Global & Disaster Medicine

Archive for March, 2018

Six African countries have confirmed human cases of monkeypox since 2016, many of which had not reported a case in decades.


“……What is already known about this topic?

Human monkeypox is a viral zoonosis that occurs in West Africa and Central Africa. Most cases are reported from Democratic Republic of the Congo. The disease causes significant morbidity and mortality, and no specific treatment exists.

What is added by this report?

Nigeria is currently experiencing the largest documented outbreak of human monkeypox in West Africa. During the past decade, more human monkeypox cases have been reported in countries that have not reported disease in several decades. Since 2016, cases have been confirmed in Central African Republic (19 cases), Democratic Republic of the Congo (>1,000 reported per year), Liberia (two), Nigeria (>80), Republic of the Congo (88), and Sierra Leone (one). The reemergence of monkeypox is a global health security concern.

What are the implications for public health practice?

A recent meeting of experts and representatives from affected countries identified challenges and proposed actions to improve response actions and surveillance. The World Health Organization and CDC are developing updated guidance and regional trainings to improve capacity for laboratory-based surveillance, detection, and prevention of monkeypox, improved patient care, and outbreak response……”

Images of a child with monkeypox, a lab worker, and vaccine.


A pedestrian bridge suddenly collapsed onto the road below near Florida International University, crushing cars, killing 4 and sending at least 9 to hospitals



Saudi Arabia has spent billions in fighting Middle East Respiratory Syndrome (MERS) since 2012.

Saudi Gazette

“…..The ministry has taken a number of precautionary and preventive measures to contain the disease.

More than 3,000 firms have been closed down as part of temporary and permanent punitive measures.

Seven health ministers have worked to eradicate MERS-CoV since it broke out first in the Kingdom. They are Dr. Abdullah Al-Rabeeah (1430-35 Hijri), Adel Fakeih (1435-36 Hijri), Dr. Mohammed Ali Al-Hayazie (1436 Hijri), Ahmed Oqail Al-Khateeb (1436 Hijri), Mohammed Abdulmalik Al-Asheikh (1436 Hijri), Khalid Al-Falih (1436-37 Hijri) and Dr. Tawfiq Al-Rabiah (the present minister)…..”


14 people, including four children, were hospitalized after a mass botulism food poisoning outbreak in southern Kyrgyzstan.


  •  3 are in a serious condition.
  • All patients have received the anti-botulinum serum.

Jars of canned vegetables

WHO renews its call for the protection of health workers and for immediate access to besieged populations.


Seven years of Syria’s health tragedy

News release

After seven years of conflict in Syria, WHO has renewed its call for the protection of health workers and for immediate access to besieged populations.

Attacks on the health sector have continued at an alarming level in the past year. The 67 verified attacks on health facilities, workers, and infrastructure recorded during the first two months of 2018 amount to more than 50% of verified attacks in all of 2017.

“This health tragedy must come to an end,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Every attack shatters communities and ripples through health systems, damaging infrastructure and reducing access to health for vulnerable people. WHO calls on all parties to the conflict in Syria to immediately halt attacks on health workers, their means of transport and equipment, hospitals and other medical facilities.”

Health systems are being attacked in the very places where they are needed most. An estimated 2.9 million Syrians live in UN-declared hard-to-reach and besieged locations. WHO is providing health assistance to many of these areas but lacks consistent access.

In East Ghouta, nearly 400,000 people have lived under siege for half a decade. Basic health supplies have all but run out, and there are now more than 1,000 people in need of immediate medical evacuation.

“It is unacceptable that children, women, and men are dying from injuries and illnesses that are easily treatable and preventable,” said Dr Tedros.

Critical medical supplies are also routinely removed from inter-agency convoys to hard-to-reach and besieged locations. Earlier this month, more than 70% of the health supplies intended to reach East Ghouta were removed by authorities and sent back to the WHO warehouse. The items removed are desperately needed to save lives and reduce suffering.

