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24 May 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

 Army releases April 2013 suicide information

 Other than honorable

 Sgt. John Russell gets life sentence for murder of 5 at clinic in Iraq

 Signs, symptoms, and ill-defined conditions, active component, U.S. Armed Forces, 2000-2012

GLOBAL

 4 germs cause most of infants’ severe diarrhea

 New malaria test kit boosts elimination efforts worldwide

 New tracking of a patient's radiation exposure

 Pfizer takes its shot at a vaccine for evasive superbug

 Scientists' goal: Even earlier early warnings

 SM-IV boss presses attack on new revision

 Study finds vitamin C can kill drug-resistant TB

 UNFPA focuses on contraception for 222 million in developing world

 WHO experts nix yellow fever vaccine booster

INFLUENZA

 CDC: Weekly Influenza Surveillance Report

 DoD Global Laboratory-Based Influenza Surveillance Program

 Google.org: Flu Trends

 Naval Health Research Center: Febrile Respiratory Illness Surveillance Update

 PANDEMIC AND AVIAN INFLUENZA

 Estimates reveal low population immunity to new bird flu virus H7N9 in humans

 GSK flu shot may raise adult narcolepsy risk: Finnish scientists

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

 Study of H7N9 cases shows extent of severe disease

VETERINARY/FOOD SAFETY

 China: New rice contamination reported

 U.S.: GAO - APHIS needs to align its strategy with US biosecurity efforts

 U.S.: Swine virus confirmed in Iowa, Indiana hog herds
2

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WELLNESS

 Heartburn tied to throat cancer

 Los Angeles voters approve limiting medical marijuana shops

 NIH scientists discover molecule triggers sensation of itch

 Schoolmates of suicide victims at higher risk

 Schools should make exercise 'core' subject, U.S. panel urges

 Study: Whole-cell pertussis vaccine far more protective than current vaccine

 Sugary drinks tied to kidney stone risk

 Sunshine vitamin 'may treat asthma'

USAFRICOM

 A fate worse than death for scores of African women

 Democratic Republic of Congo: Malaria overstretching healthcare

 Tunisian man dies of new coronavirus

 Wild poliovirus in the Horn of Africa

USCENTCOM

 Pakistan: Gunmen attack polio vaccination team, kill policeman in Pakistan

 Middle East: Novel coronavirus infection - update

 WHO expert concerned guest workers could spread coronavirus

USEUCOM

 United Kingdom: £74m wasted on flu drugs destroyed because of poor record keeping

USNORTHCOM

 U.S.: Alabama officials probe respiratory illness cluster

 U.S.: Deaths associated with Hurricane Sandy — October–November 2012

 U.S.: Federal report recommends NPS policy changes after Yosemite hantavirus

 U.S.: Microbes in pool filter backwash as evidence of the need for improved swimmer hygiene

 U.S.: Navajo confront an increase in new H.I.V. infections

 U.S.: Oklahoma tornado tears massive path of death, destruction

 U.S.: Sex trafficking laws toughen in TN after study

USPACOM

 Bangladesh: Collapse blamed on shoddy materials

 South Korea confirms its first illness from emerging tick-borne virus

USSOUTHCOM

 Belize: Death of babies linked to bacteria outbreak

 Progress toward elimination of onchocerciasis in the Americas — 1993–2012

U.S. MILITARY

Army releases April 2013 suicide information

23 May – The Army released suicide data today for the month of April 2013. During April, 

among active-duty soldiers, there were 11 potential suicides: one has been confirmed as a 

suicide and 10 remain under investigation. For March 2013, the Army reported 10 potential 

suicides among active-duty soldiers; six have been confirmed as suicides and four are under 
3

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investigation. For 2013, there have been 52 potential active-duty suicides: 22 have been 

confirmed as suicides and 30 remain under investigation. Updated active-duty suicide 

numbers for 2012: 184 (159 have been confirmed as suicides and 25 remain under 

investigation). Defense.gov

Other than honorable

21 May - A Gazette investigation shows an increasing number of soldiers, including 

wounded combat veterans, are being kicked out of the service for misconduct, often with 

no benefits, as the Army downsizes after a decade of war. Gazette

Sgt. John Russell gets life sentence for murder of 5 at 

clinic in Iraq 

16 May - An Army judge on Thursday handed down the toughest sentence he could to a 

soldier who murdered five fellow service members at a Baghdad combat stress clinic four 

years ago. Sgt. John Russell will serve life without parole for shooting to death two care 

providers, two patients and an escort at the clinic in Baghdad’s Camp Liberty on May 11, 

