H5N1

Paraguay: A look back at the year in dengue

Via the Paraguayan Ministry of Public Health and Social Welfare: Leve disminución de casos de Dengue.[Slight diminution of dengue cases] Excerpt, with my translation:

La Directora General de Vigilancia de la Salud, Dra. Águeda Cabello, manifestó que el Dengue se encuentra en un periodo interipidémico, con tendencia a una leve disminución de casos en comparación el periodo del año anterior. 

Dr. Águeda Cabello, Director General of Health Surveillance, says dengue is in an inter-epidemic period, with a tendency toward a slight diminution of cases compared to this time last year.

“Hemos registrado la notificación en nuestros servicios de unos 500 a 800 cuadros febriles por semana. Si tenemos en cuenta el mismo periodo del año pasado, la diferencia es importante porque se computaban hasta 2.000 casos”, refirió. 

"We have registered notification of some 500 to 800 fever cases per week," she said. "If we compare the same period last year, the difference is important; we were counting up to 2,000 cases."

Pese a esta mejoría, la Dra. Cabello remarcó que este no es el momento de bajar la guardia, pues inicia el periodo en el que las personas salen de viaje, pudiendo recalar en algún destino con circulación de Dengue, lo que repercutiría en una epidemia para nuestro país, debido a la circulación viral. 

Despite this improvement, Dr. Cabello remarked that this is no time to lower our guard, since the period is starting when people go travelling, perhaps to destinations with dengue, which could result in another epidemic for our country.

Entre las semanas epidemiológicas (SE) 49, 50 y 51 se registraron un total de 1.846 notificaciones de casos sospechosos y confirmados procedentes de 16 departamentos. Sin embargo, 1.567 (83,4%) proceden del área metropolitana de Asunción (Asunción, Central y bajo Chaco). 

Between weeks 49, 50 and 51, 1,846 suspected and confirmed cases in 16 departments. Still, 1,567 cases (83.4%) occurred in the Asunción metropolitan region (Asunción, Central, and lower Chaco).

A la fecha, las regiones de Misiones y Alto Paraguay han tenido períodos mayores a 3 semanas sin casos notificados. 

To date, the regions of Misiones and Alto Paraguay have seen periods of over three weeks without reported cases.

El área metropolitana de Asunción, intensamente intervenida desde la declaración de la alerta epidemiológica por Epidemia registra brotes, en las siguientes zonas: Itá y San Lorenzo y los barrios: Itá Enramada, Tablada Nueva, Botánico y Zeballos Cué de Asunción. 

Metropolitan Asunción, intensely treated since the declaration of epidemiological alert, has recorded outbreaks in the following zones: Itá and San Lorenzo, and the neighbourhoods of Itá Enramada, Tablada Nueva, Botánico, and Zeballos Cué of Asunción.

Desde el 30 de diciembre 2012 al 21 de diciembre de 2013, se han notificado al sistema de vigilancia 153.793 casos de síndrome febril agudo, de los cuales 131.306 (85,3%) fueron casos confirmados de Dengue por laboratorio y/o nexo epidemiológico, 9.700 (6,3%), se descartaron y continúan sospechosos 12.787 (8,3%). 

Between December 30, 2012 and December 21, 2013, the surveillance system has been notified of 153,793 cases of acute fever syndrome, of which 131,306 (85.3%) were confirmed as dengue by laboratory and or epidemiological nexus; 9,700 tested negative and 12,787 (8.3) remain suspected.

Paraguay vivió una epidemia de Dengue muy prolongada, desde la SE 48 de 2012 hasta la SE 23 (junio de 2013). El serotipo con predominio es el 2.

Paraguay endured a very prolonged dengue epidemic from week 48 of 2012 until week 23 (June, 2013). The predominant serotype is 2.

