Wednesday, October 31, 2012

FDA: Ameridose Announces Voluntary Recall Of All Products

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Photo Credit CDC


# 6685

 

Ameridose, a sister company to the New England Compounding Center (NECC) – the pharmacy at the center of investigation involving contaminated steroid products – has announced a voluntary recall of all of their products as their facilities are coming under review by the FDA.

 

The FDA reassures that - This recall is not based on reports of patients with infections associated with any of Ameridose’s products, and the agency recommended this recall out of an abundance of caution.

 

The company posted a carefully worded announcement on their website earlier today:

 

Ameridose Issues Recall of All Products

Contact:
Consumer:
888-820-0622
amdservice@ameridose.com

FOR IMMEDIATE RELEASE - October 31, 2012 - Ameridose today announced it will commence a voluntary recall of any unexpired products remaining in circulation. This action is voluntary, and represents an expansion of our cooperation with the U.S.Food and Drug Administration and the Massachusetts Board of Registration in Pharmacy.

 

During the course of its on-going inspection of our facility, FDA has notified Ameridose that it will be seeking improvements in Ameridose’s sterility testing process.  Ameridose and FDA agree that the use of injectible products that are not sterile can represent a serious hazard to health and could lead to life-threatening injuries and/or death.

(Continue . . .)

 

 

The first sentence in the second paragraph of their press release, which reads . . .

 

During the course of its on-going inspection of our facility, FDA has notified Ameridose that it will be seeking improvements in Ameridose’s sterility testing process.

 

. . .  is apparently their interpretation of the FDA’s assessment from below, which states:

 

FDA’s preliminary findings have raised concerns about a lack of sterility assurance for products produced at and distributed by this facility.

 

Without comment, I'll also mention that both parties managed to agree that injecting non-sterile products is generally a bad idea, and represents a - `serious hazard to health and could lead to life-threatening injuries and/or death’.

 

Moving on.   Here is the FDA’s statement in its entirety.

 

 

    FDA NEWS RELEASE

For Immediate Release: Oct. 31, 2012
Media Inquiries: Sarah Clark-Lynn, 301-796-9110,
sarah.clark-lynn@fda.hhs.gov
Consumer Inquiries: 888-INFO-FDA

FDA reports voluntary recall of all Ameridose drug products

The U.S. Food and Drug Administration announced today that Ameridose, LLC, based in Westborough, Mass., is voluntarily recalling all of its unexpired products in circulation. Products from Ameridose can be identified by markings that indicate Ameridose by name or by its company logo . A complete list of all products subject to this recall can be accessed at www.ameridose.com .

 
The FDA is currently conducting an inspection of Ameridose’s facility. Although this inspection is ongoing, the FDA’s preliminary findings have raised concerns about a lack of sterility assurance for products produced at and distributed by this facility. Use of non-sterile injectable products can represent a serious hazard to health that could lead to life-threatening injuries. Most products produced at and distributed by this facility are represented by Ameridose to be sterile products. Ameridose entered into a voluntary agreement with the Massachusetts Board of Registration in Pharmacy to cease all pharmacy and manufacturing operations starting on Oct. 10, 2012.

 

This recall is not based on reports of patients with infections associated with any of Ameridose’s products, and the agency recommended this recall out of an abundance of caution. Therefore, at this time, the FDA is also recommending that health care professionals do not need to follow up with patients who received Ameridose products. Health care professionals should stop using Ameridose products at this time, and return them to the firm.

 

Hospitals, clinics, health care professionals, and other customers with Ameridose products on hand should contact Ameridose at 888-820-0622 to obtain instructions on how to return products to Ameridose.

 

“The FDA’s top priority is to ensure that drugs are safe for the American public,” said FDA Commissioner Margaret A. Hamburg, M.D.

 

Together with the State of Massachusetts, the FDA commenced the current inspection of the Ameridose facility as part of the agency’s ongoing fungal meningitis outbreak investigation. Ameridose is a company sharing common management by the same parties as New England Compounding Center (NECC) of Framingham, Mass., the firm associated with compounded drugs linked to the ongoing fungal meningitis outbreak.

 

“Because the preliminary results of the FDA’s inspection raise concerns about the sterility assurance of Ameridose’s products, the FDA is advising health care professionals to stop using all Ameridose products and follow the recall procedures provided by the firm,” explained Janet Woodcock, M.D., director of FDA’s Center for Drug Evaluation and Research.

 

The FDA has identified some Ameridose products that currently appear on the critical shortage list. These products were in shortage before the Ameridose recall, but supplies may be further affected as a result of the Ameridose recall. The FDA is working with alternative manufacturers to maintain supplies of these life-saving drugs.

 

“The agency is taking all steps within its authority to help prevent or alleviate shortage situations and to minimize the impact this recall may have on drug supplies,” added Commissioner Hamburg.

 

As new information becomes available, the FDA will issue additional public communications.

 

Health care professionals and patients may dial the FDA’s Drug Information Line at 855-543-DRUG (3784) and press * to get the most recent information regarding the Ameridose recall and speak directly to a pharmacist.

 

The FDA asks health care professionals and consumers to report any adverse reactions to the FDA’s MedWatch Program by fax at 800-FDA-0178, by mail at MedWatch, FDA, 5600 Fishers Lane, Rockville, MD 20852-9787, or on the MedWatch website at www.fda.gov/medwatch.

WHO Update: Marburg Virus In Uganda

 

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Credit CDC PHIL

 

# 6684

 

 

The World Health Organization has updated the situation in Uganda, where authorities are dealing with a rare outbreak of Marburg virus.

 

The Marburg virus was first isolated after an outbreak at a lab in Germany (hence the name) imported via African Green Monkeys, but is normally found in parts of equatorial Africa.  It is closely related to the Ebola viruses, and is of the same family; Filoviridae.

