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Friday, August 10, 2012

Swine Flu Cases Rising With New H3N2 Strain, Now Transmissible From Human

Swine flu is making a comeback as a new strain of the virus has begun spreading, with more than 100 U.S. cases reported this year, according to the Centers for Disease Control and Prevention. The surprising culprit? State and county fairs. And doctors warn it has become much easier to transmit among humans...



.."This time of the year is the time when you have fairs around the country ... thousands of them," Bresee told CNN. "That accounts for the increased transmission more than anything else."

[link to www.ibtimes.co.uk]

Driver with 'ebola' symptoms quarantined in Mombasa

Health officials at the Aga Khan Hospital confirmed that
the 61- year-old man was admitted at the hospital on
Friday as soon as he arrived, and kept in isolation

.
MOMBASA, (Xinhua) -- A long-distance truck driver has been quarantined at a Mombasa hospital.
The patient was admitted that the Aga Khan Hospital after he was suspected to be infected with the deadly Ebola virus, a few days after his arrival from Kampala, Uganda.
Health officials at the Aga Khan Hospital confirmed that the 61- year-old man was admitted at the hospital on Friday as soon as he arrived, and kept in isolation...

Fears of Ebola outbreak as patient admitted in Kenya's coast

Fears of Ebola outbreak as patient admitted in Kenya's coast

English.news.cn 2012-08-11 00:55:38
MOMBASA, KENYA, Aug. 10 (Xinhua) -- Fears gripped Kenya's coastal city of Mombasa on Friday after a truck driver was quarantined at the local hospital.
The patient was admitted that the Aga Khan Hospital after he was suspected to be infected with the deadly Ebola virus, a few days after his arrival from Kampala, Uganda.
Health officials at the Aga Khan Hospital confirmed that the 61- year-old man was admitted at the hospital on Friday as soon as he arrived, and kept in isolation.
The Coast Provincial Director of Public Health and Sanitation Dr. Anisa Omar said the truck driver was admitted and found to be having symptoms of fatigue, sore throat and fever, prompting doctors to seclude him from the rest of the patients at the hospital.

"Yes, it's true the man was in Kampala from Aug. 3 and when he arrived at the facility, he was found to be having those symptoms, " Omar said.
He said the truck driver decided to seek medical attention at Agha Khan Hospital where he was isolated from the other patients after being examined by the doctors.
"He is a truck driver and he is likely to have contracted the virus while on his trip. But what I can tell Kenyans is that our doctors are on high alert and that is why they were able to detect the symptoms. We are yet to confirm if indeed it is Ebola," said Anisa.

The driver only identified as Moses, was examined by doctors at the hospital who said he had symptoms resembling those of Ebola, but tests would be conducted to confirm the same.
Omar said that the patient's blood samples have been taken to Kenya Medical Research Institute in Nairobi and the results will be relayed as soon as they are back.
She at the same time allayed fears of the virus spreading to other parts of the region urging that the situation was under control.
The incident comes a week after Public Health and Sanitation Minister Beth Mugo assured the country that the government was doing all it can to shield Kenyans from the deadly virus.
The development comes as a team of experts from the UN World Health Organization (WHO) and its partners are supporting the Ugandan government's response to an Ebola outbreak in the western part of the country.
The initial case was identified on July 28 in a family from the village of Nyanswiga, where 9 of the deaths were recorded. The total number has since risen to more than 15.
The deceased include a clinical officer who attended to a patient, and her 4 month-old child. Nine of the 14 deaths have occurred in a single household, according to WHO.
Both cases were admitted to hospital with fever, vomiting, diarrhoea and abdominal pain. Uganda has previously experienced outbreaks of Ebola fever, but the most recent outbreak was declared over in early 2008.
Last week, fears of an Ebola outbreak gripped the residents of Siaya and Eldoret Counties in Western and northwest Kenya respectively had caused panic in the country after words went round that suspect cases had been detected.
Experts say there is an urgent need to increase public awareness on this deadly disease as well as to put in place as strong surveillance mechanism to allow for proper follow-up of all the cases.
The East African nation has been full alert following the outbreak of the deadly disease in neighboring Uganda last week. The government has since established a taskforce to respond to the Ebola outbreak in neighboring Uganda.
The virus is transmitted by direct contact with the blood, secretions, other bodily fluids or organs of infected persons or animals such as chimpanzees, gorillas, monkeys and antelopes, and it has an incubation period of two to 21 days.
Sufferers can experience fever, intense weakness, muscle pain, headaches and a sore throat, as well as vomiting, diarrhoea, rashes and impaired kidney and liver function. In the most severe cases, the virus leads to both external and internal bleeding. http://news.xinhuanet.com/english/world/2012-08/11/c_131777040.htm

Kenya-Alert after truck driver exhibits Ebola symptoms

Alert after truck driver exhibits Ebola symptoms

A truck driver who recently returned from Uganda has been indisposed and medical practitioners are investigating if he has contracted ebola hemorrhagic fever.
Friday evening the Coast Provincial Public Health Officer Anisa Omar confirmed an unnamed patient who was bleeding from several orifices had been taken to a private hospital in Mombasa.

She told the Press patient returned from Uganda on August 3 and sought treatment after developing the symptoms.
Samples taken from him are being tested at the Kenya Medical Research Institute in Nairobi.
The patient has been admitted and segregated at the private Aga Khan Hospital in Mombasa together with four other people, all Kenyan, including a nurse who came in close contact with him at the institution when he came to seek treatment
Medical authorities have been on the alert following the eruption of the fever in Uganda because thousands of Ugandans and Kenya live and gravel between the two East African nations.
There is no consensus about the patient’s nationality because some accounts in the Public Health ministry said the man is a Ugandan visiting Kenya.
The director of medical services, Dr Shahnaz Sharrif confirmed the hospital had taken samples to Nairobi for verification.
http://www.standardmedia.co.ke/?articleID=2000063806&story_title=Alert-after-truck-driver-exhibits-Ebola-symptoms

200 H3N2v Cases In Gallia County Ohio


Recombinomics Commentary 14:00
August 10, 2012
The following update is currently available from Gerald E. Vallee, MD, Gallia County Health Commissioner, in regard to H3N2v virus:

There have been 200 suspected cases reported; 69 of those tested positive for Influenza A using the rapid flu test. Representative samples of the suspected cases have been sent for further testing.

