H5N1

State of Global Air Report 2024

Via the Health Effects Institute: State of Global Air Report 2024. Click or tap through todownload the complete report. The summary:

The State of Global Air 2024 report provides a comprehensive analysis of data for air quality and health impacts for countries around the world. The analysis finds that: 

 ● Air pollution accounted for 8.1 million deaths globally in 2021, becoming the second leading risk factor for death, including for children under five years. Of the total deaths, noncommunicable diseases including heart disease, stroke, diabetes, lung cancer, and chronic obstructive pulmonary disease (COPD) account for nearly 90% of the disease burden from air pollution. 

 ● In 2021, more than 700,000 deaths in children under 5 years were linked to air pollution; this represents 15% of all global deaths in children under five. 

As in previous years, the State of Global Air 2024 report and accompanying website provides comprehensive data on the levels and trends in air quality and health for every country in the world. This State of Global Air report was produced in partnership with UNICEF. 

In the State of Global Air 2024 interactive app, you can explore, compare, and download data and graphics reflecting the latest air pollution levels and associated burden of disease for over 200 individual countries, territories, and regions, as well as track trends from 1990 to 2021.

See also this Guardian story on the report.

WHO: Global immunization efforts have saved at least 154 million lives over the past 50 years

WHO has published a news release: Global immunization efforts have saved at least 154 million lives over the past 50 years. Excerpt:

A major landmark study to be published by The Lancet reveals that global immunization efforts have saved an estimated 154 million lives – or the equivalent of 6 lives every minute of every year – over the past 50 years. The vast majority of lives saved – 101 million – were those of infants.  

The study, led by the World Health Organization (WHO), shows that immunization is the single greatest contribution of any health intervention to ensuring babies not only see their first birthdays but continue leading healthy lives into adulthood.  

Of the vaccines included in the study, the measles vaccination had the most significant impact on reducing infant mortality, accounting for 60% of the lives saved due to immunization. This vaccine will likely remain the top contributor to preventing deaths in the future.  

Over the past 50 years, vaccination against 14 diseases (diphtheria, Haemophilus influenzae type B, hepatitis B, Japanese encephalitis, measles, meningitis A, pertussis, invasive pneumococcal disease, polio, rotavirus, rubella, tetanus, tuberculosis, and yellow fever) has directly contributed to reducing infant deaths by 40% globally, and by more than 50% in the African Region.  

"Vaccines are among the most powerful inventions in history, making once-feared diseases preventable,” said WHO Director-General, Dr Tedros Adhanom Ghebreyesus. “Thanks to vaccines, smallpox has been eradicated, polio is on the brink, and with the more recent development of vaccines against diseases like malaria and cervical cancer, we are pushing back the frontiers of disease. With continued research, investment and collaboration, we can save millions more lives today and in the next 50 years.”  

The study found that for each life saved through immunization, an average of 66 years of full health were gained – with a total of 10.2 billion full health years gained over the five decades. As the result of vaccination against polio more than 20 million people are able to walk today who would otherwise have been paralysed, and the world is on the verge of eradicating polio, once and for all.  

These gains in childhood survival highlight the importance of protecting immunization progress in every country of the world and accelerating efforts to reach the 67 million children who missed out on one or more vaccines during the pandemic years.

‘Deadliest outbreak ever seen’: Climate crisis fuels Bangladesh’s worst dengue epidemic

Via The Guardian: ‘Deadliest outbreak ever seen’: climate crisis fuels Bangladesh’s worst dengue epidemic. Excerpt:

In a small, dimly lit control room at the Directorate General of Health Services (DGHS) in Dhaka, data on Bangladesh’s dengue outbreak flashes across multiple computer screens. Government analysts here have been busy collecting and monitoring the impact of the disease across the country since cases were first reported last April.  

In 2023, the total reported cases of dengue numbered 321,179, with 1,705 deaths recorded, a massive jump from the year before, when 62,000 people were known to have had the virus, and 281 died. It was the highest number of annual deaths caused by the mosquito-transmitted disease ever recorded in Bangladesh.

The deaths last year included at least 113 children. According to Save the Children, the majority of these deaths were of children under the age of 10, with 38 deaths among those under five.  

“Children make up around 30% of all dengue cases in Bangladesh and are particularly vulnerable to the virus because of underdeveloped immune systems,” says Dr Shamim Jahan, Bangladesh director of Save the Children. “Those under five are particularly at risk from developing severe symptoms, such as dehydration and shock.”  

Over the past few months, the surge in cases has pushed Bangladesh’s health system to the limit, with hospital corridors overflowing with patients as wards run out of beds.  

“It’s been the deadliest outbreak of dengue the country has ever seen,” says Dr Mohammad Shafiul Alam, a scientist at the ICDDR,B health research centre in Dhaka.  

The high death toll has continued into the new year. As of Wednesday, the outbreak had affected 756 people so far this month, resulting in 10 deaths, compared with 424 cases and three deaths this time last year.  

However, the official figures may not give a true indication of the scale of the outbreak. “These reported figures are likely an underestimation of the actual burden,” says Alam. “Numerous healthcare facilities in Bangladesh operate beyond the reporting framework. This underscores the likelihood that the actual figures could be several times higher.”

Canada’s lack of public data about pediatric flu numbers leaves pediatricians ‘flying blind’

Via The Globe and Mail, health reporter Carly Weeks writes: Canada’s lack of public data about pediatric flu numbers leaves pediatricians ‘flying blind’. Excerpt:

At least two children have died in Canada after contracting influenza in recent weeks, but Ottawa has so far not released any data on how flu season is affecting pediatric patients across the country – a situation clinicians say is leaving them in the dark and may be compromising the response to emerging problems.  

“It’s really concerning that we don’t know what’s going on,” said Manish Sadarangani, a pediatric infectious diseases specialist. “I sort of feel like we’re flying blind.”  

“It really helps to know what infections are currently circulating and which infections are causing more severe illness and hospitalization in children,” said Ashley Roberts, a clinical assistant professor of pediatric infectious diseases at the University of British Columbia.  

“To not have that active data present for our clinical care is certainly a loss right now,” Dr. Roberts added.  

Each week, the Public Health Agency of Canada publishes a FluWatch report that details influenza trends across the country. Last season, for instance, the report helped pediatricians understand and respond to soaring rates of hospital admission for the flu at a time when COVID-19 and respiratory syncytial virus (RSV) were also sickening many kids across Canada.  

But as of Oct. 1, FluWatch reports have not included any information on the number of children who have fallen severely ill as a result of the flu. The reports simply state the data were “not available.” 

The lack of information appears to be the result of a decision by PHAC to put a new group in charge of collecting pediatric data on severe outcomes for respiratory viruses.  

On Nov. 1, the agency awarded a new contract to the University of Calgary, PHAC spokesperson Tammy Jarbeau wrote in an e-mail. She said the government is working with the group “on the implementation of the contract and the transition” to ensure the new data will be comparable to information collected in previous years.  

According to another PHAC spokesperson, Marie-Pier Burelle, the government received the first cache of data on Nov. 24, and the information is being used internally. It should be made public sometime this month, she wrote in an e-mail.  

For more than 25 years, Ottawa had been using the same surveillance network, IMPACT, to collect this data. IMPACT, which stands for Canada’s Immunization Monitoring Program ACTive, is run by the Canadian Paediatric Society and has experts based in 12 pediatric sites, representing 90 per cent of tertiary care pediatric beds in the country.  

Dr. Sadarangani, a co-principal investigator of IMPACT, said it’s critical to have data on pediatric respiratory virus outcomes for this season, given that last season hospitals saw an unusually high influx of flu, RSV and COVID-19 cases. And it’s expected that a new vaccine to prevent severe illness in infants with RSV will become available next season, so experts will need detailed information on RSV cases this season to help them determine who should get that vaccine and when, he said.  

“We really need that data this year, almost more than ever,” Dr. Sadarangani said.

Progress toward regional measles elimination — worldwide, 2000–2021

Via MMWR: Progress Toward Regional Measles Elimination — Worldwide, 2000–2021. The summary:

What is already known about this topic?  

Progress toward measles elimination experienced setbacks in 2020 during the COVID-19 pandemic.  

What is added by this report?  

During 2000–2021, measles vaccination prevented an estimated 56 million deaths worldwide. In 2021, only 81% of children received their first dose of measles containing vaccine (MCV), the lowest coverage reported since 2008, leaving 25 million children vulnerable to measles. Measles surveillance continues to be suboptimal, and large and disruptive outbreaks were reported in 22 countries.  

What are the implications for public health practice?  

Reaching all children with 2 doses of MCV and strengthening measles surveillance is critical to close immunity gaps, prevent outbreaks, and recover progress lost during the pandemic.

Ebola in Mbandaka: Death of a 4th confirmed case

Via Radio Okapi: Ebola in Mbandaka: death of a 4th confirmed case. The Google translation, with my bolding:

The fourth confirmed case of the Ebola virus disease died on Friday May 20 in Mbandaka. This is the fourth recorded since the outbreak of the epidemic on April 21. He was discovered on Thursday in the Maman Balako health area, Wangata health zone and commune.  

Only 24 hours after his discovery, the patient died, after having dragged around the community for a long time without proper care.  

Medical sources claim that the victim was a 12-year-old child in the Maman Balako health area. Since May 14, he had been developing symptoms of Ebola, including fever, fatigue, blackish vomit.  

For five days, he was cared for at home, until Thursday, May 19; date on which he was taken to a medical center in the Mbandaka II district. The results of the analysis of the samples taken on the same day from the child were found to be positive for the Ebola virus disease.  

But the family resisted and brought the child home on Thursday evening, where he passed away on Friday morning.  

Sources add that another 9-year-old child died with the same symptoms, in the same neighborhood, on May 6 and buried, without post-mortem collection or a dignified and secure burial. This raises fears of a multiplication of cases.  

The response teams are preparing for the decontamination of different places, through which the deceased child passed. They seek the cooperation of the populations around the case and in the health area concerned.  

They also invite the inhabitants to appropriate all the preventive measures recently enacted by the provincial authority, in order to avoid a large-scale spread of the disease. Among these measures, there is a compulsory post-mortem sample before any burial of bodies in the city.

Joint ECDC-WHO Regional Office for Europe Hepatitis of Unknown Origin in Children Surveillance Bulletin

ECDC and WHO have published Joint ECDC-WHO Regional Office for Europe Hepatitis of Unknown Origin in Children Surveillance Bulletin. The surveillance summary:

This report provides an overview of the cases of hepatitis of unknown origin in children aged 16 years and below reported to ECDC and the WHO Regional Office for Europe through The European Surveillance System (TESSy) hosted at ECDC.  

As of 13 May 2022, 232 cases of acute hepatitis of unknown aetiology in children aged 16 years or below have been reported, of which 229 were classified as probable and three as epidemiologically linked, by 14 countries (Belgium (12), Cyprus (two), Denmark (six), Greece (two), Ireland (six), Italy (24), the Netherlands (six), Norway (five), Poland (one), Serbia (one), Slovenia (one), Spain (26), Sweden (nine), and the United Kingdom (131)).  

Of the 229 probable cases, 122 have recovered, while 18 remain under medical care.  

The epicurve shows cases by the date of onset of first symptoms of disease. An increase in the number of cases has occurred from week 9. As severe hepatitis can take some time to develop after the onset of the first symptoms and as investigations take time, there may be a delay in the reporting of cases. The recent decrease in cases is therefore challenging to interpret.  

The majority (75.9%) of cases are <5 years of age.  

Of 143 cases with information, 22 (15.4%) were admitted to an intensive care unit. Of the 98 cases for which this information was available, six (6.1%) have received a liver transplant. There has been one death associated with this disease.  

Overall, 151 cases were tested for adenovirus by any specimen type, of which 90 (59.6%) tested positive. The positivity rate was the highest in whole blood specimens (68.9%).  

Of the 173 cases PCR tested for SARS-CoV-2, 20 (11.6%) tested positive. Serology results for SARS-CoV-2 were only available for 19 cases, of which 14 (73.7%) had a positive finding. Of the 56 cases with data on COVID-19 vaccination, 47 (83.9%) were unvaccinated.

ECDC epidemiological update: Hepatitis of unknown aetiology in children

ECDC has published Epidemiological update: Hepatitis of unknown aetiology in children. Excerpt:

Since the first alert launched by the United Kingdom (UK) on 5 April 2022, probable cases of hepatitis of unknown aetiology in children have been reported from several countries worldwide. It is not yet clear whether the cases identified following the alert are part of a true increase compared to the baseline rate of hepatitis of unknown aetiology in children.  

The aetiology and pathogenetic mechanisms of disease are still under investigation. A possible association with current adenovirus infection has been found in cases in the UK in particular but other hypotheses and possible co-factors are under investigation. Most cases continue to be reported as sporadic un-linked cases.  

This report presents an update of probable cases identified in the European Union/European Economic Area (EU/EEA) and worldwide. Whereas cases detected in the EU/EEA have been reported according to the ECDC/WHO case definition, worldwide cases are collected through screening of official websites and media sources and therefore different case definitions could have been used. 

