H5N1

Indonesia: 100 hospitals prepare against coronavirus

Thanks to Lucie Lecomte for sending the link this report from Tempo.co: 100 Hospitals Prepare against Coronavirus. Excerpt:

The Health Ministry has prepared 100 hospitals around the nation to anticipate the spread of the coronavirus from Muslims returning home from their pilgrimage to Saudi Arabia. 

Tjandra Yoga Aditama, director general of Disease Control and Environmental Health at the Health Ministry, says these hospitals were the ones referred to during the bird flu threat. 

However, Tjandra did not mention the location of the hospitals and simply said they are located throughout the archipelago and were selected because they have good emergency response teams that will help combat the corona virus. 

Canada: Norovirus kills nine people in Victoria

Via News1130.com: Norovirus kills nine people in Victoria. Excerpt:

Nine people have died this month as an outbreak ravages a residential care facility in Victoria. 

Dr. Richard Stanwick says the Norovirus has so far made 100 patients and 50 staff sick at Selkirk Place. “That really speaks to how infectious this particular virus is. You can catch it either from the person's vomit or diarrhea.” 

“One might suspect some sort of common exposure, you know, it could have been associated with food. This is one of those situations where we haven’t identified a common source.” 

He says this outbreak is unusual. “In most outbreaks they tend to be limited to a single floor, starting with a couple of patients. In many instances, we’re able to contain it to a wing, ward, or a floor of a long-term care facility. In this case, what was a little unusual, we had 40 individuals to start the outbreak. Because so many individuals fell ill, it did allow for this very catchy virus to affect this entire institution.”

Meanwhile, The Local in Sweden reports 19 Swedish kids at a Turkish rest are among the 30 persons suddenly ill with what also sounds like norovirus.

North Korea: Multi-drug resistant TB

Via The Atlantic, a disturbing report: The Airborne Infection That Beats Antibiotics: North Korea's Other Crisis. Excerpt:

There's a crisis brewing in North Korea that has nothing to do with nuclear weapons or six-party talks. Tuberculosis has long been recognized as one of the biggest public health problems in North Korea, but there is a disturbing new development: much of the TB in North Korea is resistant to regular antibiotics. 

Throughout the course of history, TB has killed more people than all other pandemics combined. The development of modern antibiotic therapy turned this feared plague into a treatable infectious disease. A six-month course of standard first-line TB drugs cures almost all patients with regular TB. 

But like any other infectious disease, TB can become resistant to antibiotics if not treated correctly. The most serious strains of drug-resistant TB, called "multidrug-resistant," or MDR-TB, don’t respond to treatment with first-line TB drugs. 

Treatment of MDR-TB relies on older and weaker drugs that are hundreds of times more expensive than regular TB drugs. Even in the U.S., a diagnosis of MDR-TB is very serious. A single patient may require medications costing thousands of dollars, months of hospitalization, and even surgery to cut out diseased lung. 

For North Korean patients, MDR-TB is basically a death sentence. 

Until now, there has never been any clear scientific evidence that drug-resistant TB is a serious problem in North Korea, mainly because North Korea does not yet have a laboratory with the capacity to do this sort of research. 

Nevertheless, evidence about drug-resistant TB is not difficult to find. I regularly travel to North Korea as part of my work with the Eugene Bell Foundation, a private non-profit organization that supports patients in the TB sanatoria that dot the North Korean countryside. The doctors who work in these sanatoria have been quite open about the fact that they have patients who are not being cured with regular TB drugs. They’ve suspected that these patients had drug-resistant TB, but they couldn't know for sure without access to laboratory testing. 

My research, published today in PLOS Medicine, analyzed sputum samples from more than 200 of these patients and found that the North Korean doctors were indeed correct—87 percent were proven to have MDR-TB.

Uganda: Nodding syndrome preys on the displaced

Via The Africa Report: Nodding syndrome preys on the displaced. This is one of the longer and more detailed reports I've seen recently. Excerpt:

Walter Ojok should be enjoying his life as a young teenage boy with all life's trials and tribulations. Instead, he lies hapless and nude on a stack of dry reeds, peering at the grass thatched roof of his family's hut, unable to communicate, always watched over.   

Ojok has the frame of four year old, and yet he is 14 years old. His body is miserably thin and frail, his back severely hunched and his eyes teary. He should, at 14, be able to construct sentences, but all he is able to say is 'wota...wota...' a desperate attempt to say his name. 

Ojok is afflicted with an unexplained neurologic condition called Nodding Syndrome, characterised by episodes of repetitive head dropping movements, and accompanied by seizures and convulsions, as well as 'staring' spells. 

Even as he is severely under-nourished, the sight of food acts as a trigger intensifying the symptoms. 

Ojok was born in Aware Camp, a refuge for those escaping the Lord's Resistance Army (LRA), who ravaged northern Uganda and abducted children for training as child soldiers. 

