H5N1

H5N1 controversy: Dr. Sandman on talking to the public

Via Risk = Hazard + Outrage, Dr. Peter Sandman has an excellent article: Talking to the Public about H5N1 Biotech Research. Excerpt from a must-read:

Fouchier and others responded to the furor by organizing a research moratorium, aimed at calming the waters and buying time to make the case for unfettered research and publication. Soon after, the World Health Organization convened a meeting in Geneva, mostly of influenza researchers, which predictably concluded that research and publication should be unfettered. 

But the group acknowledged that a time-out was needed. In a press briefing after the meeting, WHO’s Keiji Fukuda said one key reason for the pause was to allow time to reassure the public. 

The “public” following these events is tiny. Despite editorials in The New York Times and a satirical monologue by Jon Stewart – and continuing poultry outbreaks and human cases – most people aren’t worried about an H5N1 lab accident or terrorist attack. 

They’re even less worried about an H5N1 natural pandemic. Convincing people that the H5N1 natural pandemic risk is alarming is a tougher and more important task than convincing people that the H5N1 terrorism risk is less so. 

Like the run-up to Asilomar nearly 40 years ago, the H5N1 research controversy is much more a battle within the scientific community than a battle between the scientific community and the public. 

But let’s take WHO’s Fukuda at his word and assume the job is to reassure the public that it’s okay to publish the Fouchier and Kawaoka papers and okay to resume H5N1 bioengineering research. What are proponents of this position doing wrong in their effort to reassure the public? I’ll focus on just two (of many) issues: education and contempt.

Tuberculosis: UK government must act to curb this killer disease

Via The Observer, an editorial: Tuberculosis: the government must act to curb this killer disease.

Figures just released show a 5% rise in the numbers of new cases of tuberculosis in the UK. TB is still the number one killer globally, increasing enormously in some parts of the world such as the former Soviet Union and South Africa. As the Observer reports, the fight against new antibiotic-resistant strains of TB is being lost in some areas and could become a problem in countries such as India and China. 

Dr Paul Nunn, head of the World Health Organisation's global TB response team, says that although curable and preventable, TB requires a carefully followed regime of medication over six months. Anything less leads to drug-resistant strains. 

One undiagnosed TB-infected person can infect 10 others a year. More than 350,000 people living with HIV died because of TB in 2010. 

Yesterday marked World TB Day, the day in 1882 when Dr Robert Koch announced that he had discovered the cause of TB, the TB bacillus: 130 years later, London is the capital of TB in western Europe. 

While TB incidences have dropped significantly in other western European countries, in London rates have increased slightly. This is in part because of high immigration but also, according to the WHO's Dr Mario Raviglione, it is a result of the reluctance of the British government to comply with international standards and recommendations on notifications and the need for greater co-operation between departments, particularly the Department of Health and the UK Border Agency. That needs to be rectified. 

The UK also needs to screen new immigrants from intermediate to high-incidence countries for active rather than latent TB. In addition, funding to fight TB along with HIV and malaria must be increased internationally, as Peter Hain argues in these pages. 

Without that funding, progress will be lost along with the opportunities offered, for instance, by effective new rapid diagnostic tests. Campaigners are calling for a replenishment of the global fund at the G20 meeting in Mexico in June. It is vital that those demands are heard.

The Observer also has a very good article on drug-resistant TB in today's issue.

India: Dengue cases double, deaths rise four times

Via DNA, a report datelined Mumbai: Dengue cases double, deaths rise four times - Mumbai. Excerpt:

It was a matter of pride for the government of Maharashtra that it had managed to substantially curb malaria cases over the last year. In a strange turn of events, while the number of malaria cases has been halved over the last year, the numbers of dengue cases have almost doubled. The deaths caused by dengue have risen four-fold as well. 

The strange part in this sudden increase is that the measures taken to restrict dengue infections are the same as the ones taken to curb malaria. 

According to figures included in the Economic Survey of Maharashtra 2011-12, the number of dengue cases for the year 2011-12 (up to Jan 2012) has been the highest over the last 5 years. In that period, 7,898 cases of dengue were recorded, as opposed to 3,746 cases the year before. The deaths caused by dengue have risen from six cases in 2010-11 to 25 cases in 2011-12. 

