H5N1

New Zealand: It's not a flu "epidemic"

Via the Science Media Centre: Flu reaching ‘epidemic’ proportions? – Expert responds. Excerpt:

Claims that an influenza epidemic of swine flu proportions are set to overwhelm the country are overblown, according to virologists at the National Influenza Centre.  

Media reports that a ‘new strain’ of influenza — H3N2 — causing hallucinations and crippling nausea, is heading north from Canterbury, and that flu admissions are at ‘epidemic’ levels, are out-of-step with the latest surveillance data released yesterday. 

ESR’s weekly influenza report shows that the current levels of influenza admissions are at ‘normal’ and ‘baseline’ levels throughout the country. 

A full copy of the report is available on the ESR website [PDF]. 

Dr Sue Huang is a virologist at ESR and Director of New Zealand’s World Health Organisation (WHO) National Influenza Centre. She comments:  

“I do not believe this year’s influenza activity will reach an ‘epidemic as big as swine flu’ [as claimed]. This is because the current predominant influenza strain is A(H3N2). These viruses do not appear to be anything extraordinary and they have not changed as much as the swine flu did. 

“We are tracking within range of a typical flu season. In fact, the speed of the increase of the influenza activity this week is slower than last week. This week’s influenza -like illness consultation rate is just a third of the 2009 pandemic peak. (108.5 per 100 000 population this week vs 284 per 100 000 during the 2009 pandemic peak). 

“I would not call the A(H3N2) virus a new strain yet, since although some minor genetic changes might have occurred, it is still quite similar to the vaccine strain (A/Perth/16/2009) antigenically. This means that the vaccine would still offer significant protection. 

“Influenza vaccination is the most effective means of preventing influenza related illness and it is highly recommended.”

Branswell: When will bird flu transmission studies resume?

Via Metro, a report by Helen Branswell of The Canadian Press: When will bird flu transmission studies resume? Excerpt:

Six months after leading influenza scientists announced they would voluntarily halt research into what it takes to make bird flu viruses transmit among mammals, it’s still not clear when and how the cease-work order will be lifted. 

Figuring out what an acceptable path towards that end might be will likely occupy considerable time and brain power as many of the researchers capable of doing this work meet in New York next week. 

Several months ago many expected the research moratorium would have been lifted by now. But it is becoming clear to the flu community that getting back to business as usual may not be an easy or quick task. 

“I very much hope … that no decision is made at that meeting,” microbiologist David Relman says of the annual gathering of the Centers of Excellence for Influenza Research and Surveillance. 

“I think that would be a terrible mistake for this particular sequestered private group to make a declaration and decide on their own that the moratorium has been lifted. I think that would be a terrible thing.” 

The group goes by the acronym CEIRS, pronounced like the department store Sears. Its annual three-day get-together begins work Monday in New York City. 

Relman is not an influenza researcher and he won’t be at the meeting. But he will be watching for developments. He is a member of the National Science Advisory Board for Biosecurity, a group that advises the U.S. government on so-called dual-use research — legitimate science that could pose a security threat in the wrong or in sloppy hands. 

Last fall, the group touched off a fire storm by urging that two studies detailing how H5N1 viruses could evolve to transmit among mammals — they currently do not — should not be published in full. 

After months of public and private wrangling, the group relented, though some members continue to question whether details of the research should be in the public domain. Relman is among them. 

He also worries about a resumption of this type of research, which many flu experts insist is crucial but which some scientists suggest is tempting disaster. If one of these potentially transmissible viruses were to escape from a high containment lab, critics argue, the world could face a pandemic with a virus which so far seems unusually lethal for humans. 

“I think the most important point is that this can’t be a self-proclaimed decision or assessment by a very narrow group of people behind closed doors. This has to be an open process,” insists Relman, who teaches at Stanford University in California. 

“It really has to involve all of the other sectors of the scientific research community and all of the other kinds of communities that have a vested interest, including policy makers, including the national security community, including the general public.”

