H5N1

'No medical emergency among Kashechewan children': Health Canada (I beg to disagree)

A photo from the Twitter feed of Timmins-James Bay MP Charlie Angus. Credit: Charlie Angus.

Via CBC News: No medical emergency among Kashechewan children: Health Canada. Excerpt and then a comment:

Doctors flown into Kashechewan First Nation say they have identified dozens of children with skin conditions but no medical emergencies. 

The Cree community of about 1800 is situated on the Albany River near James Bay.  

Deputy Chief Hosed Wesley says he was told there were 34 people, including one adult, now identified as having a skin condition at a briefing with doctors this afternoon. 

The diagnoses so far in the children aged one to the mid-teens are scabies, mild impetigo and eczema, said Keith Conn, associate deputy minister of Health Canada's First Nations and Inuit Health branch. It's unclear if the kids have a combination of these or one or the other.  

Three children are being treated outside the community, he said, because their cases were "exacerbated" by conditions at home. Three other children are being monitored in case they need outside treatment.  

"The photos are alarming and disturbing but that doesn't represent the community, according to Dr. Green, [who] saw all the children," Conn said. "They're at various levels of severity and infections. Some are milder than others. 

"There is a treatment regime in place," he added. 

He noted that, in some cases, when eczema is not treated in a consistent way, it can be exacerbated. 

"It can be very unappealing — as in the photos shared on Facebook," Conn said. 

"But according to Dr. Green, they're not representative of the individual cases that he's seen thus far." 

One of the children that appeared in the photos is being treated in Moose Factory, Ont., and doing well, he said. Another is in Timmins and another in Kingston.

I beg to differ with the medical experts. Kashechewan and countless other aboriginal reserves do indeed have a medical emergency.

Kashechewan residents (I almost wrote inmates) suspect the water, though the authorities say it's OK. But it's not OK in scores of other reserves, some of which have been on boil-water alerts for many years. 

Canadian reserves might have been designed to promote infectious diseases. Water supplies are inadequate, housing is overcrowded and full of mould, and sanitation is a joke in very poor taste. Since most rural reserves have little economic base, they depend on the bureaucratic largesse of the federal government.

With little work, bad schools, and no control over their own lives, many aboriginal Canadians look like classic examples of the public-health consequences of a very wide income gap.

Like white North Americans in similar conditions, they self-medicate with alcohol and opioids, abuse their women and children, and die young—often in their teens, by suicide. Under our previous Conservative government, the closest we ever got to an adequate aboriginal housing program was an expanded federal penitentiary system.

While our new Liberal government promises to do more, I remain unpersuaded. For a century and a half, the destruction of Canada's aboriginal peoples has been government policy—not by massacres like Wounded Knee, but by paternalistic, soul-destroying residential schools and criminal neglect. In fact, we have a law here that will put parents in jail for "failing to provide the necessities of life." If it were fully enforced, every Canadian government would end up in prison.

Canada: Medical teams on way to Kashechewan

Via the Timmins, Ontario Daily Press: Medical teams on way to Kashechewan. Kashechewan is a First Nations community on the western shore of Hudson's Bay. Earlier today I idly speculated that it might be scarlet fever, but this is clearly something else. Excerpt and then a comment:

Medical teams will be in Kashechewan First Nation on Tuesday investigate and treat a large outbreak of serious rashes and sores that has affected at least 16 of the reserve community's children and a few of the adults. Those children already identified will be flown out of the community for treatment. 

Concerned parents from the community were posting pictures of their children rashes on Monday, which range from the occasional red discolouration to large clusters of painful-looking crusty sores. 

What condition the rashes are a symptom of won't be known until doctors from Health Canada arrive in the remote community to examine the children. 

But Health Canada's interim assistant director of regional operations for First Nations and Inuit health, Keith Conn, doubts the rashes are being caused by just one factor in the community. More likely, he says, the blemishes are the result of many different things. 

“Without going into specific cases, there are certainly some heightened concerns in the community about skin irritations; whether it be a rash, or scabies, or eczema. We don't know what it is exactly, but there is some combination of factors,” he said. “That's my understanding after talking to the Health Canada nurses who are already on the ground. There are various conditions requiring various treatments. Some may need a cream; others may have to be treated with antibiotics.” 

Representatives of Kashechewan, the Mushkegowuk Council and Health Canada, as well as physicians from Moosonee and other medical experts, had a conference call on Monday to discuss the situation and come up with a plan to address it. 

