1 February 2013

Army Public Health Weekly Update

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

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

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Contents

U.S. MILITARY

 Johns Hopkins Hospital performs double arm transplant on Army soldier

 Lawmakers require VA to track effects of burn pits

 Seasonal variation in incident diagnoses of appendicitis among beneficiaries of the Military 

Health System, 2002-2011

GLOBAL

 Antibiotics boost power of malnutrition cure: study

 Can pneumonia be reliably diagnosed without x-rays?

 Dengue fever vaccine trials clear first hurdle

 Insight: Think preventive medicine will save money? Think again

 Link to African Ebola found in bats suggests virus is more widespread

INFLUENZA

 Armed Forces Health Surveillance Center: DoD Influenza Surveillance Summary

 CDC: Weekly Influenza Surveillance Report

 DARPA produces 10 million flu vaccine doses in one month

 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

 Tamiflu's effectiveness is now the center of debate

 USAPHC: U.S. Army Influenza Activity Report

 PANDEMIC AND AVIAN INFLUENZA

 Cambodian bird flu deaths prompt awareness drive

 Scientists find genetic clue to severe flu among Chinese

 Study finds post-H1N1-vaccination rise in narcolepsy in 3 nations

VETERINARY/FOOD SAFETY

 U.S.: Cats killing billions of animals

 U.S.: Produce leads list of food vehicles for illness

 U.S.: Salmonella linked to ground beef sickens 16, CDC
Got Germs? Poster

A new poster on 

preventing the spread of 

illnesses such as influenza 

is now available in print or 

for download from the 

Health Information 

Products eCatalog.

WELLNESS

 Breast cancer survival better after lumpectomy than mastectomy

 First-ever guidelines issued for treating type 2 diabetes in kids

 Health apps fail first full checkup

 London Marathon runner died after using supplement

 Myths of weight loss are plentiful, researcher says

 Obesity in girls tied to higher multiple sclerosis risk

USAFRICOM

 Nigeria: Lassa fever

 Nigeria to tackle lead poisoning

 Zimbabwe: Flash flooding strikes Zimbabwe’s dry areas

USCENTCOM

 Egypt: Investigation continues after wild poliovirus is detected

 Syrian refugees top 700,000, U.N. struggling to cope

USEUCOM

 Israel reviews contraceptive use for Ethiopian immigrants

 Russia: State Duma passes anti-smoking bill in 2nd reading

 United Kingdom: Gloucestershire hospital nurses 'too busy' to feed patient

 United Kingdom: North East measles outbreak 'serious'

USNORTHCOM

 U.S.: Antibacterial products pollute freshwater lakes

 U.S.: Doxycycline shortage

 U.S.: Majority of Americans support dozens of policies to strengthen U.S. gun laws

 U.S.: New rule protects patient privacy, secures health information

 U.S.: Noninfluenza vaccination coverage among adults — United States, 2011

 U.S., North Dakota: An oil boom takes a toll on health care

 U.S.: Whooping cough vaccine for pregnant women among new recommendations

USPACOM

 Bangladesh: Nipah encephalitis

 China: Beijing choking on hazardous smog - again

 China: Child trafficking - a cruel trade

 Philippines: Chikungunya

USSOUTHCOM

 Brazil: Four arrested after deadly nightclub fire
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U.S. MILITARY

Johns Hopkins Hospital performs double arm transplant 

on Army soldier

28 January - A former soldier who became a quadruple amputee 

after an explosion in Iraq three years ago has undergone a rare 

double arm transplant at Johns Hopkins Hospital in Baltimore, the 

hospital said Monday. Brendan Marrocco, 26, of Staten Island, who 

underwent the marathon surgery last month, was the first service 

member from the wars in Iraq and Afghanistan to survive the loss of four limbs, officials 

have said. [W.P. Andrew Lee professor and chairman of the Department of Plastic and 

Reconstructive Surgery at the hospital] said results in such cases have been good, although 

transplanted arms are never going to have 100 percent of the function of the limbs they 

replace. But he said patients have learned to tie shoes, use chopsticks and put their hair in 

ponytails. Washington Post

Lawmakers require VA to track effects of burn pits

26 January - ... A new Department of Veterans Affairs registry, mandated by Congress, will 

be used to try to determine if there is a link between the burn pits and long-term health 

problems. Military personnel who were stationed near an open burn pit can sign up.

