Icelandic Met Office Raises Alert Level On Katla

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Katla, one of the biggest volcanoes in Iceland, has been showing signs of increased activity this summer after going nearly 100 years without a violent eruption.  Buried under 600 to 2000 feet of glacial ice, Katla has erupted 16 times over the past 11,00 years. 

Over the past 48 hours, shallow earthquake  activity has been unusually high (see chart above), although the telltale signs of rising magma - changes in harmonic tremors - have not been reported.

While this activity could easily subside without an eruption (as we saw with Mt. Hekla in 2011 and 2013), the Icelandic Met Office has taken the precaution of raising the alert level for Katla from Green to Yellow and tourists are being advised to leave the Mýrdalsjökull glacier.

This was posted on the Icelandic Met Office website a short time ago:

Seismic swarm at Katla

30.9.2016

 

An intense seismic swarm is ongoing since yesterday morning 29 September at Katla volcano. An intense pulse started today at 12:02 (30 September) with several earthquakes around magnitude 3 or larger. No seismic tremor has been detected. Due to the unusually high level of unrest at the Katla volcano we rise the aviation colour code from green to yellow. The volcano continues to be monitored closely.

Aviation colour code yellow means that the volcano is experiencing signs of elevated unrest above known background levels. More on colour codes on our website.

We saw a similar alert in late August, when Katla rumbled for several days, before quieting down for several weeks.  So Katla may well rumble for a while, and then return to its century-long slumber.

But Katla is considered `overdue' to erupt, and so the experts are taking this threat seriously.

 
Some local media reports today include:

The colour code for Katla volcano raised to yellow — a new and powerful earthquake swarm hit at noon 

Katla Volcano Could Erupt 

In 2014, after several weeks of rumbling, we saw a Modest Fissure Eruption Near Bárðarbunga, while in the spring of 2010, the relatively small eruption of Iceland’s Eyjafjallajökull volcano sent thick plumes of ash into the atmosphere, closing many air corridors in Europe and disrupting travel for 6 days.

An estimated 100,000 flights were affected, at a cost of over 1.7 billion dollars.  That said, not every volcanic eruption produces large ash plumes.. 

So this volcano, which has the potential for very large eruptions, bears watching.  While there isn't much to see right now, you can monitor the Mt Katla volcano webcam here.

WHO Statement On Zika-Related Microcephaly In Thailand

Credit WHO Zika SitRep

 
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In the wake of the announcement this morning (see Thailand Confirms 2 Zika-Related Microcephalic Births), the World Health Organization has issued the following statement calling for stronger measures against Zika and reminding pregnant women not to travel to areas where Zika is circulating.
 

WHO calls for stronger measures against Zika as Thailand confirms disease-related microcephaly

SEAR/PR/1641

New Delhi, 30 Sep 2016 – The World Health Organization today urged countries across the WHO South-East Asia Region to continue to take decisive action to prevent, detect and respond to Zika virus as Thailand confirmed two cases of Zika-related microcephaly.

“Zika virus infection is a serious threat to the health and wellbeing of a pregnant woman and her unborn child. Countries across the Region must continue to strengthen measures aimed at preventing, detecting and responding to Zika virus transmission,” Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia, said.

Thailand has confirmed two cases of Zika-related microcephaly, which, along with other neurological disorders, can occur when a neonate has been exposed to Zika virus in utero.

“Thai authorities have been active in detecting and responding to Zika virus,” Dr Khetrapal Singh said. “Thailand’s diligence underscores the commitment of health authorities to the health and wellbeing of the Thai public, and provides a positive example to be emulated.”

The presence of Zika virus in the WHO South-East Asia Region has been documented in recent years, including from Thailand, Indonesia, Maldives and Bangladesh.

Since a Public Health Emergency of International Concern was declared in February, WHO has been working with countries across the Region to strengthen Zika virus and birth-defect surveillance; enhance vector surveillance and control; scale-up laboratory capacity; and amplify risk communication and community engagement. All countries now have the laboratory capacity to conduct Zika virus testing, as well as to assess and identify microcephaly cases.

In addition to official efforts, WHO has been urging householders and community groups to be on the frontlines of mosquito control. “Controlling mosquito populations is crucial to diminishing Zika virus transmission, as well as the transmission of other vector-borne diseases such as dengue and chikungunya. Alongside government efforts, householders are encouraged to disrupt standing water that can gather in gutters, pot plants and spare or discarded tires, and to dispose of household waste in sealed plastic bags,” Dr Khetrapal Singh said.

“WHO also urges pregnant women as well as the rest of the general public to take precautions to limit mosquito-human contact, including wearing long-sleeved, light colored clothing; using mosquito repellant; sleeping under a bed net; and fitting windows and doors with screens wherever possible.”

Based on available evidence, WHO does not recommend trade or travel restrictions with countries, areas and/or territories with Zika virus transmission. Travelers to areas with Zika virus outbreaks should seek up-to-date advice on potential risks and appropriate measures to reduce the possibility of exposure to mosquito bites and sexual transmission of Zika.

Pregnant women should be advised not to travel to areas with an ongoing Zika virus outbreak. Pregnant women’s sexual partners living in or returning from areas with Zika virus outbreaks should ensure safer sex or abstain from sex for the duration of their partner’s pregnancy.

For regions with active transmission of Zika virus, WHO recommends correct counselling and that women be offered a full range of contraceptive methods to enable informed choice regarding whether and when to become pregnant. WHO recommends safer sex or abstinence for a period of 6 months for men and women who are returning from areas of active transmission, whether they are trying to conceive or not.

#NatlPrep: Today Is National PrepareAthon! Day

 

Note: This is day 30 of National Preparedness Month . Follow this year’s campaign on Twitter by searching for the #NatlPrep hash tag.

This month, as part of NPM16, I’ll be rerunning some edited and updated older preparedness essays, along with some new ones.