Saudi Arabia: More on the suspected MERS cases in Afif

Many thanks to Lucie Lecomte, who's sent the links to a lot of Saudi online sources I would never have found. Here's a report from one of them, afifnp.com: Mobilization of teaching chaste after the death of a teacher b «Corona» and wounding Director. "Chaste" seems to be a translation artifact from the name of the province. A Google translation:

Live middle school second for Boys "province chaste state of anxiety after the death of one of its teachers as a result of his symptoms disease Koruna awaiting the emergence of analyzes with lying director of the school on the white bed after their suspected cases of cholera. 

was Director of the Department of Education Bafeef "Saad Nfaiei" the day, accompanied by a medical team a visit to the school to make sure that there are no symptoms of the disease on the students or teachers were transferring a student to the hospital after noticing the temperature rise has as been awarded the director of the school vacation until his recovery. 

confirmed "Nfaiei" that the safety of his sons students of higher interests, and that his administration is following the development of the school closely, and will take the necessary precautions. mentions that the teacher of the deceased enter the Emergency Hospital chaste public early last week complaining of respiratory problems, then his condition worsened and enter to the intensive care unit at the hospital until he was transferred to a specialized hospitals in Riyadh, and died, while lying Director on White bed after rising to a jolt of heat and doctors suspected cases of cholera are being checks to make sure of that.

The reference to "cholera" may also be an artifact. In any case, the city appears to be truly alarmed about the two cases (neither of which seems to have been confirmed as MERS).

El Salvador: Volcano continues to vent gases

Via La Prensa Gráfica: Volcán Chaparrastique continúa emanando gases. [Chaparrastique volcano continues to vent gases] Excerpt, with my translation:

El volcán Chaparrastique de San Miguel continúa emanando gases, combinado con pequeñas emanaciones de cenizas, notifica el Ministerio de Medio Ambiente, quienes a su vez indican que es normal debido a que ayer hizo erupción explosiva este cráter. 

Chaparrastique volcano in San Miguel continues to vent gases, together with small eruptions of ashes, according to the Ministry of Environment, which adds that it's normal after yesterday's explosive eruption.

En el lugar y aledaños puede sentirse un olor a azufre, emanación de gases del suelo y algunos sismos. 

In the surroundings there is an odour of sulfur, venting of gases from the soil, and some tremors.

Las autoridades piden a la población evitar rumores y acatar las recomendaciones de la Comisión de Protección Civil. 

Authorities are asking the public not to spread rumours and to follow the recommendations of the Civil Protection Commission.

La ceniza del volcán se estará haciendo presente en todo el país, de acuerdo con la entidad, que aconseja que esta se limpie sin agua y se evite lanzarla a las alcantarillas. 

Ash from the volcano is present all over the country, according to the ministry, which advises that it can be cleaned off without water ad should not be discarded in the sewers.

El resto de volcanes activos en El Salvador continúan siendo monitoreados por las autoridades de Medio Ambiente.

The other active volcanoes in El Salvador continue to be monitored by authorities in Environment.

Haiyan/Yolanda: What the survivors want

Via InterAksyon.com: WHAT YOLANDA SURVIVORS WANT | Jobs and participation in rehab, reconstruction plan. Excerpt:

Begging and living on relief and aid forever are not options, thus said several associations of workers in the informal sector in Yolanda-hit Eastern Visayas on Monday, as they launched a campaign demanding employment, social protection, and people’s participation as bedrocks of the Yolanda rehabilitation and reconstruction plan to address not only the immediate but also the long-term needs of every affected Pepe and Pilar. 

The campaign came days after the government announced the US$8.17-billion or P361-billion plan under the so-called Reconstruction Assistance on Yolanda (RAY) which will be completed in four years or by 2017, labor group Partido ng Manggagawa (PM) said in a news release. 

Held in Tacloban City, the campaign launch was spearheaded by tricycle and trisikad drivers and operators (TODAs) in Tacloban, Hilongos, and Baybay, in coordination with PM. 

After attending a twelve noon mass at the Sto. Nino Church, TODA members held a motorcade around Tacloban City with posters bearing the call, “Make jobs a priority in Yolanda rehab,” wrapped around their trikes. A gathering and small salo-salo followed the motorcade at the Church’s Social Hall where family members and other Yolanda survivors gathered to hear the groups’ manifesto and affirm their commitment to the collective struggle of rebuilding their lives and their communities. 

