Same Chick-Different Brain

A place to expand knowledge and share information relating to the fields of biodefense, biosecurity and pandemic planning. I am a grad student at SLU, finishing up a degree (MPH) in Biosecurity and Pandemic Response and created this blog to exchange thoughts and information with like minded individuals. Welcome!

[biodefensebugchaser-blog]

Syrian chemical weapons use backed-up by second investigation

By Damien McElroy, Foreign Affairs Correspondent

7:12PM BST 11 May 2014

Two new and independent investigations have confirmed the use by theSyrian regime of chlorine gas to attack civilians in rebel-held areas, backing up the first clear evidence that was produced by The Telegraph last month.

Chlorine gas canister munitions have been photographed at the sites where tests conducted by The Telegraph demonstrated that the Assad regime had conducted gas attacks on civilians.

Daniele Raineri, a reporter for Italy's Il Foglio, visited the town of Kafr Zita on Monday and took a series of photographs of the Chinese-made munitions that contained chlorine gas and were dropped from government helicopters on April 13.

Markings on one of the casings (DANIELE RAINERI)

Meanwhile reporters from the German magazine Der Spiegel managed to reach the affected area and interviewed doctors who treated victims of the attack, as well as a survivor who described seeing the cloud of yellow gas approaching the nearby town of Al-Tamanah, and its effects. After hours in hospital Abu Abda said he was still coughing blood and could barely move.

The accounts corroborate eyewitness reports given to The Telegraph last month, as well as scientific testing of soil samples which revealed the presence of high concentrations of chlorine and ammonia.

Hundreds of people – many of them children – were wounded in a spate of at least eight attacks over two weeks last month. There have been 10 attacks in Idlib province in recent months, with unconfirmed reports of a further two last week.

At least six people fatally succumbed to the gas, including two children. Six-year-old Mahmud, and his half sister 16-year-old Maryuma died slow deaths when the gas formed hydrochloric acid in their lungs. It scourged and burned their alveoli, until their breathing organs filled with liquid, essentially drowning them.

Mr Raineri's photographs clearly show the marking of the Chinese arms manufacturer Norinco and the stamp Cl2, the scientific shorthand for chlorine. He has been asked to pass his images to the Organisation for Prohibition of Chemical Weapons (OPCW), which is investigating the attacks.

The OPCW established a fact-finding team in the wake of the evidence gathered by the original Telegraph investigation. Officials on the team travelled to Damascus earlier this week but reported it was impossible to cross the front lines to make its own first-hand investigation in Kafr Zita, al Tamanah and Talmenes, the third affected town.

Mr Raineri said: "Most of the pictures were taken in a sort of tiny cemetery of barrel bombs in a farmyard just out the first line of buildings of the city. One of metallic remnants was clearly marked with the sign Cl2, another still had inside the cylinder which contained chemicals."

The soil samples analysed by The Telegraph were gathered by Dr Ahmad – a Syrian medic whose real identity cannot be revealed for his own protection – who had previously received training in sample collection by western chemical weapons experts. Several people, including children, died and hundreds were seriously wounded in the attacks.

Mr Raineri's visit on Monday to Kafr Zita, where the remnants of some chlorine bombs are stored, was the first additional examination of the site. He said he had counted scores of bomb sites.

The remains of metal canisters, which were packed inside barrel bombs dropped on the area, were stacked outside a deserted farm house. Local guides told him that unexploded bombs and other ordinance had been buried in nearby fields.

"An unknown quantity of chlorine bombs is buried in the middle of a soccer field, on the entry of the town. The soil there is freshly dug and the site could become important if an independent team is dispatched in the town to collect evidence," wrote Mr Raineri in his report. "The third site, which has just one bomb, is in a second yard, two minutes' drive away."

Hamish de Bretton-Gordon, a British chemical weapons expert involved in The Telegraph testing, said the photographs brought out by Mr Raineri build on the body of evidence available to the OPCW for its report.

"Our contacts in Syria took samples from these pre-made chlorine canisters that have been detonated in barrel bombs that were dropped from helicopters," Mr de Bretton-Gordon said.

"The evidence presented by The Telegraph and by Mr Raineri is the only realistic way of acquiring material from the site of those attacks."

Mr de Bretton-Gordon has proposed a private effort to supply gas masks and training in surviving chemical weapons attacks to Syrian civilians in front-line areas. The gas masks and other equipment could be sourced in Britain and distributed through humanitarian networks.

[biodefensebugchaser-blog]

As MERS virus reaches U.S., public health system springs into action

The man arrived at the hospital with a fever and a bad cough. Relatives accompanied him through the doors, beneath the red neon sign reading "Emergency."

It looked like pneumonia, but when doctors at Community Hospital learned that the patient was a healthcare worker in Saudi Arabia, they began suspecting something more sinister.

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FOR THE RECORD

MERS virus: An article in the May 10 Section A said a man infected with the deadly Middle East respiratory syndrome, or MERS, took a bus trip from Chicago to Indiana on April 27. He made the trip on April 24, the same day he arrived in Chicago on a flight from Saudi Arabia. —

------------

Swabs from the man's nose and mouth confirmed it: The United States had its first case of a new and often deadly ailment called MERS, or Middle East Respiratory Syndrome, and health experts were facing a medical drama that all of them had anticipated but none of them ever hoped to see.

