H5N1

Haiti: 7,398 cholera deaths as of June 24

The MSPP has published four more days' worth of cholera statistics on its Documentation page, bringing us up to June 24. Here are the daily tallies, with cases, hospitalizations, deaths and departments in which deaths occurred:

June 21: 277, 176, 9 (2 Centre, 5 Port-au-Prince, 2 not given)

June 22: 215, 126, 1 (Centre)

June 23: 188, 134, 2 (1 Artibonite, 1 Centre)

June 24: 205, 132, 2 (I Nord, 1 Sud Est)

Totals since the outbreak began in October 2010:

Cases: 574,850

Hospitalizations: 310,859

Deaths: 7,398

I have no idea why so many deaths were reported on June 21. As always, these numbers are an approximation. Departments such as Grande Anse and Sud did not report on some days. 

Pakistan: Arrangements made to combat dengue threat

Via The News International: Arrangements made to combat dengue threat: Shahbaz Sharif. Excerpt:

LAHORE: Punjab Chief Minister Shahbaz Sharif Wednesday said that foolproof arrangements had been made to combat potential threat of dengue.   

In this regard, he said, measures have been taken to ensure availability of trained staff, necessary medical equipments and WHO-approved medicines, whereas high dependency units in hospitals have been fully activated. In order to control dengue, cooperation at the societal level is also very important, he added.   

The chief minister was presiding over a meeting at his tent office, Minar-e-Pakistan. The meeting held to review arrangements to combat potential dengue virus, was attended by Special Assistant Khawaja Salman Rafique, Members National and Provincial Assembly, the secretaries of different departments, the commissioner and the district coordination officer (DCO) of Lahore, Dr. Faisal Masood, principals of teaching hospitals, experts, and senior officers.   

Addressing the meeting, the chief minister issued directions to distribute pamphlets, containing information about preventive measures against dengue, in all mosques and Imam Bargahs in the province on Friday. He also urged Khateebs to highlight the importance of cleanliness and sanitation in their sermons. 

He said that dengue prevention had been made a part of the curriculum. After the summer vacation, he said, weekly tests conducted at schools, colleges and universities ought to contain questions regarding prevention against dengue.   

Last year, the CM said, Punjab had to face a serious situation as requisite information about dengue was not available. However, he pointed out, an effective strategy was adopted to control dengue this time.

US: NDM-1 in a Rhode Island hospital

Via the CDC's Morbidity and Mortality Weekly: Carbapenem-Resistant Enterobacteriaceae Containing New Delhi Metallo-Beta-Lactamase in Two Patients — Rhode Island, March 2012. Excerpt:

U.S. and international efforts to control carabapenem-resistant Enterobacteriaceae (CRE) are critical to protect public health. Clinicians caring for patients infected with such organisms have few, if any, therapeutic options available. CRE containing New Delhi metallo-beta-lactamase (NDM), first reported in a patient who had been hospitalized in New Delhi, India, in 2007 (1), are of particular concern because these enzymes usually are encoded on plasmids that harbor multiple resistance determinants and are transmitted easily to other Enterobacteriaceae and other genera of bacteria (2). 

A urine specimen collected on March 4, 2012, from a patient who recently had been hospitalized in Viet Nam, but who was receiving care at a hospital in Rhode Island, was found to have a Klebsiella pneumoniae isolate containing NDM. The isolate was susceptible only to tigecycline, colistin, and polymyxin B. 

Point-prevalence surveys of epidemiologically linked patients revealed transmission to a second patient on the hematology/oncology unit. These two cases bring to 13 the number of cases of NDM reported in the United States. 

After contact precautions were reinforced and environmental cleaning was implemented, no further cases were identified. Similarly aggressive infection control efforts can limit the spread of NDM in acute-care medical facilities

CIDRAP on the new CDC report on H1N1 pandemic deaths

Via CIDRAP, Robert Roos has a very good summary of both the CDC report and the immediate response to it: CDC estimate of global H1N1 pandemic deaths: 284,000. Excerpt:

The estimation approach used by the authors received a general endorsement from Marc Lipsitch, PhD, an epidemiologist and director of the Center for Communicable Disease Dynamics at the Harvard School of Public Health. 

Lipsitch told CIDRAP News via e-mail that he was not completely independent from the study because he served on a WHO working group that gave the authors some advice, and he cautioned that he had not yet read the full report. 

But he said, "I know the broad outlines of their method and think it is a plausible approach to a very difficult problem of making estimates with extremely limited data, where even the available data are really very uncertain. 

"I don't know if the number is right, but certainly any reasonable estimate would be far above the WHO number of confirmed deaths," he added. "Confirming flu deaths is not routine (and much less than 100% sensitive) in the richest countries, and would be exceptional rather than likely in much of the world. Thus the disparity from the WHO confirmed number is a good sign, not a red flag." 

