7 December 2012

Army Public Health Weekly Update

The Army Public Health Update is a collection of articles taken verbatim

from public sources to offer awareness of current health issues and the

media coverage given to them. The articles do not necessarily represent

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Contents

U.S. MILITARY

 Boston researchers find new evidence linking repeat concussions to permanent brain injury

 Experts: Restricting troops’ access to firearms is necessary to reduce rate of suicides

 Lead limits on military firing ranges outdated, report says

 Officials assess ballistic undergarment

GLOBAL

 Diabetes rates higher in countries using lots of high fructose corn syrup: study

 Experts recommend closer scrutiny of radiation exposure from CT scans

 Experts say systematic approach key to fighting drug-resistant hospital infections

 For athletes, risks from ibuprofen use

 Whooping cough vaccine less effective over time: study

INFLUENZA

 Armed Forces Health Surveillance Center: DoD Influenza Surveillance Summary

 CDC sees signs of early, bad flu season

 CDC: Weekly Influenza Surveillance Report

 DoD Global Laboratory-Based Influenza Surveillance Program

 European Centre for Disease Prevention and Control: Weekly Influenza Surveillance Overview

 Influenza Activity — United States, September 30–November 24, 2012

 Naval Health Research Center: Febrile Respiratory Illness Surveillance Update

 USAPHC: U.S. Army Influenza Activity Report

 PANDEMIC AND AVIAN INFLUENZA

 Predicting, preventing, and controlling pandemics: Making the case for a strategic action plan

VETERINARY/FOOD SAFETY

 Pesticides in tap water, produce linked to food allergies

WELLNESS

 More drugs cited as a risky mix with grapefruit

 New study shows how copper restricts the spread of global antibiotic-resistant infections

 Overprescribing of opioids impacts patient safety and public health

 Psychiatrists OK vast changes to diagnosis manual

 Running farther, faster and longer can kill you
The Role of 

Telehealth in an 

Evolving Health 

Care Environment -

Workshop Summary

The IOM examined how 

the use of telehealth 

technology can fit into the 

U.S. health care system. 

The workshop focused on 

the potential for health 

care to serve 

geographically isolated 

individuals and extend the 

reach of scarce resources 

while also emphasizing the 

quality and value in the 

delivery of health care 

services. This document 

summarizes the workshop. 

 'Synthetic pot' sending thousands of young people to ER

 Tobacco companies ordered to publicly admit deception on smoking dangers

USAFRICOM

 Ebola in Uganda - update

 Nato forces 'attack Afghan health clinic'

 'Transport infrastructure' determines spread of HIV subtypes in Africa

 Zambia meeting addresses health emergency response gaps in Africa

USCENTCOM

 Novel coronavirus infection - update

 Pakistan: Tackling Pakistan’s population time bomb

USEUCOM

 French sperm count 'falls by a third'

 Greece: Basic hygiene at risk in debt-stricken hospitals

 Portugal: Dengue

 United Kingdom: Whooping cough cases this year are 10 times peak in 2008

USNORTHCOM

 Puerto Rico: Take-home lead exposure among children with relatives employed at a battery 

recycling facility

 U.S.: 18 treated for chemical exposure after New Jersey train derails

 U.S.: Additional contamination identified in medical products from New England Compounding 

Center

 U.S. birth rate falls to a record low

 U.S.: Behind a call that kept nursing home patients in storm’s path

 U.S.: Chlorine gas release associated with employee language barrier — Arkansas, 2011

 U.S.: Valero says worker died after chemical exposure

USPACOM

 Australia: Obesity strategy a 'wasteful failure'

 India: Appalling condition of primary healthcare services

 Nepal: Pneumonia, children

USSOUTHCOM

 Cuba: Cholera, diarrhea, and dysentery update

U.S. MILITARY

Boston researchers find new evidence linking repeat 

concussions to permanent brain injury

2 December - The most extensive examination to date of deceased athletes’ brains shows 

that most had signs of brain damage after suffering repeated head injuries—including two 

high school football players who died in their teens. Being published Monday by Boston 

University School of Medicine researchers, the study reports on the autopsies of 85 brain 

donors, most of them professional athletes... The work provides new insight into an 

Alzheimer’s-like condition, called chronic traumatic encephalopathy, that is thought to be 
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caused by repeat concussions or blows to the head. The autopsies revealed extensive 

evidence of protein tangles called tau clogging brain tissue and causing the destruction of 

brain cells in football players, wrestlers, hockey players, boxers, and military veterans who 

served in combat zones. Boston Globe

Experts: Restricting troops’ access to firearms is 

necessary to reduce rate of suicides

3 December - ... Why hasn’t the Army or Defense Department 

been able to reduce the number of suicides? Experts say it’s 

because efforts have ignored the most evidence-backed, proven 

prevention method: making suicide harder by restricting access 

to lethal means. “There are two ways to reduce suicide: You can 

make it harder for them to die in an attempt, or you can heal underlying distress,” said Dr. 

