H5N1

Brazil: 85 H1N1 deaths so far this year

Prensa Latina, the Havana-based news agency, still hasn't said anything about the cholera outbreak in Cuba, but it does a pretty good job on the rest of Latin America. For example, this July 6 report: Brasil confirma 85 muertes por Influenza A (H1N1) hasta junio pasado. [Brazil confirms 85 H1N1 deaths as of June] Excerpt, with my translation:

El Ministerio de Salud de Brasil confirmó hoy la muerte de 85 personas en el primer semestre de este año debido a la Influenza A (H1N1), de los 790 casos reportados, más de cuatro veces lo verificado en todo 2011.   

The Brazilian Ministry of Health confirmed today the deaths of 85 person in the first half of this year owing to H1N1. Seven hundred and ninety cases have been reported, more than four times those confirmed in all of 2011.

El boletín de las autoridades sanitarias refiere que el año pasado fueron registrados 181 casos de la dolencia, con 27 muertes, poco más de tres veces los 85 fallecidos en el primer semestre de 2012. 

The bulletin of the health authorities notes that last year 181 cases were recorded, with 27 deaths; the 85 deaths in the first of 2012 are a little more than three times that number.

A pesar de las altas cifras de los primeros seis meses de este año en comparación con lo verificado en 2011, el Ministerio de Salud sostiene que no hay una epidemia de Gripe A, como también es conocida esa enfermedad.

Despite these high numbers compared to 2011, the Ministry of Health insists that there is no epidemic of Influenza A, as the disease is also known.

Cuban cholera outbreak reaches Havana

Thanks to FluTrackers for today's "uh-oh..." report, via BBC News: Cuban cholera outbreak reaches Havana. Excerpt:

The BBC has learned that a patient has been diagnosed with cholera in the Cuban capital, Havana, days after three people died in a rare outbreak in the south-eastern town of Manzanillo. 

More than 50 people were infected and about 1,000 have received medical attention. 

The authorities say the outbreak is under control but four hospitals are prepared to isolate patients. 

They say people became ill after drinking water from contaminated wells. 

 But it is not clear what the source of the cholera is.

"Black swan" heat wave leaves 30 dead across the US

After a long, grey, cool, wet spring, Vancouver is now enjoying sunshine and temperatures in the mid-20s Celsius. But our skies are white from the smoke of the Colorado fires, themselves a product of global warming. Via The Globe and Mail:  Record-setting heat wave leaves 30 dead across the U.S. Excerpt:

Americans dipped into the water, went to the movies and rode the subway just to be in air conditioning Saturday for relief from unrelenting heat that has killed at least 30 people across half the country. 

The heat sent temperatures soaring over 38-degrees in several cities, including a record 40.5-degrees in Washington, St. Louis (41), and Indianapolis (40), buckled highways and derailed a Washington-area train even as another round of summer storms threatened. 

The heat sent temperatures soaring in more than 20 states to 40.5-degrees in Louisville, Kentucky, 38.5 in Philadelphia, and 35 in New York; besides Washington, a record of 40-degrees was set in Sioux Falls, South Dakota, and Baltimore set a record at 39-degrees. 

At least 30 deaths were blamed on the heat, including nine in Maryland and 10 in Chicago, mostly among the elderly. Three elderly people found dead in their houses in Ohio had heart disease, but died of high temperatures in homes lacking power because of recent outages, officials said. Heat was also cited as a factor in three deaths in Wisconsin, two in Tennessee and three in Pennsylvania. 

Officials said the heat caused highways to buckle in Illinois and Wisconsin. In Maryland, investigators said heat likely caused rails to kink and led a green line train to partially derail in Prince George’s County, Maryland, on Friday afternoon. No one was injured, and 55 passengers were safely evacuated. 

Thousands of mid-Atlantic residents remained without power more than a week after deadly summer storms and extreme heat struck the area, including 120,000 in West Virginia and some 8,000 in the suburbs around Baltimore and Washington, D.C. In the Washington area, the utility company Pepco asked customers to conserve power, saying the heat was stressing the system. 

“This is becoming a black swan of heat waves, in the sense that it’s such a long heat wave, such a severe heat wave and encompassing such a large area,” said Chris Vaccaro, spokesman for the National Oceanic and Atmospheric Administration.

China: Hand, foot, mouth disease kills 240

Thanks to Laurie Garrett for the link to this China Daily report: Hand, foot, mouth disease kills 240. She wonders if this is the source of the undiagnosed Cambodian outbreak, but the case fatality ratio of Chinese and Vietnamese HFMD is minuscule by comparison with the Cambodian cases. Excerpt:

At least 240 people, mainly children younger than 5 years old, have died from hand, foot and mouth disease from January to May as China enters a peak season of the epidemic, the Ministry of Health has said. 

