August Tropical Climatology

 

 

 

# 5727

 

Although August is still one day away, it appears likely that the 5th named tropical system of the 2011 Atlantic Hurricane season is about to form about 600 miles east of the Windward Islands.

 

The National Hurricane Center in Miami, Florida has this area of disturbed weather listed as having a high chance – nearly 100% - of forming into a depression or storm in the next 48 hours. 

 

From the looks of the latest satellite photos, that may yet happen today.

 

 

 

The 8am EST tropical outlook states:

IF THE LOW BECOMES A TROPICAL
CYCLONE LATER TODAY... TROPICAL STORM WATCHES OR WARNINGS WOULD LIKELY BE REQUIRED FOR PORTIONS OF THE NORTHERN WINDWARD ISLANDS AND THE LEEWARD ISLANDS.

INTERESTS IN THESE AREAS SHOULD CLOSELY MONITOR THE PROGRESS OF THIS SYSTEM.  AN AIR FORCE RESERVE UNIT RECONNAISSANCE AIRCRAFT IS SCHEDULED TO INVESTIGATE THIS DISTURBANCE LATER THIS AFTERNOON.

 

It is a little too soon to project where this storm will go, as hurricane computer models don’t really initialize well until the storm’s circulation matures.

 

Early guidance, however, suggests that beyond the Windward & Leeward Islands . . . Puerto Rico, Hispaniola, and the Bahamas need to be paying close attention. 

 

 

August is when the Atlantic hurricane season really begins to pick up steam, and that trend usually peaks in mid-September. 

 

 

Compare the areas of origin and typical hurricane tracks in these two maps (below) showing July and August, and you will see a considerable amount of difference.

 

 

You’ll notice that the system we are watching is just now entering the  orange `Most Likely’ area of development east of the Windward Islands.   

 

As the summer progresses the spawning grounds for Hurricanes moves further east into the warming Atlantic ocean. It isn’t until August and September that the Cape Verde basin begins to produce what often turn into very large and persistent hurricanes.

 

You can find much more on Hurricane Climatology at NOAA’s  Tropical Cyclone Climatology page.

 

When it comes to getting the latest information on hurricanes, your first stop should always be the National Hurricane Center in Miami, Florida. These are the real experts, and the only ones you should rely on to track and forecast the storm.

 

Last year there were some significant changes in how the NHC will advise us on hurricanes.   Some of the (excerpted) highlights include:

 

Watches and warnings for tropical storms and hurricanes along threatened coastal areas will be issued 12 hours earlier than in previous years.

• Tropical storm watches will be issued when tropical storm conditions are possible along the coast within 48 hours.
• Tropical storm warnings will be issued when those conditions are expected within 36 hours. Similar increases in lead-time will apply to hurricane watches and warnings.

 

The second official information source you should have bookmarked is your local Office of Emergency Management.  Here you’ll be able to access local warnings, flood maps and evacuation information.

 

To find it, you can Google or Yahoo search with your county/parish name and the words `Emergency Management’.   Below you’ll find a screenshot of the entry page to my county’s page.

 

 

If you are on Twitter, you should also follow @FEMA, @CraigatFEMA, @NHC_Atlantic, @NHC_Pacific and @ReadydotGov.

 

NOAA’s NWS National Hurricane Center in Miami also has a Facebook page, where you can keep up with the latest tropical developments.

 

 

Of course, knowing about an approaching storm isn’t enough.  You need to be prepared as well.

 

Since last May was National Hurricane Preparedness week, this blog devoted considerable time to the subject.  A few of my blogs on hurricane preparedness included:

 

National Hurricane Preparedness Week 2011

Hurricane Preparedness Week: Inland Flooding

How Not To Be Gone With The Wind

Getting SLOSHed For Hurricane Season

 

With the busiest two months of the hurricane season about to begin, if you haven’t already done so,  now is the right time to make preparations.

NPM 2011: Just Over A Month Away

 

 

 

# 5726

 

 

Now just over a month away, National Preparedness Month (NPM) 2011 will observed throughout the month of September. In June Ready.gov, FEMA, and the Citizen Corps began their awareness campaign and they continue to look for new coalition members.

 

This year – being the 10th anniversary of 9/11 – we are being asked to remember past disasters as well as prepare those that may come in the future.

 

As you might expect, Avian Flu Diary has already signed up.  And you can too.

 

Follow the link below to learn more and join.

 

 

National Preparedness Month Coalition

Welcome! Join this community to:

1. Download the coalition members toolkit
2. Add your event to the calendar
3. Participate in national preparedness discussions
4. Connect with fellow coalition members by posting in the Community Forum for national or general topics or in a Regional Forum for regional topics.

 

September is National Preparedness Month (NPM)! This awareness month is sponsored by the Ready Campaign in partnership with Citizen Corps. NPM is held each September and is designed to encourage Americans to take simple steps to prepare for emergencies in their homes, businesses, and communities.

 

(Continue . . . )

 

Over the past 30 days FEMA has declared no fewer than 12 Major disasters within the United States.  And in June, they classified 10 events as major disasters.

 

 

While these major events affected thousands of Americans, every day thousands more are affected by smaller, more localized emergencies.

 

Household accidents, car wrecks, heart attacks, fires, floods,  storm damage . . .   

 

While we can’t prevent most emergencies and disasters  . . . we can be better prepared to deal with them.

 

As Ready.gov urges.

 

 

By joining the National Preparedness Month coalition, and holding events to promote awareness, you will be helping to spread this vital message. 

 

And that’s a win-win situation.

 

For you, your family, and your community.

One On The Way, Another To Watch

 

 

 

 

# 5725

 

Tropical storm Don, with winds around 50 MPH, is moving relentlessly towards the Texas coastline, and is expect to make landfall sometime tonight.

