H5N1

Nepal: H5N1 situation ‘getting out of hand’

Via eKantipur.com: Avian flu situation ‘getting out of hand’. Excerpt:

As the Capital on Tuesday witnessed the 15th bird flu outbreak in the last two weeks, health experts warned that the spread of the H5N1 virus has gone out of control and called for an immediate and more coordinated intervention from the government. While they say a government decision is being delayed due to strong lobbying from people in the poultry sector, the Nepal Chicken Sellers Business Association refuted such a claim. 

Since the first outbreak in a poultry farm in Matatirtha and Chabahil on July 16, the virus has claimed over 25,000 chickens in Kathmandu, Bhaktapur and Lalitpur districts.  Animal health authorities on Tuesday confirmed the flu in two more poultry farms in Bhaktapur. Tests on chicken samples were conducted by the Central Veterinary Laboratory at Tripureshwor in Kathmandu. 

According to the experts, farmers selling the potentially infected chickens in the market in the absence of effective monitoring has worsened the situation. “There is total impunity; the authorities know who is at fault, but still they have failed to take immediate action,” said Dr Shital Kaji Shrestha, General Secretary of the Nepal Veterinary Association. 

While some farmers have dumped dead birds openly in public places, others have buried them secretly without following the standard procedures. Such practices have increased the chances of the epidemic spreading, experts said. The police on Monday seized 426 chickens that were being transported to Birgunj for sale from a flu-affected farm in Bhaktapur. 

Government officials concede that the existing measures fall way too short of what is required to combat the ‘epidemic’ and that this fact has led to the situation going out of hand.

NEJM on person-to-person spread of MERS

Via NEJM, an editorial: Person-to-Person Spread of the MERS Coronavirus — An Evolving Picture. Excerpt:

Approximately 1 year ago, a novel coronavirus, the Middle East respiratory syndrome coronavirus (MERS-CoV), was first identified in the Journal as the causative agent of a lethal pneumonia in several patients in the Middle East.1 As of July 10, 2013, a total of 80 cases have been identified in the Middle East (Saudi Arabia, Jordan, Qatar, and the United Arab Emirates), Europe (United Kingdom, France, Italy, and Germany), and North Africa (Tunisia), with a case fatality rate of 56%. 

Since this coronavirus is a close relative of the virus that caused the severe acute respiratory syndrome (SARS), a short-lived but alarming epidemic in 2002–2003 that resulted in approximately 8000 cases and 800 deaths, governmental, public health, clinical, and laboratory authorities all mobilized rapidly to respond to the new virus outbreak. 

Soon after the identification of MERS-CoV, information about its genomic sequence and organization, species tropism, and host-cell receptor (dipeptidyl peptidase 4) was published.2,3 These initial studies did not identify the source of this newly identified virus, nor did they reveal whether MERS-CoV could be transmitted from human to human, a requirement for designation as an epidemic disease. 

In this issue of the Journal, Assiri et al.4 describe the largest outbreak of MERS-CoV infection thus far, showing that the virus is transmitted from human to human. This outbreak occurred in several hospitals in the governorate of Al-Hasa in eastern Saudi Arabia, with transmission probably occurring in dialysis units, intensive care units, and wards. Most patients had underlying diseases, with a remarkable number (17 of 23) having diabetes. 

In addition to showing that human-to-human transmission occurred frequently, the relatively large number of patients infected in this outbreak made it possible to define characteristics of the infection, such as the incubation time (5.2 days) and the serial interval (7.6 days). As seen in the SARS epidemic, there was variability in the numbers of patients infected by each index patient, with 1 patient transmitting virus to 7 contacts; superspreading events, in which a few patients infected large numbers of contacts, were critical factors in SARS reaching epidemic proportions. 

The study by Assiri et al. shows that MERS-CoV has the potential to spread widely within health care settings, infecting primarily other patients but also health care workers and family contacts, although to a lesser extent. Patients with diabetes or chronic renal failure appear to be at especially high risk for severe MERS-CoV infection, but whether these coexisting conditions represent true risk factors or whether these patients happened to be preferentially exposed to index cases is not known, given the relatively small number of infected patients. 