Two weeks ago, in Marburg Virus Reported In Western Uganda, I recounted a bit of the history of the virus since it’s discovery in 1967.

 

As of now, there are 18 confirmed cases (9 deaths), and perhaps of most concern, cases have now been detected in 5 districtsKabale district, Kampala (the capital city), Ibanda, Mbarara and Kabarole.

 

 

 

Marburg haemorrhagic fever in Uganda - update

31 October 2012 - As of 28 October 2012, a total of 18 cases and 9 deaths, including a health worker, have been reported from 5 districts namely Kabale district, in south-western Uganda, Kampala (the capital city), Ibanda, Mbarara and Kabarole. The case fatality rate is 50%. The outbreak was declared by the Ministry of Health in Uganda on 19 October 2012. Blood samples from 9 cases have been confirmed for Marburg virus at the Uganda Virus Research Institute (UVRI).

 

Currently, 13 patients have been admitted to hospital (2 in Kampala, 8 in Kabale, 3 in Ibanda) and their contacts are listed for daily follow up. The latest confirmed case was admitted to Ibanda district isolation ward on 26 October 2012.

 

The World Health Organization (WHO) and international partners including, the Centers for Disease Control and Prevention (CDC), the Uganda Red Cross (URCS), African Field Epidemiology Network (AFENET) and Médecins-Sans-Frontières (MSF) are supporting the national authorities in outbreak investigation and response. The national task force has identified additional health care workers and epidemiologists to strengthen the teams in the field. Training of health workers on infection prevention and control, surveillance and clinical case management is ongoing. Social mobilization activities are being conducted which include the dissemination of IEC (Information Education Communication) material, sensitization on Marburg prevention and control and broadcast of information through radio channels. The first shipment of personal protective equipment (PPE) provided by WHO arrived over the weekend.

 

The WHO Regional office has deployed an epidemiologist and a logistician to Uganda to support the response teams on the ground. In addition, a social mobilization expert from WHO Zambia Country Office and a logistician from the Regional Rapid Response Team network have been mobilized for immediate deployment. More experts are being identified by the Global Outbreak Alert and Response Network (GOARN).

 

As the investigation into the outbreak continues, WHO and partners continue to support the national authorities as needed in the areas of coordination, infection prevention and control, surveillance, epidemiology, public information and social mobilization, anthropological analysis and logistics for outbreak response.

 

Neighbouring countries have been contacted to strengthen cross border surveillance and preparedness to prevent cross border spread of the outbreak.

 

WHO advises that there is no need for any restrictions on travel or trade with Uganda.

Canada & Switzerland Clear Novartis Flu Vaccine For Use

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# 6683

 

Last week (see Novartis Fluad And Agriflu Vaccines Suspended In Canada), Canada joined Italy, Switzerland, and France in temporarily suspending the use of two Flu vaccines produced by a Novartis plant in Italy pending a review after `protein clumping’ was observed in some vials.

 

Today  Reuters is reporting that Health Canada, and the Swiss government have lifted their suspensions, after being reassured of the vaccine’s safety.  

 

 

Italy, reportedly, is `cautiously positive’ that they will be able to lift their ban in the next few days as well.

 

As I mentioned on Saturday, the clumping of proteins is not uncommon in flu vaccines, and has never been associated with a health risk in the past.  But given ongoing fungal meningitis outbreak due to contaminated steroids in the United States, public health officials are understandably being cautious.

 

Here is the Health Canada announcement, released earlier today.

 

Voluntary Suspension of Flu Vaccines (Agriflu and Fluad) Lifted

Information Update
2012-164
October 31, 2012
For immediate release

OTTAWA - Health Canada has completed its review of safety information for Agriflu and Fluad and is releasing the two seasonal flu vaccines for immediate use. As a precautionary step, the products were temporarily pulled from distribution last week by the manufacturer and held from use in flu vaccination clinics at the request of Health Canada while it investigated any possible concerns.

 

Health Canada looked at the results of its own testing, conducted a health risk assessment, and reviewed information from its European partners and data submitted by Novartis in making its decision. None of the information reviewed indicated a safety issue.

 

The Public Health Agency of Canada is now advising health care professionals in possession of these vaccines that they can start using them once again. As such, those administering the vaccines are reminded to follow existing labelling directions as well as allowing the vaccine to come to room temperature before use. The products should also be shaken and checked for any white floating material before they are injected. Such material is not uncommon in vaccines and does not pose a risk to health.

 

The Public Health Agency of Canada closely monitors for vaccination-related adverse events to detect potential safety issues in a timely manner. To date it has received no reports of serious or unexpected adverse events related to these vaccines.

 

The Public Health Agency of Canada and Health Canada will continue to work with the company to monitor the safety and effectiveness of the vaccines used here in Canada. Should a safety concern be identified, immediate and appropriate action will be taken.

 

Agrippal is marketed in Canada as Agriflu and is authorized for use in people older than 6 months. Fluad is authorized for use in Canadians 65 years of age or older.

 

Flu season is upon us, and a seasonal influenza vaccine is a safe and effective way to protect children, families and communities from influenza viruses. Canadians can learn more about fighting flu by getting a copy of Fight Flu: Your Seasonal Flu Guide by contacting 1 800 O-Canada or visiting  Fight Flu.

 

WHO: Yellow Fever Outbreak In Sudan

 

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Source Lancet Infect Dis. 2011;11:622-32 via CDC

 


# 6681

 

For three weeks the newshounds on FluTrackers (among others) have been keeping track of a disease outbreak  in Sudan that has claimed several dozen lives.

 

Today, the World Health Organization’s regional office for the Eastern Mediterranean has posted the following notice (h/t Ronan Kelley on FluTrackers), indicating they’ve been notified of a yellow fever outbreak in that country.

