H5N1

Safety blunders expose lab staff to potentially lethal diseases in UK

Via The Guardian: Safety blunders expose lab staff to potentially lethal diseases in UK. Excerpt:

Safety breaches at UK labs that handle harmful bacteria, viruses and fungi have spread infections to staff and exposed others to potentially lethal diseases, the Guardian has learned. 

The Health and Safety Executive (HSE) has investigated a series of mistakes over the past two years that led to scientists falling ill at specialist labs run by hospitals, private companies, and even Public Health England (PHE), the government agency which exists to protect and improve the nation’s health and wellbeing. 

One scientist at a PHE laboratory became sick after contracting Shigella, a highly contagious bacterial infection that causes most cases of dysentery in Britain. The incident led the HSE to send the agency an enforcement letter to improve its health and safety practices. 

The HSE held formal investigations into more than 40 mishaps at specialist laboratories between June 2015 and July 2017, amounting to one every two to three weeks. Beyond the breaches that spread infections were blunders that led to dengue virus – which kills 20,000 people worldwide each year – being posted by mistake; staff handling potentially lethal bacteria and fungi with inadequate protection; and one occasion where students at the University of the West of England unwittingly studied live meningitis-causing germs which they thought had been killed by heat treatment. 

Of the scientists who became infected in the line of work, one was admitted to hospital after falling ill with salmonella poisoning at Pall Life Sciences, a private medical company. Another picked up a paratyphoid infection at Nottingham University Hospitals NHS Trust; four contracted Shigella at Brighton and Sussex University Hospitals NHS Trust, and a biomedical scientist at The Royal Free Hospital in London became sick with two different strains of gastrointestinal bug after testing an infected stool sample.

In Britain, microbes that are a risk to human health are ranked by hazard groups. The most harmful are listed in groups 3 and 4. Group 3 bugs, such as those that cause anthrax and leprosy, can pose a serious hazard to employees, and may spread to the community, but there is usually a vaccine or treatment. Group 4 pathogens, such as Ebola, are more dangerous. These are a serious threat to employees and the community, and there is often no vaccine or treatment. The germs must be handled in labs that meet strict safety and security requirements. 

The HSE investigated a number of close shaves. In August 2015, scientists at Bristol University accidentally posted live dengue virus – a group 3 germ carried by mosquitoes in south-east Asia – to Glasgow University’s Centre for Virus Research. Because the person who packed the material had no idea it contained live dengue, the parcel did not meet safety requirements for posting dangerous agents. With luck, the package did not leak; it arrived in one piece and was spotted on arrival at the lab, where staff destroyed the material. 

On another occasion, a diagnostic lab called Viapath posted a hazard group 3 bacteria called Chlamydia psittaci, which can cause pneumonia, to PHE’s infectious disease unit in north London. The sample was improperly labelled and, on arrival, was handled in a way that could have infected the PHE lab worker. The HSE found failings on both sides.

Nigeria: NCDC counters Kogi govt, says cause of strange killer disease not yet identified

So maybe it's not a mix of gastroenteritis and malaria. Via Kogi Reports: NCDC Counters Kogi Govt, Says Cause of Strange Killer Disease Not Yet Identified. Excerpt:

The Nigeria Centre for Disease Control, NCDC, says tests are ongoing in their collaborating laboratories to ascertain the cause of the strange illness in Kogi State. 

The Kogi State Commissioner for Health, Saka Audu, had earlier on Sunday said that the unknown disease has been diagnosed to be gastroenteritis.  

According to a statement issued on Sunday in Abuja, the centre said its Event Based Surveillance (EBS) system on August 1 detected the news of a strange illness in Kogi State.  

“In addition to this, we had received a report of a strange illness in Kwara State a week before. Our Surveillance Team immediately contacted the State Epidemiology Teams of both states. 

“Preliminary findings from the states showed that some cases presented with symptoms fit the case definition of Lassa fever. 

“However, laboratory test came out negative for Lassa fever and tests are now being carried out for other viral diseases in one of our collaborating laboratories,’’ the statement quoted. 

According to the centre, the Kogi State Epidemiology Team, led by the State Commissioner of Health, “visited the towns said to be affected by the strange illness and found five cases with mild illness. 

“The patients were treated and discharged immediately. No other cases or deaths of unknown illness have been identified. 

“However, samples for routine laboratory investigation have been taken from the sick and results are being awaited.  

“The NCDC is supporting Kogi and Kwara States in ongoing investigations and our Rapid Response Teams are ready to be deployed as required.”