Also unclear from this study is the extent to which MERS-CoV infection is a systemic disease. Acute renal failure developed in several patients with the infection,1,5-7 possibly reflecting a high level of dipeptidyl peptidase 4–receptor expression in the kidney. However, in the absence of tissue samples obtained at surgery or autopsy, it has been difficult to determine the extent to which kidneys or other organs are infected. 

Although the report by Assiri et al., as well as others in the Journal and elsewhere,6,7 indicates that human-to-human transmission occurs, at least in the context of close contact, many additional questions related to the transmission of MERS-CoV and its ability to reach epidemic proportions are unanswered.

The article discussed in this editorial is Hospital Outbreak of Middle East Respiratory Syndrome Coronavirus. Meanwhile, the KSA Ministry of Health hasn't posted any updates since July 18.

Saudi Arabia: Another reason not to get MERS

Credit: Saudi Gazette

Via Arab News: Patients forced to bring own appliances to hospital rooms. This seems strange in a country that literally has energy to burn, and it suggests other Saudi hospitals may not be able to deal effectively with MERS patients and others requiring intensive care.

Patients at a hospital in Riyadh are forced to bring their own portable mini air-conditioners and other appliances to keep themselves comfortable following frequent breakdowns of air-conditioning units in the hospital. 

Inpatients and their families have been complaining about this never-ending problem that forces them to bring in their own appliances until they are fit to leave the hospital. 

According to a source, the problem has been dogging the hospital for the past two years. The Ministry of Health is also aware of the issue. “We have brought it to the notice of the Ministry several times through letters and faxes but so far, there has been no solution,” he said, adding that the air-conditioners in place were installed 29 years ago. 

Prince Salman bin Abdulaziz Hospital serves residents in the west of Riyadh, including the neighborhoods of Dhahra, Al-Badiea, Al-Urajaha, a limited-income neighborhood, Al-Swaidi and Shabra. 

According to official statistics, over 2 million people reside in these neighborhoods. “The load on the hospital is huge, with several patients referred to the hospital every day despite limited medical services available,” an official pointed out. 

He called on the Ministry of Health to move fast and solve the problem and develop other services at the hospital. Any visitor walking through the hospital’s corridors can see these mini air-conditioners in both the men’s and women’s sections put in place to beat the summer heat. 

A visit to the hospital by a reporter revealed several other shortcomings that need urgent addressing, including the low-quality level of treatment and services offered to patients and visitors alike. 

Although one can see new buildings constructed beside the main building of the hospital, they are yet to become operational. 

Hospital sources have said that patients can’t take the heat in their rooms, although healthcare services mandate the provision of temperature-controlled rooms for patients’ comfort. “We can’t afford this, so we ask the patients to bring their own appliances until the problem is solved,” he said. 

One patient said his room’s airconditioner has not been working since the beginning of Ramadan. “The temperature is unbearable in the room, so I was forced to buy my own portable air-conditioner,” he said, adding that the hospital served a huge number of patients because of its location in highly populated neighborhoods. 

Some social networking sites have held debates in the past few days on the poor medical services and treatment provided by the hospital.

Canada: Norovirus outbreak waning after Victoria seniors’ home reports nine dead

Via The Globe and Mail: Norovirus outbreak waning after Victoria seniors’ home reports nine dead. Excerpt:

A norovirus outbreak at a seniors’ home in Victoria is unusual for the way it hit the facility, but now “on the wane” after making 100 patients and 50 staff sick, and being suspected as the cause of nine deaths. 

“It’s on the wane. It seems to have been brought under control. There’s very few new cases that are showing up. We have only 11 residents currently affected,” said Sarah Plank, a spokesperson for the Vancouver Island Health Authority. 

“It seems to be being brought under control,” she said in an interview on Wednesday. 

While there have been nine deaths since the outbreak began at Selkirk Place on July 11, Ms. Plank said they cannot yet be attributed to the virus pending further analysis. 

