H5N1

Yemen cholera outbreak: 384,719 cases as of July 22

On a frustratingly slow news day (even for a Sunday), I'm grateful to Ronan Kelly at FluTrackers for tweeting this PDF from WHO EMRO, an update on the number of cases and deaths in Yemen's worsening cholera disaster. I can't find the update on WHO EMRO's site, but it also helps explain this update from Yemen's Ministry of Health and Population. It too is a PDF, and since it's in Arabic I can't read it. But now I can see which columns are which. The ministry has been good about posting updates, but I wish it could post them in English as well.

It's worth reflecting on the fact that this outbreak began on April 27. In 87 days, cholera has sickened 384,719 Yemenis and killed 1,858 of them. That's an average of 4,402 cases a day, and it's currently running well over 5,000 cases a day.

Fukushima: Robot images show massive deposits thought to be melted nuclear fuel

Via The Guardian, a report by The Associated Press: Fukushima: robot images show massive deposits thought to be melted nuclear fuel. Excerpt:

Images captured by an underwater robot on Saturday showed massive deposits believed to be melted nuclear fuel covering the floor of a damaged reactor at Japan’s destroyed Fukushima nuclear plant. 

The robot found large amounts of solidified lava-like rocks and lumps in layers as thick as 1m on the bottom inside a main structure called the pedestal that sits underneath the core inside the primary containment vessel of Fukushima’s Unit 3 reactor, said the plant’s operator, Tokyo Electric Power Co.

On Friday, the robot spotted suspected debris of melted fuel for the first time since the 2011 earthquake and tsunami caused multiple meltdowns and destroyed the plant. The three-day investigation of Unit 3 ended on Saturday.  

Locating and analysing the fuel debris and damage in each of the plant’s three wrecked reactors is crucial for decommissioning the plant. The search for melted fuel in the two other reactors has so far been unsuccessful because of damage and extremely high radiation levels.

India: Kota patient misdiagnosed with H5N1 bird flu in Punjab

Via The Times of India, a TNN report: Kota patient misdiagnosed with bird flu in Punjab.

Jaipur: A Rajasthan resident, who had gone to Mohali for treatment, was wrongly diagnosed with avian flu at a hospital in Punjab on Friday. This created panic in the state's health department.

When the woman, a resident of Kota, fell ill, her relatives took her to Mohali for treatment. A hospital in Punjab mentioned in her prescription that she was suffering from avian flu (H5N1). 

When Punjab's health department came to know that a patient from Rajasthan was diagnosed with avian flu, they immediately informed their counterparts in Rajasthan. 

"We do not have cases of avian flu, also known as bird flu. When we collected more information about it, we found that it was not avian flu (H5N1), but the woman was suffering from swine flu (H1N1). Had she been suffering from avian flu, it would have been a major health problem," additional director (rural health), Rajasthan, Dr Aditya Atreya, said. 

He said that the doctor in Punjab, who had written avian flu on the patient's prescription, admitted having committed a mistake.

India has certainly had a lot of H5N1 outbreaks in poultry, but for some reason not a single human case has been identified. 

Climate change and sugarcane expansion increase Hantavirus infection risk

Via PLOS Neglected Tropical Diseases: Climate change and sugarcane expansion increase Hantavirus infection risk. The abstract:

Hantavirus Cardiopulmonary Syndrome (HCPS) is a disease caused by Hantavirus, which is highly virulent for humans. High temperatures and conversion of native vegetation to agriculture, particularly sugarcane cultivation can alter abundance of rodent generalist species that serve as the principal reservoir host for HCPS, but our understanding of the compound effects of land use and climate on HCPS incidence remains limited, particularly in tropical regions. 

Here we rely on a Bayesian model to fill this research gap and to predict the effects of sugarcane expansion and expected changes in temperature on Hantavirus infection risk in the state of São Paulo, Brazil. The sugarcane expansion scenario was based on historical data between 2000 and 2010 combined with an agro-environment zoning guideline for the sugar and ethanol industry. 

Future evolution of temperature anomalies was derived using 32 general circulation models from scenarios RCP4.5 and RCP8.5 (Representative greenhouse gases Concentration Pathways adopted by IPCC). 

Currently, the state of São Paulo has an average Hantavirus risk of 1.3%, with 6% of the 645 municipalities of the state being classified as high risk (HCPS risk ≥ 5%). Our results indicate that sugarcane expansion alone will increase average HCPS risk to 1.5%, placing 20% more people at HCPS risk. Temperature anomalies alone increase HCPS risk even more (1.6% for RCP4.5 and 1.7%, for RCP8.5), and place 31% and 34% more people at risk. Combined sugarcane and temperature increases led to the same predictions as scenarios that only included temperature. 

Our results demonstrate that climate change effects are likely to be more severe than those from sugarcane expansion. Forecasting disease is critical for the timely and efficient planning of operational control programs that can address the expected effects of sugarcane expansion and climate change on HCPS infection risk. The predicted spatial location of HCPS infection risks obtained here can be used to prioritize management actions and develop educational campaigns.

