H5N1

Magnitude 6.1 quake jolts southeastern Iran

Via PressTV.com, an Iranian news source: Magnitude 6.1 quake jolts southeastern Iran.

An earthquake with a magnitude of 6.1 on the Richter scale has jolted southeastern Iran near the city of Kerman, the Iranian Seismological Center says. 

The seismic activity on Friday hit at a shallow depth of 10 kilometers, in the city of Hejadk some 58 kilometers northeast of Kerman, followed by a magnitude 4.0-aftershock some 10 minutes later.  

The quake struck at 06:00 a.m. local time (0230 GMT), with a provincial governor saying there was no report of casualties yet but as many as 30 homes had been destroyed.  

"Assessment teams are surveying the earthquake-stricken areas and villages in Kerman," IRNA quoted Mohammad-Reza Mir-Sadeqi as saying.  

Yemen: 964,477 cholera cases as of November 29

WHO's Cholera Response Dashboard reports 964,477 cases and 2,220 deaths as of November 29. That is an increase of 1,941 cases, and one death, in 24 hours.

Unless we see a sharp drop in cases, Yemen should see its millionth cholera case well before Christmas, and certainly by December 27. That will mark the eighth month since the outbreak began on April 27.

Russia stands on brink of unprecedented HIV/AIDS crisis as thousands of victims deny it even exists

Putin's Russia may be skilled at decapitating Trump's America, but it's not so good at protecting its own people. Via The Independent: Russia stands on brink of unprecedented HIV/Aids crisis as thousands of victims deny it even exists. Excerpt

You can often chart the story of an HIV denialist live on social media. From dismissing the scientific truth about the virus to the development of Aids symptoms and ultimately to death, the progression is as predictable as it is heartbreaking. 

“They said that if I don’t give my son the therapy, he’d die over the New Year holidays. Of course, I didn’t give him anything,” wrote Sofia Kuzmina on 20 March 2013. Seven months pass, and she writes again. “Now he isn’t smiling, he isn’t sitting in his buggy. They killed my son. He’s like a phoenix. Damned you Aids!” The boy died just before his fourth birthday. 

This year, Russia recorded the third highest number of new HIV cases anywhere in the world. But trust in doctors remains low, and a joined-up public health policy lacking. Within the cracks, a cult of pseudoscience has taken root. Thousands, perhaps tens of thousands of Russians now deny the basic facts about HIV. In the last three years alone, there have been at least 70 deaths attributable to HIV denialism, many of them young children.

Two weeks ago, authorities were finally moved to action. A regional court in Perm, western Siberia, took up the case of a woman who had ignored the protestations of doctors, and over three years withheld treatment from her dying eight-year-old son. The mother was sentenced to 18 months home arrest, the first ever punishment of its kind. 

Meanwhile, a trial is ongoing in neighbouring Tyumen, over the death of a two-year-old girl denied treatment by HIV-sceptic parents. 

For Kirill Vorobyev, a doctor specialising in infectious diseases, it is a case of too little and – quite evidently – too late. Why, he asks, did social services do nothing in the case of a 10-year-old girl who died in August in St Petersburg? Activists, after all, had repeatedly raised the alarm several times during the child’s excruciating final months. For whatever reason, those in charge chose not to take her away from her foster father, a local priest. 

“And what is 18 month home arrest in any case?” says Vorobyev. “That is a very lenient sentence for murder.” 

Since 2014, Vorobyov has managed a social media group on Vkontakte, Russia’s Facebook, designed to counteract bogus online information about HIV. His group monitors Russia’s denial communities for clues about people, especially children, who might be at risk. When possible, they alert the authorities and try to pull people away. Sometimes they are successful, but more often than not they are not.

HIV denialism can be a closed group, says Vorobyov, and the ties that bind leaders to new victims are strong: “Sometimes, there’s nothing you can do.” 

“Denialism is usually a coping mechanism for people in crisis,” says former HIV denialist Julia Vereshchagina. Vereshchagina found out her positive diagnosis in 2007, after being tested without her consent during a routine appendicitis operation. She found out the news after doctors paid a visit to her parents’ house. They incorrectly told her mother that she had not just HIV, but full-blown Aids. 

“That’s when my denialism began – I understand the way I was told had a colossal effect on how I accepted things later,” she says.  

