Tag Archives: pandemic

Prevention of tick bites: an evaluation of a smartphone app

Lyme borreliosis (LB) is the most common reported tick-borne infection in Europe, and involves transmission of Borrelia by ticks. As long as a vaccine is not available and effective measures for controlling tick …

Hong Kong: Scarlet Fever Cases Rise Sharply

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While once greatly feared and the cause of numerous epidemics up until the early 20th century, Scarlet Fever –  caused by a bacteria called group A Streptococcus – can be successfully treated by modern antibiotics and today is usually a mild illness

The illness is caused by the same bacteria that causes `strep throat’, and is characterized by fever, a very sore throat, a whitish coating or sometimes `strawberry’ tongue, and a `scarlet rash’ that first appears on the neck and chest.

It primarily affects children under the age of 10.  Adults generally develop immunity as they grow older. Untreated, this bacterial infection can lead to:

  • Rheumatic fever
  • Kidney disease
  • Ear infections
  • Skin infections
  • Abscesses of the throat
  • Pneumonia
  • Arthritis

For reasons that remain unclear (see The Lancet’s Resurgence of scarlet fever in England, 2014–16: a population-based surveillance study), Scarlet Fever has been on the rise since 2009 across much of Asia, and more recently in the UK, with perhaps the best-documented outbreak coming out of Hong Kong.

Early in this decade (see Hong Kong: Scarlet Fever In 2012), I wrote often about this abrupt, nearly 10-fold increase, in scarlet fever cases between 2010 and 2011 (see chart below).

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Since then Hong Kong has seen a high level of cases each year. Much of Asia – including China, Vietnam, and South Korea – have also reported rising numbers of cases.  

In the few years the UK has reported a resurgence in Scarlet fever infections as well (see UK PHE: Scarlet Fever Still Rising, with more than 15,500 cases reported during the first 47 weeks of 2017. 

This year Hong Kong is seeing another major surge, with 1,947 cases reported in the first 11 months of the year (a  > 50% increase over 2016).  Two weeks ago, Hong Kong’s CHP sent out a letter to doctors, as well as warning the public (see Heightened vigilance warranted amid marked increase in scarlet fever activity).  

Today, with 94 new cases reported in the last week, Hong Kong’s CHP has issued the following appeal to the public, schools, and doctors.

     The Centre for Health Protection (CHP) of the Department of Health today (December 4) appealed to parents, schools/institutions and healthcare professionals for heightened vigilance against scarlet fever (SF) as its activity sharply increased last week and has reached a very high level.
 
     According to the CHP’s surveillance data, the weekly number of SF cases increased from 48 in the week of November 19 to 94 in the last week (week of November 26). Regarding SF outbreaks in schools/institutions, as of December 3, eight outbreaks (five kindergartens/child care centres and three primary schools) affecting 22 pupils/children were recorded in November.
 
     “While SF has occurred throughout the year locally, a seasonal pattern for SF in Hong Kong with higher activity was observed from May to June and from November to March in the past few years. The activity of SF has increased again since November this year. Based on the past epidemiological pattern, we expect that the SF activity will remain at a higher level in the coming few months. Parents have to take extra care of their children in maintaining strict personal, hand and environmental hygiene,” a spokesman for the CHP said.
 
     A total of 1 947 cases were reported in the first 11 months of 2017, representing a marked increase from the figures for the same period in 2016 (1 244 cases) and 2015 (1 060 cases). The epidemiological features of the cases in 2017 were similar to those in previous years.
 
     The 1 947 SF cases reported this year comprised 1 156 males and 791 females aged from 2 months to 43 years (median: 5 years), nearly all of whom (1 863, 95.7 per cent) were under 10 years. Most presented with mild illnesses. Among them, 695 cases (35.7 per cent) required hospitalisation. While one severe case reported in March required admission to an intensive care unit, no deaths have been recorded so far.
 
     “We will issue letters to doctors, hospitals and schools again to alert them to the latest situation. Schools should promptly make a report to the CHP in case of an increase in respiratory illnesses or absentees for immediate epidemiological investigations and outbreak control,” the spokesman said.
 
     SF is a bacterial infection caused by Group A Streptococcus and mostly affects children. It is transmitted through either respiratory droplets or direct contact with infected respiratory secretions.
 