Seven years of conflict have devastated Syria’s healthcare system. More than half of the country’s public hospitals and healthcare centres are closed or only partially functioning and more than 11.3 million people need health assistance, including 3 million living with injuries and disabilities.

WHO is committed to ensuring that people across Syria have access to essential, life-saving healthcare. Last year, WHO delivered over 14 million treatments across the country, including through cross-border and cross-line services.

“The suffering of the people of Syria must stop. We urge all parties to the conflict to end attacks on health, to provide access to all those in Syria who need health assistance, and, above all, to end this devastating conflict,” said Dr Tedros.

It works! Sending community health workers door-to-door to look for sick kids in Mali


“…..When the study began in 2008, one in seven children in the Bamako region died before the age of five. By 2015, that had fallen to one in 142, which is comparable to the rate in the United States. This level would meet the UN’s goal of reducing deaths among children under five to no more than 25 deaths per 1,000 live births by 2030…..

The intervention sent health workers to people’s homes to ask about children’s well-being, provided care at the doorstep and triaged the sickest patients to health care facilities. The community health care workers provided counseling, diagnosed malaria for people of all ages, as well as pneumonia, diarrheal disease and malnutrition for children under five. They treated the uncomplicated cases, and referred patients with danger signs or conditions that were outside their scope of practice to primary health centers.

Over the course of the study, the percentage of young children who had fevers was cut in half and the number of patient visits in the home and the clinic increased by ten times.

The workers offered antimalarial treatment, and the number of children with fevers who received antimalarial treatment within 24 hours of the onset of their symptoms more than doubled, from about 15 percent to just over 35 percent.

The intervention also strengthened government primary care facilities with more infrastructure, training, and staff. And workers were on call, in case someone needed their services. They also made follow-up visits to help patients adhere to their therapy, particularly in the case of diarrheal disease, and searched for sick newborns, pregnant women and those who had just given birth and needed care, to evacuate them to primary care facilities for treatment.

The approach, which the researchers called Proactive Community Case Management, cost between $6 and $13 dollars per person, per year, over what the government was already spending on health care.

During the seven years of the study, the childhood mortality rate in Mali was falling, although not by much, and in 2015, it was still among the highest in the world at 114 deaths per 1,000 live births. By contrast, that same year, the area of the intervention had a child mortality rate of 7 deaths per 1,000 live births. The researchers are currently at work on a large-scale randomized trial that will follow 100,000 people at 137 different sites to see if door-to-door home visits by community health workers lowers childhood mortality……”


Monsoon season: The world’s largest refugee camp, a temporary home to more than half a million Rohingyas that sprawls precariously across barren hills in southeastern Bangladesh may soon face landslides, flash floods, & inundation.

NY Times

Antismoking Activists Face Threats and Violence in Certain Parts of the World

NY Times

“……They were first quietly warned that they were upsetting cigarette companies, tobacco farmers or government officials connected to the industry. If the activists persisted, threats or violence escalated suddenly and unpredictably……”

A United States-FAO partnership working to strengthen the capacity of developing countries to manage outbreaks of diseases in farm animals has in just 12 months succeeded in training over 4,700 veterinary health professionals in 25 countries in Africa, Asia and the Middle East.


March 2018, Rome – A United States-FAO partnership working to strengthen the capacity of developing countries to manage outbreaks of diseases in farm animals has in just 12 months succeeded in training over 4,700 veterinary health professionals in 25 countries in Africa, Asia and the Middle East.

The FAO-provided technical trainings covered a gamut of key competencies, including disease surveillance and forecasting, laboratory operations, biosafety and biosecurity, prevention and control methods and outbreak response strategies.

All told, 3,266 vets in Asia, 619 in West Africa, 459 in East Africa, and 363 in the Middle East benefitted. They are on the front line of the effort to stop new diseases at their source. (Full list below)

“Over the course of this relationship we’ve learned that there are many mutually beneficial areas of interest between the food and agricultural community and the human health community,” said Dennis Carroll, Director of USAID’s Global Health Security and Development Unit.

