Saturday, November 30, 2013

Qatar, Camels, And the Coronavirus

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# 2020

 

 

 

Although I’m not seeing much news on the UAE family cluster of MERS this morning in the Arabic press (see Following The UAE MERS Cluster) there appears to be ample coverage over fears of camels being infected by the virus.  So much so, that tomorrow the Qatar’s Supreme Council of Health will hold a special press conference .

 

Corona virus Tomorrow: hold the Supreme Council of Health held a press conference tomorrow ... # Qatar # News

Hold the Supreme Council of Health held a press conference on Sunday at half past twelve at the headquarters of the Council on the first case of infection with Corona for three camels in Qatar, which recently announced the latest developments. Will speak at the conference a number of senior officials in the Supreme Council of Health and the Ministry of Environment.

 

Another press reports tells us of rising concerns that camels are being imported into Qatar without testing for the MERS coronavirus, and also question’s Qatar’s ability to adequately detect the virus. Camel owners are calling for mobile veterinarian clinics to visit camel farms and inspect and vaccinate their herds.

 

The problem of course being, there is currently no vaccine available for the MERS coronavirus.  And as far as imported camels are concerned, we’ve no idea if they are the source of the virus, or if the virus is being acquired locally.

 

The following report comes from The Peninsula.

 

MERS: Ministry slammed for not checking imported camels

November 30, 2013 - 5:08:48 am

DOHA: Camel owners are critical of the Ministry of Environment and say it doesn’t carry out medical check-ups on the animals imported from a neighbouring country.

Owners claim that when it was earlier announced that the dreaded Middle East Respiratory Syndrome (MERS) virus spread from camels in Saudi Arabia, the animals brought from there should be checked.

One owner said he suspected that camels could also contract the virus through fodder and yet the fodder isn’t tested.

A camel owner, Musfir Al Marri, told the local Arabic daily Al Raya that in recent years camels were being ignored by authorities. “Not enough attention is being paid to the animal wealth of the country although their collective value could be billions of riyals.”

According to Al Marri, after three camels have been detected with the virus, there is panic among camel owners.

 

 (Continue . . . )

 

Following The UAE MERS Cluster

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UAE’s Proximity to Saudi Arabia

 

 

# 8019

 

Last night Crof over at Crofsblog picked up a story (h/t MERScoV) that reported on a family cluster (a 38 year-old man, his 8 months pregnant wife, and 9 year old child) of MERS infection (Abu Dhabi: Confirmation of the 9-year-old's MERS case) in the UAE.  This story built on earlier reports of the couple’s illness, and at least one report suggesting a child was infected as well (see FluTrackers thread).

 

This morning, the Abu Dhabi Health Authority and UAE Health Ministry websites remain silent on these cases, and most of the Arabic press is still repeating yesterday’s reports of just the couple being infected.

 

Two new cases of Mers coronavirus diagnosed in Abu Dhabi

 Health Authority Abu Dhabi (HAAD) has announced the diagnosis of two additional cases of coronavirus (Mers- cov) at a hospital in Abu Dhabi.

The affected two patients are Jordanians.The first patient, 38 year old man, was complaining of respiratory symptoms and admitted to the ICU, where he was diagnosed with the disease. His wife was later diagnosed with the same disease. She is pregnant (eight months) and currently admitted to the ICU too.

The Health Authority in Abu Dhabi (HAAD) confirmed that it is coordinating with the Ministry of Health (MoH) and other authorities in the country. The MoH has taken the necessary measures as per the international standards and recommendations of the World Health Organisation (WHO).

 

 

With much of the Middle East closed down on Friday and Saturday for religious gatherings, news is often slow to emerge late in the week. When more information is published, I’ll either update this post or add a new one.

Friday, November 29, 2013

WHO: MERS-CoV Update – Nov 29th

 

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Photo Credit Wikipedia

 

 

# 8018



The news earlier this week that three camels which had had contact with two Qatari MERS-CoV patients had tested positive for the MERS coronavirus (see Dr. Mackay On MERS Cluster In Camels) has opened up a new, and possibly promising avenue of investigation – but there are still a great many unanswered questions regarding the role that camels may (or may not) play in the transmission of the virus.

 

Today the World Health Organization has posted a GAR update on these findings in camels, and reminds us:

These results demonstrate that camels can be infected with MERS-CoV but there is insufficient information to indicate the role camels and other animals may be playing in the possible transmission of the virus, including to and from humans.

 

Follow the link to read:

Middle East respiratory syndrome coronavirus (MERS-CoV) - update

Disease outbreak news

29 November 2013 - On 27 November, 2013, the National IHR Focal Point of Qatar notified WHO that the Supreme Council for Health and the Ministry of Environment, in collaboration with the National Institute of Public Health and Environment (RIVM) of the Ministry of Health and the Erasmus Medical Center in the Netherlands, have detected Middle East Respiratory Syndrome coronavirus (MERS-CoV) in a herd of camels in a barn linked to two confirmed human infections infections (see DONs dated 18/10/13 and 29/10/13).

Qatar investigation findings

Following the detection of two human cases infected with MERS-CoV, Qatar authorities (Public Health Department and the Department of Animal Resources) conducted a comprehensive epidemiological investigation into potential sources of exposure of human cases, with the support of an international team constituted by WHO and FAO.

Laboratory investigations at RIVM and Erasmus Medical Center have confirmed the presence of MERS-COV in 3 camels in a herd of 14 animals with which both human cases had contact. As a precautionary measure, the 14 camels on the farm have been isolated. All camels were asymptomatic or with mild symptoms when samples were taken and remained so during the following 40 days. All contacts of the two confirmed human cases, as well as the other worker employed in this barn, have been screened and laboratory tests were all negative for MERS-CoV.

These results demonstrate that camels can be infected with MERS-CoV but there is insufficient information to indicate the role camels and other animals may be playing in the possible transmission of the virus, including to and from humans. The Supreme Council of Health is working with the RIVM and the Erasmus Medical Center to test additional samples from other animal species and from the environment of the barn. In addition, the Public Health Department and the Department of Animal Resources are conducting further studies at the national level to investigate the infection risk among individuals in close contact with animals.

People at high risk of severe disease due to MERS-CoV should avoid close contact with animals when visiting farms or barn areas where the virus is known to be potentially circulating. For the general public, when visiting a farm or a barn, general hygiene measures, such as regular hand washing before and after touching animals, avoiding contact with sick animals, and following food hygiene practices, should be adhered to.

WHO is working with the Qatari authorities to further review these findings and to develop additional guidance as necessary.

