H5N1

Cambodia: US embassy will be closed February 1-4

Via the Embassy of the United States in Phnom Penh: EMERGENCY MESSAGES AND PUBLIC ANNOUNCEMENTS: The US Embassy will be closed from Friday, February 1, through Monday, February 4.

The U.S. Embassy in Phnom Penh will be closed from Friday, February 1, to Monday, February 4, for the King Father’s cremation and associated activities.  

An influx of over three million people into Phnom Penh is expected during this four-day period, with many activities centered in the Wat Phnom area. Due to the increase in population and government-mandated road closures, movement around the city will be heavily restricted.  

The U.S. Embassy advises all U.S. citizens to exercise caution while traveling in and around Phnom Penh, and strongly recommends avoiding large crowds. The Embassy will reopen Tuesday, February 5.

Cambodia: More on the latest H5N1 deaths

Via The Phnom Penh Post: Bird flu claims lives of two girls. We have no new cases, but this report fills in a lot of detail. Excerpt:

Two more children died from avian influenza yesterday, bringing the total to four deaths and five confirmed cases in the past month’s outbreak. 

A two-year-old girl from Kampong Speu province, first confirmed on Saturday to be infected with the virus, and an eight-year-old girl from Kampot province had both died from H5N1 at Phnom Penh’s Kantha Bopha Hospital yesterday, hospital officials confirmed last night. 

In response to the spike in cases, the government had sent out a rapid response team and was ramping up surveillance and investigation of the virus as the World Health Organisation worked with the Ministry of Agriculture, Forestry and Fisheries to control the movement of poultry, Sonny Krishnan, communications officer for the WHO in Cambodia, said. 

“The National Committee on Information, Education and Communication is holding an emergency meeting tomorrow to increase radio and TV spots with preventative messages,” Krishnan said yesterday. 

“We are insisting all chickens and eggs be well cooked, and that people wash their hands and don’t let children play with chickens and ducks.” 

Krishnan noted that ducks, in particular, could be infected with the disease without showing symptoms for a very long time, “so when ducks die, it’s a serious situation”, as was the case in the Takeo province village of the 15-year-old girl who died from the virus last week. 

Seng Thoung, the chief of Thmey commune in Kampot’s Teuk Chhou district, the home of the eight-year-old who died yesterday afternoon, said the girl had fallen ill about 10 days ago and was sent for treatment at the Kantha Bopha after local doctors and Kampot’s provincial hospital staff were unable to identify the disease. 

The girl’s parents had kept a lot of chickens, most of which were sick, but they allowed the girl to play with the birds anyway, Thoung said. 

“This is a new disease in our commune, so that’s why they did not worry much when they saw the sick chickens,” he said. He added that health and agriculture officials had killed and burned the chickens at the girl’s house, sprayed the village to kill the virus and told the villagers not to eat or touch sick or dead poultry, but instead to burn and bury them. 

Officials also took samples of the neighbours’ birds to test them for the virus, he said. 

Meanwhile, he said, the girl’s body was returned from Phnom Penh to the village for her funeral yesterday evening, which was attended by many villagers. 

“All the villagers who attended the girl’s funeral were distributed face masks to protect them,” he said. 

A security guard at Phnom Penh’s Kantha Bopha Hospital said the body of the two-year-old who succumbed to the virus there yesterday also had been sent home. 

On Sunday, Kantha Bopha’s Dr Denis Laurent told the Post that the hospital’s staff was “looking every day” for suspected cases of the virus and frequently sent samples to Institut Pasteur to be tested for H5N1, although most samples came back negative. 

Specific reasons for the increase in cases, compared with the three seen in all of 2012, are so far unclear, Krishnan said, though he noted that flu cases tend to rise during the colder parts of the year and that Cambodia was experiencing a “relatively cool spell”. 

Health officials were working with the Institut Pasteur du Cambodge to understand the causes of the new outbreaks, he said. 

He added that the spread of the virus would be of particular concern with the increased movement of people into Phnom Penh for the coming week’s funeral procession and cremation of the late King Father Norodom Sihanouk. 

“Poor people coming from the provinces normally bring their own food,” he said, noting that live poultry would be among the food they would bring.

China uses PM 2.5 in weather alert system

Via Xinhua: China uses PM 2.5 in weather alert system. Excerpt:

China's meteorological authority has introduced a new weather warning system for smog which will use readings of PM 2.5, a particle pollutant. 