 

Yellow fever hits Central and South Darfur

29 October 2012 – Sudan’s Federal Ministry of Health has notified the World Health Organization (WHO) of a yellow fever outbreak in seven localities in Central and South Darfur. Since the first week of October, a total of 84 suspected cases, including 32 deaths, have been reported from the districts of Azoom, Kass, Mershing, Nertiti, Nyala, Wadi Salih and Zalingei.

 

The Federal Ministry of Health has said that the immediate priority is to control the vector, reinforce the disease surveillance system and raise public awareness of prevention and control of this disease. Preparations for a mass vaccination campaign are underway to vaccinate the at-risk population in Darfur.

 

Yellow fever is spread by mosquitoes. There is no specific treatment for yellow fever, only supportive care to treat dehydration and fever, and blood transfusion, if and when needed. It is a preventable disease with symptoms and severity varying from case to case. Protective measures such as the use of bednets, insect repellent and long clothing are considered the best methods to contain an outbreak.

 

Vaccination is the single most important measure for preventing yellow fever.

 

The Federal Ministry of Health, WHO and other health partners are working on the ground to ensure timely containment of the outbreak.

 

Yellow fever (aka Yellow Jack) is a viral disease transmitted by the Aedes mosquito (and others). There is a relatively safe, and effective, vaccine available and travelers to parts of equatorial Africa and South America are often advised to get it.

 

The CDC’s 2012 Yellow Book describes the clinical presentation this way:

 

Asymptomatic or clinically inapparent infection is believed to occur in most people infected with YFV. For people who develop symptomatic illness, the incubation period is typically 3–6 days.

 

The initial illness presents as a nonspecific influenzalike syndrome with sudden onset of fever, chills, headache, backache, myalgias, prostration, nausea, and vomiting. Most patients improve after the initial presentation.

 

After a brief remission of hours to a day, approximately 15% of patients progress to a more serious or toxic form of the disease characterized by jaundice, hemorrhagic symptoms, and eventually shock and multisystem organ failure. The case-fatality ratio for severe cases with hepatorenal dysfunction is 20%–50%.

 

In the 18th and 19th century Yellow fever caused major epidemics in Europe and in the United States, up the Atlantic seaboard and as far north as New England (Boston was hard hit in 1780, and Philadelphia saw several thousand deaths in 1793).

 

Yellow Fever has been cited as one of the primary reasons why the French abandoned their attempt to build a Panama canal in the late 1800’s, as the combined burden of Yellow Fever and Malaria reportedly claimed the lives of more than 20,000 construction workers.

 

 

For more on the fascinating history of `Yellow Jack’, I would point you to Ian York’s excellent Mystery Rays blog, where he gives us some terrific background in:

 

Yellow fever, stasis, and diversification
The deadliest, most awe-inspiring of the plagues
The good old days

 

While currently not a threat in Europe and the United States, yellow fever is on the radar screens of some epidemiologists as climate change, and the spread of suitable vectors, continue.

 

This from Eurosurveillance in 2010, and it is an excellent overview of the issue.

 

Eurosurveillance, Volume 15, Issue 10, 11 March 2010

 

Yellow fever and dengue: a threat to Europe?

P Reiter

The introduction and rapidly expanding range of Aedes albopictus in Europe is an iconic example of the growing risk of the globalisation of vectors and vector-borne diseases.

The history of yellow fever and dengue in temperate regions confirms that transmission of both diseases could recur, particularly if Ae. aegypti, a more effective vector, were to be re-introduced.  The article is a broad overview of the natural history and epidemiology of both diseases in the context of these risks.

 

 

You can find more information on yellow fever at these websites:

 

http://www.cdc.gov/yellowfever/

http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/yellow-fever.htm

http://www.who.int/topics/yellow_fever/en/

Tuesday, October 30, 2012

Central Florida Man Diagnosed With Dengue

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# 6680

 

 

A Seminole county man, aged 19, has been diagnosed with what is believed to be locally acquired Dengue, according to a press release today from the Orange County Health Department.

 

HEALTH HEALTH ADVISORY – DEPARTMENTS  INVESTIGATING LOCALLY ACQUIRED DENGUE FEVER CASE


Tuesday, October 30, 2012 -

ORLANDO – The Seminole and Orange County Health Departments are investigating a locally acquired case of dengue fever near the Seminole and Orange County line by the University of Central Florida. The 19 year old Seminole County man was diagnosed with dengue fever based on symptoms and confirmed by laboratory tests. The individual is recovering from this illness.

 

Dengue fever is a viral disease transmitted by a type of mosquito common to the southeastern United States and the tropics. It is not spread from person to person. Mosquitoes usually bite at dusk and dawn, but the mosquitoes that carry dengue bite during the day as well – especially indoors, in shady areas, or when the weather is cloudy.

 

Though some people may experience little to no symptoms; the most commons symptoms of dengue include high fever (over 101 degrees Fahrenheit), severe headache, severe pain behind the eyes, muscle, joint and bone pain, rash, loss of appetite, nausea and vomiting. There is no specific medication or vaccine for dengue fever. If you are experiencing symptoms consistent with dengue fever, please call your healthcare provider to see if you need to be seen.

 

The health departments encourage all residents and visitors to help lower mosquito populations by taking appropriate measures to guard against these diseases by practicing Drain and Cover. 

This includes:

DRAIN standing water:
• Drain water from garbage cans, buckets, pool covers, coolers, toys, flowerpots or any other containers where sprinkler or rainwater has collected.
• Discard old tires, drums, bottles, cans, pots and pans, broken appliances and
other items that aren't being used.
• Empty and clean birdbaths and pets' water bowls at least once or twice a week.
• Protect boats and vehicles from rain with tarps that don't accumulate water.
• Maintain swimming pools in good condition and appropriately chlorinated. Empty plastic swimming pools when not in use.

 

The most recent Florida Arbovirus Surveillance Report (Oct 27th) only lists one other locally acquired case of Dengue in Florida in 2012 (see Miami Reports Locally Acquired Dengue Case).

