H5N1

Saudi Arabia: No new MERS cases, one death as of noon January 23

Via the KSA MOH Command and Control Center: MOH: 'No New Corona Cases Recorded'. An 80-year-old Saudi male has died of MERS in Riyadh. Another Riyadhi, a 61-year-old Saudi male, has recovered.

The numbers are now six cases under care, 472 recovered, 842 total, and 364 deaths.

Families left haunted by Liberia’s Ebola crematorium

Via The Guardian: Families left haunted by Liberia’s Ebola crematorium. Excerpt:

Brian Lomax, 26, sleeps on a pile of bones – the remains of cremated Ebola victims whose relatives may never get the chance to collect. 

He was hounded out of his community by neighbours who feared his work at the Margibi crematorium in Boys Town, Lower Margibi county, was helping to spread the disease rather than contain it. This is the only place he has left to go. 

Lomax is just one of many Liberians whose lives have been altered by the cremations at Margibi, which came to an end in December after a burial site was found for new victims. 

For authorities and health workers, who believe they are now beating back the virus, the cremations – an alien and unwelcome practice in Liberia – were a successful measure that helped contain the disease. 

“Cremation is not our culture. It was due to necessity that we had to cremate people, but it worked very well,” said Tolbert Nyensuwah, head of the government’s Ebola task force. 

However, over the past four months, waves of protests have taken place against it. Those who worked at the facility are left facing stigma, and the relatives of those who were cremated have no graves for their loved ones.

Liberia was the country hardest hit by the Ebola outbreak, which has now claimed over 8,500 lives. In the midst of the crisis, disposing of the bodies of victims quickly and safely had been, and remains, paramount, as the bodily fluids from the corpses can still transmit the virus. 

By August last year, Liberia’s government was struggling to keep up with the rising death toll. Underpaid, under-equipped and overworked burial workers couldn’t cope. When teams clad in space-man like protective suits came to collect victims, terrified residents often chased them out. 

When members of Margibi county’s Indian community, which ran the Margibi crematorium 50 miles from the capital, offered to help, it seemed like an obvious solution. A group of Liberians were quickly taught how to carry out the Indian cremation method to dispose of the bodies.

Sometimes up to a hundred bodies were burned at once. Members of the community living nearby reported huge explosions as it burned with smoke rising through the air.t 

The burial process and honouring deceased relatives is an important tradition in Liberia, and often involves touching the body of the deceased. On decoration days, crowds visit cemeteries to clean and decorate the graves of relatives. The cremations, which were often rushed and en masse, left many relatives alienated, and often unable to locate and identify the remains of their loved ones. 

Lomax, a student who had never worked in a crematorium before, was one of those who volunteered to work at the crematorium. “[We] opted for it because we had to do a service to the country because no one wanted to do such a work,” Lomax said. 

“When they [the government] got here, they put us together and told us that this issue was an emergency issue, so we did not discuss anything with them,” he said. “All of a sudden they started the method that the Indian people taught them. They started training us on the method to carry out the cremation.” 

The process of cremation burns corpses, but the bones then have to be ground to a powder afterwards – a stage that was neglected in the Margibi crematorium. 

“All these containers are filled with human bones and because we have nowhere to go, we sleep with the bones [inside this] fence,” Lomax said, pointing to a row of steel drums which he and his colleagues were placing wooden planks over to form makeshift beds every night.

Experimental Ebola vaccine shipped to Liberia

Via The Guardian: Experimental Ebola vaccine shipped to Liberia. Excerpt:

Healthcare workers and others at high risk from Ebola in Liberia could be given an experimental vaccine as early as next week following the shipment of the first doses to Monrovia, according to the manufacturer GlaxoSmithKline. 

The potential vaccine has been developed with unprecedented speed, but the rapid decline in Ebola cases in Liberia may make it hard to find out whether it works. Last week, there were only eight cases in the country, the World Health Organisation said on Thursday, down from a high of more than 300 a week in September. 

GSK’s vaccine is the first of several under development to enter trials in west Africa. Trials of healthy volunteers in Europe, the US and unaffected African nations have shown it is safe and produces a response from the immune system. The question is whether that response will protect vaccinated health workers and burial teams from infection or enable them to fight off the disease. 

The trial is being carried out by the National Institutes of Health in the US, which will vaccinate 30,000 people. Only one-third will get the candidate vaccine; others will get a routine vaccine against another disease, such as measles. The investigators will be looking to see whether there are further cases of infection in the control group than among those who were given the potential Ebola vaccine. 

