Global & Disaster Medicine

Archive for October, 2017

10/21/1910: A massive explosion destroys the Los Angeles Times building in the city’s downtown area, killing 21 and injuring many more.

History Channel

 


Paramedics, Stress & the Las Vegas Mass Shooting

EMS1

“…..Weber said the green-tagged patients had minor injuries, the yellow-tagged patients had non-life-threatening injuries, and those with red tags needed to be transported to the hospital immediately. The black-tagged individuals were expected to die.
“We had to take the red-tagged patients first,” Weber said. “But it’s not always that easy. People were begging me to take them because they were in so much pain. One woman grabbed at my ankle and we locked eyes. All she could say was ‘please.’ She had tears all over her face. But she was tagged in yellow, and there were people in red. So I had to say, ‘I’m so sorry. Someone will be back for you soon.’”
Weber said patients were growing more desperate on their second round of pickups.
“They’d been waiting for maybe 20-30 minutes at that point, and they’re hurt and they’re bleeding,” Weber said. “So as you walked past them, they’d be like, ‘Help me, please. Help me.’ There was a man tagged yellow who said, ‘I have a new baby. Please save me.’”
“There were officers helping us triage, but there was still some discretion,” Weber added. “Do I pick up this red tag or that red tag? Which patient do we take? What if we choose the wrong one? It can be agonizing.”
Weber said that patients with green tags suffered injuries such as broken limbs and waited for hours to be transported to the hospital. He added that some of the green patients were with people who had already been transported to the hospital and had no idea if their loved ones were alive or dead…..”


Ebola’s survivors: Cataracts

NY Times

“….Cataracts usually afflict the old, not the young, but doctors have been shocked to find them in Ebola survivors as young as 5. And for reasons that no one understands, some of those children have the toughest, thickest cataracts that eye surgeons have encountered, along with scarring deep inside the eye….”

PHIL Image 17772

Under a magnification of 25,000X, this scanning electron microscopic (SEM) image depicts numerous filamentous Ebola virus particles budding from a chronically-infected VERO E6 cell.

 


10/20/1944: Two liquid gas tanks explode in Cleveland, Ohio, killing 130 people

History Channel


Puerto Rico: The USNS Comfort, a 70,000-metric-ton ship staffed with roughly 800 medical and support personnel and 250 beds, has treated only about 150 people since it arrived on Oct. 3

WSJ

  • “….Hurricane Maria, a Category 4 storm, slammed into the U.S. Commonwealth of 3.4 million people on Sept. 20 with sustained winds of 155 miles an hour, killing nearly 50 residents and leaving 250,000 without homes…..”
  • “….Patients who show up at the Comfort aren’t turned away. But the normal path is through San Juan’s Centro Medico hospital, where doctors evaluate requests for transfer from other hospitals, contact a medical-operation center which in turn dials the ship. Patients are flown to the vessel via helicopter from other hospitals. …”

Image result for USNS Comfort

  • “……officials recently changed the protocol to allow regional hospitals to contact the operation center directly….”
  • “….The DoD…stationed personnel outside of hospitals around the island with satellite phones to relay information about hospitals’ power, water and patient count, in case there was need to evacuate or transfer patients…..”
  • “…..Four U.S. Army crews were recently certified to land on the ship during daytime…”
  • “…..Ryder Memorial Hospital….The Oct. 4 power failure prompted the evacuation of 29 patients by helicopter to San Juan, where five were transferred to the Comfort…..”
  • “….Two days later, the Comfort took in four patients after generators failed at Hospital Menonita in Caguas….”
  • “….As it has moved along Puerto Rico’s north coast, the ship has also supplied hospitals with more than 10 tons of food and water, plus 29,100 liters of oxygen…….”

 


Uganda has confirmed 2 deaths from Marburg virus

Reuters

UVRI (Uganda Virus Research Institute) confirms cases of the deadly Marburg virus in Kween District in Eastern Uganda.

Uganda Virus Research Institute has confirmed cases of the deadly Marburg virus in Kween District on the western slopes of Mt. Elgon in Eastern Uganda. Two people have died from the deadly hemorrhagic fever.