The peak will last until October but the infection commonly seen among toddlers can be easily prevented and treated with early detection and intervention, said Xiao Donglou, a division director of the ministry's disease prevention and control bureau. 

According to official statistics the infection claimed more than 240 lives on the mainland in the first five months of the year. 

The epidemic appeared to hit harder this year in terms of scale and severity, Xiao said. 

From January to June last year, 132 deaths were reported. 

An official tally showed China reported nearly 1.62 million HFMD cases in 2011, including 509 deaths.

India: Breathing uneasy over TB

Via The Hindu, an op-ed: Breathing uneasy over TB. Excerpt:

Tuberculosis is a disease of antiquity that claims nearly 1,000 lives every day in India. There are serious challenges that continue to exist in the TB landscape. One of these is drug resistance to anti-TB drugs. Though drug resistant TB has been in existence for long, it has lethal forms that continue to emerge and threaten to undermine the extensive work undertaken to prevent and control the spread of TB. 

Drug resistant TB is a man-made problem, the result of treatment mismanagement due to which the TB bacteria develops resistance to the two or more most commonly used drugs in the current four-drug (or first-line) regimen, leading to multidrug-resistant TB (MDR-TB). 

In some cases, this mismanagement can transform itself into extensively drug resistant TB (XDR TB), where the bacteria do not respond to even second line drugs. This poses a serious threat to global TB control. 

To make matters worse, an advanced form of drug resistance has been reported recently in India. It is known as extremely drug resistant TB (XXDR-TB). In this form of the disease, none of the known TB drugs or their combinations work. 

A study 

The reasons for the rise in drug resistance are many. In most instances, detection of the disease is delayed due to the non-availability of good diagnostic laboratories and patients receiving treatment with non-standardised and arbitrary drug regimens of questionable quality. There is continuous use of incorrect diagnostics like serological tests for detecting TB which are utilised in the private sector. Though the World Health Organisation (WHO) has recommended the ban on the use of these tests, $15 billion is being spent annually in India on these. 

A recent study carried out by the All India Institute of Medical Sciences (AIIMS) concludes that serological tests can detect the disease only in a quarter of TB patients while three-fourths will be wrongly diagnosed as non-TB cases, even if they are smear positive. In other words, most who have the disease will be diagnosed as healthy, and most healthy persons will be diagnosed as TB infected patients, if serology alone is relied upon. 

Although drug resistant TB in India has been reported frequently during the last four decades, the available information from here is incomplete. Most patients are not notified to the Revised National Tuberculosis Control Programme (RNTCP) and many treatment outcomes remain unknown. Recently, the Central TB Division (CTD) has taken a policy decision to make it mandatory to notify all TB cases — a positive step. 

Treatment costs 

MDR-TB can only be treated with second line drugs which are very expensive. The treatment course is very long and expensive. It is vital to have mechanisms of appropriate regimen and ensuring access to quality assured drugs. Self-prescription of anti-TB drugs promotes drug resistance. This is made worse by the lack of regulation in accessing these drugs. 

Treatment of MDR TB commences after detection, a process that takes many months when conventional methods are used. As a result, patients with MDR- or XDR TB continue to spread the infection to others. 

Drugs used to treat MDR- and XDR TB are toxic and expensive when compared to those used in the treatment of basic TB. While a course of standard TB drugs costs approximately Rs.1,000 [US$18], MDR-TB drugs can cost more than Rs.1 lakh [US$1,800]. XDR-TB treatment is far more expensive. 

The need of the hour is not only detecting drug resistant strains early, but also initiating measures for optimising disease management and care so that each patient is diagnosed quickly and treated appropriately.

Haiti: Drought threatens crops

Via Le Nouvelliste: The Drought threatens crops. Apparently the rainy season hasn't been all that rainy, regardless of cholera numbers. Excerpt from a slightly edited computer translation:

The observed decline in rainfall since the end of May last undermines the production of several crops, including maize, rice and beans, sown in April and May, according to the latest bulletin of the National Coordination of Food Security (CNSA). 

This state of drought, including potential losses to crops is estimated at 40% or more depending on the region, threatens household food security especially in the communes of Lower Northwest, Upper Artibonite, West ( In particular Gonave, Gressier, Leogane), Southeast (Bainet, Iron Hill, Anse-à-Pitre), North (Pignon, Victory, Ranquite), Grande-Anse (Coral, Pestel, apricot, candy) and especially the Northeast (particularly Ferrier, Capotille ...). 

However, overall, prices could remain stable until August. "Increasing the availability of local food products on the market, and therefore a relative price stability of the latter remains possible," we read in the bulletin dated June 2012. 

