H5N1

WHO: Fighting the rise in cholera cases in Haiti

WHO published this on June 28: Fighting the rise in cholera cases in Haiti. Excerpt:

There was a rise in the number of cholera cases reported in May and early June, particularly around Port-au-Prince and in the southern peninsula (Grand Anse, Nippes, Sud and Sud-Est) as well as in Artibonite and Nord. 

This increase may be due in part to the beginning of the rainy season and the flooding that hit the capital. Between 2 May and 12 June, 18 182 new cases were notified in Port-au-Prince, where 90% of the 2300 beds in cholera treatment facilities were occupied. As of 21 June, the occupancy rate had dropped to 72%. 

On 12 June, the Ministry of Public Health (MoPH) reported 344 623 cases of cholera and 5397 related deaths (average case fatality rate 1.6%) since the beginning of the outbreak in October 2010. 

Poor access to clean water and proper sanitation remains the main challenge in fighting the epidemic. Water-trucking is now down to 20% of what it was after the earthquake. According to the Water and Sanitation Cluster, about a third of the NGOs supporting camps in Port-au-Prince will be closing down their water-trucking and sewage removal activities over the next few months because funds are running out. 

Lack of sanitation facilities and the maintenance of existing latrines remain critical problems in the camps. WHO/PAHO supports all cholera treatment facilities to ensure safe water is available for patients and sanitation measures are respected. 

According to Health Cluster partners, as of 14 June there were 38 cholera treatment centres and 216 cholera treatment units functioning in Haiti. Most of the facilities are financed by NGOs. 

While support continues in Port-au-Prince, many NGOs are scaling down operations in rural areas and transferring responsibilities to the MoPH, which does not have sufficient funds to cover health personnel.

So just as MINUSTAH is named as the source of the cholera outbreak, the NGOs and the Ministry of Public Health and Population find themselves too broke to deal with the resurgence of cholera eight months later. Neither the Haitian nor the North American media seem to have much to say about this state of affairs.

Dear Maria… A letter from a Haitian cholera clinic

Dr. John Carroll's latest post in the Peoria Journal Star: Dear Maria… – Dispatches from Haiti: from a Cholera Treatment Center at Hopital Albert Schweitzer. Please bear in mind that this is happening today, while the rest of us go about our daily routines.

Dear Maria, 

This little guy came to the pediatric section of the Cholera Treatment Center today. His gaunt pathetic appearing father carried him in. 

The baby is four months old and weighs about 9 pounds. 

His father brought him in because the baby had vomiting and diarrhea. 

His mother is dead, but not from cholera. 

While the 24 gauge angiocath slipped in the back of his right hand he did not wince or move. And the magic “wake up” solution started trickling in… 

Our Luke is very fortunate to have you as his mom. He is not here suffering like his Haitian brothers and sisters are. You “woke” Luke up with your love. 

And I am very fortunate to have you as my wife. 

Mwen remen ou ampil… 

Love, John

WHO/Europe: EHEC update 27

WHO/Europe has published Outbreaks of E.coli O104:H4 infection: update 27. Excerpt:

On 28 June 2011, the Institut de veille sanitaire, France, published new figures for the continuing verocytotoxin-producing Escherichia coli (VTEC)/haemolytic uraemic syndrome (HUS) outbreak in Bordeaux, France. In total, 8 enterohaemorrhagic E. coli (EHEC) cases and 8 HUS cases were reported since 22 June. E. coli O104:H4 infection has been confirmed in 4 cases. 

Also on 28 June, Sweden reported a confirmed case of E. coli O104:H4 in southern Sweden in an adult male. None of the new cases in France or Sweden were in people who had travelled in Germany since 1 May 2011. 

In France, investigations continue, but initial findings suggest that locally grown bean or seed sprouts might be involved. In Sweden, the vehicle of infection remains under investigation. 

On 30 June 2011, the Institut de veille sanitaire announced that the results of the analyses performed by the French national reference centre for E. coli and Shigella and its associated laboratory showed that the E. coli O104:H4 that caused the outbreak in Germany in May–June 2011 and that causing the outbreak in France in June were genetically related. This further increased the evidence pointing to a common source behind these outbreaks.

Fukushima aftershocks in the UK

Via the Guardian: Revealed: British government's plan to play down Fukushima. This is a link-rich story, so click through to follow the documentation. Excerpt:

British government officials approached nuclear companies to draw up a co-ordinated public relations strategy to play down the Fukushima nuclear accident just two days after the earthquake and tsunami in Japan and before the extent of the radiation leak was known. 

