Category Archives: Viva!

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.

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).

‘Integration’ or ‘Assimilation’ is a Two-sided Negotiation

well thought out

Media Diversified

by Chimene Suleyman 

A much older cousin lived in London’s Turkish neighbourhood of Green Lanes for forty years, and never learnt to speak English. She earned money tailoring clothes from a sewing machine in her living room. She shopped in local stores owned and frequented by other Turks. She socialised with her family. There was —as she saw it— little urgency for another language. In fact, there was little time. Above all, she had raised two children to speak English perfectly, have English friends, and to contribute to British society with good jobs in IT and wins at martial-art championships.

Attributing blame to a woman who does not learn the language of a country, is as good as forgetting we are not the sum of every ambition life got in the way of. Being a working mother of two will almost certainly “get in the way”. Depression and social…

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Warlords to the Lebanese People: Let’s Forgive and Forget!

Lebanese “Warlords Collage”. Geagea (with mustache) and Aoun (in uniform) appear in the photo at the upper right. Source: moulahazat.wordpress.com

Lebanon is special, we know, because our ancestors are Phoenician and because we can swim and ski in the same day. But Lebanon is also special because key figures of the Lebanese civil war are still in power, waltzing on the corpses of thousands of dead civilians and the living bodies of 4.5 million Lebanese citizens.

On January 18th, 2016, Lebanese Forces leader Samir Geagea publicly endorsed his wartime rival Michel Aoun’s candidacy for president. This agreement means that Lebanon might finally have a new president, after 20 months in which the country’s top post has been vacant.

Here’s some context. Geagea, the executive chairman of the Lebanese Forces, the second largest Christian political party in Lebanon, and Aoun, a former Lebanese Army Commander and founder of the Free Patriotic Movement, are former enemies who fought against each other during the Lebanese Civil War (1975-1990). On January 31, 1990, the Lebanese Army, with Aoun as its commander-in-chief, clashed with the Lebanese Forces (then a militia). The latter objected to Aoun’s assertion that it was in the national interest for the government to “unify weapons”, meaning that the Lebanese Forces should submit to his authority as acting head of state. The clash resulted in the deaths of hundreds of civilians.

I felt the need to add my two cents’—or two liras—on this state of affairs because of what General Aoun said during what blogger Joey Ayoub compared to an acceptance speech at the Oscars—that he wanted to leave the past behind in order to build the future.

“I would like to thank the academy for giving me this opportunity to shine” http://bitly.com/1JjfMA7

— Joey Ayoub جووي أيوب (@joeyayoub) January 18, 2016

People are sharing stories online of the times Aoun and Geagea bombed their neighborhoods. I can’t testify to that, as I was too young at the time and had the “luxury” of being born in a remote village in the north of Lebanon. I can’t testify first-hand to the pain of the war, to the loss, to the fear, to the experience of living surrounded by death. But I can testify to the hatred I saw, and continue to witness, between people my age or younger who also did not live through the war. No matter what anyone says, Lebanon’s regions, cities and neighborhoods, already riven by sectarian divisions, are still divided between the Aoun and Geagea camps.

I am not dismissing these experiences of these young partisans, nor the experiences of their loved ones. But I do wonder how they, with no direct experience of the war, manage to muster such hatred, why they listen to songs about an ugly war that ended 25 years ago that describe one leader as the alpha and omega and the other as god sent. I’m puzzled as to why they learn how to signal their support by honking their car horns—a “taratatata” or a “tata tatata tata tata tata” in the wrong place or time can get you into trouble—display party stickers on their cars, and wage their own second-hand war. A bloodless one, it’s true, but a cold war nevertheless.

“I’m puzzled as to why they learn how to signal their support by honking their car horns—a “taratatata” or a “tata tatata tata tata tata” in the wrong place or time can get you into trouble…”

Where is the urge to question those they blindly follow, and ask questions like “what happened”? “Who won”? “How many people died”? “What happened to those who were kidnapped”? “How many women and girls were raped”? “How many corpses were tied and dragged behind cars like war trophies”? “How many loaves of bread were stolen at checkpoints”?

During his “acceptance speech” Aoun basically said that what happened happened, and we should put it behind us, and maybe remember it so that we don’t repeat it. Geagea was smiling beside him.

Well, even though it is our fault (we elected them, after all, over again over again, those times we were actually allowed to have elections), I don’t want to stop believing that we deserve better. This endorsement, this deal between two war criminals, represents yet another nail in the coffin of our collective memory. Those of us who didn’t experience the war are now stripped of our ability to hold these men accountable for the deaths of thousands. And now they tell us to forget and move on. Because it is convenient for them? Because after years of wanting to eliminate each other, this is the only way to survive? We shouldn’t question their pasts or demand justice, yet these men want us to trust them with our future?

It’s about peacemaking, they say. But can peace really exist in a vacuum? How can we   achieve peace without a reconciliation process? Without healing the wounds of the past? How can peace exist when a silent, brutal, cold, war is being waged every day?

Where, indeed, is there room for peace when all we see is corruption, unaccountability, nepotism, theft, and the dismissal of an entire people?

