Global & Disaster Medicine

Archive for February, 2017

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The United Nations has declared a famine in parts of South Sudan, the first to be announced anywhere in the world in 6 years. There have also been warnings of famine in north-east Nigeria, Somalia and Yemen.



Famine Hits Parts Of South Sudan

Published on 20 February 2017

Copyright: WFP/Cagri Ilban

UN agencies warn that almost 5 million people urgently need food, agriculture and nutrition assistance

JUBA – War and a collapsing economy have left some 100,000 people facing starvation in parts of South Sudan where famine was declared today, three UN agencies warned. A further 1 million people are classified as being on the brink of famine.

The Food and Agriculture Organization of the United Nations (FAO), the United Nations Children’s Fund (UNICEF) and the World Food Programme (WFP) also warned that urgent action is needed to prevent more people from dying of hunger. If sustained and adequate assistance is delivered urgently, the hunger situation can be improved in the coming months and further suffering mitigated.

The total number of food insecure people is expected to rise to 5.5 million at the height of the lean season in July if nothing is done to curb the severity and spread of the food crisis.

According to the Integrated Food Security Phase Classification (IPC) update released today by the government, the three agencies and other humanitarian partners, 4.9 million people – more than 40 percent of South Sudan’s population – are in need of urgent food, agriculture and nutrition assistance.

Unimpeded humanitarian access to everyone facing famine, or at risk of famine, is urgently needed to reverse the escalating catastrophe, the UN agencies urged. Further spread of famine can only be prevented if humanitarian assistance is scaled up and reaches the most vulnerable.

Famine is currently affecting parts of Unity State in the northern-central part of the country. A formal famine declaration means people have already started dying of hunger. The situation is the worst hunger catastrophe since fighting erupted more than three years ago.

“Famine has become a tragic reality in parts of South Sudan and our worst fears have been realised. Many families have exhausted every means they have to survive,” said FAO Representative in South Sudan Serge Tissot. “The people are predominantly farmers and war has disrupted agriculture. They’ve lost their livestock, even their farming tools. For months there has been a total reliance on whatever plants they can find and fish they can catch.”

Malnutrition is a major public health emergency, exacerbated by the widespread fighting, displacement, poor access to health services and low coverage of sanitation facilities. The IPC report estimates that 14 of the 23 assessed counties have global acute malnutrition (GAM) at or above the emergency threshold of 15 percent, with some areas as high as 42 percent.

“More than one million children are currently estimated to be acutely malnourished across South Sudan; over a quarter of a million children are already severely malnourished. If we do not reach these children with urgent aid many of them will die,” said Jeremy Hopkins, UNICEF Representative a.i in South Sudan. “We urge all parties to allow humanitarian organizations unrestricted access to the affected populations, so we can assist the most vulnerable and prevent yet another humanitarian catastrophe.”

“This famine is man-made. WFP and the entire humanitarian community have been trying with all our might to avoid this catastrophe, mounting a humanitarian response of a scale that quite frankly would have seemed impossible three years ago. But we have also warned that there is only so much that humanitarian assistance can achieve in the absence of meaningful peace and security, both for relief workers and the crisis-affected people they serve,” said WFP Country Director Joyce Luma. “We will continue doing everything we possibly can to hold off and reverse the spread of famine.”

Across the country, three years of conflict have severely undermined crop production and rural livelihoods. The upsurge in violence since July 2016 has further devastated food production, including in previously stable areas. Soaring inflation – up to 800 percent year-on-year – and market failure have also hit areas that traditionally rely on markets to meet food needs. Urban populations are also struggling to cope with massive price rises on basic food items.

FAO, UNICEF and WFP, with other partners, have conducted massive relief operations since the conflict began, and intensified those efforts throughout 2016 to mitigate the worst effects of the humanitarian crisis. In Northern Bahr El Ghazal state, among others, the IPC assessment team found that humanitarian relief had lessened the risk of famine there.

FAO has provided emergency livelihood kits to more than 2.3 million people to help them fish or plant vegetables. FAO has also vaccinated more than 6 million livestock such as goats and sheep to prevent further loss.

WFP continues to scale up its support in South Sudan as humanitarian needs increase, and plans to provide food and nutrition assistance to 4.1 million people through the hunger season in South Sudan this year. This includes lifesaving emergency food, cash and nutrition assistance for people displaced and affected by conflict, as well as community-based recovery or resilience programs and school meals.

In 2016, WFP reached a record 4 million people in South Sudan with food assistance — including cash assistance amounting to US$13.8 million, and more than 265,000 metric tons of food and nutrition supplies. It is the largest number of people assisted by WFP in South Sudan since independence, despite problems resulting from the challenging context.