A tropical storm warning is in effect for the Texas coast from the mouth of the Rio Grande to Matagorda. 

 

Residents should be making preparations for heavy rains, high winds, and possible flooding conditions.

The 7am (CST) intermediate advisory from the National Hurricane Center states:

MAXIMUM SUSTAINED WINDS REMAIN NEAR 50 MPH...85 KM/H...WITH HIGHER GUSTS.  SOME STRENGTHENING IS POSSIBLE UNTIL LANDFALL...WITH WEAKENING LIKELY BY SATURDAY MORNING.  AN AIR FORCE RESERVE
HURRICANE HUNTER AIRCRAFT IS CURRENTLY APPROACHING THE CENTER OF DON.

TROPICAL-STORM-FORCE WINDS EXTEND OUTWARD UP TO 105 MILES...165 KM
FROM THE CENTER.

The National Hurricane Center in Miami will issue their next complete advisory at 10am CST. You can also follow the storm’s progress on twitter by following @NHC_Altantic.

Meanwhile, as might be expected this time of year, we’ve another area of disturbed weather to keep an eye on situated well east of the Leeward islands that shows some potential for development.

Designated INVEST 91, early models have it continuing on a generally WNW course for the next several days, bringing it near the Leeward islands in 3 or 4 days time. 

Which means that if you haven’t already done so, now is the perfect time to review your family and/or business disaster plan.  

To help you along, NOAA, FEMA, and the American Red Cross have released an updated preparedness guide for the 2011 tropical season.

WER: Cholera, 2010

 

 

 

# 5724

 

Today’s World Health Organization’s  WER (Weekly Epidemiological Record) has an extensive overview of the global spread of cholera between the years 2000 and 2010. 

 

Last year, the WHO listed 317,534 cases worldwide, including 7,543  deaths, an increase of 43% over 2009 and up 130% compared to 2000.

 

A good deal of this increase is due to the epidemic which began last October in Haiti.

 

Globally, these numbers are widely assumed to be an undercount, and specifically do not include the 500,000-700,000 cases of ‘acute watery diarrhea’ in southeastern and central Asia.

 

In truth, many countries do not report cholera due to a lack of surveillance and testing capacity or out of fears of negative economic impact. 

 

Under the International Health Regulations adopted in 2005, mandatory notification of all cases of cholera is no longer required.

 

So the true burden of cholera around the world can only be estimated.

 

Last May, the World Health Organization recognized the re-emergence of cholera as a significant global public health problem during their World Health Assembly, and adopted resolution WHA 64.15 (Cholera: mechanism for control and prevention), calling for an integrated and comprehensive global approach to cholera control.

 

A few excerpts from the report follow, but the entire 15-page article is highly informative and very much worth worth reviewing.

 

 

Cholera, 2010

 

 

Cholera control

  Current responses to cholera outbreaks tend to be
reactive, taking the form of ad hoc emergency responses. This approach may prevent deaths but it
fails to prevent cases of cholera.

  Controlling cholera requires more than the prompt medical treatment of cases. The interplay of prevention, preparedness and response activities
within an efficient surveillance system is  
paramount to preventing occurrence, mitigating
outbreaks and decreasing case-fatality rates.

  Sustained development is critical to effectively  
containing cholera. However, simple and efficient
measures can curb the incidence of the disease, pro-
vided that there is a concerted multidisciplinary
approach and strong community involvement aimed
at improving access to safe water, and providing
hygiene education and proper sanitation.

  National and subregional action plans that include
cross-border collaboration should be developed to
enhance multidisciplinary prevention, and preparedness and response activities.

  Travel sanctions and trade sanctions serve only to
increase the burden of cholera in countries affected by the disease.

 

 

 

Future challenges

 

Greater financial support and commitment are needed to strengthen and encourage environmental management in developing countries, in particular to improve water supplies, access to hygiene and sanitation, and to support research on new strategies for prevention and control.

 

Cholera and other epidemic-prone diarrhoeal diseases are major public health problems, which should be recognized and addressed. It is critical that commitments be made and financial support provided for recognition of the burden of cholera and for efforts to implement efficient control measures, in view of the emergence of new strains and the ongoing trends in increasing incidence of the disease.

(Continue . . . )

 

Cambodia: 7th Bird Flu Fatality Of 2011

 

 

 

 

# 5723

 

Yesterday Giuseppe Michieli, editor & director of del Forum Italiano on FluTrackers, posted on a new case of H5N1 in Cambodia he found listed in the latest World Health Organization’s FluNet (www.who.int/flunet), Global Influenza Surveillance Network (GISN) report.

 

At the time, the only information available was a single entry in a table of virus in detections in Cambodia for week 29.

 

 

Overnight Crof at Crofsblog picked up on a newswire report (Cambodian girl dies from bird flu: WHO) published in the Straits Times on this latest Cambodian case that filled in some of the details.

 

Unlike the six earlier cases, which were all clustered in the southeastern region of the country, this latest case involved a 4-year-old girl who lived in the northwestern province of Banteay Meanchey. 

 

After seeing only 4 cases of H5N1 infection in humans over the past 4 years, Cambodia has suddenly become the focus of renewed attention after 7 fatal cases have been reported over the past six months.

 

All but one of these cases have involved young children. This latest case marks the 17th known Cambodian H5N1 infection, and the 15th fatality.

 

Earlier reports on these cases include:

 

Cambodia: 6th Bird Flu Fatality Of 2011

Cambodia Reports 5th Bird Flu Fatality

IRIN: Cambodia’s Bird Flu Risk "under control" – Experts

Cambodia: 4th Bird Flu Fatality Of 2011

WHO Update On Cambodian H5N1 Fatalities

 

 

Although we continue to see isolated human infections around the world, H5N1 remains difficult for humans to catch. The virus remains poorly adapted to human physiology, and for now is primarily a threat to poultry.

