H5N1

Bulletin of the World Health Organization: May issue

The May issue of the Bulletin is now online. Most of the articles deal with electronic health technologies, and the issue also has a useful Public health round-up. Excerpt:

New guidelines on how to manage chikungunya, a mosquito-borne viral disease which causes severe fever and joint pain, have been published. 

The disease, which is occasionally fatal, could start circulating in the western hemisphere if mosquito populations in the United States of America (USA) or elsewhere in the Americas become infected with the virus and begin spreading it to people in that area. 

The Guidelines for Preparedness and Response for Chikungunya Introduction in the Americas, a joint publication from the Pan American Health Organization (PAHO), the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) in the United States, notes that two million people have been infected with the virus in Africa and Asia since 2004. 

From 2006 to 2010, 106 laboratory-confirmed or probable cases of chikungunya were detected among travellers returning to the USA. This compares with only three cases reported from 1995 to 2005. 

“The broad distribution of mosquitoes capable of spreading chikungunya virus, coupled with the fact that people in the Americas have not been exposed to chikungunya virus, places this region at risk for the introduction and spread of the virus,” write the authors, Otavio Oliva, PAHO advisor on viral diseases, José Luis San Martín, PAHO advisor on dengue and Roger S Nasci, chief of the Arboviral Diseases Branch at CDC.

CIDRAP: Outbreak of uncommon Salmonella strain probed in North Carolina

Via CIDRAP, Lisa Schnirring writes: Outbreak of uncommon Salmonella strain probed in North Carolina. Excerpt:

Health officials in North Carolina and their federal partners are investigating an outbreak of an uncommon Salmonella strain that has sickened 34 people who visited or live in Buncombe County since the end of February. 

The Buncombe County Health Department (BCHD) listed the strain as Salmonella (enterica serotype) Paratyphi B and said it has a genetic fingerprint that is not common. 

In a press release today, BCHD officials said lab tests have not yet conclusively identified the source of the outbreak. Gibbie Harris, MPH, the county's health director, said in a statement that until the cause is identified, officials are implementing broad control measures focused on food establishments. 

Based on preliminary tests, BCHD environmental health specialists have recommended control measures to the county's food establishments, and the Asheville Independent Restaurant Association is working with the health department to educate food workers on ways to prevent disease spread. 

Harris said further tests to characterize the outbreak strain are underway, which may shed more light on ways to control the outbreak. She urged the public to wash their hands before preparing food and see a doctor if they have symptoms. The county launched a hotline number today to offer automated information about the outbreak and connect people experiencing symptoms to a communicable disease nurse. 

Symptoms, which can include bloody diarrhea, fever, headache, and abdominal pain, can occur 1 to 10 days after exposure and last 4 to 7 days. Harris said S Paratyphi B infections may sometimes last longer.

Sanitation: "Who wants to talk about shit?"

Via Reuters AlertNet: INTERVIEW-Toilet "taboo" hurts poor, development says expert. Excerpt:

Governments are failing to fund projects to improve access to toilets and other sanitation services in poor countries because the subject remains "taboo", a director at the Bill & Melinda Gates Foundation said on Monday. 

"Who wants to talk about shit?" asked Frank Rijsberman, Director of Water, Sanitation and Hygiene at the $34 billion charitable foundation, during an interview with Reuters on Monday. 

"It's the last big taboo and as a result more than one million kids die every year. Diarrhoea is the second largest cause of death after respiratory infections in young children," he said at the Global Water Summit 2012 conference in Rome. 

Rijsberman said global leaders should take opportunities like the U.N. conference for sustainable development in Rio in June to set new sanitation targets. 

The Bill & Melinda Gates Foundation, set up by the founder of technology giant Microsoft and his wife, has already given grants to researchers to come up with cheaper and more efficient toilets, he added. 

"We need the cellphone of sanitation, an aspirational product," Rijsberman said. 

Ideas submitted so far include inventions that turned dried human waste into a kind of cooking fuel, or used microwaves to transform it into electricity. 

About 1.1 billion people across the world still defecate in the open because they have no toilets, according to the United Nations.

Brazil: Dengue cases in Paraíba remain low

Via Folha do Sertão, a reminder that not all of Brazil has Rio's problems: Notificações de casos suspeitos de dengue se mantêm abaixo da média. [Suspect dengue cases remain below average] Excerpt, with my translation:

O número de notificações de casos suspeitos de dengue continua abaixo da média histórica e do número registrado no ano passado, conforme revela o boletim da 17ª semana epidemiológica divulgado nesta segunda-feira (30) pela Secretaria de Estado da Saúde (SES). 

The number of suspected dengue reports remains below the historical average and the number recorded last year. This was stated in the State Secretariat of Health in its bulletins on the 17th epidemiological week, released this Monday (April 30).

A Gerência de Vigilância em Saúde (Gevs) informa que a situação está sob controle, por se encontrar dentro do limite esperado de casos. Entretanto, a intensificação das ações de controle vetorial, educação da população e articulação intra e interinstitucional são prioritárias para o atual período. 

