H5N1

New Zealand: Ten in Auckland hospitals with imported typhoid

Via Radio New Zealand News: Auckland typhoid outbreak: 10 people in hospital. Excerpt:

Public health officials are trying to trace the path of a typhoid outbreak that has hospitalised 10 people in Auckland.

The Auckland Regional Public Health Service (ARPHS) said it was tracing people who had been in touch with the people confirmed to have had the disease, and was trying to control its spread.

Typhoid is a serious illness which can be potentially fatal, although it is treatable with antibiotics.  

Symptoms include a high fever developing over several days, headaches, general weakness and muscle aches. 

Stomach pain and constipation are also common, with some victims suffering diarrhoea. 

Medical Officer of Health David Sinclair said the disease was spread mainly through water and food, but could be spread person to person.  

Dr Sinclair said the outbreak had developed over the past 10 days or so and the patients were from a range of places in central and southern parts of Auckland.  

He said those in hospital were quite unwell.  

"These are people who have been admitted to hospital because their symptoms are quite severe, and quite a large proportion of people who develop typhoid fever do get admitted to hospital for antibiotic treatment and assessment." 

Most of the typhoid cases in New Zealand were imported, from people coming back into the country, either with symptoms or as carriers, mainly from the Pacific or southeast Asia.

US: A therapy dog might have sniffed out a major problem for kids across San Diego Unified

Via the Voice of San Diego: A Therapy Dog Might Have Sniffed Out a Major Problem for Kids Across San Diego Unified.

It took a dog to protect children from lead in the water at one San Diego school. 

On January 26, a therapy dog at San Diego Cooperative Charter School in Mountain View wouldn’t drink the water a teacher had poured from the classroom sink.  

A teacher then noticed the water had a sheen, similar to the appearance of oil on water. When district officials sampled water on the campus, they found the presence of vinyl chloride, a carcinogen, which likely came from degraded plastic plumbing materials, known as PVC pipe. 

It turns out the oily sheen was less of a concern than the lead that follow-up tests revealed.  

The charter school shares a campus with the Emerson-Bandini Elementary School. Officials took 10 water samples from fountains and sinks on campus. Those tests revealed water from three different sources contained more than the allowable limit of lead. The water at one sink contained more than twice the allowable limit. Lead can damage children’s brains.  

Now, officials are setting off to test every school in the district. So far, the only district school that’s been tested for lead turned up positive, which could indicate a larger problem for San Diego Unified and its students.

District officials say they started providing bottled water to the Emerson-Bandini campus on January 26, the day the therapy dog refused to drink the water. 

But NBC reported that when a reporter visited the campus on March 1, the water was still running and no signs told students to steer clear of the fountains. “The water is just fine but we don’t drink from it,” third-grader Francisco Orejel told the television station. “We get cups. We get bottled water sometimes.” 

But the water wasn’t fine.  

Emails obtained by NBC reveal that school officials had good reason to be concerned about the water for at least a month before the Emerson-Bandini principal sent a letter home to parents, on March 24, notifying them the school would switch to bottled water until the lead contamination is resolved. 

Findings from preliminary field tests and observations, noted in an email a water consultant sent to a district official on February 21, indicated: 

• Reports of a chemical odor in the water at the charter school 

• Reports of a blue tinge to water at the charter school  

• Reports from a school nurse who said several charter school students experienced nausea and vomiting following consumption of the water 

• The presence of elevated levels of disinfection byproducts in one sample collected from the charter school

• The presence of vinyl chloride in one sample collected from the charter school 

Emerson is the second elementary school in San Diego to report having unacceptable levels of lead in recent months.

OCHA: Drought response in Somalia

Via ReliefWeb, a report from OCHA: Somalia: Drought Response - Situation Report No. 2 (as of 31 March 2017). The summary:

Highlights

• Since November 2016, around 444,000 people have been internally displaced in Somalia due to drought. On average, over 8,000 people a day are forced to abandon their homes in search of water and food. Around 81,000 IDPs have arrived in Baidoa since November in search of food and water.  

• Depletion of water sources and lack of sanitation facilities have led to a sharp increase in cases of AWD/cholera, in particular in Bay and Bakool regions, with over 1/3 of all cases reported in Mogadishu. Case fatality rates of AWD/cholera at 2.3 per cent and spread of measles are of serious concern.  

• Humanitarian partners are scaling up response and reached an estimated 1.9 million people with cash and vouchers in March. Further scale-up is urgently required across all clusters. Priorities include treatment and prevention of AWD/cholera and prevention of measles, improved access to food and safe water, nutritional treatment for malnourished children, protection, shelter and non-food support to newly displaced. 

• A Drought Operations Coordination Centre (DOCC) was opened in Garowe on 30 March.  

