Global & Disaster Medicine

Archive for February, 2020

Every day 102,835 people across the world suffer serious injuries caused by road crashes, costing communities $US6 billion ($9 billion) daily. Crash, repeat, every day of the year.

“The annual Global Ministerial Conference on Road Safety in Stockholm this week will consider proposals to reduce fatalities and injuries by 50 per cent by 2030. The goal of reducing road trauma by 30 per cent fell short, with an estimated 600,000 more deaths than the target.”
The human impact every day

Chart

Source: iRAP

New research: Cytotoxic lymphocytes (CTLs) and cerbral malaria

https://www.nih.gov/news-events/news-releases/nih-study-supports-new-approach-treating-cerebral-malaria

Researchers at the National Institutes of Health found evidence that specific immune cells may play a key role in the devastating effects of cerebral malaria, a severe form of malaria that mainly affects young children. The results, published in the Journal of Clinical Investigation, suggest that drugs targeting T cells may be effective in treating the disease. The study was supported by the NIH Intramural Research Program.

Image of immune cells Specific immune cells accumulate within brain blood vessels of people affected by cerebral malaria. This finding suggests a new treatment strategy for the disease. McGavern Lab/NINDS

“This is the first study showing that T cells target blood vessels in brains of children with cerebral malaria,” said Dorian McGavern, Ph.D., chief of the Viral Immunology and Intravital Imaging Section at the NIH’s National Institute of Neurological Disorders and Stroke (NINDS) who co-directed the study with Susan Pierce, Ph.D., chief of the Laboratory of Immunogenetics at the National Institute of Allergy and Infectious Diseases (NIAID). “These findings build a bridge between mouse and human cerebral malaria studies by implicating T cells in the development of disease pathology in children. It is well established that T cells cause the brain vasculature injury associated with cerebral malaria in mice, but this was not known in humans.”

More than 200 million people worldwide are infected annually with mosquito-borne parasites that cause malaria. In a subset of those patients, mainly young children, the parasites accumulate in brain blood vessels causing cerebral malaria, which leads to increased brain pressure from swelling. Even with available treatment, cerebral malaria still kills up to 25% of those affected resulting in nearly 400,000 deaths annually. Children who survive the infection will often have long-lasting neurological problems such as cognitive impairment.

The researchers, led by Drs. Pierce and McGavern, examined brain tissue from 23 children who died of cerebral malaria and 11 children who died from other causes. The scientists used state-of-the-art microscopy to explore the presence of cytotoxic lymphocytes (CTLs) in the brain tissue samples. CTLs are a type of T cell in our immune system that is responsible for controlling infections throughout the body.

Current treatment strategies for cerebral malaria focus on red blood cells, which are thought to clog blood vessels and create potentially fatal blockages leading to extreme pressure in the brain. However, findings in the mouse model demonstrated that CTLs damage blood vessels, leading to brain swelling and death. The role of CTLs in cerebral malaria in children hasn’t been thoroughly investigated prior to this study.

The results of the current study demonstrate an increased accumulation of CTLs along the walls of brain blood vessel in the cerebral malaria tissue samples compared to non-cerebral malaria cases. In addition, the CTLs were shown to contain and release effector molecules, which damage cells, suggesting that CTLs play a critical role in cerebral malaria by damaging the walls of brain blood vessels.

“The disease appears to be an immunological accident in which the CTLs are trying to control a parasitic infection but end up injuring brain blood vessels in the process,” said Dr. McGavern.

“In separate studies we discovered that treatment of mice with a drug that targets T cells rescued over 60% of otherwise fatal cases of experimental cerebral malaria,” said Dr. Pierce. “Given our findings of T cells in the brain vasculature of children who died of the disease, we are excited by the possibility that this drug may be the first therapy for cerebral malaria.”

The impact of HIV coinfection on the risk of developing cerebral malaria is not known. The NIH researchers compared CTL patterns in the cerebral malaria cases that were co-infected with HIV and those that were HIV negative. In the HIV-negative cases, the CTLs were seen lining up against the inside wall of brain blood vessels. In the HIV-positive cases, the CTLs had migrated across the surface to the outside of the vessels. There were also significantly more CTLs present in the HIV-positive cases.

