H5N1

India: After Delhi gangrape, anger is overtaking fear

Via The Guardian, a commentary by an English woman with long experience in India: Delhi gang-rape: in India, anger is overtaking fear. Click through for the full article and links. Excerpt:

The statistics are not new but they are as visible as the families, men, women and children at the protests. More than 635 reported rapes in Delhi last year, one conviction. In places like Karnataka it's worse, but Delhi, remember, prides itself on being modern India. As the Guardian's correspondent Jason Burke rightly said, what is happening in this peculiarly Indian mix of anger, sentimentality and denial is a clash between the new and the old. 

The new, modern, techno India, the image this country wants to sell, is tainted by its attitudes to women. I watched the news as "Braveheart", as the victim is nauseatingly called, was flown to Singapore. Why? Out of sight, out of mind? India has some of the best hospitals in the world. You cannot move in places like Chennai for Europeans coming for hip and knee replacements. Who moves a patient with organ failure, brain injury, infection, who has already had a cardiac arrest? Young men were calling up news stations to offer their own intestines as hers had been removed as the result of the damage done to her with an iron bar. 

This is the crux of it and not yet a discussion that many are prepared to have here. Rape is not about sex. It is about power. It is about torture. It is about brutality. Yesterday, another girl was assaulted on a bus. Last week a two-year-old girl was raped to death in Gujarat while the victim of another gang rape committed suicide. Her choice was to drop the charges or marry one of her attackers. 

Arundhati Roy has spoken about how the army uses rape as a weapon in Kashmir and Manipur. As do the police and the upper caste. Surprise has been registered that Damini was not even a dalit. For untouchables rape is everyday; where there are no toilets, women are raped in the woods. 

Yet what is emerging is that middle-class women are not safe. They do not go out after sunset. One told me India is worse than Saudi Arabia. No one trusts the police. A raped woman may have to undergo "a finger test", where a doctor determines whether the woman's vagina is "habituated to sexual intercourse". 

Ordinary women here are angry. They carry placards saying "Kill the cruels" or "Torture them to death", but it is heartening to see young articulate women on TV having a long overdue conversation. 

The political response has been appalling. Sonia Gandhi's address to the nation was totally inadequate. Some female politicians blame rape victims for their "adventurous spirit". The president's son spoke of women protesters as "highly dented" and "painted". The statements of the political class have been slammed as inane and meaningless. 

Damini's body was brought back from Singapore and cremated at night, surrounded by huge security to avoid more protests. She was not taken to her village as is the custom. Her mother collapsed. 

Damini is not her name. She remains unidentified. To be raped, after all, is a shameful thing. Damini is a word from Sanskrit. It means lightning. It is also the name of the heroine in a famous Indian movie who refused to let a rapist escape justice, and several big Bollywood stars have expressed their outrage. Nonetheless, Bollywood continues to churn out movies in which women are harassed into submission in the name of romance. 

What some politicians fear most is that this young, educated population reminds them of the Arab spring and they are demanding change. They fear what they call "the pink revolution". 

When people say, as they so often do, that feminism is the preoccupation of a few white middle-class women in the west agonising over whether to wear lipstick or not, I wish they could see these angry men and women out at night demanding that women be safe, who say rape is always a weapon used to keep women in fear. 

For something is happening here, anger is overtaking fear. The dam has burst. The debate the politicians want is one of law and order, but the radical one is about how to change the culture itself. And because this is India we are taking about a myriad of cultures. 

Somehow, though, through the shock and the trauma, this country is examining itself and its much-vaunted modernity does not look so modern.

Canada: Officials say no new illnesses after woman on VIA train dies

Via The Globe and Mail: Officials say no new illnesses after woman on VIA train dies. Excerpt:

Provincial health officials reported no new or worsening illnesses but also offered no answers on Monday, after one woman died and three people were taken to hospital with flu-like symptoms having become ill aboard a passenger train Saturday morning. 

A spokesperson for the provincial Coroner told the Globe and Mail a post-mortem has been completed on the deceased passenger, whose name has yet to be released, but no cause of death has been determined, and test samples have been sent to public health authorities for further analysis. 

Ministry of Health spokesperson Joanne Woodward Fraser said it is unlikely the province will release further information until Wednesday, after the Jan. 1 holiday.

I'm surprised that they also have nothing to say about the woman's three companions and their present condition.

Looking ahead at global health in 2013

With a little time on the afternoon of New Year's Eve, I'm looking at what we might see in the coming year for some of the health issues this blog deals with. Full disclosure: Coming from a science-fiction writer, these forecasts are almost certainly wrong, and where accurate are likely to be much too conservative.

