H5N1

India: Dengue fear sharper than sting

Via The Times of India: Dengue fear sharper than sting. Excerpt:

LUDHIANA: The mayhem created by dengue in the city last year has forced residents to be extra cautious while fighting the disease now. 

While the number of persons suffering from dengue has just crossed the 50 mark this year, the spread was far wider in 2011, when in one month alone 1,200 people were rushed to hospitals for transfusion of platelets after they tested positive for the disease. 

Having learned lessons from last years shortage of blood units and aided by fewer cases this year, city hospitals claim they are ready with adequate measures. However, residents are finding it hard to fight the scare. 

For instance, BRS Nagar resident Manjit Singh says recently when his relative was suspected of dengue, he made sure the platelets were available for meeting any eventuality even before the final test reports were in. 

Allaying fears, Dr Sandeep Puri of Dayanand Medical College and Hospital said, "Dengue has not reached epidemic proportions this year and very few cases have been reported at our hospital. Last year, the number was huge. We have taken advanced measures and can carry out platelet transfusion on even 100 dengue patients in a day as we have seven separator machines. The hospital receives the maximum dengue cases in the city every year."

A judicial crisis erupts in Haiti

Thanks to Dr. John Carroll for tweeting the link to this Miami Herald report by Jacqueline Charles: A judicial crisis erupts in Haiti. It's a political story, but politics can affect public health in many ways. Excerpt:

While Haiti President Michel Martelly and Prime Minister Laurent Lamothe made the rounds in New York this week, a judicial crisis erupted at home with the firing of a chief prosecutor, the swearing-in of another and an alleged resignation in less than 24 hours. 

Former Chief Prosecutor for Port-au-Prince Jean Renel Senatus said Haiti’s Justice Minister Jean Renel Sanon fired him Thursday because he refused to execute an order to arrest 36 government opponents. 

Senatus also said that Josue Pierre-Louis, a presidential legal advisor and head of the six-member electoral council, asked him to serve warrants against two attorneys — Newton St. Juste and Andre Michel — who have brought corruption complaints against the presidential family and members of Haiti’s government. 

“I told him, ‘No, I don’t have a case against them in my hand,’ ’’ Senatus said. “It’s not democratic. It’s not democracy.”

Pakistan: Cuba offers assistance to control dengue outbreak

Via the Daily Times: Cuban govt offers assistance to control dengue outbreak. Excerpt:

LAHORE: The Cuban government and dengue experts have offered their expertise and technical assistance to the Punjab government to help control outbreak of deadly disease in the provincial capital. 

“We have offered our services in the form of technical assistance, technology transfer and use of larvicide Bti (Bacillus thuringiensis israelensis),” Cuban vector expert Dr Aramis Martínez Arias told Daily Times in an exclusive interview. 

Dr Arias, who was accompanied by LABIOFAM Director Dr Jorge Luis Martínez López, said the objective of their visit to Pakistan was to share knowledge on dengue control with government officials and other stakeholders and formally offer Cuban government’s support to the Punjab government in this regard. 

Dr Arias, who is a microbiologist having 20 years of experience in the field of dengue and malaria control, said, “You spray thousands of time in the city and it wouldn’t impact because the best time to kill dengue is the larvae stage. In order to control dengue outspread, strong political will, intersectoral collaboration, law enforcement and community mobilisation is needed. If you don’t combine these four principles, you cannot control dengue,” he said. 

“Once hatched, it becomes very difficult to locate mosquitoes and kill them. You can use chemical sprays in areas where mosquitoes are found in a large number,” Dr Arias said. 

He said role of entomologist is very important in controlling dengue outbreak. 

“You can use chemicals [to kill mosquitoes] to a certain limit because this also affects environment. Therefore, you have to use biological treatment in the form of larvicide Bti,” Dr Arias said. 

To a question, he said lifetime of a dengue mosquito is 30-45 days depending on environment. He said that he had been working extensively in South America and all over Africa in collaboration with WHO and governments to offer his expertise and consultancy in vector control. 

Dr Arias and Dr López said they had received good response during their meeting with Punjab government’s focal persons of dengue control, including Dr Waseem Akram and Khawaja Salman Rafique. 

They said they had shared their knowledge and experience with Pakistani experts and managers of the anti-dengue campaign.