 

This compared to 28 cases reported in 2009, and then 63 locally-acquired cases in Key West, one in Broward County, and one in Miami-Dade County for 2010.

 

The following year, 2011, saw a significant reduction in cases with just three locally acquired in Miami-Dade County, two in Palm Beach County, and one each in Martin and Hillsborough counties.

 

Although cooler weather has finally arrived in the Sunshine state, we’ve yet to see a freeze, and so mosquitoes are still active.  For this reason, the Florida DOH recommends.

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Flood Dangers Run Deep

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Photo Source VOANews

 

# 6679

 

Although the storm has passed, flood waters are often slow to recede, and they can leave behind a multitude of dangers. 

 

Not only do flood waters easily hide dangerous objects - like broken bottles, razor sharp metal sheeting, live electrical wires, and rusty nails – they can also harbor nasty viruses and bacteria, along with dangerous wildlife. 

 

The CDC’s Webpage on Infectious Disease After a Disaster provides a long list of possible risks (many associated with flood waters) that include:

 

Down here in Florida, and along the Gulf Coast, alligators and poisonous snakes are a genuine threat after a hurricane. Urban legends about crocs inhabiting the sewers of New York City aside, wayward reptiles are probably not going to pose much of a threat to life and limb in the Mid-Atlantic states.

 

But there are probably a fair number of rats that have likely evacuated to higher ground or have been driven out of basements and tunnels due to the flooding.

 

And with rats, you don’t actually have to see or come in direct contact with them, to be endangered.

 

Striped field mouse (Apodemus agrarius)

 

In June of 2010, the New York Times carried a story called Subway Study Finds Rats Remain Wily, that quoted rodentologist Robert M. Corrigan, by saying:

 

while rats were a problem in the subways, the rodents inhabited many other public spaces, particularly parks. “Virtually all of New York,” he said, “is vulnerable to this uncanny mammal.”

 

The good news, at least according to the New York City Bureau of Communicable diseases, is:

 

Could a bubonic plague outbreak occur in New York City?

In New York City and other eastern cities, the rat flea that usually transmits bubonic flea (the oriental rat flea) is rare. Outbreaks of bubonic plague in these areas would be unlikely.

 

But there are other diseases, notably Hantavirus and Leptospirosis, that are rat-borne and potentially hazards in the post-Sandy environment.

 

We’ve covered Hantavirus a number of times in the past (see here, here, & here) but Leptospirosis is less well known in the United States, although it is not exactly unheard of.

 

The CDC’s Leptospirosis Webpage describes the bacteria this way:

 

The bacteria that cause leptospirosis are spread through the urine of infected animals, which can get into water or soil and can survive there for weeks to months. Many different kinds of wild and domestic animals carry the bacterium.

These can include, but are not limited to:

  • Cattle
  • Pigs
  • Horses
  • Dogs
  • Rodents
  • Wild animals

When these animals are infected, they may have no symptoms of the disease.

Infected animals may continue to excrete the bacteria into the environment continuously or every once in a while for a few months up to several years.

Humans can become infected through:

  • contact with urine (or other body fluids, except saliva) from infected animals
  • contact with water, soil, or food contaminated with the urine of infected animals.

The bacteria can enter the body through skin or mucous membranes (eyes, nose, or mouth), especially if the skin is broken from a cut or scratch. Drinking contaminated water can also cause infection. Outbreaks of leptospirosis are usually caused by exposure to contaminated water, such as floodwaters. Person to person transmission is rare.

 

Risk of Exposure

Leptospirosis occurs worldwide, but is most common in temperate or tropical climates. It is an occupational hazard for many people who work outdoors or with animals, such as:

  • farmers
  • mine workers
  • sewer workers
  • slaughterhouse workers
  • veterinarians and animal caretakers
  • fish workers
  • dairy farmers
  • military personnel

 

While most often associated with tropical climes, according to the New York Health Department they see an average of 1 or 2 cases a year in the city.

 

image

 

Again, like hantavirus, not terribly likely . . . but not impossible either.  Illness after exposure to flood waters should not be dismissed as `nothing’, but checked by a doctor.

 

 

In truth, the risks associate with flood waters are more likely to come from raw sewage, chemicals, or hidden sharp objects. But for bacteria and viruses, post-disaster situations are a `target rich environment’.

 

Those dealing with flood waters or disaster cleanup, who have not had a tetanus booster in recent years, may want to consider the wisdom of getting one.

 

The CDC maintains a page on dealing with flood dangers:

 

Flood Waters or Standing Waters

Health Risks

Flood waters and standing waters pose various risks, including infectious diseases, chemical hazards, and injuries.

Infectious Diseases
Diarrheal Diseases

Eating or drinking anything contaminated by flood water can cause diarrheal disease. To protect yourself and your family,

  • Practice good hygiene (handwashing) after contact with flood waters.
  • Do not allow children to play in flood water areas.
  • Wash children's hands frequently (always before meals).
  • Do not allow children to play with toys that have been contaminated by flood water and have not been disinfected.

For information on disinfecting certain nonporous toys, visit CDC Healthy Water's Cleaning and Sanitizing with Bleach section.

Wound Infections

Open wounds and rashes exposed to flood waters can become infected. To protect yourself and your family,

  • Avoid exposure to flood waters if you have an open wound.
  • Cover open wounds with a waterproof bandage.
  • Keep open wounds as clean as possible by washing well with soap and clean water.
  • If a wound develops redness, swelling, or drainage, seek immediate medical attention.

For more information, visit

Chemical Hazards

Be aware of potential chemical hazards during floods. Flood waters may have moved hazardous chemical containers of solvents or other industrial chemicals from their normal storage places.
Injuries
Drowning

Flood water poses drowning risks for everyone, regardless of their ability to swim. Swiftly moving shallow water can be deadly, and even shallow standing water can be dangerous for small children.