The virus broke out with 40 people suddenly affected – a scenario that suggests a common exposure, said Ms. Plank. 

“It’s not unheard of, but it is unusual in the sense that a fairly significant number of people fell ill right away, which meant it spread to quite a few more people than it might have in a more typical outbreak situation.”  

Noroviruses are part of a group of viruses that cause the stomach flu, and the health authority says they are common in long-term care homes and are spread by people who don’t wash their hands.

Haiti: 8,197 cholera deaths as of July 28

MSPP has posted another week's worth of cholera statistics on its Documentation page. As usual two or more departments failed to report at least once during the week, so the numbers are incomplete.

Also as usual, the total daily cases (810) don't match the cumulative total cases since October 2010, which rose by 1,148 cases during the week. That number on the 28th was 668,270; so over two-thirds of a million Haitians have contracted cholera.

For once, the daily and cumulative death totals actually match, with 7 deaths during the week and a cumulative total of 8,197.

I think we can call Haiti's cholera the single greatest failure of the global health system, since not one of those cases or deaths was inevitable; all were the result of meddling (however well-meant) by the international community, followed by that community's wretched denial of responsibility (clearly self-interested).

The early history of MERS

WHO's Eastern Mediterranean Health Journal has published EMRO | Volume 19, supplement 1 (Coronavirus). This seems likely to become the standard set of references for the first 18 months of MERS.

I haven't had time to read all the articles, but I did read a report on the investigation of the first cases in Jordan. While it answers a lot of questions, it raises others: The first case was a 25-year-old university student with no contact with animals and no travel, whose onset was on March 21. He was admitted to Zarqa hospital in April 4, put into critical care next day, and then transferred to a hospital in Amman where he died on April 25. Two of his caregivers in Zarqa fell ill, but his mother did not.

Intriguingly, Case 2 was probably a 30-year-old male nurse whose onset was estimated as March 29—days before the university student was admitted. The nurse spent time in critical care but recovered and was discharged on April 23. Similarly, Case 3, a 40-year-old ICU nurse, had onset of symptoms on April 2, two days before the admission of Case 1.

Something, clearly, was in the environment of Zarqa and its hospital. I hope this is just the first of numerous studies of the origins of MERS.

China: At least 10 dead in Shanghai as record temperatures top 40ºC

Here in Vancouver we've just completed our sunniest, driest July in history. But our temperatures have been little more than half as high as those in Shanghai. Via the South China Morning Post, an AFP report: At least 10 dead in Shanghai as record temperatures top 40c. Click through to see the video mentioned in the report.

More than 10 people have died in China’s commercial hub Shanghai, a local health official said on Wednesday as the city grapples with its highest temperatures in at least 140 years. 

Much of China is in the grip of a summer heatwave, and the China Meteorological Association issued a high temperature warning for several eastern and central provinces, saying temperatures could reach 41 degrees Celsius on Wednesday. 

Leng Guangming, a spokesman at the Shanghai Municipal Centre for Disease Control and Prevention, said there had been at least 10 victims of heat stroke up to last Friday in the city. He declined to give a more precise or more recent number. 

City forecasters said temperatures were “rising rapidly” and could reach 40 degrees [104ºF] in People’s Square on Wednesday. 

Experts blame a subtropical high pressure system and a lack of rain for the record-breaking heatwave, according to state media. 

Pictures have shown people sheltering from the heat in air-conditioned shops or subways, and trying to cool off in swimming pools and rivers. 

Footage of a slice of pork cooked through in 10 minutes on outdoor stone slab, taken by a Shanghai TV station, has gone viral online. 

“It turns out that the only difference between me and roast meat is a pinch of cumin,” joked one user of Sina Weibo. 

Tuesday was the eighth consecutive day with temperatures above 38 degrees in Shanghai, the official Xinhua news agency reported, citing the local weather bureau. 

The temperature reached 40.6 degrees last Friday, topping a previous high of 40.2 degrees in 1934 and the highest since records began in 1873, Xinhua said earlier.

