FAO Calls For Phasing Out Of Highly Hazardous Pesticides In Developing Nations

 

Photo Credit FAO

 

 

# 7530

 

Organophosphate insecticides were phased out of residential use in the United States starting in the year 2000, and was completed in 2005. 

 

Prior to that time, toxic exposures were all too common, peaking in 1997 with more than 20,000 incidents (cite Organophosphate exposures in the United States: a longitudinal analysis of incidents reported to poison centers).

 

I had more than one run in with these dangerous chemicals during my career as a paramedic 35 years ago, usually involving migrant farm workers who were given the chemical to spread with little or no instruction or protective gear.

 

A couple of weeks ago we saw the tragic story of 23 school children in Bihar, India killed (and others sickened) after eating a school lunch that had been inadvertently contaminated with monocrotophos, an organophosphate pesticide (see The Hindu Death toll rises to 22).

 

This chemical is so toxic, most western countries banned it years ago. The World Health Organization  reportedly called upon the Indian Government to do likewise in 2009 (see Reuters report WHO had asked India to ban toxin that killed children)

.

 

Yesterday, the FAO came out with the following statement regarding the phasing out and banning of these highly dangerous pesticides.

 

 

 

Highly hazardous pesticides should be phased out in developing countries

Tragedy of poisoned school children in India provides another reminder

30 July 2013, Rome - The tragic incident in Bihar, India, where 23 school children died after eating a school meal contaminated with monocrotophos, is an important reminder to speed up the withdrawal of highly hazardous pesticides from markets in developing countries, the UN Food and Agriculture Organization (FAO) said today.

 

Monocrotophos is an organophosphorus pesticide that is considered highly hazardous by FAO and the World Health Organization. Experience in many developing countries shows that the distribution and use of such highly toxic products very often poses a serious risk to human health and the environment.

 

The incident in Bihar underscores that secure storage of pesticide products and safe disposal of empty pesticide containers are risk reduction measures which are just as crucial as more prominent field-oriented steps like wearing proper protective masks and clothing.

 

The entire distribution and disposal cycle for highly hazardous pesticides carries significant risks. Safeguards are difficult to ensure in many  countries.

Among international organizations, including FAO, the World Health Organization and the World Bank, there is consensus that highly hazardous products should not be available to small scale farmers who lack knowledge and the proper sprayers, protective gear and storage facilities to manage such products appropriately.

 

FAO therefore recommends that governments in developing countries should speed up the withdrawal of highly hazardous pesticides from their markets.

 

Non-chemical and less toxic alternatives are available, and in many cases Integrated Pest Management can provide adequate pest management that is more sustainable and reduces the use of pesticides.

 

The International Code of Conduct on Pesticide Management, adopted by FAO member countries, establishes voluntary standards of conduct for all public and private entities involved in pesticide management. This Code has been broadly accepted as the main reference for responsible pesticide management.

 

The Code states that prohibiting the importation, distribution, sale and purchase of highly hazardous pesticides may be considered if, based on risk assessment, risk mitigation measures or good marketing practices, are insufficient to ensure that the product can be handled without unacceptable risk to humans and the environment.

 

For monocrotophos, many governments have concluded that prohibition is the only effective option to prevent harm to people and the environment. This pesticide is prohibited in Australia, China, the European Union and the United States, and in many countries in Africa, Asia and Latin America.

Taiwan’s Rabies Outbreak

 

 

# 7529

 

 

Up until June of this year, Taiwan was considered to be rabies free (along with Iceland, Ireland, Sweden, Norway, the United Kingdom (Great Britain and Northern Ireland), Australia, New Zealand, Fiji, Hawaii, and Guam). The last report of rabies on the island was in 1959, and Taiwan received its rabies free designation in 1961.

 

But that status abruptly changed with the filing of an OIE report on July 17th  citing three dead ferret badgers (collected in 2012) that had tested positive for an untyped lyssavirus over the summer.

 

The following day (July 18th) Taiwan’s Department of Health convenes emergency ACIP meeting to amend recommendations for rabies vaccination.

 

A week after that the  Ministry of Health and Welfare and Council of Agriculture establishes rabies prevention inter-ministerial working group on July 24, 2013 to coordinate rabies management and ensure health and wellbeing of public.

 

With rabies confirmed on the island, testing of animals increased, and within a couple of weeks the number of positive cases had jumped to 14.

 

 

Rabies cases rise to 14

2013/07/30 12:34:18

Focus Taiwan

(EXCERPT)

As of July 29, a total of 52 wild carnivorous animals had been tested for rabies and 14 were reported positive, it noted.

 

All of the 14 cases involved Formosan ferret-badgers from the mountainous areas, with seven cases reported in Nantou County, one each in Yunlin County, Taichung City, and Tainan City, and two each in Kaohsiung City and Taitung County, according to the council.

 

Prompting this announcement last Monday (July 29th):

 

Taiwan CDC urges public to avoid contact with wild animals; If bitten or scratched by wild animals, please seek immediate medical attention to prevent rabies

 

Today, news reports indicate that this particular lyssavirus has been subtyped, and it appears to be related to strains endemic in China.

 

Taiwan's rabies virus closest to China type

2013/07/30 22:02:21

Taipei, July 30 (CNA) The virus type of the fourth case of a rabies-infected Formosan ferret-badger in Taiwan is 91-92 percent similar to that found in China, a sign that the two sides of the Taiwan Strait share the same source of the virus, the Council of Agriculture's Animal Health Research Institute said Tuesday.

 

The latest test was in line with earlier tests carried out by the institute that showed the virus found in the first three local cases were 88-92 percent similar to the Chinese virus

(Continue . . . )

 

Today we learn that a woman was bitten by a house shrew last week, and that it too has tested positive for rabies.

 

COA confirms rabies in Taitung house shrew

By Joy Lee ,The China Post
July 31, 2013, 12:15 am TWN

TAIPEI, Taiwan -- A house shrew that bit a woman in Taitung City on July 24 has been confirmed to have been a carrier of the rabies virus, according to the Council of Agriculture (COA) yesterday.