Together these findings suggest that CTLs may play an important role in cerebral malaria and that HIV infection may worsen the disease.

Additional research is needed to uncover the role of T cells in human cerebral malaria. Future studies will also investigate how targeting T cells may help treat the disease. Plans for a clinical trial are underway to test the effects of a specific T cell blocker in cerebral malaria patients in Malawi.

The NINDS is the nation’s leading funder of research on the brain and nervous system. The mission of NINDS is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease.

NIAID conducts and supports research — at NIH, throughout the United States, and worldwide — to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID website.


The Center for Health Security & COVID-19

February 17, 2020

 

EPI UPDATES China’s National Health Commission reports 2,048 new confirmed cases, 1,563 suspected cases, and 105 deaths (including 100 in Hubei province). There have been 70,548 confirmed cases, and 1,770 deaths across 31 provincial regions in mainland China. A total of 150, 539 individuals are now under medical observation.

 

WHO reports a total of 683 confirmed cases outside of China across 25 countries and 3 deaths.

France has reported its first death in an 80-year Chinese tourist, becoming the first fatality in Europe from COVID-19.

Japan reports that 454 individuals have tested positive on the Diamond Princess cruise ship, including 189 asymptomatic cases. Japan also reported an additional 38 cases in the country.

Singapore has also confirmed a total of 77 cases, with 103 cases pending test results. Among the new cases reported in the country today, one came from Wuhan and one was linked to a previous case.

 

 

 

US STATEMENT ON REPATRIATION OF DIAMOND PRINCESS PASSENGERS The US State Department undertook voluntary repatriation of over 300 US citizens and immediate family members from the Diamond Princess cruise ship. During the evacuation, US officials were notified that 14 passengers had tested positive for the virus. These individuals, who were asymptomatic, were isolated on the aircraft. The flight will land at Travis Air Force Base or Joint Base San Antonio and individuals will remain under quarantine for 14 days.

 

 

COMPLEX SUPPLY CHAINS Supply chain disruptions and access to critical commodities such as personal protective equipment continues to be a primary concern during the ongoing COVID-19 outbreak. The challenge rests not only in the manufacturing of final product goods, but in the access to raw materials needed for manufacturing. For the United States, even if a commodity is manufactured domestically, it is likely that at least some component comes from a foreign supplier. So while economic projections may be estimating the impact epidemic in one way, understanding of supply chain complexities suggests that the indirect impacts may be far greater. Currently Chinese manufacturers of masks are operating at 76% capacity, producing approximately 15.2 million masks daily. However, projections of mask demand are estimated to be 50-60 million resulting in global runs on face masks and the implementation of rationing procedures by the Chinese government.

 

 

WHO RESPONSE TEAM ON THE GROUND IN CHINA The multidisciplinary international team of experts responding on behalf of the World Health Organization arrived in China and is beginning meetings with Chinese officials to discuss response strategies. The team is currently in Beijing and scheduled to visit Guangdong and Sichuan. The question remains on whether the team will visit Hubei province, the epicenter of the epidemic. Without visiting the epicenter of the outbreak it is unclear how well the team will be able to fully understand the current situation on the ground.

 

 

EMERGING CRITICISM OF RESPONSE IN CHINA Some news media have been critical of China’s home quarantine policy in Wuhan, citing the deaths of four family members while self-quarantining in their home.


Storm Dennis and the UK


In past four days alone, more than 150,000 Syrians flee villages as government forces close in on rebel-held Idlib.

 

AJ


Is there a risk for transportation of COVID-19 from Wuhan to other cities in China?

Du Z, Wang L, Chauchemez S, Xu X, Wang X, Cowling BJ, et al. Risk for transportation of 2019 novel coronavirus disease from Wuhan to other cities in China. Emerg Infect Dis. 2020 May [date cited]. https://doi.org/10.3201/eid2605.200146

DOI: 10.3201/eid2605.200146

Abstract:  “On January 23, 2020, China quarantined Wuhan to contain 2019 novel coronavirus disease (COVID-19). We estimated the probability of transportation of COVID-19 from Wuhan to 369 other cities in China before the quarantine. Expected COVID-19 risk is >50% in 130 (95% CI 89–190) cities and >99% in the 4 largest metropolitan areas.