Over the last week, investigators have worked to track down every person who shared space with the unidentified elderly patient before he showed up at the hospital, including passengers on the April 24 flight that brought him from the Saudi capital of Riyadh to Chicago O'Hare International Airport. Through passenger manifests, credit card receipts and other clues, they have also traced people who rode with the man on the bus he took from the airport to northwestern Indiana on April 27.

So far, nearly all the fellow travelers — about 112 — have been traced, and none has tested positive for the crown-shaped virus that causes MERS. At least 50 hospital workers who had even the slightest contact with the man remain in home isolation, but they also show no symptoms. The same is true for the Indiana relatives whom the man, an American living in Riyadh, had come to visit.

On Friday, the MERS patient was cleared to leave the hospital and authorized to travel.

"It appears we have contained this," Alan Kumar, chief medical information officer at Community Hospital, said this week.

For the last two years, since the virus that kills one-third of those it infects first appeared on the other side of the world, on the Arabian Peninsula, U.S. epidemiologists have waited and prepared for the day it would appear in this country.

"Anyone is a planeload away from any disease on Earth," said Indiana's state epidemiologist, Pam Pontones.

The response in Munster, a bedroom community about 30 miles south of downtown Chicago, was a textbook example of how the public health system is supposed to work, said those involved in this case, citing the rapid diagnosis and the quick tracing of the patient's contacts.

Diseases don't respect borders. In this day and age, we need to be prepared for diseases coming to the United States.- Daniel Feikin, CDC epidemiologist

Warnings from the federal Centers for Disease Control and Prevention were carried to state health officials and from there to healthcare workers on the front lines — who, months down the road, remained attentive enough to ferret out an infected patient in time.

"It's really cool, when you think about it," said Johns Hopkins epidemiologist Trish Perl, who studies the virus.

But medical experts say that although this case was handled successfully, it is a sign of things to come and highlights the need for continued heightened vigilance, as people crisscross the globe with greater frequency than ever before.

"It's a small world these days," said Daniel Feikin, an epidemiologist with the CDC in Atlanta. Feikin was the leader of a six-member team of specialists who came to Indiana on May 2, the day the agency confirmed the Munster patient had MERS.

"Diseases don't respect borders," Feikin said. "In this day and age, we need to be prepared for diseases coming to the United States."

Health officials have been keeping a close eye on the virus since scientists first discovered it in a 60-year-old Saudi man, who died in 2012 after suffering pneumonia and kidney failure. By June 2013, nearly 80 people in the region had been infected with MERS, and more than half had died. Saudi Arabia, which has been hit hardest by MERS, reported Wednesday that it had recorded 449 cases and that 121 of those infected had died.

MERS worried medical experts because it seemed to bear a resemblance to SARS, another coronavirus that infected nearly 8,500 people in 2003 and killed more than 800, mostly in Asia.

MERS, which has also been found in camels and bats, does not appear to be as contagious as SARS, however. It seems to spread through prolonged and close contact, meaning relatives of victims and healthcare workers tending to victims are the most vulnerable.

But when it hits, it often is deadly. There is no treatment, so MERS patients get standard "supportive" care for respiratory infections, such as medication to reduce fevers and oxygen to aid breathing.

The World Health Organization reported that as of April 24, MERS had killed nearly 37% of 254 confirmed victims. On Tuesday, the European Center for Disease Prevention and Control, which compiles its own statistics, reported a 28% death rate among 495 cases globally.

That mortality level is "reminiscent of the way things were in the pre-antibiotic era," said Robert Quigley, International SOS' medical director for the Americas. The company provides medical and other crisis services for corporate clients. Among its clients, more than 36,000 U.S.-based travelers made 83,214 trips to the Arabian Peninsula — the breeding ground for MERS — between April 1, 2013, and April 30, 2014, underscoring the risk of the virus' spread.

Pontones and the state health commissioner, William VanNess II, learned that MERS might be in their midst April 30, a Wednesday, two days after the patient showed up at the Munster hospital. When the man arrived at the emergency room two nights earlier, he was able to walk on his own. But he was sick enough that he was given oxygen and put in a private room with negative air flow, which prevented air in his room from mixing with air in the rest of the hospital.

Healthcare workers wore masks, gloves and gowns as they tended him. His fever spiked to 102.7 degrees, and his symptoms were similar to those of the flu or pneumonia. A team of doctors at Community, a 427-bed facility, interviewed the patient's family and learned that he had flown to Chicago, via London, from Riyadh four days earlier.

When they learned that he worked at a medical facility, the team — aware of MERS because of CDC warnings — alerted Indianapolis that a possible MERS sample was being sent there for testing.

On the afternoon of May 1, a respiratory epidemiologist in Indianapolis phoned the CDC.

The sample was positive.

The next day, the CDC did its own test, confirmed the state's finding, and deployed a team to work with state and local officials to contain the threat.

The man's relatives — officials wouldn't say how many — were tested and told to stay home and to wear masks if they had to go out. The hospital used video surveillance and GPS-like devices worn by staff to determine which employees had encountered the patient. They were tested and sent home for two weeks of isolation.

A telephone hotline was set up for people to call for information as the hospital, the CDC, and the state announced the MERS case in news releases and on social media. They urged anyone who might have been near the patient, including those who were on the shuttle bus from the airport, to get tested.

"It was like, let's get out the facts, but let's not create panic," said VanNess. "We didn't want everyone fleeing northwestern Indiana."

At least 114 calls have come into the hotline since it was established May 3, but the frequency is decreasing. Health officials seem confident that they stopped MERS before it could spread, thanks to Community Hospital's quick response. They also benefited from timing: The patient had no symptoms during his flight, so he probably was not contagious at the time.