The Ministry of health is sending an emergency response team to the district.

The public is urged to be vigilant and report suspected cases.

Symptoms of the Marburg virus include Nausea and vomiting, Diarrhea (may be bloody), Red eyes, Raised rash, Chest pain and cough, Sore throat, Stomach pain, Severe weight loss among others.”

PHIL Image 10814

CDC/ Frederick Murphy

 


Madagascar: Between 1 August and 15 October 2017, a total of 849 plague cases (suspected, probable and confirmed) including 67 deaths (case fatality rate 7.9%)

WHO

“Madagascar is experiencing a large outbreak of plague affecting major cities and other non-endemic areas since August 2017.

Between 1 August and 15 October 2017, a total of 849 cases (suspected, probable and confirmed) including 67 deaths (case fatality rate 7.9%) have been reported from 37 (32.5%) out of 114 districts in the country. Of these, 568 cases (67%) were clinically classified as pneumonic plague, 155 (18.3%) were bubonic plague, one case was septicaemic plague, and 125 cases were unspecified. At least 39 healthcare workers have contracted plague since the beginning of the outbreak.

Of the 849 reported cases, 78 (9.2%) were confirmed, 304 (35.8%) were classified as probable after testing positive on rapid diagnostic tests (RDT) and 467 (55%) remain suspected. Eleven strains of Yersinia pestis have been isolated and were sensitive to antibiotics recommended by the National Program for the Control of Plague.

Eighteen (81.2%) out of 22 regions in the country, including traditionally non-endemic areas, have been affected. The district of Antananarivo Renivohitra has been the most affected, accounting for 57.1% of the reported cases. As of 16 October 2017, a total of 3745 contacts were identified, 79.2% (2 967) of them were followed up on the day of reporting…..”


H7N9: Global time bomb

CDC

Summary of Influenza Risk Assessment Tool (IRAT) Results

 

The Influenza Risk Assessment Tool (IRAT) is an evaluation tool conceived by CDC and further developed with assistance from global animal and human health influenza experts. The IRAT is used to assess the potential pandemic risk posed by influenza A viruses that are not currently circulating in people. Input is provided by U.S. government animal and human health influenza experts. Information about the IRAT is available at Influenza Risk Assessment Tool (IRAT) Questions and Answers(https://www.cdc.gov/flu/pandemic-resources/national-strategy/risk-assessment.htm).

Below is a table of results for influenza A viruses that have been assessed using IRAT because they serve as a representative of a particular subtype or are of unique interest.

Virus Most Recent Date Evaluated Potential Emergence Risk(https://www.cdc.gov/flu/pandemic-resources/tools/risk-assessment.htm#emergence-risk) Potential Impact Risk(https://www.cdc.gov/flu/pandemic-resources/tools/risk-assessment.htm#impact-risk) Overall Summary
H1N1 [A/duck/New York/1996] Nov 2011 2.3 2.4 Low
H3N2 variant [A/Indiana/08/2011] Dec 2012 6.0 4.5 Moderate
H3N2 [A/canine/Illinois/12191/2015] June 2016 3.7 3.7 Low
H5N1 Clade 1 [A/Vietnam/1203/2004] Nov 2011 5.2 6.6 Moderate
H5N1 [A/American green-winged teal/Washington/1957050/2014] Mar 2015 3.6 4.1 Low-Moderate
H5N2 [A/Northern pintail/Washington/40964/2014] Mar 2015 3.8 4.1 Low-Moderate
H5N6 [A/Yunnan/14564/2015] – like Apr 2016 5.0 6.6 Moderate
H5N8 [A/gyrfalcon/Washington/41088/2014] Mar 2015 4.2 4.6 Low-Moderate
H7N7 [A/Netherlands/2019/2003] Jun 2012 4.6 5.8 Moderate
H7N8 [A/turkey/Indiana/1573-2/2016] July 2017 3.4 3.9 Low
H7N9 [A/Hong Kong/125/2017] May 2017 6.5 7.5 Moderate-High
H7N9 [A/Shanghai/02/2013] Apr 2016 6.4 7.2 Moderate-High
H9N2 G1 lineage [A/Bangladesh/0994/2011] Feb 2014 5.6 5.4 Moderate
H10N8 [A/Jiangxi-Donghu/346/2013] Feb 2014 4.3 6.0 Moderate

