H5N1

Oman: Near silence on the new MERS case

Via the Times of Oman, another non-story: Oman announces first MERS infection. Excerpt:

The Sultanate has reported its first case of MERS coronavirus, local dailies reported yesterday, quoting Health Affairs Undersecretary Mohamed bin Saif al Hosni as saying. 

According to the official, the patient was admitted to a hospital in Nizwa suffering from a chest infection. 

Oman is the fourth Gulf Arab country where the strain has been found since it emerged in Saudi Arabia last year. 

The statement gave no more details on the case, the first in Oman.

The Arabic-language media aren't any better.

Sudan: SPLM-N ready for talks with Sudan Government for polio campaign to start

Via Radio Dabanga: SPLM-N ready for talks with Sudan Government for polio campaign to start.

The humanitarian wing and the top political leadership of the Sudanese People’s Liberation Movement-North (SPLM-N) held a three-day extraordinary meeting that ended on Monday. The meeting was to assess the humanitarian situation in the war-torn states of South Kordofan and the Blue Nile, and to reiterate the SPLM-N’s commitment for the polio vaccination campaign to take place as scheduled.   

The meeting resolved on the readiness of the SPLM-N for talks with the Sudanese government to agree on the arrangements needed for the polio campaign. 

In a press statement issued today by Yasir Arman, Secretary General of the SPLM-N, the SPLM-N notes that “the meeting came at a time when 28 months have passed since the Khartoum government denied humanitarian access to the civilian population in South Kordofan and the Blue Nile, which resulted in more than one million displaced people and refugees in South Sudan and Ethiopia. It came at the time when the Sudan government intensified its aerial bombardments resulting in the killing and wounding of hundreds and terrorising hundreds of thousands.” 

According to the statement, “the Sudan government, meanwhile, is carrying out its charming public relations and diplomatic campaigns while on the other hand continuing to deny access for humanitarian aid, which constitutes a war crime in international humanitarian law, and bombarding civilian populations, and refusing to sit with the SPLM-N as the two parties to the conflict who are responsible for resolving the humanitarian issues and were asked to do so by the African Union and by UNSC Resolution 2046 and the last UN Security Council statement on October 10, 2013.”  

ECDC epidemiological update: Suspected polio cases confirmed by WHO

ECDC has published Epidemiological update: Suspected polio cases in Syria confirmed by WHO.

Ten of the 22 acute flaccid paralysis (AFP) cases in the Syrian Arab Republic suspected of being caused by wild poliovirus have been confirmed as wild poliovirus type 1 (WPV1) by the World Health Organization (WHO). The WHO announced that final genetic sequencing results are pending to determine the origin of the isolated viruses. The cluster of 22 AFP cases in Syria was first reported to the WHO on 17 October.   

ECDC published a rapid risk assessment on 24 October in response to the suspected polio cases and the risk posed to the EU/EEA. The confirmation by WHO of these ten cases does not change the ECDC risk assessment and its recommendations that remain valid.

India: Encephalitis claims 7 more lives; toll climbs to 473

Via DNA, a PTI report: Encephalitis claims 7 more lives; toll climbs to 473.

Seven more children succumbed to encephalitis in the district, taking the death toll due to the disease in eastern Uttar Pradesh to 473 this year, health officials said on Wednesday. 

The seven died at the Baba Raghav Das Medical College Hospital (BRD-MCH) here yesterday. They belonged to different district of eastern Uttar Pradesh. As many as 18 new patients of encephalitis were admitted to the hospital during the past 24 hours, they said. 

A total of 2,320 encephalitis patients have been admitted to hospitals this year, the officials said. 

Over 200 patients are being treated at BRD MCH at present, they said.

India: 12 more cholera cases in Holalu

Via The Hindu, a report from Karnataka state: 12 more cholera cases in Holalu. Excerpt:

Twelve more cases of suspected cholera were reported on Tuesday in Holalu village, where a farmer died of the epidemic on Thursday last. 

The number of cholera cases has risen to 210, T.N. Marigowda, Mandya District Health Officer, told The Hindu here on Tuesday. 

Of the fresh cases, six have been referred to the Mandya Institute of Medical Sciences (MIMS) Hospital here and the others are admitted to the Primary Health Centre (PHC) in Holalu. 

The patients are out of danger now, he said. 

The Department of Health and Family Welfare has taken a serous note of the rise in cholera cases in the village. 

Geetha Nyamagowda, Director, Department of Health and Family Welfare, who visited the village, said all possible steps would be taken to tackle the spread of the waterborne disease in Holalu. 

Meanwhile, the district administration has decided to replace damaged water pipes in the village. 