Matthew Miller, the associate director of the Harvard Injury Control Research Center at the 

Harvard School of Public Health... “Means restriction,” as it’s called in public health, has 

been proven to reduce the suicide rate in a wide variety of places... Commanders typically 

disable or take the firearms of deployed troops identified as potentially suicidal, but they do 

not have that authority with private firearms kept off base. Last year, the National Rifle 

Association successfully lobbied Republican legislators to include in the annual defense 

authorization bill a measure barring commanders from collecting information about troops’ 

personal weapons. Stars & Stripes

Lead limits on military firing ranges outdated, report 

says

4 December - Researchers commissioned by the Defense Department said Monday that 

decades-old limits on lead exposure are inadequate to protect the health of workers on 

military firing ranges. Moreover, the National Academy of Science reported, lead from 

ammunition fired on Army, Navy and Air Force ranges in the last five years has "frequently 

exceeded" those limits, "in some cases by several orders of magnitude." ... Under the 1978 

standards, exposure to 50 micrograms of lead per square meter of air, or a blood lead level 

of 40 micrograms per deciliter, was considered acceptable. But the council's review of 

research since then showed that blood lead at much lower levels may cause neurologic, 

cardiovascular, reproductive and other problems. The council also reported "compelling 

evidence" of effects on the development of offspring in utero or during breastfeeding, 

which it said "raises additional concerns about exposures of women of childbearing age."

Baltimore Sun

Officials assess ballistic undergarment

29 November - The Army is one step closer to issuing an updated version of its ballistic 

underwear after a recent review and approval by the U.S. Army Public Health Command. 

Experts in the command’s Health Hazard Assessment Program completed an occupational 

health assessment of the new protective outer garments and undergarments, and provided 

recommendations on how to minimize any risks... Although these undergarments look 
similar to a set of men’s bicycle pants, they are no ordinary underwear. “They are designed 

to use protective fabric and withstand injuries to the pelvic region that may result from the 

blast of an improvised explosive device,” said [Robert] Booze. From 2003 to 2011, more than 

600 Soldiers suffered injuries to the genital region during the wars in Iraq and Afghanistan. 

Fort Campbell Courier

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GLOBAL

Diabetes rates higher in countries using lots of high 

fructose corn syrup: study

27 November - In the United States and elsewhere, high fructose corn syrup is ubiquitous in 

soft drinks, sweet baked goods and many processed foods. But a new study shows that as a 

nation's rate of fructose intake rises, so do levels of type 2 diabetes. The study cannot prove 

a cause-and-effect link, but it does conclude that diabetes prevalence is about 20 percent 

higher in countries where use of the sweetener is high, relative to those where it is not. The 

association between high fructose corn syrup intake and diabetes risk persisted regardless 

of an individual's overall sugar intake or obesity status. According to the study authors, that 

suggests that there's something special about the sweetener that's boosting diabetes risk 

beyond what other sugars would. Medline Plus

Experts recommend closer scrutiny of radiation exposure 

from CT scans

28 November - Amid increasing fear of overexposure to radiation from CT scans, a panel of 

experts has recommended more research on the health effects of medical imaging and 

ways to reduce unnecessary CT tests, as well as industry standardization of CT machines. 

The recommendations, published in the November 2012 issue of Radiology, were developed 

at the Radiation Dose Summit, organized by the National Institute of Biomedical Imaging 

and Bioengineering (NIBIB). UC Davis Health System

Experts say systematic approach key to fighting drugresistant hospital infections

5 December - Hospitals can combat outbreaks caused by multidrug-resistant organisms 

(MDROs) by promoting hand hygiene of healthcare workers, meticulous cleaning and 

disinfection of equipment, adherence to established infection-control practices, and better 

screening, two Harvard infectious disease experts said today. Writing in the New England 

Journal of Medicine (NEJM), Thomas J. Sandora, MD, MPH, and Donald A. Goldmann, MD, of 

Boston Children's Hospital and the Department of Pediatrics at Harvard Medical School, 

said, "Reliable adherence to basic infection control practices is the key to interrupting 

transmission in our hospitals." They add, "We urgently need screening media (or real-time 
genomic tests) that can be deployed quickly to identify patients who are colonized with 

MDROs that surveillance networks have identified as emerging threats." They also 

encourage hospitals to design systems to facilitate adherence to best practices for stopping 

MDROs—such as "de-escalation" of antibiotic treatment—rather than to approach each 

infection individually. CIDRAP

For athletes, risks from ibuprofen use

5 December - Many active people use the painkiller ibuprofen on 

an almost daily basis. In surveys, up to 70 percent of distance 

runners and other endurance athletes report that they down the 

pills before every workout or competition, viewing the drug as a 

preemptive strike against muscle soreness. But a valuable new 

study joins growing evidence that ibuprofen and similar anti-inflammatory painkillers taken 

before a workout don’t offer any benefit and may be causing disagreeable physical damage 

instead, particularly to the intestines. New York Times

Whooping cough vaccine less effective over time: study

27 November - Vaccination does safeguard children against whooping cough, but its 

protective effect seems to lessen over time, new research finds. The 2010 outbreak of 

whooping cough (pertussis) in California, which sickened more than 9,000 people and left 