 Top of Page

IRAT emergence and impact
IRAT chart

 

H1N1: [North American avian H1N1 [A/duck/New York/1996]

Avian influenza A viruses are designated as highly pathogenic avian influenza (HPAI) or low pathogenic avian influenza (LPAI) based on molecular characteristics of the virus and the ability of the virus to cause disease and death in chickens in a laboratory setting. North American avian H1N1 [A/duck/New York/1996] is a LPAI virus and in the context of the IRAT serves as an example of a low risk virus.

Summary: The summary average risk score for the virus to achieve sustained human-to-human transmission was in the low risk category (less than 3). Similarly the average risk score for the virus to significantly impact public health if it were to achieve sustained human-to-human transmission also falls into the low risk range (less than 3).

H3N2 Variant:[A/Indiana/08/11]

Swine-origin flu viruses do not normally infect humans. However, sporadic human infections with swine-origin influenza viruses have occurred. When this happens, these viruses are called “variant viruses.” Influenza A H3N2 variant viruses (also known as “H3N2v” viruses) with the matrix (M) gene from the 2009 H1N1 pandemic virus were first detected in people in July 2011. The viruses were first identified in U.S. pigs in 2010. In 2011, 12 cases of H3N2v infection were detected in the United States. In 2012, 309 cases of H3N2v infection across 12 states were detected. The latest risk assessment for this virus was conducted in December 2012 and incorporated data regarding population immunity that was lacking a year earlier.

Summary: The summary average risk score for the virus to achieve sustained human-to-human transmission was in the moderate risk category (less than 6). The summary average risk score for the virus to significantly impact public health if it were to achieve sustained human-to-human transmission was in the low-moderate risk category (less than 5).

H3N2: [A/canine/Illinois/12191/2015]

The H3N2 canine influenza virus is an avian flu virus that adapted to infect dogs. This virus is different from human seasonal H3N2 viruses. Canine influenza A H3N2 virus was first detected in dogs in South Korea in 2007 and has since been reported in China and Thailand. It was first detected in dogs in the United States in April 2015(https://www.cdc.gov/flu/news/canine-influenza-update.htm). H3N2 canine influenza has reportedly infected some cats as well as dogs. There have been no reports of human cases.

Summary:  The average summary risk score for the virus to achieve sustained human-to-human transmission was low risk (less than 4). The average summary risk score for the virus to significantly impact public health if it were to achieve sustained human-to-human transmission was in the low risk range (less than 4).

H5N1 clade 1: [A/Vietnam/1203/2004]

The first human cases of highly pathogenic avian influenza (HPAI) H5N1 virus were reported from Hong Kong in 1997. Since 2003, highly pathogenic H5N1 avian influenza viruses have caused over 850 laboratory-confirmed human cases; mortality among these cases was high. A risk assessment of this H5N1 clade 1 virus was conducted in 2011 soon after the IRAT was first developed and when 12 hemagglutinin (HA) clades were officially recognized.

Summary: The summary average risk score for the virus to achieve sustained human-to-human transmission was in the moderate risk category (less than 6). The summary average risk score for the virus to significantly impact public health if it were to achieve sustained human-to-human transmission was in the high-moderate risk category (less than 7).

H5N1: [A/American green winged teal/Washington/1957050/2014]

In December 2014, an H5N1 highly pathogenic avian influenza virus was first isolated from an American green-winged teal in the state of Washington. This virus is a recombinant virus containing four genes of Eurasian lineage (PB2, HA, NP and M) and four genes of North American lineage (PB1, PA, NA and NS).In February 2015, the Canadian government reported isolating this virus from a backyard flock in the Fraser Valley. When this risk assessment was conducted in 2015, these were the only reported isolations of this virus. There have been no reports of human cases.

