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Tuesday, December 25, 2012

Getting Polio Campaigns Back on Track

The following is an excerpt from an article in:


The New York Times
Tuesday, December 25, 2012

Getting Polio Campaigns Back on Track

By DONALD G. McNEIL Jr.

How in the world did something as innocuous as the sugary pink polio vaccine turn into a flash point between Islamic militants and Western “crusaders,” flaring into a confrontation so ugly that teenage girls — whose only “offense” is that they are protecting children — are gunned down in the streets?

Nine vaccine workers were killed in Pakistan last week in a terrorist campaign that brought the work of 225,000 vaccinators to a standstill. Suspicion fell immediately on factions of the Pakistani Taliban that have threatened vaccinators in the past, accusing them of being American spies.

Polio eradication officials have promised to regroup and try again. But first they must persuade the killers to stop shooting workers and even guarantee safe passage.

That has been done before, notably in Afghanistan in 2007, when Mullah Muhammad Omar, spiritual head of the Afghan Taliban, signed a letter of protection for vaccination teams. But in Pakistan, the killers may be breakaway groups following no one’s rules.

Vaccination efforts are also under threat in other Muslim regions, although not this violently yet.

In Nigeria, another polio-endemic country, the new Islamic militant group Boko Haram has publicly opposed it, although the only killings that the news media have linked to polio were those of two police officers escorting vaccine workers. Boko Haram has killed police officers on other missions, unrelated to polio vaccinations.

In Mali, extremists took over half of the country in May, declaring an Islamic state. Vaccination is not an issue yet, but Mali had polio cases as recently as mid-2011, and the virus sometimes circulates undetected.

Resistance to polio vaccine springs from a combination of fear, often in marginalized ethnic groups, and brutal historical facts that make that fear seem justified. Unless it is countered, and quickly, the backlash threatens the effort to eradicate polio in the three countries where it remains endemic: Pakistan, Afghanistan and Nigeria.

In 1988, long before donors began delivering mosquito nets, measles shots, AIDS pills, condoms, deworming drugs and other Western medical goods to the world’s most remote villages, Rotary International dedicated itself to wiping out polio, and trained teams to deliver the vaccine.

But remote villages are often ruled by chiefs or warlords who are suspicious not only of Western modernity, but of their own governments.

For more, visit www.nytimes.com.

Saturday, December 22, 2012

Alabama to End Isolation of Inmates With H.I.V.

The following is an excerpt from an article in:


The New York Times
Saturday, December 22, 2012

Alabama to End Isolation of Inmates With H.I.V.

By ROBBIE BROWN

A federal judge on Friday ordered Alabama to stop isolating prisoners with H.I.V.

Alabama is one of two states, along with South Carolina, where H.I.V.-positive inmates are housed in separate prisons, away from other inmates, in an attempt to reduce medical costs and stop the spread of the virus, which causes AIDS.

Judge Myron H. Thompson of the Middle District of Alabama ruled in favor of a group of inmates who argued in a class-action lawsuit that they had been stigmatized and denied equal access to educational programs. The judge called the state’s policy “an unnecessary tool for preventing the transmission of H.I.V.” but “an effective one for humiliating and isolating prisoners living with the disease.”

After the AIDS epidemic of the 1980s, many states, including New York, quarantined H.I.V.-positive prisoners to prevent the virus from spreading through sexual contact or through blood when inmates tattooed one another. But most states ended the practice voluntarily as powerful antiretroviral drugs reduced the risk of transmission.

For more, visit www.nytimes.com.

Dangerous Abscesses Add to Tainted Drug’s Threat

The following is an excerpt from an article in:


The New York Times
Saturday, December 22, 2012

Dangerous Abscesses Add to Tainted Drug’s Threat

By DENISE GRADY

YPSILANTI, Mich. — Dr. David Vandenberg admitted three patients to St. Joseph Mercy Ann Arbor hospital on Tuesday, and called a fourth with news that left her in tears: She had a large abscess deep inside her back, near her spine, and would need surgery as soon as possible.

The patients were part of a second, growing wave of serious infections from the same tainted drug that caused a nationwide meningitis outbreak. The drug, contaminated with a fungus, was injected near the spine to treat chronic back or neck pain.

This public health disaster, in its third month, is far from over. Meningitis seems to have waned, but spinal infections near the injection site are on the rise. They can be dangerous and hard to detect. At least 200 have occurred, and more are expected because nearly 14,000 people had injections from tainted lots of the drug.

On Thursday, the Centers for Disease Control and Preventionurged doctors to look harder for these infections — to consider M.R.I. scans even in patients who did not feel worse after the injection, but whose existing back or neck pain simply did not get better. This advice was more aggressive than previous recommendations, which had called for scans only if patients had new or worsening symptoms. The new message could lead to thousands of additional scans, and will almost certainly find new cases.