 

The concern, of course, is that over time that may change.

 

And so the world remains at Pre-pandemic Phase III on the H5N1 virus, and we continue to watch for signs that the virus is adapting to humans.

Reassuring Study On Cell Phones & Brain Cancer Risks

 

 

Photo Credit – Wikipedia

 

# 5822

 

Two months ago the World Health Organization’s International Agency for Research on Cancer (IARC) issued a new statement (IARC Press Release N° 208) that lists mobile phone use in same carcinogenic hazard category as exposure to gasoline, engine exhaust and lead.

 

For details on this announcement, you may wish to revisit IARC: Cell Phones `Possibly Carcinogenic’.

 

For a number of years some scientists had expressed concerns that prolonged exposure to cell phone RF (radiofrequency) electromagnetic fields might cause certain types of head and neck cancers.

 

And many researchers worried that children, teenagers, and young adults - who rank among the most fervent users of cell phones - could be at particular risk.

 

While it probably won’t settle the debate, today we’ve a new study that appears in the Journal of the National Cancer Institute that reassuringly found no link between cell phone use and brain tumors in children and adolescents.

 

 

Mobile Phone Use and Brain Tumors in Children and Adolescents: A Multicenter Case–Control Study

Denis Aydin, Maria Feychting, Joachim Schüz, Tore Tynes, Tina Veje Andersen, Lisbeth Samsø Schmidt, Aslak Harbo Poulsen, Christoffer Johansen, Michaela Prochazka, Birgitta Lannering, Lars Klæboe, Tone Eggen, Daniela Jenni, Michael Grotzer, Nicolas Von der Weid, Claudia E. Kuehni and Martin Röösli

 

The authors examined the medical records of 352 children aged 7-19  from Norway, Denmark, Sweden, & Switzerland with brain tumors. They conducted interviews with them to determine their cell phone usage, and compared this data to 646 control subjects.

 

The researchers found no statistically significant increase in the incidence of brain tumors among children and adolescents who were exposed to cell phone radiation, compared to those who were not.

 

Their conclusion:

 

The absence of an exposure–response relationship either in terms of the amount of mobile phone use or by localization of the brain tumor argues against a causal association.

 

 

Today’s study has some limitations. 

 

It is based primarily on self-reported data, the subjects had been using cell phones for an average of only 4 years, and much of this usage was likely text messaging -as opposed to voice calls – which would reduce radiation exposure to the head and neck.

 

Since it can take years – or even decades – for brain cancers to develop, the true health impacts from the stratospheric rise in cell phone use over the past decade may be difficult to accurately gauge for some time.

 

While today’s results are encouraging, the authors believe that it is important to continue to study the issue and be on the lookout for potential negative health effects related to cell phone use in children.

World Hepatitis Day Roundup

 

 

# 5721

 

 

As I mentioned last week, today – July 28th – has been designated World Hepatitis Day by the World Health Organization in an attempt to shed light on a group of viruses that infect nearly 1/3rd of the globe’s population.

 

Source – WHO click on images for Fact Sheets

 

 

Today a brief roundup of some of the news stories, research, and web resources dealing with this often `silent’ killer.

 

First stop, the WHO.

 

Marking the first World Hepatitis Day

28 July 2011 -- About one million deaths per year are attributed to viral hepatitis infections. The first World Hepatitis Day raises awareness and understanding of viral hepatitis and the diseases that it causes. This provides an opportunity to focus on actions like: strengthening prevention, increasing hepatitis B vaccine coverage and coordinating a global response to hepatitis.

(Continue . . . )

 

Next stop is the CDC, which released a media statement yesterday, excerpts of which I have posted below:

 

For Immediate Release: July 27, 2011
Contact: CDC Media Relations
(404) 639-3286

CDC Statement on World Hepatitis Day 2011

On this first World Health Organization (WHO)-sponsored World Hepatitis Day, July 28, 2011, the Centers for Disease Control and Prevention (CDC) joins the world in reflecting on the remarkable successes and enormous challenges in the global effort to prevent and control viral hepatitis.

 

These successes and challenges are amplified because viral hepatitis is not a single disease. Hepatitis is caused by at least five viruses—including two spread by water or food contaminated with feces (hepatitis A and E) and three transmitted by blood and body fluids (hepatitis B, D, and C) during childbirth (from infected mother to child); through injecting drug use, needle sticks, or transfusions; or through sexual contact. Hepatitis B and C infections can cause cirrhosis of the liver and lead to liver cancer.

 

Today, more than 500 million persons worldwide are living with viral hepatitis and do not have adequate access to care—increasing their risk for premature death from liver cirrhosis and liver cancer. Each year, more than 1 million people die from viral hepatitis and millions of new infections add to this global burden of disease and death.

(Continue . . . )

 

 

From IRIN today, a feature on the prevalence of Hepatitis C in Egypt, and that country’s attempts to combat it.

 

EGYPT: Taking on the hepatitis C virus

CAIRO, 28 July 2011 (IRIN) - Egypt has stepped up efforts to curb the hepatitis C virus (HCV) by opening treatment centres, offering free drugs to the poor, and launching a massive public awareness campaign, say officials.

 

“We managed to dedicate more money for the treatment of the virus this year,” said Waheed Doss, chairman of the National Anti-Virus C Campaign, a state-run effort to fight the disease. “We managed to give free treatment to 140,000 patients last year alone,” he told IRIN.

(Continue. . . )

 

And from The Lancet  this morning, we have an extensive look at the prevalence of Hepatitis B & C among a specific subset of the world’s population; Injecting drug users:

 

Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews

Paul K Nelson MHSc , Bradley M Mathers MBChB , Benjamin Cowie PhD , Holly Hagan PhD , Prof Don Des Jarlais PhD , Danielle Horyniak BBioMedSci , Prof Louisa Degenhardt PhD

 

After a review of the available peer reviewed literature, these researchers estimated national, regional, and global prevalence of hepatitis C (HCV) and hepatitis B (HBV) among  IDUs (injecting drug users).

