H5N1

Haiti: Dr. Carroll in the Los Angeles Times

Via The Los Angeles Times: An American physician laments Haiti's sick healthcare system, as a grinding doctors' strike drags on. Click or tap through for the full story and several of Dr. Carroll's remarkable photographs. Excerpt:

On a busy day, the Rosalind Rendu Pediatric Clinic deep inside Cité Soleil, a densely populated slum in Haiti’s capital of Port-au-Prince, is crammed with some 300 patients by 7 a.m.  Mothers come with babies and toddlers suffering a gamut of illnesses, from coughs and fever to skin infections and malnutrition. 

Even so, these children could be counted lucky. The clinic is private, run by the Catholic missionary group Daughters of Charity, and the youngsters might have the opportunity to be treated by two veteran Haitian pediatricians and Dr. John Carroll, an internist from West Peoria, Ill., who regularly travels to Haiti to treat children.  

“They are the fortunate ones because they are being seen that day and treated that day, and there is a pharmacy right there at the clinic,” Carroll said.

Fortunate, indeed. The reality is far grimmer for patients seeking help from public facilities, especially now that a strike that has ground on since March is exacerbating the already dismal and desperate state of healthcare in this impoverished Caribbean nation.  

Carroll, who recently returned from his seventh visit to Haiti in 18 months, offered first-hand accounts of the strike’s impact. Few of the other international humanitarian organizations that work in Haiti were willing to comment on the general impact of the walkout for fear of jeopardizing their status in the country. 

According to news reports, at least four public hospitals are closed, and others hobbled by the strike are limping along without the mainly young doctors and interns who have walked off the job.  

The physicians, who earn the equivalent of about $140 a month, according to international medical staff acquainted with Haitian doctors, are demanding better pay, improvements in sanitary conditions and more medical supplies, including basics like surgical gloves and gauze. 

“The public healthcare system is just deplorable in Haiti,” said Carroll, who founded Haitian Hearts, a nonprofit that since 1995 has facilitated surgery for about 200 Haitians, mainly pediatric heart surgery that is not routinely performed in Haiti. “It was bad even before the hospitals went on strike. But it's the only thing the majority of poor people had to turn to.”  

The doctors had originally demanded a pay rise to $500 per month but have now agreed to accept $360, the Associated Press reported. The government’s latest offer of $200 a month was rejected, the news agency said.  

At one hospital, the news agency described empty halls abuzz with flies with rats scampering through the wards at night. 

The conditions are not only bad for patients at public facilities, but also physicians, Carroll said. Some of his Haitian medical colleagues describe being overwhelmed by the number of patients, getting threatened by patients’ relatives, working without running water and performing operations under the glow of handheld flashlights because of the lack of regular electricity.

Thailand: Young Kuwaiti man cleared of MERS

Via the Bangkok Post: Young Kuwaiti man cleared of Mers. Excerpt:

An 18-year-old Kuwaiti man suspected of contracting Middle East Respiratory Syndrome was cleared of the virus in the first round of the two mandatory laboratory tests, director of the Bamrasnaradura Infectious Diseases Institute said Sunday.

The man still had to go through another round of tests to officially confirm he was negative for the deadly virus, according to WHO guidelines. Final results for clinical specimens obtained from the patient are expected to be released on Monday, Dr Jariya Saengsajja said.   

The unnamed man arrived in Thailand on Monday with his father and grandmother and fell ill on Tuesday. The Department of Disease Control’s screening measures initially indicated Mers, a highly contagious form of coronavirus. He was sent to the state-owned Bamrasnaradura institute in Nonthaburi on Thursday and has been treated in an isolation room.   

Dr Jariya said the patient mainly had fever. His father and grandmother who also had been placed in quarantine were also negative for Mers. However, they needed to be quarantined for 14 days to observe their symptoms before being released.   

Two known cases of Mers have been confirmed in Thailand with two Omani nationals tested positive for the virus in June last year and in January.

More on the Yamal anthrax outbreak

Via the Yamal-Nenets Autonomous Region government website: To help doctors Yamal sent experts Ministry of Health of the Russian Federation. The full report, in unedited Google translation:

To help Yamal physicians on site from Moscow to Salekhard fly experts Russian Ministry of Health. Minister Veronika Skvortsova sent to the region of the main infectious diseases Ministry of Health professoraIrinu Shestakov, and the Research Institute of Children's Infections experts to assist regional colleagues in connection with preventive measures among the population due to quarantine in the Yamal region.  

Recall from the first day of the accident (deer mortality) in the Yamal region of all structural units in the region were in constant communication with federal counterparts to give professional advice and support.  

To provide methodological and organizational assistance Yamal skilled health care system, Deputy Minister of Health of the Russian Federation Sergey spent videoselektornoe Regional Meeting, which was attended by leading experts on infectious diseases of the country, representatives of Rosselkhoznadzor and, FMBA of Russia. 