There are currently 4 confirmed cases of H3N2v in Gallia County. All individuals had direct contact with swine at fairs.
The above comments from the Gallia County Health Department in Ohio provide insight on the relationship between the number of H3N2v cases and the number of confirmed cases. Earlier reports cited 62 cases confirmed by the influenza A rapid test, which suggested more than 150 cases were tested.
The above update increases the number of influenza A confirmed cases to 69, but as noted in the August 9 CDC telebriefing, seasonal influenza levels in the United States are low, so most state lab confirmed cases with be H3N2v, especially when linked to an outbreak at an agricultural fair.
Thus, it is likely that the 200 symptomatic cases were H3N2v infected, although CDC confirmation is lagging and only four confirmed cases from Gallia County have been reported and included in the CDC update. However, the CDC has ceded H3N2v confirmation to the state labs, so the number of “confirmed” cases is expected to increase significantly in today’s MMWR as well as future updates by state labs as well as the upcoming Friday updates by the CDC.
However, as seen in the above outbreak associated with the Gallia Junior County fair, many infected cases will not be tested, and the number of “confirmed” cases will significantly undercount large outbreaks.
However, the CDC has targeted testing of ILI cases associated with agricultural fairs, which limits detection of human to human transmission in clusters with too many to test. These largely outbreaks clearly demonstrate the ability of the current H3N2v to infect large numbers of humans.
The recently released sequences from confirmed cases in Hawaii, Indiana, and Ohio represent a novel sub-clade which was first reported at the West Virginia day care center in Mineral County in late 2011. This sub-clade (
A/West Virginia/06/2011 and A/West Virginia/07/2011) had an NA gene that was distinct from the NA in the first human H3N2v cases in 2011, which has not been acknowledged by the CDC. The matching of this sub-clade with all 2012 human H3N2v sequences (from Utah, Hawaii, Indiana, and Ohio) signals human adaptation, as well as human to human spread as seen at the day care center were there was no swine exposure, but 23 of the 70 contacts of the index case had ILI, and H3N2v was confirmed in one of the classmates.
The recently flu outbreak at a summer camp in Glen Spey, New York, suggests this H3N2v sub-clade continues to spread in cases with no swine exposure.

However, such recent cases and clusters have not been reported by the CDC.

http://www.recombinomics.com/News/08101203/H3N2v_Gallia_200.html

Avian influenza – situation in Indonesia – update

Avian influenza – situation in Indonesia – update
hat tip Michael Coston
10 August 2012 - The Ministry of Health of Indonesia has notified WHO of a new case of human infection with avian influenza A(H5N1) virus.

The case is a 37 year old male from Yogyakarta province. He developed fever on 24 July 2012, was hospitalized on 27 July and died on 30 July.

Epidemiological investigation on the case found that the case had four pet caged birds in his home, which is about 50 metres from a poultry slaughter house and near a farm.

Infection with avian influenza A(H5N1) virus was confirmed by the National Institute of Health Research and Development (NIHRD), Ministry of Health and reported to WHO by the National IHR Focal Point.

To date, the total number of human influenza A(H5N1) cases in Indonesia is 191 with 159 fatalities, 8 (all fatal) of which occurred in 2012.

Nebbi deaths due to dysentery, not Ebola – health authorities


Publish Date: Aug 10, 2012
Clinical examinations ruled out Ebola as the cause of the Nebbi couples death
 
By Benedict Okethwengu in Nebbi
The Nebbi district health officer Dr. Oryema Jakor has clarified that the couple whose death last Sunday sparked off an Ebola scare in the district could have died of dysentery and not the deadly hemorrhagic fever now reported in Kibaale district.
Luciano Opio, 81 and his wife Celestina Ongoja, 75 both residents of Obat village succumbed to death at Angal Hospital due to occasional sores in the mouth, abdominal pain, fever, vomiting and bloody diarrhea which ignited fears that they could have died of Ebola.
Dr. Jakor told New Vsion that they have clinically examined the two deaths and noted that there are strong indicators that dysentery was the cause of the ageing couple’s death.
"There is no need for the team of experts from Kampala to come into the district. This couple could have died of dysentery,” he said.
He noted that they were keeping a close watch on the members of the family and the health workers who handled the deceased.
The police from Parombo police post on Monday rushed to the funeral place of the couple to prevent the people from getting into contact with the dead bodies.
They did so after the district health authorities had informed and requested for Ebola experts from the ministry which caused panic among Nebbi health workers and residents in the district.
Ebola is a highly contagious viral infection, which comes with high fever and bleeding tendencies.
The symptoms include fever, vomiting, diarrhea, abdominal pain, headache, red eyes, bleeding from openings and measles-like rash.
It spreads fast when one gets in contact with body fluids of an infected person.
Meanwhile, Jakor appealed to the people in the district to be on alert and report any person showing signs and symptoms of Ebola to the nearest health center.
"We need to be on the lookout because most of businessmen dealing in local Waragi go to Kibaale. Therefore, Ebola is not far from us," he cautioned.
Apparently all the suspected Ebola cases in the country handled by the health workers have all turned out to be negative after its outbreak was reported in Kibaale and that it had claimed18 lives.

Ebola in Uganda – update

Ebola in Uganda – update

The Ministry of Health (MoH) is continuing to work with partners to respond to the Ebola haemorrhagic fever outbreak in Uganda. As of 8 August 2012, the MoH has recorded a total of 23 probable and confirmed cases, including 16 deaths. Of these, 10 cases have been laboratory confirmed by the Uganda Virus Research Institute (UVRI) in Entebbe.
The most recent confirmed case was isolated in Kagadi isolation facility on 4 August 2012. So far, samples from other districts tested have been negative for Ebola. Suspected cases that tested negative during the laboratory investigations have been treated for their ailments and discharged following recovery.
All people who came into contact with probable and confirmed cases of Ebola are being followed-up for a period of 21 days. Among the contact persons, 190 have completed 21 days of close monitoring, while 185 are still being closely monitored for any possible sign or symptom of illness.