• Donors have moved quickly to support scale-up of response and over US$400 million has been made available for humanitarian assistance since January. Additional resources are urgently required to enable further scale-up.  

6.2m People in need. 2.9m in IPC Phase 3-4 

444,000 Internally displaced due to drought since November 2016 

42% of total displacement since Nov was from 1 to 24 March  

1.9m People reached in March with cash and vouchers 

18,819 AWD/cholera cases reported as of 27 March 

$401m Total humanitarian funding in 2017 

Situation Overview  

The humanitarian situation in Somalia continues to deteriorate at an alarming rate and a sharp rise in displacement due to drought is taking place across the country. An estimated 444,000 people have moved from their homes since November 2016 in search of food and water, mainly from rural to urban areas.  

The UNHCR-led Protection and Return Monitoring Network (PRMN) managed by Norwegian Refugee Council (NRC) works with 39 partners across Somalia gathering information on the drought-related displacement. The latest data indicates that two-thirds of all those displaced have fled from Mudug, Bay, Shabelle and Sool regions. Nearly half of the people displaced are concentrated in three regions – Banadir, Bay and Mudug. Some 81,000 people have arrived in Baidoa since November. Almost 85,000 people have arrived in Mogadishu, Banadir region since November. 

According to WHO, 18,819 cases of Acute Watery Diarrhea (AWD)/cholera have been reported as of 27 March, with 3,164 new cases and 59 additional deaths reported in the past week. The cumulative Case Fatality Rate since the beginning of the year is at 2.3 per cent, significantly above the emergency threshold of 1 per cent. The Bay region alone accounts now for more than half the total cases in the country (9,705 out of 18,819). 

With the upcoming Gu rains projected to start in April, Health and WASH response will be of increasing demand, especially in areas with newly displaced. Shelter support and non-food items is increasingly critical to prevent further vulnerability as affected people are forced to sleep out in the open. The Gu rains may lead to localized flooding and further AWD/cholera and measles, malaria, respiratory infections, especially among children, and other water-related diseases.

Canada: Thousands of HIV cases averted in BC through expanded harm reduction and HIV treatment

Thanks to Carol Dobuzinskis for sending me the link to this news release from the British Columbia Centre for Excellence in HIV/AIDS: Estimates Show Thousands of HIV Cases Averted in BC through Expanded Harm Reduction and HIV Treatment. Excerpt:

A study by the BC Centre for Excellence in HIV/AIDS (BC-CfE), published in the top-ranking medical journal The Lancet HIV, has found harm reduction and access to HIV antiretroviral therapy (ART) averted an estimated 3,204 incident HIV cases in British Columbia between 1996 and 2013. Both evidence-based public health interventions had significant, independent effects on the spread of HIV and the control of the epidemic.    

To identify the relative impact of ART and harm reduction, which have both been scaled up in BC since 1996, the authors modeled multiple hypothetical scenarios. Assuming harm reduction services were not scaled up beyond 1996 levels, ART alone is estimated to account for 44% (1,409) of the averted HIV cases across the province. The impact of universal access to ART is likely underestimated, as the study only considered its impact on transmission through needle sharing with its efficacy in reducing HIV transmission set conservatively at 50%. 

Assuming ART had no effect at all on HIV transmission through needle sharing, harm reduction services alone—defined in this study as needle distribution and opioid agonist therapy (OAT)—are estimated to account for 77% (2,473) of the averted HIV cases. 

“Both harm reduction and access to HIV treatment are keys to curbing the transmission of HIV,” said Dr. Bohdan Nosyk, Research Scientist with the BC-CfE and an author on the paper. “As a treatment for addiction, opioid agonist therapy provides benefits in terms of reduction in disease transmission and improvement in quality of life. Our research has linked the treatment to increases in workplace productivity and decreases in crime costs—making a further economic case for its implementation as part of a harm reduction effort.” 

Access to harm reduction and ART also significantly increases an individual’s quality of life years (QALY). OAT, a first-line treatment for opioid addiction that reduces cravings and withdrawal associated with opioid addiction, is linked to substantially greater QALY gains than needle distribution programs. 

Over the past 20 years, BC has rapidly expanded access to lifesaving OAT (with methadone or buprenorphine/naloxone) and implemented needle distribution programs. There are over 50 unique service providers of harm reduction services within Vancouver’s downtown core alone, covering a spectrum of services such as psychosocial treatment, housing supports and mental health care. 

BC and Vancouver are unique within Canada and compared with many jurisdictions worldwide. A global review of interventions to prevent HIV infections among PWID estimates needle distribution programs covered 5% to 8% of injections, and only around 8% of PWID[people who inject drugs] had access to OAT. Globally only 4% of PWID are estimated to have access to ART.   