Globally, from September 2012 to date, WHO has been informed of a total of 160 laboratory-confirmed cases of infection with MERS-CoV, including 68 deaths.

(Continue . . . )

 

BMC Medicine: Containing Laboratory Escape Of Pandemic Viruses

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BSL-4 Lab Worker - Photo Credit –USAMRIID

 

 

# 8017

 

While nobody really knows how the H1N1 influenza virus – absent in the human population for 20 years – managed to spark a pseudo-pandemic in 1977,  many researchers suspect it escaped a lab in either Russia or China in the mid-1970s.  Genetically, it was very similar to a strain that had circulated 2 decades earlier, something that would be difficult to occur in the wild, but might well  be explained had the virus been stored in a lab freezer (see EID Journal article Influenza Pandemics of the 20th Century Edwin D. Kilbourne).

 

The evidence is only circumstantial, so we may never know the truth of the matter.

 

With the rise of `Gain of Function’  (GOF) research – which aims to enhance the virulence, host range, or transmissibility of dangerous pathogens so that we may better understand their pandemic potential – biosecurity experts have warned that an accident at a BSL-3 or BSL-4 lab could have global ramifications (see mBio: The H5N1 Biosafety Level Debate).

 

While most researchers involved in this sort of work call the risks both manageable, and negligible, the truth is - lab accidents have occurred in the past, and despite very strict bio-safety rules and procedures, they are likely to happen again in the future. 

 

In 2009, the United States GAO issued a 104 page report (HIGH-CONTAINMENT LABORATORIES : National Strategy for Oversight Is Needed ) that looked at four high-profile biosecurity breeches {see below), and examined the risks of future lab accidents.

 

  • Alleged insider misuse of a select agent and laboratory;
  • Texas A&M University’s (TAMU) failure to report to CDC exposures to select agents in 2006
  • Power outages at CDC’s high-containment laboratories in 2007 and 2008
  • The release of foot-and-mouth disease virus in 2007 at the Pirbright facility in the U.K.

 

The GAO described the risks going forward (bolding mine):

 

Four highly publicized incidents in high-containment laboratories,  as well as evidence in scientific literature, demonstrate that (1) while laboratory accidents are rare, they do occur, primarily due to human error or systems (management and technical operations) failure, including the failure of safety equipment and procedures, (2) insiders can pose a risk, and (3) it is difficult to control inventories of biological agents with currently available technologies. Taken as a whole, these incidents demonstrate failures of systems and procedures meant to maintain biosafety and biosecurity in high-containment laboratories. For example, they revealed the failure to comply with regulatory requirements, safety measures that were not commensurate with the level of risk to public health posed by laboratory workers and pathogens in the laboratories, and the failure to fund ongoing facility maintenance and monitor the operational effectiveness of laboratory physical infrastructure.

 

 

At one of the most secure BSL-4 facilities in the world – USAMRIID (U.S. Army Medical Research Institute of Infectious Diseases) - their safety record is exceedingly good  . . .  but it is not perfect.  This (bolding mine) from their website:

 

In order to properly assess safety performance over time, USAMRIID compares the number of incidents to the number of times employees entered BSL-3 and BSL-4 laboratories in a given year.  It is important to note that in every incident from 2010-2012, no symptoms were reported and there were no signs of illness.

For instance, in 2012, USAMRIID had 20,402 entries into BSL-3 laboratories. During that time, there were 9 safety incidents within those laboratories; 2 were Potential Biological Exposures (PBE).  A PBE means that some risk of exposure to infectious agents and/or toxins may have occurred, resulting in Occupational Health staff placing the personnel involved on precautionary medical surveillance.  No illness or disease occurred in either case. The 2012 incident rate for BSL-3 laboratories was 0.044 percent.

Looking at BSL-4 laboratories, USAMRIID had 9,154 entries during 2012, with a total of 30 incidents including 6 Potential Biological Exposures (PBE).  A PBE means that some risk of exposure to infectious agents and/or toxins may have occurred, resulting in Occupational Health staff placing the personnel involved on precautionary medical surveillance.  In every case, no illness or disease occurred.  The 2012 incident rate for BSL-4 laboratories was 0.328 percent.

 

In 2011 CIDRAP NEWS published a report called:

 

Report: 395 mishaps at US labs risked releasing select agents

By Robert Roos

Sep 28, 2011 (CIDRAP News) – US government laboratories had 395 incidents that involved the potential release of select agents between 2003 and 2009, though only seven related infections were reported, according to a new National Research Council (NRC) report.

The accidents, including animal bites, needle sticks, and other mishaps, are mentioned briefly in an NRC report on the plans for a risk assessment for an Army biodefense lab to be built at Ft. Detrick in Frederick, Md.

"The Centers for Disease Control and Prevention (CDC) reports 395 cases of potential release events at national laboratories working with select agents," the report says.

"Seven LAIs [laboratory-acquired infections] were reported to CDC; four infections involved Brucella melitensis, two involved Francisella tularensis, and one involved an unspecified Coccidioides species," it continues. "CDC plans to publish an analysis of these events." The report does not list the outcomes of the infections.

(Continue . . . )

All of which serves as prelude to a report that was published yesterday in BMC Medicine, that models the ability of a research lab to detect and contain a potentially dangerous biosecurity breech, once it has occurred.

 

Containing the accidental laboratory escape of potential pandemic influenza viruses

Stefano Merler, Marco Ajelli, Laura Fumanelli and Alessandro Vespignani

BMC Medicine 2013, 11:252  doi:10.1186/1741-7015-11-252

Published: 28 November 2013

Abstract (provisional)

Background

The recent work on the modified H5N1 has stirred an intense debate on the risk associated with the accidental release from biosafety laboratory of potential pandemic pathogens. Here, we assess the risk that the accidental escape of a novel transmissible influenza strain would not be contained in the local community.

Methods

We develop here a detailed agent-based model that specifically considers laboratory workers and their contacts in microsimulations of the epidemic onset. We consider the following non-pharmaceutical interventions: isolation of the laboratory, laboratory workers' household quarantine, contact tracing of cases and subsequent household quarantine of identified secondary cases, and school and workplace closure both preventive and reactive.

Results

Model simulations suggest that there is a non-negligible probability (5% to 15%), strongly dependent on reproduction number and probability of developing clinical symptoms, that the escape event is not detected at all. We find that the containment depends on the timely implementation of non-pharmaceutical interventions and contact tracing and it may be effective (>90% probability per event) only for pathogens with moderate transmissibility (reproductive number no larger than R0 = 1.5). Containment depends on population density and structure as well, with a probability of giving rise to a global event that is three to five times lower in rural areas.

