H5N1

Cholera hits Central African Republic

Via Africasia.com: Cholera epidemic hits Central African Republic: Minister. Excerpt:

A new cholera epidemic has hit the Central African Republic and has already claimed at least 10 victims in the south, health minister Jean-Michel Mandaba said Friday. 

His comments came the day after a health services source sounded the alarm that cholera had killed six people in the Limbo region, 20 kilometres (12 miles) from the capital Bangui. 

"The government of the Central African Republic would like to officially declare that there is a cholera epidemic in the (southern) health zones of Ombella-Mpoko and Lobaye, leaving at least 10 people dead," Mandaba said. 

The minister called for calm and urged the local population to go about their usual business while "scrupulously respecting basic hygiene and cleansing measures."

UK: Reaction to the E. coli news

Via The Guardian, an op-ed: Lift the cloak of secrecy around this E coli outbreak. Excerpt:

An eight-month outbreak of an uncommon type of E coli food poisoning left 250 people ill and one dead, with cases continuing to emerge until July of this year – but the public has only been told now. After six months of investigation by the Health Protection Agency, which has only just acknowledged the outbreak, the infection has ultimately been linked to people handling loose raw leeks and potatoes in their homes. 

This news reveals a little bit about food-borne risks and a great deal about the politics of food safety in Britain. The Food Standards Agency was created to provide the public with high standards of food safety and ways of setting and enforcing those standards that commanded public trust and confidence. Grounds for such trust have been seriously undermined. 

The politics of these events are fascinating. First, the way in which the problem was handled in Whitehall was complicated by internal squabbles: who was in charge: the Food Standards Agency or the Health Protection Agency? 

Despite both being directly accountable to the minister for public health, Anne Milton, they were at loggerheads. Responsibility for investigating outbreaks of bacterial food poisoning lies with the HPA, but the FSA insisted that communications with the public and the media on all matters of food safety were solely its responsibility. Thursday's belated press release came from the HPA, though it did include a comment from the FSA, albeit a fatuous one. 

The HPA had a difficult task to try to locate the source of the infection. It knew about 250 cases, although there must have been far more; public health microbiologists suggest that fewer than 10% of cases are formally reported. Cases were widely dispersed across Britain, though a large majority were female. The HPA concluded that the infection was probably transmitted in soil contamination on vegetables, but the original source of the infection remains unknown. 

Sources within the FSA suggest that the recent experience in Germany, when an outbreak of E coli was misleadingly attributed to Spanish cucumbers – resulting in significant losses to Spanish farmers and threats of litigation – that the organisation was wary; but that suggestion is unconvincing. The German problem emerged in June, while the decision not to tell the British public must have been taken either at the end of 2010 or early this year. 

The FSA's line is that it did not wish to say anything publicly until it has something "useful" to contribute, but useful to whom? The evidence suggests that it did not want to scare the public and disrupt normal commerce, nor did it wish to reveal how little it knew and how weak its control over microbiological food safety really is.

Pakistan: 150 dengue deaths in Punjab

Via the Daily Times: Dengue claims four more lives in Lahore. Excerpt:

LAHORE: The uncontrolled dengue epidemic claimed four more lives on Friday. 

A woman Uzma Tariq, 35, of Sanda, Abdur Rehman, 55, of Mozang, Zahid Bashir, 35, Kacchupura, Shaukat, 50, of Township, Yaseen, 15, of Sahiwal, Iqbal, 60, of Township and Asma, 17, of Ichra passed away in different hospitals. 

The virus has so far afflicted more than 20,000 people in Punjab alone while some cases have also been reported from Sindh and Khyber Pakhtunkhwa provinces. 

The Health Department of Khyber Pakhtunkhwa has released fresh figures on dengue fever in the province. The updated report issued on September 29 revealed that the overall total number of suspected cases reported so far was 377, out of which 173 were confirmed as dengue positive with only 6 deaths till date in Khyber Pakhtunkhwa. 