“We know we’re not out of the woods,” said Dr. Tom M. Chiller, the deputy chief of the mycotic diseases branch of the C.D.C. “People could still be harboring or developing infections in their spines now.”

The disease outbreak, first detected in September, was caused by contaminated batches of a steroid, methylprednisolone acetate, made by the New England Compounding Center in Framingham, Mass. The company was shut down and has been under investigation by state and federal authorities, and on Friday night announced that it had filed for Chapter 11 bankruptcy protection. The filing seeks to establish a fund to compensate individuals and families affected by the outbreak.

So far, 620 people in 19 states have fallen ill, most with meningitis or spinal infections, or both; 39 have died. Infections inside joints have also occurred. Nearly all the illnesses have been caused by a black mold called Exserohilum. The treatment is a long course of antifungal drugs, which can have dangerous side effects.

For more, visit www.nytimes.com.

Friday, December 21, 2012

CDC What's New on the Influenza Site

Received December 21, 2012

CDC What's New on the Influenza Site

January Zoonoses Articles now online

January Zoonoses Articles now online

January Tuberculosis and other mycobacteria Articles now online

January Tuberculosis and other mycobacteria Articles now online

January Staphylococci Articles now online

January Staphylococci Articles now online

January Respiratory Infection Articles now online

January Respiratory Infection Articles now online

January Parasite Articles now online

January Parasite Articles now online

January Influenza Articles now online

January Influenza Articles now online

January HIV/AIDS and Other Retroviruses Articles now online

January HIV/AIDS and Other Retroviruses Articles now online

CDC Influenza Activity Update

Received December 21, 2012.

CDC Influenza Activity Update

January Enteric Infection Articles now online

January Enteric Infection Articles now online

January 2012 Bacteria, Bioterrorism and Preparedness Articles now online

January 2012 Bacteria, Bioterrorism and Preparedness Articles now online

EPA Updates Rule for Pathogens in Drinking Water, Sets Limit for E. Coli

EPA Press Release:

FOR IMMEDIATE RELEASEDecember 20, 2012

EPA Updates Rule for Pathogens in Drinking Water, Sets Limit for E. Coli


WASHINGTON
- The U.S. Environmental Protection Agency (EPA) has updated the rule for pathogens in drinking water, including setting a limit for the bacteria E. coli to better protect public health.

The Revised Total Coliform Rule ensures that all of the approximately 155,000 public water systems in the United States, which provide drinking water to more than 310 million people, take steps to prevent exposure to pathogens like E. coli. Pathogens like E. coli can cause a variety of illnesses with symptoms such as acute abdominal discomfort or, in more extreme cases, kidney failure or hepatitis.

Under the revised rule, public drinking water systems are required to notify the public if a test exceeds the maximum contaminant level (MCL) for E. coli in drinking water. If E. coli or other indications of drinking water contamination are detected above a certain level, drinking water facilities must assess the system and fix potential sources and pathways of contamination. High-risk drinking water systems with a history of non-compliance must perform more frequent monitoring. The revised rule provides incentives for small drinking water systems that consistently meet certain measures of water quality and system performance.

Public water systems and the state and local agencies that oversee them must comply with the requirements of the Revised Total Coliform Rule beginning April 1, 2016. Until then, public water systems and primacy agencies must continue to comply with the 1989 version of the rule.

The Safe Drinking Water Act requires that EPA review each National Primary Drinking Water Regulation, such as the Total Coliform Rule, at least once every six years. The outcome of the review of the 1989 Total Coliform Rule determined that there was an opportunity to reduce implementation burden and improve rule effectiveness while at the same time increasing public health protection against pathogens in the drinking water distribution systems. EPA’s revised rule incorporates recommendations from a federal advisory committee comprised of a broad range of stakeholders and considers public comments received during a public comment period held in fall 2010.

For more information:
http://water.epa.gov/lawsregs/rulesregs/sdwa/tcr/regulation.cfm

R 204

Thursday, December 20, 2012

U.N. Suspends Polio Campaign in Pakistan After Killings of Workers

The following is an excerpt from an article in:


The New York Times
Thursday, December 20, 2012

U.N. Suspends Polio Campaign in Pakistan After Killings of Workers

By DECLAN WALSH and DONALD G. McNEIL Jr.

LAHORE, Pakistan — The front-line heroes of Pakistan’s war on polio are its volunteers: young women who tread fearlessly from door to door, in slums and highland villages, administering precious drops of vaccine to children in places where their immunization campaign is often viewed with suspicion.

Now, those workers have become quarry. After militants stalked and killed eight of them over the course of a three-day, nationwide vaccination drive, the United Nations suspended its anti-polio work in Pakistan on Wednesday, and one of Pakistan’s most crucial public health campaigns has been plunged into crisis.

