Global & Disaster Medicine

Archive for May, 2017

2 Minnesota brothers with ties to the Middle East were allegedly found with bomb-making materials, guns and ammunition in their car.

Daily Mail

Upper Mississippi Valley sector loop


H7N9 in China, Update: Another 23 human infections with Asian H7N9 bird flu, bringing the total number of such infections during the current (fifth) epidemic to 688.


More Human Infections Reported as CDC Prepares to Ship New Candidate Vaccine Virus

May 23, 2017 — Today the World Health Organization (WHO) reported another 23 human infections with Asian H7N9 bird flu, bringing the total number of such infections during the current (fifth) epidemic to 688. This is the largest epidemic of Asian H7N9 human infections in China since this virus emerged to infect people in 2013. CDC has completed development of a new Asian H7N9 candidate vaccine virus (CVV) that is matched to a recently emerged lineage of Asian H7N9 viruses which have predominated during the fifth epidemic and which could be used to make vaccine if one were needed.

CDC has been monitoring the Asian H7N9 situation closely since 2013 and taken routine preparedness measures, including previously developing three candidate vaccine viruses. Besides an increase in the number of infections being reported during the current epidemic and an increase in the geographic areas in China where human infections with Asian H7N9 are being reported, the epidemiology of H7N9 virus infections in humans does not appear to have changed. Most human infections with Asian H7N9 continue to be associated with exposure to poultry and there is no sustained person-to-person spread of this virus, however, there have been some changes in recent Asian H7N9 viruses identified that are of public health concern.

Most recent viruses belong to a lineage of Asian H7N9 called Yangtze River Delta. Antigenic analysis of some viruses belonging to the Yangtze River Delta lineage has showed reduced cross-reactivity with previously produced CVVs, suggesting that stockpiled vaccine made with earlier CVVs will not protect against the Yangtze River Delta lineage viruses now circulating. Also, based on publically available genetic data, about 10% of viruses from the 5th epidemic have markers indicating reduced susceptibility (resistance) to one or more neuraminidase inhibitor antiviral medications, which are the only currently recommended treatment for avian influenza infections in people.

The new CDC CVV was derived from a low pathogenic avian influenza A/Hunan/2650/2016-like virus and was made using reverse genetics. Creating a candidate vaccine virus is a multistep process that takes months to complete. At this time, CDC is coordinating shipping of the new Asian H7N9 CVV to various manufacturers. Information about the availability of the CVV was posted on the WHO website on Friday, May 18, 2017 at

The cumulative number of human infections with Asian H7N9 viruses reported by WHO between 2013 and May 23, 2017, was 1,486. During the first four epidemics, most human infections occurred between December and March. While new infections continue to be reported, the number of new infections being reported each week has declined since the peak of activity during January of the current epidemic.

More information about Asian H7N9 is available at and

Gunmen attacked a group of Coptic Christians traveling to a monastery in southern Egypt on Friday, killing 28 people and wounding 25 others, kids included.


UNICEF: As many as 150 children die every day in Myanmar before they reach their fifth birthday

The Guardian

  • The child mortality rate is estimated at about 50 per 1,000 live births in Myanmar. In the UK, the rate is four per 1,000.
  • Child rights violations, including the use of children as soldiers.
  • Nearly 30% of children under five suffer from moderate or severe malnutrition
  • More than half of all children live below the poverty line.
  • In western Rakhine state, 120,000 internally displaced people live in camps as a result of inter-communal conflict that erupted in 2012.
  • Violence against Rohingya Muslims, for whom the government does not provide full citizenship rights, has surged since October following attacks on border guard posts.


NOAA: Seasonal hurricane outlooks for the eastern Pacific and central Pacific hurricane basins

NOAA issued seasonal hurricane outlooks for the eastern Pacific and central Pacific hurricane basins. An 80 percent chance of a near- or above-normal season is predicted for each region. The eastern Pacific outlook also calls for a 70 percent probability of 14 to 20 named storms, of which 6 to 11 are expected to become hurricanes, including 3 to 7 major hurricanes. The central Pacific outlook calls for a 70 percent probability of 5 to 8 tropical cyclones, which includes tropical depressions, tropical storms and hurricanes.

Last year produced 5 land-falling storms, including Matthew that caused $10 billion in damage and killed 34 people in the U.S. and 551 in the Caribbean. It was one of the deadliest Atlantic hurricanes on record.

