H5N1

India: Another H1N1 death in Delhi

Via The Times of India: 27-yr-old woman dies of swine flu. Excerpt:

A 27-year-old woman admitted at Ram Manohar Lohia Hospital died on Tuesday due to swine flu, taking the total number of deaths reported in Delhi this season to 30. 

Debashish Bhattacharya, nodal officer for swine flu in the capital, said 53 new cases of H1N1 infection were reported on Tuesday. The total number of cases reported this season has now reached 926. 

 "Of the new swine flu cases reported on Tuesday, 11 patients are children,'' said Bhattacharya. 

According to sources, the latest swine flu victim, who succumbed to the disease at RML Hospital, is a citizen of Delhi. 

"There are seven other swine flu patients at RML hospital and two of them are in serious condition,'' said the source. 

Since May 2009, when the swine flu epidemic hit the capital, more than 120 deaths have been reported.

Pakistan: An administration as overwhelmed as the people

Via IRIN: PAKISTAN: An administration as overwhelmed as the people. Excerpt:

While the villagers are trying to deal with the enormity of their loss, the local administration is struggling to contain the effects of ignorance of hygiene norms. 

Abdul Latif, a government doctor who regularly visits the camp, says he has been seeing at least 40 cases of diarrhoea every day. 

There are toilets in the building but the stench emanating from them is overpowering. Sattar says if they had the resources, "We would like all the people to be stationed in one open camp, with separate areas for washing, drinking and bathing, so we can maintain proper hygiene." 

Clean drinking water is critical. "We have received water purification tablets but this is not adequate for 3.6 million people already displaced in this province," noted Mahessar. 

"And the numbers are rising as Thatta [the last district through which the Indus flows before it reaches the Arabian Sea] gets flooded - we expect the figure to rise to 4.5 million." The national highway to Thatta is already being flooded. 

District administrator Sattar maintains that lack of information is the bigger issue. "A local NGO wanted to supply us with mineral water; they brought in hundreds of bottles, but when they saw the people using it for washing their clothes they never came back." 

Adequate nutrition for children is also critical. Benazir Khatoon, 18, is worried because the children have not had milk for five days. “In the village we had our own buffaloes - they drank milk every day - see how pale and weak they look now," she said. 

"Nutrition for children is a major concern - the displaced are being provided mainly with adult food," said UN resident coordinator Mahessar. It is Ramadan [when Muslims fast from sunrise to sunset] and the administration, backed by private donors, has been trying to provide a cooked evening meal.

Australia: Mosquito control as an education issue

Via the Townsville Bulletin: Girl, 5, in mozzie-bite nightmare. Excerpt:

A little girl has gone home from Weir State School with more than 150 mosquito bites with her furious mother claiming the school has left it too long between pest control treatments. 

The five-year-old prep student has an allergy to mosquitoes and had to go on antibiotics several times already this year after some of the bites turned into palm-sized sores. 

Her concerned mother was one of two parents who spoke out to the Bulletin about the problem, which they fear poses a dengue fever risk. 

Education Queensland said the school was recently found to be clear of dengue carrying mosquitoes and said another treatment was due in October, however this would be brought forward after the Bulletin raised the concerns on behalf of the mothers. 

The school will also send home an information package to parents on how to avoid the risks of dengue fever. 

The Townsville Bulletin understands Weir State School is not alone with Kirwan High, Townsville High and Belgian Gardens State School also forgoing mid-year treatments. 

The prep student's mother, who did not wish to be named, said while her daughter's teacher was sympathetic and helped her apply insect repellent every lunch time, requests for the school to recommence pest control treatments had previously fallen on deaf ears. 

She said a treatment done at the school at the beginning of this year saw her daughter come home with only the odd bite and she begged the school to regularly employ a pest control agency. 

"My daughter is actually allergic to mozzie bites. She has about 150 bites on her at the moment, bites down her bum and on her thighs," the mother said. 

"She was getting it so bad that I had to take her out of school and take her to the doctor at one stage. "It's unfair that she's going to be scarred for life due to lack of treatment by the school." 

A second mother, who has daughters in grade one and three at Weir School, said her girls also came home covered in bites and while they were not allergic, she feared they would contract dengue.

Egypt: WHO confirms latest H5N1 death

WHO has published Avian influenza - situation in Egypt - update 37.

The Ministry of Health of Egypt has announced a new human case of A(H5N1) avian influenza infection. 

The case is a 33 year-old female from Qaluibia governorate. She developed symptoms on 17 August, was hospitalized on 24 August, where she received oseltamivir treatment, and died on 26 August. 

Investigations into the source of infection indicated that the case had exposure to sick and dead poultry. 

The case was confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network (GISN). 

Of the 112 laboratory confirmed cases of Avian influenza A(H5N1) reported in Egypt, 36 have been fatal.

