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26 April 2013

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

US Army Medical Department opinions, views, policy, or guidance, and

should not be construed or interpreted as being

endorsed by the US Army Medical Department.

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Contents

U.S. MILITARY

 Panelists: PTSD can't be cured, only managed

 Signature scars of the long war

GLOBAL

 HCV-targeting therapy shows more promise

 Research finds targeted screening for hepatitis C is cost-effective

 Scientists try new tactic against schistosomiasis

 Stronger antibiotics linked with bacteria evolving resistance faster

 Study links autism with antidepressant use during pregnancy

INFLUENZA

 Armed Forces Health Surveillance Center: DoD Influenza Surveillance Summary

 CDC: Weekly Influenza Surveillance Report

 DoD Global Laboratory-Based Influenza Surveillance Program

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

 Google.org: Flu Trends

 Naval Health Research Center: Febrile Respiratory Illness Surveillance Update

 USAPHC: U.S. Army Influenza Activity Report

 PANDEMIC AND AVIAN INFLUENZA

 Human infection with avian influenza A(H7N9) virus – update

 Report: Most H7N9 patients had underlying conditions, animal exposure

 Taiwan man contracts H7N9 bird flu, first outside mainland China

VETERINARY/FOOD SAFETY

 Europe: Schmallenberg virus, international trade

 Koala chlamydia: The STD threatening an Australian icon

 U.S.: Food industry opposes FDA plan to boost food safety budget with fees

 U.S.: Foodborne hospitalization analysis puts ground beef, chicken as top risks
2

NMCPHC to 

Host Webinar on 

Sleep Issues

The Navy and Marine 

Corps Public Health Center

webinar will identify signs 

and symptoms of sleep 

problems and common 

sleep disorders, describe 

prevalence of sleep 

problems and summarize 

health behavior strategies 

to help mitigate sleep 

disturbances. This session 

will be conducted on 

Defense Connect Online 

and certified health 

education specialists may 

receive one continuing 

education contact hour for 

the session.

Date: 1 May

Time: 12-1 p.m., EST

Register for the webinar.

WELLNESS

 40 percent of parents give young kids cough/cold medicine that they shouldn't

 Consequences of the ‘Cinnamon Challenge’

 Linking stress to diabetes and heart disease

 New medical exam policy for sexual assault cases

 U.S.: Recalls of dietary supplements highlight mystery ingredients

 When cheeseburger = walking, will we eat less?

 Why circumcision lowers risk of HIV

USAFRICOM

 Cassava and mental deficits

 Kenya: Technology revolutionizes TB management

 Nigeria: 1,000 polio cases caused by misinformation - Minister

 South Africa: Shortages of new one-a-day ARV pills

 Uganda's soaring HIV infection rate linked to infidelity

USCENTCOM

 Afghanistan - the world’s most dangerous place for aid workers

 Afghanistan: Scores dead after earthquake, flash floods

 Syria: Leishmaniasis on the rise in war-torn Syria

USEUCOM

 Ancient DNA reveals Europe's dynamic genetic history

 England: HIV spread 'could be halted within generation'

 England: Measles vaccination plan targets 1m children

USNORTHCOM

 U.S.: Deadly meningitis cases worry gay community

 U.S.: 'Misdiagnosis' leading cause of malpractice payouts

 U.S.: More cancers than expected in WTC responders

 U.S.: MRSA dropping in hospitals; elsewhere, not so much

 U.S.: New York City aims to ban cigarette sales for under age 21

 U.S.: Not enough data to support suicide screening: panel

 U.S.: Notes from the Field - Exposures to discarded sulfur mustard munitions — Mid-Atlantic 

and New England States 2004–2012

USPACOM

 Australia: Genital wart decline tracked to HPV vaccine

 Bangladesh building collapse kills at least 123

 China: Quake rescuers rush to isolated areas

 China: Tuberculosis, MDR

 In China, breathing becomes a childhood risk

 Solomon Islands: Solomons gets foreign help to deal with dengue outbreak

USSOUTHCOM

 Brazil: Trichinosis outbreak affected 30 people in San Martin de los Andes
3

American Lung 

Association’s 

"State of the Air 

2013"

Thanks to the Clean Air 

Act, the United States 

continues to make 

progress providing 

healthier air. The "State of 

the Air 2013" shows that 

the nation’s air quality is 

overall much cleaner, 

especially compared to just 

a decade ago. Still, over 

131.8 million people—42 

percent of the nation—live 

where pollution levels are 

too often dangerous to 

breathe. 