Internal emails seen by the Guardian show how the business and energy departments worked closely behind the scenes with the multinational companies EDF Energy, Areva and Westinghouse to try to ensure the accident did not derail their plans for a new generation of nuclear stations in the UK. 

"This has the potential to set the nuclear industry back globally," wrote one official at the Department for Business, Innovation and Skills (BIS), whose name has been redacted. 

"We need to ensure the anti-nuclear chaps and chapesses do not gain ground on this. We need to occupy the territory and hold it. We really need to show the safety of nuclear." 

Officials stressed the importance of preventing the incident from undermining public support for nuclear power. 

The Conservative MP Zac Goldsmith, who sits on the Commons environmental audit committee, condemned the extent of co-ordination between the government and nuclear companies that the emails appear to reveal.

"The government has no business doing PR for the industry and it would be appalling if its departments have played down the impact of Fukushima," he said. 

Louise Hutchins, a spokeswoman for Greenpeace, said the emails looked like "scandalous collusion". 

"This highlights the government's blind obsession with nuclear power and shows neither they, nor the industry, can be trusted when it comes to nuclear," she said. 

The Fukushima accident, triggered by the Japan earthquake and tsunami on 11 March, has forced 80,000 people from their homes. Opinion polls suggest it has dented public support for nuclear power in Britain and around the world, with the governments of Germany, Italy, Switzerland, Thailand and Malaysia cancelling planned nuclear power stations in the wake of the accident. 

The business department emailed the nuclear firms and their representative body, the Nuclear Industry Association (NIA), on 13 March, two days after the disaster knocked out nuclear plants and their backup safety systems at Fukushima. 

The department argued it was not as bad as the "dramatic" TV pictures made it look, even though the consequences of the accident were still unfolding and two major explosions at reactors on the site were yet to happen. 

"Radiation released has been controlled – the reactor has been protected," said the BIS official, whose name has been blacked out. "It is all part of the safety systems to control and manage a situation like this."

Dominican Medical College: "Cholera is out of control"

Via Hoy Digital: CMD advierte cólera está fuera de control;  mortalidad no  bajó. [Dominican Medical College warns cholera is out of control; mortality hasn't fallen] Evidently the College and the government are still quarrelling. Excerpt, with my translation:

El Colegio Médico Dominicano (CMD) advirtió ayer que  la epidemia de cólera está fuera de control en el país y pidió al Gobierno mayor responsabilidad para  enfrentar la pobreza en que viven amplios segmentos de la sociedad. 

The Dominican Medical College warned yesterday that the cholera epidemic is out of control in the country and said the government bears major responsibility to confront the poverty in which large segments of society live.

Asimismo, los doctores Senén Caba y Clemente Terrero, presidente y vicepresidente del CMD, pusieron en  duda que se haya registrado un descenso en las cifras de mortalidad materno-infantil, como asegura el Ministerio de Salud.  

As well, doctors Senén Caba and Clemente Terrero, president and vice-president of the DMC, questioned whether there has been a drop in maternal-child mortality figures, as the Ministry of Health claims.

Caba y Terrero aseguraron que en el país se han registrado más de 15,000 casos de cólera y decenas de defunciones que no han sido debidamente reportados.

Caba and Terrero asserted that over 15,000 cholera cases have been recorded and tens of deaths that have not been properly reported.

The latest report from the Ministry lists 952 confirmed and suspected cholera cases in 2010 (all between weeks 45 and 52) and 7,871 confirmed and suspected cases so far this year. That's an official total of 8,823 cases, with 173 confirmed and suspected deaths...quite a gap between the Ministry's figures and the College's.

Haiti: Thursday morning in the cholera clinic

Via the Peoria Journal Star, Dr. John Carroll continues his remarkable reports: Cholera Treatment Center, Thursday Morning–June 30, 2011. Excerpt:

This little 15 year old boy presented to the Cholera Treatment Center this morning after a night at home of vomiting and diarrhea. He was slumped in his chair here in the admitting area. 

We had just slipped an IV in his left arm and he proceeded to vomit many times all over everywhere. There was no bucket. He was in hypvolemic shock…but he should be ok because he is “plugged in” now and is 15 years old. 

(I didn’t get my left leg out of the way quickly enough and ended up with “rice water vomit” all over my scrubs.) 

A cholera patient can lose his entire body weight because of fluid loss in twenty four hours with this severe form of cholera. 

We had 10 people like this young man crammed into the admission room yesterday which is about 20 feet by 20 feet. And there is only one door in and out and it is the only door that leads inside to the 50-60 patients in the building. Family members and staff carrying new boxes of Ringer’s Lactate use this door too. Sometimes the admission room is so crowded that turning around can be difficult.