Pakistan: Floods increasing landmine risk in Pakistan: ICRC

Via Dawn.com, an AFP report datelined Geneva: Floods increasing landmine risk in Pakistan: ICRC. Excerpt:

Flood waters in Pakistan have dislodged and carried landmines to places previously deemed safe or demined, increasing risks to the population, the international Red Cross warned on Tuesday. 

Since the beginning of the floods, “three children, a woman and a man have been severely injured” by landmines in disaster-hit regions, Luiza Khazhgerieva, an official from the International Committee of the Red Cross, told AFP. 

“Mines and unexploded ordnance could have been easily moved by water from the original places,” she noted. 

The ICRC has in recent weeks documented incidents of explosions in areas previously deemed to be free of landmines. 

In one instance, a woman's leg was blown off after she stepped on a mine while collecting firewood in places she used to frequent before the flood. 

In another incident, a refugee in Kashmir was hurt by a mine while cutting grass to feed his cattle. 

“This incident occurred in the area which is far away from places where incidents have been reported in the past,” said Khazhgerieva, who did not have figures on the number of unexploded ordnance in Pakistan. 

In addition, two anti-personnel mines and a grenade were found in the pools of stagnant water and defused by the bomb disposal squad in Dera Ismail Kahn, south of Peshawar, said the aid official. 

“Big explosions have been seen by local people in moving flood water there,” she noted, adding that this could be due to an explosive colliding with a hard surface.

Honduras: MSF tackles outbreak of dengue fever

A superb long article in the latest e-newsletter from MSF: Honduras: MSF tackles outbreak of dengue fever. Excerpt:

Due to an alarming increase in cases of dengue fever in Honduras this year, Médecins Sans Frontières (MSF) has launched an emergency intervention in Tegucigalpa, capital of the Central American country, where the majority of cases have been reported. 

MSF is supporting local health services with a three-pronged approach focusing on medical care, vector control and community education. Such a dengue intervention is relatively new for MSF. 

More than 80 children have already been treated in an emergency pediatric ward set up by MSF. Mobile teams are also working with the local health authorities to identify and eliminate sources of infection in 4,000 households in the Tegucigalpa area. 

Dengue, endemic in Central America, is a viral disease transmitted by mosquitoes of the genus Aedes. Symptoms are similar to flu, with headaches, fever, nausea, abdominal pain and rashes on the skin. Its most severe form, hemorrhagic dengue, causes bleeding and can lead to irreversible shock and subsequent death. 

In Honduras, cases of the common form of dengue have significantly increased in 2010 compared to the previous year, with more than 50,000 cases already reported. However, the most alarming feature of this outbreak is the prevalence of hemorrhagic dengue, with more than 1,500 cases reported and 160 deaths - a massive 1850 per cent increase on 2009. 

“I had come across the previous kind of dengue,” said Herminia Moncada, whose son was recently admitted to hospital with the disease. “But this is different. This dengue kills.” 

The Honduras Ministry of Health has been responding to the high number of cases of dengue by making more hospital beds available and setting up specialized units in health centres in outlying areas. Despite this, the main referral hospital has still been overwhelmed by the upsurge in patients. Until recently, children with dengue fever had all been transferred to the referral hospital, as the decentralized units were only receiving adult patients.  

To ease the overcrowding, MSF has set up an emergency ward at the San Felipe Hospital on the outskirts of Tegucigalpa where children under 15 with symptoms of the disease can be cared for. Already, on its second day of activity, the 23-bed ward was working to full capacity. 

In hospital, treatment for children includes hydration and rest. “With dengue, we are unable to identify beforehand the patients who will improve rapidly. There is no vaccine or specific medicine for the virus, so all we can do is to control the symptoms and treat the consequences while waiting for the body to stabilize,” said Dr Elisabeth Bragança, in charge of the MSF emergency ward. 

Even if the treatment sounds simple, oral hydration involves certain complexities: serum needs to be administered carefully to avoid a fluid overdose, as dengue alters the permeability of blood vessels and there is a risk of fluids invading other parts of the body, causing complications such as pulmonary edemas. “An ongoing balance in the amount of fluids given needs to be maintained,” said Dr Bragança. 

MSF health staff are also spending time teaching the children’s parents and care-givers how to administer the fluid regularly to their children. “In my opinion, the success of this medical intervention mostly relies on us collaborating with the parents,” said Dr Bragança. 

Frequently, parents stay in the ward throughout the night, giving their children serum at set intervals and writing down the amounts so that they can tell the health staff later. Often the parents have no one to stand in for them and sometimes spend many days and nights without sleep. For this reason, emotional support for the parents is one element of the intervention.

WHO on the vaccine-narcolepsy issue

WHO has published Pandemrix® vaccine and cases of narcolepsy.

WHO's attention has been drawn to reports of narcolepsy in Sweden and Finland allegedly related to vaccinations with Pandemrix®, an adjuvanted 2009 influenza A (H1N1) vaccine produced by GSK. 