 

Their interpretation of the results states:

 

More IDUs have anti-HCV than HIV infection, and viral hepatitis poses a key challenge to public health. Variation in the coverage and quality of existing research creates uncertainty around estimates. Improved and more complete data and reporting are needed to estimate the scale of the issue, which will inform efforts to prevent and treat HCV and HBV in IDUs.

 

 

From the UK Guardian newspaper, an essay by Charles Gore - president of the World Hepatitis Alliance –  that looks at the societal stigma of Hepatitis, along with its impact on public health.

 

Hepatitis is not just a health issue

World Hepatitis Day recognises the enormous public health challenge viral hepatitis represents and gives us a chance to tackle the stigma around the disease

(Continue . . .)

 

 

And lastly, a couple of links to major online portals of information on Hepatitis that are involved in promoting World Hepatitis Day:

 

World Hepatitis Alliance

 

National Viral Hepatitis roundtable

T.S. Don Forms in Gulf Of Mexico

 

 

# 5720

 

 

As expected (see Watching the Tropics), the area of disturbed weather passing through the Yucatan Channel today has intensified into a tropical storm. 

Hurricane models suggest that this system may intensify a bit over the next 48 hours before making landfall – probably along the Texas coast Friday night.

 

For now, it is forecast to remain a tropical storm.  For more details, you can read the text of Tropical Storm DON Public Advisory #1.

 

The National Hurricane Center in Miami will issue their next complete advisory at 10pm CST. You can also follow the storm’s progress on twitter by following @NHC_Altantic.

 

 

Tropical storms may lack the extreme winds and surge tide of a hurricane, but can bring heavy tropical rains and cause severe inland flooding.  

 

Although warnings and watches have not yet been posted, residents along the Gulf Coast are advised to monitor this storm’s progress.

 

Since last May was National Hurricane Preparedness week, this blog devoted considerable time to the subject.  A few of my blogs on hurricane preparedness included:

 

National Hurricane Preparedness Week 2011

Hurricane Preparedness Week: Inland Flooding

How Not To Be Gone With The Wind

Getting SLOSHed For Hurricane Season

ECDC: Defining Bacterial Drug Resistance

 

 

 

# 5719

 

 

Although we often see research and discussions on multidrug resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) bacteria, a bit surprisingly there aren’t any universally accepted definitions for the above terms.

 

Since such ambiguities compromise the ability of scientists to review and compare research data, an international panel of experts has been assembled by the ECDC and the CDC, tasked with coming up with standardized definitions.

 

This press release from the ECDC.

 

 

Multidrug resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance

27 Jul 2011

Emergence of resistance to multiple antimicrobial agents in pathogenic bacteria has become a significant public health threat. As this problem continues to grow, harmonised definitions to describe and classify bacteria that are resistant to multiple antimicrobial agents are needed, so that epidemiological surveillance data can be reliably collected and compared across healthcare settings and countries.

 

A group of international experts came together by a joint initiative by the European Centre for Disease Prevention and Control (ECDC) and the United States Centers for Disease Control and Prevention (CDC), to create a standardised international terminology with which to describe acquired resistance profiles in Staphylococcus aureus, Enterococcus spp., Enterobacteriaceae (other than Salmonella and Shigella), Pseudomonas aeruginosa, and Acinetobacter spp., all bacteria often responsible for healthcare-associated infections and prone to multidrug resistance.

Read more:

The definitions are published in Clinical Microbiology and Infection and are openly accessible.

Updates of the definitions will, when performed, be posted on this page hosted by ECDC.

 

 

You’ll find worksheets designed to classify S. aureus, Enterococcus spp., Enterobacteriaceae (other than Salmonella and Shigella) , Pseudomonas aeruginosa , and Acinetobacter spp.  at this link.  

 

 

For those interested in the details and the work that went into defining these terms, you can read the entire article in today’s Journal of Clinical Microbiology and Infection:

 

Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance

A.-P. Magiorakos,A. Srinivasan, R. B. Carey, Y. Carmeli, M. E. Falagas, C. G. Giske, S. Harbarth, J. F. Hindler, G. Kahlmeter, B. Olsson-Liljequist, D. L. Paterson, L. B. Rice, J. Stelling, M. J. Struelens, A. Vatopoulos, J. T. Weber, D. L. Monnet

 

 

For a quick reference, I’ve created a mash up of some of the highlights of the tables.

 

 

 

Watching The Tropics

 

 

# 5718

 

This morning an area of disturbed weather which meteorologists have been watching for several days has moved into an area of the Caribbean where conditions now favor its development into a tropical system.

 

The National Hurricane Center, at 8am, issued the following statement:

THUNDERSTORM ACTIVITY ASSOCIATED WITH A TROPICAL WAVE NEAR THE YUCATAN CHANNEL CONTINUES TO BECOME BETTER ORGANIZED...AND RADAR DATA FROM MEXICO SUGGESTS THAT A CIRCULATION COULD BE FORMING ABOUT 50 MILES NORTHEAST OF CANCUN.

IF CURRENT TRENDS CONTINUE...A TROPICAL DEPRESSION COULD DEVELOP LATER TODAY.  INTERESTS IN THE NORTHEASTERN YUCATAN PENINSULA...AS WELL AS THE CENTRAL AND WESTERN GULF OF MEXICO  ...SHOULD MONITOR THE PROGRESS OF THIS SYSTEM AS IT MOVES WEST-NORTHWESTWARD NEAR 15 MPH.