UNICEF aims to treat 207,000 children for severe acute malnutrition in 2017. Working with over 40 partners and in close collaboration with WFP, UNICEF is supporting 620 outpatient therapeutic programme sites and about 50 inpatient therapeutic sites across the country to provide children with urgently needed treatment. Through a rapid response mechanism carried out jointly with WFP, UNICEF continues to reach communities in the most remote locations. These rapid response missions treat thousands of children for malnutrition as well as provide them with immunization services, safe water and sanitation which also prevents recurring malnutrition.

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For more information, please contact:

Lieke Visser, FAO/Juba: +211(0)922001661,
Zoie Jones, FAO/Rome +39 06 570 56309,

Marianna Zaichykova, UNICEF/Juba: +211 95 685 9134,
James Elder, UNICEF/Nairobi: +254 715 581 222,

George Fominyen, WFP/Juba: +211 922 465 247,
Challiss McDonough, WFP/Nairobi: +254 707 722 104,


Republic of South Sudan: Current and Projected (January-July 2017) Acute Food Insecurity Situation

Famine Report:  South Sudan


Republic of South Sudan: Current and Projected (January-July 2017) Acute Food Insecurity Situation

01/01/2017 – 31/07/2017
South Sudan
Extreme levels of food insecurity and localized famine conditions

According to the IPC Analysis update conducted by the South Sudan IPC Technical Working Group (TWG) and endorsed by the government: 


The food security situation in South Sudan continues to deteriorate, with 4.9 million (about 42% of population) estimated to be severely food insecure (IPC Phases 3, 4, and 5), from February to April 2017. This is projected to increase to 5.5 million people, (47% of the national population) at the height of the 2017 lean season in July. The magnitude of these food insecure populations is unprecedented across all periods.


In Greater Unity, some counties are classified in Famine or high likelihood/risk of Famine. In the absence of full quantitative data sets (food consumption, livelihoods changes, nutrition and mortality), analyses were complemented with professional judgment of the Global IPC Emergency Review Committee and South Sudan IPC Technical Working Group (SS IPC TWG) members. The available data are consistent with Phase 5 (Famine) classification and include available humanitarian assistance plans at the time of the analysis. In January 2017, Leer County was classified in Famine, Koch at elevated likelihood that Famine was happening and Mayendit had avoided Famine through delivery of humanitarian assistance. From February to July 2017, Leer and Mayendit are classified in Famine, while Koch is classified as Famine likely to happen. Panyijiar was in Phase 4 (Emergency) in January and is likely to avoid a Famine if the humanitarian assistance is delivered as planned from February to July 2017. With consistent, adequate, and timely humanitarian interventions, the Famine classification could be reversed with many lives saved.


Acute malnutrition remains a major public health emergency in South Sudan. Out of 23 counties with recent data, 14 have Global Acute Malnutrition (GAM) at or above 15%. GAM of above 30% is observed in Leer and Panyijiar while Mayendit had GAM levels of 27.3%. Similarly, a worsening nutrition situation atypical to the post-harvest season is observed in the Greater Equatoria region – particularly in Greater Central Equatoria – a deterioration associated with widespread insecurity, lack of physical access, disruption of the 2016 agricultural season and the ongoing economic crisis. Areas in the Greater Bahr el Ghazal show higher than usual levels of acute malnutrition expected for the post-harvest season, indicating a worsening situation. Insecurity, displacement, poor access to services, extremely poor diet (in terms of both quality and quantity), low coverage of sanitation facilities and deplorable hygiene practices are underlying the high levels of acute malnutrition.


Humanitarian assistance throughout 2016 not only sustained but also improved food security in many areas.It is of paramount importance that assistance not only continues in 2017, but scales up in the face of mounting food insecurity across the country. The expected response to Famine-affected areas in former Unity must not sacrifice much needed assistance to the other severely food insecure areas of the country. There exists a narrow window of opportunity during the dry season to pre-position and deliver humanitarian assistance to prevent drastic increases in food insecurity through the lean season that peaks in July. The overstretching of current humanitarian resources and capabilities during the projected worsening of food insecurity is a distinct possibility, raising the risk of an insufficient response to further deterioration.


Humanitarian access remains a major challenge in implementing lifesaving interventions and critical assessments of the situation in the worst affected areas.  It is imperative that unconditional humanitarian access from all parties involved in the ongoing political conflict is granted to facilitate delivery of assistance to the populations in need. The most food insecure areas show high levels of insecurity, displacement, loss of livelihoods, market failure, and constrained humanitarian access for assistance delivery and monitoring. The key areas to monitor are central and southern Greater Unity, Greater Northern Bahr el Ghazal, drought-affected Greater Pibor and Greater counties of Kapoeta, Malakal, Fashoda, Manyo, Nasir, Kajo-Keji, Yei, Morobo, and Lainya.