Summary: The summary average risk score for the virus to achieve sustained human-to-human transmission was in the low risk category (less than 4). The summary average risk score for the virus to significantly impact public health if it were to achieve sustained human-to-human transmission was in the low-moderate risk category (less than 5).

H5N2: [A/Northern pintail/Washington/40964/2014]

In December 2014, an H5N2 highly pathogenic avian influenza virus was first reported by the Canadian government from commercial poultry in the Fraser Valley.Subsequently this virus was isolated from wild birds, captive wild birds, backyard flocks and commercial flocks in the United States.This virus is a recombinant virus composed of five Eurasian lineage (PB2, PA, HA, M and NS) genes and three North American lineage (PB1, NP and NA) genes. There have been no reports of human cases.

Summary: The average summary risk score for the virus to achieve sustained human-to-human transmission was low risk (less than 4).The average summary risk score for the virus to significantly impact public health if it were to achieve sustained human-to-human transmission was in the low-moderate risk range (less than 5).

H5N6: [A/Yunnan/14564/2015 (H5N6-like)]

Between January 2014 and March 2016, there have been 10 human cases of H5N6 highly pathogenic avian influenza reported. Nine reportedly experienced severe disease and six died. Avian outbreaks of this virus were first reported from China in 2013. Subsequently avian outbreaks have been reported in at least three countries (China, Vietnam and Lao PDR) through 2015.

Summary: The summary average risk score for the virus to achieve sustained human-to-human transmission was in the moderate range (less than 6).The average summary risk score for the virus to significantly impact on public health if it were to achieve sustained human-to-human transmission fell in the moderate range (less than 7).

H5N8: [A/gyrfalcon/Washington/41088/2014]

In December 2014, an H5N8 highly pathogenic avian influenza virus was first isolated from a sample collected in the United States from a captive gyrfalcon.Subsequently this virus was isolated from wild birds, captive wild birds, backyard flocks and commercial flocks in the United States.This virus (clade 2.3.4.4) is similar to Eurasian lineage H5N8 viruses that have been isolated in South Korea, China, Japan, the Netherlands, the United Kingdom and Germany in late 2014-early 2015.There have been no reports of human cases.

Summary: The average risk score for the virus to achieve sustained human-to-human transmission was in the low-moderate range< (less than 5).  The average summary risk score for the virus to significantly impact public health if it were to achieve sustained human-to-human transmission fell in the low-moderate range (less than 5).

H7N7: [A/Netherlands/219/03]

In 2003 the Netherlands reported highly pathogenic avian influenza (HPAI) in approximately 255 commercial flocks.Coinciding with human activities around these infected flocks, 89 human cases of H7N7 were identified.Cases primarily reported conjunctivitis, although a few also reported mild influenza-like illness.There was one death.

Summary: The summary average risk score for this virus to achieve sustained human-to-human transmission was in the low-moderate risk range (less than 5). The summary average risk score for this virus to significantly impact the public’s health if it were to achieve sustained human-to-human transmission fell in the moderate risk range (less than 7).

H7N8:  [A/turkey/Indiana/1573-2/2016]

In January 2016, a highly pathogenic avian influenza (HPAI) virus of North American lineage was identified in a turkey flock in Indiana. Putative low pathogenic avian influenza (LPAI) viruses similar to A/turkey/Indiana/1573-2/2016 were subsequently isolated from 9 other turkey flocks in the area. There were no reports of human cases associated with this virus at the time of the IRAT scoring.

Summary:  A risk assessment of this LPAI virus was conducted in July 2017. The overall IRAT risk assessment score for this virus falls into the low risk category (< 4). The summary average risk score for the virus to achieve sustained human-to-human transmission is in the low risk category (3.4). The summary average risk score for the virus to significantly impact public health if it were to achieve sustained human-to-human transmission was also in the low risk category (3.9).