In a joint Manifesto signed by the Tacloban Federation of MCF Drivers and Operators (TAFEMDO), the Hilongos-based Trisikad Operators and Drivers Organization (TODO), and Partido ng Manggagawa-Region 8, the groups explained that prior to the onslaught of Yolanda (Haiyan), they already were living poor, miserable lives, transporting people around the city through motorized and non-motorized cabs for hire was their only source of income. 

“Because income is irregular in this nature of work, we earn less than what we need. This condition likewise explains why many of us, together with other poor people, live in urban poor communities where we face recurrent and extreme vulnerabilities from both man-made and natural calamities. In other words, we are poor, defenseless, and were unprepared to face the strongest typhoon in history,” read the manifesto.

India: One more child dies, Bihar encephalitis toll eight

Via Daijiworld.com: One more child dies, Bihar encephalitis toll eight. This outbreak appears to be separate from the one in Uttar Pradesh. Excerpt:

A five-year-old child suspected to have encephalitis, a condition that causes inflammation of the brain, died in Bihar's Araria district Monday taking the toll from this disease to eight in the last 10 days, officials said. 

Araria civil surgeon B.K. Thakur said that while one child died Monday, there were others admitted to hospital with similar symptoms and who were in critical condition. 

Last week, two children, a four-year-old and a six-year-old, died of the disease at Belwa panchayat near Araria town, officials said. Five children were earlier reported to have died in the district. 

Araria district magistrate Ajay Kumar Choudhury said preventive measures have been taken on a war footing since last week, after five children succumbed to encephalitis. 

A team of health experts from Patna visited the affected village in Araria three days ago, on a directive from Chief Minister Nitish Kumar, to oversee measures to check the spread of the disease.

Saudi Arabia: Dozing doctors and medical errors

Via Saudi Gazette, an opinion piece with implications for the treatment of MERS cases: Dozing doctors and medical errors.

Serious medical errors are so common that healthcare professionals have become a laughing stock. Some of the medical mistakes are so stunning because one wouldn’t expect even an ordinary person to make such an error. 

For example, in one case, doctors performed an operation on a patient’s healthy foot instead of the injured one. 

However, anyone who looks into the reality of our hospitals will discover that, in many cases, the reason for the medical mistakes is not inefficiency and negligence but the inhumane working conditions medical professionals are subjected to. 

Doctors and other medical personnel are forced to work long hours that are beyond their physical and mental capacity and at the same time they are not paid enough. 

A study in 2011 on a sample of Saudi doctors in a fellowship program of the Saudi Commission for Health Specialties at King Abdulaziz University showed that 87 percent of them suffered from acute sleep deprivation. 

A doctor is allowed only two hours’ sleep in the hospital during a 24-hour shift because his sleep is interrupted frequently. In other words, he is woken up several times to attend to emergencies. Also, resident doctors are made to work continuously for more than 36 hours without any rest or sleep. 

According to foreign studies, doctors’ lack of sleep was the basic cause for about 50 percent of all serious and fatal medical errors. For this reason, many countries have set a ceiling on doctors’ working hours. 

According to other studies, forcing doctors to work for long hours has resulted in negative phenomena in all aspects of their lives, including an increase in traffic accidents because they often nod off at the wheel. This also affects the quality of their family life. 

Low salaries and delays in payment of their wages for several months at a time is another issue that must be addressed. Saudi and foreign doctors have often resorted to Twitter to air their grievances. Several hashtags were created by doctors demanding their back pay. 

Nursing staff often find themselves in a similar situation. If these issues are not addressed, I am afraid preventable accidents will continue to occur.

Hong Kong reports rare human case of H9N2

The Centre for Health Protection has published Epidemiological investigation and follow-up actions by CHP on confirmed human case of influenza A(H9N2). As the report makes clear, this is a very rare form of avian influenza, but CHP is treating it with great care. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health (DH) is today (December 30) investigating a confirmed human case of influenza A(H9N2) affecting a man aged 86.      

The patient is a Hong Kong resident living in Huangbeiling, Luohu, Shenzhen. He has underlying illnesses and has developed chills and cough with sputum since December 28. Upon entry at Lo Wu Border Control Point (BCP) on the same day, he was transferred by ambulance direct to the Accident and Emergency Department of North District Hospital (NDH), where he presented with low fever. He was then admitted to the isolation ward. He was transferred to Princess Margaret Hospital today for further management.      

