H5N1

Haiti: Getting ready for Tomas

Via HaitiLibre.com: Haiti - Hurricane Tomas : First measures of voluntary evacuations. Excerpt:

In preparation of the arrival of Hurricane Tomas, whose trajectory could turn to the north (according to some forecast models) and hit Haiti on Friday afternoon, with heavy rains and winds up to 160 km/h (hurricane Category 2), the authorities asked the hundreds of thousands of Haitians living in tent camps, to begin the evacuation, encouraging them to travel to the homes of family or friends. An evacuation may be complicated by the presence of the cholera epidemic in the Artibonite and plateau Central. 

"We have launched an appeal for voluntary evacuation, particularly in the camps," said Alta Jean-Baptiste, the director of the Haiti's Civil Protection Office "We have plans to evacuate the camps but we won't be able to evacuate everybody." 

Nadia Lochard, the coordinator for civil protection, said authorities were showing camp dwellers how to properly tie up their tents before evacuating. She said that rains and strong winds predicted for the region south of the country could potentially affect Port-au-Prince.

Amazon Indians hit by deadly epidemic in Venezuela

Via Arkanoid Legent, an AP report on Yahoo! Green: Amazon Indians hit by deadly epidemic in Venezuela. Excerpt:

Venezuelan health workers say an epidemic that may be malaria has killed dozens of people, decimating three villages of the Yanomami Indians, whose struggle for survival in a remote part of the Amazon rain forest has attracted worldwide support. 

Two indigenous health workers who visited the area told The Associated Press on Friday that village chiefs told them that about 50 people have died recently, many of them children. 

"There are still many, many sick people," Andres Blanco said by telephone from Puerto Ayacucho in southern Venezuela. Blanco, a Yanomami health worker in a government program for the indigenous communities, alerted regional officials this month after trekking for days to visit three remote villages. 

He returned by helicopter last weekend with a team of government doctors who administered medication and confirmed that many survivors are also infected with malaria. 

A regional health official, Dr. Carlos Botto, said the initial accounts and tests have shown there was some type of epidemic and evidence of malaria. But he said the number of deaths remained unclear and further tests were needed to determine if other diseases could be involved. He said other officials were analyzing results of the five-day medical mission. 

"What's certain is that there was an epidemic with deaths," Botto said in a telephone interview. He said the number of deaths reported by those in the communities was just an estimate. 

"The number could be lower, but in any case it's an important, alarming number," said Botto, who leads a program focused on river blindness at a government institute, the Amazon Center of Research and Control of Tropical Diseases in Puerto Ayacucho.

El Nacional.com in Caracas also has a report on this outbreak dated October 30 which is clearly the basis of the AP story. A quick paraphrase: 

About 50 Yanomami, many of them children, have recently died in a population of 200. "Many, many more" are still sick. 

 Dr. Carlos Botta said the initial tests and evidence indicate malaria. More tests are needed to determine if other diseases are also involved.

 Native-rights activist Christina Haverkamp said the government's response has been slow and insufficient, and that it's urgent that doctors arrange for more helicopters so they reach similar situations in other areas.

 The government of President Hugo Chávez insists that it's improved and extended medical attention for the Yanomami, but Yanomami leaders have demanded for years that the government provide better health and transportation services.

The Day of the Dead

Via Inquirer.net in the Philippines: Safety tips for people going to cemeteries. Excerpt:

Bring food that will not spoil easily. Carry an umbrella not only for protection from the sun or a sudden downpour but also from the stray dogs that roam the cemetery. 

These were among the tips given by the Department of Health (DOH) to the millions of Filipinos who would be trooping to cemeteries to mark All Saints' Day and All Souls' Day. 

Dr. Eric Tayag, head of the DOH National Epidemiology Center, said people should avoid taking their babies or children to the resting places of their loved ones as they would be vulnerable to diseases in hot and congested conditions.

The report goes on to list the potential threats, like diarrhea and leptospirosis.

In Mexico, my parents, brothers and I sometimes went to the cemeteries on November 1 to witness the Day of the Dead (as it's called there). Families would picnic on their ancestors' tombs, and it was a colourful event. November 2 was the Day of the Dead Children. (I well recall many funerals where Papá easily carried his child's little white coffin on his shoulder.)

It didn't even cross our minds that we might risk getting sick by a visit to the cemetery. We never drank the tap water, or bought food from street vendors, but mosquito bites were just routine. (In one house, I roomed with a scorpion. We were taught to bang our shoes on the floor before we put them on in the morning.)

