H5N1

Saudi Arabia: Two die of MERS in Asir

Via the Saudi Gazette, a January 1 report: Two die of MERS in Asir. The full report and then a comment:

The Ministry of Health has reported that two people have died in southern Saudi Arabia of the Middle East Respiratory Syndrome (MERS). 

One of the deceased patients was a man in his 60s from Mahayil Asir governorate while the other was a man in his 70s in Rijaal Almaa, the ministry said. 

Another man in his 60s in Mahayil Asir contracted the deadly coronavirus that causes MERS but recovered from it shortly after and left the hospital in a good health.  

A fourth man who is in his 50s is currently receiving treatment after contracting the virus in Khamis Mushayt, the ministry said.

I can't find these cases on the KSA MOH MERS page. On December 20, a 59-year-old man in Mahail Aseer recovered; he may be the "man in his 60s" mentioned above. But I find nothing for any spelling of Rijaal Almaa or Khamis Mushayt. Perhaps the January 1 update will mention these new deaths.

And perhaps the KSA MOH could actually start connecting MERS deaths and recoveries with its initial reports of new cases.

CDC on Zika virus: Ten public health achievements in 2016 and future priorities

Via MMWR, a December 30 report: Zika Virus —10 Public Health Achievements in 2016 and Future Priorities. The summary:

What is already known about this topic? 

The introduction of Zika virus into the Region of the Americas and the subsequent increase in cases of congenital microcephaly resulted in activation of CDC’s Emergency Operations Center and the declaration of a Public Health Emergency of International Concern by the World Health Organization. As of December 15, 2016, 61 countries and territories have reported local Zika virus transmission as part of the current outbreak; 29 countries and territories have reported potential cases of congenital Zika syndrome. 

What is added by this report? 

CDC’s emergency response to Zika virus rapidly addressed many acute public health needs associated with the outbreak and developed new public health surveillance and infection control tools, including issuing travel and clinical guidance; identifying sexual transmission; monitoring blood safety; developing and distributing laboratory test kits; establishing the causal link between in utero infection and congenital Zika syndrome and assessing the range of outcomes and the magnitude of risk; improving access to contraception to prevent unintended pregnancies; implementing vector control strategies; and improving the understanding of the link between and Zika virus infection and other neurological illnesses. 

What are the implications for public health practice? 

To protect pregnant women and their fetuses and infants from the effects of Zika virus infection during pregnancy, public health activities must focus on preventing mosquito-borne transmission through vector control and personal protective practices, preventing sexual transmission by advising abstention from sex or consistent and correct use of condoms, and preventing unintended pregnancies by reducing barriers to access to highly effective reversible contraception. Collectively, these critical strategies can reduce the effect of the virus on infants, families, and communities.

Heavy smog back to choke northern China over three-day New Year holiday

Via the South China Morning Post: Heavy smog back to choke northern China over three-day New Year holiday. Excerpt:

Heavy smog returned across northern China to disrupt the three-day New Year holiday that started on Saturday – only a week after China’s hazardous smog hit the region during the Christmas period. 

Residents across the Beijing-Tianjin-Hebei area – China’s most urbanised region – and in Shandong and Henan provinces are living under the threat of a new round of heavy air pollution, which started on December 29 and is forecast to last until Thursday, the Ministry of Environmental Protection reported. 

On Saturday, the reading of PM 2.5 – airborne particles measuring less than 2.5 microns in diameter that are small enough to enter lungs and most harmful to health – rose from the heavily polluted level of 200 micrograms per cubic metre to more than 400 micrograms per cubic metre in most areas of Beijing, according to figures from the US embassy in Beijing. 

Meteorological Administration predicted that on Tuesday and Wednesday the concentration of PM 2.5 could hit 400 micrograms per cubic metre in southern Beijing and Tianjin and 500 micrograms per cubic metre in northern Henan and Hebei. 

Smog and dense fog have disrupted traffic and many people’s holiday travel plans. On Saturday morning, sections of eight expressways in Beijing were shut down, while expressways in nine cities in Hebei were closed. 

To prepare for this latest round of heavy pollution, 24 cities issued red alerts – the highest warning level out of the country’s four-tier colour-coded system – according to a notice released by the Ministry of Environmental Protection on Friday night.

As of 7:00 a.m. Sunday morning, local time, Beijing's air quality index is solidly in the "hazardous" range, with most stations reporting PM 2.5 counts in the 300s and 400s; a couple of stations are approaching 500. But Beijing has gone only to an orange alert.