But everyone tested will be retested, at the two-week mark after their initial swab, before they get the all-clear to emerge from isolation. And even after the patient is released from the hospital, he will have to spend some time in isolation and be monitored for illness before he can fly back to Saudi Arabia.

"We're feeling encouraged, but we're being overly cautious," said Feikin. "This is a new disease."

[biodefensebugchaser-blog]

U.S. confirms second case of MERS

(Reuters) - U.S. health officials confirmed the country's second case of MERS, a deadly virus first discovered in the Middle East in 2012, and said the patient was in good condition in an Orlando, Florida hospital.

The patient, 44, is a healthcare worker who lives and works in Saudi Arabia and traveled to the United States to visit relatives. He was admitted to the Dr. P. Phillips Hospital in Orlando on May 9.

The case is the second "imported" instance of Middle East Respiratory Syndrome, or MERS, reaching U.S. soil, but the two are not related, Dr Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention said on a conference call.

Schuchat said the man traveled on May 1 from Jeddah to London, and then from London to Boston. From Boston, the patient took a flight to Atlanta, changed planes again, before arriving in Orlando.

She said the patient was feeling ill on the flight from Jeddah, but did not feel sick enough to seek treatment until last Friday.

It is not clear in which hospital the patient worked, but Schuchat said she believes he was working in a facility that was caring for people with MERS.

The CDC said it is not clear whether the person was infectious on the plane, but it is now contacting some 500 people who traveled on the same U.S. flights as the infected health worker "out of an abundance of caution," CDC Director Dr. Thomas Frieden told reporters on the call.

Frieden said the latest U.S. case of MERS was "unwelcome but not unexpected news," and added it now falls to the U.S. hospital and healthcare workers in general to observe meticulous infection control procedures to keep the virus contained.

Frieden said the CDC now has a team in Saudi Arabia working with "international partners" to try to help contain the spread of the virus and better understand how it is transmitted.

So far, an analysis of the genetic sequences of the virus suggest it has not changed in the past two years.

Geo Morales, a spokesman for the Florida hospital, which is located near the Disney theme park, said the institution is tracking any of its workers who might have come in contact with the patient.

"We do believe there is a low risk the virus is being spread by him," Morales said, noting that his symptoms were mild when he arrived at the hospital and that he did not have a cough.

The other U.S. MERS case involved a man who flew from Saudi Arabia and traveled to Indiana earlier this month.

The patient in that case, a U.S. healthcare worker who lives and works in Saudi Arabia, flew from Riyadh to London and then Chicago, before boarding a bus to Highland, Indiana. He then began experiencing symptoms of fever, shortness of breath, and sought care at Community Hospital in Munster, Indiana.

After confirming the patient had MERS, the CDC and state and hospital officials traced all of the workers with whom he had contact, and all have so far tested negative for the virus.

The CDC has also checked airline and bus manifests to see if the man might have infected others during his journey and so far have not turned up any evidence fellow travelers were infected.

The patient is now clear of the virus and was released on Friday. Hospital workers remain in home isolation until the end of a 14-day incubation period, when they will be rechecked for the virus.

Although the MERS virus has been shown to transmit from person to person, it is not easily transmissible to the general public.

Saudi officials said on Friday that the number of infections in the country has reached 473. The death toll from the virus is 133 since it was identified two years ago, according to the kingdom's health ministry.

[biodefensebugchaser-blog]

DEADLY MERS VIRUS ENTERS U.S. Via Chicago O’Hare INT’L Airport (ORD)

By Dan Hensley on May 2, 2014

Chicago, IL

An unidentified airline passenger who, on April 24, 2014, “traveled by plane from Saudi Arabia to London, then from London to Chicago,” according to the Centers for Disease Control and Prevention, has carried the deadly MERS virus into the U.S. “The patient then took a bus from Chicago to Indiana. On the 27th, the patient began to experience signs of illness, including shortness of breath and coughing. The patient went to an emergency department on April 28. Because of the patient’s symptoms and travel history, Indiana public health officials had him tested for MERS,” the CDC said.

“The CDC, IDPH and CDPH do not consider passengers on the flight or bus to be close contacts of the patient and therefore are not at high risk,” CDC Director Dr. LaMar Hasbrouk said in a news release. Close contact is defined as a) any person who provided care for the patient, including a healthcare worker or family member, or had similarly close physical contact; or b) any person who stayed at the same place (e.g. lived with, visited) as the patient while the patient was ill.

Middle East respiratory syndrome — or MERS — first surfaced two years ago. Since then, at least 400 cases of the respiratory illness have been reported, and more than 100 people have died.

Saudi Arabia has been the center of the outbreak. All the victims have had ties to the Middle East or to someone who traveled there.

The virus has been found in camels, but officials don’t know how it is spreading to humans.

The Illinois Poison Center has set up a MERS-CoV hotline at [phone] for residents and medical professionals who have concerns or questions.

WHAT YOU NEED TO KNOW ABOUT MERS

At least 14 other countries have reported infections, including Egypt, Jordan, Kuwait, Qatar, the United Arab Emirates, Tunisia, Malaysia, Oman, France, Greece, Italy, the United Kingdom, the Philippines and now the U.S.

1. The virus spreads from person-to-person through close contact, but might also be transmitted to humans from animals, according to the CDC. Scientists suspect that it came from an animal. Camels and bats in Saudi Arabia have tested positive for the virus, according to the CDC.