MSF reopens first Kunduz clinic since deadly hospital air strike in 2015

Via Reuters: MSF reopens first Kunduz clinic since deadly hospital air strike in 2015. Excerpt:

Medecins Sans Frontiers (MSF) reopened a small medical clinic in Kunduz, Afghanistan, on Saturday, their first facility there since the American airstrikes that destroyed a hospital in 2015. 

"The opening of this clinic is the first step toward providing more medical assistance in Kunduz," Silvia Dallatomasina, head of programs for MSF in Afghanistan, told Reuters. "And for us it's an important step." 

Since the air attack by American special forces in 2015, which killed 42 patients, medical staff, and caregivers at the MSF trauma center, the medical aid group has been trying to secure assurances from American and Afghan military officials that their medical facilities would be respected and protected. 

"We are still finalizing commitments but we believe we were able to reach an agreement," Dallatomasina said. 

The new clinic in Kunduz, which is not situated at the site of the destroyed hospital, will only provide outpatient treatment of minor or chronic injuries, she said.  

Patients who need more advanced care including X-rays will still need to go to the government-run regional hospital, which has been overworked amid heavy fighting in the province. 

"The regional hospital is quite overwhelmed, so we want to try to reduce that burden by treating less serious injuries," Dallatomasina said. 

While no final plans have been confirmed, MSF hopes to begin building a new trauma center in Kunduz as early as 2018, although likely on a smaller scale than the previous facility, she said. 

The MSF trauma center was destroyed during a period in 2015 when Taliban militants briefly overran the city. An American military probe concluded that the attack was the result of human error and equipment failure, among other factors.  

At least sixteen U.S. military personnel were disciplined for their role, but MSF has criticized the lack of independent investigation into the incident.

Cholera in Yemen: A rough timeline

The war in Yemen has involved the Saudis and their allies since the spring of 2015, but cholera appears to have become a serious problem just since April, after a minor outbreak last fall. Here's a very rough timeline, based on ReliefWeb reports and posts here on H5N1:

500 days of conflict leave Yemen in worst crisis ever (August 6, 2016). No cholera yet, but almost 20 million lack access to clean water

UNICEF on cholera in Yemen (October 7, 2016): Cholera cases confirmed in Sana'a, suspected in Taiz.

OCHA: Cholera Outbreak Situation Report No.1 (as of 13 October 2016). Fifteen confirmed cases.

UNICEF: Cholera Outbreak Situation Report No. 2 (as of October 25, 2016). As of October 23, 31 confirmed cases including 15 children under age 15; 32 deaths related to "acute watery diarrhea."

We then see a long pause in cholera reports, until the spring of 2017:

WHO & other agencies: Yemen: Acute Watery Diarrhea/Cholera Outbreak - Situation Report #1 (May 9, 2017). Between April 27 and May 9, 2,301 suspected AWD/cholera cases, 47 deaths.

Reuters: Yemen cholera cases could hit 300,000 within six months: WHO. (May 19, 2017) 

MSF.org: Cholera outbreak threatens to get out of control. (May 21, 2017) Cases have doubled from 11,000 on May 14 to over 23,500 on May 19.

IFRC: IFRC in Yemen: Cholera outbreak, May 31. Suspected cholera/AWD cases now total 52,140; 417 deaths. 

Reuters: Yemen cases pass the 100,000 mark: WHO (June 8, 2017). Deaths: 789.

Save the Children: Yemen cholera epidemic infecting one child every minute (June 14, 2017). Almost half of 5,470 new daily cases are in children under 15.

WHO/UNICEF: Suspected Yemen cholera cases reach 200,000 (June 24, 2017). Over 1,300 deaths; cases increased at an average of 5,000 a day.

WHO: Yemen: Cholera Outbreak Daily Epidemiology Update (July 1, 2017). Between April 27 and June 30, 246,867 suspected cholera cases and 1,517 deaths.

WHO: Yemen: Cholera Outbreak daily Epidemiology Update (July 5, 2017). As of July 4, 275,987 suspected cholera cases and 1,634 deaths.

WHO: Yemen: Cholera Outbreak Daily Epidemiology Update (July 13, 2017). As of July 12, 326,082 suspected cholera cases and 1,743 deaths.

WHO: Cholera Outbreak Daily Epidemiology Update (July 20, 2017). As of July 19, 368,207 suspected cases and 1,828 deaths.

All hell breaks loose as the tundra thaws

Via The Guardian: All hell breaks loose as the tundra thaws. Excerpt:

Strange things have been happening in the frozen tundra of northern Siberia. Last August a boy died of anthrax in the remote Yamal Peninsula, and 20 other infected people were treated and survived. Anthrax hadn’t been seen in the region for 75 years, and it’s thought the recent outbreak followed an intense heatwave in Siberia, temperatures reaching over 30C that melted the frozen permafrost. 