“A partnership with FAO not only enables us to protect human populations from future viral threats, but also to protect animal populations from viruses that could decimate food supplies. It’s not just a global health, infectious disease issue, but also a food security, food safety, and economic growth issue,” Carroll added.

“Some 75 percent of new infectious diseases that have emerged in recent decades originated in animals before jumping to us Homo sapiens, a terrestrial mammal. This is why improving adequately discovering and tackling animal disease threats at source represents a strategic high-ground in pre-empting future pandemics,” said Juan Lubroth, FAO Chief Veterinary Officer

“A proactive approach is absolutely critical, and for that, the world needs well-trained, up-to-speed professionals — biologists, ecologists, microbiologists, modellers, physicians and veterinarians — which is why the United States’ consistent support for building up that kind of capacity has been invaluable,” Lubroth said.

Viral risks

Population growth, agricultural expansion and environmental encroachment, and the rise of inter-continental food supply chains in recent decades have dramatically altered how diseases emerge, jump species boundaries, and spread, FAO studies have shown.

A new study just published by USAID’s Dennis Carroll and experts from several institutions including FAO suggests that just  0.01 percent of the viruses behind zoonotic disease outbreaks are known to science.  The authors have proposed an international partnership, The Global Virome Project, aimed at characterizing the most risky of these. Doing so would allow more proactive responses to disease threats, with benefits not only for public health but also for the livelihoods of poor, livestock-depending farming communities.

Partnering for global health security

The close FAO-USAID partnership on animal health goes back over a decade.

Experts from the two organizations are meeting in Rome this week to review progress achieved in the past year and how to respond to threats like species-jumping zoonotic illnesses and the growing trends of antimicrobial resistance and options for intervention measures in food production and protection of public health.

In addition to trainings, via the USAID- Emerging Pandemic Threats (EPT) programme, FAO conducts research and advises on policy in order to help countries increase their resilience to disease emergence and protect animal and human health.

And to enable rapid responses by governments to disease events FAO has leveraged USAID support to work with the United Nations Humanitarian Response Depots to establish a series of emergency equipment and gear stockpiles in 15 countries that facilitate rapid and adequate responses to outbreaks.

FAO is also key player and advisor to the Global Health Security Agenda (GHSA), a growing partnership of over 60 countries, NGOs and international organizations working to improve early detection of and responses to infectious disease threats. USAID support under the GHSA umbrella is helping FAO engage with 17 countries in Africa and Asia to strengthen capabilities to detect and respond to zoonotic diseases.

Thanks to USAID support for the EPT and GSHA, FAO is actively tackling disease issues and building national capacities in over 30 countries

Economic impacts as well as health consequences

Beyond the risks posed to human health, animal diseases can cost billions of dollars and hamstringing economic growth.

The most damaging outbreaks of high impact disease in recent decades all had an animal source, including H5N1 highly pathogenic avian influenza, H1N1 pandemic influenza, Ebola, severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS).

For example, the H5N1 outbreak of the mid-2000s caused an estimated $30 billion in economic losses, globally; a few years later, H1N1 racked up as much as $55 billion in damages.

Not to mention that for millions of the world’s poorest people, animals are their primary capital assets — “equity on four legs”. Losing them can push these families out of self-reliance and into destitution.

Note to editors.  The countries where the trainings took place were: Bangladesh, Burkina Faso, Cambodia, Cameroon, China, Democratic Republic of the Congo, Egypt, Ghana, Guinea, Indonesia, Jordan, Kenya, Laos People’s Democratic Republic , Liberia, Mali, Myanmar, Nepal, Senegal, Sierra Leone, United Republic of Tanzania, Uganda and Viet Nam.

The nerve agent Novichok is believed to be orders of magnitude more lethal than sarin or VX.

NY Times

“…..Novichok nerve agent, a weapon invented for use against NATO troops, was released in the quiet town of Salisbury, its target a former Russian spy named Sergei V. Skripal. Mr. Skripal and his daughter, Yulia, collapsed onto a bench in a catatonic state on March 4, and remain hospitalized, in critical condition.……”



Recent Posts