Global & Disaster Medicine

Archive for April, 2016

Saudi Arabia MOH reports a new MERS case that involves a household contact of an earlier case.


** In disasters and pandemics, kids aren’t just little adults

CDC & Kids in Disasters

How are children different from adults?

Disasters affect children differently than they do adults. Learn more about the unique needs of children during and after disasters.

Photo of little boy playing with toy train.

  • Children’s bodies are different from adults’ bodies.
    • They are more likely to get sick or severely injured.
      • They breathe in more air per pound of body weight than adults do.
      • They have thinner skin, and more of it per pound of body weight (higher surface-to-mass ratio).
      • Fluid loss (e.g. dehydration, blood loss) can have a bigger effect on children because they have less fluid in their bodies.
    • They are more likely to lose too much body heat.
    • They spend more time outside and on the ground. They also put their hands in their mouths more often than adults do.
  • Children need help from adults in an emergency.
    • They don’t fully understand how to keep themselves safe.
      • Older children and adolescents may take their cues from others.
      • Young children may freeze, cry, or scream.
    • They may not be able to explain what hurts or bothers them.
    • They are more likely to get the care they need when they have parents or other caregivers around.
    • Laws require an adult to make medical decisions for a child.
    • There is limited information on the ways some illnesses and medicines affect children. Sometimes adults will have to make decisions with the information they have.
  • Mental stress from a disaster can be harder on children.
    • They feel less of a sense of control.
    • They understand less about the situation.
    • They have fewer experiences bouncing back from hard situations.

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Mapping Zika Virus now and in the future: More than 2.17 billon people live in tropical and subtropical regions of the world that are suitable for Zika virus spread.



Apr 19 eLife abstract



Latest research on a possibly new Zika reservoir: Sera and oral swabs from 15 marmosets (Callithrix jacchus) and 9 capuchin-monkeys (Sapajus libidinosus) captured in Brazil tested positive for Zika virus.

Are monkeys in Brazil a new reservoir for Zika Virus?


First detection of Zika virus in neotropical primates in Brazil: a possible new reservoir.            , , , , , ,



** NEJM: Zika Virus Review

Zika virus is rapidly spreading throughout the Americas and the Caribbean. The association with microcephaly has led the WHO to declare a public health emergency. This review describes our current understanding of the characteristics of Zika virus infection.


Papua New Guinea: 6 cases of Zika virus infection


Zika virus infection – Papua New Guinea

Disease Outbreak News
22 April 2016

On 11 March 2016, the National Department of Health of Papua New Guinea reported that 6 cases of Zika virus infection had been confirmed through retrospective testing of samples taken from patients presenting with a febrile illness between July 2014 and March 2016. Cases were confirmed by polymerase chain reaction (PCR). The following are the results by year:

  • no Zika virus positive results were identified among 64 samples tested in 2014,
  • 1 sample collected during a malaria outbreak in Morobe in May 2015 (a total of 34 samples were tested),
  • 2 samples collected during a dengue outbreak in Western province in December 2015 (a total of 21 samples were tested), and
  • 3 samples collected during a dengue outbreak in Kiunga in February 2016 (a total of 60 samples were tested).

None of the patients positive for Zika virus had travelled outside Papua New Guinea prior to their illness.

Martinique: Two cases of Zika-encephalopathy



Case 1

At the end of February 2016, two months after the detection of the first Zika virus-positive cases on Martinique, a previously healthy young adult was admitted to the University Hospital of Martinique, after having experienced an episode of convulsive seizures that occurred six hours after the onset of a dengue-like syndrome (fever, arthralgia, asthenia and headache). Upon initial clinical evaluation, the patient was febrile, with a low level of consciousness (Glasgow coma scale (GCS) 9) and no neurological focal signs. After direct intravenous injection of clonazepam (one milligram), the patient recovered to a normal level of consciousness (GCS 15). The patient was hospitalised for three days, then returned back home with symptomatic treatment of acetaminophen and codeine against headache and arthralgia. One week later, clinical assessment found no new neurological symptoms, but headache and arthralgia persisted for 45 days.

Brain magnetic resonance imaging (MRI) and video-electroencephalogram (EEG) performed on day 5 after onset of neurological symptoms, were normal.