Dengue, like malaria, is mainly caused by mosquitoes, but by a different kind. Dengue is caused by the aedes aegypti mosquito that also spreads Chikunguniya and Yellow fever. While there are readily available antibiotics to treat malaria, dengue has no direct medicine. 

“Malaria is caused by the plasmodium parasite. Dengue is a virus so antibiotics are useless against it. As doctors we try to take care of the complications caused by dengue, like infusing the patient with platelets when the platelet count falls. Other than that dengue is a self-limiting disease,” says Dr Anil Ballani, consultant physician with Lilavati and PD Hinduja hospitals.

Haiti: Still no basic sanitation

I'm on a mailing list for Haiti watchers, and today I got a letter from Stuart Leiderman, who's been watching Haiti a lot longer than I have. He's given me permission to publish his letter here:

1. PREPAREDNESS - As another wave of cholera is anticipated soon, it is worthwhile to review what, how and why cholera contamination of Haiti's waterways occurred in October 2010.  As the United Nations' expert panel reported last spring ... Haitian water supply habits and infrastructure and sanitation systems were unprepared for the introduction of a new pathogen.  Well and good, as far as that goes.  But neither were the United Nations' systems prepared, even though world governments spend almost a billion dollars a year to maintain peacekeepers in the country, covering everything from food and fuel but evidently not feces, or at least not very well.

MINUSTAH has been in Haiti several years, yet, per below, "the sanitation conditions at the Mirebalais MINUSTAH camp were not sufficient to prevent contamination of the Meye Tributary System with human fecal waste."  It is reasonable to ask about the conditions at all the MINUSTAH bases, approx. seventy-four of them.

2. FECES ISOLATION - To date, despite all the illnesses and deaths, there is still no appropriate sanitary policy from either the Haitian government or the United Nations to simply, cleanly and expeditiously with low technology, isolate human feces from Haiti's hydrological cycle.  This, despite centuries if not millennia of experience doing this in other parts of the world where feces are managed as recyclable organic resources, not filth.

3. PLAY IT WHERE IT LANDS - In addition to the on-site problems documented at the U.N. base near Mirebalais, note below the practice of long-distance trucking of wastes from Hinche and Terre Rouge to the same disposal site at Mirebalais used by the Nepalese contingent.  Referring to the MINUSTAH's map of bases March 2012, http://www.un.org/Depts/Cartographic/map/dpko/minustah.pdf  Terre Rouge is about ten miles south of Mirebalais and Hinche appears to be more than twenty-five miles north.  [Note, this map is not within the MINUSTAH website, nor linked from there; you have to go the long way around, through the un.org system's collection.]

4. COST-BENEFIT - Per excerpt below, the pumper trucks come all the way from Port-au-Prince, approx. thirty miles or more southwest of Mirebalais and, taking the Nepalese camp as an example, were doing that trip twice a week.  It can be reasonably asked, "What are the economics, fascination and persuasiveness of semi-weekly, long-distance trucking of peacekeepers' feces to a riverside disposal site in the Central Plateau, upstream of a major concentration of Artibonite Delta-dwelling Haitians?"  

It is also reasonable to ask whether MINUSTAH practices long-distance trucking of feces to and from bases in other parts of the country and, if so, a) who does it, b) what precisely are the disposal locations, c) what do they pay and d) how does the cost and effectiveness compare with on-site disposal such as composting?

These questions are germane not just for peacekeepers but for all who are now in motion with plans for housing developments and for resettling earthquake refugees in new villages and lakous.  They are germane because, for example, recent peer-review of USAID's north Haiti housing project solicitation reveals serious sanitation weaknesses.  I can provide copies on request.

5. FIELD INVESIGATION - Readers should also note that the current MINUSTAH map shows only Uruguayan peacekeepers in the vicinity of Mirebalais, not any Nepalese.  I don't recall reports of that base being closed, so I would appreciate readers' independent confirmation.  Hometown associations such as FATEM.org in Mirebalais should be able to ascertain this.