2009... Russell’s attorney, James Culp, had argued that the soldier suffered from posttraumatic stress disorder and depression at the time of the killings. He had several 

frustrating encounters with psychiatrists at Camp Liberty and at nearby Camp Stryker in the 

days before he snapped and shot up the combat stress clinic. Seattle Times

Signs, symptoms, and ill-defined conditions, active 

component, U.S. Armed Forces, 2000-2012

April 2013 - ...The report documents that 3.5 percent of all hospitalizations of active 

component males resulted in discharge diagnoses of “chest pain,” “abdominal pain,” or 

“syncope and collapse” of unknown etiology. The finding is not surprising; the first two of 

these diagnoses were previously reported in the MSMR among the most frequent causes of 

emergency room visits in the active component. In a relatively young and healthy 

population such as U.S. military members, most chest pain is non-cardiac in nature and 

likely caused by gastroesophageal or musculoskeletal disorders. Of the 1.1 million 

ambulatory visits due to SSIC annually, approximately 30 percent are due to abdominal 

pain, chest pain and sleep disturbances. Since 2005, sleep disturbances have been the 

number one cause of SSIC visits among male service members. Medical Surveillance 

Monthly Report

top of page...

GLOBAL

4 germs cause most of infants’ severe diarrhea 

20 May - Just four germs are responsible for most of the severe and fatal diarrhea among 

the world’s infants, according to a large new study. Diarrhea is a major killer of children, 
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with an estimated 800,000 deaths each year; it has many causes, and doctors want to focus 

on the most common ones to bring death rates down. The study, financed by the Bill and 

Melinda Gates Foundation and published by The Lancet, found that the most common 

causes were rotavirus; a protozoan called Cryptosporidium; and two bacteria, Shigella and a 

toxin-producing strain of E. coli. In some areas, other pathogens, including the bacteria that 

cause cholera, were also important. New York Times

New malaria test kit boosts elimination efforts worldwide

22 May - A new, highly sensitive blood test that quickly detects even the lowest levels of 

malaria parasites in the body could make a dramatic difference in efforts to tackle the 

disease in the UK and across the world... In two studies led by researchers in the UK and 

Switzerland, the new LAMP (loop-mediated isothermal amplification) test was compared to 

existing methods in London laboratories that deal with imported cases of malaria to the UK, 

and to diagnostic methods used in the field in Uganda, where malaria is a leading cause of 

illness and death... LAMP was faster than PCR (polymerase chain reaction) tests, which 

require specialised laboratory equipment, costly reagents and advanced training. It was also 

more accurate than microscopic examination of blood slides, which require a trained 

specialist to identify the malaria parasites. Infection Control Today

New tracking of a patient's radiation exposure

21 May - ...[Intermountain Healthcare, a] Salt Lake Citybased nonprofit group of 22 hospitals and 185 clinics is 

launching the first major system of its kind to measure and 

report patients' cumulative medical radiation exposure 

from tests that deliver the highest amount of radiation. 

This includes CT scans, nuclear medicine scans and interventional radiology exams for the 

heart. In addition to educating doctors and patients about the risks and benefits of medical 

radiation, Intermountain will allow them to access their exposure data via its electronic

health record. Wall Street Journal

Pfizer takes its shot at a vaccine for evasive superbug

23 May - Kathrin Jansen is a microbiologist with at least two 

breakthrough vaccines to her name: she brought the cervical 

cancer vaccine Gardasil to market for Merck and helped 

develop the $4 billion a year pneumonia and meningitis 

vaccine Prevnar 13 for Pfizer. Jansen's next vaccine success 

could come by taming the superbug MRSA, a drug-resistant bacterium that she has seen 

ravage a healthy man up close and personally... Pfizer's initial vaccine targeted three 

mechanisms key to staph's survival and ability to cause disease... [Jansen's team] added a 

fourth antigen, a protein that allows the bacterium to steal manganese - a key nutrient -

from host cells. The result is a four-antigen vaccine that generates antibody responses at 

distinct points of the life cycle of the bug. Reuters
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Scientists' goal: Even earlier early warnings

21 May - The recent outburst of deadly tornadoes highlights the scientific scramble to 

detect these violent seasonal storms more quickly to add precious minutes to warnings. An 

alert from the National Weather Service on Monday gave people in Moore, Okla., 16 

minutes to take shelter before the tornado touched down and swept much of city off the 

map with its 200-miles-per-hour winds—about two minutes more than average, experts 

said. Wall Street Journal

SM-IV boss presses attack on new revision

17 May - A new edition of psychiatry's diagnostic guide "will probably lead to substantial 

false-positive rates and unnecessary treatment," charged the man who led development of 

the last version. To be released this weekend at the American Psychiatric Association's 

annual meeting, the fifth edition of the Diagnostic and Statistical Manual of Mental 

