H5N1

Dr. Mackay: New influenza A(H7N9) virus case

On his VDU's blog, Dr. Ian Mackay writes: New influenza A(H7N9) virus case.

Chinanews reports a new infection by H7N9 today. 

A 57-year old male was confirmed as positive 27-Nov and is in hospital in Hangzhou, the largest city in Zhejiang province. Zhejiang province was the hot spot for H7N9 earlier in the year. 

This is the 141st case of H7N9 which emerged in 2013 in south east China. Most of the recent cases have been in Zhejiang.

Central African Republic: "There are really no towns anymore"

This sounds very bad. Via ReliefWeb, an IRIN report: Religious violence prompts genocide fears in CAR.

Shocked by an escalation of killings, rapes and other abuses committed by Muslims against Christians, and vice versa, in the Central African Republic (CAR), leading clerics from both faiths recently travelled together to preach peace and listen to tales of horror. 

The level of violence, lawless and impunity that prevails in CAR - where a "human catastrophe of epic proportions is unfolding", according to Amnesty International - is so great that Archbishop Dieudonne Nzapalainga and Oumar-Kobine Layama, the country's leading imam, had to travel under an armed escort. 

The latest chapter in CAR's history of violence began in December 2012, when a coalition of predominantly Muslim rebel forces - known as Seleka - bolstered by mercenaries from neighbouring Chad and Sudan and convicts sprung from prison, advanced southwards, eventually toppling president Francois Bozizé in March. 

In response to the rebellion and the wave of lawlessness that followed the official disbanding of Seleka in September, and in the absence of police or other state security forces, the largely Christian population in villages across the north formed self-defence units called anti-balaka ("anti-machete" in the Sango language.) 

"Now we need to ask ourselves, do we want to push this country towards inter-confessional war, or should people work together and build this country? This is what leaders need to consider," said Nzapalainga in Bossangoa - 300 km north of the capital, Bangui - where some 36,000 people are seeking refuge in the grounds of the Catholic mission as well as in a school. 

In all, some 400,000 people are displaced in CAR, most of them living in the bush with little access to clean water or humanitarian relief. 

The country had "reached the worst of the worst" in every sense, he said. 

"We've never seen people fleeing to a Catholic mission for safety, kids abandoning their schools in their masses, hospitals without medicines, or the Christian and Muslim populations turning against one another," he said. 

Fears of genocide 

The town's bishop, Nestor Aziagba, and Imam Layama both spoke of their fears of a genocide, a prospect also recently evoked by French Foreign Minister Laurent Fabius, senior UN officials as well as human rights activists. 

"The rebels fight the non-Muslim local population, and then the [anti-balaka] militias fight back the rebels and the Muslim community. We are at this divide, this sharp divide, between the Christian and the Muslim community," said Aziagba. 

"What I want to prevent is a war against brother and sisters who have been living side by side for many years," he said, admitting this was impossible without greater commitment from the new government led by Michel Djotodia, the country's first Muslim head of state. For his part, Djotodia has conceded he has little or no control of the former rebels. 

"But unfortunately this government is not assuming its responsibilities," Aziagba said. 

Loyama appeared shocked by the level of destruction he had seen on the way to Bossangoa. 

"What we have seen surpassed our understanding, as what we saw along the road is that there are really no towns anymore," he said. 

"We, the religious leaders, are trying to do our part, but we ask the government to also do their part. It's not all the Christians that are anti-balaka, like we're hearing here, or that all the Muslims are Seleka, which is the perception," he added.

Meanwhile France has 400 soldiers in the country and says it will send another 1,000 sometime next week, after the UN passes the necessary resolution.

The MERS virus post-Hajj

Thanks to Lucie Lecomte for the link to this thought-provoking post in Ha'am.org, UCLA's Jewish newsmagazine: MERS virus post-hajj. Excerpt:

Although there have not yet been any confirmed cases reported in Israel, government officials said in June that they were keeping a close eye on the disease’s behavior in neighboring countries and were prepared to handle it in the event of an outbreak. Israel’s Jordanian border is under particular scrutiny due to the high volume of traffic passing through every day. 