Dr Moncef Slaoui, chairman of global vaccines at GSK, said getting to the point of shipping the vaccine, due to arrive in Liberia on Friday, was a major achievement. 

He said: “The initial phase I data we have seen are encouraging and give us confidence to progress to the next phases of clinical testing, which will involve the vaccination of thousands of volunteers, including frontline healthcare workers. If the candidate vaccine is able to protect these people, as we hope it will, it could significantly contribute to efforts to bring this epidemic under control and prevent future outbreaks."

Hong Kong: CHP reports four new H7N9 cases in Mainland

Via the Centre for Health Protection: CHP closely monitors four additional human cases of avian influenza A(H7N9) in Mainland. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health (DH) is today (January 23) closely monitoring four additional human cases of avian influenza A(H7N9) in the Mainland, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.      

According to the notification of the Health and Family Planning Commission of Guangdong Province, the two cases involved a 68-year-old man in Shantou who was hospitalised for treatment in serious condition, and a 4-year-old boy in Zhaoqing who is in stable condition.      

According to the Shanghai Municipal Commission of Health and Family Planning, the patient in Shanghai is a woman aged 75 who was under treatment in critical condition. In addition, according to the Health and Family Planning Commission of Yiwu Municipality, the patient in Yiwu, Zhejiang, is a man aged 45 who was under isolation and treatment.

Mike Coston at Avian Flu Diary has more details on these cases as well as a newly reported imported H7N9 case in Hong Kong itself.

York: Ebola crisis in West Africa appears to be receding

Via The Globe and Mail, Geoffrey York writes: Ebola crisis in West Africa appears to be receding. Excerpt:

When the Ebola epidemic was terrifying the world a few months ago, experts measured its soaring growth rate by counting how swiftly the cases doubled. Today, there’s a new metric: how fast they are halving. 

For the first time, the worst seems over. The World Heath Organization on Thursday announced dramatic declines in the number of new Ebola cases in all of the hardest-hit countries of West Africa. As swiftly as it escalated, the crisis now appears to be receding. 

The WHO and other experts are warning that it is much too early to be complacent, since Ebola has shown an ability to come roaring back as soon as the world loses focus. Intense hot spots remain, and the United Nations is still trying to raise a further $1-billion to help defeat Ebola completely by June. 

But the figures on Thursday were encouraging. The number of new Ebola cases is now dropping in half every 10 days in Guinea, every two weeks in Liberia and every 19 days in Sierra Leone, the WHO reported. 

In Liberia, there were more than 300 new infections a week at the peak of the crisis in August and September. That frightening rate has now tumbled to just eight new cases a week this month. 

Sierra Leone, the country with the largest number of Ebola cases, had seemed to defy every effort at control. But now it, too, is showing dramatic progress. “Case incidence is decreasing quickly in Sierra Leone,” the WHO said on Thursday.

WHO: Middle East respiratory syndrome coronavirus (MERS-CoV) – Oman

WHO has published Middle East respiratory syndrome coronavirus (MERS-CoV) – Oman.

On 17 January 2015, the National IHR Focal Point of Oman notified WHO of 1 additional case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection. 

Details of the case are as follows: 

A 43-year-old male from Dakhelyia Region. The patient is a direct contact of a laboratory-confirmed, fatal MERS-CoV case and was identified through contact screening. He was admitted to hospital on 16 January and discharged on 19 January but the patient remains asymptomatic. He has no comorbidities. 

The patient visited the fatal case at home and participated in the funeral rites. He has no history of exposure to other known risk factors in the 14 days prior to a respiratory sample being taken. 

Tracing and monitoring of household contacts and healthcare contacts is ongoing for this case. 

Globally, WHO has been notified of 956 laboratory-confirmed cases of infection with MERS-CoV, including at least 351 related deaths.

Doomsday clock now set at three minutes to midnight

Via The Independent: We are closer to doom than any time since the Cold War, say scientists.

The end of the world has come a lot closer in the past three years, with every single person now in danger as climate change and nuclear weapons pose an escalating threat – according to the scientists behind the Doomsday Clock, a symbolic measure which counts down to armageddon. 

They moved the minute-hand of their 68-year old concept clock forward by two minutes today, showing a time of three minutes to twelve, to reflect the fact that the “probability of global catastrophe is very high”. 

The time change symbolised their damning assessment of world leaders and the outlook for their citizens. 

“Today, unchecked climate change and a nuclear arms race resulting from modernisation of huge arsenals pose extraordinary and undeniable threats to the continued existence of humanity,” said Kennette Benedict, executive director of the Bulletin of the Atomic Scientists in Chicago, the group of scientists which set the clock. 