Conclusions

Results suggest that controllability of escape events is not guaranteed and, given the rapid increase of biosafety laboratories worldwide, this poses a serious threat to human health. Our findings may be relevant to policy makers when designing adequate preparedness plans and may have important implications for determining the location of new biosafety laboratories worldwide.

(Continue . . . . )

From a press release via Northeastern University, we get additional background on this research.  Follow the link to read it in its entirety, as I’ve only included an excerpt:

 

The potential pandemic

November 28, 2013 by Angela Herring

(EXCERPT)

The results of the sim­u­la­tion sug­gest a 5–15 per­cent chance that an acci­dental escape would not be detected, espe­cially in the case of very trans­mis­sible viruses and those where symp­toms are not imme­di­ately spotted. In addi­tion, they found that con­tain­ment would depend on the struc­ture and den­sity of the local pop­u­la­tion sur­rounding a facility.

 

“Most BSL labs are in big urban areas,” Vespig­nani explained. “In those areas we show that the prob­a­bility of not con­taining the out­break is three to five times larger than what it would be in iso­lated areas.”

 

While the prob­a­bility of acci­dental release is extremely low—there’s only 0.3 per­cent chance of a virus escaping one of these labs each year—even a single event can trans­late into a vast public health emer­gency, said Ste­fano Merler, one of the researchers who is based at the Kessler Foun­da­tion. More­over, the number of BSL3 and 4 lab­o­ra­to­ries is increasing, cre­ating a greater com­bined risk the world over.

(Continue . . . )

 

 

While there are only a few dozen BSL-4 labs around the world, there are literally thousands of BSL-3 capable labs. Admittedly, few are conducting GOF research, but even the release of an un-enhanced pathogen could potentially produce a huge impact.

 

Although many researchers can justifiably point out their lab’s exemplary safety record, the standards set and met in labs around the world can vary substantially.  And even the finest biosecurity methods can be thwarted by deliberate `bad acts’ by staff.  

 

Whether researchers doing this sort of research like to admit it it, the risks of seeing an accidental release from one of these labs is far from zero. While a .3% chance of release from any given lab works out to be roughly one every 100 years, with hundreds of of BSL-3 and BSL-4 labs around the world, the odds of seeing an accident in any given year somewhere in the world go up substantially.

.

And if today’s BMC Medicine study is correct, containment – particularly of a high R0 pathogen (highly infectious) – is far from guaranteed.

Thursday, November 28, 2013

Qatar Supreme Council of Health Statement On MERS-CoV In Camels

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# 8016

 

Yesterday was a bit of a `lost day’ for me, but I’m slowly catching up.  Below you’ll find the official statement from the Qatar’s Supreme Council of Health on the detection of the coronavirus in three camels. For more context, I would refer you to a pair of overnight blogs by  Dr. Mackay On MERS Cluster In Camels. 

Based on recent Scientific Research:

Three camels hit by MERS Coronavirus in Qatar

Doha - Wednesday, 27 Nov 2013

The Supreme Council of Health and the Ministry of Environment in collaboration with the National Institute of Public Health and Environment (RIVM) of the Ministry of Health and the Erasmus Medical Centre in the Netherlands announced confirmation of the first case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in 3 camels in a herd in Qatar in a barn, which is linked to two confirmed human cases who have since then recovered.

 

For transparency purposes, we can confirm that the 3 camels were investigated among a herd of 14 camels, and the samples were collected as part of the epidemiological investigation in coordination between the Public Health Department and the Department of Animal Resources. It is to be noted that none of the 14 camels showed any sign of disease when the samples were collected. As a precautionary measure, the 14 camels were put in quarantine since the initial sampling and after 40 days as of now, none have shown any symptom or sign of the disease.

 

For information, the presence of the MERS-CoV is newly recognized among animals, and currently there is neither clear scientific case definition nor enough information as to the role animals may play in transmitting and spreading the diseases.

 

All contacts of the two recovered MERS-CoV cases, including relatives, friends and workers in the same barn have been screened with negative results. The two Departments are following up with the reference laboratory and Erasmus Medical Centre to test additional samples from other animal species and from the environment of the barn. The joint team of the Supreme Council of Health and the Department of Animal Resources is continuously monitoring the development of this disease and taking all necessary measures to prevent the spread of the disease.

 

This discovery came as a result of the collaborative efforts between the two ministries, and the RIVM laboratory and Erasmus Medical Centre in the Netherlands, together with the World Health Organization (WHO). Currently the two Departments are conducting a national survey to investigate the presence of virus in animals, humans and the environment, and the potential modes of transmission and exposure to the virus among humans who are in close contacts with animals. Until more information is available, it is recommended, that as a precautionary measure, any animals that have been in close contact with newly detected human MERS-CoV cases are separated for investigation of the presence of infection with the virus.

 

It is also recommended that people with underlying health conditions, such as heart disease, diabetes, kidney disease, respiratory disease, the immunosuppressed, and the elderly, avoid any close animal contacts when visiting farms and markets, and to practice good hygiene, such as washing hands

Dr. Mackay On MERS Cluster In Camels

 

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Photo Credit Wikipedia


# 8015


While I’ve been occupied trying to determine if one can put their Thanksgiving dinner in a blender and then drink it through a straw (I’m 36 hours post-wisdom teeth extraction),  Dr Ian Mackay has doing something considerably more productive.  He’s been hot on the story of Qatari camels testing positive for the MERS virus.

 

Ian has two blogs, which I’ve linked to in reverse order. In addition to Ian’s insights you’ll find comments by both Marion Koopmans, DVM, PhD, head of virology at the Laboratory for Infectious Diseases at the RIVM in the Netherland and Prof Andrew Rambaut, of the Institute of Evolutionary Biology, University of Edinburgh.

Highly recommended.

 

Clustered camel coronavirus cases...

and

Dutch researchers in collaboration with Qatar are at work sequencing MERS-CoV from camels...

NASA Webcast: Comet ISON’s Close Encounter With Our Sun

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Photo Credit NASA

 

 

 

# 8014

 

It’s been touted as possibly the brightest comet in a century, but first ISON must survive a close encounter with the sun as it reaches perihelion: just 1 million miles above the surface.  Will it survive?  

 

No one is quite sure, but NASA will be live streaming video coverage, and expert commentary this afternoon.