Response

The Government is closely working with partners to implement interventions to respond to the outbreak. The partners include African Field Epidemiology Network (AFENET), EMESCO Foundation (a local NGO), Infectious Diseases Institute (IDI), Uganda Red Cross Society (URCS), Médecins Sans Frontières (MSF), US Centers for Disease Control and Prevention (US CDC), and WHO. WHO is also coordinating with Global Outbreak Alert and Response Network (GOARN) partners.
Efforts are in progress to mobilize additional resources to respond to the outbreak.
With the support of MSF, a temporary isolation facility for suspected cases has been established in Kagadi, Kibaale district.
Active surveillance is ongoing in and around Kibaale district, where the index case was identified. Teams are also being trained to provide psycho-social support to families affected by the outbreak.
Campaigns to raise awareness about prevention and control of Ebola are being carried out throughout the country. The MoH is advising the public to take measures to avert the spread of the disease and to report any suspected patient to the nearest health unit. Public announcements are being disseminated in 11 local languages on 20 radio stations at the national level. At the local level, over 120 URCS volunteers are conducting active door-to-door and community campaigns in over 85 villages.

Neighbouring countries

Countries sharing a border with Uganda are taking steps to enhance surveillance regarding Ebola; at the time of this update, none of them have reported any confirmed cases.
WHO does not recommend that any travel or trade restrictions are applied to Uganda. http://www.who.int/csr/don/2012_08_10/en/index.html#.UCUAuaoKxAE.twitter

198 Ebola Contacts Cleared to Go Home

One hundred ninety eight of the 410 suspected Ebola contacts in Kibaale district have been declared free of the hemorrhagic virus and reunited with family and community members. Dr Dan Kyamanywa, the Kibaale district Health Officer, says the contacts were declared Ebola free after 21 days elapsed without them showing the disease signs and symptoms.

Read more: http://ugandaradionetwork.com/a/story.php?s=44396#ixzz2396Xx5jh

Thursday, August 9, 2012

Health Ministry: 2 Ebola Patients In “Acute Condition”

Health Ministry: 2 Ebola Patients In “Acute Condition”

The Health Ministry has Thursday given the latest update on steps being taken to combat the deadly Ebola Epidemic.
The announcement came just hours before the government of Malawi cancelled a match with Cranes, citing 'the escalation of the deadly Ebola disease' in Uganda.
The government of Malawi further advised their FA to identify another team which is 'not a health risk' to the people of Malawi.

Below is the full statement by Health Ministry.

The Ministry has informed the general public that Kagadi Government Hospital has resumed its routine service, receiving and is attending to general patients.
The hospital had for the past two weeks been shunned by patients due to the inflow of suspected Ebola patients.
The reduction in Ebola suspected cases is due to the intensive sensitization of the public about the signs and symptoms of the disease.
Currently, there are still three conformed Ebola cases admitted at the hospital isolation unit. One patient is reportedly progressing well while the two are still in acute condition. The hospital recorded one suspected case yesterday bringing the current number of admissions in the isolation facility to 32.
A total of seven more patients who tested negative are being prepared by doctors and the psychosocial support teams for discharge.
So far, 17 people have been discharged from the hospital isolation facility.
A total of 408 people who got contact with the dead have been listed and monitored for possible signs since the onset of the outbreak.
Of these, 190 have passed the 21 days necessary for monitoring meaning that they did not contract the diseases.
The Ministry surveillance team, however, continues to follow up 211 cases. Five teams have been deployed in 26 villages to conduct contact listing and follow up.
The Ministry of Health wishes to clarify that no confirmed case has been reported outside Kibaale district since all alert and suspect cases from other parts of the country have tested negative.
The Ministry of Health wishes to clarify on media reports alleging that three more cases at Kagadi Government Hospital were yesterday confirmed to have Ebola.
There are no new confirmed cases as the people being referred to were confirmed by August 3rd and admitted in the acute section of the isolation facility. All samples tested since August 3rd have tested negative for Ebola.
The Ministry of Health wishes to further clarify that that since the onset of the epidemic, 10 cases have been confirmed to have Ebola.
Of these, three died, three are still admitted at Kagadi Hospital Isolation Facility while four recovered from the highly deadly contagious disease.
All confirmed cases are from Kibaale district as samples taken from other parts of the country tested negative.
All patients that tested negative are being discharged and re-integrated into their communities as per the discharge protocol. Every discharged case receives a discharge package including new beddings, clothing, kitchen ware, jerry cans and many others. Yesterday, the hospital registered one more suspected case bringing the current number of admissions to 30.
The Ministry of Health surveillance team is following up 248 people who got in contact with the dead and suspects.
A total of 84 people have completed the 21 days for monitoring meaning that they did not contract the disease and are therefore presumed free from the disease.
A total of 2,000 400sets sets of Personal Protective Equipment and body bags donated by the World Health Organization, MSF and the U.S. Center for Disease Control have been distributed to Kagadi Hospital, Mulago National Referral Hospitals and some regional referral hospitals.
Ministry of Health mobile van, airing short messages on Ebola prevention and control have has so far covered nine sub counties.
A total number of 62 village health teams and Red Cross volunteers were trained on Ebola prevention and control in Kibaale Town Council.
The Ministry of Health calls on the public to stay calm as assures the general public that all necessary measures have been put in place are being done to contain the spread of the epidemic and there should be no panic.  http://www.chimpreports.com/index.php/people/health/5448-health-ministry%3A-2-ebola-patients-in-%E2%80%9Cacute-condition%E2%80%9D.html

Dallas County declares state of emergency due to West Nile


WFAA
Posted on August 9, 2012 at 8:40 PM

DALLAS - Dallas County Judge Clay Jenkins declared a public health emergency in Dallas County Thursday due to the West Nile virus epidemic in the area.

Jenkins instructed the Homeland Security and Emergency Management Department to file a local disaster declaration with the state.

“This declaration will expand our avenues for assistance in our ongoing battle with West Nile virus," Jenkins said. "We are in constant communication with our state and regional partners. We will continue to make data and research driven decisions in seeking to supplement the outstanding work of Dallas County’s director of Health and Human Services (DCHHS) Zachary Thompson."

Jenkins organized a work session on Friday, August 10, with county, state and federal health and emergency management officials to discuss their response to the virus outbreak. They will hold a press conference afterward to share any pertinent information, updates and decisions reached.
 