 Brazil: Increase in the number of cases of whooping cough

 Paraguay: Suman 48 killed by dengue

U.S. MILITARY

Panelists: PTSD can't be cured, only managed

24 April - There is no way to cure post-traumatic stress 

disorder, but those suffering from it can learn to manage it, 

health professionals said Tuesday night. Kevin Smythe, a 

supervisory psychologist in the Mental Health Service Line at 

the Fayetteville VA Medical Center, said managing the disorder 

is currently the only option. "There are a lot of ebbs and flows (with the disorder)," Smythe 

said. He was one of five panelists to speak about the disorder and post-traumatic stress 

symptoms. Military.com

Signature scars of the long war

April 2013 - ... For 15 of the 16 illness/injury categories of interest, annual hospitalization 

rates remained fairly stable, with some year-to year variability, throughout the 11-year war 

period. However, for mental disorders, annual hospitalization rates were fairly stable from 

2002 through 2006 and then sharply increased from 2006 through 2012. As such, the 

hospitalization rate for mental disorders was approximately 8 percent higher in 2006 than 

2002 but more than twice as high in 2012 as 2006. Medical Surveillance Monthly Report

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GLOBAL

HCV-targeting therapy shows more promise

23 April - An investigational drug that acts directly against the hepatitis C virus (HCV) works 

quickly and effectively, according to new reports. Each report on the oral nucleotide 

analogue sofosbuvir, appearing in the New England Journal of Medicine, focuses on different 

patient populations, but, with one exception, they suggest that the drug can deliver high 

cure rates and an acceptable safety profile with 12 weeks of therapy. In contrast, the current 

standard of care – involving pegylated interferon and ribavirin -- can take up to 48 weeks. 

MedPage Today

Research finds targeted screening for hepatitis C is costeffective

24 April - Researchers at the University of Cincinnati have found that targeted screening for 

populations with a higher estimated prevalence for hepatitis C may be cost-effective. These 
4

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findings, published in the April 24, 2013, online edition of the journal Clinical Infectious 

Diseases, indicate that targeted screening for chronic hepatitis C virus infection is costeffective when the prevalence of hepatitis C in a population exceeds 0.84 percent 

(84/10,000). EurekAlert!

Scientists try new tactic against schistosomiasis 

22 April - Every year, more than 240 million people get a 

potentially deadly parasitic infection known as 

schistosomiasis, transmitted by fresh water snails. Infection 

rates have risen to as high as 80 percent in some parts of 

Africa, where communities often rely on rivers and lakes for 

bathing, cooking and other household chores. In Saint-Louis, Senegal, aid workers are using 

another indigenous species, the prawn, to keep parasite levels in check in local rivers. VOA

Stronger antibiotics linked with bacteria evolving 

resistance faster 

24 April - Combining various antibiotics will not help kill bacteria 

and in fact, help the bacteria evolve resistance to the drug 

combination faster, a new study says. The study included 

researchers from University of Exeter and Kiel University in 

Germany. The team first treated E-coli with various combinations 

of antibiotics. They found that the bacteria evolved resistance more quickly if it was treated 

with a strong combination of antibiotics. Researchers say that the bacteria thrive under 

aggressive treatments. This happens because the strong antibiotics kill all non-resistant 

bacteria, so the resistant forms of bacteria have very less competition and can multiply 

faster. Nature World News

Study links autism with antidepressant use during 

pregnancy

22 April - A cautiously worded study based on data collected in Sweden has found that “in 

utero exposure to both selective serotonin reuptake inhibitors (S.S.R.I.’s) and nonselective 

monoamine reuptake inhibitors (tricyclic antidepressants) was associated with an increased 

risk of autism spectrum disorders, particularly without intellectual disability.” The Swedish 

medical birth register (which contains data on current drug use reported by mothers early in 

their pregnancies), along with a system of publicly funded screenings for autism spectrum 

disorders and extensive national and regional registers of various health issues, make a 

detailed, population-based case-control study possible — one that controls for other 

variables like family income, parent educational level, maternal and paternal age and even 

maternal region of birth (all factors the authors note have been previously associated with 

autism). New York Times

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INFLUENZA

Armed Forces Health Surveillance Center: DoD Influenza 

Surveillance Summary

18 April - AFHSC is monitoring the current status of the H7N9 influenza outbreak in China. 

More information will be presented as it becomes available. 

 ILI and Pneumonia and Influenza (P&I) incidence rates continued to trend downward for 

all regions. This season, there have been 305 reportable medical event (RME) influenza 

cases among service members (82.6% were vaccinated); an additional 325 cases were 

reported among other beneficiaries. 

 Across the overseas DoD laboratory surveillance network, influenza activity was at low 

levels. 

 As of 26 March 2013, vaccine coverage in the active component of the U.S. Armed 

Forces is 97%. AFHSC DoD Influenza Surveillance Summary

CDC: Weekly Influenza Surveillance Report

During week 15 (April 7-13, 2013), influenza activity decreased in the United States. 

 Viral Surveillance: Of 3,802 specimens tested and reported by collaborating laboratories, 

354 (9.3%) were positive for influenza.

 Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia 

and influenza (P&I) was below the epidemic threshold. 

 Influenza-Associated Pediatric Deaths: Ten pediatric deaths were reported. 

 Geographic Spread of Influenza: Three states reported widespread influenza activity; 6 

states reported regional influenza activity. FluView

DoD Global Laboratory-Based Influenza Surveillance 

Program

 During Week 15, 27 specimens were tested from 15 locations. There were three 

influenza A(H1N1)pdm09 and three influenza B viruses detected. 

 To date this influenza season, 3,530 specimens have been tested from 81 locations of

which 1,057 were positive for influenza A (940 A(H3N2), 104 A(H1N1)pdm09, seven coinfections, and six A/not subtyped). Also, 338 specimens were positive for influenza B. 

Of these, there were 14 B/Yamagata, two B/Victoria, and two B & enterovirus coinfections. The lineage is pending or unknown for 320 specimens. 