10 infants dead, prompted an examination of the current vaccine's effectiveness. That study 

concluded that the vaccine is effective but loses power over the years, leaving children 7 to 

10 years old particularly susceptible. "The pertussis vaccine is our best protection against 

disease," said the study's lead author, Lara Misegades, an epidemiologist at the U.S. Centers 

for Disease Control and Prevention in Atlanta. "We found that unvaccinated children were 

eight times more likely to be a pertussis case than vaccinated children. Parents should 

ensure children complete the childhood series and make sure your children get the 

adolescent booster too." Medline Plus

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INFLUENZA

Armed Forces Health Surveillance Center: DoD Influenza 

Surveillance Summary

6 December:

 Influenza-Like Illness (ILI) incidence rates increased throughout the MHS, including 

increased outpatient visits due to ILI except in PACOM other beneficiaries (nonServicemember). 

 Influenza activity is at moderate levels across the overseas DoD laboratory surveillance 

network except in Europe where the activity is low; sites reported variable co-
circulation of influenza A/H1, A/H3, and B. 

 The influenza vaccination coverage for the DoD (Active Duty component only) is 91%. 

AFHSC DoD Influenza Surveillance Summary

CDC sees signs of early, bad flu season

3 December – The early uptick in flu infections that are predominantly the H3N2 strain 

shows some worrisome parallels to the nation's last bad regular flu season in 2003-04, 

officials from the US Centers for Disease Control and Prevention (CDC) said today. The 

CDC's warning today that flu has picked up its pace about a month earlier than usual came 

during a media teleconference with reporters and at the start of its annual National 

Influenza Vaccination Week (NIVW), designed to encourage vaccination ahead of the main 

holiday season and the most active months for flu activity. CDC Director Thomas Frieden, 

MD, MPH, said though influenza is notoriously unpredictable, there are early signs that it 

could be a bad year. "It's time to get vaccinated," he said, adding that one promising 

development is that about 90% of the circulating flu viruses are well matched to the strains 

contained in the seasonal flu vaccine. CIDRAP

CDC: Weekly Influenza Surveillance Report

During week 47 (18-24 November 2012), influenza activity increased in the U.S. FluView

DoD Global Laboratory-Based Influenza Surveillance 

Program

 During week 48 (25 November – 1 December 2012), 61 specimens were collected and 

tested from 20 locations. There was one A(H1N1pdm09) at Luke AFB, AZ and 23 

influenza A/H3 viruses detected.

 Since Week 47, there has been an increase in influenza A/H3 virus isolated by USAFSAM 

and CDC. The CDC reports recent testing on viruses collected since 1 October 2012: 

0.0% (0 of 122) of A/H3 viruses tested were resistant to oseltamivir/zanamivir 

 To date, 490 specimens have been submitted and tested from 51 locations of which 72 

were positive for influenza A (two co-infections of A/H3 & B, 65 A/H3, and five 

A(H1N1pdm09) and six were positive for influenza B. There have been 52 other 

respiratory viruses isolated (12 adenovirus, six RSV, four enterovirus, and 30 

parainfluenza). USAF School of Aerospace Medicine (restricted access)

European Centre for Disease Prevention and Control:

Weekly Influenza Surveillance Overview

During week 47 (19-25 November 2012), all 28 countries reporting experienced lowintensity activity of influenza-like illness or acute respiratory infection. Weekly Influenza 

Surveillance Overview
Influenza Activity — United States, September 30–

November 24, 2012

7 December - Influenza viruses were detected in the United States throughout the summer 

months (1), and activity increased steadily during October and November. Most influenza 

viruses characterized thus far this season are well matched to the 2012–13 vaccine viruses. 

This report summarizes U.S. influenza activity* during September 30–November 24, 2012.

CDC

Naval Health Research Center: Febrile Respiratory 

Illness Surveillance Update 

For the week ending 1 December 2012:

Influenza

A cluster of influenza A/H1N1(09) cases were identified at MCRD Parris Island in September 

– October.

Adenovirus 

 Vaccination against types 4 and 7 adenovirus was instituted at all basic training centers 

by mid-November 2011 (week 45). 

 FRI rates and the proportion of FRI cases positive for adenovirus have decreased 

markedly since vaccine was reintroduced. 

 Type 14 adenovirus cases continue at MCRD Parris Island , though FRI rates remain low

FRI surveillance at all eight U.S. military basic training centers indicated FRI rates were at or 

below expected values. NHRC Febrile Respiratory Illness Surveillance Update 

USAPHC: U.S. Army Influenza Activity Report

24 November - Influenza activity has increased over the past two weeks, yet overall 

influenza and influenzalike illness (ILI) activity remains at baseline in US Army and civilian 

populations.