2. Most of the fatal cases have involved the elderly and people with pre-existing medical conditions.

3. Symptoms of the MERS virus include fever and cough, which are also symptoms of the flu. MERS can also cause diarrhea and shortness of breath, and can lead to pneumonia and kidney failure.

There’s No Cure

There’s no treatment for MERS. People who get sick are given supportive treatment to address the infection’s various symptoms, according to the CDC. There’s no vaccine, either.

What is MERS-CoV?

MERS-CoV is a beta coronavirus. It was first reported in 2012 in Saudi Arabia. MERS-CoV used to be called “novel coronavirus,” or “nCoV”. It is different from other coronaviruses that have been found in people before.

MERS-CoV is not the same coronavirus that caused severe acute respiratory syndrome (SARS) in 2003. However, like the SARS virus, MERS-CoV is most similar to coronaviruses found in bats. CDC is still learning about MERS.

Is there a lab test?

Lab tests (polymerase chain reaction or PCR) for MERS-CoV are available at state health departments, CDC, and some international labs. Otherwise, MERS-CoV tests are not routinely available. There are a limited number of commercial tests available, but these are not FDA-approved.

The CDC has released this statement about community outbreak possibilities:

“It is understandable that some may be concerned about this situation, but this first U.S. case of MERS-CoV infection represents a very low risk to the general public,” said Dr. Anne Schuchat, assistant surgeon general and director of CDC’s National Center for Immunizations and Respiratory Diseases.  In some countries, the virus has spread from person to person through close contact, such as caring for or living with an infected person. However, there is currently no evidence of sustained spread of MERS-CoV in community settings.

CDC Statement on Travel:

At this time, CDC does not recommend anyone change their travel plans. The World Health Organization also has not issued Travel Health Warnings for any country related to MERS-CoV.  Anyone who develops fever and cough or shortness of breath within 14 day after traveling from countries in or near the Arabian Peninsula should see their doctor and let them know where they travelled.

[biodefensebugchaser-blog]

CDC Confirms First Case Of MERS Infection In U.S.

AP/Mike Stobbe May 2, 2014

(NEW YORK) — Health officials say a deadly virus from the Middle East has turned up for the first time in the U.S.

No details about the case have been released. The Centers for Disease Control and Prevention planned a Friday afternoon briefing about the case.

The CDC says it is investigating along with health officials in Indiana.

Middle East respiratory syndrome — or MERS — first surfaced two years ago. Since then, at least 400 cases of the respiratory illness have been reported, and more than 100 people have died.

Saudi Arabia was been the center of the outbreak. All the victims have had ties to the Middle East or to someone who traveled there.

The virus has been found in camels, but officials don’t know how it is spreading to humans.

[biodefensebugchaser-blog]

Unidentified illness kills 23 in Guinea

Agence French-Presse Published on 20 Mar 2014

CONAKRY, March 20, 2014 (AFP) - A mysterious illness has killed at least 23 people in southern Guinea in six weeks, but the disease has yet to be positively identified, the health ministry announced Thursday.

"A feverish sickness whose first symptoms were observed on February 9 has claimed at least 23 lives, including that of the director of the Macenta district hospital and three staff, out of a total of 36 cases," said Sakoba Keita, the doctor in charge of the ministry's preventive wing.

"The administrative district of Gueckedou is the worst affected, with 13 deaths for 19 cases," Keita added, noting that "the illness is characterised by fever, diarrhoea, vomiting, and bleeding in the cases of some patients."

Medical experts have been sent to the district to try to identify the highly contagious disease, whose symptoms are similar to those caused by Lassa fever, yellow fever and Ebola.

About 30 test samples have been sent to France for analysis, with results expected "within 48 hours", the doctor said, adding that further samples are due to be examined at the Pasteur Institute in the Senegalese capital Dakar.

Protective measures have been taken on the spot, including quarantine for each of the patients, as well as individual and collective measures affecting the local population.

Three thousand health kits intended for medical personnel and residents of high-risk areas are awaited from Burkina Faso, while the Swiss branch of Doctors Without Borders (MSF) has already sent 100 tonnes of medical equipment.

[biodefensebugchaser-blog]

Overuse of Agriculture Antibiotics causing a potential public health crisis

Two recent articles address the issue of over use of agricultural antibiotics. Thought I would pass them along. Links:

Extensive use of antibiotics in agriculture creating public health crisis, researcher says

FDA Inaction on Antibiotics Is Making the World Deadlier

[biodefensebugchaser-blog]

What Local Health Departments Need to Adopt Social Media and mHealth Technologies for Emergency Preparedness

Nidhi Bouri, Katie Minton, Nina Jolani (NACCHO), Sara Rubin (NACCHO) Poster presented at the 5th Annual mHealth Summit, December 8-11, 2013, National Harbor, MD.

LINK to PDF file

Introduction 

Social media and mobile health technologies (mHealth) are influential tools for promoting preparedness before an emergency, and facilitating response after disaster strikes. Local Health Departments (LHDs) could benefit from using these technologies both on a day-to-day basis and during emergencies.

The increasing use of cell phones and social media by the American public on a day-to-day basis has led to a corresponding in- crease in communication through these technologies to share and find information during emergencies. Evidence indicates that during emergencies the use of cell phones and social media are effective methods LHDs could use to provide real-time updates, rapidly exchange information with the public, and enhance situational awareness. Nevertheless, despite these and other poten- tial benefits, only a small fraction of LHDs have adopted and implemented such technology effectively.

