Archive for February, 2017
Neglected tropical diseases are finally getting the attention they deserve
Wednesday, February 15th, 2017“…Yet one of the most inspiring success stories is perhaps the one most overlooked: the global effort to eliminate neglected tropical diseases, or NTDs.
Much of the recent success stems from a meeting in London on Jan. 30, 2012 ……
NTDs affect nearly 1.5 billion of the poorest and most marginalized people around the world. And while 500,000 people lose their lives to NTDs every year, these diseases are more likely to disable and disfigure than to kill. …….These agonizing conditions keep children from school and adults from work, trapping families and communities in cycles of poverty……
Today, the landscape is dramatically different. In 2015, nearly 1 billion people received NTD treatments — 20 percent more than just two years before. As a result, fewer people are suffering from these diseases than at any point in history. ……Much of this success can be traced to the 2012 meeting in London. There, the World Health Organization, pharmaceutical companies, donors, governments, and non-governmental organizations committed to work together to control and eliminate 10 NTDs. …”
London Declaration on Neglected Tropical Diseases
Wednesday, February 15th, 2017THE LONDON DECLARATION
For decades, partners including pharmaceutical companies, donors, endemic countries and non-government organisations have contributed technical knowledge, drugs, research, funding and other resources to treat and prevent Neglected Tropical Diseases (NTDs) among the world’s poorest populations. Great progress has been made, and we are committed to build on these efforts.
Inspired by the World Health Organization’s 2020 Roadmap on NTDs, we believe there is a tremendous opportunity to control or eliminate at least 10 of these devastating diseases by the end of the decade. But no one company, organization or government can do it alone. With the right commitment, coordination and collaboration, the public and private sectors will work together to enable the more than a billion people suffering from NTDs to lead healthier and more productive lives-helping the world’s poorest build self-sufficiency. As partners, with our varied skills and contributions, we commit to doing our part to:
We commit to doing our part to:
- Sustain, expand and extend programmes that ensure the necessary supply of drugs and other interventions to help eradicate Guinea worm disease, and help eliminate by 2020 lymphatic filariasis, leprosy, sleeping sickness (human African trypanosomiasis) and blinding trachoma.
- Sustain, expand and extend drug access programmes to ensure the necessary supply of drugs and other interventions to help control by 2020 schistosomiasis, soil-transmitted helminthes, Chagas disease, visceral leishmaniasis and river blindness (onchocerciasis).
- Advance R&D through partnerships and provision of funding to find next-generation treatments and interventions for neglected diseases.
- Enhance collaboration and coordination on NTDs at national and international levels through public and private multilateral organisations.
- Enable adequate funding with endemic countries to implement NTD programmes necessary to achieve these goals, supported by strong and committed health systems at the national level.
- Provide technical support, tools and resources to support NTD-endemic countries to evaluate and monitor programmes.
- Provide regular updates on the progress in reaching the 2020 goals and identify remaining gaps.
To achieve this ambitious 2020 vision, we call on all endemic countries and the international; community to join us in the above commitments to provide the resources necessary across sectors to remove the primary risk factors for NTDs-poverty and exposure-by ensuring access to clean water and basic sanitation, improved living conditions, vector control, health and education, and stronger health systems in endemic areas.
We believe that, working together, we can meet our goals by 2020 and chart a new course toward health and sustainability among the world’s poorest communities to a stronger, healthier future.
Legatum Foundation: Allocating capital at the bottom of the Prosperity Ladder to projects, people and ideas that create sustainable prosperity.
Wednesday, February 15th, 2017
Taiwan: A bus appeared to lose control as it was navigating a long curve on the exit ramp and flipped over the barrier on the right side of the road and at least 33 are dead.
