Global & Disaster Medicine

Archive for the ‘Global Health’ Category

Agony in a Venezuelan Mental Health Hospital: NY TIMES, 12/18/16



OHIO: Six out of 10 on Key Indicators Related to Preventing, Detecting, Diagnosing and Responding to Outbreaks


Ready or Not? examines the nation’s ability to respond to public health emergencies, tracks progress and vulnerabilities, and includes a review of state and federal public health preparedness policies.  Some key Ohio findings include:

No. Indicator Ohio Number of States Receiving Points
A “Y” means the state received a point for that indicator
1 Public Health Funding Commitment: State increased or maintained funding for public health from FY 2014 to FY 2015 and
FY 2015 to FY 2016.
Y 26
2 National Health Security Preparedness Index: State met or exceeded the overall national average score (6.7) of the National Health Security Preparedness IndexTM, as of 2016. 30 + D.C.
3 Public Health Accreditation: State had at least one accredited public health department. Y 43 + D.C.
4 Flu Vaccination Rate: State vaccinated at least half of their population (ages 6 months and older) for the seasonal flu from Fall 2015 to Spring 2016. 10
5 Climate Change Readiness: State received a grade of C or above in States at Risk: America’s Preparedness Report Card. 32 + D.C.
6 Food Safety: State increased the speed of DNA fingerprinting using pulsed-field gel electrophoresis (PFGE) testing for all reported cases of E. coli. Y 45 + D.C.
7 Reducing Healthcare-Associated Infections (HAIs): State implemented all four recommended activities to build capacity for HAI prevention. Y 35 + D.C.
8 Public Health Laboratories: State public health laboratory provided biosafety training and/or provided information about biosafety training courses for sentinel clinical labs (from July 1, 2015 to June 30, 2016). 44
9 Public Health Laboratories: State public health laboratories reported having a biosafety professional on staff (from July 1, 2015 to June 30, 2016). Y 47 + D.C.
10 Emergency Healthcare Access: State has a formal access program or a program in progress for getting private sector healthcare staff and supplies into restricted areas during a disaster. Y 10
Total 6

“Starving to death”: UN aid chief urges global action as starvation, famine loom for 20 million across Kenya, Yemen, South Sudan and Somalia


Image result for horn of africa

10 March 2017 – Just back from Kenya, Yemen, South Sudan and Somalia – countries that are facing or are at risk of famine – the top United Nations humanitarian official today urged the international community for comprehensive action to save people from simply “starving to death.”

“We stand at a critical point in history. Already at the beginning of the year we are facing the largest humanitarian crisis since the creation of the UN,” UN Emergency Relief Coordinator Stephen O’Brien told the Security Council today.

Without collective and coordinated global efforts, he warned, people risk starving to death and succumbing to disease, stunted children and lost futures, and mass displacements and reversed development gains.

“The appeal for action by the Secretary-General can thus not be understated. It was right to sound the alarm early, not wait for the pictures of emaciated dying children […] to mobilize a reaction and the funds,” Mr. O’Brien underscored, calling for accelerated global efforts to support UN humanitarian action on the ground.

Turning to the countries he visited, the senior UN official said that, about two-thirds of the population (more than 18 million people) in Yemen needed assistance, including more than seven million severely food insecure, and the fighting continued to worsen the crisis.

“I continue to reiterate the same message to all: only a political solution will ultimately end human suffering and bring stability to the region,” he said, noting that with access and funding, humanitarians will do more, but cautioned that relief-workers were “not the long-term solution to the growing crisis.”

In South Sudan, where a famine was recently declared, more than 7.5 million people are in need of assistance, including some 3.4 million displaced. The figure rose by 1.4 million since last year.

“The famine in the country is man-made. Parties to the conflict are parties to the famine – as are those not intervening to make the violence stop,” stressed Mr. O’Brien, calling on the South Sudanese authorities to translate their assurances of unconditional access into “action on the ground.”

Similarly, more than half the population of Somalia (6.2 million people) is need aid, 2.9 million of whom require immediate assistance. Extremely worrying is that more than one million children under the age of five are at the risk of acute malnourishment.

“The current indicators mirror the tragic picture of 2011, when Somalia last suffered a famine,” recalled the UN official, but expressed hope that a famine can be averted with strong national leadership and immediate and concerted support by the international community.

Concerning Kenya, he mentioned that more than 2.7 million people were food insecure, and that this number could reach four million by April.

“In collaboration with the Government [of Kenya], the UN will soon launch an appeal of $200 million to provide timely life-saving assistance and protection,” he informed.

Further in his briefing, Mr. O’Brien informed the Council of the outcomes of the Oslo Conference on the Lake Chad Basin where 14 donors pledged a total of $672 million, of which $458 million is for humanitarian action in 2017.

“This is very good news, and I commend those who made such generous pledges,” he said but noted that more was needed to fully fund the $1.5 billion required to provide the assistance needed across the region.

