H5N1

DRC: 12 Kwango province health zones affected by Konzo disease

As if the DR Congo didn't have enough to deal with, province26.drc.net reports: DRC: 12 health zones affected by Konzo disease (Kwango). The Google translation, with a link to a definition of the disease:

Kwango Provincial Health Division Chief Pierre Mwela says 12 of the 14 health zones in the province are affected by Konzo disease. 

He said it Saturday, July 20 at Okapi Radio. 

The patients show signs of malnutrition and weaknesses in the upper and lower limbs. This disease affects the nerves of the individual and mainly causes paralysis of the lower limbs. The affected subject has deformed limbs and especially has difficulty walking because he has no balance, notes Mr. Mwela.  

The cause of this disease is mainly related to the consumption of cassava which has not experienced retting, a technique that eliminates the toxic substances of certain food plants. 

Pierre Mwela adds that several households are attacked. But to date, there is only preventive treatment. 

The Italian rights NGO ISCO sensitizes the population of Kwango on this disease which mainly affects children.  

According to Rachel Muwawa, ISCO's Communications Officer, this awareness concerns six sites already identified with 4,800 households. Targeted households will receive information needed to prevent this disease, the source said. 

Rachel Muwawa calls on the country's authorities to increase awareness and care for children and women with the disease.  

Konzo is a disease that dates back decades. It is experiencing a recrudescence, to date, following chronic malnutrition in this province, say the health authorities.

No cause identified for death of children in Bihar, India

Via The Lancet: No cause identified for death of children in Bihar, India. Excerpt:

Since June 1, Bihar in eastern India, known for its lush lychee orchards, has been in the news because almost 150 children in Muzaffarpur and adjoining districts have died from an illness that many experts call acute encephalitis syndrome, a blanket term for several neurological manifestations. 

There is no definitive epidemiological diagnosis of these deaths as yet, but local reports suggest that several factors could be responsible, including a toxin that can be found in lychees, extreme heat and humidity, child malnutrition, and an ill-equipped public health system that could not offer timely treatment. The children who died were from very poor families, and most deaths have been attributed to hypoglycaemia. 

Bouts of recurring acute encephalopathy have been reported in Bihar since 1995. A Lancet Global Health study found that these outbreaks are “associated with both hypoglycin A and [methylenecyclopropylglycine] toxicity from lychee consumption” and that “this illness is also associated with absence of an evening meal”. 

“Muzaffarpur is a poor district with a cluster of significant risk factors for widespread child undernutrition—the available data from the National Family Health Survey highlights this very clearly”, Purnima Menon, a senior research fellow at the International Food Policy Research Institute's Poverty, Health and Nutrition Division, told The Lancet. “While we await the epidemiological diagnoses, at this point in time, it seems very much like this cluster of child deaths is very similar to what occurred in the same district in previous years.” 

T Jacob John, a retired virology professor from the Christian Medical College, Vellore, Tamil Nadu, who, along with colleagues, had investigated the disease in Muzaffarpur during outbreaks in 2012, 2013, and 2014, says the children would not have died had they not gone to sleep on an empty stomach. 

“The lychee is not the primary cause”, John told The Lancet. “You have to fix the primary health-care system and the gross malnutrition. No child from a well-to-do family has ever suffered because he or she ate lychees.”

India: More on acute encephalitis syndrome in Muzaffarpur

Via The Washington Post: A mysterious sickness has killed nearly 100 children in India. Could litchi fruit be the cause? Excerpt:

NEW DELHI — The children go to sleep as best they can in the sweltering heat. Early in the morning, the fever spikes and the seizures begin. 

Nearly 100 children have died this month in India from an illness that impairs the functioning of the brain and sends the level of glucose in the blood plummeting.  

The deaths have occurred in and around the city of Muzaffarpur in the northern state of Bihar, one of the poorest regions in India. The illness strikes the area each summer, but in recent years the death toll has been less than 20.  

This year, at least 97 children have died, most of them under the age of 7, said Alok Ranjan Ghosh, a senior government official in Muzaffarpur. About 100 more remain in hospitals. The deaths represent the worst toll since 2014, according to figures provided by a state health official. 

