Cholera in Haiti - CDC Update

Updated: January 28, 2013

What Is the Current Situation?

An outbreak of cholera has been ongoing in Haiti since October 2010. According to the Ministere de la Sante Publique et de la Population (MSPP), as of December 31, 2012, 635,980 cases and 7,912 deaths have been reported since the cholera epidemic began in Haiti. Cases have been officially reported in all 10 departments of Haiti. In Port-au-Prince, the country’s capital, 173,485 cases have been reported since the beginning of the outbreak. Cases in Port-au-Prince have been reported from the following neighborhoods: Carrefour, Cite Soleil, Delmas, Kenscoff, Petion Ville, Port-au-Prince and Tabarre.

For more information on cholera cases, see theHealth Summary Report from MSPP.

What Is Cholera?

Cholera is a bacterial disease that can cause diarrhea and dehydration. Cholera is most often spread through the ingestion of contaminated food or drinking water. Water may be contaminated by the feces of an infected person or by untreated sewage. Food is often contaminated by water containing cholera bacteria or by being handled by a person ill with cholera.

How Can Travelers Protect Themselves?

Since the earthquake, the U.S. Department of State has maintained a travel warning for Haiti urging U.S. citizens to avoid all nonessential travel to Haiti. For more information, seehttp://travel.state.gov/travel/cis_pa_tw/tw/tw_5541.html.

Most travelers are not at high risk for getting cholera, but people who are traveling to Haiti should still take their own supplies to help prevent the disease and to treat it. Items to pack include

• A prescription antibiotic to take in case of diarrhea
• Water purification tablets*
• Oral rehydration salts*

*In the United States, these products can be purchased at stores that sell equipment for camping or other outdoor activities.

Although no cholera vaccine is available in the United States, travelers can prevent cholera by following these 5 basic steps:

1) Drink and use safe water*

• Bottled water with unbroken seals and canned/bottled carbonated beverages are safe to drink and use.
• Use safe water to brush your teeth, wash and prepare food, and make ice.
• Clean food preparation areas and kitchenware with soap and safe water and let dry completely before reuse.

*Piped water sources, drinks sold in cups or bags, or ice may not be safe. All drinking water and water used to make ice should be boiled or treated with chlorine.
To be sure water is safe to drink and use:

• Boil it or treat it with water purification tablets, a chlorine product, or household bleach.
• Bring your water to a complete boil for at least 1 minute.
• To treat your water, use water purification tablets, if you brought some with you from the United States, or one of the locally available treatment products, and follow the instructions.
• If a chlorine treatment product is not available, you can treat your water with household bleach. Add 8 drops of household bleach for every 1 gallon of water (or 2 drops of household bleach for every 1 liter of water) and wait 30 minutes before drinking
• Always store your treated water in a clean, covered container.

2) Wash your hands often with soap and safe water*

• Before you eat or prepare food
• Before feeding your children
• After using the latrine or toilet
• After cleaning your child’s bottom
• After taking care of someone ill with diarrhea

*If no soap is available, scrub hands often with ash or sand and rinse with safe water.

3) Use latrines or bury your feces (poop); do not defecate in any body of water

• Use latrines or other sanitation systems, like chemical toilets, to dispose of feces.
• Wash hands with soap and safe water after using toilets or latrines.
• Clean latrines and surfaces contaminated with feces using a solution of 1 part household bleach to 9 parts water.

What if I don’t have a latrine or chemical toilet?

• Defecate at least 30 meters away from any body of water and then bury your feces.
• Dispose of plastic bags containing feces in latrines, at collection points if available, or bury it in the ground. Do not put plastic bags in chemical toilets.
• Dig new latrines or temporary pit toilets at least a half-meter deep and at least 30 meters away from any body of water.

4) Cook food well (especially seafood), keep it covered, eat it hot, and peel fruits and vegetables*

• Boil it, cook it, peel it, or leave it
• Be sure to cook shellfish (like crabs and crayfish) until they are very hot all the way through.
• Do not bring perishable seafood back to the United States.

*Avoid raw foods other than fruits and vegetables you have peeled yourself.

