Global Influenza Update – March 9th

 

# 9802

 

Although it has been a heavily H3N2-centric flu season in North America and most of Europe, as the map above shows, portions of Africa and parts of the Middle and Far East have seen a good deal of seasonal H1N1 (aka A(H1N1)pdm09), which continues to be misrepresented in the press in some nations as `swine flu’ or in some cases `bird flu’.

 

While influenza has peaked across much of the Northern Hemisphere, and is on the decline in North America, some countries are still reporting abundant flu activity.

 

We continue to see hyperbolic press accounts of India’s H1N1 Outbreak, and almost daily suggestions that something `has changed’ with the virus, but so far no evidence has been presented that the virus has altered either its genetic profile or behavior. 

 

Meanwhile, the re-formulated flu vaccine for the next Southern Hemisphere flu season  - which includes the `drifted’ H3N2 strain that has caused considerable illness in the Northern Hemisphere this winter – should be available sometime in April.

 

This from the World Health Organization Global Flu Update.

 

 

Influenza update

9 March 2015 - Update number 232, based on data up to 22 February 2015

Summary

Globally, influenza activity remained high in the northern hemisphere with influenza A(H3N2) viruses predominating. Some countries in Africa, Asia and southern part of Europe reported an increased influenza A(H1N1)pdm09 activity.

• In North America, the influenza activity remained elevated following the influenza peak. Influenza A(H3N2) remained the dominant virus detected this season
• In Europe, the influenza season was at its height, particularly in central and western countries . Influenza A(H3N2) virus continued to predominate this season.
• In northern Africa and the middle East, influenza activity was decreasing in most of the region. Influenza A was predominant in the region.
• In the temperate countries of Asia, influenza activity decreased from its peak in northern China and Mongolia, but continued to increase in the Republic of Korea. Influenza A(H3N2) virus predominated.
• In tropical countries of the Americas, influenza activity remained low in most countries.
• In tropical Asia, influenza activity continued to increase in India and Lao People’s Democratic Republic. Influenza activity remained high in southern China, China Hong Kong Special Administrative Region, and the Islamic Republic of Iran.
• In the southern hemisphere, influenza activity continued at inter-seasonal levels.
• The vaccine recommendation for the 2015-2016 northern hemisphere winter season was made and can be consulted at the link below:
• Based on FluNet reporting (as of 5 March 2015 16:25 UTC), during weeks 6 to 7 (8 February 2015 to 21/02/2015), National Influenza Centres (NICs) and other national influenza laboratories from 89 countries, areas or territories reported data for the time period from 8 to 21 February 2015. The WHO GISRS laboratories tested more than 133 895 specimens. 34 056 were positive for influenza viruses, of which 25 455 (74.7%) were typed as influenza A and 8601 (25.3%) as influenza B. Of the sub-typed seasonal influenza A viruses, 2382 (20.5%) were influenza A(H1N1)pdm09 and 9253 (79.5%) were influenza A(H3N2). Of the characterized B viruses, 1656 (97.1%) belonged to the B-Yamagata lineage and 49 (2.9%) to the B-Victoria lineage.

 

 

FluNet Summary

9 March 2015

Source: Laboratory confirmed data from the Global Influenza Surveillance and Response System (GISRS).

Based on FluNet reporting (as of 5 March 2015, 16:25 UTC), National Influenza Centres (NICs) and other national influenza laboratories from 89 countries, areas or territories reported data for the time period from 8 to 21 February 2015.^a The WHO GISRS laboratories tested more than 133 895 specimens. 34 056 were positive for influenza viruses, of which 25 455 (74.7%) were typed as influenza A and 8601 (25.3%) as influenza B. Of the sub-typed seasonal influenza A viruses, 2382 (20.5%) were influenza A(H1N1)pdm09 and 9253 (79.5%) were influenza A(H3N2). Of the characterized B viruses, 1656 (97.1%) belonged to the B-Yamagata lineage and 49 (2.9%) to the B-Victoria lineage.

• View the full influenza update

Global circulation of influenza viruses
(GISRS-FluNet, snapshot 5 March 2015)

View full size chart
pdf, 359kb

^a The time period from 8 to 21 February 2015 corresponds to

• FluNet / American calendar: weeks 6 and 7
• International standard ISO 8601: weeks 7 and 8

The New Normal: The Age Of Emerging Disease Threats

Photo Credit- CDC

 

# 8930

 

The reality of life in this second decade of the 21st century is that disease threats that once were local, can now spread globally in a matter of hours or days.  Vast oceans and prolonged travel times no longer protect us against infected travelers crossing borders. 

 

And despite the media hype over airport screening, we have no technology that can realistically, or reliably detect infected individuals and prevent them from entering a country (see  Head ‘Em Off At The Passenger Gate?).

 

As our ability to transport diseases rapidly to any corner of the globe has increased, so has the number and variety of emerging infectious diseases.  Something that was foretold two decades ago by anthropologist and researcher George Armelagos of Emory University, which I described in considerable detail in The Third Epidemiological Transition.

 

According to Dr. Armelagos, the Third Epidemiological Transition began in the late 1970s or early 1980s, and is hallmarked by newly emerging infectious diseases, re-emerging diseases carried over from the 2nd transition, and a rise in antimicrobial resistant pathogens.

 

When you combine those factors with an increasingly mobile global population of about 7 billion people, and huge increases in the number of animals being raised for food consumption (often in environments conducive to the spread of diseases), and you have a recipe for explosive growth in diseases.

 

In a 2010 paper, Armelagos along with Kristin Harper, updated his original paper.  Both papers are well worth reading.

 

Int J Environ Res Public Health. 2010 February; 7(2): 675–697.

Published online 2010 February 24. doi: 10.3390/ijerph7020675.

The Changing Disease-Scape in the Third Epidemiological Transition

Kristin Harper and George Armelagos

 

We are, quite simply, living in an age of emerging infectious diseases. 