Vehicles do not provide adequate protection from flood waters. They can be swept away or may stall in moving water.

Animal and Insect Bites

Flood waters can displace animals, insects, and reptiles. To protect yourself and your family, be alert and avoid contact.

Electrical Hazards
Avoid downed power lines.
Wounds

Flood waters may contain sharp objects, such as glass or metal fragments, that can cause injury and lead to infection.

 

Cleanup of Flood Water

When returning to your home after a flooding emergency, be aware that flood water may contain sewage. For more information on how to protect yourself and your family, visit CDC’s Cleanup of Flood Water.

 

Resources and Guidance

And one last flood-related item to bear in mind, is:

 

Mold After a Disaster

Overview

Educational Materials

Public Service Announcements

Bangalore: More Poultry Culled Due To H5N1

 

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Photo Credit – FAO


# 6678

 

 

Last Friday in Bangalore, India: H5N1 in Turkeys, I reported on the discovery of H5N1 at a government-run poultry operation on the outskirts of Bangalore, that had resulted in the deaths and culling of more than 3,300 birds.

 

Today, we are learning that the culling operation has been increased nearly 10-fold, with roughly 33,000 birds now culled.  This from the IBT.

 

Bird Flu Outbreak in Karnataka: Over 33,000 Poultry Birds Culled at CPDO

 

By Ankita Mehta | October 30, 2012 10:39 AM GMT

Fear of avian influenza continued to create panic in Karnataka after more than 33,000 poultry birds -19,235 chicken, 13,673 ducks and 369 emus - were culled at Central Poultry Development Organization (CPDO) in Hesaraghatta, 40 km from Bangalore.

(Continue . . )

 

 

The freewheeling Indian media is rarely shy about criticizing the government’s response to bird flu (or any other crisis). Today we get an example from DNA.

 

Bird flu is on, so is passing-the-buck

Published: Tuesday, Oct 30, 2012, 16:43 IST
By Nirad Mudur & Deepthi MR | Place: Bangalore | Agency: DNA

The Centre on October 25 notified its confirmation that avian influenza has indeed struck the Central Poultry Development Organisation & Training Institute (CPDOTI) located in Byatha village in Hesaraghatta on the outskirts of Bangalore.

 

But despite the confirmation that 4,265 turkeys had died due to avian influenza and 206 chicken and 17 ducks died due to suspected infection from the same disease, the state health department and the Bruhat Bengaluru Mahanagara Palike (BBMP)’s health department are engaged in a bureaucratic passing-the-buck. Each is stating that the responsibility of checking the disease spread lies solely with the state department of animal husbandry.

(Continue . . .)

 

 

Of particular concern, the story above goes on to state that several poultry farms close to the affected farm had already moved their flocks in order to avoid culling them.

 

Since that can spread the virus to other regions, neighboring states are now taking steps to prevent entry of birds from Karnataka.


This from the Deccan Herald.

 

Bird flu in Karnataka: Kerala bans poultry from outside

Thiruvananthapuram, Oct 30, 2012 (PTI)

Kerala has banned entry of poultry from other states following detection of avian influenza (bird flu) in a central government farm at Hesserghatt in southern Karnataka.


Following an intimation in this regard from the Karnataka Government, the state Animal Husbandry Department has banned movement of poultry from both Karnataka and Tamil Nadu since last evening, official sources said today.

(Continue . . .)

 

For now, H5N1 remains primarily a threat to poultry and wild birds.  India has yet to report a human infection from the virus. 


But elsewhere around the world more than 600 widely scattered human infections have been reported, and the mortality rate has been a horrendously high 60% among known cases.

 

And so we watch outbreaks such as this with keen interest.

The Morning After

 

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Minimum Preps : Emergency Weather Radio, First Aid Kit, Battery Lantern, Water storage

 


# 6677

 

The sun is just now coming up across the Mid-Atlantic states - roughly 12 hours after post-tropical storm Sandy slammed into New Jersey and New York. Early damage reports suggest this storm has lived up to it’s epic billing, but it will take a day or more before we really know the true extent of the destruction.


For 7 million residents across several states, this morning breaks cold, dark, and damp.  Power is out in many places, and may remain out for days, leaving millions without heat, light, communications, or the ability to cook. 

 

Temperatures are chilly, but running above freezing at night.  At least for now.

 

New York City’s infrastructure . . . particularly their mass transit systems, appear to have been significantly impacted. There are reports of subway tunnels flooded with salt water, which may produce corrosion problems even after they are pumped out.

 

In a town where most people ride, instead of drive, this will have a major impact on how quickly that city returns to work.

 

There are reports this morning  of levee breaks in New Jersey, prompting fresh rescue operations.  Hurricane force gusts whipped a major fire in Queens, which at last report had engulfed dozens of homes.



If it’s been a bad night for residents, keep in mind it’s been even a worse night for emergency responders and emergency management personnel. Even though they have their own homes and families to worry about, they are out there taking care of others.

 

Some twitter feeds to follow today, to keep track of the damage, and the emergency response:

 

FEMA Director Craig Fugate   @CraigAtFema 

FEMA                                    @FEMA 

NYC Mayor's Office                @NYCMayorsOffice

New Jersey Gov Christie       ‏@GovChristie

NY Gov Andrew Cuomo          @NYGovCuomo

American Red Cross               @RedCross 

Monday, October 29, 2012

CMAJ On Mandatory Flu Shot For HCWs

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Photo Credit – CDC PHIL


# 6676

 

In an editorial today, the CMAJ (Canadian Medical Association Journal) endorsed requiring HCWs (Health Care Workers) to get a seasonal flu shot, thus joining a growing list of medical associations around the world calling for similar policies.

 

First, the press release followed by a link to the editorial, then I’ll return with more.