5) Clean up safely—in the kitchen and in places where the family bathes and washes clothes

• Wash yourself, your children, diapers, and clothes at least 30 meters away from drinking water sources.

Before departing for Haiti, talk to your doctor about getting a prescription for an antibiotic. If you get sick with diarrhea while you are in Haiti, you can take the antibiotic, as prescribed. Also, remember to drink fluids and use oral rehydration salts (ORS) to prevent dehydration.

If you have severe watery diarrhea, seek medical care right away.

Comments: If you are traveling to Cuba or Haiti or the Dominican Republic, we do have the oral cholera vaccine (Shanchol) in India at various branches of TravelSafe Clinic that can prevent you from getting ill due to cholera.

MUMPS - PAKISTAN: (SINDH), FATALITIES

A ProMED-mail post
http://www.promedmail.org
Date: Thu 10 Jan 2013

Source: Milenio, EFE Agency report [in Spanish, machine trans., summ., edited]

http://www.milenio.com/cdb/doc/noticias2011/58e132e4827a63012a2ed82bbc081e0c

More than 100 children have died in the province of Sindh in the south of Pakistan, after an outbreak of mumps was declared a month ago and today [10 Jan 2013] many experts attributed it to the poor vaccination policy of the authorities, which did not reach the necessary population to prevent the spread of the disease. "When there is a large group of unimmunized children it is very easy to see an outbreak such as this one," Dr Buttha Tariq, Unicef responsible for immunization in neighboring Punjab province, told EFE news agency, adding that mumps "is one of the most contagious diseases and it spreads very quickly."
"The outbreak was declared at the beginning of last month [December 2012]; just during that month about 90 children died, and in January [2013] we've had 14 deaths already," said Dr Suresh Kumar of the Sindh Provincial Health Ministry.
Kumar added that a vaccination campaign that aims to reach more than 3 million children aged between 6 months and 12 years was launched months ago, and he hopes the outbreak [will be contained] by immunisation and greater awareness of parents. Kumar, like other experts consulted, said that the affected area, close to the river Indus, has been badly hit by flooding in the past 3 years, which has worsened the living conditions of many households. "Many lost their homes and now live with other families crammed into small houses with limited resources, which is an ideal breeding ground for infections such as mumps," said Kumar.
A spokeswoman for the World Health Organization (WHO), Maryam Yunus, also recalled that child malnutrition is directly related to the risk of mumps virus infection and its effects are greater. "Many of the people displaced by the floods are malnourished," she said, adding that most deaths of affected children occur from complications such as pneumonia or diarrhea. "Pneumonia is the most common complication and that which causes most deaths," said Buttha.
The experts agreed that now it is important to focus on the treatment of those affected (in December there were at least 2500 cases, according to official figures) with antibiotics and vitamins to improve the immune system of sick children.
Comments: It is a sad indictment of the health status of developing countries in South East Asia that so many children are suffering and even dying due to these easily (vaccine) preventable diseases. We must remember that each death actually represents the tip of an iceberg, wherein hundreds of children who are suffering from the disease are probably not even reporting to health care authorities. 

New York Times - Yellow Fever: China Plans to Scan Travelers From Sudan

In a move that underlines how many Chinese citizens now work in Africa, China’s quarantine officials recently urged greater efforts to make sure that a yellow fever epidemic now raging in Sudan does not come back to China.

Local health authorities were asked to scan all travelers arriving from Sudan for fevers. Chinese citizens planning travel to Sudan were advised to get yellow fever shots. Customs officers were told that containers arriving from Sudan might have stray infected mosquitoes inside.

Sudan’s epidemic is considered the world’s worst in 20 years. Sweden, Britain and other donors have paid for vaccinations. The United States Navy’s laboratory in Egypt has helped with diagnoses.

Estimates of the number of Chinese working in Africa, many in the oil and mining industries or on major construction projects, range from 500,000 to 1 million. Experts onAIDS have previously warned that the workers could become a new means of bringing that disease to China, which has a low H.I.V.-infection rate.

