BMJ, European group criticize WHO pandemic actions

first_imgJun 4, 2010 (CIDRAP News) – An article published by the British Medical Journal says three scientists who helped frame World Health Organization (WHO) guidance on pandemic influenza preparedness had consulted for pharmaceutical companies that stood to profit from the WHO guidance and that the WHO did not disclose the scientists’ industry ties.The lengthy report, published online yesterday, says the scientists had declared their industry connections in other publications, but the WHO did not reveal them in its guidance document, WHO Guidelines on the Use of Antivirals and Vaccines During an Influenza Pandemic, issued in 2004.The report also raises other questions about the WHO’s transparency and its management of potential conflicts of interest. In particular, it is critical of the WHO’s refusal to reveal the names of the members of its Emergency Committee, which was set up to help guide the WHO response to the H1N1 pandemic, including when to change pandemic alert phases. The secrecy fuels conspiracy theories about issues such as the triggering of vaccine contracts, the article says.In related developments, a committee of the Parliamentary Assembly of the Council of Europe (PACE) today approved a report that denounced the response of the WHO and European national health agencies to the pandemic as an “unjustified scare” that led to a waste of public resources, according to a Council of Europe press release. PACE’s social, health, and family affairs committee approved the report in Paris today, setting the stage for a debate on Jun 24 during PACE’s summer session.The WHO in recent months has repeatedly rejected charges of undue pharmaceutical company influence on its pandemic preparations and response and has said it has appropriate procedures for managing potential conflicts of interest. The agency recently commissioned a group of independent experts to review the WHO response to the pandemic.WHO advisors namedThe BMJ article was written by the journal’s features editor, Deborah Cohen, and Philip Carter, a journalist with the London-based Bureau of Investigative Journalism.The article lists the three experts who helped develop the WHO guidance as Fred Hayden, of the University of Virginia and the Wellcome Trust; Arnold Monto of the University of Michigan, and Karl Nicholson of the University of Leicester, England.Hayden authored the part of the 2004 guidance document dealing with the use of antivirals in a pandemic, the article says. He told the BMJ that he was being paid by Roche, maker of oseltamivir (Tamiflu), for lectures and consulting when the guidance was produced. The guidance advised governments to consider making plans to ensure they would have a supply of antivirals in the event of a pandemic.The article says Monto wrote an annex to the WHO guidance that covered vaccine usage in a pandemic. At the time, he was declaring receiving honorariums, consulting fees, and/or research support form three companies, Roche, GlaxoSmithKline (GSK), and ViroPharma, according to the report.Nicholson wrote another annex, “Pandemic Influenza,” to the WHO guidance, the article says. According to declarations he made in BMJ and The Lancet in 2003, he had received travel funding and honoraria from Roche and GSK for consulting and for speaking at medical conferences.All three experts told the BMJ that the WHO required experts attending agency meetings to complete declarations of interest. But the article adds, “WHO itself did not publicly disclose any of these conflicts of interest when it published the 2004 guidance. It is not known whether information about these conflicts of interest was relayed privately to governments around the world when they were considering the advice contained in the guidelines.”The BMJ writers say they asked the WHO for the conflict-of-interest declarations for the meeting that launched the development of the 2004 guidance document. The request was turned down by WHO Director-General Margaret Chan.Since 2004, according to the BMJ, the WHO has produced additional pandemic guidance prepared by experts who had received payments from manufacturers of antivirals and vaccines. These activities included a global preparedness plan in 2005 and an interim Pandemic Influenza Task Force in 2006.The article also contends that the WHO is inconsistent in its approach to transparency and its management of possible conflicts of interest. While it has kept secret the names of its Emergency Committee members, the names of its Strategic Advisory Group of Experts (SAGE) on Immunization are public knowledge, and the agency publishes summaries of their declarations of interest.Following a Jun 1 meeting of the Emergency Committee, the WHO yesterday announced it would maintain the current phase 6 pandemic alert for the time being. In the announcement, Chan said the agency guards the names of the committee members “to protect the integrity and independence of the members while doing this crucial work,” but promised to reveal them eventually.The agency told the BMJ it protects the names of the Emergency Committee members to shield them from being influenced or targeted by industry.The BMJ article also raises questions about the quality and disclosure of data that led to the licensing of oseltamivir and zanamavir (Relenza) in Europe and the United States, a topic that the journal covered in a review in December. At that time the journal said it couldn’t get access to manufacturer data on the two drugs. Since then, staff members of the US Food and Drug Administration and the European Medicines Agency have said the two agencies struggled with the “paucity” of data on zanamivir and oseltamivir, respectively, during the licensing process, the article says.Call for transparency supportedSteven Miles, MD, a bioethicist at the University of Minnesota Medical School in Minneapolis, said the BMJ article shows that the WHO needs to be more transparent about its advisors’ potential conflicts of interest and the data it relies on.”The bottom line is that the WHO is looked to for health policy by the world community, including many countries which do not have the capacity to evaluate the health policy and technical questions that they turn to the WHO for guidance on,” he said.”For this reason the WHO has to have the strongest possible standard both with regard to managing conflicts of interest and transparency regarding the origins of its recommendations,” he added. “That includes disclosure not only of conflicts of interest bearing on its experts, but also transparency regarding the data they’re relying on.”In this circumstance it appears that neither was present—that there was no disclosure of industry ties of experts, but also that at least some of the data they were relying on was from industry-funded studies which were under proprietary control.”Miles said the fact that the three experts’ connections with industry were known because of their declarations in other publications doesn’t excuse the WHO from listing those ties in its guidance document.’It’s not enough if you disclose in one location if you don’t disclose in all the locations where you publish,” he said. Also, many of the journals in which the experts publish are not open-source journals, so many of the users of WHO guidelines, such as health officials in countries like Thailand or Nepal, would not have access to the publications in which disclosures were made, he added.In defense of the WHOThe WHO was defended today by Michael T. Osterholm, PhD, MPH, director of the University of Minnesota Center for Infectious Disease Research and Policy, which publishes CIDRAP News.Osterholm said the WHO needs to rely on leading experts on issues such as antivirals, and such experts will often have some ties to industry. He also said the BMJ writers presented no evidence that the industry connections of its advisors led to any inappropriate actions or recommendations by the WHO.”Over the years there’s been a small group of researchers who have concentrated in antiviral treatment and prevention for flu. Why should it be surprising that they may have worked with drug companies on these drugs?” he said. “To exclude them would be to exclude the universe of expertise.””Today it’s very easy to do science witch hunts or character assassination by inference. There’s no evidence whatever that any of these individuals acted improperly, nor did WHO,” Osterholm added.If the WHO wanted authoritative information on the use of antivirals, he said, “I can’t think of anybody in the world who would know more about it” than Hayden. “Is there any evidence that Fred or anyone like him recommended drugs that benefited him financially?”Osterholm said he is very supportive of transparency and disclosure, while asserting that the WHO has systems in place to prevent conflicts of interest from distorting recommendations or votes. Ultimately, he said, the relevant decisions were made by the WHO itself, not by its expert advisors.Council of Europe reportThe PACE committee report denouncing the pandemic response by the WHO and European governments was produced by committee member Paul Flynn, a Labour member of the British parliament.The Council of Europe, a group separate from the European Union, works on issues such as civil rights, economics, and democracy. The group was established after World War II and is made up of elected officials from 47 nations.The committee’s report charges that there were “grave shortcomings” in the transparency of decision making during the pandemic, which they say raises questions about pharmaceutical industry influence. They questioned why the WHO emergency group and European advisory groups didn’t publicize the names and conflict-of-interest declarations of their members.Fiona Godlee, editor-in-chief of the BMJ, appeared before the committee today to detail the journal’s report that scientists with drug industry ties helped WHO develop guidelines on flu vaccine stockpiling.The PACE committee’s report recommends several measures designed to improve transparency and safeguard against what it says is undue influence. The group also calls for a public fund to support independent research and expert advice, possibly funded by the pharmaceutical industry, and closer collaboration with the media to avoid sensationalistic coverage of public health events.Before and during a PACE committee hearing in January, the WHO defended itself from the accusations. Keiji Fukuda, MD, special advisor on pandemic influenza to the WHO director-general, said the new virus that quickly swept the globe required an unprecedented global cooperation from wide-ranging groups, including pharmaceutical companies.He said the International Health Regulations (IHR) provide an orderly framework for assessing and declaring a pandemic.A pharmaceutical company representative also rejected the committee’s charges at its hearing in January. Dr Luc Hessel, chairman of the European Vaccine Manufacturers Public Health Policy and Advocacy working group, said vaccine companies delivered a safe, effective vaccine in a timely manner, as countries asked them to do, based on the best information they had at the time.He said many governments had preexisting contracts for pandemic vaccine to avoid difficult negotiations and ease the response during a public health emergency. Hessel countered that vaccine companies have shouldered financial risks in advance of the pandemic by expanding production capacity.Several top health officials have defended government and WHO actions in the wake of the PACE committee’s criticisms.  For example, British Heath Secretary Andy Burnham told the House of Commons in January that he would not apologize for preparing to protect the public during a pandemic, and Australia’s chief medical officer, Jim Bishop, in a media report called some of the groups claims “historically and medically inaccurate” and said the WHO made its pandemic decisions based on cases and deaths in Mexico and the United States, not on pharmaceutical industry influence.At the recent World Health Assembly, which wrapped up its work on May 21, representatives from several nations, including France, India, and the United States, also defended the WHO’s pandemic actions, according to media reports. French health minister Roselyne Bachelot called criticism of the WHO’s response unfair.”The vaccine, which was the answer to a real danger, turned into a source of risk in the collective mind,” Bachelot said, according to Agence France-Presse. “The effects of this smear campaign are potentially devastating.”Cohen D, Carter P. Conflicts of interest: WHO and the pandemic flu “conspiracies.” BMJ 2010;340 (published online Jun 3) [Full text]See also:Jun 4 PACE statementJan 14 CIDRAP News story “WHO, vaccine group deny pandemic scare charges”Jan 26 CIDRAP News story “European hearing airs WHO pandemic response, critics’ charges”Jun 3 WHO emergency committee statementlast_img read more

