WHO Statement On Joint H5N1 Mission To Egypt

 

# 10,054

 

 

We’ve been following an unprecedented surge in human H5N1 infection in Egypt since late last fall, and while the Egyptian MOH has been less than forthcoming in their public statements regarding the outbreak, between the WHO, the FAO, and the efforts of independent news gatherers like FluTrackers’ Egypt - 2015 WHO/MoH/Provincial Health Depts H5N1 Confirmed Case List we’ve managed to keep reasonable track of its progress.

 

Two months ago  World Health Organization, along with the  FAO, OIE,  NAMRU-3, CDC & UNICEF were invited to Egypt as a joint mission to investigate and to make recommendations on containing that outbreak.   We’ve been expecting a report on what they found for some time.

 

As I mentioned earlier this week, a summary report was briefly posted on the WHO EMRO  website on May 3rd, but was taken down almost immediately without explanation. 

 

Today the WHO has posted a similar - but more abbreviated - summary of their findings along with a link to an executive summary.  Changes from the May 3rd release include updated case counts to the end of April (165 cases, 48 deaths), and the removal of a section with specific recommendations for addressing the crisis, which are now to be found in the executive summary.

 

 

Egypt: upsurge in H5N1 human and poultry cases but no change in transmission pattern of infection

 

15 May 2015 – The recent increase in the number of people affected by the avian influenza virus H5N1 in Egypt is not related to virus mutations but rather to more people becoming exposed to infected poultry, according to a recent mission of six organizations assessing the H5N1 situation in the country.

Since November 2014 to 30 April 2015, the period analysed by the international mission, a total of  165 cases, including 48 deaths were reported. This is by far the highest number of human cases ever reported by a country over a similar period. There are indications that H5N1 is circulating in all sectors of poultry production and in all parts of Egypt.

The mission stressed that the way the influenza H5N1 virus is transmitted in Egypt appears to have remained stable despite the recent upsurge in numbers of human and poultry infections. While the risk for the current situation to escalate into an H5N1 pandemic does not appear to have been changed appreciably, the situation remains a cause for considerable concern.

“Based on all the evidence we have, we believe the upsurge is not explained by changes in the virus itself,” said Dr Keiji Fukuda, WHO Assistant Director-General for Health Security and head of the H5N1 investigation team in Egypt. “The most likely reason for the increase in cases is that more poultry in Egypt are infected by H5N1 and so more people are exposed to this virus. Coupled with insufficient awareness, behavioural patterns and inadequate precautions taken by humans when interacting with poultry this explains what we are seeing.”

For successful reduction of the negative impact on human health and associated economic and food security consequences, it will be essential to strengthen animal and human disease surveillance, biosecurity and disease control programmes, in a context of a strengthened and close collaboration between human health and animal health departments. This includes appropriate animal vaccination programmes through joint efforts by the public and private sector in charge of animal health.

The report found that: 

• although  human-to-human transmission cannot be excluded, the key epidemiological and demographic features of the recent human cases did not significantly change compared to those reported before the recent increase;  
• there was no evidence for transmission from patients to health care workers during the upsurge; 
• the vast majority of recent human cases – approximately 70% – had known exposure to infected backyard poultry; 
• analysis of the genetic sequence data did not identify changes suggesting more efficient human-to-human transmission.

Although some of the apparent upsurge in cases might be a result of increased testing for H5N1 in humans, this cannot explain the whole picture. The upsurge of infections in poultry and the cases in people has likely been caused by changes in the economy and the poultry industry.

Many small farmers have turned to raising poultry for food and income in an unmonitored and uncontrolled farming sector. The implementation of a proper veterinary control strategy will require strengthening the response capacity, public–private partnerships, vaccination strategies and biosecurity in most poultry production sectors. Ensuring compliance with intergovernmental standards on animal health and regulatory statutes at national level, both in poultry production enterprises or households will be critical for limiting the spread of the H5N1 virus.

The report also notes that Egypt has already recognized the key features leading to the increase in disease, and has recently proposed important structures, sound policies and strategies. However, for them to be effective will require better implementation and concerted commitments at national, governorate and local level. The report recommended that Egypt should make long-term investments in agriculture, veterinary services, health and rural communities to combat H5N1. Policies should be developed to engage the large number of unlicensed commercial and semi-commercial poultry farms in developing new means of implementing and assuring effective disease prevention and control.

 

 

The 7-page executive summary, warns:

` . . .  the presence of H5N1 viruses in Egypt with the ability to jump more readily from birds to humans than viruses in other enzootic countries is of concern and requires a high level of vigilance from the Ministries of Health and Agriculture.’

After reviewing their findings, and listing their recommendations, the report concludes:

 

The way forward

A successful approach to addressing H5N1 requires long-term, sustainable investments in agriculture, health and communities. In particular, close collaboration between sectors is required in communications, policy development, surveillance and response, and the production and sharing of information. Accurate, regular assessment of the impact of control measures is required to evaluate progress.