The meeting discussed the basic medical diagnostician of sul activities required in respect of persons hospitalized GOVERNMENTAL suspected of disease infection, including issues of specific vaccines, prophylaxis, especially emergency prophylaxis (preventive treatment) Antibacterial E preparations, especially organizing and conducting protivosibireyazv ennyh events. 

in addition, the chief freelance specialist in infectious diseases in the Urals federal District, Edward Kaszuba for regional doctors conducted a training webinar to provide medical care to persons with suspected anthrax. 

Doctors Health Yamal involved in outreach quarantine zone, received a comprehensive briefing, preventive training and compulsory vaccination. 

From the first day, and in the outbreak of animal diseases, and in a clean area of the state of the reindeer herders families watch specialists Yar-Salinskoy hospital there on the spot are the Department of Health experts YaNAO. In medical institutions all patients receive preventive treatment and observation. Everyone with suspected disease tests were taken and sent to the final determination of the diagnosis (or lack thereof) in the ad hoc expert laboratory Rospotrebnadzor.  

For vaccination campaign Yamal was promptly bought the vaccine at doses of 1000, which has already been delivered in Yar-Sale and transferred to medical facilities.  

Trained health workers Yamal proinstruktirova us and sent to the vaccination of the population of the Yamal region. 

Currently Yamal provided medicines, antibiotics and vaccines in full. 

The address Tatiana Deputy District Governor and Acting Buchkovoy Head of District Health Department Sergey Novikov treatment come from the chief physicians of municipalities, statements about the readiness to help and, if necessary, to send the best experts to help staff Salekhard and Yar-Salinskoy hospitals.

Siberia: Military biological protection troops sent to stop Yamal anthrax outbreak

Via The Independent Barents Observer: Military biological protection troops sent to stop Yamal anthrax outbreak.

So far, 40 people are hospitalized, among them several children that are under intensive care at the regional health centre in Salekhard. The people are Nenets reindeer herders from the outbreak area on Russia’s Yamal Peninsula. 

The Defence Ministry reports that a special emergency task force unit on Saturday was sent from the Central Military District’s base in Ekaterinburg to Salekhard with 30 tons of biologically active agents aimed at decontamination of infected areas.  

Chief of the Army’s Sanitary Inspection, Pavel Davydov, says to Vesti Yamal that the vaccine in use is approved for use by the Russian Armed Forces for prevention of anthrax and has repeatedly shown its effectiveness in outbreak of epidemic disease. 

“Its effectiveness is 95 percent,” Davydov says. 

The Army’s Il-76 airplane with military specialists from the corps dealing with chemical, radioactive and biological protection also brought a laboratory to help test people, the ground and animals. 

“Reconnaissance will be carried out from the air to determine the boundaries of the area where to take actions, arrange for field camps and direct routes for ground forces,” a press note from the Defence Ministry reads. 

In total, 200 specialists are now working on the tundra to eliminate the the outbreak, Vesti Yamal reports. A major task will be to dispose the large number of dead reindeers. 

1,200 reindeer are so far found dead, making the anthrax outbreak the largest in the country since the 1979 Sverdlovsk incident when spores of the bacteria allegedly accidentally leaked from a military laboratory. 

The current outbreak on the Siberia tundra could be linked to thawing reindeer carcasses. A heat wave has led to record-high temperatures up to 35 degrees Celsius across the Yamal tundra this July causes melting of the permafrost in the area. The anthrax bacteria can persist in soil for more than 70 years. 

The site of Yamalo-Nenets AO Governor’s office on Sunday reports that regional health authorities now receive assistance from medical specialists from Moscow. 

Russia’s Ministry of Health is closely following the situation on the Yamal Peninsula.

Vesti Yamal has an extensive report, and Google Translate can handle Russian reasonably well.

Finland: Domestic ticks now carry even more pathogens

Via Yle Uutiset: Domestic ticks now carry even more pathogens. Excerpt:

Turku University researchers have discovered additional dangerous bacteria on ticks found in southwest Finland. In addition to the already-familiar Borrellia bacteria behind Lyme disease and the virus that causes TBE encephalitis, the scientists also found traces of Rikettsia and Anaplasma bacteria never observed before in Finland. 

The two new strains of bacteria are however familiar. Jari Hänninen of the University of Turku’s Archipelago Research Institute says the find didn’t come unexpected, as the bacteria were already found in several of Finland’s neighbouring countries.  

“One of the Rikettsia diseases is typhus, an epidemic of which brought Napoleon’s army to its knees,” he says. 

Rikettsia is transmitted to humans via external parasites like lice, fleas or ticks and are the pathogen responsible for typhus and spotted fever.