A positive diagnosis handled badly is often the main trigger for HIV denialism, agrees Kirill Barsky, programme director of Steps, an HIV patient group in Moscow. Vereschagina’s case is an extreme example of how not to inform patients, but it isn’t unique. 

Typically, Russians will discover their fate from an A4 envelope, he says. They won’t even have to open it; the diagnosis will already be written on the doctor’s white face.

WHO: Contact tracing for plague in Madagascar

WHO has published Encounters with plague: tracing and preventing infection. Excerpt:

In Madagascar, where a severe plague epidemic has unfolded since August 2017, the number of new infections is finally in decline. WHO is supporting health authorities to respond to the outbreak, from setting up specialized plague treatment units in health centres, to distributing medicines across the country. 

A particularly effective action has involved training teams to find people who have been in contact with a plague patient – a system known as "contact tracing" – to help ensure these contacts are protected from falling sick themselves. 

A sudden sickness 

Rakoto [not his real name], a 17-year-old man from Antananarivo, began feeling sick one day in October. Although he was coughing and spitting up blood for several days, Rakoto was reluctant to go to a health centre. The plague outbreak was in the news every day, and his family was concerned that he might be infected. When he eventually collapsed while visiting his aunt, Rakoto’s father took him to a clinic. 

Clinical analysis confirmed that Rakoto was indeed sick with plague. He was infected with the pneumonic form, which affects the lungs and can spread to other people if they come into contact with infected sputum. He was put under treatment.  

Understanding Rakoto’s movements before his arrival at the clinic became of primary importance. The fact that he was symptomatic for several days increased the number of people who may have become exposed. 

Retracing steps  

Health workers spoke to Rakoto and his family to get exact details on where he had been in the week leading up to his admission to the clinic. They learnt that he had been mostly at home, but had visited relatives. He had also been to church for a healing ceremony as he searched for relief from his symptoms.  

The health workers passed the information along to the contact tracing team in their area, headed by WHO epidemiologist Harena Rasamoelina. They worked together to build a list of people who had been in close contact (i.e. under 2 metres) with Rakoto while he was symptomatic. These people became “contacts” who would need to take medication to ensure they did not fall sick as well. 

In Madagascar’s capital, Antananarivo, there are nine teams of contact tracers headed by WHO epidemiologists. The teams work with two community health workers in each of the city’s roughly 900 sectors. At the peak of the outbreak, these teams and similar ones in other districts followed over 1 000 contacts each day during the peak of the epidemic. 

Since WHO began supporting the Ministry of Health to establish the system in October, over 7 000 people have been identified as close contacts. Some 99% of them were provided with counselling and sufficient antibiotics to eliminate the plague bacteria in their system in case they had been infected. Follow-up teams visited them twice a day for a week to ensure they were still feeling well, that they were taking medication, and to answer any questions they might have.

HIV testing in Europe

Via Eurosurveillance: HIV testing in Europe: Evaluating the impact, added value, relevance and usability of the European Centre for Disease Prevention and Control (ECDC)’s 2010 HIV testing guidance. Excerpt from the discussion section:

This study attempted to assess the impact of the ECDC HIV testing guidance 5 years after its release, using a multidisciplinary approach. The findings indicate there is a high level of awareness of the guidance, that it has reached a wider audience than the intended audience, that it is perceived to be relevant and useful, and that it adds value by providing an EU/EEA-wide perspective. 

The guidance has been widely used to develop and revise national policies, guidelines, programmes and strategies as well as to support monitoring and evaluation and advocacy, and has contributed to changes in HIV testing strategies in a number of EU/EEA countries. 

There is, however, a lack of data on HIV testing coverage and uptake, and of standardised data in particular. This makes it difficult to accurately measure changes in testing across the EU/EEA over time but the limited improvements described in testing rates and in the number of late presenters suggest that testing policies and guidelines are not being implemented effectively. For example, the ECDC 2010 guidance emphasises the need for scaling up indicator condition guided HIV testing and community-based testing, which are the focus of a number of recent initiatives and projects in Europe, including the EU funded OptTEST, Euro HIV EDAT and COBATEST projects.  

Despite this, recent data show that indicator condition guided HIV testing is not being widely implemented in Europe. The OptTEST project has reviewed national HIV testing guidelines and audited implementation of indicator condition guided HIV testing in seven pilot countries. The results show low rates of HIV testing in patients presenting with indicator conditions as well as sub-optimal inclusion of indicator condition guided testing recommendations both in national HIV testing guidelines and relevant specialty guidelines.  