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All month long FEMA, READY.Gov, state and local Emergency agencies, and grassroots coalition members (including this blog) have been promoting National Preparedness Month through community events, drills, and exercises.

Over the past 30 days I've written roughly 20 preparedness blogs, some of which I hope you have found useful. To view them (newest to oldest) click this link.

Today is the culmination of these combined efforts, where it is hoped that you and your family will take action, review their local threats, and increase their level of preparedness to deal with them.

Although preparedness takes a lot of forms, FEMA has some basic steps to get you started.

Take Action and Be Disaster Ready: National PrepareAthon! Day

Release date: 

September 27, 2016

Release Number: RV-NR-2016-13

 

CHICAGO –Join National PrepareAthon! Day on September 30 and take action to improve your emergency preparedness and resilience to disasters.  America's PrepareAthon! is a grassroots campaign developed to encourage individuals, organizations and communities to prepare for specific hazards through drills, group discussions and exercises.

“It’s important to be proactive about emergency preparedness so you know what to do if disaster strikes,” said FEMA Region V Administrator Andrew Velasquez III. “Engage your family, friends and neighbors to identify the risks in your community and understand what to do to stay safe.”

• Sign up for local alerts and warnings and check for access to wireless emergency alerts. Visit the websites for your city and/or county to find out if they offer emergency alert notifications. You should also ensure your cell phone is enabled to receive Wireless Emergency Alerts (WEA) to warn you of extreme weather and other emergencies in your area. Remember, warning sirens are intended for outdoor notification. When indoors, your alert-enabled smart phone or weather radio can provide you with critical alerts.
  
• Develop and test emergency communications plans. Visit www.Ready.gov/plan-for-your-risks for tips on how to ensure your plan is as comprehensive as possible.
  
• Assemble or update emergency supplies. Include drinking water, a first-aid kit, canned food, a radio, flashlight and blankets. Visit www.Ready.gov/build-a-kit for a disaster supply checklist. Don’t forget to store additional supply kits in your car and at the office.
  
• Collect and safeguard critical documents. Make copies of important documents (mortgage papers, deed, passport, bank information, etc.). Keep copies in your home and store originals in a secure place outside the home, such as a bank safe deposit box.
  
• Document property and obtain appropriate insurance for relevant hazards. Discuss with your insurance agent the risks that may threaten your home and the types of coverage you may need to ensure your property is adequately insured.
  
• Download the FEMA app to your smartphone. You’ll receive alerts from the National Weather Service for up to five locations across the U.S. and have access to information about how to stay safe.

More information about the ways to register for and participate in America’s PrepareAthon! Day is available at 
www.Ready.gov/prepare. For even more readiness information, follow FEMA Region V at twitter.com/femaregion5 and facebook.com/fema.

Follow FEMA online at twitter.com/femaregion5, www.facebook.com/fema, and www.youtube.com/fema.  Also, follow Administrator Craig Fugate's activities at twitter.com/craigatfema. The social media links provided are for reference only. FEMA does not endorse any non-government websites, companies or applications.

FEMA’s mission is to support our citizens and first responders to ensure that as a nation we work together to build, sustain, and improve our capability to prepare for, protect against, respond to, recover from, and mitigate all hazards.

As you can see, it doesn't  take a huge investment in either time or money for you and your family to become better prepared.  It just takes the resolve to do so.  But I can assure you, just having the peace of mind knowing you are prepared for an emergency is well worth the effort.
 

After all, preparing is easy . . . it’s worrying that is hard.

CDC Issues Zika Travel Recommendations For Southeast Asia

Zika Transmission in Asia- Credit ECDC

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For just over a month we've been watching as the number of Zika virus infection reported by Southeast Asian nations has grown (see Zika Updates: Singapore - Malaysia - Thailand) raising new concerns for the spread of the virus.

While the numbers remain small compared to what has been reported from South and Central America, surveillance in many areas is just starting to ramp up, and so the actual risk is difficult to gauge. 

Last night the CDC issued new travel advice for 11 Southeast Asian Nations.  Follow the link to read the full report.

Zika Virus in Southeast Asia

What is the current situation?

Travelers have returned from certain areas of Southeast Asia with Zika virus infection. While our understanding of the complications of Zika virus infection continues to evolve, and pending broader international surveillance efforts for Zika virus infection, we are providing pregnant women and their partners updated recommendations on reducing their risk for travel related Zika virus infection.

CDC recommends pregnant women should consider postponing nonessential travel to Southeast Asia countries with reports of Zika virus infection from local transmission or related to travel to those countries, and those countries with adjacent borders where limited information is available to fully evaluate risk of Zika virus infection.

Zika virus has been present in areas of Southeast Asia for many years, and several countries have reported occasional cases or small outbreaks of Zika virus infections. Zika virus is considered endemic in some countries, and a large number of local residents are likely to be immune. However, US travelers to endemic areas may not be immune to Zika virus and infections have occurred among travelers to Southeast Asia.

Recent variations have been observed in the number of cases reported in Southeast Asia. This can reflect changes in awareness of Zika virus, surveillance and testing for Zika virus, or changes in intensity of Zika virus transmission. Pregnant women traveling to Southeast Asia could become infected with Zika virus. The level of this risk is unknown and likely lower than in areas where Zika virus is newly introduced and spreading widely.

Countries included in this travel message include those listed below. For country-specific information, please visit Health Information for Travelers for individual countries:

• Brunei
• Burma (Myanmar)
• Cambodia
• Indonesia
• Laos
• Malaysia
• Maldives
• Philippines
• Thailand
• Timor-Leste (East Timor)
• Vietnam

Travel Considerations for Pregnant Women Traveling to Southeast Asia

Zika virus infection during pregnancy causes severe birth defects, including microcephaly and severe fetal brain abnormalities. Therefore, pregnant women should talk with their healthcare provider and consider postponing nonessential travel to Southeast Asia. Zika virus testing should be offered to pregnant women and considered for other people who have symptoms of Zika virus disease if they have recently traveled to Southeast Asia.