 ILI Activity: Army incident ILI outpatient visits in week 47 were 12% higher than the 

same week last year.

 Influenza cases: Eighteen hospitalized influenza cases have been reported in DRSi this 

influenza season, but some represent emergency room visits.

 Acute Respiratory Disease at BCT sites: ARDS rates remain lower at all Army BCT sites 

compared to the same period last year.

 Viral specimens: During week 47, 127 of 602 (21%) clinical specimens tested were 

positive for respiratory pathogens. Influenza A was identified in 74 (58%) of these 

positive samples. Most of the Army influenza positive specimens were from SRMC 

(50%), primarily Ft. Gordon (51%) and Ft. Stewart (22%). USAPHC U.S. Army Influenza 

Activity Report
PANDEMIC AND AVIAN INFLUENZA

Predicting, preventing, and controlling pandemics: 

Making the case for a strategic action plan

4 December – ... According to Dr. Morse and the other authors of the Lancet series, there 

are several stages in disease emergence and each change increases the likelihood of the 

pathogen making contact with humans. The spread of zoonoses is strongly affected by such 

human activities as global travel, changes in land use, and animal agriculture. Thus 

prevention will require intervention and planning on many fronts. Recent developments in 

modeling and technology, including revolutionary advances in communications, database 

design, and use of the latest molecular screening methods to identify previously unknown 

infectious agents, have put us on the verge of being able to predict the next zoonotic 

pandemic, according to Dr. Morse... "There is no question of whether we will have more 

zoonotic pandemics – the question is merely when, and where, the next pandemic will 

emerge," says Dr. Morse. "The challenge now is to establish whether and how researchers 

can intervene before a pathogen reaches the human population and develop appropriate 

triggers for action. Zoonotic diseases, by definition, should be a key mission of human 

health agencies, agricultural authorities and producers, and natural resource managers, all 

working cooperatively." EurekAlert

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VETERINARY/FOOD SAFETY

Pesticides in tap water, produce linked to food allergies

4 December - Pesticides in produce and drinking water 

may be playing a role in the increasing prevalence of food 

allergies, according to a new study. Researchers looked at 

2,211 people and found those in the top 25% for urine 

concentrations of chemical dichlorophenols – used to 

chlorinate tap water and keep pests off produce - were also 80% more likely to have a food 

allergy. "Adults can develop food allergies even though they're not kids anymore," says 

allergist and study author Dr. Elina Jerschow. "Adult allergies to foods are on the rise. That 

certainly includes shellfish and fish allergies, but also peanuts. We don't know what 

influences this development. But having been exposed to dichlorophenols in our study 

suggests there could be some link." CNN

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WELLNESS

More drugs cited as a risky mix with grapefruit

27 November - Grapefruit sprinkled with a little sugar has 

just the right amount of kick for a morning meal. But when 

the bitter fruit is mixed with medication, things can get a 

bit tricky. Compounds in grapefruit can dramatically 

change how some popular drugs work in the body. And 

the number of drugs that can have severe side effects when combined with grapefruit has

more than doubled in the last four years, says a study published Monday in the Canadian 

Medical Association Journal. NPR

New study shows how copper restricts the spread of 

global antibiotic-resistant infections

4 December - Horizontal gene transfer (HGT) in bacteria is largely responsible for the 

development of antibiotic-resistance, which has led to an increasing number of difficult-totreat healthcare-associated infections (HCAIs). The newly-published paper, which appears in 

the journal mBio, shows that while HGT can take place in the environment, on frequentlytouched surfaces, such as door handles, trolleys and tables, which are made from stainless 

steel – copper prevents this process from occurring and rapidly kills bacteria on contact. 

PhysOrg

Overprescribing of opioids impacts patient safety and 

public health

3 December - A Viewpoint article published recently in the Journal of the American Medical 

Association suggests that the clinical practice of prescribing amphetamines, opioids, and 

benzodiazepines to treat chronic pain may be contributing to the increase in fatal drug 

overdoses and the likelihood that those drugs will be diverted to the illegal market... “More 

people in the U.S. die from a drug overdose than they do from motor vehicle accidents and 

more of those deaths are caused by prescription opioids than those attributable to cocaine 

and heroin combined,” said [G. Caleb] Alexander, associate professor of Epidemiology at the 

Bloomberg School and co-director of the new Johns Hopkins Center for Drug Safety and 

Effectiveness. There are measures currently in place to monitor the increasing epidemic of 

opioid abuse, including limits on the number of opioid prescriptions covered by insurers, 

requirements that these drugs be supplied through a single physician or pharmacy, and 

state prescription drug monitoring programs. However, the Viewpoint conveys that unless 

there is a clinical shift in the widespread use of these medicines, efforts to reduce opioid 

abuse may not succeed. Johns Hopkins Bloomberg School of Public Health Public Health 

