H5N1

Power shut off to final Manus compounds as 600 men refuse to leave

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Via The Guardian: Power shut off to final Manus compounds as 600 men refuse to leave. Excerpt:

The Manus Island detention centre has officially closed but more than 600 men are still refusing to leave, saying they fear for their lives in the Papua New Guinean community.  

The UN has also supported claims by observers that community accommodation for detainees is not ready, refuting assurances given by the Australian government. 

Electricity was shut off to the final compounds on Wednesday morning, more than 12 hours after the scheduled 5pm shutdown, and the generator was removed. 

Food, water and other essential services had already been stopped, and all staff left early on Tuesday. 

The journalist and refugee Behrouz Boochani said detainees were keeping watch through the night, fearful of attacks by locals or attempts by authorities to forcibly remove them. They had stockpiled water in bins and some food, and obtained solar chargers for their phones.  

On Wednesday afternoon, Boochani reported one detainee had self-harmed. 

He said security and immigration staff had spoken with detainees and confirmed no services would be provided to them but multiple sources have also reported officials do not intend to use force to remove people today.  

On Wednesday Papua New Guinea’s largest newspaper, the Post-Courier, declared Australia had “literally abandoned Manus Island”, sparking chaos and confusion.  

Some services – like the health provider International Health and Medical Services – are expected to stay on the island but it is not known how long for or who is funding them. The PNG government has said all refugees and asylum seekers who won’t settle in PNG are Australia’s obligation. Australia has not responded with any clarification. 

Nat Jit Lam, regional representative for the UNHCR and speaking from Lorengau, said the purpose-built community accommodation for refugees and asylum seekers was not ready.  

The UNHCR had inspected two of the three units, including the newly built West Lorengau site. 

“There was still major earthworks in progress,” he told ABC radio. “There was heavy machinery on the ground as well, fences still being constructed. 

“It doesn’t look like it’s ready. I’m not an expert on engineering but, as a UNHCR officer who’s been working with refugees, I would not be bringing any refugees to stay there, not in that state. It’s not ready at this moment.”

Madagascar: A plague victim on the run

Via L'Express de Madagascar: Epidemic - A plague victim on the run in nature. The edited Google translation:

A new fear of recrudescence of the plague epidemic is current. A patient, whose state of health would be chaotic, is on the run. 

"We were able to reach him on his phone this morning (note: yesterday). He felt in his voice that he was very tired. He coughed a lot too. Unfortunately, he hung up on us. He was not reachable after. He comes from Arivonimamo but he is not there. Until now, we continue to search for it," reports Dr. Joséa Ratsirarson, Secretary General of the Ministry of Public Health and head of the operational cell of the fight against the plague, last night. 

This patient left the Ambohimiandra anti-plague hospital (CHAPA), Thursday, fooling the staff. 

"He fled the hospital, after his first injection, pretending to be a sick warden," continues Dr. José Ratsirarson.  

Decreasing phase 

The Ministry of Public Health calls it "public danger number one" right now. It can contaminate anyone who comes in contact with it. Yersin's bacillus becomes inactive and non-contagious only after three days of treatment of the plague patient. 

The patient could, however, take public transport. It is this kind of imprudence that provoked the plague epidemic in Toamasina at the beginning of September. A plague victim, traveling to Toamasina aboard a bush taxi, contaminated the other passengers. Two of them died on September 2nd and 3rd. They in turn passed on the bacteria to others. 

The plague epidemic is beginning to improve, however. Yesterday, there were only one hundred and six plague patients under treatment in health facilities and two new cases admitted to hospital. And the number of deaths rose to one hundred and twenty-eight, with the death of a child in a hospital in Antananarivo on Saturday. Another patient has also succumbed to the Itasy region in recent days. 

"The epidemic indicators are in a decreasing phase. No cases have been recorded in the twenty-two districts during the last fifteen days. Fifteen districts have not submitted a case for a week. Ten districts still have emerging cases," the ministry reports. 

The Minister of Public Health, Professor Mamy Lalatiana Andriamanarivo appeals to the vigilance of everyone. In addition, this is not the first case of escape listed in hospitals, such as Anosy Avaratra, Toamasina and Befelatanana. Control at the level of health facilities should be strengthened. 