“And world leaders have failed to act with the speed or on the scale required to protect citizens from potential catastrophe. These failures potentially endanger every person on Earth,” she added. 

Although the clock is essentially a barometer, it is set by a team that includes 17 Nobel Prize winners and is taken extremely seriously. 

The committee pointed out that greenhouse gas emissions have soared by 50 per cent since 1990, while more than £660bn of investment floods into fossil fuel infrastructure every year. 

“The resulting climate change will harm millions of people and will threaten many key ecological systems on which civilisation relies. This threat looms over all of humanity,” said committee member Richard Somerville. 

The report also raised considerable concerns about nuclear weapons. 

“Since the end of the Cold War, there has been a cautious optimism about the ability of nuclear weapon states to keep the nuclear arms race in check and to walk back slowly from the precipice of nuclear destruction,” said Sharon Squassoni, a member of the clock committee. 

“That optimism has essentially evaporated in the face of two trends: sweeping nuclear weapon modernisation programmes and a disarmament machinery that has ground to a halt,” she added. 

The clock was established in 1947, with a debut time of 7 minutes to 12, after the atomic bombs hit Hiroshima and Nagasaki. The latest change is the 19th time the minute hand has been moved – sometimes forward and sometimes backwards – most recently in 2012 when it was pushed forward by a minute, again on concerns about climate change and nuclear weapons. 

The last time the clock read three minutes to midnight was in 1983 when “US-Soviet relations were at their iciest” according to the bulletin. The lowest ever reading was of 11.58 in 1953 when the US decided to pursue the hydrogen bomb, a weapon far more powerful than any nuclear bomb. 

The highest reading was 17 minutes to midnight in 1991, when the Cold War officially ended and the US and Russia began cutting their nuclear arsenals.

Sierra Leone ends Ebola bonuses for health workers

Lucie Lecomte sends the link to this AFP report published by Classic105.com: Sierra Leone ends Ebola bonuses for health workers. Excerpt:

Sierra Leone said on Thursday it was ending the “risk allowances” it has been paying to thousands of healthcare workers on the front line of its battle with Ebola. 

Steven Gaojia, the co-ordinator of the government’s response to the outbreak, told reporters the payments of up to 500,000 leones ($118, 102 euros) a week on top of regular salaries would finish by the end of March. 

The move comes with Sierra Leone, one of three west African countries at the epicentre of the epidemic, seeing a decrease in new cases across most of its territory. 

Officials registered 117 last week against 184 the week before, according to the World Health Organization’s latest situation update. 

“We have developed an exit strategy in the fight against Ebola. If there are still cases beyond that, we will re-contract people. Now the hazard payment has become a dependency issue, making too many depend on it,” said Ngauja. 

Sierra Leone estimates that 26,000 healthcare workers — either state employees or volunteers — are involved in its fight against Ebola, while 221 have died after catching the deadly virus. 

“The incidence of health worker infections has fallen in Liberia and Sierra Leone, but rose in Guinea throughout December,” the WHO said on Wednesday. 

The risk payments have represented a lucrative sideline for the workers in Sierra Leone, one of the world’s poorest countries where the vast majority earn less than a dollar a day, according to the World Bank. 

But the withdrawal of the incentive has not generally been greeted negatively since it was always viewed as a temporary measure and many healthworkers see it as a symbol that the worst of the epidemic is over. 

David Koroma, who works with an Ebola burial team in the capital Freetown, said however he expected to be out-of-pocket when the crisis ended. 

“It will be a disappointment for me when the job folds up. It will mean going back to search for any job, as I have been unemployed for four years now after leaving school,” he told AFP.

Saudi Arabia: Gerontocracy as a public health issue

Via The Guardian, confirmation of a death foretold: Saudi Arabia’s King Abdullah dies at 90. Excerpt and then a comment:

King Abdullah of Saudi Arabia has died aged 90 after a short illness, state television announced late on Thursday. He has been succeeded by Crown Prince Salman, his half-brother. 

The news came after the king was admitted to hospital on 31 December suffering from pneumonia. His condition was said to have improved a few days later. 

Rumours of the king’s death circulated on social media before Saudi TV began broadcasting Qur’anic verses – often a sign of bad news – and the announcement was made. He is to be buried on Friday afternoon. 

Beyond confirmation that Salman has ascended the throne lie troubling questions about the succession, the stability of an unreformed absolute monarchy and the prospects for its younger generation of royals at a time of turmoil in the region – including the destabilising crisis in Yemen. 

