Global & Disaster Medicine

Archive for November, 2017

About 5,000 barrels of oil, or about 210,000 gallons, gushed out of the Keystone Pipeline on Thursday in South Dakota

NY Times


Multistate Outbreak of Multidrug-Resistant Salmonella Heidelberg Infections Linked to Contact with Dairy Calves


Since the last update on August 2, 2017, eight more ill people have been reported from six states.

People infected with the outbreak strain of Salmonella Heidelberg, by state of residence, as of October 30, 2017

  • CDC, several states, and the U.S. Department of Agriculture’s Animal and Plant Health Inspection Service (USDA-APHIS) are investigating a multistate outbreak of multidrug-resistant Salmonella Heidelberg infections.
  • A total of 54 people infected with the outbreak strains of Salmonella Heidelberg have been reported from 15 states.
    • Seventeen (35%) people have been hospitalized. No deaths have been reported.
    • Illnesses started on dates ranging from January 27, 2015 to October 15, 2017.
    • Eighteen (33%) people in this outbreak are children under the age of 5.
  • Epidemiologic and laboratory investigations linked ill people in this outbreak to contact with calves, including dairy calves.
    • In interviews, ill people answered questions about contact with animals and foods eaten in the week before becoming ill. Of the 54 people interviewed, 34 (63%) reported contact with dairy calves or other cattle. Some of the ill people interviewed reported that they became sick after their dairy calves became sick or died.
    • Ongoing surveillance in veterinary diagnostic laboratories showed that calves in several states continue to get sick with the outbreak strains of multidrug resistant Salmonella Heidelberg. ‎
    • Information collected earlier in the outbreak indicated that most of the calves came from Wisconsin. Regulatory officials in several states are now tracing the origin of the calves that are linked to the newer illnesses.
  • Antibiotic resistance testing( conducted by CDC on clinical isolates from ill people shows that the isolates were resistant to multiple types of antibiotics.
    • Antibiotic resistance may be associated with increased risk of hospitalization, development of a bloodstream infection, or treatment failure in patients.
    • Whole genome sequencing has identified multiple antimicrobial resistance genes in outbreak-associated isolates from 43 ill people, 87 isolates from cattle, and 11 isolates from animal environments.
    • These findings match results from standard antibiotic resistance testing( methods used by CDC’s National Antimicrobial Resistance Monitoring System (NARMS)( laboratory on clinical isolates from eight ill people in this outbreak.
    • All eight isolates from ill people were resistant to amoxicillin-clavulanic acid, ampicillin, cefoxitin, ceftriaxone, streptomycin, sulfisoxazole, and tetracycline, and had reduced susceptibility to ciprofloxacin. Seven isolates were also resistant to trimethoprim-sulfamethoxazole. Five were also resistant to nalidixic acid. Three were also resistant to chloramphenicol. All eight isolates tested were susceptible to azithromycin and meropenem.
  • Follow these steps to prevent illness when working with any livestock:
    • Always wash your hands thoroughly with soap and water right after touching livestock, equipment, or anything in the area where animals live and roam. Use dedicated clothes, shoes, and work gloves when working with livestock. Keep and store these items outside of your home.
    • It is especially important to follow these steps if there are children under age 5 in your household. Young children are more likely to get a Salmonella infection because their immune systems are still developing.
    • Work with your veterinarian to keep your animals healthy and prevent diseases.
  • This investigation is ongoing and we will provide updates as more information becomes available. Livestock owners should continue to watch for increased sicknesses in dairy calves and consult their veterinarian if needed.


New Zealand: An outbreak of mumps.


What is the current situation?

Public health officials in New Zealand have reported an outbreak of mumps.

Mumps is a contagious disease that is spread when infected people cough, sneeze, or talk. Sharing items, like cups or drink cans, with infected people can also spread the virus. The virus can also live for several hours on items and surfaces touched by an infected person. Symptoms of mumps include fever, headache, muscle aches, tiredness, loss of appetite, and swollen and tender salivary glands (under the ears or jaw) on one or both sides of the face. Some people who get mumps have very mild or no symptoms, and often they do not know they have the disease.

CDC recommends that travelers to New Zealand protect themselves by making sure they are vaccinated against mumps. The only mumps vaccines available in the United States are the measles-mumps-rubella (MMR) and the measles-mumps-rubella-varicella (MMRV) vaccines. Children should get two doses of MMR vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Teens and adults also should be up to date on their MMR vaccinations (two doses at least 28 days apart).