 

 

WATCH LIVE THURSDAY: Comet ISON Buzzes the Sun - NASA Webcast @ 1 p.m. ET

by SPACE.com Staff   |   November 27, 2013 12:00pm ET

NASA will hold a live Google+ hangout on Thursday (Nov. 28) to webcast the solar passage of Comet ISON as it whips around the sun. The webcast will begin at 1 p.m. EST (1800 GMT) and last until 3:30 p.m. EST (2030 GMT). You will be able to watch the webcast live in the window below at the start time. LATEST STORY: Comet ISON's Thursday Sun Encounter a Thanksgiving Feast for NASA

China: Zhejiang Province Reports H7N9 Case

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#  8013

 

 

For the 5th time this fall, and the 3rd time this November, we’ve a report of a human infection from the emerging H7N9 avian virus in China.  Although the number of cases this fall thus far  pales when compared to last spring, they do show that the virus continues to circulate widely in the Eastern provinces of that country.

 

While it is probable that there may be more mild or asymptomatic cases not being picked up by Chinese surveillance, so far we have not seen evidence of sustained human-to-human transmission of this virus.

 

Nevertheless, no one from the Chinese CDC (see Chinese CDC: Be Alert For H7N9), to Hong Kong’s CHP (see Dr. Ko Wing-man: Joint Measures To Control H7N9, to our own CDC (see CDC: H7N9 Update) is taking this viral threat lightly.

 

This report from Xinhua News.

 

 

China reports 3rd H7N9 case in Nov.

English.news.cn   2013-11-28 15:09:15
 

HANGZHOU, Nov. 28 (Xinhua) -- A new human H7N9 bird flu case was reported in east China's Zhejiang Province, the fifth in China this autumn, according to local health authorities on Thursday.

 

The patient surnamed Zhang, 57, from Anji County tested positive for the H7N9 virus on Wednesday when he went to the First Affiliated Hospital of College of Medicine, Zhejiang University, for treatment for a fever, said the Zhejiang Provincial Health Department.

 

He then suffered respiratory failure and shock and is still in critical condition, said the hospital.

 

This is the third case reported in November, following the one confirmed on Nov. 4 in Zhejiang and one on Nov. 5 in southern Guangdong Province

 

In October, two new human H7N9 avian flu cases were reported. No new cases were reported in September.

 

China had reported 134 cases by the end of August, with 45 fatalities, according to the National Health and Family Planning Commission.

Tuesday, November 26, 2013

Thanksgiving Roll Call 2013

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@FLA_MEDIC on Twitter

It is hard  for me to believe this makes my eighth Thanksgiving blogging at Avian Flu Diary.  Somehow, even after 8,000 blog posts, I still find there are new and interesting things to write about nearly every day. 

In November of 2006 I began what has turned out to be a joyous tradition for me - taking the time to publicly acknowledge and thank those working in the public health arena to prevent, or mitigate, global health threats, and to mention some of the friends I've made along the way on this remarkable journey through Flublogia.

While I pen AFD alone, this is by no means a solitary effort.  I rely (heavily) on the the advice, expertise, hard work, and generosity of dozens of others in Flublogia, without whom, this blog would not be possible.

This is my once-a-year chance to thank them.

You’ll find earlier editions of this roll call at:

Thanksgiving Roll Call 2012

Thanksgiving Roll Call 2011

Thanksgiving Roll Call - 2010

Thanksgiving Roll Call 2009

Thanksgiving Roll Call - 2008

Thanksgiving Roll Call, Redux

AVIAN FLU THANKSGIVING ROLL CALL

Over the years this list has grown in length to the point where it is a bit unwieldy, and so this year I’m trimming it down a bit. This is, in no way, a complete list.

But it’s a start.

 

You may know some of these people by name, and some by the organizations they represent, while others you may not be aware of at all. So, in no particular order, a tip of the hat and a world of thanks go to:

 

The career members of the HHS, CDC, and FDA who during the spring of 2009 were faced with an emerging pandemic during a time of political transition. The kind of work they do in the face of an outbreak was nicely dramatized a couple of years ago in the movie Contagion (see  The `Contagion’ Conversation Continues).

 

There are countless people at the CDC, the NIH, the WHO, ECDC, FAO, and OIE who are working, mostly anonymously and often in less than optimal conditions, to promote better public health and hopefully to prevent the next pandemic. But four names you might recognize, and may want to follow on twitter are Gregory Hartl and Sari Setiogi at the World Health Organization, Marc Sprenger, director of the ECDC, and Dr. Thomas Frieden, director of the CDC.

 

There are also researchers and scientists, too numerous to mention, but who’s work moves us closer to understanding infectious diseases. A woefully inadequate list of flu researchers would include:

 

Dr. Robert G. Webster at St. Jude’s Research Hospital, Greg Poland of the Mayo Clinic, John Oxford, Professor of Virology at St Bartholomew’s and the Royal London Hospital, Dr. Allison E. Aiello at the University of Michigan,  Professor Peter Doherty, and Richard Webby of St. Judes, Ab Osterhaus and  Ron Fouchier of Erasmus Medical Center in Rotterdam, and Chairul A. Nidom, at the Tropical Disease Centre at Airlangga University.

 

And there are universities and medical centers around the world; places like the University of Minnesota, St. Jude Research Hospital, UPMC Center For Biosecurity,The University of South Florida, Australian National University, and Baylor College of Medicine in Houston, which are major sponsors of influenza and emerging infectious disease research - along with others too numerous to mention.

 

Readers of this blog no doubt have noticed that I’ve referenced the work of CIDRAP  often over the years. The reason is simple: The reporting from CIDRAP News  is always first rate, with most of the heavy lifting done by Editor Robert Roos, and Lisa Schnirring.

 

Besides, Dr. Michael Osterholm, Director of CIDRAP, is arguably the best spokesperson on pandemic influenza in the country.  Before devoting his attentions to CIDRAP, Dr. Osterholm served for 24 years (1975-1999) in various roles at the Minnesota Department of Health (MDH), the last 15 as state epidemiologist and chief of the Acute Disease Epidemiology Section.

 

I consider myself fortunate indeed to have become friends with Lisa, Robert, Nick Kelley – CIDRAPs Preparedness Program Coordinator - and Dr. Osterholm.

All of them have been very supportive of me, and my blog, and I am very grateful.

 

CIDRAP, of course, is made up of more than just the handful of people I've mentioned. A more complete list is available here along with their mission statement.

 

This year I’m extraordinarily pleased to help welcome Virologist  Dr. Ian Mackay, curator of the Virology Down Under Blog, and associate professor of clinical virology at the University of Queensland to Flublogia.

 

Not only does Ian lend a much appreciated level of scientific expertise to the flu blogging scene, he’s fun to read, and a genuinely nice fellow. If you aren’t already reading his blog, you need to add him to your list.

