H5N1

Paraguay: 1,347 dengue cases on Wednesday

Via Español UPI.com: El miércoles ingresaron 1347 casos nuevos de dengue en Paraguay. [1,347 new dengue cases admitted in Paraguay on Wednesday] Excerpt, with my translation:

Un reporte de la dirección general de Vigilancia de la Salud señala que este miércoles ingresaron 1.347 casos, elevando la cifra de sospechosos de dengue a 45.677 a nivel país, en total. 

A report by the General Directorate of Health Surveillance says that 1,347 cases were admitted this Wednesday, raising the number of suspected cases to a national total of 45,677.

El departamento Central encabeza las notificaciones con el 68,9% y le siguen Asunción, con el 14,1%; Alto Paraná, con el 3,9%; Presidente Hayes, con el 2,6%, y Cordillera, con el 2,3%, consignó un reporte del portal de la Información Pública del Paraguay (IP). 

Central department leads the reports list with 68.9 percent, followed by Asunción with 14.1 percent; Alto Paraná, 3.9 percent; Presidente Hayes, 2.6 percent; and Cordillera with 2.3 percent, according to a report on the website of Paraguay Public Information.

La directora general de Vigilancia de la Salud Celia Martínez, informó que suman 910 las personas internadas a la fecha, de las cuales 211 corresponden a nuevos ingresos. Se encuentran en Unidades de Terapia Intensiva 45 pacientes, tanto en hospitales públicos, como privados, hospital policial, militar e IPS.

The General Director of Health Surveillance, Celia Martínez, said that 910 persons were hospitalized on that day, of which 211 were new admissions. Forty-five patients were in intensive care units, in public and private hospitals as well as police and military hospitals.

Butler: Much of Fukushima's fallout was gone with the wind

Via Nature News and Comment, Declan Butler reports on the new WHO study: Much of Fukushima's fallout was gone with the wind. Excerpt:

The World Health Organization this morning released a relatively reassuring report suggesting few health impacts from the 2011 disaster at the Fukushima Daiichi nuclear power plant in Japan. But the accident is likely to cause small, but significant, increases in cancers in populations in a few hotspots exposed to higher radioactive doses. 

These conclusions regarding the worst nuclear accident since Chernobyl in 1986 could be less comforting than they sound: In fact, Japan dodged a bullet thanks to the weather. The pattern of prevailing winds during the accident meant that most of the radioactive materials released from the plant were blown out to sea. The results therefore say little about the health risks of any future nuclear accidents. 

"Had the winds been less favourable, the consequences could have been more serious than Chernobyl," says Keith Baverstock, a radiobiologist at the University of Eastern Finland in Kuopio.  

The WHO's assessment last year of the doses of radiation received by the population in the area provided the basis for the health-risk estimates in today's report. 

The report, drafted by a panel of international experts in radiation risks and public health, concluded that there was no additional cancer risk for the population in most of Japan — even most parts of Fukushima Prefecture — or in neighbouring countries. But the risks were slightly increased in hotspots such as Iitate village and Namie town, which were contaminated by plumes of fallout to the northwest of the plant. 

In such hotspots the WHO panel estimated that the fallout has increased the risks of most cancers in children by only a few percent — though for thyroid cancer in young girls the increased risk was put at 70%. These figures are relative risks, however, and the absolute risks are less alarming. For thyroid cancer the baseline lifetime rate in women is 0.75%, so the risk in hotspots would be increased by 0.50%. 

"Given the projected very low frequency, 3.2 per 10,000, of radiation-associated thyroid cancer among young people, it is unlikely that any excess would be detectable by the usual epidemiologic approaches," says Roy Shore, head of research at the Radiation Effects Research Foundation in Hiroshima, and a co-author of the WHO report. Most emergency workers were estimated to have minimal increased risks but around one-third had a small but significant increase in cancer risks. 

Experts will probably argue intensely over the report during the coming weeks and months. Although many say the report is well done, the exercise largely depended on modelling of radiation doses rather than on direct measurements of population exposures, and the data were often sub-optimal. 

"One of the major problems for those of us interested in estimating the public-health consequences of the accident has been the paucity of reliable data," says Baverstock. "That problem still persists. If the WHO data are not better than we have been able to obtain, then the resultant estimates will be of limited value." 

Geraldine Thomas, a radiation-health expert at Imperial College London, argues that the report's cancer risks are likely be overestimates, as its authors openly erred on the side of caution in various assumptions. 

"Very few members of the population will have been exposed to any more than a lifetime dose equivalent to a single whole-body CT scan," she says.

