H5N1

BBC: UN rejects Haiti cholera compensation claims

Via BBC News: UN rejects Haiti cholera compensation claims. Click through for video clip (1:44). Excerpt:

The United Nations has formally rejected all claims for compensation from victims of the cholera outbreak in Haiti that has killed nearly 8,000 people. Evidence suggests cholera was introduced to Haiti through leaking sewage pipes at a camp housing Nepalese peacekeepers, but the UN has never acknowledged responsibility. It says it is immune from such claims under the UN's Convention on the Privileges and Immunities of the UN.

I bring this up because of the timing of the UN's denial. If it's based on Article 29 of the Convention, why take months before saying so, and why spend months before that not only denying its liability but obfuscating it? The evidence was clear within weeks of the outbreak's start late in 2010. 

The UN could have simply said, "Oops, too bad. We're really sorry, we won't do it again and we'll put our best-paid health bureaucrats on the job of fighting the cholera we tracked in. But under Article 29, cholera victims and their families get no compensation."

It would have been blunt, ugly, and unpleasant, but at least it would have been honest.

Branswell: Flu shot offered little protection to older people, study finds

Via The Globe and Mail, Helen Branswell of The Canadian Press writes: Flu shot offered little protection to older people, study finds. Excerpt:

This year’s flu vaccine provided little protection to people 65 and older who got a shot, new data released by the U.S. Centers for Disease Control reveal. 

The study estimates how well the vaccine did at preventing people from becoming sick enough to need to see a doctor – preventing “medically attended flu,” in influenza-science parlance. And the data suggest that this year the vaccine did not perform well for older adults. 

It found that a flu shot cut an older adult’s risk of contracting a case of influenza A H3N2 that needed medical care by only 9 per cent. 

When the scientists calculated the overall effectiveness – the vaccine’s ability to prevent medically attended flu caused by both flu A and B viruses – the estimate was 27 per cent for older adults. 

The findings are disappointing, given that the H3N2 component in this year’s vaccine is well matched to the viruses circulating. Paradoxically, the B component of the vaccine is not as closely matched to circulating viruses, yet it is performing better, according to the study. 

Dr. Joe Bresee, a flu expert with the CDC, said older adults need to know that if they got a flu shot and they develop flu-like illness, they may have influenza and should see a doctor to determine if they should take antiviral drugs. 

“We wanted to make sure that people knew that – especially if you’re elderly to know that – because we still want to communicate the fact that if you do get sick, get antivirals. And don’t assume just because you got the vaccine, that that flu-like illness you’ve got can’t be flu,” said Bresee, who heads the CDC flu division’s epidemiology team. 

This type of study may actually overestimate the effectiveness of the vaccine, some experts say. It cannot capture a picture of what percentage of people got a shot and got the flu but did not see a doctor. Most people simply ride out a case of the flu in bed. 

As well, it does not account for people who become so sick they go directly to hospital, which would not be uncommon in elderly people with influenza. 

The findings are an interim estimate and could change slightly in the final analysis; in this run-through, the overall vaccine effectiveness figure dropped to 56 per cent from 62 per cent in an analysis conducted in January. 

But Bresee suggested that the current figures are likely a pretty accurate reflection of the vaccine’s performance in older adults. 

“The 9 (per cent) is going to change a little bit one way or the other,” he said in an interview from Atlanta.

Comparing SARS and NCoV is premature: Scientist

Via Xinhua: Comparison on severity between novel CoV, SARS-CoV premature: scientist. Excerpt:

Any comparison between the novel coronavirus, which caused seven deaths globally, and SARS virus in terms of spread speed or disease severity is premature, a Swiss immunobiologist said Friday. 

Volker Thiel of the Institute of Immunobiology at Cantonal Hospital in St. Gallen, Switzerland, with other researchers, published the new findings on the novel coronavius Tuesday in the American online journal mBio, which showed the new virus replicates very well in human airway epithelial cells. 

However, "from these data one can't conclude that the novel CoV is more dangerous than SARS-CoV," Thiel told Xinhua. 

"For example, we don't know how the novel CoV interacts with the immune system, therefore, any comparison between the novel CoV and SARS-CoV with regard to spread, disease severity, ect. is premature," he said. 