 

The COA said that this is the first confirmed cross-species rabies infection since the first ferret-badger with rabies was discovered earlier this month.

 

The council also announced yesterday that two more ferret-badgers have been confirmed to have the rabies virus, bringing the national total of rabies cases to 15.

(Continue . . . )

 

With vaccines for pets reportedly in short supply, some people have taken to abandoning their animals. Yesterday, in the face of increasing public anxiety, Taiwan’s CDC issued the following press release:

 

 

To effectively control ongoing rabies situation, Taiwan CDC urges public to support and cooperate with government policies and not to panic as the agency continues to actively organize different types of prevention efforts and produce mutli-faceted promotional materials ( 2013-07-30 )

In response to the ongoing rabies outbreak in wild animals in Taiwan, the sixth meeting convened by the inter-ministerial working group was held on July 30, 2013. According to statistics compiled by the Taiwan Centers for Disease Control (Taiwan CDC), between 4pm on July 28 and 4pm on July 29, 2013, a total of 100 new animal bite cases applying for rabies vaccine were received.

 

Of the applications, 49 have been approved, including 5 applications from Taipei, 4 applications from northern Taiwan, 12 applications from central Taiwan, 15 applications from southern Taiwan, 8 applications from Kaohsiung and Pingtung, 4 applications from eastern Taiwan, and 1 application from out of the country. Between 4pm on July 21 and 4pm on July 29, 2013, an accumulative total of 245 animal bite cases applying for rabies vaccine were received. Of the applications, 115 have been approved, including 7 applications from Taipei, 9 applications from northern Taiwan, 33 applications from central Taiwan, 25 applications from southern Taiwan, 14 applications from Kaohsiung and Pingtung, 20 applications from eastern Taiwan, and 7 applications from out of the country. 16 applications were approved for the use of human rabies immune globulin (HRIG) and 5 of them have received the prophylaxis.

 

According to Taiwan CDC, rabies is widely distributed around the world, with only 9 countries being free of the disease. Rabies cases primarily occur in Africa, Asia, Latin America, and the Middle East. The United States and a number of countries in Europe are also affected by rabies. Nevertheless, as long as relevant prevention activities are carefully implemented, the occurrence of human rabies cases remains rare. Currently, the distribution of rabies in Taiwan is only limited to wild animals. As a result, the public is urged not to panic. The government has procured sufficient human rabies vaccine and HRIG and planned to continue to purchase more to ensure the recommended target groups for rabies vaccination and frontline health workers can all receive the vaccine. In addition, to ensure the public has access to most current and accurate information on rabies prevention and control, Taiwan CDC has set up a rabies website and uploaded relevant health education and health promotion materials, including posters, brochures, and newsflash, to the website. More health education and health promotion materials will be developed and uploaded to the website for public reference.

 

To effectively prevent rabies, Taiwan CDC reminds the public to take heed of the following three preventive actions against rabies:

1. Avoid animal bite: Avoid contact with wild animals and do not pick up sickened animals or animal carcasses and report sightings of sickened animals or animal carcasses to local animal epidemic prevention agencies or the Council of Agriculture (COA) through calling the hotline: 0800-761-590.

2. When bitten or scratched by animals, please remember to take the following 4 steps:

1.Remember: Try to remain calm and remember the characteristics of the biting animal; 2. Wash: Immediately wash the wound with soap and an ample amount of clean water for 15 minutes and then disinfect the wound with iodine or 70% alcohol; 3. Seek: Seek prompt medical attention for proper evaluation and treatment to reduce the risk of infection; and 4. Observe: Try to detain the biting animal for a 10-day observation if possible. However, do not risk capturing the animal if it gets violent.

3. Seek medical attention when bitten or scratched by animals: Please seek medical assistance at one of the 28 hospitals with a stockpile or rabies vaccine, which can be found in every city and county in the nation.

Taiwan CDC reminds clinicians who encounter wild animal bite cases to remember to record the location where the bite occurred, the animal species that made the bite, and whether the animal has been retained for observation. If a patient is qualified for post-exposure vaccination, please contact a Taiwan CDC Regional Center to facilitate the application for rabies vaccines. For more information on rabies prevention, please visit the Taiwan CDC’s website at http://www.cdc.gov.tw or call the toll-free Communicable Disease Reporting and Care Hotline, 1922, or 0800-024582 if calling from a cell phone. For more information on outbreaks of animal diseases, please call the COA’s hotline, 0800-761-590.

 

And for our last stop: According to the World Health Organization, rabies still exacts a terrible toll each year around the globe, killing tens of thousands.

 

Rabies

Fact Sheet N°99
Updated July 2013

Key facts

• Rabies occurs in more than 150 countries and territories.
• More than 55 000 people die of rabies every year mostly in Asia and Africa.
• 40% of people who are bitten by suspect rabid animals are children under 15 years of age.
• Dogs are the source of the vast majority of human rabies deaths.
• Wound cleansing and immunization within a few hours after contact with a suspect rabid animal can prevent the onset of rabies and death.
• Every year, more than 15 million people worldwide receive a post-exposure vaccination to prevent the disease– this is estimated to prevent hundreds of thousands of rabies deaths annually.

Honduras Declares Dengue Emergency

 

 

# 7528

 

Although historical records suggest that Dengue fever has been endemic in South and Central America and the Caribbean for centuries, it was all but eliminated by an intensive Yellow Fever eradication campaign organized by PAHO in the late 1940s.

 

According to the 2002 paper  Dengue in the Americas by Mary E Wilson and Lin H Chen:

 

Records show no evidence of epidemic dengue in the Americas from 1946 through 1963, presumably reflecting in part the benefits from the eradication programme. In areas where Aedes aegypti was eliminated, transmission of dengue virus was interrupted.

 

Support for programmes waned and vector control activities declined allowing the mosquito to reinfest areas where it had been eliminated and to spread to areas where it had never previously been recorded.

 

Aedes aegypti was repeatedly introduced from areas where the vector was not controlled.

 

Dengue re-emerged in the 1960s and 1970s, initially affecting Jamaica, then Puerto Rico, other Caribbean islands,and Venezuela. Subsequently, dengue was reported from at least 43 countries in the region.