Risks for transportation of 2019 novel coronavirus disease (COVID-19) from Wuhan, China, before a quarantine was imposed on January 23, 2020. A) Daily travel volume to and from Wuhan, given as a percentage of the Wuhan population. Gray shading indicates the start of Spring Festival season on January 10, 2020, a peak travel period in China. B) Estimated and reported daily prevalence of COVID-19 in Wuhan. The green line and shading indicate model estimates of cumulative cases since December 1, 201

Risks for transportation of 2019 novel coronavirus disease (COVID-19) from Wuhan, China, before a quarantine was imposed on January 23, 2020. A) Daily travel volume to and from Wuhan, given as a percentage of the Wuhan population. Gray shading indicates the start of Spring Festival season on January 10, 2020, a peak travel period in China. B) Estimated and reported daily prevalence of COVID-19 in Wuhan. The green line and shading indicate model estimates of cumulative cases since December 1, 2019, with 95% credible interval bounds, assuming an epidemic doubling time of 7.31 days (95% credible interval 6.26–9.66 days). Black dots indicate cumulative confirmed case counts during January 1–22, 2020 (10). Gray shading at right indicates the start of Spring Festival season. C) Probability that >1 COVID-19 case infected in Wuhan traveled to cities in China by January 22, 2020. The 131 cities with a risk threshold >50% are indicated in shades of orange; 239 cities below that threshold are indicated in shades of blue. Map generated by using Mapbox (https://www.mapbox.com).

 


China: Feb 13’s briefing on novel coronavirus cases in China

 

Feb 13: Daily briefing on novel coronavirus cases in China

Updated: 2020-02-13

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en.nhc.gov.cn

On Feb 12, 31 provincial-level regions on the Chinese mainland as well as the Xinjiang Production and Construction Corps reported 15,152 new cases of confirmed infections (including 13,332 clinical cases in Hubei province), 2,807 new cases of suspected infections and 254 deaths (242 in Hubei province, 2 in Henan province, 1 in Tianjin, 1 in Hebei province, 1 in Liaoning province, 1 in Heilongjiang province, 1 in Anhui province, 1 in Shandong province, 1 in Guangdong province, 1 in Guangxi Zhuang autonomous region, 1 in Hainan province and 1 in the Xinjiang Production and Construction Corps). Serious cases decreased by 174. 1,171 patients were released from hospitals after being cured. 29,429 people who had had close contact with infected patients were freed from medical observation.

As of 24:00 on Feb 12, the National Health Commission had received 59,804 reports of confirmed cases and 1,367 deaths in 31 provincial-level regions on the Chinese mainland and the Xinjiang Production and Construction Corps, and in all 5,911 patients had been cured and discharged from hospital. There still remained 52,526 confirmed cases (including 8,030 in serious condition) and 13,435 suspected cases. So far, 471,531 people have been identified as having had close contact with infected patients. 181,386 are now under medical observation.

On Feb 12, Hubei province reported 14,840 new cases of confirmed infections (including 13,436 in Wuhan), 1,377 new cases of suspected infections (including 620 in Wuhan), and 242 deaths (including 216 in Wuhan). 802 patients were released from hospitals after being cured, including 538 in Wuhan.

As of 24:00 on Feb 12, Hubei province had reported 48,206 cases of confirmed infections (including 32,994 in Wuhan) and 1,310 deaths (including 1,036 in Wuhan). In all, 3,441 patients had been cured and discharged from hospital, including 1,915 in Wuhan. There still remained 43,455 confirmed cases (including 30,043 in Wuhan), with 7,084 in serious condition (including 5,426 in Wuhan), and 9,028 suspected cases (including 4,904 in Wuhan).

In order to promote the early diagnosis and treatment of patients infected with novel coronavirus and ensure all the patients in Hubei can be received and treated, the diagnosis criteria have been differentiated between Hubei and other provincial regions. Clinically diagnosed criteria have been established in Hubei. Suspected cases with pneumonia images are diagnosed as clinical cases, so that they can receive standard treatment as soon as possible in accordance with the relevant requirements of confirmed cases, further improving the success rate of treatment. At present, 13,332 clinical cases reported in Hubei have been included in the confirmed case statistics, and all-out efforts have been made to enhance treatment, reduce serious cases and decrease the fatality rate.