And we learned to appreciate,if not enjoy, the Mexican intimacy with death: we went to the bullfights on Sundays, and saw the embalmed arm of a famous president, and the exhumed mummified corpses in the Guanajuato cemetery. In the autumn, you could go into the local bakeries and buy a skull made of sugar, with your name written in frosting across its forehead. (Well, not if your name was Crawford.)

Given the horrendous war now going on in Mexico between the government and the narcotraficantes, the Mexican flirtation with death may be wearing thin. 

But they and many other cultures probably have a healthier attitude toward death than North Americans and Europeans do. In our culture, death is something awkward and embarrassing, consigned to hospitals and hospices. When we die, it's a kind of faux pas, leaving our friends and colleagues with nothing to do but tell the bereaved how desolated we are—so the bereaved have to console us for how bad we feel.

Apart from being an attitude only a deeply protected culture can afford, our attitude will make the next major pandemic harder on us than on the Third World countries we now patronize. 

We elders already understand that losing our contemporaries is the biggest hazard of long life. But even we, unlike the Haitians and Pakistanis and Indonesians, are not prepared to help bury our grandchildren.

Alcabes on real Hallowe'en scares

Here in North Vancouver the trick-or-treaters will be out on the streets in an hour or so. My wife and I have become Hallowe'en Scrooges, shouting "Bah! Humbug!" to the whole over-marketed event. All it means to us is upset dogs and a massive subsidy to the Canadian candy and dental industries. So our porch light will be off and no jack o'lantern will greet the kids.

My favourite contrarian, Dr. Philip Alcabes, is rarely upset by dire threats of possible pandemics. So when he worries, I worry. On his blog today, he writes about Bed Bug Worry, Mosquito Mayhem. Now, this is scary. Excerpt:

An extensive outbreak of rift valley fever in South Africa produced dozens of human cases earlier this year, and seems to be continuing among livestock.  

An epidemiologist friend in Europe told me a few weeks back that he and other European disease control specialists, already concerned about dengue and yellow fever, are looking at RVF exposures in the southern part of the continent — a worrisome finding for a virus that has primarily been African.   

The European Center for Disease Control is, appropriately, concerned about the establishment of Ae. albopictus in Europe. 

Ditto chikungunya, which has produced 33 cases in Delhi, India, this year, possibly including an illness in the city’s mayor.

Dengue  demands control most pressingly of all. Although the CDC is busily advising Americans not to worry (“Nearly all dengue cases reported in the 48 continental states were acquired elsewhere by travelers or immigrants,” its info page reads), there is active spread through much of the Caribbean basin — see the map at Dengue Watch, for instance.  

The Mexican ministry of health reports dengue transmission in areas bordering the U.S.  There has already been an outbreak in Texas (in 2005).  And other highly industrialized countries with strong surveillance and control systems are experiencing dengue cases, including the first report of domestic transmission within France this summer. 

(Hats off to Crof at H5N1, who has been following both chikungunya and dengue assiduously.) [And my Tilley is off to Phil for his kind plugging of my site--CK]

The expansion of the range of Ae. albopictus, a secondary but by no means ignorable vector for dengue, makes the geographic extension of these pathogens worthy of concern.

Haiti braces as Hurricane Tomas roars over Caribbean

Via Reuters: Haiti braces as Hurricane Tomas roars over Caribbean. Excerpt:

Authorities on Sunday urged hundreds of thousands of Haitians living in crowded tent camps to seek new shelter as Hurricane Tomas roared across the Caribbean with Haiti in its projected path. 

Tomas was downgraded to a Category 1 storm after ripping off roofs and knocking down trees and power lines across several small eastern Caribbean islands. It is expected to weaken to a tropical storm in the next 24 hours, the U.S. National Hurricane Center said. 

But the storm is seen regaining strength by Wednesday as it passes south of the Dominican Republic and Haiti, where more than one million survivors of a devastating Jan. 12 earthquake are living in sprawling tent camps. 

Under some models of the storm's track, Tomas is forecast to turn to the north and head toward Haiti as a hurricane as early as Thursday. Other projections show the storm possibly shifting course farther east toward the Dominican Republic or even west toward Jamaica. 

Any heavy rains and powerful winds from Tomas would pose a significant threat to the some 1.3 million homeless survivors now living in tent and tarpaulin camps in the Haitian capital of Port-au-Prince. 