Community-based testing has been expanded in the EU/EEA since 2010 through a variety of service delivery models. However, limited funding, poor integration with national HIV programmes and regulatory barriers in some cases (for example, restricting testing to trained health professionals), have hindered further scale up. 

These findings reinforce the need for guidance to clearly address these implementation challenges, including through direct guidance in relation to engagement with the broader target audience. There is a need to assist countries to a greater extent in the development of national policies, their implementation and evaluation and to support them when undertaking future revisions. The focus group discussions confirmed this need.  

This assessment has shown that the guidance has successfully reached a wider audience than the intended one. This observation may reflect the broadening range of stakeholders involved in health policy and decision making at least in some countries, as well as of healthcare workers involved in delivery of HIV testing services. The lessons learned from this evaluation should be used to inform future evaluations as well as the development of potential new guidance.

Hong Kong: Exercise "Garnet" tests government response to novel influenza

Via the Centre for Health Protection: Exercise "Garnet" tests government response to novel influenza (with photos/video). Excerpt:

The Government tested its preparedness for possible detection of a novel influenza case today (November 30) during an exercise code-named "Garnet", organised by the Centre for Health Protection of the Department of Health (DH) in collaboration with other government departments and organisations at Wo Che Plaza, Sha Tin.      

Exercise "Garnet" was aimed at assessing the interoperability of government departments and organisations in response to the detection of a case of novel influenza, testing their execution of the Preparedness Plan for Influenza Pandemic, as well as enhancing the alertness and readiness of relevant stakeholders in guarding Hong Kong against novel influenza and the threat of the spread of communicable disease.      

About 50 participants from relevant government departments and organisations took part in the exercise, with 11 experts from the Mainland and Macau health authorities as observers. The exercise consisted of two parts. The first part was a table-top exercise conducted on November 15, in which relevant departments and organisations discussed and co-ordinated the communicable disease response measures required in the simulated scenario of detection of a confirmed case of novel influenza in Hong Kong.      

The second part, conducted today, was a ground movement exercise. Under the exercise simulation, a female staff member of a telecommunications company working at Wo Che Plaza tested positive for novel influenza virus. Initial epidemiological investigations revealed that while she had no poultry contact locally, she had travelled to a country with a novel influenza outbreak. Among other staff members who had close contact with her, some had also developed symptoms of novel influenza.       

The DH responded immediately and co-ordinated with relevant departments and organisations to formulate and implement corresponding measures. In addition to conducting on-site assessment and epidemiological investigations by its Public Health Team, the DH under this exercise also held a briefing for the staff members concerned, advised them on infection control measures, prescribed antiviral prophylaxis for the close contacts, and instructed the shopping mall operator and its cleaning services company to disinfect the contaminated areas.

Se also Mike Coston's excellent Avian Flu Diary post on this exercise. 

WHO: Global response to malaria at crossroads

WHO has published Global response to malaria at crossroads. Excerpt:

After unprecedented global success in malaria control, progress has stalled, according to the World malaria report 2017. There were an estimated 5 million more malaria cases in 2016 than in 2015. Malaria deaths stood at around 445 000, a similar number to the previous year.  

“In recent years, we have made major gains in the fight against malaria,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “We are now at a turning point. Without urgent action, we risk going backwards, and missing the global malaria targets for 2020 and beyond.”  

The WHO Global Technical Strategy for Malaria calls for reductions of at least 40% in malaria case incidence and mortality rates by the year 2020. According to WHO’s latest malaria report, the world is not on track to reach these critical milestones.  

A major problem is insufficient funding at both domestic and international levels, resulting in major gaps in coverage of insecticide-treated nets, medicines, and other life-saving tools. 

Funding shortage  

An estimated US$ 2.7 billion was invested in malaria control and elimination efforts globally in 2016. That is well below the US $6.5 billion annual investment required by 2020 to meet the 2030 targets of the WHO global malaria strategy.

In 2016, governments of endemic countries provided US$ 800 million, representing 31% of total funding. The United States of America was the largest international funder of malaria control programmes in 2016, providing US$1 billion (38% of all malaria funding), followed by other major donors, including the United Kingdom of Great Britain and Northern Ireland, France, Germany and Japan. 