On the UN response in these locations, Mr. O’Brien highlighted that strategic, coordinated and prioritized plans are in place and dedicated teams on the ground are closely working with partners to ensure that immediate life-saving support reaches those in need.

“Now we need the international community and this Council to act,” he highlighted, urging prompt action to tackle the factors causing famine; committing sufficient and timely financial support; and ensuring that fighting stops.

In particular, he underscored the need to ensure that humanitarians have safe, full and unimpeded access and that parties to the conflict in the affected countries respect humanitarian law and called on those with influence over the parties to the conflict to “exert that influence now.”

“It is possible to avert this crisis, to avert these famines, to avert these looming human catastrophes,” he concluded. “It is all preventable.”


Togo: Since 1 January 2017, 201 suspected cases of meningitis with 17 deaths were reported by 19 health districts.


Meningococcal disease – Togo

Disease outbreak news
23 February 2017

Since 1 January 2017, 201 suspected cases of meningitis with 17 deaths were reported by 19 health districts. In week 2, the district of Akebou which is part of the Plateau Region issued an alert after four cases of meningitis were reported. In week 4, the epidemic threshold was reached with nine cases and an attack rate of 12.4 per 100 000 inhabitants. From 2 January to 12 February 2017, 48 suspected meningitis cases with three deaths were reported (case fatality rate of 6.3%). Of these, 14 specimens were confirmed as Neisseria meningitidis serogroup W by PCR.

The Plateau Region, together with the other three regions in the country benefited from the mass vaccination campaign with MenAfriVac in December 2014.

Togo is part of the African meningitis belt and documents cases and deaths due to meningitis every year. In 2016, the country recorded an epidemic in the northern part caused by Neisseria meningitidis serogroup W. A total of 1975 cases and 127 deaths were reported in 2016.

Public health response

In response to the outbreak, the following measures are being implemented:

  • 56 000 doses of meningitis vaccines have been requested from the International Coordinating Group (ICG) for the planned vaccination campaign.
  • WHO Field Mission was deployed in the field to strengthen outbreak management.
  • Strengthening of meningitis surveillance at the district level.
  • Training of clinicians at the district level on case management.
  • Conducting cross-border meetings with Ghana and Benin.

WHO risk assessment

The largest burden of meningococcal disease occurs in the African meningitis belt. Although the successful roll-out of MenA conjugate vaccine has resulted in the decreasing trend of meningitis A, other meningococcal serogroups are shown to have caused epidemics. This report of the Neisseria meningitidis W outbreak in Togo calls for a close monitoring of the changing epidemiology of meningococcal disease. There is a need to ensure that global stocks of vaccines are available, laboratory and epidemiologic surveillance systems are strengthened and outbreak response strategies in the countries are on hand.

WHO advice

The epidemic response consists of prompt, appropriate case management involving reactive mass vaccination of populations, and strengthening of meningitis surveillance.


China: Increasing rate of MCR-1 carriage in humans


High rates of human faecal carriage of mcr-1-positive multi-drug resistant isolates emerge in China in association with successful plasmid families

Lan-Lan Zhong, Hang TT Phan, Xi Huang, Karina-Doris Vihta, et al.

Nepal: Almost all isolates of Acinetobacter baumannii were found to be resistant to multiple antibiotics

BioMed Central

Co-existence of bla OXA-23 and bla NDM-1 genes of Acinetobacter baumannii isolated from Nepal: antimicrobial resistance and clinical significance

  • Prabhu Raj Joshi1,
  • Mahesh Acharya1,
  • et al
Antimicrobial Resistance & Infection Control20176:21

DOI: 10.1186/s13756-017-0180-5

“…..Nepalese researchers analyzed 44 isolates of A baumannii, an increasingly important pathogen. The found that 43 (98%) were resistant to carbapenems….. The same number of isolates were multidrug resistant, but all were susceptible to colistin. The bla-OXA-23 gene was detected in all of the isolates, while the New Delhi Metallo-beta-lactamase-1 (NDM-1) gene was identified in 6 (14%)……”

A new study describes a novel combination therapy that could serve as a weapon against a growing antibiotic resistance threat.

Antimicrobial Agents and Chemotherapy

“….Ceftazidime/avibactam, which was approved in the United States in 2015, has been a valuable tool for treating certain multidrug-resistant gram-negative infections. It works by inhibiting class A and class C bacterial enzymes, such as extended-spectrum beta lactamases (ESBLs), Klebsiella pneumoniae producing carbapenemases (KPCs), and cephalosporinases, which confer resistance to beta-lactam antibiotics.

But ceftazidime/avibactam has a significant weakness: metallo-beta-lactamase enzymes, which have emerged as a significant global antibiotic resistance threat, particularly in Southeast Asia and parts of Europe. Aztreonam, on the other hand, is susceptible to the class A and C beta-lactamases but isn’t broken down by metallo-beta-lactamases.

