H5N1

Fukushima: Still more bad news

Via The New York Times: Radiation Near Japanese Plant’s Tanks Suggests New Leaks. Excerpt:

TOKYO — A crisis over contaminated water at Japan’s stricken nuclear plant worsened on Saturday when the plant’s operator said it had detected high radiation levels near storage tanks, a finding that raised the possibility of additional leaks. 

The operator, Tokyo Electric Power Company, or Tepco, said it had found the high levels of radiation at four separate spots on the ground, near some of the hundreds of tanks used to store toxic water produced by makeshift efforts to cool the Fukushima Daiichi plant’s three damaged reactors. The highest reading was 1,800 millisieverts per hour, or enough to give a lethal dose in about four hours, Tepco said. 

The contaminated spots were found as Tepco employees checked the integrity of the tanks after a leak two weeks ago released 300 tons of toxic water into the Pacific. That leak prompted Prime Minister Shinzo Abe to announce that the government would step in at the plant, which was crippled two years ago by a huge earthquake and tsunami, to help get it under control amid rising public fears of a second environmental disaster. 

Saturday’s discoveries suggested that there may have been other leaks from the tanks, many of which appear to have been shoddily built as Tepco has scrambled to find enough storage space for the contaminated water being produced by the plant. However, Tepco said that it had found no evidence of fallen water levels in nearby tanks, making it unclear how much water, if any, may have leaked out, and whether any reached the Pacific, about 1,500 feet away. 

About 430,000 tons of contaminated water, or enough to fill 170 Olympic-size pools, are stored in rows of tanks at the plant, which appears to be running out of open space to put them all. 

The contaminated water increases by 400 tons every day as groundwater flows into the basements of the damaged buildings housing the three ruined reactors, which melted down in the worst nuclear accident since Chernobyl in 1986.

US: Measles cases put Texas megachurch under scrutiny

Via Time.com: Measles Cases Put Texas Megachurch Under Scrutiny. Excerpt:

The teachings of televangelist Kenneth Copeland and his family focusing on the virtues of trusting God to keep healthy are under scrutiny after a cluster of measles cases linked to his family’s North Texas megachurch revealed many congregants hadn’t been vaccinated against the highly contagious disease. 

Kenneth Copeland Ministries has won supporters worldwide through television programs, crusades, conferences and prayer request networks. He was a pioneer of the prosperity gospel, which holds that believers are destined to flourish spiritually, physically and financially. 

Although church officials were quick to act after the outbreak — including hosting clinics in August where 220 people received immunization shots — and have denied they are against medical care or vaccinations, people familiar with the ministry say there is a pervasive culture that believers should rely on God, not modern medicine, to keep them well. 

“To get a vaccine would have been viewed by me and my friends and my peers as an act of fear — that you doubted God would keep you safe, you doubted God would keep you healthy. We simply didn’t do it,” former church member Amy Arden told The Associated Press. 

Health officials say 21 people were sickened with the measles after a person who contracted the virus overseas visited the 1,500-member Eagle Mountain International Church located on the vast grounds of Kenneth Copeland Ministries in Newark, about 20 miles north of Fort Worth. 

Of the 21 people who contracted measles linked to the church, 16 were unvaccinated. The others may have had at least one vaccination, but had no documentation. 

Symptoms of the measles, which is spread by coughing, sneezing and close personal contact with infected people, include a fever, cough and rash. Those infected are contagious from about four days before breaking out into the rash to four days after. 

The Centers for Disease Control and Prevention recommends that children get two doses of the combined vaccine for measles, mumps and rubella, called the MMR. The first dose should be given when the child is 12 to 15 months old and the second at 4 to 6 years old. 

During an August 2010 broadcast, Copeland expressed shock at the number of vaccinations recommended for his great-grandchild. 

“I got to looking into that and some of it is criminal. … You’re not putting — what is it Hepatitis B — in an infant! That’s crazy. That is a shot for a sexually transmitted disease. What? In a baby?” he said. 

“You don’t take the word of the guy that’s trying to give the shot about what’s good and what isn’t. You better go read the can or read the thing — find out what’s going on there and get the information on there because I’m telling you, it’s very dangerous the things that are happening around us all the time.” 

His wife Gloria bragged during a conference that she and her husband don’t need prescription drugs, adding that the Lord heals all diseases.

Saudi Arabia: Two asymptomatic MERS cases released from hospital in Batin

Via a tweet in Arabic, a story in Al-Weeam: «Health» confirms two cases of healing the Corona virus. Excerpt from a typically confusing Google translation:

The Ministry of Health today announced the exit of two cases of people infected with "Corona" from the hospital and they are in good condition, after Tmathlhma to heal Batin governorate. 

The ministry said in a statement that the conditions are in contact with a patient infected with the virus, indicating that one of them at the age of 7 years, and the other 16 years old, and left the hospital after the results of the tests carried out are positive.

