H5N1

India: Air quality index hits 999 in Anand Vihar, Delhi

Wow: Mandir Marg, Delhi, Delhi Air Pollution: Real-time PM2.5 Air Quality Index (AQI). At 8:00 a.m. on Tuesday morning, local time, the index shows a PM2.5 of 999. That's listed as "hazardous," but four other Delhi sites are showing other hazardous indexes of 457, 485, 528, 560 and 750. For 999, we need a better adjective. 

Nigeria: Lassa fever hits Kaduna, kills pregnant woman, doctor, nurse

Thanks to @LassaFeverNews for tweeting the link to this report in Leadership: Lassa Fever Hits Kaduna, Kills Pregnant Woman, Doctor, 1 Other.

A pregnant woman and two health workers have been confirmed dead following the outbreak  of Lassa fever in Kaduna. 

The three people including a medical doctor who was undergoing his national youth service year as a corp and a community health nurse died at the Saint Louis Hospital in Zonkwa, area of Zango Kataf local government of the state.  

The doctor and the nurse it would be recalled contacted the lassa fever disease after conducting an operation on a pregnant woman who later died of the same disease two weeks ago. 

Confirming the outbreak, the state commissioner for health, Professor Jonathan Andrew Nok told journalists, that two weeks ago, there was a pregnant woman that visited the Saint Louis Hospital after she was referred from a clinic in Kamuru. 

‘‘She was pregnant and an operation was conducted on her by the doctor and nurse. She subsequently died.”  

He added: “The two individuals that died were the people that actually attended to the pregnant woman. She died about two weeks ago. No one thought they would die like that after the woman. The woman died of lassa disease. She was buried properly. And it was after her death that symptoms of lassa started to show on the medical doctor and the community nurse. 

“The doctor and the nurse died after they had high temperature consistently for four days,” said the commissioner. 

He said that the doctor and nurse showed signs of lassa fever shortly  after operating a  pregnant woman who was brought in from another hospital in from a primary health care centre in Kamuru in the same local government. 

‘‘The woman later died few days after they were tested positive to lassa.’’

US: Rare, polio-like illness suspected in Bellingham child’s death

As a polio survivor (class of 1948), I take reports like this very seriously. Via The Seattle Times: Rare, polio-like illness suspected in Bellingham child’s death. Excerpt:

A 6-year-old Bellingham boy who was among eight children hospitalized this fall with a mysterious, polio-like illness has died, family and health officials said.  

Jonathan Daniel Ramirez Porter, known as Daniel, was on life support for several days before his death Monday, according to his grandmother, Mitzie De Guzman, of Bellingham. 

The child fell ill on Oct. 15 with vomiting, a high fever and other symptoms. He was taken to a hospital in Bellingham and flown to Seattle Children’s, where his condition worsened. 

“It was just all of a sudden, out of nowhere,” De Guzman said. 

Daniel was one of three children who remained hospitalized at Seattle Children’s with neurological symptoms. All of the children, who ranged in age from 3 to 14, were suspected to have acute flaccid myelitis, or AFM, a neurological illness that causes a range of problems, including paralyzed limbs. However, none of the children, including Daniel, have been confirmed to have AFM.  

The children came from King, Pierce, Franklin and Whatcom counties, health officials said. The first case was seen in mid-September and the most recent was in mid-October. 

AFM is a mysterious illness that appears to target the spinal cord. It has been associated with various viruses, including enteroviruses, both polio and non-polio types. It has also been associated with West Nile virus and the viruses that cause the common cold.  

The key symptom is the sudden onset of weakness in legs or arms, though neck stiffness is also reported. Facial drooping or trouble swallowing and speaking also have been reported.  

There has been an uptick in cases of AFM nationwide, according to the Centers for Disease Control and Prevention (CDC). Cases spiked in 2014, with 120 in 34 states. Just 21 cases were reported in 2015. As of August, 50 people in 24 states were confirmed to have AFM this year, the CDC said. Still, it remains quite rare, with fewer than one in every million people affected.  

