Global & Disaster Medicine

Archive for the ‘Documents’ Category

Portugal: First Case of Tularemia

Frontiers in PH

Case Report

Front. Public Health, 19 November 2018 |
First Case of Tularemia Reported in Portugal: Probably of Imported Origin
Isabel Lopes de Carvalho, Paula Nascimento, Maria Sofia Núncioand Miguel Toscano Rico

“……A previously healthy 47-years-old male developed abruptly malaise, high fever (40°C) and chills only 3 days after walking and sleeping in the countryside of the island of Bornholm (Denmark) during summer season. He also reported profuse night sweats, a small left infraclavicular non-painful cutaneous lesion. The patient did not report outdoor activities in the month before and did not recall any tick bite. Three days later the fever vanished and he was first observed in a hospital in Berlin. He was prescribed with amoxicillin/clavulanate 875mg/125mg twice-a-day for 7 days.

On the 15th day of disease, he was observed in Portugal because of ongoing malaise. During the observation he did not complain of respiratory symptoms nor headache.

He presented a non-pruritic macular erythematous rash of the trunk, a non-painful left infraclavicular cutaneous lesion covered with a black crust suggestive of a skin eschar and multiple small painless, non-adherent cervical, and axillar lymphadenopathies……”

Interim Updated Planning Guidance on Allocating and Targeting Pandemic Influenza Vaccine during an Influenza Pandemic


“Effective allocation and administration of pandemic influenza vaccine will play a critical role in preventing influenza and reducing its effects on health and society during a future pandemic. Although the timing and severity of a future pandemic and characteristics of the next pandemic influenza virus strain are not known, it is important to plan and prepare. The overarching aim of the national pandemic influenza vaccination program is to vaccinate all persons in the United States (U.S.) who choose to be vaccinated, prior to the peak of disease. The U.S. government’s  goal is to have sufficient pandemic influenza vaccine available for an effective domestic response within four months of a pandemic declaration. Additionally, plans are to have first doses available within 12 weeks of the President or the Secretary of Health and Human Services declaring a pandemic 1. To meet these timelines, the U.S. government is investing significant resources to create and evaluate new vaccine development approaches and production technologies. Pre-pandemic influenza vaccine stockpiles of bulk vaccine against viruses with pandemic potential are also being established and maintained.

Despite these investments, there are other issues to consider. Stockpiled pandemic vaccine availability will depend on the degree to which they match the circulating pandemic strain and other properties, and manufacturing capacity.  In a pandemic, a novel virus has not circulated in humans, and it is assumed that the majority of the population may not have immunity to the virus, causing more people to become ill. Rates of severe illness, complications, and death may be much higher than seasonal flu and more widely distributed. The greater frequency and severity of disease will increase the burden on the health care system, the risk of ongoing transmission in the community, and may increase rates of absenteeism and disruptions in the availability of critical products and services in health care and other sectors. Similarly, homeland and national security and critical infrastructure (e.g., transportation and power supply) could be threatened if illness among critical personnel reduces their capabilities.

Given that influenza vaccine supply will increase incrementally as vaccine is produced during a pandemic, targeting decisions may have to be made. Such decisions should be based on vaccine supply, pandemic severity and impact, potential for disruption of community critical infrastructure, operational considerations, and publicly articulated pandemic vaccination program objectives and principles. The overarching objectives guiding vaccine allocation and use during a pandemic are to reduce the impact of the pandemic on health and minimize disruption to society and the economy. Specifically, the targeting strategy aims to protect those who will: maintain homeland and national security, are essential to the pandemic response and provide care for persons who are ill, maintain essential community services, be at greater risk of infection due to their job, and those who are most medically vulnerable to severe illness such as young children and pregnant women.

Recognizing that demand may exceed supply at the onset of a pandemic, federal, state, tribal, and local governments, communities, and the private sector have asked for updated planning guidance on who should receive vaccination early in a pandemic.  This document uses pandemic severity categories based on the current CDC Pandemic Severity Assessment Framework1.  Several new elements have been incorporated into the 2018 guidelines to update and provide interim guidance for planning purposes, and to provide the rationale for a new vaccination program during a pandemic allowing for local adjustment where appropriate.  These guidelines replace the 2008 Guidance on Allocating and Targeting Pandemic Influenza Vaccine.”

