H5N1

India: Thiruvananthapuram deliberates on dengue scene

Via The Hindu: Thiruvananthapuram deliberates on dengue scene. Excerpt:

The district health administration has pointed out that more than the civic or the health administration, it should be the responsibility of residents to ensure that their own premises are not the breeding grounds of mosquitoes. 

At a meeting of construction companies, building contractors, hotel and restaurant owners, and representatives of the residents’ associations in apartments in the city called here by the Corporation and health administration on Saturday, a detailed presentation made by the health officials explained that the current crisis over solid-waste management was only a contributing factor to the increasing burden of dengue fever cases in the city. 

“The rotting waste in plastic bags and abandoned plastic articles may be contributing to increased vector breeding. But Aedes mosquitoes are peri-domestic and hence its breeding grounds are essentially within and around a household. In the city, we have often found thriving vector breeding sites inside households — in flower vases, ‘lucky bamboo’ pots, and in the water trays behind refrigerators,” a senior health official pointed out. 

In the city, another main ground of vector breeding was the overhead water tanks, most of which would not be covered properly. 

Sustained source-reduction measures with community participation could check the vector population. However, there was a lack of involvement of the public and the apathy of the local bodies in taking up vector control initiatives at the local level, it was pointed out. 

Officials pointed out that even as they were preparing to launch a massive campaign to promote source-reduction, there were limitations as many residents were wary of letting in strangers into their houses or even into the compound. They pointed out that all ASHA workers had identity cards and they should be allowed access into apartments. 

High-rises, it was pointed out, were not immune to mosquito breeding. 

The meeting also stressed the need to organise systematic vector and fever surveillance drives around construction sites in the city to check the spread of dengue fever. Construction sites would often have stagnant water on every floor as water used for various purposes during construction remain in stagnant pools, becoming fertile breeding grounds for Aedes mosquitoes.

CDC: Meningitis update for October 20

CDC has posted another regular update to its HAI - Multistate Meningitis Outbreak - Current Case Count. It shows the first cases and death in North Carolina, bringing the total number of states affected to 16. Total cases are now 284, including 3 peripheral joint infections, and deaths have risen by 2 to 23. Tennessee is the worst-hit state, with 69 cases and 9 deaths.

Haiti: MSF surveys the cholera situation

Two years ago today (it's already October 21 where I am in Sweden), the mystery outbreak in the Artibonite was confirmed to be cholera. Via ReliefWeb, a report from MSF: Le choléra reste un problème de santé publique majeur. [Cholera remains a major public health problem] Excerpt, with my translation from French:

Deux ans après le début de l’épidémie de choléra en Haïti, rien ne garantit que la prise en charge des patients sera assurée alors que la population demeure encore largement exposée aux risques de contamination. 

Two years after the start of Haiti's cholera epidemic, nothing guarantees that patient care will be assured, since the resident population remains largely exposed to the risks of infection.

À Port-au-Prince, plus de 350 000 rescapés du séisme de 2010 vivent encore dans des camps et plusieurs milliers de personnes sont entassées dans des bidonvilles où la situation sanitaire reste déplorable et favorise l’exposition à la maladie. 

In Port-au-Prince, over 350,000 survivors of the 2010 earthquake are still living in the camps and thousands more are crowded into shantytowns where sanitation remains deplorable and increases the chance of exposure to the disease.

Wilsème, vit dans un camp depuis bientôt trois ans : « Nous vivons dans des conditions difficiles, sans accès à du savon et à de l’eau propre. Nous savons que nous risquons d’être contaminés par le choléra mais nous n’avons pas les moyens de nous protéger contre la maladie. » 

Wilseme, who has lived in a camp for close to three years, says: "We live under difficult conditions, with no access to soap or clean water. We know we risk being infected with cholera, but we lack the means to protect ourselves against the disease."

Depuis le début de l’année, plus de 12 000 personnes atteintes du choléra ont été soignées dans les cinq centres de traitement du choléra (CTC) de Médecins Sans Frontières (MSF) à Port-au-Prince et à Léogâne, une ville située à une trentaine de kilomètres à l’ouest de la capitale. « C’est une diminution par rapport aux quelque 35 000 cas que nous avions admis en 2011 à la même période à Port-au-Prince », indique Oliver Schulz, chef de mission de MSF en Haïti. « Mais nous continuons à recevoir en moyenne 250 nouveaux cas par semaine dans nos structures. Cela reste un chiffre important », s’inquiète-t-il.