 

Last year I added a new friend, Dr. John Sinnott, MD FACP FIDSA and Director of the Florida Infectious Disease Institute, who has also been extraordinarily kind to this blogger.

 

I’d be remiss if I didn’t mention another generous MD, Dr. Michael Greger, Director of Public Health and Animal Agriculture at the Humane Society of the United States, and author of Bird Flu: A Virus of Our Own Hatching. The entire text of which is available online, without charge (thank you Dr. Greger!).

 

Among members of the fourth estate, there are some truly remarkable science and health writers and reporters.

 

Helen Branswell, health reporter for the Canadian Press, has produced some of the finest reportage on the emergence of the H5N1 virus (and now H1N1) as exists anywhere in the world, and she started back when few had heard of the threat.

 

Her writing is clear, concise, and absent of the breathless prose that many lesser journalists rely upon.  Whenever I find a Branswell article, I know in advance it is going to be well worth reading.

 

Likewise, Maggie Fox - who has recently moved over to NBC News from the National Journal (and before that, Reuters) - is another standout in the world of health reporting. Maggie understands the science, having completed fellowships at the National Institutes of Health on Genomics, at Harvard Medical School on infectious disease, and at the University of Maryland on child and family health policy.

 

Declan Butler, senior reporter for Nature, and blogger, who very early on called the attention of the world to the pandemic threat, and who has used Google Earth to great effect mapping avian flu outbreaks around the world.

 

And for overall excellence in science writing I would also hasten to mention Carl Zimmer at The Loom and Ed Yong at Not Exactly Rocket Science, both of whom relocated to National Geographic over the past year.

 

Other luminaries in the health & science field include Jason Gale of BloombergPatrick Thibodeau of ComputerWorld, Betsy McKay at the Wall Street Journal, Robert Bazell at NBC News and Dr. Richard Besser at ABC News, and Laurie Garrett at Foreign Policy.

 

On the Internet we have a number of dedicated and astute bloggers, and they too deserve special mention.  Among them:

 

Crawford Kilian, author of Crofsblog, was one of the first to devote his blog to pandemic flu – but has branched out to cover many of the neglected diseases and disasters - like Dengue, Malaria, Chikungunya, and the Cholera epidemic in Haiti.

 

Writer and blogger Maryn McKenna lends considerable talent and expertise to Flublogia, particularly on the antimicrobial resistance front.

 

In 2010 her second book, SUPERBUG: The Fatal Menace of MRSA was published to sterling reviews (you can read my review here). Her Superbug Blog continues to be one the best resources on antibiotic resistance issues available online. Maryn is also the author of Beating Back The Devil, the inside story of the CDC’s Epidemic Intelligence Service, and an upcoming book on MRSA.

 

Ian York, who now works at the CDC, also pens the  wonderful Mystery Rays blog (although his work schedule has severely limited his blogging). His eclectic meanderings through the world (and history) of infectious diseases are a delight for disease geeks and highly recommended.

 

In 2009, after several years of email correspondence, I finally got to meet the irrepressible (and now zombified!Scott McPherson. We were both part of the CIDRAP H1N1 summit in September 2009, and I got to spend two glorious days hanging out with him and Indigo Girl (of the AllNurses forum), forming what we called The Flu Amigos.

A fellow Floridian, Scott is the CIO of the Florida House of Representatives, and rubs elbows with State and Federal officials every day.  His insights, often sprinkled with a dash of healthy whimsy, are always a pleasure to read.  I remain hopeful that Scott will resume blogging on a regular basis again in the future.

 

While not necessarily flu-centric, some other bloggers of note that I follow, and recommend include:

 

Vincent Racaniello’s always excellent Virology Blog, which devotes a good deal of time to influenza.   His TWiV and TWiP  podcasts are also highly recommended.

Assistant Professor of Epidemiology, Tara Smith’s blog Aetiology and Celeste Monforton and Liz Borkowski of The Pump Handle are highly recommended as well.

Jim Garrow’s The Face of the Matter explores emergency communications in an age of social media.

And for a variety of infectious disease news, there’s Giuseppe Michieli’s eclectic A Time’s Memory.

And last, but hardly least, there’s Dr. Peter Sandman who, along with his wife and colleague  Dr. Jody Lanard, produce a wealth of invaluable risk management and pandemic communications advice on their Risk Communication Website.

 

Relatively new are the Twitter generated daily newspapers, like Cesar Sanchez’s Microbiology Daily, and All Hands’s Emergency Management Daily and Business Continuity Daily, Jim Garrow’s Public Health Daily, and Dave Walker’s Healthcare Daily.

 

In a special category I mention author, journalist, filmmaker, and friend Peter Christian Hall who’s pandemic novel American Fever (see It Gives You Fever ) was published in paperback this year. After the release of the movie `Contagion’ -  Peter interviewed flu bloggers for The Huffington Post (see Contagion Grips ‘Flublogia').

And every day outside of the limelight dozens of hardworking flubies scour foreign language news reports, using search engines, text-finding software, and translating programs to bring us the latest tidbits of news from around the world.

 

While there are many who contribute, some of the names that pop up most often on the sites I visit include: Gert van der Hoek, Shiloh, Pathfinder, Emily, Sally, Giuseppe Michieli, Treyfish, Commonground,  Carol@SC, mojo, bgw in MT, Readymom, Sharon Sanders, Cottontop, dbg, Tetano, Diane Morin, Missouriwatcher, and Ronan Kelly.

 

There are many others, of course.  My sincere apologies to those I failed to name.

I’ve written numerous times about the work they do, but if you want to know how they do it, check out Newshounds: They Cover The Pandemic Front. The work they do is remarkable. And I couldn't do much of what I do without them.  Thank you all.

 

The owners and moderators of the flu forums deserve mention, too. 

 

Labors of love, and devourer's of both time and money, flu forums provide a place for laymen and professionals to gather to discuss the various aspects of pandemic planning, and quite often, the science behind influenza and epidemiology. The founders and moderators do a terrific job keeping things on track, and do so without compensation.  Most of the time, the costs (which can run into the hundreds of dollars each month) are borne by the owners.

 

There are a number of flu forums out there, but the two where I hang my hat are the Flu Wiki and  Flutrackers. Each has their own style and personality, and in many cases, members of one forum belong to several other forums as well. The Flu Wiki, the first of the dedicated flu forums, was founded by DemFromCt, Pogge, and Melanie Matson.  In 2008, we lost Melanie after a long illness.  She was a pioneer, and an activist, and is greatly missed.