Health checks to install  

The National Office of Risk and Disaster Management (BNGRC) indicates the need for the establishment of seven new health checkpoints to better close the plague centers that are still active. Recommended locations are Ambohimalaza, Alakamisy Fenoarivo, Maevatanana I, Alakamisy Ambohimaha, Ihosy and Betafo. 

In addition, six Chinese medical experts, specialists in the control of plague epidemics in China, presented yesterday to the Minister of Public Health, will support Malagasy teams in the fight against the plague.

Pathogen population structure can explain hospital outbreaks

Via bioRxiv: Pathogen Population Structure Can Explain Hospital Outbreaks. The abstract:

OBJECTIVE: To analyze Hospital Acquired Infection (HAI) outbreaks using microbial population biology dynamics in order to understand outbreaks as a biological system. 

DESIGN: Computational modeling study. 

METHODS: The majority of HAI transmission models describe dynamics on the level of the host rather than on the level of the pathogens themselves. Accordingly, epidemiologists often cannot complete transmission chains without direct evidence of either host-host contact or large reservoir populations. 

Here, we propose an ecology-based model to explain the transmission of pathogens in hospitals. The model is based upon metapopulation biology, which describes a group of interacting localized populations and island biogeography, which provides a basis for how pathogens may be moving between locales. Computational simulation trials are used to assess the applicability of the model. 

RESULTS: Results indicate that pathogens survive for extended periods without the need for large reservoirs by living in localized ephemeral populations while continuously transmitting pathogens to new seed populations. Computational simulations show small populations spending significant portions of time at sizes too small to be detected by most surveillance protocols. The number and type of these ephemeral populations enable the overall pathogen population to be sustained. 

CONCLUSIONS: By modeling hospital pathogens as a metapopulation, observations characteristic of hospital acquired infection outbreaks for which there has previously been no sufficient biological explanation, including how and why empirically successful interventions work, can now be accounted for using population dynamic hypotheses. Epidemiological links between temporally isolated outbreaks are explained via pathogen population dynamics and potential outbreak intervention targets are identified.

Yemen: 891,439 cholera cases as of October 31

This morning I posted the October 30 cholera numbers: 887,440 cases and 2,184 deaths. This afternoon, WHO's Cholera Response Dashboard has the numbers for October 31: 891,439 cases and 2,185 deaths since the outbreak began on April 27. That is an increase in 24 hours of 3,999 new cases and one death, and almost a thousand more than yesterday's increase of 3,072.

In the 187 days of this outbreak so far, the average number of cholera cases has been 4,767. Assuming this average continues, Yemen will record its one-millionth cholera case on Wednesday, November 22—just over three weeks from today. And remember that so far a little more than half of all cases have been in children under the age of 18.

WHO AFRO: 1,554 plague cases in Madagascar as of October 27

Thanks to Mike Coston at Avian Flu Diary for linking to the week 43 issue of WHO AFRO's Weekly Bulletin on Outbreaks and Other Emergencies. Excerpt on the Madagascar plague situation:

The outbreak of plague in Madagascar continues to improve, with the number of new cases of pulmonary plague declining in all active areas across the country. In the past 2 weeks, 16 previously affected districts reported no new confirmed or probable cases of pulmonary plague.

From 1 August to 27 October 2017, a total of 1 554 suspected cases of plague, including 113 deaths (case fatality rate 7%), were reported. Of these, 985 (63%) were clinically classified as pulmonary plague, 230 (15%) were bubonic plague, 1 was septicaemic, and 338 were unspecified (further classification of cases is in process). Since the beginning of the outbreak, 71 healthcare workers (with no deaths) have been affected.

Of the 985 clinical cases of pneumonic plague, 245 (25%) were confirmed, 336 (34%) were probable and 404 (41%) remain suspected (additional laboratory results are in process). Fourteen strains of Yersinia pestis have been isolated and were sensitive to antibiotics recommended by the National Program for the Control of Plague.