Doctors describe the illness as acute encephalitis syndrome, or AES, which is characterized by the rapid onset of fever combined with disorientation and seizures.  

The syndrome has myriad causes, including viruses spread by mosquitoes and human contact, bacterial infections, parasites and toxins.   

In the Muzaffarpur case, officials say the precise cause of the outbreak remains unclear. Elsewhere in India, a mosquito-borne virus called Japanese encephalitis sometimes played a leading role in outbreaks of AES. But in Muzaffarpur, the virus appears absent in the vast majority of the cases, said Sanjay Kumar, principal secretary at the Bihar state ministry of health.  

The illness has been observed in the area since 1995, Kumar said, flaring up during the Indian summer when temperatures soar and subsiding with the arrival of the rains and somewhat cooler weather. Children are arriving at hospitals with critically low blood-sugar levels, he said.  

Sunil Kumar Shahi, the superintendent of Sri Krishna Medical College and Hospital in Muzaffarpur, where most of the children are being treated, said that all of the patients with the illness were under the age of 9.   

“You can imagine my mental condition. The situation is horrible,” he said, before rushing off to treat more children. “Think of the parents whose kids are admitted.”  

Gopal Shankar Sahni, the head of the pediatrics department at the same hospital, said its halls were crowded with distressed and crying parents. “They ask us to treat their kids, but we ask them to believe in God,” he said.  

A recent study conducted by India’s National Center for Disease Control in conjunction with the Centers for Disease Control and Prevention in the United States pointed to a different possible cause for the illness. The area around Muzaffarpur is a major litchi-growing region, and the study found that toxins occurring naturally in the fruit were a plausible source of the illness, especially when children failed to eat an evening meal the day before becoming sick. 

The outbreaks of this “acute unexplained neurological illness . . . begin in mid-May and peak in June, coinciding with the month-long litchi harvesting season,” the researchers noted, adding that most of the affected children come from poor and rural families.   

They posited that the illness might only occur with a combination of factors, for instance when a poorly nourished child eats a large number of litchis and then misses an evening meal. They also pointed to the limitations on local hospitals in providing critical care to such patients, which likely contributes to the death toll. 

UK: Hancock pledges hospital food overhaul after listeria deaths

Via The Guardian: Hancock pledges hospital food overhaul after listeria deaths. Excerpt:

Health secretary Matt Hancock has ordered a “root and branch” review of NHS food after two more patient deaths were linked last week to a listeria outbreak. The new deaths bring the number of suspected fatalities to five and doctors have warned that further cases could occur.  

Hancock said he was “incredibly concerned” after it emerged the patients were suspected of dying as a result of eating pre-packaged sandwiches and salads linked by the same supplier, The Good Food Chain. 

The affected products have since been withdrawn from hospitals and Public Health England said evidence suggested all the deaths had occurred before the items were removed from circulation on 25 May. 

“We need a radical new approach to the food that is served in our NHS,” added Hancock. “Our NHS should be at the forefront of supporting people to make healthy choices.”  

A Public Health England official said investigations into the outbreak were taking place and were being conducted in partnership with the Food Standards Agency. Listeria is caused by the bacterium Listeria monocytogenes and can trigger very severe disease in humans. It usually affects people whose immune systems have been weakened – such as the elderly, pregnant women or patients taking immuno-suppressant drugs. The disease is caught by eating contaminated food.  

The first three deaths were at Manchester University NHS foundation trust and Aintree University Hospital NHS foundation trust in Liverpool. One of the two new cases is understood to have died after these three cases. However, the other patient died before the three succumbed. Doctors have only just discovered the death was linked to the same strain of the bacterium. 

“These two cases had already been reported to Public Health England but were re-analysed using whole genome sequence data,” said Dr Catherine Rees, associate professor in microbiology at Nottingham University. “This showed that the listeria isolated from these patients were highly likely to have come from the same source.”

The trusts where the latest two victims were receiving treatment have not yet been named, although PHE said there are now seven trusts across the country dealing with listeria cases. The first case showed symptoms on 25 April and sandwiches and salads were withdrawn on 25 May. It is understood that some of the products were sold at hospitals, while others were given to patients.