Nigeria: Kogi addresses gastroenteritis outbreak

Via Kogi Reports: Gastroenteritis: Kogi Govt Addressing The Health Issues in Yagba West – Spokesman. Excerpt:

The Kogi State Government has been reported to be working round the clock to avert further loss of lives in Yagba West Local Government Area of the state over an epidemic which medical scientists are still examining. 

Addressing reporters in Lokoja, Sunday, the Director General on Media and Publicity to the Governor, Kingsley Fanwo said the Governor is handling the issue “with utmost seriousness”, saying government will ensure the epidemic is tamed from doing further damage. 

He said government has been working hard to arrest the situation since some deaths were reported in some Fulani settlements, assuring inhabitants of the settlements of government readiness to provide healthcare support to affected persons. 

“We have been circumspect in disclosing the cause of the deaths and the statistics of casualties because Kogi State Government will not rely on unverified claims by people who do not have accurate information and data on the incident. 

“The Governor has directed the Commissioner for Health to immediately ensure we have scientific proofs of the causes of the epidemic with a view to finding medical remedies to the unfortunate incident. Survivors are under intensive care by the State Government and our fears that the victims died of Lassa Fever are being allayed. There is no proof to link it with Lassa Fever. 

“In a couple of days, we will be able to address all the issues surrounding the epidemic and give accurate information to the public as medical experts are on the field gathering facts. We sympathize with families who have lost lives of their loved ones. But as a responsible government, we shall do everything possible to curtail the spread of the epidemic or ailment as the case may be”.

Nigeria: ‘Strange illness’ diagnosed as gastroenteritis, malaria; Kogi govt. appeals for calm

Via Kogi Reports, a News Agency of Nigeria report: ‘Strange Illness’ Diagnosed as Gastroenteritis, Kogi Govt. Appeals for Calm.

The Kogi State Commissioner for Health, Dr Saka Audu, has appealed for calm over reports of a disease outbreak in the state. 

The commissioner, who denied that 62 people had died from the disease, told newsmen in Lokoja that those so far diagnosed were found to be suffering from Gastroenteritis and Malaria. 

The News Agency of Nigeria (NAN) reports that the state Ministry of Health had in a statement put the figure of those who died at 62 in Okunran, Okoloke and Isanlu-Esa all in Yagba West Local Government Area. 

“The current information available to us is that the disease actually started six weeks ago in Okoloke village in Yagba West, which is a settlement that is predominantly inhabited by Fulani herdsmen. 

“There have been cases of reported deaths following abdominal pain, vomiting and diarrhoea, but the patients who showed signs of illness had since been evacuated and transported to Kogi State Specialist Hospital, Lokoja for better treatment. 

“So far, we have evacuated 39 patients from Okoloke area and only six of them were admitted and have shown significant sign of improvement while others have since been discharged. 

“Out of the six that were admitted, three of them were diagnosed of gastroenteritis and the remaining three were just cases of malaria, and they have shown remarkable signs of improvement,” Audu said. 

He also stressed that the disease was not Lassa fever, saying the result of samples taken from the patients to Irua General Hospital for investigation proved negative. 

On the 62 persons earlier reported to have died, the commissioner said the figure was given by local leaders in the affected areas and was yet to be verified by government. 

“We will investigate and trace the dead people to the grave yard and come up with the correct figure. 

“We want to assure the general public that government is doing all that is humanly possible to stay on top of the situation and forestall further loss of lives. 

“We will continue to inform the public as the investigation progresses,’’ Audu said.

UK: Hotel says it's not to blame for athletes' norovirus

Via Reuters: Athletics: Hotel says it's not to blame for athletes' stomach bug. Excerpt:

The London hotel at the center of an outbreak of sickness that has struck down scores of competitors at the World Athletics Championships said on Tuesday it was not the source of the illness. 

Several Botswana, German, Canadian, Irish and Puerto Rican athletes staying at the Tower Hotel, near Tower Bridge, have been taken ill over the last few days, with some put into effective quarantine and others forced to miss their events. Thirty German competitors arriving on Tuesday will be moved to other accommodation.  

Competition organizers said on Monday that the illnesses were a result of gastroenteritis, but public health officials said on Tuesday that laboratory tests have confirmed two cases of norovirus among approximately 30 illness victims. 

Norovirus, sometimes called "the winter vomiting bug," is easily spread, partly because the virus can survive for several days outside the body, Britain's National Health Service says. It advises sufferers to avoid contact with others for at least 48 hours after the symptoms have passed.  