As of 24:00 on Feb 12, 78 confirmed infections had been reported in the Hong Kong and Macao special administrative regions and Taiwan province: 50 in Hong Kong (1 had been dead  and 1 had been cured and discharged from hospital), 10 in Macao (2 had been cured and discharged from hospital) and 18 in Taiwan (1 had been cured and discharged from hospital).


World experts and funders set priorities for COVID-19 research

https://www.who.int/news-room/detail/12-02-2020-world-experts-and-funders-set-priorities-for-covid-19-research

12 February 2020

News release
Geneva, Switzerland

Leading health experts from around the world have been meeting at the World Health Organization’s Geneva headquarters to assess the current level of knowledge about the new COVID-19 disease, identify gaps and work together to accelerate and fund priority research needed to help stop this outbreak and prepare for any future outbreaks.

The 2-day forum was convened in line with the WHO R&D Blueprint – a strategy for developing drugs and vaccines before epidemics, and accelerating research and development while they are occurring.

“This outbreak is a test of solidarity — political, financial and scientific. We need to come together to fight a common enemy that does not respect borders, ensure that we have the resources necessary to bring this outbreak to an end and bring our best science to the forefront to find shared answers to shared problems. Research is an integral part of the outbreak response,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “I appreciate the positive response of the research community to join us at short notice and come up with concrete plans and commitment to work together.”

The meeting, hosted in collaboration with GloPID-R (the Global Research Collaboration for Infectious Disease Preparedness) brought together major research funders and over 300 scientists and researchers from a large variety of disciplines. They discussed all aspects of the outbreak and ways to control it including:

  • the natural history of the virus, its transmission and diagnosis;
  • animal and environmental research on the origin of the virus, including management measures at the human-animal interface;
  • epidemiological studies;
  • clinical characterization and management of disease caused by the virus;
  • infection prevention and control, including best ways to protect health care workers;
  • research and development for candidate therapeutics and vaccines;
  • ethical considerations for research;
  • and integration of social sciences into the outbreak response.

“This meeting allowed us to identify the urgent priorities for research. As a group of funders we will continue to mobilize, coordinate and align our funding to enable the research needed to tackle this crisis and stop the outbreak, in partnership with WHO,” said Professor Yazdan Yazdanpanah, chair of GloPID-R. “Equitable access – making sure we share data and reach those most in need,  in particular those in lower and middle-income countries, is fundamental to this work which must be guided by ethical considerations at all times.”

During the meeting, the more than 300 scientists and researchers participating both in person and virtually agreed on a set of global research priorities. They also outlined mechanisms for continuing scientific interactions and collaborations beyond the meeting which will be coordinated and facilitated by WHO. They worked with research funders to determine how necessary resources can be mobilized so that critical research can start immediately.

The deliberations will form the basis of a research and innovation roadmap charting all the research needed and this will be used by researchers and funders to accelerate the research response.

Note to editors

GloPID-R is a global alliance of international research funding organizations investing in preparedness and response to epidemics.


Singapore: As of 13 February 2020, 12pm, the Ministry of Health (MOH) has confirmed and verified eight additional cases of COVID-19 infection in Singapore, all of which are linked to previous cases.

https://www.moh.gov.sg/news-highlights/details/eight-more-confirmed-cases-of-covid-19-infection

As of 13 February 2020, 12pm, the Ministry of Health (MOH) has confirmed and verified eight additional cases of COVID-19 infection in Singapore, all of which are linked to previous cases.