H7N9: Analysis of virus samples from China and Taiwan hint at mutations including resistance to the antiviral class of drugs known as neuraminidase inhibitors

Avian Flu Diary: Guangdong

Avian Flu Diary: Taiwan

WHO: The burgeoning number of H7N9 cases this season now account for a third of all cases reported since the outbreak began in 2013.


Human infection with avian influenza A(H7N9) virus – China

Disease outbreak news
20 February 2017

Between 19 January and 14 February 2017, a total of 304 additional laboratory-confirmed cases of human infection have been reported to WHO from mainland China though the China National IHR focal point.

On 19 January 2017, the National Health and Family Planning Commission of China (NHFPC) notified WHO of 111 additional laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus. On 24 January 2017, the NHFPC notified WHO of 31 additional laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus. On 30 January 2017, the NHFPC notified WHO of 41 additional laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus. On 7 February 2017, the NHFPC notified WHO of 52 additional laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus. On 14 February 2017, the NHFPC notified WHO of 69 additional laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus.

Details of the cases

Between 19 January and 14 February 2017, the NHFPC reported a total of 304 human cases of infection with avian influenza A(H7N9). Onset dates range from 13 December 2016 to 9 February 2017. Of these 304 cases, 86 are female (28%). Cases range in age from 3 to 85 years, with a median age of 58 years. The cases are reported from Jiangsu (67), Zhejiang (53), Guangdong (32), Anhui (31), Jiangxi (27), Hunan (26), Fujian (20), Hubei (20), Sichuan (6), Guizhou (4), Henan (4), Shandong (4), Shanghai (3), Liaoning (2), Yunnan (2), Beijing (1), Hebei (1), and Guangxi (1).

At the time of notification, there were 36 deaths, two cases had mild symptoms and 82 cases were diagnosed as either pneumonia (34) or severe pneumonia (48). The clinical presentations of the other 184 cases are not available at this time. 144 cases reported exposure to poultry or live poultry market, 11 cases have no clear exposure to poultry or poultry-related environments. 149 cases are under investigation.

Two clusters of two-person were reported:

  • A 22-year-old female (mother of 3-year-old girl case who had symptom onset on 29 January 2017, died on 7 February 2017) reported from Yunnan province. She had developed symptom on 4 February 2017. She took care of her daughter during her daughter was sick. Both are reported to expose to poultry in Jiangxi province.
  • A 45-year-old female (previously reported on 9 January) from Sihui city, Guangdong province. She had symptom onset on 17 December 2016, and died on 24 December 2016. She was exposed to poultry. Another case was a 43-year-old female from Guangzhou city, Guangdong province. She had symptom onset on 30 December 2016 and was admitted to hospital on the same day. She is the sister of the 45-year old female described above. She took care of her hospitalized sister but also had exposure to poultry. At the time of reporting, she was suffering from pneumonia.

While common exposure to poultry is likely, human to human transmission cannot be ruled out.

To date, a total of 1222 laboratory-confirmed human infections with avian influenza A(H7N9) virus have been reported through IHR notification since early 2013.

Public health response

Considering the increase in the number of human infections with avian influenza A(H7N9) since December 2016, the Chinese government has enhanced measures such as:

  • Strengthened early diagnosis and early treatment, treatment of severe cases to reduce occurrence of severe cases and deaths.
  • Convened meetings to further deploy prevention and control measures.
  • Conducted public risk communication and sharing information with the public.
  • The NHFPC strengthened epidemic surveillance, conducted timely risk assessment and analysed the information for any changes in epidemiology.
  • The NHFPC requested local NHFPCs to implement effective control measures on the source of outbreaks and to minimize the number of affected people.
  • The NHFPC, joined by other departments such as agriculture, industry and commerce, Food and Drug Administration, re-visited Jiangsu, Zhejiang, Anhui and Guangdong provinces where more cases occurred for joint supervision. The affected provinces have also strengthened multisectoral supervision, inspection and guidance on local surveillance, medical treatment, prevention and control and promoted control measures with a focus on live poultry market management control.
  • Relevant prefectures in Jiangsu province have closed live poultry markets in late December 2016 and Zhejiang, Guangdong and Anhui provinces have strengthened live poultry market regulations.

WHO risk assessment

While similar sudden increases in the number of human avian influenza A(H7N9) cases identified have been reported in previous years the number of cases reported during this season is exceeding previous seasons. The number of human cases with onset from 1 October 2016 accounts for nearly one-third of all the human cases of avian influenza A(H7N9) virus infection reported since 2013.

