1

29 March 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.

U.S. Army Public Health Command

U.S. Military | Global | Influenza | Veterinary/Food Safety | Wellness | Contact Us

USAFRICOM | USCENTCOM | USEUCOM | USNORTHCOM | USPACOM | USSOUTHCOM

Subscription or 

Comments

If you wish to be added to 

the APH Weekly Update 

mailing list, removed from 

the mailing list, or if you 

have comments or 

questions about the 

update, please contact us. 

We welcome your 

comments. Please feel free 

to share this update with 

others who may be 

interested.

Follow us!

Facebook

Twitter

 YouTube

Approved for public release, distribution unlimited.

Contents

U.S. MILITARY

 Human papillomavirus seroprevalence among men entering military service and seroincidence 

after ten years of service

 Menu changes serve up a healthier diet for U.S. military

GLOBAL

 Burn dressing 'lights up' to signal an infection

 DNA test reveals 80 markers for inherited cancer risk

 GAO report reiterates biolab oversight gaps

 J&J recalling more than 2 million blood glucose meters worldwide

 Novel coronavirus infection – WHO update

 Study: Hospital-onset C diff may raise risk of death in kids significantly

 Will there be enough water for everyone?

INFLUENZA

 Armed Forces Health Surveillance Center: DoD Influenza Surveillance Summary

 CDC reports about 90 percent of children who died from flu this season not vaccinated

 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

VETERINARY/FOOD SAFETY

 According to CPSI reports of foodborne-illness outbreaks decline by 40%

 Congress passes bill to avert meat inspector furloughs

 Kenya: Insecticide-treated nets protect livestock and boost milk yields in UN pilot projects

WELLNESS

 Brain differences seen in people with migraines

 Employers try to spur healthy behaviors with health plan rewards

 Liquid drops could replace allergy shots

 New prostate cancer tests could reduce false alarms
2

Returning Home 

from Iraq and 

Afghanistan: 

Assessment of 

Readjustment 

Needs of Veterans, 

Service Members, 

and Their Families

The wars in Iraq and 

Afghanistan have been the 

longest sustained U.S. 

military operations since 

the Vietnam era, sending 

more than 2.2 million 

troops into battle, and 

resulting in more than 

6,600 deaths and 48,000 

injuries. While many service 

members return home 

relatively unscathed and 

report rewarding 

experiences, others return 

with varied complex health 

conditions and find that 

readjusting to life at home, 

reconnecting with family, 

finding work, or returning 

to school is an ongoing 

struggle. 

This report presents the 

IOM's comprehensive 

assessment of the physical, 

psychological, social, and 

economic effects of 

deployment on service 

members, veterans, their 

families, and their 

communities. 

 Online dating for people with sexually transmitted infections

USAFRICOM

 Africa: Climate change likely to worsen threat of diarrheal disease in Botswana, arid African 

countries

 Africa: Weaknesses persist in immunization systems

 Rwanda: Congolese refugee camps in Rwanda “full”

USCENTCOM

 Pakistan: Measles outbreak: 12 more children die in Dir, North Waziristan

 Pakistan security force blocks attack on polio vaccination team

 Syria’s brain drain – another twist to the country’s crisis

USEUCOM

 Europe: Drug-resistant TB threatens Europe

 European Union in "denial" that sick economy costs lives, health experts say

 United Kingdom: Food vouchers to provide emergency help but prevent spending on alcohol

 United Kingdom: Swansea measles epidemic - MMR vaccine take-up disappointment

 United Kingdom: Young cancer deaths 'halved in last 30 years'

USNORTHCOM

 EPA: More than half of US streams and rivers in poor shape

 FDA approves first Botulism antitoxin for use in neutralizing all seven known botulinum nerve 

toxin serotypes

 U.S. agency puts poison prevention in spotlight

 U.S.: Increase in reported coccidioidomycosis — United States, 1998–2011

 U.S.: Kids' meals at most restaurant chains fail nutrition test, consumer group says

 U.S.: Meningitis outbreak - New York City advises vaccines for all gay men

 U.S.: Norovirus is now the leading cause of severe gastroenteritis in US children

 U.S.: Prevention and control of meningococcal disease: Recommendations of the Advisory 

Committee on Immunization Practices (ACIP)