News Center
Psychiatrists OK vast changes to diagnosis manual

1 December - For the first time in almost two decades the nation's psychiatrists are 

changing the guidebook they use to diagnose mental disorders. Among the most 

controversial proposed changes: Dropping certain familiar terms like Asperger's disorder 

and dyslexia and calling frequent, severe temper tantrums a mental illness. The board of 

trustees for the American Psychiatric Association voted Saturday in suburban Washington, 

D.C., on scores of revisions that have been in the works for several years. Details will come 

next May when the group's fifth diagnostic manual is published. Yahoo! News

Running farther, faster and longer can kill you

3 December - ... There is accumulating evidence that, over the long term, endurance sports 

like distance running might actually hurt the heart, an editorial in the British journal Heart 

argues. And that’s especially true for aging runners, says the editorial’s lead author Dr. 

James O’Keefe, head of preventive cardiology at the Mid America Heart Institute at Saint 

Luke’s Health System. O’Keefe points to studies that show subtle signs of heart damage in 

marathon runners tested right after their races have been run. And backing that up, he says, 

is data from the “Iron Mouse” study that found scarring in the hearts of mice forced to run 

long distances every day for four months. The good news is that the mice seemed to 

improve after they stopped running and were allowed to return to normal rodent life. But 

O’Keefe is worried that distance runners who keep at it year after year after year don’t ever 

give their hearts a chance to heal. Health on TODAY

'Synthetic pot' sending thousands of young people to ER

4 December - U.S emergency rooms tended to more than 11,400 cases of drug-related 

health complications specifically linked to the use of synthetic marijuana in 2010, a new 

government report reveals. Released Tuesday, The DAWN Report from the U.S. Substance 

Abuse and Mental Health Services Administration (SAMHSA) attaches a hard figure to the 

potential health risks associated with the growing use of synthetic marijuana. The report 

also puts such use in context, observing, for example, that actual marijuana use accounted 

for far more ER visits (exceeding 461,000) in the same time frame. U.S. News and World 

Report

Tobacco companies ordered to publicly admit deception 

on smoking dangers

28 November - Tobacco companies have been ordered by a federal judge to publicly admit, 

through advertisements and package warnings, that they deceived American consumers for 

decades about the dangers of smoking. Federal Judge Gladys Kessler issued her ruling 

Tuesday in one of the last legal steps settling liability in the long-running government 

prosecution of cigarette makers. "By ensuring that consumers know that [tobacco 

companies] have misled the public in the past on the issue of secondhand smoke in 

addition to putting forth the fact that a scientific consensus on this subject exists," said 
Kessler, "defendants will be less likely to attempt to argue in the future that such a 

consensus does not exist." CNN

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USAFRICOM

Ebola in Uganda - update

30 November - As of 28 November 2012, the Ministry of Health in Uganda reported 7 cases 

(6 confirmed, 1 probable) with Ebola haemorrhagic fever in Luweero and Kampala districts. 

Of these cases, 4 died. Field teams continue to investigate cases alerted to them from the 

communities. The major challenge faced in some communities is the belief that witch-craft 

and not Ebola was the cause of deaths, despite ongoing intensive awareness campaigns. 

Social mobilization teams are working closely with traditional healers and religious leaders 

to raise awareness on prevention and control of the disease...

Note: The total number of cases reported on 23 November2012 was 10 (6 confirmed, 4 

probable) Probable cases that tested negative for Ebola have been classified as Non-Cases 

and excluded from the case counts. WHO

Nato forces 'attack Afghan health clinic'

6 December - Nato forces stormed into a clinic in central 

Afghanistan, damaging doors, windows and medical 

equipment, before using it as a jail and military command 

centre, in violation of the Geneva conventions, according to 

the aid group that runs the facility. Nato and Afghan troops 

were dropped off by helicopters late one October evening and headed straight to the clinic, 

according to the Swedish Committee for Afghanistan, which has published details of the 

assault on their small centre in Wardak province, a few dozen miles south-west of Kabul.

The soldiers knocked down a wall to enter the building, damaged doors, windows, 

examination beds and other equipment, and detained clinical staff and civilians inside. And 

for the next two and a half days they brought dozens, maybe hundreds of prisoners through 

the clinic, using it as a jail, logistics hub and for mortar fire, contravening the Geneva 

conventions, which protect medical centres. Guardian

'Transport infrastructure' determines spread of HIV 

subtypes in Africa

4 December - Road networks and geographic factors affecting "spatial accessibility" have a 

major impact on the spread of HIV across sub-Saharan Africa, according to a study 

published online by the journal AIDS... Using sophisticated mapping techniques and 

detailed databases, Dr Andrew J. Tatem of the University of Florida and colleagues have 

found "coherent spatial patterns in HIV-1 subtype distributions" across Africa. The 
researchers write, "A comprehensive understanding and evidence-base on accessibility, 

travel and mobility in resource poor settings would...provide a valuable resource for the 

strategic planning of disease control." ... In addition to roads, the data included a wide 

range of factors affecting "spatial accessibility," such as land cover, settlement locations, 

bodies of water, and topography. Sophisticated models were used to calculate not just the 

distance between locations, but also the ease of traveling from one place to another. Even 

simply laying a chart of HIV subtypes over a map of travel times between settled areas 

makes the link between spatial accessibility and HIV subtype "clearly evident." EurekAlert