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NEWS SCAN: Cholera in Haiti, Listeria kills two, MRSA variant

first_imgJun 3, 2011Cholera cases spike in Haiti’s capitalHaiti’s capital, Port-au-Prince, is experience a surge of new cholera infections, according to aid groups working in the area. An official from Oxfam, an international confederation of 14 organizations, said yesterday that the impact of the disease on the city’s Carrefour area is currently worse than during the height of the country’s outbreak in November 2010. Mimy Muisa Kambere said in a statement that the area is registering 300 new cases a day, compared with 900 per week earlier in the outbreak. However, she added that the death rate is lower than before, because people are getting treatment faster.Jun 2 Oxfam statementIn a related development, the American Red Cross said today that it is reopening a treatment center in Carrefour to handle the spike in cholera cases in and around Port-au-Prince. In a statement, the group said it was stepping up other outbreak response efforts as Haiti enters its rainy season. It is deploying teams of health educators to cholera hot spots and is sending text messages to people in high-risk areas to notify them about treatment center locations and share cholera prevention tips.Two die of Listeria in DenverThree Listeria infections, two of them fatal, are being investigated in Denver, the Colorado Department of Public Health and Environment (CDPHE) announced yesterday. Those who died were a man in his 30s and a woman in her 60s. All three cases involve people of Hispanic heritage, the CDPHE said. The source of the cases was unknown and under investigation. Alicia Cronquist, a CDPHE epidemiologist, urged the public to take precautions to avoid Listeria, including avoiding soft cheeses unless they are made with pasteurized milk, hot dogs and deli meats unless reheated to 165ºF, refrigerated pate or meat spreads, and refrigerated seafood. Those at high risk include people with weakened immune systems, pregnant women, and those older than 60, she noted. Colorado has only about 10 cases of listeriosis per year on average, the statement said.Research groups detail new MRSA variantTwo research groups have identified a new variant of methicillin-resistant Staphylococcus aureus (MRSA), according to two studies that appeared yesterday and today in different medical journals. One group reported finding the new type in patients in Irish hospitals, and their study appeared yesterday in Antimicrobial Agents and Chemotherapy, published by the American Society for Microbiology (ASM). Another group detected the strain’s emergence in human and cow populations in the United Kingdom and Denmark and detailed its results in Lancet Infectious Diseases. The new strain isn’t identified as MRSA by current lab tests, which has implications for clinical diagnosis and treatment. Irish and German researchers used high-throughput DNA microarray screening to identify the new strain, which belongs to a genetic lineage clonal complex seen only previously in cows and other animals, according to an ASM press release. While preparing their study for press, the researchers learned that a UK group had identified a bovine MRSA strain with a nearly identical genetic pattern that had emerged in both bovine and human populations in the United Kingdom and Denmark. They identified the MRSA strain in bulk milk, and they also found it when they looked for the strain in veterinary and human MRSA reference lab collections. They say the findings suggest that cows may be reservoirs for human MRSA.Jun 2 Antimicrob Agents Chemother abstractJun 3 Lancet Infect Dis abstractlast_img read more