ProMED-mail, a Web site that follows emerging diseases, has tracked reports about the Sudan outbreak, with its moderators adding valuable context. China’s mosquito-killing winters make a large yellow fever outbreak there unlikely, moderators said. But Sudan’s containment efforts are troubled. For example, vaccinated people cannot get cards proving they have had shots, but the cards are reported to be for sale at police checkpoints.

Australia’s now-endemic dengue fever, according to ProMED moderators, may have come from mosquitoes arriving in containers from East Timor.

A version of this article appeared in print on January 8, 2013, on page D6 of the New York edition with the headline: Yellow Fever: China Plans to Scan Travelers From Sudan.

Sudanese Minister of Health announces 5 states of Darfur are now 'free' of yellow fever

A ProMED-mail post
http://www.promedmail.org
Archive Number: 20130107.1486073
Date: Sun 6 Jan 2013

Source AllAfrica, Radio Dabanga report [edited]

http://allafrica.com/stories/201301070095.html

The Sudanese Minister of Health, Bahr Idriss Abu Garda, announced the 5 states of Darfur are now 'free' of yellow fever and stressed that the Ministry is waiting for the official statement of the World Health Organization (WHO).
Abu Garda informed Radio Dabanga in a statement on Sat 5 Jan [2013], that during the last 3 weeks no new cases or deaths, as a result of the fever, have been reported.
The minister stressed that approximately 5 million people in Darfur have been vaccinated during the recent vaccination campaign. The official announcement of the WHO will follow in the upcoming days, the minister added.
--
[One hopes that the Minister of Health is correct, and the worst yellow fever outbreak in Africa in 20 years is now over. The outbreak has affected 34 localities in Central, North, South, East, and West Darfur. However, the vaccination campaign is not yet complete, some areas not yet having been covered due to a lack of vaccine (see ProMED-mail archive no. 20130106.1484642). Also, on Wed 26 Dec 2012, the health minister of Central Darfur announced that new cases of yellow fever have been registered in the state, all patients having come from the gold mining area of Jebel 'Amer, North Darfur (see ProMED-mail archive no. 20121227.1471487). Although the dates when these patients became ill is not mentioned, they appear to have occurred less than 3 weeks ago, raising questions about the accuracy of the Minister of Health's statement. It would be good news indeed if these were the last cases in Darfur.

And now Dengue in Madiera, Portugal

CDC / Dengue in Madeira, Portugal

Center for Disease Control and Prevention: Outbreak notice: December 20, 2012

 

What Is the Current Situation?

As of December 9, 2012, 2,050 cases of dengue fever have been reported from the Portuguese island of Madeira. There have been 58 cases of dengue reported in European travelers returning from Madeira.

At this time, CDC does not advise against travel to Madeira. However, travelers should protect themselves from mosquito bites.

 

What Is Dengue?

Dengue is an illness caused by a virus that is spread through mosquito bites. Symptoms include fever, headache, nausea, vomiting, rash, and pain in the eyes, joints, and muscles. Symptoms can take up to 2 weeks to develop after you are bitten by an infected mosquito but usually last one week. In severe cases, symptoms may include intense stomach pain, repeated vomiting, and bleeding from the nose or gums. See a doctor right away if you have these symptoms.

Travelers who go to tropical and subtropical regions are at risk of getting dengue. These areas include parts of the Caribbean, Central and South America , Western Pacific Islands, Australia (Queensland), Southeast Asia, and Africa. 

Dengue is more common in urban areas and is not usually seen at altitudes above 5,000 feet (1,500 meters). The mosquito that carries the dengue virus bites both day and night and is commonly found indoors as well as outdoors.

 

Clinician Information:

 

Early and proper diagnosis of dengue is important, as many other diseases may mimic dengue. Health care providers should consider dengue, malaria, chikungunya, and leptospirosis, depending on the itinerary and exposure, in the differential diagnosis of patients who have fever and a history of travel to tropical areas during the 2 weeks before symptom onset.