       (Continue . . . . )

Thailand Confirms 2 Zika-Related Microcephalic Births

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The Asian strain of Zika has been circulating - presumably at low levels - in Asia for a couple of decades. But unlike we've seen over  the past year in the Americas, maternal infection with the virus in Asia has not been linked to congenital defects.


Over the past few weeks, however, we've seen a spike in the number of Zika cases reported in Asia, and concerns it may have led to congenital defects. This from the World Health Organization's Zika Update of Sept 29th.

• Countries in the Western Pacific Region continue to report new cases as seen in Singapore, Philippines, Malaysia and Viet Nam. Thailand, in the South-East Asia Region, has also recently reported Zika cases. Key areas of the response as identified by members of the Association of Southeast Asian Nations (ASEAN) are disease surveillance and risk assessment, relevant and timely sharing of data, regional surveillance and response, vector control, diagnostic testing, laboratory networks and risk communication, and sharing knowledge and best practices. The Ministry of Public Health of Thailand is investigating cases of microcephaly to determine if they may be linked to Zika infection.  
• The investigation of microcephaly cases in Thailand is important to determine whether these cases are linked to Zika infection – if found to be linked, these would be the first identified cases of Zika-associated microcephaly in Southeast Asia. If Zika is identified, viral sequencing would be necessary to determine the strain of the virus to determine whether it is a local or imported strain.

Less than 24 hours later, we appear to have an answer.  This from Xinhua News.

Two Thai babies confirmed born with Zika-linked microcephaly

Source: Xinhua   2016-09-30 16:08:22  

BANGKOK, Sept. 30 (Xinhua) -- Thailand confirmed on Friday that the Zika virus had caused two cases of microcephaly, a condition results in babies being born with small heads, which is the first time microcephaly had been linked to Zika virus in Southeast Asia.

"We have found three infants who are born with microcephaly and two cases are caused by Zika," Prasert Thongcharoen, an adviser to the Department of Disease Control, told reporters in Bangkok, according to Thai media Khaosod.

"As for the third infant, we have not detected the virus until now, " Prasert said, adding that their is still a suspected case of microcephaly in an unborn baby.

He said a team has be set up to look up the mother of the unborn baby and try their best to keep her from being infected with Zika.

The World Health Organization said this was the first Zika-linked microcephaly in Southeast Asia.

Similar reports are available from Reuters and the AP.

It isn't clear at this time is whether these cases indicate that a change has occurred in the virus, making it more virulent, or if birth defects from Zika have occurred all along in Asia, but were at such a low level they we're never linked to the virus.

In either event, Zika in Southeast Asia is rapidly becoming a new front for the battle against the virus.

EID Journal: Reassortant EAH1N1 Virus Infection In A Child - Hunan China, 2016

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While we watch as avian influenza viruses make tentative jumps to humans - and are justifiably concerned over their pandemic potential -  many researchers believe that pigs may pose an even bigger risk of producing the next pandemic virus.


Last December, in PNAS: The Pandemic Potential Of Eurasian Avian-like H1N1 (EAH1N1) Swine Influenza, we looked at a study where researchers had isolated and characterized a number avian H1N1 virus variants circulating in Chinese pigs that had the ability to infect, and potentially transmit efficiently, in humans.

In the `Significance' section the authors boiled it down to this:

Here, we found that, after long-term evolution in pigs, the EAH1N1 SIVs have obtained the traits to cause a human influenza pandemic.

Xinhua News carried an English Language report on this study, with interviews with the lead author, which you can read at the following link:

 Avian-like H1N1 swine flu may "pose highest pandemic threat": study

In March of this year (see WHO: H1N1v Cases In China), it was revealed that during 2015 China had reported 3 H1N1v infections, including a 30 month old boy from Hunan Province, described as follows:

A 2.5-year-old male from Hunan Province with illness onset on 30 June 2015 was detected through sentinel Severe Acute Respiratory Infection (SARI) surveillance. The patient was hospitalized with pneumonia and later recovered. He had no underlying medical conditions. The case investigation found that the case was exposed to pigs in his village. 

And in June, in Sci Rpts: Transmission & Pathogenicity Of Novel Swine Flu Reassortant Viruses we looked at another study - again out of China - where researchers experimentally infected pigs with one of these  Eurasian-Avian H1N1 swine influenza viruses and the 2009 H1N1pdm virus.


In doing so, they generated yielded 55 novel reassortant viruses spread across 17 genotypes, demonstrating not only how readily EAH1N1 SIV can reassort with human H1N1pdm in a swine host, but also finding:

`Most of reassortant viruses were more pathogenic and contagious than the parental EA viruses in mice and guinea pigs'. 

All of which brings us to an EID Journal report today, on the 30-month old child from Hunan Province, who was infected with one of these reassortant EAH1N1 viruses.

Not only do we learn about the course, and severity, of the child's illness, we also learn that in a mouse model, this reassortant virus displayed increased infectivity and virulence.

It's a long, detailed report, and you'll probably want to read it in its entirety.  I've provided some excerpts below:

Volume 22, Number 11—November 2016
Research
Reassortant Eurasian Avian-Like Influenza A(H1N1) Virus from a Severely Ill Child, Hunan Province, China, 2015
 
Wenfei Zhu1, Hong Zhang1, Xingyu Xiang1, Lili Zhong, Lei Yang, Junfeng Guo, Yiran Xie, Fangcai Li, Zhihong Deng, Hong Feng, Yiwei Huang, Shixiong Hu, Xin Xu, Xiaohui Zou, Xiaodan Li, Tian Bai, Yongkun Chen, Zi Li, Junhua LiComments to Author , and Yuelong Shu Comments to Author
 
Abstract

In 2015, a novel influenza A(H1N1) virus was isolated from a boy in China who had severe pneumonia. The virus was a genetic reassortant of Eurasian avian-like influenza A(H1N1) (EA-H1N1) virus. The hemagglutinin, neuraminidase, and matrix genes of the reassortant virus were highly similar to genes in EA-H1N1 swine influenza viruses, the polybasic 1 and 2, polymerase acidic, and nucleoprotein genes originated from influenza A(H1N1)pdm09 virus, and the nonstructural protein gene derived from classical swine influenza A(H1N1) (CS H1N1) virus.