Disorders, or DSM-5, "introduce[s] several high-prevalence diagnoses at the fuzzy boundary 

with normality," according to Allen Frances, MD, who chaired the task force responsible for 

DSM-IV issued in 1994. Frances, now an emeritus professor at Duke University, wrote online 

in Annals of Internal Medicine that changes from DSM-IV will apply disease labels to 

individuals who may be unhappy or offensive but still normal. Such individuals would 

include those experiencing "the forgetfulness of old age" as well as children with severe, 

chronic temper tantrums and individuals with physical symptoms with no medical 

explanation. MedPage Today

Study finds vitamin C can kill drug-resistant TB

21 May— In a striking, unexpected discovery, researchers at Albert Einstein College of

Medicine of Yeshiva University have determined that vitamin C kills drug-resistant 

tuberculosis (TB) bacteria in laboratory culture. The finding suggests that vitamin C added to 

existing TB drugs could shorten TB therapy, and it highlights a new area for drug design... 

About 650,000 people worldwide now have multi-drug-resistant TB (MDR-TB), 9 percent of 

whom have extensively drug-resistant TB (XDR-TB). EurekAlert

UNFPA focuses on contraception for 222 million in 

developing world

21 May – [H]ow does the international community meet the massive unmet needs for 

contraception by over 222 million women in the developing world?” The U.N. Population 

Fund (UNFPA) points out that increased contraceptive use and reduced unmet needs for 

contraception are central to achieving three of the U.N.’s Millennium Development Goals 

(MDGs) – improving maternal health, reducing child mortality and combating HIV/AIDS –

heading towards the 2015 deadline. Inter Press Service

WHO experts nix yellow fever vaccine booster

17 May – Yellow fever vaccination boosters, typically given 10 years after initial 

immunization, are no longer necessary, the World Health Organization (WHO) said today... 
6

There is no treatment for yellow fever, so vaccination is the key strategy for protecting 

people. Of 600 million doses of the vaccine given since vaccination programs began in the 

1930s, only 12 cases of post-vaccination yellow fever cases have been identified, the WHO 

said. All of the "vaccine failure" cases occurred within 5 years of vaccination, which suggests 

that immunity does not wane over time. CIDRAP

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INFLUENZA

CDC: Weekly Influenza Surveillance Report

During week 19 (May 5-11, 2013), influenza activity remained low in the United States. 

Viral Surveillance: Of 2,416 specimens tested and reported by collaborating laboratories, 

124 (5.1%) 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: One pediatric death was reported. 

Geographic Spread of Influenza: 1 state reported regional influenza activity. FluView

DoD Global Laboratory-Based Influenza Surveillance 

Program

 During Week 19, 17 specimens were tested from 11 locations. There were no viruses 

detected. 

 To date this influenza season, 3,714 specimens have been tested from 81 locations of 

which 1,070 were positive for influenza A (949 A(H3N2), 111 A(H1N1)pdm09, five coinfections, and five A/not subtyped). 

 To date this influenza season, 363 specimens were positive for influenza B. Of these, 

there were 14 B/Yamagata, two B/Victoria, and two B & enterovirus co-infections. The 

lineage is pending or unknown for 345 specimens. 

 There have been 251 other respiratory viruses isolated (60 adenovirus, 91 RSV, 90 

parainfluenza, and 10 enterovirus) cumulatively this season. 

 From September 2012 to date, WHO has been informed of 31 laboratory confirmed 

cases of human infection with nCoV, including 18 deaths. 

 To date, a total of 131 laboratory-confirmed cases of human infection with avian 

influenza A(H7N9) virus, including 32 deaths, have been reported to WHO. USAF School 

of Aerospace Medicine
7

Google.org: Flu Trends

23 May – Estimates of flu activity based on certain Internet search queries indicate that the 

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

southern hemisphere ranges from minimal to moderate. Google.org Flu Trends

Naval Health Research Center: Febrile Respiratory 

Illness Surveillance Update 

For the week 20, ending 18May 2013:

 Influenza: No cases of NHRC laboratory-confirmed influenza (A/H3) among US military 

basic trainees.

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

remain low in general. 

 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 

PANDEMIC AND AVIAN INFLUENZA

Estimates reveal low population immunity to new bird 

flu virus H7N9 in humans

21 May - The level of immunity to the recently circulating H7N9 influenza virus in an urban 

and rural population in Vietnam is very low, according to the first population level study to 

examine human immunity to the virus, which was previously only found in birds. The 

findings have implications for planning the public health response to this pandemic threat. 