Tower Hotel, used annually as the base for the London Marathon, said in a statement: "We have worked collaboratively with the EHO (Environmental Health Officer) and the IAAF to investigate the origins of the illness and can confirm that the hotel was not the source. 

"We have followed strict hygiene protocol, ensuring that those affected are not in contact with other guests and all public areas have been thoroughly sanitized."  

London 2017 organizers said on Monday night that a number of teams had reported cases of gastroenteritis. 

"Those affected have been supported by both team and LOC medical staff, in addition we have been working with Public Health England to ensure the situation is managed and contained," the organizing committee said in a statement.

One of the highest-profile victims was Botswana's Isaac Makwala, who was withdrawn from the 200-meter heats on Monday after vomiting in the call room where athletes make their final preparations. 

Makwala is now hoping to be cleared to race in Tuesday's 400m final, where he had been among the main threats to world record holder Wayde van Niekerk.

Efficacy of a low-cost, heat-stable oral rotavirus vaccine in Niger

Via NEJM, perhaps the best news of 2017 so far: Efficacy of a Low-Cost, Heat-Stable Oral Rotavirus Vaccine in Niger. The abstract and then a comment:

BACKGROUND 

Each year, rotavirus gastroenteritis is responsible for about 37% of deaths from diarrhea among children younger than 5 years of age worldwide, with a disproportionate effect in sub-Saharan Africa.

METHODS 

We conducted a randomized, placebo-controlled trial in Niger to evaluate the efficacy of a live, oral bovine rotavirus pentavalent vaccine (BRV-PV, Serum Institute of India) to prevent severe rotavirus gastroenteritis. Healthy infants received three doses of the vaccine or placebo at 6, 10, and 14 weeks of age. Episodes of gastroenteritis were assessed through active and passive surveillance and were graded on the basis of the score on the Vesikari scale (which ranges from 0 to 20, with higher scores indicating more severe disease). The primary end point was the efficacy of three doses of vaccine as compared with placebo against a first episode of laboratory-confirmed severe rotavirus gastroenteritis (Vesikari score, ≥11) beginning 28 days after dose 3. 

RESULTS 

Among the 3508 infants who were included in the per-protocol efficacy analysis, there were 31 cases of severe rotavirus gastroenteritis in the vaccine group and 87 cases in the placebo group (2.14 and 6.44 cases per 100 person-years, respectively), for a vaccine efficacy of 66.7% (95% confidence interval [CI], 49.9 to 77.9). Similar efficacy was seen in the intention-to-treat analyses, which showed a vaccine efficacy of 69.1% (95% CI, 55.0 to 78.7). There was no significant between-group difference in the risk of adverse events, which were reported in 68.7% of the infants in the vaccine group and in 67.2% of those in the placebo group, or in the risk of serious adverse events (in 8.3% in the vaccine group and in 9.1% in the placebo group); there were 27 deaths in the vaccine group and 22 in the placebo group. None of the infants had confirmed intussusception.

CONCLUSIONS 

Three doses of BRV-PV, an oral rotavirus vaccine, had an efficacy of 66.7% against severe rotavirus gastroenteritis among infants in Niger. (Funded by Médecins sans Frontières Operational Center and the Kavli Foundation; ClinicalTrials.gov number, NCT02145000.)

Yet another reason why I'm happy to donate monthly to MSF. For a news report on this finding, see The New York Times.

Now the trick will be to provide millions of rotavirus survivors with something like a life.

Hong Kong: CHP appeals for vigilance against acute gastroenteritis

Via the Centre for Health Protection: CHP appeals for vigilance against acute gastroenteritis. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health (DH) today (March 15) drew the attention of the public and management of schools and institutions to the prevention of acute gastroenteritis (AGE) by maintaining personal, environmental and food hygiene in view of the recent increase in AGE activity locally. 

According to the latest surveillance data, the number of institutional AGE outbreaks rose from three (affecting 28 persons) in the week ending February 25 to 12 (affecting 132 persons) in the week ending March 11. As of yesterday (March 14), five outbreaks (affecting 46 persons) had also been reported this week. Most of the recent outbreaks occurred in kindergartens and child care centres.      

In addition, the DH's sentinel surveillance based at General Outpatient Clinics and child care centres/kindergartens also recorded corresponding increases in AGE activity.      

"AGE, commonly caused by norovirus and rotavirus, is a frequent cause of outbreaks in schools and institutions. AGE outbreaks may occur throughout the year but are known to occur more frequently in winter. AGE is highly infectious and may result in outbreaks which are difficult to control," a spokesman for the CHP said.      

