Global & Disaster Medicine

Archive for July, 2017

Ohio State Fair: 1 dead, 7 injured; the ‘worst tragedy in the history’ of the state fair

Columbus Dispatch

 


Saudi MOH: ‘1 New Confirmed Corona Cases Recorded’

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Cholera: Life and Death in yemen

WHO

The life and death struggle against cholera in Yemen

July 2017

Cholera continues to spread in Yemen, causing more than 390 000 suspected cases of the disease and more than 1800 deaths since 27 April.

WHO and its partners are responding to the cholera outbreak in Yemen, working closely with UNICEF, local health authorities and others to treat the sick and stop the spread of the disease.

Each of these cholera cases is a person with a family, a story, hopes and dreams. In the centres, where patients are treated, local health workers work long hours, often without pay, to fight off death and help their patients make a full recovery.

WHO/S. Hasan

Fatima Shooie sits between her 85-year-old mother and 22-year-old daughter who are both receiving treatment for cholera at the crowded 22 May Hospital in Sana’a.

“We have no money even for transportation to the hospital. My husband works as a street cleaner but he hasn’t received a salary for 8 months and he is our only breadwinner,” Fatima said. “I’m afraid that the disease will transmit to other family members.


WHO/S.Hasan

Dr Adel Al-Almani is the head of the diarrhoea treatment centre in Al-Sabeen Hospital in Sana’a. He and his team often work 18 hours a day to deal with the influx of patients.

More than 30 000 Yemeni health workers have not been paid in more than 10 months. Yet many, like Dr Al-Almani, continue to treat patients and save lives.


WHO/S. Hasan

Eight-year-old Mohannad has overcome cholera following 3 days of treatment in the diarrhoea treatment centre at Al-Sabeen Hospital in Sana’a. Mohannad lost his mother and sister when a bomb went off near their home in Hajjah. He and his father have since fled to Sana’a.

“Mohannad is all I have in this life after my wife and daughter died. When he was infected with cholera I was very anxious that he would have the same fate of his mother and sister,” said Mohannad’s father


WHO/S. Hasan

A health worker tends to Khadeeja Abdul-Kareem, 20. Khadeeja was forced to flee the conflict in Al-Waziya District, Taiz. Displaced from her home, she struggles to make ends meet – a situation compounded by her illness.


WHO/S. Hasan

It was a long and painful journey in search of treatment for Abdu Al-Nehmi, 53. The road from his village in Bani Matar District to Sana’a City was bumpy and the car broke down along the way. The whole time he was suffering from kidney pain in addition to severe diarrhoea and vomiting.

“There is no health centre in our area. We have to spend 2-3 hours to arrive at a proper health facility in Sana’a,” he said.

To date, WHO, UNICEF, and partners have supported the establishment of 3000 beds in 187 diarrhoea treatment centres and 834 fully operational oral rehydration therapy corners.


WHO/S. Hasan

Nabila, Fatima, Amal, Hayat and Hend are working as nurses in Azal Health Centre in Sana’a and have dedicated themselves to treating patients arriving with severe dehydration.

“Every day, we receive severe cases that come with complicated conditions, but we manage to save the lives of most of them. Sometimes, a new severe case arrives while we’re so busy treating another case,” said Nabila Al-Olofi, one of nurses working in the centre.

“Yes, we have no regular salaries as nurses, but saving lives is our biggest gain.”

WHO, together with UNICEF, is also delivering medical supplies and paying incentives, travel costs and overtime payments for health workers to enable them to continue to treat patients.


UNICEF Executive Director, Anthony Lake, WFP Executive Director, David Beasley and WHO Director-General, Dr Tedros Adhanom Ghebreyesus visit Yeme

WHO

Joint WHO/UNICEF/WFP statement
26 July 2017

“As the heads of three United Nations agencies – UNICEF, the World Food Programme (WFP) and WHO – we have travelled together to Yemen to see for ourselves the scale of this humanitarian crisis and to step up our combined efforts to help the people of Yemen.

