Reuters

NY Times

**  “…..some of the Paris attackers whose Nov. 13 assaults killed 130 people entered Europe by infiltrating the throngs of migrants who have inundated Greek islands……”

UK Office for National Statistics

An estimated 43,900 excess winter deaths occurred in England and Wales in 2014/15; the highest number since 1999/00, with 27% more people dying in the winter months compared with the non-winter months.

• The majority of deaths occurred among people aged 75 and over; there were an estimated 36,300 excess winter deaths in this age group in 2014/15, compared with 7,700 in people aged under 75.
• There were more excess winter deaths in females than in males in 2014/15, as in previous years. Male excess winter deaths increased from 7,210 to 18,400, and female deaths from 10,250 to 25,500 between 2013/14 and 2014/15.
• Respiratory diseases were the underlying cause of death in more than a third of all excess winter deaths in 2014/15.
• The excess winter mortality index was highest in the South West in 2014/15 and joint lowest in Yorkshire and The Humber, and Wales.

WHO

Flare up of Ebola in Liberia

On 19 November 2015, Liberia identified a new “flare-up” of Ebola after stopping transmission in September. There are currently three confirmed cases from the same family being treated in an Ebola treatment unit in Monrovia and 150 contacts being monitored. Dr Bruce Aylward, Special Representative of the Director-General for the Ebola Response, gave a full briefing on the current state of the Ebola outbreak on 20 November.

“We are in a very strong position with the epidemiology of Ebola right now, we are very close to seeing the end of that chain of transmission that began more than nearly two years ago now, in a place called Gueckedou in Guinea. We may have seen the last case associated with that chain, we won’t know for another month and a half.

The virus can persist in some individuals

What we are learning in this Ebola outbreak is that very rarely the virus can persist in a some individuals who have recovered from the disease and from that it can be reintroduced into the population, it’s a rare event, but we have seen it happen, about a half a dozen times. And so as the virus dies out of the community, or the individuals clear the virus over the coming six to nine months, we have to make sure that we have the ability to rapidly find that, to rapidly detect it and rapidly respond to stop the flares.

Of the few flares that we have seen so far, they have been managed very quickly, very rapidly, but again…we have to be on guard, right through 2016, to make sure that any new emergences are stopped.

In Liberia we have received a report that a boy has come down with Ebola, with no obvious history of exposure to the virus, because the child hadn’t travelled or had not been exposed to someone with Ebola, so we believe that this is probably again, somehow, someone who has come in contact with a virus that had been persisting in an individual, who had suffered the disease months ago, and we are hoping that this will be one of the very few last flares we see of the disease.

It is concerning, it has to be managed incredibly aggressively and professionally, because it occurring in a capital city, of an important country in West Africa, that is Monrovia of course, but based on the performance of that programme over the last 12 months we have strong confidence that this will get managed very quickly.

Prevent, detect and respond

The key to making sure that we do not have a major problem with Ebola in West Africa in 2016 will be to prevent, detect and respond to any residual virus as it is cleared from the survivor and convalescent population.

In terms of prevention, it means making sure survivors are educated and have the new information about persistence of the virus, that they have the tools to make sure that they and their families are safe and don’t get exposed to that virus if it is there, they can be screened if they want to, and then of course receive the basic medical care all survivors need.

In terms of detection, that means ensuring that countries have the ability to find a new suspect case very very rapidly, either live cases or through swabbing high risk deaths or even all deaths in some cases to make sure they weren’t due to Ebola. That will need to continue in 2016.

And then finally, the countries will need to have rapid response teams to be able to respond to an event. With that in place, countries will be able to prevent, detect and respond and ensure that Ebola no longer causes the kind of horrific consequences we saw over the last years in these countries.”

FDA

The U.S. Food and Drug Administration today approved a new indication for BioThrax (Anthrax Vaccine Adsorbed) to prevent disease following suspected or confirmed exposure to Bacillus anthracis, the bacterium that causes anthrax disease. The vaccine’s new use is approved for people 18 through 65 years of age in conjunction with recommended antibiotic treatment. BioThrax was initially approved by the FDA in 1970 for the prevention of anthrax disease in persons at high risk of exposure.