Likewise, Haitian hometown associations in the vicinity of other MINUSTAH bases should be investigating the safety of sanitation there.  It shouldn't take a search warrant for hometown teams accompanied by sanitarians to simply knock on those gates and be welcomed inside to use the bathroom and look around.

6. THE UN-LATRINE - While MINUSTAH's current bulletin, http://minustah.org/pdfs/fiche_information/CholeraResponse_EN.pdf  itemizes an impressive cholera-fighting campaign, latrines aka pit toilets are still the standard prescription, not composters.  This is disconcerting, to say the least, and tells us a full-seat press, so to speak, is needed to get MINUSTAH out of the pits and into the piles.

Bangladesh: H5N1 takes toll on poultry industry

Via The Daily Star: Bird flu takes toll on poultry industry. Excerpt:

Renewed attacks of avian influenza on the poultry industry cut chicken production and hiked prices of meat and eggs. 

The weekly production of day-old chicks fell by half to 46 lakh [4.6 million] in the last three months from 91 lakh 9.1 million] a year ago due to avian influenza or bird flu attacks at farms or hatcheries, according to an estimate of poultry breeders. 

In the wake of a fall in farming, egg prices rose 32 percent to Tk 34-Tk 36 [US$0.41-0.44] for every four pieces yesterday from Tk 26-Tk 27 [US$0.31-0.33] in the beginning of the year. 

Prices of broiler chicken increased 22 percent to Tk 150-Tk 160 [US$1.83-1.95] per kilogramme during the same period, according to data from the Trading Corporation of Bangladesh. 

“The situation is alarming,” said Moshiur Rahman, president of Breeders Association of Bangladesh. 

More parent stock farms got affected this year compared with the previous year, Rahman said. 

"It means that there is a shortfall in production of day-old chicks that are needed for farming. It may take a year to fill the supply deficit," he said. 

It is the fifth year the bird flu attacks have been ravaging the poultry industry, a key job provider in rural and semi-urban areas. 

Over the past years since 2007, half of nearly 150,000 poultry farms have been facing losses due to bird flu attacks, forcing tens of thousands of people out of jobs, according to MM Khan, secretary general of Bangladesh Poultry Industries Association (BPIA). 

To overcome the crisis, industry operators want the government to conduct regular vaccination but the government is yet to respond, Khan said.

Canada: Whooping cough spreading into Metro Vancouver

Via CBC News: Whooping cough spreading into Metro Vancouver. Excerpt:

A whooping cough outbreak in the Fraser Valley appears to be spreading into Metro Vancouver with 38 confirmed cases detected across the region in January, health officials say. 

Vancouver Coastal Health that's more than three times the usual number of cases for this time period, and as a result it is now offering free vaccines to pregnant women, their partners and for anyone with children under 18 months. 

“Since the outbreak in the Fraser Valley began in December, we’ve been closely monitoring the incidence of whooping cough in our region.” said Dr. Patricia Daly, the chief medical health officer for Vancouver Coastal Health. 

“Because the number of cases has risen over the last week in the Vancouver Coastal Health region, we are stepping up measures to protect residents.” 

The health authority says whooping cough causes coughing fits that can turn into severe illness and may last for months. It spreads easily through the air when an infected person coughs, sneezes, or laughs. It can be a very serious illness, even fatal, in young infants. 

The free vaccine is available through family doctors’ offices, public health clinics and some pharmacies. Details are avaliable by calling HealthLink BC at 8-1-1.

10 people killed in Mozambique cholera outbreak

Via Xinhua: 10 people killed in Mozambique cholera outbreak. Excerpt:

At least 10 people were killed in a cholera outbreak in Mozambique's northern province of Nampula, local health authorities reported on Saturday. 

The authorities fear the deteriorating of the situation with more than 1,000 cases reported between February and March. 

In a statement, the authorities said apart from poor sanitation, heavy rains in January and February were the main cause of the water-born disease. 

The rains have left shallow waters in the neighborhoods, where informal stall are selling food and other items without hygiene surveillance, the authorities said, warning that the disease may spread if rains resume in the most populous region of Mozambique.