Indeed, the note said CNSA stability of food prices on local markets of most countries and expects this trend continued until August next, under the assumption that harvests in June and July will allow households to meet their food needs at least until this month. 

In many areas, spring harvest, a little earlier than last year, has already begun. This is true especially in the departments of South and Southeast, as well as in the lower Central Plateau, in Lower Artibonite and in some northern municipalities. Farmers have harvested beans, maize, cassava, sweet potato and many other commodities such as fruit trees true, vegetables and bananas they have sown in February and March. In these areas more food will be available on the market and accessible to rural households and their prices, for the most part remain relatively stable compared to April 2012. 

This July should mark the beginning of the harvest of corn, peas and vegetables by the end of the lean season, which was extended in June in the Lower Northwest and certain municipalities of Upper Artibonite as Anse-Rouge, Newfoundland and Gros Morne. Most prices will remain stable in July and August. However, beans will rise, because of the increased demand for seeds required for planting in wet mountain for the same period. 

But from August, the CNSA expects a rise in food prices, given the low production of the spring campaign. The fall rains have caused widespread drought across the country, which has seriously affected production of maize and sorghum, from the beginning of June. This trend is particularly worrying as corn, much cheaper and far more accessible to the poor as rice, particularly in rural areas, is the main cereal planted during the spring campaign. 

If the second rainy season starting in August will offer employment opportunities to the poor level of wet mountain plantations of beans and tubers, it is also likely to be disastrous because of possible floods and cyclones. 

In this sense, the CNSA is sounding the alarm about the possibility of a new resurgence of the cholera epidemic, as was the case in 2011, which may affect households and test the contingency plans put in place by the management of Emergency Preparedness, Red Cross and their partners.

Fukushima: Reactor in trouble before tsunami?

Via The Japan Times Online: Reactor 1 quake-damaged? This has implications for many other Japanese reactors. Excerpt:

The 9.0-magnitude quake that rocked the Fukushima No. 1 plant in March 2011 may have knocked out one of the emergency generators at reactor 1 before the site was engulfed by tsunami, according to a Diet panel's final report on the nuclear crisis. 

The independent panel's findings, released Thursday, challenge Tokyo Electric Power Co.'s assertion that the tsunami single-handedly disabled all the plant's emergency power generators and that the massive temblor wasn't directly responsible. 

If the diesel generator at the No. 1 reactor was crippled by the megaquake, this would seriously undermine Tepco's claims that the Fukushima No. 1 complex survived its initial impact and also question the quake-resistance of many other old reactors nationwide. 

The government and Tepco should not assume that a "total power loss would have been averted if not for the tsunami," the panel stated in the report. 

The power outage halted the critical cooling function in reactor cores, which led to three of the plant's units suffering meltdowns and emitting massive quantities of radioactive materials into the environment. 

The panel suggested that some of the emergency generators at reactors 2 and 3 also might have been knocked out by the quake. 

Tepco has consistently claimed that the initial tsunami that smashed into the power station at 3:35 p.m. on March 11 knocked out all the emergency generators, resulting in a total power outage. 

But the panel pointed out that a wave gauge set up about 1.5 km off Fukushima's coast recorded the first tsunami sweeping by at exactly 3:35 p.m., and estimated that it would have taken at least two more minutes for it to reach the No. 1 plant. 

This would mean that the power generators were knocked out sometime after 3:37 p.m. 

But it is believed the power generator in question was disabled between 3:35 p.m. and 3:36 p.m., implying the quake rather than the waves was responsible, according to the report.

The TB/HIV syndemic

Via Morbidity and Mortality Weekly Report: CDC Grand Rounds: the TB/HIV Syndemic. A syndemic is a multiple epidemic affecting the same population. Excerpt from a long, informative report:

TB and HIV act synergistically within a population to cause excess morbidity and mortality. PWHA [persons with HIV/AIDS] are more likely to develop TB disease because of their immunodeficiency; HIV infection is the most powerful risk factor for progressing from TB infection to disease (4). 

Diagnosing TB disease among PWHA is particularly challenging because PWHA who have pulmonary TB frequently have negative sputum smears and up to one third might have completely normal chest radiographs (5). 

Furthermore, TB in PWHA often occurs outside the lungs, evading traditional diagnostic tests. Because TB is both common and difficult to diagnose, many PWHA feel ill but are unaware that they have TB. 

A recent review found that when systematic efforts were undertaken to diagnose TB, approximately 8% of patients who went to HIV care and treatment facilities were found to have TB disease (9), although the exact proportion varies substantially depending on the epidemiology of TB in the area. 