Zambia meeting addresses health emergency response 

gaps in Africa

5 December - A 4-day regional forum for African governments, agencies, and other 

stakeholders is under way in Zambia to discuss unmet needs in surveillance and response 

capacities for public health emergencies in Africa. A press release yesterday from the World 

Health Organization Regional Office for Africa (WHO/AFRO) says that many African 

countries were unable to meet the original Jun 15, 2012, deadline set under the 

International Health Regulations (IHR) for developing core capacities for all-hazards 

emergency response, and the deadline has been extended until Jun 15, 2014. The WHO said 

gaps and weaknesses exist in core capacities, including legislation, preparedness, risk 

communication, human resources, food safety, and chemical and radionuclear attack. The 

goal of the meeting, which brings together 80 participants from 22 countries, is to allow the 

sharing of experiences and challenges in IHR implementation and to identify priorities and 

next steps where gaps exist. Dr. Patrick Chikusu, deputy minister of health in Zambia, said 

the delay in strengthening the region's core capacities is a major concern for global health 

security. CIDRAP

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USCENTCOM

Novel coronavirus infection - update

30 November - In addition to the fatal case of novel coronavirus in Saudi Arabia reported to 

WHO on 28 November, two fatal cases in Jordan have been reported to WHO today, 

bringing the total of laboratory-confirmed cases to nine. The latest confirmed case from 

Saudi Arabia occurred in October 2012 and is from the family cluster of the two cases 

confirmed earlier. The two cases from Jordan occurred in April 2012. At that time, a number 

of severe pneumonia cases occurred in the country and the Ministry of Health (MOH) 

Jordan promptly requested a WHO Collaborating Centre for Emerging and Re-emerging 

Infectious Diseases (NAMRU – 3) team to immediately assist in the laboratory investigation. 

The NAMRU-3 team went to Jordan and tested samples from this cluster of cases. On 24 

April 2012 the NAMRU-3 team informed the MOH that all samples had tested negative for 

known coronaviruses and other respiratory viruses. As the novel coronavirus had not yet 
been discovered, no specific tests for it were available. In October 2012, after the discovery 

of the novel coronavirus, stored samples were sent by MOH Jordan to NAMRU-3. In 

November 2012 NAMRU-3 provided laboratory results that confirmed two cases of 

infection with the novel coronavirus. WHO

Pakistan: Tackling Pakistan’s population time bomb

5 December - A high birth rate is not making life any easier for 

Pakistan’s 180 million people, already affected by political 

instability, economic stagnation and natural disasters. Internal 

pressures in the country with the world’s sixth largest 

population are likely to get worse before they get better: At 

2.03 percent Pakistan has the highest population growth rate in South Asia, and its total 

fertility rate, or the number of children born per woman, is also the highest in the region, at 

3.5 percent. By 2030, the government projects that Pakistan’s population will exceed 242 

million. The failure to adequately manage demographic growth puts further pressure on the 

current population, who already lack widespread basic services and social development.

IRIN

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USEUCOM

French sperm count 'falls by a third'

4 December - The sperm count of French men fell by a third between 1989 and 2005, a 

study suggests. The semen of more than 26,600 French men was tested in the study, 

reported in the journal Human Reproduction. The number of millions of spermatozoa per 

millilitre fell by 32.3%, a rate of about 1.9% a year. And the percentage of normally shaped 

sperm fell by 33.4%. The average sperm count remained within the fertile range, but experts 

want to see more research into possible causes. BBC News

Greece: Basic hygiene at risk in debt-stricken hospitals

4 December - - Greek hospitals are in such dire straits that staff are failing to keep up basic 

disease controls such as using gloves and gowns, threatening a rise in multidrug-resistant 

infections, according to Europe's top health official. Greece already has one of the worst 

problems in Europe with hospital-acquired infections, and disease experts fear this is being 

made worse by an economic crisis that has cut health care staffing levels and hurt standards 

of care. With fewer doctors and nurses to look after more patients, and hospitals running 

low on cash for supplies, risks are being taken even with basic hygiene, said Marc Sprenger, 

director of the European Centre for Disease Prevention and Control (ECDC). Reuters
Portugal: Dengue

5 December - The dengue fever outbreak that began in early October [2012] on the island 

of Madeira in the Autonomous Region of Madeira continues to increase in numbers,

according to the latest case count from the European Centre for Disease Prevention and 

Control (ECDC) on 3 Dec [2012; available at http://bit.ly/RCbNU4]. European health 

authorities report 1819 dengue cases as of 25 Nov [2012]. This is up from 1672 cases 

reported one week prior. ProMED-mail

United Kingdom: Whooping cough cases this year are 10 

times peak in 2008

30 November - More than 7,700 whooping cough cases have been reported in England and 

Wales this year, almost 10 times the number seen in the last peak year for the illness in 

2008, the Health Protection Agency said. The number of cases in October reached 1,614, 

bringing the total for the year to 7,728 including 13 infant deaths, the agency said today in 

an e-mailed statement. Almost 800 cases were reported in 2008, according to the HPA. 