NOAA: Above-normal Atlantic hurricane season is most likely this year


For the upcoming Atlantic hurricane season, which runs from June 1 through November 30, forecasters predict a 45 percent chance of an above-normal season, a 35 percent chance of a near-normal season, and only a 20 percent chance of a below-normal season…..

Forecasters predict a 70 percent likelihood of 11 to 17 named storms (winds of 39 mph or higher), of which 5 to 9 could become hurricanes (winds of 74 mph or higher), including 2 to 4 major hurricanes (Category 3, 4 or 5; winds of 111 mph or higher). An average season produces 12 named storms of which six become hurricanes, including three major hurricanes.

2017 Atlantic Hurricane Season Outlook.

These numbers include Tropical Storm Arlene, a rare pre-season storm that formed over the eastern Atlantic in April.

“The outlook reflects our expectation of a weak or non-existent El Nino, near- or above-average sea-surface temperatures across the tropical Atlantic Ocean and Caribbean Sea, and average or weaker-than-average vertical wind shear in that same region,” said Gerry Bell, Ph.D., lead seasonal hurricane forecaster with NOAA’s Climate Prediction Center.

Strong El Ninos and wind shear typically suppress development of Atlantic hurricanes, so the prediction for weak conditions points to more hurricane activity this year. Also, warmer sea surface temperatures tend to fuel hurricanes as they move across the ocean. However, the climate models are showing considerable uncertainty, which is reflected in the comparable probabilities for an above-normal and near-normal season…..

NOAA brings exciting new observing, modeling, forecasting and communications tools to the table this year to improve our hurricane warning capabilities and aid public readiness:

  • Even before its final positioning, the sophisticated camera on NOAA’s new GOES-16 satellite will give our hurricane forecasters a sneak peek at its greater image resolution, sharp detail and rapid-refresh rate. One of the powerful instruments aboard GOES-16, the lightning mapper, will allow forecasters to see lightning strikes that build within tropical cyclones – a possible signal of strengthening.

  • The combination of two high-resolution hurricane models will improve forecast guidance for the National Hurricane Center this season. The upgraded Hurricane Weather Research Forecast model adds better representation of storms at higher vertical resolution, and has advanced data assimilation and improved physics. With these upgrades, the model can improve intensity forecasts by as much as 10 percent and track forecasts by as much as seven percent. NOAA’s Environmental Modeling Center also is replacing the Geophysical Fluid Dynamics Laboratory Hurricane Model with a new hurricane model called HMON, for Hurricanes in a Multi-Scale Ocean-Coupled Non-Hydrostatic, which has superior track and intensity forecast skill.

  • NOAA’s National Hurricane Center is providing a suite of new forecast and communication tools this season. Forecasters there will issue Storm Surge Watches and Warnings operationally this year, in addition to issuing advisories, watches and warnings for disturbances that aren’t yet a tropical cyclone but still threaten land with tropical storm or hurricane conditions within 48 hours. The center added a new experimental visualization tool so the public can easily see when damaging winds are forecast to reach their community. Also, beginning this year, the public will be able to click on the hurricane track cone graphic and see how far outside of the cone hurricane and tropical-storm-force winds extend, which can be hundreds of miles.

2017 Atlantic Tropical Cyclone Names.

The 2016 season was the most active since 2012, with 15 named storms, including 7 hurricanes and 4 major hurricanes.

NOAA will update this outlook in early August, just prior to the peak of the season.


WHO: Attacks on health care questions and answers


Health care is under attack

We witness with alarming frequency a lack of respect for the sanctity of health care and for international humanitarian law: patients are shot in their hospital beds; medical personnel are threatened, intimidated or attacked; vaccinators are shot; hospitals are bombed.

What are attacks on health care?

We consider attacks on health care to be any act of verbal or physical violence or obstruction or threat of violence that interferes with the availability, access and delivery of curative and/or preventive health services during emergencies.

Attacks on health can include bombings, explosions, looting, robbery, hijacking, shooting, gunfire, forced closure of facilities, violent search of facilities, fire, arson, military use, military takeover, chemical attack, cyberattack, abduction of health care workers, denial or delay of health services, assault, forcing staff to act against their ethics, execution, torture, violent demonstrations, administrative harassment, obstruction, sexual violence, psychological violence and threat of violence.

What are the consequences of attacks on health care?