The government should undertake one or more pilot projects at the district level to determine which changes in policies and practices are most effective in reducing spread of infection among poultry and to humans and sustainable on a medium- to long-term basis. Addressing H5N1 nationally will require long-term changes in policies, practices, culture, awareness and community engagement.

Within three months, a two-year action plan that encompasses these recommendations and includes clear outcomes and indicators for monitoring will be developed by the ministries of health, agriculture and local development. FAO, WHO and OIE will support development of the plan, which will be presented to the NSC.

 

Hopefully we’ll soon see another Influenza at the Human-Animal Interface report from the WHO updating us on the progress and the epidemiology of this outbreak.

HK CHP Avian Flu Report: 2 Weeks Without An H7N9 Case Report

 

# 9856

 

Compared to the first two waves of H7N9 in China, where we saw daily reports from affected provinces which included both case counts and rudimentary epidemiological information, this year’s reporting has been less detailed and far more haphazard. 

 

Some provinces have just reported an aggregate total in their end of month infectious disease reports, while others have dumped `bulk’ case announcements at irregular intervals (see Jiangsu Province’s Uncertain H7N9 Count).

 

All of which has made it very difficult to compare this year’s outbreak to previous years. As I mentioned last week, in H7N9: No News Is . . . . Curious, for the past couple of weeks H7N9 case reporting has gone strangely silent.   As the first two H7N9 waves didn’t end until May, an abrupt halt in case in early March is unexpected.

 

Today, Hong Kong’s CHP has published their latest Avian Influenza Report, and for the second week in a row, confirm that no new H7N9 cases have been reported by the Chinese Mainland since March the 9th.  

 

Avian Influenza Report (Volume 11, Number 12 (Week 12))

Summary

1. There were no new human cases of avian influenza A(H5N1) reported by the World Health Organization (WHO)#. One new human case of avian influenza A(H5N1) involving a 34-year-old man from Yunnan Province was reported by the National Health and Family Planning Commission (NHFPC) on March 23, 2015.

2. From 2010 to 2014, 32 to 62 confirmed human cases of avian influenza A(H5N1) were reported to WHO annually (according to onset date). In 2015 (as of March 23, 2015), 89 cases were reported by WHO* and two additional cases were reported by NHFPC.

3. Since the previous issue of Avian Influenza Report, there were no new human cases of avian influenza A(H7N9). Since March 2013 (as of March 23, 2015), there were a total of 638 cases reported.

 

It is certainly possible that fewer infections are being recorded this winter, and interventions such as the closing of live poultry markets have dramatically reduced transmission.  It is also worth noting that more spring-like weather has returned to many areas of Eastern China over the past several weeks, which could be a mitigating factor.

 

But this precipitous drop in reporting also comes – perhaps coincidentally – at the same time we saw a major study appear in the Journal Nature  (see Dissemination, Divergence & Establishment of H7N9 In China) warning that the H7N9 virus was evolving rapidly, and that it posed a growing pandemic threat.

 

China is, of course, required to notify the World Health Organization of new H7N9 cases under the terms of the IHR, but how and when they choose to publically disclose case information – even to Hong Kong’s CHP - is pretty much up to them. 

If we are truly seeing a less active, and truncated H7N9 wave, then that would be good news indeed.  But the inconsistent reporting out of China these past few months makes it difficult to assume the best based simply on the absence of data.

Fujian Province Reports 6 H7N9 Cases In December

Fujian Province – Credit Wikipedia

 

# 9545

 

One of the more encouraging aspects of 2013’s H7N9 epidemic in China was the unprecedented openness on the part of the Chinese government in announcing cases, releasing studies, and keeping the outside world well informed on this newly emerged avian threat.   

 

It was a dramatic, and praiseworthy change from the tactics employed during the 2003 SARS outbreak, and it was followed in much the same fashion the following winter for the second wave.

But this year, not so much.

 

We’ve seen a smattering of very brief case reports issued from a few provinces, but rarely with the kind of detail we became used to during the first two waves. Onset dates, routes of likely exposure, and follow up reports have been few and far between.

And quite frankly, there’s been a growing feeling among the newshounds following these reports that we’re not seeing all of the cases reported in a timely fashion.

 

Supporting this concern, this morning there was a report in the Chinese press that last month – December of 2014 – Fujian Province recorded 6 H7N9 cases. The only one previously announced was on December 3rd (see Fujian Province: 1 H7N9 Case Reported), meaning that we have no details at all on at least 5 cases.

 

This report from Chinanews.com

Fujian six people infected with H7N9 avian bird flu cold city

At 14:21 on January 8, 2015 Source: China News Network 

Reporters learned from the Fujian Provincial Health Planning Commission last month, the province reported a total of six cases of human infection with the H7N9 bird flu cases and no deaths reported. Health experts said the Planning Commission of Fujian Province, people infected with H7N9 is an acute respiratory infection caused by the H7N9 virus. At present, evidence suggests that exposure to live poultry markets are risk factors for the incidence of human infection with H7N9, carrying the virus in poultry and their droppings, secretions of human infection with H7N9 virus may be the source of infection.

