Global & Disaster Medicine

Cyclone Idai & Mozambique

CNN

‘…….”Officially, we have a record of more than 84 dead but everything indicates that we can have a record of more than 1,000 dead,” [President] Nyusi said, adding that “100,000 people are in danger.”…..’


Utrecht: A shooting on a tram in which three were killed and another 5 were wounded at least

BBC


3/19/1937: Nearly 300 students in Texas are killed by an explosion of natural gas at their school

HxC

Nearly 300 students in Texas are killed by an explosion of natural gas at their school


Video: Perspectives on Federal, State, and Local Pandemic Influenza Preparedness and Response

This one-hour and 56-minute symposium, cosponsored with George Washington University’s Milken Institute School of Public Health and the Association of State, Health, and Territorial Officials (ASTHO), features a discussion with national leaders on the emerging issues, trends, and areas of continued challenges and opportunities for success in preparing to respond to the emergence of the next influenza pandemic. Speakers discuss the state of preparedness today, and current perspectives on America’s biosecurity.


WHO launches new global influenza strategy

WHO

WHO launches new global influenza strategy

11 March 2019

News Release
Geneva

WHO today released a Global Influenza Strategy for 2019-2030 aimed at protecting people in all countries from the threat of influenza. The goal of the strategy is to prevent seasonal influenza, control the spread of influenza from animals to humans, and prepare for the next influenza pandemic.

“The threat of pandemic influenza is ever-present.” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “The on-going risk of a new influenza virus transmitting from animals to humans and potentially causing a pandemic is real.   The question is not if we will have another pandemic, but when.  We must be vigilant and prepared – the cost of a major influenza outbreak will far outweigh the price of prevention.”

Influenza remains one of the world’s greatest public health challenges. Every year across the globe, there are an estimated 1 billion cases, of which 3 to 5 million are severe cases, resulting in 290 000 to 650 000 influenza-related respiratory deaths. WHO recommends annual influenza vaccination as the most effective way to prevent influenza. Vaccination is especially important for people at higher risk of serious influenza complications and for health care workers.

The new strategy is the most comprehensive and far-reaching that WHO has ever developed for influenza.  It outlines a path to protect populations every year and helps prepare for a pandemic through strengthening routine programmes. It has two overarching goals:
 

  1. Build stronger country capacities for disease surveillance and response, prevention and control, and preparedness. To achieve this, it calls for every country to have a tailored influenza programme that contributes to national and global preparedness and health security.
  2. Develop better tools to prevent, detect, control and treat influenza, such as more effective vaccines, antivirals and treatments, with the goal of making these accessible for all countries.

“With the partnerships and country-specific work we have been doing over the years, the world is better prepared than ever before for the next big outbreak, but we are still not prepared enough,” said Dr Tedros. “This strategy aims to get us to that point. Fundamentally, it is about preparing health systems to manage shocks, and this only happens when health systems are strong and healthy themselves.”

To successfully implement this strategy, effective partnerships are essential.  WHO will expand partnerships to increase research, innovation and availability of new and improved global influenza tools to benefit all countries.  At the same time WHO will work closely with countries to improve their capacities to prevent and control influenza.

The new influenza strategy builds on and benefits from successful WHO programmes.  For more than 65 years, the Global Influenza Surveillance and Response System (GISRS), comprised   of WHO Collaborating Centres and national influenza centres, have worked together to monitor seasonal trends and potentially pandemic viruses. This system serves as the backbone of the global alert system for influenza.

Important to the strategy is the on-going success of the Pandemic Influenza Preparedness Framework, a unique access and benefit sharing system that supports the sharing of potentially pandemic viruses, provides access to life saving vaccines and treatments in the event of a pandemic and supports the building of pandemic preparedness capacities in countries through partnership contributions from industry.

The strategy meets one of WHO’s mandates to improve core capacities for public health, and increase global preparedness and was developed through a consultative process with input from Member States, academia, civil society, industry, and internal and external experts.

Supporting countries to strengthen their influenza capacity will have collateral benefits in detecting infection in general, since countries will be able to better identify other infectious diseases like Ebola or Middle East respiratory syndrome-related coronavirus (MERS-CoV).

Through the implementation of the new WHO global influenza strategy, the world will be closer to reducing the impact of influenza every year and be more prepared for an influenza pandemic and other public health emergencies.


2018-2019 Influenza Season Week 10 ending March 9, 2019: Influenza activity decreased slightly, but remains elevated in the United States.

CDC

INFLUENZA Virus Isolated

national levels of ILI and ARI

INFLUENZA Virus Isolated

Click on image to launch interactive tool

 


CDC estimates that, from October 1, 2018, through March 9, 2019, there have been:

person coughing icon25.5 million – 29.3 million flu illnesses

 

11.8 million – 13.8 million flu medical visits

 

 327,000 – 394,000 flu hospitalizations

 

 21,500 – 35,500 flu deaths

Preliminary Cumulative Estimates of Hospitalizations in the U.S. 2018-2019 Flu Season


Pandemics: Reusability of Facemasks

Institute of Medicine 2006. Reusability of Facemasks During an Influenza
Pandemic: Facing the Flu. Washington, DC: The National Academies Press.
https://doi.org/10.17226/11637.

“…….First, of the forms of respiratory protection the committee was asked to
consider, N95 filtering facepiece respirators that are certified by the National
Institute for Occupational Safety and Health (NIOSH) and properly
fit-tested are likely to provide the best protection against influenza to the
extent that it may be spread via an airborne route. Similarly, a closely fitting
high-efficiency medical mask is likely to provide appropriate protection
against droplets, whereas a surgical N95 will provide protection against
both droplets and aerosols. While recognizing the methodological and data
limitations regarding the efficacy of medical masks as a form of respiratory
protection against avian influenza, and in the absence of data to the contrary,
the committee concluded that masks are likely to provide far less
protection against aerosols than an N95 filtering facepiece but may offer

better protection than cotton masks, homemade alternatives such as handkerchiefs
and scarves, or no protection at all. No device is fail-safe, and its
effectiveness depends on fit, level of exposures, and appropriate use. Finally,
none of these devices protects against contact transmission, and appropriate
hand hygiene is necessary when using and after removing these devices…..”


Maternal and neonatal mortality is high in Africa. Why?

Lancet

Volume 7, ISSUE 4,
Pe513-e522, April 01, 2019
Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study

“…….Findings

Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2–2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3–0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2–18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46–13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99–17·34]) or anaesthesia complications (11·47 (1·20–109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7–5·0)……..”

A review: Dromedary camels as the main reservoir for human Middle East respiratory syndrome (MERS) infections.

Sikkema, R., Farag, E., Islam, M., Atta, M., Reusken, C., Al-Hajri, M., & Koopmans, M. (2019). Global status of Middle East respiratory syndrome coronavirus in dromedary camels: A systematic review. Epidemiology and Infection, 147, E84. doi:10.1017/S095026881800345X

“…..In general, camels only show minor clinical signs of disease after being infected with MERS-CoV. Serological evidence of MERS-CoV in camels has been found in 20 countries, with molecular evidence for virus circulation in 13 countries. The seroprevalence of MERS-CoV antibodies increases with age in camels, while the prevalence of viral shedding as determined by MERS-CoV RNA detection in nasal swabs decreases. In several studies, camels that were sampled at animal markets or quarantine facilities were seropositive more often than camels at farms as well as imported camels vs. locally bred camels. Some studies show a relatively higher seroprevalence and viral detection during the cooler winter months. …..”

 


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