 

Canadian Medical Association Journal

Mandatory flu vaccine for health care workers to protect patients

All health care workers in health care institutions should be vaccinated with the annual influenza vaccine to protect patients, argues an editorial in CMAJ (Canadian Medical Association Journal).

 

Each season, 20% of health care workers get influenza, and 28% of young healthy adults who get it have asymptomatic or subclinical infections," writes Dr. Ken Flegel, Senior Associate Editor, CMAJ. "Some of them may shed virus up to a day before symptoms appear. It is time that all people who work in a health care institution be vaccinated."

 

In Canada, there are approximately 20 000 hospital admissions related to influenza and an estimated 4000 to 8000 deaths attributed to the illness. However, 55%% of physicians do not get vaccinated against the flu and are putting patients at risk of illness and death.

 

Dr. Flegel argues that flu vaccination for health workers must be compulsory, although there could be exemptions for medical or religious reasons. A vaccination rate above 90% is required to prevent outbreaks in hospitals. Mandatory programs for health care workers in many US institutions have resulted in participation rates of about 95%.

 

"Our schools have shown us the way. During measles outbreaks, access to schools has been successfully denied to nonvaccinated children and staff. The time has come for health care institutions to demand that all health care workers be vaccinated. Our patients' lives depend on this change," Dr. Flegel concludes.

 

You can read the entire editorial at this link:

 

EDITORIAL

Health care workers must protect patients from influenza by taking the annual vaccine


October 29, 2012

We know that health care workers import and transmit seasonal influenza to patients. We know that many patients get seriously ill from it and that some die. We know that the annual influenza vaccine can interrupt most of this imposed disease burden. It is time that we act on our knowledge and require all health care workers to be vaccinated. 

Full article

 

 

Despite vocal resistance from some HCWs and their unions, calls for mandatory flu vaccination for health care workers have been coming from many professional organizations for several years.

 

A few earlier blogs on these include:

 

APIC Calls For Mandatory Flu Vaccination For HCWs
AAP: Recommends Mandatory Flu Vaccinations For HCWs
SHEA: Mandatory Vaccination Of Health Care Workers
IDSA Urges Mandatory Flu Vaccinations For Healthcare Workers

 

In 2011, the following editorial opinion appeared in The Lancet.

 

The Lancet, Volume 378, Issue 9788, Pages 310 - 311, 23 July 2011

doi:10.1016/S0140-6736(11)61156-2

Time to mandate influenza vaccination in health-care workers

 

This perspective was penned by Arthur Caplan, Ph.D., who is director of the Center for Bioethics at the University of Pennsylvania, and addresses the ethics of mandating yearly influenza vaccination for Health Care Workers (HCWs).

 

Caplan argues that the evidence overwhelmingly shows that vaccinating HCWs helps to protect patients from infection (and possible death), and that the influenza vaccine is both safe and effective.

 

Citing language common to all oaths sworn by health care professionals (Doctors, Nurses, Techs, etc.), he points out the universal concept that the interests of the patient must come first, and that all HCWs must honor the core medical principal of, “First, do no harm.”

 

Both tenets, he argued, are violated when HCWs fail to accept a yearly flu vaccination.

 

While strongly advocating HCW influenza vaccination, the CDC has stopped short of mandating them. I blogged on this back on June 23rd, 2010  in  CDC: Proposed Influenza Infection Control Guidance.

 

And earlier this month we saw Rhode Island Adopts New Flu Vaccination Requirements For HCPs.

 

Although many infection control experts see this as a long overdue step in patient and employee protection, compulsory vaccination remains a hugely divisive issue, with many HCWs believing that it is an infringement of their rights to decide what will be injected into their bodies.

 

I’ve covered some of the HCW’s objections to forced flu shots in the past, including:

 

HCWs: Refusing To Bare Arms

HCWs: Developing a Different Kind Of Resistance

 

While their concerns over the vaccine’s safety may be overblown, one of their arguments that does carry some weight is the relative effectiveness of the flu vaccine.

 

It simply isn’t as good as with other vaccines.

 

Most years (see CIDRAP: The Need For `Game Changing’ Flu Vaccines), protection from the flu shot runs under 60% for healthy adults, and probably even less for those over 65 or with weakened immune systems.

 

Having a better flu vaccine would remove at least one of the objections that many HCWs have voiced.

 

Popular with HCWs or not, hospitals are increasingly looking at this as both a liability and an economic issue. Unless the courts intervene, the momentum increasingly appears to be moving towards mandating yearly flu shots for many Health Care Workers down the road.

Uganda MOH: Update On Marburg Outbreak

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  Credit Wikipedia

 

 

# 6675

 

The Ugandan Minister of Health, Dr. Christine Ondoa, has issued the following update on the Marburg virus outbreak which has been ongoing in that nation since October 19th.

 

The major points are that there are now 8 deaths confirmed, and that cases have now been confirmed in three districts; Kabale , Ibanda, and Mbarara.

 

This from the Ugandan Media Centre.

 

 

PRESS STATEMENT ON THE UPDATE OF MARBURG OUTBREAK

October 29th 2012


Today on behalf of the Ministry of Health, I take this opportunity to welcome you all to this press briefing organized to update you on the outbreak of Marburg in the country. You will recall that we declared an outbreak of this highly infectious disease on October 19th and since then the Ministry of Health and its partners have undertaken a number of interventions to control the spread of the disease.

 
I wish to inform you that cases are now reported in the neighbouring districts of Ibanda and Mbarara. However, I want to assure you that the Ministry of Health and its partners are on the ground in the mentioned districts to contain the spread and manage the identified cases.

 

To date, the death toll of both the probable and confirmed cases stands at eight, with the latest being a case that died at the isolation facility at Rushoroza Health Centre III on October 27th (Saturday). The case that was referred from Ibanda Hospital – Ibanda to Mbarara Regional Referral Hospital died on October 24th.