"At the age of eight my son started getting convulsions," said Ojok's mother, Alice Akwero. "When we tried to give him food, he would nod his head and begin to drool." 

Ojok would become the first child to display the condition's unique symptoms at Awere camp. Being susceptible to falling into fires or drowning, when convulsing or wandering off, Ojok required a carer at all hours of the day. 

When the family left the camp in 2007, after peace had returned to northern Uganda, Ojok's mother charged three of her children to remain at home to help with his upbringing. 

Hard Lessons 

Yet Ojok, while physically wasting away, is one of the luckier ones. 

Since the start of 2013, three children have died from the condition. 

According to last year's records from the Office of the Director-General at Uganda's Ministry of Health, more than 3000 cases were registered in the northern districts of Lamwo, Kitgum and Pader, where the condition was first registered in 2010. 

To date, 17 deaths have been reported. In Odek, where Ojok is based, over 300 children are known suffer from nodding syndrome.

Global warming: $60 trillion cost before counting public health impact

Via Nature Comment, published on July 24: Climate science: Vast costs of Arctic change. Excerpt:

We calculate that the costs of a melting Arctic will be huge, because the region is pivotal to the functioning of Earth systems such as oceans and the climate. The release of methane from thawing permafrost beneath the East Siberian Sea, off northern Russia, alone comes with an average global price tag of $60 trillion in the absence of mitigating action — a figure comparable to the size of the world economy in 2012 (about $70 trillion). The total cost of Arctic change will be much higher.

Click through and read the whole article. It deals with many aspects of intensified warming from the release of 50 gigatonnes of methane hydrates, and it notes that "Much of the cost will be borne by developing countries, which will face extreme weather, poorer health, and lower agricultural production as Arctic warming affects climate."

But "poorer health" means the explosive spread of waterborne diseases like cholera and vector-borne diseases like malaria and dengue, as well as the stunting of millions of children born into poverty and malnutrition.

We in the relatively rich nations will, as La Rochefoucauld famously observed, always find the strength to bear the misfortunes of others. But we may find our own misfortunes arrive too quickly anyway for us to spare any concern for the poorer nations.

India: 23 leptospirosis cases, 1 death

More health troubles in Mumbai. Via The Indian Express: One dies of leptospirosis, 23 cases reported this monsoon. Excerpt:

The city recorded its first death due to leptospirosis since the onset of monsoon this year. According to the BMC's health department, Jhantu Shaikh, 25, of Dharavi complained of breathlessness and cough, following which he was diagnosed with the ailment. 

"The deceased had a history of frequent alcohol consumption and was admitted to Sion Hospital on July 21," said Dr Mangala Gomare, deputy chief executive health officer at BMC. Shaikh died on July 25. 

Leptospirosis is caused by leptospira bacteria, which can be found in fresh water contaminated by animal urine. The symptoms, which develop after 10 days on an average, include dry cough, headache, nausea and shaking chills, Gomare added. 

According to the civic health department, 23 leptospirosis cases were reported in July. The same number of cases was reported in July last year. BMC Additional Municipal Commissioner Manisha Mhaiskar said, "If we compare the data with last year, cases of malaria, dengue and leptospirosis have remained static." In July, 1,076 cases of malaria and 62 cases of dengue were reported, as opposed to 1,485 malaria and 60 dengue cases recorded in July last year. 

However, there has been a significant rise in the cases of cholera, with 12 recorded in June and 40 recorded this month. Last year, no case of cholera was reported. 

Cases of gastroenteritis have shot up with 2,481 cases recorded in July, while last year there were 1,592 cases in July.

India: Mumbai acknowledges cholera cases for 1st time in 5 years

Via the Mumbai Mirror: BMC acknowledges cholera cases for 1st time in 5 years. Excerpt:

For the first time in the last five years, BMC  [Brihanmumbai Municipal Corporation]  has acknowledged cholera in the city, with 52 cases reported this year. Of these, 42 were reported in July and 12 in June. 

Transmitted through contaminated water and food, the increasing number of cholera cases has now sent alarm bells ringing at the civic body. 

"Cholera is a concern right now. Our lookout is to detect cases at the earliest so that there are no fatalities," said additional municipal commissioner Manisha Mhaiskar. 

All these cases were detected through culture tests. A hanging drop test can also be conducted to detect the disease but BMC officials rely on only the culture tests. 

Senior physician Dr Pratit Samdani, however, said that if a patient had classic symptoms such as acute gastroenteritis, severe diarrhoea and vomiting, and if the hanging drop test was positive, he or she should be counted as cholera patient. 

The waterborne disease, also known as an infectious gastro-enteritis, is caused by the bacterium Vibrio cholerae. The BMC has advised against eating roadside food and drinks and urged people to boil water before consumption. According to the officials, the 'E' ward including Byculla has been especially affected.