According to Conn, the plan they came up with is to take the 16 children already identified by their parents out of the community for treatment in either Moosonee, Timmins or Kingston. 

Doctors from the Moosonee hospital will be arriving in the community by Tuesday and will conduct a door-to-door home visits to see if there are any more cases and any possible causes that can be identified. 

After that, preventative measures will be put in place, along with some public education efforts, to help people avoid developing skin problems in the future. 

Timmins–James Bay MP and NDP Indigenous Affairs critic Charlie Angus, who helped set up Monday's conference call, said that he is pleased that everyone was able to come together quickly to address the situation. 

“I'm very pleased to see that Health Canada is taking this as seriously as the medical team on the call laid it out,” the MP said. “(The doctors) believe we need to get in and see every child in the community, so we have the initial evacuation starting today (Monday) and a team of physicians going in to examine all the children.” 

Just how long the people of Kashechewan have been developing these rashes and other skin conditions is not clear, but it appears it has been an issue for some time. 

But it wasn't until former Kashechewan Chief Derek Stephen posted pictures of his infant niece on his Facebook page late last week that there was a public push to get Health Canada to look into the problem. 

Stephen's niece was recovering from heart surgery when she developed a series of crusty sores all over her body. The former chief said the family took her to the local nursing station, and all they could offer was some baby aspirin. The girl is now being treated in a hospital outside the community. 

The story prompted others to share their own children's problems with skin conditions and it snowballed until Monday when a plan to deal with the issue was put in place. 

“I noticed that we had very little response from the federal government in regards to the state of emergency that was declared in Treaty 9 over a month ago. I think what we're seeing here is the power of social media,” said Angus. “These pictures of children horrified Canadians and people across the country were demanding action. But we shouldn't have to be in a situation of continually responding to crisis in these communities.”

Southern Canada studiously ignores most of its hinterland. We are a kind of giant horizontal Chile, clustering as close to the US border as possible, with our backs turned to the north that provides most of our wealth. Our backs are turned also to the aboriginal peoples who live there, but perhaps this outbreak will distract us for a moment from our normal rapt attention to our American neighbours.

Canada: Kashechewan children's skin lesions not caused by water: Health minister

Via CBC News: Kashechewan children's skin lesions not caused by water: health minister. Click or tap through for the full report, a video, and some appalling photographs. Excerpt:

Federal Health Minister Jane Philpott says an outbreak of skin lesions among children at Kashechewan First Nation in northern Ontario is not the result of the community's water, as some have suggested. 

"The water has been tested as recently as last Tuesday and we know that it meets all of the appropriate standards for safety in drinking water and for water to be used for other purposes," Philpott said Monday. 

She would not give any specifics about the case, but said that one possible cause of the lesions is an infectious condition.

Nishnawbe Aski Nation Grand Chief Alvin Fiddler disagrees that the water can be ruled out. 

"I think if you spoke with a council member of a community member from Kash they would tell you differently. What we hear today is that community members are to the point now where they don't trust the water coming from their taps to even bathe or do their laundry, so I think there's a real need for an independent and outside assessment and inspection of their water system." 

Three children have been removed from the First Nation near James Bay, including a five-month-old recovering from open-heart surgery, to get medical help. 

A total of 16 children with acute cases of skin infection have been identified as in need of immediate help, said Timmins–James Bay MP Charlie Angus.

Heavy rains bring disease and disaster to France's forgotten refugee camp

Via The Guardian: Heavy rains bring disease and disaster to France's forgotten refugee camp. Excerpt:

Hundreds of refugees are living in dangerous, unsanitary conditions after days of heavy rain left their camp in northern France ankle-deep in filthy water, while guards have blocked migrants’ attempts to replace tents and rebuild temporary shelters. 

Aid agencies working at the camp in Grande-Synthe, Dunkirk, say they are concerned for the health of the refugees due to an apparent ban on building materials, firewood and even blankets being brought into the compound during the cold, damp period. 

The site, known as France’s “forgotten” camp and which is about 50 miles from Dover, is estimated to hold 3,000 refugees mainly from Syria, Iran and Iraq. 

After Sunday night’s rain, 200 refugees – many of them children – had to leave their sodden tents to keep dry in the distribution shelter. By Monday a huge pool of water stood in the middle of the camp, which has destroyed large numbers of tents. Building rain-proof dry shelters or bringing new tents is forbidden, according to aid workers on the ground. 

