H5N1

Uganda: Why the nodding disease should make us re-examine our journalism

Via the African Centre for Media Excellence, a thoughtful commentary that applies to journalists everywhere: Why the nodding disease should make us re-examine our journalism. Excerpt:

If, as reports in the Daily Monitor and The Observer have noted, at least 3,000 children had been affected by the disease in the seven districts by December 2011, and yet Uganda’s leading media houses had not realised the seriousness of such a prevalent problem until the MPs spoke out, then we need to ask ourselves some hard questions:   

1. Until late last year, where were we – the journalists?   

2. How did this nodding disease spread so widely, affect so many children and cause so many deaths under our very own noses?   

3. How did we not, at the very least, notice a trend from the few stories that some of us had written about the disease?   

4. If the MPs had not brought the issue to Parliament, how much longer would the disease have ravaged the children in northern Uganda before we finally gave it sufficient attention?   

It is no secret that many journalists, especially non-staff reporters, operate under very difficult conditions – even in the country’s leading media houses. I will therefore not go into those problems that we cannot do away with in the near-future (although it doesn’t mean we should stop trying).   

One of the key issues coverage of nodding disease has once again exposed is the scope of our news coverage and the importance that we attach to stories from the countryside. Had the nodding disease attacked children in Kampala in December 2009, I believe we would have dedicated lots of newspaper space and broadcast airtime to highlighting its devastating effects – and perhaps compelled the government to act much earlier.   

Kampala, and its immediate neighbouring districts, currently has arguably more journalists (and certainly the most experienced) than the rest of the country combined. The argument for this imbalance, besides of course the pay packages, is that media houses need all their top journalists at their respective headquarters because they are able to write about ‘the big picture’.   

But what is that big picture and can it only be seen from Kampala? My take is that the big picture is not only visible from Kampala, because big picture issues are those that affect Ugandans in any part of Uganda. If anything, whatever problem people in Kampala face is likely to be multiplied several times in the countryside. If the price of fuel goes up by 50% in Kampala, it is likely to go up by up to 100 to 150% in the districts of Moroto, Adjumani or Bundibugyo. If Mulago Hospital has only five kidney dialysis machines or incubators, Soroti Hospital is likely not to have even one. And the situation is likely to be worse the lower one goes down the health centre structure.   

We often fault global media houses for flying reporters to our countries for a few days to file half-baked stories that do not reflect the reality on the ground. Yet we are replicating the same model in our setting. 

If CNN stations one foreign correspondent in Nairobi to cover the entire East and Central Africa, and we assign one ill-equipped reporter to cover the whole of the West Nile region or the entire Karamoja region, what moral authority do we have to criticise CNN? 

It is only when we get wind of a big story like the nodding disease that we parachute one or two experienced reporters to the affected parts of the country to write one or two special reports and take pictures.

Philippines: DOH taking steps to address cholera ‘epidemic’ in Bicol

Via GMA News Online: Palace: DOH taking steps to address cholera ‘epidemic’ in Bicol. Excerpt:

As it voiced concern Saturday over reports that cholera has reached epidemic level in the Bicol area, Malacañang said the Department of Health is taking appropriate action to address the problem. 

Deputy presidential spokesperson Abigail Valte said the priority of the DOH is to render assistance to the local government units concerned. 

“We’ll have to check and ask the DOH to work with the local government units to continue rendering assistance para hindi lumala, hindi dumami ang cholera cases doon," she said on government-run dzRB radio. 

She also said the problem is a “concern.” 

Earlier reports indicated health authorities in Bicol had noted a sharp rise in the number of cholera cases from January to July, compared to the same period last year. 

State-run Philippines News Agency (PNA) said health authorities in Bicol raised an alert after cholera cases already reached an epidemic level with 30 deaths and 3,158 people affected. 

The PNA quoted DOH Bicol head Dr. Nestor Santiago as saying the 3,158 cases from January to July was a sharp rise from 445 in the same period last year.

Japan: Rainfall evacuees now number 400,000

The number was 240,000 earlier Saturday. Via The Globe and Mail, an AFP report: 400,000 people told to evacuate homes as rain continues to pound Japan. Excerpt:

About 400,000 people were ordered or advised to leave their homes in southwest Japan Saturday as heavy rain pounded the area for a third day leaving 29 dead or missing, officials and media said. 

The Japan Meteorological Agency warned of more landslides and floods on the main southern island of Kyushu as rainfall of up to 4.3 inches per hour was recorded Saturday. 

