H5N1

Haiti: 7,805 cholera deaths as of December 9

MSPP has published five more days' worth of cholera statistics on its Documentation page, bringing us up to December 9. As usual, the numbers for the first day are silently inflated with cases and deaths that must have been reported late.

So while the daily total of cases for these five days is 1,606, the cumulative total since October 2010 has risen by 2,240. It now stands at 628,139 cases.

Similarly, 10 persons died of cholera in these five days, but the cumulative totals show an increase of 18 and a current total of 7,805.

The highest daily number of cases was on December 5, with 368. The numbers gradually fell to 176 on December 9; but that day also saw the highest number of deaths, 3.

Nicaragua: Third dengue death confirmed

Via El Nuevo Diario: Confirman tercer muerto por dengue. [Third dengue death confirmed] Excerpt, with my translation:

El Ministerio de Salud, Minsa, confirmó este viernes el fallecimiento de un niño de 12 años, habitante de un barrio del Distrito Seis de la capital, producto del dengue, con el cual suman ya tres menores de edad fallecidos en lo que va del año por esta causa. 

The Ministry of Health, Minsa, confirmed on Friday the death of a 12-year-old boy, resident of a neighbourhood of District 6 in the capital, as a result of dengue. Three children have now died of the disease so far this year.

El caso del tercer niño fallecido por dengue fue considerado como dramático por la directora del Silais Managua, la doctora Maritza Cuan Machado. 

The case of the third dead child from dengue was considered dramatic by the director of Silais Managua, Dr. Martiza Cuan Machado.

El niño, a quien las autoridades del Minsa no identifican por su nombre, fue llevado de emergencia al Hospital Alemán Nicaragüense este miércoles a las 8 de la noche, presentándose en una condición delicada, aseguraron médicos del hospital, quienes confirmaron a El Nuevo Diario el lamentable hecho. 

The boy, whom Minsa authorities did not name, was taken to emergency at the German Nicaraguan Hospital this Wednesday at 8:00 p.m., presenting in fragile condition, according to hospital doctors who confirmed the sad fact to El Nuevo Diario.

“Tenemos que decir tristemente que el día de hoy (ayer) falleció un niño de 12 años de un barrio del Distrito Seis, fue un caso bastante dramático para nosotros, ya que llegó en condiciones bastante graves. Estuvimos acompañando permanentemente a la familia y falleció a las 6 de la mañana”, dijo la doctora Cuan a un medio oficialista.

"We must sadly say that today [yesterday] a 12-year-old boy from a neighborhood of District 6 has died. It was a dramatic case for us, since he arrived in very grave condition. We were constantly informing his family and he died at 6 in the morning," said Dr. Cuan to official media.

Pacific: Tropical Cyclone Evan Situation Report No. 2 (December 15)

Via ReliefWeb, an OCHA report: Pacific: Tropical Cyclone Evan Situation Report No. 2 (as of 15 Dec 2012). The summary:

• The Ministry of Police in Samoa has confirmed that there have been four casualties and eight people remain missing. 

• The main water treatment plant in Samoa has suffered major damages and access to water is yet to be restored. 

• The island of Upolo in Samoa remains without electricity and reports suggest it may take months to reconnect the entire island. 

• Tropical Cyclone Evan (TC Evan) is forecast to pass Wallis and Futuna as a Category 4 tropical cyclone tonight. 

• A strong wind warning remains in force for islands in northern Tonga. 

• TC Evan is expected to pass northern and western Fiji as a Category 3 tropical cyclone on Monday.

Netherlands: The dog who can sniff out C. diff

Via BMJ: Using a dog’s superior olfactory sensitivity to identify Clostridium difficile in stools and patients: proof of principle study. The abstract:

Objective To investigate whether a dog’s superior olfactory sensitivity can be used to detect Clostridium difficile in stool samples and hospital patients. 

Design Proof of principle study, using a case-control design. 

Setting Two large Dutch teaching hospitals. 

Participants A 2 year old beagle trained to identify the smell of C difficile and tested on 300 patients (30 with C difficile infection and 270 controls). 

Intervention The dog was guided along the wards by its trainer, who was blinded to the participants’ infection status. Each detection round concerned 10 patients (one case and nine controls). The dog was trained to sit or lie down when C difficile was detected. 

Main outcome measures Sensitivity and specificity for detection of C difficile in stool samples and in patients. 

Results The dog’s sensitivity and specificity for identifying C difficile in stool samples were both 100% (95% confidence interval 91% to 100%). During the detection rounds, the dog correctly identified 25 of the 30 cases (sensitivity 83%, 65% to 94%) and 265 of the 270 controls (specificity 98%, 95% to 99%). 

Conclusion A trained dog was able to detect C difficile with high estimated sensitivity and specificity, both in stool samples and in hospital patients infected with C difficile.

For an excellent 10-minute video about Cliff the beagle, click here.

