All posts by nedhamson

Activist, writer, researcher, addicted to sharing information and facts.

Guillain-Barré syndrome – El Salvador

The National IHR Focal Point of El Salvador has notified PAHO/WHO of an unusual increase of Guillain-Barré Syndrome (GBS) in the country. In El Salvador, the annual average number of GBS is 169; however, from 1 December 2015 to 6 January 2016, 46 GBS were recorded, including 2 deaths.

Of the 46 GBS cases, 25 (54%) are male and 35 (76%) are 30 years old or older. All cases were hospitalized and treated with plasma exchange or intravenous immunoglobulin. One of the two deceased patients had a history of multiple underlying chronic diseases. Out of the 22 patients whose information was available, 12 (54%) presented with febrile rash illness in the 15 days prior to the onset of symptoms consistent with GBS.

Zika virus infection – Haiti

On 18 January 2016, the National IHR Focal Point for Haiti notified PAHO/WHO of 5 laboratory-confirmed cases of Zika virus infection. Of the 5 confirmed cases, 4 are from the Delmas commune while the remaining case is from the Pétion-Ville commune. Samples of the patient were sent to the Caribbean Public Health Agency (CARPHA) laboratory in Trinidad and Tobago for testing. All cases were confirmed by reverse transcription polymerase-chain reaction (RT-PCR).

In addition, between 4 and 12 January 2016, the National IHR Focal Point for Germany notified PAHO/WHO of 2 cases of Zika virus infection in German nationals who had returned from Haiti to Germany in late December. Samples from both patients were collected and sent for laboratory testing to the national reference centre for tropical diseases in Germany. While one of the cases was confirmed by both RT-PCR and serology, the other was confirmed only by serology.

Zika virus infection – France – Saint Martin and Guadeloupe

On 18 January 2016, the National IHR Focal Point (NFP) for France notified WHO of the first laboratory-confirmed case of locally-acquired Zika virus in Saint Martin, an overseas department of France. On the same day, 1 autochthonous case of Zika virus infection was confirmed in Guadeloupe, another overseas department of France.

The proximity of mosquito vector breeding sites to human habitation is a significant risk factor for Zika virus infection. Prevention and control relies on reducing the breeding of mosquitoes through source reduction (removal and modification of breeding sites) and reducing contact between mosquitoes and people. This can be achieved by reducing the number of natural and artificial water-filled habitats that support mosquito larvae, reducing the adult mosquito populations around at-risk communities and by using barriers such as insect screens, closed doors and windows, long clothing and repellents. Since the Aedes mosquitoes (the primary vector for transmission) are day-biting mosquitoes, it is recommended that those who sleep during the daytime, particularly young children, the sick or elderly, should rest under mosquito nets (bed nets), treated with or without insecticide to provide protection.

WHO: Updated Q&A On The Zika Virus

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The World Health Organization has released an updated (Jan 20th) Q&A file on the Zika virus, one that offers an assessment of the risk and advice to travelers.

Cautionary advice that falls far short of what some other health agencies have offered in recent days.

Granted, the link between Zika infection and Microcephaly has not yet been conclusively established, and the risks of other complications (Guillain-­Barré Syndrome, meningitis) are only just now coming to light.

We’ll know far more about the actual risks six months from now.

But where the WHO only advises pregnant women to `take extra care to protect themselves from mosquito bites‘, our own CDC (see CDC Level II Travel Advisory) recommends that pregnant women `consider postponing travel to the areas where Zika virus transmission is ongoing’.
 

The United States is not alone.  On Monday Hong Kong’s CHP recommended `Pregnant women should consider deferring their trip to areas with past or current evidence of ongoing Zika virus transmission’.

Meanwhile, the governments of Jamaica and Columbia have both recommended women postpone becoming pregnant for the next 6 months to a year, until the risks of Zika can be better understood. By contrast, under Should pregnant women be concerned about Zika?, the WHO states:  
 

Health authorities are currently investigating a potential link between Zika virus in pregnant women and microcephaly in their babies. Until more is known, women who are pregnant or planning to become pregnant should take extra care to protect themselves from mosquito bites.