     It usually starts with a fever and sore throat. Headache, vomiting and abdominal pain may also occur. The tongue may have a distinctive strawberry-like (red and bumpy) appearance. A sandpaper texture-like rash would commonly begin on the first or second day of onset over the upper trunk and neck before spreading to the limbs. The rash is usually more prominent in armpits, elbows and groin areas. It usually subsides after one week and is followed by skin peeling over fingertips, toes and groin areas.
 
     SF is sometimes complicated with middle ear infection; throat abscess; chest infection; meningitis; bone or joint problems; damage to the kidneys, liver and heart; and, rarely, toxic shock syndrome. SF can be effectively treated by appropriate antibiotics. People suspected to have SF should consult a doctor promptly.
 
     There are no vaccines available against SF. Members of the public are advised to take heed of the health advice below: 

Maintain good personal and environmental hygiene;Always keep hands clean and wash with liquid soap when they are dirtied by mouth and nasal discharges;Cover your nose and mouth while sneezing or coughing and dispose of nasal and mouth discharges properly;Avoid sharing personal items such as eating utensils and towels;Maintain good ventilation; andChildren suffering from SF should refrain from attending school or child care settings until the fever has subsided and they have been treated with antibiotics for at least 24 hours.   The public may visit the CHP’s SF page for more information.

Ends/Monday, December 4, 2017

Issued at HKT 18:00

WHO Update On Plague In Madagascar: 1554 Suspected Cases & 113 Deaths

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The tally from Madagascar’s outbreak of (primarily pneumonic) plague continues to rise with the WHO regional office for Africa’s weekly bulletin on outbreaks and other emergencies – Week 43: 21 – 27 October 2017 now placing the number at 1554 cases and 113 deaths.

This represents a steep increase (245 cases and 20 deaths) over what was just reported by the WHO on Friday (current thru the 26th), and is considerably higher than anything being reported by the Madagascar MOH.

Given the wide spread of numbers we’re seeing, isn’t entirely clear whether everybody is reading from the same page. 

With the caveat that these numbers continue to shift back and forth, here is today’s update from the WHO.

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http://ift.tt/2iP0dsN 

 

The outbreak of plague in Madagascar continues to improve, with the number of new cases of pulmonary plague declining in all active areas across the country. In the past 2 weeks, 16 previously affected districts reported no new confirmed or probable cases of pulmonary plague.

From 1 August to 27 October 2017, a total of 1 554 suspected cases of plague, including 113 deaths (case fatality rate 7%), were reported. Of these, 985 (63%) were clinically classified as pulmonary plague, 230 (15%) were bubonic plague, 1 was septicaemic, and 338 were unspecified (further classification of cases is in process). Since the beginning of the outbreak, 71 healthcare workers (with no deaths) have been affected.


Of the 985 clinical cases of pneumonic plague, 245 (25%) were confirmed, 336 (34%) were probable and 404 (41%) remain suspected (additional laboratory results are in process). Fourteen strains of Yersinia pestis have been isolated and were sensitive to antibiotics recommended by the National Program for the Control of Plague.

Between 1 August and 27 October 2017, 28 districts reported confirmed and probable cases of pulmonary plague. During the last two weeks, the number of districts that reported confirmed and probable cases of pulmonary plague reduced to 12.

About 78% (4 825) of 6 203 contacts identified completed their 7-day follow up and a course of prophylactic antibiotics. A total of nine contacts developed symptoms and became suspected cases. On 27 October 2017, 1 055 out of 1 087 (97%) contacts were followed up and provided with prophylactic antibiotics.

         PUBLIC HEALTH ACTIONS

A high level inter-Ministerial coordination forum, chaired by the Prime Minister, has been established to provide strategic and policy directions to the plague outbreak response. Similarly, the Country Humanitarian Team of the United Nations system established a strategic coordination platform for partners, chaired by the Resident Coordinator.

The health response is coordinated by the Ministry of Public Health, co-led by WHO and supported by agencies and partners directly involved in the health response. The health sector response is organized into four major committees: (i) surveillance, (ii) community engagement and education, (iii) case management, and (v) communication; with the logistics committee crosscutting all committees.