Evacuation orders were issued to about 260,000 people in the north of the island where more rivers burst their banks, Kyushu’s local media reported. 

They were told to go to designated shelters such as schools and other public facilities. 

Nearly 140,000 other people were advised to leave their homes to avoid possible disaster, according to officials contacted by AFP in the four affected prefectures in Kyushu. 

Television footage showed torrents of muddy, debris-strewn water and flooded houses following what officials described as “unprecedented” downpours from a seasonal rain front. 

Along the Yamakuni river in Oita prefecture, water levels were seen reaching the roof of a riverside drive-in restaurant before subsiding later. 

In Fukuoka prefecture alone, 78,600 people were ordered to evacuate their homes as rivers overflowed in dozens of places and 181 landslides occurred, an official said.

Italy: A hint of Japanese encephalitis

Via Eurosurveillance: Japanese encephalitis virus RNA detected in Culex pipiens mosquitoes in Italy. Excerpt:

Discussion 

While the potential risk of JEV spreading to Europe has been acknowledged before [8], and despite the active surveillance for flaviviruses such as WNV and USUV, to the best of our knowledge, this is the first report of a JEV-like sequence in mosquitoes in Europe. 

The JEV-like sequence was detected within a small scale preliminary study, and some details of the field work along with mosquito subspecies identification were unfortunately not documented in detail. Laboratory contamination as the source of the obtained JEV sequence was highly unlikely, as no JEV virus, RNA or PCR products had ever been handled in the laboratories where the mosquitoes were processed or where the RT-PCRs were performed. 

Interestingly, Mani et al. have reported detecting in 1996-97 JEV antibodies and RNA in Italian birds [9], but unfortunately no further information is currently available about the sequences found in that study. 

Recently, autochthonous dengue virus (DENV) infections have been detected in France [10] and Croatia [11]. While these viruses are most likely to have been imported there from endemic regions, most probably through viraemic travellers or via materials harbouring infected mosquitoes, eggs or larvae, JEV could have been introduced to Italy through waterfowl or wild waterbirds. 

Future arbovirus surveillance should include JEV-specific or pan-flavivirus detection methods, and it should be noted that due to cross-reactions, serological assays with the exception of seroneutralisation are probably unable to differentiate an immune response to JEV from one to WNV and USUV. 

Conclusions 

A partial genomic sequence of JEV was detected in Italian C. pipiens mosquitoes for the first time, but confirmation of the finding by additional sequence data or virus isolation has not yet been successful. The authors are aware that these findings are preliminary, and confirmation of the results is necessary. 

Further evidence of JEV circulation is required for evaluating the possible need for precautionary measures against JEV transmission in Italy and other European countries.

Malaysia: Increase in HFMD cases in Sarawak

After Cambodia, all of southeast Asia is getting nervous. Via The Malaysian Insider: Increase in HFMD cases in Sarawak.

The number of hand, foot and mouth disease (HFMD) affecting children in Sarawak is still high, but has yet to reach an epidemic level, State health director Dr Zulkifli Jantan said today. 

He said more HFMD cases were reported among children when they returned home for the Gawai Dayak festival and school holiday. 

However, he said, no deaths from HFMD had been reported yet.  

He advised the public to take the necessary precautions to prevent the spread of the disease. 

“They should take care of their hygiene and children with symptoms of the disease should not go to schools,” he told reporters after opening the Clinical Research Centre (CRC) at Sibu Hospital here today. 

Dr Zulkifli said so far the Kuching division reported the highest number of HFMD, totalling 115 cases, followed by Sri Aman (64); Miri (57); Sibu (31); Kapit (26); Betong (21), Bintulu (15); Mukah (14) and Sarikei (3).

Nigeria: Polio staging big return

Via allAfrica.com, a report from the Daily Trust: Nigeria: Polio Staging Big Return. Excerpt:

Damaturu, Abuja, Maiduguri, Katsina — Nigeria is one of the four countries - the rest are India, Pakistan, and Afghanistan - where polio transmission remains a worrying concern. 

Indeed, the United Nations Children's Fund said in June this year that Nigeria has so far recorded 45 cases of wild polio virus this year. 

The cases occurred in 10 northern states of the country according to a news note by the UNICEF, signed by Fatratra Lalaina Andriamasinoro. The affected states are Niger (1); Jigawa (2); Kaduna (8); Kano (8); Katsina (7); Sokoto (5); Zamfara (4); Borno (6); Yobe (3) and Bauchi (2). 

