Global & Disaster Medicine

Archive for July, 2016

Maryland: A torrent of raging brown water was devouring Ellicott City’s historic downtown.

Washington Post

“…In two hours, nearly 6 inches of rain had fallen, an event so extraordinary that the National Weather Service said it should, statistically, occur there just once every 1,000 years…..”

Puerto Rico’s Zika Response in Chaos

NY Times

“….The war against the Aedes aegypti mosquito carrying the virus is sputtering out in failure. Infections are skyrocketing: Many residents fail to protect themselves against bites because they believe the threat is exaggerated.  Federal and local health officials are feuding, and the governor’s special adviser on Zika has quit in disgust.  There are only about 5,500 confirmed infections on the island, including of 672 pregnant women. But experts at the Centers for Disease Control and Prevention say they believe that is a radical undercount…..”


A hot air balloon carrying 16 people crashed in central Texas after catching fire in the air on Saturday morning. There were no survivors


YF Update


Angola: 3748 suspected cases

In Angola, as of 21 July 2016 a total of 3748 suspected cases have been reported, of which 879 are confirmed. The total number of reported deaths is 364, of which 119 were reported among confirmed cases. Suspected cases have been reported in all 18 provinces and confirmed cases have been reported in 16 of 18 provinces and 80 of 125 reporting districts.

Mass reactive vaccination campaigns first began in Luanda and have now expanded to cover most of the other affected parts of Angola. Recently, the campaigns have focused on border areas. All districts continued with house to house immunization campaigns and routine vaccination.

Democratic Republic of the Congo: 1907 suspected cases

According to the latest confirmed information, DRC has reported 1907 suspected cases (as of 20 July) and 68 confirmed cases (as of 24 June) including 95 reported deaths (Table 1). Cases have been reported in 22 health zones in five of 26 provinces. Of the 68 confirmed cases, 59 were imported from Angola, two are sylvatic (not related to the outbreak) and seven are autochthonous.

The recent technical difficulties at the national laboratory in the Democratic Republic of The Congo (DRC) have been resolved and the laboratory confirmation of yellow fever cases in DRC has resumed. According to the preliminary results of tests performed on a backlog samples, seven new patients have tested positive for yellow fever. Additional investigations to determine the definitive status of these cases are ongoing. Until these investigations are completed, the official case count in DRC remains unchanged.

In DRC, surveillance efforts have increased and vaccination campaigns have centred on affected health zones in Kinshasa and Kongo Central and Kwango. Reactive vaccination campaigns started on 20 July in Kisenso health zone in Kinshasa province and in Kahemba, Kajiji and Kisandji health zones in Kwango province.

The risk of spread

Seven countries (Brazil, Chad, Colombia, Ghana, Guinea, Peru and Uganda) have reported yellow fever outbreaks or sporadic cases not linked to the Angolan outbreak.

An Emergency Committee (EC) was convened on 19 May 2016. The WHO Director-General accepted the EC’s assessment that the urban yellow fever outbreaks in Angola and DRC are serious public health events which warrant intensified national action and enhanced international support. The situation does not currently constitute a Public Health Emergency of International Concern.


WHO Strategic Advisory Group of Experts (SAGE) on Immunization reviewed existing evidence that demonstrates that using a fifth of a standard vaccine dose would still provide protection against the disease for at least 12 months and possibly longer. This approach, known as fractional dosing, will be implemented in a pre-emptive mass vaccination campaign in DRC in Kinshasa.

Risk assessment

  • The outbreak in Angola is receding and no confirmed case has been reported in the country during July (as of 21 July). The confirmed case with the most recent date of symptom onset, 23 June, was reported in Cuanhama district in Cunene province. However, a high level of vigilance needs to be maintained throughout the country.
  • In DRC, the situation remains concerning as the outbreak has spread to three provinces. Given the presence and activity of the vector Aedes in the country, the outbreak might extend to other provinces, in particular Kasai, Kasai Central and Lualaba.
  • Transmission of yellow fever in Angola and DRC is mainly concentrated in cities; however, there is a high risk of spread and local transmission to other provinces in both countries. In addition, the risk of potential spread to bordering countries, especially those classified as low-risk (i.e. Namibia, Zambia) and where the population, travelers and foreign workers are not vaccinated for yellow fever.

MERS update in Saudi Arabia


MMWR: As of July 7, Zika has been diagnosed in 5,582 people, including 672 pregnant women, in Puerto Rico.


“…The situation in Puerto Rico warrants urgent, comprehensive action to protect pregnant women:

  • The government of Puerto Rico and its municipalities can promote an integrated mosquito management program that includes reducing places with water where mosquitoes lay eggs, keeping mosquitoes out of houses with screens on windows and doors, and reducing the number of mosquitoes by using EPA-approved products. Everyone can follow these steps to help reduce the number of mosquitoes in and around homes.
  • People who live in or travel to Puerto Rico should avoid mosquito bites by using EPA-registered insect repellents, wearing long-sleeved shirts and pants, and staying indoors in places with screens and air conditioning to the greatest extent possible.
  • Pregnant women and their partners should use condoms and other barriers to prevent sexual transmission of Zika virus, or not have sex throughout the pregnancy.
  • Couples who want to prevent or delay pregnancy should talk to their healthcare provider about safe and effective contraceptive methods.
  • Clinicians who suspect Zika in patients who live in or have recently returned from areas with Zika, such as Puerto Rico, should report cases to public health officials…..”


CDC has been informed by the State of Florida that Zika virus infections in 4 people were likely caused by bites of local Aedes aegypti mosquitoes. The cases are likely the first known occurrence of local mosquito-borne Zika virus transmission in the continental United States.


“….We continue to learn about Zika virus, and we are working hard to find out more about these cases. Here is what we do know:

  • Zika is spread to people primarily through the bite of an infected Aedes species mosquito (Ae. aegypti and Ae. albopictus).
  • A pregnant woman can pass Zika virus to her fetus during pregnancy or during birth.
  • Zika virus infection can cause microcephaly and other severe fetal brain defects, and is associated with other adverse pregnancy outcomes.
  • A person who is infected with Zika virus can pass it to sex partners.
  • Many people infected with Zika virus won’t have symptoms or will only have mild symptoms.
  • No vaccines or treatments are currently available to treat or prevent Zika infections……”


Save the Children: A maternity hospital it supports in the rebel-held Syrian province of Idlib has been hit by an apparent airstrike. It’s the only such hospital for more than 40 miles.





A wildfire burning along California’s Big Sur coastline spans 42 square miles and is only 10% contained.

The Washington Post

“…It has destroyed at least 34 homes and put at least 2,000 homes and other buildings at risk….”


Outcomes of Pregnancies with Laboratory Evidence of Possible Zika Virus Infection in the United States, 2016


Pregnancy Outcomes in the United States and the District of Columbia

Liveborn infants with birth defects*:  13

Includes aggregated data reported to the US Zika Pregnancy Registry as of July 21, 2016

Pregnancy losses with birth defects**:  6

Includes aggregated data reported to the US Zika Pregnancy Registry as of July 21, 2016

Pregnancy Outcomes in the United States Territories

Liveborn infants with birth defects*:  0

Includes aggregated data from the US territories reported to the US Zika Pregnancy Registry and data from Puerto Rico reported to the Zika Active Pregnancy Surveillance System as of July 21, 2016

Pregnancy losses with birth defects**:  1

Includes aggregated data from the US territories reported to the US Zika Pregnancy Registry and data from Puerto Rico reported to the Zika Active Pregnancy Surveillance System as of July 21, 2016


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