“Pre-packed sandwiches are recurrently incriminated in the UK in listeriosis episodes,” added Professor Jose Vazquez-Boland of Edinburgh University. “For example, in 2017 there was an outbreak in Yorkshire and the Humber that also involved sandwiches supplied to hospitals. There is clearly a warning here that microbiological controls for listeria need to be stepped up with pre-packed sandwiches. 

“In general, foods involved in listeria infections are industrially processed foods that are kept at refrigeration temperatures and are consumed without previous cooking.”  

The Good Food Chain, which supplied 43 NHS trusts across the UK, voluntarily ceased production. The company was supplied with meats from North Country Cooked Meat. Some of these have since tested positive for the outbreak strain of Listeria monocytogenes and the company has also stopped production. 

“Since the source has been traced, there should be no more exposure, but the bacterium’s long incubation period means that the risk of new cases coming to light cannot be ruled out yet,” added Rees.

At least 31 children in India killed by toxin in lychees

Via The Guardian: At least 31 children in India killed by toxin in lychees. Excerpt:

At least 31 children have died in northern India in the past 10 days from a brain disease believed to be linked to a toxic substance found in lychee fruit, health officials have said. 

The deaths were reported by two hospitals in Muzaffarpur in Bihar state, famed for it lush lychee orchards, officials said. 

The children all showed symptoms of acute encephalitis syndrome (AES), senior health official Ashok Kumar Singh said, adding most had suffered a sudden loss of glucose in their blood. 

At least 40 other children complaining of similar symptoms were being treated at intensive care units. 

“We are trying our best to save them,” said S P Singh, the chief medical officer of Sri Krishna medical college and hospital.

The outbreaks of the disease have happened annually during summer months in Muzaffarpur and neighbouring districts since 1995, typically coinciding with the lychee season. 

“The health department has already issued an advisory for people to take care of their children during the hot summer when day temperature is above 40 degrees,” Ashok Kumar Singh said.

Canada: Outbreak of Salmonella infections

Via the Public Health Agency of Canada: Public Health Notice - Outbreak of Salmonella infections. Excerpt:

The Public Health Agency of Canada is collaborating with provincial public health partners, the Canadian Food Inspection Agency and Health Canada to investigate an outbreak of Salmonella infections involving six provinces: British Columbia, Alberta, Saskatchewan, Manitoba, Ontario and Quebec.

The source of the outbreak has not been identified, and the investigation is ongoing. Outbreak investigators are gathering information on possible sources. The outbreak appears to be ongoing, as illnesses continue to be reported. 

The Public Health Agency of Canada is issuing this public health notice to inform Canadians of the investigation findings to date and to share important safe food handling practices to help prevent further Salmonella infections. 

This public health notice will be updated on a regular basis as the investigation evolves. 

Investigation summary 

As of April 5, 2019, there have been 63 laboratory-confirmed cases of Salmonella Enteritidis illness investigated in the following provinces: British Columbia (23), Alberta (10), Saskatchewan (8), Manitoba (10), Ontario (10) and Quebec (2). Individuals became sick between November 2018 and March 2019. Eighteen individuals have been hospitalized. Two deaths have been reported; however, it has not been determined whether Salmonella was a contributing cause in these deaths. Individuals who became ill are between 1 and 87 years of age. The majority of cases (57%) are female. 

It is possible that more recent illnesses may be reported in the outbreak because there is a period of time between when a person becomes ill and when the illness is reported to public health officials. For this outbreak, the illness reporting period is between four and five weeks. 

The Canadian Food Inspection Agency is conducting a food safety investigation. If contaminated food products are identified, they will take the necessary steps to protect the public, including recalling food products as required. Currently there are no Food Recall Warnings associated with this outbreak. 

Who is most at risk 

Anyone can become sick with a Salmonella infection, but infants, children, seniors and those with weakened immune systems are at higher risk of serious illness because their immune systems are fragile.  

Most people who become ill from a Salmonella infection will recover fully after a few days. It is possible for some people to be infected with the bacteria and to not get sick or show any symptoms, but to still be able to spread the infection to others.

