H5N1

Haiti: A doctor's view

Dr. John Carroll works in Cité Soleil and blogs at Dying in Haiti. Here's a post from October 28: Cholera and the Capital. Excerpt:

This week we have seen thousands of kids in the clinic and the hospital in Cite Soleil. 

I have not checked one child who had a history consistent with cholera. 

There are no confirmed cases of pediatric cholera in Saint Catherine's Hospital in Soleil either. We admit our sickest kids to this hospital which lies across a field from the pediatric clinic. 

However, the kids seems sicker than usual. Lots of malnutrition, diarrhea, fever, colds. 

And we have about 5 documented cases of malaria each week at the clinic in the back of Soleil. 

Port-au-Prince and its slums do not need a cholera epidemic. I can't hardly think of a worse nightmare. Haiti is beyond fragile at this point and the people are suffering more than I have ever seen.

I'm putting this site in the Bloggers list.

Barbados: Health Ministry safeguarding against cholera

Via The Barbados Advocate: Health Ministry safeguarding against cholera. Excerpt:

The outbreak of cholera in Haiti has led to a swift reaction by the Ministry of Health to safeguard the country. 

Speaking on the systems that are being put in place, Chief Medical Officer Dr. Joy St. John stated on Friday night that this included heightened surveillance at the ports of entry. 

“The risk of cholera coming to Barbados may seem remote and it probably is a lot less than other countries that are nearby and that have illegal traffic, but there is considerable traffic and direct flights, private jet flights between Barbados and Haiti,” she stated, 

St. John noted that the ministry had been in contact with one company that was sending several of its employees to Haiti and advised them on the precautionary steps to take. 

“We also have under surveillance a person who has returned from Haiti recently, thankfully not infected, but still,” she said. 

Meanwhile, a travel advisory has been issued for those Barbadians traveling to Haiti, which will soon be made available to this island. 

This includes the need to travel with bottled water and instructions on how to purify water and the avoidance of uncooked or raw meats.

PAHO: Sitrep #9 on Haiti

This was just posted on ReliefWeb, and PAHO's own websites don't have it up yet. Haiti: Cholera Situation Report #9, 30 October 2010. The summary:

• The Ministry of Health reports 337 deaths and 4,764 hospitalized cases of cholera as of 10:00 A.M. 

• Water purification materials, in particular that which are used to treat water with sediment, are urgently needed. Additional stocks of water purification tablets and soap also need urgent replenishing. 

• Preparations begin for Hurricane Tomas which has a likelihood of impacting Haiti early next week. 

• UNICEF has made 100 megaphones and 800 batteries available to the departmental health authorities of St Marc and Gonaives to conduct sensitization on cholera prevention and treatment.

Dengue danger: Over 3,000 cases across Pakistan – The Express Tribune

Via The Express Tribune: Dengue danger: Over 3,000 cases across Pakistan. Excerpt:

Dengue virus is spreading across the country, as three deaths were reported in Sukkur, Sargodha and Naushero Feroz. 

The total number of dengue cases has risen to 2,000 in Sindh, with 53 new cases being reported in Karachi, taking the total to 1,800 in the city. 

In Punjab, a total number of 1,600 cases have been reported, with 194 new cases being reported in Lahore and six in Faisalabad. Out of the 493 reported cases in Rawalpindi, 437 have been discharged from the hospitals after treatment. 

In Khyber-Pakhtunkhwa, the number of dengue patients up till now is 400.

Haiti: Update on Tomas

Mike Coston at Avian Flu Diary has posted Haiti: Anxiously Watching Tomas. It's a very good summary of what we know (and don't know) so far about this late-season hurricane and its implications for Haiti.

Cholera in Haiti: "a disease of poverty"

Via The Huffington Post: Cholera in Haiti: "a disease of poverty". This puts Ansel Herz's lasst three articles in one place, and also quotes Partners in Health:

As PiH Chief Medical Officer Joia Mukherjee put it, cholera is "a disease of poverty" . During the previous government of Jean-Bertrand Aristide, she pointed out, Inter-American Development Bank loans for a public water supply in the Artibonite Valley, where the cholera originated, were blocked by international donors on political grounds. 

In rural areas, where most of the country's population lives, fewer than 8 percent have access to safe drinking water, according to the International Fund for Agricultural Development. 

The dearth of potable water and sanitation facilities not only in the camps, but also in many permanent communities, are now major factors contributing to the spread of the deadly disease.

