H5N1

WHO AFRO: Outbreaks and other emergencies, week 15

WHO AFRO has published its Weekly Bulletin on Outbreaks and Other Emergencies for week 15 (April 7-13). The overview:

This Weekly Bulletin focuses on selected acute public health emergencies occurring in the WHO African Region. The WHO Health Emergencies Programme is currently monitoring 58 events in the region. This week’s edition covers key ongoing events, including:

• Cholera in Zimbabwe

• Lassa fever in Liberia

• Crimean-Congo haemorrhagic fever in Namibia

• Cholera in Uganda

• Humanitarian crisis in Niger

• Humanitarian crisis in Ethiopia

For each of these events, a brief description followed by public health measures implemented and an interpretation of the situation is provided.

A table is given at the end of the bulletin with information on all new and ongoing public health events currently being monitored in the region, as well as events that have recently been closed.

Major issues and challenges include:

• Two haemorrhagic fever outbreaks are reported this week, both of which are persistent problems in their respective countries. This emphasises the importance of a One Health approach to surveillance and response in countries with endemic diseases with an animal host population or reservoir.

• Cholera remains an ongoing issue in many countries in the region. This week we report on a newly declared cholera outbreak in Zimbabwe, who declared their most recent outbreak over only three weeks ago. We also report on an outbreak in Uganda where targeting WASH and risk communication activities appears to be effective. However the prevailing risk factors in both countries emphasise the need for a regional approach to this persistent disease.

Yemen: 1,090,109 cholera cases as of April 16

On the eve of the first anniversary of Yemen's cholera outbreak, WHO's Cholera Response Dashboard reports 1,090,109 cases and 2,275 deaths. That is an increase of 292 cases and one death in 24 hours.

Saudi Arabia: A week's worth of MERS cases

After a week of silence, the KSA MOH Command and Control Center has released a batch of updates covering April 10-16 (but with no report for April 11). Here's the link to the most recent case, reported on April 15: MOH: '1 New Confirmed Corona Cases Recorded'.

To summarize the week:

 

April 10: Two recoveries in Jeddah, one death in Riyadh.

 

April 11: No update.

 

April 12: Two new cases, one in Hofuf and one in Najran.

 

April 13: No new cases, recoveries, or deaths.

 

April 14: One death in Hofuf.

 

April 15: One new case in Alqunfudha.

 

April 16: No new cases, deaths, or recoveries.

 

At this point, six MERS cases remain hospitalized.

Rare human outbreak of monkey malaria detected in Malaysia

Via Nature News & Comment: Rare human outbreak of monkey malaria detected in Malaysia. Excerpt:

Several people in Malaysia have become infected with a species of monkey malaria parasite that, until recently, had been recorded in just one person outside of the lab.  

Although only a few cases have been detected, researchers are worried that the ongoing destruction of monkeys’ forest habitat is increasing the amount of contact between people and primates, providing more opportunities for infections to jump to people.  

In January, researchers identified the parasite Plasmodium cynomolgi in five people being treated for malaria in hospitals and clinics around Kapit, a heavily forested area in the centre of the island of Borneo. Although laboratory trials in the United States in the 1960s showed that mosquitoes can transmit the parasite from macaques to humans, researchers had thought that in the wild, P. cynomolgi was transmitted only among macaques. That view changed in 2014, when a study re-examined malaria patient samples and found that a Malaysian patient had been infected with P. cynomolgi in 2011. 

Malaria specialist Balbir Singh of the University Malaysia Sarawak presented the latest cases at a scientific meeting of the Malaysian Society of Parasitology and Tropical Medicine, held in Kuala Lumpur last month. He says that many more cases of P. cynomolgi in humans might be detected if researchers look for them. Singh was able to detect the cases because his tests used primers — short sequences of targeted DNA — that could distinguish P. cynomolgi from closely related parasites. 

The monkey parasite is unlikely to start a public-health emergency, researchers say. It does not seem to cause serious illness in people, and it can be treated with antimalarial drugs, says José Rubio, a malaria scientist at the Carlos III Health Institute in Madrid.  