Coordination of partners in the Health cluster has been strengthened to ensure effectiveness, avoid duplication in the field and ensure efficient coverage of the affected areas. The Health cluster is having weekly meetings, with some partners participating in the national coordination platforms.

Cross sectoral non-Health actors (media, transport, defence, education, etc.) are being coordinated by the National Risk and Disaster Management Office (BNGRC).

Nine plague treatment centres have been established, of which six are in Antananarivo. The treatment centres are supported by IFRC, MSF, MdM, UNICEF, and WHO.

USAID provided six mobile clinics to transport patients to hospitals within Antananarivo.

UNICEF supported production of field-tested public awareness/education materials (posters, brochures, radio/television spots). A total of 69 000 posters and brochures have been produced and distributed, including to partners in the Ministries of Transport and Tourism, church groups and other key influencers.

SITUATION INTERPRETATION

While progress has been made in response to the plague outbreak in Madagascar, sustainability of ongoing operations (during the outbreak and through the plague season usually from September to April) remains critical.

Funds for operations are running low, given the fact that only 26% of the multisector response plan has been funded. Additional response logistics such as temperature monitoring equipment (infrared thermometers), rapid diagnostic tests, personal protective equipment, infection prevention and control supplies, and medicines (antibiotics) need to be provided. Efforts to strengthen outbreak control measures should continue. To that effect, partners and the donor community are called upon to provide additional resources (funds, logistics and human capacity) to ensure continuity of the response operations and eventual containment of the outbreak.

Where Does the Ebola Virus Hide Between Outbreaks? – UCSF News Services

Interesting how many different ways the story on Ebola is being used to promote profit, reputation, status and not knowledge. Ebola does not hide but that’s a catchy headline that helps promote a professor and his university. Deadly diseases are “quiet” or not killing hundreds and thousands of people in an epidemic or pandemic mode when the natural system is in balance. When a local or regional balance is disrupted by natural processes or human activity, an outbreak occurs. So where it hides or waits until called forth to rebalance the system is not as important as the triggering action. We can do something about deforestation, monocultural agriculture or dams but do not because that’s business and it is easier to pretend disease outbreaks are just freaks of natures that are not connected to humans causing the imbalance.

UCSF News Services
Where Does the Ebola Virus Hide Between Outbreaks?
UCSF News Services
You might be thinking, “Isn’t Ebola carried by bats?” In a recent episode of UC San Francisco’s Carry the One Radio, DeRisi – a UCSF professor of Biochemistry and Biophysics and co-president of the Chan Zuckerberg Biohub – revealed that the evidence …

WHO: Plague Cases In Madagascar Increase To 1365

Pandemic Watch – Bubonic Plague

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With the epidemiological reports posted by Madagascar’s MOH becoming increasingly convoluted – and falling even farther behind the WHO’s tally of cases and deaths – it has become increasingly difficult to use them to  gauge the full extent of their pneumonic plague outbreak.

Exactly what is behind the stark (40%+) difference in cases totals being reported by the MOH and the WHO is unknown, although differences in what each consider `suspected‘ cases might be a factor.

Today the WHO has updated their numbers again, through October 20th, which shows an increased of 68 cases, and 4 deaths over the last 24 hours of reporting. Once again we are seeing a large increase in the number of HCWs reported as infected (n=54).

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Some excerpts from today’s report follow:

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EVENT DESCRIPTION
 
Madagascar has been experiencing a large outbreak of plague affecting major cities and other non-endemic areas since August 2017. Between 1 August and 20 October 2017, a total of 1 365 cases (suspected, probable and confirmed) including 106 deaths (case fatality rate 7.8%) have been reported. Of these, 915 cases (67%) were clinically classified as pneumonic plague, 275 (20.1%) were bubonic plague, one case was septicaemic plague, and 174 cases were unspecified. Of the 915 cases of pulmonary plague, 160 (17.5%) have been confirmed, 375 (50%) were probable and 380 (41.5%) were suspected (further classification of cases is in process). A total of 54 healthcare workers have contracted plague since the beginning of the outbreak.


Of 1 087 cases with age and sex information available, 58% (544) were children and young people aged less than 21 years, while 36% (387) were adults aged between 21 and 40 years. Male were the most affected, accounting for 57% of all cases, and have experienced a slightly higher case fatality rates in comparison to females, 9.4% to 7.7%, respectively.