The announcement comes as thick haze chokes many cities. 

The National Meteorological Center (NMC) has introduced a three-tier color-coded weather warning system to alert the public to the severity of smog. The system uses yellow to imply moderately smoggy weather, orange for severe conditions and red for extremely severe levels of smog. 

The system not only measures the density of PM 2.5, a major pollutant that triggers smog, but also takes into account visibility and relative humidity to better reflect air quality conditions, according to the center. 

The smog that has blanketed many Chinese cities in recent days has affected a total area of 1.3 million square kilometers, according to the Ministry of Environmental Protection. 

The municipalities of Beijing and Tianjin, together with the provinces of Hebei, Shandong and Henan, will remain the hardest-hit regions on Tuesday evening through Wednesday daytime.

Haiti: Has cholera reporting collapsed?

MSPP's most recent cholera statistics, as published on its Documentation page, were for January 15. We then got a long pause, interrupted only by the publication of a "Statistical Report" for 2011 and newsletters dated January 21 and 28. 

Now we have two more days of cholera numbers, but MSPP has simply left out seven days between January 16 and 22, and given us numbers for January 23 and 24.

What's more, these two days omit reports from six Haitian departments: Grande Anse, Nippes, Nord Ouest, Nord Est, Ouest, and Port-au-Prince. Some of these departments haven't reported at all since sometime late in 2012.

For what it's worth, the numbers for January 23 and 24 show an increase in the cumulative total since January 15 of 3,446. Deaths have increased by 39, from 7,965 to 7,994. But these numbers represent only a fraction of the country, and for all we know they were pulled out of the air.

The collapse of the cholera reporting system is bad enough. It's even worse that MSPP, the media, and the NGOs including PAHO have said nothing about it.

Canada: Windsor votes to end fluoridation after 51 years

Via The Windsor Star, just across the river from Detroit: Fluoridation to end after 51 years. This is like a flashback to the 1950s. Excerpt:

Windsor on Monday joined the growing number of municipalities which have voted to end the decades-old practice of adding fluoride to the water supply in the fight against tooth decay. 

"A lot has changed in the last 60 years ... fluoride is not the be-all and end-all to prevent tooth decay," said Mayor Eddie Francis, who voted with the majority. 

The motion to end fluoridation passed 8-3. 

Council's rejection of fluoride after more than five hours of debate went contrary to the almost unanimous opinion of health and dental experts, as well as others with scientific backgrounds, present among the 27 delegations which spoke at the meeting. 

"Do not be the municipal council known for making a health decision against the advice of your health advisers," said Dr. Mark Drkulec, president of the Essex County Dental Association. 

The safety and the effectiveness of fluoride added to municipal water to help in the fight against tooth decay is "the general consensus of the scientific community," said Dr. Allen Heimann, the local medical officer of health. 

"I'm using the best scientific information that is provided to me," he added, citing studies and reports from such agencies as Health Canada, the U.S. Centers for Disease Control and the World Health Organization. 

But opponents of continuing with a practice that began more than 50 years ago in Windsor were quick to draw on their own list of experts, studies and reports to support their contention that Windsor should join the growing number of Canadian communities, including Lakeshore, Tecumseh, Amherstburg, Calgary and Waterloo, that have voted to end fluoridation. 

"I want to be shown that when we ingest this, we are safe," said Kimberley DeYong of Fluoride Free Windsor. 

She and others said not a single study among those cited by fluoridation proponents looked specifically at the industry-sourced chemical used by the municipality and its impact on human health outside of tooth enamel hardening. 

The fluoride compound being added to Windsor's water supply, hydrofluorosilicic acid, would be illegal to dump in the environment and represents "the only chemical we're adding to our water for mass medication," said Ayesha Drouillard, another member of Fluoride Free Windsor. 

Sixteen of the 27 delegations spoke in support of the Windsor Utility Commission's recommendation, made a year ago, to end fluoridation of Windsor's municipal water, which is also piped to the residents of LaSalle and Tecumseh. Going into the meeting, council also had 81 submitted written reports and letters to digest. 

"We've been inundated with emails and reports," said Ward 8 Coun. Bill Marra. He asked why, with proponents so convinced of the continued "critical medical benefits" of fluoridation, the matter is left to individual municipal councils to decide. 

"We're part-time politicians asked to overrule what the scientists are telling us," Ward 3 Coun. Fulvio Valentinis said prior to the meeting. 