Pakistan: High dependency wards for dengue patients soon

Via the Pakistan Observer: High dependency wards for dengue patients soon. Excerpt:

Commissioner Multan Khurrum Ali Agha has ordered to set up high dependency wards for dengue patients in all district headquarters of Multan division. Presiding over a meeting at committee room, he directed to officials concerned to speed up dengue campaign and ensure zero period at govt schools and colleges for creating awareness among students about dengue virus. He also directed to complete all arrangements at high dependency ward. 

He said that pamphlets and banners would be distributed among the citizens and special campaign would also be launched through media. He also directed to ensure spray at the buses coming from Lahore. On this occasion, Additional Commissioner Mian Maqbool Abass, Director Health Dr Imtiaz Paracha, Director Colleges Prof Dr Muhammad Azad and other officials concerned were also present. Meanwhile it is reported from Lahore that Operation Officer of World Health Organization is providing full technical assistance and cooperation to the Punjab government to combat dengue virus. 

Speaking at a training workshop titled “Dengue Prevention and Control”, organized by WHO and IPH for Health Education Focal Persons at IPH, he said main objective of the training was to deliver feedback to the training team regarding further trainings to be held for the remaining master trainers at district level and polish their skills. 

IPH Prof Dr Rubina Sarmad said that with collaboration of WHO and IPH, a number of training sessions and workshops for teachers, district health officers and assistant entomologist had been organized and the process was still in progress.

Tsunami-linked fishing boat spotted off BC

Via CBC News: Tsunami-linked fishing boat spotted off B.C. Excerpt:

A Japanese fishing boat that was washed out to sea in the March 2011 Japanese tsunami has been located adrift off the coast of B.C., according to the federal Transport Ministry. 

The 50-metre vessel was spotted by the crew of an aircraft on routine patrol about 275 kilometres off Haida Gwaii, formerly known as the Queen Charlotte Islands, ministry spokeswoman Sau Sau Liu said Friday. 

"Close visual aerial inspection and hails to the ship indicate there is no one on board," Liu said. "The owner of the vessel has been contacted and made aware of its location." 

U.S. senator Maria Cantwell, of Washington, said in a release that the boat was expected to drift slowly southeast. 

"On its current trajectory and speed, the vessel wouldn't make landfall for approximately 50 days," Cantwell said. 

Cantwell did not specify where landfall was expected to be.

WHO: Redefining drug-resistant TB

Here is the WHO news release mentioned in the CIDRAP report two posts below: More evidence and better diagnostics needed before redefining severe forms of drug-resistant TB says WHO. Excerpt:

Reports of tuberculosis (TB) cases with severe patterns of drug resistance are increasing, said experts who attended a WHO meeting in Geneva on 21-22 March. Participants stressed that the emergence of drug resistance should be a wake-up call for Ministries of Health. The group urged the global TB community to make greater efforts to prevent drug resistance and scale up provision of appropriate care and management to avoid a scenario where TB becomes incurable. 

Insufficient evidence 

The meeting concluded that there is currently insufficient evidence to adopt new case definitions for drug-resistant TB. Drug susceptibility testing (DST), which is key to defining new levels of drug resistance, lacks accuracy for several of the drugs that are used to treat multi drug-resistant (MDR) and extensively drug resistant (XDR)-TB. 

Secondly, there is insufficient correlation of DST results with clinical response to treatment for several drugs currently used to treat XDR-TB. 

Thirdly, new drugs are currently undergoing clinical trials, and could prove effective against drug resistant strains. 

The meeting urged diagnostics companies and TB laboratories to develop better diagnostic tests and also agreed that WHO and technical partners should develop more detailed guidance on XDR-TB treatment. 

Prior to results from randomized controlled trials, which are not expected for at least four years, participants called on WHO to lead a process with partners to improve the quality and quantity of observational data on the management of cases of severe forms of drug resistance. These data should be collected in a standardized manner which is essential for stronger future policy decisions on the management of drug resistant TB. 

Several new drugs belonging to new classes of anti-mycobacterial agents are under development for treating TB, but until they are shown to be effective in properly conducted clinical trials, WHO cannot include them in recommendations for treatment regimens. 

WHO is therefore leading a process to accelerate their introduction into clinical settings. The meeting also advised pharmaceutical companies to collaborate in the early development of combination regimens.