What can travelers do to protect themselves?

  • Before you travel, make sure you have already been vaccinated. If you are not, get the MMR vaccine.
  • While traveling, wash your hands often. If soap and water aren’t available, use hand sanitizer (containing at least 60% alcohol) to clean hands.
  • Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.
  • Cover your mouth and nose with a tissue or your sleeve (not your hand) when coughing or sneezing.
  • Try to avoid close contact, such as kissing, hugging, or sharing eating utensils or cups, with people who are sick.

Learn more about preventing mumps and what to do if you think you have it on the mumps page for travelers.

Traveler Information

Clinician Information

After the earthquake in Iran: The new wing of the Imam Khomeini hospital partly crumpled like “an empty soft-drink can in the hands of a child” while the original hospital building, 40 years old, stood beside the wreckage, barely damaged.

NY Times

  • The magnitude 7.3 earthquake killed more than 500 people in Iran and eight in neighboring Iraq.

  • More than 40,000 properties became uninhabitable including many newly built state hospitals, schools, apartment complexes and even army barracks.

  • The earthquake has laid bare what many Iranians have been saying for a long time: Corruption inside state organizations has led to shoddy construction work and undermined Iran’s infrastructure.


WHO: Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities


Focus on AMR – evidence, guidelines and publications

Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities

The eight recommendations are:

  • Adopt multipart strategies to prevent and control CRE, CRAB, or CRPsA infection or colonization that includes at least hand hygiene, surveillance (especially for CRE), contact precautions, patient isolation (single room or cohorting), and environmental cleaning
  • Implement hand hygiene best practices spelled out in earlier WHO guidance
  • Conduct surveillance for CRE-CRAB-CRPsA infection and colonization, especially targeting those with previous CRE colonization, contacts of CRE patients, or those with a history of recent hospitalization in CRE-endemic settings
  • Implement contact precautions when caring for infected or colonized patients
  • Isolate infected or colonized patients, either in a single room or with others who have the same pathogen
  • Comply with environmental cleaning protocols in the “patient zone” of infected or colonized patients, though the optimal cleaning agent was not identified
  • Take surveillance cultures of the environment to detect contamination
  • Monitor the impact of the interventions

Carbapenem-resistant gram-negative bacteria, namely, carbapenem-resistant Enterobacteriaceae (CRE), Acinetobacter baumannii (CRAB) and Pseudomonas aeruginosa (CRPsA), are an emerging cause of health-care acquired infection that pose a significant threat to public health. The first ever global guidelines for the prevention and control of CRE-CRAB-CRPsA in health care facilities were published on 14 November 2017. They include 8 recommendations distilled by the world’s leading experts from a review of the latest evidence. They are designed to provide evidence-based recommendations on the early recognition and specific required infection prevention and control practices (IPC) and procedures to effectively prevent the occurrence and control the spread of CRE-CRAB-CRPsA colonization and/or infection in acute health care facilities. They provide an evidence-based framework to help inform the development and/or strengthening of national and facility IPC policies and programmes to control the transmission of CRE-CRAB-CRPsA in a variety of health care settings. The recommendations included in these guidelines build upon the overarching standards set by the WHO publication Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level.

These guidelines are intended to support IPC improvement at the facility level, targeting infection prevention leads, senior managers, other health care professionals and patients alike. They are also relevant to policy makers, regulatory and professional bodies at the national level, among others. We encourage you all to use and promote these guidelines.

Teleclass: Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities

Tehama, CA: This incident, as tragic and as bad as it is, could have been so much worse.


“…..a much bigger death toll was averted when the killer was unable to break into an elementary school.  The staff at tiny Rancho Tehama Elementary School west of Corning moved quickly when they heard gunfire nearby just before classes were set to begin…”



Iran-Iraq EQ Toll: More than 430 dead and over 7000 injured



Bangladesh steps up vaccination for new Rohingya arrivals as measles cases rise


Press release 1671


Bangladesh steps up vaccination for new Rohingya arrivals as measles cases rise

Cox’s Bazar, Bangladesh, 10 November 2017 – An increase in the number of suspected measles cases among the newly arrived Rohingya and their host communities in southern Bangladesh has prompted the Government and UN partners to step up immunization efforts in overcrowded camps and makeshift shelters close to the border with Myanmar.
Nearly 360 000 people in the age group of six months to 15 years among the new Rohingya arrivals in Cox’s Bazar and their host communities, irrespective of their immunization status, would be administered measles and rubella  vaccine through fixed health facilities, outreach vaccination teams, and at entry points into Bangladesh.
Measles, a childhood killer disease which can be particularly dangerous among unimmunized and malnourished children,  is one of the major health risks among the over  611 000 people who have crossed over to Bangladesh from Myanmar since late August and are now living in cramped and insanitary conditions  in Cox’s Bazar district.