McNeil: Zika cases in Puerto Rico are skyrocketing

Via The New York Times, an excellent report by Donald G. McNeil Jr.: Zika Cases in Puerto Rico Are Skyrocketing. Note that he's using the CDC July 29 Zika numbers, based on week 27, which were boosted 30% by the Puerto Rico Health Department's July 29 report based on week 28. Excerpt:

The Zika epidemic that has spread from Brazil to the rest of Latin America is now raging in Puerto Rico — and the island’s response is in chaos.  

The war against the Aedes aegypti mosquito carrying the virus is sputtering out in failure. Infections are skyrocketing: Many residents fail to protect themselves against bites because they believe the threat is exaggerated. 

Federal and local health officials are feuding, and the governor’s special adviser on Zika has quit in disgust. 

There are only about 5,500 confirmed infections on the island, including of 672 pregnant women. But experts at the Centers for Disease Control and Prevention say they believe that is a radical undercount. 

Just four cases of infection were confirmed last week in Florida. But in Puerto Rico, officials believe thousands of residents — including up to 50 pregnant women — are infected each day. 

Most never get tested. Tests on donated blood, the most reliable barometer of the epidemic’s spread, show that almost 2 percent of the donors were infected in the last 10 days.  

“That’s a stunning number and reflects an explosion of cases,” Dr. Thomas R. Frieden, the director of the C.D.C., said in an interview. The proportion of pregnant women testing positive for the virus has risen sevenfold since January, the agency said on Friday. Officials warned that hundreds of infants could be born with microcephaly in the coming year.  

But a wave of microcephaly like Brazil’s may yet be averted for two reasons. The pregnancy rate is falling so precipitously that this year, for the first time in history, Puerto Rico will have fewer births than deaths. 

Obstetricians, too, are quietly urging their infected pregnant patients to have regular ultrasounds and to consider abortion if brain damage turns up.

Rural counties across the US becoming a powder keg for HIV outbreak

Via The Guardian, a long, alarming report: Rural counties across the US becoming a powder keg for HIV outbreak. Excerpt:

A man was lying sedate after injecting drugs. His fellow users, to amuse themselves, threw needles at him like a human dartboard to see if they would stick, according to a recent police report in Wolfe County, Kentucky. 

“Back in the day, all we had to worry about was people drinking or smoking weed,” said special deputy Gary Smith, who is entering his 25th year with the Wolfe County sheriff’s department.  

But with a growing US opioid epidemic that has escalated the number of injection drug users, the bucolic county has become acutely at risk from another public health problem. 

Wolfe County tops the list of places that are most vulnerable to an HIV outbreak. 

A new alarm for the HIV epidemic sounded early last year when a small, rural town in Indiana was beset with a staggering 188 cases of the hard-to-control disease – and the sirens have been heard in similar towns across the country. 

The threat of another outbreak such as the one in Austin, Indiana, so concerned the Centers for Disease Control and Prevention (CDC) that the federal agency drafted a report showcasing which places in the US are most vulnerable to a similar outbreak. 

HIV rates among drug users have dropped substantially since they peaked in the 1980s and before Indiana’s outbreak, rural counties had been largely insulated from outbreaks of HIV. But the opioid addiction epidemic has put new communities at risk. 

“If we don’t begin to think about how we could prevent this from happening again, it could really erode our success,” said John Brooks, a CDC epidemiologist and the senior author of the vulnerability assessment.  

The CDC determined a county’s vulnerability with a sobering recipe: high rates of drug overdose deaths and prescription opioid sales, a high white population, astounding rates of hepatitis C and searing poverty.  

“For many years this was an urban issue, an inner-city issue, but what we learned from southern Indiana is that rural parts of our country are now at significant risk,” said Ardis Hoven, an infectious disease specialist with Kentucky’s department for public health. 

“If you look at these areas, the uniqueness is not only the poverty, not only the issue of unemployment and early teen births and educational issues, but the cultural issues embedded in many of those areas.”

Hope for 'end of Aids' is disappearing, experts warn

Via The Guardian: Hope for 'end of Aids' is disappearing, experts warn. Excerpt:

Efforts to combat Aids in Africa are seriously faltering, with drugs beginning to lose their power, the number of infections rising and funding declining, raising the prospect of the epidemic once more spiralling out of control, experts have warned. 

The UN has set a target of 2030 for “the end of Aids”, which has been endorsed by donor governments including the US, where the president, Barack Obama, said the end was in sight last month. 

But the reality on the ground, especially in the developing world, looks very different. Many experts believe that the epidemic will continue to spread and the Aids death toll, still at 1.5 million people a year, could begin to soar again. 