H7N9: [A/Hong Kong/125/2017]

Low pathogenic avian influenza (LPAI) H7N9 viruses were first reported from China in March 2013. These viruses were first scored using the IRAT in March 2013 and again in April 2013, and then annually in 2014, 2015, and 2016 with no change in overall risk scores. Between October 2016 and May 2017 evidence of two divergent lineages of these viruses was detected – the Pearl River Delta lineage and the Yangtze River Delta lineage. The IRAT was used to assess LPAI H7N9 [A/Hong Kong/125/2017], a representative of the Yangtze River Delta viruses.

Summary:  A risk assessment of H7N9 [A/Hong Kong/125/2017] was conducted in May 2017. The overall IRAT risk assessment score for this virus falls into the moderate-high risk category and is similar to the scores for the previous H7N9 viruses. The summary average risk score for the virus to achieve sustained human-to-human transmission is in the moderate risk category (less than 7). The summary average risk score for the virus to significantly impact public health if it were to achieve sustained human-to-human transmission was in the moderate-high risk category (less than 8).

H7N9: Avian H7N9 [A/Shanghai/02/2013]

On 31 March 2013, the China Health and Family Planning Commission notified the World Health Organization (WHO) of three cases of human infection with influenza H7N9. As of August 2016, the WHO has received reports of 821 cases, 305 have died. This low pathogenic avian influenza virus was rescored most recently in April 2016 with no substantive change in risk scores since May 2013.

Summary: The summary average risk score for the virus to achieve sustained human-to-human transmission was in the moderate risk category (less than 7). The average risk score for the virus to significantly impact public health if it were to achieve sustained human-to-human transmission fell in the high-moderate risk range (less than 8).

H9N2: Avian H9N2 G1 lineage [A/Bangladesh/0994/2011]

Human infections with influenza AH9N2 virus have been reported sporadically, cases reportedly exhibited mild influenza-like illness. Historically these low pathogenic avian influenza viruses have been isolated from wild and domestic birds. In response to these reports, a risk assessment of this H9N2 influenza virus was conducted in 2014.

Summary: The summary average risk score for the virus to achieve sustained human-to-human transmission was in the moderate risk category (less than 6). The summary average risk score for the virus to significantly impact public health if it were to achieve sustained human-to-human transmission also fell in the moderate risk range (less than 6).

H10N8: Avian H10N8 [A/Jiangxi-Donghu/346/2013]

Two human infections with influenza A(H10N8) virus were reported by the China Health and Family Planning Commission in 2013 and 2014 (one each year). Both cases were hospitalized and one died. Historically low pathogenic avian influenza H10 and N8 viruses have been recovered from birds. A risk assessment of the H10N8 influenza was conducted in 2014.

Summary: The summary average risk score for the virus to achieve sustained human-to-human transmission was low-moderate (less than 5). The average risk score for the virus to significantly impact public health if it were to achieve sustained human-to-human transmission was in the moderate risk range (less than 7).


“My World is Finished”: Rohingya targeted in crimes against humanity in Myanmar

Amnesty International

“…..The Rome Statute of the International Criminal Court lists 11 types of acts which, when knowingly committed during such an attack, constitute crimes against humanity. Amnesty International has consistently documented at least six of these amid the current wave of violence in northern Rakhine State: murder, deportation and forcible displacement, torture, rape and other sexual violence, persecution, and other inhumane acts such as denying food and other life-saving provisions……”

“More than 530,000 Rohingya men, women and children have fled northern Rakhine State in terror in a matter of weeks amid the Myanmar security forces’ targeted campaign of widespread and systematic murder, rape and burning, Amnesty International said today in its most detailed analysis yet of the ongoing crisis.

‘My World Is Finished’: Rohingya Targeted in Crimes against Humanity in Myanmar describes how Myanmar’s security forces are carrying out a systematic, organized and ruthless campaign of violence against the Rohingya population as a whole in northern Rakhine State, after a Rohingya armed group attacked around 30 security posts on 25 August.

Dozens of eyewitnesses to the worst violence consistently implicated specific units, including the Myanmar Army’s Western Command, the 33rd Light Infantry Division, and the Border Guard Police. ……”+

 


Since Sunday, 10,000 to 15,000 Rohingya have crossed into Bangladesh at Anjuman Para

NY Times

 

 


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