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Puzzles persist as European E coli outbreak grows

first_img May 27 CIDRAP News story “Questions abound in European E coli outbreak” See also: The CDC said it was “not aware that a specific food has been confirmed as the source of the infections,” but it said travelers to Germany should be aware of the warning against eating cucumbers, lettuce, and tomatoes there. The CDC is working with state health departments to learn more bout the two HUS cases and identify others, the agency said in an e-mailed statement. It said anyone who recently traveled to Germany and has signs or symptoms of a Shiga-toxin producing E coli (STEC) infection or HUS should seek medical care and tell their provider about the outbreak in Germany and the importance of being tested. Germany’s Robert Koch Institute (RKI) said today the number of cases of hemolytic uremic syndrome (HUS), a potentially fatal kidney disorder, in the outbreak reached 373, with 6 deaths. The Associated Press (AP) said the death toll for all countries has reached 16, with 1,150 E coli cases in Germany and “hundreds more” in other countries. In the United States, two cases of HUS have been reported in people who recently traveled to Hamburg, Germany, the apparent epicenter of the outbreak, the Centers for Disease Control and Prevention (CDC) reported this afternoon. But no confirmed infections with the rare outbreak strain, E coli O104:H4, have been reported in the US, officials said. German officials have identified the outbreak strain as a multidrug-resistant E coli O104:H4, which the CDC termed a “very rare” strain. The agency said today that this precise serotype has never been seen in the United States and has rarely been seen in other countries. As reported previously, a small E coli O104 outbreak occurred in Helena, Mont., in 1994, but the serotype was O104:H21, not O104:H4. Antibiotics as risk factorCraig Hedberg, PhD, a foodborne disease expert at the University of Minnesota School of Public Health, commented today that if antibiotics are being used to treat E coli patients in Europe, this might help explain the high risk of HUS in the outbreak. Yesterday’s HUS total in Germany was 329 cases, two thirds of them in women, the European Centre for Disease Prevention and Control reported. Meanwhile, the US Food and Drug Administration is stepping up inspections of cucumbers, lettuce, and tomatoes from Spain, according to a Reuters report today. FDA spokesman Doug Karas said Spanish cucumbers are not imported into the United States in large numbers at this time of year. May 31, 2011 (CIDRAP News) – Reported severe illnesses caused by Escherichia coli in Germany and neighboring countries continued to pile up in recent days, while mysteries about the source of the infection, why it’s so severe, and why it seems to strike mainly women remained unresolved.center_img “There is good evidence that treating a patient infected with E coli O157:H7 with an antibiotic to treat their diarrhea may increase their risk for developing HUS,” Hedberg said. “Most E coli O157:H7-associated HUS cases involve children, and children are not typically treated with ciprofloxicin. On the basis of a case-control study and limited lab evidence, the outbreak is believed to be linked to fresh cucumbers, lettuce, and tomatoes, especially Spanish cucumbers, but that has not been confirmed. Another persisting question is why the apparent proportion of HUS cases has been so high. A total of 373 HUS cases out of about 1,150 E coli cases signals an HUS rate of about 32%, far higher than in previous E coli outbreaks. In the outbreak linked to Jack in the Box hamburgers in 1992 and 1993, for example, about 7% of all cases involved HUS. Biggest E coli outbreak?The outbreak is clearly one of the largest E coli epidemics on record, but the CDC stopped short of calling it the biggest ever. “We are still learning more about the overall size of this outbreak,” the agency said. “The number of HUS cases involved indicates that the outbreak is very large.” “However, ciprofloxicin would be the drug of choice for empirically treating an adult with an acute diarrheal illness [in which the specific pathogen has not been identified]. If this were a common practice in Germany, it could account for some of the apparently high risk of HUS associated with this outbreak. I don’t have any information on this, but it is certainly something that should be evaluated.” German officials today continued to warn against eating raw cucumbers, lettuce, and tomatoes, especially in northern Germany, according to the RKI. A public health laboratory in Hamburg on May 26 identified E coli on four cucumbers, three of them from Spain, as reported previously. But according to today’s AP report, Hamburg officials said tests on two of the cucumbers pointed to a strain different from the outbreak strain. In other observations, he said that if fresh produce items are confirmed as the source of the outbreak, that may help explain why so many of the patients are women. Produce has been the source food in some Salmonella and E coli O157:H7 outbreaks that mainly involved women, he noted, adding, “Because women are more likely to eat these food items, they are more likely to be exposed to the [E coli] strain contaminating the food items,” he said. The agency also commented, “It is too early to know why this is such a large outbreak. The large size may have to do with contamination of a popular food item. However, to our knowledge a specific food vehicle has yet to be confirmed. It is also possible that the unusual strain is particularly likely to cause HUS.” Hedberg called the size and severity of the outbreak “unprecedented” and predicted that it will lead to research that will “greatly expand our understanding of the pathogenesis and variability” of enterohemorrhagic E coli.last_img read more