 In a mouse model, the reassortant virus, termed influenza A/Hunan/42443/2015(H1N1) virus, showed higher infectivity and virulence than another human EA-H1N1 isolate, influenza A/Jiangsu/1/2011(H1N1) virus. In the respiratory tract of mice, virus replication by influenza A/Hunan/42443/2015(H1N1) virus was substantially higher than that by influenza A/Jiangsu/1/2011(H1N1) virus. 

Human-to-human transmission of influenza A/Hunan/42443/2015(H1N1) virus has not been detected; however, given the circulation of novel EA-H1N1 viruses in pigs, enhanced surveillance should be instituted among swine and humans.

 (SNIP)

EA-H1N1 SIVs have been shown to preferentially bind to human-type receptors, and ferrets have been experimentally infected with some EA-H1N1 SIVs via respiratory droplet transmission (12). EA-H1N1 SIVs reportedly have the potential to transmit efficiently and cause a pandemic among humans after long-term evolution in pigs (12). We report a severe human infection with a reassortant influenza virus in China and the results of genetic, infectivity, and virulence investigations of the novel virus.

(SNIP)

Discussion

In conclusion, EA-H1N1 swine influenza viruses occasionally infect humans. We report on a novel EA-H1N1 virus reassortant, HuN EA-H1N1 virus, which was isolated from a boy in China with severe pneumonia. The virus contained 2 surface genes from an EA-H1N1 virus and 4 internal genes from A(H1N1)pdm09 virus.

Compared with JS/1/11 EA-H1N1 virus, the reassortant virus exhibited higher infectivity, virulence, and replication in C57BL/6J mice, demonstrating the need for further evaluation of HuN EA-H1N1 virus to assess the threat it poses to public health. Our results indicate the need for heightened surveillance.

Dr. Zhu is an influenza researcher at the Chinese National Influenza Center, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention. Her research interests include evolutionary analysis and pathogenicity mechanism of influenza viruses.

Since the influenza subtypes that commonly circulate in swine (H1, H2 & H3) are also the same that have caused all of the human pandemics going back 130 years (see Are Influenza Pandemic Viruses Members Of An Exclusive Club?), they are generally regarded as having less far to `jump’ to humans than many avian viruses.

Which is precisely how the H1N1 pandemic virus emerged in 2009, after kicking around (and reassorting in) swine herds for a decade or longer.

Which is why we watch reports like today's with particular interest. For more on swine variant viruses, both in the United States and around the world, you may wish to revisit:

CDC On Protecting Against Swine Variant Viruses

Front. Microbiol.: A Novel H1N2 Reassorted Influenza Virus In Chinese Pigs

Eurosurveillance: Seroprevalence Of Cross-Reactive Antibodies To Swine H3N2v – Germany
 
JID: Evolutionary Dynamics Of Influenza A Viruses In US Exhibition Swine 

Live Markets & Novel Flu Risks In The United States

BMJ Research: NSAIDs & The Risk Of Heart Failure

Highlights

• New BMJ Research Article Links NSAID use to Heart Failure
• BMJ Editorial On NSAIDs and The Failing Heart

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NSAIDs (non-steroidal anti-inflammatory drugs) are likely the most commonly consumed class of medication in the world. While most people assume these drugs are perfectly safe if taken as directed – like with all medicines, there are always possible downsides.

No drug is 100% benign, 100% of the time, for 100% of the population.

Over the past dozen years or so the evidence linking the use of NSAIDs - both Rx and OTC - to adverse cardiac events has steadily grown.

• In 2004 Vioxx, a COX-2 inhibitor which had been marketed by Merck as being less likely to cause stomach bleeding, was abruptly pulled from the market after a study showed that prolonged use increased one’s chances of having a heart attack or stroke.
• Bextra, another COX-2 inhibitor, was also recalled after it was linked to increased cardiovascular accidents and to several rare, but potentially deadly, skin disorders.
• In 2005, the FDA required the inclusion of a `black box warning’ for prescription NSAIDs and a couple of years later stiffened the labeling requirements on OTC NSAIDs as well. 

In 2011 we explored a pair of studies that looked at NSAID use and the increased risk of cardiovascular events (see NSAIDs and Prior Heart Attacks). 

• The BMJ published an open access meta-analysis on the safety of NSAIDs called Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis that concluded: Although uncertainty remains, little evidence exists to suggest that any of the investigated drugs are safe in cardiovascular terms.  
• The American Heart Association  Journal Circulation looked at the risks of NSAID use among those who have previously had a heart attack (Duration of Treatment With Nonsteroidal Anti-Inflammatory Drugs and Impact on Risk of Death and Recurrent Myocardial Infarction in Patients With Prior Myocardial Infarction) that found that even short duration treatment (1 week) with NSAIDs resulted in a 45% increased risk of death or recurrent M.I. in those who had previously had a heart attack.

And just last year, we saw the FDA Strengthen Warnings Of Cardiovascular Risks With NSAIDs, issuing a communique with the following findings: 

• The risk of heart attack or stroke can occur as early as the first weeks of using an NSAID. The risk may increase with longer use of the NSAID.
• The risk appears greater at higher doses.
• It was previously thought that all NSAIDs may have a similar risk. Newer information makes it less clear that the risk for heart attack or stroke is similar for all NSAIDs; however, this newer information is not sufficient for us to determine that the risk of any particular NSAID is definitely higher or lower than that of any other particular NSAID.
• NSAIDs can increase the risk of heart attack or stroke in patients with or without heart disease or risk factors for heart disease. A large number of studies support this finding, with varying estimates of how much the risk is increased, depending on the drugs and the doses studied.
• In general, patients with heart disease or risk factors for it have a greater likelihood of heart attack or stroke following NSAID use than patients without these risk factors because they have a higher risk at baseline.
• Patients treated with NSAIDs following a first heart attack were more likely to die in the first year after the heart attack compared to patients who were not treated with NSAIDs after their first heart attack.
• There is an increased risk of heart failure with NSAID use.