 There have been 234 other respiratory viruses isolated (55 adenovirus, 90 RSV, 80 

parainfluenza, and nine enterovirus) cumulatively this season. 

 According to WHO, a total of 63 patients have been laboratory-confirmed with 

influenza A(H7N9) virus in China; including 14 deaths. More than a thousand close 
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contacts of the confirmed cases are being closely monitored. 

 USAFSAM has prepared the Novel Respiratory Pathogens Quick Sheet in the event you 

have a suspect case of a novel respiratory pathogen. 

 The final vaccination rates by service are as follows: Army - 94%, Air Force - 98%, 

Marines - 93%, Navy - 96%, Coast Guard - 98%. USAF School of Aerospace Medicine

European Centre for Disease Prevention and Control:

Weekly Influenza Surveillance Overview

 In week 15/2013(8–14 April2013), 25 of 28 reporting countries indicated low-intensity 

transmission. 

 Decreasing or stable trends were reported by all reporting countries. 

 The proportion of influenza-positive sentinel specimens (34%) has continued to 

decrease since the peak observed in week 5/2013 (61%), in line with the lower numbers 

of specimens being tested. 

 Since week 40/2012, 47% of sentinel surveillance specimens testing positive for 

influenza virus have been type A and 53% type B. Of the influenza A viruses subtyped, 

the proportion of A(H1)pdm09 viruses was 64%. 

 Forty-four hospitalised, laboratory-confirmed influenza cases were reported by three 

countries. 

In all reporting countries, influenza activity continued to decline or had already returned to 

baseline levels. After more than three months of active transmission, a long period 

compared to other years, the 2012–13 influenza season is waning and moving towards its 

end. Weekly Influenza Surveillance Overview

Google.org: Flu Trends

24 April – Estimates of flu activity based on certain Internet search queries indicate that the 

level of flu activity in the northern hemisphere ranges from primarily minimal and low to 

moderate in Russia and in the southern hemisphere ranges from minimal to low. Google.org 

Flu Trends

Naval Health Research Center: Febrile Respiratory 

Illness Surveillance Update 

For the week ending 13 April 2013:

 Influenza: One cases of NHRC laboratory-confirmed influenza (B) among US military 

basic trainees.

 Adenovirus: Sporadic adenovirus cases at basic training centers in 2013.

 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 
7

USAPHC: U.S. Army Influenza Activity Report

For the week ending 13 April 2013 (Week 15):

Influenza-like illness (ILI) activity continues decreasing in both Army and civilian 

populations. Influenza B still exceeds influenza A among typed specimens. More cases of 

influenza virus A(H7N9) continue to be identified in China; risk to DoD personnel is still 

assessed as very low.

ILI Activity: Army incident ILI outpatient visits in week 15 were 2% lower than the same week 

last year.

Influenza cases: Two hospitalized influenza cases were reported to USAPHC in week 15. 97 

hospitalized cases have been reported during this influenza season, 85 in dependents and 

12 in Active Duty.

Acute Respiratory Disease at BCT sites: ARD rates remain low; rates did not increase 

significantly at any sites during week 15.

Viral specimens: During week 15, 127 of 611 (21%) laboratory specimens tested were 

positive for respiratory pathogens. Influenza B accounted for 51% of positive specimens. 

Most of the influenza positive specimens were from PRMC (11%); ERMC and WRMC 

accounted for 7% each. USAPHC U.S. Army Influenza Activity Report

PANDEMIC AND AVIAN INFLUENZA

Human infection with avian influenza A(H7N9) virus –

update

25 April - As of 25 April 2013 (16:30 CET), one laboratory-confirmed case of human infection 

with the virus has been reported by the Taipei Centres for Disease Control (CDC). The 

patient is a 53-year-old man who had been working in Jiangsu province from 28 March to 9 

April 2013. He returned from Jiangsu via Shanghai on 9 April 2013, and became ill on 12 

April 2013. The patient was laboratory confirmed with the virus on 24 April 2013. To date, a 

total of 109 laboratory-confirmed cases of human infection with avian influenza A(H7N9) 

virus including 22 deaths have been reported to WHO. Contacts of the confirmed cases are 

being closely monitored. WHO

Report: Most H7N9 patients had underlying conditions, 

animal exposure

24 April – Chinese health professionals said in a detailed account today of H7N9 flu cases 

that about three fourths of patients had underlying medical conditions, and the same 

percentage had been exposed to animals, including chickens... [The] review includes data 
8

from 82 cases that were reported as of Apr 17. Since then, the outbreak total has grown to 

109 illnesses, including 22 deaths... Among 664 hospitalized patients with unexplained 

pneumonia, 81 (12.2%) were infected with the new virus...

Most of the patients who had confirmed infections were men (73%), and most lived in urban 

settings (84%). Of 71 patients with available information, 54 (76%) had underlying medical 

conditions. Among 46 of that group with available data, 40 (87%) were at increased risk due 

to their age—either younger than 5 years or 65 or older. Four of the patients were poultry 

workers...

Details about animal exposure were available for 77 of the patients, and 59 (77%) said they 

had recent exposure to animals while working at or visiting a live-animal market...

The investigators wrote that the current mortality rate is 21%, but they expect it to increase, 

given that many of the patients are still critically ill... 