Laurent Sury, an emergency coordinator for the charity Médecins Sans Frontières (MSF), which has been working in Dunkirk since October, said: “We are worried as there have been almost six weeks of discussions of moving people and nothing has been done. 

“Despite the rain there are items we are not allowed to take, such as building materials like wood and new tents, and this is almost certainly because they do not want the camp to expand. It has made help very difficult.” 

The French national gendarmerie, or military police, did not respond before publication to a request for clarification of why some building materials and much-needed supplies appeared to be blocked from entering the camp. The French embassy in London were also contacted but again did not provide a comment before the publication deadline. 

One week after swaths of northern UK were flooded by Storm Frank, torrential rainfall across the Nord-Pas-de-Calais region has mounted new pressure on a camp already under severe strain. 

According to volunteers on the new arrivals desk, between 50 and 100 new refugees have been arriving every day, which combined with the drop in temperature and recent downfall has left the camp completely devoid of resources. A number of refugees have been driven out of the Kurdish part of the Calais camp due to attacks of tear gas and rubber bullets from local guards. 

As well as severely damaging their shelter, the rain has also brought disease, attracting flies and rats and causing significant health problems. The organisation Health and Nutrition Development Society International recently came to the camp to distribute flu vaccinations, and out of the 155 individuals they treated 96 had scabies and many were coughing up blood.

UNHCR: 12,000 refugees stranded at Syria-Jordan border in deteriorating conditions

Via UNHCR: 12,000 people stranded at Syria-Jordan border in deteriorating conditions. Excerpt:

This is a summary of what was said by UNHCR spokesperson Melissa Fleming – to whom quoted text may be attributed – at the press briefing, on 8 December 2015, at the Palais des Nations in Geneva. 

UNHCR recognizes the tremendous contribution of Jordan in hosting over 630,000 refugees, which has put a heavy strain on its infrastructure and economy. We also acknowledge the serious impact of the Syria conflict on Jordan's security. 

With worsening situation inside Syria, UNHCR is gravely concerned for some 12,000 people trying to flee Syria and stranded in remote areas at the north eastern Jordanian border, facing deteriorating humanitarian conditions. 

The population includes about 11,000 people in Rukban (about 8 kilometres to the west of the point at which the Iraq, Syria, and Jordan borders meet) and 1,000 people in Hadalat (some 90 km further west), and has been growing in recent weeks. It includes elderly people, others who are sick or wounded, children, women, and others who are vulnerable and need help. The refugees are gathering near an earthen wall or 'berm' on Jordanian territory in a rocky area devoid of shade, water or vegetation. 

The number of people massing in these locations has risen sharply since the start of November, from 4,000 to 12,000 following the recent intensification of conflict in Syria. 

Women have had to give birth at the berm, in unsanitary and unhygienic conditions. Common medical complaints among the growing population include respiratory tract infections, gastroenteritis, and skin diseases such as scabies. The health situation is deteriorating, with increasing signs of diarrhoea, vomiting and acute malnutrition among children. If refugees are not admitted to Jordan and substantial assistance not provided, the lives of refugees will be at risk in the coming winter months. 

UNHCR has an excellent working relationship with the Government of Jordan and has together managed difficult issues over the years. We appeal to the Government of Jordan to allow refugees stranded at the border to enter the country, prioritizing entry for the most vulnerable adults and children, including serious and emergency medical and surgical cases, pregnant women, children below six months together with their families and the severely disabled. 

We note that Azraq camp (some 320 kilometres from Rukban) has capacity to receive additional people. UNHCR has also provided considerable support in recent months to improve the capacity of the Ruwaished transfer facility to allow the proper screening and processing of newly arrived refugees from the Berm.

WHO: Yemen situation report, April 16

Via WHO EMRO: Situation reports. Click through to download the PDF of this and earlier sitreps. The key points:

• During the reporting period, 119 deaths and 715 injuries were reported by health facilities. This brings the total number of health-facility reported deaths since 19 March to 767, and the number of health facility-reported injuries to 2906. 

• 18 out of 22 governorates are now affected by the conflict. The humanitarian situation in Aden is deteriorating and residential areas are still witnessing fighting. Damages to the grain mills have resulted in shortages in the availability of flour. Most of the bakeries in the city have shut down, creating a bread shortage crisis. 

• Fuel shortages continue to be reported in the capital city of Sana’a and other governorates, making it difficult to transport medicines and health supplies. Fuel prices have increased up to ten fold in some governorates. Food and water pumping prices have also increased sharply. 