 

Admittedly, not much of a report.  But Sharon Sanders on FluTrackers has found another confirmation, via a monthly summary of communicable diseases published by the Fujian Provincial Health Department.

 

Fujian December 2014 notifiable infectious diseases

Published: 2015-01-07 |

December 2014 (at 0:00 on December 1, 2014 to December 31 24), the province reported a total of A and B infectious diseases 11,363 cases and 19 deaths. This month except plague, cholera, SARS, polio, highly pathogenic avian influenza, rabies, Japanese encephalitis, anthrax, epidemic cerebrospinal meningitis, whooping cough, diphtheria, neonatal tetanus, leptospirosis, schistosomiasis no case reports, the rest are being reported. The top five reported incidence of A and B infectious diseases: viral hepatitis, syphilis, tuberculosis, gonorrhea, HIV, accounting for 98.29% of the total incidence; infectious disease deaths reported as: AIDS, tuberculosis. December, the province reported a total of six cases of human infection with the H7N9 cases, no deaths.

December 2014, the province reported a total of 11,036 cases of class C infectious diseases, no deaths. Reported incidence of the top five diseases were: other infectious diarrheal diseases other than cholera, bacillary and amoebic dysentery, typhoid and paratyphoid, foot and mouth disease, influenza, mumps, acute hemorrhagic conjunctivitis, accounting for 99.88% of the total number of class C infectious diseases.

 
While there is no mention on the front page of the Fujian Provincial Health & Family Planning’s website of these cases, yesterday they did feature prominently the following advisory on avoiding H7N9.

 

Do routine prevention, away from people infected with H7N9

Published: 2015-01-07 | Source: Ministry of Health and Family Planning | Hits:210|

    People infected with H7N9 is an acute respiratory infection caused by the H7N9 virus. At present, evidence suggests that exposure to live poultry markets are risk factors for the incidence of human infection with H7N9, carrying the virus in poultry and their droppings, secretions of human infection with H7N9 virus may be the source of infection. Everyday life, experts say, away from people infected with H7N9, take the following precautions are critical:

   (1) daily life should avoid direct contact with live poultry, birds or their droppings, especially disease (dead) birds; if it has contact Wash hands with soap and water as soon as possible. Children should avoid direct contact with poultry and wild birds. If you find disease (dead) birds, animals, do not deal with on their own, should report the authorities.

   (2) Do not buy live poultry slaughtered on their own, do not touch, do not eat sick (dead) poultry, meat, do not buy without quarantine certificates fresh, live, frozen poultry and their products.

   (3) raw poultry, meat and eggs must be cooked fully cooked.

   (4) attention to food hygiene, food processing, food process, there must be raw and cooked separately to avoid cross contamination, handling raw poultry, meat chopping board, knives and containers can not be used for cooked food; in processing raw poultry After the meat and eggs thoroughly wash their hands.

   (5) a healthy lifestyle is very important for the prevention of this disease. Usually should strengthen physical exercise, plenty of rest, avoid over exertion; no smoking, wash hands, pay attention to personal hygiene, cover your nose and mouth when sneezing or coughing.

   (6) children, the elderly, the infirm and those with chronic diseases should be minimal to crowded public places.

   To wear a mask (7) when the doctor or go to the hospital to visit patients.

   (8) If fever and respiratory symptoms should wear a mask, as soon as possible to medical institutions, and remember to tell your doctor before the onset of whether the travel or contact history with poultry. Should be under the guidance of a doctor for regular treatment and medication. (Committee Propaganda Department)

While we are always cognizant that surveillance and reporting can only pick up a portion of the actual number of cases, over the past couple of years we’ve come to rely heavily upon the excellent reporting by China’s provinces in providing us a pretty good real-time barometer of their H7N9 epidemic status.

It would be a great loss if this year should prove any different.

Egypt: Media Reports Of Another H5N1 Case

 

# 8436

 

Just over two weeks ago (see Watching Egypt Again . . .) the newshounds at FluTrackers picked up several Arabic media reports regarding a pair of H5N1 cases; a 56 years old housewife in Beheira (Damanhur) and a 4 year-old child in Damietta (Annaana).  Six days later the World Health Organization  confirmed those reports here.

Today the Arabic media is once again carrying reports (h/t Gert van der Hoek  on this FluTrackers Thread)  of another H5N1 case (again from Damanhur) – that of  an 86 year-old housewife – who is listed in critical condition and on a ventilator.

 

I’ve checked the Egyptian Ministry of Health website, but so far, I’ve found nothing posted.  These recent cases come after nearly a year without any human infections reported out of Egypt.