In BC, since the 2013 implementation of the Treatment as Prevention® (TasP®) strategy supported by the provincial government, access to ART has been universally offered upon diagnosis with HIV. On sustained and consistent treatment, an individual living with HIV achieves an undetectable viral load and the chances of HIV transmission drop to negligible. Previous BC-CfE research, based in Vancouver’s Downtown Eastside, found community viral load was the strongest predictor of HIV transmission among PWID.

'It's abominable': Vancouver mayor reacts to opioid overdose deaths

Via CBC News British Columbia: 'It's abominable': Vancouver mayor reacts to overdose deaths. Excerpt:

Vancouver Mayor Gregor Robertson reacted once again to the opioid overdose situation in the city on Thursday after another bad week of overdoses and deaths. 

Firefighters responded to 162 overdose calls during the week beginning on March 20 — a 56 per cent increase from the week before. 

Police suspect drugs were to blame for five deaths in the city, though officers don't typically respond to overdose calls, and the cause of death in those cases has not yet been confirmed by the B.C. Coroners Service.  

Including the five suspected deaths, Vancouver has now reached 100 drug overdose deaths this year alone. In all of 2016, there were 216 deaths, meaning the city is on track to dramatically surpass last year's levels. 

'Tragic preventable deaths' 

"It's abominable that with 100 overdose deaths already this year in Vancouver — almost half of 2016's total — we have yet to see effective action from the provincial and federal governments on health care solutions that will stop the death toll in this fentanyl crisis," said Robertson in a statement. 

"Overdose death totals have long surpassed horrific levels and the B.C. government urgently needs to spend the $10 million received from the federal government before yet another hundred families are impacted by tragic preventable deaths," he said.  

Robertson is calling on the B.C. Government to put $8 million into injectable therapies, like prescription heroin and hydromorphone, as well as mental health support for patients in Vancouver.

Significantly elevated number of human infections with H7N9 virus in Jiangsu in eastern China, October 2016 to January 2017

Via Eurosurveillance: Significantly elevated number of human infections with H7N9 virus in Jiangsu in eastern China, October 2016 to January 2017. The abstract:

Since first identified in 2013, the H7N9 virus has caused several waves of human infections in China, with a current wave including a number of patients with very severe disease. Jiangsu is one of the most impacted provinces, whereby as of 31 January 2017, the number of human infections (n = 109) in the ongoing fifth H7N9 wave has exceeded the sum of those in the four preceding ones. 

Ten of 13 cities in Jiangsu have been affected, and clustered infections as well as one co-infection with seasonal influenza have been observed. With a median age of 58 years and 74.3% (81/109) of patients being male, the characteristics of cases are similar to those in previous waves, however patients with H7N9 seem to have an accelerated disease progression. Preliminary case fatality remains above 30%. 

No significant viral mutations have been found in key functional loci. Environmental H7N9 detection rate and number of days with high risk ambient temperatures were both significantly elevated during the month of December 2016 when most human infections were reported. 

A number of municipal governments in Jiangsu have implemented live poultry market closures to impede viral transmission to humans. A detectable decline in human infections has been observed in these municipalities and the entire province since January 2017.

Flu News Europe, week 12

Via Flu News Europe:

Week 12/2017 (20 - 26 March 2017) 

• Influenza activity across the region continued to decrease with the great majority of countries reporting low intensity. 

• The number of influenza virus detections further decreased, but the proportion of influenza virus detections (18%) among sentinel surveillance specimens remained at the same level as the previous week. 

• This was the second week during the season that the proportion of type B viruses exceeded the proportion of type A viruses in sentinel detections, as is commonly seen in the second half of an influenza season. However, the overall number of type B virus detections remained low. 

Season overview  

• Influenza activity started early this season, in week 46/2016, which is the earliest week that the overall influenza virus-positivity rate in sentinel specimens reached 10% since the emergence of A(H1N1)pdm09 viruses in 2009/10. 

• Since week 40/2016, influenza A viruses have predominated, accounting for 94% of all sentinel detections; the great majority (99%) of subtyped influenza A viruses from sentinel sites being A(H3N2). 

• Confirmed cases of influenza virus type A infection reported from hospitals have predominantly been in adults aged 65 years or older. Excess all-cause mortality has been observed substantially in people aged 15–64 years and markedly in people aged 65 years or older in the majority of the 19 reporting countries. This is commonly seen when the predominant viruses circulating are A(H3N2). 

• Two-thirds of the A(H3N2) viruses genetically characterized belong to genetic subclade (3C.2a1), which are in the main antigenically similar to the clade 3C.2a vaccine virus, as mentioned in the WHO recommendations for vaccine composition for the northern hemisphere 2017–18. 