WHO: Global report on Fukushima nuclear accident details health risks

WHO has published Global report on Fukushima nuclear accident details health risks. The news release:

A comprehensive assessment by international experts on the health risks associated with the Fukushima Daiichi nuclear power plant (NPP) disaster in Japan has concluded that, for the general population inside and outside of Japan, the predicted risks are low and no observable increases in cancer rates above baseline rates are anticipated. 

The WHO report ‘Health Risk Assessment from the nuclear accident after the 2011 Great East Japan Earthquake and Tsunami based on preliminary dose estimation’ noted, however, that the estimated risk for specific cancers in certain subsets of the population in Fukushima Prefecture has increased and, as such, it calls for long term continued monitoring and health screening for those people. 

Experts estimated risks in the general population in Fukushima Prefecture, the rest of Japan and the rest of the world, plus the power plant and emergency workers that may have been exposed during the emergency phase response. 

“The primary concern identified in this report is related to specific cancer risks linked to particular locations and demographic factors,” says Dr Maria Neira, WHO Director for Public Health and Environment. “A breakdown of data, based on age, gender and proximity to the nuclear plant, does show a higher cancer risk for those located in the most contaminated parts. Outside these parts - even in locations inside Fukushima Prefecture - no observable increases in cancer incidence are expected.” 

In terms of specific cancers, for people in the most contaminated location, the estimated increased risks over what would normally be expected are: 

• all solid cancers - around 4% in females exposed as infants; 

• breast cancer - around 6% in females exposed as infants; 

• leukaemia - around 7% in males exposed as infants; 

• thyroid cancer - up to 70% in females exposed as infants (the normally expected risk of thyroid cancer in females over lifetime is 0.75% and the additional lifetime risk assessed for females exposed as infants in the most affected location is 0.50%). 

For people in the second most contaminated location of Fukushima Prefecture, the estimated risks are approximately one-half of those in the location with the highest doses.

Mike Coston at Avian Flu Diary has the story with some helpful commentary.

Measles epidemic affects thousands in DR Congo

Via IRIN Africa: Measles epidemic affects thousands in DRC. Excerpt:

A measles epidemic has affected tens of thousands of children in northern Democratic Republic of Congo (DRC), overwhelming health facilities, says medical charity Médecins Sans Frontières (MSF). 

“Most health centres are either not functional, out of medical stocks or inaccessible for the majority of the population. Many children die in their villages because the health facilities cannot provide adequate care,” Anja De Weggheleire, MSF Medical Coordinator in DRC, told IRIN via email. 

“The disease is extremely contagious and can spread quickly in countries like DRC, which have large gaps in their healthcare system,” MSF said in a statement. 

Measles mostly affects children and can cause complications including pneumonia, malnutrition, severe dehydration, ear infections and eye infections that can lead to blindness. 

Despite the availability of a vaccine for the disease, measles remains one of the biggest killers of children. 

According to MSF, measles can kill between one and 15 percent of unvaccinated children who contract the disease and up to 25 percent of malnourished or vulnerable groups with limited access to healthcare. 

Since March 2012, MSF says it has treated more than 18,000 patients and vaccinated 440,000 children in DRC’s Equateur and Orientale provinces.

Indonesia: Three doctors infected with HIV/AIDS in Surabaya in 2012

Via The Jakarta Globe: Three Doctors Infected With HIV/AIDS in Surabaya Last Year.

The Institute of Tropical Disease at the University of Airlangga in Surabaya, East Java, revealed on Wednesday that three doctors practicing in the city were infected with HIV/AIDS last year. 

Although it remains unknown how they contracted the virus, it is believed that the doctors likely caught it after handling HIV/AIDS patients. 

ITD chairman Nasronudin noted that doctors who ignored medical procedures were more likely to develop HIV/AIDS, and he reminded medical workers to continue to exercise caution since doctors and paramedics are very prone to contracting the disease.

Solomon Islands: More on the dengue outbreak

Via Radio New Zealand International: Solomon Islands coping with hundreds infected with dengue fever. Excerpt:

The World Health Organisation in Solomon Islands says four new cases of dengue fever were detected in Gizo on Wednesday while there are now over 300 suspected cases of the illness in Honiara. 

Country Representative Dr Juliet Fleischl says surveillance has increased since January when clinics noticed an increase in the number of people attending clinics with dengue symptoms such as high fever. 

She says earlier this week teams visited Malaita and Guadalcanal as part of a step up in training and surveillance and there were no cases found in either province. 

Dr Fleischl is asking for the public to help limit the outbreak by clearing water from around their homes where the mosquito carriers breed, as well as using insect repellent and bed nets. 