Tuesday, February 14th, 2017Mortality Associated with Hurricane Matthew — United States, October 2016
Tuesday, February 14th, 2017Notes from the Field: Mortality Associated with Hurricane Matthew — United States, October 2016
Weekly / February 10, 2017 / 66(5);145–146
Alice Wang, PhD1,2; Anindita Issa, MD1,2; Tesfaye Bayleyegn, MD2; Rebecca S. Noe, MPH2; Christine Mullarkey3; Julie Casani, MD3; Craig L. Nelson, MD4; Aaron Fleischauer, PhD3,5; Kimberly D. Clement, MPH3; Janet J. Hamilton, MPH6; Christopher Harrison, MPH7; Laura Edison, DVM5,7; Kathrin Hobron, MPH8; Katie M. Kurkjian, DVM5,8; Ekta Choudhary, PhD2; Amy Wolkin, DrPH2; Hurricane Matthew Incident Management System Team, CDC Emergency Operations Center
After 3 days as a Category 3 and 4 hurricane in Haiti and Bahamas, Hurricane Matthew moved along the coast of the southeastern United States during October 6−8, 2016 (1). Early on October 8, the storm made landfall southeast of McClellanville, South Carolina, as a Category 1 hurricane with sustained winds of approximately 75 mph, leading to massive coastal and inland flooding, particularly in North Carolina and South Carolina (2). Florida, Georgia, North Carolina, South Carolina, and Virginia made major disaster declarations; approximately 2 million persons were under evacuation orders in Florida, Georgia, North Carolina, and South Carolina (3). In response to the hurricane, CDC activated the Emergency Operations Center Incident Management System, tracked online media reports of Hurricane Matthew–associated deaths, and contacted states for confirmation of deaths. This report summarizes state-confirmed Hurricane Matthew–associated deaths that occurred during October 1−October 21 in Florida, Georgia, North Carolina, and South Carolina.
Forty-three hurricane-associated deaths were reported in four states; the median decedent age was 58 years (range = 9–92 years) (Table). Drowning was the most common cause of death, accounting for 23 (54%) deaths. Among all deaths, 26 (60%) occurred in North Carolina; 18 (69%) of these were drowning deaths associated with a motor vehicle. Twelve deaths occurred in Florida, including five that resulted from injuries during prestorm preparation or poststorm cleanup (e.g., a fall from a ladder or roof). A child’s death in Florida resulted from carbon monoxide poisoning related to indoor generator use.
Despite public health warnings to avoid flood waters, among all 23 hurricane-related drownings, 18 deaths (78%) occurred in motor vehicles (e.g., vehicle driven into standing water, vehicle swept away by water, or person found in car). As little as 6 inches of water might result in loss of control of a vehicle, and 2 feet of water can carry most cars away (4). An evaluation of public health messages to drivers about avoiding flood waters might inform future prevention measures. Evaluation of the public’s reception and response to those messages, as well as an assessment of ascertainment of child deaths in disaster settings, might inform future prevention measures. Mortality surveillance after disasters plays a critical role in evaluating the causes, manners, and circumstances of deaths, and data can be used to guide prevention messages during the response and recovery period and to prevent deaths during future public health emergencies (5).