Zimbabwe hit by H3N2 influenza

Via Xinhua: Zimbabwe hit by H3N2 influenza. Excerpt:

Zimbabwe has been hit by H3N2 influenza with one person dead while more than 140,000 people affected by the disease circulating all over the country, ZBC News reported on Friday. 

Ministry of Health and Child Welfare Director for Epidemiology and Disease Control Dr Portia Manangazira said the upsurge in the number of influenza cases is typical in winter but what is worrying is the number of cases of the H3N2 influenza that have been recorded. 

"There has been an upsurge in the number of influenza cases, we have only recorded one death so far. The virus is likely to continue spreading as the cold season is still upon us," said Manangazira. 

Manangazira said the recorded figures of the H3N2 influenza cases have been derived from the weekly disease surveillance report that is compiled by the Ministry of Health and Child Welfare.

Cambodia: More cases of EV71 reported in Battambang

Via The Phnom Penh Post, a July 27 report: More cases of EV-71 reported in Battambang. Excerpt:

Twenty-four new cases of EV-71 have been reported by executive health centres in Battambang province for the month of July alone, with three of the patients in a serious condition requiring hospitalisation, health officials said yesterday. 

Meas Maisak, chief of Sampov Loun district health centre and deputy chief of Sampov executive district health office, said that 24 children between one and 10 years of age, had symptoms of EV-71 in Sampov Loun, Phnom Phrek and Kam Rieng districts. 

Previously, the Ministry of Health and World Health Organization have said that recorded EV-71 fatalities and cases have emerged from south and central Cambodia. 

“They have rashes and blisters on arms, legs and mouth, with a high fever, but none of them have died,” Maisak said. 

“We are paying much attention to them,” he said. However, he added that three of them were in serious condition, with fevers between 38 degrees and 40 degrees, and were sent to Kantha Bopha Children’s Hospital in Siem Reap last week. 

“[The other cases] have been quarantined, but some returned home after getting treatment, because we do not have enough space for them [at the executive health centre],” Maisak said. 

Chea Kimnieng, health officer at Sampov executive district health office, said that people are aware of the disease in the wake of a public announcement. 

“We urge parents to hurry to send their children to health centres when they suspect the disease,” he said. 

WHO country director Pieter Van Maaren told the Post this week that while EV-71 has been known since 1969, testing for the virus had not occurred in Cambodia before the recent unexplained child deaths. 

As investigations continue, the case fatality ratio – currently 56 deaths out of a now 85 case tally – will drop as more non-fatal cases are recorded, Van Maaren said.

While the official describes symptoms that could be hand-foot-mouth disease, I notice that no one uses the term—perhaps because Dr. Beat Richner does not concur with the diagnosis offered by WHO.

India: ‘Hepatitis more lethal than HIV, malaria & dengue’

Via The Times of India:  ‘Hepatitis more lethal than HIV, malaria & dengue’. Excerpt:

NEW DELHI: Hepatitis, which causes inflammation of liver, kills more people in India than HIV/AIDS, malaria and dengue combined, WHO representative to India Nata Menabde said on Saturday, which was World Hepatitis Day. She said mass awareness, universal guidelines for immunization and hygienic handling of food and water can reduce the liver disease burden substantially. 

Menabde was speaking at the inauguration of the 'Health Liver' campaign by Institute of Liver and Biliary Sciences (ILBS), India's first NABH accredited super specialty institute. Delhi health minister AK Walia and K Srinath Reddy, director of the Public Health Foundation of India (PHFI), among others, were present on the occasion. 

Menabde said there are five main hepatitis viruses, types A, B, C, D and E, of which B and C are most lethal as they can lead to liver cirrhosis and cancer. She added, "About six lakh [600,000] people die every year due to the acute or chronic consequences of hepatitis B, nearly 100 times more than HIV/AIDS." 