But malaria scientist Bridget Barber, of the Menzies School of Health Research in Darwin, Australia, says that it will be important to determine the prevalence of P. cynomolgi in human populations in other areas and to study if the species can cause severe disease. She says it is too early to comment on the health burden of the parasite.

Nigeria: Nobody is quarantined for Lassa fever in Adamawa

Via the Daily Trust: Nobody is quarantined for Lassa Fever in Adamawa. Excerpt:

 Adamawa Commissioner for Health, Dr Fatima Atiku says that nobody was quarantined following a case of Lassa Fever outbreak in the state. 

Atiku who spoke to newsmen in Yola on Tuesday said that the reported case of 81 people placed under quarantine in the state by some media was misrepresentation of fact. 

 “The situation in Adamawa is that nobody is quarantined; what we have is one person who is isolated, while some 102 people that had contact with the infected patient who passed away are under observation. 

“The people are only asked to stay at home to minimize contact. They were given thermometers to be measuring their body temperature on daily basis. 

“If they notice any increase in temperature, they should call EOC for immediate evacuation to hospital,’’ the commissioner said. 

Atiku said the outbreak was an imported one from neigbouring Taraba state, adding that the patient diagnosed with the fever came to Adamawa from Taraba where he took ill. 

She said the ministry had taken preventive measures to interrupt transmission such as contact tracing, setting up of emergency operation Centre, publicity and provision of Personal Protection Equipment.

UK: Rise in attacks on NHS workers blamed on lack of staff and delays

Via The Guardian: Rise in attacks on NHS workers blamed on lack of staff and delays. Excerpt:

Growing numbers of NHS personnel in England have been the victim of a violent attack at work, with understaffing and delays in patients accessing services being blamed for the rise. 

Figures supplied by hospital trusts have shown that they recorded 56,435 physical assaults on staff in 2016-17, up 9.7% on the 51,447 recorded the year before.  

The data, from 181 of the NHS’s 244 hospital trusts, was obtained by the Health Service Journal on behalf of the union Unison under the Freedom of Information Act.  

Nurses, paramedics and mental health staff are among those most likely to be assaulted.  

Acute hospital trusts have seen the biggest increase in attacks. There were 18,720 assaults on their staff during 2016-17, 21% more than the 15,469 the previous year. Unison said the jump was staggering and was linked to NHS pressures and growing waits for urgent and emergency care. 

The figures appear to show that trusts with the worst performance in terms of key NHS-wide treatment targets are more likely to see their personnel being attacked.

Hospitals should treat and then admit, transfer or discharge 95% of A&E patients within four hours, provide non-urgent care to 92% of patients within 18 weeks and meet strict financial targets. But short staffing, tight budgets and rising demand mean that many cannot meet all targets.

ECDC rapid risk assessment: Dengue outbreak in Réunion, France

ECDc has published Rapid risk assesment: Dengue outbreak in Réunion, France. Click or tap through to download the PDF. The summary:

A dengue outbreak of unusual magnitude is currently taking place in the French Outermost Region of Réunion. Aedes albopictus mosquitoes are considered to be the principal vector of dengue virus in Réunion. Dengue virus (DENV) transmission in Réunion is not unexpected: over the last ten years a number of limited dengue outbreaks have been reported on the island.

Uganda to roll out cholera vaccination in Congolese refugee settlements

Via Xinhua: Uganda to roll out cholera vaccination in Congolese refugee settlements. Excerpt:

Uganda's ministry of health is set to roll out the Oral Cholera Vaccine exercise to contain the outbreak of the disease that has left 44 refugees dead and over 2,000 others hospitalized since Feb. 23. 

Charles Olaro, acting Director General Health Services, in a statement on Tuesday said the vaccination exercise scheduled to start next month will be held in Kyangwali and Kyaka II refugee settlements.  

The settlements located in the western districts of Hoima and Kyegegwa host thousands of Democratic Republic of the Congo refugees.  

"The vaccine is administered in two doses which are given two weeks apart and offers individuals protection of up to 5 years," Olaro said. 

Cholera, according to World Health Organization, is an acute diarrheal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae.  

Uganda Red Cross, a humanitarian organization, says the influx of Congolese refugees has overwhelmed health facilities in the area and led to squalid conditions in the settlements, fueling the outbreak. 