Study Background

Given the potential for LHD use of social media and mHealth technologies to improve public health preparedness and re-sponse, and the limited, effective use of these platforms by LHDs, the UPMC Center for Health Security and the National Association of County and City Health Officials (NACCHO) conducted a qualitative study to identify what challenges prevent LHDs from using these technologies, as well as some of the best practices that have helped some LHDs to overcome those barriers.

Since social media and mobile technologies have the ability to rapidly transmit information, it is important that emergency preparedness communications integrate these platforms into messaging efforts. LHDs need to do more with less staff and money: prepare communities for emergencies and help with response and recovery when emergencies occur. This study aims to clarify the challenges faced by LHDs interested in implementing such programs, share the successes of LHDs that have overcome those challenges, and ultimately mitigate such organizational barriers that might prevent the successful adoption of these technologies.

Methods

This study examines LHDs’ organizational capacity to adopt and use social media and mHealth technologies for preparedness.

Literature search and use of 2010 NACCHO National Profile of LHDs to identify an initial pool of 10 departments

Snowball sampling method to expand interviewee pool

126 LHD staff invited to participate in interviews

65 (52%) agreed to participate and were interviewed

From January to June 2013, 65 phone-based interviews with practitioners at 47 LHDs from 23 states.

Interviewees positions: 8 (12%) in communications, 15 (23%) in public information and public relations, 6 (9%) in communications and public information with a focus on emergency risk, 6 (9%) in social media or mHealth specific positions, 19 (29%) in emergency preparedness and re-sponse, and 11 (17%) in public health programming and education

Findings and Key Recommendations

Interviewees discussed key capacity issues that enable or hinder LHDs to use social media and mHealth, and suggested ways LHD could improve their work using these tech-nologies. The research team categorized the identified factors into 4 main thematic areas, as outlined below.

Thematic Area

Key Factors

Interviewee Suggestions & Requests

Recommended Actions for LHD Partners

Recommended Actions for Policymakers

In-House Capacity

• Knowledge among program staff and throughout the health department  

• Amount of funding and staff allocated to programs  

• Access to hard resources and technical support

• Improve staff and department knowledge of platforms  

• Expand LHD peer-information sharing about mHealth and social media uses  

• Build collaborations with industry to improve in-house capacity

• Assess internal baseline capacity and augment with support of external partners  

 • Expand existing communication plans

• Promote the creation of an information exchange database  

• Identify how to integrate local information sharing into a national-level system   

Leadership Support & Policies

• Support for mHealth and social media initiatives from LHD leadership  

• LHD policies to inform program development and platform use  

• Local, state, and federal policies and support for platform use

• Share best practices and advance an evidence base  

• Share internal policies among LHDs  

• State and federal policies should encourage platform use at the local level

• Learn from existing practices at other LHDs

• Support research to improve the evidence base for technology use  

• Develop methods to disseminate uniform messages  

• Modify requirements for Public Health Emergency Preparedness (PHEP) Cooperative Agreements  

• Revise public health preparedness capabilities 

Legal & Security Issues

• Ambiguous applicability of federal laws to LHDs  

• Liability concerns impeding platform use  

• Security concerns undermining program expansion

• Provide LHDs with guidance on the applicability of federal laws  

• Provide LHDs with resources to manage liability concerns

• Identify resources to inform internal health department policy development

• Circulate guidance to LHDs regarding the applicability of existing federal laws  

• Clarify how new technologies are regulated

Audiences

• Different platforms used for different purposes  

• Limited coordination and capabilities for two-way communication  

• Platforms tailored for vulnerable populations

• Improve collaboration with NGOs and other external entities  

• Integrate mHealth and social media platforms into communications plans

• Identify key audiences and understand how they communicate  

• Increase coordination with Community Based Organizations (CBOs)  

• Support system interoperability among programs and jurisdictions

• Support resources to reach vulnerable and at-risk populations

[biodefensebugchaser-blog]

59 test positive for tuberculosis after outbreak at Las Vegas neonatal unit

Associated Press, 12/23/13

LAS VEGAS - Las Vegas public health officials say dozens of people linked to a tuberculosis outbreak at a neonatal unit have tested positive for the disease.

The Southern Nevada Health District reported on Monday that of the 977 people tested, 59 showed indications of the disease, though all but two of the cases are latent - meaning patients don't show symptoms and aren't contagious.

Dr. Joe Iser, chief medical officer at the health district, said the report demonstrates the importance of catching tuberculosis early.

"We want physicians to really think about making the diagnosis and quarantining, and then calling us," he said. "This has been very expensive for us in terms of time and effort and dollars."

A state report released last month found that Summerlin Hospital Medical Center failed to recognize and take precautions to diagnose the infected woman's contagious lung disease when she gave birth in May to premature twin daughters, and allowed the woman to continue visiting her babies after she was discharged.

One of 25-year-old Vanessa White's babies died in June. White died in July at a Los Angeles hospital and was diagnosed with tuberculosis through an autopsy. Her other baby died of tuberculosis on Aug. 1 at Summerlin Hospital.

Iser said officials cannot know for sure that all 59 cases are directly linked to the Las Vegas hospital. Several of those tested are immigrants from countries where tuberculosis is more prevalent, and could have been exposed earlier in their lives, he said.

The health district is encouraging all 59 people to accept treatment.

TB is spread through the air when a sick person coughs, sneezes or speaks. Symptoms include coughing, chest pain, fever and fatigue. The disease usually attacks the lungs, but can affect other organs and can be fatal if not properly treated.