Under Should I avoid travelling to areas where Zika virus is occurring?, the WHO states:  

Based on available evidence, WHO is not recommending any travel or trade restrictions related to Zika virus disease. 

But grants that:  As a precautionary measure, some national governments may make public health and travel recommendations to their own populations, based on their assessments of the available evidence and local risk factors.

It may well turn out that some of the initial response to Zika turns out to be overdone.  Or not.  We’ll know better in a few months.

But given the tragic impact to families and society of these birth defects, this is one crisis you really don’t want to be seen playing catch-up with.


Zika virus disease: Questions and answers

Online Q&A
20 January 2016

 

Where does Zika virus occur?

Zika virus occurs in tropical areas with large mosquito populations, and is known to circulate in Africa, the Americas, Southern Asia and Western Pacific.

Zika virus was discovered in 1947, but for many years only sporadic human cases were detected in Africa and Southern Asia. In 2007, the first documented outbreak of Zika virus disease occurred in the Pacific. Since 2013, cases and outbreaks of the disease have been reported from the Western Pacific, the Americas and Africa. Given the expansion of environments where mosquitoes can live and breed, facilitated by urbanisation and globalisation, there is potential for major urban epidemics of Zika virus disease to occur globally.
 
How do people catch Zika virus?
 
People catch Zika virus by being bitten by an infected Aedes mosquito – the same type of mosquito that spreads dengue, chikungunya and yellow fever.
 
What are the symptoms of Zika virus disease?
 
Zika virus usually causes mild illness; with symptoms appearing a few days after a person is bitten by an infected mosquito. Most people with Zika virus disease will get a slight fever and rash. Others may also get conjunctivitis, muscle and joint pain, and feel tired. The symptoms usually finish in 2 to 7 days.
 
What might be the potential complications of Zika virus?
 
Because no large outbreaks of Zika virus were recorded before 2007, little is currently known about the complications of the disease.
 
During the first outbreak of Zika from 2013 – 2014 in French Polynesia, which also coincided with an ongoing outbreak of dengue, national health authorities reported an unusual increase in Guillain-Barré syndrome. Retrospective investigations into this effect are ongoing, including the potential role of Zika virus and other possible factors. A similar observation of increased Guillain-Barré syndrome was also made in 2015 in the context of the first Zika virus outbreak in Brazil.

In 2015, local health authorities in Brazil also observed an increase in babies born with microcephaly at the same time of an outbreak of Zika virus. Health authorities and agencies are now investigating the potential connection between microcephaly and Zika virus, in addition to other possible causes. However more investigation and research is needed before we will be able to better understand any possible link.

Should pregnant women be concerned about Zika?

Health authorities are currently investigating a potential link between Zika virus in pregnant women and microcephaly in their babies. Until more is known, women who are pregnant or planning to become pregnant should take extra care to protect themselves from mosquito bites.

If you are pregnant and suspect that you may have Zika virus disease, consult your doctor for close monitoring during your pregnancy.
 
What is microcephaly?
 
Microcephaly is a rare condition where a baby has an abnormally small head. This is due to abnormal brain development of the baby in the womb or during infancy. Babies and children with microcephaly often have challenges with their brain development as they grow older.
Microcephaly can be caused by a variety of environmental and genetic factors such as Downs syndrome; exposure to drugs, alcohol or other toxins in the womb; and rubella infection during pregnancy.
 
How is Zika virus disease treated?
 
The symptoms of Zika virus disease can be treated with common pain and fever medicines, rest and plenty of water. If symptoms worsen, people should seek medical advice. There is currently no cure or vaccine for the disease itself.
 
How is Zika virus disease diagnosed?
 
For most people diagnosed with Zika virus disease, diagnosis is based on their symptoms and recent history (e.g. mosquito bites, or travel to an area where Zika virus is known to be present). A laboratory can confirm the diagnosis by blood tests.
 
What can I do to protect myself?
 
The best protection from Zika virus is preventing mosquito bites. Preventing mosquito bites will protect people from Zika virus, as well as other diseases that are transmitted by mosquitoes such as dengue, chikungunya and yellow fever.

This can be done by using insect repellent; wearing clothes (preferably light-coloured) that cover as much of the body as possible; using physical barriers such as screens, closed doors and windows; and sleeping under mosquito nets. It is also important to empty, clean or cover containers that can hold water such as buckets, flower pots or tyres, so that places where mosquitoes can breed are removed.