In a commentary accompanying the study, Cecile Viboud, PhD, and Lone Simonsen, PhD, write, "Future research should focus on obtaining additional country-specific estimates of the burden of seasonal and pandemic influenza in understudied locations through traditional excess mortality approaches or innovative surveys of mortality, and address the lack of estimates of case fatality rates from middle-income and low-income regions." 

Viboud works at the National Institutes of Health's Fogarty International Center, and Simonsen is with George Washington University's School of Public Health. The two were part of a team that in March 2010 estimated years of life lost because of the 2009 H1N1 pandemic in the United States. 

The authors of the study say their findings point up the need to expand delivery of flu vaccines to Africa and Southeast Asia, since those regions may have borne a disproportionate share of the pandemic mortality burden.

Nigeria: Malaria control under threat from insecticide resistance

Via Vanguard, an interview with Dr. Sam Awolola, head of the Department of Public Health in the Nigerian Institute of Medical Research: Malaria control under threat from insecticide resistance – Sam Awolola. Excerpt:

Awolola noted that their research in the last 10 years has shown clearly that there is a lot of resistance to public health insecticides used for malaria vector control in Nigeria. Due to continuous use of the four classes of chemical insecticides (pyrethroids, carbamates, organophosphates and organochlorines), the mosquitoes were subjected to a lot of pressure and over the years, they adapted to the environment so well that they have now become resistant to the insecticides. 

“Mosquitoes react to an insecticide in two main ways: One is by trying to metabolise (decay) it using some chemical enzymes so that it becomes non-toxic. Another way is mutation. The mosquito gets in touch with the insecticide through its integument (legs, wings), it then changes the configuration of the gene that recognises the insecticide so that the site of recognition of the mosquito changes and the insecticide becomes ineffective. 

"For the insecticide to be effective, the site of recognition with the mosquito must be identical. So immediately the mosquito changes the site of recognition, the whole system changes and the mosquito is able to survive. If that happens, the mosquito has mutated because genes are involved. 

"The gene is a heritable material which means that the next generation of mosquitoes will be resistant to the insecticide because it has passed the gene to them and that gene will continue in that population. We, therefore, have an insecticide-resistant gene in the population and  the next set of mosquitoes from that line, whether they have been exposed before or not, will be resistant to insecticides. 

"You know that 350 mosquitoes can come out from one set of eggs. So if out of the 350, 100 survive and have a blood meal and are able to lay eggs, they will go on to produce another 350 mosquitoes each, and there will be an exponential increment in the number of mosquitoes that will be resistant in that population. That is how resistance spreads." 

Way forward: 

Dr. Awolola advised that all interventions must be evidence-based for them to be effective. “This means that before the intervention, you must have sufficient evidence to show that it will work. You must have collected some baseline information prior to the intervention, but unfortunately, that is not done inNigeria. But things have started changing at the national level because people have seen that you can spend millions of naira and it goes down the drain if you don’t do these things. 

"We want to scale up our intervention, to have an ambitious coverage. So if you don’t get these fundamental bases of malaria control, then you are running your programme on a faulty start and you will end up having faulty results and faulty intervention and then malaria continues to stay with us. 

“With insecticide resistance, we are in for it unless we put our house in order to ensure that our interventions are evidence-based.”

India: Dengue deaths rise in Kolar district; 45 victims this year

Via the Deccan Herald: Dengue deaths rise in Kolar district; 45 victims this year. Excerpt:

Dengue has claimed 45 lives in the district so far this year, according to Dr G Prakash Kumar, district health officer. 

In his report submitted to the Zilla Panchayat on June 21, he had stated that 32 cases of dengue deaths were reported and in four days it has increased to 45. 

The medical officers attributes the spread of dengue to storage of water in residences in the summer. The vector of dengue, Aedes Aegypti, chooses fresh water to breed. 

In summer, as the borewells go dry and the water is supplied through tankers once or twice a week, the residents store the water in sumps, large containers and all the available vessels to use for over seven to 10 days. 

If the water containers are not cleaned at least once in three days, they become breeding ground for the carriers of the disease, said Dr Shashikanth, district in-charge surveillance officer. 

During the survey of the villages, he found thriving of larvae in the water stored in sumps for more than a week were responsible for the death of nine-year-old Kokila of Bangarpet. Kokila had died of dengue at a hospital in Bangalore  on Tuesday. 

The only solution to check the spread of the disease is to avoid storing water for more than three days and keeping the containers clean. 

But the residents refused to buy their suggestions as water is more precious in the drought-prone region, he said.