In Washington, five children affected this fall have been released from the hospital and are recovering. Two remain at Seattle Children’s. Hospital officials said those families declined to discuss the situation.

Vietnam confirms at least 23 Zika cases

Via VnExpress International: Vietnam confirms at least 23 Zika cases. Excerpt:

At least 23 people have been infected with the Zika virus in Vietnam, including 17 confirmed cases in Ho Chi Minh City, according to a new report from the leading epidemiology center Pasteur Institute.  

The new figure is astonishing, considering that the city had earlier confirmed only five cases. It declared a pandemic state of the mosquito-borne disease in October.  

Vietnam reported the first Zika cases, also in HCMC, in April. There have been six other infections in the neighboring Binh Duong, Long An and Tra Vinh Provinces in the Mekong Delta, and Dak Lak, Khanh Hoa and Phu Yen in the central region. 

Tran Dac Phu, director of the Preventive Health Department under the health ministry, said HCMC has high risk of infection given its large population, which is around 12 million including migrants. 

There is a lot of mobility around the city while "the hygiene is not very good," Phu said.  

He said the population of the Aedes aegypti mosquito, a vector species for the Zika virus that also carries dengue and yellow fever, has increased significantly in the city.  

The department on Sunday officially linked the first case of microcephaly to Zika, a four-month-old girl in Dak Lak. Her mother reportedly contracted the virus during the pregnancy.  

Health officials said people, either men or women, should avoid mosquito bites and traveling to places with Zika epidemic if they plan to have children.

Millions of Yemeni children facing triple threat of cholera, measles and malnutrition

Via ReliefWeb, a report from Save the Children: Millions of Yemeni children facing triple threat of cholera, measles and malnutrition. Excerpt:

Millions of Yemeni children are at risk from a triple threat of malnutrition which has left their immune systems low, a spiralling cholera epidemic, and a new outbreak of the highly infectious measles virus.  

The warning comes as fighting between the Saudi Arabia-led coalition and Houthi opposition group has raged all week, since a 72-hour ceasefire ended and failed to secure lasting peace.  

At least 1.5 million children are already acutely malnourished and millions more are ‘food insecure’, going to bed hungry every night. This is the result of 19-months of hostilities during which imports of essential supplies including food, fuel and medicine have been severely restricted; humanitarian access obstructed; and hospitals and other vital civilian facilities bombed.  

Of the 7.6 million people declared to be ‘at risk’ of cholera, approximately half are assumed to be children – around 3.8 million. 

One girl named Yasmine, seven, was treated for cholera in al-Sabeen Children’s Hospital in the capital city Sana’a, alongside her sister and triplet brothers. 

Her father Bashir, 38, said: “Their grandmother had symptoms and three days later, six of our children – three girls and three boys – were infected. They got severe diarrhea. Immediately, we went to the closest clinic in our area but the doctors could not accept the cases. My daughter Yasmine went into a coma, I was very scared. The doctor in the clinic suggested I take her and the other children to the hospital in Sana’a.” 

Because al-Sabeen Hospital has run out of some supplies, like many hospitals in Yemen, staff have been forced to ask patients to buy their own medicines externally. When available, it is vastly overpriced.  

Bashir said: “I called my cousin to lend me some money for the medicine, I got the money, but I didn't find the medicine. I kept driving all night to find potassium for oral intake. I found only one bottle while I need two bottles. So I gave it to my daughter Yasmine first who is in a seriously bad situation.” One bottle cost £15 (4,500 Yemeni Riyal). 

The father spent most of the money he had been saving for years: “I had saved about 650,000 riyal (£2,120) but I spent it all now, I only have 8,000 riyal (£26) left. I own a minibus, it is in bad condition but I’m willing to sell it for my children.” 