Thiel said so far the risk of human infection with the novel coronavirus is very low, so standard hygiene is recommended for prevention. 

The research also showed that certain types of interferons can efficiently reduce the replication of the virus in human airway epithelial cells, which may provide a possible treatment option in cases of suspected human novel coronavirus infection.

ECDC: Epidemiological update on 13th case of NCoV

ECDC has published an Epidemiological update: additional case of severe lower respiratory tract disease associated with a novel coronavirus in Saudi Arabia. The summary:

On 19 February 2013, the Ministry of Health in Saudi Arabia has informed the World Health Organization (WHO) about an additional confirmed case of novel coronavirus (NCoV) infection. 

The patient was admitted to hospital on 29 January 2013 and died on 10 February. An investigation by the Ministry of Health in Saudi Arabia is on-going. This case has been notified through the International Health Regulation (IHR) on 20 February 2013. Since April 2012, thirteen cases of NCoV have been confirmed, including seven deaths. 

In the United Kingdom, the Health Protection Agency (HPA) is actively investigating the recent family cluster of cases to identify the possible route of infection and detect any additional secondary cases. Active follow-up of contacts of the three confirmed cases of the family cluster have not detected additional confirmed secondary cases by 22 February 2013. 

On 19 February, in light of the NCoV family cluster in the United Kingdom, the European Centre for Disease Prevention and Control (ECDC) has updated its risk assessment. This 13th case reported from Saudi Arabia does not change the ECDC assessment of the situation. 

ECDC is closely monitoring the situation in collaboration with WHO and the European Member States.

Australia: New drug developed to combat flu pandemic

Via CSIRO, Australia's scientific research agency: Flu breakthrough: New drug developed to combat flu pandemic. Excerpt:

The new drug has been proven to be effective in preventing the spread of different strains of influenza in laboratory models – including resistant strains of the virus. 

The breakthrough is the result of a global collaboration between scientists from CSIRO, the University of British Columbia and the University of Bath. 

In order to infect cells, flu viruses bind onto sugars on the cell surface. To be able to spread they need to remove these sugars. The new drug works by preventing the virus from removing sugars and blocking the virus from infecting more cells. It is hoped the drug will also be effective against future strains of the virus. 

According to the World Health Organisation, influenza kills approximately 500,000 people each year, with up to 2500 of those deaths occurring in Australia. Costs to the Australian health care system are estimated to be more than A$85M, with more than 1.5 million work days lost annually. 

CSIRO scientist Dr Jenny McKimm-Breschkin, a researcher in the team that developed the first flu drug Relenza, said that understanding exactly how flu viruses become resistant to drugs has helped them to design a better flu drug. 

"CSIRO researchers have shown that flu viruses continually mutate and some have become resistant to available treatments," Dr Jenny McKimm-Breschkin said. 

"The new drug is effective against these resistant strains. As the site where the drug binds is found in all flu strains, the new drug is expected to be effective even against future flu strains. 

"With millions of poultry currently infected with 'bird flu' globally, there are still concerns about its adaptation and potential to spread among humans, causing the next pandemic," she added. 

Professor Steve Withers, University of British Columbia, has led the research team for the past seven years and said that although further studies are required to determine efficacy against a broader range of flu strains, the findings are extremely positive. 

"Despite recent improvements in vaccine production, when a new strain of flu emerges it can take several months before vaccines are available to the public," Professor Steve Withers said. 

"This antiviral drug would play an important role as the first line of defence in modulating disease severity and in controlling a pandemic while vaccines are prepared," he added.

Cambodia: More on the 7th H5N1 death

Via The Cambodia Daily, an informative report: Seventh H5N1 Death; Cambodia World’s Worst Hit This Year.

A 2-year-old boy has become the latest victim of avian influenza, bringing the total number of deaths to seven since January 21, and making Cambodia, globally, the country worst hit by the deadly virus so far this year. 

The toddler from Kampot prov­ince’s Angkor Chey district died in the early hours of Tuesday morn­ing at Phnom Penh’s Kantha Bo­pha II Hospital, 18 hours after he was admitted, said Denis Lau­rent, the hospital’s deputy director. 