The officials concerned on Tuesday deployed an earthmover to remove pipes that have either developed cracks or have caught rust. 

The gram panchayat has arranged tankers to supply water in the village. The villagers have been asked not to consume borewell water for the next few weeks.

Syria: UN and health organisations call for ceasefire to deal with polio threat

Via The Guardian: Syria: UN and health organisations call for ceasefire to deal with polio threat. Excerpt:

Syria's government and rebels were urged on Tuesday to respect "vaccination ceasefires" and permit access to hundreds of thousands of children threatened by an outbreak of polio – another sign of the mounting cost of the country's conflict. 

The call came as prospects for peace talks receded yet again. The UN envoy to Syria, Lakhdar Brahimi, was said after talks in Damascus to be resigned to postponing the long-awaited Geneva II conference from next month to January. 

Save the Children issued the ceasefire appeal after the World Health Organisation and the Damascus government confirmed an outbreak of the highly contagious disease in eastern Syria, the first for 14 years. 

Half a million children under the age of five are at risk of contracting polio, which is incurable and can result in lifelong paralysis as well as death. The mass movement of Syrians fleeing to neighbouring countries means there is a high risk the virus could spread. 

The WHO confirmed 10 cases of polio and said 12 more were being investigated. Most of the 22 people who have been tested are babies and toddlers. Before the war began in 2011, 95% of Syrian children were vaccinated against the disease. The UN now estimates that 500,000 children have not been immunised. 

The news will galvanise international attempts to secure safe access for humanitarian relief workers – even if the prospects for talks between President Bashar al-Assad and the opposition remain poor. Assad's international position has improved since he agreed to surrender his chemical weapons arsenal after the attacks in the Ghouta area in August. 

Justin Forsyth of Save the Children said: "Polio doesn't respect conflict lines or borders so we need these ceasefires to reach all children with vaccines, no matter where they live. If chemical weapons inspectors can be allowed access across Syria with notebooks, surely aid workers can be allowed in with vaccines."

Branswell: "Tsunami" of liver disease looms for boomers with HepC

Via The Montreal Gazette, a disturbing report by Helen Branswell of The Canadian Press: Experts worry tsunami of liver disease looms in hepatitis C-infected boomers. Excerpt:

Doctors like Jordan Feld and Morris Sherman are worried about how many people like Lance Gibson are out there across Canada. 

Gibson, a sergeant in the Canadian Armed Forces based at CFB Borden, north of Toronto, has hepatitis C. 

He was completely unaware of the chronic infection for years, probably decades. Tests done during a military physical in late 2008 noted Gibson had an abnormal blood platelets reading and further testing led to an early 2009 diagnosis. By the time Gibson realized he was carrying the virus, he was already on a potentially fatal track — he had stage 5 liver failure. 

Gibson had had no clue his liver was dying. He'd never felt fitter in his life. 

"It just came right out of the blue," says Gibson, 49, who has served in the military for 30 years. 

Feld and Sherman are hepatologists — liver specialists — who have seen too many cases like Gibson's. And they fear they will soon face many more people who are completely unaware that they are on the verge of irreversible liver damage due to a virus most contracted years earlier. They believe a silent epidemic of hepatitis C infections will soon reach the point where it bursts into view, placing a huge strain on the health-care system. 

Attempts to puzzle out how they became infected sometimes arrive at a conclusion. Some may have tried injection drugs in the freewheeling late 1960s, or had a blood transfusion before blood products were screened for hepatitis C (that began in 1992 in Canada). Some had medical procedures in parts of the world where needle reuse was or remains a common practice. Some got a tattoo in the wrong place at the wrong time. 

But in about 30 per cent of cases no answer can be found, says Feld. That's why, he argues, efforts aimed at finding people infected with hepatitis C cannot focus solely on people who fall into high-risk groups such as injection drug users (present and past), immigrants from countries with high rates of hepatitis C and people who had blood transfusions before screening went into effect. 

"It is true that if you really dug deep, obviously everyone (with hepatitis C) has some risk factor. They got the infection somehow. But finding the risk factor is so difficult that risk factor-based screening for almost any infection that it's been studied in is ineffective," says Feld, who practises at Toronto Western Hospital. 

Gibson had blood transfusions in 1981, when he was a teenager. That's how, he believes, he became infected. 

In the world of hepatitis C, he's one of the lucky ones. Gibson's sister gave him a piece of her liver in May 2012. But he remains infected and will continue to be monitored by his doctors. 

In the same month Gibson had his liver transplant, the U.S. Centers for Disease Control took the unusual step of recommending that all baby boomers be screened once for hepatitis C. That's because the evidence suggests rates of the disease are higher among this age cohort in the U.S. than groups born before or since.

