David Bowie has been honored with a small mountain of flowers outside his SoHo apartment, late night television odes, musical performances by his peers and fans, and a (symbolic, but not real) constellation since his death at the age of 69 last week. And now he’s gotten his own official day in NYC. [ more › ]
On Thursday, the findings of a public inquiry into the murder of Russian spy Alexander Litvinenko will be published. The case has put a strain on UK-Russian relations, as Samira Shackle reports from London.
The death of a popular turtle – celebrated as a symbol of Vietnam’s struggle for independence – has led to a national outpouring of grief. The revered reptile is thought to have been about 120 years old.
The European Parliament will require the Danish government to explain its controversial plans to confiscate cash and valuables from arriving migrants.
But not everyone is. The brilliant thing about an incremental state-level anti-choice strategy is that it can be easy for the average person to miss. There’s been no blanket federal abortion ban that makes national headlines and provokes mass protests—just 318 state laws passed since 2010 that each, individually, made the procedure just a little harder to get but collectively make it all but impossible for millions of Americans in many states.
It’s not surprising then that much of the public has no idea just how many barriers to abortion care politicians have enacted lately. A new national poll commissioned by the National Institute for Reproductive Health (full disclosure: I used to work there) finds that less than half of voters are aware of this trend. But once they learn about it, they’re not happy about it. Nearly two thirds say these anti-choice laws are taking us in the wrong direction and huge majorities support policy proposals to, well, basically undo them: to ensure, above all, that abortion is regulated based on medical evidence, not politicians’ political beliefs.
Like a recent survey by Vox, the NIRH poll also found widespread agreement about what the abortion experience should be like: safe, legal, informed by accurate medical information, respectful, supportive, affordable, and without shame.
Only about one in five respondents said getting an abortion should be emotionally difficult, expensive, uncomfortable, embarrassing, or difficult in terms of travel or logistics. In other words, the vast majority of American voters—whether they identify as pro-choice or pro-life, whether they think abortion is morally wrong or not, whether they’d personally get one or wouldn’t dream of it—think abortion should be a positive experience for those who do chose it. Which makes them utterly out of step with the anti-choice extremists currently populating our state legislatures—a fact they may just not realize.
There’s hope that tide may be turning though. NIRH reports that the number of proactive pro-choice state bills, both proposed and enacted, more than doubled between 2014 and 2015. Last year, 76 of them passed in 31 states. And NIRH is looking to make it even easier for advocates and lawmakers to go on the legislative offensive with a “playbook for abortion rights” that includes dozens of model bills to advance reproductive health and rights. It’s a page literally out of the anti-choice movement’s playbook: Americans United for Life’s model legislation has spread like wildfire throughout the states. If it’s been a winning strategy for an agenda only a vocal minority of Americans support, it’s past time for those of us with public opinion on our side to get in the game.
Your apology is NOT ACCEPTED, Governor Snyder. OWN it, You’re responsible for the poisoning of Flint citizens. You can’t say you take full responsible for fixing something and not accept responsibility for CAUSING THE DISASTER.
A 6-year-old girl gets tested for levels of lead in her blood. A study found that the levels of lead in the blood of young children had more than doubled since this city switched its water source.
Between 14 and 15 January 2016, the National IHR Focal Points (NFP) for Guyana, Barbados and Ecuador notified PAHO/WHO of cases of Zika virus infection.
On 14 January, the NFP for Guyana reported the first laboratory-confirmed case of locally-acquired Zika virus infection in the country. The case is a 27-year-old female from Berbice, Region 6, with onset of symptoms on 1 January.
On 16 January 2016, Ministry of Health of Bolivia, through its National IHR Focal Points (NFP), notified PAHO/WHO of the first laboratory-confirmed cases of locally-acquired Zika virus infection in the country. The case is a 32-year-old pregnant woman from Portachuelo, Santa Cruz Department, with onset of symptoms on 8 January. She has no recent history of travel.
On 12 January, samples of the patient were sent to the National Center for Tropical Diseases for testing. On 14 January, the case was confirmed by polymerase-chain reaction (PCR) (viral genome detection).
Five days ago the CDC issued a Level 2 (Enhanced Precautions) Travel Alert for Zika Virus for portions of South & Central America and the Caribbean, and while specifically mentioning 14 countries and territories, granted that the number of affected regions would likely expand.
As of today, PAHO lists 20 countries and territories in the Americas with autochthonous transmission of the Zika Virus, and that number is only expected to rise.
Yesterday it was widely reported (see 2 cases of Zika virus confirmed in Miami-Dade County) that Florida’s DOH had confirmed 3 recently arrived international travelers had been diagnosed with the Zika virus; two in Miami-Dade who returned from Columbia last month, and one in Hillsborough County who visited Venezuela in December.
Again yesterday, the Illinois State Department of Health announced two pregnant women – with recent travel to Zika endemic areas – have tested positive for the virus.
19th Jan, 2016
SPRINGFIELD – The Illinois Department of Public Health (IDPH) is alerting the public of the potential of contracting Zika virus while traveling abroad. Zika virus is spread to people through mosquito bites, similar to West Nile virus or dengue fever. While illness is usually mild and severe disease requiring hospitalization is uncommon, there is a possible link between Zika virus infection in pregnant women and subsequent birth defects.