 

Over the past half century the disease has literally exploded in the Americas – often infecting millions of people each year.  The 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 also emerged. The WHO now estimates there may be as many as 50 million dengue infections each year (Dengue and dengue haemorrhagic fever fact sheet).

 

In 2009, Honduras saw their worst dengue season in more than a decade, resulting in 12 deaths. The following year, 83 people died. While Dengue outbreaks tend to be cyclical, once again Honduras is facing a dengue epidemic, and yesterday declared a state of emergency.

 

 

Honduras declares state of emergency due to dengue fever

English.news.cn   2013-07-31 10:56:13

TEGUCIGALPA, July 30 (Xinhua) -- The Honduran government declared a state of emergency Tuesday due to the spread of dengue fever, which has killed 16 people this year and infected more than 12,000, local media reported.

 

Dengue has affected more than half of all the municipalities in Honduras. Out of the 12,135 reported cases, 1,839 are suspected to be of the fatal hemorrhagic variety, which can lead to shock and internal bleeding.

 

Minister of Health Salvador Pineda said five cities, including the capital of Tegucigalpa and its surrounding central district, had the largest number of Dengue cases.

 

Pineda declared a national priority to control mosquitoes and prevent them from transmitting dengue.

 

He said more than 4 million U.S. dollars were needed to control the nationwide epidemic effectively and that his ministry would seek coordinated efforts from other government institutions.

 

Honduras is no stranger to dengue outbreaks. In 2009, a dozen of people were killed by hemorrhagic dengue, with more than 66,700 people infected. In 2010, the disease killed 83 people.

 

 

In late June, PAHO issued the following epidemiological alert for the Americas on Dengue:

 

Epidemiological Alert:

Dengue

June 21, 2013

The Pan American Health Organization / World Health Organization (PAHO / WHO) ecommended to Member States that entered the rainy season where there greater transmission of dengue, such as Mexico and those in Central and Caribbean continue their preparedness and response efforts, based on the lessons learned and using the approach of Integrated Management Strategy (IMS) for the prevention and control, with emphasis on reducing deaths from this disease.

 

Current Situation

 

During the year 2013 and to epidemiological week (EW) 21, in the region of the Americas were 868 653 cases of dengue, 8,406 cases of severe dengue and 346 deaths (case fatality 1 0.04%). With the circulation of the 4 serotypes in the region, increases the risk of severe forms of dengue. The breakdown of the number of cases, cases serious, deaths and circulating serotypes are available on our website.

 

In the first half of 2013, outbreaks of dengue in Brazil, Costa Rica, Colombia, Paraguay and the Dominican Republic. In places like Peru, cases recorded in areas where there had been no indigenous cases of dengue before.

 

Given the usual behavior of dengue in the region, is expected to in the coming months to register an increase in cases in Central America, Mexico and the Caribbean, which coincides with the rainy season in these countries.

 

The purpose of this alert is to reiterate to member states that they will enter the period increased transmission of dengue, to continue their coordination efforts with other sectors 3, Based on the activities identified in the national and EGI-dengue in comprehensive plans outbreak response. They also recommended that the services fit health for a greater flow of patients as well as to strengthen and provide one upgrade to detect warning signs and clinical management of dengue cases health personnel.

 

The most recent numbers from PAHO on Dengue in the Americas for 2013 show well over 1.3 million cases in the first half of the year.

 

 

The World Health Organization’s Dengue and Severe Dengue Fact Sheet highlights the following points about the disease.

Key facts

• Dengue is a mosquito-borne viral infection.
• The infection causes flu-like illness, and occasionally develops into a potentially lethal complication called severe dengue.
• The global incidence of dengue has grown dramatically in recent decades.
• About half of the world's population is now at risk.
• Dengue is found in tropical and sub-tropical climates worldwide, mostly in urban and semi-urban areas.
• Severe dengue is a leading cause of serious illness and death among children in some Asian and Latin American countries.
• There is no specific treatment for dengue/ severe dengue, but early detection and access to proper medical care lowers fatality rates below 1%.
• Dengue prevention and control solely depends on effective vector control measures.

 

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

PHAC: Lyme Disease Risk Increasing In Canada

Female blacklegged ticks in various
stages of feeding. Note the change in
size and colour.-  Credit PHAC

 

#7527

 

Lyme disease, spread by infected ticks, has become a major vector-borne disease in the United States with nearly 35,000 confirmed or suspected cases reported in 2011 (cite Reported Cases of Lyme Disease by Year, United States, 2002-2011).

 

While cases have been reported in Canada (Lyme became a reportable disease there in 2009), they have run about 1/100th the rate seen in the United States (just 258 cases in 2011).

 

But those numbers may poised to increase, according to the following public health notice posted today by the PHAC, as infected ticks appear to be spreading into new regions of Canada.

 

 

Public Health Notice: Lyme disease

Why you should take note

Lyme disease is a serious illness spread by the bite of certain ticks; specifically, blacklegged ticks. Ticks are small, insect-like parasites that feed on the blood of animals, including humans. In regions where blacklegged ticks are found, people can come into contact with ticks by brushing against vegetation while participating in outdoor activities, such as, hiking, camping and gardening. When a tick bites, it attaches to the skin and the bite is usually painless. For most Canadians, the risk of getting Lyme disease is fairly low, but is increasing.

 

Risk to Canadians

The Public Health Agency of Canada, in partnership with provincial and territorial public health authorities, conducts surveillance for Lyme disease in Canada and studies show the risk of the disease is growing in this country. Risk occurs in parts of Manitoba, Ontario, southern Quebec, New Brunswick, Nova Scotia and southern British Columbia, and is increasing in south eastern and south central Canada due to spread of populations of the ticks that carry the bacterium that causes Lyme disease.

 

You are most at risk of being exposed to Lyme disease in the regions listed above where blacklegged and western blacklegged ticks are found. But migratory birds can also carry these ticks to other parts of Canada. Current research tells us that blacklegged ticks may be establishing themselves in new areas that are not identified yet. This may mean that risk of Lyme disease may occur over broader regions of Canada than we are presently aware of.