 

Over the past three decades, dozens of new – mostly zoonotic – diseases have been identified.   Some of these new, or re-emerging disease threats, include:

 

• HIV
• SARS
• The re-emergence and spread of H5N1 bird flu in 2003
• An H1N1 `Swine Flu’  pandemic in 2009
• Swine Variant Influenza viruses (H1N1v, H1N2v, H3N2v)
• MERS-CoV and other `bat borne’ viruses like Nipah and Hendra
• H7N9, H10N8, H5N2 and other emerging avian flu viruses
• Lyme Disease, CCHF, Heartland Virus, SFTS, and other tickborne diseases
• The global spread of MRSA, along with the recent arrival of of NDM-1 and other Carbapenemases that threaten the viability of our antibiotic arsenal. 
• An explosion and spread of mosquito-borne diseases like  dengue, chikungunya & malaria
• Even old scourges, once thought on the way out, are showing new signs of life . . . like Pertussis, measles, and polio.
• Perhaps most troubling of all has been the emergence of increasingly drug resistant strains of tuberculosis.
• And the one that has everyone’s attention right now;  Ebola.

 

If you consider the toll they take each year in terms of lives lost, misery, and dollars – the most effective terrorists in this world are not humans, they are microbial.  

 

And in a lot of places around the globe, they not only have the upper hand, they are gaining territory. .

 

Yet, it wasn’t until the mid-1990s that interest in these emerging pathogens really took off. The CDC only began publishing the EID Journal, a highly respected peer-reviewed journal on emerging pathogenic threats, in 1995.   Today emerging disease threats, and neglected tropical diseases, are a hot topic in scores of respected journals.

 

Currently there is a lot of public concern over the Ebola virus, and while it is a fearsome disease, it has far less potential to wreak global havoc than many of the pathogens on the list above.   

 

Viruses that spread via respiratory routes, like MERS-CoV, the ever expanding flock of avian flu viruses, reassortant swine flu viruses, and other respiratory pathogens are all better equipped to start a global epidemic than is Ebola.

 

None of which is to suggest that Ebola isn’t a serious threat, only that if it manages to spread beyond Africa, it is more likely to manifest in the form of very small, sporadic, localized outbreaks, rather than as a global epidemic.

 

Alas, the same can not be said for many other emerging viruses, should any of them adapt well enough to humans to transmit easily.  Which is why, early this year, we looked at an assessment by the Director Of National Intelligence who includes emerging infectious diseases and  Influenza Pandemic As A National Security Threat. 

From that report:

 

Worldwide Threats Assessment – published January 29th, 2014,

(Excerpt)

Health security threats arise unpredictably from at least five sources: 

• the emergence and spread of new or reemerging microbes;
• the globalization of travel and the food supply;
• the rise of drug-resistant pathogens;
• the acceleration of biological science capabilities and the risk that these capabilities might cause inadvertent or intentional release of pathogens; and
• adversaries’ acquisition, development, and use of weaponized agents. 

Infectious diseases, whether naturally caused, intentionally produced, or accidentally released, are still among the foremost health security threats.  A more crowded and interconnected world is increasing the opportunities for human, animal, or zoonotic diseases to emerge and spread globally.  Antibiotic drug resistance is an increasing threat to global health security.  Seventy percent of known bacteria have now acquired resistance to at least one antibiotic, threatening a return to the pre-antibiotic era.

This was, admittedly, just one of many threats discussed in this 27 page threat assessment.  Others include cyber attacks, terrorism, extreme weather events, WMDs, food and water insecurity, and global economic concerns.

 

A week before that report was issued, Dr. Thomas Frieden – Director of the CDC – penned an opinion piece for CNN called How to Prevent the Next pandemic ( see CDC Director Frieden: On Preventing A Pandemic).  Many of these themes are carried forward on the CDC’s Global Health Website at:

Why Global Health Security Matters

Disease Threats Can Spread Faster and More Unpredictably Than Ever Before

(Excerpt)

A disease threat anywhere can mean a threat everywhere. It is defined by

• the emergence and spread of new microbes;
• globalization of travel and trade;
• rise of drug resistance; and
• potential use of laboratories to make and release—intentionally or not—dangerous microbes.

(Continue . . .)

 

In 2014 alone, in addition to the spread of Ebola, we’ve seen the importation of H5N1 into Canada, imported MERS-CoV cases in the United States (along with 20+ other countries), imported H7N9 to Taiwan and Hong Kong, imported CCHF in the UK, and Lassa fever in a traveler in Minneapolis, and Chikungunya has infected 500,000 people in the Caribbean over the past nine months.

 

And frankly, these are just the highlights.

 

The simple truth is, while Ebola isn’t likely to rise to the level of a global epidemic, nature’s lab is open 24/7, and it is continually producing new candidates (or refining old ones) to spark the next pandemic.  

 

Viruses like H7N9, H5N1, and H3N2v continue to mix and match genes, looking to hit the right combination to spread easily in humans.  Old influenza nemeses, to which we have limited community immunity (like H2N2) still lurk in avian populations, and upstart coronaviruses like SARS and MERS-CoV are still testing the waters, as they try to `figure us out’.

 

All of which means that if and when Ebola is contained (and I believe it will be), the greater threat won’t have gone away.  Whether the `next pandemic threat’ comes in six weeks, six months, or six years – or from what location or source - is unknowable. 

 

But few scientists would argue that another pandemic won’t emerge at some point.

 

Which is why, when the media hype and public concerns over Ebola dies down –  we should not let our resolve to strengthen public health – both here, and around the globe -  die with it. 

 

We live in an age where these threats aren’t going to go away, and we can ill afford to let our guard down.

 

For more on pandemic preparedness, you may wish to revisit:

 

The Global Reach Of Infectious Disease

HSPH Video: The Next Pandemic: Are We Ready? 