Researchers will use the database to monitor health trends in participants, and the VA will 

alert them to major problems detected. Over the long term, the findings could make it 

easier for veterans who served near burn pits to obtain disability payments. Yahoo! News

Seasonal variation in incident diagnoses of appendicitis 

among beneficiaries of the Military Health System, 2002-

2011

December - during the surveillance period there were 111,430 incident diagnoses of 

appendicitis in service members of the active and reserve component and all other 

beneficiaries of the Military Health System (e.g., family members, retirees). The average 

number of cases per month was higher in the summer (i.e., June to August) and lower in the 

late fall and winter months (i.e., November through February) (Figures 1,2). Accounting for 

the varying numbers of days per month, the average numbers of cases per day was highest

in June and lowest in December (Figure 2). Despite the overall increase in appendicitis cases 

during the surveillance period, the seasonal variation was demonstrated each year. Medical 

Surveillance Monthly Report

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GLOBAL

Antibiotics boost power of malnutrition cure: study

31 January - Adding a low-cost antibiotic to dietary treatments could help save many 

children with acute malnutrition, according to new research out Thursday in the New 

England Journal of Medicine. Researchers from the Washington University in Saint Louis 

medical school followed the treatment of more than 2,700 Malawian children, six months to 

five years old, all diagnosed with severe malnutrition. The children were all given a regimen 

of a peanut-based nutrient-dense food supplement, standard procedure in impoverished 

countries like Malawi. But the children were also randomly assigned to receive a seven-day 

course of one of two antibiotics -- amoxicillin or cefdinir -- or just a placebo. Neither the 

researchers nor the families knew which pills the child was taking. The treatment was 

effective for most of the children, regardless of whether an antibiotic was given -- more 

than 85 percent of the children recovered, in all three groups. But among the children 

treated with either antibiotic, the success rate was noticeably higher. Global Post

Can pneumonia be reliably diagnosed without x-rays?

28 January - Doctors may miss some cases of pneumonia if they rely solely on their patient's 

medical history and symptoms without the help of x-rays, according to a new study from 

Europe. Dutch researchers, who published their findings in the European Respiratory 

Journal, found that of 140 patients who had their pneumonia diagnosed by x-ray, doctors 

initially thought only 41 of them had the severe lung infection. "That's worse than flipping a 

coin," said Dr. Richard R. Watkins, who was not involved with the new research but has 

studied how doctors diagnose pneumonia. "I think that's an argument for doing chest xrays," said Watkins, from Ohio's Akron General Medical Center. Medline Plus

Dengue fever vaccine trials clear first hurdle 

24 January - Human trials of an experimental dengue fever vaccine have just concluded, and 

the experimental compound looks promising in offering protection against the complex 

mosquito-borne illness that afflicts millions of people living in tropical and sub-tropical 

regions. Dengue fever, spread by the bite of an infected Aedes mosquito, is caused by four 

different but related viruses, making the development of a vaccine difficult, according to 

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases... 

Researchers at Johns Hopkins School of Public Health in Baltimore, Maryland formulated 

four different versions of the combination vaccine, and tested a separate vaccine in each of 

four groups of 20 study participants. All of the dengue vaccines produced an antibody 

response. But one experimental compound, called TV003, induced an immune response 

against all four dengue viruses in 45 percent of participants. And an immune response to 

three viruses was seen in about 90 percent of participants. VOA
Insight: Think preventive medicine will save money? 

Think again

29 January - It seems like a no-brainer. Since about 75 percent of healthcare spending in the 

United States is for largely preventable chronic illnesses such as Type 2 diabetes and heart 

disease, providing more preventive care should cut costs. If only. In a report released on 

Tuesday, the non-profit Trust for America's Health outlined a plan "to move from sick care 

to health care" by putting more resources into preventing chronic disease rather than 

treating it, as the current system does. There is a strong humanitarian justification for 

prevention, argued Trust Executive Director Jeffrey Levi in an interview, since it reduces 

human suffering. But the report also makes an economic argument for preventive care, 

highlighting the possibility of reducing healthcare spending -- which in 2011 reached $2.7 

trillion, just shy of 18 percent of gross domestic product -- by billions of dollars. And that 

has health economists shaking their heads... A 2010 study in the journal Health Affairs, for 

instance, calculated that if 90 percent of the U.S. population used proven preventive 

services, more than do now, it would save only 0.2 percent of healthcare spending... [S]ome 

of the best-known forms don't actually improve someone's health. These low- or no-benefit 

measures include annual physicals for healthy adults... Similarly, some cancer screenings --

including for ovarian cancer and testicular cancer, and for prostate cancer via PSA tests --

produce essentially no health benefits. Reuters

Link to African Ebola found in bats suggests virus is 

more widespread

28 January - For the first time, scientists have found evidence of the African Ebola virus in 

Asian fruit bats, suggesting that the virus is far more widespread around the world than had 

been previously known. That does not mean that outbreaks of hemorrhagic fever are 

inevitable, said Kevin J. Olival, leader of the bat-hunting team at EcoHealth Alliance. But the 

possibility exists: bats are believed to drink out of jars attached to trees to collect tasty date 

palm sap, and fatal outbreaks in Bangladesh of Nipah virus, which is not related to Ebola, 

have been blamed on fresh sap contaminated with bat saliva, urine or feces. Palm sap 

gatherers should be encouraged to put bamboo covers on their collecting jars to keep bats 

out, Dr. Olival said. New York Times

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INFLUENZA

Armed Forces Health Surveillance Center: DoD Influenza 

Surveillance Summary

 In Week 3 (through 19 January 2013), Influenza-Like Illness (ILI) incidence rates 

decreased from last week for all populations except among PACOM unvaccinated. The 

percents of all outpatient visits due to ILI and Pneumonia & Influenza (P&I) were at or 
below previous seasons except for US Other Beneficiary (dependents) ILI percents, 

which remain elevated. Influenza activity among inpatient populations remained 

elevated; the majority of positive inpatient cases occurred in the dependent population. 

