The first is a 39 y.o. male - already listed as deceased - from Jazan City in the far southwest of the country, on the border with Yemen. The second is a 50 y.o. male from Rania, which is about 150 miles east of Taif.Today's report brings the Saudi 2019 total to 116 cases.
Additional laboratory testing is ongoing in order to detect (or rule out) any other infectious agents.Below you'll find two statements, released by Guyana's Department of Public Information, on the investigation. First, from the MOH, a statement that mainly tells us what this outbreak isn't.
No Swine Flu in Mathew’s Ridge
Apr 01, 2019 Government, Ministry of Public Health, News, Press Releases
DPI, Guyana, Monday, April 1, 2019
Public Health Officials have ruled out Swine Flu (H1N1), Zika, Chikungunya, Dengue, Influenza A and B as possible causes of the recent spate of illnesses and death in Mathews Ridge.
Thus far, there has been no evidence of person to person transmission of infection. It is noted that only persons who were directly exposed to one common area became ill.
As of the Sunday, March 31, a response team comprising the Environmental Protection Agency (EPA), Surveillance, EH, doctors and nurses were dispatched to Region 1 to support the efforts taken in the region to address the illnesses. The fortified health response focuses on:
1) providing uninterrupted health services to the residents of Mathews Ridge and,The decision was taken to transfer all the patients with the acute respiratory illness, rash and fever to our tertiary institution – the Georgetown Public Hospital (GPHC) where critical care can be provided, should the need arise.
2) on conducting health assessments of all persons working in the mining area.
While the specialists continue to work on the seven patients admitted on Saturday, results have shown that two patients tested positive for Leptospirosis, which is known to be spread by direct contact with rat urine or faeces.
Further tests are being conducted locally, and samples will be sent overseas with support from PAHO and CARPHA to get further tests done to rule out other possible infections.
The Public Health Ministry is taking all necessary precautions to ensure staff and members of the community at Mathews Ridge are kept safe.
The mining company has been instructed to halt further exploration until the ministry and a team from the Occupational Health and Safety department of the Ministry of Social Protection can advise further. The Ministry of Public Health, along with partners, will continue to monitor the situation closely until resolution.
Second NEOC meeting held to provide updates on action plan
Apr 01, 2019
─ NEOC monitoring the situation, deploying personnel at necessary locationsThe National Emergency Operation Centre (NEOC), activated on Sunday following reports of employees from the Guyana Manganese Incorporated (GMI) firm being infected by an ailment, today held their second meeting to provide updates to the action plan. The action plan was developed on Sunday at an initial meeting where agencies were designated specific responsibilities. The Director-General of the Civil Defence (CDC), Lieutenant Colonel, Kester Craig activated NEOC to bring all the key stakeholders together to ensure there is a Common Operating Picture (COP).
─ ensuring all safety measures are being taken especially regarding use of personal protective equipment
─ tests are currently being conducted by Ministry of Public Health to identify the ailment
The Ministry of Public Health was identified as the lead agency for response. It will be supported by the Guyana Civil Aviation Authority (GCAA), Ministry of Indigenous Peoples’ Affairs (MoIPA), Ministry of Communities (MoC), the Civil Defence Commission (CDC), the Guyana Geology and Mines Commission (GGMC), the Maritime Administration (MARAD) and the Guyana Police Force (GPF).
The NEOC continues to monitor the situation and is deploying personnel at the necessary locations. It is also ensuring that all safety measures are being taken especially as it relates to the use of personal protective equipment.
Contrary to the reports in the local media, there has been no determination of what the ailment is but all the patients have displayed similar symptoms. Tests are currently being conducted by the Ministry of Public Health to identify the ailment.
Nikosi Bruce.
Incidence and Trends
- It is estimated that 100-150 Leptospirosis cases are identified annually in the United States. About 50% of cases occur in Puerto Rico.
- The largest recorded U.S. outbreak occurred in 1998, when 775 people were exposed to the disease. Of these, 110 became infected.