Prof Peter Piot, the first executive director of UNAIDS and director of the London School of Hygiene and Tropical Medicine, told the Guardian: “I don’t believe the slogan ‘the end of Aids by 2030’ is realistic and it could be counterproductive. It could suggest that it’s fine, it’s all over and we can move to something else. No. Aids is still one of the biggest killers in the world.”  

At the recent International Aids Conference in Durban, South Africa, Bill Gates, a self-proclaimed optimist whose foundation has invested heavily in combatting HIV, warned of trouble ahead. 

“If we only do as well as we have been doing, the number of people with HIV will go up even beyond its previous peak,” Gates said. “We have to do an incredible amount to reduce the incidence of the number of people getting the infection. To start writing the story of the end of Aids, new ways of thinking about treatment and prevention are essential.”

Thailand: A little more on the imported MERS case

Via The Nation: Kuwaiti teenager becomes third MERS case in Thailand. Excerpt:

Thailand has found a third case of the Middle East respiratory syndrome corona virus (MERS-CoV) in an 18-year-old Kuwaiti man, Disease Control Department (DCD) chief Amnuay Kajeena revealed yesterday.  

The incident prompted the DCD to set up a special coordination centre at its head office to trace those exposed to him, including those on the same flight. 

The patient, who entered Thailand on July 25 along with his father and grandmother, was being treated in an isolated room while the two relatives as well as a taxi driver were put on quarantine. 

After 14 days, when the patient's condition improves and he is cured of the infection, he would be allowed to go home, Amnuay added. 

Amnuay said the family had come to seek treatment for the grandmother's knee problem when her grandson developed flu-like symptoms on July 26. The private hospital that treated the grandmother collected his sample for lab test, which showed the next day that he had MERS-CoV. 

 The DCD stepped in and took the man for treatment to an isolated room at the Bamrasnaradura Infectious Diseases Institute in Nonthaburi last Thursday. 

 "The patient's fever has come down and he does not have any worrisome symptoms. Fourteen days after his treatment started, if the lab test results show he is free of the infection, he would be released from the institute," he said, adding the young man's two close relatives as well as a taxi driver were also brought under the institute's care.  

Amnuay explained that this teenager, despite detection of the virus in him, was categorised as a person "likely to fall ill" from MERS-CoV - apart from two other categories of "confirmed" patients and the "variable group". The tests of his bodily fluids at four labs (Medical Science Department, Bamrasnaradura Infectious Diseases Institute, Chulalongkorn Hospital and Ramathibodi Hospital) found the virus but the results had some uncertainty pending confirmation from experts.

Ebola nurse Pauline Cafferkey desperate to end 'stressful' misconduct case

Via The Telegraph: 'I don't know why it has not been finished': Ebola nurse Pauline Cafferkey desperate to end 'stressful' misconduct case. Excerpt:

Pauline Cafferkey, the British nurse who almost died from Ebola, has told for the first time of her anguish after being accused of misconduct over her return to the UK with the virus. 

Miss Cafferkey said she was upset to still have an official inquiry hanging over her head more than 18 months after she returned to Britain. She is at risk of being struck off by the Nursing and Midwifery Council (NMC). 

The Scottish nurse contracted Ebola while working in a hospital in Sierra Leone at the height of the crisis. She flew back to Heathrow in December 2014 with a high temperature.   

Public Health England (PHE) staff, in charge of screening for the virus at the airport, took Miss Cafferkey’s temperature six more times before allowing her on to a connecting flight back to her home in Glasgow. 

Miss Cafferkey, 40, then fell critically ill and had to be flown back to London for life-saving treatment at the Royal Free Hospital. 

She was told after leaving hospital that she was under investigation by the NMC after concerns were passed to them by PHE. The reasons why have never been disclosed. 

“The report on how they are dealing with my case is still ongoing,” said Miss Cafferkey, in an interview with The Telegraph. “I don’t know why it has not been finished. It’s very stressful. It would be nice to have closure.” 

On the specific allegations, Miss Cafferkey said: “My lawyer just says I can’t speak about it. I am unable to discuss the investigation whilst it is ongoing and I am looking forward to its conclusion.” 

Miss Cafferkey spoke to The Telegraph to highlight her support for Street Child, a British charity that helps vulnerable children in west Africa. The charity has launched an appeal to raise funds for 20,000 children affected by the Ebola virus in Sierra Leone and in Liberia. 

Miss Cafferkey spent five weeks working in Sierra Leone, tending to Ebola patients. She twice came close to death - once from Ebola and later from meningitis triggered by the virus. 

She is back working but cannot continue her old job of home visits as a community nurse because she is currently prevented from driving because of the seizures caused by the meningitis. 

“I was in a pretty bad way. I am really happy with how I am now. I couldn’t walk, I was in a wheelchair,” she said. “Now I am just a bit weak. My joints ache, things like that. I feel like I am having my whole life back.”