H5N1

Yemen: Escalating Conflict Situation Report No. 1 (as of 31 March 2015)

Via ReliefWeb, OCHA has published Yemen: Escalating Conflict Situation Report No. 1 (as of 31 March 2015). Click through to download the PDF. The key points:

• Conflict has escalated significantly in Yemen since 23 March, when clashes between Houthi fighters and other parties intensified mainly in the south. On 26 March, air strikes began to hit Houthi targets and military installations, primarily in Sana’a and Sa’ada before expanding to other Governorates. As of 31 March, 13 of Yemen’s 22 Governorates were affected. 

• According to the World Health Organization (WHO), escalating violence has killed 361 people and injured 1,345 – many of whom are civilians. Casualty reports are often underestimates of true number of casualties. Displacement is also rising quickly. Overall displacement estimates could not be verified. 

• Conflict has had an impact on civilian infrastructure – including an IDP camp that was hit by an air strike in Hajjah Governorate on 30 March, killing 29 civilians and injuring 40. Indiscriminate shelling in Al Dhale’e and Lahj has damaged or destroyed two schools, two mosques and many houses. 

• Immediate humanitarian needs are for mass casualty management, protection and WASH services. In the south, reported fuel shortages are threatening people’s access to water. Partners in Aden estimate water services could be cut off within three to five days unless more fuel is provided to power water pumps. In Lahj, electricity and water services have not been functioning for several days. Response efforts are focusing on supporting mass casualty management. Access has been severely constrained by ongoing clashes in the south and the unpredictability of air strikes in the north.

"Mass casualty management" is an expression I would rather not have learned.

‘Polio-like’ strain of enterovirus D68 may be responsible for mystery paralysis, study says

Via The Washington Post: ‘Polio-like’ strain of enterovirus D68 may be responsible for mystery paralysis, study says. Excerpt:

Genetic sequencing of a virus found in respiratory secretions of children in California and Colorado who suffered from paralysis or muscle weakness last fall reveals that they were infected with a mutated strain of enterovirus D68 that is closer to polio than other strains common in previous years. 

The study, published Monday in Lancet Infectious Diseases, sheds new light on one of the most troubling medical mysteries of recent years. Amid a nationwide outbreak of severe respiratory illness, doctors at hospitals nationwide began to report that they were seeing an alarming number of children with unexplained weakness in an arm or a leg to complete paralysis that required them to be put on ventilators. 

Treating physicians noted that many of the children appeared to be infected with enterovirus D68, but researchers were cautious about drawing a causal link because virus had been bouncing around the world since the 1960s and had typically only caused breathing issues such as coughing and wheezing. 

While the research does not provide a definitive link -- that would only be established if the virus were  found in the spinal fluid and it was not -- it provides the strongest evidence to date of the link between enterovirus D68 and paralysis. The researchers theorize that the reason the virus was not found in the spinal fluid could be because the samples were taken too late. Scientists also tested the children for the presence of other pathogens capable of causing the symptoms but didn't find other viruses, bacteria, fungi or parasites. 

The new research reveals that the children had a novel strain of the virus, called B1, which emerged about four years ago. That strain has only five to six coding differences from previous strains that were commonly found in the United States but each of those are mutated in the direction of polio or another nerve-damaging virus known as EV-D70. 

"These are changes that may have made the virus more polio-like," said Charles Chiu, an associate professor at the University of California-San Francisco who worked on the study. 

While the study identified D68 as a possible trigger of the paralysis, it was not able to shed any light on another key question: Why have some children been affected so severely while others have been fine?

The study included a pair of siblings with a 100 percent genetically identical strain of the virus. One experienced muscle weakness and paralysis while the other only experienced upper respiratory symptoms.

Trevor Noah on Ebola

Well, this may be the only chuckle in the whole sad outbreak: Stand-up set by Trevor Noah. His description of a South African flying to the US during the Ebola scare makes him a very promising successor to Jon Stewart. His accents are as eerily accurate as those of the late Peter Sellers.

Senior UN officials deeply concerned over civilian casualties in wake of recent fighting in Yemen

Via the UN News Centre: Senior UN officials deeply concerned over civilian casualties in wake of recent fighting in Yemen. Excerpt:

Senior United Nations officials today expressed their deep concern about the fast deteriorating situation in Yemen, where dozens of civilians have been killed in fighting in recent days. 