Though extensive testing is needed to verify the source of H7N9, the Chinese authors 

strongly suspect poultry that don't show signs of disease... Limited human-to-human 

contact remains a possibility, the scientists wrote, especially in blood relatives. CIDRAP

Taiwan man contracts H7N9 bird flu, first outside 

mainland China

24 April - A 53-year-old Taiwan businessman has contracted the H7N9 strain of bird flu 

while travelling in China, Taiwan's Health Department said on Wednesday, the first reported 

case outside of mainland China. The man was hospitalized after becoming ill three days 

after returning from Suzhou on April 9, Health Department Minister Wen-Ta Chiu told a 

news conference. Chiu said the patient was diagnosed with the H7N9 virus and was in 

serious condition. Chiu said Taiwan will take appropriate measures, including opening a 

special out-patient clinic for H7N9 cases. Reuters

top of page...

VETERINARY/FOOD SAFETY

Europe: Schmallenberg virus, international trade

23 April - Belarus has suspended import of beef cattle, sheep and goats from Denmark, 

BelTA learnt from the veterinary and food supervision department of the Agriculture and 

Food Ministry of Belarus. The decision was made in connection with the reemergence of 

Schmallenberg virus [SBV] infection in Denmark (Zealand island). In this regard, Belarus' 

veterinary authorities have suspended the imports and transit through its territory of cattle 

and small ruminants from Denmark. The recently detected virus provisionally named 

"Schmallenberg" (SBV) virus (Simbu serogroup, Bunyaviridae family, genus Orthobunyavirus) 

is found in ruminants... Current knowledge suggests that it is unlikely that SBV can cause 

disease in humans. ProMED-mail
9

Koala chlamydia: The STD threatening an Australian 

icon

24 April - The koala is unique to Australia and is an 

important symbol of the country. But numbers are 

plummeting and the survival of koalas is under threat. 

One of the reasons is the sexually transmitted disease 

chlamydia... Last year, [veterinary surgeon Amber]Gillett 

and her team treated about 300 koalas for chlamydia - and so far, 2013 has been a busy 

year too... Many have to be put down, and about half of females are left infertile - which 

means fewer koalas are being born. Experts say it's hard to predict the total number of 

koalas in Australia, but it's likely to be somewhere between 50,000 and 100,000 - and in 

some areas, numbers have dropped by as much as 80% in the last 10 years. BBC News

U.S.: Food industry opposes FDA plan to boost food 

safety budget with fees

22 April - Much of the food industry opposes paying fees that the US Food and Drug 

Administration (FDA) is proposing to pay for an increase in its food safety budget in fiscal 

year 2014, Food Safety News (FSN) reported today. Earlier this month the FDA announced 

that it was seeking a $295.8 million increase in its food safety budget for next year, with 

$252.4 million of that coming from a food facility registration and inspection fee and a food 

importer fee. In connection with a hearing late last week, a coalition of industry groups sent 

a letter to leaders of the Senate appropriations subcommittee that oversees the FDA, urging 

them not to impose any "new food regulatory taxes on industry and consumers," FSN 

reported. CIDRAP

U.S.: Foodborne hospitalization analysis puts ground 

beef, chicken as top risks

23 April - An analysis of hospitalization rates in foodborne outbreaks over the past 12 years 

found that ground beef and chicken are the riskiest meats, according a 25-page report 

today from the Center for Science in the Public Interest (CSPI), a health and food safety 

watchdog group based in Washington, D.C. The CSPI ranked 12 categories of meat and 

poultry based on the likelihood of hospitalizations linked to the most common pathogens 

reported in the foods. Ground beef topped the list, because Escherichia coli O157:H7 

hospitalizes about half of those it infects, the CSPI said in a press release. Caroline Smith 

DeWaal, the CPSI's food safety director, said that a quarter of those sickened with 

Salmonella are hospitalized. CIDRAP

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10

WELLNESS

40 percent of parents give young kids cough/cold 

medicine that they shouldn't

22 April - ... More than 40 percent of parents reported giving their children under age 4 

cough medicine or multi-symptom cough and cold medicine, according to the latest 

University of Michigan C.S. Mott Children's Hospital National Poll on Children's Health. 

Twenty-five percent gave those children decongestants. In 2008, the federal Food and Drug 

Administration issued an advisory that these over-the-counter medicines not be used in 

infants and children under age 2. They have not been proven effective for young children 

and may cause serious side effects. EurekAlert!

Consequences of the ‘Cinnamon Challenge’

22 April - It is known as the cinnamon challenge, and in recent years, the phenomenon has 

become wildly popular. On YouTube, tens of thousands of videos show people shoveling a 

tablespoon of ground cinnamon into their mouths. The videos show them coughing, 

choking and lunging for water, usually as friends watch and laugh... But now doctors and 

poison control experts are warning people that this seemingly harmless dare is more 

dangerous than it appears. A report published in the journal Pediatrics on Monday found 

that the stunt has led to a growing number of calls to poison control centers and visits to 

emergency rooms. Some teenagers have suffered collapsed lungs and ended up on 

ventilators. New York Times

Linking stress to diabetes and heart disease

22 April - High levels of cortisol — the so-called stress hormone — have been associated 

with cardiovascular disease in some studies, but not in others. This may be because 

measuring cortisol in blood or saliva at one point in time may pick up acute stress, but it 

fails to account for long-term stress. Now Dutch researchers have assessed cortisol levels 

over several months by analyzing scalp hair samples... The researchers measured the cortisol 

content in hair samples corresponding to roughly three months of growth from 283 older 

men and women, average age 75. They also gathered self-reported data about coronary 

heart disease, stroke, peripheral artery disease, Type 2 diabetes, lung disease, cancer and 

osteoporosis. Compared with those in the lowest quarter for cortisol, those in the highest 

quarter had about three times the risk for cardiovascular disease and diabetes. There was no 

association between cortisol levels and the risk for lung disease, cancer or osteoporosis.