Haiti is likely to be a persistent and discouraging concern, and for several reasons. The Ministry of Public Health and Population (MSPP) tells us that in the 50 weeks of 2012 between January 1 and December 17, it recorded 107,808 cholera cases (2,156/week). Of those, 65,233 were serious enough to require hospitalization (1,304/week). Eighty hundred and twenty-six Haitians (16.5/week) died of the disease. I doubt that cholera will get much better, or much worse, so another 100,000 cases in 2013 seems likely—and another 800 to 1,000 deaths. The real economic and social burden will be in the nonfatal cases, which will continue to stress Haiti's rudimentary healthcare system.  

Haiti can also expect less publicized health issues to persist: HIV, malnutrition, and all the opportunistic infections that exploit them. The destruction of so much food production by Sandy means Haiti will need even more food aid—which, if past experience holds true, will arrive too late to prevent starvation and just in time to depress prices for next year's locally grown crops.

Climate: Storms and drought caused a lot of health problems around the world this year. Right across sub-Saharan Africa, climate is causing warfare between herders and farmers, with massive dislocation of people into camps where diseases spread easily. Pakistan is dealing with the aftermath of new floods, including malnutrition and waterborne diseases. So are many parts of the Philippines.

The self-proclaimed "advanced" nations will take little note except when climate change affects them directly—by killing people in heat waves, for example, or when a hurricane hits, or when distant forest fires create local smog. (Vancouver had some bad days last summer thanks to such fires in Siberia.)

Violence: We have managed to forget that until very recently, disease killed more soldiers than their enemies did. Armies have imaginatively shifted the burdens of both disease and violence onto civilian populations, while giving their own troops the benefits of socialized health care. Meanwhile, warfare has (for example) driven Ebola and Marburg out of the forests of the Democratic Republic of Congo into Uganda. Refugee camps from Darfur to Turkey to Afghanistan to Thailand are full of cold, underfed children with diarrhea.

The awful gangrape case in Delhi has alerted a billion people (or at least half a billion females) to the public health impact of sexual violence, but I am pessimistic about a rapid improvement in that situation. Too many males simply blank out when presented with an opportunity to get laid. Similarly, the kind of necrotizing male ego that results in both individual and mass shootings will continue to cause thousands of American deaths thanks to the availability of firearms.

H5N1—the original inspiration for this blog—seems likely to me to remain very much in the background. Those who contract it will be a tiny, very unlucky minority. WHO's tally of cases and deaths since 2003 shows a steady decline from a very low peak in 2006 of 115 cases to just 32 in 2012. But the high case fatality rate (59 percent worldwide, and 83 percent in Indonesia) makes it still a disease to watch. And as a threat to poultry, H5N1 is also a genuine threat to the nutrition and economic wellbeing of billions of people from Egypt to Indonesia.

Everything else will continue as well: tuberculosis, malaria, dengue, HIV, encephalitis, antibiotic resistance, and all the ills of poverty and inequality.

Those are the obvious key issues, but I keenly recall being completely blindsided by H1N1 in the spring of 2009: The wrong flu strain, turning up on the wrong side of the Pacific. No doubt we'll be surprised by still other viruses and bacteria in the coming year. And no doubt our public health services will do brilliantly at coping with them. But they will also know that they could have done better—might even have prevented the outbreak altogether—if only they had been better funded and resourced long before.

Whatever turns up, I'll do my best to cover it and to support the healthcare workers and other professionals who work to keep us well. I wish you all—but especially them—a very happy, prosperous, and healthy 2013.

New H5N1 outbreak reported in central Nepal

Via The Poultry Site: New H5N1 Outbreak Reported in Central Nepal.

Highly pathogenic avian influenza (HPAI), probably of the H5N1 subtype, has broken out in farmed broilers in the region of Bagmati. 

The veterinary authority sent Follow Up Report No.2 dated 24 December to the World Organisation for Animal Health.   

The report describes one new outbreak of HPAI at a commercial farm with 42-day-old broiler chickens reared in a closed farm premises in the region of Bagmati in central Nepal, starting on 13 December. Of the 3,000-bird flock, all but 150 broilers died and they were subsequently destroyed. 

According to the report, the birds showed swollen head with respiratory distress and started to die. High morbidity and mortality were recorded in the affected farm. All remaining birds, poultry product and poultry production materials were destroyed and disposed as per the standard operating procedure. Cleaning and disinfection activities are being continued. 

Intensive surveillance activities are ongoing throughout the country. The neuraminidase type is not yet known.

West Africa: Cholera lessons learned

Via IRIN Africa, a thoughtful and informative report: WEST AFRICA: Cholera - lessons learned. Excerpt:

DAKAR, 31 December 2012 (IRIN) - The cholera epidemic that struck Guinea and Sierra Leone in 2012 is winding down. What to do now? Start preparing - for cholera. 