 U.S.: Unfit for work - the startling rise of disability in America

USPACOM

 Australia: Drug-resistant tuberculosis knocks at Australia’s door

 China's "black clinics" flourish as government debates health reform

 India: Cashless treatment for road accident victims

 India: Sex discrimination begins in the womb

USSOUTHCOM

 Belize: Hepatitis A

 Paraguay: Dengue epidemic still out of control

U.S. MILITARY

Human papillomavirus seroprevalence among men 

entering military service and seroincidence after ten 

years of service

February 2013 - ...This study characterized HPV acquisition among male military members 

by evaluating both seroprevalence at entry into service and seroincidence of HPV infection 
3

Potential Health 

Risks to DOD FiringRange Personnel 

from Recurrent Lead 

Exposure

The Department of 

Defense (DOD) asked the 

National Research Council 

to evaluate potential health 

risks from recurrent lead 

exposure of firing-range 

personnel. Specifically, 

DOD asked the National 

Research Council to 

determine whether current 

exposure standards for 

lead on DOD firing ranges 

protect its workers 

adequately.

after ten years of service. At entry, 29 of 200 (14.5%) male service members were positive for 

HPV serotypes 6, 11, 16, or 18. Of 199 initially seronegative for at least one of the four HPV 

serotypes, 68 (34.2%) seroconverted to one or more serotypes at ten years; more than onethird of these were seropostive for oncogenic HPV serotypes. This estimate of HPV 

seroprevalence among male military accessions is higher than that reported among U.S. 

civilian males. Vaccination to prevent genital warts and cancers resulting from HPV infection 

may decrease health care system burdens. Further analyses are warranted to understand the 

potential costs and benefits of a policy to vaccinate male service members. Medical 

Surveillance Monthly Report

Menu changes serve up a healthier diet for U.S. military

26 March - ...According to Dr. Jonathan Woodson, assistant secretary of defense for health 

affairs, only about two percent of armed services members had weight problems in the mid 

1990s. In 2005, that figure was five percent, which suggests an eight percent increase in 

obesity amongst military personnel in as many years. The obesity epidemic amongst military 

personnel could negatively impact operational readiness and jeopardize Department of 

Defense operations, according to the report. Researchers involved in the report wondered 

whether the food being served in military cafeterias could be at least partially to blame, as 

nearly three-quarters of military personnel eat at least one meal a day in garrison 

cafeterias... The study found that small changes in food service practices and menus in 

military cafeterias produced significant improvement in soldiers' nutritional intake. 

Increasing the availability of fresh fruit, vegetables, whole-grain foods, reducing the 

availability of foods with high dietary fat and sugar, and offering one main lean meat or 

vegetarian entrée at lunch and dinner all helped to increase soldiers' health. Justmeans

top of page...

GLOBAL

Burn dressing 'lights up' to signal an infection

24 March - Scientists have developed a medical dressing that 'lights up' when a burn is 

infected. It could be lifesaving in young children with serious burns in whom infections can 

rapidly become fatal, the Bath researchers said. A prototype dressing, which glows under UV 

light when it detects harmful bacteria, is featured on BBC science show Bang Goes the 

Theory. But trials in humans are still some years away. Fast diagnosis of infection in children 

with burns, such as those caused by scalds from hot drinks, is a big problem for clinicians, 

the researchers said... They can quickly develop a condition called toxic shock syndrome, 

which if left untreated can be fatal in half of cases. BBC News

DNA test reveals 80 markers for inherited cancer risk

27 March - More than 80 genetic markers that can increase the risk of developing breast, 

prostate or ovarian cancer have been found in the largest study of its kind. The DNA of 

200,000 people - half of them with cancer and half without - was compared, revealing an 
4

Classified Version of 

the Weekly Update

An Army Public Health

Weekly Update is available 

with articles classified up to 

the SECRET level from the 

USAPHC SIPRNet site: 

http://phc.army.smil.mil

Look under Hot Topics & 

Current Issues.

To access this version, you 

will need a SECRET

clearance and a SIPRNet 

account.