THIS SYSTEM HAS A HIGH CHANCE...80 PERCENT...OF BECOMING A TROPICAL CYCLONE DURING  THE NEXT 48 HOURS.  AN AIR FORCE RESERVE HURRICANE HUNTER AIRCRAFT IS SCHEDULED TO INVESTIGATE THIS SYSTEM LATER TODAY.

 

The computer models are a bit of a mess right now, since the system is not yet well defined. Most show the system moving into the Western Gulf of Mexico over the next several days, possibly posing a threat Mexico, Texas, or Louisiana by the weekend.

 

 

 

Regardless of what this system does, we have more than four months left to the 2011 Atlantic hurricane season, and predictions (see NOAA Issues 2011 Atlantic Hurricane Outlook) are calling for:

• 12 to 18 named storms 
• 6 to 10 could become hurricanes
• 3 to 6 major hurricanes (Category 3 or greater)

 

Which means that if you haven’t already done so, this week is the perfect time to review your family and/or business disaster plan.

 

To help you along, NOAA, FEMA, and the American Red Cross have released an updated preparedness guide for the 2011 tropical season.

 

Netherlands: Large Nosocomial KPC Outbreak

 

 

K. pneumoniae on a MacConkey agar plate.

# 5717

 

For nearly two months a hospital in Rotterdam in the Netherlands has been battling an outbreak of CRKP - Carbapenem-Resistant Klebsiella pneumoniae – which may have been linked to as many as 27 deaths.

 

The exact cause of death has yet to be determined in all of these cases.

 

Klebsiella pneumoniae is a Gram negative, rod shaped bacterium commonly found in the flora of the human intestinal tract. Most of the time, it resides harmlessly in the intestines.

 

But when K. pneumoniae moves beyond the intestinal tract – particularly in people with weakened immune systems – it can cause cause severe pneumonia, urinary tract infections (UTI), septicemia, and soft tissue infections.

 

Complicating matters, over the past decade doctors have seen the emergence of antibiotic resistant forms of K. pneumoniae – known as CRKP or  KPC (K. pneumoniae carbapenemase).

 

Bacteria resistant to the Carbapenem class of antibiotics – called carbapenemases – are of particular concern since Carbapenems are often used as the drug of last resort for treating difficult bacterial infections

 

K. Pneumoniae’s opportunistic qualities – attacking those with weakened immune systems - makes it an important, and difficult to control, hospital acquired (nosocomial) infection.

 

First a report from Xinhua News, and then I’ll return with more, including a press release from the hospital.

 

Multiple-resistant bacteria likely cause 27 deaths in Netherlands: hospital

2011-07-27 02:26:27

THE HAGUE, July 26 (Xinhua) -- Klebsiella bacterie Oxa-48, a kind of multi-resistant bacteria, may have caused 27 deaths in the Netherlands since June 1, a hospital source said Tuesday.

 

Though the 27 people died have all been infected with the bacteria, it didn't mean that all the deceased have died as a result of the bacteria, added the Maastad hospital in Rotterdam.

 

Research is under way to show the link between the deaths and the multiple resistant bacteria.

 

The hospital announced the first two death cases on June 1, while the latest report said 78 people are carrier of the bacteria and another 1,967 people are suspected carriers for the time being.

(Continue . . .)

 

 

According to the following (machine translated) press release from the Maastad hospital, there have been no new infections detected since July 18th, and while more infections may be discovered, the situations is `under control’.

 

Press Release: Update multi-resistant bacteria in Rotterdam Hospital: July 26, 2011

On July 26, 2011, the Hospital Rotterdam the next situation that: 78 carriers of multiresistant bacteria, 27 in 1967 and deceased persons suspected patients.

 

Compared to July 21 this represents an increase of 8 carriers, two deceased persons and 143 suspected patients.

 

An increase of carriers automatically means more suspected patients, as they have been in the vicinity of the carriers.  Given the current culture tests and examinations will increase the numbers in the near future.

 

At present, the Hospital Rotterdam, since July 18, no infections in patients receiving for the first time hospitalized. On this basis we can conclude that the outbreak is still under control.

 

This is the current state of affairs until July 26, 2011:

• The number of carriers of the bacteria increased from 70 to 78 patients
• • Of these 78 patients, a total of 27 deceased patients.
  • It does not mean these 27 patients were deceased by the bacterium.
  • Investigated the role of bacteria in the death of patients.
  • -Of the 78 patients are currently only 8 patients in the hospital, which cared isolated.

• The number of people in a room located in the 78 carriers of the bacterium has increased from 1824 to 1967 people.
  • The 143 additional people receive today a culture test by mail.
  • At present there are 43 patients included isolated and tested.
  • If it appears that more patients are infected, should be monitored in any patient with whom they have been in contact. This allows the number of infections is increasing.

 

 

While this is an unusually large nosocomial outbreak, it is by no means an isolated incident.

 

In 2010, a survey presented at the IDSA  conference in Vancouver showed that Chicago was reporting a 42% rise in the number of hospitals and long-term care facilities reporting cases of KPC over last year.

 

Similarly, Brazil reported a substantial outbreak of KPC in 2010, which has been identified in more than 200 patients, and blamed for 22 deaths last year.

 

There have been outbreaks in many other countries, including Italy, Israel, France, Germany, the United Kingdom, Argentina, Lebanon, Israel, Morocco and Tunisia, and Ireland.

 

The gene that gives K. Pneumoniae its carbapenem resistance resides on a plasmid — a snippet of transferable DNA – that has the potential to jump to other strains of bacteria.

 

A trait that was recently demonstrated in an EID Journal dispatch (Transfer of Carbapenem-Resistant Plasmid from Klebsiella pneumoniae ST258 to Escherichia coli in Patient) in June, 2010.

 

One of the big concerns is that that we will see a transfer of carbapenem drug-resistance into a highly fit E. coli clone that could spread widely around the world. 