Ward 6 Coun. Jo-Anne Gig-nac said "it really ticks me off" that senior government has left the decision over continued fluoridation up to municipal councils to decide. She voted against any cessation. 

London [Ontario] recently voted 10-5 in favour of continued fluoridation of municipal water.

Paraguay: Dengue emergency zone expands

Via Prensa Latina: Amplían emergencia en zonas paraguayas por dengue. [Dengue emergency zones expanded in Paraguay] Excerpt, with my translation:

Las autoridades sanitarias decretaron el estado de emergencia por el incremento del dengue en Ciudad del Este, cabecera del departamento paraguayo de Paraná, localizado a 327 kilómetros de esta capital. 

Health authorities have declared a state of emergency over the increase of dengue in Ciudad del Este, capital of the Paraguayan department of Paraná, 327 km from Asunción.

Según las fuente, está latente el peligro de epidemia de la enfermedad, transmitida por el mosquito Aedes aegypti. 

According to the sources, there is danger of an epidemic of the disease spread by the Aedes aegypti mosquito.

Con la medida, Ciudad del Este se suma a la emergencia declarada ayer en el departamento Central, zona con alto índice de infestación larvaria. 

With this measure, Ciudad del Este is added to the emergency declared yesterday in Central department, a region with a high rate of larva infestation.

El Ministerio de Salud confirmó la muerte por dengue de 13 personas, y otras, seis aún sin verificar, pero que presentaban síntomas de la afección. Luego de las lluvias de los últimos días aumentó el número de pacientes que acuden a los hospitales y centros médicos con sospechas de estar contagiados.

The Ministry of Health has confirmed the deaths from dengue of 13 persons; six others have not been confirmed but presented the symptoms. After the rains of recent days, hospitals and medical centres have seen a growing number of patients with suspected dengue.

Cambodia: Two events that could spread H5N1

Deutsche Welle has an excellent summary of what we know so far: Bird flu spreads in Cambodia. But here's the key passage, citing WHO communications officer Sonny Inbaraj Krishnan:

The WHO's Krishnan said health teams have monitored the condition of people who came in contact with the victims, adding that all had tested negative for the virus. The government has also boosted the number of television and radio spots warning of avian flu and telling people how to protect themselves, and staff at health clinics in the affected provinces will receive refresher training on avian flu in February. 

Population influx 

However, two imminent events will add to the challenges of containing the spread of the disease. 

The first is the February 4 cremation of Norodom Sihanouk, the country's revered former king, in Phnom Penh. The government expects that more than a million people will travel to the capital to pay their respects. Many will bring food, including live poultry. 

The other is Chinese New Year on February 10. In preparation for the festival, large numbers of chickens and ducks are usually transported ahead of that date to markets in the cities and towns. 

Either event could promote the spread of the disease. On Tuesday, government and UN health experts met to work out how best to prevent that. Krishnan said officials would hand out information leaflets to people coming to the capital to warn them of the risks and advise them how to avoid contracting the disease. That includes not eating birds that have died from illness, and cooking poultry thoroughly. 

Most of the efforts underway are designed to ensure that people do not get infected with avian flu in the first place. Once they do, the chances of recovery are slim - not least due to the country's weak healthcare system. In total, 23 Cambodians out of 26 infected to date with avian flu have died - a fatality rate close on 90 percent, and well above the global figure of nearly 60 percent. 

Krishnan said part of the problem is that Cambodians typically first seek medication at their local pharmacy or private clinic. That costs precious days. Given that H5N1 can kill in around a week, by the time patients arrive at hospital "the chances are slim that they will survive."

Philippines: DOH to curb spread of chikungunya

Via Sun.Star.com.ph: DOH to curb spread of chikungunya disease. Excerpt:

PALO, Leyte -- Seven villages in Villareal, Samar are now affected by the spreading mosquito-borne chikungunya disease, raising the number of victims to 535 last week, the Department of Health (DOH) regional office here reported. 

From 235 afflicted by this rare disease in just two barangays last month, the mosquito-borne disease has downed more residents in new areas, said DOH regional information officer Bryant Labastida. 

Of the 535 cases in Villareal town, 76 were reported in Barangay Miramar, 23 in Mercado, 14 in Mahayag, 13 in Tayud, 31 in Central (town center), 235 in Banquil, and 154 in Guintarcan. 