Dr Najat, who treated Yasmine, said: “Yasmine suffers from kidney failure owing to severe dehydration which stemmed from cholera, she needs intensive care. 

“The situation is very bad here in the hospital, we are really facing a crisis. We are lacking medicines, equipment, doctors and staff salaries.”

And all thanks to the House of Saud.

Florida Health Zika update, October 31: Five new cases

Florida Health has published its Department of Health Daily Zika Update for October 31. Excerpt:

There are four new travel related Zika cases today with one in Collier, one in Miami-Dade, one in St. Lucie and one involving a pregnant woman. Please visit our website to see the full list of travel-related cases. 

There is one non-travel associated case today. The individual is a Miami-Dade County resident and the department is investigating to determine where exposure occurred.

Today's numbers: 771 travel-related cases; 183 local cases; 124 cases involving pregnant women; 6 undetermined cases. Total: 1,103 cases.

Weathering a Zika storm in Colombia

Via The New York Times: Weathering a Zika Storm in Colombia. Excerpt:

BARRANQUILLA, Colombia — This tropical city on the Caribbean coast may hold the answer to one of the deeper mysteries of the Zika epidemic: Why has the world’s second-largest outbreak, after Brazil’s, produced so few birth defects?  

In Brazil, more than 2,000 babies have been born with microcephaly, abnormally small heads and brain damage caused by the Zika virus. In Colombia, officials had predicted there might be as many as 700 such babies by the end of this year. There have been merely 47.  

The gap has been seen all over the Americas. According to the World Health Organization, the United States has 28 cases — almost all linked to women infected elsewhere. Guatemala has 15, and Martinique has 12.  

Had the rest of the Americas been as affected as northeastern Brazil, a tidal wave of microcephaly would be washing over the region. Most experts say that will not happen, but they are at a loss as to why.

Discovering what stopped microcephaly in Colombia may help other countries tamp down the epidemic’s worst effects. 

There are some obvious differences between Colombia’s epidemic and Brazil’s. The population here is less than a quarter that of Brazil, and almost half of its residents live at higher altitudes, where mosquitoes are rarer. 

And Zika circulated silently for much longer in Brazil. The virus arrived there by early 2014, and not in Colombia until late 2015. Having just fought a severe chikungunya epidemic in 2014, Colombia was more ready than Brazil to send forth the anti-mosquito battalions.  

But all that does not seem sufficient to explain the disparity. Increasingly, there is evidence for two other possibilities. 

Pregnant women here, alerted to the tragedy unfolding in Brazil, may have sought abortions in greater numbers, officials say. Others seem to have heeded the government’s controversial advice to delay pregnancy altogether.  

Dr. Miguel Parra-Saavedra, the director of maternal-fetal medicine at the Cedifetal Clinic in Barranquilla and one of the country’s leading high-risk pregnancy specialists, is among the experts who suspect many pregnant women in Colombia, alarmed by news reports, sought ultrasounds and aborted deformed fetuses. 

Some of his own patients have done so. 

Dr. Parra-Saavedra heads a study of Zika-related birth defects in cooperation with the Centers for Disease Control and Prevention. In the course of the research thus far, he has diagnosed 13 cases of fetal microcephaly.

Four of the mothers terminated their pregnancies immediately, he said. Another four, and possibly a fifth, sought abortions but were turned down by their health insurance companies.  

Only four patients, Dr. Parra-Saavedra said, deliberately chose to have their babies.

Dr. Carroll's situation reports from Haiti, October 29

Via Haiti Resilience System, a very interesting site whose latest post is Situation Reports via John A. Carroll MD. Excerpt:

October 19, 2016

Family from Chantal just told me that a zone called LaCotte has much cholera. Five people in same house died. Unable to give exact date. 

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October 29, 2016 

Port Salut hospital served by two Cuban docs--very nice. Fidel and his brother also supplied the Ringers Lactate for the hospital . . . 

