WHO Corrects The Record On `Self-Inflicted’ HIV In Greece Story

@WHO Twitter Account

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Over the past 24 hours there have been a number of headlines – and media pundits – proclaiming that a recent WHO report found  half of the HIV cases in Greece are `self-inflicted’ in order to obtain government benefits.   A few examples include:

 

HO report: Greeks self-inflict HIV to get €700 benefits RT

Greeks self-inject HIV to claim benefits  Aljazeera.com

Half of HIV Infections in Greece Are Self-Inflicted Fox Business

 

Since last night, the story went viral - which is truly unfortunate - since the story apparently is the result of a typo. This morning the World Health Organization issued a statement that clarifies the situation, and explains how this all came about.

 

WHO correction: Greece and HIV case study featured in WHO Europe report on social determinants

In September 2013, the WHO Regional Office for Europe published a report “Review of social determinants and the health divide in the WHO European Region” which was prepared by the Institute of Equity, University College London, United Kingdom. In this report, an erroneous reference is made to: “HIV rates and heroin use have risen significantly, with about half of new HIV infections being self-inflicted to enable people to receive benefits of €700 per month and faster admission on to drug substitution programmes.”

The sentence should read: "half of the new HIV cases are self-injecting and out of them few are deliberately inflicting the virus".

The statement is the consequence of an error in the editing of the document, for which WHO apologizes.

The source for the statement is a correspondence published in the Lancet by Alexander Kentikelenis and colleagues in September 2011. In this article, Kentikelenis mentions “accounts of deliberate self-infection by a few individuals to obtain access to benefits of €700 per month and faster admission onto drug substitution programmes.”, based on the report of the “Ad hoc expert group of the Greek focal point on the outbreak of HIV/AIDS in 2011” (Greek Documentation and Monitoring Centre for Drug, 2011).

Greece has reported a significant, 52% increase of new HIV infection in 2011 compared to the 2010, largely driven by infections among people who inject drugs in recent years. The reasons for this increase remain multifaceted and WHO welcomes efforts of the ad hoc working group and other entities to fully understand the underlying reasons and recommend appropriate measures to extend the benefits of the comprehensive package of interventions for harm reduction to all people who inject drugs.

Key References:
Kentikelenis A et al. Health effects of financial crisis: omens of a Greek tragedy. Lancet, 2011, 378(9801):1457−1458.
Paraskevis D, Hatzakis A. An ongoing HIV outbreak among intravenous drug users in Greece: preliminary summary of surveillance and molecular epidemiology data. EMCDDA Early Warning System, 2011.
Dimitrios Paraskevis, Economic Recession and Emergence of an HIV-1, Outbreak among Drug Injectors in Athens Metropolitan, Area: A Longitudinal Study,  doi:10.1371/journal.pone.0078941.g005
WHO: Technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users, 2012 revision

WHO MERS-CoV Update – Nov 26th

 

Photo Credit - WHO

 

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Overnight the World Health Organization released a new MERS Coronavirus update with details on three previously announced cases from Saudi Arabia. 

 

I’m pleased to note that this update contains more details (in particular, onset and hospitalization dates) than we’ve normally seen coming out of the Saudi Ministry of Health.  Hopefully this is the start of a welcome trend.

 

Of these three cases, two died.  I’ve excerpted the case information.  Follow the link to read the entire update.

 

 

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

Disease outbreak news

26 November 2013 - WHO has been informed of an additional three laboratory-confirmed cases of infection with Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia.

 

The first patient is a 73-year-old woman with underlying medical conditions from Riyadh who became ill on 12 November 2013, was hospitalized on 14 November 2013 and died on 18 November 2013. The second patient is a 65 year-old man with an underlying medical condition from Jawf region who became ill on 4 November 2013 and was hospitalized on 14 November 2013. The third patient is a 37-year-old man from Riyadh who became ill on 9 November 2013, was hospitalized on 13 November 2013 and died on 18 November 2013. None of the three patients had exposure to animals or contact to a previously laboratory-confirmed case with MERS-CoV.

 

Globally, from September 2012 to date, WHO has been informed of a total of 160 laboratory-confirmed cases of infection with MERS-CoV, including 68 deaths.

(Continue . . . )

 

Indonesian Veterinarian Tests Negative For H5N1 Infection

 

 

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In a follow up to Sunday’s blog  (see Watching Indonesia Again), the veterinarian who was placed into isolation after developing a fever and respiratory symptoms  in the wake of doing poultry inspections has tested negative for the H5N1 virus.  The early symptoms of H5N1 infection are pretty much the same as with any respiratory viral infection, which means we tend to see a number suspected cases turn out to be negative.

 

This from Solopos.com.

DA Veterinarian Bird Flu Negative

Solopos.com, KLATEN - DA, vet initially suspected of contracting the H5N1 virus after examining poultry in Balong Kulon village, Village Kragilan, Gantiwarno Subdistrict, Klaten, declared bird flu negative.