Laboratory findings at onset of neurological symptoms showed normal blood count and a sterile CSF with no white blood cells (norm: < 10/ml), and 0.20 g/L protein (norm: 0.15–0.40). The glycorachia/glycaemia ratio was normal (norm: >0.5).

The patient was screened for the common aetiologies of viral encephalitis: test results for herpes simplex virus, varicella zoster virus and cytomegalovirus (CMV) by PCR were negative in CSF. Direct detection in CSF of enterovirus, dengue virus (DENV) and chikungunya virus by real-time RT-PCR were negative. Serological tests for HIV, CMV and venereal research disease laboratory (VDRL) were negative. Serology for toxoplasmosis was positive in IgG. Direct detection of Leptospira sp. in plasma by PCR was negative. Cryptococcus sp. antigenemia in serum was negative. Detection of Zika virus by real-time RT-PCR in plasma, cerebrospinal fluid and urine were positive.

Case 2

In the last week of February 2016, a patient in their late 70s was brought to the University Hospital of Martinique by their family who reported symptoms including acute mental confusion, speech disorder, and right facial palsy, which had started three hours before hospital admission. Upon initial clinical evaluation the patient was afebrile and aphasic; conjunctivitis, bilateral hands oedema, and peripheral arthritis were present. Facial palsy was not noticed upon clinical examination. Aphasia resolved spontaneously 45 minutes after the first clinical evaluation.

Upon initial clinical evaluation, brain MRI was only consistent with leukoaraiosis, and EEG revealed an unequivocal asymmetry with abnormal left fronto-temporal slow waves. These waves were consistent with the presence of a pathological process, but had no specific pattern. The EEG performed one week later showed almost complete regression of the slow waves.

The analysis of CSF showed a protein count of 0.40 g/L and a white blood cell count of 2/mL. The glycorachia/glycaemia ratio was normal. PCR for common aetiologies of encephalitis was negative. Detection of Zika virus by real-time RT-PCR in plasma, CSF and urine gave a positive result.”

A sinking, in which 500 migrants may have died, making it the 2nd deadliest episode for asylum seekers trying to reach Europe

NY Times



** WHO: Locally acquired malaria cases in Europe have decreased from more than 90,000 to 0 over the past 20 years.

WHO: From over 90 000 cases to zero in two decades: the European Region is malaria free

Copenhagen, 20 April 2016

The European Region is the first in the world to have achieved interruption of indigenous malaria transmission. The number of indigenous malaria cases dropped from 90 712 in 1995 to zero cases in 2015. Ahead of World Malaria Day 2016, WHO announces that the European Region hit its 2015 target to wipe out malaria, thus contributing to the global goal to “End malaria for good”. Key partners funded malaria elimination efforts in European countries substantially.

“This is a major milestone in Europe’s public health history and in the efforts to eliminate malaria globally. I applaud this achievement as the result of strong political commitment from European leaders with WHO support”, says Dr Zsuzsanna Jakab, WHO Regional Director for Europe. “This is not only the time to celebrate our success but is also the opportunity to firmly maintain the malaria-free status we have laboriously attained. Until malaria is eradicated globally, people travelling to and from malaria-endemic countries can import the disease to Europe, and we have to keep up the good work to prevent its reintroduction”.

The path towards malaria elimination: from Tashkent to the Regional Strategy

The 2005 Tashkent Declaration “The Move from Malaria Control to Elimination”, endorsed by malaria-affected countries in the Region, was a turning-point in achieving a malaria-free Europe. The Declaration led the way to the new Regional Strategy 2006–2015, which guided affected European countries to reduce the number of indigenous malaria cases to zero.

This achievement was made possible through a combination of strong political commitment, heightened detection and surveillance of malaria cases, integrated strategies for mosquito control with community involvement, cross-border collaboration and communication to people at risk. When a country has zero locally acquired malaria cases for at least three consecutive years, it is eligible for official certification of malaria elimination by WHO.

Avoiding malaria reintroduction: the Ashgabat high-level meeting

“The European Region has been declared malaria free on the basis of the present situation and the likelihood that elimination can be maintained. This means that we cannot afford to drop our guard on this disease”, concludes Dr Nedret Emiroglu, Director of Communicable Diseases and Health security, WHO Regional Office for Europe. “Experience shows that malaria can spread rapidly, and, if Europe’s countries are not vigilant and responsive, a single imported case can result in resurgence of malaria”.