“Unfortunately, the boy passed away after only 18 hours of hospitalization. Of course, as with the other cases, the doctors tried to do the max­imum to save him,” Dr. Laurent said, adding that the boy had been ill for about a week before his family admitted him to the hospital. 

The child’s home commune, Ang­kor Chey, is located just 2 km from where the last fatal case of H5N1 was reported last week, when a 3-year-old girl died of the virus, Dr. Laurent said. A 9-year-old girl also died in Kampot prov­ince, in a neighboring district, in late January. 

Out of the eight confirmed cases in Cambodia in the past month, only one person has survived, making it the worst single outbreak of the disease in humans in the world this year. 

“We’re all working in emergen­cy phase,” said Lotfi Allal, team leader of the U.N. Food and Agriculture Organization’s Emergency Center for Transboundary Animal Disease in Phnom Penh. 

Dr. Allal said the main task is to prevent the spread of the disease in poultry—an uphill battle given the underreporting of the disease by Cambodian farmers. 

Rural people are hesitant to no­tify the authorities about their sick ducks and chickens because when their poultry are culled, they receive no compensation for their loss. 

“We acknowledged long ago there are big weaknesses in this field,” Dr. Allal said, referring to the reliance by authorities on local farmers to voluntarily report possible H5N1 outbreaks. 

So far, no poultry cull has been or­dered in Angkor Chey commune where the latest victim lived, an official said. 

“We did not find bird flu in the location where the children died so we did not incinerate any poultry,” said Khoy Khun Huor, Kampot provincial governor, speculating that diseased chickens may have been brought into the commune from other locations, which may have infected the child. 

Pa Mon, Angkor Chey commune chief, said commune authorities were disseminating information about bird flu and preventing residents from transporting poultry in and out of the commune. 

“Dealing with backyard poultry is much more difficult than commercial farms—which is easier to contain,” Dr. Allal explained. “The farmers are not reporting and un­fortunately children play with chick­ens, which is why they’re the ones mainly infected.” 

Sok Touch, head of the communicable disease department at the Ministry of Health, declined to comment.

Another H5N1 patient dies in SW China

Via Shanghai Daily, a Xinhua report: Another H5N1 patient dies in SW China. Excerpt:

The second of two people confirmed by the Ministry of Health to have contracted avian influenza H5N1 died in a hospital in southwest China's Guizhou province on Friday, according to health authorities. 

The patient, a 31-year-old man, died of multiple organ failure at Jinyang Hospital in Guizhou, the provincial capital, at 4:40 p.m., sources with the provincial health department said. 

The man developed symptoms on Feb. 3 and was hospitalized on Feb. 8. 

Another patient, a 21-year-old woman, died of multiple organ failure on Feb. 13. They both tested positive for the H5N1 virus on Feb. 17. 

The two patients both had close contact with birds, sources said. 

A total of 110 people who had close contact with the patients have been released from quarantine, as no abnormal symptoms were discovered. 

No new avian influenza H5N1 cases have been reported, sources said.

DOH: No case of new coronavirus infection in Philippines

Via Sun.Star.com.ph: DOH: No case of new coronavirus infection in Philippines. Considering the number of Filipinos working in Saudi Arabia and the Gulf states, NCoV is a reasonable concern. Excerpt:

The Philippines is still free from the new coronavirus that has affected some residents in the United Kingdom (UK), an official of the Department of Health (DOH) said Friday. 

Health Secretary Enrique Ona, in an interview, said: “Right now, there has been no reported case in the Philippines.” 

Earlier, the DOH issued a directive to all hospitals in the country to report suspected cases of the new coronavirus following reports that the UK government confirmed its first human to human transmission of the SARS-like virus. 

Patient samples may be sent to the Research Institute for Tropical Medicine (RITM) for confirmatory testing, said Ona last Monday. 

The DOH had also directed the Bureau of Quarantine to maintain the routine screening of in-bound passengers, regardless of country of origin, in ports of entry, for any signs of illness that may require temporary isolation in a health facility or at home.

Cambodia: H5N1 chronology to February 21

On February 12, I posted Cambodia: H5N1 chronology continued. Here it is again, updated to include the latest case.

January 8: An 8-month-old boy shows the first symptoms of H5N1 in Chrey Korng village, Phnom Penh. This seems to be part of the metropolitan region, with several good hotels.  