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FLU NEWS SCAN: H5N1 death in Egypt, flu vaccine effectiveness in Europe

first_imgApr 12, 2012 Egypt reports H5N1 deathA 36-year-old woman who succumbed to H5N1 avian flu has become Egypt’s ninth H5N1 case-patient and fifth to die this year, the World Health Organization (WHO) reported today. The woman, from Giza governorate, became sick Apr 1, was admitted to a hospital Apr 7, and died the same day, the WHO said. Her case was confirmed by a WHO-linked national laboratory. She had exposure to backyard poultry. Since 2006 Egypt has confirmed 167 H5N1 cases, 60 of which have been fatal. Egypt is second in the world in H5N1 cases, after Indonesia, and third in the world in H5N1 deaths, well behind Indonesia in that category but only one death behind Vietnam. Egypt’s nine cases lead the world this year, with Indonesia second at five cases. Egypt has had the most H5N1 cases each year by a good margin since 2009.Apr 12 WHO updateApr 12 WHO global case count Preliminary study: Flu vaccine was 43% effective against H3N2 in EuropeA preliminary study from eight European countries suggests that this year’s flu vaccine was 43% effective against H3N2 viruses, with antigenic drift cited as a possible contributor to the limited vaccine effectiveness (VE). The study, reported today in Eurosurveillance, was conducted by the Influenza Monitoring Vaccine Effectiveness in Europe (I-MOVE) Network in France, Hungary, Ireland, Italy, Poland, Portugal, Romania, and Spain. It focused on people in flu-vaccination target groups. Over the last 5 weeks of 2011 and the first 7 weeks of this year, providers recruited 2,090 patients with flu-like illness, 575 of whom were in the target groups. Of 935 confirmed flu cases, 867 were H3N2 viruses. Because of the small sample size, the study focused on this subtype only. Of 538 cases included in the analysis, there were 208 H3N2 infections and 330 negative controls. Among the 533 patients with known vaccination status, 179 (33.5%) had been vaccinated. The adjusted VE was found to be 43% (95% confidence interval, -0.4% to 67.7%). “The low to moderate VE we observed may be explained by a limited match identified between the circulating influenza A(H3) virus strains and the vaccine strain,” the report says, noting that the WHO picked a different H3N2 strain for next year’s vaccine in view of signs of increasing antigenic drift in the circulating strains. The report also says the median time between vaccination and illness was 105 days for cases and 74 for controls, which suggests that waning immunity might have contributed to the low VE, but the sample was too small to verify this.Apr 12 Eurosurveillance reportlast_img read more

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News Scan for Dec 05, 2013

first_imgSaudi Arabia reports two more MERS casesSaudi Arabia’s health ministry today announced two more Middle East respiratory syndrome coronavirus (MERS-CoV) infections, one of which appears to be in a health worker with an asymptomatic infection who had contact with a confirmed case, according to a machine-translation of a statement posted on the ministry’s Web site.The health worker is a 26-year-old working in Riyadh, and the second case is in a 51-year-old resident of the Jawf region who has underlying medical conditions and is hospitalized in an intensive care unit in Riyadh. The relationship between the case-patients isn’t clear from the translation, nor are their genders.The new cases raise Saudi Arabia’s MERS-CoV count to 132 cases with 55 deaths.Dec 5 Saudi health ministry statement IDSA offers guidelines on vaccines for immunocompromised patientsNew guidelines from the Infectious Diseases Society of America (IDSA) are designed to fill an information gap by offering comprehensive recommendations on immunizations for people who have compromised immune systems, such as those with cancer, HIV, or Crohn’s disease, the IDSA announced today.Vaccination rates tend to be lower in immunocompromised patients, in part because their physicians may be concerned about vaccine safety and effectiveness, the IDSA said in a press release. The group said most such patients should receive the influenza vaccine and other immunizations.The recommendations were published today in Clinical Infectious Diseases. They are intended for both primary care physicians and specialists who treat immunocompromised patients, and they include recommendations for vaccinations for those who live with such patients.”The guideline provides ‘one-stop shopping’ for clinicians caring for children and adults with compromised immune systems and includes recommendations and evidence for all vaccinations, from influenza to chicken pox,” said Lorry G. Rubin, MD, lead author of the guideline. “Previously, the recommendations were difficult to retrieve because in most cases information had to be accessed individually by vaccine rather than by the category of patient disease.”The 122 specific recommendations in the guideline cover patients with all types of immunocompromising conditions, the IDSA said.The guidance says that inactivated influenza vaccine is recommended for immunocompromised patients aged 6 months and older, except those who are very unlikely to respond, such as those receiving intensive chemotherapy or those who have received anti–B-cell antibodies within the past 6 months. It says the live attenuated flu vaccine should not be used in immunocompromised persons. Dec 5 IDSA press releaseIDSA guidelines in Clin Infect Dis Raw-burger holiday tradition led to Wisconsin outbreak last yearA 17-case outbreak of Escherichia coli infections last holiday season in Wisconsin was linked to consuming raw ground beef as “tiger meat” or “cannibal sandwiches” as part of a winter holiday tradition, health officials reported today in Morbidity and Mortality Weekly Report (MMWR).The outbreak came to light Jan 8 this year when Wisconsin’s state lab notified the Wisconsin Division of Public Health of two patients with identical E coli O157:H7 clinical isolates. The two had bought raw ground beef at the same Watertown, Wis., market and served it raw with onions on rye bread or crackers as part of a holiday specialty.Health professionals identified 17 outbreak patients, 4 with confirmed illness and 13 listed as probable cases. The patients ranged in age from 1 to 82 years, with a median of 46. Thirteen of them were female. Eight had received outpatient care, but none died or required hospitalization.Fourteen patients reported eating raw ground beef as tiger meat or cannibal sandwiches during the holidays, and three were exposed via cross-contamination.The investigators also interviewed 58 people who bought raw ground beef from the meat market from Dec 22, 2012, through Jan 4, 2013, or their household contacts or people in the area who reported gastrointestinal illness. The list included outbreak patients. All but 1 of 56 who answered the question said they consumed raw ground beef only on special occasions.Fifty-three of the 58 (91%) knew that eating raw ground beef could cause illness, but only 17 of 42 (41%) thought that sickness could be severe. Six of 15 patients (40%) and 28 of 40 other respondents (70%) said they planned to continue eating raw burger.The meat market voluntarily recalled 2,532 pounds of raw ground beef because of the outbreak, the authors said. The MMWR report does not name the market, but a Jan 15 US Department of Agriculture (USDA) recall notice specified that it was Glenn’s Market and Catering of Watertown.This same region of Wisconsin saw outbreaks of more than 50 cases linked to eating raw ground beef in 1972, 1978, and 1994, the MMWR report says. It adds that the sandwiches are a tradition in some Upper Midwest regions.Dec 6 MMWR report Jan 15 USDA recall noticeLawlessness, violence in Pakistan spur 2013 polio increaseOf the three countries in the world in which polio is still endemic, Pakistan ranks first in the number of cases so far in 2013, with 72, and is the only one with an increase in cases over last year, according to a story from Agence France-Presse (AFP). World Health Organization (WHO) officials count opposition to the vaccination campaigns by militant groups and violence against vaccination workers as the reasons behind these dubious honors.Of this year’s cases in Pakistan, the large majority (50) have been in the lawless northwest tribal areas bordering Afghanistan. Pakistani Taliban groups banned polio vaccinations in Waziristan last year, claiming the campaigns were covers for espionage, says the story. Vaccination workers have been attacked and in many cases killed while trying to reach children with vaccine in the northwest as well as other areas of the country.Elias Durry, emergency coordinator of the WHO Polio Eradication Pakistan Program, said 33 million children were vaccinated in the recent campaign but that 2.3 million had been missed, mainly because of violence and security threats.The two countries in addition to Pakistan where polio remains endemic are Nigeria, with 50 cases this year, and Afghanistan, with 6. Last year Nigeria had 110 cases, Pakistan 58, and Afghanistan 31. Dec 4 AFP storyMost recent (Dec 2) CIDRAP News scan addressing violence in Pakistanlast_img read more