Cholera: Uruguay orders troops out of Haiti

Via Blouin Beat, a news source I don't know: Uruguay orders troops out of Haiti. Click through for some very useful links. The full report:

President Jose Mujica has ordered Uruguayan troops to withdraw from the United Nations Stabilization Mission in Haiti (MINUSTAH), the latest blow against the controversial mission which has been under fire for its role in sparking a cholera epidemic in Haiti. Mujica’s decision comes weeks after human rights lawyers filed a class action lawsuit against the U.N. for its handling of the cholera crisis. 

Though the U.N. is already scaling down its peacekeeping mission in Haiti, Uruguay’s early withdrawal further undermines MINUSTAH, which has operated in the country since 2004 when it was deployed to restore order after the overthrow of President Jean-Bertrand Aristide. The U.N.’s determination to maintain its legal immunity and refusal to acknowledge its role in the cholera epidemic, sparked in the wake of Haiti’s devastating earthquake in 2010, have shot the credibility of the mission. 

The scandal over a case of sexual assault by peacekeepers (of Uruguayan origin) has only added to the outrage within Haiti against the mission. 

Earlier this month, Haitian Senator Jean-Charles Moise met with Mujica to urge the leader to withdraw Uruguayan peacekeepers from MINUSTAH — one of many meetings the official made with Latin American leaders contributing troops to the mission. His push appears to have been successful amid signs that other major contributors like Brazil are also planning to scale back their involvement. As one of the biggest contributors to the mission, Uruguay’s decision to withdraw earlier than expected is a significant one and, along with its serious pursuit of justice in the case of the Haitian sexual assault survivor, shows that it is taking accountability seriously– in contrast with the U.N. 

That Mujica would even be willing to forgo the financial incentives offered by participation in MINUSTAH — a valuable source of income for Uruguay’s military — speaks to how toxic the mission has become. As Haiti’s cholera epidemic begins to spread past the Caribbean into Latin America, this show of accountability on Uruguay’s part is well-timed as the cholera issue threatens to become a regional one. The Mujica government’s tendency to stay ahead of the curve on regional trends such as drug policy reform may not be endearing it to the U.N. — but it appears to be boosting its own regional standing.

José Mujica is quite a guy—a former Tupamaro guerilla in the 1970s who survived and came back to become first an elected politician and then "the world's poorest president," driving an old '87 VW Beetle (when he's not taking the bus to work) and donating 90% of his $12,000 monthly salary to charity. At 78, he's a role model for us old gaffers.

He doesn't seem to have a Twitter handle, but the #José Mujica hashtag shows what a following he has. He also has a stunning 20-minute interview on Al Jazeera that you'd really better watch. A key quote: 

Pobre no es el que tiene poco, si no que verdaderamente pobre es el que necesita infinitamente mucho y desea y desea mas y mas.

The poor person is not the one who has little; the truly poor is the person who needs infinitely much and wants more and more.

Mexico: Cholera cases rise to 181

Via El Heraldo de San Luis Potosí:  Son ya 181 casos de cólera en México: OMS.[Now 181 cholera cases in Mexico: WHO] Excerpt, with my translation, and then a reminiscence:

La Organización Mundial de la Salud (OMS), informo que hay cinco nuevos casos de cólera en la Región Huasteca en México con lo que suman un total de 181 en total. 

The World Health Organization (WHO) reports 5 new cases of cholera in the Huasteca region of Mexico, bringing the total to 181.

Estos cinco casos hacen un total de 181 si se suman a las 176 infecciones registradas en el país entre el 9 de septiembre y el 25 de octubre, de las cuales 157 fueron en Hidalgo, nueve en el Estado de México, seis en Veracruz, dos en San Luis Potosí y otras dos en Distrito Federal. 

The 5 cases make a total of 181 if they are added to 176 cases registered between September 9 and October 25: 157 in Hidalgo, 9 in Mexico State, 6 in Veracruz, 2 in San Luis Potosí, and 2 more in the Federal District.

En este sentido, pese a que no se dieron a conocer específicamente los lugares en los que se registran, se informó que es en “un área con escasas infraestructuras urbanas y limitada disponibilidad de agua potable y saneamiento”. 

Although the  specific places where these cases occurred weren't specified, the announcement said they were in "an area of scanty urban infrastructure and limited availability of potable water and sanitation."

Cabe señalar que la región huasteca se extiende por territorios de los estados de Tamaulipas, Veracruz, Puebla, Hidalgo, San Luis Potosí, Querétaro y Guanajuato. 