Kagadi Hospital cleared as Iganga Hospital gets a new suspect

     Kagadi Hospital cleared as Iganga residents panic
Friday, August 10 2012 at 01:00
KIBAALE Kagadi Hospital in Kibaale District, which has been handling cases of Ebola patients, can now resume normal routine after officials yesterday gave it a go-ahead.
“The ministry wishes to inform the general public that Kagadi Government Hospital has resumed its routine service; receiving and are attending to general patients,” Dr Denis Lwamafa, a senior ministry official, said in a statement.
“There are still three confirmed Ebola cases admitted at the hospital isolation unit. One patient is reportedly progressing well while the two are still in acute condition. The hospital recorded one suspected case yesterday bringing the current number of admissions in the isolation facility to 32.”
But as Kagadi was sighing with relief, in Iganga, the situation was tense at the main hospital when a three-year-old girl was admitted with Ebola-like symptoms.
“The patient was oozing blood from the nose, mouth and other body parts, with high fever and high body temperatures which made us suspect that could be Ebola,” said Dr Siraji Kizito, the medical superintendent.
He said that the health ministry directed the hospital to isolate the victim as they send a team of experts to take samples and establish whether it was Ebola.
A total of 408 people who got contact have been monitored for possible signs . Of these, 190 have passed the 21 days necessary for monitoring and were cleared while 211 cases are still being followed up. http://www.monitor.co.ug/News/National/Kagadi+Hospital+cleared+as+Iganga+residents+panic/-/688334/1475548/-/gglqks/-/index.html

Uganda Ministry of Health Ebola Update (9 august).wmv

The bird flu has appeared in five northern provinces

 According to the Veterinary Department, Ministry of Agriculture and Rural Development, avian flu has hit the province of Ninh Binh. So far there were five provinces recurrence of avian influenza, Quang Binh and Ha Tinh and Hai Duong, Hai Phong and Ninh Binh.  Spray disinfection for ducks. (Photo: Lake Bridge / VNA)

 Specifically, 27/7, avian influenza occurred in Rural Nho Hao, Yen Lin, Yen Mo District, Ninh Binh province 730 children infected poultry. Then, on 31/7, avian influenza continue to be found in Yen Son, Tam Diep town makes 985 sick ducks, dead ducks and destruction of 1282.  Soon after discovery, Veterinary Department in cooperation with local authorities to conduct the entire destruction of infected poultry.  Animal Health Department said today the bird flu began appearing in some provinces in the Red River Delta region and some of North Central Province. The outbreak appears small, scattered, mainly on waterfowl forum in households. In the future, the outbreak may continue to appear scattered on poultry in areas at high risk. Up to now, almost 3 million doses of bird flu vaccine has been granted to the local and the number of dead poultry and local destruction of nearly 100,000. Veterinary Department also asked the local implementation of measures, not to drastically prevent the outbreak.  http://www.xaluan.com/modules.php?name=News&file=article&sid=449406

Uganda: interview with Ebola survivor, Kiiza Isaac

 

Date Published: 09/08/2012 12:32
Nurse Kiiza Isaac is no stranger to the deadly Ebola virus he caught it and survived. Kiiza was infected with a new strain of the virus, named after his home district of Bundibugyo in western Uganda, as he helped fight a outbreak of the disease there in 2007.
Kiiza Isaac, a 42-year-old Ugandan nurse who contracted Ebola and survived in 2007.
Kiiza Isaac, a 42-year-old Ugandan nurse who contracted Ebola and survived in 2007.© Agus Morales
Although Kiiza survived the outbreak, Ebola has claimed more than 1,500 lives since its discovery in 1976. The disease is spread via contact with infected bodily fluids and, without a known cure, can cause terror among infected communities.
As Kiiza’s story shows, health workers are often the first to fall victim to the virus. He is now working alongside Médecins Sans Frontières/Doctors Without Borders (MSF) to help others who have contracted the virus in the nearby town of Kagadi, where an outbreak of the disease was declared at the end of July 2012.
Question: Ebola outbreaks are often hard to identify due to the virus’ non-specific symptoms. What happened when the virus broke out in Bundibugyo?
Kiiza Isaac: In August 2007, a strange disease was identified in Bundibugyo. Deaths within the community became rampant and people were going to the health centres with high temperatures, abdominal pain, vomiting, diarrhoea and fatigue. They were not responding to anti-malarial treatment.
What were you doing at the time?
I was working as a nurse at Kikyo health centre, in Bundibugyo district. The Ministry of Health was informed about a strange disease in the area and their epidemiologists came and advised that the patients should be taken to hospitals.
How did people react to the outbreak?
The community did not know what was happening – they thought that the affected were bewitched. This continued until October, when we had 18 people admitted in Kikyo health centre.
Were you in close contact with the patients?
Emergency logistic coordinator Henry Gray helps a colleague into protective clothing during the ebola outbreak.
Emergency logistic coordinator Henry Gray helps a colleague into protective clothing during the Ebola outbreak. © MSF
I was collecting blood samples from them. I contracted Ebola because we did not have enough protective equipment to use. But at that time I did not know. I developed the same symptoms as the patients.
Blood samples were taken from me but the malaria test proved negative. I had a persistent fever. I was ill for three weeks. On 19th November 2007, I received the laboratory confirmation – I had contracted Ebola. It was a new strain, not the Sudan or Zaire strain; they named it Bundibugyo Ebola.
How did you become involved with MSF?
MSF came to Bundibugyo and they were running a treatment centre like the one here in Kagadi. Many patients were cared for in their treatment centre. Thank God, I survived.
After my recovery, I joined MSF and the Ministry of Health in the case management of Ebola patients until 2nd February 2008, when Bundibugyo was declared Ebola free.
With Ebola being transmitted through close contact with people, did anyone in your family catch the virus?
I was the head of the household and my infection was not yet confirmed. Three of my children and I contracted Ebola. We all survived.
But a cousin who was also a nurse at Kikyo and was taking care of me also contracted the virus. He was rushed to the hospital and died on 3rd November, before my results were confirmed.
How did your life change after this experience?
When I recovered, I continued treating others and doing psycho-social support until the district was declared free of Ebola. Currently, I am working at Bundibugyo hospital as a nurse.
When the outbreak was declared in Kibaale at the end of July, the World Health Organisation (WHO) requested the district to send a team of seven people who had worked in the isolation centre in 2007. So now I am giving my help to the Ministry of Health and the WHO.
What can patients learn from your story?
We tell patients that this is a disease. It has nothing to do with witchery. They should not fear.
When there is an outbreak, people just need to avoid contact with bodily fluids. But if they recover, after 21 days they are not patients any more – they are free of Ebola.
People should not fear them. They can have a normal life. http://www.msf.org.uk/articledetail.aspx?fId=interview_with_Ebola_survivor_20120809