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

moderate levels except in East Africa, where influenza activity remains 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 96%. 

AFHSC DoD Influenza Surveillance Summary

CDC: Weekly Influenza Surveillance Report

During week 3 (January 13-19), influenza activity remained elevated in the United States, but 

decreased in some areas. 

 Viral Surveillance: Of 11,984 specimens tested and reported by collaborating 

laboratories, 3,129 (26.1%) were positive for influenza.

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

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

 Influenza-Associated Pediatric Deaths: Eight influenza-associated pediatric deaths were 

reported. 

 Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like 

illness (ILI) was 4.3%; this is above the national baseline of 2.2%. 

 Geographic Spread of Influenza: Forty-seven states reported widespread geographic 

influenza activity FluView

DARPA produces 10 million flu vaccine doses in one 

month

26 January - ...[T]he Defense Advanced Research Projects Agency 

(DARPA) has developed a new way of making vaccines that has 

turned out 10 million doses of H1N1 influenza vaccine in a month, 

in a recent test run... Working with Medicago Inc., [the 

Accelerated Manufacture of Pharmaceuticals (AMP) project] uses 

tobacco plants instead of eggs to produce recombinant proteins that are key to vaccines. 

According to the company, introducing viral genes into tobacco has a number advantages: 

the full-grown plants can be used because the protein is produced in the leaves; it avoids 

the need to procure eggs in huge quantities; and, there’s no danger of the virus killing the 

egg embryo. Medicago said that the tobacco process can generate the proteins within 14 

days of the gene sequence of the virus being identified, with vaccine-grade proteins 

generated within four weeks. Gizmag
DoD Global Laboratory-Based Influenza Surveillance 

Program

 During Week 3 (13-19 January 2013), 190 specimens were tested from 43 locations. 

There were 64 influenza A viruses (61 influenza A(H3N2) and 3 A(H1N1)pdm09) and 18 

influenza B viruses detected. 

 To date, 1,863 specimens have been tested from 68 locations of which 607 were 

positive for influenza A (572 A(H3N2), 31 A(H1N1)pdm09, two co-infections of A(H3N2) 

& B, and two A/not subtyped); and 101 were positive for influenza B (14 B/Yamagata, 

two B/Victoria, and 85 B/lineage undetermined). 

 There have been 120 other respiratory viruses isolated (46 Parainfluenza, 35 Adenovirus, 

30 RSV, and nine Enterovirus). USAF School of Aerospace Medicine

European Centre for Disease Prevention and Control:

Weekly Influenza Surveillance Overview

 In week 3/2013 (14–20 January 2013), 13 countries and the UK (Northern Ireland) 

reported medium intensity and Iceland reported high intensity. Geographic spread was 

reported as widespread or regional by 13 countries. 

 Seventeen countries reported increasing transmission, compared to 19 countries in 

week 2/2013. Five countries, mostly in western Europe, reported decreasing trends, 

compared to only two countries in week 02/2013. 

 Since week 40/2012, 48% of influenza-positive sentinel specimens were type A, and 

52% were type B viruses. Of 1 253 influenza A viruses subtyped, 58% were A(H1)pdm09 

and 42% were A(H3). Of 269 type B viruses with known lineage, 86% were Yamagata 

and 14% were Victoria. The latter lineage is not included in the 2012–2013 vaccine. 

 For week 3/2013, all eight reporting countries described hospitalised severe influenza 

cases, 30 in total. Of seven sub-typed A viruses from these patients, six were 

A(H1N1)pdm09 and one A(H3). 

Based on the ILI/ARI intensity and the percentage of positive sentinel specimens at the 

EU/EEA level, influenza activity remains high and increasing in many European countries, 

although transmission may have peaked in some countries, mostly in western Europe. 

Weekly Influenza Surveillance Overview

Google.org: Flu Trends

30 January – Estimates of flu activity based on certain Internet search queries indicate that 

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

intense in Norway, Japan, and the United States 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 26 January 2013:

 Influenza: Seven cases of NHRC laboratory-confirmed influenza (A/H3) among US 

military basic trainees.