Germany: A little more on the gastroenteritis outbreak

Via Deutsche Welle: Thousands of German schoolchildren taken ill. Excerpt:

Thousands of German schoolchildren have fallen ill with a vomiting and diarrhea bug. Officials are still awaiting laboratory results, but the norovirus has been found in some cases. 

More than 8,300 preschoolers and schoolchildren in eastern Germany, as well as a few teachers, have fallen ill with gastroenteritis after eating food in school cafeterias and daycare centres. 

Laboratory investigations have been under way over the weekend to determine the cause of the outbreak. 

In Saxony, at least 16 cases of the highly contagious norovirus were found, while in Thuringia, seven cases of norovirus were discovered. Norovirus is a mostly food or water-borne illness. 

Whether the norovirus is the main source of the outbreak, however, remains unclear. Health authorities say it is still too early to determine the definitive cause of the epidemic. 

"We still do not know what the cause is," said a spokesman for the Ministry of Social Affairs in Dresden. 

The number of illnesses has been rising since the initial reports surfaced on Tuesday, affecting the areas of Saxony, Thuringia, Berlin, Brandenburg and Saxony-Anhalt.

Germany: 8,400 now sick in outbreak

Thanks to André Picard for tweeting the link to this post on the vividly named barfblog: 8400 kids now sick in German outbreak; probably norovirus from single food source. Excerpt:

Last year it was sprouts that sickened some 4,400 and killed 53 in an outbreak centered in Germany; now the number of children that have fallen ill with vomiting and diarrhea after eating food from school cafeterias and daycare centers has risen from about 4,500 to 8,400.

Where healthcare money goes (and where it doesn't)

WHO has published the Global Health Expenditure Atlas for 2011, and it is an eye-opener. You should download the PDF and plan to spend a little time exploring it, especially the data for your own country and region. 

My own experience in running this blog is that an awful lot of stories deal with awfully poor countries. The WHO report tends to confirm that impression. Here are a few numbers from the report's global overview:

Total global health spending: $6.5 trillion (all figures in US dollars)

Total global health spending per person per year: $948

Country with highest health spending per person: US ($8,362)

Country with lowest health spending per person: Eritrea ($12)

Country with highest out-of-pocket household spending on health: Switzerland ($2,412)

Country with lowest out-of-pocket household spending on health: Kiribati ($0.20)

Average per-person health spending in OECD countries: $4,380

Percentage of world population living in OECD countries: 18%

Percentage of world total financial resources devoted to health currently spent in OECD countries: 84%

WHO estimate of minimum spending per person per year to provide basic services: $44

Number of WHO member states spending less than $50 per person (including external donations): 34

Number of WHO member states where health spending is less than $20 per year: 7

Percentage of funds spent on health in WHO Africa region provided by donors: 11%

Most of the report's country statistics are from 2009, and they show some striking disparities. In the Americas, for example, the top three countries for health spending are the US ($7,960), Canada ($4,519) and the Bahamas ($1,741). After that, everyone else is in three or even two digits. Examples:

Chile ($802), Cuba ($672), Mexico ($525), Dominican Republic ($279), Bolivia ($90), Haiti ($40).

The Southeast Asian region also has some surprises: India is scarcely better than Haiti, at $44. Bangladesh spends only $21, and Myanmar just $14. (North Korea is a blank.)

The Western Pacific region ranges from Australia ($3,945) and Japan ($3,754) and New Zealand ($2,702) to China ($191), Papua New Guinea ($44), Cambodia ($41), and Laos ($39).

Some oil-rich Middle Eastern countries spend surprisingly little: Qatar ($1,612), Kuwait ($1,579), and Saudi Arabia ($608). Other countries in the region spend appallingly little: Pakistan can build nuclear weapons, but spends only $20 on health. Afghanistan is well ahead at $34. And Syria, well before the current civil war, was spending only $95 a year on each citizen's health.

In 2009 Europe had the world's top health spender, Luxembourg ($8,262). You don't go into just three digits until you look at the fringe nations like Estonia ($967) and Belarus ($311). In Central Asia, Tajikistan is at the bottom with $44.

Africa is a continental disaster. Enormous Nigeria spends only $67, Ghana fights cholera with $54, and Uganda battles Ebola and nodding syndrome on $44. The Democratic Republic of Congo, with continuing civil war, cholera, and another strain of Ebola, spends $17 per person. Zimbabwe, like North Korea, doesn't provide data.