The study used a new, high throughput method that allows blood samples to be analysed 

for antibodies to multiple human and animal influenza viruses at the same time and is easier 

to standardise than previous techniques. However, the assay is yet to be validated clinically 

for the H7N9 virus, and the researchers caution that the results must be interpreted with 

care. EurekAlert!

GSK flu shot may raise adult narcolepsy risk: Finnish 

scientists

23 May - GlaxoSmithKline Plc's H1N1 pandemic flu shot may put adults at higher risk of 

developing narcolepsy, not only children as previous studies found, Finland's National 

Institute for Health and Welfare said on Thursday. Reuters
8

Human infection with avian influenza A(H7N9) virus –

update

17 May -Since 8 May 2013, no new laboratory-confirmed cases of human infection with 

avian influenza A(H7N9) have been reported to WHO by the National Health and Family 

Planning Commission, China. However, four additional deaths have been reported from 

previously laboratory-confirmed cases. To date, WHO has been informed of a total of 131 

laboratory-confirmed cases, including 36 deaths. WHO

Study of H7N9 cases shows extent of severe disease

22 May - Researchers from China today published a detailed clinical analysis of 111 patients 

sickened in the country's H7N9 influenza outbreak that showed how severe patients' 

illnesses have been, with 77% admitted to intensive care units (ICUs)... Some of the findings 

echoed those from the earlier study. For example, 42% were 65 years old or older, males 

outnumbered females two to one, and many patients—in this case, 61%—had underlying 

medical conditions. Fever and cough were the most common symptoms, and though 

conjunctivitis has been a hallmark in people infected with other H7 strains, none of the 

study patients had the symptom. As with other patients with avian influenza, those with 

H7N9 illnesses didn't report sore throat or runny nose. CIDRAP

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VETERINARY/FOOD SAFETY

China: New rice contamination reported 

23 May - Authorities are investigating rice mills in southern China following tests that found 

almost half of the staple grain in one of the country's largest cities was contaminated with a 

toxic metal. The mills in Hunan province's Youxian county were ordered to suspend business 

and recall their products after samples showed excessive levels of cadmium, according to an 

official notice issued Tuesday by the county government. It said the mills had been 

operating legally and sourced their rice from local farmers. The announcement followed 

reports over the weekend that government inspectors discovered that 44.4 percent of rice 

and rice products tested this year in the southern city of Guangzhou in Guangdong 

province showed high levels of cadmium. The carcinogenic metal can seriously damage the 

kidneys and cause other health problems. Miami Herald

U.S.: GAO - APHIS needs to align its strategy with US 

biosecurity efforts

22 May - The US Department of Agriculture's (USDA's) Animal and Plant Health Inspection 

Service (APHIS) needs to develop goals and measures to ensure that its approach to 

monitoring animal health meshes with the country's goals for early detection of biological 
9

threats, the US Government Accountability Office (GAO) said in a report yesterday. APHIS 

has moved from a disease-specific approach to surveillance to a focus on monitoring the 

overall health of livestock and poultry. "APHIS has a vision for its new approach but has not 

integrated that vision into an overall strategy with associated goals and performance 

measures that are aligned with the nation's larger biosurveillance efforts," the GAO said in 

the report. APHIS has developed planning documents related to disease surveillance, but 

they focus primarily on processes and don't address outcomes necessary to reach goals, the 

GAO said. In addition, none of the documents indicates how APHIS efforts support national 

homeland security goals. The USDA agreed with the GAO's assessment, the report said. 

CIDRAP News Scan

U.S.: Swine virus confirmed in Iowa, Indiana hog herds

20 May - Farms in two of the nation's leading pork producing states have tested positive for 

the potentially fatal porcine epidemic diarrhea virus (PEDV), U.S. pork industry veterinarian 

official said Monday. Three farms in Iowa and one Indiana operation have confirmed cases 

of the virus, said Dr Lisa Becton, director of swine health information and research for the 

National Pork Board. Reuters

top of page...

WELLNESS

Heartburn tied to throat cancer

23 May - Frequent heartburn increases the risk for throat cancer, a new study has found, 

and over-the-counter antacids may provide protection. Researchers studied heartburn 

incidence and medication use in 631 patients with squamous cell cancers of the throat and 

vocal cords who were not heavy smokers or drinkers, matching them with 1,234 healthy 

controls... After controlling for age, sex, race, smoking, alcohol consumption, HPV 16 

infection, education and body mass index, they found that people who had reported a 

history of frequent heartburn were 78 percent more likely to have cancer than those who 

did not. Those with frequent heartburn who took antacids reduced their risk for cancer by 

41 percent, compared with those whose heartburn was untreated. New York Times

Los Angeles voters approve limiting medical marijuana 

shops

22 May - Los Angeles, which has more storefront medical 

marijuana shops than any other U.S. city, will close hundreds of 

the dispensaries and hike taxes on those that will be allowed to 

remain under a ballot measure approved by a wide margin of 

voters. Nearly 63 percent of voters supported Proposition D, 

which will cap the number of medical pot dispensaries at 135, compared with 37 percent 
10

opposed, according to preliminary results released on Wednesday, the day after the vote. 