"We have issued letters to doctors, hospitals, institutions and schools today on the latest situation. Schools and institutions are also reminded to follow the Guidelines on Prevention of Communicable Diseases on preventive and control measures as well as management of outbreaks, which should be reported to the CHP for prompt follow-up. Health advice has also been given," the spokesman said.

Haiti: A health nightmare at the National Penitentiary

Via HaitiLibre.com: Nightmare at the National Penitentiary.

At the National Penitentiary of Port-au-Prince has a capacity of 778 prisoners, at a rate of 2.25 m per prisoner below international standards which sets the minimum area per prisoner at 4.50 m². However, in reality because of prison overcrowding, in January 2017, the National Penitentiary had 4.257 prisoners, each with less than half a square meter of living space!  

Note that only 548 prisoners in this prison are convicted and that all other prisoners are held in preventive detention without trial, some have been waiting for several years.  

The detainees live in disreputable conditions: there is no toilet in the cells forcing prisoners to use polystyrene containers and throwing them out of the windows, no lighting, no ventilation. The overpopulation is such that it is not uncommon for 4 detainees to share a bunk.  

In addition to the shortage of food the water is unsuitable and causes skin diseases: itch, scabies etc.... and intestinal: diarrhea and cholera. In addition, the presence of rats and various insects in the cells, promote the spread of certain diseases, as a result that healthy inmates often fall ill.  

In addition, penitentiary staff are understaffed and can not guarantee the safety of prisoners who are confronted with everyday violence. Only about forty agents each day, an agent for 112 detainees while the international standards are of an agent for 4 detainees.  

Several prisoners, already weakened by the conditions of detention and the physical environment of the prison, died of disorders due inter alia to malnutrition. 

Number of detainees who died in 2016: January (8); February (10); March (6); April (2); May (2); June (0); July (6); August (5); September (3); October (1); November (4); (13). In 2017: Until January (14).  

Between 1 and 19 January there is an increase in deaths from previous months. The causes of the deaths, declared by the authorities of the prison for January 2017 are: anemia, severe anemia, cardiorespiratory arrest, respiratory distress, pulmonary tuberculosis, hypovolemic shock and gastroenteritis.  

Today, 30 detainees are currently in a state that could cause their deaths in the next few days due to conditions of detention and food rationing due to non-payment of inputs by the Directorate of Prison Administration (DAP), in particular since last December. Stock shortages and delays in condiment payments have had serious repercussions on the health of prisoners. 

Numerous steps have been taken by the National Penitentiary with the DAP but they have remained unsuccessful so far and the alarming situation in which prisoners live now becomes chronic and critical.

Steep rise in norovirus cases and emergence of a new recombinant strain GII.P16-GII.2, Germany, winter 2016

Via Eurosurveillance: Steep rise in norovirus cases and emergence of a new recombinant strain GII.P16-GII.2, Germany, winter 2016. The abstract:

Since early November 2016, the number of laboratory-confirmed norovirus infections reported in Germany has been increasing steeply. Here, we report the detection and genetic characterisation of an emerging norovirus recombinant, GII.P16-GII.2. This strain was frequently identified as the cause of sporadic cases as well as outbreaks in nine federal states of Germany. 

Our findings suggest that the emergence of GII.P16-GII.2 contributed to rising case numbers of norovirus gastroenteritis in Germany.

Finland: 140 hospital staff members fall ill with gastroenteritis in Helsinki

Via Xinhua: 140 hospital staff members fall ill with gastroenteritis in Helsinki.

About 140 staff members working at the Malmi Hospital in Helsinki have fallen sick with gastroenteritis recently, said the Helsinki Environment Center on Friday.  

Three of the sufferers have tested positive for Norovirus. The sick have suffered from nausea, vomiting and diarrhea, which are typical symptoms caused by Norovirus, the most common cause of viral gastroenteritis in humans. 

The first group of people was found infected at the beginning of November, said the center. 

The authority is working with infectious diseases specialists to investigate the gastroenteritis epidemic and its possible link with the hospital's staff restaurant and cafe.  

Only a part of the patients have dined in the restaurant and cafe. Norovirus is highly infectious, said the center, and it can be transmitted directly from person to person and indirectly via contaminated water and food.  

So far, no signs have been found linking the outbreak of the disease to either the restaurant or the cafe. 

Mia Laiho, director of emergency duty at the Malmi Hospital, told Finnish daily Turun Sanomat that the epidemic has not affected hospital operations and patients in the hospital have not been seriously affected. 

The Environment Center suggested that those who have suffered from the disease should be absent from work for at least two days after cessation of symptoms.