The humanitarian organization estimates that 70,000 Congolese have fled to Uganda since the start of the year, 80 percent of them are women and children.

Canada: BC health official voices 'grave concerns' after child given homeopathic remedy using rabid-dog saliva

Via CBC News, an embarrassing report: B.C. health official voices 'grave concerns' after child given homeopathic remedy using rabid-dog saliva. Excerpt:

A B.C. naturopath's claim that she treated a small child's behaviour problems with a homeopathic remedy derived from rabid dog saliva has prompted a letter to the federal government from the province's senior public health official. 

Provincial health officer Dr. Bonnie Henry said she will be writing to Health Canada to protest its approval of a treatment known as lyssinum after reading a blog post written by naturopath Anke Zimmermann of Victoria.  

Henry wasn't aware of the substance before reading Zimmermann's post, but said she has already expressed concerns to the federal government about the regulation of homeopathic products.

"I will be writing to Health Canada about this preparation again," Henry told CBC News. "There's no way I can understand why we would have anything that was meant to be saliva of a rabid dog approved for use in this country." 

Substance approved by Health Canada 

Lyssinum, also known as lyssin or hydrophobinum, is one of more than 8,500 homeopathic products approved by Health Canada. 

Homeopathy is based on the notion that "like cures like," and so-called nosodes like lyssinum are created by taking a bodily substance from a diseased human or animal and repeatedly diluting it in water and/or alcohol.

The case Zimmermann wrote about in February features a four-year-old boy who she says was aggressive and violent toward classmates, tended to hide under tables and growl, had trouble sleeping, and experienced nightmares about wolves and werewolves. 

Zimmermann wrote that the boy improved dramatically after taking lyssinum, and she suspects the root of his problem was that he had been bitten by a rabid dog or a dog that had recently received the rabies vaccine  

"The way I see it, he is coming back into a more human state from a slightly rabid dog state," Zimmermann wrote.

The Lancet Commission on malaria eradication

Via The Lancet: The Lancet Commission on malaria eradication. Excerpt:

The process that has been called shrinking the malaria map is accelerating. Since 1900, roughly half of all countries in the world have eliminated malaria, including 19 countries since 2000.5 The European region is now malaria free, and Sri Lanka has been free of local malaria transmission for more than 5 years.  

Despite this progress, in 2017 there was an increase in malaria cases in the Americas, Asia, the Western Pacific, and particularly, in high burden countries in Africa. This setback has contributed to scepticism about the technical feasibility of eradication. Although there are insufficient data on factors underlying the increase in cases, possible culprits include heavy rainfall in sub-Saharan Africa and India, declining malaria funding, insecticide resistance, and decreased access to interventions. 

In light of these challenges, should the global health community still aim to eradicate malaria—have we set the bar too high? Or are these fluctuations in transmission to be expected as we work towards the ultimate goal of eradication? 

The malaria community is reaching consensus that eradication is the only acceptable end goal. If we aim for anything short of eradication, the parasite and vector will become increasingly resistant to the drugs and insecticides available to combat the disease. Without eradication, sustained effort would also be needed indefinitely, as the disease would be able to return with a vengeance, particularly in tropical areas with high anopheline vectorial capacity. 

There is also a strong ethical imperative to eradicate malaria, a disease mainly affecting poor and marginalised people. Malaria eradication offers a massive return on investment: every dollar spent returns up to US$60 for the wellbeing of countries and their populations. 

With malaria eradication emerging as a pragmatic, ethical, and economically advantageous investment, the global health community needs more evidence to guide eradication strategies at national, regional, and global levels. To address this, The Lancet and the Malaria Elimination Initiative at the Global Health Group, University of California, San Francisco have convened the Lancet Commission on malaria eradication, designed to complement and supplement the WHO Strategic Advisory Group on malaria eradication. 

The Commission will elaborate the scientific, financial, and operational requirements to achieve malaria eradication. Some of the questions to be addressed by the Commission are shown in the panel. The Commission comprises 24 leaders in science, epidemiology, policy, finance, economics, and implementation (appendix). The Commissioners will meet two or three times over the next 12 months with the aim of publishing the Commission's report in 2019.