References
- National Oceanic and Atmospheric Administration. Hurricane Matthew. Discussion number 26. Washington DC: US Department of Commerce, National Oceanic and Atmospheric Administration, National Hurricane Center; 2016. http://www.nhc.noaa.gov/archive/2016/al14/al142016.discus.026.shtml
- The Weather Channel. Hurricane Matthew recap: destruction from the Caribbean to the United States. Atlanta, GA: The Weather Company; 2016. https://weather.com/storms/hurricane/news/hurricane-matthew-bahamas-florida-georgia-carolinas-forecast
- Federal Emergency Management Agency. Hurricane Matthew. Washington DC: US Department of Homeland Security, Federal Emergency Management Agency; 2016. https://www.fema.gov/node/292516?utm_source=hp_promo&utm_medium=web&utm_campaign=femagov_hp
- CDC. Driving through water after a disaster. Atlanta, GA: US Department of Health and Human Services, CDC; 2012. https://www.cdc.gov/disasters/psa/driving.html
- CDC. Preliminary medical examiner reports of mortality associated with Hurricane Charley—Florida, 2004. MMWR Morb Mortal Wkly Rep 2004;53:835–7. PubMed
TABLE. Characteristics of reported deaths related to Hurricane Matthew for all deaths including drowning — North Carolina, Florida, Georgia, and Virginia, October 2016
| Characteristic | North Carolina (n = 26) No. (%)* | Florida (n = 12) No. (%) | Georgia (n = 3) No. (%) | Virginia (n = 2) No. (%) | Total (n = 43) No. (%) |
|---|---|---|---|---|---|
| Sex | |||||
| Male | 18 (69) | 9 (75) | 3 (100) | 2 (100) | 32 (74) |
| Female | 8 (31) | 3 (25) | 0 | 0 | 11 (26) |
| Age group (yrs) | |||||
| ≤17 | 0 | 1 (8) | 0 | 0 | 1 (2) |
| 18–64 | 14 (54) | 5 (42) | 2 (67) | 2 (100) | 23 (54 |
| ≥65 | 11 (42) | 6 (50) | 1 (33) | 0 | 18 (42) |
| Unknown | 1 (4) | 0 | 0 | 0 | 1 (2) |
| Cause of death | |||||
| Drowning | 22 (85) | 0 | 0 | 1 (50) | 23 (54) |
| Trauma | 2 (8) | 8 (67) | 3 (100) | 1 (50) | 14 (33) |
| Exacerbation of condition† | 1 (4) | 1 (8) | 0 | 0 | 2 (5) |
| Electrocution | 0 | 2 (17) | 0 | 0 | 2 (5) |
| CO poisoning | 0 | 1 (8) | 0 | 0 | 1 (2) |
| Fire | 1 (4) | 0 | 0 | 0 | 1 (2) |
| Directly related mechanism of death§ | |||||
| Vehicle drowning | 18 (69) | 0 | 0 | 0 | 18 (42) |
| Non-vehicle drowning | 4 (15) | 0 | 0 | 0 | 5 (12) |
| Tree-related trauma | 1 (4) | 2 (17) | 2 (67) | 0 | 5 (12) |
| Indirectly related mechanism of death§ | |||||
| Vehicle crash injury | 1 (4) | 1 (8) | 1 (33) | 1 (50) | 4 (9) |
| Preparation/repair injury | 0 | 5 (42) | 0 | 0 | 5 (12) |
| Electrocution | 0 | 2 (17) | 0 | 0 | 2 (5) |
| Medical exacerbation | 1 (4) | 1 (8) | 0 | 0 | 2 (5) |
| CO poisoning | 0 | 1 (8) | 0 | 0 | 1 (2) |
| Fire | 1 (4) | 0 | 0 | 0 | 1 (2) |
Abbreviation: CO = carbon monoxide.
* Percentages might not sum to 100% because of rounding.
† Exacerbation of a person’s preexisting medical condition because of storm-related power failure.
§ A direct death is defined as a death caused by environmental forces of the hurricane and direct consequences of these forces, whereas an indirect death is caused by unsafe or unhealthy conditions as a result of loss/disruption of usual services, personal loss, or lifestyle disruption.
Suggested citation for this article: Wang A, Issa A, Bayleyegn T, et al. Notes from the Field. Mortality Associated with Hurricane Matthew — United States, October 2016. MMWR Morb Mortal Wkly Rep 2017;66:145–146. DOI: http://dx.doi.org/10.15585/mmwr.mm6605a3.
Famine: Tens of millions in urgent need in Yemen, South Sudan, Nigeria and Somalia
Tuesday, February 14th, 2017“Right now, in Ethiopia, Kenya and Somalia, there are 12 million people affected [by food insecurity]. These three countries together look as bad as Somalia in 2011. If you add South Sudan on top of that, with that conflict, and Nigeria, you have millions more. And Yemen has 18 million people. That’s creating this real concern that we are facing a major crisis that we have not seen before.”