 

From EID Journal Dispatch I referenced above, the authors write:

 

Such an event may have severe public health consequences, leading to elimination of any effective antimicrobial drug treatment against the most common human bacterial pathogens.

 

Ominous words.

 

Which is why such an emphasis is being placed on the proper stewardship over our dwindling arsenal of effective antibiotics.

 

Some recent blogs on this subject include:

 

Going, Going, Gonorrhea

The Path Of Increased Resistance

Carbapenemases Rising

WHO: The Threat Of Antimicrobial Resistance

 

Perhaps the single best place I can direct you to learn about the dangers and impact of antimicrobial resistance is our favorite `scary disease girl’ Maryn McKenna’s SUPERBUG BLOG  and her terrific book on the subject  SUPERBUG: The Fatal Menace Of MRSA.

Australia: Dog Tests Positive For Hendra Virus

 

 

 

Nipah/Hendra Virus & Fruit Bat Home Range – WHO

 

 

 

# 5716

 

 

Over the past month more than a dozen horses in and around Queensland Australia have died from the Hendra Virus – a pathogen normally carried by flying foxes (bats), but that can be transmitted to horses and, on rare occasions, to humans as well.

 

The virus was first isolated in 1994 after the deaths of 13 horses and a trainer in Hendra, a suburb of Brisbane, Australia. A stable hand, who also cared for the horses, was hospitalized, but survived.

 

Another outbreak took place in MacKay, 1000 km to the north of Brisbane, the previous month. Two horses died, and the owner was hospitalized several weeks later with meningitis. 

 

He recovered, but developed neurological symptoms and died 14 months later.

Subsequent studies have showed a high prevalence of the newly identified Hendra virus in Pteropid fruit bats (flying foxes) in the region.

 

In 1999, a very similar virus emerged at a Malaysian pig farm, resulting in 105 human deaths and the culling of one million pigs.  Exported pigs caused another outbreak at an abattoir in Singapore, resulting in 11 infections and 1 additional death.

This virus was designated Nipah, named after the place where it was first isolated in humans. It too, is believed to be carried by the fruit bat.

 

 

Since then, there have been scattered outbreaks of both viruses in Australia (Hendra virus) and in Bangladesh and adjacent parts of India (Nipah).  Of the two, the Nipah virus has infected and killed the most humans.

 

For more background on these two rare viruses, the CDC’s Special Pathogens Branch maintains a fact sheet:

 

Hendra Virus Disease and Nipah Virus Encephalitis

 

The World Health Organization maintains a website on the Hendra Virus (Hendra Virus (HeV) Infection) and Nipah Virus (Nipah Virus (NiV) Infection) on their Global Alert And Response (GAR) site.

 

Today, we’ve news of an unusual discovery out of Australia.  

 

A dog on one of the quarantined ranches in Queensland has tested positive for antibodies to the Hendra Virus.  Although the dog appears healthy, this indicates a previous exposure to the virus.

 

And this marks the first known infection of a dog by the virus in the wild.

 

The following notice appears on the Queensland Government Primary Industry & Fisheries website:

 

Current situation as at 26 July 2011

The Australian Animal Health Laboratory (AAHL) in Geelong has confirmed that a dog has tested positive for Hendra virus.

 

This is an unprecedented situation, and the first time outside a laboratory that an animal other than a flying fox or horse, or a human has been confirmed with Hendra virus infection.

 

Biosecurity Queensland´s policy is to test cats and dogs on properties where there are infected horses.

 

The remaining horses and dogs on this property are still being monitored daily and show no signs of illness.

 

We recommend that people keep dogs and cats away from sick horses to reduce the risk of such an infection happening.

 

 

While it is too soon to gauge the impact of this particular discovery, anytime a virus jumps species we tend to pay close attention.

 

Many of the common illnesses we think of as `human’ diseases actually began in other species, and only later migrated to humans.

 

Tuberculosis probably jumped to humans when man began to domesticate goats and cattle. Measles appears to have evolved from canine distemper and/or the Rinderpest virus of cattle.   And Influenza, as most of you know, is native to aquatic birds.

 

The list of zoonotic diseases (those shared between humans and animals) is long and continually expanding, and includes: SARS, Babesiosis, Borrelia (Lyme), Nipah, Hendra, Malaria, Hantavirus, Ebola, Bartonella, Leptospirosis, Q-Fever, bird flu and many, many others.

 

When a virus adapts to a new host, it not only gives it fresh opportunities to mutate and evolve, it provides another potential vector to spread the pathogen.

 

And when that host is a dog or a cat – animals with whom humans closely interact – the risks of spreading to humans are even greater.

 

As the following article from the Sydney Morning Herald tells us, in light of this latest discovery scientists are now tasked with determining what – if any – changes may have occurred in the Hendra virus.

 

 

Scientists guessing over Hendra dog

Kym Agius, Jessica Marszalek and Petrina Berry

July 26, 2011 - 5:49PM

AAP

The first dog to contract the Hendra virus has scientists guessing whether the virus is being transmitted differently or if humans can now catch the disease from canines.

(Continue . . . )

 

 

For now, there are far more questions than answers.

 

 

 

IDSA: Educational Guidelines Lower Antibiotic Use

 

 

 

Photo Credit – CDC

 

# 5715

 

From the IDSA (Infectious Diseases Society of America) today, a major report on the reduction in outpatient antibiotic use in Quebec since an educational campaign, directed primarily at pharmacists and physicians, was begun in 2005.

 

On a per capita basis, outpatient use of antibiotics has declined by 4.2% in Quebec, while increasing by 6.5% across the rest of Canada.

 

The latest version of these guidelines are available at the Le conseil du médicament website.

 

 

 

This study appears in today’s online edition of Clinical Infectious Diseases. The press release (below) provides details.

