H5N1

Uganda: Portrait of a girl with nodding disease

Via Acholi Times, a very sad photo essay: 12-year-old Nancy Lamwaka reduced to living like pigs.

I can't excerpt it, but click through to read the text and see the photographs. Whatever this is, it's a terrible disease.

Vietnam: Medical workers struggle to contain spread of HFMD

Via Saigon Giai Phong: Medical workers struggle to contain spread of HFMD. I think the "460,000" in the first paragraph is a typo; the number in the third paragraph is 46,277. Excerpt:

More than 460,000 hand-foot-mouth cases have been reported in the   country since the beginning of 2012, with 27 fatalities, but till now the disease has not been contained. 

Why the disease is developing into a complicated strain and the various difficulties in preventing it from spreading were topics of grave concern at an online meeting held by the Ministry of Health with 19 provinces and cities across the country on May 25. 

Tran Thanh Duong, deputy head of the ministry’s Department of Preventive Medicine, said that across 63 provinces and cities in the country, 46,277 people had become infected with the disease since the beginning of the year, including 27 fatalities. 

Apart from that, in May alone, an additional 6,569 people were reported infected with hand-foot-mouth disease, said Duong. 

Cities and provinces with the most number of new HFMD cases include the northern provinces of Thanh Hoa, Hai Phong, Phu Tho, Ninh Binh, Hoa Binh, Thai Binh, Yen Bai, Lang Son, Hanoi; the central city of Da Nang and Binh Dinh Province; the highland province of Dak Lak; the southern provinces of Ba Ria-Vung Tau, Dong Nai and Ho Chi Minh City. 

Deputy Health Minister Tran Thanh Long stated that despite a lower number of cases in 2012, medical workers are facing difficulties in verifying the disease, and hence unable to warn of the spread of the disease. 

In addition, most deaths in Vietnam were caused by Enterovirus 71 (EV-71), which accounted for 90 per cent of cases this year while last year the rate was only 20 per cent, added the deputy health minister. 

Long warned of the spread of the dangerous virus Enterovirus 71 from the south to the north, expressing his concern about preventive measures and low awareness in parents of the disease. 

Representatives from the HCMC Department of Health said the habit of washing hands with soap is not a regular feature, even though medical workers have distributed chemicals and soaps to each household along with proper instructions. 

Noticeably, most cases are from highly urbanized areas where many workers live in rented houses, whose lifestyles are of relatively low standards.

Haiti: ‘Really quite disastrous’ (in more ways than one)

In The Washington Post, the editorial board says "Tsk-tsk": ‘Really quite disastrous’. Excerpt:

As the world's worst outbreak of cholera continues to ravage Haiti, international donors have averted their gaze.  

Humanitarian relief groups, short of cash, are folding their tents. A pilot project to vaccinate Haitians against the disease, recently undertaken at a cost of $400,000, reached only 1 percent of the population, with no immediate prospect of expansion. Of the 100 or so cholera treatment centers that sprang up around the country after the disease was detected 19 months ago, fewer than a third remain. 

The United Nations’ humanitarian coordinator for Haiti, Nigel Fisher, said this month that donors have so far met just 9 percent of the $230 million U.N. appeal for 2012 — not only for cholera but for a range of relief programs including flooding, tent cities and food insecurity. “It’s really quite disastrous,” he said. 

Meanwhile, cholera’s deadly toll has mounted in the Western Hemisphere’s poorest country. Unknown in Haiti for a century before the first cases appeared in October 2010, cholera has now killed 7,100 people, infected more than 550,000 and hospitalized nearly 300,000. 

It has also spread across the border to the Dominican Republic, killing more than 400 people there. Five percent of Haiti’s 10 million people have already been infected, and health experts estimate that 200,000 could contract the disease this year.

I know I'm becoming a crank on the subject of the PAHO prediction of 200,000 cases this year. And I'm getting worse. At this rate, I'll soon start assuming that any argument invoking "experts" is bogus.

But the 200,000 argument has told me more than I want to know about some important institutions. 

It's told me that PAHO is making stuff up about Haiti (or if it's not, it's failing to tell us where it got the number). That speaks very poorly for the integrity of PAHO and WHO, of which it's a part.