US: Multidisciplinary, multifaceted approach to C. difficile prevention

Via the always interesting blog Controversies in Hospital Infection Prevention: Multidisciplinary, multifaceted approach to C. difficile prevention - It works! Excerpt:

Clostridium difficile - bad. 

Many good people doing a lot of good things to prevent C. difficile - Priceless 

That's the basic summary of a recent report  in The Joint Commission Journal on Quality and Patient Safety by Len Mermel and colleagues at Rhode Island Hospital. Faced with a high burden of CDI, they implemented a series of six "interventions" targeting C. difficile between 2006 and 2012.  

These interventions were: (1) develop a C. difficile hospital infection control plan based on a risk assessment; (2) monitor hospitalwide morbidity and mortality associated with C. difficile infection; (3) improve sensitivity of C. difficile toxin detection in stool specimens using a PCR assay; (4) enhance environmental cleaning of patient rooms and equipment; (5) develop a C. difficile infection treatment plan; and (6) conduct other interventions including attempting antimicrobial stewardship. 

Overall, the results were impressive with a 70% reduction in incidence. From a peak of 12.2 cases per 1000 discharges in 2006 rates fell to 3.6/1,000 discharges in 2012 with comparable declines in CDI-related mortality.

Cuba: Three cholera deaths reported in Las Mangas prison

Via Hablemos Press: Ya suman tres los prisioneros muertos en la cárcel de Bayamo producto del cólera. [Three prisoners now dead of cholera in Bayamo prison] Bear in mind that this comes from a dissident website and its chief sources are convicts. That said, the report still deserves attention (not to mention a response from the government). The full report, with my translation:

Otros dos prisioneros murieron, el 28 de Julio, en la cárcel provincial de Granma, conocida por Las Mangas, y otros siete permanecen grave producto de la epidemia de cólera que ha infectado a más de 30 reclusos en ese centro. 

Two more prisoners died on July 28 in the Granma provincial prison known as Las Mangas, and another 7 are in critical condition due to the cholera epidemic that has infected over 30 convicts in the centre.

Con estas dos muertes ya suman tres los fallecidos por cólera en la cárcel Las Mangas. El primer fallecido de esta temporada fue Yoneidis Ríos Palomino, que murió, el 26 de Julio. 

With these two death, the total of those dead from cholera in Las Mangas is now three. The first death this season was Yoneidis Ríos Palomino, who died on July 26.

Palomino tenía 31 años de edad, era natural del poblado Veguitas, a unos 28 kilómetros del municipio Bayamo, en la provincia Granma. 

Palomino was 31, a resident of the hamlet of Veguitas, some 28 km from Bayamo municipality in Granma province.

El cantante de hip hop Ángel Yunier Remón Arzuaga, detenido desde marzo en Las Mangas, fue trasladado de urgencias el lunes hacia el Hospital Celia Sánchez del municipio Manzanillo debido a las abundantes diarreas y vómitos que presenta, informaron varios reclusos. 

The hip-hop singer Ángel Yunier Remón Arzuaga, detained in Las Mangas since March, was urgently moved Monday to the Celia Sánchez Hospital in Manzanillo owing to abundant diarrhea and vomiting, several convicts reported.

Alexander Otero, compañero de causa de Ángel Yunier se declaró en huelga de hambre el lunes “para llamar la atención de la opinión pública sobre la epidemia, que está cobrando vidas aquí en Las Mangas”, dijo un prisionero también recluido en ese centro que no damos a conocer su nombre para protegerlo. 

Alexander Otero, a comrade in the cause of Ángel Yunier, declared himself on a hunger strike on Monday "To call the public's attention to the epidemic, which is taking lives here in Las Mangas," said another prisoner whose name we won't release to protect him.

El prisionero comentó que un reo murió también el 29 de Julio luego de que carceleros le propinaran una golpiza cuando protestaba que lo trasladaran a un Hospital. 

The prisoner said another prisoner died on the 29th after the guards gave him a beating when he demanded to be taken to a hospital.

“Dicen los guardias que se ahorcó en la celda, pero todos sabemos que lo mataron a golpes y luego lo colgaron para hacer creer que se había suicidado”.

"The guards say he hanged himself in his cell, but we all know they beat him to death and then they hanged him to make it look as if he'd committed suicide."

WHO: July 29 MERS update

WHO has published Middle East respiratory syndrome coronavirus (MERS-CoV) - update. It adds nothing to what we know already, but it's now on the official record. Excerpt:

WHO has been informed of an additional laboratory-confirmed case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in Saudi Arabia. 

The patient is an 83-year-old man from Assir region who became ill on 17 July 2013 and is currently hospitalized. 

Additionally, a previously laboratory-confirmed case, also from Assir region, has died. 

Globally, from September 2012 to date, WHO has been informed of a total of 91 laboratory-confirmed cases of infection with MERS-CoV, including 46 deaths. 

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns.

In other non-news, I still don't see these cases reported by the KSA Ministry of Health.