Walia said that both hepatitis B and C spread through contact with the blood of an infected person. It can be through transfusion of infected blood, sharing of contaminated needles or injection material. Hepatitis B can also be transmitted from mother to child. 

"To check the spread of the disease through blood transfusion, we are going to introduce Nucleic Acid Test ( NAT) to ensure immediate and accurate screening of infectious diseases such as hepatitis and HIV in donated blood," Walia said. 

He added that Delhi is among the first few states to have introduced vaccination for hepatitis B in the universal immunization programme. Hepatitis A and E, the commonest forms of viral hepatitis, spread mainly through contaminated food or water. The state health minister said that they are taking all measures to ensure clean drinking water facility to all citizens.

Uganda's Ebola: The New York Times takes note

The Ugandan online media remain surprisingly silent about the outbreak, while the rest of the world is talking about it, including The New York Times: Ebola Outbreak Kills 14 in Midwestern Uganda. Excerpt:

KAMPALA, Uganda — An outbreak of the rare and deadly Ebola virus has killed 14 people in midwestern Uganda, many in the past week, the Ugandan government said Saturday. 

A team of health experts from the Centers for Disease Control and Prevention, the World Health Organization and the Ugandan government has been sent to the area, roughly three hours from Uganda’s capital, Kampala, to begin emergency response measures, according to a government statement. 

The strain of the virus, which in recent years has killed at a rate often above 70 percent of those infected, has been identified as Ebola Sudan, one of the virus’s more common strains. 

Ebola manifests itself as a hemorrhagic fever. In 2000, an outbreak killed 224 people in Uganda. The virus was first reported in 1976 in what is now the Democratic Republic of Congo and is named for the river where it was recognized, according to the Centers for Disease Control and Prevention, or C.D.C. 

A “strange disease” was first reported in the area several weeks ago, according to the government’s statement. Laboratory tests confirmed that the disease was Ebola hemorrhagic fever. The first confirmed death was a baby in the village of Nyanswiga, according to a health official; her family has since lost eight others to the outbreak. Fourteen of the 20 people who are suspected of having contracted the virus have died. 

A clinical officer who treated the original case fell ill and died soon afterward. Her 4-month-old baby, admitted for treatment on Monday, died Friday evening. 

The clinical officer’s sister, who took care of her when she became ill, has been admitted for treatment with similar symptoms, but is in “fairly stable” condition, the government statement said. 

While outbreaks of different strands of Ebola occur every few years, the virus’s delicate composition has impeded a sustained attack. But much about the disease, including its origins and cure, remain unknown. 

Between 2007 and 2008, an outbreak in western Uganda of a new strain of Ebola killed 39 people. In May 2011, Ebola Sudan was identified as the cause of death in the case of a 12-year-old girl in Uganda.

Risk of cholera spreading in Mali high, ICRC warns

Via Reuters AlertNet: Risk of cholera spreading in Mali high, ICRC warns. Excerpt:

A cholera outbreak in northern Mali which has killed two children and infected 47 people is a major concern and the risk of the disease spreading is high, the International Committee of the Red Cross (ICRC) says. 

The outbreak began earlier this month in Mali's troubled north, where insecurity has deepened since separatist rebels launched a coup in March. 

The region is now in the hands of Islamist groups who first fought alongside and then outflanked Tuareg-led rebels that routed government forces there in early April. 

Although the spread of cholera has been contained in and around the city of Gao on the Niger river, the risk of the water-borne disease resurfacing especially in towns and villages along the river is high, ICRC said on Friday. 

"Any new outbreak would be a disaster, given the dysfunctional state in which many referral healthcare centres find themselves due to the massive departure of skilled staff as a result of the conflict," said Jean-Nicolas Marti, head of ICRC's regional delegation for Mali and Niger. 

"In most villages, the hand pumps and wells are no longer working for lack of maintenance and spare parts," he said in a statement. "This places an extra strain on the limited number of pumps still functioning. As a result, a great many people are having to use water from the river." 

