Archive for December, 2017
Researchers around the world analyzed 27 extreme weather events from 2016 and found that human-caused climate change was a “significant driver” for 21 of them.
Friday, December 15th, 2017Global Maps
Between 291,000 and 646,000 people worldwide die from seasonal influenza-related respiratory illnesses each year, higher than a previous estimate of 250,000 to 500,000
Friday, December 15th, 2017“….The new estimates use more recent data, taken from a larger and more diverse group of countries than previous estimates. Forty-seven countries contributed to this effort. Researchers calculated annual seasonal influenza-associated respiratory deaths for 33 of those countries (57 percent of the world’s population) that had death records and seasonal influenza surveillance information for a minimum of four years between 1999 and 2015. Statistical modeling with those results was used to generate an estimate of the number of flu-associated respiratory deaths for 185 countries across the world. Data from the other 14 countries were used to validate the estimates of seasonal influenza-associated respiratory death from the statistical models.
Poorest nations, older adults hit hardest by flu
Researchers calculated region-specific estimates and age-specific mortality estimates for people younger than 65 years, people 65-74 years, and people 75 years and older. The greatest flu mortality burden was seen in the world’s poorest regions and among older adults. People age 75 years and older and people living in sub-Saharan African countries experienced the highest rates of flu-associated respiratory deaths. Eastern Mediterranean and Southeast Asian countries had slightly lower but still high rates of flu-associated respiratory deaths.
Despite World Health Organization recommendations to use flu vaccination to help protect people in high-risk populations, few developing countries have seasonal flu vaccination programs or the capacity to produce and distribute seasonal or pandemic vaccines.
Global flu surveillance protects all nations, including U.S.
CDC works with global partners to improve worldwide capacity for influenza prevention and control. CDC has helped more than 60 countries build surveillance and laboratory capacity to rapidly detect and respond to influenza threats, including viruses with the potential to cause global pandemics. These efforts, along with technical support, has helped some partners generate estimates of influenza-associated deaths, which contributed to this global effort.
Global surveillance also provides the foundation for selecting the viruses used to make seasonal flu vaccines each year. This helps improve the effectiveness of flu vaccines used in the United States. Global surveillance also is crucial to pandemic preparedness by identifying viruses overseas that might pose a human health risk to people in the United States.
“This work adds to a growing global understanding of the burden of influenza and populations at highest risk,” says CDC researcher Danielle Iuliano, lead author of The Lancet study. “It builds the evidence base for influenza vaccination programs in other countries.”
The study authors note that these new estimates are limited to flu-associated respiratory deaths and therefore may underestimate the true global impact of seasonal influenza. Influenza infection can create or exacerbate other health factors which are then listed as the cause of death on death certificates, for example cardiovascular disease, diabetes, or related complications. Additional research to estimate non-respiratory causes of flu-associated deaths are ongoing…..”
ADE (antibody dependent enhancement): The dengue phenomenon wherein antibodies from a previous dengue infection counterintuitively worsen subsequent infections with the flavivirus.
Friday, December 15th, 2017WHO advises Dengvaxia be used only in people previously infected with dengue
13 December 2017 – Following a consultation of the Global Advisory Committee on Vaccine Safety, the World Health Organization (WHO) finds that the dengue vaccine CYD-TDV, sold under the brand name Dengvaxia, prevents disease in the majority of vaccine recipients but it should not be administered to people who have not previously been infected with dengue virus.
This recommendation is based on new evidence communicated by the vaccine’s manufacturer (Sanofi Pasteur), indicating an increase in incidence of hospitalization and severe illness in vaccinated children never infected with dengue.
The WHO Global Advisory Committee on Vaccine Safety considered the company’s new results from clinical trial data analyses. Those studies indicate that increased risk of severe dengue disease in people who have never been infected affects about 15% of the vaccinated individuals. The magnitude of risk is in the order of about 4 out of every 1000 seronegative patients vaccinated who developed severe dengue disease during five years of observation. The risk of developing severe dengue disease in non-vaccinated individuals has been calculated as 1.7 per 1000 over the same period of observation. By contrast, for the 85% who have had dengue disease before immunization, there is a reduction of 4 cases of severe dengue per 1 000 who are vaccinated.
The possibility of risk for seronegative people was raised by WHO and published in a position paper in July 2016: “…vaccination may be ineffective or may theoretically even increase the future risk of hospitalized or severe dengue illness in those who are seronegative at the time of first vaccination regardless of age.”[i] As this risk had at that time not been seen in the age groups for which the vaccine was licensed, WHO issued a conditional recommendation, emphasizing the use of the vaccine in populations having been previously infected with dengue virus.
To minimize illness for seronegative vaccinated people, WHO recommends enhancing measures that reduce exposure to dengue infection among populations where the vaccine has already been administered. For vaccine recipients who present with clinical symptoms compatible with dengue virus infection, access to medical care should be expedited to allow for proper evaluation, identification, and management of severe forms of the disease.