Should I avoid travelling to areas where Zika virus is occurring?
 
Travellers should stay informed about Zika virus and other mosquito-borne diseases and consult their local health or travel authorities if they are concerned.
 
To protect against Zika virus and other mosquito-borne diseases, everyone should avoid being bitten by mosquitoes by taking the measures described above. Women who are pregnant or planning to become pregnant should follow this advice, and may also consult their local health authorities if travelling to an area with an ongoing Zika virus outbreak.
 
Based on available evidence, WHO is not recommending any travel or trade restrictions related to Zika virus disease. As a precautionary measure, some national governments may make public health and travel recommendations to their own populations, based on their assessments of the available evidence and local risk factors.
 
What is WHO doing?
 
To help countries prepare for and respond to Zika, WHO is working with ministries of health to improve laboratory capacity to detect the virus, providing recommendations for clinical care and follow-up of infected patients (in collaboration with national professional associations and experts), and encouraging monitoring and reporting on the virus’s spread and the emergence of complications.
 
WHO is also coordinating with countries that have reported outbreaks of Zika virus and other partners to investigate the potential relationships between Zika and microcephaly and other issues.

Exploring The Zika – Guillain-Barré Connection

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The exact cause of Guillain-Barré Syndrome – a rare immune disorder that damages nerve cells, and can cause muscle weakness and sometimes paralysis is unknown, but it often follows a viral or bacterial illness.

In the United States between 3,000 and 6,000 cases are reported every year.  Most people recover fully, but some may have lingering neurological damage.

Not quite two years ago (Feb 2014), in Zika, Dengue & Unusual Rates Of Guillain Barre Syndrome In French Polynesia, we saw the first hint that a relatively obscure, and previously thought to be mild virus – Zika – might be causing neurological symptoms following an outbreak in the South Pacific.

Unlike Dengue, or even Chikungunya, little had been written about the Zika virus, although in 2009 the CDC’s EID Journal carried a report called Zika Virus Outside Africa by Edward B. Hayes that explored the virus’s arrival in Yap Island where 70% of the population was affected.

While most cases had reported relatively mild symptoms, the author cautioned that until the West Nile Virus began causing neuroinvasive symptoms in Romania and North America, it too was considered a fairly innocuous viral infection.

In February of 2014, a report came from Le Centre d’Hygiène et de Salubrité Publique  (CHSP) in French Polynesia Bulletins health surveillance in French Polynesia and related documents which reported of 41 Guillain-Barré syndrome (GBS) and 26 cases of other neurological complications they believed linked to the ongoing Zika/Dengue outbreak which had started in 2013.

The expected incidence of GBS is 1 to 2 cases per 100,000 population per year . With a population of 275,000, one would expect fewer than 10 cases per year in that sized population. 

A month later, in Eurosurveillance: Zika Virus Infection Complicated By Guillain-Barré Syndrome, we looked at a report that calculated a 20 fold increase in GBS after the arrival of Zika in French Polynesia.   The authors wrote:

Since the beginning of this epidemic, and as up to 8,200 cases of ZIKA infection have already been reported of a 268,000 total population, the incidence of GBS has been multiplied by 20 in French Polynesia (data not shown), raising the assumption of a potential implication of ZIKA.

Since these islands were seeing a concurrent Dengue outbreak there was speculation that co-infection by Dengue and Zika  – or sequential arboviral immune stimulation might predispose one to more severe illness. 

Adding some credence to this notion, with dengue, it is usually a person’s second infection that causes severe illness, while the first infection is usually mild.


The prevailing theory is that the host’s immune system – which already has neutralizing antibodies to the first DENV infection – mistakenly identifies the second DENV infection as being the same strain.

Rather than creating new neutralizing antibodies to fight the infection, it deploys its existing cross reactive, but non-neutralizing (read: ineffective) antibodies to the field of battle.


Sometimes called OAS or Original Antigenic Sin, this is the immunological equivalent of taking a knife to a gun fight.

Since many populations now seeing  Zika have long dealt with Dengue, or Chikungunya – or both – teasing out the cause or causes of increased neurological side effects (including microcephaly) isn’t going to be easy.