Reuters

NIH scientists discover molecule triggers sensation of 

itch

23 May - Scientists at the National Institutes of Health report they have discovered in 

mouse studies that a small molecule released in the spinal cord triggers a process that is 

later experienced in the brain as the sensation of itch. The small molecule, called natriuretic 

polypeptide b (Nppb), streams ahead and selectively plugs into a specific nerve cell in the 

spinal cord, which sends the signal onward through the central nervous system. When Nppb 

or its nerve cell was removed, mice stopped scratching at a broad array of itch-inducing 

substances. The signal wasn’t going through. NIH

Schoolmates of suicide victims at higher risk

21 May - Teens who have a classmate die of suicide are more likely to consider taking, or 

attempt to take, their own lives, according to a new study... [Researchers] used data from a 

long-running national survey of more than 8,000 Canadian kids aged 12 to 17 years old. 

Students were asked about suicides of schoolmates, friends and their own thoughts of 

suicide, and researchers checked in with the kids two years later. By the age of 17, one in 

four kids had a schoolmate who had committed suicide, and one in five knew the deceased 

personally, according to results published in the Canadian Medical Association Journal. For 

the 12- and 13-year-old adolescents exposed to a schoolmate's suicide, 15 percent reported 

thinking seriously about killing themselves and seven percent actually made an attempt, 

compared to 3 percent and 2 percent of unexposed kids, respectively. The effect persisted 

even if the schoolmate had died more than a year earlier. Reuters

Schools should make exercise 'core' subject, U.S. panel 

urges

23 May - U.S. schools need to boost efforts to get students moving, and make gym class as 

critical as other core subjects if they want to increase test scores as well as students' general 

well-being, a leading group of health advisers said on Thursday. The Institute of Medicine 

called for younger students to get at least 30 minutes of physical activity per day in school 

and older students 45 minutes, with at least half that time spent moving vigorously. Reuters

Study: Whole-cell pertussis vaccine far more protective 

than current vaccine

20 May - No-longer-used whole-cell pertussis (DTwP) vaccines better protected kids against 

pertussis (whooping cough) than acellular pertussis (DTaP) vaccines during a large 2010-11 

outbreak in California, according to a study today in Pediatrics. The study involved 10- to 

17-year-olds who were born from 1994 to 1999 and received four doses of either pertussis 

vaccine during the first 2 years of life at Kaiser Permanente Northern California, some of 

whom received DTwP before it was discontinued in the 1990s because of adverse events. 
11

The study included 138 children who had lab-confirmed pertussis, 899 who tested negative, 

and 54,339 matched controls. Researchers found that kids who received four DTaP doses 

had an almost six times higher risk of pertussis than those who received four DTwP doses. 

People who received mixed DTwP and DTaP vaccines had a nearly fourfold higher risk of 

pertussis than those who received all DTwP vaccines. CIDRAP News Scan

Sugary drinks tied to kidney stone risk

22 May - Adults who drink at least one sugar-sweetened drink a day are slightly more likely 

to develop kidney stones than people who rarely imbibe them, according to a new study... 

They found that 159 out of every 100,000 people who drank a sugar-sweetened non-cola 

beverage, such as clear soda, less than once a week developed kidney stones, compared to 

306 out of every 100,000 who drank soda daily. Reuters

Sunshine vitamin 'may treat asthma'

19 May - The amount of time asthma patients spend soaking up the sun may have an 

impact on the illness, researchers have suggested. A team at King's College London said low 

levels of vitamin D, which is made by the body in sunlight, was linked to a worsening of 

symptoms. Its latest research shows the vitamin calms an over-active part of the immune 

system in asthma... [Prof Catherine Hawrylowicz’s] group investigated the impact of the 

vitamin on a chemical in the body, interleukin-17. It is a vital part of the immune system and 

helps to fight off infections. However, it can cause problems when levels get too high and 

has been strongly implicated in asthma. In this study, published in the Journal of Allergy and 

Clinical Immunology, vitamin D was able to lower levels of interleukin-17 when it was added 

to blood samples taken from 28 patients. BBC News

top of page...