Tomas, the 12th hurricane of a very active 2010 Atlantic hurricane season, was packing top sustained winds of 75 miles (120 km) per hour, the Miami-based center said. 

In Haiti, the government and international aid groups are already struggling with a major cholera epidemic that has killed at least 330 people and sickened over 4,700 people. 

As Tomas churned over the open Caribbean sea, officials appealed to Haitians in tent camps to start evacuating, encouraging them to travel to the homes of family or friends.

I see their point, but putting thousands of Haitians on the road (assuming they have relatives or friends who can put them up) will also slow down vehicles carrying medical supplies—and likely expose the evacuees to cholera, or spread it, or both.

Uganda: School closed over cholera

Via The Daily Monitor: School closed over cholera in Nakapiripirit. Excerpt:

The authorities in Nakapiripirit District have closed down a primary school within the town council over cholera. 

Namorotot Primary School was closed down on Friday after 11 cholera cases were registered at the school. 

The district education officer, Mr Yahaya Oriokot Juma, said; “We closed down the school because we didn’t want the disease to affect many children and teachers.” 

Namorotot Primary School is a day school. 

Mr Oriokot said the school has an enrolment of about 200 pupils. He said the school will be re-opened after an assessment by the health team.

Haiti: An abnormally high death rate?

Via HaitiLibre.com: Haiti - Epidemic : An abnormally high death rate. Excerpt (but read the whole article):

Despite what the authorities of the Ministry of Health said, the analysis of figures provided by the Haitian government does not correspond to the "reassuring" words diffused daily since Saturday, October 23, 2010 (1st official assessment) and October 30, 2010 last assessment available. 

We can only conclude, on reading these figures, that the number of people infected and hospitalized rose by 210.52% and 173.71% of deaths. 

The average rate of deaths on the number of people infected (recognized cases) (1) between October 24 (assessment # 1) and October 30 (assessment # 8) is of 7.42 %, a rate abnormally high if one refers to the figures released by WHO. In 2008, about 56 countries (190.130 cases reported) 5.143 deaths reported (2.7% mortality rate). 

WHO estimates on its website that the real between assessment of cholera in the world, amounting to 3 to 5 million cases and between 100,000 and 120,000 deaths per year (a mortality rate between 2.4 and 3.33%). 

Given these figures, mortality rate of cholera in Haiti is of 2.24 to 3.09 times higher than average numbers of deaths from WHO, without knowing why.

Hong Kong: Bird flu outbreak drill held

Via the Hong Kong government website, a reported dated October 28: Bird flu outbreak drill held. Excerpt:

The Agriculture, Fisheries & Conservation Department conducted a field simulation exercise today to review its preparedness for an avian influenza outbreak.   

The exercise saw 100 staff familiarise themselves with work procedures and biosecurity measures for conducting the operation and identify areas for response improvement.   

It focused on the overall on-site preparation and implementation of biosecurity measures, such as putting on and removing protective gear, as well as the disinfection and disposal of carcasses.

Hong Kong is of course where H5N1 first infected and killed humans in 1997, and the medical authorities take it very seriously.

India: Dengue dips in Delhi, chikungunya takes over

Via Indian Express.com: Dengue dips, chikungunya takes over.

In just about a month’s time, the Capital has witnessed around 33 cases of chikungunya, a virus that causes headache, fever, fatigue, nausea, vomiting, muscle pain and swelling of the joints. 

From eight cases that were reported from Palam village on the outskirts of Delhi in September, the number has increased four times in just four weeks. 

According to the Municipal Corporation of Delhi, the number of cases is higher than usual and the additional money sanctioned to the civic agency — Rs 35 crore [3.5 million rupees=US$78,989] — to fight dengue and malaria will also be used to contain the chikungunya virus. 

While South Delhi localities such as Defence Colony and GK reported the highest number of chikungunya cases, the South and Central zones were the most affected by the dengue outbreak. 

However, the dengue virus — which had seen an upsurge in the last two months, with the average number of cases coming to almost 100 every day — is now on the decline, with only 59 positive cases being reported on Saturday and the total count touching 5,485.

Israel: Nurse in serious condition with malaria

Via Arutz Sheva: Nurse stricken with Malaria in Nahariya.

A 29-year-old nurse was admitted to a Nahariya hospital in serious condition with malaria on Sunday. Doctors were reported working to stablilize her condition. 

The nurse had been working at a hospital in Guinea and was in Israel for a vacation.