Likewise on September 28, 8 suspected cases were reported wherein 3 cases were confirmed while one patient was admitted and 7 patients were discharged after treatment. 

Dengue has affected both rich and ordinary citizens with some senior civil and military officials also falling prey. 

In Punjab 11,584 cases of dengue have been reported out of which 10,244 are in Lahore. The total number of deaths in Punjab touched 150, of which 110 deaths occurred in Lahore alone. Many patients falling sick in other cities have been shifted to Lahore because of the better treatment facilities. 

Authorities in Lahore have blamed the crisis on prolonged monsoon rains and unusually high seasonal temperatures. But the people said the outbreak was an example of government inefficiency, citing failure to take preventive measures to kill off the mosquitoes and lengthy power cuts as the reason behind the epidemic. 

People said that there were many factors contributing to the dengue fever. 

CIDRAP: Study suggests 1918 flu waves were caused by 'distinct' viruses

A fascinating report from CIDRAP by Robert Roos: Study suggests 1918 flu waves were caused by 'distinct' viruses. Excerpt

A new analysis of influenza outbreak patterns in several navies in 1918 suggests that the first and second waves of the pandemic were caused by "antigenically distinct" viruses, a conclusion that runs counter to some other recent studies that have tried to discern why the second wave was so much more deadly than the first. 

A team of Australian and American researchers, writing in The Lancet Infectious Diseases, says its analysis suggests that those who were infected in the mild first wave, in the spring or summer of 1918, remained susceptible to infection in the deadly second wave in the fall, but were protected from death. 

If this is true, "the two waves of infection were probably caused by antigenically distinct influenza viruses—not by one virus that suddenly increased in pathogenicity between the first and second waves," says the report by G. Dennis Shanks, MD, of the Australian Army Malaria Institute, and colleagues. 

This conclusion contrasts with a study published last week, in which US researchers examined preserved lung specimens from 68 US soldiers who died in the pandemic between May and October of 1918. They found that earlier and later cases featured the same type of lung damage, and they concluded that the pandemic virus was circulating by May. 

The new findings also contrast with those of a 2008 study that covered similar ground. In that one, US researchers examined data mainly from US Army camps and found that soldiers who were infected in the first wave were both less likely to be infected and less likely to die in the fall onslaught of flu. 

Sifting naval records 

Researchers have been trying for years to explain the puzzling pattern of the 1918 pandemic, in the hope of drawing lessons for pandemic preparedness today. The Lancet report notes that the 1918-19 pandemic had three waves: one in the spring and summer of 1918 that was "highly infectious but clinically mild," one in the fall that was highly infectious and caused far higher mortality, and one in the winter of 1919 that was smaller and less deadly than the fall episode. 

"The three waves of infection are often assumed to share the same viral cause; however, little objective evidence supports this notion," the report says. 

The researchers studied illness records for the crews of ships in the British, Australian, US, and Japanese navies in 1918, and also looked at morbidity and mortality records for some island residents. They focused on ships' crews because of their homogeneous composition, isolation at sea, and consistent record keeping. 

Nearly all ships had flu outbreaks, but few had deaths, the team found. However, the ships that did have deaths tended to have many, mostly during the second wave. Citing previous work, the authors say an estimated 1.1% of US Navy personnel died during the pandemic. 

One ship that exemplified the general pattern was the USS Salem, which patrolled the Caribbean, according to the report. In February 1918 the ship had a flu outbreak that affected many of the crew but caused no serious complications. Then in September and October, during the second wave, 13% of the crew got sick, but all survived. 

A contrasting example was the USS Pittsburgh, which patrolled the Atlantic off South America in 1918. When the ship docked in Rio de Janeiro in early October, 663 sailors—about 80% of the crew—contracted flu, and 59 of them died. Those deaths accounted for nearly half of all flu-pneumonia deaths on US Navy cruisers that year. 