It should be noted that while relative risks of having a heart attack, heart failure, or stroke while taking some of these drugs may double, in terms of absolute risk, the numbers go up far less.  If your risk of having a heart attack is 1%, and it goes up by 20% by taking the drug, you are still only at a 1.2% chance of a cardiac event.

Like just about everything else in life, the taking of any medicine involves balancing the risks and the rewards.

Last year the FDA recommended that people with heart disease or high blood pressure consult a health care provider before taking NSAIDs, and that everyone try to take the lowest effective dose for the shortest length of time possible.

All of which brings us to a new open-access research article appearing in the BMJ describing a nested case-control study based on almost 10 million NSAID users from 4 European nations.

You'll want to follow the link below to read the full study, as I've only excerpted the main findings.

Non-steroidal anti-inflammatory drugs and risk of heart failure in four European countries: nested case-control study

 BMJ 2016; 354 doi: http://dx.doi.org/10.1136/bmj.i4857 (Published 28 September 2016) Cite this as: BMJ 2016;354:i4857 
 

Results Current use of any NSAID (use in preceding 14 days) was found to be associated with a 19% increase of risk of hospital admission for heart failure (adjusted odds ratio 1.19; 95% confidence interval 1.17 to 1.22), compared with past use of any NSAIDs (use >183 days in the past). 

Risk of admission for heart failure increased for seven traditional NSAIDs (diclofenac, ibuprofen, indomethacin, ketorolac, naproxen, nimesulide, and piroxicam) and two COX 2 inhibitors (etoricoxib and rofecoxib). Odds ratios ranged from 1.16 (95% confidence interval 1.07 to 1.27) for naproxen to 1.83 (1.66 to 2.02) for ketorolac.

Risk of heart failure doubled for diclofenac, etoricoxib, indomethacin, piroxicam, and rofecoxib used at very high doses (≥2 defined daily dose equivalents), although some confidence intervals were wide. Even medium doses (0.9-1.2 defined daily dose equivalents) of indomethacin and etoricoxib were associated with increased risk. There was no evidence that celecoxib increased the risk of admission for heart failure at commonly used doses.

Conclusions The risk of hospital admission for heart failure associated with current use of NSAIDs appears to vary between individual NSAIDs, and this effect is dose dependent. This risk is associated with the use of a large number of individual NSAIDs reported by this study, which could help to inform both clinicians and health regulators.

 

What this study adds

• Use of seven individual traditional NSAIDs (diclofenac, ibuprofen, indomethacin, ketorolac, naproxen, nimesulide, and piroxicam) and two individual COX 2 selective NSAIDs (etoricoxib and rofecoxib) is associated with and increased risk of hospital admission for heart failure
• Risk of admission for heart failure is doubled for some NSAIDs used at very high doses
• Estimates of the risk of heart failure associated with the use of many individual NSAIDs in this study could help to inform both clinicians and health regulators

This study, despite its size, is subject to a number of limitations (listed in the article), but it provides additional evidence that NSAID use may be linked to higher rates of heart failure.

Statistically, some NSAIDs produced a much greater impact than others, so those who are concerned will want to discuss their options with their health care provider.

 

T.S. Mathew Forms In The Caribbean

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As forecasters have been expecting for several days, a `lowriding' tropical wave that has been making its way across the Atlantic for the past week has entered the Caribbean - and more favorable conditions - and has intensified into a tropical story named Mathew.

Mathew is forecast to grow into a hurricane over the next couple of days as it treks west, and then is expected to make a sharp turn north by the weekend.

While the current track takes it across or near Jamaica and then Cuba, the exact timing of that northerly turn is impossible to predict.  This is one that everyone - from the Gulf of Mexico to the Atlantic Seaboard, needs to monitor.


 The National Hurricane Center's initial discussion states:

Since the center has very recently formed, the initial motion
estimate is a highly uncertain 275/18 kt.  A strong deep-layer ridge over the western Atlantic should steer Matthew westward across the eastern Caribbean during the next few days, and the track guidance is tightly clustered through 72 hours.  After that time, the tropical cyclone will be approaching the western portion of the ridge and a northwestward turn is expected, although there are significant differences among the track models as to when the turn takes place and how sharp it will be.  The GFS takes the cyclone northwestward much faster than the ECMWF with more troughing developing over the eastern Gulf of Mexico.  For now, the NHC track lies near a consensus of the faster GFS and slower ECMWF.

Simply put, the storm is too new, and the variables are too great, to put a lot of stock in the models more than 72 - 96 hours out.

I suspect there will  be a good deal of press coverage of the models over the next couple of days, since some of them show a threat to the Atlantic Seaboard early next week. 

While that could happen, there are other models that put the storm into the Gulf of Mexico or South Florida.  We should have a much better idea where Mathew will go by the weekend.


While most people heave a sigh of relief after September when it comes to hurricanes, the season lasts until the end of November, and as Superstorm Sandy proved in 2012 - late season storms can be formidable.


So, if you haven’t already downloaded the updated Tropical Cyclone Preparedness Guide, now would be an excellent time to do so. You'll find additional preparedness information in my Hurricane Preparedness 2016 post from last May.


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

And if you are on Twitter, you'll want to follow @FEMA, @CraigatFEMA, @NHC_Atlantic, @NHC_Pacific and @ReadyGov.