- Although incidence in the United States is relatively low, leptospirosis is considered to be the most widespread zoonotic disease in the world.
- It’s estimated that more than 1 million cases occur worldwide each year, including an about 59,000 deaths.
Although not included on the list of diseases to be considered at the meeting, monkeypox and leptospirosis were discussed and experts stressed the risks they pose to public health. There was agreement on the need for: rapid evaluation of available potential countermeasures; the establishment of more comprehensive surveillance and diagnostics; and accelerated research and development and public health action.
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| CDC AFM Website |
While the exact causes of AFM aren't fully understood, it has been linked to a number of viral infections, including West Nile Virus, Adenoviruses, and - quite often - to number of (polio and non-polio) enteroviruses, including EV-71 and more recently, EV-D68.While AFP has been described for hundreds of years, starting about a decade ago we began seeing unprecedented outbreaks of AFM - mostly in children - increasingly associated with recent infection with NPEVs (non-polio enteroviruses).
Coincident with this outbreak doctors reported a rise in cases of neurological illness presenting with AFP (acute flaccid paralysis) or limb weakness – often associated with a recent respiratory illness – mostly in children.A second, similar outbreak was reported in the fall of 2016, but no concurrent outbreak of EV-D68 was noted. This was followed by an even larger third outbreak in 2018 (see CDC chart below), which appears to be at least partially linked to both EV-D68 and EV-71.
EID Journal: Morens & Taubenberger On The Evolution Of HPAI H5Nx
Morens & Taubenberger - Influenza Viruses: Breaking All the Rules
mBio: An H7N9 Perspective by Morens, Fauci & Taubenberger
Morens and Taubenberger: A New Look At The Panzootic Of 1872
Perspective | Clinical Science and Epidemiology
Acute Flaccid Myelitis: Something Old and Something New
David M. Morens, Gregory K. Folkers, Anthony S. Fauci
Arturo Casadevall, Editor
DOI: 10.1128/mBio.00521-19
ABSTRACT
Since 2014, acute flaccid myelitis (AFM), a long-recognized condition associated with polioviruses, nonpolio enteroviruses, and various other viral and nonviral causes, has been reemerging globally in epidemic form. This unanticipated reemergence is ironic, given that polioviruses, once the major causes of AFM, are now at the very threshold of global eradication and cannot therefore explain any aspect of AFM reemergence.
Instead, the new AFM epidemic has been temporally associated with reemergences of nonpolio enteroviruses such as EV-D68, until recently thought to be an obscure virus of extremely low endemicity. This perspective reviews the enigmatic epidemiologic, virologic, and diagnostic aspects of epidemic AFM reemergence; examines current options for clinical management; discusses future research needs; and suggests that the AFM epidemic offers important clues to mechanisms of viral disease emergence.
PERSPECTIVE
In recent decades, new human infectious diseases such as HIV/AIDS, severe acute respiratory syndrome (SARS), and Nipah virus infection, among others have emerged. Well-known diseases also have reemerged because of human movement, crowding, and other population factors (e.g., dengue and dengue hemorrhagic fever), warfare and natural disasters (e.g., cholera), and viral evolution (e.g., poultry-adapted influenza A H5N1 and H7N9) (1).
Joining this list is epidemic acute flaccid myelitis (AFM), characterized by sudden denervation-associated muscle paralysis of healthy children (and occasionally adults) in one or more limbs that mimics poliomyelitis but which is not caused by polioviruses (2). AFM was first recognized around 2010 as a seemingly novel condition (3, 4) and quickly grew into an alarming and important disease threat, with the first large outbreak occurring in 2014 (5).