Links

A-Z Index 

About USAPHC

Army Public Health and 

Health Information 

Weekly Update Archives

Medical Surveillance 

Monthly Report 

Medical Threat Briefings

(AKO)

Request USAPHC Services 

USAPHC Library

USAPHC Homepage 

USAPHC Training 

Contact USAPHC

individual's inherited risk of the diseases. British scientists, who led the research, believe it 

could lead to a DNA screening test within five years. They also hope it will boost knowledge 

of how the cancers develop. BBC

GAO report reiterates biolab oversight gaps

26 March - – The United States still lacks a way to assess the need for high-containment 

laboratories and national standards for building and maintaining them, despite 2009 

recommendations, according to a report yesterday from the Government Accountability 

Office (GAO). Members of Congress asked the GAO to explore the issues, which come at a 

time when lab safety has come under scrutiny in light of controversies about dual-use 

research, especially that involving lab-modified H5N1 avian influenza viruses. The report 

focuses on biosafety level 3 (BSL-3) and BSL-4 labs, which expanded in number after the 

2001 anthrax attacks and growing federal support of research on potential bioterror threats 

and the medical countermeasure needed to contain them. In September 2009 the GAO 

issued a report noting that the United States lacked an oversight strategy that would 

periodically weigh the need for more labs. CIDRAP

J&J recalling more than 2 million blood glucose meters 

worldwide

25 March - Johnson & Johnson is recalling and replacing more than 2 million meters used 

to measure blood glucose levels in diabetics due to a failure to operate properly at 

extremely high glucose readings, the company's LifeScan unit said on Monday. In the 

United States, about 90,000 OneTouch Verio IQ meters are affected out of some 1.2 million 

units of that model being recalled worldwide, the company said. Reuters

Novel coronavirus infection – WHO update

26 March - The Robert Koch Institute informed WHO of a new confirmed case of infection 

with the novel coronavirus (nCoV). The patient was a 73-year-old male from United Arab 

Emirates, who was transferred from a hospital in Abu Dhabi to Munich by air ambulance on 

19 March 2013. He died on 26 March 2013. In the United Kingdom, the index patient in the 

family cluster reported on 11 February 2013 with travel history to Pakistan and Saudi Arabia 

prior to his illness, has died. To date, WHO has been informed of a global total of 17 

confirmed cases of human infection with nCoV, including 11 deaths. Based on the current 

situation and available information, WHO encourages all Member States (MS) to continue 

their surveillance for severe acute respiratory infections (SARI) and to carefully review any 

unusual patterns. WHO is currently working with international experts and countries where 

cases have been reported to assess the situation and review recommendations for 

surveillance and monitoring. WHO

Study: Hospital-onset C diff may raise risk of death in 

kids significantly

27 March - Children who contracted hospital-onset Clostridium difficile infections had an 

almost sevenfold greater risk of dying compared with hospitalized children who didn't 

contract the disease or those who contracted community-onset C difficile, according to a 
5

large multicenter study yesterday in Clinical Infectious Diseases... In addition, the hospitalassociated version led to much longer hospital stays (21.6 vs 5.6 days) and much greater 

standardized costs ($93,600 vs $18,900) compared with community-onset C difficile. CIDRAP 

News Scan

Will there be enough water for everyone?

22 March - As the global population grows, so does the need for water. The Worldwatch 

Institute says increased demands for food, energy and industry, along with climate change, 

could lead to water scarcity in some places. The warning comes on World Water Day, March 

22. Worldwatch says billions of people are already facing some kind of water scarcity or 

shortage. Spokesperson Supriya Kumar said that it’s only expected to get worse as the 

population increases. VOA

top of page...

INFLUENZA

Armed Forces Health Surveillance Center: DoD Influenza 

Surveillance Summary

 In Week 11 (through 16 March 2013), ILI and Pneumonia and Influenza (P&I) incidence 

rates continued to decrease in all regions except PACOM where P&I rates increased 

slightly. This season, there have been 269 reportable medical event (RME) influenza 

cases among service members (81.8% were vaccinated); an additional 301 cases were 

reported among other beneficiaries. 

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

levels except in Europe, where high levels of influenza activity were detected with cocirculation of influenza A/H1, A/H3, and B. 

 Current vaccine coverage in the active component of the U.S. Armed Forces is 97%. 

AFHSC DoD Influenza Surveillance Summary

CDC reports about 90 percent of children who died from 

flu this season not vaccinated

22 March– The number of influenza-associated pediatric deaths reported to CDC during the 

current season surpassed 100 this week as an additional 6 deaths were reported in FluView. 