 

Simple guidelines decreased unnecessary antibiotic use in Quebec, Canada

Infectious Diseases Society of America

[EMBARGOED FOR JULY 26, 2011] Antibiotic overuse and resistance have emerged as major threats during the past two decades. Following an outbreak of Clostridium difficile infections, which often result from antibiotic use, health care professionals in Quebec, Canada targeted physicians and pharmacists with an education campaign that reduced outpatient antibiotic use, according to a study published in Clinical Infectious Diseases and now available online.

 

The Quebec Minister of Health and the Quebec Medication Council collaborated with designated physicians and pharmacists to develop guidelines to improve prescribing practices. First issued in January 2005, the guidelines emphasized proper antibiotic use, including not prescribing antibiotics when viral infections were suspected and selecting the shortest possible duration of treatment. Approximately 30,000 printed copies of the original recommendations were distributed to all physicians and pharmacists in Quebec. An additional 193,500 copies were downloaded from the Medication Council's website. (The current versions of the guidelines are available online: LINK.)

 

During the year after the guidelines were initially distributed, the number of outpatient antibiotic prescriptions in Quebec decreased 4.2 percent. In other Canadian provinces, the number of these prescriptions increased 6.5 percent during the same period.

 

According to study author Karl Weiss, MD, of the University of Montreal, "It is possible to decrease antibiotic consumption when physicians, pharmacists, state governments, etc., are working together for a common goal. This is the key to success: having everybody involved and speaking with a common voice."

 

Dr. Weiss added, "Simple, short, easy-to-use guidelines have an impact on physicians when they are readily available. The web is an increasingly important tool to reach our audience and should now be used as such in the future. With handheld electronic devices available for all health care professionals, these downloadable guidelines can be accessed and used at any time and any circumstance."

 

The paper may be accessed at the following link.

 

Impact of a Multipronged Education Strategy on Antibiotic Prescribing in Quebec, Canada

Karl Weiss, Re´gis Blais, Anne Fortin,  Sonia Lantin, and Michel Gaudet

Department of Infectious Diseases and Microbiology, Faculty of Medicine, University of Montreal, Montreal, Canada;Department of Health Administration, Faculty of Medicine, University of Montreal, Montreal, Canada; and Conseil du Me´dicament du Que´bec, INESSS, Que´bec City,Canada

Study: Predictors Of Sudden Coronary Death

 

 

# 5714

 

 

According to The American Heart Association (data for 2009) every year an estimated 785,000 Americans experience their first heart attack, and another 470,000 suffer a recurrent heart attack. They also estimate another 195,000 `silent’ myocardial infarctions occur each year.

Making for just under 1.5 million coronary attacks a year (cite Lloyd-Jones D, Adams RJ, Brown TM, et al. Heart Disease and Stroke Statistics—2010 Update. Circulation. 2010;121:e1-e170).

 

While many people survive their first heart attack, for far too many Americans, their first heart attack is also their last. 

 

Every year American EMS units respond to roughly 300,000 cardiac arrests, and the vast majority of those prove fatal (cite  AHA CPR Stats). Why some people survive their first heart attack, and others do not, has been a subject of considerable interest for many years. 

 

The BMJ journal HEART recently published an article that looks at ECG and clinical predictors of sudden cardiac death. 

 

Electrocardiographic and clinical predictors separating atherosclerotic sudden cardiac death from incident coronary heart disease

Elsayed Z Soliman, Ronald J Prineas, L Douglas Case, Gregory Russell, Wayne Rosamond, Thomas Rea, Nona Sotoodehnia, Wendy S Post, David Siscovick, Bruce M Psaty, Gregory L Burke

 

 

While this study found many commonalities between those who suffer sudden cardiac death and those who survive their heart attacks, researchers found several risk factors that appear to suggest a higher risk of sudden death.

 

• Black race/ethnicity (compared to non-black)
• Hypertension and increased heart rates
• Extreme high or low body mass index

Additionally, ECG readings showing a prolongation of QT interval (QTc) and abnormally inverted T waves were seen as possibly being predictors of a higher risk of sudden cardiac death.

 

This research was conducted at the Epidemiological Cardiology Research Center (EPICARE) at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina.

 

The authors conclude by stating that these results need to be validated in another cohort.

 

A press release, with more details, is available on the Wake Forest Medical Center Website.

 

 

Predictors of Dying Suddenly Versus Surviving Heart Attack Identified

WINSTON-SALEM, N.C. – July 25, 2011 – Is it possible to predict whether someone is likely to survive or die suddenly from a heart attack?

 

A new study by researchers at Wake Forest Baptist Medical Center has answered just that.

 

“For some people, the first heart attack is more likely to be their last,” said Elsayed Z. Soliman, M.D., M.Sc., M.S., director of the Epidemiological Cardiology Research Center (EPICARE) at Wake Forest Baptist and lead author of the study. “For these people especially, it is important that we find ways to prevent that first heart attack from ever happening because their chances of living through it are not as good.”

(Continue . . . )

 

 

While preventing that first heart attack is a laudable goal, this is an excellent time to remind my readers of the importance of learning CPR. 

 

This from the American Heart Association.

 

• Sudden cardiac arrest is a leading cause of death in the U.S.
• Everyone should know how to perform CPR in an emergency.
• Immediate, effective CPR could more than double a victim's chance of survival.
• Push on the chest at a rate of at least 100 beats per minute.
• Push to the beat of "Stayin' Alive" and you could save a life.
• Click here for more information on Hands-Only CPR.

Today, CPR is easier to do than ever.

 

Compression-only CPR is now the standard for laypeople, and so you don’t have to worry about doing mouth-to-mouth.

 

While it won’t take the place of an actual class, you can watch how it is done on in this brief instructional video from the American Heart Association.

 

A class only takes a few hours, and it could end up helping you save the life of someone you love.