Since then, seasonal waves have occurred every other year in the United States, the largest occurring in 2018 (Fig. 1) (6–8)). Because of its uncertain cause and pathogenesis, enigmatic epidemiology, and limited treatment options, the disease captured national attention and triggered considerable concern among parents of young children.(Continue . . . . )
Acute Flaccid Myelitis In Canada - CMAJ Review
CDC Update & Statement On Acute Flaccid Myelitis (AFM)
mBio: Contemporary EV-D68 Strains Have Acquired The Ability To Infect Human Neuronal Cells
More AFM Reports & Recent Studies On AFM
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| Credit Wikipedia |
While H5N1 has been reported in recent months in India and Nepal, China's last HPAI H5N1 outbreak was reported from Qinghai Province in June of 2018. Prior to that, you have to go back to an outbreak in Inner Mongolia in August of 2017.Today China's MOA is reporting an outbreak in Liaoning Province - which lies adjacent to North Korea - and the culling of more than 25,000 birds.
A highly pathogenic avian influenza outbreak of poultry H5N1 occurred in Xinmin City, Liaoning Province
Date: 2019-04-02 10:48 Author: Source: Ministry of Agriculture and Rural Press Office
The Information Office of the Ministry of Agriculture and Rural Affairs released on April 2, a high-pathogenic avian influenza epidemic of poultry H5N1 in Xinmin City, Shenyang City, Liaoning Province.
On April 2, the Ministry of Agriculture and Rural Affairs received a report from the China Animal Disease Prevention and Control Center and was diagnosed by the National Avian Influenza Reference Laboratory. H5N1 subtype highly pathogenic avian influenza epidemics occurred in poultry raised by a farmer in Xinmin City.
The farmer kept 24,500 poultry and died more than 1,000 birds. After the outbreak, the local authorities in accordance with the relevant plans and technical requirements for prevention and control, do a good job in the treatment of the epidemic situation, has culled 25,472 poultry, all the sick and culled poultry have been harmless treatment.
Updated 1900 hrs EST
Local media is reporting (links below) that 6 more mine workers have been airlifted from Matthew's Ridge - presumably with similar symptoms - to a Georgetown hospital and that two of the 7 original patients have tested positive for Leptospirosis.
More manganese workers medevaced from Matthew’s RidgeLeptospirosis is most commonly associated with exposure to rodent urine, but has also been detected in bats (see 2015 PLoS Pathogens Leptospira and Bats: Story of an Emerging Friendship) - and can cause severe pulmonary infections - making this a plausible cause of this outbreak.
BREAKING: Two diagnosed with Leptospirosis from Matthew’s Ridge mines
Thus far, I've not found any official statements corroborating these media reports.
But there is, in the past hour or so, some additional news being reported by local media on the `mystery' respiratory illness contracted by 8 miners in Guyana (see A Curious Report From Guyana) who were tasked with removing bat guano from a manganese mine.In yesterday's report we learned at least one of the workers had died, and 7 others had been isolated at a local (Matthew's Ridge) hospital before being moved to the capital city Georgetown on Saturday.
While local health officials have denied rumors that it was H1N1 - more than thirty hours later, we still have no laboratory confirmation of their illness.About an hour ago, however, local media (inewsguyana.com) reported that the hospital where these patients were initially transported has been shut down, and the staff (and operations) moved to a community health center, in order to allow the facility to be `fumigated'.
This comes 48 hours after the infected patients were moved to another facility, and may be mostly a public relations move designed to reassure their staff and local patients.First an excerpt from the media story, then I'll return with a postscript.
Operations at Matthew’s Ridge Hospital temporarily shut down
April 1, 2019(Continue . . . )
–medical staff working from community centre, building to be fumigated
Operations at the Matthew’s Ridge Hospital, Region One (Barima/Waini), have been temporarily ceased with its medical staff working out of the Community Centre in that area.
<> was told this morning that this latest development is in light of the recent situation where at least eight Chinese nationals were air-dashed to the capital city on Saturday afternoon after experiencing a “mysterious” illness with severe symptoms similar to those of the H1N1 virus (Swine Flu).
This undiagnosed illness has already claimed the life of one individual.