Written by Abir Ghattas · comments (0)
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AWWP Poet to Make Guest Appearance at Michigan Poetry Slam

ClarkstonHighSchoolPoetrySlam2015

AWWP Poet Marzia will make a guest appearance via Skype at the Clarkston High School Voices for Change poetry slam on Friday, January 22nd at 7 p.m. This is the second year Marzia has participated as a guest reader. The slam, co-produced by sisters Madeline and Olivia Maday, will feature twenty Clarkston High School students selected to perform their work. Proceeds will go to the Afghan Women’s Writing Project.

“I am very excited about Voices for Change,” says Marzia, 25. “I believe my voice is not only for me, it is for millions of women and girls who have been fighting the violence and discrimination.”

Olivia Maday, 17, speaks to the importance of the poetry slam: “In a world where so many people are shouting to have their voices heard, important words can get lost in the noise. Slam poetry has the purpose of conveying personal messages as well as universal demands for change.”

The Maday sisters chose to include the Afghan Women’s Writing Project after a suggestion from a Clarkston High School teacher. “The AWWP saying ‘to tell one’s story is a human right’ inspired us because it was exactly the message which we wanted to convey throughout the Clarkston community as well as one that should be promoted globally,” says Olivia. “We were very moved by the courage that the women had in sharing their stories and messages with the world, and we greatly wanted to encourage a similar sense of empowerment for all students through the creative outlet of poetry.”

Voices for Change debuted last year to acclaim. “We were so surprised by how fantastic the response was,” says Maday. “My sister and I sat together after the show, reading aloud the incredible messages and tweets that people were sending to us, letting us know how inspired they were from hearing the voices of others. It definitely united our community on a whole new level.”

Admission is $1 and can be paid at the door. Follow the slam via Twitter at @_Voices4Change and hashtag #Voices4Change. Clarkston High School, 6093 Flemings Lake Rd. Clarkston, MI 48346 

Photo: Olivia (left) and Madeline Maday at 2015 Voices for Change Poetry Slam in Clarkston, MI. Photograph by Nathan Brown.

Cherokee Nation to Disperse Heirloom Seeds February 1st

Two-week-old Native Tobacco/Cherokee Ceremonial Tobacco seedlings grown by Cherokee Nation citizen Eugene Wilmeth using Cherokee Nation Seed Bank inventory.

Two-week-old Native Tobacco/Cherokee Ceremonial Tobacco seedlings grown by Cherokee Nation citizen Eugene Wilmeth using Cherokee Nation Seed Bank inventory.

Published January 20, 2016

TAHLEQUAH, OKLAHOMA — The Cherokee Nation will begin dispersing its limited supply of heirloom seeds to tribal citizens interested in growing traditional Cherokee crops and plants starting February 1, 2016.

The Cherokee Nation keeps an inventory of seeds from rare breeds of corn, beans, squash, gourds, Trail of Tears beads, tobacco and several plants traditionally used for Cherokee customs. The seeds are not available in stores.

“The seed bank continues to expand and get more popular every year with our citizens. It’s also an important way the Cherokee Nation can keep our link to the land strong and preserve our history and heritage,” said Cherokee Nation Principal Chief Bill John Baker. “For Cherokee people, the process of harvesting seeds and passing them down has gone on for generations. It is an essential part of who we are today, and because of the seed bank program, we have created a growing interest with a new generation of Cherokees.”

In 2015, the tribe distributed 3,463 packages of seeds to Cherokee Nation citizens.

Eugene Wilmeth, a Cherokee Nation citizen of Midwest City, Oklahoma, planted Cherokee White Eagle Corn and Native tobacco seeds.

“I am very grateful for the Cherokee Nation seed bank, which gives me the opportunity to grow traditional and sacred plants that connect us to our culture and to our Creator. The program allows each of us to play an important role in the preservation of our heritage,” Wilmeth said.

Citizens are limited to two varieties. To get the seeds, citizens can either make an appointment to pick them up or email their request to seedbank@cherokee.org to have them sent by mail. Individuals must include a copy of his or her Cherokee Nation tribal citizenship card, proof of age and address.

For more information, contact Pat Gwin at 918-453-5704.

 

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Navajo Nation Confirms First Hantavirus Death of 2016

deer mousePublished January 20, 2016

NAVAJO NATION —The Navajo Nation has confirmed the first Hantavirus death of 2016.

Hantavirus Pulmonary Syndrome is transmitted to people that come into contact with or breathe infected urine, droppings and/or saliva of wild mice, primarily deer mice. Anyone who comes into contact with rodents that carry Hantavirus is at risk of HPS. The illness is not spread from person to person.

Hantavirus Pulmonary Syndrome was first identified in 1993 when an outbreak of this infectious lung disease took place in the southwestern United States on the Navajo Indian Reservation.

The illness starts with fever, headache and muscle aches, and progresses rapidly to severe difficulty in breathing and, in some cases, death.

People should make sure to rodent-proof their homes to prevent infected mice from coming inside.

When cleaning rodent droppings, people should use a mask, disinfectant and gloves.

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