Background
Dengue is a mosquito-borne flavivirus disease that has spread to most tropical and many subtropical areas. The disease is caused by four closely related viruses. There is no specific dengue treatment and prevention is mainly limited to vector control measures. A safe and effective dengue vaccine would therefore represent a major advance in the control of the disease.
CYD-TDV is a live attenuated tetravalent vaccine made using recombinant DNA technology and is administered in three phases separated by six-month intervals. It became commercially available in 2016 and is currently licensed in 19 countries.
[i] Dengue vaccine: WHO position paper – July 2016 http://www.who.int/wer/2016/wer9130.pdf
Rohingya: From 3 November 2017 through 12 December 2017, a total of 804 suspected diphtheria cases including 15 deaths were reported among the displaced Rohingya population in Cox’s Bazar.
Thursday, December 14th, 2017Diphtheria – Cox’s Bazar in Bangladesh
From 3 November 2017 through 12 December 2017, a total of 804 suspected diphtheria cases including 15 deaths were reported among the displaced Rohingya population in Cox’s Bazar (Figure 1). The first suspected case was reported on 10 November 2017 by a clinic of Médecins Sans Frontières (MSF) in Cox’s Bazar.
Figure 1: Number of diphtheria cases among the displaced Rohingya population in Cox’s Bazar, Bangladesh reported by date of illness onset from 3 November 2017 through 12 December 20171
1Date of onset information is missing for 45 (5.6%) cases.
Source: Médecins Sans Frontières
Of the suspected cases, 73% are younger than 15 years of age and 60% females (the sex for one percent cases was not reported). Fourteen of 15 deaths reported among suspected diphtheria cases were children younger than 15 years of age. To date, no cases of diphtheria have been reported from local communities.
Public health response
Since August 2017, more than 646 000 people from neighbouring Myanmar have gathered in densely populated camps and temporary settlements with poor access to clean water, sanitation and health services. A multi-agency diphtheria task force, led by the Ministry of Health Family Welfare of Bangladesh, has been providing clinical and public health services to the displaced population. WHO has mobilized US$ 3 million from its Contingency Fund for Emergencies (CFE) to support essential health services in Bangladesh.
WHO is working with health authorities to provide tetanus diphtheria (Td) vaccines for children aged seven to 15 years, as well as pentavalent vaccines (diphtheria, pertussis, tetanus, Haemophilus influenzae type b, and hepatitis B) and pneumococcal conjugate vaccines (PCV) for children aged six weeks to six years. A list of essential medicines and required supplies to support the response is being finalized by WHO and partners.The Serum Institute of India has donated 300 000 doses of pentavalent vaccines for use in the response.
WHO risk assessment
The current outbreak in Cox’s Bazar is evolving rapidly. To date, all suspected cases have occurred among the displaced Rohingya population, who are living in temporary settlements with difficult and crowded conditions. The coverage of diphtheria toxoid containing vaccines among the displaced Rohingya population is difficult to estimate, although diphtheria outbreaks are an indication of low overall population vaccination coverage. Available vaccination data for Bangladesh indicates that the coverage of diphtheria toxoid containing vaccines is high. However, spillover into the local population cannot be ruled out. WHO considers the risk at the national level to be moderate and low at the regional and global levels.
WHO advice
WHO recommends timely clinical management of suspected diphtheria cases that is consistent with WHO guidelines consisting of diphtheria antitoxin, appropriate antibiotics and implementation of infection prevention and control measures. High-risk populations such as young children, close contacts of diphtheria cases, and health workers should be vaccinated on priority basis. A coordinated response and community engagement can reduce the risk of further transmission and help to control the outbreak.
For more information on diphtheria, please see the link below:
Doctors Without Borders: At least 6,700 Rohingya were killed in attacks during the first month of a military crackdown in Myanmar in late August
Thursday, December 14th, 2017“…..[ Médecins Sans Frontières ] interviewed several thousand Rohingya refugees in four camps in Bangladesh in late October and early November, asking how many members of their families had died and how, both before and after the violence began.
11/14/2012: A 20-year-old man shoots and kills his mother at their Newtown, Connecticut, home then drives to nearby Sandy Hook Elementary School, where he kills 20 first graders and six school employees before turning a gun on himself.
Thursday, December 14th, 2017A study from the University of Georgia surveyed over 400 emergency medical workers from the United States and Japan and found that more than half had not received any formal training on radiation-related health issues.
Thursday, December 14th, 2017“……”What we found was that medical personnel were actually more afraid of radiation than they were of biological or chemical events,” the study’s lead author Cham E. Dallas said in a statement……”
Dallas CE, Klein KR, Lehman T, Kodama T, Harris CA and Swienton RE (2017) Readiness for Radiological and Nuclear Events among Emergency Medical Personnel. Front. Public Health 5:202. doi: 10.3389/fpubh.2017.00202
Port Authority Pipe Bomb Blast video
Wednesday, December 13th, 2017“…..Using the internet, Mr. Ullah began researching how to build explosives about a year ago, the complaint said. Within the past two to three weeks, it said, he began gathering the materials to construct the bomb: a metal pipe which he filled with explosive material he created; screws to pack inside; and Christmas tree lights and a nine-volt battery to spark its detonation. Then, about one week ago, he built the pipe bomb at his apartment in Brooklyn.….”