“This is the world’s worst cholera outbreak in the midst of the world’s largest humanitarian crisis. In the last 3 months alone, 400 000 cases of suspected cholera and nearly 1900 associated deaths have been recorded. Vital health, water and sanitation facilities have been crippled by more than 2 years of hostilities, and created the ideal conditions for diseases to spread.

“The country is on the brink of famine, with over 60 per cent of the population not knowing where their next meal will come from. Nearly 2 milllion Yemeni children are acutely malnourished. Malnutrition makes them more susceptible to cholera; diseases create more malnutrition. A vicious combination.

“At one hospital, we visited children who can barely gather the strength to breathe. We spoke with families overcome with sorrow for their ill loved ones and struggling to feed their families.

“And, as we drove through the city, we saw how vital infrastructure, such as health and water facilities, have been damaged or destroyed.

“Amid this chaos, some 16 000 community volunteers go house to house, providing families with information on how to protect themselves from diarrhea and cholera. Doctors, nurses and other essential health staff are working around the clock to save lives.

“More than 30 000 health workers haven’t been paid their salaries in more than 10 months, but many still report for duty. We have asked the Yemeni authorities to pay these health workers urgently because, without them, we fear that people who would otherwise have survived may die. As for our agencies, we will do our best to support these extremely dedicated health workers with incentives and stipends.

“We also saw the vital work being done by local authorities and NGOs, supported by international humanitarian agencies, including our own. We have set up more than 1000 diarrhoea treatment centres and oral rehydration corners. The delivery of food supplements, intravenous fluids and other medical supplies, including ambulances, is ongoing, as is the rebuilding of critical infrastructure – the rehabilitation of hospitals, district health centres and the water and sanitation network. We are working with the World Bank in an innovative partnership that responds to needs on the ground and helps maintain the local health institutions.

“But there is hope. More than 99 per cent of people who are sick with suspected cholera and who can access health services are now surviving. And the total number of children who will be afflicted with severe acute malnutrition this year is estimated at 385 000.

“However, the situation remains dire. Thousands are falling sick every day. Sustained efforts are required to stop the spread of disease. Nearly 80 percent of Yemen’s children need immediate humanitarian assistance.

“When we met with Yemeni leaders — in Aden and in Sana’a — we called on them to give humanitarian workers access to areas affected by fighting. And we urged them – more than anything – to find a peaceful political solution to the conflict.

“The Yemeni crisis requires an unprecedented response. Our 3 agencies have teamed up with the Yemeni authorities and other partners to coordinate our activities in new ways of working to save lives and to prepare for future emergencies.

“We now call on the international community to redouble its support for the people of Yemen. If we fail to do so, the catastrophe we have seen unfolding before our eyes will not only continue to claim lives but will scar future generations and the country for years to come.”


Yemen: From 27 April to 25 July 2017, 402,484 suspected cholera cases and 1,880 deaths (CFR: 0.5%) have been reported in 91.3% (21/23) of Yemen governorates, and 88.9% (296/333) of the districts.

WHO

A physician checking a patient for dehydration    Person washing hands over a bucket of water

 


Texas: First human case of indigenous Zika Virus infection

Texas Health

 


Overnight wildfires force mass evacuations in southern France (at least 10 000)

BBC

 


The Mumbai police on Wednesday arrested a man affiliated with a local political party, accusing him of making illegal alterations to the ground floor of a five-story building that caused it to collapse a day earlier, killing at least 17 people and injuring many others.

NY Times

“…..The building’s collapse is reflective of a sadly familiar phenomenon in India. A severe housing shortage, lax regulation and political corruption have resulted in too many people crowded into old, weak and substandard structures. Politically connected people such as contractors and developers often circumvent safety rules with impunity until disaster strikes…..”