Abdullah bin Abdulaziz, who had been king since 2005 and effectively in charge since his brother Fahd’s stroke in 1995, accepted limited change after 2011 in response to the Arab spring. Yet Saudi women are still not allowed to drive, citizens are unable to vote except in municipal elections and public beheading by sword remains a standard feature of the judicial system. Political parties are banned. 

Salman is widely believed to be unwell, with speculation he is suffering from dementia or Parkinson’s disease, though Saudis deny that. He is 79, so there is bound to be uncertainty about his rule. 

Stability and continuity are likely to be his guiding principles, at a time of alarm over the rise of Isis in Iraq and Syria, turmoil in neighbouring Yemen, the kingdom’s rivalry with Iran and controversy over its resisting calls for Opec production cuts as the price of oil has plummeted.

Stability and continuity may be his principles, but whether they will be reflected in the state of Saudi public health remains to be seen. MERS is only the most publicized of Saudi health problems; obesity, heart disease, and diabetes are far more serious. According to one report, three out of four Saudis over 40 are obese. Another report says a quarter of adult Saudis have diabetes, and that number is expected to double by 2030.

Bear in mind that all the kings of Saudi Arabia since the death of the founding father, Ibn Saud, in 1953, have been his sons. The House of Saud has been the most successful dynasty in modern history, without ever reaching its third generation. The patriarch passed along some brains to his countless offspring, but at some point an elderly grandson will be next in line for the throne and his subjects will say, "Enough."

If not sooner. 

And at that point the world could be in for a long, hot Arab Summer, with pilgrims still struggling to reach Mecca while the government's public-health cordon frays and snaps, and its expatriate healthcare workers head for home. 

I may actually live to see the day when "Saudi" Arabia goes into the ashcan with the Ottoman Empire, and some kind of Arab Republic assumes the guardianship of the Two Holy Mosques. And I hope I'm happy with the result.

Ebola in Guinea: Dr. Nabarro still worried about a resurgence

Via Guineeinformation.fr: (AUDIO) Dr. David Nabarro, UN coordinator for the fight against Ebola believes that Ebola outbreak can still ignite in Guinea, Click through to hear the interview in French. The text in Google translation, lightly edited:

In the fight against Ebola epidemic, there was finally good news. The virus begins to retreat. But beware, the battle is not over, however. British physician David Nabarro is the UN coordinator for the fight against Ebola. While in Paris, he sends a message to the affected population on RFI: "Funeral rites should be secured to the maximum," he said. 

RFI: Is the worst is over? 

David Nabarro: I hope ... Perhaps the epidemic has passed in Liberia and we also begin to see a decrease in new cases, week after week, in Sierra Leone and Guinea. But in Guinea, there is a spread of the epidemic to the north, east, west ... it makes us fear, maybe [that] it can still catch fire if no control. That's why you need to be vigilant, to be sure that we can finish the job. 

Have we turned a corner? Are we on the downward slope? 

In Liberia, yes, we believe we have turned the corner. It is on a falling edge. In Sierra Leone, so too, but in Guinea, it is not exactly sure. That is why we must [be well aware] in the next three or four weeks. 

What worries you most in Guinea? Is it east to west in Forecariah region, is it the Nzerekore region? 

We have problems in both places. To the east, in Nzérékoré or Lola near the Ivory Coast, there are new cases, it was always a fear that the disease would advance in Côte d'Ivoire. On the other side to the west, around Conakry, there are new cases arriving and the reluctant population makes it a little hard for caregivers. 

Does that mean that there are people who still have not understood the need to change behavior? 

You are right in the center of the epidemic, it is the behavior that drives the epidemic. It is not a disease that [spread] by water or in the air, it's an epidemic that [spread] because of people's behavior. But this behavior is very important because for the people, funeral rites are absolutely central to their lives. This is not a reluctance because people are angry with the trainers; it happens because people want to know their future. 

It's a matter of respect to the dead? 

Absolutely and that's why it is very difficult to change behavior. 

And that's why people touch their dead, embrace their deceased? 

Yes, it really is like that. 

And what do you tell people? 

Always start with the negotiations. This is a medical diplomacy. In Guinea, I was told that this is beginning to change. The reluctance diminish week after week. If it is possible for people to see the body of someone and be close but maybe [without] touch, it is possible for them to have the rituals without danger of contamination. 

When will the illness disappear? 

It's hard for me to say exactly when it might happen because if you have the Ebola disease in any place, it can catch fire very, very quickly. I would like to reassure people that it will go away, that's for sure, but I'm not sure of the date. 

In the year 2015? 

I cannot say.