An enormous explosion rocked a major natural gas hub in Austria on Tuesday, killing 1 employee, injuring at least 18
Wednesday, December 13th, 2017Cholera in Zambia: From 28 September through 7 December 2017, 547 cases including 15 deaths (case fatality rate = 1.8%), have been reported since the beginning of the outbreak.
Wednesday, December 13th, 2017Cholera – Zambia
On 6 October 2017, the Minister of Health declared an outbreak of cholera in the Zambian capital, Lusaka. From 28 September through 7 December 2017, 547 cases including 15 deaths (case fatality rate = 1.8%), have been reported since the beginning of the outbreak. The initial outbreak period was from 28 September through 20 October. From 21 October through 4 November 2017 there were less than five cases reported each week. However, from 5 November 2017 an increase in the number of cases was observed with a total of 136 cases reported in the week beginning 26 November.
Figure 1: Number of cholera cases in Zambia reported by date of illness onset from 28 September to 2 December 2017
The cholera outbreak initially started in the Chipata sub-district and spread to Kanyama sub-district around 9 October 2017. The outbreak has spread from the peri-urban townships on the Western side of Lusaka City to the Eastern Side with a new case reported in Chelstone sub-district. As of 7 December, the affected sub-districts include Chipata, Kanyama, Chawama, Matero, Chilenje and Chelston. Sixty-two cases are currently receiving treatment in Cholera Treatment Centres in Chipata, Kanyama, Matero and Bauleni. One third of the cases are children under five years old and two thirds are persons five years and older.
A total of 282 Rapid Diagnostic Tests were performed, of which 230 were positive. Of 310 culture tests, 53 were positive for Vibrio cholerae O1 Ogawa (48 from Chipata, four from Kanyama and one from Bauleni). Water quality monitoring is ongoing in all sub-districts, with intensified activity in Kanyama, Matero and Chipata. The results so far show that nearly 42% of tested water sources are contaminated with either Faecal Coliforms or Escherichia coli.
Public health response
The following public health measures are currently being implemented:
- The Ministry of Health is collaborating with WHO and other partners to control the outbreak.
- Five Cholera Treatment Centres have been established in Chawama, Chipata, Kanyama, Matero and Bauleni sub-districts to manage cases. So far, 441 cases were successfully treated and discharged.
- Cholera Outbreak Guidelines and standard operating procedures have been updated and shared with health workers.
- The facilities in Lusaka District have continued with active surveillance, health education, chlorine distribution, contact tracing and environmental health monitoring.
- The local authorities in collaboration with the Ministry of Health have embarked on closing contaminated water points and has implemented Water Sanitation and Hygiene (WASH) interventions to improve water supplies in affected areas. This includes provision of household chlorine, disinfection of pit latrines, erection of water tanks, installation of water purifiers and intensification of water quality monitoring.
- The Lusaka City Council has intensified collection of garbage and emptying of septic tanks in Kanyama and Chipata as priority areas.
WHO risk assessment
The current outbreak is occurring in Zambia’s largest city, Lusaka. The main affected sub-districts, Chipata and Kanyama, are densely populated and have an inadequate water and sanitation infrastructure, which may favour the spread of the disease. The sources of infection transmission in this outbreak have been associated with contaminated water supplies, contaminated food, inadequate sanitation and poor hygiene practices.
The coming of the rainy season, coupled with inadequate water supply and sanitation increases the risk of outbreaks in Lusaka and other parts of the country. Adequate supplies for cholera response should be obtained as part of preparedness activities.
Zambia hosts about 60 000 refugees (as of September 2017) from neighbouring countries. A large proportion of refugees are from the Democratic Republic of the Congo (DRC) and are mostly residing in Nchelenge refugee camp located more than 1000 km distant from Lusaka. The influx of refugees has led to overcrowded settlements with high needs for shelter, healthcare and WASH facilities. Most refugees are in poor health condition, especially children; therefore, risk of disease outbreaks is high. Sanitation is a challenge at hosting sites. Given the security situation in DRC, further influx of refugees is expected.
WHO advice
WHO recommends proper and timely case management in Cholera Treatment Centres. Improving access to potable water and sanitation infrastructure, and improved hygiene and food safety practices in affected communities, are the most effective means of controlling cholera. Use of oral cholera vaccine may also be used for outbreak control. Key public health communication messages should be provided.
WHO advises against any restriction to travel to and trade with Zambia based on the information available on the current outbreak.
For more information on cholera, please see the link below: