H5N1

Congenital brain abnormalities during a Zika virus epidemic in Salvador, Brazil, April 2015 to July 2016

Via Eurosurveillance: Congenital brain abnormalities during a Zika virus epidemic in Salvador, Brazil, April 2015 to July 2016. Excerpt from the discussion section, with my bolding:

In this study, we described a high prevalence of confirmed CBAs in Salvador, as high as 2.2% of the live births in December 2015. The prevalence of image-confirmed CBA estimated for the study period adjusted for one year was 52 times higher than the estimated baseline prevalence of microcephaly in the north-east region (average of 5 cases per 100,000 live births per year, between 2000 and 2014). Unfortunately, we did not have information on serological or virological ZIKV testing, which would allow ascertaining the aetiology of such an outbreak. 

However, the peak of births of babies with microcephaly occurred 30–33 weeks after the peak of ZIKV epidemic in Salvador, and this is consistent with the growing body of evidence suggesting that the first trimester of pregnancy is the period when ZIKV infections pose the highest risk of adverse fetal outcome. Taken together, it is reasonable to assume that most of the imaging-confirmed cases in this study were due to congenital ZIKV infection. 

As we only considered cases with specific neuroimaging findings as confirmed cases, we certainly underestimated cases of congenital ZIKV infection. Several suspected cases had not been investigated by the time we analysed the data and the imaging modality most commonly used was prenatal or postnatal intracranial ultrasound, which is not an optimal modality to detect abnormalities of the corpus callosum and cerebral cortex. 

In addition, suspected microcephaly cases were reported based on birth head circumference, which could be well within normal limits in some cases of congenital ZIKV infection. Although reporting of spontaneous abortions, stillbirths and fetuses presenting alterations in the central nervous system was also encouraged, allowing us to confirm a few cases with normal or large head circumference at birth, we could not evaluate whether there was an increase in abortions and stillbirths in Salvador during the study period. 

On the other hand, some cases counted as confirmed could be due to other causes such as congenital cytomegalovirus infection or genetic disorders, but the number of these cases is expected to be small, considering the baseline rate of microcephaly before the epidemic. In addition, in north-east Brazil (a region in which Salvador was one of the epicenters for the ZIKV outbreak), only 1.3% of confirmed cases of infection-related microcephaly during the 2015–16 period had laboratory evidence of syphilis, toxoplasmosis, cytomegalovirus, or herpes simplex.  

A similar increase in microcephaly cases was reported in other locations where ZIKV epidemics have occurred, such as Colombia, where the prevalence of microcephaly also increased around 6 months after the peak of ZIKV transmission in July 2016. However, the microcephaly prevalence reported in Colombia peaked at 17.7 cases per 10,000 live births, much lower than observed in Salvador. Potential reasons for this difference may include, variable intensity levels of ZIKV transmission, differences in circulating ZIKV strains and different case definitions and surveillance criteria. Further, co-circulation of other arboviruses (dengue and chikungunya, for example), differences in mosquito control measures, and prior exposure to yellow fever vaccination could be contributing factors. 

Additionally, Brazil was the first country in the Americas to experience a large outbreak of ZIKV and to detect an increase in microcephaly cases, and this allowed other countries as Colombia to issue recommendations for delaying pregnancies, which might have resulted in decreased risk of congenital abnormalities associated with ZIKV infection during pregnancy.

MSF in Yemen: Influx of war wounded as fighting intensifies in Hodeidah, Hajjah, Saada and Taiz

MSF.org has published Yemen: Influx of war wounded as fighting intensifies in Hodeidah, Hajjah, Saada and Taiz. Excerpt:

As conflict intensifies on several frontlines across Yemen, an influx of people with war-related injuries are being treated at facilities run by Médecins Sans Frontières (MSF) in Hodeidah, Hajjah, Aden, Saada and Taiz governorates. 

In Hodeidah, a major offensive was launched on 1 November by forces loyal to President Hadi, backed by the Saudi and Emirati-led coalition (SELC), against Ansar Allah troops. Heavy ground fighting and aerial bombardments are threatening the lives of thousands of civilians.  

Between 1 and 6 November, MSF teams in Hodeidah treated 24 war-wounded civilians at Al Salakhana hospital, including five women and nine children. Of these patients, 17 had blast injuries and one had a gunshot wound.    