Flu News Europe: Week 51

Via Flu News Europe:

Week 51/2016 (19–25 December 2016) 

• Influenza activity continues to increase across the region. Very high intensity was reported in one country (Finland). 

• The proportion of virus detections among sentinel surveillance specimens increased to 47% from 38% last week. 

• The great majority of influenza viruses detected this week were influenza A and of those subtyped, the majority were A(H3N2). 

• Influenza cases from hospital settings increased in some countries, but comparison to last week was not possible as few countries reported data. A risk assessment on seasonal influenza in EU/EEA countries was published by ECDC on 24 December 2016 stating that influenza viruses, mainly A(H3N2), started circulating early. If A(H3N2) continues to predominate it is likely that people over 65 years will be the most severely affected age-group this season. More than half of the detected characterised A(H3N2) viruses belong to a new genetic clade, but all are antigenically similar to the vaccine strain (Click here to read the full document).   

Season overview  

• The overall sentinel specimen positivity reached 10% in week 46/2016, an indication of a slightly earlier start of the influenza season compared to previous seasons. 

• Week 46/2016 is the earliest week that the overall positivity rate reached 10% in the last 7 years; during the previous six seasons this occurred between weeks 48 and 51. 

• Since week 40/2016, influenza A viruses have predominated accounting for 95% of all sentinel detections; the great majority (99%) of subtyped influenza A viruses from sentinel sites have been A(H3N2). This is in contrast to the same period during the previous season in which influenza A(H1N1)pdm09 predominated. 

• In an influenza season in which influenza A(H3N2) predominates, elderly populations can be expected to be most severely affected.

Colombia: Microcephaly update, week 51

The National Institute of Health has published its Boletín Epidemiológico for week 51. On page 112 it reports that the number of Zika-related microcephaly cases (and other congenital CNS defects) is now 75. This is an increase of three from last week. It also says 180 cases were discarded, 60 cases did not meet the case definition, and 513 cases are under study.

More work lies ahead to fight Zika, other threats: Frieden

Via Thomson Reuters: INTERVIEW - More work lies ahead to fight Zika, other threats - CDC chief. Excerpt:

A year ago, the mosquito-borne Zika virus was only beginning to reveal itself as a threat to pregnant women and their unborn babies. 

Since then, U.S. officials have issued 60 travel alerts along with guidance for athletes and tourists traveling to the Olympics in Rio. They have also deployed more than 1,000 experts to Puerto Rico and elsewhere, tested more than 147,000 lab specimens, initiated 25 major studies and issued more than 230 scientific publications. 

And the work is not done, said Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention.  

"We have a lot more to do to control both Zika and diseases spread by this mosquito," Frieden told Reuters in an interview.  

Frieden, appointed by President Barack Obama to run the CDC in 2009, will hand in his resignation on Jan. 20, the day of President-elect Donald Trump's inauguration. 

The former New York City health commissioner will not say what he plans next. He did share his wish list for the incoming president and Congress which contains several items, not least of which is a public health emergency fund. 

"We've dealt with Ebola, H1N1 influenza, MERS, fungal meningitis. We're dealing now with influenza and drug-resistant bacteria," he said. 

And then there was Zika, the first-ever mosquito-borne virus shown to be capable of causing birth defects. The virus has spread to more than 60 countries and territories since the current outbreak was identified last year in Brazil.  

"We don't know when the next global health threat will come. We don't know where it will come from. We don't know what pathogen it will be, but we are 100 percent certain that there will be a next one," he said.

Saudi Arabia: One new MERS case, one recovery as of noon December 31

Via the KSA MOH Command and Control Center: MOH: '1 New Confirmed Corona Cases Recorded'. A 49-year-old Saudi man in Al Khurma is a primary, camel-contact case; he is in stable condition. Meanwhile, a 58-year-old Saudi man in Riyadh has recovered. No deaths are reported.

South Korea: H5N6 found in two dead cats

Via Arirang: Highly pathogenic strain of bird flu found in 2 dead cats.

A highly pathogenic strain of bird flu has been discovered in two dead cats, marking the first case of the virus found in mammals in almost two years. 

Citing information from health authorities, an official from the Gyeonggi-do provincial government said the H5N6 strain, which has infected chickens across the country, was found in the bodies of the cats in Pocheon. 

The cats were found dead this week nearby a chicken farm where the strain was first reported in November. Health authorities say they are looking to verify whether they were infected with a more highly pathogenic strain of bird flu. 