That’s part of the message from donors, aid workers and health officials after the most serious cholera outbreak in years that infected some 30,000 people and killed 400 others in the two countries - mostly in Sierra Leone. They say there should be better preparations for cholera, based on lessons learned and on a strategy in Guinea that was put to the test in 2012. 

Since 2009 the UN Children’s Fund (UNICEF), Action Against Hunger (ACF), the Guinean government, the European Union aid body ECHO, and the US Agency for International development (USAID) have taken steps to prepare for an outbreak - including setting up community detection sites, public information campaigns and drills. 

“Cholera thrives on disorganization,” said Christophe Valingot, water, sanitation, and hygiene (WASH) specialist with ECHO. “Cholera spreads very rapidly - it can go from 30 cases to several hundred cases per week in a very short period. When there is little to no preparation, we’ve lost the chance to avoid all those infections.” 

But preparation is hardly a motivator for governments and donors. “We had a very difficult time justifying funds for this preparation work in Guinea,” Valingot said. 

Strategies needed 

Data from the past decade in West Africa show that a country can go several years with few to no cases of cholera then be hit with thousands of cases. “Donors, NGOs, and governments go all-out during a serious epidemic then it’s as if that all disappears completely with a couple of calmer periods,” Valingot said. “What this means in the end is meagre progress against cholera.” 

Health workers said UNICEF’s strategy proved effective in Guinea this year and ECHO and UNICEF are looking to replicate it across the region. 

So why did Guinea still see some 7,300 cases? For one, the strain found in the region is far more virulent than past strains, said François Bellet, WASH specialist with UNICEF’s West and Central Africa regional office. 

“Of course we can’t possibly know what the situation would have been in Guinea in the absence of this strategy,” he told IRIN. “But given the virulence of this strain we might well have avoided a Zimbabwe 2008-09.” In that period cholera infected some 100,000 people in Zimbabwe and killed more than 4,000. 

As of mid-December Sierra Leone had 22,345 cases and 286 deaths in a population of 5.6 million; Guinea, whose population is nearly double that, registered 7,321 cases and 121 deaths.

One of the notable consequences of any serious epidemic outbreak is collective amnesia: Whether you caught the disease or not, you forget all about it. The only effective reminder is the next epidemic.

Philippines: Typhoon survivors celebrate New Year's Eve

Via ABS-CBN News: Typhoon survivors celebrate New Year's Eve. Click through for the full story and a video. Excerpt:

Despite the tragedy brought by typhoon Pablo, many survivors in New Bataan, Compostela Valley are trying their best to greet the New Year with optimism and with what little they have left.     

Rona Quiapo went to the market Monday morning to buy fruits. Like many Filipinos, she believes that having round fruits on the table for the New Year will bring them luck. 

But instead of buying 13 fruits, she only bought five. “Wala naman tayong pambili ng 13 fruits,” said Quiapo. 

The Barabat family finally left the evacuation center. Even if their house is still damaged, they want to spend the New Year there. Their media noche will be composed of relief goods given to them. 

They also bought a kilo of sticky rice which they believe will allow luck to stick with them this coming 2013.

Indonesia: East Kalimantan tightens checks on H5N1 fears

Via The Jakarta Globe: East Kalimantan Tightens Checks on Bird Flu Fears. Excerpt:

Samarinda, East Kalimantan. Authorities in East Kalimantan have tightened their checks on poultry from Java, Sumatra and Sulawesi, following recent reports of bird flu outbreaks in those regions.  

Slamet Soebagyo, head of disease control at the Samarinda Health Office, said on Sunday that animal quarantine officials at ports and airports throughout the province would work around the clock to screen incoming poultry for symptoms of the disease. 

“We’re being very strict about the checks because we don’t want the bird flu virus getting in and spreading,” he said. 

“Each and every chicken or duck that comes in will be checked. If it shows symptoms similar to those of bird flu, it will be culled on the spot.” 

In addition to tightening screening of incoming poultry shipments, health officials are also visiting local poultry farms to spray disinfectant in and around the animal pens and cages. Slamet said his office was also urging poultry farmers to routinely clean out their facilities. 

Indonesia has been hit hard by bird flu, accounting for 159 human fatalities out of 359 worldwide cases reported, according to the World Health Organization. 

That figure does not take into account the death of a boy in Bogor in early December who was confirmed by the Health Ministry to have died from bird flu. His death brought the country’s total this year to 10.

US: FDA approves Sirturo for MDR-TB treatment

Thanks to Dr. Megan Coffee for retweeting the link to this news release from the Food and Drug Administration: FDA approves first drug to treat multi-drug resistant tuberculosis. Excerpt:

On Dec. 28, the U.S. Food and Drug Administration approved Sirturo (bedaquiline) as part of combination therapy to treat adults with multi-drug resistant pulmonary tuberculosis (TB) when other alternatives are not available. 