Two pregnant Illinois residents who recently traveled to countries where Zika virus is found have tested positive for the virus. Physicians are monitoring their health and pregnancies.
“There is virtually no risk to Illinois residents since you cannot contract Zika virus from another person, but only through the bite of an infected mosquito,” said IDPH Director Nirav D. Shah, M.D., J.D. “But since this is a time of year when people travel to warmer climates and countries where Zika virus is found, we are urging residents, especially pregnant women, to take preventive measures when traveling in affected countries and check health travel advisories.”
This is precisely the kind of scenario the CDC hopes to avoid going forward with their recently issued travel warning.
During the dead of winter mosquito activity is practically non-existent across much of the nation, and significantly dampened even here in central Florida. Were this summer or fall, there would be greater concern over the possibility of viremic visitors `seeding’ the virus into local mosquito populations and sparking local transmission.
This is how both Dengue and Chikunungya are believed to have been (temporarily) introduced into Florida’s mosquito population in recent years, and local transmission has occurred (see Arboviruses: (Already) Coming To America).
With Zika, Dengue and Chikungunya all spreading rapidly across the tropical Americas, this is a threat we will undoubtedly have to deal with increasingly over the coming months and years.
|Zika Testing Algorithm – MMWR Jan 2016|
Last Friday the CDC issued a HAN advisory for clinicians on Recognizing, Managing & Reporting ZIka Virus Infections In Travelers. Yesterday the CDC’s MMWR published a lengthy set of interim guidance for pregnant women during a Zika Outbreak.
These guidelines include recommendations for pregnant women considering travel to areas where Zika may be acquired and recommendations for screening, testing, and management of pregnant returning travelers.
Last week the CDC issued a travel advisory suggesting:
- Pregnant women in any trimester should consider postponing travel to the areas where Zika virus transmission is ongoing. Pregnant women who must travel to one of these areas should talk to their doctor or other healthcare provider first and strictly follow steps to avoid mosquito bites during the trip.
And as I reported earlier today, health authorities are already seeing pregnant women with travel history to Zika endemic areas return with the virus (see PAHO: Zika Marches On).
As we’ve seen with so many other emerging infectious diseases (MERS-CoV, Avian Flu, Dengue, etc), one of the most important steps is for patients to share their travel history with their health care provider.
Follow the link below to view the full MMWR interim guidance:
Early Release / January 19, 2016 / 65(2);1–4
Emily E. Petersen, MD1; J. Erin Staples, MD, PhD2; Dana Meaney-Delman,, MD3; Marc Fischer, MD2; Sascha R. Ellington, MSPH1; William M. Callaghan, MD1; Denise J. Jamieson, MD1 (View author affiliations)
CDC has developed interim guidelines for health care providers in the United States caring for pregnant women during a Zika virus outbreak. These guidelines include recommendations for pregnant women considering travel to an area with Zika virus transmission and recommendations for screening, testing, and management of pregnant returning travelers.
Updates on areas with ongoing Zika virus transmission are available online (http://1.usa.gov/1OGZ6iI). Health care providers should ask all pregnant women about recent travel. Pregnant women with a history of travel to an area with Zika virus transmission and who report two or more symptoms consistent with Zika virus disease (acute onset of fever, maculopapular rash, arthralgia, or conjunctivitis) during or within 2 weeks of travel, or who have ultrasound findings of fetal microcephaly or intracranial calcifications, should be tested for Zika virus infection in consultation with their state or local health department. Testing is not indicated for women without a travel history to an area with Zika virus transmission. In pregnant women with laboratory evidence of Zika virus infection, serial ultrasound examination should be considered to monitor fetal growth and anatomy and referral to a maternal-fetal medicine or infectious disease specialist with expertise in pregnancy management is recommended. There is no specific antiviral treatment for Zika virus; supportive care is recommended.
Zika virus is a mosquito-borne flavivirus transmitted primarily by Aedes aegypti mosquitoes (1,2). These vectors also transmit dengue and chikungunya virus and are found throughout much of the Americas, including parts of the United States. An estimated 80% of persons infected with Zika virus are asymptomatic (2,3). Symptomatic disease is generally mild and characterized by acute onset of fever, maculopapular rash, arthralgia, or nonpurulent conjunctivitis. Symptoms usually last from several days to 1 week. Severe disease requiring hospitalization is uncommon, and fatalities are rare. Guillain-Barré syndrome has been reported in patients following suspected Zika virus infection (4–6).
Pregnant women can be infected with Zika virus in any trimester (4,7,8). The incidence of Zika virus infection in pregnant women is not currently known, and data on pregnant women infected with Zika virus are limited. No evidence exists to suggest that pregnant women are more susceptible to Zika virus infection or experience more severe disease during pregnancy.