New York Times

New medical exam policy for sexual assault cases

24 April - On Wednesday, the Department of Justice issued new national guidelines for 

forensic medical examinations in cases of sexual assault. The recommendations, revised 

from those issued in 2004, are aimed at establishing voluntary standards for care when rape 

victims seek help at hospitals or other medical facilities. The standards will be mandatory for 

practitioners working in federal prisons or in the military. The guidelines emphasize that the 
11

rape victim’s physical and emotional needs should take precedence over criminal justice 

considerations... “Research shows that once victims get support, they’re more likely to 

cooperate with the criminal justice system,” Ms. Hanson said... Unlike the 2004 protocol, the 

new guidelines also recommend that rape victims be offered emergency contraception or 

— in cases where health professionals have moral objections — information on how to 

immediately obtain the medication. New York Times

U.S.: Recalls of dietary supplements highlight mystery 

ingredients

23 April - Just because an over-the-counter product is called a dietary supplement doesn't 

mean that it's harmless. Quite a few supplements have been found to include hidden and 

potentially risky ingredients, including drugs. A recent study published in JAMA Internal 

Medicine found 273 recalls of dietary supplements between 2004 and 2012 because they 

contained drugs that could cause "serious adverse health consequences or death." When it 

comes to regulation of supplements, the FDA is "more reactive ... than proactive," explains 

Dr. Ziv Harel, an internist at St. Michael's Hospital in Toronto and lead author of the study. 

The majority of these supplements were marketed for sexual enhancement, bodybuilding or 

weight loss. About one-quarter of them were manufactured outside the U.S. NPR

When cheeseburger = walking, will we eat less?

23 April - Nutrition labeling has been required on packaged food since 1990, and the new 

federal food safety law will require calorie counts to be posted for restaurant food — all in 

an effort to get the American public to eat healthier. But most studies on calorie count 

labels show they don't do much to nudge people toward better food choices. If I want that 

oh-so-delicious Chunky Monkey ice cream, knowing that a half-cup serving delivers 300 

calories and 18 grams of fat isn't going to stop me. But what if I knew that it would take me 

an hour and 20 minutes of brisk walking to burn off those Chunky Monkey calories? Would I 

think twice? Probably, says Ashlei James, a graduate student at Texas Christian University. 

She tested how much people ate when given menus with labels that stated how much brisk 

walking would be required to burn off the calories in a given food item. She compared that 

to menus with calorie counts, and those with no information, and tracked how much people 

ordered and ate. The menus with and without calorie counts had no effect on how much 

the 300 participants, ages 18 to 30, ordered and ate. But the people who saw the walking 

times listed ordered fewer of the burgers, fries, chicken tenders, salad, dessert, sodas and 

water on the menu. They ordered less food, and ate less, too. NPR

Why circumcision lowers risk of HIV

19 April - Promising trials hinted that circumcision could 

lower rates of HIV infection, but until now, researchers 

didn't fully understand why. Now, in a study published in 

the journal mBio, scientists say that changes in the 

population of bacteria living on and around the penis may 

be partly responsible. Relying on the latest technology that make sequencing the genes of 
12

organisms faster and more accessible, Lance Price of the Translational Genomics Research 

institute (TGen) and his colleagues conducted a detailed genetic analysis of the microbial 

inhabitants of the penis among a group of Ugandan men who provided samples before 

circumcision and again a year later. CNN

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USAFRICOM

Cassava and mental deficits

22 April - Konzo, a disease that comes from eating bitter cassava that has not been 

prepared properly — that is, soaked for days to break down its natural cyanide — has long 

been known to cripple children. The name, from the Yaka language of Central Africa, means 

“tied legs,” and victims stumble as if their knees were bound together. Now researchers 

have found that children who live where konzo is common but have no obvious physical 

symptoms may still have mental deficits from the illness... The mental damage was like that 

done by lead exposure but more subtle, Dr. Boivin said. New York Times

Kenya: Technology revolutionizes TB management

18 April - The use of technology is revolutionizing the way Kenya manages tuberculosis (TB). 

Through a computer- and mobile-phone based programme called TIBU, health facilities are 

able to request TB drugs in real-time and manage TB patient data more effectively, health 

officials say. They also use the platform to carry out health education. “One of the 

challenges we have had with TB treatment is people defaulting [on treatment], but this will 

reduce significantly because through TIBU we will be able to track down patient treatment 

progress,” Joseph Sitienei, head of the Division of Leprosy, TB and Lung Disease at Kenya’s 