Pandemic Preparedness: Taking Our Cue From The Experts

The Global Reach Of Infectious Disease

Photo Credit- CDC

 

# 8303

 

This week we’ve seen two of the world’s most prestigious public health organizations (CDC & WHO) publicly express concerns over the increasing dangers of global disease spread – including, but certainly not limited to – pandemic influenza. 

 

On Wednesday, in WHO: IHR & Global Health Security, we looked at the large number of member states which have yet to meet the core surveillance and response requirements of the International Health Regulations that went into force in 2007.

WHO IHR Infographic

 

On Friday, in CIDRAP On The Global Health Security Agenda, we looked at a 26 nation initiative to improve global health surveillance & emergency response in an age of rising infectious diseases.  The rationale for which is explained on the CDC’s Global Health Website at:

 

Why Global Health Security Matters

Disease Threats Can Spread Faster and More Unpredictably Than Ever Before

(Excerpt)

A disease threat anywhere can mean a threat everywhere. It is defined by

• the emergence and spread of new microbes;
• globalization of travel and trade;
• rise of drug resistance; and
• potential use of laboratories to make and release—intentionally or not—dangerous microbes.

 (Continue . . .)

 

These are hardly new concerns for either agency, as both have worked for decades to prevent the spread of disease around the world. But over the past decade there has come a greater awareness of the ability of once rare, and geographically remote, infectious diseases to travel in a matter of hours to virtually any part of the globe.

A partial list of recent global health threats we’ve discussed previously includes:

 

• The  importation of West Nile Virus to North America in 1999 (see WNV: The Economic Costs Of An Invasive Arbovirus)
• The more recent arrival of Dengue Fever in Florida and Texas (see MMWR: Travel Associated Dengue Surveillance 2006-2008)
• Last fall’s Chikungunya outbreak in the Caribbean (see ECDC Update On The Spread Of Chikungunya In The Caribbean)
• The huge increase in antibiotic resistant bacteria (see NDM-1: A Matter Of Import)
• SARS in 2003 (see SARS & Remembrance)

 

To this short list you can add Pandemic H1N1 in 2009, the emergence of MERS-CoV from the Arabian Peninsula (see WHO MERS-CoV Summary Update #13, the continual spread of H7N9 and H5N1 avian flu viruses (see The Expanding Array Of Novel Flu Strains), Polio in the Middle East and Africa, contaminated food or drugs, XDR-TB, and of course the one(s) we don’t even know about yet . . .  Virus X.

 

This rationally paranoid listing of disease threats is backed up by a recent Assessment by the Director of National Security (see DNI: An Influenza Pandemic As A National Security Threat) that finds the global spread of infectious diseases – along with cyber attacks, terrorism, extreme weather events, WMDs, food and water insecurity, and global economic concerns.- constitutes a genuine threat to national security.

 

Although the specter of pandemic influenza and  bioterrorism get the most attention in the media, already each year thousands of people in the United States (and around the world) are sickened or die from `imported’ diseases like WNV, HIV/AIDS, Carbapenem-resistant  bacteria, and TB. 

 

History has shown, that once a disease takes flight, it is notoriously difficult to reign in.  Hence the need to tackle infectious diseases where they emerge, not once they arrive on our shores.

 

While you and I cannot do much about disease threats around the world (except for supporting elected representatives who vote to fund public health, and contributing to NGOs who fight the battles every day), there are things you can do to prepare for the day when – inevitably, and despite the best efforts of public health agencies to prevent it – the next pandemic threat emerges.

 

We’re not talking building a `doomsday bunker’, or stockpiling a 2-year supply of N95 masks and Tyvek suits, but rather taking reasonable steps to prepare your family, business, and community against what is perceived by many as being all but inevitable; another pandemic.

 

Pandemics, while rare, are just one of scores of possible disaster scenarios that one can find themselves suddenly thrust into. When you add in the risks from earthquakes, hurricanes, tornadoes, floods, blizzards, and other – even more common – emergencies, it makes sense to maintain a general level of preparedness against `all threats’.

 

Every family needs an appropriate disaster plan, just as everyone should have a good first aid kit, a `bug-out bag’, and sufficient emergency supplies to last a bare minimum of 72 hours.

 

Most preparedness experts would recommend that people should consider maintaining a 2-week supply of supplies in their home.  A topic I address in When 72 Hours Isn’t Enough.

And businesses, if they hope to survive a pandemic (or any other disaster), need a comprehensive business continuity plan. Although there are many good resources on the web to get you started, a couple of places to begin are The Business Continuity Daily and Cambridge Risk Perspectives, both of which provide daily reviews of current threats and advice on preparedness.

 

One of the nation’s leaders in pandemic and disaster planning is Public Health - Seattle & King County.  In 2008 they produced a 20 minute film called Business Not As Usual, designed to help introduce businesses to the core concepts of pandemic planning.

Frankly, this video should be required viewing for every businesses owner, manager, and employee.

 

 

Flu.gov maintains a pandemic planning and preparedness page, where the following appears.

 

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

 

Given the speed at which a well-adapted virus could spread globally (days or weeks), the time to practice and prepare for the next pandemic is now, not after an outbreak has begun. Given the seriousness with which U.S. and International  agencies and organizations obviously give the pandemic threat, it only makes sense to take it seriously yourself.

 

For more on pandemic preparedness, you may wish to revisit:

NPM13: Pandemic Planning Assumptions

The Pandemic Preparedness Messaging Dilemma

Pandemic Planning For Business

CDC: Pandemic Planning Tips For Public Health Officials

H7N9 Preparedness: What The CDC Is Doing

WHO Global Atlas Of Unmet Palliative Care Needs

 

# 8234

 

Almost exactly two years ago, in His Bags Are Packed, He’s Ready To Go, I wrote about the end-of-life home hospice care my father was receiving, and how our family had worked to ensure he could spend his final days at home, and pain free.  As difficult as those final days were for everyone involved, my father was lucky.