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New H7N9 cases in China include first in Jilin province

first_imgChina today reported four new H7N9 infections, one fatal, including the first case from Jilin province, which lies well north of the main outbreak area.Three of the latest illnesses are from Guangdong province, a hotspot of disease activity during the outbreak’s second wave. Patients include a 46-year-old woman and a 69-year-old man, both of whom are hospitalized, and a 64-year-old man who died from his infection, according to a provincial health ministry statement translated and posted by FluTrackers, an infectious disease news message board.The patient from Jilin province is a 50-year-old poultry farmer in the capital city of Changchun, according to a news report today in Chinese from Xinhua, China’s state news agency, that was translated and posted by FluTrackers. He is reportedly hospitalized in stable condition.Jilin province, located in northeastern China, borders North Korea and Russia. The area where the H7N9 case was detected is about 600 miles northeast of Beijing, the northernmost site where H7N9 cases have previously been detected. So today’s news of a case in Jilin represents an expansion of the outbreak area.The four new cases boost the outbreak total to 365, according to a case list kept by Flu Trackers. The latest death lifts the unofficial number of fatalities to 113.Over the past several days the second wave of infections has tapered off, after exceeding the last spring’s first wave. So far 229 H7N9 infections have been reported in the second wave, compared with 136 during the first.Researchers detail father-son case clusterIn other developments today, researchers from China reported on a family case cluster in Shandong province that occurred last April during the outbreak’s first wave. The team reported its findings in the latest online edition of BMC Infectious Diseases.The two sick family members were a 36-year-old father and his 4-year-old son. The man got sick first and was hospitalized with acute respiratory distress on Apr 21, followed by his son’s hospitalization a week later. Samples from both patients were positive for H7N9, and a genetic analysis found that the viruses were almost identical.An investigation into the sources of their illnesses found that the boy had significant unprotected exposure to his father while he was sick and that the two had not had contact with poultry, but had been near a poultry environment.The family lived in a rural-urban area of Zaozhaung, a city of 3.7 million in southern Shandong, near the border with Jiangsu province. Several live poultry in cages were located 10 meters (33 feet) from the family’s apartment, and two live poultry slaughtering sites were housed about a third of a mile  and about two thirds of a mile from their neighborhood.Two days before the father got sick, he had visited a village that had several large poultry farms, but he didn’t enter them. None of the family members had bought poultry at the local slaughter sites or had contact with any sick or dead poultry,Follow-up of 11 close contacts found no other H7N9 infections. Health officials collected 96 environmental samples, and only one yielded the virus: a swab taken from a chopping block at a live poultry market about 6 miles from where the family lived.Researchers concluded that the father’s infection probably resulted from contact with a contaminated environment and that the son was likely infected during prolonged unprotected exposure to his sick father, but they added that the environment or other sources can’t be excluded.The case fits with a risk assessment from the World Health Organization (WHO) that says the virus doesn’t transmit easily from human to human, but human-to-human transmission may have occurred when there was close unprotected contact with sick patients.See also:Feb 21 FluTrackers threadFluTrackers human H7N9 case countFeb 21 BMC Infect Dis abstractJan 21 WHO H7N9 risk assessmentlast_img read more

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Senate committee probes proposed US Ebola funding