Finally, TB is a frequent cause of death for PWHA, particularly if HIV disease is advanced and antiretroviral therapy (ART) has not yet been initiated. Persons with both diseases must adhere to complex drug regimens that might interact with each other and might have overlapping toxicities. 

Combating the Dual Burden of Disease 

TB disease and death can be prevented in PWHA by early TB diagnosis and effective treatment of both diseases. Early diagnosis and treatment ensure that TB treatment is provided before the illness reaches an advanced stage, thereby decreasing mortality, and ensures that the duration of infectiousness is limited, thereby reducing transmission of TB to others. 

TB disease also can be prevented by treating persons with TB infection. Treatment of TB infection requires reliably excluding the presence of TB disease to avoid the development of drug resistance; drug resistance could emerge if a patient receives a single drug to treat TB infection when the patient, in fact, requires a multidrug regimen to treat TB disease. 

Until recently, no internationally accepted, evidence-based, sensitive approach existed to screen PWHA for TB disease, although some preliminary data had begun to suggest that commonly used approaches were inadequate. 

CDC investigators partnered with the U.S. Agency for International Development (USAID), ministries of health, and nongovernmental organizations in three Southeast Asian countries to derive a TB screening algorithm that would solve this problem. This study concluded that asking patients about three symptoms (i.e., cough, fever of any duration, or night sweats lasting longer than 3 weeks) accurately categorized PWHA for targeted interventions. 

Patients with none of these three symptoms can be considered free of TB disease and offered treatment to prevent TB disease, if indicated; patients with at least one of these symptoms should have further diagnostic tests performed for TB disease (5,6) 

These criteria mark a significant improvement over the 2007 World Health Organization (WHO) guidelines in which screening was based primarily on the presence of chronic cough.

Philippines: Iloilo dengue reaches endemic levels

Via the Manila Bulletin: Iloilo Dengue Reaches Endemic Levels. Excerpt:

Dengue hemorrhagic fever cases in Iloilo City have reached endemic levels. 

According to the City Health Office (CHO), 982 cases have been recorded from January 1 to June 30 this year and of this number, seven have already died. 

Dr. Mae Delmo, assistant city health officer, said the number of dengue cases has jumped significantly. In June 2012 alone, the CHO recorded 125 new cases versus 30 cases during the same period last year. 

Villages with high-incidence of dengue include Bolilao in Mandurriao district as well as San Juan, Calaparan, and Calumpang in Molo district. 

Delmo also noted that a significant number of cases have been recorded in the past month in Dulonan, Sto. Niño and San Jose in Arevalo district. 

Delmo said other dengue strains are already present and that explains the significant number of increase in such cases. 

Also a reason is the intermittent or on-and-off occurrence of rains, a factor conducive for mosquitoes to find breeding places. 

Delmo warned that even children belonging to middle-class and upper middle class families have been infected with dengue. 

“Some cases are already found in private subdivisions,” Delmo said.

Cambodia: Hospital is in desperate need of our help

Via The Phnom Penh Post, a letter to the editor confirming the report below from Salon.com: Hospital is in desperate need of our help.

I was sad to learn there is apparently no public sympathy for the financial crisis the Kantha Bopha Hospital is facing. 

Several reports in local and international media have highlighted that the hospital urgently needs help if it is to survive. Indeed, this is an extremely urgent issue for us all. 

Unlike the Koh Pich stampede in 2010 or the fighting on the Cambodia-Thai border, this in-house health crisis is largely ignored by Khmers. 

The Kantha Bopha Hospital has greatly enhanced the lives of the next generation of Cambodians by generously treating thousands of infants and young children whose impoverished parents could not afford proper medical care. 

Many of them would have died were it not for the treatment provided by this hospital. 

I have followed up the news about the fund-raising, and it appears few people have made their contribution; most of us continue to ignore it. 

I have visited the Kantha Bopha Hospital several times, bringing my two-year-old son for treatment of his respiratory disease. I was warmly welcomed, and he was hospitalised safely. I will never forget the goodness this hospital has shown me and my family. 

Although I cannot help the hospital much by donating, as I live in another country, I know the families of the patients and the hospital staff in this time of crisis would be far from calm. 

I can’t imagine the death of my own child from lack of medical care. 

I would like to see a real commitment from everyone, especially those with power and resources, to do something like establishing a social foundation to gather resources from everyone, like the one that was set up after the Koh Pich tragedy. 

At the very least, such a step would save hundreds of young lives, safeguarding the future of our nation. 

This is very urgent, as the lives of young Cambodians are at risk, and it is in your hands to help. 

Please do something to help the Kantha Bopha Hospital. I am sure that with our hearts and hands, we can do it. 

Chanthy Sam 

Bangkok, Thailand