It is worth noting that a there is now a suspected link between GBS and Chikungunya infection as well (see Eurosurveillance Increase in cases of Guillain-Barré syndrome during a Chikungunya outbreak, French Polynesia, 2014 to 2015).

Earlier this week PAHO released an updated epidemiological report on Zika, and mentioned the Polynesian increase in GBS, along with increased reports in Brazil and El Salvador (see PAHO: Epidemiological Update On Zika – Jan 17th) where they wrote:

Currently, similar situations are being investigated in other countries of the Americas. These findings are consistent with a temporal and spatial link between Zika virus circulation and the increase of GBS. Although the etiopathogenesis and associated risk factors have not yet been well established, Member States should implement surveillance systems to detect unusual increases in cases and prepare health services for patients care with neurological conditions.

Today the World Health Organization published the following statement on the increase in GBS in El Salvador.

Guillain-Barré syndrome – El Salvador

Disease Outbreak News
21 January 2016 

The National IHR Focal Point of El Salvador has notified PAHO/WHO of an unusual increase of Guillain-Barré Syndrome (GBS) in the country. In El Salvador, the annual average number of GBS is 169; however, from 1 December 2015 to 6 January 2016, 46 GBS were recorded, including 2 deaths. 

Of the 46 GBS cases, 25 (54%) are male and 35 (76%) are 30 years old or older. All cases were hospitalized and treated with plasma exchange or intravenous immunoglobulin. One of the two deceased patients had a history of multiple underlying chronic diseases. Out of the 22 patients whose information was available, 12 (54%) presented with febrile rash illness in the 15 days prior to the onset of symptoms consistent with GBS.

Investigations are ongoing to determine the cause of infection and acquire further details about the laboratory diagnosis. Possible associations between GBS and Zika virus infection are also being investigated. Since the confirmation of the first case of Zika virus infection in November 2015 until 31 December 2015, Salvadoran health authorities reported 3,836 suspected cases of Zika virus infection.

(Continue . . . )

Unlike microcephalic births, which are a lagging indicator, GBS symptoms usually appear within days or weeks of acute infection, and therefore may give us a more immediate read on the progress and severity Zika’s spread.

Despite all of this, it is not at all a certainty that Zika – or even a combination of Zika and other viral infections (concurrent or sequential) – is responsible for this apparent increased incidence of GBS.

The evidence, however – while not conclusive – continues to mount.

WHO reports more local Zika confirmations, GBS spike | CIDRAP

Local transmission on St. Martin, GuadeloupeMeanwhile, the WHO today confirmed the first two locally acquired Zika infection cases in the French part of St. Martin and in Guadeloupe. It said French health officials notified the WHO of both cases on Jan 18.The two territories already appear on PAHO’s list of affected locations in the Americas, which stands at 20. Like most other parts of the Caribbean, both areas have been affected by the chikungunya virus outbreak over the past year.WHO urges no travel restrictionsThe WHO said in both statements today it does not recommend any trade or travel restrictions to the affected areas.So far the WHO has held off on recommending that pregnant women, or those planning to become pregnant, avoid the affected countries due to the microcephaly threat. In its most recent update on the

The two territories already appear on PAHO’s list of affected locations in the Americas, which stands at 20. Like most other parts of the Caribbean, both areas have been affected by the chikungunya virus outbreak over the past year.WHO urges no travel restrictionsThe WHO said in both statements today it does not recommend any trade or travel restrictions to the affected areas.So far the WHO has held off on recommending that pregnant women, or those planning to become pregnant, avoid the affected countries due to the microcephaly threat. In its most recent update on the

WHO urges no travel restrictionsThe WHO said in both statements today it does not recommend any trade or travel restrictions to the affected areas.So far the WHO has held off on recommending that pregnant women, or those planning to become pregnant, avoid the affected countries due to the microcephaly threat. In its most recent update on the

The WHO said in both statements today it does not recommend any trade or travel restrictions to the affected areas. {Deja vu – same thing they said too long about ebola outbreak last year – giving in to local government’s fears of losing trade dollars and further increased the impact of the epidemic}

So far the WHO has held off on recommending that pregnant women, or those planning to become pregnant, avoid the affected countries due to the microcephaly threat. In its most recent update on the disease it urges pregnant women to take steps to protect against mosquitoes and to consult with their local health officials before traveling.