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October 29, 2016 

On Thursday spent day on Southern coast--Cayes, Torbeck, Port Salut, Coteaux, Damassin, Port a Piment, Kalapa, Chardonnieres. We were fording some small creeks/rivers in the truck, but Les Anglais River too deep and wide so we stopped. The trucks were very few here cause road in South so horrible. I would imagine Hiroshima like this. Port Salut CTC had 30 patients according to nurse last week but only 3 when I was there. Port Salut is a MSPP hospital and made of cement and seemed structurally sound even though it was right on beach.  

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October 29, 2016 The biggest problems I see are lack of food and water for almost 4 weeks now. The roofs are getting patched with tarp or corrugated metal ("toll"). Groups of kids run after the vehicle looking for food. 

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October 29, 2016  . . . I tried to get to Pestel my first day and took the wrong Y at Carrefour Charles and ended up in Corail and then Jeremie. There were truck convoys of aid inching through the mountains escorted by UN and by UDMO (Haitian police). The mountain roads were muddy and treacherous with tons of potholes which really slows the big truck (counted about 10 trucks in largest convoy). Very narrow in places too. My point is that delivery of aid to the South still very difficult even though fallen trees and electric poles are not on roads now. I drove back from Jeremie in the dark and gushing rains high in the mountains with no other vehicles except a couple from Jeremie to Cayes on Wednesday night--took 4 hours. JC

In mouse study, Zika damages cells in testes, impedes fertility

Via STAT: In mouse study, Zika damages cells in testes, impedes fertility. Excerpt:

The Zika virus attacks cells in mouse testes crucial for sperm and sex hormone generation and hampers reproduction, according to new research that raises the possibility that the virus could affect fertility in men. 

There are major caveats to the research, which was published Monday in the journal Nature. The study was conducted in mice, and many findings from mouse studies do not hold up in people. The researchers also used a very powerful dose of Zika when infecting the mice. 

And even if the same outcomes bear out in people, researchers have no idea what percentage of men who contract Zika would be affected or just how damaging the infection could be. Many men, for example, can see a drop in their sperm count without having a harder time conceiving a child.  

But the findings were enough for the paper’s authors to call for further study of the issue in men who have contracted Zika to determine whether the virus affects the male reproductive tract over time.  

“This is what we see in mice,” said Dr. Michael Diamond, a viral immunologist at Washington University School of Medicine and senior author of the paper. “How much of this applies to humans? That’s the key question that needs to be addressed in longitudinal studies.” 

Nikos Vasilakis, a Zika expert at the University of Texas Medical Branch in Galveston who was not involved with the new work, praised the research and said it warranted additional studies in monkeys and possibly finding a group of infected men to study. 

“The key is, would that translate as well in humans?” Vasilakis said about the study’s findings.

Haiti’s Ministry of Health takes action to control cholera in areas affected by Hurricane Matthew

Via News-Medical.net: Haiti’s Ministry of Health takes action to control cholera in areas affected by Hurricane Matthew. Excerpt:

The Haitian Ministry of Health (MSPP) is setting up  a vaccination campaign against cholera in areas ravaged by Hurricane Matthew, with support from the Pan American Health Organization / World Health Organization (PAHO / WHO).  

The decision of WHO and other member of the Global Task Force for Cholera Control to approve the request of the MSPP to bring 1 million doses of oral vaccine against cholera is based on the goal of reducing the burden of cholera cases on health care facilities, and of reducing deaths in the departments of the Sud and Grand'Anse, the areas most affected by Hurricane Matthew. 

The target population is estimated at over 820,000 people over one year of age. The vaccination campaign will begin November 8, 2016.  Activities will focus on the municipalities most vulnerable to cholera outbreaks in the two southern departments of Grand’Anse and Sud, where there has been significant destruction of water and sanitation supply systems.

To this news, an emergency responder in Haiti says via WhatsApp:

Again with another vaccine campaign, after the first was an utter failure.  This is just wrong.