His clinical diagnosis was chest infection. He has been in stable condition all along and is currently afebrile.      

His sputum specimen tested positive for the influenza A(H9N2) virus upon testing by the CHP's Public Health Laboratory Services Branch.      

"The epidemiological investigations, enhanced disease surveillance, port health measures and health education against avian influenza are all ongoing," a spokesman for the DH remarked.      

Investigations by the CHP revealed that the patient had no recent poultry contact, consumption of undercooked poultry, or contact with patients. His home contact in Shenzhen has remained asymptomatic.      

Over 50 health-care workers of NDH and the ambulance service have been put under medical surveillance.      

"The H9N2 virus is of avian origin and has been isolated mainly from poultry. Rare and sporadic human cases have been reported and are generally mild respiratory tract infections. The public should avoid contact with poultry and other birds, including chickens, ducks and sparrows," the spokesman explained.      

Influenza A(H9) is a local statutorily notifiable infectious disease. Two local cases were reported in 1999. One local case was respectively filed each in 2003 and 2007. An imported case was recorded in 2008 while an imported case and one with the source of infection unclassified were filed in 2009. All are mild infections and the patients have recovered. No deaths have been recorded so far.   

Locally, enhanced surveillance over suspected cases in public and private hospitals is under way.      

As the patient was staying in Shenzhen for the whole incubation period, the CHP will inform the health authority of Guangdong of the case for necessary investigation and follow-up action.      

The case will also be notified to the World Health Organization (WHO), the National Health and Family Planning Commission, and the health authority of Macau.      

The CHP will issue letters to doctors and hospitals to keep them abreast of the latest situation.

Mike Coston at Avian Flu Diary has two posts on this case, here and here. The South China Morning Post also has a report.

Saudi Arabia: MERS cases in a school?

With the Saudi media essentially mouthpieces for the government, I rarely find find any news, or even details, in Saudi papers that haven't already appeared in a KSA MOH statement. 

Twitter is a little different, and the # Corona hashtag sometimes gives me an alert via some individual or group. This evening, Google Translate seems to be reporting two or maybe three MERS cases in a school: the principal, a teacher, and now a student. I think the school is in Afif, or in a province whose name translates as "chaste." The principal and teacher may have died, and the student is reported running a 40ºC (104ºF) temperature.

But these tweets don't link to any news reports, and some tweeters complain that the ministry of education is denying the outbreak and refusing to close the school down. If any tests have confirmed or refuted these cases, no one's saying.

This is one of those times when social media and machine translation are more trouble than they're worth.

El Salvador: 1,635 evacuated due to volcanic eruption

Via La Prensa Gráfica: Funes confirma 1,635 evacuados por erupción volcánica. [Funes confirms 1,635 evacuated due to volcanic eruption] Excerpt, with my translation:

Hace unos minutos el presidente de la República, Mauricio Funes, informó que 1,635 personas fueron trasladadas a distintos albergues ubicados en San Miguel y Usulután, debido a la erupción que registró el volcán Chaparrastique de San Miguel, a las 10:30 de la mañana. 

A few minutes ago President Mauricio Funes announced that 1,635 persons have been moved to various shelters in San Miguel and Usulután owing to the eruption of the Chaparrastique volcano in San Miguel at 10:30 this morning.

Los evacuados están en Jiquilisco, Puerto Parada, San Jorge, San Miguel y otros puntos, como Chinameca. En su mensaje a la Nación, Funes habló de la probabilidad de que el número de evacuados se incrementara, como respuesta al comportamiento que manifieste el volcán. También mencionó que no puede descartarse que vayan a producirse nuevas erupciones. 

The evacuees are in Jiquilisco, Puerto Parada, San Jorge, San Miguel and other locations such as Chinameca. In his message to the nation, Funes said it was likely the number of evacuees will grow, depending on the volcano's activity. He also said he can't dismiss the possibility of new eruptions.