AVIAN INFLUENZA (49): CAMBODIA, POULTRY, SOIL AND DISEASE TRANSMISSION


A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
Date: Wed 8 Aug 2012
Source: Emerging Infectious Diseases journal [edited]
http://wwwnc.cdc.gov/eid/article/18/9/12-0402_article.htm


Ref: Gutierrez RA, Buchy P: Contaminated soil and transmission of influenza virus (H5N1) [letter]. Emerg Infect Dis [serial on the internet]. 2012 Sep [date cited]
----------------------------------------------------------------------
Highly pathogenic avian influenza (HPAI) virus (H5N1) has been responsible for 603 confirmed human cases worldwide, including 356 that resulted in death, and for over 7000 epizootic outbreaks (1,2). Direct contact between hosts is the main mechanism of transmission for avian influenza viruses, but the possible role of the environment as a source of HPAI virus (H5N1) infection has been rarely studied, particularly in the context of countries where the virus is enzootic or epizootic (3-7). To determine if contaminated soil contributes to the transmission cycle of HPAI virus (H5N1), we used experimental and simulated field conditions to assess possible transmission in chickens.

All experiments were conducted by using HPAI virus (H5N1) strain A/chicken/Cambodia/LC1AL/2007 (GenBank accession nos. HQ200574-HQ200581). All animal experiments were conducted in the biosafety level 3 laboratory of Institut Pasteur in Cambodia (IPC), in compliance with the European Community 86/609/CEE directive and approved by the Animal Ethics Committee of IPC (permit: AEC/IPC/003/2010). Specific pathogen-free (SPF) chickens were provided by the National Veterinary Research Institute of Cambodia.

We used 3 types of soil: 1) sandy topsoil collected from around rice fields in Phnom Penh Province, Cambodia; 2) building sand purchased from a local building company; and 3) soil-based compost purchased from a local tree nursery. Physicochemical and microbiologic parameters were measured for water extracts obtained for each type of soil (Technical Appendix Table [available at the source URL above]), and low- and high-dose contamination protocols (Technical Appendix Figure [available at the source URL above]) were used to experimentally contaminate each soil type. In brief, we seeded the soil samples with 1-56 infectious units of contaminated feces; one infectious unit was 

Variant H3N2 cases surge in Indiana, Ohio

Date: Wed 8 Aug 2012
Source: CIDRAP (Center for Infectious Disease Research & Policy) News [edited]
http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/aug0812h3n2v.html


Variant H3N2 cases surge in Indiana, Ohio
-----------------------------------------
The count of swine-origin variant H3N2 influenza (H3N2v) cases in Indiana soared to 113 today [8 Aug 2012], a jump of about 100, while Ohio reported a total of 30 cases, double the previous number. But the states said they have not found any person-to-person transmission of the virus.

In a news release, the Indiana State Department of Health (ISDH) said the 113 cases are scattered among 18 counties and predicted that more cases would be confirmed this week. Most of the previous cases have been in children who had contact with pigs at county fairs, but today's announcement gave no details about the patients' age range, swine exposure, or severity of illness. The Ohio announcement states, "There are currently 30 cases of H3N2v statewide; all individuals had direct contact with swine at fairs and no human-to-human passage of the virus has been confirmed." The counties and their case numbers are Butler, 16; Clark, 3; Gallia, 4; Greene, 4; and Hamilton, 3.

The Ohio patients range from 6 months to 36 years old, the statement said. It said one patient was hospitalized as a precaution but has since been released. One other H3N2v case was reported recently in Hawaii. With the new Indiana and Ohio cases, the apparent total for the past few weeks has now reached 144. However, Tom Skinner, a spokesman for the US Centers for Disease Control and Prevention (CDC), cautioned that the growing case count in part reflects increased testing and that some of the cases may not ultimately be confirmed.

"The increase in Indiana and soon to be other states is because states are now reporting presumptive positive cases based on testing in their labs and part of this is because of increasing numbers of samples arrived for testing compared with last week," Skinner commented via e-mail. He added that the CDC believes most of the cases are still due to contact with pigs. "However, limited human-to-human transmission with this virus has been observed in the past, and we expect that some human to human spread will be observed in these current outbreaks," he said. The Indiana release said, "Health officials have not determined person-to-person transmission at this time, but continue to investigate the possibility."
Skinner and officials from the 2 states reemphasized the need to take precautions around pigs and when attending fairs. People should wash their hands before and after touching animals and should avoid eating, drinking, or putting anything in the mouth when visiting animal areas, officials said. They also reiterated that the virus is not spread through eating properly prepared pork. The CDC has said that people who have an increased risk for flu complications, such as the elderly, small children, and those with chronic diseases, should consider avoiding pigs and swine barns this summer. "It's important for folks to remember this is a mild illness with symptoms similar to what we see with seasonal flu," said State Health Commissioner Gregory Larkin, MD, in the Indiana statement today. The CDC has developed a candidate vaccine for the new strain, and clinical trials of versions made by two companies are expected this fall.

Indiana counties that have had H3N2v cases, according to today's announcement, are Bartholomew, Greene, Hamilton, Hendricks, Jackson, Jennings, Johnson, Kosciusko, LaPorte, Lawrence, Monroe, Morgan, Owen, Porter, Scott, Tipton, Washington, and White. A report from Indiana Public Media today said 68 people in Monroe County have contracted the virus. Penny Caudill, administrator of the Monroe County health Department, said the virus does not appear to have spread from person to person, according to the story. The swine barn at the Monroe County Fair was closed last week because of sickness among the pigs.