Links between previous cases found

1.     Further epidemiological investigations and contact tracing have uncovered links between previously announced and new cases. This was made possible with the assistance of the Singapore Police Force.

a.    Cases 8 and 9, as well as Cases 31, 33 and 38, are linked to The Life Church and Missions Singapore (146B Paya Lebar Road). This is a possible cluster involving five cases (Cases 8, 9, 31, 33 and 38).

b.     Nine of the confirmed cases (Cases 19, 20, 21, 24, 25, 27, 28, 34 and 40) are linked to the cluster associated with Yong Thai Hang (24 Cavan Road).

c.     Three of the confirmed cases (Cases 30, 36 and 39) are linked to the private business meeting held at Grand Hyatt Singapore from 20 to 22 January.

d.     Four of the confirmed cases (Cases 42, 47, 52 and 56) are linked to the Seletar Aerospace Heights construction site.

e.     Seven of the confirmed cases (Cases 48, 49, 51, 53, 54, 57 and 58) are linked to the Grace Assembly of God.

Investigations on these clusters are ongoing.

3.     Contact tracing is underway for the other seven locally transmitted cases to establish any links to previous cases or travel history to mainland China. Case 44 was a contact of Cases 13 and 26. Case 55 is linked to Case 50.

About the confirmed cases

Case 51

4.     Case 51 is a 48 year-old male Singapore Citizen with no recent travel history to China. He is currently warded in an isolation room at the National Centre for Infectious Diseases (NCID). He is linked to the cluster at Grace Assembly of God.

 

5.    He reported onset of symptoms on 4 February and sought treatment at a general practitioner (GP) clinic on 5 February and 10 February. He went to NCID on 11 February, and subsequent test results confirmed COVID-19 infection on 12 February afternoon.

 

6.     Prior to hospital admission, he went to work at Grace Assembly of God (Tanglin) (355 Tanglin Road) and Grace Assembly of God (Bukit Batok) (1 Bukit Batok West Avenue 4). He stays at Bishan Street 13.

Case 52

7.     Case 52 is a 37 year-old male Bangladesh national who is a Singapore Work Pass holder, and has no recent travel history to China. He is currently warded in an isolation room at NCID. He is linked to the cluster at Seletar Aerospace Heights construction site.

8.     He reported onset of symptoms on 7 February. As he was identified as a close contact of Cases 42 and 47, he was transported by an ambulance to Tan Tock Seng Hospital on 11 February. Subsequent test results confirmed COVID-19 infection on 12 February afternoon.

9.     Prior to hospital admission, he had gone to work at the Seletar Aerospace Heights construction site, the same location where Cases 42 and 47 had worked. He reported that he had mostly stayed at his rental apartment at Campbell Lane since the onset of symptoms.

Case 53

10.     Case 53 is a 54 year-old male Singapore Citizen with no recent travel history to China. He is currently warded in an isolation room at NCID. He is linked to the cluster at Grace Assembly of God.

11.     He reported onset of symptoms on 10 February, and went to NCID on 12 February where he was immediately isolated. Subsequent test results confirmed COVID-19 infection on 12 February afternoon.

12.     Prior to hospital admission, he reported that he had mostly stayed at home at Hillview Avenue. He works at the National University of Singapore, but had not interacted with colleagues and students after onset of symptoms.

Cases 54 to 58

13.     Cases 54 (54 year-old female Singapore Citizen), 57 (26 year-old male Singapore Citizen) and 58 (55 year-old male Singapore Citizen) are linked to the cluster at Grace Assembly of God. All three cases did not have recent travel history to China. They were confirmed to have COVID-19 infection on 13 February morning, and are currently warded in separate isolation rooms at NCID.

14.     Case 55 is a 30 year-old male Singapore Citizen with no recent travel history to China. He was confirmed to have COVID-19 infection on 13 February morning, and is currently warded in an isolation room at NCID. He is a family member of Case 50.

15.     Case 56 is a 30 year-old male Bangladesh national with no recent travel history to China. He was confirmed to have COVID-19 infection on 13 February morning, and is currently warded in an isolation room at NCID. He is linked to the cluster at the Seletar Aerospace Heights construction site.

16.     MOH has initiated epidemiological investigations and contact tracing to identify individuals who had close contact with the cases.

Case 50 (Announced on 12 February)

17.     Case 50 is a 62 year-old male Singapore Citizen with no recent travel history to China. He is currently warded in an isolation room at NCID.

18.     He reported onset of symptoms on 7 February and had sought treatment at two GP clinics on 7 February, 10 February and 11 February. He was admitted to NCID on 11 February and was immediately isolated. Subsequent test results confirmed COVID-19 infection on 12 February morning.