 

FluTrackers, founded by Sharon Sanders (but is run with the aid of dozens of tireless volunteer moderators), boasts nearly 2,000 members and prides themselves on maintaining an impressive library of scientific literature on pandemic influenza and other emerging infectious diseases.

 

Sharon is also a dear friend, fellow Floridian, confidant, and unindicted co-conspirator.  

 

And then there are the flubies, which number in the thousands. Some are active posters on the flu forums, while others take a more passive role.  Many have become activists in their communities.

 

Readymom, whom I've highlighted before in these pages, runs her own website Emergency Home Preparation.

 

Starting in mid-2007, more than a dozen volunteers worked to put together the GetPandemicReady.Org website.   There you will find more than 3 dozen easy-to-follow preparedness guides, written by some pretty familiar names from the Flu Forums.

 

Now is a good time to remind my readers that agencies like the Red Cross, Red Crescent, CARE, Save The Children, UNICEF, and others are working around the world every day to combat poverty and disease, including pandemic flu.

They could use your support. These NGO’s do a great deal with very little, and even small donations can help make a difference.

 

Often forgotten, I also send out thanks to all who wear the uniform of our country, and who will are often called upon to be on the front lines during any crisis, including a pandemic.

 

This includes our military and national guard troops, both at home and abroad. You guys and gals do a tough, often thankless job, 365 days a year; and are deserving of both our respect and our nation's gratitude.

 

Please know, you have mine.

 

There are hundreds of thousands of doctors, nurses, technicians, EMT's, paramedics, firefighters, and law enforcement officers out there who put it on the line each and every day. I'm proud to have been able to be a part of that universe. And my thanks, and fervent best wishes go out to each of you.

 

And of course, thanks go to the readers of these forums and blogs. There are far more of you out there than you imagine.

 

Those that post on flu forums, or comment on blog sites are just the tip of the iceberg. Ninety percent of our visitors read and absorb the information here, and say nothing. We know you are out there because our web counter software logs every visit.

 

No, I’m not going to `out' anyone. Your secret is safe with me.

 

But even this humble blog gets visits every day from hundreds of corporations, government agencies, financial institutions, and even medical research facilities. Names that you would readily recognize. And that is both extremely gratifying and humbling at the same time.

 

It has been an amazing journey, these past eight years blogging on influenza and emerging infectious diseases.  I've been fortunate enough to meet scores of people, either in person, or via email or chat, from around the world due to this blog.

 

To Camille, Sharon & Lance, Cliff, Cheryl, Scott and Crof, Maryn, Maggie and Helen, MTO & Lisa & Nick & Robert at CIDRAP, Chacal & Family, Dr. John Sinnott, Dr. Ian Mackay, Jody Lanard & Peter Sandman, Peter C. Hall,  Anne, Eric Starbuck, Rolf, Dr. Michael Greger, Jim in Thailand, Anne, Seazar, Paul, Joel, AnnieRn, Caroldn,and Bonnie  (and many more I've no doubt  left out) a special holiday thanks to you and your families.  

 

You guys, whether you know it or not, help light the path for me every day.

 

And to everyone else, a safe, happy, and healthy Holiday.

Editor’s Note;  I’m having two wisdom teeth extracted later today (and at my age!) , and so I probably won’t be blogging anymore today and probably not tomorrow as well. 

Given how loopy pain pills make me, that’s probably a good thing. ;)

WHO: Update On Polio Detection In Syria

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Syria - Credit Wikipedia

# 8012

 

The World Health Organization has announced the detection of an additional two cases of polio in Syria, one each in rural Damascus and Aleppo, which confirms the ongoing spread of the virus.  Earlier this month 13 cases of AFP (Acute Flaccid Paralysis) in Syria were confirmed due to the WPV1 polio virus (see WHO: Polio Update In Syria – Nov 11th).

 

 

Polio in the Syrian Arab Republic - update

Disease outbreak news

26 November 2013 - A total of 17 cases due to wild poliovirus type 1 (WPV1) have been confirmed in the Syrian Arab Republic. In addition to 15 cases confirmed in Deir Al Zour province, two additional cases have been confirmed, one each in rural Damascus and Aleppo, confirming widespread circulation of the virus. The case with most recent onset developed paralysis on 8 October 2013.

 

A comprehensive outbreak response continues to be implemented across the region. Seven countries and territories are holding mass polio vaccination campaigns targeting 22 million children under the age of five years. In a joint resolution, all countries of the WHO Eastern Mediterranean Region have declared polio eradication to be an emergency, calling for support in negotiating and establishing access to those children who are currently unreached with polio vaccination. WHO and UNICEF are committed to work with all organizations and agencies providing humanitarian assistance to Syrians affected by the conflict to ensure all Syrian children are vaccinated no matter where they live.

 

It is anticipated that outbreak response will need to continue for at least six to eight months, depending on the area and based on evolving epidemiology.

 

Given the current situation in the Syrian Arab Republic, frequent population movements across the region and subnational immunity gaps in key areas, the risk of further spread of wild poliovirus across the region is considered to be high. A surveillance alert has been issued for the region to actively search for additional potential cases in addition to implementing the recommended supplementary immunization activities with oral polio vaccine.

WHO Corrects The Record On `Self-Inflicted’ HIV In Greece Story

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@WHO Twitter Account


# 8011

 

 

Over the past 24 hours there have been a number of headlines – and media pundits – proclaiming that a recent WHO report found  half of the HIV cases in Greece are `self-inflicted’ in order to obtain government benefits.   A few examples include:

 

HO report: Greeks self-inflict HIV to get €700 benefits RT
Greeks self-inject HIV to claim benefits  Aljazeera.com

Half of HIV Infections in Greece Are Self-Inflicted Fox Business

 

Since last night, the story went viral - which is truly unfortunate - since the story apparently is the result of a typo. This morning the World Health Organization issued a statement that clarifies the situation, and explains how this all came about.

 

WHO correction: Greece and HIV case study featured in WHO Europe report on social determinants

In September 2013, the WHO Regional Office for Europe published a report “Review of social determinants and the health divide in the WHO European Region” which was prepared by the Institute of Equity, University College London, United Kingdom. In this report, an erroneous reference is made to: “HIV rates and heroin use have risen significantly, with about half of new HIV infections being self-inflicted to enable people to receive benefits of €700 per month and faster admission on to drug substitution programmes.”


The sentence should read: "half of the new HIV cases are self-injecting and out of them few are deliberately inflicting the virus".

The statement is the consequence of an error in the editing of the document, for which WHO apologizes.