Filing of Federal Charges against Robert Bowers of Baldwin, PA

Department of Justice

Department of Justice
U.S. Attorney’s Office
Western District of Pennsylvania

Saturday, October 27, 2018
                                                                           Statement on Filing of Federal Charges

PITTSBURGH – Scott W. Brady, United States Attorney for the Western District of Pennsylvania, and Robert Jones, Special Agent in Charge of the Federal Bureau of Investigation, issued the following statement today in response to media inquiries:

“On Saturday, October 27, 2018, at 8:05 p.m., U.S. Magistrate Judge Robert C. Mitchell signed a criminal complaint charging Robert Bowers of Baldwin, Pa., with 29 counts setting forth federal crimes of violence and firearms offenses. The crimes of violence are based upon the federal civil rights laws prohibiting hate crimes. The FBI in Pittsburgh is leading the investigation.”

The federal complaint alleges that Bowers committed the following crimes on or about October 27, 2018, in the Western District of Pennsylvania:

• Eleven counts of Obstruction of Exercise of Religious Beliefs Resulting in Death (18 U.S.C. §§ 247(a)(2) and 247(d)(1))

• Eleven counts of Use of a Firearm to Commit Murder During and in Relation to a Crime of Violence (18 U.S.C. §§ 924(c)(1)(A) and 924(j)(1)

• Four counts of Obstruction of Exercise of Religious Beliefs Resulting in Bodily Injury to a Public Safety Officer 18 U.S.C. §§ 247(a)(2) and 247(d)(3))

• Three counts of Use and Discharge of a Firearm During and in Relation to a Crime of Violence (18 U.S.C. §§ 924(c)(1)(A) and 924(iii))

Link to Signed Bowers Complaint


Nidal Hasan : Document

Intergovernmental Panel on Climate Change: A world of worsening food shortages and wildfires, and a mass die-off of coral reefs as soon as 2040


Document:  Global Warming of 1.5 Degrees Centigrade


8 October 2018

Summary for Policymakers of IPCC Special Report on Global Warming of 1.5ºC approved by governments

INCHEON, Republic of Korea, 8 Oct – Limiting global warming to 1.5ºC would require rapid, farreaching and unprecedented changes in all aspects of society, the IPCC said in a new assessment. With clear benefits to people and natural ecosystems, limiting global warming to 1.5ºC compared to 2ºC could go hand in hand with ensuring a more sustainable and equitable society, the Intergovernmental Panel on Climate Change (IPCC) said on Monday.

The Special Report on Global Warming of 1.5ºC was approved by the IPCC on Saturday in Incheon, Republic of Korea. It will be a key scientific input into the Katowice Climate Change Conference in Poland in December, when governments review the Paris Agreement to tackle climate change.

“With more than 6,000 scientific references cited and the dedicated contribution of thousands of expert and government reviewers worldwide, this important report testifies to the breadth and policy relevance of the IPCC,” said Hoesung Lee, Chair of the IPCC.

Ninety-one authors and review editors from 40 countries prepared the IPCC report in response to an invitation from the United Nations Framework Convention on Climate Change (UNFCCC) when it adopted the Paris Agreement in 2015.

The report’s full name is Global Warming of 1.5°C, an IPCC special report on the impacts of global warming of 1.5°C above pre-industrial levels and related global greenhouse gas emission pathways, in the context of strengthening the global response to the threat of climate change, sustainable development, and efforts to eradicate poverty.

“One of the key messages that comes out very strongly from this report is that we are already seeing the consequences of 1°C of global warming through more extreme weather, rising sea levels and diminishing Arctic sea ice, among other changes,” said Panmao Zhai, Co-Chair of IPCC Working Group I.