 

In many regions the world, effective pain management and palliative care simply isn’t readily available, and millions of people die each year without such merciful interventions.

 

Today the World Health Organization has released the first global Atlas illustrating this great unmet need and the huge inequalities across countries. Below you’ll find excerpts from the press release, and a link to the new document.

 

First ever global atlas identifies unmet need for palliative care

News release

28 January 2014 | GENEVA/LONDON - Only 1 in 10 people who need palliative care - that is medical care to relieve the pain, symptoms and stress of serious illness - is currently receiving it. This unmet need is mapped for the first time in the "Global atlas of palliative care at the end of life", published jointly by the WHO and the Worldwide Palliative Care Alliance (WPCA).

More than just pain relief

Palliative care is more than just pain relief. It includes addressing the physical, psychosocial and emotional suffering of patients with serious advanced illnesses and supporting family members providing care to a loved one.

About one third of those needing palliative care suffer from cancer. Others have progressive illnesses affecting their heart, lung, liver, kidney, brain, or chronic, life-threatening diseases including HIV and drug-resistant tuberculosis.

It is estimated that every year more than 20 million patients need palliative care at the end of life. Some 6% of these are children. The number of people requiring this care rises to at least 40 million if all those that could benefit from palliative care at an earlier stage of their illness are included. Hospice and palliative care often encompasses some support to family members, which would more than double care needs.

Greatest need in low-and middle-income countries and for noncommunicable diseases

In 2011, approximately 3 million patients received palliative care, the vast majority at the end of their life. Although most palliative care is provided in high-income countries, almost 80% of the global need for palliative care is in low- and middle-income countries. Only 20 countries worldwide have palliative care well integrated into their health-care systems ¹.

(Continue . . )

• Download The Atlas
• Global Action Plan for the Prevention and Control of NCDs 2013-2020
• Worldwide Palliative Care Alliance (WPCA)

WHO: Global Tuberculosis Report – 2013

 

Credit WHO

 

# 7889

 

Nearly twenty years ago the World Health Organization declared tuberculosis a public health emergency, and that organization (along with many others) has been working towards a goal of reducing the number of TB related deaths in half by 2014.

 

Today, WHO has today release their 18th global report on tuberculosis,  which outlines the progress to date, and the challenges ahead in the global battle.  Using their @WHO twitter account, WHO began tweeting details early this morning.

 

A few excepts from the Executive Summary, and then links to and excerpts from the press release follow:

COUNTDOWN TO 2015: key findings

On track:

• The rate of new TB cases has been falling worldwide for about a decade, achieving the MDG global target. TB incidence rates are also falling in all six WHO regions. The rate of decline (2% per year) remains slow.
• Globally by 2012, the TB mortality rate had been reduced by 45% since 1990. The target to reduce deaths by 50% by 2015 is within reach.
• Two WHO regions have already achieved the 2015 targets for reduced incidence, prevalence and mortality: the Region of the Americas and the Western Pacific Region.
  
• Of the 22 high TB burden countries (HBCs) that account for about 80% of the world’s TB cases, seven have met all 2015 targets for reductions in TB incidence, prevalence and mortality. Four more HBCs are on track to do so by 2015.

Off track:

• By 2012, the level of active TB disease in the community (prevalence) had fallen by 37% globally since 1990. The target of a 50% reduction by 2015 is not expected to be achieved.
• The African and European regions are currently not on track to achieve the mortality and prevalence targets.
• Among the 22 HBCs, 11 are not on track to reduce incidence, prevalence and mortality in line with targets. Reasons include resource constraints, conflict and instability, and generalized HIV epidemics.
• Progress towards targets for diagnosis and treatment of multidrug-resistant TB (MDR-TB) is far off-track. Worldwide and in most countries with a high burden of MDR-TB, less than 25% of the people estimated to have MDR-TB were detected in 2012.
• Many countries have made considerable progress to address the TB/HIV co-epidemic. However, global-level targets for HIV testing among TB patients and provision of antiretroviral therapy (ART) to those who are HIV-positive have not been reached.

 

And the press release:

 

Gains in tuberculosis control at risk due to 3 million missed patients and drug resistance

Progress in TB control can be substantially accelerated by addressing these challenges

News release

23 October 2013 | LONDON/GENEVA - Tuberculosis (TB) treatment has saved the lives of more than 22 million people, according to the WHO "Global tuberculosis report 2013" published today. The report also reveals that the number of people ill with TB fell in 2012 to 8.6 million, with global TB deaths also decreasing to 1.3 million.

The new data confirm that the world is on track to meet the 2015 UN Millennium Development Goals (MDGs) target of reversing TB incidence, along with the target of a 50% reduction in the mortality rate by 2015 (compared to 1990). A special "Countdown to 2015" supplement to this year’s report provides full information on the progress to the international TB targets. It details if the world and countries with a high burden of TB are “on-track” or “off-track” and what can be done rapidly to accelerate impact as the 2015 deadline approaches.

(Continue . . . )

You can download the 2013 report (either in sections, or in its entirety) at the following link:

Global tuberculosis report 2013

This is the eighteenth global report on tuberculosis (TB) published by WHO in a series that started in 1997. It provides a comprehensive and up-to-date assessment of the TB epidemic and progress in implementing and financing TB prevention, care and control at global, regional and country levels using data reported by 197 countries and territories that account for over 99% of the world’s TB cases.

Global Risks Report: 2013

 

# 6832

 

The World Economic Forum is a Geneva based non-profit foundation, originally called the `European Management Forum’ when it was created in 1971 by a business professor at the University of Geneva. In 1987, the foundation was renamed as they expanded their scope beyond Europe, to include broader global issues.

 

Late each January, the WEF invites more than two thousand select business, political and NGO leaders, academics, intellectuals, and members of the media to meet for 5 days in Davos, Switzerland to discuss the most pressing issues facing the world, and each January we get a new Global Risks Report.