Sweden has figured out how to keep food free of salmonella. Why can't Canada?

Via CBC News: Sweden has figured out how to keep food free of salmonella. Why can't Canada? Excerpt:

When it comes to controlling salmonella outbreaks, Canada could learn a lot from Sweden.  

The Nordic country is on a passionate mission to eliminate the harmful bacteria from its food. Thanks to strict regulations that apply to chickens and other animals, few Swedes get sick from salmonella. 

Meanwhile, outbreaks caused by contaminated food, especially chicken, are frequent occurrences in Canada.  

Every year, there are an estimated 87,500 cases of salmonella infection across Canada, according to the federal government's yearly foodborne illness estimates. While it's not clear how many of them were caused by contaminated chicken, as of last week, 566 Canadians had been diagnosed since May 2017 with salmonella infections linked specifically to frozen breaded chicken products, and 95 of them were so sick with fever and diarrhea, they had to be hospitalized.  

As a consequence, there have been 13 recalls of raw breaded chicken products in Canada since July 2017.  

What is salmonella? 

Salmonella is normally found in the intestines of animals, including birds, but the bacteria can be harmful when humans ingest it. 

Diarrhea, nausea, vomiting, fever and chills are all symptoms of salmonella infection, also known as salmonellosis.  

The bacteria can be spread between animals and people, through water, and can even survive on the surface of some objects.

Sweden's anti-salmonella stance 

While Canadians continue getting sick, Sweden is leading the fight against foodborne illness. Along with strict biosecurity rules, it's normal procedure in the country to heat chicken feed to kill bacteria and to regularly inspect for salmonella contamination 

"The number of cases among humans that are affected in Sweden is very low," said Lena Hult, the contagious disease co-ordinator with the Swedish Board of Agriculture's animal welfare department.    

Only about 3,000 people a year get sick from salmonella, and between 70 and 80 per cent are infected while travelling outside the country, according to Sweden-based research.

No food, no shelter, no livelihood: Families in Mozambique hit by Cyclone Idai

Via The Guardian: No food, no shelter, no livelihood: families in Mozambique hit by Cyclone Idai. Excerpt:

Beneath the crumbling arcade of the municipal council building in Beira, in Mozambique, a group of families has set up a dismal camp. They sleep on dirty concrete pavement and cook with branches from the trees brought down by Cyclone Idai which swept through southern Africa last week. 

Winds of more than 100mph triggered devastating floods and more than 400 people were killed, according to government sources. Land and environment minister Celso Correia said that the situation in the country was now critical. 

Laila Jorge, a mother of three, was one of those caught by the storm. A street vendor of alcoholic drinks, she was living in Zona B, a poor area of the port city of Beira, where shacks were once located close to the sea. “When the wind came, it took off the roof and blew down the wooden walls of my house. We had to run because we thought that we were going to die. There was waist-deep water [from the storm surge] in the street, so we ran here. We didn’t have our shoes and our feet got cut from glass we couldn’t see. We stopped when we got here because it was dry and because it was empty.” 

Jorge and the others have lost everything, she added. Her pots and flipflops were donated by workers cleaning up the damage and who took pity on them. Apart from that, they have received no aid.  

Near Jorge, several children are gathering water in large plastic bottles from a deep puddle that has overflowed from the fountain pool in the square opposite. Next to them, a boy of about eight is washing tiny sprat-like fish that glisten in a pot. Jorge said the fish were washed up by the cyclone and stranded in the pools of standing water left in the city and were now being collected by local boys. “Dead or alive, we’ve been eating them,” she said, “because it’s all we have to eat.” 

Jorge said dirty water being scooped up and carried by the children from the square was for cooking and washing, not drinking, but added that her children aged three, five and seven all had diarrhoea. 

Despite a huge global-aid appeal that has raised tens of millions across the world, including in the UK, many like Jorge have yet to see assistance. For their part, international aid officials have admitted they were initially blindsided by the nature of the catastrophe. They had focused their initial efforts on Beira, which the Red Cross initially thought was largely destroyed by the cyclone. They did not foresee the arrival of devastating floods that would hit huge areas of the countryside more than a day later.