[Byline: Robert Roos, Lisa Schnirring]

Medical workers’ tales of treating Ebola patients

       
Coming face to face with death
Dr Samuel Ssemanda Kazibwe sits outside an isolation unit deeply engrossed in his newspaper.
About ten grey tents have been set up and cordoned off as the isolation camp for suspected Ebola patients at Mulago hospital.
From where I and other people are standing, Dr Ssemanda could as well be sitting in a recreation park enjoying a best seller. When some people learn it’s the Ebola isolation camp, they run as fast as their legs can carry them. Before letting ourselves in, we ask if it’s okay to proceed. Where can we step or not? Do they have any protective gear we can wear?
“Do you see him wearing anything?” the askari asks, pointing at Dr Ssemanda who is wearing no more than a blue stripped shirt, black stripped trousers and black shoes.
“One can say knowledge is power. So, the main thing that protects us as medical workers is precautionary measures,” Dr Ssemanda says.
“We fear but we are brave. Some medical workers agreed to work with the team and others refused.”
But Ssemanda’s colleague, Dr Baterana Byarugaba, the executive director at Mulago hospital who has worked on Ebola cases and continues with this outbreak, is more reticent.
“Why don’t you ask why policemen go into riots and demonstrations? You go and ask the soldiers why they go to war even when there are flying bullets. Isn’t it their work? Then why ask me?” Byarugaba responds.
Just over the fence and outside from where Ssemanda is sitting, the public is in panic. No shaking hands, no touching, no kissing. Last week, President Yoweri Museveni advised people to avoid handshakes and casual sex.
He himself does not shake hands anymore. At Parliament, disinfectants are provided at the entrance and people must sanitise their hands before walking in least they carry the virus and put the lives of MPs and Parliament staff at risk.
Anyone entering or exiting the country must also wash with water and bleach or chlorine at the airport. While Ebola may not be as contagious as some other deadly diseases like Marburg, people live in fear of it. And you can understand why.
The disease kills in less than a week and the deaths are painful - severe fever, non-stop bleeding from all openings, diarrhoea and vomiting. Even more scary, there is no treatment and no vaccine. One has to rely on their immune response to fight off the disease.
But even with this frightening scenario, doctors, the most at risk group for secondary infection, know how to navigate the risks because they have the facts: transmission requires direct contact with infected bodily fluids, including blood, sweat or saliva.
When a case is announced, doctors know what to do; wear protective gear like gloves, gowns, boots, face masks, goggles. Do not touch anything that has come in contact with an infected person, keep a distance from the patient, and disinfect using chlorine.
“Whenever you are exposed to something for a long time, you lose fear. For me I have worked on several outbreaks like the Marburg, Ebola in Bundibugyo, and cholera,” Ssemanda says.
But Ssemanda concedes that medical workers are subjected to psychological torture at times. For instance, some of their colleagues tend to avoid them, often referring to them with the viral name. However, as professionals, they have to simply carry on with the work.
Ssemanda’s observations bring back memories of Dr Mathew Lukwiya who braved the Ebola outbreak at Lacor hospital in Gulu district where some 425 cases were reported and 224 people died.
But Lukwiya’s bravery cost him; a patient spat blood in his face as he coughed and the doctor caught the virus. He died shortly after. When the disease reoccurred in Bundibugyo, Dr Jonah Kule and other medical workers were caught unawares.
Ebola presented itself as a typical infection and the medical workers handled it as a mysterious disease. By the time it was identified, it was too late. Kule was moved to Mulago but his fate had been sealed - he died. In the recent outbreak, 13 doctors were isolated and monitored for possible infection.
Perhaps what is keeping Ssemanda calm is because all the 29 patients who were quarantined at the Mulago isolation camp were discharged because the laboratory tests done at the Uganda Virus Research Institute in Entebbe returned negative for the hemorrhagic fever. So far, 18 people have died and scores are being monitored in Kibaale district, where the disease is mostly concentrated.
“I work because I like helping people, I like challenges. I fear death but this is my profession. I am also a brave man,” Ssemanda says.

What is Ebola?

Dr Joseph Wamala, a senior epidemiologist at the ministry of Health, explains that Ebola is a Zonotic disease primarily found in bats and monkeys. It affects humans when a person gets in contact with an infected bat or something contaminated, like a fruit. This partly explains why it usually starts in the countryside.
The disease was first detected in 1976 when it broke out in the DRC and South Sudan. It is named after a river in the Congolese village where cases were first reported.
The first time Ebola was heard in Uganda was in 2000 when there was an outbreak in Gulu. Many people suspected that Ugandan soldiers returning from DRC had carried it over, but that link was never proven.
Cases were also reported in Masindi and Mbarara. By the time the disease came to light last week, it had killed 15 people in Kibaale district. Worldwide, some 1,800 people have been diagnosed with the disease, 1,200 of whom died.
When doctors receive a patient, they look out for symptoms such as high fever, weakness, nose bleeding, vomiting and diarrhoea. But the same symptoms can also manifest in many other ailments. Mulago hospital recently received a 32-year-old patient from Kyebando with these symptoms but on closer scrutiny, it wasn’t the dreaded Ebola.
A picture [of Ebola infection] can come but we have to evaluate before we can tell it is indeed Ebola,” says Dr Ssemanda, who is heading the Ebola team at Mulago.
“Anybody from an area with Ebola is an alert case ... we only got Ebola suspects whom we were treating as Ebola patients basing on clinical diagnosis. But when we got viral lab results from Entebbe, we discharged them. The Ebola cases are now in Kibaale.”
When suspected cases are received, the patients are given anti-malarials, antibiotics for bacterial infections, vitamins, anxiety drugs and anti-amoebic drugs.  http://www.observer.ug/index.php?option=com_content&view=article&id=20302%3Amedical-workers-tales-of-treating-ebola-patientscoming-face-to-face-with-death&catid=34%3Anews&Itemid=114

HFMD eases in Vietnam, dengue and H5N1 take stage

      
Last Updated: Wednesday, August 08, 2012 05:40:00
A child with blisters on his knee is examined for hand, foot and mouth disease at a hospital in Vietnam.
Vietnam’s Health Ministry said the spread of hand, foot, and mouth disease is cooling its heels as dengue infects more people and bird flu threaten to recur.
The number of new HFMD cases has dropped and caused six deaths in July.
The ministry’s Preventive Health Department reported 7,461 infections in July, a 49.2 percent drop from June. The death rate meanwhile is nearly six times lower than the same period last year, news website VietNamNet reported Monday.
Local governments were asked to stay vigilant to contain any new outbreaks and the spread of current ones.
Vietnam recorded 57,900 cases of hand, foot and mouth disease over the first half of this year, including 29 casualties, the department said in a report. Last year, 110,000 people were infected including 169 deaths.
Most of the patients are children under five years old, falling sick first with mouth sores and blisters on the hands and feet.
The disease, which has no vaccine or specific medication, is caused by the Enterovirus, but health officials said HFMD in Vietnam is plagued by the most dangerous strain EV-71, which has caused all the fatalities and around 80 percent of the infections this year.
Meanwhile, the department warned about dengue fever outbreaks in southern Vietnam, where monsoon season has just begun.
A report from the Pasteur Institute in Ho Chi Minh City listed 11 deaths out of 21,215 dengue fever cases in the south this year, a 20 percent increase year-on-year, according to a Nhan Dan report July 2. Three of the deaths and nearly 5,000 of the infections were from Ho Chi Minh City. The bird flu outbreak is also likely to recur as sick fowl were reported in northern Vietnam in recent months.

