Global & Disaster Medicine

A blaze roared through an apartment building on the blue-collar edge of Beijing, killing at least 19 people, many of whom were apparently migrant workers from the Chinese countryside.

NY Times

“…..The fire broke out Saturday evening in a two-story structure in the Daxing District, about 11 miles south of the Chinese capital’s prosperous downtown. Around 6 p.m., the flames began consuming the building, and thick smoke spilled into the air. Firefighters spent three hours battling the fire……..

Eight people were injured, and a “suspect” was being detained……”

Is Madagascar winning the battle against the Plague?


Plague – Madagascar

Disease outbreak news
15 November 2017

Since 1 August 2017, Madagascar has been experiencing a large outbreak of plague. As of 10 November 2017, a total of 2119 confirmed, probable and suspected cases of plague, including 171 deaths (case fatality rate: 8%), have been reported by the Ministry of Health of Madagascar to WHO.

From 1 August through 10 November 2017, 1618 (76%) cases and 72 deaths have been clinically classified as pneumonic plague, including 365 (23%) confirmed, 573 (35%) probable and 680 (42%) suspected cases. In addition to the pneumonic cases, 324 (15%) cases of bubonic plague, one case of septicaemic plague, and 176 unspecified cases (8%), have been reported to WHO (Figure 1). Eighty-two healthcare workers have had illness compatible with plague, none of whom have died.

Figure 1: Number of confirmed, probable and suspected plague cases in Madagascar reported by date of illness onset from 1 August through 10 November 2017 (n=2119)1

1 Date of onset is missing for 295 cases

From 1 August through 10 November, 16 (out of 22) regions of Madagascar have reported cases. Analamanga Region has been the most affected, reporting 72% of the overall cases (Figures 2 and 3).

Figure 2: Geographical distribution of confirmed and probable pneumonic plague cases in Madagascar from 1 August through 12 November 2017

Figure 3: Geographical distribution of confirmed and probable bubonic plague cases in Madagascar from 1 August through 12 November 2017

As of 10 November 2017, 218 out of 243 (90%) contacts under follow-up were reached and provided with prophylactic antibiotics. Since the beginning of the outbreak, a total of 7122 contacts were identified, 6729 (95%) of whom have completed their 7-day follow up and a course of prophylactic antibiotics. Only nine contacts developed symptoms and became suspected cases.

Laboratory confirmation of plague is being conducted by the Institut Pasteur of Madagascar, National WHO Collaborating Center for plague in Madagascar. Twenty-five isolates of Yersinia pestis have been cultured and all are sensitive to antibiotics recommended by the National Program for the Control of Plague.

The number of new cases and hospitalizations of patients due to plague is declining in Madagascar. The last confirmed bubonic case was reported on 24 October and the last confirmed pneumonic case was reported on 28 October.

Since plague is endemic to parts of Madagascar, WHO expects more cases to be reported until the end of the typical plague season in April 2018. It is therefore important that control measures continue through to the end of the plague season.

Public health response

The Ministry of Public Health of Madagascar is coordinating the health response, with the support of WHO and other agencies and partners.

The Ministry of Public Health of Madagascar has activated crisis units in Antananarivo and Toamasina and all cases and contacts have been provided access to treatment or prophylactic antibiotics at no cost to themselves.

Public health response measures include:

  • Investigation of new cases
  • Isolation and treatment of all pneumonic cases
  • Enhanced case finding
  • Active finding, tracing and monitoring of contacts and provision of free prophylactic antibiotics
  • Strengthened epidemiological surveillance in the all affected districts
  • Disinsection, including rodent and vector control
  • Raising public awareness on prevention for bubonic and pneumonic plague
  • Raising awareness among health care workers and providing information to improve case detection, infection control measures and protection from infection
  • Providing information about infection control measures during burial practices.

Enhanced measures for exit screening have been implemented at the International Airport in Antananarivo. These measures include: filling a special departure form at the airport (to identify passengers at risk); temperature screening of departing passengers, and referring passengers with fever to airport physicians for further consultation; passengers with symptoms compatible with pneumonic plague are immediately isolated at the airport and investigated using a rapid diagnostic test and notified according to the response alert protocol. Symptomatic passengers are not allowed to travel. A WHO GOARN team, consisting of US Centers for Disease Control and Prevention (CDC) and L’Institut de veille sanitaire/ Santé publique France (InVS/SPF), is providing technical support at the airport.

