Global & Disaster Medicine

Nigeria: As of 19 March 2017, a total of 1407 suspected cases of meningitis and 211 deaths (case fatality rate: 15%) have been reported from 40 local government areas (LGAs) in five states of Nigeria since December 2016.


Disease outbreak news
24 March 2017

As of 19 March 2017 (epidemiological week 11), a total of 1407 suspected cases of meningitis and 211 deaths (case fatality rate: 15%) have been reported from 40 local government areas (LGAs) in five states of Nigeria since December 2016. Zamfara, Katsina and Sokoto account for 89% of these cases. Twenty-six LGAs from all five states reported 361 cases in epidemiological week 11 alone. Twenty-two wards in 15 LGAs have crossed the epidemic threshold. Three of these LGAs share borders with Niger. NmC is the predominant serotype in this outbreak.

The most affected age group is 5 to 14 year olds and they are responsible for about half of reported cases. Both sexes are almost equally affected.

Public health response

WHO and partners including National Primary health Care Development Authority, UNICEF, Nigeria Field Epidemiology and Laboratory training Program, eHealth Africa, Médecins Sans Frontières, Rotary International, and Nigeria Centers for Disease Control and Prevention are providing support to this outbreak.

The following measures are being implemented:

  • Nigeria Centers for Disease Control and Prevention, with support from the WHO, is taking the overall lead in coordinating the response at the national level.
  • Daily coordination meetings are being held at the state and LGA levels.
  • The rapid response teams are conducting active case finding, performing lumbar puncture of suspect cases and training local staff on case management.
  • Case management is being carried out at the public health centres at the LGA level.
  • 19 600 persons were vaccinated with the meningococcal ACWY vaccine in Gora ward in Zamfara state.
  • 500 000 doses of meningococcal AC PS vaccines and injection supplies was approved by the International Coordination Group (ICG) for utilization in Zamfara State which are planned to arrive on 27 March 2017.
  • Katsina state is preparing an ICG request for submission.

WHO risk assessment

The successful roll-out of MenA conjugate vaccine has resulted to the decreasing trend of meningitis A, however, other meningococcal serogroups are still causing epidemics. The most recent outbreak that has been reported was in Togo due to Neisseria meningitidis serogroup W (see Disease Outbreak News as published by WHO on 23 February 2017).

WHO advice

The outbreak response consists of appropriate case management with reactive mass vaccination of populations. Promptness of the reactive campaign is essential, ideally within four weeks of crossing the epidemic threshold.

WHO does not recommend any travel or trade restriction to Nigeria based on the current information available on this outbreak.

Torrential rain and violent winds lashed residents along the coast of northeast Australia as Tropical Cyclone Debbie churned closer to shore Tuesday.

NWS: Scattered to numerous severe thunderstorms are expected across the Lower Mississippi and Ohio Valleys into the Tennessee Valley this afternoon and evening. Very large hail, damaging winds, and a couple tornadoes will be possible.


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Tropical Cyclone 13P (Debbie): Thousands of Australians fled their homes on Monday as a powerful cyclone bore down on coastal towns in Queensland, where authorities urged 30,000 people to evacuate low lying areas most at risk from tidal surges and winds of up to 300 km per hour (185 mph).


French Disaster Plans: Dealing With the Paris Terror Attacks (Red, Yellow, and White Plans)


In the event of a disaster in France, two complementary plans are activated: the Red Plan and the White Plan.

The Red Plan concerns what is happening in the field. It is based on the principle of extracting and grouping the injured. The injured are grouped in the field hospital, the triage and care center where the treatment that is strictly necessary is given, to ensure survival, calm the pain, and be able to transport the victims without making their condition worse. The field hospital is placed under the authority of the medical response coordinating physician.

The Alpha Red Plan, such as that activated on the night of November 13, is designed to deal with multisite events.

The Yellow Plan is a variant of the Red Plan adapted to nuclear, radiological, biological, and chemical risks. At the same time, the hospitals must be prepared to deal with an influx of victims: this is the responsibility of the White Plan.

On November 13, the emergency services counted 479 victims: operations on chronic cases therefore had to be put on hold in order to deal with the urgent cases.

The White Plan includes setting up a unit tasked with communication with the media, informing families, programming the release of beds, calling in reinforcements, etc. In line with the Social Security Modernization Act of 2004, the White Plan was extended to cover all establishments around the hospital, including clinics

About the devastating series of attacks that struck Paris and Saint Denis on the evening of Friday, November 13, at six different locations, with 132 dead so far and more than 250 injured


“….The White Plan has been enshrined in law since 2004 and enables additional means and human resources to be mobilized, nonessential activities to be rescheduled, and additional beds to be opened.


“All the personnel are mobilized, in particular the [Service d’Aide Médicale Urgente] and A&E teams. The necessary staff are called in directly by the hospitals,” the AP-HP stated in a press release Friday evening. All the emergency services of the largest university hospital in France were mobilized. The victims of the attacks were mainly distributed among Saint-Louis Hospital, La Pitié Salpêtrière Hospital, Georges Pompidou European Hospital, Henri Mondor Hospital, Lariboisière Hospital, Saint-Antoine Hospital, Bichat Hospital, and Beaujon Hospital…..

On Saturday, November 14, at least 300 people were being treated in Paris hospitals, with 80 of them being considered absolute emergencies and 177 relative emergencies, plus 43 additional persons — either witnesses or family members.

AP-HP issued the somber warning that “most of the patients are in a state of shock and suffering from various and sometimes multiple injuries, which could require very long-term medical attention.” By late afternoon on Sunday, November 15, about 415 people, or about 100 more than the previous day, had been admitted to the hospitals for psychological shock. Of the 80 absolute emergency cases, 35 had been downgraded, but an additional three had died, raising the death toll from the attacks to 132. Of the 415 persons receiving treatment, 218 were discharged on Sunday evening.