 

Although blacklegged ticks can be active throughout much of the year in some locations, your risk of acquiring Lyme disease, especially in areas where tick populations are established, is greatest during the summer months when younger ticks are most active.

 

Lyme disease is much more common in the United States than in Canada, with risk areas in the Midwest and northeastern states. In 2011, approximately 35,000 cases of Lyme disease were reported in the United States compared to approximately 258 cases in Canada for the same year.

 

(Continue . . . )

 

As Public Health Canada’s Lyme FAQ explains, black legged ticks carry and can transmit more than just Lyme disease:

 

Although rarer than Lyme disease, there are other infections that can also be contracted from blacklegged ticks. These include Anaplasma phagocytophilum, the agent of human granulocytic anaplasmosis; Babesia microti, the agent of human babesiosis and Powassan encephalitis virus. Most of the precautions outlined above will also help to protect individuals from these infections.

 

The CDC lists a growing number of diseases carried by ticks in the United States, including: Anaplasmosis, Babesiosis , Ehrlichiosis, Lyme disease, Rickettsia parkeri Rickettsiosis, Rocky Mountain Spotted Fever (RMSF), STARI (Southern Tick-Associated Rash Illness), Tickborne relapsing fever (TBRF), Tularemia, and 364D Rickettsiosis.

 

We’ve discussed a number these in the past, including:

 

Referral: Maryn McKenna On Babesia And The Blood Supply

NEJM: Emergence Of A New Bacterial Cause Of Ehrlichiosis

New Phlebovirus Discovered In Missouri

tick . . . tick . . . tick . . .

Minnesota: Powassan Virus Fatality

 

When you consider the wide panoply of diseases carried by ticks it makes sense to avoid tick bites whenever possible.

 

This from the Minnesota Department of Health.

 

Lastly, the CDC offers the following advice:

 

Preventing Tick Bites

While it is a good idea to take preventive measures against ticks year-round, be extra vigilant in warmer months (April-September) when ticks are most active.

Avoid Direct Contact with Ticks

• Avoid wooded and bushy areas with high grass and leaf litter.
• Walk in the center of trails.

Repel Ticks with DEET or Permethrin

• Use repellents that contain 20% or more DEET (N, N-diethyl-m-toluamide) on the exposed skin for protection that lasts up to several hours. Always follow product instructions. Parents should apply this product to their children, avoiding hands, eyes, and mouth.
• Use products that contain permethrin on clothing. Treat clothing and gear, such as boots, pants, socks and tents. It remains protective through several washings. Pre-treated clothing is available and remains protective for up to 70 washings.
• Other repellents registered by the Environmental Protection Agency (EPA) may be found at http://cfpub.epa.gov/oppref/insect/.

Find and Remove Ticks from Your Body

• Bathe or shower as soon as possible after coming indoors (preferably within two hours) to wash off and more easily find ticks that are crawling on you.
• Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body upon return from tick-infested areas. Parents should check their children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and especially in their hair.
• Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats, and day packs. Tumble clothes in a dryer on high heat for an hour to kill remaining ticks.

Hong Kong’s H7N9 Hygiene Messaging

All photos credit Hong Kong’s CHP

 

# 7526

 

 

Among the scores of publications produced by Hong Kong’s Centre for Health Protection (CHP) each year is their semi-annual (Jan/July) glossy PDF magazine called the CHP Newsletter.

 

The latest edition (CHP newsletter Issue No.33 (July 2013) ( 6.02 MB)) features a cover story on tuberculosis, a feature article on Hypertension, and then spends considerable time looking at two recent CHP emergency drills –`Exercise Ruby’ which concerned a response to MERS-CoV and `Exercise Amber’ which tested their response to a novel flu outbreak.

 

Hong Kong was hit particularly hard by SARS in 2003. Between March 11th and June 6th of that year a total of 1750 cases were identified, and of those, 286 died.  So Hong Kong authorities are exceptionally proactive when it comes to protecting the city from infectious disease threats.

 

A brief excerpt from the `Amber’ exercise follows:

 

The Exercise aimed at testing the response actions against the locally acquired ‘novel influenza infection’ (simulated) of a Hong Kong citizen, with emphasis on the escalation of the response level in accordance with the risk to the community. The scenario of the exercise was: ‘Emergency’ level response was activated in Hong Kong in times of a novel influenza that had been identified initially in overseas countries recently; 300 such local cases were found and 40 fatalities
were caused.

 

Another feature of this 16-page newsletter is a look at Hong Kong’s public health messaging on preventing the spread of H7N9.

 

Hand hygiene messages are ubiquitous in the city, appearing on billboards, the sides of busses, and in posters in shop windows.

 

PSAs (or what they call APIs – announcement of public interest) abound as well.  Below is an excerpt from the article on how the CHP is leveraging social media and new technologies to get the message out.

 

Two Announcements of Public Interest (APIs) were re-launched for disseminating the health message to the public. The APIs are not only broadcast through electronic media, including television and radio, but
also through the video systems on MTR, buses, minibuses, and even government and commercial buildings.

In view of the rising popularity of smartphones and tablet PCs, CHEU has launched an animated version of the two posters on the Yahoo! Homepage in late April. Both animated ads were also shown on MTR’s digital panel network.

Moreover, health messages on avian influenza were disseminated through non-conventional channels such as newspapers’ mobile applications. With our extensive coverage via different channels, we hope the health messages can reach the members of public and raise their awareness of avian influenza.

 

 

Hong Kong’s CHP continues to impress with not only their extensive public health messaging, but with their proactive exercises and drills and their openness in discussing surveillance and testing with the public for all manner infectious disease threats.

 

Once can’t help but wonder how much further along the world would be in combating emerging infectious disease threats if all other public health agencies around the globe were even half this diligent and forthcoming.

WHO: MERS-CoV Update - July 29th

 

Photo Credit WHO

 

# 7525

 

The World Health Organization has posted a GAR (Global Alert & Response)  update on the MERS-CoV, adding one additional case (and the death of an earlier announced patient) reported by Saudi Arabia.

 

Although media reports surfaced over the weekend on both of these cases, as of this writing, the Saudi MOH coronavirus website has not been updated.