 

DEFRA: Update On HPAI & LPAI Avian Flu Outbreaks in France

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Two months ago in DEFRA: Update On HPAI Outbreaks In France
we looked at the UK's Department of  Environment, Food and Rural Affairs mid-summer update on a prolonged, and multi-subtype string of avian flu outbreaks in Southern France which began last November. 

These outbreaks involved new strains of HPAI H5N1, H5N2, and H5N9, along with LPAI H5N2 and H5N3.  All are reported to be of European lineage, and unrelated to the more dangerous Eurasian H5N1 virus.

Since then we've only seen a handful of new detection's (see France: Another HPAI H5 Outbreak In Aveyron & FAO LPAI 15/09/2016: France - Influenza - Avian), raising hopes that the threat may be winding down.

The summer, however, is typically a time where avian flu outbreaks decline. So with the onset of fall, reminders are going out to all poultry producers on the importance of maintaining good biosecurity and promptly reporting any signs of infection.

I've excerpted the majority of the report, but follow the link to read it in its entirety. 

Updated Outbreak Assessment Avian Influenza (H5N1, H5N2, H5N3 and H5N9) in poultry in France

26 September 2016
Ref: VITT/1200 HPAI /LPAI 

 Disease Report

Since the last update on the 20th July, a small number of outbreaks in poultry have been reported as a result of increased surveillance in South West France (see map for outbreaks reported since the fallow period began). To date there have been 81 outbreaks of HPAI H5 (N1, N2 and N9) and nineteen outbreaks of LPAI H5 (N2 and N3) which have been reported to the EU Animal Disease Notification System since the disease was first confirmed in November 2015. The latest results are an increase of two HPAI and three LPAI outbreaks on July’s figures (OIE, 2016; Huneau-Salaün et al., 2016). Disease control measures in line with EU rules have been put in place around each infected premises including culling all poultry present.

The restriction zone (under an amendment to Implementing Decision 2015/2460/EU) remained in place until the 15th September but has now been lifted on the basis of the French eradication plan and level of surveillance carried out in the last few weeks.

Situation Assessment

France has been carrying out surveillance in the Restriction Zone and reporting the results of this testing, in order to lift the zone this September. For more information see the French Epidemiology platform at http://www.plateforme-esa.fr/

According to Huneau-Salaün et al (2016) the surveillance entailed testing to detect 1% prevalence, with 99% confidence in poultry holdings with ducks and geese destined for production. This included young birds, fattening birds and the gavage units. For the young birds, up to 3-4 weeks of age, virological testing only was carried out on statistical samples. For fattening units, serological testing was done, with follow-up PCRs if positive results are found. At the gavage holdings, for birds destined for slaughter, statistical sampling by serology and PCR was undertaken.

The same prevalence level was used for the Galliform poultry which were located close to holdings for ducks and geese (as these are considered at higher risk). Samples were only taken where clinical suspicion was reported following veterinary clinical inspection. The majority of surveillance has now been completed. No outbreaks were detected in the gavage units or in the Galliform units.

Since surveillance began at the beginning of the year, 96 serology positive (virus negative) breeding premises have been detected, of which 19 were in the free zone (and were depopulated) and 77 were in the restriction zone. These will be under restriction until March 2017 and tested regularly, although 15 have pre-emptively culled.

In total, prior to the disinfection and fallow period, 93 outbreaks were detected. Since that period (on the 15th July) there have been just seven detections of HPAI or LPAI. In terms of premises visited or tested, there were 425 Galliform holdings, 287 samples taken at slaughter houses, 231 at gavage units and 421 at holdings for young and fattening birds (pre-gavage). It is the latter group where there are still some seropositive birds and these will remain restricted and retested until March 2017.

As additional evidence about lifting the zones, surveillance has been carried out in wild birds in the restriction zone, and commensal wild birds (mainly passerines) around the outbreaks (Anses, 2016). During the programme, 32 wild species were tested (600 samples); over 100 droppings from heronries (migratory Ibis) close to outbreaks; 10 samples from raptors in the restriction zone; 23 samples from crows from an area close to the outbreaks. All tested negative by PCR. The conclusions of the study were that if virus has spread from the poultry into wild birds, the prevalence of infection would be very low; that it would be unlikely the viruses were maintained in wild birds; if wild birds had been infected, the prevalence would have been very low and therefore unlikely to be a source of contamination when the farms were restocked.

Conclusion

Any new outbreaks detected in France will be treated as any other outbreaks of avian influenza in poultry in accordance with EU rules, but the strict sanitary measures which were put in place across the wide restriction zone to allow C&D to take place, will now be lifted as a result of the surveillance results.

We will continue to monitor the situation as usual. We would like to remind all poultry keepers to maintain high standards of biosecurity, remain vigilant and report any suspect clinical signs promptly and in addition using the testing to exclude scheme for avian notifiable disease where appropriate for early safeguard. For more information, please see
www.defra.gov.uk/ahvla-en/disease-control/nad

The risk level for the UK remains at low, but heightened.

South Australia Blackout Due To Severe Storms

Credit Wikipedia

#11,774

A week ago today, in Puerto Rico's Blackout, we saw the power grid go down for several million people for roughly 60 hours.   Today, it appears that the entire state of South Australia is without electrical power in the wake of a violent spring storm. 

The following are pinned tweets on the South Australian Power Network's twitter feed.

https://twitter.com/SAPowerNetworks

The ABC News live blog - updated about 9am EDT - shows:

44 minutes ago

That's where I'll be leaving the live blog tonight. I hope you've got some power back, or at least aren't running out of candles...

Keep an eye on the BOM website for the latest weather updates - the winds and storm surges tomorrow are forecast to be quite destructive.

So, to recap:

• Power is continuing to be restored overnight. Metro areas will be first
• People in the state's north are likely to be without power for "considerably longer than the rest of the state"
• There are no reports of deaths or serious injury
• Adelaide Metro trains are expected to be running from Thursday morning
• All schools in the state will be open, but some still without power may have different programs

Although this outage is blamed on severe weather, and power is already being restored to some areas, this is another reminder of just how dependent we are on the grid, and why we need to be prepared for prolonged outages.