Nine countries and overseas territories in the African region (Comoros, Ethiopia, Kenya, Mauritius, Mozambique, La Réunion (France), Seychelles, South Africa, and Tanzania) have been identified as priority countries for plague preparedness and readiness by virtue of their trade and travel links to Madagascar. These countries are implementing readiness activities, including increased public awareness of plague, enhancing surveillance for the disease (particularly at points of entry), and prepositioning of equipment and supplies.

WHO risk assessment

Since mid-October, the number of new cases of plague, the number of hospitalizations of patients due to plague, and the number of geographic districts reporting plague has decreased. While the declining trend in new plague case reports and reduction in hospitalizations due to plague are encouraging signs, WHO expects more cases of plague to be reported from Madagascar until the typical plague season ends in April 2018.

The decline in case reports suggests that the epidemic phase of the outbreak is ending, however sustaining ongoing operations is critical to minimize bubonic plague infections and human-to-human transmission of pneumonic plague.

The trend in the number of new cases of plague has been declining for more than a month, indicating that measures taken to contain the outbreak have been effective. WHO is working with the Ministry of Health in Madagascar and other partners to maintain ongoing outbreak control efforts, including active case finding and treatment, comprehensive contact identification, follow-up and antibiotic treatment, rodent and flea control, and safe and dignified burials through this outbreak and the plague season into 2018, and to outline a longer term strategy for plague preparedness and control.

Since the beginning of this outbreak, the vast majority of cases, and more than 7000 contact persons, have been treated and have recovered. As of 15 November 2017, only 12 people are hospitalized for plague. There has been no international spread outside the country.

Based on available information and response measures implemented to date, WHO estimates the risk of potential further spread of the plague outbreak at national level remains high. The risk of international spread is mitigated by the short incubation period of pneumonic plague, implementation of exit screening measures and advice to travellers to Madagascar, and scaling up of preparedness and operational readiness activities in neighbouring Indian Ocean islands and other southern and east African countries. The overall global risk is considered to be low. WHO is re-evaluating the risk assessment based on the evolution of the outbreak and information from response activities.

Advice on prevention and control measures and treatment options has been provided to Madagascar and to priority countries in the region.

WHO travel advice

Based on the available information to date, the risk of international spread of plague appears very low. WHO advises against any restriction on travel or trade on Madagascar. To date, there are no reported cases related to international travel.

International travellers arriving in Madagascar should be informed about the current plague outbreak and the necessary protection measures. Travellers should protect themselves against flea bites, avoid contact with dead animals, infected tissues or materials, and avoid close contact with patients with pneumonic plague. In case of sudden symptoms of fever, chills, painful and inflamed lymph nodes, or shortness of breath with coughing and/or blood-tainted sputum, travellers should immediately contact a medical service. Travellers should avoid self-medication, even if for prophylaxis. Prophylactic treatment is only recommended for persons who have been in close contact with cases, or with other high risk exposures (such as bites from fleas or direct contact with body fluids or tissues of infected animals). Upon return from travel to Madagascar, travellers should be on alert for the above symptoms. If symptoms appear, travellers should seek medical care and inform their physician about their travel history to Madagascar.

Morocco: A sudden stampede for flour killed 15 and injured many more

Washington Post

“……Last year, wheat and barley production in Morocco was at its lowest level in a decade…… The shortage was due to “inadequate rainfall during the planting season and the shortage of rain during the critical months of February and March.”

Wheat is a staple in Morocco and elsewhere in North Africa……. The average Moroccan consumes more than 440 pounds of wheat every year, one of the highest per capita rates in the world……”


An undersea earthquake of magnitude 7.0 struck in the South Pacific on Monday, sending tsunami waves towards New Caledonia and Vanuatu.

Daily Telegraph

ShakeMap Intensity image


Geologists: deadly earthquakes could become more frequent in the coming year due to the slowing down of the Earth’s rotation.