 

I wish to clarify that since the onset of the outbreak, we have collected a total of 45 samples of which nine were confirmed positive; five in Kabale, two in Kampala and two from Ibanda.

 

Working closely with the US Center for Disease Control and Prevention (CDC), we have set up a field diagnostic laboratory at Kabale Regional Referral Hospital. All samples from the affected neighbouring districts will hence be taken to this laboratory for quick diagnostics. This will shorten the time when we get results to three hours from the original 24 hours due to distance. Further serological testing will be undertaken at the Uganda Virus Research Institute (UVRI).

 

Due to the presence of cases in other districts, we have established temporary isolation facilities to accommodate the suspected and confirmed cases. In Ibanda, a temporary isolation ward has been created at Ibanda Hospital, while plans are underway to set up a proper isolation facility by tomorrow.

 

At Mbarara Regional Referral Hospital, a separate temporary has been designated for the suspect Marburg cases. A triage has also been set up at the causality ward.

 

We have assembled a team of experts to work in the newly established isolation facilities and they are expected in these districts today.  We also plan to undertake infection control procedures in these facilities as safety measures for the workers and the admitted patients.

 

Today, the total number of cases admitted is 12. Eight are currently admitted at Rushoroza Health Center III in Kabale. Two confirmed cases, a couple (husband and wife) still remain admitted at Mulago National Referral Hospital. Another two suspect cases are currently admitted at Mayanja Memorial Hospital in Mbarara.

 

There are seven suspect cases (student nurses) quarantined at Ibanda. These cases attended to the confirmed case that later died at Mbarara Regional Referral Hospital on October 24th. Other health workers who attended to the patient are closely being monitored.

 

We have line-listed a total of 436 contacts for close observation in four districts of  Kabale, Kam-pala, Ibanda, Mbarara, Fort Portal and Rukungiri. Those being monitored got into contact with either the dead or confirmed cases. The team continues to monitor them on a daily basis for possible signs and symptoms of this highly infectious disease until they have completed 21 days without showing any signs and symptoms.

 

We have completed an orientation of the Kabale district taskforce on Marburg case presentation and prevention, barrier nursing and infection control. Plans are underway to conduct the orien-tation at Ibanda and at Mbarara Regional Referral Hospital.
We have trained a total of 42 volunteers from the Uganda Red Cross Society and deployed them to conduct house to house community sensitization and active case tracing.

 

We plan to set up burial committees in Ibanda district to manage burials of people suspected to have died of the disease. The committee will be oriented on burial procedures and infection prevention and control. This is one of the control measures to curb the spread of the highly con-tiguous disease.

The Ministry of Health would also wish to clarify on media reports that one of its officers, Dr. Sheila Ndyanabangi, the head of the Mental Health Unit Division, had contracted Marburg and had been isolated. Dr. Ndyanabangi has not been isolated but has been advised to exercise social distancing. She is one of the contacts who are being monitored. She has not developed any signs or symptoms of the disease and therefore cannot be isolated from the community. She is due to complete the 21 days of observation.

 

I once again urge the public to take the following measures to avert the spread of the disease.

  • Report immediately any suspected patient to a nearby health unit
  • Avoid direct contact with body fluids of a person suspected to be suffering from Marburg by using protective materials like gloves and masks
  • Persons who have died of Marburg must be handled with strong protective wear and buried immediately
  • Avoid eating dead animals
  • Avoid unnecessary public gathering especially in the affected district
  • Burial of suspicious community deaths should be done under close supervision of well trained burial teams
  • Report all suspicious deaths to a nearby health facility 


Once again the Ministry of Health calls upon the public to stay calm as all possible measures are being undertaken to control the situation. 

 

For a history of the Marburg virus, you may wish to revisit Marburg Virus Reported In Western Uganda.

Red Cross Apps

 

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# 6675

 

With nearly 60 million people in the path of Hurricane Sandy, and estimates that as many as 10 million may be without electricity over the next several days, their ability to communicate with friends and loved ones may be temporarily compromised.

 

To aid those in the midst of a disaster, the Red Cross has maintained a SAFE & WELL web-based program since 2006 that lets people log in and post their name, address, phone number and a brief message that worried family members can check for.

 

To search for someone, you need their name and either address or phone number.  Multiple (date stamped) messages may be retrieved.

 

The Red Cross has recently updated their Safe & Well  program, and it now lets users update their Facebook  and Twitter statuses as well.

 

The Red Cross also has a web based FIND SHELTER app that lets you input a location and gives you the locations of open emergency shelters in the vicinity.

 

You’ll also find a wide selection of mobile Apps available for iPhone/iPad and Android on their Red Cross Mobile Apps page.

 

Wildfire App

First Aid App

Hurricane App

Shelter Finder App

Earthquake App

 

Now would be a good time to download these apps, and to let your friends and family know - that should they be unable to reach you by conventional means - they should look for a message from you on the Red Cross Safe and Well site.

Sandy Strengthens Overnight

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# 6674

 

As predicted by the National Hurricane Center in  Miami, Sandy’s barometric pressure has dropped to an astonishing 946 millibars and its winds have increased to 85MPH, as it moves north at 15 mph.

 

Although a hurricane at present, Sandy is expected to transition into a post-tropical storm later today as it merges with a trough from the west and cold Arctic air.  

 

This transition will not diminish the storm’s impact, which is expected to be experienced over a wide area.

 

 

This from the 5am Advisory on Hurricane Sandy.

 

BULLETIN
HURRICANE SANDY ADVISORY NUMBER  28
NWS NATIONAL HURRICANE CENTER MIAMI FL       AL182012 500 AM EDT MON OCT 29 2012

...SANDY STRENGTHENS...EXPECTED TO BRING LIFE-THREATENING STORM SURGE...COASTAL HURRICANE WINDS AND HEAVY APPALACHIAN SNOWS...