At least 188,000 people remain under evacuation orders after Northern California authorities warned an emergency spillway in the country’s tallest dam was in danger of failing Sunday and unleashing uncontrolled flood waters on towns below.
Monday, February 13th, 2017- About 150 miles northeast of San Francisco
- Lake Oroville is one of California’s largest man-made lakes
- The 770-foot-tall Oroville Dam is the nation’s tallest.
Roads leading out of Oroville, Calif., were jammed with traffic Sunday evening as people evacuated the area due to the possibility of failure of the alternate spillway at Oroville Dam.
Monday, February 13th, 2017“….California Department of Water Resources officials had decided to use the emergency spillway to take pressure off the dam’s regular spillway, which developed a giant crater last week, Redding (Calif.) Record Searchlight reported. That crater had been growing daily, so to take pressure off the spillway, the state began using the emergency spillway, but that also became compromised….”
An increase in human infections with H7N9 virus has been reported by China since October 2016. Why?
Monday, February 13th, 2017Analysis of recent scientific information on avian influenza A(H7N9) virus
10 February 2017
Background
An increase in human infections with avian influenza A(H7N9) virus has been reported by China since October 20161. This document presents recent scientific findings on A(H7N9) viruses.
An early, brisk spike in H7N9 avian flu infections in China, which is in its fifth wave of activity, has now reached at least 347 cases, passing the record 319 of infections seen in the second wave during the winter of 2013-14, just months after the first human cases were detected.
Current information
Geographical distribution in animals:
A(H7N9) virus causes little or no illness in poultry and is therefore generally only detected through active virological surveillance. A number of surveillance systems routinely monitor for A(H7N9) activity in animals in China. From December 2016, the Chinese national animal influenza virus surveillance program of the Ministry of Agriculture detected influenza A(H7N9) virus in birds in Anhui, Guangdong and Zhejiang provinces2. Based on live poultry market (LPM) surveillance conducted by the Chinese provincial Health and Family Planning Commissions in December 2016, 9.4% of environmental samples were positive for A(H7N9) from LPMs in Guangdong and 15.8% of samples from LPMs in Jiangsu were positive for A(H7), of which most were positive for A(H7N9)3,4.
The low pathogenicity of the virus in birds adds to the difficulty in identifying its international spread through infected birds. To date, A(H7N9) virus has not been reported in poultry populations outside China. Some countries adjacent to China have intensified their surveillance, and several countries have imposed a temporary ban on importing live birds from China2.
Human infections:
Sudden increases in the number of human A(H7N9) cases reported during December and January have been observed in previous years5.* Compared to earlier waves of infection, further geographic spread of the virus was observed in this fifth wave6. Of the cases where information on exposure history was known, as previous waves, most reported prior exposure to live poultry or potentially contaminated environments, including in LPMs6.
Among cases reported in the fifth wave, three clusters were reported, comparable to findings in previous waves1,6. Limited human-to-human transmission could not be ruled out in these clusters. So far, there has been no indication of significant changes in the epidemiology of the human infections reported, no evidence of sustained human-to-human transmission and no significant changes in the clinical presentation or disease outcome6.
Population immunity:
In the general population, three serological surveys using specimens collected in 2011 to 2013 reported zero or very low human population immunity against A(H7) viruses7-9. Studies of poultry workers with specimens collected in 2011 to 2013 reported between 0 and 7% seropositivity7,8,10. In 2015-2016, 15,191 serum samples from poultry workers were collected by 31 provincial Centers for Disease Control (CDCs) in Mainland China, and were tested for A(H7N9) antibody in the WHO Collaborating Centre for Reference and Research on Influenza (WHOCC) in Beijing (also as the Chinese National Influenza Center), of which 26 were positive (0.17%).
Disease severity:
In most cases, infection with A(H7N9) virus is characterized by high fever, cough, shortness of breath and rapidly progressing severe pneumonia. Complications include acute respiratory distress syndrome (ARDS), septic shock and multi-organ failure requiring intensive care11. Severe illness and fatal outcome have been more frequently observed in pregnant women12, in older persons6 and those with underlying chronic conditions13. Asymptomatic and mild infections with A(H7N9) virus have been detected, but the underlying rate of such infections is not well understood14,15.