first_imgThe White House’s $6.18 billion emergency funding request for the domestic and global fight against Ebola received its first hearing in Congress today, prompting questions from senators on whether the funding and response steps have the right targets and garnering support from dozens of health groups, whose representatives said the funds are needed to build preparedness.Also in Washington, DC, today nurses from the nation’s biggest union held a vigil and press conference outside the White House to call for better personal protective equipment (PPE) for Ebola caregivers. The nurses also voiced concern over eroding patient care standards in the United States and globally.Events planned by National Nurses United (NNU) included strikes, pickets, rallies, and candlelight vigils in 15 states, as well as in Australia, Canada, Ireland, the Philippines, and Spain.Senators scrutinize emergency funding requestPresident Barack Obama on Nov 5 asked Congress for the Ebola investment, which includes $4.5 billion for the immediate response and $1.5 billion in contingency funds. The funding would be part of a $1 trillion spending package that House and Senate members are working on to fund the government past Dec 11 through the end of the fiscal year.Barbara Mikulski, D-Md., appropriations committee chair, said the $6.2 billion request was in line with emergency requests approved with bipartisan support to battle other diseases: $6.1 billion to address the avian flu threat during the Bush administration and $6.4 billion to respond to the 2009 H1N1 influenza pandemic during the Obama administration.”We have done this before when we have been faced with emergencies. Now we have to tackle this new development,” she said.Representatives from all of the federal agencies involved in the response were on hand to testify. Also, testimonies of at least 60 outside witnesses were submitted, representing 116 different health organizations. Mikulski said the bulk of the statements said sustained investments are needed for public health and that emergency funds are needed to battle Ebola in the short term.Richard Shelby (R-Ala.), the committee’s ranking member, said the size of the request, the government’s slow progress in detailing how it would spend the money, and missteps warrant the committee’s scrutiny. He said the Centers for Disease Control and Prevention (CDC) guidance for hospitals has been a moving target and that the Obama administration has sent mixed messages on quarantine issues. He said he is worried that federal Ebola plans revolve mainly around preparing for best-case scenarios.”Competent crisis planning, however, must include contingencies for the worst-case scenario, as well,” Shelby said, urging officials not to rule out any reasonable option for preventing the disease in the United States, including travel and visa restrictions.Officials who testified today were from the State Department, which includes the US Agency for International Development (USAID), the Department of Defense (DoD), the Department of Homeland Security (DHS), and the Department of Health and Human Services (HHS). In their opening statements, each official outlined agency requests:HHS: $2.43 billion focusing on preparedness for US health and public health systems, development of vaccines and drugs, and battling the disease in West AfricaDHS: $13.2 million, which includes $10.2 million for enhanced medical screening personnel and the rest for PPE, overtime, and other response costsState Department/USAID: $2.89 billion, which includes $2.1 billion in base funding to battle the outbreak in West Africa and $792 million in contingency funding as the outbreak evolvesDoD: $112 million for the Defense Advanced Research Projects Agency (DARPA) to work on technologies to provide immediate temporary immunity and shorten the timelines for vaccine developmentMikulski aired some of the NNU concerns, including a request that Obama use his executive authority to set standardized PPE protocols.HHS Secretary Sylvia Burwell said federal efforts have trained about 250,000 health workers in Ebola infection control and efforts are needed to continue the training, measure if it’s working, and assess if caregivers are comfortable with it. She said the funding request includes money for continuing Ebola training.Quarantine questioningSeveral senators questioned federal officials on why the DoD has a more stringent quarantine policy for troops returning from West Africa than the CDC’s recommendations  for travelers arriving from West Africa, including healthcare workers returning from treating Ebola patients.On Nov 7 the DoD announced more details about its mandatory 21-day controlled monitoring for service members returning from Operation United Assistance, which involves seven bases that will temporarily house the troops. So far, nearly 2,000 troops have been deployed to the region.Maj Gen James Lariviere, deputy director for politico-military affairs (Africa) and the Joint Chiefs of Staff, said that although the approach is more conservative, it isn’t based on scientific information that other agencies don’t have. He characterized the decision as operationally based, rather than medically based.Burwell added that the differences in approaches is influenced by the desires of the groups involved, and said that although the quarantine decisions should be based on level of risk and science, “it’s also important to respect those who are serving and the desires of those who have taken the step to serve.”Other medical concernsMike Johanns, R-Neb., asked federal officials if funds should be included to help cover costs for treating Ebola patients, since the cost of treatment can be extremely high, with private insurance not likely to cover all of the costs. Nebraska Medical Center in Omaha is one of the high-biocontainment units that has treated some of the US-based Ebola patients. Johanns urged federal officials to consider, given the challenge of treating Ebola patients, a more regional care model.Burwell said federal officials are taking a phased approach to beefing up biocontainment capacity and for now are focusing on facilities that are near five airports that are funneling all of the travelers arriving from West Africa.Some senators raised concerns about whether there is enough in Obama’s request to build up health systems and disease detection capacities in the wider West Africa region. Chris Coons, D-Del., said he spoke with Liberia’s President Ellen Johnson Sirleaf, who relayed her gratefulness to Americans for the US response efforts but urged the country to not ease off on its efforts.CDC Director Tom Frieden, MD, MPH, said the CDC already has teams in each of the surrounding countries, and he said the cluster of Ebola infections in Mali (see related CIDRAP News story today) is a great concern.A handful of legislators pressed federal officials about why the United States hasn’t limited visas for people traveling from West Africa, similar to what Australia and Canada have done.DHS secretary Jeh Johnson said there are already mechanisms in place for denying visas to people when officials determine that travel would be too risky. He said, however, that putting a broader ban in place would set a dangerous precedent and hamper the response effort.”The biggest concern about limiting the number of visas is that other nations would follow, and that would isolate [outbreak] countries,” Johnson said. “I don’t want to see our country become a leader in isolating those countries.”Health groups weigh in on Ebola fundingTrust for America’s Health (TFAH), one of the groups that submitted a witness statement, said it supported the request, especially the funds that will go toward building long-term public health capacity in West Africa, assist state and local public health departments, and beef up the Strategic National Stockpile and hospital preparedness.Jeffrey Levi, PhD, TFAH’s executive director, said in the group’s statement that infectious disease control needs constant vigilance, requiring both emergency and ongoing funding. “Quite simply, we will never have a reliable public health system if it is constantly scrambling from crisis to crisis and from emergency funding stream to emergency funding stream with no continuity.”In testimony submitted by the Infectious Diseases Society of America, the group’s president, Stephen Calderwood, MD, said it and the Pediatric Infectious Diseases Society strongly support the Ebola funding request, both for response and to build capacity to address infectious diseases. “We urge that that this funding not come at the expense of other infectious disease programs, so that preparedness and response efforts for future outbreaks are not undermined.”Liberian man’s family, hospital reach settlementIn other US Ebola developments today, the Dallas hospital that cared for the Liberian man who was the nation’s first Ebola patient said it has resolved matters with the man’s family.Thomas Eric Duncan, who got sick with the virus after arriving from Liberia, was hospitalized at Texas Health Presbyterian Hospital, where he died on Oct 8. After he died, his family called for an investigation into the care the man received, especially why he was released from the emergency department during an initial visit 2 days before he was isolated at the hospital.In a statement today, the hospital’s parent company, Texas Health Resources, repeated its condolences and said it regretted that the Ebola diagnosis wasn’t made during Duncan’s first visit to the emergency department, 2 days before he returned by ambulance and admitted. The man’s travel history to Liberia wasn’t fully communicated to his care team at that visit, and some experts have said a quicker Ebola diagnosis could have improved Duncan’s prognosis.Texas Health Resources said it is honoring Duncan by creating a memorial fund in his name to assist Ebola victims in Africa. It said it appreciates acknowledgment by the family’s attorney that Duncan received excellent inpatient care. “We are grateful to reach this point of reconciliation and healing for all involved,” it said in the statement.Financial details of the agreement were confidential, but Duncan’s family will benefit, the Dallas Morning News reported today.See also:Senate appropriations committee background materials and testimonyNov 11 NNU press releaseNov 12 TFAH news releaseNov 12 Texas Health Resources statementNov 12 Dallas Morning News storylast_img read more