 Adenovirus: 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 elevated FRI 

rates at Ft. Jackson, Ft. Leonard Wood, and CGTC Cape May. NHRC Febrile Respiratory 

Illness Surveillance Update 

Tamiflu's effectiveness is now the center of debate

28 January - ... Medical experts internationally are debating whether [Tamiflu’s] power 

against a virus that kills thousands annually was oversold. At best, experts say, Tamiflu can 

shorten the misery of the flu by a day or so — which could make a big difference in the 

most vulnerable patients, such as frail seniors. But at about $10 a pill it's expensive, and 

most people recover just fine without a drug whose reported harmful effects include rare 

but serious hallucinations in kids... In 2009, the British government commissioned a review 

of neuraminidase inhibitors by the Cochrane Collaboration, a group of experts whose 

systematic reviews of medical treatments are considered the gold standard of evidencebased research. Cochrane researchers found that much of the clinical trial data on Tamiflu 

was never vetted publicly. They asked to see the company's internal studies. Three years 

later, they still are waiting. "This means that taxpayers in the United Kingdom and around 

the world have spent billions of dollars stockpiling a drug for which no one except the 

manufacturer has seen the complete evidence base," the British journal BMJ editorialized in 

October. Tampa Bay Times

USAPHC: U.S. Army Influenza Activity Report

For the week ending 19 January 2013 (Week 3)

 During week 3, influenza-like illness activity remained relatively stable in Army MTFs. 

Dependent populations were most affected. Although still elevated, US civilian influenza 

activity indicators are declining while severity indicators (i.e., mortality) are rising.

 ILI Activity: Army incident ILI outpatient visits in week 3 were 12% higher than the same 

week last year.

 Influenza cases: 5 hospitalized influenza cases were reported to USAPHC in week 3. 59 

hospitalized cases have been reported during this influenza season, 54 in dependents 

and 5 in Active Duty Service Members.

 Acute Respiratory Disease at BCT sites: While ARD rates remain low at all Army BCT sites 

after the initiation of the adenovirus vaccine, decreasing activity was noted at all sites.

 Viral specimens: During week 3, 620 of 2124 (29%) laboratory specimens tested were 
positive for respiratory pathogens. Influenza A accounted for 60% of positive 

specimens. Most of the influenza positive specimens were from SRMC (37%); 28% were 

from NRMC, and 23% from WRMC. USAPHC U.S. Army Influenza Activity Report

PANDEMIC AND AVIAN INFLUENZA

Cambodian bird flu deaths prompt awareness drive

28 January - Health authorities in Cambodia will bolster public awareness campaigns on 

H5N1 avian influenza after four people became infected in January, resulting in two 

fatalities. “Ongoing public awareness campaigns need to be reinforced through TV and 

radio,” Sok Touch, director of Cambodia’s Communicable Disease Control Department 

(CDC), told IRIN on 28 January, calling on people to be vigilant. “We’re planning on doing 

this immediately as there is no room for complacency.” The four cases of H5N1 avian 

influenza, commonly known as bird flu, are the first confirmed in Cambodia this year. There 

were three recorded cases (all fatal) in 2012. IRIN

Scientists find genetic clue to severe flu among Chinese

29 January - British and Chinese scientists have found a genetic variant which explains why 

Chinese populations may be more vulnerable to the H1N1 virus, commonly known as swine 

flu. The discovery of the variant could help doctors find those people at high risk of severe 

flu and prioritize them for treatment, researchers said. It may also help explain why new 

strains of flu virus often emerge first in Asia, where the variant known as rs12252-C is more 

common in the population than elsewhere, they said. Reuters

Study finds post-H1N1-vaccination rise in narcolepsy in 3 

nations

30 January - A large study of narcolepsy background rates in six European countries before 

and after 2009 H1N1 pandemic vaccine campaigns confirmed increases in Finland and 

Sweden—the two countries that first reported the problem—but also detected a rise in 

Denmark. The findings, from one of the largest known studies of narcolepsy epidemiologic 

patterns, are the latest piece of the puzzle for European health officials who have been 

investigating a link between narcolepsy and vaccination with Pandemrix, a monovalent 

vaccine made by GlaxoSmithKline (GSK) that contains the AS03 adjuvant. CIDRAP

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VETERINARY/FOOD SAFETY

U.S.: Cats killing billions of animals

29 January - Cats are one of the top threats to US wildlife, killing billions of animals each 

year, a study suggests. The authors estimate they are responsible for the deaths of between 

1.4 and 3.7 billion birds and 6.9-20.7 billion mammals annually. Writing in Nature 

Communications, the scientists said stray and feral cats were the worst offenders. BBC

U.S.: Produce leads list of food vehicles for illness

29 January - After scrutinizing a decade's worth of data on foodborne disease outbreaks, 

federal health officials estimate that produce was the vehicle in close to half of all illnesses 

and that poultry was the culprit in 19% of all deaths. The report released today by the 

Centers for Disease Control and Prevention (CDC) covers data from 1998 to 2008. It says 

that produce of all kinds was implicated in 46% of illnesses and 23% of deaths. A high 

number of produce-linked norovirus outbreaks was a major factor in the big contribution 

from produce. In other findings, the analysts estimated that contaminated meat and poultry 

together were to blame for 22% of cases and 29% of deaths, while dairy and eggs 

accounted for 20% of illnesses and 15% of deaths. Fish and shellfish were implicated in 6.4% 

of illnesses and 6.1% of deaths. CIDRAP

U.S.: Salmonella linked to ground beef sickens 16, CDC

28 January - Sixteen people across five states have fallen ill from Salmonella poisoning, 

several from a raw ground-beef dish served at a single restaurant, the U.S. Centers for 