Long dormant spores of the highly infectious anthrax bacteria frozen in the carcass of an infected reindeer rejuvenated themselves and infected herds of reindeer and eventually local people.

More recently, a huge explosion was heard in June in the Yamal Peninsula. Reindeer herders camped nearby saw flames shooting up with pillars of smoke and found a large crater left in the ground. Melting permafrost was again suspected, thawing out dead vegetation and erupting in a blowout of highly flammable methane gas. 

Over the past three years, 14 other giant craters have been found in the region, some of them truly massive – the first one discovered was around 50m (160ft) wide and about 70m (230ft) deep, with steep sides and debris spread all around.

See also this recent report in The Siberian Times about methane explosions in the tundra.

Hong Kong tackles world’s first case of patient contracting Japanese encephalitis through blood transfusion

Via the South China Morning Post: Hong Kong tackles world’s first case of patient contracting Japanese encephalitis through blood transfusion. Excerpt:

Hong Kong health authorities are tackling the world’s first case of a patient contracting the potentially fatal mosquito-borne disease, Japanese encephalitis (JE), through a blood transfusion.

The 52-year-old man was fighting for his life at Queen Mary Hospital on Friday. 

Doctors determined that two others received the same infected blood as the patient, who underwent a lung transplant at Queen Mary in May, followed by a blood transfusion at Grantham Hospital two weeks ago. 

Doctors said the other two patients had not shown any symptoms, though one of them died of a brain haemorrhage after undergoing surgery earlier this month. 

While the globally unprecedented case put the focus on the city’s current blood donation policy, which does not require testing for JE, health officials ruled out changing the system. 

University of Hong Kong microbiologist Professor Yuen Kwok-yung said there was no need to start screening blood donations for JE as the chance of infection was very low. 

“This is a very rare and unfortunate case,” he said, adding that the lung transplant operation could have made the patient more vulnerable to the JE virus. 

“From a medical point of view, I don’t see the need to develop a mass screening test, unless there is a surge in the cases of JE virus infection in Hong Kong.”

There have been only three cases of the disease so far this year, and only one in 100 infected people show symptoms such as headache, high fever and neck stiffness, usually between four and 14 days after contracting the virus. It may lead to a swelling of the brain and death. 

Yuen added that it was practically impossible to check the Red Cross blood bank for the JE virus, and there was no need for public alarm. 

“I hope this case won’t discourage the general public from donating blood in future,” he said. 

Dr Lee Cheuk-kwong of the Red Cross suggested that in addition to filling in questionnaires regarding their health, donors should report any symptom of illness after giving blood. 

Investigations revealed that the donor, a 46-year-old man living in Tin Shui Wai and working in Kwun Tong, had given blood through the Red Cross mobile donation service on May 29. He had passed all required health tests and showed no symptoms of JE.

Saudi Arabia: No new MERS cases, one recovery on July21

Via the KSA MOH Command and Control Center: MOH: 'No New Corona Cases Recorded. A 30-year-old female expatriate healthcare worker in Riyadh has recovered. No deaths are reported.

Press briefing notes on Yemen (21 July 2017)

Via the UN Office of the High Commissioner for Human Rights: Press briefing notes on Yemen (21 July 2017).

Our office in Yemen has gathered more information about a deadly airstrike that took place in a small village in Taizz Governorate in Yemen on Tuesday, 18 July. The Arab Coalition Forces airstrike took place in Al Asheerah village, which is near the town of Mawza, and is currently controlled by the Houthis, at around 8:30 a.m. on Tuesday. 

According to witnesses who fled the area and were interviewed by one of our monitors, the airstrike destroyed a makeshift house made of straw, killing all three families who were inside it at the time. At least 18 civilians in all, including ten children and two women, are believed to have died in the incident.  

The three families had been recorded by our office in Yemen as displaced, along with three others, from their homes in a different village nearby three months ago as a result of other airstrikes, and had set up four rough shelters in an open area in Al Asheerah. The village is located approximately eight kilometres away from Khalid Bin Al Walid Military Camp, where clashes between pro-Hadi forces, backed by the Coalition Forces, and the Houthis are taking place, and, according to available information, there do not appear to have been any military objectives anywhere in the immediate vicinity of the destroyed house. 

Attacks targeting civilians or civilian objects or indiscriminate or disproportionate attacks are prohibited under international humanitarian law, a​nd we also remind all parties to the conflict, including the Coalition, of their duty to ensure full respect for international humanitarian law and to respect their obligations under international human rights law. We call on the relevant authorities to carry out a comprehensive and impartial investigation into this incident. 

Since March 2015, OHCHR has documented 13,609 civilian casualties, including 5,021 killed and 8,588 injured. These numbers are based on the casualties individually verified by the UN human rights office in Yemen. The overall number is probably much higher, with some estimates suggesting a total of more than 11,000 civilians have been killed since the beginning of the conflict.

And that number doesn't include deaths from cholera, other diseases, and simple starvation.

Meanwhile, WHO has just posted a new web page on the Yemen crisis. It''s going in the Key Sites list.