Between 1 August and 27 October 2017, 28 districts reported confirmed and probable cases of pulmonary plague. During the last two weeks, the number of districts that reported confirmed and probable cases of pulmonary plague reduced to 12.

About 78% (4 825) of 6 203 contacts identified completed their 7-day follow up and a course of prophylactic antibiotics. A total of nine contacts developed symptoms and became suspected cases. On 27 October 2017, 1 055 out of 1 087 (97%) contacts were followed up and provided with prophylactic antibiotics.

Meanwhile, BNGRC has posted its plague numbers for October 30: 106 under care, 1,014 recovered, and 64 deaths. Just two new cases and two deaths were reported on October 30. I have no idea why we see such a disparity in numbers between WHO AFRO and BNGRC.

Australia: The refugees are in a state of terror on Manus

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Thanks to Shane Granger for alerting me to a very bad situation. Via The Guardian Australia edition: The refugees are in a state of terror on Manus. Excerpt:

Behrouz Boochani is a journalist and an Iranian refugee held on Manus Island since August 2014. The Guardian invited Boochani to keep a diary of the countdown to the closure of the Australian-run detention camp that is closing on Tuesday.  

Tuesday 31 October 

Last night the refugees were up until the early hours of the morning. You see, the department of immigration posted a document on the fences in the prison warning us that we only have until 5pm to exit the camp. If we remain we will be confronted with soldiers from the navy. 

This is a serious warning. It is a warning of impeding danger that has sent the refugees spiralling into terror. This is what has impelled the refugees to stay up until the morning. At 5am all the local and Australian guards have abandoned the camp. For the whole day there has not been a single person inside or around the parameters of the camp to protect the refugees. The situation has descended into an even worse crisis. 

At the same time we are receiving news from outside that the soldiers and police have armed themselves. The whole precarious situation has been militarised in a terribly perverse manner. However, no one knows for sure if the police and navy want to attack the refugees, or if they want to set upon the locals who have stolen everything from around the rim of the camp.  

Many of the locals have now entered the camp and are taking away whatever they can. The situation is perilous, it is volatile to such an extent that the refugees have been forced to lock the gates from the inside because of the possibility of an attack at any moment. The refugees are in a state of terror, but they have announced that they refuse to quit and leave the camp for Lorengau.  

After a few hours Senator Nick McKim and an ABC reporter enter the camp. Their presence here has instilled a sense of safety among the refugees. A number of refugees represent the drama that is unfolding here; they shed tears as they stand face-to-face with the ABC cameras. The other refugees feel that those few are reflecting the anguish felt by everyone else, those few shed tears that channel the sorrows of hundreds of refugees.

The senator and ABC reporters have now left the camp, and the refugees once again have to grapple with the isolation. As I write, the refugees are engaged in a large meeting inside Delta camp; they have all decided not to leave the prison and continue resisting through peaceful means. The situation has reached a critical juncture, right now there is not enough food and water here – at 5pm they will also cut off the power. The hours that await us are going to be extremely harrowing intensely dangerous.

Climate change isn’t just hurting the planet – it’s a public health emergency

Via The Guardian, an opinion piece by Christiana Figueres, chair of the Lancet Countdown advisory board: Climate change isn’t just hurting the planet – it’s a public health emergency. Excerpt:

When the doctor tells you that your cholesterol is too high, you tend to listen and change your diet. When the world’s climate scientists tell us that temperatures are rising to dangerous levels, we should heed their advice. It’s time to give up climate change, it’s bad for our health.  

I’m not talking about the health of our planet or the health of species such as the polar bear, so often associated with climate change – though they are suffering. I’m talking about human health. The health of you, your family, your neighbours – each and every one of us. 

A report just published in The Lancet from the specially created Lancet Countdown initiative, reveals just how bad climate change is for public health. The diagnosis reveals that hundreds of millions of people are already suffering the health impacts of climate change. Its insidious creep is being felt in multiple ways: rising temperatures are hastening the spread of infectious diseases; crop yields are becoming uneven and unpredictable, worsening the hunger and malnourishment for some of the most vulnerable people on the planet; allergy seasons are getting longer; and at times it is simply too hot for farmers to work in the fields. 