As a result of the declining concern over a pandemic, media coverage of the disease has decreased as well. While there have been relatively few cases recently reported (27 new cases between mid-September and mid-November), the infection has continued to travel to other countries, with the World Health Organization adding Spain, Kuwait and Oman to the list of countries with infected patients. 

Considering Israel’s borders and high volume of tourist traffic, particularly to Jordan, it is remarkable that no cases have yet been reported from there. However, for the student or other young adult taking advantage of a winter Birthright trip or other opportunity to go to the Middle East, a lack of awareness is a serious disadvantage, particularly for those planning to cross over from Eilat to Petra. While cold and flu season will hopefully remain just that and frequent handwashing will prevent any further infection progression, MERS-CoV is still on the international radar.

Jordan, after all, is the cradle of MERS as we know it, and it hadn't even crossed my mind that traffic between Jordan and Israel is both heavy and routine (even though my kid brother and his wife, on a trip to Israel last year, popped over to Jordan to see Petra).

Traffic between Israel and Europe and North America is also heavy and routine, and deserves careful surveillance.

Qatar: Three camels identified with MERS

Via Kuwait News Agency, a November 28 report: Qatar announces the first recorded case of an outbreak of a virus (Corona) between three camels. The Google translation:

The Supreme Council of Health Qatar here tonight for detection in collaboration with the National Institute of Public Health and the Environment of the Ministry of Health, Dutch and College (Aarasems) Medical in the Netherlands for the first case of an outbreak of laboratory confirmed the virus (Corona) that causes Acquired Middle East respiratory between three camels in Qatar. 

said the Supreme Council for the health of the country in a statement, "it was the discovery of those cases in a barn on one link with the two previous cases equalize laboratory among humans has been Chweahma." 

He explained that he was examined three cases within 14 camels took samples based on the epidemiological investigation of the Inter-Public Health Department of the Supreme Council of Health and the livestock department at the Ministry of Environment of Qatar, and pointed out that the camels of the 14 were not suffering from symptoms when taken samples of which were isolated as a precaution for 40 days and is still in good condition and did not show any symptoms until today. 

noted that the fruit of this discovery is the result of ongoing efforts between the Supreme Council of Health and the Ministry of Environment and the National Institute for Public Health and Environment Dutch as well as the World Health Organization. 

considered the disease a modern discovery in animals does not have a working definition currently there is no scientific information is sufficient for The role of animals in the transmission of the disease and its spread.

So if I understand the translation, the camels are MERS-positive but asymptomatic. But we still don't know if MERS transmission from camel to human is direct (I suspect it's not), or whether another vector is involved.

Sudan: Yellow fever confirmed, 14 deaths

Via ReliefWeb, a joint statement by the government of Sudan and WHO: Yellow fever in Sudan Situation Report No 4, 26 November 2013. Click through to download the full report. Highlights:

• Institute Pasteur in Dakar has reconfirmed the current outbreak as Yellow Fever (YF). 

• Between 3 October and 24 November 2013, a total of 44 suspected cases of YF were reported including 14 deaths. 

• A total of 12 localities in West and South Kordofan are affected by the current outbreak. 

• Communicable disease surveillance system has been strengthened in White Nile, Gezira, Kassala, Gedarif and Khartoum.

Haiyan/Yolanda: DOH-8 reports deaths due to leptospirosis, tetanus

Via the Philippine Information Agency: DOH-8 reports deaths due to leptospirosis, tetanus.

The Department of Health (DOH) in Eastern Visayas reported two deaths due to tetanus and leptospirosis in typhoon-affected areas.   

DOH Assistant Secretary Paulyn Rosell-Ubial said that at present, they have received 13 suspected cases due to leptospirosis with one death. 

As for tetanus cases, Ubial said 10 cases were reported with one death.   

“I would like to inform the public especially those who need medical attention to visit our hospitals, we have already eight functional hospitals in the region,” said Ubial.   