 

To find a local CPR course contact your local chapter of the American Red Cross, the American Heart Association, or (usually) your local fire department or EMS can steer you to a class.

 

For more on the recent changes to bystander CPR, you may wish to visit these recent blogs.

 

CPR As A Requirement For High School Graduation

AHA Unveils 2010 CPR Guidelines

JAMA: Compression Only CPR

MMWR: Sudden Cardiac Arrest Awareness Month

Chickenpox Deaths Plummet After Introduction of Vaccine

 

 

 

# 5713

 

Photo Credit – CDC

 

 

Before the vaccine was introduced in 1995, the week-long misery of itchy skin lesions and fever that accompanied chickenpox was practically a universal rite of passage.

 

Extremely contagious, infection by the varicella zoster virus is perhaps the most common of the childhood diseases. It is not, however, as benign of an illness as many people believe.

 

While most children recover after an uncomfortable week, prior to the introduction of the vaccine the United States saw between 100 and 150 chickenpox-related deaths each year.

 

Complications included bacterial infections of the skin, encephalitis, and pneumonia, and every year chickenpox hospitalized over 10,000 people. 

 

Today, in a report in the journal Pediatrics, we get a study that finds that the number of chickenpox-related deaths have plummeted in the United States since the introduction of the vaccine.

 

 

Near Elimination of Varicella Deaths in the US After Implementation of the Vaccination Program

Mona Marin, MD, John X. Zhang, PhD, Jane F. Seward, MBBS, MPH

 

During the first 12 years of the varicella vaccination program – when 1 dose of vaccine was generally administered - the mortality rate declined by 88% in the United States.

 

In 2006 ACIP recommended moving to 2 doses of vaccine - with the first dose administered at age 12--15 months and the second dose at age 4--6 years  (MMWR  june 22, 2007 / 56(RR04);1-40), which is expected will further reduce the number of deaths over the next few years.

 

The CDC’s Vaccines & Immunizations website provides more information on the Varicella vaccine.

 

 

Varicella (Chickenpox) Vaccination

 

Chickenpox vaccine is the best way to prevent chickenpox. Vaccination not only protects vaccinated persons, it also reduces the risk for exposure in the community for persons unable to be vaccinated because of illness or other conditions, including those who may be at greater risk for severe disease.

 

While no vaccine is 100% effective in preventing disease, the chickenpox vaccine is very effective: about 8 to 9 of every 10 people who are vaccinated are completely protected from chickenpox. In addition, the vaccine almost always prevents against severe disease. If a vaccinated person does get chickenpox, it is usually a very mild case lasting only a few days and involving fewer skin lesions (usually less than 50), mild or no fever, and few other symptoms.

 

While some parents may remain skeptical over the value of a vaccine against what they perceive to be a `mild illness’, today’s report goes a long ways towards demonstrating the benefits.

Dengue Roundup: Puerto Rico, Florida, Bahamas

 

 

# 5712

 

Aedes aegypti

 

This time last year Dengue fever was a big story in Puerto Rico, and to a lesser extent, also in South Florida and the Bahamas. 

 

• The worst epidemic in more than a decade had swept across the island of Puerto Rico, and at one point as many as  900 new cases were being reported each week (see Puerto Rico Dengue Week 31: Cases Back On The Ascendant).
• Florida, for the second year in a row, was reporting relatively small numbers of Dengue infections - (2010: a total of 63 locally-acquired cases in Key West, one in Broward County, and one in Miami-Dade County) – after more than six decades without a locally acquired case.
• And last September the Bahamas issued a public health advisory after a rise in Dengue cases and at least one death (see Dengue Reports From The Bahamas).

 

 

Outbreaks of Dengue fever are often cyclical, and thus far in 2011 - for Florida, Puerto Rico, and the Bahamas - reports of Dengue fever have been far lower than we saw last year.

 

The epidemic in Puerto Rico, which claimed 31 lives, finally burned itself out over the winter.  The chart below shows what a difference a year can make.

 

 

 

While fewer than 100 cases are being reported each week right now, it should be noted that the rainy season still lies ahead.  Precautions against mosquitoes are still important.

 

In Florida, only one locally acquired case of Dengue has been reported in 2011, likely due to the extended drought the state has been experiencing. That situation could change, of course, with the arrival of one good tropical storm.

 

For now, mosquito activity remains relatively low for this time of year (see report  Florida Arbovirus Surveillance :Week 28: July 10 – July 16, 2011) with only one county (Seminole) under a mosquito-borne illness advisory.

 

 

 

According to a recent report in The Bahamas Weekly, the Bahamas are once again seeing a rise in Dengue activity, with two laboratory confirmed cases in New Providence, and another eleven cases awaiting test results. 

 

DEHS ‘steps up’ source reduction in response to 2 cases of dengue

Jul 21, 2011 - 5:27:13 PM

 

 

Across the rest of South America, Central America, and the Caribbean dengue activity varies considerably, with more than 700,000 cases and 400 deaths reported in 2011.

 

The chart below is gleaned from the latest PAHO Dengue surveillance report.

 

 

 

 

The explosive growth of Dengue around the world is well illustrated by the following graph from the World Health Organization. . 

 

Since the 1950s a rare, but far more serious form of the disease – DHF or (Dengue Hemorrhagic Fever) –  has emerged.  

 

The WHO now estimates there may be as many as 50 million dengue infections each year (Dengue and dengue haemorrhagic fever fact sheet).

 

 

For an extensive list of my blogs on Dengue and Mosquito Borne Diseases you can select the DENGUE Quick Search here,  on my sidebar.

 

Despite the lower numbers of dengue cases this year, the threat of mosquito borne illnesses (which may include Dengue, EEE, St. Louis Encephalitis, West Nile Virus, and others) remains.

 

So if you live in mosquito territory, it pays to be mindful of the 5 D’s.