 

"Around 09.00 pm last [Tuesday] we got good news from dr Moewardi. That the results of laboratory tests of veterinary negative DA. Now he is no longer in the isolation room and moved in the treatment room, "said Head of the Department of Agriculture (Dispertan) Klaten, Wahyu Prasetyo, told reporters on Tuesday (26/11/2013).

 

Previously, a few days ago, the vet came to Hamlet Balong DA Kulon, Kragilan Village, District Gantiwarno. It was to follow up on reports of local residents about the birds that died suddenly and allegedly exposed to the H5N1 virus that causes bird flu.

 

At that time, the vet came to the location to do the spraying. A few days later, the DA is in a condition not fit ill with bird flu-like symptoms such as high fever accompanied by shortness of breath, cough, and headache. He was treated in dr Moewardi for further examination.

ECDC: Epidemiological Update On MERS-CoV

 

Credit ECDC Epidemiological Update

 

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The ECDC has released their latest epidemiological update on the MERS Coronavirus (the last one appeared on Oct 4th), and as we’ve come to expect, it’s a concise and informative update with excellent graphics.

Among primary cases (those without a known exposure), the demographics are heavily skewed towards older men (median age 59), and mortality rates of 59%.    Secondary cases, those with a known exposure, were more evenly divided between male and female, were younger (median age 45) , and saw a lower fatality rate (29%).

 

Follow the link below to read:

 

Epidemiological update: Middle East respiratory coronavirus (MERS-CoV)

•  25 Nov 2013

​In June 2012, a case of fatal respiratory disease in a previously healthy 60-year-old man was reported from Saudi Arabia [1]. The cause was subsequently identified as a new coronavirus that has been named Middle East respiratory syndrome coronavirus (MERS-CoV).

By 22 November 2013, 160 cases of MERS have been reported. All cases have either occurred in the Middle East or have direct links to a primary case infected in the Middle East.

From the Middle East, Saudi Arabia has reported 130 cases, including 55 deaths, Jordan two cases, including two deaths, Qatar seven cases, including three deaths, the United Arab Emirates six cases, including two deaths. During the second week of November 2013, two new places from the Middle East have acknowledged cases. Oman (reported one case, which died) and Kuwait (reported two cases, without any deaths).

Twelve cases were reported outside of the Middle East in the United Kingdom (4), Italy (1), France (2), Germany (2), and Tunisia (3). The primary case for each chain was infected in the Middle East, and local secondary transmission following importation was reported from the United Kingdom, France, and Tunisia.

Two probable cases [2]  were recently reported from Spain [3] , the first case was reported on 4 November 2013, and the second case was reported on the 14 November. Both cases have travel history to Saudi Arabia. The first case was symptomatic on the flight from Saudi Arabia to Spain. These probable cases tested positive by the first screening test. Further confirmatory testing is on-going [4]. Probable cases with inconclusive test results have previously been reported from France [5] and Italy [6].

(Continue . . . )

Referral: Dr. Mackay On MERS-CoV, Asymptomatic Infections, And Viral Shedding

Coronavirus – Credit CDC PHIL

 

 

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One of the many unknowns about the MERS coronavirus (and indeed, many other viruses) is how many asymptomatic cases there really are, and whether these cases shed enough virus to be contagious.  With sporadic community cases popping up  the virus must be either quietly circulating, or in the environment somewhere.

 

In August we learned of a man who, while hospitalized in a Saudi facility that reported no other MERS infections, fell ill with the virus 14 days after admission. Given the believed incubation period of < 14 days, this suggests he may have acquired the virus from contact with an asymptomatic carrier inside the hospital (see  Study: Possible Transmission From Asymptomatic MERS-CoV Case).

 

We know that influenza patients can be infectious for up to 24 hours before they display overt symptoms, and some studies suggest that asymptomatic carriers carry a viral load similar to those with symptoms (see PLoS One: Influenza Viral Shedding & Asymptomatic Infections). But how well asymptomatic influenza carriers actually spread the virus remains a topic of considerable debate (see Public Health Report Does Influenza Transmission Occur from Asymptomatic Infection or Prior to Symptom Onset?). 

 

This morning Dr. Ian Mackay takes us on a tour of virus testing (PCR, viral culture, and serology) done for SARS a decade ago, and explains how those results might (or might not) apply to the MERS coronavirus.  Follow the link below to read:

 

 

No symptoms but still shedding virus?

Monday, 25 November 2013

One of the many questions that remain unresolved for MERS-CoV is whether a human who is PCR-positive for the virus, but does not show signs or symptoms of being sick, can spread that infection on to other humans - or animals for that matter.