That wrongfooting had consequences. Badly needed helicopters, required to rescue people in the countryside sheltering in trees, on roofs and in electric pylons, were slow to arrive. “We could see from our first aerial surveys that Beira had been badly hit,” Jamie LeSueur of the Red Cross told the Observer. “What we weren’t able to predict was the scale of the flooding that would follow.”  

Even now officials admit they have yet to get a full picture of the scale of the disaster. They merely describe it as “overwhelming”.

ECDC rapid outbreak assessment: Multi-country outbreak of Salmonella Poona infections linked to consumption of infant formula

ECDC has published Rapid outbreak assessment: Multi-country outbreak of Salmonella Poona infections linked to consumption of infant formula. The executive summary:

An outbreak of Salmonella Poona cases affecting France (30 cases), Belgium (1) and Luxembourg (1) has been linked to infant formula products based on rice proteins. All 32 patients were infants and young children infected with the same bacterial strain with onset of symptoms between August 2018 and February 2019. 

The suspected infant formula products based on rice proteins were made by a factory in Spain between August and October 2018 and marketed by a French company. The products were distributed to EU/EFTA and four non-European countries through wholesalers, online shops or e-commerce. 

So far all tests performed at the Spanish factory and on samples of the implicated batches have been negative for Salmonella Poona. This may be due to the fact that Salmonella is typically difficult to detect in dried products and requires sampling and testing methods with a high degree of sensitivity.  

A recall and a withdrawal of infant formula products and baby food of the same brand were initiated on 24 January 2019 by the French company in France, followed by a recall in Luxembourg. Public warnings released in France, Belgium and Spain should decrease the risk of new infections. However, additional outbreak cases may be reported, among those who bought and consumed the products before the recall. 

In order to prevent infections when using infant formula, Member States should consider providing advice to the public on basic hygiene rules for the preparation of food for infants, including information on the safe preparation, handling and storage of powdered infant formula products. Caregivers of children who have consumed infant formula and develop diarrhoea should be advised to contact their healthcare provider. 

Cases of salmonellosis in infants should be notified to the national health authorities for serotyping. S. Poona isolates should be sequenced to identify whether they are associated with this outbreak. 

ECDC is funding whole genome sequencing (WGS) analysis of human S. Poona isolates from cases possibly related to this outbreak and reported in countries that do not routinely perform WGS.

US: FDA 2018 lapse in funding information

Via the US Food & Drug Administration: FDA 2018 Lapse in Funding Information.

In the absence of either an FY 2019 appropriation or a Continuing Resolution for FDA, beginning on December 22, 2018 and continuing until the date of enactment of an FY 2019 appropriation or Continuing Resolution ("lapse period"), agency operations continue to the extent permitted by law, such as activities necessary to address imminent threats to the safety of human life and activities funded by carryover user fee funds.  

The FDA plays a critical public health role. Our work protects the food that families feed their children and pets and ensures the effectiveness of the medicine they need, all of which contribute to improving the health and welfare of Americans. All our work is important, but only some of our work is permitted to continue during a lapse in funding. 

During the lapse period, the agency will be continuing vital activities, to the extent permitted by the law, that are critical to ensuring public health and safety in the United States. The mission critical, public health activities that will continue include, among other things: maintaining core functions to handle and respond to emergencies – such as monitoring for and quickly responding to outbreaks related to foodborne illness and the flu, supporting high-risk food and medical product recalls when products endanger consumers and patients, pursuing civil investigations when we believe public health is imminently at risk and pursuing criminal investigations, screening the food and medical products that are imported to the U.S. to protect consumers and patients from harmful products, and addressing other critical public health issues that involve imminent threats to the safety of human life. Mission critical surveillance for significant safety concerns with medical devices and other medical products will also continue. 

In addition, the FDA will continue to support activities funded by carryover user fee balances, which allows us to continue to bring new therapeutic options to the patients that need them. However, during the lapse period, the FDA will not have legal authority to accept user fees assessed for FY 2019 until an FY 2019 appropriation or Continuing Resolution for the FDA is enacted. This will mean that the FDA will not be able to accept any regulatory submissions for FY 2019 that require a fee payment and that are submitted during the lapse period.