WHO notes that the European Medicines Agency (EMA) has launched a review to look carefully at all of the available data and determine whether there is sufficient evidence to establish a causal association between the vaccine and narcolepsy. WHO, through its Global Advisory Committee on Vaccine Safety, is monitoring the situation closely. 

Pending the outcome of the ongoing reviews, Pandemrix® remains licensed for use by the EMA and prequalified by WHO. Given that the benefits of 2009 influenza A (H1N1) vaccines are established, WHO recommendations to immunize vulnerable populations remain unchanged.

Children in Pakistan hit by flood illnesses

Via BBC News: Children in Pakistan hit by flood illnesses. Excerpt:

Children in Pakistan are bearing the brunt of water-borne illnesses spreading because of the floods, says the World Health Organization. 

Its officials say the young have been especially affected by a rise in acute cases of diarrhoea and malaria from stagnant water. 

The flood waters are beginning to drain away to the Arabian Sea but inundations continue in parts of Sindh province. 

Few of the eight million people displaced have clean drinking water. 

Meanwhile, neighbouring rival India announced it would raise its flood aid to Pakistan by five-fold, to $25m (£16m). 

As the water retreats across Sindh back to the Indus river and down to the Arabian Sea, it is deluging new areas in the province. 

Flooding has submerged the town of Gaji Khwawar and was also threatening the towns of Wara and Dadu in Sindh on Tuesday. 

The BBC's M Ilyas Khan in Islamabad says many areas in Sindh and its neighbouring south-western province of Balochistan still look like lakes, with tens of thousands of people stranded on islands. 

But the situation can vary widely from town to town. 

The Sindh coastal town of Thatta, earlier evacuated, has been saved thanks to the plugging of a breach in a flooded embankment, say Pakistani officials. 

But the town of Sujawal, just 40km (25 miles) away, remains under 2.5m (8ft) of water, says the BBC's Riaz Sohail in Sindh. 

And about 30km south of Sujawal, fast-moving floodwaters are threatening the towns of Jati and Choohar Jamali.

WHO issued a news release on August 30, describing the details of diarrheal infections and mentioning other problems such as acute respiratory infections, hepatitis A and E, malaria, and skin infections.

UK: Avian flu still likely to strike in humans, says Welsh expert

Via Wales Online: Avian flu still likely to strike in humans, says Welsh expert. Excerpt:

The threat of bird flu crossing over to humans and igniting a pandemic remains real, one of Wales’ leading experts on health and disaster management has claimed. 

Alan Hawley, who until recently was the UK’s Director General of Army Medical Services, said climate change and international food scarcity has the potential to spread social and economic chaos across the globe. 

His comments follow the decision of the Assembly Government to reduce the surveillance of live wild birds for avian influenza. Instead, attention will be focused on dead birds. 

However, Prof Hawley said bird flu is not the greatest threat to Wales and the world. 

The former major general, who is now the University of Glamorgan’s professor of disaster studies, described the Assembly Government’s decision to narrow the field of monitoring as “quite sensible”. 

He said: “I think, scientifically, you have to constantly re-prioritise what you are doing. We have got a resource issue and hard decisions have to be made; I’m really glad I’m not a politician.” 

But he said the threat of avian flu mutating into a form which could be passed between people “absolutely” remained on the radar. 

He said: “The one we worry about is the avian epidemic where it moves from birds to the human species. I think that’s likely to happen, just being dispassionate about it. 

“It will be bad enough to give us a jolt, but the technology and the modern public health techniques will allow us to cope with it.”

Singapore: Dengue, malaria and chikungunya cases down

Via Channel NewsAsia: Dengue, malaria and chikungunya cases down in S'pore. Excerpt:

The number of dengue, chikungunya and malaria cases in Singapore is falling. The National Environment Agency (NEA) said this is due to the Integrated Vector Management system (IVM), introduced by the World Health Organisation. 

The system helps stakeholders decide how to allocate their resources like manpower and collaborate with other agencies to control the disease. 

Preventing mosquitoes from multiplying is the key to keeping dengue cases down. And with the IVM approach, NEA said it can also keep malaria and chikungunya at bay. 

Tai Ji Chong, Head of NEA's Operations Environmental Health Department, elaborated: "For the case of dengue, the trend has been going down. In the past we have seen cyclical trends of dengue where it peaks every six or seven years, but from 2006 till today, we do not see that kind of trend anymore. 

"In fact, for the last two years, the trend has been going down. With the IVM system in place for dengue, we apply the same system for chikungunya when it comes in, and as a result, chikungunya did not become endemic in Singapore." 

And the strategy works. Dengue fever cases have gone down from 7,000 in 2008 to 4,500 in 2009. 

Similarly, the number of chikungunya cases has gone down from 720 in 2008 to 340 cases in 2009. NEA said the downward trend has continued this year, with a total of 22 local and imported chikungunya cases so far. 

Malaria cases here also went down from 29 last year to just nine cases in the first 33 weeks of this year.