National AIDS Control Programme, told IRIN. IRIN

Nigeria: 1,000 polio cases caused by misinformation -

Minister

23 April - The Minister of State for Health, Dr Muhammad Pate, has expressed shock that 

more than 1,000 children have been paralysed by the wild polio virus largely due to the 

rejection of immunisation in the northern part of the country. Pate was reacting to a 

newspaper report that an Ahmadu Bello University (ABU) don, Prof Haruna Kaita, whose 

previous utterances allegedly stirred up the anti-polio controversy, had repented his 

decision. The minister told the New Agency of Nigeria (NAN) in Abuja on Sunday that 

Kaita's decision was a welcome development. "We are glad that the professor from ABU, 

whose previous utterances were associated with the misguided anti-polio controversy, has 

finally come out to straighten the facts from his perspective. AllAfrica
13

South Africa: Shortages of new one-a-day ARV pills

19 April - Just days into the rollout of fixed-dose combination (FDC) antiretrovirals (ARVs) 

by South Africa’s HIV treatment programme - the world's largest - activists are raising fears 

of drug shortages. Patients on the triple-therapy regimen will be able to take just one pill 

daily to control the virus. This has the advantages of improving adherence, simplifying 

regimens so that prescribing errors are reduced, and enabling the introduction of 

community models of care. IRIN

Uganda's soaring HIV infection rate linked to infidelity 

19 April - HIV activists are struggling to find ways to 

address one of Uganda's biggest health crises: soaring HIV 

infections among couples, caused largely by cheating 

spouses. The subject can be too politically and culturally 

sensitive to discuss. The face of Uganda’s AIDS epidemic is 

changing. In the 1990s, the country brought down its infection rate dramatically with a 

campaign advocating ABC - abstinence, being faithful and condoms. The government urged 

people to get off the so-called “sexual network” and into stable, committed relationships, 

which were considered safe. But that is no longer true. According to the results of a national 

survey released last year, more than 40 percent of new infections are happening among 

married couples. VOA

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USCENTCOM

Afghanistan - the world’s most dangerous place for aid 

workers

18 April - Attacks on aid workers in Afghanistan - the 

world’s most dangerous country for aid workers - are likely 

to be as high in 2013 as the worst year on record, 2011, 

according to a new report from the Afghanistan NGO 

Safety Office (ANSO) published today. The latest figures -

which tally only incidents affecting NGO personnel, excluding UN aid workers - show that in 

the first three months of this year, NGOs were affected by 39 separate incidents of violence, 

a 63 percent increase over 2012. Twenty incidents were attributed to armed opposition 

groups, 11 to pro-government forces and eight to criminals. IRIN

Afghanistan: Scores dead after earthquake, flash floods

24 April - A powerful earthquake and flash floods in eastern Afghanistan have left scores of 

people dead. The U.S. Geological Survey said the earthquake had a magnitude of 5.7 and its 
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epicenter was 11 kilometers from Mehtar Lam, the capital of Afghanistan's eastern province 

of Laghman, at a depth of 70 kilometers. The Afghan Red Crescent in neighboring 

Nangarhar Province told RFE/RL that the quake left 12 people dead in Nangarhar. The 

Afghan Health Ministry said in a statement the quake injured more than 100 people in 

Nangarhar... Meanwhile, flash floods caused by heavy rains killed at least 13 people in the 

northern province of Balkh. Dozens of homes were destroyed and at least five people 

remain missing. Radio Free Europe / Radio Liberty

Syria: Leishmaniasis on the rise in war-torn Syria

22 April - Health workers in northern Syria have reported a dramatic rise in cases of 

Leishmaniasis--locally dubbed “Aleppo Button Disease” for the sores it produces--and are 

calling on the World Health Organization and other international agencies for help. 

Leishmaniasis, transmitted through the bite of the common sandfly, is a complex of diseases 

affecting different parts of the body. The kind most commonly found in Syria is called 

cutaneous Leishmaniasis, which is characterized by welts or sores on the skin. These can 

sometimes become infected. VOA

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USEUCOM

Ancient DNA reveals Europe's dynamic genetic history

23 April - Ancient DNA recovered from a series of skeletons in 

central Germany up to 7,500 years old has been used to 

reconstruct the first detailed genetic history of modern Europe. 

The study, published today in Nature Communications, reveals a 

dramatic series of events including major migrations from both 

Western Europe and Eurasia, and signs of an unexplained genetic turnover about 4,000 to 

5,000 years ago. The research was performed at the University of Adelaide's Australian 

Centre for Ancient DNA (ACAD). Researchers used DNA extracted from bone and teeth 

samples from prehistoric human skeletons to sequence a group of maternal genetic 

lineages that are now carried by up to 45% of Europeans. Science Daily

England: HIV spread 'could be halted within generation'

23 April - The spread of HIV in England can be stopped within a generation, according to a 

new prevention campaign funded by the Department of Health. There are around 90,000 

people living with HIV in England. One person in four does not know they have it. Gay and 

bisexual men and people in African communities make up three-quarters of cases. Focused 

screening and information for high-risk groups could end the epidemic, experts say. BBC 