The Health Surveillance Management reports that the situation is under control and within the expected limit of cases. Meanwhile, it is intensifying vector-control activities, educating the public, and articulating within and between institutions as its priorities for the current period.

Dos 2.302 casos notificados neste ano, no período de 1º de janeiro a 27 de abril, 23% já foram descartados e 19,3% estão confirmados como dengue. O percentual dos casos graves da doença – Dengue com Complicações e Febre Hemorrágica da Dengue – é de 5,1% dos casos confirmados. 

Of the 2,302 suspected cases reported this year between January 1 and April 27, 23 per cent have been dismissed and 19.3 per cent have been confirmed as dengue. The percentage of severe dengue cases—dengue with complications and hemorrhagic dengue fever—is 5.1 per cent of confirmed cases.

Conforme dados recentes verificados pela Gevs, o Coeficiente de Incidência da doença é de 47 casos para cada 100 mil habitantes, ainda considerado baixo, dentro dos parâmetros definidos pelo Ministério da Saúde.

According to the Management's recently confirmed data, the coefficient of incidence of the disease is 47 cases per 100,000 persons, down considerably and within the parameters defined by the Ministry of Health.

Rio declared a dengue epidemic when the incidence hit 300 cases per 100,000. Comparatively speaking, 47 is a low incidence.

Haiti: Cholera cases have tripled in Port-au-Prince

Via HaitiLibre.com: Haiti - Health : Cholera cases have tripled in Port-au-Prince...

 

With the arrival of the rainy season in Haiti, Medecins Sans Frontieres (MSF), notes an increase in the number of cholera patients. In less than a month, the number of admissions has more than tripled in the Cholera Treatment Centres (CTC) of MSF in Port-au-Prince and Léogâne. 134 people in Martissant between April 16 and 23, and nearly 400 in total in the different CTC of MSF in Port-au-Prince and Léogâne. 

To cope with this new influx of patients, MSF had to reopen a CTC in Carrefour, south of the capital, for the institutions of Martissant, Delmas and Drouillard, closer to the center and north, are not saturated. Counting all of its structures, MSF has so far over 200 beds in Port-au-Prince and 45 to Léogâne to exclusively treat people with cholera, and stands ready to open other sites depending on the evolution of the epidemic. 

The arrival of the rainy season also favors the spread of the disease. That is why, in parallel of the medical care of patients, MSF continues to support the Haitian health authorities and international humanitarian partners to distribute the disinfected water and soap as well as install and maintain latrines to maintain good hygiene practices and avoid the spread of the epidemic. 

The Ministry of Health, as each time the situation worsens and threatens populations, contradicting its reassuring message who want to be reassuring... no longer publishing the latest figures of the situation, having suspended the publication of its daily reports since April 10, 2012... Behavior that we deplore and that we have denounced many times in our articles since the beginning of the cholera epidemic in Haiti.

Australia: Alarm at spread of superbugs beyond hospitals

Via the Brisbane Times: Alarm at spread of superbugs beyond hospitals. Excerpt:

Dangerous superbugs that previously had been found only in hospitals are starting to spread throughout the community, putting lives at risk. 

The state and federal governments are so concerned by the rise in infections they have commissioned an expert group to try to stop it, the Herald has learnt. 

The chairman of the Australian Group on Antimicrobial Resistance, John Turnidge, said the Antimicrobial Resistance Subcommittee would have its findings reported to state and federal health ministers. "People in a position with the authority to make changes are now saying we have got to make changes," Professor Turnidge said. 

The Australian Group on Antimicrobial Resistance has released a survey of 30 hospitals treating outpatients for infections. The survey found a "worrying trend" of E. coli and Klebsiella species that produce enzymes which make them resistant to some of the most powerful antibiotics. 

E. coli is a common bacteria found in humans, dogs, cats and other mammals. It can cause urinary tract and post-operative wound infections and is often the cause of severe blood poisoning. 

"These strands of E. coli are carrying a form of resistance which we never wanted to see in the community, and that is resistance to our hospital drugs," Professor Turnidge said. 

"We have gone from virtually none of these kinds of resistance in the year 2000 to now, where it's commonplace." 

The superbugs are a particular threat because they require expensive hospital treatment and the use of last-line antibiotics, which need to be used sparingly to ensure the bugs do not develop resistance to them. 

''The more we use them, the more resistance we are going to see,'' Professor Turnidge said. ''It's kind of a vicious circle.'' 

Sydney had a noticeably higher rate of superbugs than other states, although the overall differences between the states was small, he said.

US: California BSE prion comes with a different twist

Via Nature News Blog: California BSE prion comes with a different twist. Excerpt:

In a statement released on 24 April, Karen Ross, Secretary of the California Department of Food and Agriculture said, “The detection of BSE shows that the surveillance program in place in California and around the country is working.”  Food safety advocates such as Yonkers, New York, -based Consumers Union say it’s a warning sign that surveillance is inadequate and needs to be stepped up. 