ICRC said the rainy season, which is under way, would only add to the risk of cholera spreading. 

There are also worries about more cases of malaria and diarrhoea since most villages and fishing camps close to the river have limited access to clean drinking water.

Uganda: More on the Ebola outbreak

Via Reuters, more details: Ebola outbreak in Uganda kills 13: official. Excerpt:

An outbreak of the deadly Ebola virus has killed 13 people in Uganda and efforts are under way to contain the hemorrhagic fever, the World Health Organisation (WHO) said on Saturday. 

There is no treatment and no vaccine against Ebola, which is transmitted by close personal contact and, depending on the strain, kills up to 90 percent of those who contract the virus. 

Joaquim Saweka, WHO's representative in Uganda, said that although suspected Ebola infections emerged in early July in Kibale district, about 170 km (100 miles) west of the capital Kampala, the outbreak was not confirmed until Friday. 

"There are a total of 20 people suspected to have contracted Ebola and 13 of them have died," Saweka said. 

"A team of experts from the government, WHO and CDC (U.S. Centers for Disease Control) are in the field and following up on all suspected cases and those who got into contact with patients." 

Saweka said the origin of the outbreak had not yet been confirmed, but 18 of the 20 cases are understood to be linked to one family.

India: Cholera superbug found

Thanks to Haiti MPHISE for the link to the Deccan Chronicle, which has the least welcome headline of the week: Cholera superbug found. Excerpt:

In a major cause for concern, a new strain of cholera bacterium resistant to third generation antibiotics has been found to be circulating in India. 

This cholera bacterial strain contains two super bug genes, including the notorious New Delhi Metallo beta-lactamase-1 (blaNDM-1). The other super bug gene is plasmid-mediated beta-lactamase-1 (blaDHA-1). 

Thanks to these two super bug genes, the new cholera bacterial strain (O1 El Tor Ogawa) has developed resistance to a majority of known antibiotics. 

The blaNDM-1, discovered a couple of years ago from hospitals in New Delhi, created ripples in the health sector worldwide. The gene was then found in E.coli strains. This is the first time that doctors have found the super bug gene, blaNDM-1, in the cholera bacterium, Vibrio cholerae. 

A team of doctors led by Dr Jharna Mandal from Jawaharlal Institute of Post-graduate Medical Education and Research (Jipmer), Puducherry, isolated the cholera germ strain from the stools of a two-year-old patient. It reported the findings in the journal of the Centres for Disease Control and Prevention (CDC), USA.

UK: Five infant deaths in whooping cough outbreak

Via The Guardian: Five infant deaths signal serious UK whooping cough outbreak. Excerpt:

Health experts are warning of a major outbreak of whooping cough: five infants have died so far this year, prompting doctors to consider a new round of vaccinations. 

The Health Protection Agency said on Friday it was very concerned by figures which show 2,466 confirmed cases between January and June, six times the comparable figure for the previous big outbreak in 2008. 

The government's vaccination committee is now considering recommending booster vaccinations for teenagers and pregnant women and has already recommended immunising healthcare workers who treat young children because infants are most at risk. 

Mary Ramsay, the agency's head of immunisation, said: "We are working closely with the Department of Health's Joint Committee of Vaccination and Immunisation to consider the most effective ways to tackle the ongoing outbreak. The committee is reviewing a number of options, including the introduction of a booster dose in teenagers and offering whooping cough vaccination to pregnant women. 

"In the meantime we are actively reviewing our cases to see what interventions could have the quickest impact on the spread." 

On average, in the last 10 years in England and Wales, 800 cases of whooping cough were reported, with more than 300 babies being admitted to hospital and four babies dying each year. 

"Whooping cough can spread easily to close contacts such as household members," said Ramsay. "Vaccination is the most effective way to protect people from this infection and uptake of the vaccine in the UK is very good. In addition to this, parents should ensure their children are up to date with their vaccinations so that they are protected at the earliest opportunity.