 

 

 

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

29/07/2013

WHO has been informed of an additional laboratory-confirmed case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in Saudi Arabia.

 

The patient is an 83-year-old man from Assir region who became ill on 17 July 2013 and is currently hospitalized.

 

Additionally, a previously laboratory-confirmed case, also from Assir region, has died.

 

Globally, from September 2012 to date, WHO has been informed of a total of 91 laboratory-confirmed cases of infection with MERS-CoV, including 46 deaths.

 

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns.

 

Health care providers are advised to maintain vigilance. Recent travelers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations.

 

Specimens from patients’ lower respiratory tracts should be obtained for diagnosis where possible. Clinicians are reminded that MERS-CoV infection should be considered even with atypical signs and symptoms, such as diarrhea, in patients who are immunocompromised.

 

Health care facilities are reminded of the importance of systematic implementation of infection prevention and control (IPC). Health care facilities that provide care for patients suspected or confirmed with MERS-CoV infection should take appropriate measures to decrease the risk of transmission of the virus to other patients, health care workers and visitors.

 

All Member States are reminded to promptly assess and notify WHO of any new case of infection with MERS-CoV, along with information about potential exposures that may have resulted in infection and a description of the clinical course. Investigation into the source of exposure should promptly be initiated to identify the mode of exposure, so that further transmission of the virus can be prevented.

 

WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.

 

WHO has convened an Emergency Committee under the International Health Regulations (IHR) to advise the Director-General on the status of the current situation. The Emergency Committee, which comprises international experts from all WHO Regions, unanimously advised that, with the information now available, and using a risk-assessment approach, the conditions for a Public Health Emergency of International Concern (PHEIC) have not at present been met.

Aiding & Abetting H5N1 In Nepal

Located as it is between two nations with a long history of outbreaks of H5N1 (India and China), and separated by but a few kilometers from Bangladesh – another bird flu hotspot – it isn’t surprising that bird flu continues to show up in Nepal.

 

 

# 7524

 

Over the past couple of days Crof has carried reports on a number of outbreaks of H5N1 in Nepal (see Nepal: Kathmandu reports 12 H5N1 outbreaks in 13 days & Nepal: H5N1 outbreak in Bhaktapur poultry).

 

Although not as well known for bird flu as Indonesia, Egypt, or Bangladesh, H5N1 has been showing up with some regularity in Nepal since it was first detected in January of 2009 (see Nepal: Concerns Rise Over More Poultry Deaths).

 

In year’s past, outbreaks have occurred in Nepal primarily during the winter months. What is a bit unusual is the timing of this year’s activity, which has seen outbreaks continuing well into the summer (see OIE Follow up Report #9).

 

Worldwide the pattern with the H5N1 virus has been that it declines during the warmer summer months, only to increase when cooler weather returns with the fall and winter. 

 

This pattern is easily seen in the FAO chart below:

 

Of course, outbreaks don’t stop completely during the summer months, particularly in countries where the H5N1 virus is extremely well-entrenched (e.g. Indonesia, Egypt).

 

But there is clearly a seasonal pattern.

 

When an outbreak does occur, the procedure is to quarantine the affected farm and set up an exclusion zone around it from which poultry may not be sold or transported until the outbreak is contained.

 

Infected and exposed birds are culled, while birds in the exclusion zone are tested and monitored for at least 21 days.

 

At least, that’s how things are supposed to work.

 

The reality is that farmers will sometime elect not to report outbreaks immediately in hopes it will burn itself out  - or worse - will attempt to sell off or transport exposed birds before they can fall ill, in order to avoid a major financial loss.

 

Which is what allegedly has recently happened in Nepal, according to this report from the Himalayan Times.

 

According to this report, not only were two farm outbreaks hidden from authorities, infected birds were supposedly sold to local shops.

 

Chickens taken for sale from bird flu detected farm seized

Added At:  2013-07-29 3:30 PM

BHAKTAPUR: Police have seized live chickens being transported to Bhairahawa from a bird flu detected poultry farm in Bhaktapur.

 

The Ganga Jamuna Poultry Farm based in Katunje-2 in Bhaktapur was caught red-handed while transporting 450 live chickens to Bhairahawa.

 

According to District Livestock Service Office Bhaktapur, acting on a tip-off, chickens were seized from Sundarighat of Lalitpur. The confiscated chickens were buried in a ditch near Sundarighat, District Livestock Service Office Lalitpur chief Dr Mugal Prasad Saha said.

(Continue . . .)

 

 

These types of stories are not unusual; we've seen similar reports over the years from China, Vietnam, Egypt, Nigeria and Indonesia. 

 

Not unexpectedly, these types of actions can lead to a wider spread of the virus, endangering not only the local poultry industry, but the lives of people who come in contact with these infected birds.

 

For now, H5N1 remains primarily a threat to poultry. The virus remains poorly adapted to human physiology, and despite ample opportunities to cause illness in humans, the virus only causes rare, sporadic infections.

 

The concern, of course, is that over time the virus will adapt further and pose a pandemic threat to humans.

August Tropical Climatology

Photo Credit NOAA 

 

# 7523

 

 

Mariner’s Poem On Hurricanes

June too soon.
July stand by.
August look out you must.
September remember.
October all over.

- Published in “Weather Lore” by R. Inwards in 1898

 

 

As a native Floridian, and a long-time boater, I’m used to keeping a weather-eye out year round. But come the 1st of August my attention grows keener, and my gaze moves eastward, as the next three months are historically the time when the Atlantic produces the most dangerous tropical activity.

 

As you can see by the chart at the top of this post, the peak of the hurricane season comes in the second week of September, and then slowly tapers off.

 

Hurricanes are driven by the heat of the oceans, and so they tend to form over the shallower Caribbean and Gulf waters – which heat up fastest in the summer – first.  The map below shows the areas likely to produce tropical systems in June.

 

 

By early August, the deeper waters of the eastern and middle Atlantic have soaked up enough heat to make them fertile breeding grounds as well.  These storms are also likely to be stronger, and longer lasting.  