Case definition used in EU/EEA: 

• Confirmed: N/A 

• Probable: A person presenting with an acute hepatitis (non-hepatitis viruses A, B, C, D and E*) with aspartate transaminase (AST) or alanine transaminase (ALT) over 500 IU/L, who is 16 years old or younger, since 1 October 2021.  

• Epi-linked: A person presenting with an acute hepatitis (non-hepatitis viruses A, B, C, D and E*) of any age who is a close contact of a probable case since 1 October 2021.  

Cases of hepatitis with known aetiology such those due to specific infectious diseases, drug toxicity, and metabolic hereditary, or autoimmune disorders should not be reported under this protocol.    

In EU/EEA countries, approximately 106 cases have been identified in 14 EU/EEA countries as of 10 May 2022. 

Worldwide update

United Kingdom: As of 3 May 2022, the UKHSA has identified a total of 163 children, aged under 16 years, with acute hepatitis of unknown aetiology. Of these cases, 11 children have received a liver transplant. A second detailed technical briefing on the investigations among the UK cases was published by the UKHSA on 6 May 2022. 

Outside of EU/EEA and the United Kingdom: as of 10 May 2022, there are at least 181 cases of acute hepatitis among children. Cases have been reported by Argentina [8], Brazil [16], Canada [7], Costa Rica [2], Indonesia [15], Israel [12], Japan [7], Panama [1], Palestine* [1], Serbia [1], Singapore [1], South Korea [1] and the United States [at least 109].  

The total number of cases reported worldwide is approximately 450, including 11 deaths reported from Indonesia [5], Palestine [1], and the United States [5].  

On 3 May 2022, the media quoting public health authorities reported a death of an eight-year-old child with acute hepatitis of unknown aetiology in Palestine*. It is currently unclear whether this is the same child who was diagnosed in the previous week. Confirmation of this case is pending.

Jakarta health agency talks of mysterious acute hepatitis

Via Tempo, an Indonesian news site: Jakarta Health Agency Talks of Mysterious Acute Hepatitis. Excerpt:

Jakarta Health Agency Head Widyastuti said the agency is still studying the clinical criteria and epidemiology of the mysterious acute hepatitis or liver inflammation. She said the government has not yet dared to conclude the pattern of the disease.  

“It is a mysterious [disease] that surely needs investigation. We are not in haste to conclude what it is,” she said at City Hall, Central Jakarta, Monday, May 9, 2022.  

Previously reported, the Health Ministry stated that three child patients at Dr. Cipto Mangunkusumo Central National Hospital (RSCM) died of suspected mysterious hepatitis. They were treated for two weeks starting April 30, 2022. The cause remains unknown.  

Widyastuti said hepatitis was not a new disease as there have been hepatitis types A-E. Thus, early vigilance has been practiced from the beginning. “So of course, we all must stay vigilant,” she remarked.

Kwilu: 286 children died in 3 months from an unknown disease

Kwilu province, DR Congo. Gungu is in the south-central part of the province. Google Maps.

Thanks to @BojoBodean for alerting me to this Radio Okapi report: Kwilu: 286 children died in 3 months from an unknown disease. The Google translation:

The head of the provincial health division of Kwilu, Dr Jean-Pierre Basake, told Radio Okapi on Monday, November 8 that two hundred and forty-six children whose age varies between 0 and 5 years had died since the end of the month. of August 2021 of an illness of unknown origin, in the health zone of Mukedi, in the territory of Gungu, in the province of Kwilu.  

According to him, this figure was drawn from the cumulative amount of 4,881 cases including 286 registered deaths. "The cases are still there. Children have a fever with abdominal pain, vomiting, some lead to a picture of anemia. We are at 4,481 cases and 286 cumulative deaths," said Dr Basake.  

He also said that the province and some partners had provided material and financial support to strengthen the response:  

"We brought in medical, material and technical support. The drugs we used did not have the right active principle. We nevertheless obtained the support of the provincial government on the recommendation of the provincial assembly, five million francs. Congolese (US $ 2,450) taken out of the provincial fund and drugs. The partners also made available antimalarials, therefore ACTs and inputs of nearly US $28 to 29,000. From the weekend to this day, this 'was $33 to 34,000 USD. Drugs and inputs. We have with us here a biologist technician who takes the samples, we will send nationally to the INRB."