In addition to the medical community, the residents of the Paris area as a whole made a commitment to the medical effort. Although blood reserves were announced by AP-HP as being sufficient on Friday evening, large numbers of the population nonetheless lined up to give blood. The French blood bank noted that “this mobilization needs to be a long-term one: 10,000 blood donations are required every day, and all blood groups are needed.” The Ministry for Health, for its part, stated that the ministry’s health emergency center had been immediately activated, along with the health emergencies preparation and response facility. “Medico-psychological emergency units…were set up on a number of Paris sites, in order to treat the victims and their families,” the ministry added……

Last Friday, in barely 1 hour, the staffing levels had been doubled. The triage system also enabled the injured to be evenly distributed, with the largest hospitals taking several dozens of the injured, which was not a strain on the hospitals. Even if treatment of the injured at the time went smoothly, Dr Prudhomme is concerned that the hospitals could be submerged by those suffering from the psychological shock: “We could see thousands of people suffering from psychological distress, and we do not necessarily have the resources.”…..”

Brazil: Like malaria or yellow fever, Zika is a continuing threat rather than an urgent pandemic.

NY Times

“….And doctors and researchers are just starting to grasp the medical consequences of Zika. Besides the alarmingly small heads characteristic of microcephaly, many babies have a long list of varied symptoms, leading experts to rename their condition “congenital Zika syndrome.” They can have seizures, breathing problems, trouble swallowing, weakness and stiffness in muscles and joints preventing them from even lifting their heads, clubbed feet, vision and hearing problems, and ferocious irritability.

Some have passed their first birthdays, but have neurological development closer to that of 3-month-old infants, doctors say. Some microcephaly cases appear so dire that experts liken them to a previously rare variant called “fetal brain disruption sequence.” And new issues keep cropping up, including hydrocephalus,…..”


2016-2017 Influenza Season Week 11 ending March 18, 2017



During week 11 (March 12-18, 2017), influenza activity decreased, but remained elevated in the United States.

  • Viral Surveillance: The most frequently identified influenza virus subtype reported by public health laboratories during week 11 was influenza A (H3). The percentage of respiratory specimens testing positive for influenza in clinical laboratories decreased.
  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was above the system-specific epidemic threshold in the National Center for Health Statistics (NCHS) Mortality Surveillance System.
  • Influenza-associated Pediatric Deaths: Two influenza-associated pediatric deaths were reported.
  • Influenza-associated Hospitalizations: A cumulative rate for the season of 50.4 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
  • Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 3.2%, which is above the national baseline of 2.2%. Seven of ten regions reported ILI at or above their region-specific baseline levels. 12 states experienced high ILI activity; six states experienced moderate ILI activity; nine states experienced low ILI activity; New York City, Puerto Rico, and 23 states experienced minimal ILI activity; and the District of Columbia had insufficient data.
  • Geographic Spread of Influenza: The geographic spread of influenza in 36 states was reported as widespread; Guam, Puerto Rico and 10 states reported regional activity; the District of Columbia and two states reported local activity; two states reported sporadic activity; and the U.S. Virgin Islands reported no activity.

INFLUENZA Virus Isolated

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national levels of ILI and ARI

Weekly Flu Activity Map: Week 11

Why drug-resistant tuberculosis?

The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis

Dheda, Keertan et al.

The Lancet Respiratory Medicine , Volume 5 , Issue 4 , 291 – 360


Global tuberculosis incidence has declined marginally over the past decade, and tuberculosis remains out of control in several parts of the world including Africa and Asia. Although tuberculosis control has been effective in some regions of the world, these gains are threatened by the increasing burden of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis. XDR tuberculosis has evolved in several tuberculosis-endemic countries to drug-incurable or programmatically incurable tuberculosis (totally drug-resistant tuberculosis). This poses several challenges similar to those encountered in the pre-chemotherapy era, including the inability to cure tuberculosis, high mortality, and the need for alternative methods to prevent disease transmission. This phenomenon mirrors the worldwide increase in antimicrobial resistance and the emergence of other MDR pathogens, such as malaria, HIV, and Gram-negative bacteria. MDR and XDR tuberculosis are associated with high morbidity and substantial mortality, are a threat to health-care workers, prohibitively expensive to treat, and are therefore a serious public health problem. In this Commission, we examine several aspects of drug-resistant tuberculosis. The traditional view that acquired resistance to antituberculous drugs is driven by poor compliance and programmatic failure is now being questioned, and several lines of evidence suggest that alternative mechanisms—including pharmacokinetic variability, induction of efflux pumps that transport the drug out of cells, and suboptimal drug penetration into tuberculosis lesions—are likely crucial to the pathogenesis of drug-resistant tuberculosis. These factors have implications for the design of new interventions, drug delivery and dosing mechanisms, and public health policy. We discuss epidemiology and transmission dynamics, including new insights into the fundamental biology of transmission, and we review the utility of newer diagnostic tools, including molecular tests and next-generation whole-genome sequencing, and their potential for clinical effectiveness. Relevant research priorities are highlighted, including optimal medical and surgical management, the role of newer and repurposed drugs (including bedaquiline, delamanid, and linezolid), pharmacokinetic and pharmacodynamic considerations, preventive strategies (such as prophylaxis in MDR and XDR contacts), palliative and patient-orientated care aspects, and medicolegal and ethical issues.

March 25, 1911: the Triangle Shirtwaist Company factory in New York City burns down, killing 145 workers.

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