Since the start of the year, over 12,000 persons infected with cholera have been treated in MSF's five cholera treatment centres (CTCs) in Port-au-Prince and Leogane, a town some 30 km west of the capital. But we continue to receive an average of 250 new cases a week in our tents. It remains an important number," he said with concern.

La diminution des financements internationaux restreint la réponse des acteurs humanitaires travaillant sur la prise en charge médicale ou sur l’accès à l’eau et à l’assainissement. 

The reduction of international funding has limited the response of the humanitarian agencies working in the medical field and in providing clean water and sanitation.

« Cette année nous avons gardé la plupart de nos CTC ouverts toute l’année car l’épidémie de choléra est loin d’être sous contrôle. Les mesures pour prévenir et soigner le choléra font toujours défaut », déplore Oliver Schulz.

"This year," Oliver Schultz worries, "we have kept most of our CTCs open all year because the cholera epidemic is far from being under control. The measures for preventing and treating cholera are still inadequate."

My own estimate, entirely lacking Schultz's first-hand experience, is the same: Cholera remains a problem but those who first responded to it (not to mention those in the UN who caused it) have run out of money or simply lost interest.

PAHO's response to it has been all too clear from its "emergency blog," which now posts infrequently and usually about brave bureaucratic actions and meetings. The current ten-year plan for eradicating cholera in Hispaniola looks more like a lot of career opportunities for First World health officials than a decisive action to end cholera for its own sake.

When you visit PAHO's blog, note that the photos and videos are of officials sitting at tables talking with other officials, and the posts themselves are also about officials. This reflects a career opportunity taken by some communications consultant who knows his clients are more concerned about political appearances than about fighting cholera.

So there we are, two years after the first terrifying days of the outbreak, with cholera reduced to just another agenda item and budget cost centre. Meanwhile Vibrio cholerae will continue to entrench itself. 

India: Dengue cases cross 600 in Delhi

Via Business Line, a PTI report: Dengue cases cross 600 in Delhi, most zones affected. Excerpt:

Dengue appears to be fast spreading in the national capital with 31 fresh cases being reported today, taking the total number of cases this season to 611. 

Two people have succumbed to dengue ever since the disease began spreading in the capital early this month. 

Except civil lines and city zones, all other 10 zones reported fresh cases today with Shah (South) area topping the list with 8 cases. 

According to the data released by three Municipal Corporations of Delhi, one case was reported from Haryana today. 

South Delhi Municipal Corporation reported the maximum number of cases at 234, while 211 cases were detected from the North Delhi Municipal Corporation area. 144 cases have so far been reported from East Delhi Municipal Corporation. 

Other cases were reported from NDMC and Delhi cantonment area. 

Out of the 611 cases, six cases have been reported from outside Delhi. Last year, the capital saw 216 cases of dengue, including eight originating from outside, and three deaths. 

In 2010, there were 4,108 cases, including 24 from outside, and five deaths while the figures for 2009 were 29 dengue cases and no deaths.

Uganda: Now 5 dead in Marburg virus outbreak

Via allAfrica.com, a report from The New Vision: Uganda: Marburg Virus Claims Another Victim - Death Toll At Five. Excerpt:

Another person has died of Marburg virus disease in South West Uganda, bringing the toll from the outbreak to four, government officials said on Saturday. 

The death occurred in Bukora Kitumba sub-county in Kabale district. 

"It's sad the fifth person has died because the emergency team delayed to reach Kabale on Friday," Patrick Besigye Keihwa, the Kabale District Chairman said. 

Meanwhile, the emergency team dispatched to deal with the outbreak has arrived in Kabale. The team will be conducting burials and managing an emergency zone to treat people. 

Efforts are also underway to track all people who had had contact with the victims, the government said. Authorities urged the public to avoid direct bodily contact with a person suffering from Marburg and unnecessary public gatherings. 

Marburg virus disease, also known as Marburg haemorrhagic fever is transmitted through bodily fluids such as saliva and blood, or by handling infected wild animals such as monkeys. 

The disease, from the same family of viruses as Ebola, starts with severe headache and leads to haemorrhaging and, in previous outbreaks in Africa, to death in 80 percent or more of cases, usually within eight to nine days. 

The last outbreak of Marburg in Uganda came in 2007 and killed two miners in the country's west. The latest outbreak comes after at least 16 people died from Ebola in August. In 2000, 425 people contracted Ebola in Uganda and more than half of them died.

CIDRAP on the first fungal-meningitis patient

Via CIDRAP, Lisa Schnirring writes: Report describes case that launched meningitis outbreak probe. Excerpt:

A medical team from Tennessee today described the diagnosis and medical care of the first patient sickened in the ongoing fungal meningitis outbreak, the case that triggered an investigation by the state's public health officials and led to the uncovering of the problem. 