Anthrax disease, especially the inhalation form, is often fatal if not promptly treated. Anthrax is considered one of the more likely agents to be used in a biological attack, primarily because its spores are very stable and easy to disperse. Although it is rare, people may contract anthrax disease through natural exposures, such as contact with infected animals or contaminated animal products.

“With today’s approval of BioThrax, we now have a vaccine that can be used, together with antibiotic treatment, to prevent disease after exposure to anthrax spores,” said Karen Midthun, M.D., director of the FDA’s Center for Biologics Evaluation and Research.

BioThrax is the first vaccine to receive approval based on the Animal Rule. The Animal Rule allows animal efficacy data to be used as a basis for approval when human efficacy studies are not ethical or feasible.

Protective antibody levels, which were determined in rabbit and monkey studies, were used to predict efficacy in humans based on an assessment of the extent of antibody response achieved in human study participants. A 70 percent probability of survival in animal models from inhalational anthrax disease was deemed a reasonable level of protection and likely to provide reasonable benefit in humans.

The ability of BioThrax to increase the probability of survival after stopping post-exposure antibiotic treatment was assessed in rabbits. Rabbits treated with both antibiotics and BioThrax had a survival rate of 70 to 100 percent, depending on the vaccine dose administered. In contrast, in two studies of rabbits that received only antibiotic treatment, survival rates were 44 and 23 percent respectively.

The safety and antibody responses to BioThrax in humans were evaluated in a multi-center study conducted in the United States. Subcutaneous (under the skin) injections were given to 200 healthy adults in three doses at zero, two, and four weeks. The majority of study participants generated antibody responses that correlated to a 70 percent probability of survival that was observed in animal models.

The observed adverse reactions were comparable with those observed when BioThrax is used for pre-exposure disease prevention. The safety profile for BioThrax is well-established, with the majority of localized adverse events reported as tenderness, pain, swelling, and redness at the injection site, as well as limited movement of the injected arm. The most common systemic adverse reactions were muscle aches, headache, and fatigue.

BioThrax is manufactured by Emergent BioDefense Operations Lansing LLC, based in Lansing, Michigan.

Hawaii

 Aedes aegyptii

 Aedes albopictus

The Hawaii Department of Health (HDOH) is investigating a cluster of locally-acquired cases of dengue fever on Hawaii Island. Dengue is not endemic to Hawaii. However, it is intermittently imported from endemic areas by infected travelers. This is the first cluster of locally-acquired dengue fever since the 2011 outbreak on Oahu.

As of November 24, 2015*:

Of the confirmed cases, 80 are Hawaii residents and 13 are visitors.
70 cases have been adults; 23 have been children (<18 years of age). Onset of illness has ranged between 9/11/15 – 11/17/15.

REUTERS

Time

Dec. 19, 2014:
Man Haron Monis storms a Sydney café and held 17 people hostage for 16 hours. Two people and the Iranian-born attacker died in the siege.

Aug. 2, 2013:
Intercepted electronic communications prompted Washington to temporarily close diplomatic missions in the Middle East and North Africa.

October 1, 2011:
The State Department feared worldwide anti-American violence in retaliation for the killing of senior al-Qaeda members.

May 2, 2011:
After Osama bin Laden’s death in Pakistan.

Significant Activity: Nov 22 – 23

Tropical Activity:

• Atlantic: Tropical cyclone activity is not expected during the next 48 hours
• Eastern Pacific: Disturbance 1(90%)
• Central Pacific: Tropical cyclone activity not expected through Tuesday evening
• Western Pacific: No activity affecting U.S. territories

Significant Weather:

• Unseasonably cold – Southern Plains, Lower Mississippi Valley & Pacific Northwest
• Wintery mix/Snow – Pacific Northwest, Central Great Basin, Great Lakes & Maine
• Rain – Coastal Pacific Northwest, Southern Florida and portions of New England
• Red Flag Warnings: None
• Critical/Elevated Fire Weather Areas: None
• Space weather: Past 24 hours – none, Next 24 hours – none

Declaration Activity:

• Major Disaster Declaration Request – Texas

• FEMA Daily Ops Briefing 11-23-2015.pdf