USAFRICOM

A fate worse than death for scores of African women

23 May – [I]n a culture where a woman's status and dignity is decided by her ability to 

provide a husband with multiple children, it can be a fate worse than death... An obstetric 

fistula occurs when a woman withstands days of obstructed labor, when a baby's head is 

constantly pushing against her pelvic bone during contractions -- preventing blood flow 

and causing tissue to die. This creates a hole, or a "fistula," between a woman's vagina and 

her bladder or rectum. Her baby is unlikely to survive. If the mother lives, she is unable to 

hold her urine and, in some cases, bowel content, Paluku Lussy says. A woman with a fistula, 

who is perpetually leaking urine and sometimes feces, is often rejected by her husband and 

shunned by her village because of her foul smell and inability to bear more children. CNN
12

Democratic Republic of Congo: Malaria overstretching 

healthcare

20 May - Gaps in the healthcare system in the Democratic Republic of Congo (DRC) are 

hampering the fight against malaria, a leading killer of children, say experts. Malaria 

accounts for about a third of outpatient consultations in DRC clinics, Leonard Kouadio, a UN 

Children’s Fund (UNICEF) health specialist, told IRIN. He added, “It is the leading cause of 

death among children under five years and is responsible for a significant proportion of 

deaths among older children and adults.” Kouadio continued: “Recent retrospective 

mortality surveys have revealed that in all regions of the country, the fever is associated with 

40 percent of [deaths of] children under five.” IRIN

Tunisian man dies of new coronavirus 

21 May - A man has died of the novel coronavirus (NCoV) in Tunisia, in what is believed to 

be the first such case in Africa. Tunisia's health ministry said the 66-year-old had visited 

Saudi Arabia, which is badly affected by the virus... The Tunisian man, a diabetic, had been 

complaining of breathing problems since he returned from Saudi Arabia and he died in 

hospital in the coastal city of Monastir, AFP news agency reports. Two of his children also 

contracted the virus, but had responded to treatment, the health ministry said, in a 

statement... Cases have been detected in Saudi Arabia, Jordan, Qatar, the United Arab 

Emirates (UAE), Germany, the UK and France. BBC News

Wild poliovirus in the Horn of Africa

22 May -The Horn of Africa is currently experiencing an outbreak of wild poliovirus type 1 

(WPV1). A four-month-old girl near Dadaab, Kenya, developed symptoms of acute flaccid 

paralysis (AFP) on 30 April 2013. Two healthy contacts of the child tested positive for WPV1. 

They are the first laboratory confirmed cases in Kenya since July 2011. Investigation into this 

outbreak is ongoing. In addition, a case of WPV1 in Banadir, Somalia was confirmed on 9 

May 2013... The risk to neighbouring countries is deemed as very high, due to large-scale 

population movements across the Horn of Africa and persistent immunity gaps in some 

areas. Dadaab hosts a major refugee camp, housing nearly 500 000 persons from across the 

Horn of Africa. WHO

top of page...

USCENTCOM

Pakistan: Gunmen attack polio vaccination team, kill 

policeman in Pakistan

20 May - Officials say gunmen have killed a policeman who was guarding a polio 

vaccination team in north-western Pakistan. Local government administrator Faramosh 
13

Khan says the gunmen attacked the team on Monday in the town of Mamound in the Bajur 

tribal area, just as it had started a vaccination drive. Straits Times

Middle East: Novel coronavirus infection - update

23 May - The Ministry of Health in Saudi Arabia has notified WHO of an additional

laboratory-confirmed case of infection with the Middle East respiratory syndrome 

coronavirus (MERS-CoV). The fatal case was reported from Al-Qaseem region in the Central 

part of the country and is not related to the cluster of cases reported from Al-Ahsa region in 

the Eastern part of the country... The Saudi authorities are also continuing the investigation 

into the outbreak that began in a health care facility since the beginning of April 2013 in AlAhsa. To date, a total of 22 patients including 10 deaths have been reported from the 

outbreak. Globally, from September 2012 to date, WHO has been informed of a total of 44 

laboratory-confirmed cases of infection with MERS-CoV, including 22 deaths.

WHO has received reports of laboratory-confirmed cases from the following countries in the 

Middle East: Jordan, Qatar, Saudi Arabia, and the United Arab Emirates (UAE). France, 

Germany, Tunisia and the United Kingdom also reported laboratory-confirmed cases; they 

were either transferred for care of the disease or returned from Middle East and 

subsequently became ill. In France, Tunisia and the United Kingdom, there has been limited 

local transmission among close contacts who had not been to the Middle East but had been 

in close contact with the laboratory-confirmed or probable cases. WHO

WHO expert concerned guest workers could spread 

coronavirus

21 May – A World Health Organization (WHO) expert has expressed concern that guest 

workers in the Middle East could carry the Middle East respiratory syndrome coronavirus 