An official said that, even if it is the same N6 strain in the cats, there's very little chance the virus could jump from cats to humans, although the authorities are preparing for any possible outcome. 

This season's bird flu outbreak has led to more than 20 million chickens and ducks nationwide being culled since mid-November.

Canada: On Cheque Day, a toxic mix of money and drugs in Vancouver’s Downtown Eastside

Via The Globe and Mail: On Cheque Day, a toxic mix of money and drugs in Vancouver’s Downtown Eastside. Excerpt and then a personal comment:

Deirdre is leaning against an alley wall, prepping a needle full of crystal methamphetamine that could be contaminated with fentanyl. She and a friend have paused to cheer as an employee of a nearby needle exchange rushes over to revive an overdosing man.  

“Breathe bro, breeeeathe!” another bystander shouts as he gently slaps the man’s blue face while the employee preps oxygen and a syringe of naloxone that can reverse the deadly effects of opioids. 

A small team of firefighters and paramedics take over. The first responders believe the man – Justin – is the one they revived in the same spot a day earlier.  

Deirdre, who asked that her real name not be used, and her friend prepare their rigs and inject them into their arms, the scene in front of them no deterrent to the risk that could put them on the pavement in need of a similar lifesaving intervention. 

It is 11:29 a.m. on a frigid Wednesday morning– the second-last Wednesday of December, when millions of dollars of social-assistance payments flood into the Downtown Eastside, or DTES. For recipients who regularly use drugs, this day – known in the neighbourhood as “Cheque Day,” “Welfare Wednesday” or “Mardi Gras” – dramatically increases their risk of a fatal overdose. 

Though much of Canada has felt the effects of the fentanyl-driven overdose crisis, British Columbia has been hardest hit, experiencing more fatal overdoses this year than in three decades of record-keeping. The death toll is expected to climb to more than 800. Two weeks ago, eight overdose deaths were recorded in the Downtown Eastside in a single day.  

In the troubled neighbourhood, more than 6,300 people draw social assistance and more than half the 18,000 residents are thought to be drug users. 

In the streets and back alleys, people slump against walls, their bodies suddenly limp as an overdose of synthetic opioids crashes their system, and their skin turns blue from a lack of oxygen. There are cries of people calling for help, shouting for the naloxone antidote kits that can reverse the effects of opioids. The names of loved ones lost are tagged on brick walls, in long lists. In the background, there is the constant wail and yelp of sirens.

I have some family skin in this wretched game. My son-in-law is a Vancouver firefighter who's worked the DTES for years. When you're saving four or five lives a shift, and maybe losing a few as well, it can take a toll. 

Opioids are a catastrophic epidemic, not just for the addicts, but their rescuers as well. Whatever we may think of the addicts and how they got that way, we owe the first responders all the support we can give.

Canada: Deadly drug carfentanil has been in Hamilton for nearly two months

Via CBC News Hamilton, in Ontario: Deadly drug carfentanil has been in Hamilton for nearly 2 months: police. Excerpt:

Hamilton police have confirmed the presence of the deadly opioid carfentanil — a substance so potent that doctors wear gloves and face masks to avoid contact.   

On Nov. 5, police were called to the Durand neighbourhood to seize a bottle of suspected liquid fentanyl. 

Almost two months later, Health Canada has the suspected liquid was a bottle of carfentanil, a deadly elephant tranquilizer.  

The individual who turned it over was aware of the dangers of the drug, and allowed it to be seized for analysis. It was in an unmarked nasal inhaler. 

Hamilton police are taking action to educate the community on the dangers of carfentanil and other opioids.  

"It is important for the community to know the dangers of taking unknown amounts of drugs that is not prescribed by a physician can be fatal," police said in a Friday media release.  

Even worse, naloxone kits used in case of overdose are useless against carfentanil.  

"Carfentanil is notorious for being very aggressive," said Dr. Bill Krizmanich, chief of emergency medicine for Hamilton Health Sciences, earlier this month.  

It would take several kits of naloxone to reverse the effects of carfentanil, which is 10,000 stronger than heroin. Even tiny amounts are deadly.  

They're so deadly that police advise not to even touch the substance if you see it.  

"If you have come into physical contact with any illegal substances you should immediately seek medical attention and notify police," the release said. 

The drug is so potent that emergency room staff wear face masks, shields, gloves and gowns to treat patients suspected of using the drug.