"Nigeria contributes 90 per cent to the polio burden in Africa and more than 50 per cent of this year's cases worldwide are from Nigeria," the agency added, but said the number has reduced compared to 25 cases in six states for the same period in 2011. 

The UNICEF said: "In key infected states like Borno, Kano, Sokoto and Yobe more than one in three children received less than four doses of oral polio vaccine. Polio-free states like Kaduna and Niger were re-infected in 2012." 

"While the proportion of missed children has shown a slightly decreasing trend in the last three rounds (7.2 per cent in February, 7.4 per cent in March and 7.2 per cent in May), hundreds of thousands of children continue to be missed during polio immunization campaigns in Nigeria. 

"According to the latest UNICEF Social Data Analysis, Kano has the highest percentage of missed children (8.9 per cent), followed by Kebbi (8.4 per cent) and Sokoto (8.1 per cent). In all northern high risk states, caregivers' refusals to vaccinate their children account for 24 per cent of the total number of missed children during the May Immunization Plus Days." 

UNICEF, however, acknowledged that Nigeria's funding of polio eradication has increased from $17m to $30m per year. 

The statement added: "In 2012, the President of Nigeria declared polio eradication as a national emergency, and Nigeria has committed additional funds to the program from its own treasury. "Domestic funding to polio eradication increased from $17m to $30m per year. Nevertheless, the Global Polio Eradication Initiative is currently facing its largest funding gap worldwide since its inception, with a total shortfall of $1 billion out of the $2.23 billion budget."

Cambodia: A battle of diagnoses

Via the blog Penh Pal.com: Cambodia’s Mysterious Disease Produces Battle of the Diagnoses. I can't find The Cambodia Daily or any other source near Dr. Richner, but I'll keep looking.

The Cambodia Daily reports that Dr Beat Richner is disputing the results of a briefing at the Ministry of Health on Friday by a pubic health specialist from the WHO, Dr Numa Asgari.  Asgari said that 79% of the children that died from the hand, food and mouth disease caused by enterovirus 71 had been treated with steroids at the Kantha Bopha hospitals. 

Children who died at the Kantha Bopha hospitals were suffering from encephalitis and all contracted severe pneumonia several hours before they died. 

“Steroid use has been shown to worsen the condition of patients with EV-71,” according to the statement. 

Dr Richner, meanwhile, has claimed that these deaths were caused by counterfeit medicines and faulty infections from private clinics prior to being admitted to his hospitals – a tacit criticism of the local health system. He also insisted that encephalitis is treated with steroids “all over the world” 

Moreover, Richner is insisting the encephalitis and following respiratory collapse represents a new development – an evolution of the disease we that may well be seeing here for the first time in the disease’s history. 

Richner is an iconic figure here in Cambodia, having devoted a significant part of his life to the hospitals that he has established in the Kingdom. He has also been a tireless campaigner and fund-raiser. He didn’t lose the opportunity, early in the drama for example, to mention that his hospitals risked running out of cash. 

This latest development, which looks suspiciously like point scoring, is a worrying development.

Japan: 240,000 evacuated amid Kyushu deluge

Via The Japan Times Online: 240,000 evacuated amid Kyushu deluge. Excerpt:

Some 240,000 people from about 85,000 households in Kyushu were told to evacuate as storms that have already killed 22 people continued to dump more rain on the region Saturday, local authorities said. 

 The orders were issued in four of Kyushu's seven prefectures — Fukuoka, Saga, Kumamoto and Oita. The police, meanwhile, have launched searches for seven missing people in Oita and Kumamoto. 

In Fukuoka Prefecture alone, around 190,000 people from 65,000 households were ordered to evacuate, including from the cities of Yanagawa and Miyama. At one point, all residents in Yanagawa were instructed to evacuate, although the order was later lifted in some areas. 

In the city of Yame, three people were hit by landslides early Saturday. Two were rescued but an 83-year-old woman was missing, police said. 

"I've been living here for 60 years, but I've never experienced this before," Yame resident Tsuneo Otsu, 63, said as he tried to push muddy water out of his house. 

In Hita, Oita Prefecture, Gov. Katsusada Hirose requested help from the Ground Self-Defense Force as police attempted to verify a report that a vehicle had been swept away. 

Meanwhile, the Yamakunigawa River in the city of Nakatsu and the Kagetsugawa River in Hita both overran their banks. 