(MERS-CoV) to India and the Philippines, according to a media report, while a few more 

details emerged about three Tunisian cases reported yesterday. Anthony Mounts, MD, the 

WHO's technical lead for MERS-CoV, said guest workers could bring the virus to their home 

countries, where it might spread widely before being detected, according to a report in the 

Toronto Star. CIDRAP

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USEUCOM

United Kingdom: £74m wasted on flu drugs destroyed 

because of poor record keeping

21 May - Taxpayers lost £74m when 6.5m doses of an anti-flu drug were written off as 

being past their shelf life because of poor record-keeping by the health service, the 

government's auditors have found. A total of £424m was spent in stockpiling 40m units of 
14

Tamiflu between 2006-07 and 2012-13, despite question marks over the effectiveness of the 

drug, a National Audit Office memo says. Viruses are reported to have developed resistance 

to the drug in some cases. Guardian

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USNORTHCOM

U.S.: Alabama officials probe respiratory illness cluster

22 May – Alabama health officials are investigating a cluster of severe respiratory infections 

from an unknown origin centered around the Dothan area and have asked the state's health 

providers to be alert for and report similar cases. In a press release yesterday the Alabama 

Department of Public Health (ADPH) said seven people have been hospitalized with similar 

symptoms: fever, cough, and shortness of breath. Two of the patients have died. The ADPH 

said it and the Houston County Health Department are conducting the investigation and 

have consulted with the US Centers for Disease Control and Prevention... Tests on samples 

sent to the ADPH clinical lab revealed on May 17 the 2009 H1N1 influenza virus in one of 

the patients, who died the following day... Polymerase chain reaction flu panel testing on 

three other patients who were admitted yielded one H3 influenza positive. CIDRAP

U.S.: Deaths associated with Hurricane Sandy —

October–November 2012

24 May - On October 29, 2012, Hurricane Sandy hit the northeastern U.S. coastline. Sandy’s 

tropical storm winds stretched over 900 miles (1,440 km), causing storm surges and 

destruction over a larger area than that affected by hurricanes with more intensity but 

narrower paths. To characterize deaths related to Sandy, CDC analyzed data on 117 

hurricane-related deaths captured by American Red Cross mortality tracking during October 

28–November 30, 2012. This report describes the results of that analysis which found 

drowning was the most common cause of death related to Sandy, and 45% of drowning 

deaths occurred in flooded homes. Morbidity and Mortality Weekly Report

U.S.: Federal report recommends NPS policy changes 

after Yosemite hantavirus

21 May - Federal investigators probing the hantavirus outbreak blamed for three deaths at 

Yosemite National Park recommended on Monday that design changes to tent cabins and 

other privately run lodging first be reviewed by National Park Service officials... The report 

also recommended that the park service begin cyclical pest monitoring and inspections of 

all public accommodations. Washington Post
15

U.S.: Microbes in pool filter backwash as evidence of the 

need for improved swimmer hygiene

17 May - ...The detection of E. coli in over half of filter backwash samples indicates that 

swimmers frequently introduced fecal material into pools and thus might transmit infectious 

pathogens to others. The risk for transmission and recreational water illness (RWI) increases 

if swimmers introduce feces when ill with diarrhea. A single diarrheal contamination incident 

can introduce 107–108 Cryptosporidium oocysts into the water, a quantity sufficient to cause 

infection if a mouthful of water from a typical pool is ingested. Additionally, each person 

has an average of 0.14 grams of fecal material on their perianal surface that could rinse into 

the water if swimmers fail to take a pre-swim shower with soap. The 1) frequent occurrence 

of fecal contamination of pools documented in this study and 2) marked increase in the 

incidence of RWI outbreaks... underscore the need for improved swimmer hygiene.

Morbidity and Mortality Weekly Report

U.S.: Navajo confront an increase in new H.I.V. 

infections

19 March - A surge in H.I.V. infections on the Navajo reservation here has doctors and 

public health workers increasingly alarmed that the virus that causes AIDS has resurfaced 

with renewed intensity in this impoverished region. A report released last month by the 

federal Indian Health Service found that there were 47 new diagnoses of human 

immunodeficiency virus on the reservation in 2012, up 20 percent from 2011. Since 1999, 

new H.I.V. cases among Navajo are up nearly fivefold, the report found... That increase, Dr. 