A senior source told this publication that the Matthew’s Ridge Hospital has been evacuated to allow for fumigation of the facility since medical staff are still to determine the cause of the sickness that the men experienced over the past week.
Their News and Events webpage still works, but alas, the most recent entry is from May, 2016.The most reliable official source of information so far has been Guyana's Department of Public Information Facebook page, but their last update on this topic was 16 hours ago. They did report late yesterday on a meeting held by the Ministry of Health, Civil Defense, their CDC, and other agencies due to this outbreak:
NEOC coordinating response to ailment in Region One
Mar 31, 2019 Government, Ministry of the Presidency, News
DPI, Guyana, Sunday, March 31, 2019
Following the reports of employees from the Guyana Manganese Incorporated (GMI) firm in Barima-Waini, Region One being infected by an ailment, the Director-General of the Civil Defence (CDC) Lieutenant Colonel Kester Craig activated a National Emergency Operations Centre (NEOC) to bring all the key stakeholders together to ensure there is a Common Operating Picture (COP).
The seven employees who are currently hospitalised at the Georgetown Public Hospital displayed symptoms of pain, fever, headache and respiratory distress, which resulted in the death of another worker.
The meeting which was hosted at CDC’s headquarters, Thomas Lands on Sunday, aimed at identifying the key response stakeholders who will track, monitor and document the situation.
The Ministry of Public Health was identified as the lead agency for response. It will be supported by the Guyana Civil Aviation Authority (GCAA), Ministry of Indigenous People’s Affairs (MoIPA), Ministry of Communities (MoC), the Civil Defence Commission (CDC), the Guyana Geology and Mines (GGMC), the Maritime Administration (MARAD) and the Guyana Police Force (GPF)
At the end of the meeting, a plan of action was developed and agencies were designated specific responsibilities which are to be executed within an identified timeframe.
Contrary to the reports in the local media, there has been no determination of what the ailment is but all the patients have displayed similar symptoms. Tests are currently being conducted by the Ministry of Public Health to identify the ailment.
During the month of March, Vietnam reported more than 400 outbreaks, as the disease has spread from 6 provinces to 23 provinces. China, meanwhile, reported only 5 outbreaks last month.As mentioned previously, there are strong indications that we're not getting the most accurate accounting out of China's Ministry of Agriculture (see Reuters report Piles of pigs: Swine fever outbreaks go unreported in rural China), and there are almost daily reports of dead pigs (Google search `死猪') being dumped into rivers, or quietly disposed of, without an official finding of ASF.
While China's reporting of outbreaks has dropped off, a month ago, in China MPS Announces Prosecution Of Crimes Related to African Swine Fever, we saw nearly 1,000 people had been arrested for crimes related to African Swine Fever.For what its worth, yesterday (March 31st), China's MOA published their 4th outbreak announcement for the month of March, involving two farms in Hubei Province.
Lichuan City, Hubei Province occurrence of African swine fever outbreak
Date: 2019-03-31 16:49 Author: Source: Agriculture and Rural Department of Public Information Office
Ministry of Agriculture and Rural Press Office issued March 30, Lichuan City, Hubei Province occurrence of African swine fever epidemic.
March 30, the Ministry of agriculture and rural areas to the control center reported Chinese animal epidemic prevention, Animal Disease Control Center of Hubei Province confirmed, Lichuan City, two farms occurrence of African swine fever epidemic. Up to now, a pig farm 142 population, the incidence of eight, five deaths; other farm pig herds 83, incidence of 83, 73 died.
After the outbreak, the Ministry of Agriculture and Rural immediately sent a steering group to the local. Started as required by local emergency response mechanism, to take the blockade, culling measures to deal with harmless treatment, disinfection, culling of all pigs died and sound processing. At the same time, prohibiting all pigs and their products to bring up the blockade zone, prohibiting the transport of live pigs blockade zone. At present, these measures have been implemented.