These cases have not been announced on the KSA MOH English coronavirus news page. They appear to be the asymptomatic family contacts of the 38-year-old who died recently: They are #106 and #107 on the FluTrackers list of all known MERS cases.

Five months of H7N9

Huizhou poultry market, August 2013. Credit: Nanfang Ribao.

One of the strange aspects of running a blog like this one is the occasional, unpredictable jolt of a new outbreak. I got a jolt in the spring of 2009 when the first reports came in about H1N1. When you're primed for H5N1 to come flying in from Asia, the way SARS did in 2003, it's an unpleasant but instructive experience to be blindsided by a virus no one's been thinking about—and right in your own back yard.

That happened again five months ago, on March 31, when a virus that had never troubled anyone was announced to have killed two of its first three victims. That set off a frenzied ransacking of the web in search of more news; I even learned to love Google Translate because so much of the H7N9 news was in the Chinese media only. 

At the end of spring H7N9 news seemed to taper off; it looked like another seasonal influenza that would likely come back in the fall. And of course the case of Moumou Chen, the Huizhou chicken dealer, showed that H7N9 is no respecter of seasons. 

I realize that flu viruses aren't very bright, but as a novelist I give them full marks as masters of plot. No sooner do we think we understand the situation than we feel the proverbial carpet yanked out from under us. If nothing else, it keeps our attention.

Curious to see what the researchers were doing during this mostly quiet summer, I searched for H7N9 on Google Scholar, set for 2013 alone. I gather there have been over 700 scholarly articles on the subject, about two-thirds of them in Chinese. 

So while Xinhua is pretty quiet about H7N9, scientific journals are publishing a lot—on everything from developing effective vaccines  to naming specific hospitals for H7N9 to the requirement for free medical treatment of H7N9 cases. (The last thing the authorities want is for patients to be more scared of medical bills than of the disease itself, or for cheese-paring bureaucrats to fuss over paperwork that might slow down treatment.)

Clearly, China's medical experts have responded to the challenge of a disease no one had ever heard of six months ago. While a few Weibo users have been "detained" for spreading false rumours of outbreaks, the scholarly literature seems to be wide open and on the web. I'm even a little surprised that the Chinese media haven't been scavenging that literature; one nursing journal's report on dealing with airway bleeding in H7N9 patients sounds very adequately lurid for mass audiences.

So as surprising as H7N9's very existence may be, it's encouraging to see both Chinese and world health agencies taking it so seriously. They're giving themselves a crash course in a new virus, and even if it remains a minor threat we'll know better how to handle the next threat.

By contrast, a Google Advanced Scholar search for MERS-CoV turned up 174 articles. That response seems a little tepid, given that MERS has turned up internationally from the Persian Gulf to Britain. 

Strikingly, most of the new literature has been in English, and I get the impression that more researchers with Chinese names are studying MERS than are researchers with Arabic names. Even the occasional article in Oman Medical Journal appears in English, and #Coruna, the Arabic hashtag for MERS, has little or nothing from researchers. It's as if the Arabic medical experts are too few to have their own discussions, or that English is the de facto language of their research.

So we have contrasting styles of dealing with outbreaks of new diseases. After their embarrassment over trying to cover up SARS, the Chinese have been remarkably transparent in both mass media and scholarly journals. 

The Saudis, however, are saying much less about their MERS cases except in research reports usually written in English. In official Saudi announcements we always get the bare minimum of information, and we have to play detective to figure out even if the latest reported death was a nosocomial infection.

This seems to me a strategic error in crisis communications, right up there with the Cubans' official silence on cholera. It makes us skeptical even of the little information we get, and very skeptical of the Saudis' (and Cubans') basic competence in dealing with such outbreaks. And it reminds me of an old saying my grandfather was fond of: "If you're so rich, why aren't you smart?"

Saudi Arabia: Was latest MERS death a nosocomial infection?

Via Arab News, some details on the 55-year-old man whose death was reported here last night: MERS virus claims second Jeddah victim. Excerpt and then a comment:

A 55-year-old Jeddah man suffering from renal failure died of complications from Middle East Respiratory Syndrome (MERS) at a Madinah hospital. His death brings the number of patients worldwide killed by the virus to 49. 

Forty-three people have died of MERS in Saudi Arabia. The total number of cases in the Kingdom is 84. 

Earlier this week, the Health Ministry reported that a 38-year-old Saudi, who was suffering from severe pneumonia and respiratory failure had died. 

The victim in Madinah was a Saudi originally from Jeddah, making it the second reported MERS case from the city. A 2-year-old child died early in July. 

The man was also suffering from chronic renal failure and was undergoing treatment at the ICU at King Fahd Hospital. 

Meanwhile, Dr. Halden S. Shane, president and CEO of TOMI Environmental Solutions, Inc., of Beverly Hills, California, told an environmental and medical group at an infectious diseases conference in Riyadh that binary ionization technology could be effective in combating bacteria and viruses. 