• The Marib central electricity network has been damaged, causing total disruption of the electricity supply to the city of Sana’a and most of the neighboring governorates. 

• WHO has appealed for US$25.2 million in funding to address increasing health needs in Yemen. 

• Health partners are increasingly working with limited resources and supplies in-country. More gaps are emerging and diseases of overcrowding and poor hygiene, such as diarrhoeal and skin diseases, have been reported among the IDPs. 

• WHO has delivered critical life-saving medicines, and medical/surgical supplies to Yemen, where fighting has resulted in hundreds killed and thousands injured, and newly displaced up to 100 000 people since March. The shipment, which landed in Sana’a on 16 April, contains more than 17 tonnes of medicines and medical/surgical supplies for a total of 41,100 beneficiaries

Pakistan: Infections haunt IDP children as displaced number crosses 900,000

Via Dawn.com: Infections haunt IDP children as displaced number crosses 0.9m. The displacement results from a current Pakistani army campaign against the Taliban; it's provided an opportunity to immunize many children against polio, but it's also causing many other health problems. Excerpt:

BANNU: The number of internally displaced people (IDPs) registered with the Fata Disaster Management Authority (FDMA) reached 910,040 on Saturday and those feeling from North Waziristan Agency face health related challenges. 

As the registration of the internally displaced persons (IDPs) continued for the sixth day in Peshawar, 4,500 people were added to the list, which according to the FDMA has reached to 80,122 families, among them 235,499 are male and 261,734 are female, and the rest 393,636 are children who are faced with severe health hazards and ailments. 

Almost half of that number, mostly children and women, face serious health hazards due to poor hygienic conditions, in addition to severe hot weather which has increased ARI (Acute Respiratory Infection), gastro infections, skin and other water borne diseases. 

Hundreds of patients mostly children, women and elderly tribesmen are arriving at hospitals with gastroenteritis, ARI infections and diarrhea infections but further, the hospital conditions and facilities are inadequate to cope with the situation. 

Many of the IDPS are complaining that the children are the most affected as many of them are malnourished as well. 

Living in highly unhygienic conditions has multiplied their problems and the infection ratio is very high due to poor sanitation. 

Yousaf Shah of Mirali, who brought his two children to the Khalifa Gul Nawaz Hospital now run and managed by the army stated that rashes and break outs of the skin have appeared on his children who are also suffering from stomach ailments. 

He said that most people are suffering from diseases as they are living in highly congested environment with at least 20 to 25 people living in one room. 

Furthermore, he said the drinking water and toilet facilities at the host families houses and schools were really poor and could not cater to their needs. 

Akran Wazir from Dattakhel who was visiting the District Headquarters Hospital for treatment had a severe heat stroke, while his children were also suffering from gastro infection. 

He said that the people living beyond Miramshah belonged to colder areas and the heat here (at the IDP camps) was beyond tolerance.

CIDRAP: News scan for March 6

Via CIDRAP: News Scan for Mar 06, 2014: Skin infections in seafood markets; MERS case in Saudi Arabia; Mouse model for MERS-CoV; H7N9 in china; Funds for Ebola, Marburg research. Excerpt:

Scientists report that they have developed a mouse model for MERS-CoV infection, possibly opening the way to test potential MERS drugs and vaccines in mice. 

Mice and other small lab animals are not susceptible to MERS-CoV, and experimental infection has been demonstrated only in macaques, the authors said in a report published yesterday in the Proceedings of the National Academy of Sciences (PNAS). The scientists are from several US universities and a research center in Madrid. 

The team modified an adenovirus to express the human host-cell receptor for MERS-CoV, dipeptidyl peptidase 4. After they inoculated mice intranasally with this virus, it sensitized them to MERS-CoV. Mice infected with MERS-CoV became ill with pneumonia involving extensive inflammation, but they were able to clear the virus within 6 to 8 days. Mice with normal immune systems had mild disease, whereas immunocompromised mice were more severely affected. 

In further steps, the team determined that a toll-like receptor agonist called poly I:C showed promise as a MERS treatment in mice. They also found that a Venezuelan equine encephalitis virus engineered to express the MERS-CoV spike protein might have potential as a vaccine. 

The authors say it took only 2 to 3 weeks to develop the mouse model using the engineered adenovirus, whereas it can take months to years to develop transgenic mice that express a human receptor. 