January 9: The boy goes to the National Pediatric Hospital. He's tested and confirmed as H5N1 on January 22 (2nd case). He is reported recovered in the January 25 news reports that break the story.  

January 11: A 15-year-old girl in Snao village, Takeo province, falls ill. This province is south of Phnom Penh and on the border with Vietnam. I can't find the precise location of the village.  

January 13: A 35-year-old man falls ill in Trapeang Sla, Kampong Speu province, west of Phnom Penh.  A 17-month-old girl (4th case), also in Kampong Speu, shows symptoms. 

January 17: The 15-year-old girl enters Kantha Bopha Hospital. So does the 17-month-old. 

January 19: A 9-year-old girl in Thmei commune, Kampot province, shows symptoms. 

January 21: The 35-year-old man admitted to Khmer-Soviet Friendship Hospital in Phnom Penh. Samples are taken; he dies soon after. The 15-year-old girl also dies on this day.  

January 25: A 5-year-old girl from Prey Kabass commune, Takeo province, falls ill. 

January 26: 17-month-old girl in Kampong Speu province diagnosed with H5N1.  

January 27: The 9-year-old from Kampot is admitted to Kantha Bopha. 

January 28: The 17-month-old girl dies in Kantha Bopha. So does the 9-year-old girl from Kampot. 

January 31: The 5-year-old girl from Prey Kabass is admitted to Kantha Bopha after several days of private treatment. 

February 3: A 3-year-old girl from Ang Phnom Toch commune, Kampot province, develops a red rash. 

February 6: The 3-year-old girl is admitted to Kantha Bopha with fever, abdominal pain, and somnolence. She is the 7th case this year. The 8th case, a 20-month-old boy from Ang Romduol village, Kampot province, develops fever and runny nose.

February 7: The 5-year-old girl from Prey Kabass dies in Kantha Bopha. 

February 13: The 3-year-old dies in Kantha Bopha.

February 18: The 20-month-old boy, after private treatment, is admitted to Kantha Bopha Hospital with fever, cough, and dyspnea.

February 19: The 20-month-old boy dies in Kantha Bopha. He is the 8th case and 7th fatality in Cambodia in the six weeks between January 8 and February 19th. With a total of 29 confirmed cases and 26 deaths, the Cambodian H5N1 case fatality rate is now 89.6 percent.

Cambodia: The official word on the eighth H5N1 case

Via WHO's Western Pacific Region Office, a report dated February 21: Eighth New Human Case of Avian Influenza H5N1 in Cambodia in 2013. Excerpt:

The Ministry of Health (MoH) of the Kingdom of Cambodia wishes to advise members of the public that one more new human case of avian influenza has been confirmed positive for the H5N1 virus. 

The eighth case, a 20-month-old boy from Ang Romduol village, Angkor Chey commune, Angkor Chey district in Kampot province, was found positive for influenza H5N1 on 19th February 2013 by Institut Pasteur du Cambodge. 

He developed fever and runny nose on 6th February 2013 and was initially treated by local private practitioners. His condition worsened and he was admitted to Kantha Bopha Hospital on 18th February 2013 with fever, cough and dyspnea and died on 19th February 2013. There is evidence of recent deaths among poultry in the village. 

The boy is the eighth person this year and twenty-ninth person to become infected with H5N1 virus, and the twenty-sixth person to die from complications of the disease in Cambodia. Of the twenty-nine confirmed cases, 20 were children under 14, and nineteen of the twenty-nine were female. 

"Avian influenza H5N1 remains a serious threat to the health of Cambodians, especially children. This is the eighth case of H5N1 infection in humans this year, and children still seem to be most vulnerable. Children are at high risk because they may play where poultry are found and I urge parents and guardians to keep children away from sick or dead poultry and prevent them from playing with chickens and ducks. 

"Parents and guardians must also make sure children wash their hands with soap and water after any contact with poultry. If they have fast or difficult breathing, they should seek medical attention at the nearest health facility and attending physicians must be made aware of any exposure to sick or dead poultry. The greatest risk of exposure to the virus is through the handling and slaughter of infected poultry. Home slaughtering and preparation of sick or dead poultry for food is hazardous: this practice must be stopped”, said HE Dr. Mam Bunheng, Minister of Health. 