Ecuador reports 137 H1N1 cases, 11 deaths

Via Xinhua: Ecuador reports 137 H1N1 cases, 11 deaths.

The H1N1 Influenza A virus has killed 11 and infected 137 people this year in Ecuador, spreading to 14 provinces out of its 24 provinces, the Ministry of Public Health said Tuesday. 

The latest report said 4 deaths were registered in the Andean province, while the province of Pichincha had most infections of 56 cases. 

"These figures fall within the range expected by the Pan American Health Organization," said Norma Armas, national undersecretary of Public Health Monitoring. 

She added the Ministry of Public Health has been monitoring the spread of the disease on a daily basis since March. 

Last week, the ministry banned the over-the-counter sale of cold remedies, anti-inflammatories and pain-relief remedies that can only be acquired by prescription, warning that self-medication can hide the symptoms of the virus and make the situation worse. 

The H1N1 virus first appeared in Ecuador during a worldwide pandemic in 2009, killing at least 14 people and infecting as many as 2,251. 

Last year, the health ministry vaccinated 3.5 million people. It plans to vaccinate another 4 million in October and November this year.

Honduras declares dengue emergency

Via ElHeraldo.hn: Emergencia en Salud por epidemia de dengue. [Health emergency over dengue epidemic] Excerpt, with my translation:

El Consejo de Ministros decretó esta martes estado de emergencia en salud, que le permite a las autoridades del ramo obtener los fondos necesarios para la lucha contra el dengue. 

The Council of Ministers this Tuesday declared a state of health emergency, permitting the authorities in the ministry to obtain funds needed for the struggle against dengue.

El ministro de Salud, Salvador Pineda presentó el proyecto de decreto en la reunión del Consejo que se realizó en Roatán, Islas de la Bahía. 

Health Minister Salvador Pineda presented the proposed decree at the meeting of the Council held in Roatán, Bay Islands.

Pineda detalló que se necesitan 87 millones 575 mil lempiras para hacer frentes a esta enfermedad, que incluye desde las campañas de prevención hasta el tratamiento de los pacientes en los centros de asistenciales del país. 

Pineda explained that 87,575,000 lempiras [US$4.29 million] are needed to deal with the disease, including prevention campaigns and treatment of patients in the country's hospitals.

El informe de casos hasta la semana epidemiológica número 28 reporta la muerte certificada de 15 personas , 12,135 casos de dengue clásico y 1839 casos de dengue grave o hemorrágico.

The report for epidemiological week 28 lists the certified deaths of 15 persons, 12,135 classic dengue cases, and 1,839 cases of severe or hemorrhagic dengue.

UAE: Call for unified MERS guidelines

Via Khaleej Times: Mers: Call for unified guidelines. Excerpt:

Unified local and national guidelines are needed for healthcare workers for a better dealing of any suspected Middle East Respiratory Syndrome coronavirus (Mers-CoV) cases in the UAE, according to an infection control expert. 

Till date, the UAE has reported six cases of the virus of which four are healthcare workers who were handling an infected 82-year-old patient in Abu Dhabi. 

The patient and workers – two nurses and two doctors - are said to be in a stable condition. “The infection was due to the negligence of the healthcare workers who did not take the necessary precautions…people are lax and that is why we need guidelines,” said Dr Ashraf Mahmoud El Houfi, Chairman of the Infection Control Committee UAE. 

“We are living in a dangerous environment be it Mers-CoV, Sars or any other virus, we need to take the necessary precautions,” he added. 

Dr El Houfi said that all healthcare workers needed to stick to the infection control protocol for suspected cases including wearing surgical masks, keeping a 3-foot distance among others. 

“However, we need to re-educate them again on how to deal with suspected cases.” Plans are to send letters of orientation to healthcare workers on how to handle suspected cases. 

He also added that despite the rate of fatalities of the infected cases, the virus could not be termed ‘deadly.’ “The patients who died had co-morbidities,” he said. 

Speaking to Khaleej Times earlier this month, a top official from the World Health Organisation (WHO) had said that remaining informed was the key prevention against the disease especially if the virus was new.