19.     Prior to hospital admission, other than going to work at DBS Asia Central at Marina Bay Financial Centre (12 Marina Boulevard), he had stayed at his home at Mei Hwan Drive, except to seek medical treatment.

Update on condition of confirmed cases

20.     To date, a total of 15 cases have fully recovered from the infection and have been discharged from hospital. Of the 43 confirmed cases who are still in hospital, most are stable or improving. Seven are in critical condition in the intensive care unit.

Update on suspect cases

21.     As of 13 February 2020, 12pm, 711 of the suspect cases have tested negative for COVID-19, and 58 have tested positive. Test results for the remaining 82 cases are pending.

Update on contact tracing for confirmed cases

22.     Contact tracing for the confirmed cases is ongoing. Once identified, MOH will closely monitor all close contacts. As a precautionary measure, they will be quarantined for 14 days from their last exposure to the patient. In addition, all other identified contacts who have a low risk of being infected will be under active surveillance, and will be contacted daily to monitor their health status.

23.     As of 13 February 2020, 12pm, MOH has identified 1,278 close contacts. Of the 1,161 who are still in Singapore, 1,144 have been contacted and are being quarantined or isolated. Efforts are ongoing to contact the remaining 17 close contacts.

Health advisory

24.     Singaporeans are advised to defer all travel to Hubei Province and all non-essential travel to Mainland China.

 

25.     All travellers should monitor their health closely for two weeks upon return to Singapore and seek medical attention promptly if they feel unwell. Travellers should inform their doctor of their travel history. If they have a fever or respiratory symptoms (e.g. cough, shortness of breath), they should wear a mask and call the clinic ahead of the visit.

26.     Travellers and members of the public should adopt the following precautions at all times:

  • Avoid close contact with people who are unwell or showing symptoms of illness;
  • Observe good personal hygiene;
  • Practise frequent hand washing with soap (e.g. before handling food or eating, after going to toilet, or when hands are dirtied by respiratory secretions after coughing or sneezing);
  • Wear a mask if you have respiratory symptoms such as a cough or shortness of breath;
  • Cover your mouth with a tissue paper when coughing or sneezing, and dispose the soiled tissue paper in the rubbish bin immediately; and
  • Seek medical attention promptly if you are feeling unwell.
  • MOH will continue to monitor the situation closely. As medical practitioners are on the lookout for suspect cases, Singapore is likely to see more cases that will need to be investigated.

MINISTRY OF HEALTH

13 FEBRUARY 2020


CDC Confirms 14th Case of 2019 Novel Coronavirus

Media Statement

For Immediate Release: Wednesday, February 12, 2020
Contact: Media Relations
(404) 639-3286

CDC today confirmed another infection with 2019 novel coronavirus (COVID-19) in the United States in California. The patient is among a group of people under a federal quarantine order because of their recent return to the U.S. on a State Department-chartered flight that arrived on February 7, 2020.

All people who have been in Hubei Province in the past 14 days are considered at high risk of having been exposed to COVID-19 and subject to a temporary 14-day quarantine. This is the second person at this base who has tested positive for COVID-19. The first and second patients arrived on different planes and were housed in separate facilities; there are no epidemiologic links between them.

According to CDC on-site team lead Dr. Chris Braden, “At this time there is no indication of person-to-person spread of this virus at the quarantine facility, but CDC will carry out a thorough contact investigation as part of its current response strategy to detect and contain any cases of infection with this virus.”
This brings the total of number of COVID-19 cases in the United States to 14. There are likely to be additional cases in the coming days and weeks, including among other people recently returned from Wuhan. While 195 people were discharged from quarantine yesterday, more than 600 people who returned on chartered flights from Wuhan remain under federal quarantine.

For the latest information on the outbreak, visit CDC’s Novel Coronavirus 2019 website.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESexternal icon

CDC works 24/7 protecting America’s health, safety and security. Whether disease start at home or abroad, are curable or preventable, chronic or acute, or from human activity or deliberate attack, CDC responds to America’s most pressing health threats. CDC is headquartered in Atlanta and has experts located throughout the United States and the world.

Page last reviewed: February 12, 2020


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