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South Korea MERS totals grow by 1 infection, 1 death

first_imgIn a further sign of slowing in South Korea’s MERS-CoV outbreak, the country reported just one new case and one additional death over the past few days, edging the total to 182 infections, 32 of them fatal.The World Health Organization has said that the recent drop in infections linked to a single healthcare-related transmission chain signals that South Korea’s control measures are having an impact. But it warned that more cases were likely to be detected, perhaps even some in the community, given the large number of contacts still under monitoring.Another ill health workerSouth Korea has gone 2 days without reporting a newly confirmed MERS-CoV (Middle East respiratory syndrome coronavirus) case. The health ministry said the most recent case, announced on Jun 27, was in a nurse who was exposed to the virus while treating a patient, according the Korea Times.According to a health ministry update today, 36 healthcare workers have been sickened in the outbreak.Yesterday health officials reported that a 55-year-old man who contracted the virus at Samsung Medical Center in Seoul died from his infection, Agence France-Presse (AFP) reported today. His illness was confirmed on Jun 9.Samsung was the second hospital to be hit by the virus, which spread in the facility quickly when a man who was unknowingly infected at the first hospital spent nearly 3 days in the emergency department, where he exposed other patients, visitors, and staff.Currently, 2,682 possible contacts are in home or hospital monitoring, 120 more than the day before, the health ministry said.Index patient recoversIn a related development, the index patient—a 68-year-old man who got sick after traveling to four Middle Eastern countries—has recovered from MERS-CoV and was discharged from National Medical Center, the Korea Times reported today.He still has pneumonia but has cleared the virus, based on several rounds of testing, the story said. He is now being treated at a general hospital.The man had visited a handful of clinics and hospitals before his MERS-CoV infection was confirmed on May 20, which triggered a large nosocomial outbreak—the largest outside of the Middle East—that affected several hospitals.Policy changesIn other outbreak developments, government officials announced some new policy changes to help stem future disease outbreaks.Kwon Deok-cheol, a senior health ministry official, said the government will expand national health insurance coverage for people who have infectious diseases, along with those who need to be isolated in negative-pressure rooms in hospitals, the Korea Herald reported today.He said national health insurance would also cover the installation of more negative-pressure rooms and maintain the ones that are already in operation. He added that the MERS outbreak showed that South Korea has a severe shortage of negative-pressure rooms and that some of the existing ones haven’t been properly maintained.As another measure, hospitals will be required to separate their emergency departments and areas for patients who need to be isolated from other hospital wards, according to Kwon. The health ministry will also roll out regular incentive-based infection control evaluations for hospitals.He said the new measures will be finalized and confirmed in July, according to the report.Thai patient declared virus-freeAn Omani man who was hospitalized with a MERS-CoV infection in Thailand, becoming its first imported case, has been declared free of the virus but will remain in quarantine for the time being, Reuters reported today, citing the country’s health ministry.The 75-year-old man had symptoms before he departed Oman, accompanied by three family members, but his infection wasn’t detected until he arrived in Thailand for treatment of a cardiac condition.Surachet Satitramai, acting secretary of the health ministry, said the man’s latest test results were negative for MERS-CoV, but he will remain hospitalized to assess if his other health conditions will have any effect on his recovery.The man’s relatives remain free of the virus, and the health ministry is still monitoring 36 people who may have had contact with the Omani man, according to the Reuters report.See also:Jun 27 Korea Times storyJun 29 AFP storyJun 29 South Korean health ministry statisticsJun 29 Korea Herald storyJun 29 Reuters storylast_img read more

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Minnesota measles outbreak to cost state $1 million

first_imgYesterday Minnesota Health Commissioner Ed Ehlinger, MD, MSPH, asked state lawmakers for $5 million to address growing infectious disease crises, including the current measles outbreak in Minnesota’s Somali-American population that is projected to cost the state at least $1 million.When it began last month, public health officials knew this outbreak could be large and ongoing, because many Somali-Americans have been refusing the measles, mumps, and rubella (MMR) vaccine for years over unfounded rumors that the childhood immunization, whose first dose is routinely given to babies at 12 to 15 months, causes autism.At this point, the state has identified 51 cases of measles, all but 3 involving children, with at least 7,000 additional exposures.But convincing the “hearts and minds” of a community is proving to be much more expensive and complicated than making the MMR vaccine more widely available.Initial costs are tip of iceberg”This is not an access question,” said Kristen Ehresmann, RN, MPH, director for infectious diseases at the Minnesota Department of Health (MDH). “It’s an issue of being misinformed about the risk. Doing community outreach and engagement is much more labor intensive, because it’s not about just offering more clinics and opportunities to get the vaccine.”Ehresmann said that staffing costs for the current measles outbreak, which includes the communication office, are an extra $207,096 for the state per 21-day period. But Ehresmann said the $200,000 number is just the “tip of the iceberg.””We’re already into the second month of this outbreak, and we haven’t plateaued yet,” she said. Ehresmann said the costs incur from several different departments: $165,000 for staffing infectious disease and communication departments; $9,600 for having staff on call 24/7; $14,000 for materials, testing supplies, translations, and shipping.”We’re projecting another 3 months out at this point; it’s going to be expensive,” said Ehresmann.”If the measles outbreak lasts 3 months,” said Kate Awsumb, MA, MPH, “the back-of-the-envelope costs are approaching $1 million.” She is the assistant director of communications with the MDH.And those are just the MDH costs. Hennepin County, the epicenter of the outbreak, has to date incurred $79,000 on the outbreak, according to Lori Imsdahl, a communications specialist with the county.But that cost does not include staffing and payroll, information that won’t be calculated until May 19, Imsdahl said. On that date, the county will be able to estimate an average weekly cost for the outbreak.Other costs of ‘unnecessary’ outbreak”This is an unnecessary outbreak,” said Ehresmann. “The fact that we have to spend so many public health resources is challenging. And we just have to suck it up; there’s no special emergency fund for this sort of thing.”The costs provided by the MDH and Hennepin County do not include the money healthcare facilities spend on post-exposure prophylaxis, nor the economic costs spent by the state’s departments of education or human services.”No one thinks about the cost of this sort of thing,” said Ehresmann. “We think about health and human costs, of course, but dollars and cents are the other thing.”See also:MDH most current outbreak numberslast_img read more