Brazil: 57 H1N1 deaths in south

Via Prensa Latina, a June 26 report: Región Sur de Brasil confirma 57 muertes por influenza A (H1N1). [South region of Brazil confirms 57 deaths from H1N1 influenza] Excerpt, with my translation:

En total 57 personas han muerto por la influenza A (H1N1) este año en el sur de Brasil, según reportes sanitarios de los estados de Santa Catarina, Paraná y Río Grande do Sul, divulgados hoy.   

A total of 57 persons have died from H1N1 flu this year in southern Brazil, according to health reports released today by the states of Santa Catarina, Paraná, and Río Grande do Sul.

De acuerdo con los boletines de las secretarías estaduales de salud de los tres estados en los primeros meses de 2012 han fallecido debido a la gripe A 35 residentes de Santa Catarina, 13 en Paraná y nueve en Río Grande do Sul. 

According to bulletins from the three state secretariats of health, 35 residents of Santa Catarina, 13 in Paraná, and 9 in Río Grande do Sul have died of flu in the first months of 2012.

Datos oficiales del Ministerio de Salud reflejan que la pandemia de influenza A (H1N1) en 2009 mató a dos mil 60 brasileños, de los cuales 789 vivían en la zona sur del país. Tras el fin de la epidemia, en 2010 en Brasil fallecieron por esa dolencia 113 personas y 27 en 2011.

Official data from the Ministry of Health show that the 2009 H1N1 pandemic killed 2,600 Brazilians, of whom 789 lived in the south. After the end of the epidemic, 113 persons died of the disease in 2010 and 27 in 2011.

Haiti: 2.7 million children vaccinated in eight weeks against polio and measles

Via Radio Kiskeya, a little good news: 2.7 million children vaccinated in eight weeks against polio and measles. Excerpt from a computer translation, slightly edited:

The Ministry of Public Health and Population (MSPP) announced Tuesday that vaccination coverage in Haiti has hit record 2.7 million children in eight weeks. 

At a special ceremony at the Hotel Montana, the MSPP and PAHO-WHO presented together the results of the vaccination campaign against polio and measles conducted from April 24 to June 24, 2012. 

The Health Minister, Dr. Florence Guillaume Duperval, believes that the results will form part of the advancement of the health system in Haiti. She sent special thanks to all who took part in the campaign. 

The campaign reached the ten departments of the country and is in its final stages in the Artibonite, according to Dr. Ronald Jean Cadet, director of the National Coordination Unit of the Program on Immunization (UCNPV).

Bihar: 236 encephalitis deaths

Via Rediff.com: Encephalitis continues its rampage in helpless Bihar - Rediff.com. Excerpt:

Manohar Paswan and Phulesri Devi's three-year-old child is fighting for his life after contracting Acute Encephalitis Syndrome. 

Last week, they had admitted their only son in the Encephalitis Ward of the Sri Krishna Memorial College and Hospital in Muzaffarpur, Bihar. But his condition has not shown any signs of improvement. 

"We are praying to God as only he can save our child now," said Paswan, a landless farmer. Sudhir Kumar, whose daughter is also suffering from AES, has also turned to prayers. 

"Only the rain god can save my child as the doctor told us that the monsoon will help  suppress the virus causing the disease. We are praying for the rains to arrive," Kumar said. 

Paswan and Kumar are among dozens of Muzaffarpur residents whose children have been affected by the dreaded disease. 

"We are helpless, hoping against hope for our children's survival," said Ranju Devi, mother of a five-year-old boy who was admitted to Kejriwal Hospital five days ago 

Some influential people, along with the held of the local legislator, have organised special prayers and jagran (religious discourses) in Muzaffarpur to seek divine blessings to get rid of AES. 

Muzaffarpur Civil Surgeon Dr Gyan Bhusan said that experts are of the view that monsoon rains will decrease prevalence of AES. 

"Heat wave conditions help the virus to spread and intensify the disease," he said. 

Alarmed by the number of children dying of AES in Muzaffarpur, a team of experts from the National Centre for Disease Control has already paid a visit to the district. 

They have decided to send samples and case studies collected from the affected villages to a virology laboratory based in Atlanta. 

"Till date, the cause of the disease is not known, despite repeated attempts to find that out, by local doctors and central experts," said a health official. 

Meanwhile, the deadly disease has claimed the lives of five more children, mostly in Muzaffarpur, in the last 24 hours, taking the toll to 236 since May, officials said. 

"Fresh AES cases have been reported from half a dozen of the 10 identified districts where the disease has spread," a health department official said.

Canada: An earthquake in the neighbourhood

USGS has announced a 4.9 earthquake off the west coast of Vancouver Island this evening: M4.9 - 189km SW of Port Hardy, Canada 2012-06-27 04:22:34 UTC. My wife and I are on Malcolm Island, on the east side of northern Vancouver Island, and didn't feel a thing. Just as well. We're right on the water.