"Our results demonstrate that this system will be useful for MERS-CoV studies and for the rapid development of relevant animal models for emerging respiratory viral infections," they assert.

Syria’s polio epidemic: The suppressed truth

Via The New York Review of Books: Syria’s Polio Epidemic: The Suppressed Truth. Excerpt:

One way to measure the horrific suffering of Syria’s increasingly violent war is through the experience of Syrian children. More than one million children are now refugees. At least 11,500 have been killed because of the armed conflict, well over half of these because of the direct bombing of schools, homes, and health centers, and roughly 1,500 have been executed, shot by snipers or tortured to death. At least 128 were killed in the chemical massacre in August. 

In the midst of all this violence, it is easy to miss the health catastrophe that has also struck Syrian children, who must cope with war trauma, malnutrition, and stunted growth alongside collapsing sanitation and living conditions. Syria has become a cauldron of once-rare infectious diseases, with hundreds of cases of measles each month and outbreaks of typhoid, hepatitis, and dysentery. Tuberculosis, diphtheria, and whooping cough are all on the rise. Upward of 100,000 children are stigmatized by leishmaniasis, a hideous parasitic skin disease that flourishes in war. 

Many of these diseases have already traveled beyond Syria’s borders, carried by millions of refugees. Five million more children have been forced out of their homes but are still living within Syria, increasingly vulnerable to early marriage, trafficking, and recruitment as child soldiers. 

And now polio is back. Since May, Syrian doctors and international public health agencies have documented more than ninety cases of polio in seven of Syria’s fourteen administrative districts, or governorates: Deir Ezzor, Aleppo, Idlib, Hama, Damascus, al-Hasakeh, and Ar-Raqqa. At an average age of just under two, most victims are—or used to be—literally toddlers. Few were fully vaccinated. None has had treatment to prevent paralysis from becoming permanent. All are from areas long opposed to the Assad regime, which reflects the political dimension of the outbreak. Not a single case has occurred in territory controlled by the government. 

Once the most feared disease of the twentieth century, polio in most countries had long ago passed into the history books. Syria was no exception. Polio was eliminated there in 1995 following mandatory (and free) immunization introduced in 1964 after the Baath party took power. Yet wildtype 1 polio—the most vicious form of the disease—has been confirmed across much of Syria. 

Ninety or so afflicted children may sound like a small number, but they are only a tiny manifestation of an enormous problem, since for each crippled child up to one thousand more are silently infected. Polio is so contagious that a single case is considered a public health emergency. Ninety cases could mean some 90,000 people infected, each a carrier invisibly spreading the disease to others for weeks on end. 

This man-made outbreak is a consequence of the way that Syrian President Bashar al-Assad has chosen to fight the war—a war crime of truly epidemic proportions. Even before the uprising, in areas considered politically unsympathetic like Deir Ezzor, the government stopped maintaining sanitation and safe-water services, and began withholding routine immunizations for preventable childhood diseases. 

Once the war began, the government started ruthless attacks on civilians in opposition-held areas, forcing millions to seek refuge in filthy, crowded, and cold conditions. Compounding the problem are Assad’s ongoing attacks on doctors and the health care system, his besieging of cities, his obstruction of humanitarian aid, and his channeling of vaccines and other relief to pro-regime territory.

East China kindergarteners' fingernail loss sparks panic

Via Xinhua: East China kindergarteners' fingernail loss sparks panic. Excerpt:

At least 17 children in a private kindergarten in east China's Hangzhou City have developed an unexplained condition under which their fingernails have fallen off, according to the school and local health departments. 

Li Yuefang, head of the Wenshou Kindergarten, said on Thursday that the 17 kids began to experience the nail problems in December. 

"No cause has been found," Li said, admitting that 12 students had been withdrawn from the kindergarten as their parents worried about their safety. 

A post exposing the case appeared in an internet forum on Tuesday, saying over 50 children in the kindergarten have shown similar symptoms of separated nails. 

The educational bureau in Xiacheng District of Hangzhou, which administrates the kindergarten, confirmed on Thursday that medical experts have ruled out the possibilities indoor environmental pollution and fungal infection. 

The municipal center of disease control has entrusted a local air testing center to check the air quality in the kindergarten's classroom. All indicators have proved on par with relevant safety standards. 

The Hangzhou No. 5 Hospital has also ruled out the possibility of fungal infection for five of the 17 kids whose symptoms are more severe than others.