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News Scan for May 25, 2017

first_imgWHO: DRC Ebola outbreak smaller than previously reported The World Health Organization’s  (WHO’s) regional office for Africa released a new Ebola situation report today, noting fewer cases than previously reported in the Democratic Republic of the Congo (DRC).The report said there were no new cases as of May 23, and currently there are only 2 confirmed, 3 probable, and 30 suspected cases of the deadly hemorrhagic virus. The last patient with suspected Ebola was admitted to a treatment center on May 20.It is unclear if the smaller number of reflects suspected or probable cases that have been ruled out after testing. According to the report, no healthcare workers have been infected, and the outbreak is still contained to the Likati Health Zone, in northern DRC.On May 23, 177 contacts had completed the 3-week follow-up period, leaving 294 contacts still being closely monitored by health officials for signs of the virus.While the DRC with other groups are preparing to offer the experimental Ebola vaccine to contacts and healthcare workers, the country is still waiting for approval from the national regulatory authority and the ethics review committee. Today, Stat reported that said the limited outbreak may not warrant the use of the vaccine, based on comments from a WHO official.In other outbreak developments, an influx of refugees fleeing militia attacks the Central African Republic (CAR), crossing the DRC border not far from the outbreak area, is raising worries of the virus spreading to the CAR, Reuters reported today, citing another WHO official. The attacks in the CAR have displaced about 2,750 people to Bas Uele province.May 23 WHO AFRO report May 25 Stat story May 25 Reuters story New MERS case linked to camel contactThe Saudi Arabian Ministry of Health (MOH) today reported another case of MERS-CoV in that country, in a man who had direct contact with camels.A 52-year-old man from Jeddah was diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus) after presenting with symptoms. He is in critical condition.In addition, on May 21 the MOH announced an earlier case. A 64-year-old Saudi man from Hail was diagnosed as having MERS-CoV after presenting with symptoms. He is in stable condition, and the source of his infection was listed as “primary,” meaning it is unlikely he contracted the virus from another person.The new cases raise Saudi Arabia’s number of MERS cases since the disease was first detected in humans in 2012 to 1,614, which includes 668 deaths. Five people are still being treated for their infections.May 25 MOH report May 21 MOH report Yellow fever now found in 7 Brazil statesThe Pan American Health Organization (PAHO) said yesterday that seven Brazilian states now report suspected cases of yellow fever, but the virus is still not being transmitted by Aedes aegypti mosquitoes.PAHO warned, however, that “confirmed epizootics in large cities, such as Vitoria in Espirito Santo and Salvador in Bahia, represent a high risk for a change in the transmission cycle.”So far Brazil has had 758 confirmed cases of yellow fever and 622 under investigation from December of 2016 to May 18. There have been 426 deaths.The case-fatality rate remains at 34% for confirmed cases of yellow fever. Goias state reported its first case. Minas Gerais and Espirito Santo, which have had the most outbreak cases, have reported none in the past 2 weeks.May 24 PAHO situation report Zika severity not linked to defects, prior dengue infectionA new study in Clinical Infectious Diseases showed that Zika severity, prior dengue infection, and viral load did not affect pregnancy outcomes in mothers who contracted the disease.Researchers have posited that congenital Zika syndrome, a constellation of defects and deformities—with microcephaly being the most severe—is connected the severity of maternal disease, or to the presence of previous flavivirus antibodies, which enhance Zika virus in a pregnant woman.To test this theory, researchers followed 131 Zika-positive pregnant women. Fifty-eight of them (46.4%) experienced abnormal outcomes, including 9 fetal losses (7.2%). But they found no associations between disease severity and abnormal outcomes, disease severity and viral load, viral load and adverse outcomes, or existence of prior dengue antibodies (88% of the women had previously had dengue infections). May 23 Clin Infect Dis studyIn other Zika news, researchers have used elevation as a proxy to predict the likelihood of Ae aegypti–transmitted diseases, concluding that there’s a low potential for mosquito Zika transmission above 2,000 meters in the Americas. The study was published yesterday in PLoS One.The researchers looked at 16 countries in the Americans with local Zika transmission, finding that above 1,600 meters, less than 1% of each country’s total land area could host Ae aegypti mosquitoes. The findings align with US Centers for Disease Control and Prevention travel guidance.May 24 PLoS One study WHA approves more funds for emergencies, antimicrobial resistanceThe World Health Assembly (WHA), meeting in Geneva this week, yesterday approved a proposed budget for the WHO for the next biennium totaling $4.42 billion, which factors in a 3% increase in member state contributions.In a press release, the WHO said the budget includes Sustainable Development Goal priorities and reflects increased investments for the new health emergencies program ($69.1 million) and combating antimicrobial resistance ($23.2 million).About 3,500 delegates from the WHO’s 194 member states, many of them health ministers, are at the WHA, the decision-making body of the WHO. The meeting runs through May 31.May 24 WHO statementlast_img read more

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