“The situation in Yemen is extremely alarming, with dozens of civilians killed over the past four days,” said Zeid Ra'ad Al Hussein, the UN High Commissioner for Human Rights, echoing a statement issued by UN Secretary-General's Spokesperson. 

“The country seems to be on the verge of total collapse,” the High Commissioner said, calling on all sides to protect civilians from harm, and to resolve their differences through dialogue rather than through the use of military force. 

At least 93 civilians were reported to have been killed since 27 March and a further 364 injured in Sana'a, Sa'da, Dhale, Hudayda and Lahj, among whom were “dozens” killed in an airstrike on the Al-Mazraq camp for internally displaced persons that was established by the UN in 2009. At least another 35 were injured in the raid, including 11 children. 

“The killing of so many innocent civilians is simply unacceptable,” said Zeid. “The principles of proportionality, distinction, and precaution fully apply in this context. International human rights law and humanitarian law should be fully respected.” 

The High Commissioner, who said he was “shocked” by the attack on the camp, was joined by Johannes Van Der Klaauw, the UN Humanitarian Coordinator in Yemen, who said he “deplored” the airstrike in the strongest terms. 

“Confirmed reports state that the strikes destroyed a camp management office and a bridge adjacent to one camp, as well as damaging the local market and a health facility,” said Mr. Van Der Klaauw. “These sites constitute civilian infrastructure.” 

Mr. Van Der Klaauw said around 1,100 families were living in the camp, having fled a series of conflicts in Sa'ada between 2004 and 2010. The families, who Mr. Van Der Klaauw described as being “among the most vulnerable people in Yemen” were relying entirely on external assistance to meet basic needs. 

“With many camp residents now fleeing, they are again forced to seek refuge elsewhere, adding trauma to their already vulnerable state,” he said. “In mid-March, humanitarian partners had initiated a voluntary return programme for camp-based IDPs. Unfortunately, these efforts have now come to a halt.”

Somehow I doubt that the Saudis and their allies will be remorseful about their lack of respect for international law.

I have no dog in this fight. The Houthis seem to me quite as nasty as their enemies. But the consequences of the fight are first, a public-health disaster in a poverty-stricken country, and second, an intensification of what looks like a holy civil war between Sunnis and Shia, with several nuclear powers taking an interest. 

 

The holy civil war is now being waged from Libya to the Persian Gulf, with the involvement of every great power. I suspect that the spring of 1939 must have felt something like this.

US: Poultry producers warned as H5N2 bird flu kills captive falcon in Columbia Falls

Via The Missoulian, a Montana newspaper: Poultry producers warned as bird flu kills captive falcon in Columbia Falls. Excerpt:

COLUMBIA FALLS – The death of a captive gyrfalcon here was caused by highly pathogenic avian influenza, the Montana Department of Livestock confirmed Tuesday. 

It’s the first case, outside of hunter-harvested wildlife, reported in Montana in years. 

The influenza can decimate commercial poultry stocks, killing up to 99 percent in an infected flock. 

No mortalities in domestic poultry in the state due to avian influenza have been detected, and no human health issues have been reported for this particular strain, H5N2, to date. 

Martin Zaluski, a veterinarian with the Department of Livestock, said the avian influenza is primarily found in wild waterfowl. 

“However, the extent of avian influenza in the Continental flyways right now is unprecedented,” Zaluski said, and infected domestic poultry has been found in several states in the past several weeks, including Idaho, Washington and Oregon. 

In addition to wiping out flocks, the influenza can cause international trading partners to “erect barriers” in order to refuse poultry from specific areas, states or even entire countries, according to the veterinarian. 

“We’re in better shape than others, because the influenza was not found in poultry,” Zaluski said. 

*** 

The bird that died was owned by a falconer who has approximately 50 other captive birds. They will all be tested for avian influenza by the end of the week, if not sooner, Zaluski said. 

The Department of Livestock is also identifying poultry producers in the same area so flocks can be monitored for signs of the virus. 

The gyrfalcon died of unexplained causes and was sent to the Montana Fish, Wildlife and Parks Lab in Bozeman. The National Veterinary Services Laboratory in Ames, Iowa, confirmed the highly pathogenic influenza virus strain H5N2 in the bird. 

The gyrfalcon is the largest of the falcon species. It weighs 2 to 3 pounds, and can be used as a captive bird for hunting and falconry. 