She says the increase in cases is related to more surveillance. 

“The initial outbreak was recognised in early 2013. There are now over 300 suspected dengue cases reported in Honiara. And yesterday four new cases were reported in Gizo. This is not an explosive outbreak.”

Haiti and cholera: The Micawber solution

Via The Guardian: Haiti launches 10-year plan to eradicate cholera yet UN funds fall short. Excerpt:

The Haitian government's $2.2bn (£1.5bn) 10-year plan to eradicate cholera was launched on Wednesday against the backdrop of the UN's rejection of a legal claim from more than 5,000 victims. They had demanded compensation for the deadly cholera epidemic, the worst to hit any country in modern history. 

Since October 2010, the epidemic has killed more than 8,000 people and infected nearly 648,000, according to the ministry of health. The outbreak has been blamed on the UN peacekeeping mission. 

"Haiti, with 10 million people, has seen almost twice as many patients as the entire continent of Africa with over a billion people," said Oliver Schulz, regional head of Médecins sans Frontières, one of the few NGOs still treating cholera in Haiti's capital, Port-au-Prince. 

The first two years of the plan call for an investment of almost $500m. Over 10 years, the aim is to increase access to potable water from 69% of the population to 85%; to toilets and latrines from 27% to 90%, and to healthcare from 54% to 80% – while strengthening education, infrastructure and government capacity. 

However, the plan is being launched amid waning commitments from international donors, in a country with fragile government capacity, and in the midst of a crisis. 

Dr Daniele Lantagne, a US cholera expert specialising in emergency water and sanitation interventions in developing countries, said she is concerned about the level of funding and the government's ability to deliver quick results. 

"Expecting large outcomes within short timeframes is not realistic," she said, adding that building infrastructure takes five to 10 years. 

Others, including top UN officials, say Haitians need to be given greater responsibility to solve the crisis. Before the plan was announced, nearly $200m had been raised for cholera, but less than 3% of that money went to the government of Haiti; almost 24% went to the UN and its agencies. 

"We need to do much more to strengthen Haitian institutions to be able to respond [rather] than having a massive influx of external resources," Nigel Fisher, head of the UN mission in Haiti, told the Guardian ahead of the announcement. 

According to Fisher, funding is tight – the UN has committed only $23.5m on top of money it has already spent on cholera. This compares with the $650m the UN spends annually on the troops that brought the epidemic to Haiti. 

"We're very conscious that the fund we've raised so far is very small," Fisher said. "There are major philanthropic foundations out there, there are major venture philanthropist individuals – we need to go to the private sector."

It's a solution right out of Charles Dickens. Like Mr. Micawber, Fisher seems to think that something will turn up to rescue the UN and Haiti from one another...preferably a good-hearted billionaire.

Sudan: Hepatitis ‘kills 20, infects 300’ in Blue Nile state

Via Radio Dabanga: Hepatitis ‘kills 20, infects 300’ in Sudan’s Blue Nile state.

The population of Albow locality in Blue Nile state is complaining about the high incidence of hepatitis in the area, although the exact death toll remains inconclusive.   

Locals told Radio Dabanga on Wednesday that at least 20 people died of the disease and that some 300 are infected. 

However, the general director of the state’s ministry of health Dr. Amir El-Sheikh says that three people have died so far including a pregnant woman in the El-Shahid area. 

He denied the increasing incidence of hepatitis among citizens, although sources expressed their discontent to Radio Dabanga about the state’s “delay” in dealing with the epidemic.

In other news from Sudan, Radio Dabanga says 30 percent of the children in North Darfur are malnourished, and 23 children in Central Darfur have died from drinking water polluted by toxic bombs.

Mexico: 500,000 chickens to be vaccinated against H7N3

Via El Universal: Vacunarán a 500 mil aves contra gripe aviar en Michoacán. [500,000 birds to be vaccinated against avian flu in Michoacán] This a state neighbouring Guanajuato, where the outbreak has so far been contained. Excerpt, with my translation:

La delegación en Michoacán de la Secretaría de Agricultura, Ganadería, Desarrollo Rural, Pesca y Alimentación (Sagarpa), anunció este miércoles que la próxima semana se vacunarán contra la gripe aviar un total de 500 mil aves ponedoras de granjas del estado. 

The Michoacán office of the Secretariat of Agriculture, Livestock, Rural Development, Fish and Alimentation (Sagarpa) announced this Wednesday that it will vaccinate a total of 500,000 poultry in farms within the state.