Maternal-fetal transmission of Zika virus has been documented throughout pregnancy (4,7,8). Although Zika virus RNA has been detected in the pathologic specimens of fetal losses (4), it is not known if Zika virus caused the fetal losses. Zika virus infections have been confirmed in infants with microcephaly (4), and in the current outbreak in Brazil, a marked increase in the number of infants born with microcephaly has been reported (9). However, it is not known how many of the microcephaly cases are associated with Zika virus infection. Studies are under way to investigate the association of Zika virus infection and microcephaly, including the role of other contributory factors (e.g., prior or concurrent infection with other organisms, nutrition, and environment). The full spectrum of outcomes that might be associated with Zika virus infections during pregnancy is unknown and requires further investigation.
Recommendations for Pregnant Women Considering Travel to an Area of Zika Virus Transmission
Because there is neither a vaccine nor prophylactic medications available to prevent Zika virus infection, CDC recommends that all pregnant women consider postponing travel to areas where Zika virus transmission is ongoing (10). If a pregnant woman travels to an area with Zika virus transmission, she should be advised to strictly follow steps to avoid mosquito bites (11,12). Mosquitoes that spread Zika virus bite both indoors and outdoors, mostly during the daytime; therefore, it is important to ensure protection from mosquitoes throughout the entire day (13). Mosquito prevention strategies include wearing long-sleeved shirts and long pants, using U.S. Environmental Protection Agency (EPA)–registered insect repellents, using permethrin-treated clothing and gear, and staying and sleeping in screened-in or air-conditioned rooms. When used as directed on the product label, insect repellents containing DEET, picaridin, and IR3535 are safe for pregnant women (14,15). Further guidelines for using insect repellents are available online (http://1.usa.gov/1OGZ6iF) (11,15).
Recommendations for Pregnant Women with History of Travel to an Area of Zika Virus Transmission
Health care providers should ask all pregnant women about recent travel. Women who traveled to an area with ongoing Zika virus transmission during pregnancy should be evaluated for Zika virus infection and tested in accordance with CDC Interim Guidance (Figure). Because of the similar geographic distribution and clinical presentation of Zika, dengue, and chikungunya virus infection, patients with symptoms consistent with Zika virus disease should also be evaluated for dengue and chikungunya virus infection, in accordance with existing guidelines (16,17).
Zika virus testing of maternal serum includes reverse transcription-polymerase chain reaction (RT-PCR) testing for symptomatic patients with onset of symptoms within the previous week. Immunoglobulin M (IgM) and neutralizing antibody testing should be performed on specimens collected ≥4 days after onset of symptoms. Cross-reaction with related flaviviruses (e.g., dengue or yellow fever) is common with antibody testing, and thus it might be difficult to distinguish Zika virus infection from other flavivirus infections. Consultation with state or local health departments might be necessary to assist with interpretation of results (18). Testing of asymptomatic pregnant women is not recommended in the absence of fetal microcephaly or intracranial calcifications.
Zika virus RT-PCR testing can be performed on amniotic fluid (7,9). Currently, it is unknown how sensitive or specific this test is for congenital infection. Also, it is unknown if a positive result is predictive of a subsequent fetal abnormality, and if so, what proportion of infants born after infection will have abnormalities. Amniocentesis is associated with an overall 0.1% risk of pregnancy loss when performed at less than 24 weeks of gestation (19). Amniocentesis performed ≥15 weeks of gestation is associated with lower rates of complications than those performed at earlier gestational ages, and early amniocentesis (≤14 weeks of gestation) is not recommended (20). Health care providers should discuss the risks and benefits of amniocentesis with their patients. A positive RT-PCR result on amniotic fluid would be suggestive of intrauterine infection and potentially useful to pregnant women and their health care providers (20).
For a live birth with evidence of maternal or fetal Zika virus infection, the following tests are recommended: histopathologic examination of the placenta and umbilical cord; testing of frozen placental tissue and cord tissue for Zika virus RNA; and testing of cord serum for Zika and dengue virus IgM and neutralizing antibodies. CDC is developing guidelines for infants infected by Zika virus. If a pregnancy results in a fetal loss in a woman with history of travel to an area of Zika virus transmission with symptoms consistent with Zika virus disease during or within 2 weeks of travel or findings of fetal microcephaly, Zika virus RT-PCR and immunohistochemical staining should be performed on fetal tissues, including umbilical cord and placenta.
There is no commercially available test for Zika virus. Testing for Zika virus infection is performed at CDC and several state health departments. Health care providers should contact their state or local health department to facilitate testing and for assistance with interpreting results (4).
How to Treat Pregnant Women with Diagnoses of Zika Virus Disease
No specific antiviral treatment is available for Zika virus disease. Treatment is generally supportive and can include rest, fluids, and use of analgesics and antipyretics (4). Fever should be treated with acetaminophen (21). Although aspirin and other nonsteroidal anti-inflammatory drugs are not typically used in pregnancy, these medications should specifically be avoided until dengue can be ruled out to reduce the risk for hemorrhage (4,9,17).
In a pregnant woman with laboratory evidence of Zika virus in serum or amniotic fluid, serial ultrasounds should be considered to monitor fetal anatomy and growth every 3–4 weeks. Referral to a maternal-fetal medicine or infectious disease specialist with expertise in pregnancy management is recommended.