 

A case of bird flu to the housewife in Damanhur

Damanhur – ASHA

Announced the Undersecretary of the Ministry of Health in Beheira Dr. Mohammed grace of God for the emergence of new cases of bird flu to housewife ( 86 years ) resident in Damanhur , pointing out that after the onset of symptoms of the disease have been transferred to a hospital chest and give it a " Tamiflu" and entered into intensive care and put on a respirator industrial poor condition .

The grace of God - in a statement today / Saturday / - "It immediately inform the Directorate positive case of bird flu and the team went Preventive Health Directorate where the work was necessary preventive measures , as the team went to the Veterinary Medical Action veterinary preventive measures .

He explained that he was raised from the infected on a respirator after her condition improved , where she was hospitalized in critical condition due to her diabetes , was given the drug " Tamiflu" and entered the intensive care unit .
 

Last updated : 04/05/2014 16:10 timing Cairo

ECDC: Influenza Virus Characterization Sept-Dec 2013

 

Photo Credit NIAID

 

# 8154

 

The ECDC publishes a periodic review of recently isolated flu viruses in the EU they call an Influenza Virus Characterization Report. The last one we looked at was in August (see ECDC: Influenza Virus Characterization – July 2013), and the news ;last summer was pretty good; the majority of the viruses analyzed still appeared to be antigenically similar to those in this year’s vaccine.

 

While flu season is going full steam in North America, flu reports from the EU indicate a much later start to the season.  Additionally, while we are seeing a season heavily dominated by the pH1N1 virus, in Europe it is the H3N2 virus that leads the way.

 

While we talk about the four main strains of influenza that are currently circulating in humans (A/H1N1(pdm), A/H3N2, B Victoria, B Yamagata) as if they were single entities - in reality – within each strain, you will find a good deal of diversity. New `prototypes’ from  these strains are constantly being generated (mostly by antigenic drift) and `field tested’ for biological fitness and transmissibility.

 

Most are evolutionary failures.

 

But since decisions regarding what strains to include in the next flu vaccine must be made 6 months in advance, it is important to detect any new `trends’  among the flu viruses in circulation.  Which is why scientists must monitor these viruses constantly.

 

Today the ECDC has published a new influenza characterization report, that like the last one, finds most of the viruses tested still antigenically similar to the vaccine strains.  But they do report several new H3N2 samples with specific HA amino acid substitutions, and that `antigenic characterization is pending’.

 

Here then is the summary of today’s report, with a link to the full document.

 

Influenza virus characterisation report for Europe: September to December 2013

10 Jan 2014

​The latest issue of ECDC’s series on 'Influenza virus characterisation’ covers the time period since 1 September 2013.

Indicative of the late start of the 2013-14 influenza season, a low number of 46 influenza-positive specimens have been received from six EU/EEA countries so far in WHO Collaborating Centre for Reference and Research on Influenza in London.

 

Influenza type A viruses (91%) are dominating over type B (9%), as is often seen at the beginning of Northern Hemisphere influenza seasons. For type A, H3N2 viruses have been received in greater numbers than H1N1pdm09 viruses, with the ratio of 2:1.

The report further summarises the findings as follows:

• Compared to the 2012–13 influenza season where genetic subgroup 6C dominated among A(H1N1)pdm09 viruses, and based on the current global situation, genetic subgroup 6B viruses have been detected in increasing frequency. Subgroup 6B viruses have been antigenically similar to the vaccine virus, A/California/07/2009.
• Recently circulating A(H3N2) viruses have fallen within genetic subgroup 3C represented by the recommended vaccine virus for the 2013–14 season, A/Texas/50/2012; some new genetic clusters defined by specific HA amino acid substitutions have been observed for which antigenic characterisation is pending.
• No B/Victoria-lineage viruses have been received to date.
• Two genetic clades of B/Yamagata-lineage viruses continue to circulate: clade 3 represented by B/Wisconsin/1/2010 and clade 2 represented by B/Massachusetts/2/2012 (the recommended vaccine component for the 2013–14 influenza season). The great majority of recently circulating viruses fall within clade 2.

The report is prepared under ECDC framework contract and is based on analysis of influenza-positive specimens received by the MRC National Institute for Medical Research, the WHO Collaborating Centre for Reference and Research on Influenza in London.

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.

When The Morning News Goes Viral

Villeneuve-sur-Lot -Wikipedia

 

 

# 7352

 

On an otherwise quiet Sunday morning, we’ve several  unusual virus-and-or-disease-related stories crossing the transom. With a heightened media interest in MERS and H7N9, I believe we can expect to see more these types of news reports over the coming months.

 

Caveat: Most are carried by non-English language media sources and we are forced to make do with somewhat murky machine translations.

 

Our first stop is France, where about a week ago – eight middle-aged women – all of whom helped prepare raw poultry for a catered affair, were hospitalized with an unknown respiratory infection.

Two reports, first this one from May 31st, followed by an update from late yesterday.