News
15

England: Measles vaccination plan targets 1m children

25 April - One million schoolchildren in England who missed MMR jabs are to be targeted 

by a vaccination plan aimed at curbing the growing threat of measles. Health officials warn 

epidemics similar to the one in Swansea, which has seen nearly 942 cases, could occur 

anywhere. There are fears that a generation of children have low levels of protection after 

the MMR scare a decade ago. The catch-up campaign, run through GPs, schools and 

community groups, will focus on children aged 10 to 16. BBC News

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USNORTHCOM

U.S.: Deadly meningitis cases worry gay community

23 April - A series of bacterial meningitis cases in Southern California and New York City, 

resulting in the deaths of several gay men, have set the gay community on edge. However, 

preliminary tests suggest the cases on each coast aren't connected. Health activists became 

concerned in Los Angeles after a 33-year-old gay attorney from West Hollywood suddenly 

became ill from meningitis and died on April 13. The AIDS Healthcare Foundation, which 

advocates for health for gay men, initially criticized local health officials for not pushing for 

vaccinations. However, "we don't think it's part of an outbreak or due to him being a gay 

man," said Dr. Wayne Chen, the organization's acting chief of medicine. Still, the Los 

Angeles County's public health department is offering meningitis vaccinations for free for 

those who are poor or uninsured. In New York City, health officials are recommending that 

certain groups of gay and bisexual men, along with certain visitors to the city, get 

vaccinated against meningitis. Medline Plus

U.S.: 'Misdiagnosis' leading cause of malpractice payouts

23 April - Missed or wrong diagnoses made up the lion's share of U.S. malpractice payouts -

- which totaled nearly $39 billion -- during the past 25 years, finds a new study of more 

than 350,000 claims. "These are the most common and the most costly of all malpractice 

claims," said study author Dr. David Newman-Toker, an associate professor of neurology at 

the Johns Hopkins University School of Medicine, in Baltimore. "We have to pay attention to 

this because it is too big of a problem to ignore." In the new study, researchers analyzed 

diagnosis-related claims from a national data bank from 1986 to 2010. Of all the claims, 

diagnostic errors led the pack, accounting for about 35 percent of the total payments of 

$38.8 billion (after adjusting for inflation). The study only reviewed claims that involved a 

malpractice payout, not those that did not get this far in the process. Medline Plus

U.S.: More cancers than expected in WTC responders

23 April - Incidence rates of all cancers -- and some in particular -- were higher among 

World Trade Center rescue workers than expected, researchers reported. In an ongoing 
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registry study, incidence rates of all cancers combined were 15% higher than expected... 

Incidence rates were also higher for thyroid, prostate, hematopoietic/ lymphoid, and softtissue cancers, they found. MedPage Today

U.S.: MRSA dropping in hospitals; elsewhere, not so 

much

24 April – The latest data from the US Centers for Disease Control and Prevention (CDC) 

suggest that hospitals have cut their incidence of invasive methicillin-resistant 

Staphylococcus aureus (MRSA) infections in half since 2005, but the decline in communityassociated MRSA infections has been far more modest. At a conference this week, CDC 

officials reported that the incidence of invasive MRSA infections in hospitals dropped an 

estimated 54% between 2005 and 2011, while the incidence of community-associated 

infections declined only 5% during that time. CIDRAP

U.S.: New York City aims to ban cigarette sales for under 

age 21

22 April - New York City, home to bans on trans fats and salt, is 

taking a step toward outlawing sales of cigarettes to anyone 

under age 21. City Council Speaker Christine Quinn, running to 

replace health conscious Mayor Michael Bloomberg, is due on 

Monday to announce legislation to increase the minimum age 

for buying cigarettes to 21 from 18, the current limit. On nearby Long Island, Nassau and 

Suffolk counties have boosted their legal age for buying cigarettes and other tobacco

products to 19. Reuters

U.S.: Not enough data to support suicide screening: 

panel

22 April - There is not enough evidence to recommend universal screening to find people at 

risk of suicide, according to a government-backed panel. As it did in 2004, the U.S. 

Preventive Services Task Force (USPSTF) issued draft guidelines on Monday that conclude 

"there is not enough evidence to make a definitive recommendation for or against 

screening." Its statement is available for public comment here: bit.ly/ZKptK6. "Although we 

did not find enough evidence to say ‘here are the right questions and tools to find the 

people who may be at risk for suicide,' doctors should be screening for depression and 

alcohol abuse disorders in their primary care population," said Dr. David Grossman, a 

member of the Task Force. Reuters

U.S.: Notes from the Field - Exposures to discarded 

sulfur mustard munitions — Mid-Atlantic and New 

England States 2004–2012

26 April - Before the 1970s, the United States sometimes disposed of at sea excess, 

obsolete, or unserviceable munitions, including chemical munitions (1). Chemical munitions 

known to have been disposed of at sea included munitions filled with sulfur mustard, a 
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vesicant (i.e., an agent that causes chemical burns or blisters of the skin and mucous 

membranes) (2). Signs and symptoms of exposure to a mustard agent can include redness 

and blistering of the skin, eye irritation, rhinorrhea, hoarseness, shortness of breath, and 

(rarely) diarrhea and abdominal discomfort. Since 2004, CDC has received notification of 

three separate incidents of exposure to sulfur mustard munitions. In one incident, a 

munition was found with ocean-dredged marine shells used to pave a driveway. The other 

two incidents involved commercial clam fishing operations. This report highlights the 

importance of considering exposure to sulfur mustard in the differential diagnosis of signs 

and symptoms compatible with exposure to a vesicant agent, especially among persons 

involved with clam fishing or sea dredging operations. Morbidity and Mortality Weekly 