The report highlights a number of climate change impacts that could be avoided by limiting global warming to 1.5ºC compared to 2ºC, or more. For instance, by 2100, global sea level rise would be 10 cm lower with global warming of 1.5°C compared with 2°C. The likelihood of an Arctic Ocean free of sea ice in summer would be once per century with global warming of 1.5°C, compared with at least once per decade with 2°C. Coral reefs would decline by 70-90 percent with global warming of 1.5°C, whereas virtually all (> 99 percent) would be lost with 2ºC.

“Every extra bit of warming matters, especially since warming of 1.5ºC or higher increases the risk associated with long-lasting or irreversible changes, such as the loss of some ecosystems,” said Hans-Otto Pörtner, Co-Chair of IPCC Working Group II.

Limiting global warming would also give people and ecosystems more room to adapt and remain below relevant risk thresholds, added Pörtner. The report also examines pathways available to limit warming to 1.5ºC, what it would take to achieve them and what the consequences could be.

“The good news is that some of the kinds of actions that would be needed to limit global warming to 1.5ºC are already underway around the world, but they would need to accelerate,” said Valerie Masson-Delmotte, Co-Chair of Working Group I.

The report finds that limiting global warming to 1.5°C would require “rapid and far-reaching” transitions in land, energy, industry, buildings, transport, and cities. Global net human-caused emissions of carbon dioxide (CO2) would need to fall by about 45 percent from 2010 levels by 2030, reaching ‘net zero’ around 2050. This means that any remaining emissions would need to be balanced by removing CO2 from the air.

“Limiting warming to 1.5ºC is possible within the laws of chemistry and physics but doing so would require unprecedented changes,” said Jim Skea, Co-Chair of IPCC Working Group III.

Allowing the global temperature to temporarily exceed or ‘overshoot’ 1.5ºC would mean a greater reliance on techniques that remove CO2 from the air to return global temperature to below 1.5ºC by 2100. The effectiveness of such techniques are unproven at large scale and some may carry significant risks for sustainable development, the report notes.

“Limiting global warming to 1.5°C compared with 2°C would reduce challenging impacts on ecosystems, human health and well-being, making it easier to achieve the United Nations Sustainable Development Goals,” said Priyardarshi Shukla, Co-Chair of IPCC Working Group III.

The decisions we make today are critical in ensuring a safe and sustainable world for everyone, both now and in the future, said Debra Roberts, Co-Chair of IPCC Working Group II.

“This report gives policymakers and practitioners the information they need to make decisions that tackle climate change while considering local context and people’s needs. The next few years are probably the most important in our history,” she said.

The IPCC is the leading world body for assessing the science related to climate change, its impacts and potential future risks, and possible response options.

The report was prepared under the scientific leadership of all three IPCC working groups. Working Group I assesses the physical science basis of climate change; Working Group II addresses impacts, adaptation and vulnerability; and Working Group III deals with the mitigation of climate change.

The Paris Agreement adopted by 195 nations at the 21st Conference of the Parties to the UNFCCC in December 2015 included the aim of strengthening the global response to the threat of climate change by “holding the increase in the global average temperature to well below 2°C above preindustrial levels and pursuing efforts to limit the temperature increase to 1.5°C above pre-industrial levels.”

As part of the decision to adopt the Paris Agreement, the IPCC was invited to produce, in 2018, a Special Report on global warming of 1.5°C above pre-industrial levels and related global greenhouse gas emission pathways. The IPCC accepted the invitation, adding that the Special Report would look at these issues in the context of strengthening the global response to the threat of climate change, sustainable development, and efforts to eradicate poverty.

Global Warming of 1.5ºC is the first in a series of Special Reports to be produced in the IPCC’s Sixth Assessment Cycle. Next year the IPCC will release the Special Report on the Ocean and Cryosphere in a Changing Climate, and Climate Change and Land, which looks at how climate change affects land use.
– 3 –
The Summary for Policymakers (SPM) presents the key findings of the Special Report, based on the assessment of the available scientific, technical and socio-economic literature relevant to global warming of 1.5°C.