Zaluski said it appears the bird that died was exposed to the disease through a wild harvested duck.

Witness to air strike on Yemen refugee camp: Women and children burned beyond recognition

Via The Guardian: Witness to air strike on Yemen refugee camp: women and children burned beyond recognition.Excerpt:

If Hisham Abdulaziz had left al-Mazraq refugee camp in Yemen a few minutes later, he too would have been incinerated in the strike, just like the bodies he later saw at the hospital. 

“They were burned, it was a very horrible image,” said the doctor after labouring to treat the wounded, including women and children, who streamed into the nearest hospital. By the end of the day there were 29 bodies in the hospital morgue. 

"One man came looking for his five children who were missing, and he was able to identify two of their corpses, but he couldn’t find the others,” said Abdulaziz, who spoke with the Guardian by telephone. “It was difficult to identify them.” 

More than two dozen people in the camp were killed in the apparent air strike on Monday by the Saudi-led coalition that is fighting Houthi rebels, believed to be backed by Iran. 

The coalition battling the rebels is alarmed by the growing influence of Iran in Yemen, Syria, Lebanon and Iraq. But as the fighting intensifies, so does the humanitarian cost of the struggle, which is threatening to further push Yemen– already the poorest country in the Arab world – towards disaster. 

“It is an inhumane situation, these are women and children who have nothing to do with war,” said Abdulaziz. “In fact, they had tried to flee the war.” 

The camp, which was established years ago to accommodate civilians fleeing previous rounds of fighting between government forces and the Houthis, had begun to empty before the latest outbreak of conflict. 

But almost 1,000 families had returned to seek refuge when the air strikes began, according to Julien Harneis, Unicef’s representative to Yemen.

“It’s very much a civilian population,” he said. “They’ve got nothing to do with any conflict, they just wanted to stay clear of the conflict for years.” 

During his visit on the morning of the strike, Abdulaziz, the doctor, said that many families had flocked to al-Mazraq camp’s registration centre to resettle there. 

The air strike, which humanitarian workers said occurred at the entrance of one of three camps in the complex, landed near to where they were queuing. 

Many of the wounded and the bodies were evacuated to Haradh hospital, in a town 45 km from the camp, where Abdulaziz worked with a colleague to treat them. But he said many had to be evacuated because they needed urgent surgeries, and it was difficult to get medical supplies and staff to the area. 

Poverty shrinks brains from birth

Via Nature News & Comment: Poverty shrinks brains from birth. Excerpt:

The stress of growing up poor can hurt a child’s brain development starting before birth, research suggests — and even very small differences in income can have major effects on the brain. 

Researchers have long suspected that children’s behaviour and cognitive abilities are linked to their socioeconomic status, particularly for those who are very poor. The reasons have never been clear, although stressful home environments, poor nutrition, exposure to industrial chemicals such as lead and lack of access to good education are often cited as possible factors.  

In the largest study of its kind, published on 30 March in Nature Neuroscience, a team led by neuroscientists Kimberly Noble from Columbia University in New York City and Elizabeth Sowell from Children's Hospital Los Angeles, California, looked into the biological underpinnings of these effects. 

They imaged the brains of 1,099 children, adolescents and young adults in several US cities. Because people with lower incomes in the United States are more likely to be from minority ethnic groups, the team mapped each child’s genetic ancestry and then adjusted the calculations so that the effects of poverty would not be skewed by the small differences in brain structure between ethnic groups. 

The brains of children from the lowest income bracket — less than US$25,000 — had up to 6% less surface area than did those of children from families making more than US$150,000, the researchers found. In children from the poorest families, income disparities of a few thousand dollars were associated with major differences in brain structure, particularly in areas associated with language and decision-making skills. Children's scores on tests measuring cognitive skills, such as reading and memory ability, also declined with parental income. 

Martha Farah, a cognitive neuroscientist at the University of Pennsylvania in Philadelphia, calls the research “unbelievably cool”. Having such a large sample of children allowed the researchers to show the great impact of poverty on developing brains, she says, although the study cannot measure how individual brains change over time. 

Nature versus nurture 

The findings are in line with unpublished research conducted by Farah and her colleagues that scanned the brains of 44 African American girls, each approximately a month old, from various socioeconomic groups in Philadelphia. 

