Global & Disaster Medicine

Archive for March, 2017

Egypt saw 4,650 suspected food poisoning cases in schools nationwide in March alone.

KDWN

“…..In a single incident last week in the southern city of Sohag, at least 3,353 students were affected. Similar outbreaks have taken place this week in other governorates, though on a much smaller scale, including in the canal city of Suez, Menoufiya in the Nile Delta and the southern city of Aswan…..Health Ministry official Amr Kandil said an investigation of school meals had detected no microbes linked to food poisoning…….”

 


Obstetric Tetanus in an Unvaccinated Amish Woman After a Home Birth Delivery

Yaffee AQ, Day DL, Bastin G, et al. Notes from the Field. Obstetric Tetanus in an Unvaccinated Woman After a Home Birth Delivery — Kentucky, 2016. MMWR Morb Mortal Wkly Rep 2017;66:307–308. DOI: http://dx.doi.org/10.15585/mmwr.mm6611a7.

Obstetric Tetanus in an Unvaccinated Woman After a Home Birth Delivery — Kentucky, 2016

Anna Q. Yaffee, MD1,2; David L. Day, DVM3; Glenda Bastin, MA3; Mary Powell, MPH4; Sandra Melendez4; Nancy Allen, MSN5; Julie Miracle1; Margaret Jones1; Robert Brawley, MD1 (View author affiliations)

On July 11, 2016, state and local health departments in Kentucky were notified of a case of obstetric tetanus in an unvaccinated woman. Obstetric tetanus, which occurs during pregnancy or within 6 weeks of the end of pregnancy, follows contamination of wounds with Clostridium tetani spores during pregnancy, or the use of contaminated tools or practices during nonsterile deliveries or abortions. CDC did not identify any cases of obstetric tetanus in the United States during 1972–2008 (1,2). State and local health departments in Kentucky investigated this case to identify risk factors and provide recommendations.

The patient, a woman aged 30 years, is a member of an Amish community. In late June, she delivered a child at home, assisted by an unlicensed community childbirth assistant. She had never received a vaccination for tetanus. Delivery was complicated by breech presentation, but no birth trauma, unsterile conditions, or other complications were reported. Nine days postpartum, the patient experienced facial numbness and neck pain, which progressed over 24 hours to stiff neck and jaw and difficulty swallowing and breathing. She was admitted to the hospital where a clinical diagnosis of tetanus was made, and 6,000 international units of tetanus immunoglobulin were administered intramuscularly. Endotracheal intubation and mechanical ventilation were required. Her hospital course was complicated by seizures and a need for prolonged respiratory support. After approximately a month, the patient was stable and discharged home.

The infant was monitored at home during the mother’s hospitalization. Tetanus immunoglobulin was recommended; however, the family declined treatment. A local advanced practice nurse performed weekly follow-up visits and noted no problems in the infant.

The close relationship between the local health department, health care providers, and the approximately 400-member Amish community facilitated contact with community leaders for an opportunity to discuss implementing Advisory Committee on Immunization Practices (ACIP) recommendations for tetanus immunization through a vaccination campaign. Door-to-door home visits in areas with vaccine-supportive community leaders were made by local health department staff members and the advanced practice nurse to explain the benefits of vaccination and provide vaccine. At the time of the campaign, there was one pregnant woman and one woman who was immediately postpartum in the community; both declined vaccination. Forty-seven (12%) persons were vaccinated, including 32 children aged ≤18 years. An age-appropriate diphtheria, tetanus, and pertussis vaccine (DTaP or Tdap) was administered to 30 (64%) of the 47 vaccine recipients. Because many community members reported having had pertussis disease and were opposed to receiving pertussis vaccine, 17 (36%) persons received age-appropriate tetanus and diphtheria toxoids without pertussis vaccine (DT or Td). Although none of the persons receiving vaccine had been previously vaccinated against any disease to date, none have agreed to complete the series because of little perceived ongoing vaccination need. Additional outreach initiatives are planned.

To prevent tetanus, ACIP recommends a 5-dose series of diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) for children at ages 2, 4, 6, 15–18 months, and 4–6 years, followed by 1 dose of tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap) for adolescents aged 11–12 years. Previously vaccinated adults are recommended to receive routine booster doses of a tetanus-containing vaccine every 10 years, and unvaccinated adults should complete a 3-dose primary series (3,4). Pregnant women with unknown or incomplete tetanus vaccination histories should receive a series of 3 doses of tetanus and reduced diphtheria toxoids (Td) to protect against obstetric and neonatal tetanus (5). ACIP also recommends a dose of Tdap to all previously vaccinated pregnant women at 27 to 36 weeks’ gestation during each pregnancy, regardless of time of previous vaccination, to provide protection from pertussis to infants.