The Ministry of Health's Rapid Response Teams (RRT) have gone to the hospital and the field to identify the boy’s close contacts, any epidemiological linkage among the eight cases and initiate preventive treatment as required. In addition, a public health education campaign is being conducted in the village to inform families on how to protect themselves from contracting avian influenza. The government's message is - wash hands often; keep children away from poultry; keep poultry away from living areas; do not eat sick poultry; and all poultry eaten should be well cooked. 

H5N1 influenza is a flu that normally spreads between sick poultry, but it can sometimes spread from poultry to humans. Human H5N1 Avian Influenza is a very serious disease that requires hospitalization. Although the virus currently does not easily spread among humans, if the virus changes it could easily be spread like seasonal influenza. Hence, early recognition of cases is important.

Vietnam: The return of Streptococcus suis

Via Saigon Giai Phong: Streptococcus Suis virus rears its ugly head. This brings back memories from 2005. Excerpt:

A bacterium virus called ‘Streptococcus Suis’ from pigs claimed two lives in North Vietnam, the Central Tropical Disease Hospital in Hanoi announced. 

The Central Tropical Disease Hospital has admitted two people infected with the above bacterium, said Dr Nguyen Hong Ha, head of the hospital. 

Patients were rushed to the hospital in critical condition and they were suffering from serious complications such as abscess, meningitis, septicemia and limb gangrene. 

Most patients contracted the ‘Streptococcus Suis’ bacterium after eating undercooked infected pork, blood paste, or came into direct contact with secretion from diseased pigs via open wounds or airborne tracts. 

Dr. Ha warned people not to slaughter and eat diseased pigs and go to hospitals for timely treatment or they will suffer severe complications even deaths.

CIDRAP on the 13th novel coronavirus case

Via CIDRAP, an important report by Jim Wappes: WHO confirms 13th novel coronavirus case. Click through for a lot of information and many links. Excerpt:

A patient from Saudi Arabia died from a novel coronavirus (NCoV) infection, becoming the world's 13th case and seventh death, the World Health Organization (WHO) reported today. 

According to Saudi Arabia's Ministry of Health, the patient, whose sex, age, and clinical picture were not specified, was hospitalized on Jan 29 and died on Feb 10, the WHO said in a brief statement. NCoV was confirmed in a laboratory on Feb 18, but the agency did not specify the confirmatory test used. 

"Further investigation into this case is ongoing," the WHO added. 

"Based on the current situation and available information, WHO encourages all Member States (MS) to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns," the agency said in the statement. 

"Testing for the NCoV should be considered in patients with unexplained pneumonias, or in patients with unexplained, severe, progressive or complicated respiratory illness not responding to treatment, particularly in persons traveling from or resident in areas of the world known to be affected." 

The WHO said that any SARI clusters or any SARI in healthcare workers should be thoroughly investigated, adding, "WHO does not advise special screening at points of entry with regard to this event nor does it recommend that any travel or trade restrictions be applied." 

NCoV is related to coronaviruses found in bats in a number of countries, but its source has not yet been identified. It is also related to the SARS (severe acute respiratory syndrome) virus, which spread internationally in 2002 and 2003 and killed about 900 people. 

The 13 NCoV cases that have been confirmed since last year include 6 in Saudi Arabia (4 fatal), 2 in Jordan (both fatal), 2 in Qatari patients (one of whom is still being treated in a UK hospital), and a recent cluster of 3 patients in the United Kingdom that involved 1 death.

Nepal: H5N1 kills chickens worth $337,000

Via The Himalayan Times: Bird flu kills chickens worth Rs 29.4 million. Excerpt:

KATHMANDU: Bird flu outbreaks have killed 70,000 chickens worth Rs 29.4 million [US$337,554] since 2008. The country has witnessed 38 outbreaks in the last four years. 

 Bird flu has severely affected the country’s poultry farming, said spokesperson of the Directorate of Animal Health Dr Narayan Ghimire. 

“There have been over three dozen outbreaks in the last four years which have directly affected farmers,” he said, adding that chicken, eggs and feeds worth millions of rupees have been destroyed so far. 