(Continue . . . )

 

Thanksgiving Is National Family History Day

 

Note: This post is essentially an updated version of last year’s National Family History Day blog entry.

 

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Every year since 2004 the Surgeon General of the United States has declared Thanksgiving – a day when families traditionally gather together - as National Family History Day.

 

As a former paramedic, I am keenly aware of how important it is for everyone to know their personal and family medical history.  Every day emergency room doctors are faced with patients unable to remember or relay their health history during a medical crisis. And that can delay both diagnosis and treatment.

 

Which is why I keep a medical history form – filled out and frequently updated – in my wallet, and have urged (and have helped) my family members to do the same.

 

The CDC and the HHS have a couple of web pages devoted to collecting your family history, including a web-based tool to help you collect, display, and print out your family’s health history.

 

Family History: Collect Information for Your Child's Health

Surgeon General's Family Health History Initiative

 

Using this online tool, in a matter of only a few minutes, you can create a basic family medical history.  But before you can do this, you’ll need to discuss each family member’s medial history. The HHS has some advice on how to prepare for that talk:

 

Before You Start Your Family Health History

Americans know that family history is important to health. A recent survey found that 96 percent of Americans believe that knowing their family history is important. Yet, the same survey found that only one-third of Americans have ever tried to gather and write down their family's health history.

Here are some tips to help you being to gather information:

• Before You Start (English) (PDF - 557 KB)
• Before You Start (Spanish) (PDF - 214 KB)

I’ve highlighted several other methods of creating histories in the past, some of which you may prefer.  A few excerpts (and links) from these essays.First, I’ll show you how I create and maintain histories for my Dad (who passed away last year) and myself.  This was featured in an essay called A History Lesson.

 

Today I’m going to impart a little secret that will ingratiate yourself with your doctor and not only improve the care you receive, but also reduce the amount of time you spend in the exam room. When you go to your doctor, have a brief written history printed out for him or her.

I’ve created a sample based on the one I used for my Dad (the details have been changed).   It gets updated, and goes with him, for every doctor’s visit.

And his doctors love it.

While every history will be different, there are a few `rules’.

• First, keep it to 1 page.     Even if the patient has an `extensive history’.   If your doctor can’t scan this history, and glean the highlights, in 60 seconds or less . . . it isn’t of much use.
• Second, paint with broad strokes.   Don’t get bogged down in details.  Lab tests and such should already be in your chart.
• Third, always fill in a reason for your visit.   Keep it short, your doctor will probably have 10 to 15 minutes to spend with you.   Have your questions and concerns down in writing before you get there.
• Fourth, list all Meds  (Rx and otherwise) and indicate which ones you need a refill on.   If you have a question about a med, put a `?’ next to it.   And if you have any drug allergies, Highlight them.
• Fifth,  Make two copies!   One for your doctor to keep, and one for you.  As you talk to your doctor, make notes on the bottom (bring a pen) of your copy.  

Once you create the basic template (using any word processor), it becomes a 5 minute job to update and print two copies out for a doctor’s visit.

The history above is great for scheduled doctor’s visits, but you also should have a readily available (preferably carried in your wallet or purse), EMERGENCY Medical History Card.

 

I addressed that issue in a blog called Those Who Forget Their History . . . .   A few excerpts (but follow the link to read the whole thing):

 

Since you can’t always know, in advance, when you might need medical care it is important to carry with you some kind of medical history at all times.  It can tell doctors important information about your history, medications, and allergies when you can’t.

Many hospitals and pharmacies provide – either free, or for a very nominal sum – folding wallet medical history forms with a plastic sleeve to protect them. Alternatively, there are templates available online.

I’ve scanned the one offered by one of our local hospitals below. It is rudimentary, but covers the basics.

And a couple of other items, while not exactly a medical history, may merit discussion in your family as it has recently in mine.

 

• First, all adults should consider having a Living Will that specifies what types of medical treatment you desire should you become incapacitated.
• You may also wish to consider assigning someone as your Health Care Proxy, who can make decisions regarding your treatment should you be unable to do so for yourself.
• Elderly family members with chronic health problems, or those with terminal illnesses, may even desire a home DNR (Do Not Resuscitate) Order.

 

Verbal instructions by family members – even if the patient is in the last stages of an incurable illness – are likely to be ignored by emergency personnel.

 

In Florida, the form must be printed on yellow paper. Different states have different requirements.  You should check with your doctor, or the local department of health to determine what the law is in your location.

 

My father, who’s health declined greatly in his 86th year, requested a DNR in early 2011. That – along with securing home hospice care (see His Bags Are Packed, He’s Ready To Go) – allowed him to die peacefully at home in his own bed. 

 

Admittedly, not the cheeriest topic of conversation in the world, but for a lot of people, this is an important issue to address.

 

A few minutes spent this holiday weekend putting together medical histories could spare you and your family a great deal of anguish down the road.