H5N1

A hope for 2016

Via Controversies in Hospital Infection Prevention, Eli Perencevich writes: Čojstvo - Humanity - My hope for 2016.

Mike has written often about humanism in the context of the white coat debate. He contrasts humanism with professionalism, with humanism focusing on the welfare of humankind while professionalism primarily seeks to strengthen a personal professional identity. 

With that in mind, I was just listening to The Gist and Mike Pesca was retelling the story behind his favorite sentence for 2015. While on a tour in Montenegro this past summer, he heard the guide try to explain the ethical ideal of the Montenegrin people - Čojstvo i Junaštvo, which roughly translates to Humanity and Bravery, using the sentence below: "Bravery is very easy - it is when you defend yourself from others but humanity is more difficult - it is when you defend others from yourself" - Nino Markovic (Montenegrin Tour Guide) 

So from Mike Pesca's sentence for 2015, I've found my hope for 2016: 

Čojstvo - Humanity

CDC: Zika virus in Puerto Rico

Thanks to Greg Folkers for sending the link to this CDC Travel Health Notice: Zika Virus in Puerto Rico - Watch - Level 1, Practice Usual Precautions. Excerpt:

In December 2015, a locally transmitted case of Zika virus infection was detected in Puerto Rico. This is the first case of Zika virus in Puerto Rico. Local transmission means that mosquitoes in Puerto Rico have been infected with Zika virus, spreading it to humans. 

CDC recommends that travelers to affected areas in South America, Central America, the Caribbean, or Mexico protect themselves from mosquito bites. Zika outbreaks have been identified recently in several countries in Central and South America. The outbreak began in Brazil in May. Recently, the Ministry of Health in Brazil has raised concerns about a possible association between the Zika virus outbreak and increased numbers of babies born with birth defects. For this reason, pregnant women should take extra precautions to avoid mosquito bites.

Thoughts at year's end

A year ago today I posted Year's end: A look back, a look ahead. Here's what I said about the impending year, with comments in brackets and then a few more thoughts:

As a science-fiction writer, I have an innate inability to foresee the future; my profession always misses some minor but critical development like the personal computer. But if I were to venture a cautious forecast, I would offer these guesses at the events in global health in 2015: 

• Continuation of endemic cholera in Haiti, and no compensation from the UN for its infliction of avoidable death and misery. [Got it right]

• Continuation of chikungunya's march across the Americas, with serious damage to the tourism and cruise-ship industries in the Caribbean and to the economies of the affected countries. [Got spread right; negligible damage to tourism & cruise industries]

• Establishment of Ebola as an endemic disease in West Africa, permitting the rest of us to forget about it and get back to serious stuff like the next celebrity scandal. [Not yet certain; the end of confirmed cases doesn't mean the end of Ebola]

• A similar apathy toward the malnutrition and outright famine triggered by Ebola across West Africa, not to mention the decades-long consequences of a generation stunted and stupefied by inadequate food. [Got it right]

• No outbreak of any disease that will affect Europe and North America seriously enough to make their terrified voters agree to spend money to stamp it out both at home and abroad. We will continue to rely on the mad saints of MSF and other global-health organizations to save us from ourselves. [Got it right, though the US enjoyed a few weeks of hysteria about Ebola]

• No pandemic, least of all with zombies in the streets. Just the routine, unnoticed sickness and deaths of many millions, mostly toddlers, from boring stuff like malaria and diarrhea. [Got it right]

I completely failed to foresee Zika, not to mention the refugee issue, just as in earlier years I'd been surprised by H1N1 and H7N9 and MERS. Sometimes it's the shy cousins of known diseases that sneak up on us; if that continues, then we may get yet another rare strain of avian influenza, or big outbreaks of Lassa or Marburg.

But I can foresee pretty confidently that the outbreaks will likely be in poor countries, or rich countries with large populations of poor people, and that politics will determine how well the outbreak is handled.

 

That discouraging thought notwithstanding, I wish you and yours a very happy and healthy 2016.

Quantifying poverty as a driver of Ebola transmission

Thanks to Greg Folkers for sending the link to this report in PLOS Neglected Tropical Diseases: Quantifying Poverty as a Driver of Ebola Transmission. The abstract:

Background 

Poverty has been implicated as a challenge in the control of the current Ebola outbreak in West Africa. Although disparities between affected countries have been appreciated, disparities within West African countries have not been investigated as drivers of Ebola transmission. To quantify the role that poverty plays in the transmission of Ebola, we analyzed heterogeneity of Ebola incidence and transmission factors among over 300 communities, categorized by socioeconomic status (SES), within Montserrado County, Liberia. 