It was just a week ago that I posted #NatlPrep: Revisiting The Lloyds Blackout Scenario, which looked at multiple vulnerabilities to our electrical infrastructure, and how we should prepare as individuals to cope if the power goes off for days or longer.

Among them, are having:

• A battery operated NWS Emergency Radio to find out what was going on, and to get vital instructions from emergency officials.
• A decent first-aid kit, so that you can treat injuries 
• Enough non-perishable food and water on hand to feed and hydrate your family (including pets) for the duration 
• A way to provide light (and in cold climates, heat) for your family without electricity.   And a way to cook.  And to do this safely.
• A small supply of cash to use in case credit/debit machines are not working.
• An emergency plan, including meeting places, emergency out-of-state contact numbers, a disaster buddy,  and in case you must evacuate, a bug-out bag
• Spare supply of essential prescription medicines that you or your family may need 

As demands on our infrastructure grow, the equipment in the field gets older, and violent weather and other disasters continually test the system, the odds of seeing widespread and prolonged power outages increases.

We may not be able to prevent these blackouts from happening, but we can be prepared for them, when they occur. 

For more on preparing for all types of emergencies, I’d invite you to visit: 

FEMA http://www.fema.gov/index.shtm
READY.GOV http://www.ready.gov/
AMERICAN RED CROSS http://www.redcross.org/

#NatlPrep: Radiological Emergencies

Credit CDC PHE

Note: This is day 28 of National Preparedness Month . Follow this year’s campaign on Twitter by searching for the #NatlPrep hash tag.

This month, as part of NPM16, I’ll be rerunning some edited and updated older preparedness essays, along with some new ones.

#11,773



For most Americans, the notion that we might have to deal with a radiological emergency sounds like something out of the Cold War era (1950s to the 1980s), when multiple Soviet warheads were targeted on every major American city and nuclear annihilation seemed all but unavoidable.

Today, we’ve pulled back from that brink, have reduced our nuclear stockpiles by 80%, and a global thermonuclear war seems unlikely.

But radiological threats remain, both due to deliberate acts, and due to accidents and natural disasters.  One need look only as far as the Fukushima disaster of 2011 to see how quickly a radiological emergency can affect a large population.
 
This from the CDC’s PHE website:

A radiological or nuclear incidents occurring within the U.S. homeland or elsewhere could take a number of forms, including: contamination of food or water with radioactive material; placement of radiation sources in public locations; detonation of radiological dispersal devices that scatter radioactive material over a populated area; an attack on a nuclear power plant or a high-level nuclear waste storage facility; or an improvised nuclear device.

The CDC's Emergency Preparedness and Response website lists 6 different types of potential radiological emergencies.

Types of Radiation Emergencies

Radiation emergencies may be intentional (e.g., caused by terrorists) or unintentional. Below are some examples of different types of radiation emergencies. Click on the icons to find out what to do if a radiation emergency happens in your area.

Nuclear Emergencies

• A nuclear emergency involves the explosion of a nuclear weapon or improvised nuclear device (IND).
• The explosion produces an intense pulse of heat, light, air pressure, and radiation.
• Nuclear explosions produce fallout (radioactive materials that can be carried long distances by the wind).

Dirty Bomb or Radiological Dispersal Device (RDD)

• A dirty bomb (also known as a radiological dispersal device) is a mix of explosives such as dynamite, with radioactive powder or pellets.
• A dirty bomb cannot create an atomic blast.
• When the explosives are set off, the blast carries radioactive material into the surrounding area.
  

Radiological Exposure Device (RED)

• A radiological exposure device (also called a hidden sealed source) is made of or contains radioactive material.
• REDs are hidden from sight to expose people to radiation without their knowledge.

Nuclear Power Plant Accident

• An accident at a nuclear power plant could release radiation over an area.
• Nuclear power plants have many safety and security procedures in place and are closely monitored by the Nuclear Regulatory Commission (NRC)

Transportation Accidents

• It is very unlikely that a transportation accident involving radiation would result in any radiation-related injuries or illnesses.
• Shipments involving significant amounts of radioactive material are required to have documentation, labels, and placards identifying their cargo as radioactive.
  

Occupational Accidents

• Radiation sources are found in a wide range of settings such as health care facilities, research institutions, and manufacturing operations.
• Accidents can occur if the radiation source is used improperly, or if safety controls fail.

The point of this blog is not to convince you that you should be preparing specifically for a radiological emergency - since being well prepared for far more common emergencies will cover most of your bases - but rather that you and your family should know what to do if a radiological release occurs.

The three basic tenants of radiation safety are:

Follow this link to review specifics on each of these topics, where you'll find a variety of information and helpful infographics - like the one below on decontamination - on what to do.

While a radiological hazard may be far down your list of `probable’ threats, being generally well prepared to shelter in place - and having a little bit of knowledge -  can go a long way towards protecting you and your family, even during a radiation emergency. 

For more on `all hazards’ preparedness, I’d invite you to visit: 

FEMA http://www.fema.gov/index.shtm
READY.GOV http://www.ready.gov/
AMERICAN RED CROSS http://www.redcross.org/

And for more on sheltering in place, you may wish to revisit:

When 72 Hours Isn’t Enough

Miami-Dade: Mosquito-Borne Illness Advisory After Local Dengue Case Detected

#11,772




In 2009 Dengue returned to Florida after a seven decade absence, likely brought into Key West by a viremic tourist. Local mosquitoes helped themselves to an infected blood meal, and as a result 24 cases were reported in 2009 (see MMWR: Dengue Fever In Key West), with another 63 the following year.

Since 2010 the number of Florida Dengue cases has dropped considerably, but in 2013 Martin county reported 22 cases, temporarily forcing the Suspension Of Blood Donations In Two Counties.