 

Villeneuve-sur-Lot (47): eight cases monitored in hospital

Eight women of fifty years were hospitalized with the same symptoms after preparing poultry.

Published on 31/05/2013 at 16:36

Since last week, eight women of fifty years are admitted and monitored at Saint-Cyr hospital with symptoms of fever and cough. Working for a caterer they all prepared poultry for two weddings last weekend.

 

"In a time of emerging viruses, it is probably best to learn," explains Patrick Rolland, the regional branch of the Institute of Health Surveillance (IVS). IVS continues his research, although none of the patients show evidence conclusive coronavirus, H5N1 and H7N9. Further results are expected before making different assumptions.

 

Fast forward to last night, and we learn that MERS and H7N9 have apparently been excluded and the focus now seems to be on determining a bacterial cause.

 

Villeneuve-sur-Lot (47): eight women always kept under observation in hospital

We still do not know what the eight admitted to suffering from last Friday with fever and cough patients.

If influenza H5N1 and H7N9 type virus and corona are now apart, we still do not know what's with the eight women of fifty years under observation in the pulmonology department of the hospital in Saint-Cyr-sur Villeneuve -Lot.

 

Recall that is all knowing and working for a caterer, they had participated in the evisceration of nearly 150 birds in the previous days, for the preparation of two marriages.

 

Although their status has improved thanks to venous antibiotics, the first samples have failed to establish a diagnosis. It was not until the following samples for antibodies can be detected and thus identify bacteria. The eight women are still pending, hospitalized.

 

This is a curious enough report that I’ll try to follow up on it when a cause is determined.

 

Next stop, a genuine MERS-related story out of Saudi Arabia, where a public health official appears to have tried to board a plane carrying a sample of the novel coronavirus (in exactly what kind of container is not stated), to fly to Jeddah.

Apparently the plane was not BSL-3 certified, and airport security thought better of the idea.

 

My thanks to Sharon Sanders of FluTrackers for finding this report from Alwafd.org.

 

King Fahd International Airport ..

Saudi prevent carries sample "Corona" of travel

King Fahd Airport
Gateway delegation - rebounds: Saturday, June 1, 2013 11:50

Saudi security authorities prevented in the King Fahd International Airport in Dammam employees in the Ministry of Health of the rise of the plane that he planned to travel to Jeddah on board, because of him pulled from the sample is infected with "Corona".

The general director of the King Fahd International Airport in Dammam Khaled المزعل, in a statement published Saturday, that the traveler was forced to transfer the sample via the shipping company, and did not allow him to carry on the plane, his trip was postponed so check it and boarded the plane without "Corona."

 

 

And we finish our morning tour with report out of the island nation of Bahrain (which is connected to Saudi Arabia by a causeway), that tells of a Pakistani – who was being tested for the MERS virus – escaping from a local hospital.

 

Once again, Sharon Sanders has the original Arabic story here, which suggests the patient initially tested positive for the virus.  But in short order, Bahrain’s MOH came out with a flat denial (h/t Tetano).

 

Bahrain denies coronavirus case report

Health ministry says test results were negative

By Habib Toumi Bureau Chief

Published: 16:23 June 2, 2013

Manama: Bahrain’s health ministry has denied reports that a Pakistani national who had the coronavirus had fled the country’s main public hospital.

 

The report said that the Pakistani driver was taken to Salmaniya Medical Complex after officials at the King Fahd Causeway linking Bahrain with Saudi Arabia suspected he had the respiratory virus. However, the report added, he managed to leave the hospital while the medics were waiting for the test results.

 

The health ministry on Sunday issued a statement in which it said that exhaustive tests proved that the driver had not contracted the coronavirus and that he left the hospital normally.

(Continue. . . )

 

 

If nothing else, today’s stories will give you an idea of the kind of stories that the combined volunteer newshounds of flublogia wade through (in English, Arabic, Chinese, Vietnamese, Indonesian, French, etc) each and every day.

 

Not every report is `breaking news’, of course.  But each must be identified, translated, and analyzed before they can be cataloged on the flu forums, and put into some kind of context. 

 

Often we don’t know until days, or weeks later, the true significance of these reports. But having the library of these reports can be invaluable.

 

For more on the work done by the newshounds on the Flu Forums, you may wish to revisit:

 

Newshounds On The Trail Of The Latest Beijing H7N9 Report

Flu Reports From Around The Nation

Credit CDC FluView 

# 6818

 

While a few states are still reporting low influenza activity, much of the nation has reported significant increases in influenza-like-illnesses during the month of December. Of concern, the predominate strain this year has been H3N2, which tends to produce a more severe season than does H1N1.

 

With the holidays over and schools scheduled to return to session this week and next, many communities are bracing for another spike in flu cases.

 

A brief round up today of some of the news reports of Flu Activity around the country.

 

First stop, Minnesota, where the latest CDC FluView report showed only moderate activity as of the 22nd of last month.