 

The 2013 Global Risks Report is more ambitious, and more accessible, than ever before, with an interactive website, videos, along with the detailed report.

 

I’ve only just started to examine this data-heavy report, but wanted to provide the links, and some highlights, to my readers. 

 

First some excerpts from the press release:

 

World More at Risk from Markets and Mother Nature – Global Risks 2013 report

Rim El Habibi, Media Associate, Tel.: +41 (0) 79 531 3111, rim.elhabibi@weforum.org

• Persistent economic malaise coupled with frequent extreme weather events an increasingly dangerous mix
• National resilience is crucial to tackle unpredictable global threats; new country rating system launched
• Health and hubris, digital wildfires and environmental/economic stress are the three risk cases for 2013
• The report analyses 50 global risks, with breakdowns for China, Middle East/North Africa and Latin America
• Read the Global Risks 2013 report in full at http://www.weforum.org/globalrisks2013

London, United Kingdom, 8 January 2013 – The world is more at risk as persistent economic weakness saps our ability to tackle environmental challenges, according to the World Economic Forum’s Global Risks 2013 report.

 

The report highlights wealth gaps (severe income disparity) followed by unsustainable government debt (chronic fiscal imbalances) as the top two most prevalent risks, in a survey of over 1,000 experts and industry leaders, which reflects a slightly more pessimistic outlook overall for the coming 10 years.

 

Following a year scarred by extreme weather, from Hurricane Sandy to flooding in China, respondents rated rising greenhouse gas emissions as the third most likely global risk overall, while the failure of climate change adaptation is seen as the environmental risk with the most knock-on effects for the next decade.

 

“These global risks are essentially a health warning regarding our most critical systems,” warned Lee Howell, the editor of the report and Managing Director at the World Economic Forum. “National resilience to global risks needs to be a priority so that critical systems continue to function despite a major disturbance,” he added.

 

Axel P. Lehmann, Chief Risk Officer at Zurich Insurance Group, said: “With the growing cost of events like Superstorm Sandy, huge threats to island nations and coastal communities, and no resolution to greenhouse gas emissions, the writing is on the wall. It is time to act.”

Global Risks 2013 analyses three major risk cases of concern globally:

1. Health and Hubris

2. Economy and Environment under Stress

3. Digital Wildfires

 

(Continue . . .)

Beyond the serious economic and environmental concerns expressed in the 2013 edition, the authors also focus on global health, and the risks of complacency in Health and Hubris.  Again from the press release:

Huge strides forward in health have left the world dangerously complacent. Rising resistance to antibiotics could push overburdened health systems to the brink, while a hyperconnected world allows pandemics to spread. This risk case draws on the connections between antibiotic resistance, chronic disease and the failure of the international intellectual property regime, recommending more international collaboration and different funding models.

 

While it is impossible to accurately predict future crises, or their timing, the authors - in collaboration with the science Journal Nature – also consider a set of five X factors that may be on the horizon, including:

 

• Runaway Climate Change

• Significant Cognitive Enhancement

• Rogue Deployment of Geoengineering

• Costs of Living Longer

• Discovery of Alien Life

 

 

The annual meeting at Davos, and the release of the WEF Global Risks report, is not without controversy.

 

There are many who perceive the World Economic Forum to be secretive, elitist, and as driving the world towards greater globalization. It has been targeted by many of the same groups who protest The IMF, The World Bank, and the G7 meetings.

 

Regardless of how one views the source, the issues raised in these Global Risk Reports are serious ones, and are deserving of our attention.

 

While the specifics may vary, in general terms they often match up with other `think tank’ concerns we’ve seen in the recent past.

 

A few examples include:

 

Black Swan Events  -"Global Trends 2030: Alternative Worlds

 

UK: Civil Threat Risk Assessment

 

OECD Report: Future Global Shocks

 

 

The world is an increasingly crowded, and dangerous place, with new risks emerging every year. Threats that once might only have endangered a country or a region, can now spread globally.

 

While this report focuses on national resiliency issues, true resiliency must flow from the bottom up, not just from the top down. 

 

Resilient families make resilient neighborhoods, which make for resilient communities, and from that we get resilient states. Which is why FEMA and Ready.gov  stress the importance of individual and family preparedness.

 

While as individuals there isn’t much we can do about many of the global threats in this report, we can be as prepared as we can to deal with whatever comes along.  A few links to help you along the way include:

 

FEMA http://www.fema.gov/index.shtm

READY.GOV http://www.ready.gov/

AMERICAN RED CROSS http://www.redcross.org/

 

And finally, some of my own preparedness articles may be of interest:

 

When 72 Hours Isn’t Enough

In An Emergency, Who Has Your Back?

An Appropriate Level Of Preparedness

The Gift of Preparedness 2012

WHO Global Influenza Surveillance & EuroFlu Report

Credit WHO

 

# 6831

 

 

The latest influenza surveillance report from the World Health Organization confirms that North America continues to see the highest rate of influenza in the world, but reports signs that flu transmission is picking up in Europe, Africa, and parts of Asia.

 

• Globally flu samples have been predominately Influenza A (72.6%) and of those, nearly 83% were seasonal H3N2.
• Among the B viruses, Yamagata lineage viruses were leading Victoria lineage by more than 2 to 1.

 

Out of more than 500 viruses recently tested by Global Influenza Surveillance and Response System (GISRS), all continue to be susceptible to the antiviral drugs oseltamivir and zanamivir.

 

Influenza virus activity in the world

7 January 2013

Source: Laboratory confirmed data from the Global Influenza Surveillance and Response System (GISRS).