It also tells me that major news media, including The Washington Post, are credulously accepting what they're told, instead of testing the validity of those experts' estimates. If any reporters on the ground in Haiti are still covering cholera, they're not questioning PAHO either—though it would make quite a story.

Finally, it tells me that even in public-health agencies, politics trumps health. And in the media, Haiti is forever framed as a no-hope country, about which we can moralize without knowing what the hell we're talking about.

Philippines: Zambo health office not recommending use of ‘tawa-tawa’ vs dengue

Via MindaNews.com: Zambo health office not recommending use of ‘tawa-tawa’ vs dengue. Excerpt:

ZAMBOANGA CITY (MindaNews/24 May) – The local health office here still does not recommend the use of tawa-tawa (Euphorbia hirta) despite numerous claims that it can be effective in treating patients with dengue hemorrhagic fever, which has already reached the outbreak level here. 

Dr. Rodelin Agbulos, city health officer, explained that they refrain from recommending the use of tawa-tawa because they still do not know yet what could be the herb’s other effects to the human body. “It could be effective in the control of platelet count but we do not know its effects to other organs like kidney and liver,” Agbulos said. 

Agbulos said a study is still being conducted on the effects of tawa-tawa and they are still waiting for the result to be released. 

The study, he said, is being conducted by the Department of Science and Technology (DOST) through its Philippine Council for Health Research and Development (PCHRD). 

The study being conducted is focused on the anti-viral and anti-inflammatory properties of tawa-tawa and its supposed ability to increase blood platelets. 

Even though there are no scientific findings yet, tawa-tawa is being used by many to treat family members with dengue fever. 

Tawa-tawa, which is common in the Philippines, is usually boiled and the water given to dengue fever patients.

US: Scientists observe 'tragic experiment' of tsunami debris

Via The Los Angeles Times: Scientists observe 'tragic experiment' of tsunami debris. Excerpt:

In all, more than 200 bottles, cans, buoys and floats have been reported to the National Oceanic and Atmospheric Administration. None of the debris is considered radioactive since it was dragged to sea before the nuclear disaster. 

But the agency has verified just a few traceable items as tsunami debris. Much of the rest, officials say, is items so commonplace they can't be distinguished from the flotsam that makes landfall every day. 

"We have debris washing up on the shore all the time from Japan, China and other places and they probably have ours," says Nir Barnea, West Coast coordinator of NOAA's marine debris program. 

Others say the U.S. government is downplaying the size and significance of the approaching debris. 

"Unfortunately 99.999% of debris doesn't come with a label," retired Seattle oceanographer Curtis Ebbesmeyer said. "Lawyers want something with a street number or a boat name on it. Flotsam isn't like that, so basically you can't positively track anything back to Japan." 

Ebbesmeyer, who compiles reports from West Coast beachcombers on his blog, has tallied at least 500 foam and plastic floats and fuel cans that have shown up from Japan since October. He said that's roughly 167 times the normal rate. 

"They all started arriving at once from Kodiak, Alaska, to Northern California, and that's very indicative of a disaster," he said. 

Ebbesmeyer expects the amount of debris to increase dramatically this fall with the arrival of floating refrigerators, car wheels, bath toys and shoes — items with a remarkable ability to float long distances. 

With that possibility in mind, the state of Washington has distributed fliers with instructions on how to handle everything from canisters of insecticide to personal possessions.

Japanese minister visits Fukushima nuclear plant amid safety concerns

Via The Globe and Mail, a report by The Associated Press: Japanese minister visits Fukushima nuclear plant amid safety concerns. Excerpt:

Japan's environment and nuclear minister visited the tsunami-crippled Fukushima Dai-ichi nuclear power plant on Saturday to inspect a spent fuel pool at the centre of safety concerns and said it appeared to have been properly reinforced. 

The visit by Goshi Hosono, apparently aimed at demonstrating the safety of the facility, came amid renewed concerns about conditions at the plant's No. 4 reactor after its operator reported a bulging of the building's wall. Nuclear regulators ordered a new investigation and seismic tests of the building and its pool. 

The building was damaged by an explosion and fire soon after the Fukushima plant was hit by a massive magnitude-9.0 earthquake and tsunami on March 11, 2011. The pool, located at the top of the building above the reactor, remains one of the plant's biggest risks due to its vulnerability to earthquakes. 