 

 

Flu cases spike in Minnesota

The Associated Press

MINNEAPOLIS —

Health officials predict it could be one of the worst flu seasons in years in Minnesota.

 

Flu patients have been filling urgent care centers and emergency rooms across the state. More than 120 Minnesotans were hospitalized with the flu in the week ending Dec. 22, nearly twice the number of cases in the previous week, health officials said. And it's still early in the flu season.

 

"That suggests this has the potential to be severe," said Minnesota Department of Health infectious disease director Kris Ehresmann.

(Continue . . . )

 

 

From Florida, Sharon Sanders, editor of  FluTrackers, has been in contact with the local health department, and files this report:

 

Influenza Trends Up in Central Florida in December

Sharon Sanders - Editor FluTrackers.com

January 2, 2012

Winter Park, Florida – Reports from sentinel providers indicate that influenza and influenza-like-illness have been trending up since Thanksgiving says Dain Weister who is the Florida Department of Health spokesman for Orange and Seminole counties. “We are reaching the level of activity seen in the 2009 pandemic” he said. Figure 1 on the Florida Flu Review for week 52 in 2010 shows the progression of the 2007-2008, 2008-2009, and 2009-2010 Florida influenza seasons as monitored by three surveillance systems: ILINet, Bureau of Laboratories viral surveillance, and county activity levels.

 

The Florida Department of Health    indicates "Moderate” as the current level of influenza activity in Central Florida on its website (see map 2).

Mr. Weister reported that 2 nursing homes in the Central Florida area have experienced a flu outbreak this season. Most hospitalizations have been in the 55+ age group and most emergency room visits for flu symptoms have been in the 0-19 age range.

 

The prevalent influenza type in the area confirmed by laboratory testing is A/H3 and A/H1N1 (H1N1pdm09) has also caused some illness. Mr. Weister can reached at 407-858-1400 for further inquiries.

 

From Arizona, we get:

 

Cases of flu in AZ, across US already signal busy season

All but two Arizona counties have reported cases of the flu in what is turning out to be an early and busy season.

 

A total of 581 flu cases of the flu have been laboratory confirmed by the Arizona Department of Health Services this season, state data show. At this time last year only 10 cases had been confirmed statewide.

(Continue . . .)

 

And this report (with video from WKYC-TV) from Ohio indicates a 13-fold increase in flu cases this year, over last.

 

Ohio flu season sees rise in hospitalizations

CLEVELAND -- The Ohio Department of Health is reporting a spike in the number of people hospitalized with influenza this year compared to last year.

 

Department spokeswoman Shannon Libby says it's early to see this much flu activity, with cases typically going up in January or February.

 

According to ODH influenza reports, 65 Ohioans were hospitalized with the influenza virus from October to late December 2011. In that same period this year, the number skyrocketed to 867.

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A reminder that there are still plenty of places where you can get a flu shot, and since the peak of the season may still be a month or more away, it isn’t too late to do so.

 

In addition to the shot, the CDC recommends:

 

Take everyday preventive actions to stop the spread of germs.

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.*
• Avoid touching your eyes, nose and mouth. Germs spread this way.
• Try to avoid close contact with sick people.
• If you are sick with flu–like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.)
• While sick, limit contact with others as much as possible to keep from infecting them.

 

 

These precautionary steps can also help protect against norovirus, which is spreading misery this winter as well -although Hand Sanitizers May Be `Suboptimal’ For Preventing Norovirus.

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

USGS: New Real-Time Earthquake Map

 

New Real-Time USGS Earthquake Map

 

# 6289

 

 

The USGS has introduced an impressive real-time earthquake map on their Earthquakes Hazards Webpage, that allows the user to customize how the data is delivered. 

 

The control panel (see below) allows the user to filter out quakes based on minimum display parameters.

 

 

And the map has the ability to pan and zoom, allowing the user to drill down to the local level (including information on cities, streets, and fault lines).

Close up View of seismic activity around Tokyo, Japan

 

The global map display lists the most recent earthquakes (based on your criteria), and you can click on each event to get more information.

 

 

 

For more on the unveiling of this new tool, we have the following press release from the USGS.

 

Enhanced Real-time Earthquake Information Now Online

Released: 4/17/2012 1:53:48 PM

 

New U.S. Geological Survey webpages featuring more robust, real-time earthquake information are now available.  Whether the earthquake is minor or major, earthquake.usgs.gov visitors will see a unique, interactive earthquake map that regularly updates, can be individually tailored, and provides saved settings for future map visits.

 

In 2011, the website logged almost 48 million unique visitors and nearly 468 million pageviews.

 

"For all citizens of 'Earthquake Country,' whether they reside in our Nation's Capital or near a major global tectonic plate boundary, the new USGS earthquake webpages supply increased functionality to provide more real-time information tailored to the viewer's specific needs," said USGS Director Marcia McNutt. "When the ground shakes and time is of the essence, our goal is to ensure that the most timely information is at the fingertips of those who need to know."