According to Ghimire, bird flu has displaced farmers from the business. “Bird flu has been creating havoc among poultry farmers and hundreds have already quit the business,” he said. 

This trend has been creating chicken shortage in the market and its price has climbed to an all time high of Rs 280 [US$3.21] a kg in the wholesale market and Rs 300 [US$3.44] per kg in the retail market. 

The department’s report reveals that bird flu has affected all corners of the country. The first case was reported in Jhapa in 2008; followed by Pokhara, Banke, Kailali, Dang and Tanahu in 2009; and Kathmandu, Jhapa, Ilam, Panchthar, Bhaktapur, Lalitpur and Chitwan in 2010. 

Recent outbreaks have been reported since November, 2012, in Pokhara, Kathmandu, Bhaktapur and Nuwakot. Repeated bird flu outbreaks have been noticed in Jhapa, Kathmandu, Bhaktapur and Pokhara, said Ghimire. 

 The department has suspected vaccines, feeds and other equipment used in poultry farms to be carriers of the bird flu virus — H5N1. 

Vaccines, feeds and equipment may be carriers of the virus, but we cannot inspect them, said a veterinary doctor. According to him, the Department of Drug Administration has the right under the Drug Act but its focus is only on public health, he said.

Mexico: Egg prices rising because of H7N3

Via El Universal: Reportan alzas en huevo. [Rise in egg prices reported] Excerpt, with my translation:

Al menos cinco entidades del país reportaron incrementos en el precio del kilogramo de huevo, que en algunos casos representaron entre 20% y hasta 60%, indicaron cámaras y asociaciones de comerciantes. 

At least five states in the country have reported increases in the price per kilogram of eggs, in some cases rising between 20 and 60 percent, according to business associations.

En tanto, la Secretaría de Desarrollo Agropecuario de Guanajuato aseguró que el brote de gripe aviar AH7N3, que golpeó a 12 granjas de Bachoco, “está prácticamente controlado”, pero se mantienen los cercos restrictivos. Además 480 mil aves han sido sacrificadas y 789 mil 500 gallinas fueron vacunadas. 

Meanwhile, the Secretariat of Agribusiness Development in Guanajuato said that the outbreak of H7N3 avian flu that struck 12 Bachoco farms "is practically controlled," but checkpoints are being maintained. As well, 480,000 birds have been culled and 785,900 chickens have been vaccinated.

Ayer, por tercer día consecutivo, no se registraron nuevos casos y continuaba la supervisión en 22 granjas. En su último reporte, la Senasica informó que prevalece la cifra de un millón 20 mil aves enfermas. 

For the third consecutive day, no new cases were reported yesterday and surveillance continued on 22 farms. In its latest report, Senasica said the number of infected chicken, 1.2 million, remained unchanged.

Entidades como Guanajuato, Colima, Morelos, Jalisco y Nuevo León reportaron alzas en el costo del huevo en las últimas 24 horas.

States including Guanajuato, Colima, Morelos, Jalisco and Nuevo León reported increases in egg prices in the last 24 hours.

Diseases spreading in Syria as WASH systems collapse

Via ReliefWeb, an IRIN report: Diseases spreading in Syria as WASH systems collapse. I haven't reported much from Syria because once I started I wouldn't know when to stop. But this report deserves attention. Excerpt:

In Salqin, a small town in Syria's northeastern governorate of Idlib, three members of the Islamist rebel group Ahrar al Sham are lying sick with a contagious fever characterized by an inflammation of the intestinal tract. 

"We are living together, and now we are all suffering from the same disease," said the commander of the unit, Hamza Abdurrahman, having difficulties speaking because of his sore throat. "The doctor told us we had typhoid because we drank dirty water." 

The rural area near the Turkish border has seen a growing number of infections in recent weeks, Abdurrahman told IRIN. 

"There is no running water, so people drink from the wells or the rivers." The only alternative is buying water from tankers, which is very costly. "You have to pay about US $35to fill up the tank on your roof. This is why poor people are having a problem." 

After two years of conflict in Syria, waterborne diseases are on the rise, compounding a growing humanitarian crisis. Typhoid, an infection caused by salmonella bacteria, has been reported, in addition to hepatitis A, a highly contagious viral liver disease. 