In the same period, another 50 war-wounded were treated at MSF’s surgical field hospital in Mocha, 180 kilometres south of Hodeidah, mostly injured by blasts and gunshots. They included three women and eight children.  

This increase follows an intensification of ground fighting and aerial bombardments in Hodeidah since last Thursday.

“A stronger offensive by the Saudi and Emirati-led coalition-backed forces was launched with a deployment of troops on the ground. They have moved quickly around the city,” says Frederic Bertrand, MSF head of mission in Yemen. “This raises fears of a siege which could affect the tens of thousands of people still living inside Hodeidah.” 

“Every day we hear the sound of heavy airstrikes and shooting in the city,” says Bertrand. “On Monday afternoon [5 November], ground fighting occured near Al Salakhana hospital and the MSF house. Our teams had to stay inside the hospital for their own safety.” 

Movements of civilians leaving Hodeidah were reported last weekend, but it is difficult to assess how many have already left the city. “Other civilians are reportedly trapped inside the city because of the ongoing ground fighting and airstrikes,” Bertrand explains.

A wake-up call to hit the sack

The Tyee has published my review of Dr. Matthew Walker's book Why We Sleep: The New Science of Sleep and Dreams: A Wake Up Call to Hit the Sack. Excerpt:

For a day or two after the end of daylight saving time, emergency rooms all over North America are a little less stressed. Very predictably, they have to deal with fewer heart attacks and fewer auto-accident injuries, because people will have had an extra hour of sleep on Nov. 4. 

It’s no surprise to Dr. Matthew Walker, a sleep scientist at the University of California at Berkeley. He knows that heart attacks and auto accidents spike just after daylight saving starts in the spring, and everyone is short an hour of sleep. We are indeed killing ourselves by not getting enough sleep, he argues, and not just from fooling with our clocks twice a year; we’re doing everything wrong. 

Neither business nor governments seem to care much, because, like most of us, they have little idea how important sleep is — both enough of it and the right kinds of it.  

Walker’s research has shown him that enough sleep every night — close to eight hours — keeps us healthy and alert through a long life. Too little sleep, and we fall prey to a host of ills: among others, obesity, heart disease, diabetes, infertility, and Alzheimer’s. Lack of sleep can even change our DNA.

Yemen: Children in Hudaydah hospital at imminent risk of death

Via ReliefWeb, a UNICEF news release: Yemen: Children in Hudaydah hospital at imminent risk of death.

Statement by UNICEF Executive Director Henrietta Fore 

NEW YORK- 6 November 2018 - “Intense fighting in the Yemeni port city of Hudaydah is now dangerously close to Al Thawra hospital - putting the lives of 59 children, including 25 in the intensive care unit, at imminent risk of death.  

“Medical staff and patients in the hospital have confirmed hearing heavy bombing and gunfire. Access to and from the hospital, the only functioning one in the area, is now imperilled.  

“Children in particular cannot afford for Al Thawra to be caught up in the fighting. Hudaydah and the neighbouring governates account for 40 per cent of the 400,000 children in the country who suffer from severe acute malnutrition. Some of the sickest are taken to the hospital for urgent care. 

“Fighting has also reportedly intensified around Hudaydah’s port – through which up to 80 per cent of Yemen’s humanitarian supplies, fuel and commercial goods are delivered. The toll in lives could be catastrophic if the port is damaged, destroyed or blocked.  

“UNICEF’s teams on the ground are delivering assistance including lifesaving supplies like medicines, clean water and therapeutic food to treat acutely malnourished children. Further escalation in the fighting will jeopardize these efforts. 

“UNICEF calls on all parties to cease hostilities near and around the hospital, and to ensure that civilians can safely access the hospital from all sides, and to abide by their legal obligations to stop attacks against civilian infrastructure – including the port of Hudaydah”

EBOLA DRC - Evolution of the response to the Ebola epidemic in North Kivu and Ituri on Tuesday 6 November 2018

The Ministry of Health has published EBOLA DRC - Evolution of the response to the Ebola epidemic in North Kivu and Ituri on Tuesday 6 November 2018. More bad news: An Ebola case fled from Beni to a Mai-Mai village, where the disease seems to be spreading. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Tuesday, November 6, 2018   

The epidemiological situation of the Ebola Virus Disease  dated November 5, 2018: 

• A total of 305 cases of haemorrhagic fever were reported in the region, including 270 confirmed and 35 probable. 

• Of the 270 confirmed, 154 died and 88 are cured . The others are hospitalized in the different Ebola Treatment Centers (ETCs) installed. 

