drought in 2010. 

Climate change is believed to be one of the reasons for the rising number of food crises in the Sahel, but high fertility rates and rising populations are contributing to the problem by putting huge pressure on the Sahel’s arid farmland, which can’t support many people.

Are we beating malaria?

On her excellent blog, Rosemary Drisdelle writes: Are We Beating Malaria? Excerpt:

No human parasitic disease has ever been eradicated (although we may be close to eradicating Guinea Worm), but if ever there was a target, it would be malaria. 

Keeping an eye on the news and medical journals convinces me that there has never been more activity in scientific research aimed at understanding the parasites that cause malaria and finding ways to thwart them. 

Researchers have tried to develop malaria resistant mosquitoes. They’ve uncovered how the parasites invade red blood cells. They’ve investigated enzymes and proteins essential to the parasite’s survival. They’ve developed novel drugs. Hardly a day goes by when there is not something new. One might think we’re on the cusp of success. 

But the reality is still grim. If you look at the statistics, you see that things are not really changing, at least not yet. Maps released by the Malaria Atlas Project allow us to roughly compare 2007 with 2010, and though there are clearly some changes (WHO statistics do indicate that the total number of malaria cases has dropped over the last decade), in the big picture they are minor changes that could easily reverse themselves. 

This is discouraging. I wonder how long it will take for all this new research to provide us with a successful (and likely multi-pronged) approach to loosening the grip of this terrible disease.

Zimbabwe: Typhoid cases rise to nearly 900 amid fears of cholera outbreak

Via Xinhua: Zimbabwe typhoid cases rises to nearly 900 amid fears of cholera outbreak loom. Excerpt:

In Zimbabwe's capital Harare, many of the hotels, restaurants and open air food spots face immediate closure for failing to meet health and hygienic standards amid fears that a cholera outbreak looms, state media warned on Saturday. 

The move is part of a cocktail of measures designed to contain the spread of typhoid and follow recent reports indicating that a hotel worker had tested positive for typhoid. 

Health services director Dr Prosper Chonzi raised fears of a cholera outbreak given the health conditions that gave birth to typhoid. "We can have cholera anytime. The environment is conducive for the outbreak. We need to be proactive and play our part," he said.

Dr Chonzi quoted by The Herald on Saturday said typhoid could have spread to Chitungwiza and Epworth. "I can bet my last dollar there is typhoid in Chitungwiza and Epworth. The hygienic levels there are not good," he said. 

Dr Chonzi said residents across the city should also be wary because no one was safe from the disease. The movement of people from one suburb to the other fuels the spread of the disease. 

Harare Town clerk Dr Tendai Mahachi said some businesses faced closure because it has been observed their foodstuffs were contaminated with Salmonella typhi, the bacteria that causes typhoid. "We may close some of them until they are inspected and we are assured of their cleanliness," he said. 

As of Friday afternoon, 882 typhoid cases had been attended to in Kuwadzana, the epicenter of the outbreak. Another 64 people were admitted at the Beatrice Road Infectious Diseases Hospitals while on Thursday alone, 53 people were treated of typhoid symptoms at Kuwadzana Polyclinic. 

Dr Chonzi also said some businesses should be closed. "Food businesses and those that handle raw foodstuffs like fruits, unprocessed foods and butcheries face closure. We will have to certify food handlers. They should be screened for TB and general cleanliness," he said.

Haiti: Raising UN disease prevention standards

Via the O'Neill Institute Blog: A Call for U.N. Accountability for Cholera in Post-Earthquake Haiti – Part III: Raising U.N. Disease Prevention Standards. Click through for the whole post and some good links. Excerpt:

This series has primarily considered the problem of U.N. accountability for the international spread of disease. Part I of this series explored the mounting evidence against the U.N. that suggests the international body negligently, if unintentionally, transported cholera to Haiti through infected Nepalese peacekeeping personnel. Part II of this series took a close look at the immunity provisions that could pose a major challenge to Haiti’s cholera victims from obtaining effective judicial relief from the U.N. 

Aside from accountability concerns, however, the U.N.’s standards for preventing and timely responding to the international spread of disease that ostensibly led to Haiti’s first outbreak of cholera in a century – and, importantly, from a South Asian strain of the disease previously unknown to Haiti – remain unimproved. 

More specifically, U.N. peacekeeping operations (UNPKO) pre-deployment protocol creates the potential for further inadvertent transmissions of disease across borders while the dubious leadership roles of U.N. peacekeeping missions allow the U.N., as a non-state actor, to skirt critical surveillance and response obligations that the World Health Organization (WHO) has imposed on states for the effective response to incidents of international spread of disease.  

On the prevention side, UNPKO deployments constantly create new potentially disastrous routes for pathogens to travel by regularly recruiting personnel from resource-poor and biogenetically diverse contexts to staff its missions. In Haiti, peacekeepers arrive to serve in MINUSTAH from Guatemala, Sri Lanka, Bangladesh, Burkina Faso, Burundi, Rwanda, Sierra Leone and Yemen, which constitute only a portion of the fifty-seven countries that comprise the evolving international security force. 

Around the world, the U.N. continues to deploy over one hundred thousand personnel, often from countries experiencing their own political conflicts and public health challenges, to man its sixteen peacekeeping missions around the world. 

Dr. Louise Ivers of Partners In Health recently warned in the American Journal of Tropical Medicine and Hygiene, “The risks of globalization must not be seen just as the south to north “spread of disease” or “reintroduction of disease” but also of the inverse—the introduction of deadly pathogens through routes previously not traveled.” 

The deployment of uniformed personnel from one impoverished, institutionally-weakened or conflict-beleaguered country to another for purposes of carrying out peacekeeping operations should be seen as creating an entire network of previously untraveled “south-south” routes for infectious diseases.   

When taken that globalized diplomacy creates the potential for fast-tracking pathogens between vulnerable populations, the U.N.’s pre-deployment protocol appears entirely inadequate to prevent the inadvertent spread of disease. 

In particular, UNPKO regularly deploys new peacekeepers to missions like MINUSTAH as often as every six months but does not require that uniformed personnel undergo laboratory testing for infectious diseases, including cholera, unless the personnel present active symptoms. 

Such standards do not account for important circumstantial indicators, such as the fact that cholera was known to be endemic to Nepal and that approximately 75 percent of Nepalese cholera carriers do not show active symptoms. 

The pre-deployment screening standards also did not take caution of the fact that shortly before the outbreak of cholera in Haiti, a surge in cholera infections was reported in the Kathmandu valley where Nepalese peacekeepers train for three months before departing to Haiti.

I often wonder what the people at WHO and PAHO must be thinking when they know that the UN, their parent organization, is responsible for the health disaster they're trying to deal with in Haiti.