The source for the statement is a correspondence published in the Lancet by Alexander Kentikelenis and colleagues in September 2011. In this article, Kentikelenis mentions “accounts of deliberate self-infection by a few individuals to obtain access to benefits of €700 per month and faster admission onto drug substitution programmes.”, based on the report of the “Ad hoc expert group of the Greek focal point on the outbreak of HIV/AIDS in 2011” (Greek Documentation and Monitoring Centre for Drug, 2011).

Greece has reported a significant, 52% increase of new HIV infection in 2011 compared to the 2010, largely driven by infections among people who inject drugs in recent years. The reasons for this increase remain multifaceted and WHO welcomes efforts of the ad hoc working group and other entities to fully understand the underlying reasons and recommend appropriate measures to extend the benefits of the comprehensive package of interventions for harm reduction to all people who inject drugs.

Key References:
Kentikelenis A et al. Health effects of financial crisis: omens of a Greek tragedy. Lancet, 2011, 378(9801):1457−1458.
Paraskevis D, Hatzakis A. An ongoing HIV outbreak among intravenous drug users in Greece: preliminary summary of surveillance and molecular epidemiology data. EMCDDA Early Warning System, 2011.
Dimitrios Paraskevis, Economic Recession and Emergence of an HIV-1, Outbreak among Drug Injectors in Athens Metropolitan, Area: A Longitudinal Study,  doi:10.1371/journal.pone.0078941.g005
WHO: Technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users, 2012 revision

WHO MERS-CoV Update – Nov 26th

 

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Photo Credit - WHO

 

# 8010

 

Overnight the World Health Organization released a new MERS Coronavirus update with details on three previously announced cases from Saudi Arabia. 

 

I’m pleased to note that this update contains more details (in particular, onset and hospitalization dates) than we’ve normally seen coming out of the Saudi Ministry of Health.  Hopefully this is the start of a welcome trend.

 

Of these three cases, two died.  I’ve excerpted the case information.  Follow the link to read the entire update.

 

 

Middle East respiratory syndrome coronavirus (MERS-CoV) - update

Disease outbreak news

26 November 2013 - WHO has been informed of an additional three laboratory-confirmed cases of infection with Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia.

 

The first patient is a 73-year-old woman with underlying medical conditions from Riyadh who became ill on 12 November 2013, was hospitalized on 14 November 2013 and died on 18 November 2013. The second patient is a 65 year-old man with an underlying medical condition from Jawf region who became ill on 4 November 2013 and was hospitalized on 14 November 2013. The third patient is a 37-year-old man from Riyadh who became ill on 9 November 2013, was hospitalized on 13 November 2013 and died on 18 November 2013. None of the three patients had exposure to animals or contact to a previously laboratory-confirmed case with MERS-CoV.

 

Globally, from September 2012 to date, WHO has been informed of a total of 160 laboratory-confirmed cases of infection with MERS-CoV, including 68 deaths.

(Continue . . . )

 

Indonesian Veterinarian Tests Negative For H5N1 Infection

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# 8009

 

In a follow up to Sunday’s blog  (see Watching Indonesia Again), the veterinarian who was placed into isolation after developing a fever and respiratory symptoms  in the wake of doing poultry inspections has tested negative for the H5N1 virus.  The early symptoms of H5N1 infection are pretty much the same as with any respiratory viral infection, which means we tend to see a number suspected cases turn out to be negative.

 

This from Solopos.com.

DA Veterinarian Bird Flu Negative

Solopos.com, KLATEN - DA, vet initially suspected of contracting the H5N1 virus after examining poultry in Balong Kulon village, Village Kragilan, Gantiwarno Subdistrict, Klaten, declared bird flu negative.

 

"Around 09.00 pm last [Tuesday] we got good news from dr Moewardi. That the results of laboratory tests of veterinary negative DA. Now he is no longer in the isolation room and moved in the treatment room, "said Head of the Department of Agriculture (Dispertan) Klaten, Wahyu Prasetyo, told reporters on Tuesday (26/11/2013).

 

Previously, a few days ago, the vet came to Hamlet Balong DA Kulon, Kragilan Village, District Gantiwarno. It was to follow up on reports of local residents about the birds that died suddenly and allegedly exposed to the H5N1 virus that causes bird flu.

 

At that time, the vet came to the location to do the spraying. A few days later, the DA is in a condition not fit ill with bird flu-like symptoms such as high fever accompanied by shortness of breath, cough, and headache. He was treated in dr Moewardi for further examination.

Monday, November 25, 2013

ECDC: Epidemiological Update On MERS-CoV

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Credit ECDC Epidemiological Update

 


# 8008

 

The ECDC has released their latest epidemiological update on the MERS Coronavirus (the last one appeared on Oct 4th), and as we’ve come to expect, it’s a concise and informative update with excellent graphics.


Among primary cases (those without a known exposure), the demographics are heavily skewed towards older men (median age 59), and mortality rates of 59%.    Secondary cases, those with a known exposure, were more evenly divided between male and female, were younger (median age 45) , and saw a lower fatality rate (29%).

 

Follow the link below to read:

 

Epidemiological update: Middle East respiratory coronavirus (MERS-CoV)

  •  25 Nov 2013

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​In June 2012, a case of fatal respiratory disease in a previously healthy 60-year-old man was reported from Saudi Arabia [1]. The cause was subsequently identified as a new coronavirus that has been named Middle East respiratory syndrome coronavirus (MERS-CoV).

By 22 November 2013, 160 cases of MERS have been reported. All cases have either occurred in the Middle East or have direct links to a primary case infected in the Middle East.

From the Middle East, Saudi Arabia has reported 130 cases, including 55 deaths, Jordan two cases, including two deaths, Qatar seven cases, including three deaths, the United Arab Emirates six cases, including two deaths. During the second week of November 2013, two new places from the Middle East have acknowledged cases. Oman (reported one case, which died) and Kuwait (reported two cases, without any deaths).

Twelve cases were reported outside of the Middle East in the United Kingdom (4), Italy (1), France (2), Germany (2), and Tunisia (3). The primary case for each chain was infected in the Middle East, and local secondary transmission following importation was reported from the United Kingdom, France, and Tunisia.


Two probable cases [2]  were recently reported from Spain [3] , the first case was reported on 4 November 2013, and the second case was reported on the 14 November. Both cases have travel history to Saudi Arabia. The first case was symptomatic on the flight from Saudi Arabia to Spain. These probable cases tested positive by the first screening test. Further confirmatory testing is on-going [4]. Probable cases with inconclusive test results have previously been reported from France [5] and Italy [6].