As of 4 November, one death and 412 suspected cases of measles have been reported among the vulnerable populations living in camps, settlements, and among the host communities in Cox’s Bazar. Of them, 352 cases are from Ukhia and 46 from Teknaf sub-districts, and 11 have been reported from the district hospital. Majority of cases – 398 – are among the new arrivals and 14 among the host communities. As many as 82% cases are among children under five years of age.
“Children are especially at risk from outbreaks of measles and other communicable diseases that result from the crowded living conditions, malnutrition and severe lack of water and sanitation in the camps and other sites,” said Edouard Beigbeder, UNICEF Bangladesh Representative. “To halt any wider outbreak, it’s essential that coordinated efforts begin immediately to protect as many children as possible.”
With the risk of measles being high during such health emergencies, Ministry of Health and Family Welfare (MoHFW), with support of WHO, UNICEF and other local partners, was quick to roll out a measles and rubella (MR) vaccination campaign, between 16 September and 4 October, within weeks of the start of the recent influx of Rohingyas from Myanmar. Nearly 136 000 children between six months and 15 years were administered MR vaccine. Additionally, around 72 000 children up to five years of age were given bivalent oral polio vaccine (bOPV) and a dose of Vitamin A to help prevent measles related complication. The number of new arrivals has increased since the MR campaign, which also had challenges reaching out to all children in view of movement of people within the camps and settlements.
“As part of stepped up vaccination efforts, 43 fixed health facility sites, 56 outreach vaccination teams and  vaccination teams at main border entry points will administer MR vaccine to population aged six months to 15 years, along with oral polio vaccine to children under five years and TT vaccine to pregnant women. These efforts are aimed at protecting and preventing the spread of measles among the vulnerable population,” WHO Representative to Bangladesh, Dr N Paranietharan, said.
More than 70 vaccinators from government and partners have been trained to deliver routine vaccination though fixed sites and outreach teams beginning tomorrow, while vaccination at entry points at Subrang, Teknaf, is ongoing since 1 November.
The fixed sites and outreach teams will also cover under two year olds with vaccines available in Bangladesh  EPI schedule, such as BCG, pentavalent vaccine, oral polio vaccine, pneumococcal vaccine and two doses of MR vaccine.
As an additional measure, resources to treat measles cases are being reinforced with the distribution of vitamin A supplements, antibiotics for pneumonia and Oral Rehydration Salt (ORS) for diarrhoea related to measles. To improve hygiene conditions among the refugee population, 3.2 million water purification tablets and a total of 18,418 hygiene kits have been distributed benefitting 92,090 people.
The current initiative is yet another massive vaccination drive being rolled out for the new arrivals from Myanmar and their host communities in Cox’s Bazar since 25 August this year.  After covering 136 000 people in the September- October MR campaign, MoHFW and partners administered 900 000 doses of oral cholera vaccine to these vulnerable populations in two phases. The first phase that started 10 October covered over 700 000 people aged one year and above  – both the new arrivals and their host communities, while the second phase from 4 – 9 November provided an additional dose of OCV to 199,472 children between one and five years, for added protection  and bOPV to 236,696 children under 5 years of age.


For further information please contact:

  • Catalin-Constantin Bercaru, WHO Bangladesh,  +88 01787693318
  • Shamila Sharma, WHO South-East Asia Regional Office, +91 9818287256
  • Jean Jacques Simon, UNICEF Bangladesh,, +880 01713043478
  • AM Sakil Faizullah, UNICEF Bangladesh, +880 1713 049900
  • Faria Selim, UNICEF Bangladesh, +880 1817 586 096

Pneumonia takes the lives of 920,000 children annually—a life every 2 minutes, more than malaria and diarrhea combined.

Global Health Now

  • While pneumonia deaths have dropped by nearly 50% since 2000, too many kids still don’t have access to vaccines that can prevent the disease from taking hold in the first place.
  • Approximately 1/2 of the world’s children are still not receiving PCV (pneumococcal conjugate vaccine).

Save The Children Fighting for Breath


Latest update on the Iran-Iraq Earthquake (M7.3): >400 dead and 6,500 injured


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