Clinical Infectious Diseases

“….Major limitations in vision, mobility, cognition, and affect were observed in survivors one year following the 2014-6 Ebola outbreak, highlighting the need for long-term rehabilitation…..”

Eureka News Alert

“…..A new article published by JAMA Neurology reports on a study of hospitalized adult patients with new-onset neurologic syndromes who were evaluated for Zika virus infection.

The single-center study of 40 patients, include 29 with Guillain-Barré syndrome (GBS), seven with encephalitis, three with transverse myelitis and one with newly diagnosed chronic inflammatory demyelinating polyneuropathy.

Of those 40 patients, 35 (88 percent) had evidence of recent Zika virus infection in the serum (blood) or cerebrospinal fluid, according to the results. Of the patients who were positive for Zika virus infection, 27 had GBS, five had encephalitis, two had transverse myelitis and one had chronic inflammatory demyelinating polyneuropathy, according to the results…..”

AJIC

• 75 patients with colistin-resistant Klebsiella pneumoniae bloodstream infections were examined.
• Observed:  A high in-hospital mortality rate of 69.3% (52/75 patients).
• Among the 52 patients who did not survive, 28 patients died within 48 hours of bacteremia.

Clinical outcome of dual colistin- and carbapenem-resistant Klebsiella pneumoniae bloodstream infections: A single-center retrospective study of 75 cases in India

Kaur, Amarjeet et al.

UnDark

• An estimated 40 million people — one quarter of the population — are exposed to drinking water contaminated with arsenic.
• Chronic exposure may lead to only a few visible symptoms (skin pigmentation on the chest, hands, and feet occurs in a minority of cases), but the poison is exceptional in its ability to silently attack multiple organs over the course of years, or even decades.
• Trace arsenic exposure in Bangladesh appears to have led to dramatic increases in cancers ranging from skin to liver to lung, in cardiovascular disease, and in developmental and cognitive problems for children.

NY Times

• The suspect, who was shot after the attack in Turku and hospitalized with a leg wound, is an 18-year-old Moroccan

• Four other suspects, also Moroccan citizens, have been arrested in Turku

• A search warrant was issued for a sixth.

NPR

WHO 

Civilians are #NotATarget.

Humanitarian Health Workers are #NotATarget.

Health Cluster partners and humanitarians everywhere are coming together to mark World Humanitarian Day (WHD). Every year on 19 August we pay tribute to aid workers who risk their lives in humanitarian service, and to rally support for people affected by crises around the world.

Violence against health workers providing care in conflict is prohibited by international law, and has therefore been globally condemned – yet the scale and gravity of violence remains extreme. These attacks can take many forms, including looting, sexual assault, arson and bombings. Whilst attacks against health workers remain under-reported, WHO found that in 2016 there were 302 reported attacks in 20 countries facing emergencies, resulting in 418 deaths and 561injuries to health workers. 74% of these attacks were bombings.

As well as destroying human life, such attacks inhibit the ability of humanitarian agencies to respond to health emergencies, increasing the vulnerability of civilians in conflict.

This WHD we demand that leaders:

• Do not target health workers, facilities, or patients.
• Respect the right of all wounded and sick persons to receive medical care.
• Adopt and promote the UN Secretary-General’s recommendations on the protection of medical care in armed conflict.

Learn more

• Learn more about attacks on health workers
• Read WHO’s Q&A
• Learn about World Humanitarian Day
• Access resources to share the campaign
• Hear stories from frontline humanitarian workers

WHO

Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia

Between 4 July and 12 August 2017, the national IHR Focal Point of Saudi Arabia reported 26 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection including six deaths, and two deaths among previously reported cases.

Details of the cases

Detailed information concerning the cases reported can be found in a separate document (see link below).

• MERS-CoV cases reported between 4 July and 12 August 2017.
  xlsx, 45kb

Among the 26 newly reported cases, 13 are associated with a cluster in a hospital in Al Jawf Region, Saudi Arabia. The initial case was a 51-year-old reported on 2 August 2017. To date, 12 cases have been identified through contact tracing. These cases include eight health care workers (all asymptomatic) in the hospital where the initial case was treated, one hospital contact (a 70-year-old male) and three household contacts. Follow up of health care workers, hospital and household contacts are ongoing.

Globally, 2066 laboratory-confirmed cases of infection with MERS-CoV including at least 720 related deaths have been reported to WHO.

Public health response

The Ministry of Health of Saudi Arabia evaluates each case and their contacts and implements measures to limit further human-to-human transmission and bring Middle East Respiratory Syndrome (MERS) outbreaks under control. The measures taken by Ministry of Health officials in Saudi Arabia include:

• Risk stratification and active tracing for contacts in healthcare and in communities. High risk contacts (e.g. unprotected exposure to a case or engagement in an aerosol generating procedure) are tested by PCR regardless of having symptoms. Health care workers are exempted from work until they are cleared by infection control experts.
• Trained hospital epidemiologists have been deployed to sites within 24 hours of identifying an outbreak.
• Enforcement of strict adherence to environmental disinfection and terminal cleaning of affected areas.
• Enforcement of visual triage for respiratory diseases in emergency department and outpatient departments and ensuring the 24/7 availability of trained nurses for early detection of patients with respiratory symptoms, and proper documentation on triage forms.
• Extensive training of all health care workers on case definition for early detection, implementation of isolation precautions, proper selection, donning and doffing of personal protective equipment (PPE), hand hygiene and environmental cleaning and disinfection.
• Ensuring availability of infection prevention supplies including hand sanitizer, PPEs, surface disinfectants, portable HEPA filters and fumigation machines.
• Ensuring that all health care workers are fit tested for high efficiency respirators.
• Implementing the policy of not allowing health care personnel working in a facility affected by an outbreak to travel or work in Hajj premises or in any healthcare facility until they are medical cleared.

WHO risk assessment

MERS-CoV causes severe human infections resulting in high mortality and has demonstrated the ability to transmit between humans. So far, the observed non-sustained human-to-human transmission has occurred mainly in health care settings.

The notification of additional cases does not change the overall risk assessment. WHO expects that additional cases of MERS-CoV infection will be reported from the Middle East, and that cases will continue to be exported to other countries by individuals who might acquire the infection after exposure to animals or animal products (for example, following contact with dromedaries) or human source (for example, in a health care setting). WHO continues to monitor the epidemiological situation and conducts risk assessment based on the latest available information.

WHO advice

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for acute respiratory infections and to carefully review any unusual patterns.

Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. It is not always possible to identify patients with MERS-CoV early because like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, health-care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when performing aerosol generating procedures.

Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease from MERS-CoV infection. Therefore, in addition to avoiding close contact with suspected or confirmed human cases of the disease, people with these conditions should avoid close contact with animals, particularly camels, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating. General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to.

Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.

WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.

NY Times

NY Times

“…..As many as 85 percent of those reaching Uganda recount horrific tales of seeing armed groups burning villagers alive in their houses, shooting people in front of their families, raping women and girls, and seizing boys to serve as conscripts….”