Uganda: Recalling the first nodding syndrome cases

Via The Saturday Monitor: He reported the first nodding disease case. Excerpt:

Mr Joe Otto, a member of the village health team in Kitgum District, was one of the first people to detect the nodding disease syndrome. Jimmy Kwo interviewed him. Below are the excerpts: 

I understand you were the first medical worker to notice the nodding syndrome. How did it start? 

I noticed it after observing some children in my village of Tuma-nguu nodding whenever they were served with food. We wondered what was causing that because it prevented the children from eating. When it escalated, I took three children to the late Dr Agola to find out what was wrong. He did some tests but said we could not afford the costs since it was an unknown disease. 

So, he wrote a letter referring us to the district health officer in 1998, where Vincent Oyet was care-taking. I took the children to Oyet, who referred me to district health inspector John Omoo, who again referred me to the medical superintendent Kitgum Hospital, Dr David Kitara. He took the children to the theatre to test skin snippets and other samples. 

But those days there was no cost-sharing in public hospitals so the poverty- stricken families of the affected children could not afford to pay the bills. So no tests were carried out. 

Do you recall the names of the first three victims of the nodding syndrome you took for treatment? 

They were Sunday Kibwota, Monica Abalo and Scovia Lakot, who were about five years old then. 

Where are they now? 

Kibwota has since died, Lakot was crippled by the disease and can no longer walk, while Abalo recently gave birth by caesarean section and is admitted to Kitgum Hospital because her condition has worsened. 

Has there been any improvement since then? 

The number of children affected by the disease has since escalated to at least 114 people in this village alone. 

You said nodding syndrome was first detected here in 1998, but the Ministry of Health says it received the first report about the ailment in 2009. What do you think caused this delay? 

The delay came about because district health officials and the government always undermine our reports to them, they think that what we give them is not true. When I reported the sickness, nothing was done about it.  

Was the delay in the district here or it was at the ministry? 

The delay, I think, was by the district here because if they had forwarded my report to the ministry may be they (ministry) would have acted on it faster. 

Recently, the government and other development agencies came up with measures to fight the syndrome. Do you think their efforts are bearing some fruits so far? 

Their struggle is not bearing any fruit. This is because politicians are meddling in the fight against the nodding syndrome. When taking the nodding children to Kampala, we were arrested in Gulu, which was as a result of conflicts between politicians. 

What should be done to find a solution to the disease? 

I would like experts and senior medical workers to put more effort into finding out the causes of the syndrome and how it spreads because we are already defeated. We do not know how it is caused, spread and even the name of the disease has not yet been found.

US: Guns as an unrecognized public health problem

Today's horrific killings further vindicate Rudolf Virchow on politics as medicine on a large scale. Via The Washington Post, Ezra Klein writes: Nine facts about guns and mass shootings in the United States. Excerpt:

When we first collected much of this data, it was after the Aurora, Colo. shootings, and the air was thick with calls to avoid “politicizing” the tragedy. That is code, essentially, for “don’t talk about reforming our gun control laws.” 

Let’s be clear: That is a form of politicization. When political actors construct a political argument that threatens political consequences if other political actors pursue a certain political outcome, that is, almost by definition, a politicization of the issue. It’s just a form of politicization favoring those who prefer the status quo to stricter gun control laws. 

Since then, there have been more horrible, high-profile shootings. Jovan Belcher, a linebacker for the Kansas City Chiefs, took his girlfriend’s life and then his own. In Oregon, Jacob Tyler Roberts entered a mall holding a semi-automatic rifle and yelling “I am the shooter.” And, in Connecticut, at least 27 are dead — including 18 children — after a man opened fire at Sandy Hook Elementary School. 

If roads were collapsing all across the United States, killing dozens of drivers, we would surely see that as a moment to talk about what we could do to keep roads from collapsing. If terrorists were detonating bombs in port after port, you can be sure Congress would be working to upgrade the nation’s security measures. If a plague was ripping through communities, public-health officials would be working feverishly to contain it.  

Only with gun violence do we respond to repeated tragedies by saying that mourning is acceptable but discussing how to prevent more tragedies is not. But that’s unacceptable.

Almost nine years ago, I published some thoughts about this in The Tyee. Since then, at a rough estimate, a quarter of a million more Americans have died by gunshot.

Philippines: Bopha/Pablo death toll may reach 2,000

Via ABS-CBN News: 'Pablo' death toll may reach 2,000 - NDRRMC. Excerpt:

National Disaster Risk Reduction and Management Council (NDRRMC) Executive Director Benito Ramos fears that the death toll due to typhoon "Pablo" could rise to nearly 2,000. 

Ramos gave this estimate as 932 people are still missing and feared buried deep under thick mud in Compostela Valley.

 Pablo, the worst typhoon to hit the Philippines this year, has already claimed 906 lives. 