Disease Control and Prevention said on Monday. Local, state and federal health and 

regulatory officials said the likely cause of the Salmonella Typhimurium outbreak was Jouni 

Meats Inc and Gab Halal Foods, both of Michigan. Most the people sickened were in the 

Midwest - two in Illinois, one in Iowa, three in Wisconsin and nine in Michigan, where the 

meat shops are located, the CDC said. One sick person was identified in Arizona. Reuters

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WELLNESS

Breast cancer survival better after lumpectomy than 

mastectomy

28 January - Women with small early breast cancers may have a better chance of survival if 

they have lumpectomy plus radiation therapy than mastectomy, according to a new analysis 

due to be published early online in the journal Cancer this week. Although they did not 

determine why women who had mastectomy had a higher risk of dying, Shelley Hwang of 

the Duke Cancer Institute in the US, and colleagues, suggest their findings provide 
confidence in the effectiveness of breast-conserving treatments even in women who have 

aggressive, early breast cancers. The news is timely because over the last 10 years, there has 

been a growing tendency for women diagnosed with breast cancer to opt for mastectomy, 

even if they have small early cancers. Medical News Today

First-ever guidelines issued for treating type 2 diabetes in 

kids

28 January - For the first time ever, the American Academy of Pediatrics has issued 

guidelines for the management of type 2 diabetes in children and teenagers aged 10 to 18. 

Until recently, pediatricians have mostly had to deal with type 1 diabetes, which has a 

different cause and usually a different management than type 2 diabetes. But, today, due 

largely to the rise in childhood obesity, as many as one in three children diagnosed with 

diabetes has type 2... [T]he first new guideline is to start a child or teen on insulin if it's at all 

unclear whether a child has type 1 or type 2 diabetes. The guideline further recommends 

that they continue using insulin until the diabetes type can be definitively determined. 

Medline Plus

Health apps fail first full checkup

29 January - Health care via mobile technology is still in its infancy. Of 75 trials in which 

patients used mobile tech, such as text messaging and downloadable apps, to manage a 

disease or adopt healthier behaviors, only three showed reliable signs of success, according 

to a systematic survey. In an accompanying survey of medical personnel who used smart 

phones and other devices, to help deliver care, the same team found more success: 11 of 42 

trials had positive, reliable results... There were a few promising, reliable trials: For instance, 

receiving text messages helped smokers quit in one trial that did verify its results with 

biochemical tests. Reminders also helped diabetics stick to their treatments in another trial. 

In the only successful developing-world trial, in Kenya, SMS reminders to take antiretroviral 

drugs helped reduce HIV virus counts. The limitations of today's mHealth treatments should 

not discourage researchers, Free says, because people can learn from interventions that did 

work. Huffington Post

London Marathon runner died after using supplement

30 January - A London Marathon runner whose death inspired more than $1 million in 

donations took a dietary supplement that may have contributed to her heart failure, a 

coroner ruled Wednesday. Claire Squires collapsed near Buckingham Palace last April near 

the end of the marathon. She was running to raise money for an organization that helps 

prevent suicides. According to an inquest at Southwark Coroner's Court, the 30-year-old 

runner's water bottle included a scoop of the supplement Jack3D, which contains a 

stimulant called DMAA or dimethylamylamine. DMAA is on the list of substances prohibited 

by the World Anti-Doping Agency, but Jack3D was legally available to buy in Britain before 

being banned in August because of potential risks to public safety. Sports Illustrated
Myths of weight loss are plentiful, researcher says

30 January - ...In an article published online today in The New England Journal of Medicine, 

[David B. Allison, who directs the Nutrition Obesity Research Center at the University of 

Alabama ] and his colleagues lay out seven myths and six unsubstantiated presumptions 

about obesity. They also list nine facts that, unfortunately, promise little in the way of quick 

fixes for the weight-obsessed. Example: “Trying to go on a diet or recommending that 

someone go on a diet does not generally work well in the long term.” New York Times

Obesity in girls tied to higher multiple sclerosis risk

30 January - New research suggests that obese kids - adolescent girls, in particular - are 

more likely to be diagnosed with multiple sclerosis (MS) than normal-weight youth. That 

doesn't prove carrying around some extra weight in childhood causes MS - in which the 

protective coating around nerve fibers breaks down, slowing signals traveling between the 

brain and body. But it does suggest rising levels of obesity in young people could mean 

more MS diagnoses than in the past, according to lead study author Dr. Annette LangerGould from Kaiser Permanente of Southern California and her colleagues. Reuters

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USAFRICOM

Nigeria: Lassa fever

28 January – An outbreak of Lassa fever in Lafia, the capital of Nasarawa State, which was 

confirmed last week, has led to the death of at least one person who shuttled between 