Virology:
The detailed virological surveillance data from the first 4 waves have been published16,17. For the fifth wave, since 1 October 2016, 83 full genome sequences were analysed: 2 environmental isolates from LPMs in Guangdong and 81 A(H7N9) viruses isolated from specimens collected from human cases by the WHOCC in Beijing. These human specimens were from Jiangsu (N=26), Zhejiang (N=21), Guangdong (N=13), Anhui (N=12), Fujian (N=5) and Hunan (N=4) provinces.
Phylogenetic analysis results show that all the internal genes continue to cluster with previously reported A(H7N9) and A(H9N2) viruses. And the haemagglutinin (HA) and neuraminidase (NA) genes are clustered and evolving in two lineages on the phylogenetic trees; the Yangtze River Delta lineage and the Pearl River Delta lineage (Annex 1 and Annex 2). In general, all of the viruses causing human infections remain similar to viruses analysed since 2013.
Key molecular makers associated with mammalian adaptation and pathogenicity are summarized below and detailed in Annex 3:
- All viruses contained the 177V and 217L/I (H3 numbering 186V and 226L/I) in HA1, similar with the A(H7N9) viruses since 2013.
- All viruses contained the 69-73 deletion in NA, same with the A(H7N9) viruses since 2013.
- Of the 83 viruses, 59 carried 627K in PB2 and 10 carried 701N, and 78 viruses carried I368V in PB1, similar with the A(H7N9) viruses since 2013.
Analyses of these recently isolated viruses from Mainland China as well as Hong Kong Special Administrative Region (SAR) do not show evidence of any changes in known genetic markers of virulence or mammalian adaptation. In comparison to candidate vaccine viruses, amino acid substitutions in the HA of some viruses were identified in antigenic sites. Analysis is underway to determine if existing candidate vaccine viruses remain antigenically correspondent to fifth wave viruses.
Antiviral susceptibility:
Genetic analysis of 83 recent A(H7N9) viruses showed that one virus contained 243T (N2 numbering 246T) and two contained 289K (N2 numbering 292K) mutations in the NA gene, indicating reduced sensitivity to NA inhibitors. All of the other 80 viruses did not contain any of the amino acid substitutions that are known to confer reduced inhibition by the NA inhibitor class of antivirals. Testing of some viruses is underway to assess in vitro susceptibility to the NA inhibitor class of antivirals. As observed for A(H7N9) viruses from previous waves of human infection, all 83 viruses carried the S31N mutation on the M2 protein indicating resistance to amantadine and rimantadine.
Transmission in animal models:
Transmission studies of A(H7N9) viruses from 2013 using ferret models indicate that the virus can transmit efficiently through direct contact but inefficiently through respiratory droplets18-25. The virus can replicate in swine respiratory tract tissue26, highlighting the need to screen for further mammalian adaptation. Further studies with more recent A(H7N9) viruses are needed to monitor for any changes in transmissibility.
Conclusions
Based on information reported, there is no evidence of sustained human-to-human transmission, and there are no significant changes in A(H7N9) virus properties or the epidemiology of human infections. As long as humans are exposed to infected animals and their environments, further human cases can be expected.
WHO, through its Global Influenza Surveillance and Response System (GISRS), in collaboration with the OIE FAO Network of Experts on Animal Influenza (OFFLU) and national authorities, will continue monitoring the A(H7N9) virus situation.
As traditionally the consumption of poultry among the general population increases during the Chinese New Year celebrations, the movement, trade and slaughter of poultry during this period may subsequently increase human exposure to the A(H7N9) virus6. Countries are encouraged to continue strengthening influenza surveillance, including surveillance for severe acute respiratory infections (SARI) and influenza-like illness (ILI), carefully review any unusual epidemiological patterns, immediately alert WHO Global Influenza Programme (GIP) and WHOCCs of GISRS of unsubtypable influenza viruses, ensure reporting under the International Health Regulations (IHR, 2005), and continue national influenza pandemic preparedness actions.