 


The Story of Cholera: A Video

Summary: A short animated film produced by the Global Health Media Project in collaboration with Yoni Goodman. This film makes visible the invisible cholera germs as a young boy shows how to help the sick and guides his village in preventing the spread of cholera.

The film shows how to make the basic homemade oral rehydration solution using sugar, salt, and safe water as these items were felt to be most widely available. However, a solution prepared with a readymade ORS packet is the first choice if supplies are available.

 


WHO: Early MERS-CoV identification in the community and in healthcare facilities and compliance with infection prevention and control protocols still pose major challenges

WHO

“Between 2012 and 21 July 2017, 2040 laboratory-confirmed cases of Middle East respiratory syndrome-coronavirus (MERS-CoV) infection were reported to WHO, 82% of whom were reported by the Kingdom of Saudi Arabi. In total, cases have been reported from 27 countries in the Middle East, North Africa, Europe, the United States of America, and Asia. Males above the age of 60 with underlying conditions, such as diabetes, hypertension and renal failure, are at a higher risk of severe disease, including death. To date, at least 710 individuals have died (crude CFR 34.8%)…….Since the last global update of 5 December 2016, approximately 31% of cases reported to WHO were associated with transmission in a health-care facility. These cases included health-care workers (40 cases), patients sharing rooms/wards with MERS patients, or family visitor……..”

Summary:  “….Summary – information available from 2012 to date
Thus far, no sustained human-to-human transmission has occurred anywhere in the world, however limited nonsustained human-to-human transmission in health-care facilities remains a prominent feature of this virus. WHO continues to work with health authorities in the affected countries. WHO understands that health authorities in affected countries, especially those in the most affected countries, are aggressively investigating cases and contacts, including testing for MERS-CoV among asymptomatic contacts, and applying mitigation measures to stop humanto-human transmission in health-care settings.
Of all laboratory-confirmed cases reported to date (n=2040), the median age is 52 (IQR 36-65; range >1-109 years old) and 66.4% are male.
At the time of reporting, 21.5% of the 2040 cases were reported to have no or mild symptoms, while 46.8% had severe disease or died. Overall, 19.6% of the cases reported to date have been in health-care workers.
Since 2012, 27 countries have reported cases of MERS-CoV infection. In the Middle East: Bahrain, Egypt, Iran, Jordan, Kuwait, Lebanon, Oman, Qatar, the Kingdom of Saudi Arabia, the United Arab Emirates and Yemen; in Africa: Algeria and Tunisia; in Europe: Austria, France, Germany, Greece, Italy, the Netherlands, Turkey and the United Kingdom; in Asia: China, the Republic of Korea, Malaysia, the Philippines and Thailand; and in the Americas: the United States of America (Table 1).
The majority of cases (approximately 82%) have been reported from Saudi Arabia (Figure 1).
Populations in close contact with dromedaries (e.g. farmers, abattoir workers, shepherds, dromedary owners) and healthcare workers caring for MERS-CoV patients are believed to be at higher risk of infection. Healthy adults tend to have mild subclinical or asymptomatic infections. To date, limited human-to-human transmission has occurred between close contacts of confirmed cases in household settings. More efficient human-to-human transmission occurs in health-care settings due to inadequate and/or incomplete compliance with the infection prevention and control measures and delay in triage or isolation of suspected MERS patients. Health-care-associated transmission has been documented in several countries between 2012-2016, including the Kingdom of Saudi Arabia, Jordan, the United Arab Emirates, France, the United Kingdom, and the Republic of Korea with varying outbreak sizes (2-180 reported cases per outbreak). The largest outbreak outside of the Middle East occurred in the Republic of Korea resulting in 186 cases (including one case who travelled to China) and 38 deaths.

Overall, the reproduction number (R0) of MERS-CoV is <1 with significant heterogeneity in specific contexts. Specifically, outbreaks in health-care settings can have R>1,
but they can be brought under control (R<1) with proper application of infection prevention and control measures and early isolation of subsequent cases. ….”


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