TB is an infection caused by Mycobacterium tuberculosis and is one of the world’s deadliest diseases. It is spread from person to person through the air and usually affects the lungs, but it can also affect other parts of the body such as the brain and kidneys. According to the Centers for Disease Control and Prevention, nearly 9 million people around the world and 10,528 people in the United States became sick with TB in 2011. 

Multi-drug resistant TB occurs when M. tuberculosis becomes resistant to isonazid and rifampin, two powerful drugs most commonly used to treat TB. Sirturo is the first drug approved to treat multi-drug resistant TB and should be used in combination with other drugs used to treat TB. Sirturo works by inhibiting an enzyme needed by M. tuberculosis to replicate and spread throughout the body. 

“Multi-drug resistant tuberculosis poses a serious health threat throughout the world, and Sirturo provides much-needed treatment for patients who have don’t have other therapeutic options available,” said Edward Cox, M.D., M.P.H, director of the Office of Antimicrobial Products in the FDA’s Center for Drug Evaluation and Research. 

“However, because the drug also carries some significant risks, doctors should make sure they use it appropriately and only in patients who don’t have other treatment options.” 

Sirturo is being approved under the FDA’s accelerated approval program, which allows the agency to approve a drug to treat a serious disease based on clinical data showing that the drug has an effect on a surrogate endpoint that is reasonably likely to predict a clinical benefit to patients. This program provides patients earlier access to promising new drugs while the company conducts additional studies to confirm the drug’s clinical benefit and safe use. 

The FDA also granted Sirturo fast track designation, priority review and orphan-product designation. The drug demonstrated the potential to fill an unmet medical need, has the potential to provide safe and effective treatment where no satisfactory alternative therapy exists, and is intended to treat a rare disease, respectively.

Malaysia: Sabah government intensifies monitoring to prevent spread of H5N1

Via The Malaysian Insider: Sabah government intensifies monitoring to prevent spread of H5N1 virus.

The Sabah government has taken precautionary measures by enhancing the monitoring the breeding of chicken and ducks in border areas, especially in Tawau and Sandakan to prevent the spread of a new bird flu (H5N1) virus in the state.   

Sabah Deputy Chief Minister Datuk Seri Yahya Hussin said all related agencies including the Malaysian Royal Customs, the police and the Malaysian Maritime Enforcement Agency had been asked to tighten the entry of livestock or livestock products in border checkpoints, airports or sea ports.  

“So far, the ministry has not received any report of bird flu cases, but precautionary measures remain a priority to prevent the virus from spreading to the state,” he told a press conference here today.  

Yahya, who is also Sabah Agriculture and Food Industry Minister, said the Department of Veterinary Services and Animal Husbandry would continue to run sampling of carcasses of wild birds including in the forest, for identification and surveillance.  

Estonia: A fierce war against MDR-TB

Via The Wall Street Journal: At Europe's Doorstep, a Fierce War Against Tuberculosis. Excerpt:

TARTU, Estonia—All along the edges of Western Europe, new and hard-to-defeat strains of tuberculosis are gaining a foothold, often moving beyond traditional victims—alcoholics, drug users, HIV patients—and into the wider population. 

Which is why Irina Nikolajeva, a petite 34-year-old former furniture saleswoman, spent the better part of four months in virtual lockdown here last year. She was resistant to all but one of 10 TB drugs. Nobody could figure out how she even caught the disease. 

"NAKKUSOHT!" declared a bright red sign just steps from her tiny, bare isolation room. "DANGER OF INFECTION!" To see her 18-month-old daughter, she initially needed Skype. "I could see my child running around at home," Ms. Nikolajeva recalled. "She'd say, 'Hello, Mama.' " 

Estonia's aggressiveness—and only recently, its success—in turning the corner against drug-resistant TB offers one of the few bright spots globally as the ancient plague mutates into new and more deadly forms. Indeed, experts say the country, with half the population of Chicago, could be a model for others. But there is one catch: It takes years and some pricey treatments just to gain the upper hand. 

"The easy ones are treated," said Martin Kadai, a public health adviser at Estonia's ministry of social affairs. The toughest patients, he said, remain. 

In Western Europe, drug-resistant strains of TB are starting to make a wider appearance. Last year, Britain reported 421 cases of drug-resistant TB, a 26% jump from the previous year. Most Western Europe cases can be traced to the TB-wracked eastern half of the continent. (In contrast, there were 124 case of drug-resistant TB in the U.S. in 2011.) 

Nearby nations, including Serbia, Kosovo, Montenegro and hard-hit areas in Russia, have sought Estonian advice in their own fight against the disease—and they need it. The 15 countries of the former Soviet Union, as well as Romania, Bulgaria and Turkey, together harbor more than 85% of TB cases, and 96% of multidrug-resistant tuberculosis, or MDR-TB, found in Europe, according to the World Health Organization.