However, human infections with the avian influenza A(H7N9) virus remain unusual. Close observation of the epidemiological situation and further characterization of the most recent human viruses are critical to assess associated risk and to adjust risk management measures timely.

Most human cases are exposed to avian influenza A(H7N9) virus through contact with infected poultry or contaminated environments, including live poultry markets. Since the virus continues to be detected in animals and environments, and live poultry vending continues, further human cases can be expected. Additional sporadic human cases may be also expected in previously unaffected provinces as it is likely that this virus circulates in poultry of other areas of China without being detected.

Although small clusters of human cases with avian influenza A(H7N9) virus have been reported including those involving healthcare workers, current epidemiological and virological evidence suggests that this virus has not acquired the ability of sustained transmission among humans. Therefore the likelihood of further community level spread is considered low.

WHO advice

WHO advises that travellers to countries with known outbreaks of avian influenza should avoid, if possible, poultry farms, contact with animals in live bird markets, entering areas where poultry may be slaughtered, or contact with any surfaces that appear to be contaminated with faeces from poultry or other animals. Travellers should also wash their hands often with soap and water, and follow good food safety and good food hygiene practices.

WHO does not advise special screening at points of entry with regard to this event, nor does it currently recommend any travel or trade restrictions. As always, a diagnosis of infection with an avian influenza virus should be considered in individuals who develop severe acute respiratory symptoms while travelling in or soon after returning from an area where avian influenza is a concern.

WHO encourages countries to continue strengthening influenza surveillance, including surveillance for severe acute respiratory infections (SARI) and influenza-like illness (ILI) and to carefully review any unusual patterns, ensure reporting of human infections under the IHR (2005), and continue national health preparedness actions.

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Outcomes of Pregnancies with Laboratory Evidence of Possible Zika Virus Infection in the United States



Outcomes for Completed Pregnancies in the United States and District of Columbia, 2016-2017

Completed pregnancies with or without birth defects:  1,047

Includes aggregated data reported to the US Zika Pregnancy Registry*

Liveborn infants with birth defects*:  43

Pregnancy losses with birth defects**:  5

*As of February 7, 2017

What these numbers show

  • The number of completed pregnancies with or without birth defects include those that ended in a live birth, miscarriage, stillbirth, or termination.
  • The number of liveborn infants and pregnancy losses with birth defects include those among completed pregnancies with laboratory evidence of possible Zika virus infection that have been reported to the US Zika Pregnancy Registry.
  • These numbers rely on reporting to the US Zika Pregnancy Registry and may increase or decrease as new cases are added or information on existing cases is clarified. For example, CDC cannot report the number of completed pregnancies with or without poor pregnancy outcomes that have not yet been reported to the US Zika Pregnancy Registry.
  • The number of liveborn infants and pregnancy losses with birth defects are combined for the 50 US states, and the District of Columbia. CDC is not reporting individual state, tribal, territorial or jurisdictional level data to protect the privacy of the women and children affected by Zika. CDC is using a consistent case inclusion criteria to monitor brain abnormalities and other adverse pregnancy outcomes potentially related to Zika virus infection during pregnancy in the US states and territories. Puerto Rico is not using the same inclusion criteria; CDC is not reporting numbers for adverse pregnancy outcomes in the territories at this time.
  • Birth defects reported include those that have been detected in infants infected with Zika before, during, or shortly after birth, including microcephaly, calcium deposits in the brain indicating possible brain damage, excess fluid in the brain cavities and surrounding the brain, absent or poorly formed brain structures, abnormal eye development, or other problems resulting from damage to brain that affects nerves, muscles and bones, such as clubfoot or inflexible joints, and confirmed hearing loss.

What these new numbers do not show

  • These numbers are not real time estimates. They reflect the outcomes of pregnancies with any laboratory evidence of possible Zika virus infection reported to the US Zika Pregnancy Registry as of 12 noon Tuesday the week prior. Additionally, there may be delays in reporting of pregnancy outcomes from the jurisdictions.
  • Although these outcomes occurred in pregnancies with laboratory evidence of possible Zika virus infection, we do not know whether they were caused by Zika virus infection or other factors.

Where do these numbers come from?

  • These data reflect pregnancies reported to the US Zika Pregnancy Registry( CDC, in collaboration with state, local, tribal and territorial health departments, established this system for comprehensive monitoring of pregnancy and infant outcomes following Zika virus infection.
  • The data collected through this system will be used to update recommendations for clinical care, to plan for services and support for pregnant women and families affected by Zika virus, and to improve prevention of Zika virus infection during pregnancy.

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NY Times


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