• 60 suspected cases under investigation. 

• 5 new confirmed cases, including 1 in Beni, 1 in Butembo and 3 in Kalunguta. 

• 3 new confirmed deaths, including 1 in Beni, 1 in Butembo and 1 in Mabalako.

    

Remarks: 

• To avoid that the total number of cases varies (up or down) daily, the suspect cases have been placed in a separate category. Thus, suspect cases with positive laboratory tests will be added to the confirmed category, while negative ones (non-cases) will be removed from the table. 

• The category of probable cases includes all reported deaths for which it was not possible to obtain biological samples for laboratory confirmation. The investigations will determine whether these deaths are related to the epidemic or not. 

• A community death is a death in the community, outside of a licensed health center. 

News of the response   

Epidemiological surveillance 

• Several cases of Ebola have been identified in a Mayi-Mayi village in the Kalunguta health zone, located in a red zone, following the escape of a confirmed case of Beni to this village in order to escape the teams of the response. After negotiations with the village leaders, an investigative mission was organized to examine the people who are currently ill and to investigate the deaths that occurred in the village the previous weeks. This investigation will identify deaths caused by Ebola and classify them, if any, as probable cases. So far, villagers have been cooperative and vaccination has begun.   

• Among the new confirmed cases in Kalunguta, there is a 6-day newborn baby from a confirmed case who died on November 4, 2018 at Butembo CTE. The child's mother began to show symptoms of the disease 5 days before giving birth to her son. 

Vaccination 

• Since the start of vaccination on August 8, 2018, 26,724  people have been vaccinated , including 14,160 in Beni, 4,436 in Mabalako, 2,152 in Katwa, 1,663 in Mandima, 1,435 in Butembo, 690 in Masereka, 507 in Kalunguta, 434 in Bunia, 355 in Tchomia, 240 in Komanda, 184 in Mutwanga, 178 in Oicha, 160 in Musienene and 130 in Vuhovi.

Need a flu shot? Get it now

Via The New York Times: Need a Flu Shot? Get It Now. Excerpt:

If you’ve waited until now to get your flu shot, your procrastination may actually pay off, though you’d be unwise to delay getting the vaccine any longer.  

Although there are some cases of flu in October and November in the United States, flu season here doesn’t usually get going full speed until December, peaking in most years in February and usually ending by April. 

I’ve just learned from Dr. Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, that immunity induced by the flu vaccine, which is rarely greater than 60 percent to begin with, tends to wane by 20 percent a month, leaving those who got their shot in August or September with less than desirable protection by the time they’re exposed to a variant of flu virus their body doesn’t recognize. 

Dr. Osterholm suggested that “since 95 percent of flu outbreaks start in mid-December, it’s best to get the flu shot in early to mid-November.” 

 Of course, if you, like me, were planning to travel abroad mid-fall, you should have gotten the vaccine beforehand because you never know what you’re likely to be exposed to on route or wherever you land, and no one wants a trip ruined by the debilitating fever, aches, fatigue and nausea that typically accompany the flu. 

The Centers for Disease Control and Prevention, the nation’s infectious disease watchdog, recommends that everyone, starting at age 6 months, get a seasonal flu shot every year. Children younger than 6 months can be protected if their mothers get a flu shot during pregnancy. Annual vaccination is especially important for people 65 and older, those with a chronic illness, pregnant women and anyone with compromised immunity, all of whom are most susceptible to serious and possibly fatal complications should they get the flu. 

It’s very important that children, too, get vaccinated with the current year’s vaccine, since children are less likely to have any residual protection from prior exposure to the flu and are the leading vectors for infecting others should they get sick.  

Furthermore, the flu virus is readily transmitted to others starting the day before you develop any telltale signs of the infection, which comes on suddenly. You may be fine in the morning and feel like you’ve been hit by a truck by afternoon. A seemingly healthy child who is incubating the virus can easily transmit it to a dozen others, including teacher and parents, before they know they are sick.

EBOLA DRC - Evolution of the response to the Ebola epidemic in North Kivu and Ituri on Sunday November 4 2018

The Ministry of Health has published EBOLA DRC - Evolution of the response to the Ebola epidemic in North Kivu and Ituri on Sunday November 4 2018. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Sunday, November 4, 2018   

The epidemiological situation of the Ebola Virus Disease  dated November 3, 2018: 

• A total of 298 cases of haemorrhagic fever were reported in the region, 263 confirmed and 35 probable. 