The patient, who died of a stroke after the fungus invaded the blood vessels in his brain, was a man in his 50s who started having headache and neck pain about 4 weeks after receiving the last in a series of epidural injections of methylprednisolone for low-back pain. Doctors from Vanderbilt University School of Medicine who were involved in the case reported their findings today in an early online article in the New England Journal of Medicine (NEJM). 

Since the man's infection was identified, the number of people sickened in the multistate outbreak has climbed to 271, with 14 more cases reported since yesterday, the US Centers for Disease Control and Prevention (CDC) said today in its latest update. One more death was reported, pushing that total to 21. The number of states affected remained at 16. 

The patient received a thorough work-up, including cerebrospinal fluid testing, during his first hospitalization for worsening headache and neck pain. Routine bacterial cultures were negative. The initial diagnosis was presumed community-acquired meningitis, and the patient was discharged after his condition improved with antibiotic, opiate, and nonsteroidal anti-inflammatory drug treatment. 

A week later he was hospitalized again with worsening headache, back pain, and new neurologic symptoms. Over the next 2 days his symptoms improved, but by day 6 his condition started to deteriorate. His doctors began empiric treatment with liposomal amphotericin B, and the following day the hospital's lab found Aspergillus fumigatus in the cerebrospinal fluid sample collected the first day of the man's hospitalization. 

The physicians added intravenous voriconazole to his treatment regimen and started looking for clues to the fungal source of the infection, but a computed tomography (CT) scan of the chest showed no sign of fungal infection. Magnetic resonance imaging (MRI) of the brain showed midbrain and cerebellar infarcts, but an exam of the paranasal sinuses revealed nothing unusual. 

On the eleventh day of hospitalization the man became unresponsive and had seizure symptoms. Cerebral imaging studies suggested an intraventricular hemorrhage with evidence of a mycotic aneurysm. Though cerebrospinal test findings and seizure activity improved, his doctors saw no neurologic recovery. He died 11 days later, after MRI showed new infarcts and the family decided not to pursue aggressive therapy, given the severity of the patient's injuries.

Pakistan: No risk of Naegleria if water boiled or chlorinated, say experts

Via The News International: No risk of Naegleria if water boiled or chlorinated, say experts. Excerpt:

Outbreaks of bird flu, dengue fever and now the ‘brain-eating’ Naegleria fowleri have all made people very concerned about their health, but this brain infection, caused by the amoeba Naegleria entering through the nose, can be avoided.   

This was the consensus of experts who spoke at a public health awareness programme organised by Aga Khan University Hospital (AKUH) on Thursday.   

They advised the people to keep their head out of the water while swimming and prevent water going up the nose during showering and bathing.   

Moreover, experts recommended the use of only boiled or chlorinated water when cleaning the nose for religious practices or other reasons.   

“A person cannot get an infection from drinking or bathing in contaminated water. Nor does the infection spread through person-to-person contact.”   

Speaking to the audience, Dr Syed Faisal Mahmood, consultant infectious diseases, said Naegleria causes a very rare form of brain infection, primary amoebic meningoencephalitis (PAM) that leads to the destruction of brain tissue and brain swelling.   

Initial symptoms of PAM include headache, fever, anorexia, vomiting and later progress to a stiff neck, altered mental status, seizures and coma.   

“Unfortunately, PAM is a fatal disease for which no effective treatment exists anywhere in the world. While amoeba-killing medicines are always given to patients, these usually do not work and death occurs almost 99 percent of the time. Only a small number of Naegleria cases have been reported worldwide, with a dramatic increase in Karachi recently,” he said.

India: Uttar Pradesh, Bihar struggle to combat Japanese encephalitis

Via The Times of India: Uttar Pradesh, Bihar struggle to combat Japanese Encephalitis. The full report:

GORAKHPUR: The Rs 4,000 crore [US$256 million] package cleared by the union cabinet to fight encephalitis on Thursday will not come a moment too soon for thousands of families across eastern UP and Bihar. Over 440 children have died in Gorakhpur division alone just this year, adding to the region's 35-year struggle with the disease that has taken the lives of an estimated 50,000 children. 

In eastern UP, better known as Poorvanchal, a perfect storm has gathered. High population density combined with high rates of poverty, chronic malnourishment and low levels of education collide with unfavourable topography, poor drinking water provision and sanitation to create ideal conditions for the spread of encephalitis at a magnitude that all but overwhelms the region's sole major hospital, BRD Medical College in Gorakhpur city. 