Methodology/Principal Findings 

We evaluated 4,437 Ebola cases reported between February 28, 2014 and December 1, 2014 for Montserrado County to determine SES-stratified temporal trends and drivers of Ebola transmission. A dataset including dates of symptom onset, hospitalization, and death, and specified community of residence was used to stratify cases into high, middle and low SES. Additionally, information about 9,129 contacts was provided for a subset of 1,585 traced individuals. To evaluate transmission within and across socioeconomic subpopulations, as well as over the trajectory of the outbreak, we analyzed these data with a time-dependent stochastic model. 

Cases in the most impoverished communities reported three more contacts on average than cases in high SES communities (p<0.001). Our transmission model shows that infected individuals from middle and low SES communities were associated with 1.5 (95% CI: 1.4–1.6) and 3.5 (95% CI: 3.1–3.9) times as many secondary cases as those from high SES communities, respectively. Furthermore, most of the spread of Ebola across Montserrado County originated from areas of lower SES. 

Conclusions/Significance 

Individuals from areas of poverty were associated with high rates of transmission and spread of Ebola to other regions. Thus, Ebola could most effectively be prevented or contained if disease interventions were targeted to areas of extreme poverty and funding was dedicated to development projects that meet basic needs.

Haiti sets up early warning system for Zika virus

Via HaitiLibre.com: Haiti - NOTICE : Early warning system of suspected cases of the ZIKA virus. Excerpt:

Following the warning launched by the Pan American Health Organization (PAHO/WHO) of the circulation of Zika virus in the Americas region, the Ministry of Public Health has set up an early warning system for detection in time of potential suspected cases of Zika fever in Haiti. 

The specimens of mosquitoes, vectors of the virus, including the Aedes collected in Haiti by the Epidemiology Department, Laboratory and Research on suspected cases of Zika that have been tested at Caribbean Public Health Agency (CARPHA) to Trinidad and Tobago, were negative. 

So far, the Ministry of Health has not detected the presence of Zika on national territory. However, it continues to strengthen its disease surveillance system for the timely detection of cases in Haiti.

India: Delhi driving restrictions in force from New Year's Day in bid to clear smog

Via The Guardian: Delhi driving restrictions in force from New Year's Day in bid to clear pollution. Excerpt:

Delhi is to implement a fortnight-long driving ban for certain cars from New Year’s Day in an experiment critics say falls far short of what is needed to lower the Indian capital’s lethal pollution levels. 

For two weeks from Friday, only alternate-day travel will be permitted between 8am and 8pm for private cars with odd- and even-numbered licence plates, while thousands of trucks carrying commercial goods will be discouraged from driving through the city. 

But the local government’s first major effort to clear Delhi’s air – the most polluted in the world, according to the WHO in 2014 – has been criticised by those who say sweeping exemptions render it inadequate. 

The measure’s focus is on restricting passenger cars which, critics point out, account for only 10% of the air pollution. Moreover, 27 categories of motorists are exempt, including all female drivers, the prime minister, Narendra Modi, and his ministers.

Goods vehicles, which contribute 30%, will also be regulated. But more than 5 million motorcyclists have been spared, for fear their numbers would swamp the already over-burdened bus and metro system. 

“This is just a beginning,” said Delhi’s state chief minister, Arvind Kejriwal. “We’ll have to undertake even sterner measures in the future to safeguard our health, and especially our children’s future. It has to become a movement.”

The most contested exemption is the one for female drivers, which officials say is to ensure women’s security. A court will now decide whether it is discriminatory to allow women to drive around Delhi while some of their male counterparts will be forced to leave their vehicles at home. 

Though several factors have contributed to the dirtying of the city’s atmosphere, the authorities are focusing first on reducing car pollution, despite the fact that it has yielded mixed results when tested in other cities around the world. 

While the Indian capital’s public transport system remains inadequate despite a new metro, there has been a surge in the number of private vehicles in recent years. 

Many of the new cars and sports utility vehicles run on diesel, which is more polluting than petrol. A court has now banned the sale of big diesel cars for three months. There has also been a huge increase in the number of people commuting on motorbikes, which are responsible for nearly a third of the pollution. 

The warning signs have long been there. In 2010 a top cancer institute in India warned in an authoritative report that nearly half of Delhi’s 4.4 million schoolchildren were growing up with irreversible lung damage. None of the recommendations by this government-commissioned study were implemented. 

“If this goes on, we’ll have a stunted ... population,” said Sanjeev Bagai, a paediatric nephrologist. “Delhi kids have the lungs of chain-smokers.”