The bird flu outbreak is also likely to recur as sick fowl were reported in northern Vietnam in recent months.
Four people were infected with the virus in February and March, including two fatal cases from the Mekong Delta, one from Binh Duong Province outside Ho Chi Minh City and another from the Central Highlands’ Dak Lak Province. Four people were infected with the virus in February and March, including two fatal cases from the Mekong Delta, one from Binh Duong Province outside Ho Chi Minh City and another from the Central Highlands’ Dak Lak Province. http://www.thanhniennews.com/index/pages/20120808-hfmd-eases-in-vietnam-stage-given-to-dengue-fever-bird-flu.aspx

CDC: 158 cases of new swine flu strain from pigs

This is not a pandemic situation," said Dr. Joseph Bresee of the Centers for Disease Control and Prevention.
But any flu can be a risk for some people, and people should be cautious when they can, he added.
The case count jumped from 29 a week ago to 158 this week, thanks to a wave of new cases in Indiana and Ohio, said Bresee, the agency's chief of influenza epidemiology.
Most of the infected patients are children - probably because many were working closely with raising, displaying and visiting pigs at the agricultural fairs, Bresee said.
The recent cases include at least 113 in Indiana, 30 in Ohio, one in Hawaii and one in Illinois, Bresee said in a conference call with reporters.
The count is changing rapidly. Indiana health officials on Thursday afternoon said they had seven more confirmed cases than Bresee noted. That would raise the grand total to 165 so far.
Also, diagnosis of cases has become quicker in the last week. CDC no longer must confirm a case with its own lab. Now states are using CDC test kits to confirm cases on their own on, speeding the process along. The newly reported cases were likely infected a week or two ago.
The CDC has been ..
http://hosted.ap.org/dynamic/stories/U/US_MED_SWINE_FLU?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT

CDC: 158 cases of new swine flu strain from pigs H3N2

Updated: Aug 09, 2012 2:33 PM EDT

     

Officials say there's been a five-fold increase of cases of a new strain of swine flu that spreads from pigs to people.
The case count jumped from 29 a week ago to 158 this week, thanks to a wave of new cases confirmed in Indiana and Ohio.

Nebbi DHO: Deaths due to dysentery, not Ebola

The Nebbi District Health Officer Dr Oryema Jakor has clarified that the couple whose deaths on Monday sparked an Ebola scare in the district could have died of dysentery and not the deadly disease now reported in Kibaale district.

Read more: http://ugandaradionetwork.com/a/story.php?s=44384#ixzz235Hfnr3L

more on Chinese Company Abandons Work Over Ebola Scare

Chinese Company Abandons Work Over Ebola Scare

                   By
This was after one patient in Masha, Isingiro died mysteriously last week, with residents suspecting Ebola was the cause of her death.
But when her blood was taken to Entebbe Virus Research Institute, it was found negative of the Ebola virus but this has not convinced the Chinese to get back to work.
Road construction trucks on the Isingiro road still lie idle where they are being guarded by private security personnel.
The construction works on Mbarara-Isingiro road started early this year after residents went on strike complaining about the deteriorating state of the murram road to the Uganda-Tanzania border.
The Ministry of Health on Tuesday started the reintegration of suspected patients into their communities after weeks of treatment and monitoring.
Health experts have also managed to successfully treat and save the lives of four Ebola patients while 3 have died since the breakout of the epidemic was confirmed late last month.
The Ministry of Health surveillance team is following up to 248 people who got in contact with the dead and suspects.  http://www.chimpreports.com/index.php/people/health/5431-chinese-company-abandons-work-over-ebola-scare.html

Ebola outbreak is quelled — this time


..While the immediate crisis has been averted with only 60 diagnosed patients so far, this was an outbreak that had many in the international public health community concerned. The problem was the long lag in determining whether the mysterious deaths were, indeed, part of an Ebola outbreak. In the western Kibaale district, the possibility that Ebola was responsible for the first victim’s death was not immediately understood since the patient, and several others, did not have typical symptoms. They suffered from fevers and vomiting, but there was no sign of hemorrhaging.

Funerals for the victims, who appeared to die out of the blue, became large public events where exposed family members mingled with neighbors and friends, thereby increasing the likelihood that the virus would spread. (It passes through blood or other bodily fluid secretions.) An unsuspecting public health worker from the Kibaale district then travelled to the capital city of Kampala and died there. Kampala has about 1.5 million citizens.

At last tracking, the US Centers for Disease Control, the World Health Organization, and Uganda’s ministry of health (which has increased both access and communication with support from the Gates Foundation) have all deployed resources. They now believe that they have identified the 400 or so people who came into contact with exposed patients. Monitoring of these patients will last another 21 days until the virus is contained. This means, sadly, until it has finally killed all its victims and has no other place to go....
http://bostonglobe.com/opinion/2012/08/09/how-stop-deadly-virus/IPKgrWeXfYfyJpnFRvRvOO/story.html

Uganda Ministry of Health Ebola Update (8th August).wmv

Update:In the last 24 hours,1 new suspected case of Ebola.10 people discharged.179 people have completed the 21 day follow up period.
http://www.youtube.com/watch?v=0l_1cBHHZfc&feature=plcp