 

From the website, users can access Latest Earthquakes  to zoom into and pan the world map to select different basemaps, as well as overlays such as plate boundaries, faults, and earthquake hazards. Information can be fine-tuned to display earthquakes on the map by time window, magnitude, depth, and maximum recorded intensity.  A list below the map updates for the current map view and settings and is sortable by any data column. Users can also download earthquake lists into other map interfaces like GoogleEarth (KML format) and Excel (CSV).

 

The event page when an earthquake is selected has also been upgraded and it provides interactive features and more information, including downloadable data files in various formats for each earthquake product, such as ShakeMap, Did You Feel It?, etc. This new event-centric view allows the visitor to see all the information associated with each earthquake without having to jump around the website to view each related product.

 

A future product in development will utilize the same user interface to search a comprehensive earthquake catalog populated with all existing USGS earthquake data, presenting a seamless view of recorded world-wide earthquakes current and historic.  It is anticipated that this product will be released in beta later this year.

WMD Center: BIO-Response Report Card

 

 

 

# 5894

 

While I’m personally more concerned over the probability that nature will produce a new, highly virulent pandemic than the possibility that terrorists might develop and unleash a bio-nightmare – I recognize that both are legitimate concerns - and either could deliver a substantial blow to the United States, and to the world.

 

So I’m happy to report that a new analysis outlining America’s ability to respond to either type of bio-emergency has just been released. 

 

The WMD Center, a bi-partisan group formed in 2010 and led by two well respected former Senators (Bob Graham, Chairman & Senator Jim Talent, Vice Chairman) along with an advisory group consisting of some of the nation’s leading biodefense experts, has put together an in depth report card on the nation’s ability to respond to a biological threat.

 

And while much of this report is WMD centric, many of the areas it addresses are equally important during a naturally occurring pandemic.

 

From the executive summary, this report offers:

• An overview of  current and emerging bioterrorism threats,
• Fundamental expectations and evaluations for each of  seven bio-response categories,
• An overview of challenges that affect the entire bio-response enterprise, and
• Recommended priorities that will strengthen the nation’s bio-preparedness and response capabilities.

 

The bottom line, again from the executive summary, is that:

 

The nation does not yet have adequate bio-response capability to meet fundamental expectations during a large-scale biological event.

 

 

As you can see from the color coded report card below, there are a lot of areas where this critical review gives a failing, or near-failing, grade.

 

 

Ten years after the anthrax attacks of 2001, out of 40 categories graded, 15 received an F, 10 received a D, and no area received an A.

 

You can read the entire 73 page report at the link below:

 

Bio-Response Report Card

The idea for this report card project began late last year, when we asked ourselves the question, “If the nation is unprepared for a biological attack, what more can we do?” Since 2001, the United States government has spent more than $65 billion on biodefense, and yet it has done so without an end-to-end, strategic assessment of the nation’s bioresponse capabilities. This report seeks to fill that gap.

View the complete Bio-Response Report Card PDF

 

 

This report indicates that America’s ability to respond to small-scale biological events has improved, but the ability to manage large-scale outbreaks (or worst case scenarios) is severely lacking.

 

This is a sobering report, highly critical in some areas, and will likely ruffle some feathers. 

 

But it does illustrate just how complex, and difficult, preparing for a large-scale biological threat really is. While this report provides that progress has been made, it also reminds us how much work still remains ahead.

 

There is a lot of detail in this report, so by all means, it is worth taking the time to read the whole report.

WHOSIS: World Health Statistics 2011

 

 

# 5570

 

 

The World Health Organization’s 64th World Health Assembly, being held in Geneva (May 16–24), ends today (see WHO Media Centre).

. 

 

One of the resources released to their 193 member nations, and to the public, during the past week is a compilation of global health statistics put together by WHOSIS (WHO Statistical Information System).

 

 

World Health Statistics 2011

World Health Statistics 2011 contains WHO’s annual compilation of health-related data for its 193 Member States, and includes a summary of the progress made towards achieving the health-related Millennium Development Goals (MDGs) and associated targets.

Addendum pdf, 45kb

Progress on the health-related Millennium Development Goals (MDGs)

Fact sheet N°290

DOWNLOAD THE FULL REPORT

Available in 3 languages

English pdf, 4.28Mb

French pdf, 5.50Mb

Spanish pdf, 5.89Mb

 

 

This report provides a comprehensive summary of the current status of national health and health systems in the following nine areas:

• life expectancy and mortality
• cause-specific mortality and morbidity
• selected infectious diseases
• health service coverage
• risk factors
• health workforce, infrastructure and essential medicines
• health expenditure
• health inequities
• demographic and socioeconomic statistics.

 

 

You’ll find most of the information provided in tables, charts, graphs and maps.