It should be understood that the Huasteca region extends over territory in the states of Tamaulipas, Veracruz, Puebla, Hidalgo, San Luis Potosí, Queretaro, and Guanajuato.

Según precisó la OMS, las autoridades mexicanas han iniciado una campaña de prevención que va desde la formación para el control de la enfermedad de personal médico de todos los niveles; medidas para garantizar el acceso a agua potable y saneamiento básico, y acciones de sensibilización en español y en las lenguas indígenas sobre el consumo seguro de agua y alimentos.

According to WHO, Mexican authorities have launched a preventive campaign ranging from the training in cholera control of medical personnel at all levels; measures to ensure access to potable water and basic sanitation; and actions to raise awareness, both in Spanish and in the indigenous languages about safe consumption of water and food.

Sixty years ago, we lived in a very nice house in Tacubaya, just across the road from the American School where our mother taught for a small salary and free tuition for the three of us boys. The school was a 15-acre walled enclave where no one even thought about the people living a few steps away.

The view of Mexico City from our upstairs bedroom was amazing: clear across the city of just 3 million to the volcanoes Popocatépetl and Itxtaccíhuatl, the Smoking Mountain and the Sleeping Woman, sharp against the horizon of Mexico's smogless sky.

But just over the garden wall was a slum of jerrybuilt shacks, often put up from scrap lumber in a day. They housed a lively community, built around a shallow gully where everyone came to move their bowels. Our back gate opened on a dirt lane where the sewage drained downhill between us and a local grocery store.

Ironically, the road from the affluent Lomas district, where many of our classmates lived, and down which their chauffeured limousines carried them to school and back, was just a block away.

Even as a 12-year-old, I was keenly aware of the gulf between us and the kids for whom 100 pesos (about 8 bucks) was wealth. When I revisited that barrio on Google Street View not long ago, I was glad to see that it was now a bustling middle-class neighbourhood, the shallow gully vanished under new concrete homes.

But that world still survives in many parts of Mexico and the rest of the Americas, filled with "indigenous" people who still speak pre-Columbian languages. (When I was a teenager, Nahuatl, the living language of the Aztecs, was a credit course at Mexico City College. I'm sure it still is.)

Those indigenous people are the ones who have subsidized the invading Europeans for over 500 years, supporting our prosperity and self-regard just as the Haitians—kidnapped from Africa and robbed of their labour and freedom for centuries—enriched the French with sugar that rotted their teeth.

What goes around, comes around.

Nicaragua: On the alert for dengue, cholera, and leptospirosis

Via El Nuevo Diario: Autoridades combaten dengue, cólera y leptospirosis en Matagalpa.[Authorities combating dengue, cholera and leptospirosis in Matagalpa] Excerpt, with my translation:

El Ministerio de Salud, Minsa, ejecuta en Matagalpa un plan para combatir no solo el dengue, que ha provocado 13 muertes en Nicaragua, sino también para frenar el cólera y la leptospirosis. 

The Ministry of Health is carrying out a plan in Matagalpa to combat not only dengue, which has caused 13 deaths in Nicaragua, but also to stop cholera and leptospirosis.

El director en Matagalpa del Sistema Local de Atención Integral de la Salud, Silais,  Erasmo Jarquín, explicó que el plan también es para evitar la propagación de esas enfermedades cuando comience la cosecha cafetalera, que atraerá a personas de distintos puntos del país.

The director in Matagalpa of the Local Integral Attention Health Centre, Erasmo Jarquín, says the plan is also to prevent the spread of these diseases when the coffee harvest begins, which will attract people from all parts of the country.  

“Si nos comienzan a salir casos de diarrea, brotes epidémicos de una cantidad de gente en una finca, ojo, porque también tenemos cuatro países en las Américas con cólera: México, Cuba, Haití  y República Dominicana, por lo que tenemos que vigilar el tema del cólera y  la leptospira, ya que la gente anda descalza en los charcos, tiene heriditas y por ahí entra la bacteria”, advirtió Jarquín.

"If we begin to see diarrhea cases, epidemic outbreaks in a number of people on a farm, watch out. Because we also have four countries in the Americas with cholera: Mexico, Cuba, Haiti, and Dominican Republic, so we have to be alert to cholera and leptospirosis, since people are walking barefoot through the puddles. They've got scratches and cuts, and that's how the bacteria get in," Jarquín warned.

The Nicaraguans are being provident. Given the amount of travel and migration in the Americas, it's actually a bit surprising that the Haitian strain of cholera seems to have taken three years to reach Mexico. But now that it's there, it does seem likely to migrate further, both north and south.