Esteban Cruzaley Díaz Barriga, delegado de la Sagarpa, aseguró que hasta hoy el fenómeno de la gripe aviar no se ha detectado en la entidad, pero señaló que la vacuna es una medida de prevención. 

Esteban Cruzaley Díaz Barriga, spokesperson for Sagarpa, said that as of today the avian flu has not been detected in the state, but the vaccine is a preventive measure.

La Sagarpa establecerá cuatro unidades móviles para la vacunación y atención de las aves en la entidad.

Sagarpa will establish four mobile units to vaccinate and inspect birds in the state.

Cambodia: H5N1 chronology to February 25

Here's an update of my running H5N1 chronology for Cambodia's current outbreak.

January 8: An 8-month-old boy shows the first symptoms of H5N1 in Chrey Korng village, Phnom Penh. This is part of the metropolitan region, with several good hotels.   

January 9: The boy goes to the National Pediatric Hospital. He's tested and confirmed as H5N1 on January 22 (2nd case). He is reported recovered in the January 25 news reports that break the story.   

January 11: A 15-year-old girl in Snao village, Takeo province, falls ill. This province is south of Phnom Penh and on the border with Vietnam. I can't find the precise location of the village.   

January 13: A 35-year-old man falls ill in Trapeang Sla, Kampong Speu province, west of Phnom Penh.  A 17-month-old girl (4th case), also in Kampong Speu, shows symptoms.  

January 17: The 15-year-old girl enters Kantha Bopha Hospital. So does the 17-month-old. 

January 19: A 9-year-old girl in Thmei commune, Kampot province, shows symptoms.  

January 21: The 35-year-old man admitted to Khmer-Soviet Friendship Hospital in Phnom Penh. Samples are taken; he dies soon after. The 15-year-old girl also dies on this day.   

January 25: A 5-year-old girl from Prey Kabass commune, Takeo province, falls ill.  

January 26: 17-month-old girl in Kampong Speu province diagnosed with H5N1.   

January 27: The 9-year-old from Kampot is admitted to Kantha Bopha.  

January 28: The 17-month-old girl dies in Kantha Bopha. So does the 9-year-old girl from Kampot.  

January 31: The 5-year-old girl from Prey Kabass is admitted to Kantha Bopha after several days of private treatment.  

February 3: A 3-year-old girl from Ang Phnom Toch commune, Kampot province, develops a red rash.  

February 6: The 3-year-old girl is admitted to Kantha Bopha with fever, abdominal pain, and somnolence. She is the 7th case this year. The 8th case, a 20-month-old boy from Ang Romduol village, Kampot province, develops fever and runny nose. 

February 7: The 5-year-old girl from Prey Kabass dies in Kantha Bopha.

February 8: Thoeun Doeun, a 35-year-old man in Kbal Ou village, Kompong Cham province, develops a fever. He is the 9th H5N1 case.

February 10: Thoeun Doeun develops frequent cough and dyspnea. He is treated by local private practitioners.  

February 13: The 3-year-old dies in Kantha Bopha. Thoeun Doeun is admitted to Kompong Cham hospital and immediately treated with Tamiflu.

February 18: The 20-month-old boy, after private treatment, is admitted to Kantha Bopha Hospital with fever, cough, and dyspnea. 

February 19: The 20-month-old boy dies in Kantha Bopha. He is the 8th case and 7th fatality in Cambodia in the six weeks between January 8 and February 19th. 

February 21: Thoeun Doeun develops pneumonia; he is transferred to Calmette Hospital in Phnom Penh. 

February 25: Thoeun Doeun, Cambodia's 9th H5N1 case, become its 8th fatality. He is the country's 30th case and 27th death, bringing the country's case fatality rate to 90 percent.

A couple of points: Over a week before his transfer to Phnom Penh, Thoeun Doun was being treated with Tamiflu, so the authorities must have a strong suspicion he had H5N1. Yet they did not move him until he developed pneumonia.

Secondly, by the 21st it must have been clear that he was gravely ill with H5N1. but as with all the other cases, the authorities said nothing until he died. (The first case, of the baby boy who survived, was unknown until his recovery was announced on January 25.) 

As a crisis-communication issue, this turns each case into a blip; the government could get its people's attention much more effectively if each case turned into an ongoing story, giving the Ministry of Health more chances to warn people about the threat they're facing. 

This makes me wonder if still more H5N1 cases are in intensive care in Phnom Penh's hospitals, about whom we will know nothing until they die or return alive to their grateful families.
 
If there's any consolation in all this, it's that we can still count the cases. When we lose count, as happened very early on in Haiti, we're really in trouble.