On 21–22 July 2016, WHO will convene its first high-level meeting on prevention of malaria reintroduction, in Ashgabat, Turkmenistan. European countries at risk of malaria reintroduction will come together to prevent the return of malaria to the European Region through:

  • sustained political commitment;
  • strong vigilance to test and treat all malaria cases promptly;
  • understanding how malaria transmission could be reintroduced and the risk it poses; and
  • immediate action if local malaria transmission resumes.

The meeting outcome will pave the way for preventing malaria from affecting Europe again.

** Angola: Since the outbreak began in December 2015, 1908 suspected cases of yellow fever have been reported (617 laboratory confirmed) and 250 deaths have been reported.



19 April 2016 – As Angola grapples with its worst yellow fever outbreak in decades, the Ministry of Health, with the support of the World Health Organization (WHO) and partners have extended the vaccination campaign beyond the capital Luanda into Huambo and Benguela – 2 of the other 5 provinces reporting local transmission.

Since the outbreak began in December 2015, 1908 suspected cases of yellow fever have been reported (617 laboratory confirmed) and 250 deaths have been reported. The majority of the cases are concentrated in Luanda and in two other provinces, namely, Huambo and Huila.

In order to contain the outbreak outside the capital, nearly 2.15 million people will be vaccinated in 5 densely populated urban districts in Huambo and Benguela provinces over the coming weeks. Around 1 million people in the 2 provinces have been vaccinated thus far.

“This targeted vaccination is critical to protect those most at risk countrywide and to stop the further spread of infection by making the best use of available global vaccine supplies”, said Dr Matshidiso Moeti, WHO Regional Director for Africa.

Since 2 February 2016, close to 6 million people  in Luanda have benefited from a large-scale vaccination campaign using vaccines made available from the yellow fever vaccine emergency stockpile made available through the International Coordinating Group (ICG) for Vaccine Provision, with support from Gavi (the Vaccine Alliance); the UN Central Emergency Response Fund (CERF) and a vaccine donation from Brazil.

Along with the vaccination campaign, the Ministry of Health, WHO and partners are  working to strengthen disease surveillance and diagnostic capacity, both within Angola and neighbouring countries, and enhance vector control, including using community-led public health education campaigns.

″The immediate concern is that the virus might spread to other urban centres in Angola and other countries. WHO urges all countries, especially those that border Angola, to increase disease surveillance and strengthen vector control as well as ensuring that all those travelling to Angola are vaccinated,” says Dr Bruce Aylward, Executive Director a.i., Outbreaks and Health Emergencies, WHO.

Vaccine supply

Angola’s outbreak has stretched existing yellow fever vaccine supplies. During outbreaks, available vaccine are prioritized for the emergency response. At the end of March 2016, thanks to ICG partners, including UNICEF, the yellow fever emergency vaccine stockpile was replenished and approximately 10 million doses of the vaccine are now available.

Concerns exist that if yellow fever should spread to other countries in Africa and Asia there would be a need to further prioritize vaccine supplies, which would interrupt routine immunization programmes in some countries.

“Stockpiling yellow fever vaccine has proved critical in combatting the current resurgence of the disease,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “With 12 million doses of vaccine, including 3 million for Angola, Gavi is the single biggest contributor to the emergency yellow fever stockpile. The current situation is a reminder of the importance of investing in strong and sustainable routine immunisation programmes to prevent such outbreaks and protect populations’ health.”

Strengthening international surveillance

Yellow fever cases in people who travelled from Angola have been reported in 3 countries China (11 cases), Democratic Republic of Congo (10 cases with 1 in Kinshasa) and Kenya (2 cases).

Three yellow fever cases have been reported in the south of Uganda. The patients had no travel history to Angola.

WHO is working with neighbouring countries such as the Democratic Republic of Congo (DRC), Namibia and Zambia to bolster cross-border surveillance with Angola and information sharing to prevent and reduce the spread of infection.

Travel advice

Vaccination is the single most important measure for preventing yellow fever. The vaccine is safe and highly effective and a single dose provides lifelong immunity.

The Government of Angola requires all travellers older than 9 months of age to show proof of yellow fever vaccination upon arrival.  People who are traveling to Angola must ensure that they get vaccinated against yellow fever at least 10 days prior to travel. WHO advises travellers going to and from Angola and other countries where yellow fever occurs to get vaccinated and carry their certificate of vaccination when travelling.


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