“…..Scientists, who presented their research to the Geological Society of America recently, have found that variations in the speed of the Earth’s rotation could set off intense seismic activity, particularly in the tropical-equatorial regions where over a billion people live……”

“…..The link between seismic activity and the planet’s rotation was brought out in a paper by Roger Bilham of the University of Colorado in Boulder and Rebecca Bendick of the University of Montana in Missoula……”



Everyone Needs Somewhere to Go: World Toilet Day (11/19/17)


We use toilets every day – at home, school, and work – yet 40% of the world’s population does not have this luxury.  Clean and safe toilets are more than just a place to use the restroom.  They are essential for health, human dignity, and improved education.  Sadly, 2.3 billion people lack even a basic sanitation service, which in many ways represents an ongoing public health crisis that puts much of the world’s population at risk for diseases such as cholera, dysentery, hepatitis, and typhoid fever. Almost 1 billion face the indignity every day of defecating outside without privacy. The 2015 Sustainable Development Goals include a target to ensure universal access to adequate and equitable sanitation and use of safely managed sanitation services by 2030, making sanitation a global development priority. To raise awareness of this issue, the United Nations General Assembly designated November 19 as World Toilet Day.

The Center for Global Health’s Emergency Response and Recovery Branch (ERRB), with support from the National Center for Emerging and Zoonotic Infectious Diseases’ Waterborne Disease Prevention Branch (WDPB), joined the United Nations and other development partners to reach the Sustainable Development Goal by evaluating the safety and acceptability of urine-diverting dry toilets (UDDTs).  These types of toilets collect feces (poop) and urine separately for treatment, and because they are installed above ground, they are appropriate for areas where traditional options (e.g., dug pit latrines) are not feasible. This increases the potential for access to clean and safe toilets in difficult environments, such as flood-prone or dry areas.

In 2014, CDC was awarded a grant from Research for Health in Humanitarian Crises (R2HC), an organization working to improve health outcomes by strengthening the evidence for health interventions in humanitarian crises. This grant funds a study of UDDTs in a refugee camp setting to provide guidance on their potential use in humanitarian crises.

Sanivation’s waste processing system in action – a full-scale operational and portable manufacturing plant for treating feces with solar thermal energy and manufacturing charcoal briquettes from them.
Sanivation’s waste processing system in action – a full-scale operational and portable manufacturing plant for treating feces with solar thermal energy and manufacturing charcoal briquettes from them. (Photo courtesy of Eric Mintz, CDC)

WDPB is also involved in efforts to improve sanitation by partnering with a start-up company, Sanivation, to provide in-home container-based urine-diverting toilets to households and to collect and turn the feces into fuel.  In 2013, Sanivation received a CDC Innovation Fund Award to begin this waste-to-fuel conversion project in Kenya.  Sanivation uses concentrated solar heat to treat the waste and make it safe; then the mix the treated waste with charcoal dust from agricultural waste and transform it into briquettes that widely used for cooking.  This method of waste treatment has worked in refugee camp settings and provides a cost-effective and environmentally friendly way to reuse human waste. The project has been so successful, that in 2017, Sanivation received a special CDC Innovation Fund Award to scale-up their waste collection and treatment activities beyond its household subscribers. This new award will enable Sanivation to collect and treat waste from overflowing latrines, leaking septic tanks and other unsafely managed sanitation systems throughout the community, and to expand from one ton of waste collected and treated per month to over four tons. Ultimately, Sanivation plans to expand to other regions of East Africa with the goal of serving over 1 million people by 2020.

Through these efforts, CDC is working to increase the evidence base needed to provide clean and safe toilets and safely managed sanitation services in developing countries with limited resources. CDC’s efforts to improve sanitation are part of a worldwide initiative to break the silence surrounding the sanitation crisis.

To learn more about CDC efforts and other current sanitation initiatives visit:

World Toilet Day:  November 19, 2017

World Toilet Day. Not everyone gets to “go” the same way. 2.3 billion people do not have access to a clean and safe toilet.

Multistate Outbreak of Salmonella Agbeni Infections Linked to Pet Turtles, 2017


People infected with the outbreak strain of Salmonella Agbeni, by state of residence, as of November 2, 2017

More than 168,000 people have flown or sailed out of Puerto Rico to Florida since the hurricane.

NY Times


About 5,000 barrels of oil, or about 210,000 gallons, gushed out of the Keystone Pipeline on Thursday in South Dakota

NY Times



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