More than 80 percent of the 2012 cases are in people age 15 and older. Bloomberg

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USNORTHCOM

Puerto Rico: Take-home lead exposure among children 

with relatives employed at a battery recycling facility 

30 November - Among 68 children aged <6 years, 11 (16%) had confirmed blood lead 

levels (BLLs) ≥10 μg/dL, the BLL at which CDC recommended individual intervention to 

reduce BLLs in 2010, and 39 (57%) children aged <6 years had venous or capillary BLLs ≥5 

μg/dL, the reference value for elevated BLLs in children established by CDC in 2012. To 

determine whether take-home lead exposure contributed to the children's BLLs of ≥10 

μg/dL, vehicle and household environmental samples were collected and analyzed. Eightyfive percent of vehicle dust samples and 49% of home dust samples exceeded the U.S. 

Environmental Protection Agency (EPA) level of concern of ≥40 μg/ft2 (3.7 μg/m2). EPA 

began clean-up of employee homes and vehicles, focusing first on homes with children with 

BLLs ≥10 μg/dL. EPA also required that the company set up shower facilities, shoe washes, 

and clean changing areas at the battery recycling facility. Morbidity and Mortality Weekly 

Report

U.S.: 18 treated for chemical exposure after New Jersey 

train derails 

30 November - Residents of three southern New Jersey towns were told to stay indoors and 

18 people were treated for exposure after a bridge collapsed Friday, causing a freight train 
to derail and release a potentially hazardous chemical, officials said. Three train cars 

dropped from the bridge into a creek in Paulsboro in Gloucester County at about 7 a.m. and 

were leaking, according to the statement that authorities e-mailed to reporters. At least one 

of the cars that fell into the creek is believed to have contained vinyl chloride, which can 

cause dizziness and harm breathing. The cargo in the other cars was unknown... Eighteen 

people with respiratory issues reported to Underwood Memorial Hospital, mainly 

complaining of sore throats and breathing problems, officials said. Los Angeles Times

U.S.: Additional contamination identified in medical 

products from New England Compounding Center

3 December - ... CDC and FDA have identified additional microbial contamination in 

unopened vials of betamethasone, cardioplegia, and triamcinolone solutions distributed 

and recalled from NECC. These include bacteria known as Bacillus, and fungal species 

including Aspergillus tubingensis, Aspergillus fumigatus, Cladosporium species, and 

Penicillium species. Although rare, some of the identified Bacillus species can be human 

pathogens. Some of the fungal organisms identified, particularly Aspergillus fumigatus, are 

known to cause disease in humans. It is not known how product contamination with these 

organisms could affect patients clinically. CDC

U.S. birth rate falls to a record low

29 November - The U.S. birth rate dipped in 2011 to the lowest ever recorded, led by a 

plunge in births to immigrant women since the onset of the Great Recession. The overall 

U.S. birth rate, which is the annual number of births per 1,000 women in the prime 

childbearing ages of 15 to 44, declined 8% from 2007 to 2010. The birth rate for U.S.-born 

women decreased 6% during these years, but the birth rate for foreign-born women 

plunged 14%—more than it had declined over the entire 1990-2007 period.1 The birth rate 

for Mexican immigrant women fell even more, by 23%... Despite the recent decline, foreignborn mothers continue to give birth to a disproportionate share of the nation’s newborns, 

as they have for at least the past two decades. The 23 percent share of all births to foreignborn mothers in 2010 was higher than the 13 percent immigrant share of the U.S. 

population, and higher than the 17 percent share of women ages 15-44 who are 

immigrants. Pew Research Center

U.S.: Behind a call that kept nursing home patients in 

storm’s path

2 December – [During Hurricane Sandy, the] recommendation that thousands of elderly, 

disabled and mentally ill residents remain in more than 40 nursing homes and adult homes 

in flood-prone areas of New York City had calamitous consequences. At least 29 facilities in 

Queens and Brooklyn were severely flooded. Generators failed or were absent. Buildings 

were plunged into a cold, wet darkness, with no access to power, water, heat and food. 