The plant's operator, Tokyo Electric Power Co., has reinforced the structure and says it now can withstand temblors as strong as last year's quake. 

A small group of journalists was allowed to enter the reactor building for the first time with Mr. Hosono. Inside there were piles of broken wall panels, pieces of cement and mangled equipment, showing the magnitude of the explosion. 

Mr. Hosono, wearing protective coveralls and a full-face mask, climbed a narrow scaffolding to the fifth floor to see the pool, which was covered with a protective tarp. TEPCO officials lifted part of the cover to show the water surface. 

Mr. Hosono later told reporters that he could see that the pool had been sufficiently reinforced. 

“I could see steady progress being made toward removal of the spent fuel (from the pool), which is the next major goal,” he said. 

The fuel rods in the storage pool are not enclosed as they are in reactor cores and could cause a greater release of radiation in case of a loss of water. 

Uganda: Eight years of nodding disease

Via the Saturday Monitor, a long, angry report: Eight years of nodding: The mockery of govt response to the disease. Excerpt:

Eight years ago, this month, three year old Sunday Apiyo started experiencing strange fits that her guardian suspected to be cerebral malaria for several days, sending her 70-year-old grandmother Rufia Lamaji into panic. 

Ms Lamaji, of Lapul, Atanga Sub-county in Pader District, said she took her granddaughter to the hospital and also bought medicine from a drug shop for malaria but within weeks, her daughter’s condition had worsened. 

“The fits continued and she started nodding her head whenever she was given food besides losing weight,” she said. 

Apiyo, now 11, can pass for a three year-old-child. 

In January 2010, we interacted with Ms Hellen Aol, who had that time had all three of her children malnourished and suffering from the unknown disease. 

“There is a new disease that has started here making our children to be stunted in growth,” she said at Atanga Health Centre III where she and other parents had gone to collect fortified food that was being given by World Food Programme. 

These were some of the first reported cases of the mysterious nodding disease syndrome that has ravaged the northern Uganda districts of Pader and Kitgum. 

However, eight years down the road, the story has been one pitying tale of an ignorant population caught unaware, fighting a mysterious illness that has sent many of their children to an early grave and a government caught napping as the unknown disease consumes the young people. 

Initially seen by parents as a disease akin to epilepsy, the disease has spread terror and mayhem across the region to a level commensurate to two-decade onslaught by the Lord’s Resistance Army rebels. 

Eight years since the first cases were reported and three years since government’s first response, the government, however, continues gambling with anti-nodding and seizure medicines, without evidence on how the disease is spread, or if it mutates, or what causes it. 

Government’s interventions, in form of material and medical support to nodding patients, have largely remained minimal and sluggish in coming. 

Despite putting up treatment centres in the affected four districts of Kitgum, Pader, Lamwo and Gulu, majority of affected children are still in homes, most unable to trek to health centres to pick medications Although the Ministry of Health puts the number of affected children at 3, 500, a new World Health Organisation report places the number at 7,000. 

The argument about numbers aside, the government is yet to discover the actual cause of nodding disease. The government’s first known response to the disease came in 2009 after numerous complaints from the local community. 

Residents of Lapul recount how, that year, the government sent a team to Aruu Falls that surveyed the area before warning that they should keep away from the falls and promising to deliver drugs against black fly. 

The drugs never came as much, and district leaders made several appeals to the government but nothing came forth. 

However, the government will today, officially launch the mass taking of onchorcerciasis drugs that it promised in 2009 in Angagura Sub-county at a function that will be graced by President Museveni.

Here is what the US CDC says about nodding disease. And here is what WHO says about it.

The World Health Assembly concludes

Via WHO, World Health Assembly: daily notes on proceedings for Friday, May 25. Excerpt:

Committee A today approved a draft resolution (EB130.R10) which declares the completion of poliomyelitis eradication a programmatic emergency for global public health. India was once again congratulated for stopping indigenous wild poliovirus circulation. 

However, three countries still face endemic transmission of wild polio virus; unless poliovirus transmission is stopped in these countries, there will be a global resurgence of the disease with a real risk of severe outbreaks in areas that have long been polio-free. 

The approved resolution requires the full implementation of current and new eradication strategies, the institution of strong national oversight and accountability mechanisms for all areas infected with poliovirus, and the application of appropriate vaccination recommendations for all travellers to and from areas infected with poliovirus. 