Nasarawa's 2 biggest health facilities in the frantic search for attention. The 2nd and 3rd 

cases involving a couple were confirmed last Friday [25 Jan 2013] after diagnoses conducted 

on the victims by a team of epidemiologists at the Dalhatu Araf Specialists Hospital (DASH) 

in Lafia, the Chief Medical Director (CMD), Dr Ahmed Yakubu Ashiki, told the Weekly Trust 

newspaper, yesterday [25 Jan 2013]. ProMED-mail

Nigeria to tackle lead poisoning 

28 January - Nigeria will release funds this week to tackle the world's worst lead poisoning 

outbreak which has killed at least 400 children, a senator said on Monday, ending months of 

official inaction in which 1,500 more children were put at risk. In May last year the 

government pledged 850 million naira ($5.4 million) to help clean up the lead and treat the 

thousands poisoned by contamination from an artisan gold mine in the Bagega area of 

northern Zamfara, but medical charity Doctors Without Borders (MSF) said the money never 

materialized. VOA
Zimbabwe: Flash flooding strikes Zimbabwe’s dry areas

29 January - Flash flooding across Zimbabwe’s Masvingo and Matabeleland provinces, 

normally dry areas, has caused substantial damage to infrastructure. While more than 4,000 

people across the country are in need of humanitarian assistance following heavy rains. 

“Our area is normally dry, and we were caught unawares by the floods, which destroyed 

almost all the bridges and badly damaged the roads. As a result, communication is difficult,” 

Alois Baloyi, member of parliament (MP) representing the Chiredzi North rural constituency 

in Masvingo, told IRIN. “I have... been informed that more than 10 adults and at least four 

children have drowned. The number of victims could be bigger, though, as a proper 

assessment is yet to be done,” he said. IRIN

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USCENTCOM

Egypt: Investigation continues after wild poliovirus is 

detected

27 January - Nearly eight years after the World Health Organization declared Egypt polio 

free and two years after the last reported case, wild poliovirus has popped up in the capital, 

Cairo, after routine testing of the city's sewers. Health authorities suspect the virus 

originated in Pakistan. But finding polio is sewer water is not an immediate red flag, 

according to Steve Oberste, viral division laboratory chief at the U.S. Centers for Disease 

Control and Prevention (CDC). The polio vaccine used in Egypt relies on weakened polio 

strains, which are then excreted - hence their presence in wastewater. But in this case, the 

samples were wild, or naturally occurring. So far the Egyptian government has not identified 

any cases tied to the recent polio find. But Oberste said continued vigilance is imperative 

and ongoing. All Africa

Syrian refugees top 700,000, U.N. struggling to cope

29 January - More than 700,000 Syrian refugees have fled to 

other countries in the region and aid workers are struggling to 

keep up with the exodus, the United Nations said on Tuesday. 

The number of refugees passed the 500,000 mark on Dec 11, 

meaning more than 200,000 have fled the war-torn country in 

the past seven weeks. "We have seen an unrelenting flow of refugees across all borders. We 

are running double shifts to register people," Sybella Wilkes, spokeswoman for the U.N. 

High Commissioner for Refugees (UNHCR), told Reuters in Geneva. A total of about 712,000 

refugees had registered in other countries in the region or were awaiting processing there 

as of Tuesday, according to UNHCR figures. Reuters

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USEUCOM

Israel reviews contraceptive use for Ethiopian 

immigrants

28 January - Israel's Health Ministry has ordered doctors to review how they prescribe a 

birth control drug, after accusations it was being used to control the population of 

Ethiopian immigrants. Suspicions that Ethiopian women had been coerced into receiving 

Depo-Provera arose in Israeli media a few years ago and most recently in a TV documentary 

linking the community's falling birthrate to over-prescription of the injectable contraceptive.

After a civil rights group accused it of racism, the health ministry ordered doctors not to 

renew Depo-Provera prescriptions unless they were convinced patients understood the 

ramifications, according to a letter from the ministry posted on the group's website on 

Monday. Reuters

Russia: State Duma passes anti-smoking bill in 2nd 

reading 

27 January - Lawmakers on Friday overwhelmingly voted in favor of legislation toughening 

rules for smokers and tobacco sellers, signaling that the bill could be signed into law as 

soon as next month... The anti-smoking legislation envisages banning smokers 

from lighting up in educational institutions, government buildings, short-distance forms 

of public transportation and parks from June, when tobacco companies would also be 

banned from advertising and stores would have to keep tobacco products out of sight. The 

Moscow Times 

United Kingdom: Gloucestershire hospital nurses 'too 

busy' to feed patient

29 January - A patient who was left to starve, bullying and mismanagement are among the 

allegations being made by a senior NHS clinician in Gloucestershire. The whistleblower has 

criticised the county's NHS Trust claiming his concerns have fallen on deaf ears. "I think it 

has now reached a point where people don't care anymore," said the senior member of staff 

who wants to remain anonymous. The NHS Trust has defended itself against all the 

allegations being made. Dr Frank Harsent, chief executive of Gloucestershire Hospitals NHS 