Haiti's cholera mortality rate

Via the Canadian ER nurse who runs the blog Those Emergency Blues, a good summary: Haiti Cholera Update #4. Excerpt:

According to the Pan-American Health Organization (PAHO), MSPP (Ministère de la Santé Publique et de la Population) reports, as of today, 30 October 2010, there have been 330 deaths from cholera and 4,714 confirmed cases. This represents a crude mortality rate of 14.28%. Cholera treated promptly has a mortality rate of 1-2%.

I've added Those Emergency Blues to the Bloggers list. 

Haiti: A Cuban expert's view

Via the English-language page of Haiti Liberté: Cholera catastrophe spreads in Haiti. Excerpt:

“They are doing exactly the wrong thing,” said Dr. Manolo Castro. “When you bring cholera victims into a hospital, especially one with poor conditions, you stand a good chance of infecting all the patients in that hospital.” 

Dr. Castro, 74, is a Cuban doctor working at Haiti’s finest pediatric hospital, St. Damien, in Tabarre. When it comes to cholera, where a virulent bacterium provokes severe vomiting and diarrhea which can kill in a few hours, he knows what he is talking about. He has tangled with the deadly disease before. 

In 1990, a cholera epidemic struck the Zambian town where Dr. Castro was a teacher at a hospital as part of a Cuban medical mission. Soon there were some 6,000 cholera victims. 

The hospital’s Zambian director packed up his family and fled. The Cuban Embassy and Zambian government asked Dr. Castro to step in to help the panicked population. 

Dr. Castro went to the Public Health Ministry’s office in town and with them identified a local stadium where they could quarantine hundreds of cholera patients. Within a few weeks, Dr. Castro’s team of six Cuban and six Zambian doctors had brought the outbreak under control. 

“It is essential to isolate cholera victims from other patients, especially where there is poor sanitation,” said Dr. Castro, who helped squelch another cholera outbreak when stationed in the Cape Verde islands in 1994. 

“The government should also stop all traffic and travel between the affected area and those not affected. Otherwise, the disease is going to spread.” 

The day after Dr. Castro spoke those prophetic words, it was announced that Haiti’s cholera epidemic had propagated from the Central Plateau and Artibonite departments (where it emerged) to Port-au-Prince, the capital through which thousands of people from all corners of the country circulate every day. 

But far from taking aggressive and proactive measures like stopping traffic, Haitian Public Health authorities have been trying to minimize the crisis, claiming, as the Health Ministry’s general director Gabriel Thimoté did Oct. 25, that the disease’s progress has been “stabilized.” 

At press time on Oct. 26, the only official government figures are that 3,769 people have become sick with the disease in the Artibonite and Central departments, with 273 fatalities in the Artibonite. 

Since other areas are not being tallied, the actual figures are much higher.

Haiti: 337 cholera deaths; Tomas due next Thursday

Via CNN.com: Official: Haiti cholera deaths rise above 330 as hurricane approaches. Excerpt:

The death toll from a cholera outbreak in Haiti has risen to more than 330, and officials believe Hurricane Tomas may worsen the situation as it approaches, a U.N. spokeswoman said Saturday. 

The number of confirmed cholera cases has climbed to 4,764, with 337 deaths, said Imogen Wall, spokeswoman for the U.N. Office for the Coordination of Humanitarian Affairs in Haiti, citing information provided by the Haitian government. Those numbers represent the people that were able to make it to the hospital, she said. 

Another 200 cases are suspected in the nation's West Department, or province, she said. 

Tracking maps show Hurricane Tomas nearing Haiti on Thursday as a Category 3 hurricane.

Alarm over “pig MRSA” — but not in the US

Maryn McKenna at Superbug reports on Alarm over “pig MRSA” — but not in the US. Excerpt:

I wish I could say the attention to ST398 was being paid in the United States, where there is almost certainly more MRSA in livestock than has been recorded, given that the only published surveillance, from 2009, covered only Iowa and Illinois. 

Unfortunately, there is still no indication that federal agencies have any intention to test for the presence of the organism in animals or in meat. 

In fact, the major surveillance mechanism for drug-resistant organisms in meat animals, retail meat and meat-eaters in the US, the National Antimicrobial Resistance Monitoring System or NARMS, doesn’t test for MRSA at all; it handles only enteric or gut-borne bacteria such as Salmonella and Campylobacter. (NARMS IS shared among three agencies: the CDC handles drug-resistant foodborne bacteria in humans, the FDA looks for the same bacteria in food, and the USDA looks for those bacteria being carried by livestock.)

Read the whole article to find out how and why the Danes are paying a lot of attention to this disease.