The disease was first spotted in the remote of villages of Banquil and Guintarcan last December 2012. 

“We believe, the ailment is also present in other municipalities but the number is not that alarming. Outbreak occurred in Villareal probably because of many breeding grounds for mosquitoes,” he added.

CIDRAP: News scan for January 29

Via CIDRAP: NEWS SCAN: H5N1 deaths in Cambodia, FAO avian flu warning, finding flu vaccine, severe respiratory infection in kids, polio team attack. Excerpt:

In a joint news release today, Cambodia's Ministry of Health (MoH) and the World Health Organization's (WHO's) Western Pacific Region Office confirmed two deaths in girls from H5N1 avian flu that were reported yesterday in the media. 

In the past week Cambodia has confirmed five H5N1 cases, four of them fatal. They are the world's first H5N1 cases reported this year. 

The first of the two new cases involved a 17-month-old girl from Prey Nheat village in Kampong Speu province in southwestern Cambodia. She developed a fever, cough, runny nose, and vomiting on Jan 13 and was initially treated by local private practitioners. After her condition worsened and she became very sleepy and had difficulty breathing, she was admitted to Kantha Bopha Hospital in Phnom Penh. "Unfortunately, despite intensive medical care," the news release said, she died yesterday. 

The second case involved a 9-year-old girl from Thmei village in Kampot province, which lies south of Kampong Speu. She developed a cough and fever on Jan 19 and was admitted to Kantha Bopha on Jan 27 with somnolence and dyspnea, as well. She also died yesterday after intensive treatment. 

All five cases have been in Phnom Penh or nearby provinces. Since 2005 Cambodia has had 26 confirmed H5N1 cases, 23 of them fatal.

It's now 5:00 p.m. Tuesday on the North American west coast and about 8:00 a.m. Wednesday in Phnom Penh, and we have no more recent news than CIDRAP's. I would like to think that the WHO rapid response teams didn't find any new cases on Tuesday, and that Kantha Bopha Hospital is catching its collective breath after a very stressful week or ten days.

But that is literally wishful thinking. Cambodia's Ministry of Health hasn't announced anything new, and nothing new has appeared in the Phnom Penh Post. The story hasn't even drawn much interest in Cambodia's neighbours, even though countries like Vietnam and Thailand have plenty of bad experience with H5N1.

Even if these five cases are all that Cambodia suffers this year, they deserve intense scrutiny and informed discussion. The mechanism that triggered those cases needs to be identified (and neutralized to prevent similar future outbreaks).

Ministries of health in every hot-zone country need to demand everything that Cambodia and WHO have learned, and to publicize them the way the Hong Kong government does. Otherwise the same kind of outbreak will hit again; heaven knows human beings share an amazing deafness to warnings about their health, but that doesn't excuse their governments from at least trying.

Uganda: Ministry investigates Mubende disease

Via New Vision: Ministry investigates Mubende disease. But this report doesn't tell us much more than the original story.

The health ministry has dispersed a team of experts to Mubende district after a strange infectious disease killed six people and left 30 others affected in a space of three weeks.   

Medical officers say the disease manifests in the form of excessive heat around the chest and itching in the neck and within a few hours, the patient starts vomiting and bleeding through the nose and mouth. It also causes diarrhoea and fever.   

Earlier this month when it had just broken out, the disease was suspected to be ebola as it claimed three lives at Mubende Hospital within two days.   

Residents attributed it to witchcraft and a few weeks ago, they hired a traditional healer to ‘cleanse’ the village of would-be witches.   

However, Dr. Wilson Mubiru, the district health officer, ruled out witchcraft and said they were yet to receive results from blood samples sent to the Uganda Virus Research Institute in Entebbe.   

“We are still investigating what exactly this disease is and what its cause could be. Nothing has been confirmed yet,” Mubiru said while dismissing claims of ebola. 

The team, which comprises experts from Mulago, the World Health Organisation and other health agencies was led by the ministry’s head of surveillance, Dr. Isa Makumbi. The group has pitched camp in Mubende since last Thursday.   

The experts visited areas of Kiganda and Kassanda sub-counties last week, where dozens of residents are said to be infected with the peculiar disease.   

Dr. Bosco Ssendikadiwa, the Mubende district assistant health officer, said the exercise was challenging because the residents were unco-operative.   

Zziwa Kiruba, the district council secretary for health said they had resolved to sensitise the people. The mass sensitisation campaign is yet to kick off.