 

Source: CDC / Dengue in Madeira, Portugal

AVIAN INFLUENZA, HUMAN (64): 2012 CASE COUNT

A ProMED-mail post
Archive Number: 20121230.1475459
Date: Fri 28 Dec 2012

Source: The Poultry Site [edited]

http://www.thepoultrysite.com/poultrynews/27667/who-reports-32-cases-of-h5n1-in-humans-this-year

According to the World Health Organisation (WHO), there have been 32 cases of avian A(H5N1) influenza virus infection in humans so far this year [2012], 20 of whom have died.
According to the latest figures, published by WHO on 17 Dec 2012, most of the victims were in Egypt (11 cases; 5 deaths) but there were also 9 cases in Indonesia, 4 in Viet Nam, 3 in Bangladesh and Cambodia, and 2 in China.
Last year, 2011, there were 62 cases, of whom 34 died.
Since the emergence of H5N1 influenza in 2003, 610 people are reported to have become infected, 360 of whom have died.
Comments:
It is very important to keep monitoring Avian Flu cases, since this is a potential source of the next Flu Pandemic. It is important to remember that the present Flu vaccine does not cover the Avain Flu virus, and we do not have any innate immunity against this strain, leading to high morbidity and mortality due to this infection

INFLUENZA - (116): (USA), EARLIEST START IN A DECADE

A ProMED-mail post
Archive Number: 20121231.1476318
Date: Sat 29 Dec 2012

Source: The Washington Post, Associated Press report [edited]

http://www.washingtonpost.com/national/health-science/early-flu-season-could-be-severe-experts-warn/2012/12/29/9ae51816-5045-11e2-839d-d54cc6e49b63_story.html?wpisrc=nl_headlines
The flu season in the United States is having its earliest start in nearly a decade, and health officials say this season [2012-2013] could be a bad one. Although flu is always unpredictable, the early nature of the cases and the predominant type circulating this year [2012] could make this a severe flu season, said officials at the Centers for Disease Control and Prevention [CDC]. But officials said the vaccine formulated for this year is well-matched to the strains of the virus seen so far and urged those who have not been vaccinated to get a flu shot.
In early December 2012, the CDC said it was noticing an increase in flu activity about a month before authorities normally see it, and the earliest since the 2003-2004 flu season. The primary strain this season is H3N2, an influenza A virus that has been associated in the past with more severe flu seasons.
Since the beginning of December [2012], "there has been increasing influenza activity in more parts of the United States and more cases of flu," said Joe Bresee, chief of epidemiology at CDC's influenza division, in an interview last week. "We have seen increasing trends that flu is increasing in the last few weeks of the year, and I wouldn't be surprised if we see that continue into the new year." Influenza often peaks in January, February or even later.
Reports of flu have been reported in 29 states, including Maryland and Virginia. As of 15 Dec 2012, higher-than-normal reports of flu-like illnesses had been reported in 12 states, most of them in the South and Southeast. They are: Virginia, Alabama, Georgia, Louisiana, Mississippi, Missouri, North and South Carolina, Tennessee, Texas, Illinois and Utah.
Based on data from the past 2 decades, during the years when H3N2 is the predominant flu strain, "there are more deaths and hospitalizations," Bresee said. It is not completely clear why. One factor may be that the elderly, who are at high risk for flu complications, tend to become sicker with the H3N2 strain than the other 2 common flu strains, he said.
But this flu season offers 2 bits of good news as well. Of the flu strains that are spreading this year [2012], about 80 percent are the influenza A type, and almost all of those are the H3N2 strain, Bresee said. That matches well with this year's flu vaccine, which includes the H3N2 strain. Flu vaccines are designed to protect against 3 influenza viruses that experts predict will be the most common during the upcoming season. The 3 kinds of influenza viruses that commonly circulate among people today are influenza B, influenza A (H1N1), and influenza A (H3N2). Each year, one flu virus of each kind is used to produce seasonal influenza vaccine.
Also, the Food and Drug Administration on 21 Dec 2012 expanded the approved use of Tamiflu [a neuraminidase inhibitor] to treat children as young as 2 weeks old who have shown symptoms of flu. The drug was previously approved to treat adults and children one year and older. The dose for children under one year old must be based on their exact weight.
Flu is extremely unpredictable. "You never know when the peak will occur or how big the peak will be," Bresee said. "If you've seen one flu year, it's just one flu year." Last winter's flu season [2011-2012], for example, set a new record for the lowest and shortest peak of influenza-like illness. The season began late and was mild compared with most previous seasons. The last time a regular flu season started this early was the winter of 2003-04, which proved to be one of the deadliest seasons in the past 35 years, with more than 48 000 deaths. The dominant type of flu back then was the same one seen this year [2012]. But experts said there is a critical difference between then and now: In 2003-04, the vaccine was poorly matched to the predominant flu strain. Also, health officials said more vaccine is available now, and vaccination rates have risen for the general public and for key groups such as children, pregnant women and health-care workers.
About 112 million Americans had been vaccinated by the end of November 2012, the CDC said. Manufacturers were expecting to produce about 135 million total doses this year [2012]. Flu vaccinations are recommended for everyone 6 months or older. On average, about 25 000 Americans die each flu season, according to the CDC.
Flu usually peaks in midwinter. Symptoms can include fever, cough, runny nose, head and body aches, and fatigue. Some people also suffer vomiting and diarrhea, and some develop pneumonia or other severe complications. A strain of swine flu that hit in 2009 caused a wave of cases in the spring and then again in the early fall. But that was considered a unique type of flu, distinct from the conventional strains that circulate every year, experts said.
Comments:
While this may not be true for India, it is still a good idea to cover everyone who is recommended the flu vaccine (as per IAP recommended high-risk category) as soon as possible.