"In general, naval warships that had high mortality during the second wave were not affected by the first wave because of their relative isolation (eg, in the southern hemisphere)," the report says. 

US military personnel in Hawaii offered another example, the researchers found. Many of the sailors and soldiers there had a mild flu-like illness in mid-1918. Later in the year, when the second pandemic wave hit, only one US sailor in Hawaii died of flu and pneumonia. A similar pattern was seen in a US Army camp in Puerto Rico.

Click through to the CIDRAP page to read the whole article and access the Lancet abstract.

Brazil announces troop pullout of Haiti

Via The Guardian: Brazil announces troop pullout of Haiti. Excerpt:

Brazil's defence minister has confirmed the country's troops will begin a partial withdrawal from Haiti next March, amid growing criticism of the United Nations stabilisation mission there. 

Celso Amorim told the senate foreign affairs committee on Thursday that 257 Brazilian troops, out of a total of 2,200, would leave the country as part of UN plans to reduce its numbers by 1,600. 

"We should not stay in Haiti for ever, nor do we wish to – this is not good for the Haitians or for us," he said. "But we will also not leave in an irresponsible manner. It is very important that the withdrawal is not seen as Brazil disengaging. We all agree that a gradual reduction is necessary." 

A few years ago the Brazilian soldiers that have led the UN force in Haiti since 2004 took journalists and politicians on photo-opportunity tours of Port-au-Prince's gang-free slums, which were occupied after former president Jean-Bertrand Aristide was forced from power. During a 2007 visit, one former UN military commander in Haiti said the UN's presence had helped transform Port-au-Prince into a "Disneyland". 

In an interview, Luiz Carlos da Costa, then deputy special representative of the UN secretary general in Haiti, said the UN mission, known as Minustah, had helped bring "a situation of greater stability". 

The earthquake in 2010, in which Costa and an estimated 200,000 Haitians were killed, changed everything. More UN troops were sent to the country but resentment at their presence grew following a cholera outbreak and a recent case of alleged sexual abuse.

Mexico: 114 dengue cases in Querétaro

Via UPI.com: Registra Querétaro, México 114 casos de dengue. [Querétaro, Mexico reports 114 dengue cases] Excerpt, with my translation:

El central estado mexicano de Querétaro registra 51 casos confirmados de dengue, dijeron hoy autoridades sanitarias. 

The central Mexican state of Querétaro has recorded 51 confirmed dengue cases, health authorities said today.

Del total de casos, 39 se ubican en la capital y el resto en Arroyo Seco. 

Of that total, 39 are in the state capital and the rest in Arroyo Seco.

Según la Secretaría de Salud del Estado de Querétaro (Seseq), a día de hoy suman 114 casos probables de esta enfermedad, desde que inició el brote.

According to the state secretariat of health, as of today there have been 114 probable dengue cases since the outbreak began.

Meanwhile, Florida reports two confirmed dengue cases and the Paraguayan Senate has been closed for anti-mosquito fumigation.

Indonesia: Don't drink Jakarta's water

Via The Jakarta Globe: Drink Despite Human Waste in Jakarta Water Source: Fauzi. Excerpt:

Jakarta’s water may or may not be contaminated by the gastric bacteria E. coli, depending on who’s speaking. After a water provider complained that Jakarta’s water source was heavily polluted, the city administration has claimed that it can “guarantee” the capital’s tap water is clean. 

 “PDAM Jaya [the city water utility], working with Paljya and Aetra, took random samples to check water safety,” Jakarta Governor Fauzi Bowo said at City Hall on Friday. “The results were all good, so we can be certain that [the] tap water is safe.” 

The water is free of E. coli, the government claims, because two private operators treat it before it leaves their plants in accordance with clean water standards. 

Fauzi’s reassurances followed a complaint by Bekasi water provider Tirta Bhagasasi on Thursday that the water source used to produce tap water for Bekasi and Jakarta was heavily contaminated with human waste, as indicated by a high E. coli level. 