As of 8:00 p.m. Thursday night, local time, the current Delhi AQI in Mandir Marg is a lung-clogging 890. Here in North Vancouver, AQI is currently 7.

Honduras confirms 40 Zika virus cases

Via El Heraldo, a December 29 report: Secretaría de Salud confirma 40 casos de zika en Honduras.[Health Secretariat confirms 40 Zika cases in Honduras] Excerpt, with my translation:

Al menos 40 casos de zika reporta la Secretaría de Salud este mes.

The Health Secretariat confirms at least 40 cases of Zika this month.

Así lo informó el viceministro de Salud, Francis Contreras.

So says Francis Contreras, vice-minister of Health.

Estos casos son procedente de los departamentos de Choluteca, Valle y El Paraíso.

The cases are in the departments of Choluteca, Valle, and El Paraíso.

“En estos momentos hay 40 casos de zika en el país, sabemos que es una enfermedad nueva, de estos casos hay dos confirmados laboratorialmente, los demás son diagnosticados de manera clínica, es decir, haciendo la relación con los síntomas”, dijo Contreras.

"At the moment there are 40 cases of Zika in the country. We know it's a new disease. Of these case, two have been confirmed in laboratories; the rest are diagnosed clinically, that is, on the basis of symptoms," Contreras said.

Explicó que las cifras de enfermedades serán ofrecidas de manera semanal, tal como se hizo con dengue y chikungunya.

He explained that Zika statistics will be reported weekly, as is done with dengue and chikungunya.

“Muy probablemente hay casos diagnosticados de dengue que son de zika, y casos de zika que son de dengue, todo por la similitud de los síntomas”, expresó el funcionario.

"Very likely some diagnosed dengue cases are Zika, and some Zika cases are dengue, given the similarity of the symptoms," the official said.

Pakistan: Vehicle of polio drive supervisor targeted in Parachinar

Via The Express Tribune, a bizarre report: In the line of fire: Vehicle of polio drive supervisor targeted in Parachinar. Excerpt:

Personnel of the levies forces opened fire on the car of polio drive supervisor Dr Masoom Begum in Parachinar on Tuesday. Gulzar, her brother who was driving the vehicle, was injured and rushed to the hospital. 

Political administration started an investigation into the case and held a crisis meeting with the administration officers and personnel from health department. 

Initial investigation revealed Masoom Begum’s car had broken down in Torsa, Parachinar. Gulzar approached personnel station at a levies check post to ask for help. 

However, the levies personnel were offended that Gulzar decided to park the car at the spot. As a result, they fired seven rounds on the vehicle, leaving Gulzar injured. 

Masoom Begum was a part of a special polio drive that kicked off in Parachinar to vaccinate 123,000 children against the crippling virus. Besides polio, injections will also be administered to vaccinate children against other diseases.

Meanwhile, VOA reports that a polio worker in Kandahar, Afghanistan was shot and killed on Monday.

Ebola's thin harvest

Via Science, a report by Jon Cohen and Martin Enserink: Special report: Ebola's thin harvest. Excerpt:

Since 29 November, not a single new Ebola case has been reported in Guinea, Sierra Leone, or Liberia. If no new cases pop up, the world will be able to declare on 14 January that the 2-year Ebola epidemic has ended at last, after more than 28,600 cases and 11,300 deaths. 

Victory would also mean the end of an unprecedented era in Ebola research. The tragedy offered a unique opportunity: Never before had the disease affected enough people to allow researchers to test Ebola drugs and vaccines in a real-world setting. As the number of cases exploded in mid-2014, they set in motion a vast research program that operated at breakneck speed. 

But the harvest of that massive effort is thin. 

The biggest success so far is a vaccine produced by Merck. A 31 July report in The Lancet  documented remarkable effectiveness in a real-world trial in Guinea. But all other results have yet to appear in the scientific literature. And a careful examination of the data so far—supported by dozens of interviews with the leaders of the studies and other Ebola experts—makes it clear that almost every other trial seems destined to end in questionable results or outright failure. Findings from those that have ended are proving difficult to publish in top-tier journals. 

The reasons are varied and complicated. Even under the best circumstances, clinical trials don’t always deliver satisfying results. In this case, many studies started too late, when the epidemic was already declining, and ran out of patients. Others had designs that from the outset had little chance of providing a clear answer. A pharmaceutical company aborted a trial for reasons it never clarified, and the fate of another trial remains obscure even to the World Health Organization.

Saudi Arabia: No new MERS cases as of noon December 31

Via the KSA MOH Command and Control Center: MOH: 'No New Corona Cases Recorded. No deaths or recoveries are reported either. The numbers remain at three cases under care, 729 recoveries, 1,283 total, and 551 deaths.