Foundation Trust, said: "I am disappointed that this individual feels that the best way to 

highlight their concerns about our organisation is to approach the media. BBC News

United Kingdom: North East measles outbreak 'serious'

29 January - More than 100 people have, or are suspected to have, measles, in one of the 

worst outbreaks in the North East in recent years. The Health Protection Agency (HPA) said 

the disease was mainly spreading among unvaccinated schoolchildren and it was "seriously" 

concerned. Since September there have been 49 suspected and 56 confirmed cases, 

compared to just 18 confirmed in 2011. Almost a quarter of those affected have been 
hospitalised, the HPA said... HPA North East spokeswoman, Julia Waller, said: "This measles 

outbreak is very serious and we are likely to see many more cases before it's over.

BBC News

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USNORTHCOM

U.S.: Antibacterial products pollute freshwater lakes 

24 January – [A] new study conducted in the United States has found that a chemical that 

gives soaps and hand creams their anti-germ properties is polluting freshwater lakes. The 

anti-bacterial agent triclosan was approved for use in the U.S. in 1964 and was added to 

consumer products in the 1970s. Today, the disinfectant is in everything from soaps to 

laundry detergent, according to William Arnold, a civil engineering professor at the 

University of Minnesota in Minneapolis-St. Paul. “We are using a chemical to wash our 

hands, brush our teeth and the like that isn’t actually necessary for the function of these 

products, that’s now accumulating in the environment and having potential effects out 

there," said Arnold. VOA

U.S.: Doxycycline shortage

28 January - The Food and Drug Administration (FDA) reported a shortage of doxycycline 

on January 18, 2013. Doxycycline is a recommended therapy for some sexually transmitted 

infections and syndromes including chlamydia, nongonococcal urethritis, epididymitis and 

pelvic inflammatory disease. It is also an alternative therapy for syphilis in patients with a 

penicillin allergy. Doxycycline tablets/capsules are currently available in limited supplies. For 

additional information about the availability of doxycycline, visit the FDA Drug Shortage 

Website. Other CDC recommended and additional alternative regimens are listed below and 

outlined in the 2010 STD Treatment Guidelines. CDC

U.S.: Majority of Americans support dozens of policies to 

strengthen U.S. gun laws

28 January - The majority of Americans support a broad array of policies to reduce gun 

violence, according to a new national public opinion survey conducted by researchers at the 

Johns Hopkins Bloomberg School of Public Health. These policies include: requiring 

universal background checks for all gun sales (supported by 89 percent); banning the sale of 

military-style semiautomatic assault weapons (69 percent); banning the sale of largecapacity ammunition magazines (68 percent); and prohibiting high-risk individuals from 

having guns, including those convicted of a serious crime as a juvenile (83 percent) and 

those convicted of violating a domestic-violence restraining order (81 percent). Americans 
also support a range of measures to strengthen oversight of gun dealers and various 

policies restricting gun access by persons with mental illness. Johns Hopkins School of 

Public Health

U.S.: New rule protects patient privacy, secures health 

information

17 January - The U.S. Department of Health and Human Services (HHS) moved forward 

today to strengthen the privacy and security protections for health information established 

under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The final 

omnibus rule greatly enhances a patient’s privacy protections, provides individuals new 

rights to their health information, and strengthens the government’s ability to enforce the 

law... Some of the largest breaches reported to HHS have involved business associates. 

Penalties are increased for noncompliance based on the level of negligence with a 

maximum penalty of $1.5 million per violation. The changes also strengthen the Health 

Information Technology for Economic and Clinical Health (HITECH) Breach Notification 

requirements by clarifying when breaches of unsecured health information must be 

reported to HHS. HHS

U.S.: Noninfluenza vaccination coverage among adults —

United States, 2011

1 February - In 2011, noninfluenza adult vaccination coverage in the United States was 

similar to 2010, except for modest increases in Tdap vaccination overall and HPV 

vaccination among women, with little or no improvements in coverage for the other 

vaccines recommended for adults. Many adults have not received one or more 

recommended vaccines. Vaccination coverage estimates for the three vaccines in this report 

that are included in Healthy People 2020 (pneumococcal, herpes zoster, and hepatitis B [for

HCP] vaccines) are well below the respective target levels of 90% for persons aged ≥65 

years and 60% for persons aged 18–64 years at high risk (pneumococcal vaccine [objectives 