Of the 1365 cases, 219 were confirmed, 520 were probable and 626 remain suspected (additional laboratory results are in process). Eleven strains of Yersinia pestis have been isolated and were sensitive to antibiotics recommended by the National Program for the Control of Plague.


Overall, 40 out of 114 (35.1%) districts in 14 of 22 (63.6%) regions in the country have been affected by pulmonary plague. The district of Antananarivo Renivohitra has been the most affected, accounting for 41.4% of all reported cases.


On 20 October 2017, 1 385 out of 2 293 (60.4%) contacts were followed up and provided with prophylactic antibiotics. A total of 141 contacts completed the 7-day follow up without developing symptoms.


(Continue . . . )

WHO SitRep #5: Plague In Madagascar

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The most recent update posted on Madagascar’s MOH websitereleased yesterday (October 20th) – still shows 911 plague cases, and 95 deaths, but a situation report from the World Health Organization released on the same date provides a tally more than 40% higher. 

The  reasons behind this discrepancy aren’t immediately apparent, but – assuming the WHO’s numbers are right – reports of a slowdown in cases (based on MOH reported numbers) earlier this week may have been premature.

Some excerpts from the WHO SitRep #5 follow:


Situation Update

Madagascar has been experiencing a large outbreak of plague affecting major cities and other non-endemic areas since August 2017. Between 1 August and 19 October 2017, a total of 1 297 cases (suspected, probable and confirmed) including 102 deaths (case fatality rate 7.9%) have been reported. Of these, 846 cases (65.2%) were clinically classified as pneumonic plague, 270 (20.8%) were bubonic plague, one case was septicaemic plague, and 180 cases were unspecified (further classification of cases is in process). Of the 846 cases of pulmonary plague, 91 (10.8%) have been confirmed and 407 (48.1%) were probable.

Between 1 August and 15 October 2017, a total of 793 specimens were analysed by the Institut Pasteur de Madagascar (IPM). Of these, 126 (15.9%) have been confirmed either by polymerase chain reaction (PCR) or bacteriological culture, 242 (30.5%) were probable after testing positive on rapid diagnostic tests (RDT) and 425 (53.6%) remain suspected (additional laboratory results are in process). Eleven strains of Yersinia pestis have been isolated and were sensitive to antibiotics recommended by the National Program for the Control of Plague.

Overall, 33 out of 114 (30%) districts in 14 of 22 (63.6%) regions in the country have been affected by pulmonary plague. The district of Antananarivo Renivohitra has reported the largest number of pulmonary plague cases, accounting for 63.6% of all the cases.

On 19 October 2017, 1 621 out of 2 470 (65.6%) contacts were followed up and provided with prophylactic antibiotics. A total of 372 contacts completed the 7-day follow up without developing symptoms.

Plague is endemic on the Plateaux of Madagascar, including Ankazobe District where the current outbreak originated. There is a seasonal upsurge, predominantly of the bubonic form, which occurs every year, usually between September and April. The plague season began earlier this year and the current outbreak is predominantly pneumonic and is affecting non-endemic areas including major urban centres such as Antananarivo (the capital city) and Toamasina (the port city).

There are three forms of plague, depending on the route of infection: bubonic, septicaemic and pneumonic (for more information, see the link http://ift.tt/12vOthL).

Current risk assessment
 
While the current outbreak began with one large epidemiologically linked cluster, cases of pneumonic plague without apparent epidemiologic links have since been detected in regions across Madagascar, including the densely populated cities of Antananarivo and Toamasina. 

Due to the increased risk of further spread and the severe nature of the disease, the overall risk at the national level is considered very high. The risk of regional spread is moderate due to the occurrence of frequent travel by air and sea to neighbouring Indian Ocean islands and other southern and east African countries, and the observation of a limited number of cases in travellers. This risk is mitigated by the short incubation period of pneumonic plague, implementation of exit screening measures in Madagascar and scaling up of preparedness and operational readiness activities in neighbouring Indian Ocean islands and other southern and east African countries. The overall global risk is considered to be low.

The risk assessment will be re-evaluated by WHO based on the evolution of the situation and the available information.