Global & Disaster Medicine

Port Authority Pipe Bomb Blast video

NY Times

“…..Using the internet, Mr. Ullah began researching how to build explosives about a year ago, the complaint said. Within the past two to three weeks, it said, he began gathering the materials to construct the bomb: a metal pipe which he filled with explosive material he created; screws to pack inside; and Christmas tree lights and a nine-volt battery to spark its detonation. Then, about one week ago, he built the pipe bomb at his apartment in Brooklyn.….”

An enormous explosion rocked a major natural gas hub in Austria on Tuesday, killing 1 employee, injuring at least 18

NY Times



Cholera in Zambia: From 28 September through 7 December 2017, 547 cases including 15 deaths (case fatality rate = 1.8%), have been reported since the beginning of the outbreak.


Cholera – Zambia

Disease Outbreak News
11 December 2017

On 6 October 2017, the Minister of Health declared an outbreak of cholera in the Zambian capital, Lusaka. From 28 September through 7 December 2017, 547 cases including 15 deaths (case fatality rate = 1.8%), have been reported since the beginning of the outbreak. The initial outbreak period was from 28 September through 20 October. From 21 October through 4 November 2017 there were less than five cases reported each week. However, from 5 November 2017 an increase in the number of cases was observed with a total of 136 cases reported in the week beginning 26 November.

Figure 1: Number of cholera cases in Zambia reported by date of illness onset from 28 September to 2 December 2017

The cholera outbreak initially started in the Chipata sub-district and spread to Kanyama sub-district around 9 October 2017. The outbreak has spread from the peri-urban townships on the Western side of Lusaka City to the Eastern Side with a new case reported in Chelstone sub-district. As of 7 December, the affected sub-districts include Chipata, Kanyama, Chawama, Matero, Chilenje and Chelston. Sixty-two cases are currently receiving treatment in Cholera Treatment Centres in Chipata, Kanyama, Matero and Bauleni. One third of the cases are children under five years old and two thirds are persons five years and older.

A total of 282 Rapid Diagnostic Tests were performed, of which 230 were positive. Of 310 culture tests, 53 were positive for Vibrio cholerae O1 Ogawa (48 from Chipata, four from Kanyama and one from Bauleni). Water quality monitoring is ongoing in all sub-districts, with intensified activity in Kanyama, Matero and Chipata. The results so far show that nearly 42% of tested water sources are contaminated with either Faecal Coliforms or Escherichia coli.

Public health response

The following public health measures are currently being implemented:

  • The Ministry of Health is collaborating with WHO and other partners to control the outbreak.
  • Five Cholera Treatment Centres have been established in Chawama, Chipata, Kanyama, Matero and Bauleni sub-districts to manage cases. So far, 441 cases were successfully treated and discharged.
  • Cholera Outbreak Guidelines and standard operating procedures have been updated and shared with health workers.
  • The facilities in Lusaka District have continued with active surveillance, health education, chlorine distribution, contact tracing and environmental health monitoring.
  • The local authorities in collaboration with the Ministry of Health have embarked on closing contaminated water points and has implemented Water Sanitation and Hygiene (WASH) interventions to improve water supplies in affected areas. This includes provision of household chlorine, disinfection of pit latrines, erection of water tanks, installation of water purifiers and intensification of water quality monitoring.
  • The Lusaka City Council has intensified collection of garbage and emptying of septic tanks in Kanyama and Chipata as priority areas.

WHO risk assessment

The current outbreak is occurring in Zambia’s largest city, Lusaka. The main affected sub-districts, Chipata and Kanyama, are densely populated and have an inadequate water and sanitation infrastructure, which may favour the spread of the disease. The sources of infection transmission in this outbreak have been associated with contaminated water supplies, contaminated food, inadequate sanitation and poor hygiene practices.

The coming of the rainy season, coupled with inadequate water supply and sanitation increases the risk of outbreaks in Lusaka and other parts of the country. Adequate supplies for cholera response should be obtained as part of preparedness activities.

Zambia hosts about 60 000 refugees (as of September 2017) from neighbouring countries. A large proportion of refugees are from the Democratic Republic of the Congo (DRC) and are mostly residing in Nchelenge refugee camp located more than 1000 km distant from Lusaka. The influx of refugees has led to overcrowded settlements with high needs for shelter, healthcare and WASH facilities. Most refugees are in poor health condition, especially children; therefore, risk of disease outbreaks is high. Sanitation is a challenge at hosting sites. Given the security situation in DRC, further influx of refugees is expected.

WHO advice

WHO recommends proper and timely case management in Cholera Treatment Centres. Improving access to potable water and sanitation infrastructure, and improved hygiene and food safety practices in affected communities, are the most effective means of controlling cholera. Use of oral cholera vaccine may also be used for outbreak control. Key public health communication messages should be provided.

WHO advises against any restriction to travel to and trade with Zambia based on the information available on the current outbreak.