17 patients cleared of Ebola, get Shs50,000

Dr Allan Niyonzima Muruta (L), the district health officer of Kiboga, and other health workers at Kiboga Hospital demonstrate how medics should dress while treating Ebola patients.
Dr Allan Niyonzima Muruta (L), the district health officer of Kiboga, and other health workers at Kiboga Hospital demonstrate how medics should dress while treating Ebola Thursday, August 9 2012 at 01:00
In Summary
Health workers are monitoring 400 people in communities suspected of having been in contact with Ebola patients.
Kibaale District health authorities on Tuesday discharged 10 patients who were admitted at Kagadi Hospital on suspicion of being infected with Ebola. The district health officer, Dr Dan Kyamanywa, said a total of 17 patients have been discharged from the hospital and re-united with their families.
“We have seven patients admitted in the high risk isolation ward out of which three have tested positive but they are clinically improving,” Mr Kyamanywa told this newspaper on Wednesday. He said medics were monitoring more than 400 people in communities suspected of having been in contact with Ebola patients. “Out of these, 94 have been monitored for 21 days and have been declared Ebola free,” Mr Kyamanywa added.
Those discharged were given blankets, mattresses, sauce pans, cups, plates, rice, among other items. Most of those discharged were admitted at the hospital on July 29 after showing signs similar to of Ebola but they tested negative.Also discharged were Aston Byamukama, Steven Byaruhanga and Robert Bitamazire inmates from Kibaale Prison. "That leaves 1 escapee and 1 still being monitered"  They, however, were taken back to prison. Dr Kyamanywa said the World Health Organisation also gave start-up pocket money of Shs50,000 to each discharged patient.
Meanwhile, health personnel called police to close Muhorro and Nyamarunda markets which attempted to operate last weekend despite a ban. The district Ebola taskforce vice chairperson, Mr Stephen Mfashingabo, said traders reported to the markets in the morning. “We acted swiftly and police managed to enforce the ban on markets remaining closed until the district is declared Ebola-free,” Mr Mfashingabo said.
The district LC5 chairperson also banned social gatherings such as weddings to minimise possibilities of escalating further infections of the highly contagious disease.

Meanwhile, two people suspected to be suffering from Ebola have been admitted at Kisizi Missionary Hospital in Rukungiri District and put in an isolation unit.
One of the patients is said to have been in Kibaale District three weeks ago but later decided to go back to his home in Rukungiri where he later on fell sick and developed Ebola symptoms such as vomiting and diarrhoea.
He was admitted on Sunday. The second patient arrived at the facility on Tuesday. “The patients have been isolated and their samples have been sent to Uganda Virus Research Institute Entebbe for screening,” Sister Maureen Tumwebaze, the nurse in charge of the isolation section, said on Tuesday.

http://www.monitor.co.ug/News/National/17+patients+cleared+of+Ebola++get+Shs50+000/-/688334/1474490/-/jvqtp5z/-/index.html

Wednesday, August 8, 2012

Another report of Chinese Contractors Flee Isingiro Over Ebola

Chinese Contractors Flee Isingiro Over Ebola

By The Online Team

The Chinese contractors under the China Community Company halted work immediately after news spread late last month that a resident of Masha Isingiro district might have died of Ebola. Work on the road has now stopped completely.  http://redpepper.co.ug/welcome/?p=41919



China is in Uganda doing some work for sure.. In Uganda, he said, there are about 11 Chinese companies involved in construction works out of which nine are government owned and actively compete for business in China. http://in2eastafrica.net/uganda-government-urged-to-involve-self-in-business/

a recent report of them building a school China to construct Chinese teaching school in UgandaPublish Date: Apr 11, 2012 http://www.newvision.co.ug/news/630281-china-to-construct-chinese-teaching-school-in-uganda.html

Lira Hospital on Alert as One Person is Admitted with Ebola-like Illness- UPDATE- POSSIBLE NEW SUSPECT- AWAITING TEST RESULTS

Medical workers and patients at Lira regional referral hospital are in a state of fear after one person was on Tuesday night admitted at the health facility with ebola-like symptoms.


Read more: http://ugandaradionetwork.com/a/story.php?s=44340#ixzz22yDMQG5Y

here is an update from  a Blog by Yvette Vreeker I got from here.  The latest news report says Tues nite a patient came in.
 this statement references a previous scare

 ..We were not only impressed by the performance of this woman. We also noticed that they are extremely well prepared for a possible inclusion of patients infected with Ebola. There is already a group of volunteers ready and the psychiatric department is already prepared to act as an isolation ward. They were just 'on high alert' last Saturday when a man was recorded with bleeding, but was too drunk to have a stomach bleeding and liver failure as a result. The Ebola test was also negative. They are so well prepared and that is reassuring. And Petua plays an important role in this, she knows exactly what to do. There appears Ebola does not spread from the dist target Kibaale in western Uganda, which is good news...
http://www.jehoel.eu/nl/node/57

 I am still searching for confirmation on the latest suspect.

Update #3  Another new report of a suspect in Lira. This time he has a name. Waiting for test results

Ebola Suspected Case in Lira District

  on August 9, 2012


By Emmanuel Omona
Workers in Lira Regional Referrals Hospital are in panic following the admission of a suspected Ebola patient was admitted .
Henry Lewgalethe, suspected patient, is a resident of Rainbow trading centre, Aduku road just meters from Lira town was rushed to the facility on Wednesday night at around 11pm in a critical condition after he fell sick with Ebola like symptoms.
Grace Atim, Lira district Health Educator/Ebola taskforce spokesperson advised the residents in the hospital to remain calm.
Atim also urged the patients to remain calm saying that blood sample drawn from the patient has been sent to the Uganda Virus Research Institute in Entebbe for further investigations.
Mental Unit ward at Lira Referral Hospital has been set aside as an isolation centre for the Ebola patients.

http://www.ugandapicks.com/2012/08/ebola-suspected-case-in-lira-district-65044.html?utm_source=twitterfeed&utm_medium=twitter

Rapid risk assessment: Outbreak of Ebola haemorrhagic fever in Uganda

ABSTRACT
In the light of an outbreak of Ebola haemorrhagic fever in Uganda, ECDC has considered the risk to public health in the EU.
The risk of becoming infected is considered to be low unless a person is in direct contact with bodily fluids of dead or living infected persons or animals. It is therefore unlikely that EU citizens in Uganda will become infected. In the unlikely event that a traveller infected in Uganda arrives in the EU while incubating the disease and develops symptoms, they should seek medical attention and be isolated, which will prevent further transmission. http://www.ecdc.europa.eu/en/publications/Publications/Forms/ECDC_DispForm.aspx?ID=939