• Of the 263 confirmed, 151 died and 81 are cured. The others are hospitalized in the different Ebola Treatment Centers (ETCs) installed. 

• 46 suspected cases under investigation. 

• 5 new confirmed cases, including 2 in Beni, 2 in Mabalako and 1 in Butembo. 

º The two new confirmed cases of Mabalako are a young girl residing in Beni and her 2-week-old newborn. They were transferred to the Mabalako CTE at the request of the family. 

• 4 new confirmed cases, including 3 in Beni and 1 in Butembo.

  

Remarks: 

• To avoid that the total number of cases varies (up or down) daily, the suspect cases have been placed in a separate category. Thus, suspect cases with positive laboratory tests will be added to the confirmed category, while negative ones (non-cases) will be removed from the table. 

• The category of probable cases includes all reported deaths for which it was not possible to obtain biological samples for laboratory confirmation. The investigations will determine whether these deaths are related to the epidemic or not. 

• A community death is a death in the community, outside of a licensed health center. 

News of the response 

Vaccination 

• Since the start of vaccination on August 8, 2018, 26,135  people have been vaccinated , including 13,825 in Beni, 4,436 in Mabalako, 2,062 in Katwa, 1,663 in Mandima, 1,355 in Butembo, 690 in Masereka, 457 in Kalunguta, 434 in Bunia, 355 in Tchomia, 240 in Komanda, 178 in Oicha, 150 in Mutwanga, 160 in Musienene and 130 in Vuhovi.

'End war on Yemen's children': conflict escalates around Hodeidah hospital

Via The Guardian: 'End war on Yemen's children': conflict escalates around Hodeidah hospital. Excerpt:

Fighting has intensified around the largest hospital operating in the port city of Hodeidah, preventing access to severely malnourished and vulnerable children, the UN’s children’s agency has warned. 

The escalation in conflict follows US calls for a ceasefire and suggestions that peace talks may be held in Sweden. On Thursday, the Saudi-led coalition said it had attacked Sana’a international airport and an adjoining airbase being used by Houthi insurgents. 

“It’s very clear that, despite the call for talks, and despite the call for an agreement on the cessation of hostilities in the next 30 days, the parties are intensifying the fighting – unfortunately, with an incredible impact on children,” said Geert Cappelaere, Unicef’s regional director for the Middle East and north Africa, speaking from Sana’a.

Cappelaere said the few shipments of crucial medical supplies and food arriving in the port of Hodeidah were regularly blocked, sometimes for months. “Even the humanitarian aid is taken hostage at times. It’s just unacceptable. All parties are carrying responsibility,” said Cappelaere. “The war on children needs to stop.”  

Active fighting is taking place within a few hundred metres of the largest of Hodeidah’s handful of hospitals, according to Cappelaere, who visited the city this week. Families were delaying seeking medical attention because of the hostilities, or because they could not afford the transport costs. 

Hodeidah, which has been hit particularly hard by cholera and acute diarrhoea, was already among the worst places for children in Yemen, Cappelaere said. 

The latest Unicef figures show there are an estimated 1.8 million malnourished children in Yemen. Almost 400,000 children are suffering from severe acute malnutrition, which is life-threatening, with four in 10 of such cases in Hodeidah and neighbouring governorates. 

On a visit to Al-Thawra hospital, Cappelaere said he saw the emaciated bodies of acutely malnourished children, as well as several children paralysed by diphtheria, which is preventable by vaccine. Among them was a 10-year-old girl, Sara, who is paralysed from the chest downwards because of the infection.  

“I was just thinking overnight when I heard the shelling happening … What does that mean for that poor girl who is already half-paralysed and who now has to hear all these bombs around her? For what reason? To get a better negotiating position around the table in Sweden?” said Cappelaere. 

It is feared that intensified fighting in Hodeidah would not only have a devastating impact on its population but also cut off food, fuel and medical imports to the rest of the country. Aid agencies have repeatedly warned the conflict is driving Yemen to the brink of the worst famine in living memory.

Yemeni children die as warring sides block aid deliveries

Via Thomson Reuters: Yemeni children die as warring sides block aid deliveries - UNICEF. Excerpt:

Yemeni children are dying from starvation and disease as trucks with life-saving supplies are blocked in port, leaving medical staff and desperate mothers imploring aid workers to do more, a senior U.N. official said. 