We seem to be facing a chicken-and-egg problem: Until these poor countries gain some wealth, they will continue to endure (and export) endless disease. And until their populations are healthy, wealth will be very hard to acquire. Meanwhile, climate change and political unrest will make public health and wealth even harder to achieve.

India: Kanpur fever deaths continue, but numbers abating (updated)

Via The Times of India: Fever deaths continue, but numbers abating. 

KANPUR: Four more children died of mystery fever at Lala Lajpat Rai hospital here on Friday. Meanwhile, four more cases of dengue have been reported from GSVM Medical College during the past two days, taking the total number of dengue cases in the past three weeks to 21. 

Vashok, Sania, Kashish, and Abhishek, all infants below the age of three years died at the paediatric ward of LLR on Friday. 

Children form the majority of deaths reported due to mystery fever at the hospital. According to hospital sources, at least 200 patients are admitted in the medical ward and there is a daily deluge of patients in at the pediatric ward as well. 

Dr UC Sinha, chief medical superintendent at Ursala Horseman hospital informed that since Monday, 5000 patients have been visiting the OPD daily, among which only 100 or so are complaining of fever. 

He said this number was around 300 to 500 in the second and third week of September.

A hat-tip to Ronan Kelly at FluTrackers for this story (and some useful comment).

Update: I see that almost two years ago, I posted an item on "mystery fever in Kanpur." Some things never change.

Eurosurveillance on the novel coronavirus

Via Eurosurveillance.org: Detection of a novel human coronavirus by real-time reverse-transcription polymerase chain reaction. The abstract:

We present two real-time reverse-transcription polymerase chain reaction assays for a novel human coronavirus (CoV), targeting regions upstream of the E gene (upE) or within open reading frame (ORF)1b, respectively.  Sensitivity for upE is 3.4 copies per reaction (95% confidence interval (CI): 2.5–6.9 copies) or 291 copies/mL of sample.  

No cross-reactivity was observed with coronaviruses OC43, NL63, 229E, SARS-CoV, nor with 92 clinical specimens containing common human respiratory viruses. We recommend using upE for screening and ORF1b for confirmation.

US: Lyme disease as a political issue

Via the blog Political Animal: Romney’s Lyme Disease mailer: A play for the Christian Right? Click through for the full post with a lot of links. Excerpt:

If you live in DC’s Northern Virginia suburbs, you may have received a Romney campaign mailer vowing to eradicate Lyme Disease, “A Massive Epidemic Threatening Virginia.” At least a few incredulous residents already have, which sent the slow-news Friday media into a giggle fit. 

But make no mistake, people. Northern Virginia takes Lyme seriously. As I reported this summer (see sidebar) Loudoun County has spent $20,000 soaking its public parks with high-octane pest repellent, and Governor Bob McDonnell created a statewide taskforce on the disease in 2010. Go hang out in NoVa government buildings and you’ll find Lyme pamphlets for the taking. In other words, ginning up fears about Lyme may prove to be a smart bit of retail politics. And it might also be a backdoor way of mobilizing evangelical support. Here’s how. 

The claims made in Romney’s mailing, which echo an August letter he wrote to the co-chairs of the House Lyme Disease Caucus, reflect the findings of McDonnell’s taskforce. The man who chaired that taskforce, Michael Farris, is no epidemiologist. Farris is the Chancellor of evangelical Patrick Henry College, and President of the Home School Legal Defense Association. 

Farris, who says his wife and seven of his ten children have the tick-borne disease, estimates that one in six Virginians are infected. (The CDC reported 756 Virginia cases in 2011.) He also argues the disease is chronic, a claim the Infectious Disease Society of America says is bogus. Experts be damned, Romney’s all ears.

Canada: CFIA investigation into XL Foods (E. coli O157:H7)

The Canadian Food Inspection Agency now has a dedicated web page  on the CFIA investigation into XL Foods (E. coli O157:H7). This is turning into a big, unpleasant story here in Canada. The introduction to the page:

The Canadian Food Inspection Agency (CFIA) and XL Foods, Inc., are warning the public, distributors and food service establishments not to consume, sell, or serve various ground beef products that may be contaminated with E. coli O157:H7. 

The CFIA is working with the recalling firms and distributors to identify and verify all affected products. There is a strong possibility the CFIA’s food safety investigation will identify additional products meaning the recall could be expanded. 

Consumers who are unsure if they have affected products are advised to check with the store where they were purchased. If you are unsure whether a product is part of the recall, the safest course of action is to throw it away.