While no immediate deaths were reported, it took at least three days for the Fire 

Department, the National Guard and ambulance crews from around the country to rescue 

over 4,000 nursing home and 1,500 adult home residents. Without working elevators, many 
had to be carried down slippery stairwells... The decision not to empty the nursing homes 

and adult homes in the mandatory evacuation area was one of the most questionable by 

the authorities during Hurricane Sandy. And an investigation by The New York Times found 

that the impact was worsened by missteps that officials made in not ensuring that these 

facilities could protect residents. New York Times

U.S.: Chlorine gas release associated with employee 

language barrier — Arkansas, 2011

7 December - ... This chlorine release and its resultant health effects were preventable. 

OSHA issued the owner of the poultry plant a citation for not ensuring that chemical hazard 

communication training was understood by all employees. The OSHA Hazard 

Communication Standard states, "Employers shall provide employees with effective 

information and training on hazardous chemicals in their work area at the time of their 

initial assignment, and whenever a new physical or health hazard the employees have not 

previously been trained about is introduced into their work area."** Under the standard, 

employers also are expected to communicate work instructions and information on 

workplace hazards to employees tailored to the employees' language and education level 

(3). The growing presence of Spanish-speaking workers in the United States, and the high 

rates of morbidity and fatalities among Hispanic workers, point to the need for improved 

workplace instruction and training to ensure employee comprehension (4). Morbidity and 

Mortality Weekly Report

U.S.: Valero says worker died after chemical exposure

3 December - One of two workers exposed to a hazardous chemical at Valero Energy Corp's 

Tennessee refinery early on Monday has died, the company said. Both were hurt when a 

small window on a unit ruptured at the 180,000 barrels-per-day (bpd) Memphis refinery, 

spokesman Bill Day said. He said the sight glass failed on an alkylation unit, injuring a Valero 

employee and a contractor. The Valero employee, who not identified, later died, Day said. 

Memphis Fire Department spokesman Lt. Wayne Cooke and Day said responders were 

investigating what chemicals were behind the glass that ruptured. Sources familiar with 

refinery operations said the chemical was hydrogen fluoride, which can cause severe burns 

if in contact with skin or breathed into lungs. When dissolved into water, the chemical also 

can be called hydrofluoric acid. Reuters

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USPACOM

Australia: Obesity strategy a 'wasteful failure'

2 December – The political response to Australia's obesity epidemic has 

been a ''failure'', and $49 million spent on healthy lifestyle advertising 

campaigns was a ''waste of taxpayers' money'', a key government 

adviser claims. Professor Paul Zimmet, a member of former prime 

minister Kevin Rudd's preventive health taskforce, says the 

government's strategy to fight the fat is ''weak and fragmented''... 

Professor Zimmet, director emeritus at Melbourne's Baker IDI Heart and Diabetes Institute, 

will argue there is no political will to reduce obesity. While congratulating the government 

for its action on tobacco control, he claims it has taken the ''easy option'' on obesity, with 

ineffective social marketing campaigns. Sydney Morning Herald

India: Appalling condition of primary healthcare services 

6 December - Suffering from unstable angina, asthma or dysentery? The chances of correct 

diagnosis and treatment in both rural and urban areas by private and public care providers 

are dismal. The shocking state of primary healthcare services in both private and public 

clinics in urban (Delhi) and rural (villages in Madhya Pradesh) areas has been highlighted in 

a scientifically carried out study published a few days ago in Health Affairs. What is all the 

more appalling is that the 305 healthcare providers tested in urban and rural India were 

presented with nearly uncomplicated conditions — unstable angina, asthma or dysentery —

and for which there exist well established medical protocols with clear triage, management 

and treatment checklists developed by the government’s National Rural Health Mission. 

The Hindu

Nepal: Pneumonia, children

5 December - Pneumonia is on the rise in Udayapur district due to cold weather for the past 

few days. Pneumonia has been seen in children in Triyuga Municipality and in Beltar, in the 

eastern part of the district. According to employees at Beltar Primary Health Center, some 

50 children from Beltar with pneumonia visited local health institutions for treatment within 

the past week. Janak Karki of the Sagarmatha Higher Secondary School said that most of 

the students at the school have been suffering from pneumonia due to increasing cold 

weather and have remained absent from school. District Public Health Officer Duniyalal 

Yadav said that a number of children who were suffering from pneumonia visited the 

District Hospital in Udayapur for treatment. ProMED-mail

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USSOUTHCOM

Cuba: Cholera, diarrhea, and dysentery update

26 November - The cholera epidemic that has been sweeping across Cuba since last June 

2012 has spread to the provinces of Santiago de Cuba, Guantanamo, and Holguin, with 

dozens of people hospitalized and some municipalities in critical situation, reports from the 

island the independent news agency "Hablemos Press". According to a report of the 

agency's director, Roberto de Jesus Guerra Perez, sources in the public health sector and 

residents of the eastern zone confirmed the proliferation of the epidemic, and pointed out 

that the province of Guantanamo could be declared in quarantine. A resident in the city of 

Guantanamo confirmed that there are about 206 cases of cholera in the province. Figures 

revealed by this citizen were obtained from an employee of the Ministry of Public Health 

that requested their identity not be revealed, says Hablemos Press. ProMED-mail

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