The five hospitals can now perform major surgical operations such as the Eastern Visayas Medical Center, Remedios T. Romualdez Hospital, Divine Word University Hospital (formerly St. Paul), Field Hospitals of Australia and Germany located at Palo, Leyte. 

“While the other three primary hospitals are accepting out-patient services and minor operations, ” Ubial added.

NDRRMC Update Sitrep No. 45 Effects of Typhoon YOLANDA (HAIYAN)

Via ReliefWeb: NDRRMC Update Sitrep No. 45 Effects of Typhoon "YOLANDA" (HAIYAN). Click through to download the full report. Some key numbers:

As of 6:00 PM, 27 November 2013, 5,500 individuals were reported dead, 26,136 injured and 1,757 are still missing

Austria: Follow-up on suspected polio cases in Traiskirchen

Via Der Standard: 88 tuberculosis cases reported in Traiskirchen - refugee dormitories. Excerpt from a Google translation:

The company would regret "that it has come by employees to false reports in the media," writes the ORS Service GmbH in an official statement. It will however take the opportunity to reinforce the information to the current situation. 

With the "current situation" is meant that four refugees in the refugee camp in Traiskirchen tested positive for enteroviruses, which can mean a polio disease. Several ORS staff had anonymously made ​​the accusation in the STANDARD to have been informed too late about the infectious diseases of persons cared for. A vaccination program for employees did not occur until six days after the announcement of the first suspected case. 

On Wednesday, the Interior Ministry confirmed that 88 asylum seekers in Traiskirchen positive for tuberculosis were tested. 32 of them with open tuberculosis, with six so-called multidrug-resistant form. 

Warning in October 

Wilhelm Brunner, a spokesman for ORS, said in an interview with the STANDARD, all ORS staff had been asked in late October to clarify their vaccination and to report to a need for a polio vaccine. At the time the World Health Organization warned that polio cases were found in Syria. 

Some employees are asking, however, not complied with, so it took some time to order the correct amount of vaccine, says Brunner. Since last Thursday immunization carried out by the company doctor in Traiskirchen - but only for employees who volunteer. 

"This is the other side: Not all want to be vaccinated, it is not mandatory," Brunner says. ORS have taken the necessary precautions. These include the isolation of the persons concerned, the medical monitoring and regular disinfections.

Cuba: Prison in quarantine over cholera

Via Cólera en Cuba, a report from cubanet.org: En cuarentena prisión avileña por casos de cólera.[Prison in Ciego de Ávila quarantined over cholera cases] Excerpt, with my translation:

Alberto Pérez Oliva, recluso de la prisión Canaleta, en Ciego de Ávila, dijo telefónicamente este lunes que la cárcel se encuentra en cuarentena, por el incremento de reos infestados por cólera. Pérez Oliva informó que los internos Raúl Domínguez Rivera, Erik Castellanos Blanco, Daniel Rodríguez Ruiz, Ángel Pedro de León y Nelson More Aba, se encuentran graves en el hospital, y que otros contagiados están en la enfermería de la penitenciaria. 

Alberto Pérez Oliva, a convict in Canaleta Prison in Ciego de Ávila, said on the telephone this Monday that the prison is in quarantine owing to the increased number of convicts with cholera. He reported that convict Raúl Domínguez Rivera, Erik Castellanos Blanco, Daniel Rodríguez Ruiz, Ángel Pedro de León, and Nelson More Aba are all in serious condition in hospital, and other cases are in the prison infirmary.

Los presos se encuentran encerrados en cubículos para 6 personas, no son llevados al patio y reciben la comida servida en bandejas, por debajo de las rejas. Solo una vez fue fumigada la cárcel.

The prisoners are locked in cubicles for 6 persons; they aren't taken to the patio and receive meals served on trays slid under the bars. The prison has been fumigated only once.

Haiyan/Yolanda: Deaths now at 5,497

The Official Gazette has updated its Official list of casualties: Typhoon Yolanda. Deaths are now at 5,497. Injured: 26,136. Missing: 1,757.