And in his Thursday afternoon post, Dr. Carroll estimates his hospital has 250 to 300 cholera patients, twice as many as it had at the worst point of the initial outbreak.

Hong Kong: Scarlet fever 'regional phenomenon'

Via the Hong Kong government website: Scarlet fever 'regional phenomenon'. Excerpt:

Secretary for Food & Health Dr York Chow says Hong Kong's rise in scarlet fever cases is part of a regional phenomenon, as the Centre for Health Protection has noted a simultaneous increase on the Mainland and Macau.   

Dr Chow told lawmakers today Hong Kong, Guangdong and Macau regularly exchange statistics and control measures on infectious diseases, and all three governments have noted more cases of scarlet fever this year.   

He said the underlying reasons for the upsurge are being examined. The overall epidemiological and clinical characteristics of this outbreak resemble those in the past, although infrequently some cases may have atypical clinical presentation.   

The fatality rate so far is not significantly higher than historical or international figures.   

Of the 637 scarlet fever cases reported in Hong Kong this year, only 10 involved travel to the Mainland during the incubation period.

EHEC may have had Egyptian origins

Via The Local: E. coli may have had Egyptian origins. Excerpt:

Fenugreek seeds exported from Egypt to France and Germany may have caused an E. coli outbreak that has killed 48 people in Europe, the European Food Safety Authority reported. 

A "rapid risk assessment" conducted by the EFSA and the European Centre for Disease Prevention and Control (ECDC), "has thus far shown" that Egyptian seeds exported in 2009 and 2010 may be implicated, it said in a statement. 

"There is still much uncertainty about whether this is truly the common cause of all the infections as there are currently no positive bacteriological results," it stressed. 

At least 48 people have died from an outbreak of a killer strain of E. coli bacteria centred in Germany, blamed on organic vegetable sprouts. 

There has also been a separate outbreak in France linked by the government to a British sprout company in which 10 people were taken ill. 

Sweden on Tuesday say it had detected the first case of infection in someone who had no link to Germany. 

All the deaths so far were in Germany, except for a woman in Sweden who died after being infected in Germany. 

The statement said the 2009 lot appears to be linked to the outbreak in France, and the 2010 lot to that in Germany.

Better biosurveillance could halt disease spread

Via Nature News: Better biosurveillance could halt disease spread. Excerpt:

Germany is still recovering from one of the world's worst outbreaks of enterohaemorrhagic Escherichia coli, which as of 18 June had sickened more than 3,200 people and caused 39 deaths. 

The unusually deadly bacteria moved undetected through the food supply from livestock to agriculture to the dinner table, and the response to the outbreak was branded slow and inefficient by physicians and scientists (see 'Microbe outbreak panics Europe'). 

Now a group of health professionals assembled by the US Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, has called for biosurveillance efforts in the United States and worldwide to be streamlined to help recognize and respond to threats quickly. 

"We are trying to create an international immune system, a system that has the capacity to recognize abnormalities," says Ian Lipkin, co-chair of the National Biosurveillance Advisory Subcommittee (NBAS) and director of the Center for Infection and Immunity at the Mailman School of Public Health at Columbia University, New York. 

The NBAS report, Improving the Nation's Ability to Detect and Respond to 21st Century Urgent Health Threats, is the second by the group originally assembled by former President George W. Bush over fears about bioterrorism. The report is now under consideration by the White House and the US Department of Health and Human Services.

Trace amounts of radioactive materials found in Fukushima kids' urine

Via The Mainichi Daily News: Trace amounts of radioactive materials found in Fukushima kids' urine. Excerpt:

Trace amounts of radioactive substances were found in urine samples of all of 10 surveyed children from Fukushima Prefecture in May, where a crippled nuclear power plant is located, a local citizens group and a French nongovernmental organization said Thursday. 

David Boilley, president of the Acro radioactivity measuring body, said at a press conference in Tokyo that the results of the survey on 10 boys and girls in Fukushima City aged between 6 and 16 suggest there is a high possibility that children in and near the city have been exposed to radiation internally. 

The citizens group, the Fukushima Network for Saving Children from Radiation, comprising parents in the prefecture, said the finding is "certainly" due to the nuclear crisis at the Fukushima Daiichi power plant crippled by the March 11 earthquake and tsunami. 

The group added it will urge the central and local governments to have all citizens in the prefecture undergo detailed tests soon using whole body counters. 

Chief Cabinet Secretary Yukio Edano said later in the day at a press conference, "The government is concerned" about the finding. He added the government wants to obtain detailed results of the survey so they can be thoroughly examined.