The global figures  

The report shows that, in 2016, there were an estimated 216 million cases of malaria in 91 countries, up from 211 million cases in 2015. The estimated global tally of malaria deaths reached 445 000 in 2016 compared to 446 000 the previous year.  

While the rate of new cases of malaria had fallen overall, since 2014 the trend has levelled off and even reversed in some regions. Malaria mortality rates followed a similar pattern. 

The African Region continues to bear an estimated 90% of all malaria cases and deaths worldwide. Fifteen countries – all but one in sub-Saharan Africa – carry 80% of the global malaria burden.

Saudi Arabia: One new MERS case as of November 29

Well, we learned today why the KSA MOH Command and Control Center had been so quiet for almost a week. Some web genius in the MOH has been posting them, all right, but posting them down the page, between November 17 and November 18. Mike Coston at Avian Flu Diary has the story, with full credit to CIDRAP's eagle-eyed Lisa Schnirring. (You should be following both of them on Twitter.) I will henceforth check the MOH site more carefully. 

And tonight we have another post, for November 29: MOH: '1 New Confirmed Corona Cases Recorded'. A 67-year-old Saudi woman in Bisha is a primary case, in stable condition. No deaths or recoveries are reported. 

Mount Agung: November 29 update

From the Facebook page of the National Board for Disaster Management: Posts. The reference to "rain lava flood" means the mudflow caused by heavy rain mixing with volcanic ash. Excerpt from the Google translation:

The eruption of Mount Agung followed by an increase in the status of Awas and the determination of a radius of 8 -10 km as dangerous area by PVMBG on 27/11/2017 has consequently the community must evacuate out of radiius dangerous. There are 22 villages with estimated population in the dangerous radius of about 90,000 to 100,000 people. They have to evacuate because they live in disaster-prone areas whose threat is the danger of hot clouds, lava flows, falling rocks, incandescent rocks, and heavy ash rains. Very dangerous and deadly. 

Based on preliminary data collected by Center for Operation Control (Pusdalops) BPBD Bali Province, the number of refugees per 29/11/2017 at 18.00 as many as 43,358 people spread in 229 point of refuge. Refugees are located in Buleleng Regency (5,992 inhabitants), Klungkung (7,790 inhabitants), Karangasem (22,738 people), Bangli (864 people), Tabanan (657 inhabitants), Denpasar City (1,488 inhabitants), Gianyar (2968 inhabitants), Badung soul), and Jembrana (312 souls). Governor of Bali has appealed to the community to evacuate around Karangasem only, no need far away because it will facilitate the handling of refugees, Nevertheless the people still evacuate out of Karangasem. Some even fled to Lombok. 

Given the dangers of the eruption of Mount Agung is increasing, both primary hazards are pyroclastic material of Mount Agung eruption, or secondary dangers of rain lava flood. Also the handling of refugees and other impacts, the Regent of Karangasem has determined the emergency response situation in Karangasem regency for 14 days starting 27/11/2017 until 10/12/2017. The period of validation of this emergency response statement can be extended or shortened according to the need for emergency handling in the field. 

The existence of these emergency status states, BNPB and BPBD have easy access in the field of human resources mobilization, equipment deployment, logistic deployment, immigration, excise, and quarantine, licensing, procurement of goods / services, management and accountability of money and / or goods, , and command to order agencies / institutions. This is necessary because disaster management must be fast and precise. Moreover, the handling of eruption of volcano is usually long. 

There are still some people who do not want to evacuate due to several reasons, among others, still limited public understanding of the threat of eruption. Residents living in the disaster zone feel safe and do not need to evacuate. Some people consider that the eruption of Mount Agung is a spiritual event so that they surrender themselves completely to the power of God. There is also a reason to take care of livestock, farmland, and home. Some also tend to challenge themselves, for example by doing self-images in dangerous places. In social media there are already some young people who climb to the top of the mountain and soak in the rain lava flood. Obviously this is very dangerous. 

The combination of these factors leads to differences in decisions among citizens. Some residents make a very safe decision, namely by conducting evacuation as soon as possible in accordance with the recommendations of PVMBG. On the other hand, there are also residents who make very dangerous decisions, ie they insist on staying in the danger zone.

Yemen: 962,536 cholera cases as of November 28

WHO's Cholera Response Dashboard reports 962,536 cholera cases and 2,219 deaths as of November 28. That is an increase of 2,471 cases and zero deaths in 24 hours.