Report

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USPACOM

Australia: Genital wart decline tracked to HPV vaccine

18 April - The incidence of genital warts declined by more than 90% in adolescent and 

teenage girls in the first 4 to 5 years after introduction of the human papillomavirus (HPV) 

vaccine in Australia, investigators reported. Genital warts occurred more than 70% less often 

among women 21 to 30, as compared with the 3 to 4 years before the vaccine became 

available. The reductions in wart incidence among girls and women were accompanied by 

50% to 80% decreases in the incidence of genital warts among heterosexual boys and 

young men. MedPage Today

Bangladesh building collapse kills at least 123

24 April – An eight-story building collapsed Wednesday 

morning on the outskirts of the Bangladeshi capital, 

killing at least 123 people and injuring hundreds, a 

police official said. Broken concrete and twisted metal 

stuck out from the massive pile of rubble, where 

rescuers dug by hand to reach trapped workers. Dhaka 

District Police Chief Habibur Rahman said search efforts were continuing. It was unclear how 

many people were trapped in the ruins. Video from the scene showed injured victims being 

whisked away on stretchers and crews carrying limp bodies from the rubble. Some 

onlookers wept while others frantically searched for missing loved ones. Authorities said 

they did not know what caused the collapse of the building, where five garment 

manufacturers employing about 2,500 workers were based, according to the Bangladesh 

Garments Manufacturers and Exporters Association. CNN
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China: Quake rescuers rush to isolated areas

22 April - Aftershocks and landslides continue to challenge 

rescue efforts in China’s Sichuan province on Monday as 

teams rush to reach isolated parts of the quake-struck area. 

China's worst earthquake in the past three years, which 

struck early Saturday, has already left 188 people dead and 

toppled or damaged more than 170,000 buildings and homes. Authorities say the region 

has experienced more than 2,200 aftershocks since Saturday, making it difficult to reach 

some parts of the province. VOA

China: Tuberculosis, MDR

21 April - Heavily burdened by rising multidrug-resistant tuberculosis (MDR-TB), China now 

has nearly 120 000 new cases on the mainland each year, according to public health experts. 

That accounts for 25 percent of the world's total per year, according to statistics from the 

Chinese Center for Disease Control and Prevention. MDR-TB is defined as TB, which is 

resistant to [at least] isoniazid and rifampicin, the most powerful 1st-line anti-TB drugs.

ProMED-mail

In China, breathing becomes a childhood risk

22 April - Levels of deadly pollutants up to 40 times the recommended exposure limit in 

Beijing and other cities have struck fear into parents and led them to take steps that are 

radically altering the nature of urban life for their children. Parents are confining sons and 

daughters to their homes, even if it means keeping them away from friends. Schools are 

canceling outdoor activities and field trips. Parents with means are choosing schools based 

on air-filtration systems, and some international schools have built gigantic, futuristiclooking domes over sports fields to ensure healthy breathing. New York Times

Solomon Islands: Solomons gets foreign help to deal with 

dengue outbreak

25 April - Health teams from New Zealand and Australia are providing a much needed 

boost to help control a dengue outbreak in Solomon Islands. Last week, a report totalled 

the number of sufferers at 3,189, up 485 on the week before. The Permanent Secretary of 

Health, Dr Lester Ross, says the number of provinces with dengue has risen to seven, with 

the Central Province reporting its first ten cases. With almost 89 percent of cases in Honiara, 

he says people are now choosing to go directly to the hospital. [A} a 13-year-old girl is the 

latest victim to die from the mosquito-borne viral disease, bringing the total number of 

deaths in Solomon Islands to four. Radio New Zealand International

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USSOUTHCOM

Brazil: Trichinosis outbreak affected 30 people in 

San Martin de los Andes

24 April - At least 30 people ill with the parasite Trichinella by eating smoked wild boar in 

this city, and health authorities sounded the alarm, and do not rule out the occurrence of 

more cases in the next few hours... Most victims of the disease had consumed the product 

at a family party held in San Martin de los Andes. While the outbreak is controlled to trace 

confirmed infected merchandise, other people in the city and its hinterland may have 

consumed the same batch, so no new cases were discarded. Rio Negro

Brazil: Increase in the number of cases of whooping 

cough

23 April - In recent years, the number of pertussis cases has increased dramatically in Minas 

Gerais and it is worrying. In 2011, 82 cases were reported to the State Department of Health 

(SES), while in 2012 the number reached 300, ie an increase of 365% from one year to 

another. Earlier this year [2013], the numbers follow the same pace of last year [2012]. Until 

this Thursday (18) [abril/2013] at least 106 people had been diagnosed with the disease in 

the state... Despite the growing number of cases of the disease, SES ruled that there is an 

outbreak in Minas [General] and reported that the increase is general, ie, throughout the 

country. ProMED-mail

Paraguay: Suman 48 killed by dengue

24 April - The Ministry of Health reported that there are 48 confirmed dengue deaths in the 

first four months of this year. According IP publishes Paraguay, more than 1,100 people are 

hospitalized with symptoms of the disease in different health centers in the country.

Paraguay.com

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