What Bonomo and his team hypothesized was that if aztreonam were added to the ceftazidime/avibactam combination therapy, the duo would help free aztreonam to work against infection-causing bacteria by protecting it from the other beta-lactamase enzymes, like offensive lineman in football blocking for a running back…..”

Antimicrob Agents Chemother. 2017 Feb 6. pii: AAC.02243-16. doi: 10.1128/AAC.02243-16. [Epub ahead of print]
Can ceftazidime/avibactam and aztreonam overcome β-lactam resistance conferred by metallo-β-lactamases in Enterobacteriaceae?
Marshall S, Hujer AM, Rojas LJ, Papp-Wallace KM, et al.


Based upon knowledge of the hydrolytic profile of major β-lactamases found in Gram negative bacteria, we tested the effectiveness of the combination of ceftazidime/avibactam (CAZ/AVI) with aztreonam (ATM) against carbapenem-resistant enteric bacteria possessing metallo-β-lactamases (MBLs). Disk-diffusion and agar based antimicrobial susceptibility testing were initially performed to determine the in vitro efficacy of a unique combination of CAZ/AVI and ATM against 21 representative Enterobacteriaceae isolates with a complex molecular background that included blaIMP, blaNDM, blaOXA-48, blaCTX-M, blaAmpC, and combinations thereof. Time-kill assays were conducted, and the in vivo efficacy of this combination was assessed in a murine neutropenic thigh infection model. By disk diffusion assay, all 21 isolates were resistant to CAZ/AVI alone, and 19/21 were resistant to ATM. The in vitro activity of CAZ/AVI in combination with ATM against diverse Enterobacteriaceae possessing MBLs was demonstrated in 17/21 isolates, where the zone of inhibition was ≥ 21 mm. All isolates demonstrated a reduction in CAZ/AVI agar dilution MICs with the addition of ATM. At 2 h, time-kill assays demonstrated a ≥ 4 log10 CFU decrease for all groups that had CAZ/AVI plus ATM (8 μg/ml) added, compared to the CAZ/AVI alone group. In the murine neutropenic thigh infection model, an almost 4 log10 reduction in CFUs was noted at 24 h for CAZ/AVI (32 mg/kg q8h) plus ATM (32 mg/kg q8h) vs. CAZ/AVI (32 mg/kg q8h) alone. The data presented herein, requires us to carefully consider this new therapeutic combination to treat infections caused by MBL-producing Enterobacteriaceae.

Smoking accounts for 5.7% of global health spending and a total economic cost of 1.8% of the world’s annual GDP—and almost 40% of this cost occurred in developing countries.


Global economic cost of smoking-attributable diseases

  • Mark Goodchild, 
  • Nigar Nargis, 
  • Edouard Tursan d’Espaignet

Tob Control tobaccocontrol-2016-053305  Published Online First: 30 January 2017 doi:10.1136/tobaccocontrol-2016-053305


War and economic crisis in Yemen has left an estimated 3.3 million people, including 2.2 million children, suffering from acute malnutrition and 460,000 under 5 have severe acute malnutrition.


Meritxell Relano, UNICEF representative in Yemen:

“Because of the crumbling health system, the conflict and economic crisis, we have gone back to 10 years ago. A decade has been lost in health gains,” she said, with 63 out of every 1,000 live births now dying before their fifth birthday, against 53 children in 2014.

Yemen has been divided by nearly two years of civil war that pits the Iran-allied Houthi group against a Sunni Arab coalition led by Saudi Arabia. At least 10,000 people have been killed in the fighting.

Releno later told a news briefing that the rate of severe acute malnutrition had “tripled” between 2014 and 2016 to 460,000 children…..”

Coalition for Epidemic Preparedness Innovations raises $500 million

NY Times

“Stung by the lack of vaccines to fight the West African Ebola epidemic, a group of prominent donors announced Wednesday that they had raised almost $500 million for a new partnership to stop epidemics before they spiral out of control.

The partnership, the Coalition for Epidemic Preparedness Innovations, will initially develop and stockpile vaccines against three known viral threats, and also push the development of technology to brew large amounts of vaccine quickly when new threats…arise……Bill Gates, founder of the Bill and Melinda Gates Foundation, one of the largest initial donors…has often predicted that the catastrophe most likely to kill 10 million people in the near future is a pandemic rather than nuclear war, terrorism, famine or natural disaster.

The other donors….include the governments of Japan and Norway, and Britain’s Wellcome Trust. Each is putting up $100 million to $125 million over five years; Germany, India and the European Commission are expected to announce donations soon.

Six major vaccine makers — GlaxoSmithKline, Johnson & Johnson, Merck, Pfizer, Sanofi and Takeda — joined in the coalition as “partners” rather than donors, as did the World Health Organization and Doctors Without Borders……”



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