The Meteorological Agency issued warnings for landslides and flooding rivers, saying the heavy downpours could hit parts of northern Kyushu as well. 

According to radar data, the town of Soeda in Fukuoka Prefecture was inundated by 90 mm of rain in just an hour through around 5:30 a.m., while Hita received 85 mm of precipitation between roughly 6:15 and 7:15 a.m. 

Yame, Ukiha and Chikugo in Fukuoka Prefecture all set new local records with hourly precipitation of 110 mm that ended at about 6:30 a.m.

Cuba: 158 cholera cases officially confirmed

Prensa Latina has finally posted something about the cholera outbreak: Cuba mantiene vigilancia epidemiológica ante brote enfermos de cólera. [Cuba maintains epidemiological surveillance over cholera outbreak] Excerpt, with my translation:

Las medidas preventivas e higiénicas adoptadas han posibilitado que el brote epidémico de transmisión hídrica, se encuentre disminuyendo, sin evidencia de propagación del cólera por alimentos u otra vía en el municipio de Manzanillo, provincia de Granma, según una nota informativa del Ministerio de Salud Pública de Cuba, publicada hoy por el periódico Granma.  

Preventive and hygienic measures have diminished the waterborne epidemic of cholera, with no evidence of propagation via food or otherwise in the town of Manzanillo, Granma province, according to an informative note from the Ministry of Public Health of Cuban, published today by the newspaper Granma.

Según el texto, el pasado 2 de julio, el Ministerio de Salud Pública informó sobre la presencia de un brote de enfermos de cólera en ese territorio, a más de 800 kilómetros al este de La Habana, y desde entonces, a través de las emisoras de radio y televisión de esa zona, se mantiene informada a la población sobre la evolución de la situación epidemiológica y en especial, las medidas preventivas e higiénicas a cumplir. 

According to the text, on July 2 the Ministry of Public Health reported on the presence of an outbreak of cholera cases in that province, over 800 km east of Havana. Thereafter, radio and TV broadcasts in the province kept the public aware of the evolving situation and especially about the preventive and hygienic measures needed.

Hasta el momento, añade el escrito, existen un total de 158 personas que a partir de la valoración clínica, epidemiológica y por cultivo de laboratorio, se le ha confirmado la presencia del Vibrio Cholerae O1 Tor enterotoxigénico, serotipo Ogawa. No han ocurrido nuevos fallecidos, manteniéndose la cifra de tres adultos como se había informado. 

At the moment, the note adds, a total of 158 persons have been confirmed to have the Vibrio cholerae 01 Tor enterotoxin, serotype Ogawa. No new deaths have occurred, maintaining the total of three adults as reported earlier.

Como resultado del sistema de vigilancia epidemiológica sobre enfermedades diarreicas agudas propias del verano, se han diagnosticado casos aislados en otras regiones del país, de personas que se infectaron en Manzanillo, siendo tratados y estudiados oportunamente, no existiendo diseminación de este brote epidémico, precisa la nota.

As a result of the epidemiological surveillance system over common summer acute diarrhea, isolated cholera cases have been diagnosed in other parts of the country, in persons who contracted it in Manzanillo. They are being treated and observed, but there is no dissemination of the epidemic outbreak, the note stated.

If I'm not mistaken, that's the same strain found in Haiti. If so, it should be relatively easy to trace the source of the outbreak—very likely a recently returned member of the medical brigades treating cholera there.

India: 130 encephalitis deaths in Uttar Pradesh

I've found nothing in days about the encephalitis outbreak in Bihar. But here is a report in The New Indian Express about the disease in neighbouring Uttar Pradesh: Encephalitis claims one more life in eastern UP.

A child succumbed to encephalitis here taking the death toll in the viral disease in eastern Uttar Pradesh to 130 this year, officials said today. 

Seven-year-old Akash, a native of Azamgarh district, died at the BRD Medical College Hospital here yesterday. 

Health department officials said that two patients suffering from suspected encephalitis were admitted to the hospital yesterday. 

A total of 670 encephalitis patients have been admitted to different government hospitals of Gorakhpur and Basti division this year, of which 130 died, they said. 

The dead include mostly children from different districts of eastern UP, 66 patients from adjoining Bihar and two from Nepal, they said. 

While some of the patients were suffering from Japanese Encephalitis (JE), most of them were suffering from Acute Encephalitis Syndrome (AES). 

JE spreads due to mosquito bites while AES spreads due to viruses present in contaminated water.