 

 

This morning finds the Atlantic basin fairly quiet, with only the remnants of T.S. Dorian – which sputtered and died last week on its way across the Atlantic – given a 50% chance of resurrection.

 

Credit NHC  Jul 29th, 2013

 

But as we saw last May, NOAA: Expects An Active Hurricane Season Ahead. Their prediction:

 

NOAA’s Atlantic Hurricane Season Outlook says there is a 70 percent likelihood of 13 to 20 named storms (winds of 39 mph or higher), of which 7 to 11 could become hurricanes (winds of 74 mph or higher), including 3 to 6 major hurricanes (Category 3, 4 or 5; winds of 111 mph or higher).

 

This year’s relatively slow start to the hurricane season tells us very little about the months ahead. Horrific Category 5 hurricane Andrew in 1992 – the first named storm of that season – didn’t show up until mid-August.

 

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 pros, and the only ones you should rely on to track and forecast the storm.

 

• 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.

 

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

 

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 your local one, you can Google or Yahoo search with your county/parish name and the words `Emergency Management’.  

 

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

 

If you haven’t already downloaded the Tropical Cyclone Preparedness Guide, now would be an excellent time to do so. It is a short (12-page), easy to follow guide that will walk you through the basics of understanding (and surviving) hurricanes and tropical storms.

 

Although September is National Preparedness Month, those who potentially live in the path of these storms (and that can be hundreds of miles inland) are urged every year to prepare in May, during National Hurricane Preparedness Week.

 

 

Some of my blogs on getting ready for this year’s tropical season include:

 

Hurricane Preparedness Week: Day 6 & 7

Grady Norton: The First Hurricane Forecaster

Hurricane Preparedness Week: Inland Flooding

Hurricane Preparedness Week & The Tale Of The Tape

Storm Surge Monday

National Hurricane Preparedness Week – Day 1

Head ‘Em Off At The Passenger Gate?

Scheduled airline traffic around the world, circa June 2009 – Credit Wikipedia

 

For every complex problem there is an answer that is clear, simple, and wrong. - H. L. Mencken

 

# 7522

 

With MERS-CoV (along with H7N9 & H5N1) still making headlines, this week a new poll indicates that at least 80% of respondents supported the screening of inbound airline passengers from affected countries for this emerging virus.

 

A Reuters story this week (see Support high for travel screening to stem MERS spread: poll) has the details (excerpt below).

 

More than 80 percent of people questioned in developed countries said inbound travelers from countries with cases of MERS should be screened for the illness. The number rose to 90 percent in less industrialized countries.

 

Support was highest in China, Indonesia and Saudi Arabia, where the illness has been reported, and Italy, which has also been affected, as well as in Australia, Canada and Argentina.

 

While an understandable reaction by the public, there is scant evidence to suggest that screening passengers would do much, if anything, to prevent the entry of a viral illness into a country.

 

It’s not that it hasn’t been tried.  It has. But the success rate has been, well . . .  dismal.

 

The world’s airlines carry 2.6 billion passengers each year, on more than 17 million flights.  And as the graphic at the top of this post indicates, millions of these are international flights.

 

With most viral diseases having an incubation period that ranges from a couple of days to a week or longer, someone who is newly infected with a virus could easily change planes and continents several times before ever they ever show signs of illness.

 

 

And as we saw during the 2009 H1N1 pandemic – even those who are symptomatic will often go to great lengths to get to their destination (see Vietnam Discovers Passengers Beating Thermal Scanners).

 

In April of 2012, in EID Journal: Airport Screening For Pandemic Flu In New Zealand, we looked at a study that found the screening methods used at New Zealand’s airport were inadequate to slow the entry of the 2009 pandemic flu into their country, detecting less than 6% of those infected.

 

Admittedly, New Zealand did not employ thermal scanners.  But countries that did, didn’t fare much better.

 

Thermal Scanner – Credit Wikipedia

 

In December of 2009, in Travel-Associated H1N1 Influenza in Singapore, we saw a NEJM Journal Watch article on of a new study that had been published, ahead of print, in the CDC’s  EID Journal  entitled:

 

Epidemiology of travel-associated pandemic (H1N1) 2009 infection in 116 patients, Singapore. Emerg Infect Dis 2010 Jan; [e-pub ahead of print]. Mukherjee P et al

 

Travel-Associated H1N1 Influenza in Singapore

Airport thermal scanners detected only 12% of travel-associated flu cases; many travelers boarded flights despite symptoms.

 

In Japan: Quarantine At Ports Ineffective Against Pandemic Flu  I wrote about a study that suggests between asymptomatic or mild infections, and a silent incubation period of several days, there wasn’t much chance of long-term success.

 

For every person identified, and quarantined, by port authorities  - researchers estimate 14 others infected by the virus entered undetected.

 

This is a topic that Helen Branswell of the Canadian press has written about often, including last April in:

 

Airport disease screening rarely worthwhile, study suggests

Helen Branswell, The Canadian Press
Published Wednesday, April 10, 2013 10:11AM EDT

 

Despite little evidence to suggest that passenger screening would be effective, many governments will probably find it difficult not to be seen at least making the attempt.

 

On a slightly positive note, while they may not stop a virus, passenger screening might provide some interesting surveillance data.

 

But practically, as way to keep a pandemic virus from entering a country, it has a low probability of success.

 

The place to try to stop the next pandemic is not at the inbound passenger gate, but in the places around the world where they are likely to emerge.

 

Which makes the funding and support of international public health initiatives, animal health initiatives, and disease surveillance hugely important, no matter where on this interconnected globe you happen to live.

Referral: VDU on MERS vs. SARS

 

 

# 7521

 

This week’s MERS meme appears to be the comparison of the characteristics of this new coronavirus to the SARS coronavirus of a decade ago (see articles Is MERS another SARS? & MERS and SARS: Similar Not Identical).

 

This debate has been sparked by comments from KSA Deputy Health Minister, Professor Ziad Memish, lead author of a MERS-CoV study published last week (see Lancet: Epidemiological, Demographic & Clinical Characteristics of MERS-CoV).

 

Dr. Memish argues that the vast majority of serious MERS cases in Saudi Arabia have been among the elderly with serious co-morbidities, and has been quoted by Reuters as stating that, "So far there is little to indicate that MERS will follow a similar path to SARS."  