On June 1st of this year, the Monroe County Health Department  issued a statement on Florida's first locally acquired case of 2016,  but since then, no new local cases have been reported. 


With tens of millions of visitors every year, it is inevitable that additional viremic travelers will arrive. The the most recent Florida Arbovirus Surveillance Report (Week 38) reports that so far in 2016 the Health Department has identified:

•  6 imported cases of Chikungunya, 
•  40 imported cases of Dengue 
•  41 imported cases of Malaria
•  and 748 imported cases of Zika

And those are just the ones we know about.  Many cases will be mild or asymptomatic, and so the real number is undoubtedly much higher.

So it comes as little surprise that over night another locally acquired Dengue case has been reported in Florida - just the second one of 2016.  This time it is in Miami-Dade County, and a mosquito-borne illness advisory has reportedly been issued.

The Florida DOH site doesn't yet show the advisory, and details on the case are scant. The following report from WLRN Radio provides what little we know.

More Mosquito Woes: Miami-Dade Confirms Case Of Locally-Acquired Dengue

The good news is that mosquito-borne illnesses (including WNV, Zika, CHKV, SLEV, EEE, etc.) are largely preventable. Florida’s Health department reminds everyone to always follow the `5 D’s’:

 

And for more on the complex, and growing, threat from mosquito-borne illnesses in the United States you may wish to revisit:  

Arboviruses: (Already) Coming To America

Voice Of Iraq: Avian Flu `Endemic' In Iraq

#11,771


Last Saturday in FAO EMPRES: Risk Assessment For Spread Of H5N1 In The Middle East we looked at a risk assessment on the  potential for the introduction of H5N1 HPAI from recently infected countries (Lebanon and Iraq) to other countries in the Middle East.

You may recall that over the summer we saw several million birds either killed by, or because of, H5N1 avian flu in Wasit and Baghdad Provinces. 

Today, the Voice of Iraq newspaper is carrying an Arabic report quoting Dr Salah Fadhil Abbas, Director General, Veterinary Directorate, Ministry of Agriculture of Iraq as calling avian flu `endemic' in Iraq, while also reassuring their outbreak is now under control.
  

Assurances aside, Dr. Abbas also identifies the clade in Iraq as being 2.3.2.1c, which has gained both notoriety and substantial geographic territory since it emerged in China several years ago.  

Clade 2.3.2.1c is viewed as being particularly worrisome because of some of the host adaptations it has acquired, something we looked at last July in V. Sinica: HPAI H5N1 Clade 2.3.2.1c Virus in Migratory Birds, 2014–2015.

First the report from VOI, then I'll be back with a bit more.

Veterinary: Anfelonzha birds has become endemic in Iraq, and we will announce next month to control it

3:02:50 p.m. 9/27/2016 | (Voice of Iraq) - Baghdad ,

announced the Ministry of Agriculture Veterinary Department, on Tuesday, that the disease Anfelonzha birds has become endemic in Iraq, while confirming that the announcement of the control of the disease would be next October.

Salah said Fadhil Abbas , the department said that " the department began after the date of the Director July 12 the process of investigation and monitoring for infection after the cessation of spreading infection in the fields and the provincial disease Anfelonzha birds , "noting that" Iraq will announce the final control of the infection in the 11 next October and will reach international organizations to remove his name from the list , which is installed by as states infected with this disease. "

He added Abbas said " the investigation and monitoring process are not only in the development of the area which appeared his recent unity and Tajuddin hand , but in all the provinces of Iraq , " adding that it "acts of daily ongoing exercise by the veterinary hospitals for research and investigation of injury in the event of their appearance."

He stressed Abbas " the disease Anfelonzha birds has become endemic in Iraq , " he said . "Our labs have shown that the genetic sequences isolated the virus from the fields is the 2321c is similar to viruses isolated in China, Bulgaria, Vietnam, India, Nigeria and Pakistan."

he added that " the emergence of the disease twice in Kurdistan , in the middle of the year 2015 and the end of the same year, and his appearance is also in a new Shat in Diyala and Tarmiya in 2016, and finally appearing in the crown of religion and the hand of unity in the month of June proved that the virus has become endemic in Iraq because the injuries were repeated , but the control of the disease has become a reality. "

(Continue . . . )

A check of the MOA website confirms a major bird flu conference was just held in Iraq (see Under the auspices of the Minister of Agriculture held a workshop on a campaign to control the high-pathogenic avian flu), but the MOH report provides few specifics.

While Iraq may gain bird-flu-free status later this fall, they remain vulnerable to reintroduction of the virus from migratory birds, and flare-ups of the virus once the weather turns colder.

ECDC: Updated Zika Transmission Maps

#11,770


In the wake of recent reports of Zika transmission in Malaysia, Singapore, Vietnam, Thailand, and the Philippines the ECDC has updated their Zika transmission maps.

Current Zika transmission 

Page last updated on 27 September 2016

The information on current Zika transmission is useful to evaluate the risk for people who have recently returned from or are planning to travel to countries with active local transmission. 

Countries and territories are categorised as currently experiencing active local Zika virus transmission if local Zika infections have been reported by health authorities within the last three months.

The information is updated every Friday simultaneously with the update of the epidemiological situation, also each time a country is added or removed to the list of countries who report a Zika virus transmission or a country’s transmission status changes. Countries and territories are removed from this list if no new evidence of Zika virus transmission is provided within 9 months. The first declaration of local Zika virus transmission in a country or territory is based on a laboratory confirmed case reported by competent health authority. For countries outside of the intertropical range, sub-national information is presented.

As of week 17 in 2016, ECDC extended the period for classifying whether a country or territory has active local transmission from two to three months. This change is based on the fact that Zika virus outbreaks last usually for more than two months. In addition, ECDC added a ‘countries and territories with past vector-borne transmission’ category for countries having experienced transmission since 2007 up to three months ago.