The Centers for Disease Control and Prevention counted 569 TB deaths in the U.S. in 2010, the most recent year for which data is available. The number of U.S. TB cases has been on a steady decline since a resurgence in 1992, and in 2012, reached the lowest level since national reporting began in 1953.

The Nevada Bureau of Health Care Quality and Compliance investigated the case, and determined that the Las Vegas hospital wasn't taking proper precautions to contain infections.

In November, eight employees, former patients and visitors filed a negligence lawsuit seeking damages from the hospital. Family members of the young mother who died of the illness have said they also plan to sue.

In the fall, investigators found that 26 people, including the mother's family members and hospital staff, had been infected.

Health officials then tested hundreds of babies, family members and staff who had passed through the neonatal intensive care unit. They contacted the parents of about 140 babies who were at the unit between mid-May and mid-August, and set up a temporary clinic to test them.

Health officials are expected to release a final report next summer.

They will continue to test the infants who passed through the hospital in the coming months, to ensure the babies don't develop any signs of the disease.

"I try to think, what if it was my son or daughter, my newborn infant, what would I want to be done?" Iser said.

LINK

[biodefensebugchaser-blog]

Infectious disease scorecard reveals state gaps, makes recommendations

Lisa Schnirring Staff Writer CIDRAP News Dec 17, 2013

Outdated information systems and budget cuts are among the problems that prevent the nation from doing a better job of preventing and controlling infectious disease outbreaks, according to detailed review today from two public health groups.

The report from Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) looked at key disease outbreak indicators for each state in finding gaps and overall themes that could improve the nation's detection and response capacities. The groups released the 124-page report, titled Outbreaks: Protecting Americans from Infectious Diseases 2013, today at a media telebriefing.

Over the past decade TFAH has released annual scorecards that rated the national and state preparedness and outbreak response, but Jeff Levi, PhD, executive director of TFAH, a nonprofit, nonpartisan advocacy group in Washington, DC, said the group shifted away from the preparedness focus this year because a consortium of groups has taken on the analysis of that component.

On Dec 4 groups led by the Association of State and Territorial Health Officials (ASTHO) and the Centers for Disease Control and Prevention (CDC) released the National Health Security Preparedness Index (NHSPI), billed as the most comprehensive measure to date and one that also provides a single composite measure for the country.

That 2-year effort gave the nation an overall preparedness score of 7.2 on a scale of 10, with state scores ranging from 5.9 to 8.1.

In the new report, TFAH and RWJF rated states on 10 key indicators of policies and capacities that protect against disease threats; the indicators focus on public health funding levels, meeting vaccination targets, having a climate-change adaptation plan, mandates for reporting healthcare-associated infection (HAI) reporting, public health lab capacity, and routine HIV screening.

A majority of states (34) scored 5 or lower on the key indicators, ranging from New Hampshire as the highest scoring at 8 to Georgia, Nebraska, and New Jersey, all tied for the lowest score of 2.

At the media briefing, Levi said 1 of every 20 hospitalized patients contracts an HAI, yet a third of states don't require reporting. He noted that only a quarter of states vaccinated at least half of their population against flu, and only two—Connecticut and Delaware—meet the federal goal of vaccinating preschoolers against pertussis.

He also noted that two-thirds of states reported a drop in public health funding between fiscal years 2011-12 and 2012-13. The report shines light on the nation's vulnerabilities, and though many states still grapple with austerity conditions, the report's findings can help them prioritize measures to shore up infectious disease prevention and detection, Levi said.

He said states can also take more creative paths for using existing public health dollars, such as taking advantage of Affordable Care Act and Medicare expansion measures designed to boost vaccination against flu and other preventable diseases.

Tom Inglesby, MD, chief executive officer and director of the Center for Health Security at the University of Pittsburgh Medical Center, told reporters there is a widespread misconception that infectious diseases are under control. "This report is a welcome clarion call," he said.

However, he added that there have been great US success stories in battling disease outbreaks. "When they [public health workers] have the tools they need, they do crucial work and do it very well."

Today's report contains several recommendations aimed at addressing gaps in disease prevention and control. Several revolve around boosting fundamental capacities, such as maintaining the public health workforce and arming workers with better surveillance tools. Other measures include countering antibiotic resistance, increasing vaccination levels, and improving the ability to quickly identify bioterror threats.

Another was battling complacency against ongoing infectious disease threats, such as HIV, hepatitis, and tuberculosis. The report points to an alarming rise in new HIV infections in young gay men.

Levy said constant vigilance is needed against those threats, and the nation always pays a bigger price when it lets its guard down against diseases like tuberculosis and HIV. "Each year we have a new cohort of people who need to get the prevention message."

[biodefensebugchaser-blog]

Women are much more likely than men to be killed in natural disasters. New research aims at improving their odds of survival.

[biodefensebugchaser-blog]

New York City to Require Child Flu Shots

By THE ASSOCIATED PRESS

Published: December 11, 2013

New York City will soon require young children who go to preschool or day care to receive flu shots.

The Board of Health voted on Wednesday in favor of the mandatory vaccine for children under age 6.

Dr. Jay Varma, the deputy commissioner for disease control, said the vaccine could save lives and keep as many as about 20,000 city children from getting sick. He said actual vaccinations as part of the program were likely to be performed in fall 2014 and should be given before the end of December to be effective.

The initiative takes effect in 30 days. The requirement will affect about 150,000 children.

Parents may opt out for medical and religious reasons.