• Vaccine effectiveness estimates for all age groups against A(H3N2) illness from Canada (42%), the US (43%) and Europe (38%) are consistent for persons aged 65 years or older. 

• Given typically suboptimal vaccination coverage and the partial effectiveness of influenza vaccines, rapid use of neuraminidase inhibitors (NAIs) for laboratory-confirmed or probable cases of influenza virus-infection should be considered for vaccinated and non-vaccinated patients at risk of developing complications. 

• Of the viruses tested so far, only one A(H3N2) virus (<1%) has shown reduced susceptibility to oseltamivir this season. 

• The developments during the season have confirmed the conclusions of the ECDC risk assessment on seasonal influenza, updated on 25 January 2017, specifically relating to increased severe outcomes in the elderly due to the prevalence of A(H3N2) viruses, that has put some health care systems under pressure.

Hong Kong: CHP notified of 17 human cases of avian influenza A(H7N9) in Mainland

Via the Centre for Health Protection: CHP notified of human cases of avian influenza A(H7N9) in Mainland. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health today (March 31) received notification from the National Health and Family Planning Commission that 17 additional human cases of avian influenza A(H7N9), including three deaths, were recorded from March 24 to 30. The CHP strongly urges the public to maintain strict personal, food and environmental hygiene both locally and during travel.        

The 14 male and three female patients, aged from 35 to 81, had their onset from March 6 to 24. The cases were six cases from Hunan, three cases each in Jiangsu and Guangxi, two cases each from Fujian and Guizhou, and one case in Zhejiang. Among them, 16 were known to have exposure to poultry or poultry markets.

Trump kicks off a tense debate over NIH funding to university labs

Via STAT: Trump kicks off a tense debate over NIH funding to university labs. Excerpt:

Medical research can’t be done in the dark. But should taxpayers be covering the light bills at university labs across the country? 

The Trump administration’s answer is no. The president has proposed a massive $7 billion budget cut for the National Institutes of Health over the next 18 months. And Secretary of Health and Human Services Tom Price said this week that he may find those savings in the “indirect expenses” that NIH funds, which includes everything from buying lab equipment to paying the electric bills for thousands of academic research labs from Harvard to Ohio State to Stanford. 

Such pronouncements are sending ripples of alarm through universities, which last year received $16.9 billion in federal funding for research — and another $6.4 billion to cover their overhead costs. 

STAT talked to more than a dozen university administrators and researchers across the nation. Some said they could, perhaps, find common ground with Trump in his quest to cut regulations; less red tape for federally funded labs, they said, would mean lower costs — and smaller overhead bills. 

But nearly all expressed alarm at the thought of losing taxpayer support for “indirect costs” that they consider vital to their biomedical research — costs like keeping freezers running and labs heated. 

“Unless you’re studying butterflies, you can’t conduct biomedical research in the middle of a field,” said Dr. Pamela Davis, dean of Case Western Reserve School of Medicine.

“It would be absolutely devastating. In fact, it would close down some research institutions,” said Dawn Bonnell, vice provost for research at University of Pennsylvania. “It’s just unthinkable to imagine how one would move forward.”  

MIT President L. Rafael Reif was alarmed enough to write all employees this week to warn of potential cuts to “an arcane aspect of government funding that could have large budget implications for MIT.” He pointed out that 66 percent of MIT’s total research dollars come from federal funding — and said if the president’s budget blueprint were enacted, the university would lose a vast bulk of that money.  

"Depression: let’s talk" says WHO, as depression tops list of causes of ill health

A news release: "Depression: let’s talk" says WHO, as depression tops list of causes of ill health. Excerpt:

Depression is the leading cause of ill health and disability worldwide. According to the latest estimates from WHO, more than 300 million people are now living with depression, an increase of more than 18% between 2005 and 2015. Lack of support for people with mental disorders, coupled with a fear of stigma, prevent many from accessing the treatment they need to live healthy, productive lives. 

The new estimates have been released in the lead-up to World Health Day on 7 April, the high point in WHO’s year-long campaign “Depression: let’s talk”. The overall goal of the campaign is that more people with depression, everywhere in the world, both seek and get help.  

Said WHO Director-General, Dr Margaret Chan: “These new figures are a wake-up call for all countries to re-think their approaches to mental health and to treat it with the urgency that it deserves.” 

One of the first steps is to address issues around prejudice and discrimination. “The continuing stigma associated with mental illness was the reason why we decided to name our campaign Depression: let’s talk,” said Dr Shekhar Saxena, Director of the Department of Mental Health and Substance Abuse at WHO. “For someone living with depression, talking to a person they trust is often the first step towards treatment and recovery.”