Based on FluNet reporting (as of 3 January 2013, 12:40 UTC), during weeks 50 to 51 (9 December 2012 to 22 December 2012), National Influenza Centres (NICs) and other national influenza laboratories from 77 countries, areas or territories reported data. The WHO GISRS laboratories tested more than 36 007 specimens. 5 528 were positive for influenza viruses, of which 4 013 (72.6%) were typed as influenza A and 1 515 (27.4%) as influenza B. Of the sub-typed influenza A viruses, 431 (17.2%) were influenza A(H1N1)pdm09 and 2 078 (82.8%) were influenza A(H3N2). Of the characterized B viruses, 52 (69.3%) belong to the B-Yamagata lineage and 23 (30.7%) to the B-Victoria lineage.

Summary

During weeks 50 and 51 influenza activity continued to increase in the northern hemisphere while sporadic activity was reported from the southern hemisphere. Influenza A(H3N2) viruses remained the predominant subtype globally, followed by influenza B and A(H1N1)pdm09 viruses.

 

In North America, influenza activity increased and varied from localized to widespread in both Canada and the United States of America with influenza A(H3N2) as the predominant subtype. In contrast, influenza B viruses were the predominant subtype in Mexico.

 

In Europe, influenza activity continued to increase across the region. In recent weeks, increased activity was reported from Denmark and France. Influenza A(H1N1)pdm09, A(H3N2) and B viruses co-circulated in the region.

 

Increased A(H3N2) activity was reported from China and Japan while sporadic activity was reported from the region.

 

In the Eastern Mediterranean region, increased A(H1N1)pdm09 virus detections were reported from the West Bank and Gaza Strip where 9 deaths were recorded. Increased A(H1N1)pdm09 activity was reported from elsewhere in the region as well as A(H3N2) and influenza B viruses.

 

In Africa, increased detections of influenza B viruses were reported from Algeria while A(H1N1)pdm09 viruses were detected in the Democratic Republic of the Congo.

 

In the northern hemisphere, 426 A(H3N2), 49 A(H1N1)pdm09, and 164 B viruses have been tested for antiviral resistance to neuraminidase inhibitors and all have remained resistant to oseltamivir and zanamivir.

 

 

In Europe, the Mediterranean, and parts of Africa the A(H1N1)pdm09 virus appear to be a bit more common than is currently being reported in North America. The following is a summary from the latest EuroFlu report (week 52).

 
Influenza activity is increasing mainly due to influenza detections in western Europe

Summary, week 52/2012

Influenza-like illness (ILI) and acute respiratory infection (ARI) consultation rates continue to rise, following a west-to-east progression across the WHO European Region. For the second week, reporting of influenza surveillance data was incomplete, due to the holiday period.

 

Countries mainly in the western part of the Region reported co-circulation of influenza A(H1N1)pdm09, A(H3N2) and type B viruses. The proportion of A(H1N1)pdm09 is considerably higher in comparison with the same time period last season. The number of reported hospitalizations due to severe acute respiratory infection (SARI) remains low, with no cases being associated with influenza detection.

Global Flu Surveillance Updates

 

 

# 6708

 

After an uncommonly subdued 2011-2012 influenza season (see CDC: The Close Of A Mild Season), and a summer that featured an unprecedented number of variant swine flu infections (see An Increasingly Complex Flu Field) in the United States, no one is quite sure what to expect with the coming flu season.

 

Invariably, the word most often used by researchers when describing influenza is `unpredictable’.

 

Nevertheless, in order to come up with a vaccine each year, scientists must decide – 6 months in advance – what flu strains they think will be most active in the season ahead.

 

After 3 years with essentially no changes, this year’s flu vaccine formulation makes alterations to both the H3N2 and B virus strains.

 

• The H1N1 component remains essentially unchanged, with the A/California/7/2009 (H1N1)pdm09-like  still recommended.
• The old A/Perth/16/2009 (H3N2)-like virus now gives way to the A/Victoria/361/2011 (H3N2)-like virus.
• And the Victoria lineage B/Brisbane/60/2008-like virus will be replaced by a Yamagata strain; the B/Wisconsin/1/2010-like virus. 

 

The addition of these two new strains makes getting the vaccine this year all the more important, as community immunity to these recently emerging strains is likely low.

 

The vaccine die having been cast, each fall we monitor influenza activity around the world via a number of reporting tools, including:

 

• The World Health Organization’s bi-weekly global influenza update based on `data sources, including FluNet (reported by the Global Influenza Surveillance and Response System) and influenza reports from WHO Regional Offices and Member States.’
• The WHO/Europe influenza surveillance reports, which are released on a weekly basis. 
• The ECDC provides both their Weekly Influenza Surveillance Overview (WISO) along with their periodic, highly detailed Influenza virus characterisation reports
• Canada releases a weekly FluWatch report.
• And the CDC produces a detailed FluView report each week.

 

There others, of course.

 

Hong Kong’s CHP  produces an excellent Weekly Flu Express, and when it’s summer in the Northern Hemisphere we keep a close watch on the Australian  and New Zealand influenza surveillance sites.

 

Combined, these resources provide us with a pretty good - albeit `backwards looking’ - overview of flu activity. At least in North America, Europe, and parts of the Pacific Rim.

 

Note: There are plenty of areas around the world where surveillance and reporting are lacking, and so we still run the risk of being blindsided by an emerging influenza strain. 

 

During flu season I try to provide links, and highlights, to many of these flu surveillance reports each week. For now, flu activity around the world is low, but there are signs it may be increasing. 

 

From yesterday’s WHO Flu report:

 

Summary

• Many countries of the Northern Hemisphere temperate region reported increasing detections of influenza viruses, particularly in North America and Western Europe, however none have crossed their seasonal threshold for ILI/ARI consultation rates.
• Several countries in the tropical areas experienced active transmission of influenza virus in recent weeks. In the Americas, Nicaragua and Costa Rica reported mainly influenza B virus detections. In Asia, India, Sri Lanka, Nepal, and Cambodia are all reporting a mixture of all three virus subtypes.
• In Sub-Saharan Africa, Cameroon and Ethiopia have reported an increase in influenza virus detections.
• Influenza activity in the temperate countries of the Southern Hemisphere is at inter-seasonal levels. A review of the 2012 southern hemisphere influenza season was published in the Weekly Epidemiological Record (WER) 2 November 2012, vol. 87, 44 (pp. 421–436)

 

The ECDC’s latest WISO Report finds very little flu activity across Europe.