At least 505 remain missing in landslide- and flashflood-hit Compostela Valley, while 108 have yet to be accounted for in Davao Oriental, where the typhoon made its first landfall last week. 

"Kung kasama itong missing [aabot na sa 2,000], pero hindi muna natin i-declare silang patay until makita," Ramos told dzMM. 

Ramos said search operations have proven to be difficult due to the thick mud. The rotting corpses of animals also confuse K-9 units searching for missing people.

How counting the dead helps the living in India

Via The Globe and Mail, a fascinating report by Stephanie Nolen on Dr. Prabhat Jha and the Million Death Study, which has been going on for over a decade: How counting the dead helps the living in India. Excerpt:

Using data from the first 250,000 deaths catalogued, Dr. Jha and colleagues showed that smoking was killing one million Indians each year, far more than commonly thought; the evidence prompted government to accelerate the use of warning labels on tobacco products even as the powerful industry lobby was trying to kill smoking-control legislation. 

Next the study found that 100,000 people were dying of AIDS each year, only a quarter of what the United Nations was reporting for India – and this has led to a rethink on spending on HIV treatment, which is comparatively expensive. The study also found 50,000 snakebite deaths in India a year, which was the World Health Organization’s worldwide total. 

The latest evidence concerns malaria: Dr. Jha says the verbal post-mortems show that far more adults are dying of malaria than the WHO estimates for India. Malaria is, of course, a curable illness, and the data suggest that the Indian government needs to make a new push to ensure treatment is available in the rural areas most affected. 

“If you talk to clinicians in states like Orissa where malaria is common, it’s no surprise to them, but at the central government, it’s been a shock,” he said.

Cuba: Cholera spreading in penitentiary system

Via Hablemos Press, a dissident website: Proliferación de cólera dentro del sistema penitenciario cubano. [Spread of cholera in the Cuban penitentiary system] Excerpt, with my translation:

La epidemia de cólera continúa proliferando vertiginosamente en las superpobladas cárceles de la Isla. 

The epidemic of cholera continues to spread dizzyingly in the overcrowded jails of the island.

En las prisiones camagüeyanas, el contagio afecta con mayor relevancia a la prisión provincial Kilo 7; la prisión de máxima seguridad nacional Kilo 8 y la prisión Kilo 9; desde esta última  -declarada oficialmente en cuarentena, se reportan cifras alarmantes muy celosamente ocultadas por las autoridades militares con la perversa complicidad de los servicios médicos del Ministerio del Interior y otros factores del sistema de salud de la provincia.

In Camagüey prisons, the disease is entrenched in Kilo 7 provincial prison; the national maximum security prison Kilo 8; and prison Kilo 9. From the last of these, officially declared in quarantine, alarming statistics are being jealously hidden by military authorities with the perverse complicity of the medical services of the Ministry of the Interior and other parts of the provincial health system.

I don't know how the statistics can be alarming if they're being hidden. The rest of the long report is weak on facts and strong on moralizing. Unfortunately, the best cholera reporter at Hablemos Press, Calixto Ramon Martínez, who's been under arrest since September and on a hunger strike for several weeks.

Paraguay: Alert over new dengue outbreak

Via Prensa Latina: Alerta en Paraguay por nuevos brotes de dengue. [Alert in Paraguay over new dengue outbreaks] Excerpt, with my translation:

Las autoridades sanitarias paraguayas están en estado de alerta por la aparición de nuevos brotes de dengue en Asunción y varios departamentos, tras reportar 30 mil casos positivos y 70 muertes en este año. 

Paraguayan health authorities are in a state of alert over the appearance of new dengue outbreaks in Asunción and several departments, after reporting 30,000 confirmed cases and 70 deaths in this year.

Si no nos organizamos bien, podemos recibir el 2013 con una enorme epidemia de dengue, sentenció el ministro de Salud, Antonio Arbo, al dar a conocer las preocupantes estadísticas sobre la enfermedad. 

"If we don't organize ourselves well, we could go into 2013 with an enormous dengue epidemic," said Health Minister Antonio Arbo, on releasing the worrying statistics on the disease.

Solamente en la última semana se recibieron 360 notificaciones de nuevos enfermos, 68 de barrios de esta capital, 258 del vecino departamento de Central y el resto del departamento de Cordillera, lo cual conformó una expresión de los noveles brotes. 

This past week alone, 360 new cases were reported: 68 from neighbourhoods in the capital, 258 from the neighbouring Central department, and the rest in the Cordillera department, reflecting new outbreaks.

Entre las 70 muertes registradas hasta el momento se cuentan 12 en Asunción, 50 en el departamento de Central y el resto distribuidas en Concepción, Amambay, Alto Paraná y Cordillera.

Among the 70 recorded deaths so far this year, 12 have been in Asunción, 50 in Central department, and the rest distributed in Concepción, Amambay, Alto Paraná, and Cordillera.