Member States with poliovirus transmission are urged to declare such transmission to be a “national public health emergency”, requiring the development and full implementation of emergency action plans. 

Pakistan, Nigeria and Afghanistan have already established national emergency plans for polio eradication and shifted their national polio eradication initiatives to an emergency status, with an all-of-government and society approach to ensure all children are reached and vaccinated. 

During the discussion, partners reiterated their support to the polio eradication initiative and the importance of treating polio eradication as a programmatic emergency, and urged all partners to be fully committed in their action and their financing. 

WHO Director-General Dr Margaret Chan and Assistant Director General Dr Bruce Aylward stated that polio eradication is at a tipping point between success and failure, and necessary funding is essential to ensure it tips in the right direction. The minimum additional funding needed for 2012 alone is USD 150 million.

Dominican Republic: Both cholera and dengue in Mao Valverde

Via Hoy Digital: Hay 22 casos de cólera en Mao. [22 cholera cases in Mao] Excerpt, with my translation:

MAO VALVERDE. Las autoridades del Ministerio de Salud Pública en esta ciudad  confirmaron 22 casos de cólera, al tiempo de informar que han dispuesto un  nivel máximo de alerta con relación al dengue. 

MAO VALVERDE. Ministry of Public Health officials in this city have confirmed 22 cholera cases; at the same time they have announced a maximum alert over dengue.

Los afectados han sido llevados al hospital Luis L. Bogaert, de esta ciudad. 

The cholera cases have been taken to the Luis L. Bogaert Hospital in this city.

Las personas afectadas residen en los barrios María Auxiliadora y San Antonio, de esta ciudad, donde sus moradores han mostrado temor por la aparición de la enfermedad. 

The infected persons live in the neighbourhoods of María Auxiliadora and San Antonio, in this city, where residents have expressed fear about the appearance of the disease.

El director provincial de Salud, doctor Felipe Amaro, dijo que la institución  ha iniciado una campaña de concienciación de la población, a través de los medios de comunicación, con el fin de prevenir la ocurrencia de los casos de ambas  enfermedades.

Dr. Felipe Amaro, provincial health director, said the institution has launched a public-awareness campaign in the media to prevent more cases of both diseases.

Kenya: No malaria drug resistance

Via allAfrica.com, a report in The Star: Kenya: No Malaria Drug Resistance. Excerpt:

Researchers have not identified any cases of antimalaria drug resistance in Africa. The scientists meeting in Nairobi said recent reports of resistance to the most effective treatment - the artemisinin combination therapies (ACTs) - are inaccurate. "There is no confirmed resistance in Africa," said head of disease control in Kenya Dr Willis Akhwale. 

Artemisinin resistance is considered a global emergency because the resistant parasite can kill millions of people if it spread to regions with high malaria burden such as Africa. Few cases of resistance have been reported in Asia and scientists meeting in Nairobi are now formulating a response plan for Africa. "Eastern African nations must act now: be vigilant and prepare for the possible emergence of antimalarial resistance," the scientists said in a statement. 

Dr Akhwale warned failure by malaria patients to complete dosages could easily make the parasite resistant to the artemisinin-based drugs. The drugs are derived from the sweet worm wood plant, mainly grown in Kenya, China and parts of Vietnam. The plants have been used for many generations to treat malaria. 

A combination of treatment, indoor spraying and use of treated nets have reduced incidence of malaria to less than five per cent across Kenya, except in Lake Victoria region where prevalence remains at 38 per cent. 

Head of malaria control Dr John Logedi said the ACTs should only be prescribed after blood tests confirm malaria. "We are introducing the rapid diagnostic tests should be used in all health facilities and chemists," he said. The drugs are given free in public health facilities and easily available in chemists at less than Sh40. 

Executive director of World Wide Antimalarial Resistance Network Dr Philippe Guerin said poor quality and fake drugs could also cause resistance. "Poor quality drugs may have low amounts of active ingredients that many lead to resistance," he said yesterday. 

WWARN East Africa scientific director Dr Ambrose Talisuna said the reported resistance in Asia was a wake up call for Africa. "We need international cooperation because artemisinin resistance goes beyond borders," he said.