For more information on cholera, please see the link below:

Kenya: From 1 January though 29 November 2017, a total of 3967 laboratory-confirmed and probable cases including 76 deaths (case fatality rate = 1.9%) were reported by the Ministry of Health


Cholera – Kenya

Disease Outbreak News
11 December 2017

From 1 January though 29 November 2017, a total of 3967 laboratory-confirmed and probable cases including 76 deaths (case fatality rate = 1.9%) were reported by the Ministry of Health to WHO. Of the cases reported, 596 were laboratory confirmed.

Figure 1: Number of confirmed and probable cases in Kenya reported by week of illness onset from 1 January through 25 November 20171

1Date of illness onset is missing for 92 cases.

From 1 January 2017 through 29 November, 20 of 47 counties (43%) in Kenya have reported cases. As of 29 November, seven counties continue to have active cholera outbreaks (Embu, Garissa, Kirinyaga, Mombasa, Nairobi, Turkana, and Wajir).

The epidemiology of cholera for Kenya in 2017 is characterized by continuous transmission in affected communities coupled with outbreaks in camp settings and institutions or during mass gathering events. Continuous transmission in the community accounts for around 70% of the total cases with the majority of cases coming from the capital county, Nairobi. Transmission in camp settings occurred mainly within Garissa and Turkana counties, accounting for around 23% of the total reported cases. Both counties host big refugee camps, namely Dadaab and Kakuma refugee camps. Refugees in these camps come from countries currently experiencing complex emergencies and large cholera outbreaks. Seven percent of cases occurred in institutions and mass gathering events, where a number of people get infected from a point source.

The country experiences cholera outbreaks every year; however, large cyclical epidemics occur approximately every five to seven years and last for two to three years.

Public health response

The country has activated the national task force to coordinate the outbreak response activities. Since January 2017, WHO and other partners have been providing technical support to the country to control of the outbreak. Following the development of the national response plan, WHO and other partners supported the country to scale-up the outbreak response activities such as surveillance, case management, and social mobilization. This was also coupled with the improvement of food hygiene standards and promotion of safe food handling, besides scaling-up Water, Sanitation, and Hygiene (WASH) related activities. This resulted in a decline in the number of cholera cases.

WHO risk assessment

Despite the decline in the number of cases reported, the outbreak appears to be clustered around two major types of settings. First, the refugee camps particularly Kakuma and Dadaab, and second in the populous Nairobi capital county. Both settings are concerning, considering the overcrowded conditions and limited access to care in the first setting, and the high population density in the second setting. This could enable the spread of the outbreak to other districts. Also, previous outbreaks have shown that cases increase during the rainy season, which has started recently.

In addition, various physical, social, political, and environmental factors increase the vulnerability and the susceptibility of the country’s population to the cholera outbreaks. These include regional drought, conflict, and insecurity in the Horn of Africa, and the increased movement within and to the country by people fleeing conflicts in Somalia and South Sudan.

Overall, the risk of the current outbreak is assessed as high at the national level and low at the regional and global levels.

WHO advice

WHO recommends proper and timely case management in cholera treatment centres. The affected communities should have improved access to water, effective sanitation, proper waste management, and enhanced hygiene and food safety practices. Key public health communication messages should be provided. WHO encourages travellers to the affected area to take proper hygiene precautions to prevent potential exposure.

WHO does not recommend any restriction on travel and trade to Kenya based on the information available on the current outbreak.

For more information on cholera, please see the link below:

SIGA Technologies, Inc. announces the submission of its New Drug Application (NDA) to the U.S. Food and Drug Administration (FDA) for the oral formulation of TPOXX® (tecovirimat) to treat smallpox.


“…..If approved, the oral drug would be the first FDA-approved treatment for smallpox, a disease that has been eradicated but could be used as a bioterror weapon. The news comes on the heels of media reports that North Korea could be building a bioweapons program that might include smallpox.….”


Puerto Rico: The Comfort’s mission has ended, but was it adequately used during a time of desperate medical need?

NY Times

  • The ship was prepared to support 250 hospital beds
  • Over its 53-day deployment, which included travel to and from the island, it admitted an average of only six patients a day, or 290 in total.
  • An additional 1,625 people were treated aboard the ship as outpatients, all at no cost.

US and South Korean intelligence agencies say North Korea has experimented with microbes including anthrax, cholera, and plague, and are thought to have had the smallpox virus since at least the mid-1990s

The Hill



The Koreas at Night

Ullah admitted that he had looked up online how to build the bomb and had assembled it in his residence in Brooklyn, purchasing all of the materials except the pipe, which he said he found at a job site where he was working as an electrician

French baby milk formula maker Lactalis has ordered a global product recall over fears of salmonella contamination because 26 infants in the country have become sick since early December.


“…..Lactalis is one of the world’s biggest dairy producers. Company spokesman Michel Nalet told AFP “nearly 7,000 tonnes” of production may have been contaminated….”

The 5th largest fire in California history: The fire has now burned over 230,000 acres of land and continues to grow exponentially destroying over 750 buildings and homes

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NY Times


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