Ross’s statement also makes a point of noting a key feature of this particular case: The infected cow carried what is known as ‘L-type’ BSE, a version of the disease that has not been detected before in the US and has so far not been associated with transmission through animal feed. As the policy debate over testing rumbles on, here is a short guide to what is known and not known about this rare strain and its unexpected appearance. 

How do they know that it’s ‘L’?

After brain tissue samples turned up inconclusive results in California, scientists at the USDA’s Veterinary Research Laboratories in Ames, Iowa ran two additional biochemical tests and got positive results for BSE. The second technique, western blotting, separates proteins based on their molecular weight to create a pattern on a gel. L-type prions have low weights, and another atypical strain, H-type prions have high weights compared to classic (C) strains. This sample produced a clear L-type pattern, said Mark Hall, head of the pathology, parasitology, and entomology section at Ames. 

How is it different from C? 

In addition to weighing less, L-type strains also produce different lesion profiles in the brain. Both H and L types are extremely rare and found in older cattle, with only around 30 reported cases each worldwide. Perhaps this contributes to the fact that we don’t know much about them. “Right now, the full pathogenesis is not well characterized,” says Hall of L-type. Unlike their classical counterparts, “past studies and current diagnostic tests to detect ruminant DNA and RNA in feed haven’t found atypical variants,” says Jim Cullor, a veterinarian at the University of California at Davis. 

Is it more contagious? 

“There is some evidence in primates and transgenic mice that it seems to spread faster – meaning it maybe more virulent – but we don’t know how representative these models are of the disease in humans,” says Linda Detwiler, a clinical professor at Mississippi State University’s College of Veterinary Medicine. Whether or not L-type could jump species without direct injection into the brain remains unclear, but so far it can transmit to transgenic humanized, ovinized (modified to genetically mimic sheep), bovinized, and normal mice, as well as macaques in the lab.

India: Gurgaon fears dengue and malaria

Via the Hindustan Times, a report from Gurgaon, just south of New Delhi: Dengue-malaria scare looms, health dept has no plans or enough staff.

The fear of malaria and dengue is looming large over the city this year as well. Besides, the health department claims lack of manpower to carry out any preventive measures such as fogging and others to check this menace. 

A large number of city residents fall prey to malaria and dengue every year. In 2011, the city reported 153 cases of dengue. Nine people lost their lives. The city also reported 526 malaria cases. 

And this year, as summer is approaching, the department has again showed its helplessness citing lack of manpower to carry out fogging in the city. At present, the malarial wing of the department has 16 people and the district health department has written a letter to the state health department for an additional 120 people. 

“We have shortage of staff in the district. But we will still carry out fogging and other measures to control the problem. We are waiting for additional manpower,” said Dr Parveen Garg, chief medical officer. 

Residents allege that the health department has not initiated fogging and other preventive measures till now. Last year, the department was avoiding fogging and other measures saying that fogging was ‘not good’ for health and was expensive. But this year they do not have manpower.

DRC: Poor sanitation systems hinder fight against cholera

Via IRIN Africa: DRC: Poor sanitation systems hinder fight against cholera. Excerpt:

More than 7,500 cholera cases have been identified in the Democratic Republic of Congo (DRC) since the beginning of the year as an epidemic that began in June 2011 continues to affect parts if the capital, Kinshasa, as well as four other provinces. 

In total, more than 30,000 cholera cases have been identified around the country since the epidemic started, while 230 people have succumbed to the disease since the beginning of the year, and more than 700 since June 2011. In addition to Kinshasa, the provinces of Orientale, North Kivu, Equateur and Bas Congo are currently experiencing outbreaks. 

According to Nona Zicherman, chief of emergency operations in DRC for the UN Children's Fund (UNICEF), the epidemic has continued largely because of "poor hygiene, lack of awareness of the population about transmission mechanisms, very limited access to protected and monitored water sources and lack of sanitation infrastructure." 

Kinshasa is one of Africa's most over-crowded cities, with a population of about 10 million. Poor drainage means stagnant, polluted water floods the city's streets when it rains, while huge piles of rubbish line many of its streets. 

According to the International Water Association - a network of 10,000 global water professionals - 38 percent of Kinshasa residents have no access to piped water. The city has no proper sewerage system and no major facilities for the treatment of waste water and sludge. 

"When cholera finds a situation of high population, poor sanitation and hygiene, it stays," said Dr Benoit Kebela Ilunga, the Ministry of Health's head of disease control. "The water infrastructure we have has not been improved since colonial times, yet the population has increased significantly; the supply is insufficient for today." 

According to Kebela, while cholera in Kinshasa is unlikely to last long if properly controlled, in the east it has become endemic over the past decade.

Hong Kong: 21 ill in gastro outbreak

Via the Hong Kong government website: 21 ill in gastro outbreak.

The Centre for Health Protection has confirmed a gastroenteritis outbreak involving 21 students and staff at a Kwun Tong kindergarten.   

The 19 students, aged three to six, and two staff, aged 25 and 29, have fallen ill since April 19.   

Two students required hospitalisation and have been discharged. One tested positive for Norovirus.   

The centre has provided health advice to the kindergarten.