 

But at the same time, Dr. Memish concedes there remain serious gaps in our knowledge of the epidemiology, community prevalence, and clinical spectrum of symptoms from this infection.

 

The impact of infectious diseases can vary widely between populations due to demographic, geographic, economic, and cultural differences. Since SARS never made it into Saudi Arabia in 2003, we really can’t know how it would have affected that particular population. 

Topics that Dr. Ian Mackay addresses this morning in his Virology Down Under blog.  Follow the link to read:

 

MERS-CoV & SARS-CoV zoonoses....what about the endemic human CoVs?

Sunday, 28 July 2013

The Pandemic Preparedness Messaging Dilemma

 

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

 

 

# 7520

 

 

National Preparedness Month (September) is just over a month away, and along with thousands of others across the country, AFD blog is once again proud to be part of this year’s NPM coalition.

 

FEMA and Ready.gov (along with many other state and federal agencies) urge personal, family, business, and community preparedness for all types of natural or man-made disasters, because they know that these events can and will happen.

 

We’re not talking about adopting a Ramboesque `doomsday prepper’ mentality here, but rather a rational and proportional response to genuine – if not entirely predictable – threats (see NPM12: Everyday Preppers).

 

Local, state, and federal officials know that during and following a disaster (hurricane, tornado, flood, earthquake) their ability to respond – particularly during the first 72 hours – may be limited. 

 

They also know that essential services - like electrical power, 911 service, and running potable water - could be out in some communities for days or even weeks.  

 

Which makes having minimum preps (at least 3 days of food & water, first aid supplies, flashlights & lanterns, an NWS emergency radio, and a workable emergency plan) essential for every family and business.

 

Of+ course, 3 days is a minimum recommendation.

Most emergency managers would concede that having more (say, a week or 10 days) would be preferable (see When 72 Hours Isn’t Enough).

 

The County of Los Angeles Emergency Survival Guide calls for having 3 to 10 days worth of food and water. The L.A. guide may be downloaded here (6.5 Mbyte PDF). 

 

And the HHS has historically called for `at least’  2-weeks worth of preps for families to deal with a serious pandemic.

 

But in these tough economic times, telling families and businesses they should prep for 3 days is difficult enough - if agencies set the preparedness bar too high they fear it would discourage some from trying at all.

 

While natural disasters (like earthquakes, hurricanes & floods) are a perennial threat, we are also watching two newly emerging viruses (MERS-CoV & H7N9) – along with H5N1 -  that all appear to have some degree of pandemic potential.

 

And that brings up the old problem of how do we talk (rationally and effectively) about pandemic preparedness – particularly in these difficult economic times - when we can’t know with any certainty that a pandemic is really in the offing?

 

I confess this has been a frequent topic of conversation here in backchannels of Flublogia, and is something that Sharon Sanders of FluTrackers and I wrestle with almost daily.

 

We are both sensitive to the fact that many people are simply not in a position to make extensive preparations, yet we know the more people in a community who are prepared, the better able that community will be to deal with any disaster.

 

Like this blog, FluTrackers promotes an `All Hazards’ preparedness stance.

 

`We believe in the "all disaster" methodology in preparedness. If everyone is prepared for the typical natural disaster threats in their local areas this will be an effective preparation for any infectious disease outbreak.’ – Sharon Sanders.

 

We both stress the importance of creating a good support system among family and friends (see In An Emergency, Who Has Your Back?) and strongly support the AMA’s advice for those with prescription medicine needs to store enough extra to see them through a disaster scenario (see AMA press release PERSONAL MEDICATION SUPPLY IN TIMES OF DISASTER).

 

Back in 2006-2007 many people promoted the idea of having up to 3 months of supplies on hand, including a high profile article in The Medical Journal of Australia called A food “lifeboat”: food and nutrition considerations in the event of a pandemic or other catastrophe.

But for most people this just isn’t practical, and is probably overkill anyway.

 

But a pandemic could cause you and your family to need (or desperately want) to stay home for two weeks or longer, and to do that you would need to have adequate supplies on hand.

 

While much of the pandemic preparedness messaging developed by the HHS between 2005 and 2008 is no longer online, flu.gov still maintains a pandemic planning and preparedness page, where the following appears.

 

 

Their advice (and this is for before a pandemic threat becomes imminent).

 

 

While these (and other) pandemic preparedness documents are available on the Flu.gov  website, and the CDC has been busily issuing interim pandemic guidance to the healthcare community (see CDC: Pandemic Planning Tips For Public Health Officials, H7N9 Preparedness: What The CDC Is Doing), so far there has been very little messaging directed to the general public.

 

I’m certain there is (quite understandable) concern over being perceived as `crying wolf’ again, after the huge build up the HHS gave H5N1 between 2006 and 2008, which still hasn’t produced a pandemic.

 

But of course, the H5N1 story hasn’t been completely written yet, either. 

 

As I said, it’s a dilemma. And I don’t suggest that there are any easy, or obvious answers. 

 

While the odds that we will see a severe pandemic in the near term are probably low (not that anyone really knows), they probably are no more remote than our seeing an 8.0+ earthquake or a CAT 5 hurricane strike a large American city during the same time frame.

 

Threats that are openly discussed and prepared for each and every year (see NPM12: A Whole Lotta Shakeouts Going On & Hurricane Preparedness Week: Day 6 & 7).

 

 

Perhaps there’s something about a pandemic scenario which seems more `real’ and personal than these other disasters, and therefore more difficult to discuss and plan for. After all, it took more than 80 years and the publication of John Barry’s book The Great Influenza, before the Spanish Flu of 1918 re-entered the American conversation.

 

But difficult or not, the pandemic threat needs to considered seriously, and put at least on an equal footing with the other `hazards’ we encourage the public and the business community to prepare for.

 

Not because it is an easy dialog to hold, but because by the time we know a pandemic is truly on the way, it will be well past time to have started that conversation.