Infections are spreading due to a confluence of trends, said Elizabeth Hoff, representative of the World Health Organization (WHO) in Syria. For example, water pumps cannot be run because of the shortage of electricity and fuel. The resulting lack of drinking water is in addition to an almost complete breakdown of the sewage and the waste system in some regions, she said. 

Hence, people resort to drinking from rivers or wells that might be contaminated with faeces. To make matters worse, these risks of infection coincide with the collapse of the health system. According to WHO, more than half of all hospitals in Syria have been damaged; more than one third are out of service. Many doctors have left the embattled cities, and medication is often not available. 

"Everything is coming together," Hoff told IRIN. "This is certainly a crisis with a very grave outlook."

Haiti: Katz on UN's diplomatic immunity

Via Turtle Bay, a blog at ForeignPolicy.com: U.N. invokes diplomatic immunity on Haiti cholera epidemic. The story rehashes what we already know, but concludes with this:

Jonathan Katz, a former Associated Press reporter who covered the cholera outbreak, said the U.N. has "spent the last year and change saying" they can't talk about the cholera epidemic because the claims case was pending. But now, he said, the U.N. maintains that it won't even consider the claim. 

Katz, who authored the recent book on the Haiti relief effort, The Big Truck that Went By, said U.N.'s refusal to confront responsibility reflects a deeper concern that establishing precedent could open the door to a slew of lawsuits against the United Nations around the world. 

"The United Nations is concerned about the precedent this would set for U.N. peacekeeping and the other work they do around the world," he said. "I can imagine a long line of people going around the world that would love to go after the United Nations."

WHO: Update on 13th NCoV case

WHO has published Novel coronavirus infection - update.

The Ministry of Health in Saudi Arabia has informed WHO of another confirmed case of infection with the novel coronavirus (NCoV). 

The patient was hospitalized on 29 January 2013 and died on 10 February 2013. The case was laboratory-confirmed on 18 February 2013. Further investigation into this case is ongoing. 

In the United Kingdom, the Health Protection Agency continues to investigate the family cluster where three members of the family tested positive for NCoV infection. One member of this family, who had an underlying health condition, has died. 

To date, WHO has been informed of a total of 13 confirmed cases of human infection with NCoV, including seven deaths. 

Based on the current situation and available information, WHO encourages all Member States (MS) to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns. 

Testing for the NCoV should be considered in patients with unexplained pneumonias, or in patients with unexplained, severe, progressive or complicated respiratory illness not responding to treatment, particularly in persons traveling from or resident in areas of the world known to be affected. 

Any clusters of SARI or SARI in healthcare workers should be thoroughly investigated, regardless of where in the world they occur. 

All MS are reminded to promptly assess and notify WHO of any new case or clusters of cases with NCoV infection. 

WHO does not advise special screening at points of entry with regard to this event nor does it recommend that any travel or trade restrictions be applied. 

WHO continues to closely monitor the situation.

Mike Coston at Avian Flu Diary has the story with some context. I haven't found anything in the English-language Saudi media.

Lassa fever: Why there are more public health questions than answers

Via The Guardian: Lassa fever: why there are more public health questions than answers. Excerpt:

I'm in a village in eastern Sierra Leone staring at a row of dead rats snared in branches, leaves and grass. The contraptions are called funnel traps, or tolei in the local Mende dialect. We're hoping these devices and other easily accessible or producible materials will lower the rodent populations in villages sufficiently to prevent Lassa fever. 

With a DfID-funded project called Wash (water, sanitation health), Facility Sierra Leone, Tulane University and Kenema Government Hospital are working in 20 villages introducing Lassa fever education and rodent control training. For the project to be successful, we have to control one of the most ubiquitous rodents in sub-Saharan Africa, Mastomys natalensis — the multimammate rat. 

Lassa fever is common in this part of the country where the disease can wipe out entire households and cause panic throughout villages. The disease has a gradual onset of fever, aches and pains that are indistinguishable from malaria or typhoid — diseases as familiar to villagers as the common cold. 

For some, Lassa fever will progress from these non-specific symptoms to sore throat, facial oedema, haemorrhaging and death. Although Lassa fever and its severe consequences are well-known by residents in this region, fewer know the rat that commonly infests their homes can spread the disease. 