The Summary for Policymakers of the Special Report on Global Warming of 1.5ºC (SR15) is available at or

Key statistics of the Special Report on Global Warming of 1.5ºC

91 authors from 44 citizenships and 40 countries of residence – 14 Coordinating Lead Authors (CLAs) – 60 Lead authors (LAs) – 17 Review Editors (REs) 133 Contributing authors (CAs) Over 6,000 cited references A total of 42,001 expert and government review comments (First Order Draft 12,895; Second Order Draft 25,476; Final Government Draft: 3,630)

For more information, contact: IPCC Press Office, Email: Werani Zabula +41 79 108 3157 or Nina Peeva +41 79 516 7068



“Extreme electromagnetic incidents caused by an intentional electromagnetic pulse (EMP) attack or a naturally occurring geomagnetic disturbance (GMD, also referred to as “space weather”) could damage significant portions of the Nation’s critical infrastructure, including the electrical grid, communications equipment, water and wastewater systems, and transportation modes.

The impacts are likely to cascade, initially compromising one or more critical infrastructure sectors, spilling over into additional sectors, and expanding beyond the initial geographic regions.

EMPs are associated with intentional attacks using high-altitude nuclear detonations, specialized conventional munitions, or non-nuclear directed energy devices. Effects vary in scale from highly local to regional to continental, depending upon the specific characteristics of the weapon and the attack profile. High-altitude electromagnetic pulse attacks (HEMP) using nuclear weapons are of most concern because they may permanently damage or disable large sections of the national electric grid and other critical infrastructure control systems.

Similarly, extreme geomagnetic disturbances associated with solar coronal mass ejections (when plasma from the sun, with its embedded magnetic field, arrives at Earth) may cause widespread and long-lasting damage to electric power systems, satellites, electronic navigation systems, and undersea cables. Essentially, any electronics system that is not protected against extreme EMP or GMD events may be subject to either the direct “shock” of the blast itself or to the damage that is inflicted on the systems and controls upon which they are dependent. For these reasons, the potential severity of both the direct and indirect impacts of an EMP or GMD incident compels our national attention. …..”

Terror Gone Viral: 2018

Terror Gone Viral 2018 :  Document

“…. Cumulatively, over the 2014 to 2018 period covered by the Terror Gone Viral reports, ISIS has been linked to 243 incidences, averaging five terrorist incidents per month…..”

What’s in a Cholera Kit?


Overview: In 2016 WHO introduced the Cholera Kits. These kits replace the Interagency Diarrhoeal Disease Kit (IDDK) which had been used for many years. The Cholera Kit is designed to be flexible and adaptable for preparedness and outbreak response in different contexts. The overall Cholera Kit is made up of an Investigation Kit, Laboratory materials, 3 Treatment Kits (community, periphery and central) and a Hardware Kit. The Treatment and Hardware Kits are each composed of individual modules. Each of the kits and modules can be ordered independently based on field need. To support orders, a Cholera Kit Calculation Tool was developed. This course is made up of two parts: a short introduction to the Cholera Kits and modules, and a demonstration of the Cholera Kit Calculation Tool.

Cholera Kit

How did NYC fare so well during the Pandemic of 1918?

Pandemic in NYC 1918

“……When compared with other large U.S. cities, especially its two largest neighbors, Boston and Philadelphia, New York City did not fare poorly in its overall mortality burden. During the pandemic, New York City’s excess death rate per 1,000 was reportedly 4.7, compared with 6.5 in Boston and 7.3 in Philadelphia.2 New York City emerged from the three waves of the influenza pandemic (September 1918 to February 1919) officially recording approximately 30,000 deaths out of a population of roughly 5.6 million due to influenza or pneumonia, 21,000 of them during the second “fall” wave (September 14 to November 16)…..”

Moria: A growing safety and mental health crisis in Greece’s largest migrant camp on the island of Lesbos

Unprotected, Unsupported, Uncertain :  Document

  • “……Currently, more than 8,500 people are crammed into a site which only has the capacity to host 3,100.
  • 84 people are expected to share one shower.
  • 72 people are expected to share one toilet.
  • People must rise at four in the morning to stand in line to get food and water, which is distributed at eight.
  • The sewage system is so overwhelmed, that raw sewage has been known to reach the mattresses where children sleep, and flows untreated into open drains and sewers……..”


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