 

Weekly reporting on influenza surveillance for the 2012–13 season started in week 40/2012 in Europe.

•  In week 44/2012, all 26 reporting countries experienced low intensity of clinical influenza activity.
•  Of 279 sentinel specimens tested across 19 countries, only two were positive for influenza virus.
•  No hospitalised laboratory-confirmed influenza cases were reported.

Five weeks into the surveillance season for influenza, there has been no evidence of sustained influenza virus transmission in EU/EEA countries.

 

The story is pretty much the same in Canada, as we learn from their latest FluWatch Report.

 

Overall Influenza Summary

• Influenza activity in Canada increased slightly compared to the previous week; however overall activity still remains fairly low, with most regions of the country reporting no activity.
• In week 44, a total of 64 laboratory detections of influenza were reported; of which 91% were for influenza A viruses [71% A(H3) and 29% A(un-subtyped)].
• Six influenza outbreaks in long-term care facilities were reported in week 44.
• Eleven influenza A-associated hospitalizations were reported in week 44: 8 in adults >20 years of age, and 2 in children.
• The ILI consultation rate increased in week 44 to 21.9 per 1,000 patient visits but is within the expected level for this time of year.

 

In the United States, the CDC’s FluView Reports the beginnings of limited flu activity around the country:

012-2013 Influenza Season Week 44 ending November 3, 2012

 

 

Synopsis:

During week 44 (October 28-November 3, 2012), influenza activity increased in some areas, but overall was similar to activity last week in the United States.

• Viral Surveillance: Of 3,277 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories during week 44, 227 (6.9%) were positive for influenza.
• Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was slightly above the epidemic threshold.
• Influenza-associated Pediatric Deaths: No influenza-associated pediatric deaths were reported.
• Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 1.3%, which is below the national baseline of 2.2%. All 10 regions reported ILI below region-specific baseline levels. One state experienced low ILI activity; New York City and 49 states experienced minimal ILI activity, and the District of Columbia had insufficient data.
• Geographic Spread of Influenza: The geographic spread of influenza in 1 state was reported as regional; 8 states reported local activity; the District of Columbia and 33 states reported sporadic activity; Guam and 8 states reported no influenza activity, and Puerto Rico and the U.S. Virgin Islands did not report.

 

 

Many years, influenza doesn’t begin to really spread until December or even January, so the level of activity we are seeing today is probably a poor prognosticator of what we will be seeing two or three months from now.

 

Influenza, however, is notoriously unpredictable. Which makes each flu season unique, and worthy of our attention.

 

Stay tuned.

WHO: 2012 World Health Statistics Report

 

# 6329

 

 

The World Health Organization has released the 2012 edition of their World Health Statistics report, an annual compilation of health-related data from its 194 Member States. This report also summarizes progress being made in achieving the health-related Millennium Development Goals (MDGs).

 

 

While infectious diseases get most of the world’s attention, it continues to be the NCDs (Non-Communicable Diseases) - like high blood pressure, heart disease , diabetes, and tobacco related illnesses – that exact the greatest toll on human health.

 

Some excerpts from today’s press release highlights these findings:

 

New data highlight increases in hypertension, diabetes incidence

News release

16 May 2012 | Geneva - The World health statistics 2012 report, released today, puts the spotlight on the growing problem of the noncommunicable diseases burden.

 

One in three adults worldwide, according to the report, has raised blood pressure – a condition that causes around half of all deaths from stroke and heart disease. One in 10 adults has diabetes.

 

“This report is further evidence of the dramatic increase in the conditions that trigger heart disease and other chronic illnesses, particularly in low- and middle-income countries,” says Dr Margaret Chan, Director-General of WHO. “In some African countries, as much as half the adult population has high blood pressure.”

<SNIP>

Published annually by WHO, the World health statistics is the most comprehensive publication of health-related global statistics available. It contains data from 194 countries on a range of mortality, disease and health system indicators including life expectancy, illnesses and deaths from a range of diseases, health services and treatments, financial investment in health, as well as risk factors and behaviours that affect health.

Some key trends in this year’s report are:

• Maternal mortality: In 20 years, the number of maternal deaths has decreased from more than 540 000 deaths in 1990 to less than 290 000 in 2010 – a decline of 47%. One third of these maternal deaths occur in just two countries – India with 20% of the global total and Nigeria with 14%.
• 10 year trends for causes of child death: Data from the years 2000 to 2010 show how public health advancements have helped save children’s lives in the past decade. The world has made significant progress, having reduced the number of child deaths from almost 10 million children aged less than 5 years in 2000 to 7.6 million annual deaths in 2010. Declines in numbers of deaths from diarrhoeal disease and measles have been particularly striking.

 

(Continue . . . )

DOWNLOAD THE SUMMARY BROCHURE

Available in 3 languages

• English pdf, 381kb
• French  pdf, 389kb
• Spanish pdf, 389kb

DOWNLOAD THE FULL REPORT

Available in 3 languages

• English pdf, 2.47Mb
• French pdf, 2.69Mb
• Spanish pdf, 2.84Mb

 

 

Of considerable interest to those of us who follow disease outbreaks around the world is the lack of disease and mortality information available from many low-resource countries.

 

Among low income countries, only about 1% of deaths (and their causes) are recorded, while just 34 countries – representing 15% of the world’s population – produce high quality cause-of-death documentation.

 

The two most populous countries in the world – India and China – do not have national civil registration systems in place, and instead generate estimates of births and deaths based on smaller population samples.