IAP recommended vaccines for High-risk* children (Vaccines under special circumstances):  1. Influenza Vaccine, 2. Meningococcal Vaccine, 3. Japanese Encephalitis Vaccine, 4. Cholera Vaccine, 5. Rabies Vaccine, 6. Yellow Fever Vaccine, 7. Pneumococcal Polysaccharide vaccine (PPSV 23).

*High-risk category of children:
• Congenital or acquired immunodeficiency (including HIV infection)
• Chronic cardiac, pulmonary (including asthma if treated with prolonged high-dose oral corticosteroids), hematologic, renal
(including nephrotic syndrome), liver disease and diabetes mellitus
• Children on long term steroids, salicylates, immunosuppressive or radiation therapy
• Diabetes mellitus, Cerebrospinal fluid leak,  Cochlear implant, Malignancies
• Children with functional/anatomic asplenia/hyposplenia
• During disease outbreaks
• Laboratory personnel and healthcare workers
• Travelers
Source

PERTUSSIS - AFGHANISTAN: (BADAKHSHAN), FATALITIES

Promed

Subject: PRO/EDR> Pertussis - Afghanistan: (BD), fatalities 
Archive Number: 20130101.1477768

Date: Sat 29 Dec 2012

Source: PakTribune, Pakistan News Service [edited]

http://paktribune.com/news/Whooping-cough-kills-12-children-256076.html

The provincial governor spokesman said 12 children suffering from whooping cough died in a snow-bound district in the northeastern province of Badakhshan.
Spokesman Abdulmaroof Rasekh said the children were between the ages of 1 and 5 years old, and the deaths took place in Shoorian village bordering Tajikistan, located in Nasi Darwaz district of the province. He said local officials learned of the deaths last week. About 350 other children in the area are suffering from the whooping cough epidemic.
The village remains inaccessible from Afghanistan, so a health team was sent from Tajikistan 27 Dec 2012. The team is now treating the children and providing them nutritious food, Rasekh added.
Heavy snow has blocked access to 12 districts in Badakhshan, and teams are unable to reach other areas with potential health emergencies. Officials have said they will call in the Afghan National Army for help if needed.
--
Communicated by:
ProMED-mail from HealthMap Alerts
[The scope of this outbreak is not clear. Most pertussis-associated deaths are in quite young, unimmunized children who are in contact with older children or young adults with milder illness. Pertussis mortality can be minimized not only by immunization with trivalent vaccine against tetanus, diphtheria, and pertussis, but also by early antimicrobial intervention. Large populations of susceptible people in the developing world are the cause of large outbreaks of vaccine-preventable diseases.]