The World Health Organization and Unicef ordered their staff members off the streets, while government officials reported that some polio volunteers — especially women — were afraid to show up for work.

At the ground level, it is those female health workers who are essential, allowed privileged entrance into private homes to meet and help children in situations denied to men because of conservative rural culture. “They are on the front line; they are the backbone,” said Imtiaz Ali Shah, a polio coordinator in Peshawar.

The killings started in the port city of Karachi on Monday, the first day of a vaccination drive aimed at the worst affected areas, with the shooting of a male health worker. On Tuesday four female polio workers were killed, all gunned down by men on motorcycles in what appeared to be closely coordinated attacks.

The hit jobs then moved to Peshawar, the capital of Khyber-Pakhtunkhwa Province, which, along with the adjoining tribal belt, constitutes Pakistan’s main reservoir of new polio infections. The first victim there was one of two sisters who had volunteered as polio vaccinators. Men on motorcycles shadowed them as they walked from house to house. Once the sisters entered a quiet street, the gunmen opened fire. One of the sisters, Farzana, died instantly; the other was uninjured.

On Wednesday, a man working on the polio campaign was shot dead as he made a chalk mark on the door of a house in a suburb of Peshawar. Later, a female health supervisor in Charsadda, 15 miles to the north, was shot dead in a car she shared with her cousin.

For more, visit www.nytimes.com.

Wednesday, December 19, 2012

Attackers in Pakistan Kill Anti-Polio Workers

The following is an excerpt from an article in:


The New York Times
Wednesday, December 19, 2012

Attackers in Pakistan Kill Anti-Polio Workers

By DECLAN WALSH and DONALD G. McNEIL Jr.

ISLAMABAD, Pakistan — Gunmen shot dead five female health workers who were immunizing children against polio on Tuesday, causing the Pakistani government to suspend vaccinations in two cities and dealing a fresh setback to an eradication campaign dogged by Taliban resistance in a country that is one of the disease’s last global strongholds.

“It is a blow, no doubt,” said Shahnaz Wazir Ali, an adviser on polio to Prime Minister Raja Pervez Ashraf. “Never before have female health workers been targeted like this in Pakistan. Clearly there will have to be more and better arrangements for security.”

No group claimed responsibility for the attacks, but most suspicion focused on the Pakistani Taliban, which has previously blocked polio vaccinators and complained that the United States is using the program as a cover for espionage.

The killings were a serious reversal for the multibillion-dollar global polio immunization effort, which over the past quarter century has reduced the number of endemic countries from 120 to just three: Pakistan, Afghanistan and Nigeria.

Nonetheless, United Nations officials insisted that the drive would be revived after a period for investigation and regrouping, as it had been after previous attacks on vaccinators here, in Afghanistan and elsewhere.

Pakistan has made solid gains against polio, with 56 new recorded cases of the diseases in 2012, compared with 192 at the same point last year, according to the government. Worldwide, cases of death and paralysis from polio have been reduced to less than 1,000 last year, from 350,000 worldwide in 1988.

But the campaign here has been deeply shaken by Taliban threats and intimidation, though several officials said Tuesday that they had never seen such a focused and deadly attack before.

For more, visit www.nytimes.com.

Thursday, December 6, 2012

WHO | Yellow fever in Sudan - update

WHO | Yellow fever in Sudan - update

Nursing the Flu With Help From Apps

The following is an excerpt from an article in:


The New York Times
Thursday, December 06, 2012

Nursing the Flu With Help From Apps

By KIT EATON

I wasn’t my usual self earlier this week. Some nasty flu bug had beaten me, reducing your usual quirky, chipper columnist to a feverish, bedridden shadow. It’s never fun being ill, and I’ve never been a good patient because all the sensible advice to stay warm, hydrated and in bed leads to boredom.

During this bout I was much better behaved because my smartphone, jammed with entertaining apps and Internet access, was a great sickbed companion. Apps can do more than keep you company; they can give you medical advice. And as the season of coughs and sneezes settles in, an app may even help you determine what’s wrong.

For a medical app that covers a plethora of icky illnesses, WebMD is probably your best bet (free for iPhone, iPad and Android). It’s jammed with data, and can present it to you in a number of ways. A hypochondriac’s dream, the app’s Symptom Checker first asks that you tap on the corresponding part of an image of the body and then, choosing from detailed lists, specify which symptom you have. Once you select a symptom, the app leads you through a short question-and-answer session to refine your input, like exactly what kind of cough you have. You can input a number of symptoms, perhaps adding sneezes, for example, and then press the “view possible conditions” button.

The app lists all the conditions your symptoms may match, so you need to read each one earnestly to see if it describes your situation. It’s written in plain language, and links help you find treatment or more information online. A tab takes you to pages describing symptoms in more detail, and another takes you to detailed articles about the condition.

For more, visit www.nytimes.com.