 

 

While this report cites modest improvements in global health on a number of fronts (malnutrition, vaccines, lower child and material mortality rates, stabilization of number of new HIV infections), progress varies from country-to-country, and many significant challenges remain.

 

You’ll find an overview of some of the progress that has been made in the following Millennium Development Goals FAQ sheet.

 

Millennium Development Goals: progress towards the health-related Millennium Development Goals

Fact sheet N°290
May 2011

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Key facts

• Fewer children are dying. Annual global deaths of children under five years of age fell to 8.1 million in 2009 from 12.4 million in 1990.
• Fewer children are underweight. The percentage of underweight children under five years old is estimated to have dropped from 25% in 1990 to 16% in 2010.
• More women get skilled help during childbirth. The proportion of births attended by a skilled health worker has increased globally, however, in the WHO Africa and South-East Asia regions fewer than 50% of all births were attended.
• Fewer people are contracting HIV. New HIV infections have declined by 17% globally from 2001–2009.
• Tuberculosis treatment is more successful. Existing cases of TB are declining, along with deaths among HIV-negative TB cases.
• More people have safe drinking-water, but not enough have toilets. The world is on track to achieve the MDG target on access to safe drinking-water but more needs to be done to achieve the sanitation target.

(Continue . . . )

 

 

 

The 2011 World Health Statistics report provides us with some sorely needed good news, and serves as a reminder of how much more needs to be done.

WHO: Global Report On Antimalarial Efficacy And Drug Resistance

 

 

# 5067

 

 

The World Health Organization today has released a new report on the drugs used to treat malaria, along with an appeal to nations to monitor and report any emergence of malarial drug resistance.

 

Roughly half the world’s population lives in areas where they risk infection from the malaria parasite.

 

Each year, roughly 250 million people are infected, and nearly a million people die from the disease  (source WHO 10 Facts on Malaria).

 

CDC Malaria Map.

Map Legend:

 

Over the past couple of years, a new artemisinin resistant form of malaria has appeared along the Cambodian-Thailand border, prompting concerns that it could spread.  

 

Hence the call for heightened monitoring and urgent requests that nations halt the use of oral artemisinin alone for the treatment of uncomplicated falciparum malaria, and use it as part of a drug cocktail instead.   

First the news release, then a link to the report.

 

News release

 

WHO calls on malaria-endemic countries to strengthen monitoring of antimalarial drug efficacy

National monitoring essential step in preventing the emergence of malaria drug resistance

18 NOVEMBER 2010 | GENEVA -- WHO is calling on countries to be increasingly vigilant in monitoring antimalarial drug efficacy in order to allow for early detection of artemisinin resistance.¹ This is one among several conclusions of the Global report on antimalarial drug efficacy and drug resistance: 2000–2010, released today. The report is based on 1100 studies conducted by national malaria control programs and research institutes over the ten-year period.

 

The report estimates that only 34% of malaria-endemic countries are complying with WHO recommendations to routinely monitor the efficacy of first- and second-line antimalarial medicines.²

"A greater political commitment to support and sustain national monitoring of the efficacy of antimalarial medicines is critical to prevent a wider emergence of artemisinin resistance", said Dr Pascal Ringwald of the Drug Resistance and Containment Unit, within WHO's Global Malaria Programme and one of the report authors.

Resistance to artemisinin

In February 2009, WHO confirmed that resistance to artemisinin had emerged on the Cambodia-Thailand border. Although patients infected were cured following treatment with an artemisinin-based combination therapy (ACT), the recovery took more time. In artemisinin-resistant areas, the high cure rates observed depend heavily on the efficacy of the non-artemisinin component of the combination.

 

Nonetheless, the report found that ACTs currently recommended by national malaria control programmes remain efficacious in treating malaria, with cure rates generally greater than 90%. In countries where the currently recommended ACT has a cure rate of less than 90%, policy change is ongoing to implement an efficacious replacement treatments for malaria.

 

"The emergence of artemisinin resistance on the Cambodia-Thailand border has been a wake-up call to the world to prevent its spread, increase monitoring, and preserve ACTs as the only effective treatment we have for falciparum malaria", said Dr Robert Newman, Director of WHO's Global Malaria Programme. "Prompt action will be critical to sustain progress in malaria control and achieve the health-related Millennium Development Goals."

 

(Continue . . .)

 

Global report on antimalarial efficacy and drug resistance: 2000-2010

Authors: WHO
Publication date: 2010
Languages: English
ISBN: 9789241500470

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Download [pdf 2Mb]
Questions and Answers [pdf 186kb]

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Overview

This report provides a comprehensive, global overview of antimalarial drug efficacy and the resistance of malaria parasites to the antimalarial medicines used between 2000 and June 2010. Policy-makers in national ministries of health will benefit from this document, as it provides both a global and a regional picture of the efficacy of the antimalarial medicines currently used in national treatment programmes. In addition, the report will be a reference for scientists, enhancing their understanding of the complexity of antimalarial drug resistance.