 

 

All of which helps to explain why, nearly two years after the end of the 2009 H1N1 pandemic, we still don’t have a good handle on how many people died from the virus.

 

This lack of surveillance and reporting extends far beyond just births and deaths, which is why there is so much ambiguity regarding the true prevalence of many diseases (including H5N1) around the world.

 

Much of the data that is available can be accessed via the WHO’s Global Health Observatory, which allows tailored online searches for health information by country or region.

 

Global Health Observatory (GHO)

• Global Health Observatory
• Data repository
• Reports
• Country statistics
• Map gallery
• Standards

Japan: Quake/Tsunami Risks Greater Than Previously Thought

 

Credit Wikipedia

# 6255

 

We’ve two seismic studies announced today in Japan - one regarding Tokyo’s vulnerability to a major earthquake and the other on the tsunami risk that would result from an offshore earthquake in the Nankai Trough.

 

Both substantially escalate the amount of damage that could be expected over previous estimates.

 

First stop, the Nankai quake scenario, as reported by the Japan Times.

 

 

20-meter tsunami projected from Honshu to Kyushu

Nankai quake scenario menaces Pacific coast

Kyodo

Wide swaths of the Pacific coastline stretching from Honshu to Kyushu may be hit by tsunami over 20 meters high if a newly feared megaquake occurs in the Nankai Trough, a Cabinet Office panel warned Saturday.

(Continue . . . )

 

 

Kuroshio, Kochi Prefecture could see a tsunami up to 34.4 meters (112 feet, or as high as a 10 story building), while parts of Shizuoka, Kochi and Miyazaki prefectures could see tidal waves of 10 to 20 meters.

 

Such an earthquake could send tsunami waves towards other Pacific shorelines, as well.

 

The second announcement comes from Japan’s Ministry of Education, Culture, Sports, Science and Technology (MEXT) which has determined that the fault line lying under Tokyo is shallower than previously thought, and capable of producing more damage than had been earlier estimated.

This report from Reuters:

 

Major quake impact on Tokyo could be worse than thought-study

31 Mar 2012 09:10

Source: reuters // Reuters

TOKYO, March 31 (Reuters) - The impact on Tokyo from a major quake could be much more devastating than the government has predicted, a new study shows.

 

The study by the Ministry of Education, Culture, Sports, Science and Technology comes just over a year after one of the biggest tremors on record struck Japan'se northeast coast, triggering a massive tsunami and the world's worst nuclear crisis in 25 years.

(Continue . . .)

 

 

You may recall that a couple of months ago (see Academics Debate Odds Of Tokyo Earthquake) we saw a report indicating that some scientists believe that the odds of a major earthquake striking Tokyo (previously estimated at 70% within 30 years) are overly optimistic, and that there is a 70% chance of a major Tokyo quake in the next four years.

 

And last year, in Divining Japan’s Seismic Future, I wrote about the most widely anticipated seismic event for Japan - the Tokai Earthquake – expected to be an 8+ magnitude, and forecast to occur between the Bay of Suruga and Cape Omasezaki in Shizuoka Prefecture sometime in the near future.

 

 

Major earthquakes have occurred in this region every 100-150 years, with the most recent recorded in 1498, 1605, 1707 and 1854.

 

That puts the Tokai region 157 years since their last major quake, and in the estimation of Dr Kiyoo Mogi – Japan’s leading seismologist – well overdue for another.   In 1969, Dr Mogi began warning that the Tokai area was particularly vulnerable, and today the area is monitored continually by the JMA.

 

Which is why the Prime Minister of Japan called upon Chubu Electric to shut down its No. 4 and No. 5 reactors at the Hamaoka nuclear plant last May, located roughly 200 km south-west of Tokyo.

 

While all of this is of greatest concern to those living in Japan, a major earthquake in one of the great cities of the world would not only be a horrendous human tragedy, it could cause economic repercussions around the globe.

 

In two blogs from last year we looked at the possible ripple effects of `Global Shocks’.

 

Last December in DFID: World Unprepared For Future Shocks  the UK’s DFID (Department for International Development) warned that with global economies in turmoil, and recessionary fears continuing to spread, finding money for many relief, humanitarian, or other worthwhile projects becomes more difficult.

 

And last July, in (OECD Report: Future Global Shocks), where we looked at a 139 page report  released by the OECD (The Organisation for Economic Co-operation and Development) that warned - as the world becomes more interconnected and interdependent - that `Global Shocks’ to the world economy become more likely.

 

In the report, they define a Global Shock as: a rapid onset event with severely disruptive consequences covering at least two continents.

They write:

Extremely disruptive events, such as earthquakes, volcanoes, financial crises and political revolutions destabilize critical systems of supply, producing economic spillovers that reach far beyond
their geographical point of origin.

 

While such extreme events have been relatively rare in the past, they seem poised to occur with greater frequency in the future. Global interconnections accompanying economic integration enable some risks to propagate rapidly around the world.

 

 

The bottom line here is that the world is now so interconnected – that while most disasters are localized - their economic and societal impacts can be felt thousands of miles away and can persist for months.

 

Of course Japan doesn’t have the market cornered when it comes to disasters; the United States, Europe, and the rest of the world are all capable of producing equally disruptive global shocks.  

 

Ultimately, a nation’s resilience in the face of a major crisis –whether it be local or global - comes from the bottom up, not from the top down.

 

Which is why agencies, like the ones below, urge greater individual, family, and community preparedness.

 

FEMA http://www.fema.gov/index.shtm

READY.GOV http://www.ready.gov/

AMERICAN RED CROSS http://www.redcross.org/

 

A few of my preparedness blogs from the past include:

 

When 72 Hours Isn’t Enough

Planning To Survive

An Appropriate Level Of Preparedness

In An Emergency, Who Has Your Back?

The Gift Of Preparedness: 2011