 

For far more expert commentary on pandemic preparedness and crisis communications than I can provide, I’d invite you to visit The Peter M. Sandman Risk Communication Website where Dr. Sandman and Dr. Jody Lanard explore these issues often, most recently in:

 

Pandemic preparedness and pandemic stages re H5N1, H7N9, and MERS

 

 

And for those interested, some of my recent pandemic preparedness essays include:

 

The Great Mask Debate Revisited

Pandemic Planning For Business

Practice, Practice, Practice

Arkansas: Naegleria fowleri Shuts Water Park

Photo  Credit Florida DOH

 

# 7519

 

While extraordinarily rare, each summer we usually hear about one or more cases of infection with Naegleria fowleri,  dubbed the `brain eating amoeba’ by the media.

 

Yesterday the Arkansas Department of Health (ADH) confirmed earlier local media reports of a case of PAM (primary amebic meningoencephalitis) due to this parasite in a 12 year-old girl who recently swam in the Willow Springs water park in Little Rock.

 

First stop, the ADH announcements (2), after which I’ll have more:

 

Friday, Jul 26, 2013

ADH Confirms Case of Parasitic Meningitis

Little Rock -- The Arkansas Department of Health (ADH) has confirmed a case of a rare form of parasitic meningitis. A case of primary amebic meningoencephalitis (PAM) -- a very rare form of meningitis caused by an ameba associated with warm rivers, lakes and streams -- was confirmed with the assistance of the Centers for Disease Control and Prevention.

 

Based on our ongoing investigation, the most likely source of infection is the Willow Springs Water Park. There was another case of PAM possibly connected with Willow Springs in 2010. Based on the occurrence of two cases of this rare infection in association with the same body of water and the unique features of the park, the ADH has asked the owner of Willow Springs to voluntarily close the water park to ensure the health and safety of the public.

 

The organism that causes PAM is known as Naegleria fowleri. It is commonly found in warm freshwater and soil all over the world and can cause a rare but severe brain infection that is usually fatal. Naegleria cannot be passed from person-to-person. The organism typically infects people by entering the body through the nose as they are swimming and diving. Individuals cannot be infected with Naegleria by swimming in properly cleaned, maintained and disinfected swimming pools.

 

While infection with Naegleria can occur anywhere, it usually occurs in the warm southern U.S. From 2003-2012, there have only been 31 reported infections in the U.S. This case is only the sixth case in Arkansas in 40 years.

(Continue . . . )

 

Friday, Jul 26, 2013

ADH Offers Further Guidance on Naegleria

Little Rock -- The Arkansas Department of Health (ADH) would like to remind the public that infection from naegleria fowleri, or parasitic meningitis, is very rare. If you swam at Willow Springs Water Park more than 8 days ago, you are NOT at risk for the infection. Even if you swam at Willow Springs in the past week, your risk of infection is exceedingly low.

 

“If you do not have symptoms, there is no test or preventive antibiotic or treatment needed,” said Dirk Haselow, MD, State Epidemiologist at ADH.

 

Persons with infection will develop symptoms such as fever, vomiting, stiff neck, headache, light sensitivity, irritability, sleepiness, confusion, or mental status changes within 7 days. If you develop two or more of these symptoms, please contact your doctor.

The Arkansas Department of Health (ADH) has confirmed a rare case of primary amebic meningoencephalitis (PAM) caused by an ameba associated with warm rivers, lakes and streams. The organism that causes PAM is known as Naegleria fowleri. It is commonly found in warm freshwater and soil all over the world and can cause a rare but severe brain infection that is usually fatal.

 

Naegleria cannot be passed from person-to-person. The organism typically infects people by entering the body through the nose as they are swimming and diving. Individuals cannot be infected with Naegleria by swimming in properly cleaned, maintained and disinfected swimming pools.
For more information visit: LINK

 

 

 

Local media describes this girl’s condition as `stable’, and that she in a medically induced coma. Historically, the prognosis with this type of infection has been very poor, with only 1 patient out of 128 diagnosed in the United States surviving (cite) over the past 50 years.

 

Although the primary route of infection is from swimming in shallow, warm, (usually stagnant) fresh-water lakes and streams, in 2011 we saw a couple of cases in Louisiana related to the use of Neti Pots for nasal irrigation (see FDA Advice On Safe Use Of Neti Pots).

Photo Credit FDA

 

Daily nasal irrigation is also practiced by many in the Muslim community, and that has led to dozens of deaths in recent years in Karachi, Pakistan where tap water standards are suspect. The most recent report I can find comes from late June:

 

Another man dies due to naegleria fowleri

 

KARACHI: The deadly waterborne infection, which is caused by an amoeba Naegleria fowleri claimed another life in the city on Saturday. With this case, the death toll, caused by this fatal infection, is now three since January 2013.

 

Last year, we saw Pakistan: Naegleria Fowleri Blamed For 10 Deaths, while in 2011, the CDC’s EID journal carried the following dispatch on a much bigger outbreak:

 

Primary Amebic Meningoencephalitis Caused by Naegleria fowleri, Karachi, Pakistan

Sadia Shakoor, Mohammad Asim Beg, Syed Faisal Mahmood , Rebecca Bandea, Rama Sriram, Fatima Noman, Farheen Ali, Govinda S. Visvesvara, and Afia Zafar

Abstract

We report 13 cases of Naegleria fowleri primary amebic meningoencephalitis in persons in Karachi, Pakistan, who had no history of aquatic activities. Infection likely occurred through ablution with tap water. An increase in primary amebic meningoencephalitis cases may be attributed to rising temperatures, reduced levels of chlorine in potable water, or deteriorating water distribution systems.

 

 

Since millions of people swim in waters where this amoeba naturally occur (or practice nasal irrigation) and only a small handful of infections result, the odds of acquiring this infection are exceedingly low.  

 

Still, as this infection is almost always fatal, is largely avoidable, and often involves kids - the state of Florida - which has had its share of cases over the years, takes the threat seriously.

 

 

The following short video comes from from the Volusia County Health Department.

 

The Florida Department of Health offers some common sense safety advice on how to avoid this parasite.

 

Photo Credit – Florida DOH

For more information on the Naegleria parasite, you can visit the CDC’s Naegleria webpage.