Source: WHO reports more local Zika confirmations, GBS spike | CIDRAP

Some patients develop corneal inflammation from chickenpox vaccine | Vaccine News

{Well now, some researchers have got a name for themselves, Vaccine News gets some additional readers and the anti-vaxers will have a field day screaming about the dangers of all vaccines and 20 cases were found out of millions of shots given. How do you shoot yourself in foot? Advise physicians to talk with parents about a 20 in 500,000,000 chance.}

“Keratitis, or inflammation of the clear layer on the front of the eye, is a vision issue that can cause serious complications or even permanent damage to your vision if left untreated,” Dr. Frederick Fraunfelder, chair of the Department of Ophthalmology at the MU School of Medicine, said. “By studying case reports from national and international registries, we found at least 20 cases of keratitis occurred in children and adults within a month of administration of the chickenpox and shingles vaccine. While this is a rare occurrence, it’s important for physicians to know when giving the vaccine to individuals who have a history of the condition because it could be reactivated by the vaccine.”

Source: Some patients develop corneal inflammation from chickenpox vaccine | Vaccine News

Don’t underestimate Iraqi nationalism

The anti-IS campaign in Iraq has deepened sectarian divisions between Sunni, Shiite and Kurdish regions, but despite communal and political fractures, many communities remain loyal to the Iraqi state.

Source: Don’t underestimate Iraqi nationalism

Sunni Arabs also continue to defend Iraqi sovereignty and territorial integrity. For instance, while recognizing the importance of regional relations, Sunni Arabs joined Shiite Arabs and other Iraqis in opposing Ankara’s military expansion into northern Iraq. The Iraqi parliament’s Council of Representatives, including leading Sunni and Shiite blocs, criticized Turkey’s engagement as a violation of state sovereignty. Iraq’s Sunni Arab Defense Minister Khaled al-Obeidi, as well as the Arab League, whose majority is Sunni Muslim, also requested the full departure of Turkish forces from Iraq. Only former Ninevah Gov. Atheel-al Nujaifi and Kurdish leader Massoud Barzani welcomed Ankara’s engagement in training Sunni Arab and Kurdish peshmerga forces to counter IS — as well as to check the Kurdistan Workers Party, create a Sunni Muslim zone of influence and secure energy resources in Mosul.

Nor have Iraqi Shiite groups given Iran carte blanche in Iraqi affairs. Indeed, most are grateful for Tehran’s immediate and ongoing military assistance against IS. Some Shiite political parties and militias continue to act as proxies for Iran’s Quds Force commander Qasem Soleimani. Yet another part of the Shiite community seeks to balance Iraq’s interests in the region and assure Iraqi sovereignty. Iraqi Prime Minister Haider al-Abadi has attempted to mediate the Saudi-Iranian dispute — to no avail — by insisting on Iraq’s neutrality.

US Agency for International Development initiates National Action Plan against drug-resistant TB

The U.S. Agency for International Development (USAID) recently initiated the White House’s National Action Plan for Combatting Multidrug-Resistant Tuberculosis (MDR-TB).

To make the plan a success, USAID has partnered with several prestigious health care companies. The partnerships will provide USAID will the latest technology and additional resources for fighting MDR-TB.

“Building on existing efforts and mandates, the plan articulates the U.S. government’s comprehensive strategy for addressing TB and puts us on a path to reverse the spread of this obstinate disease at home and worldwide,”

Alfonso Lenhardt, USAID’s deputy administrator, said.

The leaders from worldwide partners, global stakeholders, and local government agencies gathered in Washington, D.C. to commemorate the event. This plan shows there is significant progress in striving to fight MDR-TB and extensively drug-resistant TB on a worldwide scale.

The event included several presentations from Dr. John Holdren, director of the White House Office of Science and Technology Policy; Dr. Ariel Pablos-Mndez, USAID’s assistant administrator for global health; Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases; and Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention. There were also two special video messages given by Rep. Eliot Engel (D-NY) and Sen. Sherrod Brown (D-OH).