The Bekasi River was used as a dumping place for septic tank pumping businesses, Tirta Bhagasasi’s director of water supply, Wahyu Prihantono, said. The illegal dumping occurs at night, and so far officials seem unable or unwilling to prevent it. 

On Sept. 19, Bekasi’s Environmental Management Agency (BPLH) revealed that several key measures of environmental health in the Bekasi River were far below standard, and that the river had experienced fish kills. 

The BPLH’s Dadang Hidayat said the water was significantly acidic at about pH 4.6, with a high biological and chemical oxygen demand — a pollution indicator. 

Besides the organic material dumped in the river, he suspected “rogue factories” disposed of chemical waste in the river. 

The governor tried to play down the news.

Pakistan: UN takes note of dengue

Via the UN News Centre: Thousands of dengue fever cases emerging in Pakistan, UN reports. Excerpt:

More than 12,000 cases of dengue fever and 125 deaths linked to the disease have been reported across Pakistan so far this year, with the majority occurring in Punjab province, the United Nations World Health Organization (WHO) said today. 

WHO is supporting sub-groups that have been formed by Pakistani authorities to respond to the epidemic through case management, community mobilization, vector control and public awareness campaigns, the agency’s spokesperson, Tarek Jasarevic, told reporters in Geneva. 

He said WHO has also been facilitating and supporting dengue case management training at the district level in several provinces. A WHO expert on the disease arrived in the country last week to provide technical guidance on dengue fever control. 

A dengue fever booklet for teachers has been printed and is being circulated. WHO has also circulated new clinical case management guidelines drafted by Pakistani doctors on the basis of a retrospective study of Pakistani hospital data and global and regional experiences. 

Last year, 11,024 confirmed cases of dengue fever and 40 deaths were reported in Pakistan, but this year the number of cases has climbed to 12,466.

Indonesia: Bird flu spreads in Poso

Via Ida's Bird Flu Information Corner, a VOA News report: Poso, Central Sulawesi ::: Bird flu spreads in Poso. Excerpt:

Bird flu infection apparently has spread to Central Sulawesi. There is no culling action reported here. -adm-   

Poso – Official of Livestock Service in Poso regency, Central Sulawesi province, confirmed the sudden death of chickens recently was because of bird flu H5N1 infection. Bird flu was examined on dead chicken samples from several sub-districts in Poso. Examination was conducted in field and confirmed by veterinary disease investigation center in Maros.

Panama: Hospital says it has no KPC cases

Via La Estrella.com: Clínica Hospital San Fernando afirma que no tienen casos de KPC. [San Fernando Hospital Clinic affirms it has not cases of KPC] Excerpt, with my translation:

La Clínica Hospital San Fernando salió al paso de una nota de prensa del Ministerio de Salud (MINSA) que indica de un caso de un paciente con la bacteria KPC procedente de esas instalaciones médicas alegando que los resultados fueron negativos. 

San Fernando Hospital Clinic has denied a news release from the Ministry of Health indicating that a patient with KPC had left the clinic; the clinic says the patient's test results were negative.

En un comunicado, firmado por el doctor Edgardo Fernández, director médico y Elisa de Lewis, gerente general, se aclara que este paciente crónico de muchos años de evolución, fue admitido a finales del mes de agosto y durante su corta estancia en nuestro hospital, todos los exámenes (cultivos) que se le tomaron resultaron negativos. 

A statement signed by Dr. Edgardo Fernández, medical director, and Elisa de Lewis, general manager, said that the patient, with a longstanding chronic condition, was admitted late in August. "During a short stay in our hospital, all tests on the patient had negative results."

El paciente fue trasladado al Hospital Santo Tomás para continuar su terapia y en dicho Hospital los cultivos iniciales resultaron también negativos.

The patient was moved to Santo Tomás Hospital to continue treatment, and in that hospital the initial tests were also negative.