Iralu said, can be partly attributed to the infection being detected earlier, thanks to years of 

H.I.V. education programs and more routine screening. But Dr. Iralu and other health 

workers also said the virus was now being transmitted from one tribal member to another, a 

disquieting trend. In past years, Navajo were thought to have contracted the disease mostly 

in cities and returned with it. New York Times

U.S.: Oklahoma tornado tears massive path of death, 

destruction

20 May - Rescue workers raced against time and darkness 

Monday night looking for survivors after a powerful 

tornado blasted an area outside of Oklahoma City, leveling 

homes and leaving at least 51 people dead. At least 20 of 

the dead were children, including at least seven from Plaza 

Towers Elementary School in Moore, which lay directly in the path of the monster storm's 

wall of wind. Seventy-five students and staff members had been huddled at the school 

when the tornado hit, CNN affiliate KFOR reported. As nightfall descended, determined 

searchers in hard hats dug in the debris for those possibly trapped, but authorities 

described the work as a recovery, not rescue, effort. CNN
16

U.S.: Sex trafficking laws toughen in TN after study

23 May - As sex trafficking has garnered newfound attention, Tennessee has developed one 

of the nation’s most comprehensive anti-trafficking programs. An additional 12 new laws 

approved by lawmakers this year include harsher criminal penalties on traffickers, an 

extended window of time for prosecutors to bring charges and the creation of a state 

trafficking task force to study and respond to the issue. The measures amplify a wave of 

attention since a statewide study in 2011 documented incidents of sex trafficking. 

Tennessean 

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USPACOM

Bangladesh: Collapse blamed on shoddy materials

23 May - A government panel found substandard building 

materials among the reasons for a factory building collapse 

outside Dhaka last month that killed more than 1,100 people. 

The panel—formed to investigate the collapse of the Rana Plaza, 

which killed 1,127 people in one of the worst industrial 

accidents—also cited failure to comply with building regulations 

and the use of heavy equipment on upper floors of the building as reasons for the disaster... 

In its 400-page report, the committee recommended that the owner of Rana Plaza, Sohel 

Rana, along with the owners of the five garment factories housed in the building, to be 

charged with "culpable homicide," for allegedly forcing employees to return to work on 

April 24 even though cracks had appeared on an exterior wall the previous day. Wall Street 

Journal

South Korea confirms its first illness from emerging tickborne virus

22 May - South Korea has reported its first confirmed case and another suspected case of 

infection with an emerging tick-borne bunyavirus, called severe fever with 

thrombocytopenia syndrome (SFTS) virus, according to media reports from the country. The 

infection has previously been reported in China and Japan. A May 21 Yonhap news service 

story said the infection was confirmed in a 63-year-old woman who died in Seoul in August 

of last year. Four other patients tested negative for the virus, which is spread by

Haemaphysalis longicornis ticks, according to the story. SFTS infection is also suspected to 

have caused the death of a 73-year-old farmer on Jeju Island on May 16, according to a 

May 17 story from the Arirang news service. Medical examiners said the man died of blood 

poisoning but that he also had traces of tick bites and had had clinical signs suggestive of 

SFTS infection, which causes high fever, vomiting, and diarrhea. CIDRAP News Scan

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USSOUTHCOM

Belize: Death of babies linked to bacteria outbreak

23 May - The death of 12 babies at the Karl Heusner Memorial Hospital (KHMH), has been 

linked to the outbreak of enterobacter cloacae – an organism that is said to be responsible 

for major outbreaks in Neonatal Intensive Care Units (NICU) all over the world. In a release 

on Wednesday, Director of Medical Services at the hospital, Dr Adrian Coye noted that the 

organism is not a superbug. “The problem lies in the fact that it is very fastidious, difficult to 

clear and there is transmission by direct contact and also by indirect contact. So it can be on 

the skin of any of us right now in this room, on your clothing material, on stethoscopes, on 

IV drip stands, the surfaces in the clinical area, etc” he said. Jamaica Observer

Progress toward elimination of onchocerciasis in the 

Americas — 1993–2012

24 May - Onchocerciasis (river blindness) is caused by the parasitic worm Onchocerca

volvulus, transmitted to humans by the bite of infected black flies of the genus Simulium, 

and is characterized by chronic skin disease, severe itching, and eye lesions that can 

progress to complete blindness. Currently, among approximately 123 million persons at risk 

for infection in 38 endemic countries, at least 25.7 million are infected, and 1 million are 

blinded or have severe visual impairment. Periodic, communitywide mass drug 

administration (MDA) with ivermectin (Mectizan, Merck) prevents eye and skin disease and 

might interrupt transmission of the infection... By the end of 2012, transmission of the 

infection... had been interrupted or eliminated in four of the six endemic countries in the 

WHO Americas Region. Thus, in 2013, only 4% (23,378) of the 560,911 persons originally at 

risk in the Americas will be under ivermectin MDA. Active transmission currently is limited to 

two foci among Yanomami indigenes in adjacent border areas of Venezuela and Brazil.

Morbidity and Mortality Weekly Report

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