Binary ionization technology is a disinfection system that uses cold plasma to a hydrogen peroxide-based aerosol. The application could be effective against MERS, Shane told the group in Riyadh.

The report isn't clear, but it sounds as if the man was in intensive care for his kidney failure before contracting MERS. TOMI Environmental Solutions appears to specialize in hospital infection control.

Somalia: Puntland says first polio case found in the region

Via RBC Radio: SOMALIA: Puntland says first polio case found in the region. 

First polio case was found in the Somalia’s semi-autonomous region of Puntland, the region’s health minister said. 

Dr Ali Abdullahi Hersi, the Puntland health minister said that one child living in the port town of Bosasso was diagnosed and found with polio which means that other cases of polio could be found in the region. 

“We can confirm that polio now exists in Puntland,” the minister said. 

Meanwhile the director of the ministry Dr. Abdirisaq Abshir said that the ministry and the other health agencies launched urgent efforts to contain the disease before it could spread into other locations in the region. 

Two years ago, the world health organization has already declared that Somalia was free from polio but last month the organization itself said that polio exists in the country.

Canada: Albertan bitten by rabid bat while stopping fight with cat

Via CBC News: Albertan bitten by rabid bat while stopping fight with cat. Excerpt:

A woman has tested positive for rabies after being bitten by a bat that was fighting with a cat in Lethbridge, according to Alberta Health Services. 

Medical health officer Dr. Vivien Suttorp says it's rare for animals to carry the disease. She says the woman has been given an anti-rabies vaccine. 

"The bat was transferred to public health and then to the Canadian Food Inspection Agency laboratory here in Lethbridge," said Suttorp. 

"This is in fact the first bat in many, many years that was actually positive for rabies here in the Lethbridge area." 

Suttorp says people are advised to immunize their pets and stay away from wild animals. Wild mammals — such as bats, coyotes, raccoons and skunks — may carry the disease.

Dr. Mackay thinks out loud about MERS acquisition

On his VDU's blog, Dr. Ian Mackay ruminates on A model of MERS-CoV acquisition (ver1). Excerpt:

First we heard about Middle East respiratory syndrome coronavirus (MERS-CoV)-related viruses in bats in South Africa, then we read of antibodies in camels that reacted to MERS-CoV more than the most likely (known) other CoV to infect cattle, and most recently we were absorbed by the discovery of a probable parental strain of the MERS-CoV in the faeces of a Taphozous perforatus insectivorous bats. 

We've also heard that most patients have not had direct or obvious contact with bats and we also know that pasteurised camel milk products should be safe. But that still leaves many stones unturned. 

So if we can assume that the most likely route of acquisition of MERS-CoV is through the upper respiratory tract and that the spillover events come from animals (I'm including human-to-human exposures in this figure) then we need to consider how that might happen. 

I've included the animals above as well as baboons as they seem highly mobile, interact well with humans, visit mountains and caves (where bats are likely to hang out) and are found in the KSA. I've added ingestion but I don't really imagine how this could result in a respiratory infection, and MERS-CoV gastrointestinal involvement seems infrequent.

Click through to read the rest of his post and to see his infographic about possible ways MERS could move from animals to humans.

Saudi Arabia: A MERS death in Madinah

Via the Saudi Gazette: Madinah death takes MERS toll to 43. Excerpt:

The Ministry of Health said on Friday another man has died from Middle East Respiratory Syndrome Coronavirus (MERS-CoV), bringing to 43 the number of deaths caused by the new SARS-like respiratory virus in the Kingdom. 

It said the man who died on Friday was also suffering from kidney failure and had been in the intensive care unit of a hospital in Madinah for several days.

I think this must be the 55-year-old man mentioned in today's WHO update, who fell ill on August 17.

Another health problem with poverty

Via Science, a very interesting article on how poverty dumbs us down: Poverty Impedes Cognitive Function. The abstract:

The poor often behave in less capable ways, which can further perpetuate poverty. We hypothesize that poverty directly impedes cognitive function and present two studies that test this hypothesis. 

First, we experimentally induced thoughts about finances and found that this reduces cognitive performance among poor but not in well-off participants. Second, we examined the cognitive function of farmers over the planting cycle. We found that the same farmer shows diminished cognitive performance before harvest, when poor, as compared with after harvest, when rich. 

This cannot be explained by differences in time available, nutrition, or work effort. Nor can it be explained with stress: Although farmers do show more stress before harvest, that does not account for diminished cognitive performance. 

Instead, it appears that poverty itself reduces cognitive capacity. We suggest that this is because poverty-related concerns consume mental resources, leaving less for other tasks. These data provide a previously unexamined perspective and help explain a spectrum of behaviors among the poor. We discuss some implications for poverty policy.

The article itself is behind a paywall, but The Globe and Mail has a news story about it. So do The Atlantic and The Washington Post.