I work with a team based out of KGH. This is the Sierra Leone ministry of health and sanitation's main hub for Lassa fever activities and the only place in the entire country a person can go for laboratory testing and treatment. For the past four years, I've had the privilege of working with five members of the community outreach and disease ecology units based there. We are trying to turn their combined 115-plus years of experience working on Lassa fever into strategies to control the disease. 

We think that connecting the dots from rat to Lassa fever in at-risk communities will mobilise residents. With some training and monitoring, maybe we can make a dent in the burden of this disease. 

We're using the WHO guidelines for control of Lassa fever which include the use of food storage containers and cats along with other interventions such as house repairs and rodent extermination. Eventually, we hope to integrate these methods into sanitation and hygiene programmes, such as community-led total sanitation campaigns, throughout Sierra Leone. 

The reality is we don't yet know what will work to reduce Mastomys to prevent Lassa fever at the community level. The virus was first identified in 1969 and the rodent as harbouring the virus (that is, being its 'reservoir') in 1973. Lassa virus is among the 'viral haemorrhagic fevers' — the terrifying group of viruses that people make movies and write books about. These diseases get attention, not because of the disease burden in endemic countries, but because of the fear they induce in wealthier nations — the fear that a deadly virus will emerge out of Africa (accidentally or intentionally) and cause mass hysteria, morbidity and mortality. 

Expenditures for Lassa fever research have reflected this perspective and have concentrated on detection, vaccine development and treatment rather than prevention and control in endemic areas. So here we are, 40 years after the reservoir was identified, without one empirical piece of evidence on how to prevent Lassa fever and very limited information on how the virus is maintained in rodent populations. 

Many are sceptical Lassa fever can be prevented with rodent control, maintaining that for sustained reduction we need a vaccine. Yet vaccine development of a neglected disease only endemic in west Africa seems unlikely in the near future. The US Centers for Disease Control and Prevention, an organisation that studied Lassa fever from the early 1970s to 2003, states "the complete control of this rodent is impractical." 

In the meantime, more and more cases are reported from Sierra Leone and Nigeria, where the disease is also endemic. The only strategy we now have in our toolbox is good old-fashioned sanitation and hygiene.

Nigeria: Implications of the murders of the North Korean doctors

Via allAfrica.com, an editorial in Daily Trust: Korean Doctors' Murder in Yobe. Excerpt:

The shock and outrage that greeted the killing of nine female immunization workers in Kano last Friday week was yet to subside when news broke of another brutal attack in Yobe State. 

This one involved the slaying of three North Korean medical doctors, whose residence in Potiskum, Yobe's second city, was infiltrated by gunmen that the authorities, to date, are yet to identify. 

News accounts said that the expatriates had their throats slit at their home; one was beheaded. Their bodies bore machete wounds, according to some soldiers who arrived at the scene hours later. 

Their names were given as Dr Kim Myong Hak, Dr Jong Myong Zum, and Dr Pak Thee Jong. 

The men had been employed by the Yobe State government and deployed to the state's Hospitals Management Board. According to reports, the gruesome conduct took place over several hours and in the presence of the deceased's wives who were unhurt. 

From statements by officials of the Yobe State government and the Hospitals Management Board, it has been established that the house had no security guards. 

Like the Kano incident, this attack will certainly have the effect, at least in the near term, of putting a chilling effect on the morale of health workers who may consider it unsafe to be on duty. 

That scenario could precipitate a serious public health problem, not only in Yobe State, but in the entire North East region.

Haiti: 8,028 cholera deaths as of February 17

Hard on the heels of the UN's dismissal of responsibility for cholera in Haiti, the Ministry of Public Health and Population has released another week of cholera statistics on its Documentation page. This takes us from February 11 to 17. 

Rather than detail the daily numbers, I'll just say the daily cases total 802 while the cumulative total has risen by 985, from 646,545 to 647,530. Eight persons died of cholera during the week, making a total since October 2010 of 8,028.

As usual, Grande Anse does not appear to have reported during this period, nor have several other departments.

MSPP has also posted some "report cards" on the health systems of the various departments and of the country as a whole. These are dated September 2011 and don't seem to discuss cholera at all.