*These increases in cases have been referred to as waves. WHO defines these waves as beginning on 1 October until 30 September of the following year. Thus, currently, the increase in human cases is referred to as the fifth wave (1 October 2016 through 30 September 2017).
- World Health Organization. Human infection with avian influenza A(H7N9) virus – China. Available from: www.who.int/csr/don/17-january-2017-ah7n9-china/en/
- Food and Agriculture Organization. H7N9 situation update 24 January 2017. Available from: www.fao.org/ag/againfo/programmes/en/empres/H7N9/situation_update.html
- Health and Family Planning Commission of Guangdong Province. Available from: www.gdwst.gov.cn/a/zwxw/2017011717051.html
- Jiangsu Provincial Commission of Health and Family Planning. Available from: www.jswst.gov.cn/wsxx/nrglIndex.action?catalogID=4028816b2ba99317012ba99950740003&type=2&messageID=ff80808159433fad015981a71c580427
- World Health Organization. Monthly Risk Assessment Summary : Influenza at the Human-Animal Interface. Available from: www.who.int/influenza/human_animal_interface/HAI_Risk_Assessment/en/
- Zhou L, Ren R, Yang L, Bao C, Jiabing W, Wang D, et al. Sudden increase in human infection with avian influenza A(H7N9) virus in China, September-December 2016. Western Pac Surveill Response J. 2017;9(1). Available from: ojs.wpro.who.int/ojs/index.php/wpsar/article/view/521/733
- Wang X, Fang S, Lu X, Xu C, Cowling BJ, Tang X, et al. Seroprevalence to avian influenza A(H7N9) virus among poultry workers and the general population in southern China: a longitudinal study. Clin Infect Dis. 2014;59(6):e76-83. Available from: doi.org/10.1093/cid/ciu399
- Yang S, Chen Y, Cui D, Yao H, Lou J, Huo Z, et al. Avian-origin influenza A(H7N9) infection in influenza A(H7N9)-affected areas of China: a serological study. J Infect Dis. 2014;209(2):265-9. Available from: doi.org/10.1093/infdis/jit430
- Wang W, Peng H, Tao Q, Zhao X, Tang H, Tang Z, et al. Serologic assay for avian-origin influenza A (H7N9) virus in adults of Shanghai, Guangzhou and Yunnan, China. J Clin Virol. 2014;60(3):305-8. Available from: dx.doi.org/10.1016/j.jcv.2014.04.006
- Bai T, Zhou J, Shu Y. Serologic study for influenza A (H7N9) among high-risk groups in China. N Engl J Med. 2013;368(24):2339-40. Available from: DOI: 10.1056/NEJMc1305865
- Yang Y, Guo F, Zhao W, Gu Q, Huang M, Cao Q, et al. Novel avian-origin influenza A (H7N9) in critically ill patients in China. Crit Care Med. 2015;43(2):339-45. Available from: DOI: 10.1097/CCM.0000000000000695
- Liu S, Sha J, Yu Z, Hu Y, Chan TC, Wang X, et al. Avian influenza virus in pregnancy. Rev Med Virol. 2016;26(4):268-84. Available from: DOI: 10.1002/rmv.1884
- Liu B, Havers F, Chen E, Yuan Z, Yuan H, Ou J, et al. Risk factors for influenza A(H7N9) disease–China, 2013. Clin Infect Dis. 2014;59(6):787-94. Available from: dx.doi.org/10.1093/cid/ciu423
- Yu H, Wu JT, Cowling BJ, Liao Q, Fang VJ, Zhou S, et al. Effect of closure of live poultry markets on poultry-to-person transmission of avian influenza A H7N9 virus: an ecological study. Lancet. 2014;383(9916):541-8. Available from: dx.doi.org/10.1016/S0140-6736(13)61904-2
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