IID 13.1 and IID 13.2, respectively]), 30% (herpes zoster vaccine [IID 14]), and 90% (hepatitis 

vaccine for HCP [IID 15.3]). These data indicate little progress was made in improving adult 

coverage in the past year and highlight the need for continuing efforts to increase adult 

vaccination coverage. Morbidity and Mortality Weekly Report

U.S., North Dakota: An oil boom takes a toll on health 

care

27 January - ... The furious pace of oil exploration that has made North Dakota one of the 

healthiest economies in the country has had the opposite effect on the region’s health care 

providers. Swamped by uninsured laborers flocking to dangerous jobs, medical facilities in 

the area are sinking under skyrocketing debt, a flood of gruesome injuries and bloated 

business costs from the inflated economy... Hospitals cannot simply refuse to treat people 

or raise their rates... Mr. Kelly has pushed for the state, which has a surplus of more than $1 

billion, to allocate money intended for the oil region specifically to health care facilities in 

the area. New York Times
U.S.: Whooping cough vaccine for pregnant women 

among new recommendations

28 January - The U.S. Centers for Disease Control and Prevention and the American 

Academy of Pediatrics have released new vaccine guidelines for 2013. One change is a 

recommendation for women to receive a dose of the whooping cough (pertussis) vaccine 

with each pregnancy. Another is the suggestion that mild egg allergy need no longer 

prevent people from getting the flu vaccine under certain circumstances. The guidelines 

also clarify the use of the pneumococcal vaccine -- which protects against sometimes lifethreatening meningitis, pneumonia and blood infections -- in certain vulnerable 

populations. Medline Plus

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USPACOM

Bangladesh: Nipah encephalitis

28 January - The Director of the government's disease monitoring outfit, IEDCR [Institute of 

Epidemiology, Disease Control and Research (Bangladesh)], Prof Mahmudur Rahman on 

[Sun 27 Jan 2013] said 2 more died of [Nipah virus infection] taking the total death toll this 

year [2013] to 8. The new deaths were from Pabna and Rajshahi while one 8-month old boy 

is struggling for life in the Rajshahi Medical College Hospital. The virus that infects a person 

only after drinking raw date sap and later can pass on to other people through contact is a 

cause of public health concern in Bangladesh since 2001, as it breaks out every year during 

January-April. ProMED-mail

China: Beijing choking on hazardous smog - again

29 January - Hazardous smog was covering Beijing on 

Tuesday, reducing visibility to less than 200 meters (200 

yards) in parts of Chinese capital while forcing the 

cancellation of airline flights and the closure of highways, 

Chinese state media reported. The U.S. Embassy in Beijing 

reported that at 8 p.m. local time Tuesday air quality had been at hazardous levels for the 

past 24 hours, meaning that “everyone should avoid all physical activity outdoors; people 

with heart or lung disease, older adults, and children should remain indoors and keep 

activity levels low,” according to the embassy’s website... The latest blanket of smog, which 

began to cover the eastern China area on Monday, is the fourth to menace the area since 

the beginning of the year. CNN
China: Child trafficking - a cruel trade

26 January - ...China’s one-child policy has fuelled demand for children like his, thousands 

of whom are snatched and sold every year to desperate, usually boy-less, couples... The 

authorities have launched several crackdowns over the past two decades, but the crime has 

persisted. Since a renewed effort began in 2009, more than 54,000 children have been 

rescued and 11,000 trafficking gangs “smashed”, Xinhua, the state news-agency, reported in 

December. Officials claim the problem has become less rampant... Social media may also 

have played a role. In recent years, parents and activists have been using websites and 

microblogs to share information about cases and draw public attention to child abduction. 

Their efforts have put pressure on the police, who have responded (unusually, given their 

suspicion of internet activism) by using the internet themselves to contact the families of 

victims. Economist

Philippines: Chikungunya

28 January - Health authorities in Samar may yet face another round of chikungunya fever 

[virus] infection in Samar, as some 500 Villareal folks have been affected, which rendered 

the victims unproductive for a week. Dr. Antonio Tirazona, Department of Health (DOH) 

Representative in Samar, reported this situation during the 1st Provincial Disaster Risk 

Reduction Council (PDRRC) meeting this morning [28 Jan 2013]. He declared that they have 

received reports that chikungunya [virus infection] has threatened the municipalities of 

Daram, an island town, Jiabong, Gandara, and the city of Catbalogan... "In Villareal, the LGU 

ran out of medicines that they asked for from the provincial government. The Research 

Institute of Tropical Medicine (RITM) is now examining the blood samples taken from the 

patients in Daram," he said. ProMED-mail

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USSOUTHCOM

Brazil: Four arrested after deadly nightclub fire

28 January - Police arrested four people Monday in connection with a nightclub fire that 

killed 231 people in southern Brazil, CNN affiliate BandNews reported. Two are club owners 

and the other two members of the band that was performing, it said. The detainees will be 

held initially for five days while authorities investigate Sunday's blaze in the Kiss nightclub in 

Santa Maria, according to Marcos Viana, a police official who spoke with state-run Agencia 

Brasil... More than 100 clubgoers were injured in the fire, which authorities say began about 

2:30 a.m. Sunday during a band's pyrotechnic show. Guitarist Rodrigo Lemos Martins of the 

Gurizada Fandangueira band told the newspaper Folha de São Paulo that the fire ignited 

one song after the band had used fireworks in the show. But he said it was not clear what 

may have caused the fire. CNN

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