Geert Cappelaere, Middle East director for the U.N. Children's Fund (UNICEF), described "heart-breaking" scenes of emaciated children in hospitals in the main port city of Hodeidah and the capital Sanaa, both held by Houthi insurgents.  

"We have evidence that today in Yemen every 10 minutes a child under the age of 5 is dying from preventable diseases and severe acute malnutrition," he told Reuters from Hodeidah.  

The United Nations says about 14 million people, or half Yemen's population, could soon be on the brink of famine in a man-made disaster. 

Already 1.8 million Yemeni children are malnourished, more than 400,000 of them suffering from severe acute malnutrition, a life-threatening condition that leaves them skeletal with muscle wasting, Cappelaere said.  

"But there is more. Many children are dying from vaccine-preventable diseases. Today not more than 40 percent of the children throughout Yemen are being vaccinated," he said.  

Measles, cholera and diphtheria can be deadly for children, especially those under five, and are exacerbated by malnutrition. 

"Because of this brutal war, because of obstacles, obstructions being made, it is unfortunately not possible do much more," Cappelaere said. 

"We may not yet be at the level of a famine but we should not wait until we have declared a famine to step up and to pressure the parties to the conflict to stop this senseless war," he said.  

U.N. envoy Martin Griffiths aims to convene peace talks this month to seek a ceasefire in the three-and-half year war, which pits the Yemeni government, backed by a Saudi-led coalition, and the Iran-allied Houthi insurgents. 

As Cappelaere spoke, coaltion forces were massing for an assault on Hodeidah. 

 "HEART-BREAKING" 

Seven trucks carrying life-saving medical equipment and medicines had been blocked at Hodeidah port for two weeks awaiting clearance after being off-loaded, Cappelaere said.  

"It was heart-breaking that an hour before I was sitting at al-Thwara hospital, and I have all the doctors, all the medical staff pleading with me to get more medical supplies, to get more medicines," he said. 

A UNICEF spokeswoman said the trucks had been cleared by Houthi authorities on Friday and supplies would be distributed.  

Several extremely malnourished children were in the hospital ward, Cappelaere said.  

"All the mothers were telling me that they are simply missing that small amount of money to transport their children from their communities to the hospital," he said.

Polio and vaccination: A memoir of what we’ve forgotten

The Tyee has published my article Polio and Vaccination: A Memoir of What We’ve Forgotten. Excerpt:

We’re seeing reports of a “polio-like” disease turning up in Canada and especially in the U.S. Acute flaccid paralysis is leaving kids partially or completely paralyzed, and parents are understandably scared. The U.S. reportedly has 60 cases so far this year, and Canada has perhaps 30.  

AFP and its subtype, acute flaccid myelitis, are even becoming a political issue: the right-wing American Association of Physicians and Surgeons warns about the “public health threat from uncontrolled immigration” and suggesting that the “caravan” of asylum seekers might be bringing AFP with them. 

As literally a one-in-a-million disease, AFP is a faint echo of poliomyelitis itself. But it comes at a time when we’ve forgotten how deadly childhood diseases can be, and many have even begun to question the vaccines that saved both them and their parents from death or lifelong impairment.  

Seventy years ago this month, I was seven years old, running a fever, and unable to touch my chin to my chest. Every parent in 1948 knew those were likely symptoms of polio, and that same afternoon I was in a downtown hospital for tests. They showed I was indeed one of over 20,000 polio cases in the U.S. that year.  

My memories of the next two weeks are fragmentary but vivid. I’m carried on the shoulder of a tall black man to undergo a spinal tap — not a funny phony band, but my first experience of real pain. I’m in a ward with other kids, each of us in a crib — a crib! — learning to use bedpans and suffering the further indignity of having our temperatures taken rectally. Drop a comic book through the crib slats to the floor, and it’s gone forever.

Every day we lie on our stomachs in our cribs while “hot packs” — steaming-hot blankets — are piled on us. This is state-of-the-art therapy for polio patients.  

Toward the end of my hitch, I’m taken from my crib in a wheelchair, plunked into a bathtub and sloshed with green disinfectant soap. Then I’m taught how to walk again. After two weeks in a crib, it’s not easy.  

Finally back home, I begin to understand that I am really lucky. Other kids have died, or been trapped for life in iron lungs that keep them breathing. When I’m back in school, I see a girl with a brace on one leg from her own case of polio. She’s not the last.