Even at this early age, the researchers found, infants in the lower socioeconomic brackets had smaller brains than their wealthier counterparts. The scientists presented their research on 19 March at the Society for Research in Child Development meeting in Philadelphia. 

Jamie Hanson, a psychologist at Duke University in Durham, North Carolina, says that both papers underscore the impact of adversity on child development. “These early life circumstances make it tougher for many children and it's on many of us in society to make sure that children have equal possibilities,” he says. While he praises the cross-sectional studies, he adds that it is important to follow children over time in order to see how individual brains are affected by socioeconomic status.

WHO Ebola update, March 31: 25,178 cases; 10,445 deaths

WHO has published its March 31 Ebola data and statistics update, with numbers as of March 29 for all three countries.

Guinea: 3,492 cases; 2,314 deaths.

 

Liberia: 9,712 cases; 4332 deaths.

 

Sierra Leone: 11,974 cases; 3,799 deaths.

 

Totals: 25,718 cases; 10,445 deaths.

 

To some unknown extent, this is probably an undercount.

MSF in Yemen: Badly needed medical supplies and health personnel unable to reach conflict-affected areas

Via MSF.org: Yemen: Badly needed medical supplies and health personnel unable to reach conflict affected areas of Yemen. Excerpt:

Sana’a/Paris, March 31, 2015 – More medical supplies and trained health personnel are urgently needed in Yemen as the violence there escalates, but bringing in this essential support is currently impossible, Médecins Sans Frontières (MSF) said Tuesday. 

Clashes across the country in recent weeks, in addition to airstrikes which began on March 26, have led to huge needs for medical aid in many parts of the country, for those injured or displaced by the conflict. But the closure of all the international airports in Sana’a, Aden and Hodeida, and heavy restrictions on the seaports, are hampering the delivery of humanitarian assistance. 

“MSF is currently unable to deploy additional emergency medical staff to Yemen, where they are badly needed,” said Dr Greg Elder, MSF Director of Operations. “We urgently need to find ways to get humanitarian relief and personnel inside the country.” 

MSF has already treated hundreds of people wounded in the recent violence, but the current inability to send in medical supplies and trained personnel means the situation is reaching a critical point. 

“We must provide support to our field teams who are exhausted and overloaded. Even reaching the areas of greatest need within Yemen is difficult, as domestic flights have been cancelled and movements inside the country are risky,” said Elder. 

Fighting on the ground has proliferated, especially in the south of the country where MSF has been receiving large numbers of wounded. At its Emergency Surgical Unit in Aden, MSF has received more than 550 patients since March 19, as a result of clashes in Aden, Lahj and other areas in the south. On March 26 alone, 111 patients arrived at the hospital.

“We have had to use our office space, equipping the rooms with mattresses to receive the wounded,” said Dr Hani Isleem, MSF doctor in Aden.

Picard: We’re aiding and abetting homeopathic quackery

Via The Globe and Mail, André Picard writes: We’re aiding and abetting homeopathic quackery. Excerpt:

On April 1, the Ontario Homeopathy Act comes into force. Sadly, this is not an April Fool’s joke. 

There is no scientific case for homeopathy. It is undiluted quackery. 

Edzard Ernst, an emeritus professor at the University of Exeter, who has published more than 100 papers on the subject, describes it as follows: “Homeopathy is based on the belief that ‘like cures like’ and that the dilution of medicine – homeopaths call the process ‘potentiation’ – renders it not weaker but stronger.” 

Homeopaths believe that the water molecules retain a “memory” of the original substance, allowing nano-doses to trigger a healing response in the body. 

None of these concepts have any basis in biology, physiology or medicine. They are vestiges of centuries-ago practice, when homeopathy was an attractive alternative to bleedings, leeches and other snake-oil potions. 

This does not stop practitioners from making sweeping claims about “medicines that respect the wisdom of the body.” It is even stated repeatedly, as fact, that there are numerous studies demonstrating homeopathy’s effectiveness. 

In fact, the Australian National Health and Medical Research Council has just published what is probably the most thorough and detailed investigation of homeopathy since it was conceived by Samuel Hahnemann in the late 18th century. 

The conclusion of that blue-ribbon panel is as definitive as it is damning: “There are no conditions for which there is reliable evidence that homeopathy is effective.” None. The effect homeopathic remedies have, if any, is that of a placebo.