Typhoons and hurricanes, such as Harvey, feed off unnaturally warm waters to deliver more forceful threats to human health, including to life itself. The attribution of climate change as a contributing factor in such events is of course complex. The Lancet report’s analysis – that there has been a 46% increase in extreme weather disasters since 2000 – helps to cut through any confusion.  

Then there is the heat, which might be the most widespread and dangerous of all. In 2015 alone, according to Lancet Countdown findings, heatwaves affected the lives of 175 million more elderly people worldwide, following a strong trend over the last two decades. The list goes on. The most vulnerable – including elderly people and children – are most exposed to the risks, but everyone is affected and no country is immune. We are only just beginning to witness the manifestation of very concerning trends. Unavoidable increases in global temperature are set to further exacerbate a host of health challenges. 

Here’s the good news. While the Lancet’s report lays bare the many ways that climate change impacts on our health, it also shows that tackling climate change directly, unequivocally and immediately improves global health. It’s as simple as that. Tackling the looming global medical emergency is also an unprecedented opportunity to improve public health around the globe. Let’s get to it.

Hong Kong: CHP investigates case of Shiga toxin-producing E. coli infection

Via the Centre for Health Protection: CHP investigates case of Shiga toxin-producing E. coli infection. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health is today (October 31) investigating a case of Shiga toxin-producing Escherichia coli (STEC) infection, and hence reminded the public to maintain good personal, food and environmental hygiene against intestinal infections.      

The case involves a 1-year-old girl, with good past health, who has developed diarrhoea since October 26 and was admitted to a private hospital for management on October 27. She was discharged on October 28 in stable condition.      

Her stool specimen grew STEC upon laboratory testing.      

Initial enquiries of the CHP revealed that the patient had travelled to Bali, Indonesia, from October 22 to 25 and consumed fresh orange juice. She did not consume unpasteurised milk or raw food, or have contact with animals or visit farms. Her home contacts had diarrhoea during the trip and all recovered after seeking medical advice locally. Investigations are ongoing.      

"Escherichia coli (E. coli) is a bacterium that is commonly found in the gut of humans and warm-blooded animals. Most strains of E. coli are harmless. Some strains, however, such as STEC, can produce powerful toxins and cause severe food-borne disease. The most recognised serogroup of STEC is E. coli O157:H7," a spokesman for the CHP explained.

Saudi Arabia: One new MERS case on October 31

Via the KSA MOH Command and Control Center: MOH: '1 New Confirmed Corona Cases Recorded'. The case is a 49-year-old Saudi man in Unaizah who had indirect camel contact; he is said to be in critical condition. 

No deaths or recoveries are reported. Eight cases are now under care.

Close to three million people access hepatitis C cure

A WHO news release: Close to 3 million people access hepatitis C cure. Excerpt:

31 OCTOBER 2017 | SÃO PAULO, BRAZIL - On the eve of the World Hepatitis Summit in Brazil, WHO reports increasing global momentum in the response to viral hepatitis. A record 3 million people were able to obtain treatment for hepatitis C over the past two years, and 2.8 million more people embarked on lifelong treatment for hepatitis B in 2016.  

"We have seen a nearly 5-fold increase in the number of countries developing national plans to eliminate life-threatening viral hepatitis over the last 5 years," says Dr Gottfried Hirnschall, Director of WHO's Department of HIV and Global Hepatitis Programme. "These results bring hope that the elimination of hepatitis can and will become a reality."  

Hosted by the Government of Brazil, the World Hepatitis Summit 2017 is being co-organized by WHO and the World Hepatitis Alliance. The Summit aims to encourage more countries to take decisive action to tackle hepatitis, which still causes more than 1.3 million deaths every year and affects more than 325 million people. 

"We cannot lose sight of the fact that last year 194 governments committed to eliminating viral hepatitis by 2030. For sure we are still a long way from this goal but that doesn’t mean it’s some unattainable dream. It’s eminently achievable. It just requires immediate action," says Charles Gore, President of World Hepatitis Alliance. "The World Hepatitis Summit 2017 is all about how to turn WHO’s global strategy into concrete actions and inspire people to leave with a ‘can do’ attitude."