Opponents say mandatory vaccinations give parents little say in determining the best course of health management for their child.

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[biodefensebugchaser-blog]

Islamic law and suspicion fuel polio resurgence

Imran Ali Teepu, Special for USA TODAY, 9 a.m. EST November 30, 2013

Once close to eradication worldwide, the dreaded disease polio is resurfacing in Muslim-majority countries where vaccinations are hard to come by due to war, religious edicts and ignorance, experts say.

The latest example comes this week in Syria, where a strain of polio originating in Pakistan has crippled more than a dozen children, according to doctors for the Kurdish Red Crescent. Cases have also been showing up in Somalia, Afghanistan and Nigeria.

The problem is prompting some polio-free countries to demand that visitors from high-risk countries take oral vaccines at the airport upon arrival if they cannot prove they've gotten the vaccine.

"The Saudi government has introduced restrictions for all those traveling to the Holy Land from polio-affected countries," said Mazhar Nisar of Pakistan's Ministry of National Health Regulations and Services.

"Every pilgrim is to take polio vaccine before traveling to Saudi Arabia and also upon arrival at any of the international airports in the Kingdom," Nisar said.

Polio is a highly contagious disease caused by a virus in the throat and intestinal tract that can cause paralysis, crippling and even death. It was once the leading cause of disability in the United States and infected millions of people worldwide until the introduction of the polio vaccine in the 1950s.

The disease was eradicated in the United States. Worldwide, there were fewer than a thousand cases and it was headed for total eradication until recently, according to the World Health Organization.

Polio outbreaks have been growing in Pakistan, Nigeria and Somalia, and people from those countries have traveled and spread it elsewhere. More than 1 million children in the Horn of Africa alone have not received polio vaccinations, according to the Polio Global Eradication Initiative.

In Somalia, teams of vaccine workers have been unable to get to children because of impediments brought on by a civil war in which some militant leaders prevent food and medicine from getting to the villages of their enemies. In Nigeria, some parents refuse to let their children be vaccinated unless vaccine groups give the families more benefits.

In Pakistan's Northwest territories, where Taliban clerics have significant influence, polio vaccination teams are maligned as un-Islamic or Western purveyors of poison meant to sterilize Muslim women.

A cleric in Pakistan's Punjab province warned that a jihad would be launched against polio vaccination teams, whose mission he labeled a Western conspiracy, frightening away a team that arrived in Muzaffargarh, according to The Express Tribune.

This week, militants in northwestern Pakistan kidnapped 11 teachers involved in a polio vaccination campaign. Local official Khyali Gul said the teachers were taken from a school in the Bara area, close to Pakistan's northwestern border with Afghanistan.

The United Nations in Pakistan pulled its staff involved in immunization from Pakistan after three eradication workers were shot in Peshawar and two of them were killed, in 2012. Since then, more vaccine teams have been targeted.

Without vaccination, the cases of polio are rising in Pakistan, as is the appearance of the Pakistani strain of polio in other countries where infected Pakistanis travel.

The Pakistani polio virus was found in sewage samples in Israel in June this year (the virus can be found in fecal matter of an infected person) and in Cairo in January.

Thousands of Pakistanis travel to Saudi Arabia every year for the Hajj, the pilgrimage to Islam's holy city of Mecca. And many Pakistanis have been flowing into Syria this year to fight in a civil war against dictator Bashar Assad.

Several cases were confirmed in a province bordering the Kurdish-controlled northeast, says the Kurdish Red Crescent. The United Nations confirmed 10 polio cases in northeast Syria, the first confirmed outbreak of the disease in the country in 14 years. The confirmed cases involved babies and toddlers.

A Syrian doctor gives the polio vaccine to a Syrian child during a government campaign to rein in the spread of the disease, at a health care center in Damascus, Syria, on Nov. 6.(Photo: Youseff Badawi, epa)

The World Health Organization says the once-rare disease could be resurrected and has declared a polio emergency across the Middle East. Allias Durray, a doctor who is the chief of polio eradication for Pakistan, warned that Europe may be next.

"After the Syrian polio outbreak and the flight of refugees in proximity to Turkey and European Union, it is evident that the polio virus is at the doorstep of Europe," he said.

Not all countries check for polio vaccinations among foreign visitors from countries where polio is considered endemic. The United States requires immigrants be vaccinated, but not visitors.

"We collaborate closely with international organizations and other countries to make sure that international and U.S. guidance on vaccination for immigrants is implemented, said Donda Hansen, media spokesperson for the Center for Global Health at the Center for Disease Control in Atlanta.

"The U.S. maintains 'elimination status' in the U.S. by aggressively investigating every suspected case to determine whether an importation has occurred, taking steps to prevent transmission, and safeguarding Americans," Hansen said.

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[brains-in-vats]

[biodefensebugchaser-blog]

Measles cases in U.S. rise; most unvaccinated, CDC says

For those who are interested, this article was published after reports from the CDC came out for this year. As most of you know, I am doing my thesis on declining vaccination rates and the impact on herd immunity. Please read the article, and then look into the recent 3 years of outbreaks of Measles in Europe, where almost 80,000 cases have been reported in the last 3 years. The measles vaccine is safe, DOES NOT cause autism or neurological injuries. Please do your due diligence before putting your child's life at risk. As a side note--there were over 40,000 cases of pertussis in the U.S. last year, many of them infants who were too young to be vaccinated, who were exposed by those who do not vaccinate. Some of those babies died. I respect everyone's choice, but in the case of vaccination, your individual rights cannot place the lives of others at risk (especially babies), but also in the cases of those who cannot be vaccinated due to underlying health issues or allergies. Please educate yourself, STOP listening to bogs, websites and message boards that appeal to parents emotionally, but have no backing in actual science. Here is the article. Enjoy!!!!