Every attack on health care has a domino effect. Such attacks not only endanger health care providers; they also deprive people of urgently needed care when they need it most. And while the consequences of such attacks are as yet largely undocumented, they are presumed to be significant – negatively affecting short-term health care delivery as well as the longer-term health and well-being of affected populations, health systems, the health workforce, and ultimately our global public health goals.

Think of the years of education and experience lost with the early and tragic death of each health care worker. Think about the time and resources and dedication it takes to develop one doctor. Think of the resources required to rebuild one hospital. We cannot accept these losses as normal.

What information do we have on attacks on health care?

There is no publicly available source of consolidated information on attacks on health care in emergencies. For 2014 and 2015, WHO consolidated available data on individual attacks from open sources and found:

  • 594 reported attacks in 19 countries facing emergencies
  • 959 deaths, 1561 injuries
  • 63% against health care facilities; and 26% against health care workers
  • 62% of the attacks intentionally targeted health care.

While we recognize that these numbers are not comprehensive, they are a first attempt to provide a consolidated global view of attacks on health care in emergency settings and they serve to highlight the alarming frequency of attacks over the past two year.

Is there sufficient reporting of attacks on health care?

We believe there is considerable under reporting–most likely due to limited awareness of the possibility, means and use of reporting, perceptions of the usefulness of reporting, limited resources and time, fear of reporting, complexity and limitations of existing reporting systems, lack of standardized definitions for use in data collection, and cultural perceptions of violence.

What additional information do we need?

We need a more standardized approach to gathering and sharing information on attacks on health care and their consequences to health service delivery so that the information that is being collected is comparable. The most significant knowledge gap is the consequences of attacks on health care delivery, on the health of affected populations, on health systems, on the health workforce, and on longer-term public health. This is a priority for data collection moving forward.

Quantitative and qualitative information would help us. A combination of quantitative and qualitative information will help us to understand the extent and nature of the problem and to identify and implement concrete actions to reduce the risk and impact of attacks during emergencies.

Where is WHO with developing methods for data collection as per WHA Resolution 65.20?

WHO has developed and tested a new method in some locations; however it is not yet ready for publication. WHO aims to collect and share data on attacks on health care in emergency settings as part of its standard package of information collection and analysis within the new emergency programme. This will depend largely on the resources and capacities available to WHO going forward.

What can be done to stop attacks on health care?

Priority actions include the following:

  • Gather and consolidate comparable data; establish national registries
  • Document the consequences of attacks to health care delivery and public health
  • Establish national legislation to uphold International Humanitarian Law
  • Implement risk reduction measures, including through WHO’s Safe Hospitals Programme
  • Engage communities in protecting health care
  • Inform emergency response plans with security risk analysis
  • Document and apply good practices, including the recommendations of ICRC’s Health Care in Danger (HCiD) project
  • Promote and apply ethical principles in health care delivery
  • Speak out and advocate with zero-tolerance

What about the new Security Council Resolution 2286?

The Security Council 2286 that was unanimously adopted on May 3rd sends a strong message around the world that health care must be protected during conflict.

At the same time, we must remember that this is only part of the solution. We must remember that violence to health care is not only in conflict settings. Remember the health care workers who have been killed while working to eradicate the crippling disease of polio, or those who died from violence during the Ebola response. We also must think beyond the “wounded and sick” to all those who need health care—women giving birth and children needing vaccinations.

What is WHO doing about attacks on health care?

WHO is gathering and sharing information; advocating to build momentum for change; and helping to identify and promote good practice to reduce the risk of attacks.

Manchester: A powerful explosive in a lightweight metal container concealed either within a black vest or a blue Karrimor backpack

NY Times


World Fistula Day

Kenya Star

“…..The three-day conference, under the theme of “Ending Obstetric Fistula in a Generation” is part of the commemorations to mark the World Fistula Day, observed today.

Other related activities include an ongoing Fistula screening and medical intervention of the condition at Gatundu Level 5 hospital.

Obstetric Fistula is a devastating and demeaning condition caused by prolonged obstructed labour, leaving a woman with insufficient voluntary control over urination. It also causes suffering, indignity and disability. The condition is preventable and treatable.

Strong smells occasioned by this condition forces many affected women to remain in hiding away from any public interactions including being shunned by insensitive family members. Separation and divorce are some of the other consequences of the condition.

Globally, an estimated 2 million mothers suffer the stigma of Obstetric Fistula while giving birth……”


Two suspected suicide bombers killed three Indonesian police officers and injured 10 people on Wednesday night in twin blasts near a bus station Jakarta’s Kampung Melayu terminal





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