(Continue . . . )

Referral: Dr. Mackay On MERS-CoV, Asymptomatic Infections, And Viral Shedding

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Coronavirus – Credit CDC PHIL

 

 

# 8007

 

 

One of the many unknowns about the MERS coronavirus (and indeed, many other viruses) is how many asymptomatic cases there really are, and whether these cases shed enough virus to be contagious.  With sporadic community cases popping up  the virus must be either quietly circulating, or in the environment somewhere.

 

In August we learned of a man who, while hospitalized in a Saudi facility that reported no other MERS infections, fell ill with the virus 14 days after admission. Given the believed incubation period of < 14 days, this suggests he may have acquired the virus from contact with an asymptomatic carrier inside the hospital (see  Study: Possible Transmission From Asymptomatic MERS-CoV Case).

 

We know that influenza patients can be infectious for up to 24 hours before they display overt symptoms, and some studies suggest that asymptomatic carriers carry a viral load similar to those with symptoms (see PLoS One: Influenza Viral Shedding & Asymptomatic Infections). But how well asymptomatic influenza carriers actually spread the virus remains a topic of considerable debate (see Public Health Report Does Influenza Transmission Occur from Asymptomatic Infection or Prior to Symptom Onset?). 

 

This morning Dr. Ian Mackay takes us on a tour of virus testing (PCR, viral culture, and serology) done for SARS a decade ago, and explains how those results might (or might not) apply to the MERS coronavirus.  Follow the link below to read:

 

 

No symptoms but still shedding virus?

Monday, 25 November 2013

One of the many questions that remain unresolved for MERS-CoV is whether a human who is PCR-positive for the virus, but does not show signs or symptoms of being sick, can spread that infection on to other humans - or animals for that matter.

(Continue . . . )

 

Sunday, November 24, 2013

Thanksgiving Is National Family History Day

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Note: This post is essentially an updated version of last year’s National Family History Day blog entry.

 

# 8006

 

 

Every year since 2004 the Surgeon General of the United States has declared Thanksgiving – a day when families traditionally gather together - as National Family History Day.

 

As a former paramedic, I am keenly aware of how important it is for everyone to know their personal and family medical history.  Every day emergency room doctors are faced with patients unable to remember or relay their health history during a medical crisis. And that can delay both diagnosis and treatment.

 

Which is why I keep a medical history form – filled out and frequently updated – in my wallet, and have urged (and have helped) my family members to do the same.

 

The CDC and the HHS have a couple of web pages devoted to collecting your family history, including a web-based tool to help you collect, display, and print out your family’s health history.

 

Family History: Collect Information for Your Child's Health

Surgeon General's Family Health History Initiative

 

Using this online tool, in a matter of only a few minutes, you can create a basic family medical history.  But before you can do this, you’ll need to discuss each family member’s medial history. The HHS has some advice on how to prepare for that talk:

 

Before You Start Your Family Health History

Americans know that family history is important to health. A recent survey found that 96 percent of Americans believe that knowing their family history is important. Yet, the same survey found that only one-third of Americans have ever tried to gather and write down their family's health history.

Here are some tips to help you being to gather information:

    I’ve highlighted several other methods of creating histories in the past, some of which you may prefer.  A few excerpts (and links) from these essays.First, I’ll show you how I create and maintain histories for my Dad (who passed away last year) and myself.  This was featured in an essay called A History Lesson.

     

    Today I’m going to impart a little secret that will ingratiate yourself with your doctor and not only improve the care you receive, but also reduce the amount of time you spend in the exam room. When you go to your doctor, have a brief written history printed out for him or her.

    I’ve created a sample based on the one I used for my Dad (the details have been changed).   It gets updated, and goes with him, for every doctor’s visit.

    And his doctors love it.

    hxa

    While every history will be different, there are a few `rules’.

    • First, keep it to 1 page.     Even if the patient has an `extensive history’.   If your doctor can’t scan this history, and glean the highlights, in 60 seconds or less . . . it isn’t of much use.
    • Second, paint with broad strokes.   Don’t get bogged down in details.  Lab tests and such should already be in your chart.
    • Third, always fill in a reason for your visit.   Keep it short, your doctor will probably have 10 to 15 minutes to spend with you.   Have your questions and concerns down in writing before you get there.
    • Fourth, list all Meds  (Rx and otherwise) and indicate which ones you need a refill on.   If you have a question about a med, put a `?’ next to it.   And if you have any drug allergies, Highlight them.
    • Fifth,  Make two copies!   One for your doctor to keep, and one for you.  As you talk to your doctor, make notes on the bottom (bring a pen) of your copy.  

    Once you create the basic template (using any word processor), it becomes a 5 minute job to update and print two copies out for a doctor’s visit.

    The history above is great for scheduled doctor’s visits, but you also should have a readily available (preferably carried in your wallet or purse), EMERGENCY Medical History Card.

     

    I addressed that issue in a blog called Those Who Forget Their History . . . .   A few excerpts (but follow the link to read the whole thing):

     

    Since you can’t always know, in advance, when you might need medical care it is important to carry with you some kind of medical history at all times.  It can tell doctors important information about your history, medications, and allergies when you can’t.

    Many hospitals and pharmacies provide – either free, or for a very nominal sum – folding wallet medical history forms with a plastic sleeve to protect them. Alternatively, there are templates available online.

    I’ve scanned the one offered by one of our local hospitals below. It is rudimentary, but covers the basics.

    medhx1

    medhx2

    And a couple of other items, while not exactly a medical history, may merit discussion in your family as it has recently in mine.

     

    • First, all adults should consider having a Living Will that specifies what types of medical treatment you desire should you become incapacitated.
    • You may also wish to consider assigning someone as your Health Care Proxy, who can make decisions regarding your treatment should you be unable to do so for yourself.
    • Elderly family members with chronic health problems, or those with terminal illnesses, may even desire a home DNR (Do Not Resuscitate) Order.

     

    Verbal instructions by family members – even if the patient is in the last stages of an incurable illness – are likely to be ignored by emergency personnel.

     

    In Florida, the form must be printed on yellow paper. Different states have different requirements.  You should check with your doctor, or the local department of health to determine what the law is in your location.

    image

     

    My father, who’s health declined greatly in his 86th year, requested a DNR in early 2011. That – along with securing home hospice care (see His Bags Are Packed, He’s Ready To Go) – allowed him to die peacefully at home in his own bed. 

     

    Admittedly, not the cheeriest topic of conversation in the world, but for a lot of people, this is an important issue to address.

     

    A few minutes spent this holiday weekend putting together medical histories could spare you and your family a great deal of anguish down the road.