Desde la 1:00 p.m. se presentó una baja de la sismicidad en el volcán y se paralizó la expulsión de ceniza del volcán Chaparrastique, indicó durante la tarde el Ministerio de Medio Ambiente y Recursos Naturales (MARN). 

Since 1:00 p.m. the volcano's seismicity fell and the expulsion of ashes halted, the Ministry of Environment and Natural Resources said this afternoon.

Los grupos de vulcanólogos seguirán en las faldas del volcán, para continuar con su evaluación de las afectaciones causadas por la erupción, y para determinar el comportamiento del volcán en los próximos días. Las autoridades han confirmado que hubo lluvia de cenizas en 10 departamentos.

Groups of vulcanologists will remain at the base of the volcano to continue their studies of the eruption's effects, and to determine the volcano's activity in the next few days. The authorities have confirmed ash falls in 10 departments.

ProMED-mail clarifies the MERS case numbers

ProMED-mail has published a major post today: MERS-CoV - Eastern Mediterranean (105): Saudi Arabia, WHO, request for information. After posting four reports from WHO and the KSA MOH, ProMED-mail offers the following analysis:

The global tally of laboratory confirmed cases of MERS-CoV infection maintained by WHO is now 170, including 72 deaths. The pattern of severe disease seen in individuals with underlying co-morbidities is continuing, with milder or asymptomatic infections seen in younger individuals without pre-existing co-morbidities. In addition, there continues to be limited person-to-person transmission in the healthcare setting. 

Comparing the media report above in [2] with the WHO report in [1], there is a discrepancy in the ages of cases reported. In trying to reconcile these numbers, this moderator went to the Saudi MOH website viewing the English pages (most recent report 20 Dec 2013 (http://www.moh.gov.sa/en/CoronaNew/PressReleases/Pages/default.aspx, reflecting the report from 20 Dec 2013 seen on the MOH Arabic page and shown in [3] above) and then to the Saudi MOH website viewing the Arabic pages, where there was an additional report on the Saudi MOH Arabic page from 25 Dec 2013, reporting 5 new cases (and shown in [4] above). These 2 summary reports confirm a total of 9 newly diagnosed cases in Riyadh (and confirmed by Dr. Ziad Memish, the Deputy Minister of Public Health of Saudi Arabia): 

20 Dec 2013 report 

age N/A Healthcare Worker [HCW] asymptomatic contact 

age N/A HCW asymptomatic contact 

53 y/o Saudi multiple co-morbidities in ICU 

73 y/o Saudi multiple co-morbidities died 

25 Dec 2013 report 

57 y/o Saudi multiple co-morbidities in ICU 

73 y/o Saudi multiple co-morbidities died 

43 y/o non Saudi HCW asymptomatic contact 35 y/o non Saudi HCW asymptomatic contact 

27 y/o Saudi HCW asymptomatic contact 

In total, there have been 141 cases and 57 deaths reported by Saudi Arabia (see http://www.moh.gov.sa/en/CoronaNew/PressReleases/Pages/default.aspx for the Saudi MOH tally in English). 

The WHO global tally update report above (in [1]) refers to the cases contained in the 20 Dec 2013 report from the Saudi MOH website presented above in [3]. Hence, the addition of the 5 cases reported on 25 Dec 2013 presented above in [4] will bring the global total of MERS-CoV infections to 175 including 73 deaths.

When you follow the links, they'll take you to the same page, where the MOH has finally included the December 25 report in English. The Saudis tend to post first on their Arabic page, but they can be days late in translating a report to English. But they do tend to update the tally on both pages, which can be confusing also.

The Saudis could spare their colleagues a lot of that confusion if they would simply post new cases promptly and consistently, using the same basic information: age, sex, status in Saudi Arabia, occupation, place of residence, date of onset, presumed place where illness was contracted, relationship if any to earlier cases, initial treatment, subsequent treatment, and current status of case.

 

We never get all that information, and we're lucky (as ProMED-mail implies) to get the ages now and then. 

 

I'm keenly aware that "privacy" is a cultural issue; some countries' media will report details that others would find outrageously personal. But the Saudis' ostensible concern for privacy and desire "not to stigmatize affected individuals and families" looks more and more like keeping a political embarrassment under wraps.