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[biodefensebugchaser-blog]

Risk to Food Safety Seen in Furloughs

By RON NIXON

Published: October 9, 2013

WASHINGTON — The government shutdown is endangering what America eats, food safety experts said this week, as all inspections of domestic food except meat and poultry have halted and the Centers for Disease Control and Prevention recalled furloughed workers to handle a salmonella outbreak that sickened hundreds of people in 18 states.

Offices are dark across the federal agencies charged with making sure that the fruit, vegetables, dairy products and a vast array of other domestically produced food are safe to consume. Inspectors, administrative staff, lab technicians, communications specialists and other support staff members have been sent home while lawmakers wrangle over government spending.

“This is a self-inflicted wound that is putting people’s health at risk,” said Representative Rosa L. DeLauro, Democrat of Connecticut, a longtime food safety advocate.

Because the shutdown comes on top of earlier budget cuts to the agencies, she said, “you’re creating the potential for a real public health crisis.”

At the same time, several crucial agriculture reports used by traders and farmers have been canceled because of the shutdown, seriously hampering decision making about planting and disrupting commodities markets. The highest-profile report canceled because of the shutdown is World Agriculture Supply and Demand Estimates, which supplies statistics on the worldwide production of crops from cotton to corn. It also provides data on other agricultural products, including meat and sugar.

“It leaves the commodities market in a bit of a fog,” said Christopher Narayan, an analyst with the bank Société Générale in New York, who said investors would face difficulties in obtaining accurate information.

At the Food and Drug Administration, which is responsible for inspecting the bulk of food that Americans eat, the agency has gone from a goal of inspecting about 200 plants per week to none and has reduced inspections of imported food. At the Agriculture Department, a meat and poultry hot line that consumers can call for information about food safety or to report problems is closed. At the C.D.C., about 68 percent of staff members were furloughed, including several epidemiologists and dozens of other workers who oversee a database that tracks food-borne illness.

These staff members identify clusters of sickness linked to potentially dangerous strains of bacteria like E. coli and salmonella, and their absences have significantly reduced the center’s ability to respond to an outbreak.

Even though the agency has brought back about 30 furloughed workers to handle the salmonella outbreak, which has been linked to raw chicken, the C.D.C. remains short-handed, said Barbara Reynolds, a center spokeswoman. “We’re still down to a skeleton crew,” she said.

Others worry that the agency is not getting its message out.

“When you have an outbreak and health alert like this, you have to get this information into the hands of consumers,” said Caroline Smith DeWaal, food safety director at the Center for Science in the Public Interest, a Washington research group. “The C.D.C. may have brought back some staffers, but their communications staff is working at reduced capacity and that’s a concern. The agency’s ability to get information out is limited.”

The Agriculture Department, which traced the salmonella outbreak to a poultry producer in California, has been spared the brunt of the sequestration cuts and the government shutdown. Since Upton Sinclair’s classic 1906 novel “The Jungle” exposed unsanitary conditions at meatpacking plants, federal law has required inspectors at meat and poultry processing plants.

“We’re up and running,” said David Goldman, assistant administrator with the Agriculture Department’s Food Safety and Inspection Service, which inspects meat and poultry plants. “Our inspectors, labs and field investigators are still on the job.”

At the F.D.A., about 45 percent of the agency’s staff members are furloughed. “F.D.A. is doing what it can under this difficult situation to protect public health,” said Steven Immergut, the agency’s assistant commissioner for media affairs.

Food safety advocates say that even without the government shutdown and budget cuts, the agency is limited in what it can do. Under normal circumstances, it inspects less than 2 percent of most imported food. (Imported meat and poultry are inspected by the Agriculture Department.)

The F.D.A. will not say what percentage of imported food is now inspected, only that it is less than 2 percent. The agency continues to deploy staff members at the nation’s ports to inspect some of the millions of pounds of food that come in each day from abroad, officials said.

About 20 percent of the food Americans eat is imported, including 85 percent of seafood and a significant amount of produce. But officials said the inspections consisted mainly of routine paperwork checks. The agency will conduct physical inspection of food and take samples but will be limited because of staff reductions, the agency said.

The F.D.A. does have contracts with states to continue some inspections because those inspections were paid for with money from the previous fiscal year, officials say. But nearly 9,000 inspections that were to be done by the states for the current fiscal year have been put on hold because of a lack of money.

A new food safety law, passed in 2011, that was supposed to give the F.D.A. greater enforcement powers had already been delayed because of the across-the-board budget cuts known as sequestration. It will now be further delayed because of the shutdown.

“This puts a strain on an already strained system and raises serious concern about the safety of the food we eat,” said Tony Corbo, a lobbyist for Food and Water Watch, a food safety advocacy group in Washington.

[biodefensebugchaser-blog]

Researchers at the National Institute of Allergy and Infectious Diseases (NIAID) and the National Heart, Lung, and Blood Institute, both part of the National Institutes of Health, have identified the cells in two distinct areas of the body that are simultaneously targeted for damage by anthrax toxins, eventually causing illness and sometimes death. Their findings, which appear online in Nature, are based on testing in mice. However, the results may contribute to the development of anthrax treatments for humans, the researchers say.