SUMMARY OF 500 AM EDT...0900 UTC...INFORMATION
----------------------------------------------
LOCATION...35.9N 70.5W
ABOUT 285 MI...460 KM E OF CAPE HATTERAS NORTH CAROLINA
ABOUT 385 MI...615 KM SSE OF NEW YORK CITY
MAXIMUM SUSTAINED WINDS...85 MPH...140 KM/H
PRESENT MOVEMENT...N OR 360 DEGREES AT 15 MPH...24 KM/H
MINIMUM CENTRAL PRESSURE...946 MB...27.94 INCHES

 

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Local radio & TV stations are streaming coverage over the Internet, including:

 

Watch Live: Hurricane Sandy Coverage – NBC NYC

 

Live storm coverage from Eyewitness News – ABC NYC

WINS 1010  News Radio 

Sunday, October 28, 2012

The Very Model Of A Natural Disaster

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Credit NHC 11am Sunday Track Map

 

# 6673

 

While it is impossible to know just how bad Hurricane-Hybrid Sandy will be as it approaches and crosses the eastern seaboard over the next 48 hours – or who, exactly, will be most affected – models continue to paint a sobering picture.

 

Tidal surge models from the National Hurricane Center suggest that large areas of the coastline could see storm tides 5-10 feet above normal. 

 

The following map is for a 5 ft surge:

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Some models are suggesting that portions of New York Harbor could see tides exceeding 10 feet above normal, and the 11am advisory warns:

 

STORM SURGE...THE COMBINATION OF AN EXTREMELY DANGEROUS STORM SURGE AND THE TIDE WILL CAUSE NORMALLY DRY AREAS NEAR THE COAST TO BE FLOODED BY RISING WATERS. THE WATER COULD REACH THE FOLLOWING DEPTHS ABOVE GROUND IF THE PEAK SURGE OCCURS AT THE TIME OF HIGH TIDE...

NC NORTH OF SURF CITY INCLUDING PAMLICO/ALBEMARLE SOUNDS...4 TO 6 FT

 

SE VA AND DELMARVA INCLUDING LOWER CHESAPEAKE BAY...2 TO 4 FT

 

UPPER AND MIDDLE CHESAPEAKE BAY...1 TO 3 FT

 

LONG ISLAND SOUND...RARITAN BAY...AND NEW YORK HARBOR...6 TO 11 FT

 

ELSEWHERE FROM OCEAN CITY MD TO THE CT/RI BORDER...4 TO 8 FT

 

CT/RI BORDER TO THE SOUTH SHORE OF CAPE COD INCLUDING BUZZARDS
BAY AND NARRAGANSETT BAY...3 TO 6 FT

 

 

Based on the forecast of surge tides, heavy rains, and high winds the City of New York will suspend mass transit routes starting at 7pm tonight.

 

Gov: MTA will suspend all subway, bus and rail service as Hurricane Sandy advances

Last subway and rail trains will be at 7; last bus at 9pm

By Shane Dixon Kavanaugh / NEW YORK DAILY NEWS

 

The last time the New York Subway system was shut down due to flooding was for Hurricane Irene in 2011.  The NYC MTA carries more than 8 million passengers on a typical weekday, and shutting down the entire system will take 8 to 10 hours (cite WSJ).

 

From Johns Hopkins University, we get this `model’ of possible power outages due to Sandy, based on current track forecasts.  

 

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MEDIA ADVISORY: Hurricane Sandy – 10 million could lose power

As many as 10 million in the mid-Atlantic will lose power in the coming week, according to a computer model developed by an engineer at The Johns Hopkins University.

Please note: A multicolored map of power outage predictions is available. Email acl@jhu.edu

A map of power outages as predicted by Guikema’s model based on the official National Hurricane Center track and intensity forecast from 18UTC (3 p.m. EDT) on Saturday, Oct. 27.

 

An engineer at The Johns Hopkins University predicts that 10 million people from northern Virginia through New Jersey and into southeastern Pennsylvania will be without power in the wake of Hurricane Sandy. Seth Guikema (pronounced Guy-keh-ma) and his team have developed a computer model built on outage data from 11 hurricanes to estimate the fraction of customers who will lose power, based on expected gust wind speed, expected duration of strong winds greater than 20 meters per second, and population density. They ran their model using the official National Hurricane Center track and intensity forecast from 18UTC (3 p.m. EDT) on Saturday, and emphasize that the number of power outages could change as the storm progresses and forecasts become more definitive. It is possible that 10 million people is a conservative estimate, Guikema said.

 

Guikema’s model may help power companies allocate resources by predicting how many people will be without power and where the most outages will take place, and it provides information that emergency managers can use to better prepare for storms. Guikema, an assistant professor in the Department of Geography and Environmental Engineering at the Johns Hopkins Whiting School of Engineering, says the goal is to restore power faster and save customers money. Guikema will be running the model throughout the weekend and into next week as Hurricane Sandy makes landfall.

 

The Governor of New Jersey warned yesterday that power could be out for some residents for `seven to ten days’.  And for many people, that means no ability to cook, or to heat their homes.

 

Municipal water supplies, or water quality, could be affected as well.   Hence the need to be prepared to go several days - at least - without city services or utilities.

 

And while most people automatically worry about storm surge or high winds from hurricanes, between 1970 and 1999, the most lives have been claimed due to inland flooding. 

 

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The NHC has released this five-day precipitation forecast, which should provide some idea of the extent of flooding that may occur.

 

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While it is possible that Sandy won’t be as destructive as has been billed, storms like Camille, Andrew, and Katrina have shown us the folly of underestimating nature’s fury.

 

Today is the last day that people in the path of this storm will have to prepare. Those who are ordered to evacuate need to do so immediately.

 

 

To help track this storm, you may wish to revisit my blog from yesterday  Resources To Follow The Northeast Storm Online.