This case highlights the importance of tetanus vaccination for all persons as recommended by ACIP (5,6). Although Amish communities generally do not have religious objections to vaccination (7), preventive health care has not historically been accessed by this Amish community. Trust between the Amish community, local health department, and a familiar health care provider, as well as working within community members’ homes, and providing culturally appropriate education and recommendations through community leaders, facilitated vaccination of some persons. Ongoing outreach by health departments is beneficial to vulnerable, nonimmunized or underimmunized populations.

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Corresponding author: Anna Q. Yaffee, ayaffee@cdc.gov, 734-657-3581.

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1Kentucky Department for Public Health; 2Epidemic Intelligence Service, CDC; 3Lincoln Trail District Health Department, Elizabethtown, Kentucky; 4Louisville Metro Public Health and Wellness, Louisville, Kentucky; 5Central Medical Associates, Elizabethtown, Kentucky.

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References

  1. Murphy TV, Slade BA, Broder KR, et al. Advisory Committee on Immunization Practices (ACIP), CDC. Prevention of pertussis, tetanus, and diphtheria among pregnant and postpartum women and their infants recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2008;57(No. RR-4). PubMed
  2. CDC. Tetanus surveillance — United States, 2001-2008. MMWR Morb Mortal Wkly Rep 2011;60:365–9. PubMed
  3. CDC. Recommended immunization schedule for children and adolescents aged 18 years or younger—United States, 2017. Atlanta, GA: US Department of Health and Human Services, CDC; 2017. https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html
  4. CDC. Recommended immunization schedules for adults—United States, 2017. Atlanta, GA: US Department of Health and Human Services, CDC; 2017. https://www.cdc.gov/vaccines/schedules/hcp/adult.html
  5. CDC. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) in pregnant women—Advisory Committee on Immunization Practices (ACIP), 2012. MMWR Morb Mortal Wkly Rep 2013;62:131–5. PubMed
  6. Advisory Committee for Immunization Practices. CDC. Tdap/Td ACIP vaccine recommendations. Atlanta, GA: Advisory Committee for Immunization Practices, CDC; 2014. https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/tdap-td.html
  7. Grabenstein JD. What the world’s religions teach, applied to vaccines and immune globulins. Vaccine 2013;31:2011–23. CrossRef PubMed

 


Four people were killed, along with the assailant, and at least 50 people from 12 different countries were injured, of whom 31 needed hospital treatment. Two remain in a critical condition.

BBC


A new vaccine against rotavirus (kills about 600 children a day) worked well in a large trial in Africa and appears to be a practical way to protect millions of children.

NY Times

  • The vaccine is expected to be as cheap as or cheaper than current alternatives.
  • It can last for months without refrigeration, which makes it far easier to use in remote villages with no electricity
  • It must be approved by the World Health Organization before it can be widely distributed
  • About 215,000 children under 5 die each year of rotavirus, almost half of them in just four countries: India, Pakistan, Nigeria and the Democratic Republic of Congo


Tourism vs. Child Protection: A Compilation of Good Practices

15 Years of the UNWTO World Tourism Network on Child Protection: A Compilation of Good Practices

Copyright © 2014, World Tourism Organization (UNWTO)
15 Years of the UNWTO World Tourism Network on Child Protection: A Compilation of Good Practices
Published by the World Tourism Organization (UNWTO) First printing: February 2014 All rights reserved.

 


The Westminster attacker was British-born

BBC

 

22 March 2017

4 people killed

40 injured

  • 12 Britons in hospital
  • 3 French children injured
  • 9 other nationalities affected
  • 8 arrests made


London, Paris, Berlin, Madrid, Nice: Europe under Terror

LA Times

Northwestern Europe at Night

 


March 22, 2016: Two blasts ripped through the Brussels airport, turning a busy travel hub in the heart of Europe into a scene of carnage.

NY Times

 


A “sick and depraved terrorist attack”: 5 dead and 40 injured in London car-knife assault

Chicago Sun Times

 

 


The attack unfolded around 2:40 p.m., when the driver of a large vehicle mowed down pedestrians on Westminster Bridge, which leads to Parliament, killing 2 and injuring others, before crashing into a railing. After the crash, at least one man left the vehicle and approached Parliament, where he stabbed an armed police officer to death and was fatally shot by the police.

NY Times

 

 


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