The region is low-lying and surrounded by rivers, leaving it in the unusual position of having a dangerously high groundwater level. "In most of the country, falling groundwater levels is a serious problem, but in this region, the problem is that the water table is very high, making contamination, especially after the rains, much easier," said Gorakhpur district magistrate Ravi Kumar NG. 

Cheaper shallow handpumps give rural residents easier access to water, but are far more susceptible to contamination than more expensive, deeper ones. In addition, piggeries located within human habitations are common in the region, their relocation a vexed issue the administration has been trying to grapple with. 

"Most of the children who come here are quite malnourished and come from poor families," said Dr Bharti Bhandari, one of the dozens of young doctors on 18-hour shifts - with no holidays - at work at BRD Medical College. Two and three children crowded each bed, even in the ICUs, their parents sleeping on the floor near them. 

Jagat Singh, an agricultural labourer, tried to comfort his three-and-a-half year-old grandson, Krish Kumar. The family had come from Gopalganj in Bihar after the boy started convulsing. In the ICU, Murshid Alam, a driver, kept a close watch on his 16 month-old son, Wasim, who was on the ventilator. He had come from Paschimi Champaran in Bihar. 

The hospital caters to over ten districts of Uttar Pradesh as well as to patients from Bihar, Jharkhand and Nepal, registering staggering numbers. Over 2,500 new patients visit its OPD every day, and at any given point, it has 90-100 new born children in its neo-natal unit. Come July, the already overburdened hospital is simply inundated with paediatric encephalitis cases - close to 3,000 this year alone, in a hospital with 222 beds for paediatric cases. 

The greatest challenge it faces, though, is an acute shortage of medical and para-medical staff. 

"We face an acute shortage of specialists and have to draft in doctors from other hospitals and research students for these months every year," said Dr K P Kushwaha, principal of BRD Medical College. "Our PG students are seeing 300 patients where they should be seeing 30 and are left with little time to study," he added. 

For the last five years, doctors and researchers have been observing a fall in the proportion of mosquito-borne Japanese Encephalitis (JE) cases in the total number, and a rise in the number of water-borne Acute Encephalitis Syndrome (AES) cases. 

"In 2006, the proportion of JE cases in the total was found to be 28 per cent, after which there were mass immunisation drives in 2006 and 2010. The proportion of JE has now fallen to around 5.5 per cent," said Dr Kushwaha. 

"AES can be caused by a whole range of enteric viruses," said Dr Milind Gore who heads the National Institute of Virology's Gorakhpur research mission. "We have isolated some of these, but at least for now, no vaccine exists for them, and prevention as well as management of the symptoms is the only course of action," said Dr Gore.

Uganda: First Ebola, now Marburg

Via allAfrica.com, a report in The New Vision: Uganda: Marburg Outbreak Confirmed in Kabale. Excerpt:

Health experts have confirmed an outbreak of the deadly Marburg virus in the western district of Kabale after samples from two relatives taken to the Uganda Virus Institute tested positive. 

Police Thursday stopped the burial of Boaz Turyahikayo a lecturer at Uganda Christian University and his sister Mildrid Asasira after it emerged that their family had lost four people from a mysterious disease in just a month. 

The other two are Lillian Banegura their mother and an elder brother Bernard Rutaro who passed away early this month. 

Dr. Patrick Tusiime the Kabale district health officer said a team from the Ministry of Health and World Health Organization is on its way to oversee the burial of the two victims. 

The Marburg virus was last reported in Uganda in 2008.

Haitian journalists face constant retaliation from government: Report

Via the Knight Center for Journalism in the Americas, a likely explanation for the lack of local cholera coverage in Haitian media: Haitian journalists face constant retaliation from government: Report. Excerpt:

Journalists in Haiti critical of the government constantly face intimidation and are blocked access to official sources, according to a recent report from the University of San Francisco’s School of Law and the Institute for Justice and Democracy in Haiti. 

The report found that, since President Michel Martelly took office in May 2011, journalists are the targets of regular threats, the destruction of work equipment and government retaliation for critical reporting. 

Besides often being denied interviews with officials or access to information, journalists face “defamation lawsuits with criminal sanctions, and license revocation, in addition meager salaries and lack of training opportunities,” an IJDH press release said. 

Even though the report notes that the situation of the press in Haiti is notably better than under previous governments, the current trend has “created an atmosphere of fear and a chilling effect on journalists’ freedom of expression,” the press release said.