This brings the total number of influenza-associated pediatric deaths reported to CDC, to 

date, to 105 for the 2012-2013 season. Pediatric deaths are defined as flu-associated deaths 

that occur in people younger than 18 years. An early look at this season’s reports indicates 

that about 90 percent occurred in children who had not received a flu vaccination this 

season. This review also indicated that 60 percent of deaths occurred in children who were 

at high risk of developing serious flu-related complications, but 40 percent of these children 

had no recognized chronic health problems. CDC
6

CDC: Weekly Influenza Surveillance Report

 During week 11 (March 10 – 16, 2013), influenza activity remained elevated in the 

United States, but decreased in most areas. 

 Viral Surveillance: Of 5,526 specimens tested and reported by collaborating 

laboratories, 899 (16.3%) 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: Six pediatric deaths were reported. 

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

illness (ILI) was 2.2%. This is at the national baseline of 2.2%. Three of 10 regions 

reported ILI above region-specific baseline levels. One state experienced high ILI 

activity; 5 states experienced moderate activity. FluView

DoD Global Laboratory-Based Influenza Surveillance 

Program

 During Week 11, ending 16 March, 23 specimens were tested from 15 locations. There 

were four influenza A viruses (three A(H3N2) and one A(H1N1)pdm09); and six influenza 

B viruses detected (see Table 1). 

 To date this influenza season, 3,182 specimens have been tested from 80 locations of 

which 1,012 were positive for influenza A (906 A(H3N2), 96 A(H1N1)pdm09, five coinfections, and five A/not subtyped). 

 To date this influenza season, 255 were positive for influenza B. The onset of influenza B 

cases compared to influenza A has been somewhat later in the season. 

 There have been 211 other respiratory viruses isolated (47 adenovirus, 85 RSV, 70 

parainfluenza, and nine enterovirus) cumulatively this season. USAF School of 

Aerospace Medicine

European Centre for Disease Prevention and Control:

Weekly Influenza Surveillance Overview

In week 11/2013, 19 countries reported medium intensity and 10 countries reported low 

intensity. No country reported high intensity, indicating declining activity in an increasing 

number of countries. 

 Decreasing or stable trends were reported by 28 countries and an increasing trend was 

reported by Romania which was the only country where ILI rates have not yet peaked. 

 In week 11/2013, 46% of tested specimens were positive for influenza virus. This 

proportion had remained above 50% since week 4/2013, with a peak of 61% in week 

5/2013. However the percentage of positive specimens decreased more sharply 

between weeks 10 and 11/2013, consistent with declining influenza activity. 

 Since week 40/2012, 48% of sentinel specimens testing positive for influenza have been 
7

type A, and 52% type B viruses. Of influenza A viruses subtyped, the proportion of 

A(H1N1)pdm09 viruses has been 63%. 

 In week 11/2012, 116 hospitalised laboratory-confirmed influenza cases were reported 

by eight reporting countries. Since week 40/2012, 2 605 hospitalised laboratoryconfirmed influenza cases and 154 related fatalities have been reported. 

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

returned to baseline levels. After more than three months of active transmission, the 2012–

2013 influenza season is on the wane. Weekly Influenza Surveillance Overview

Google.org: Flu Trends

26 March - 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 high in 

Sweden and 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 16 March 2013:

 Influenza: Three cases of NHRC laboratory-confirmed influenza 1(A/H3), 1(A/H1N1) and 

1 (B) among US military basic trainees. Influenza activity at basic training centers is 

decreasing in March 

 Adenovirus: Type 14 adenovirus cases continue at MCRD Parris Island, though FRI rates 

remain low

 FRI surveillance at eight U.S. military basic training centers indicated elevated FRI rates 

at CGTC Cape May. NHRC Febrile Respiratory Illness Surveillance Update 

USAPHC: U.S. Army Influenza Activity Report

For the week ending 16 March 2013 (Week 11)

 Army influenza-like illness (ILI) activity was slightly lower than the same time last season. 

The proportion of civilian outpatient visits for ILI decreased to the national baseline of 

2.2%. Influenza B continues to exceed influenza A among typed specimens in both the 

Army and civilian populations.

 ILI Activity: Army incident ILI outpatient visits in week 11 were 3% lower than the same 

week last year.

 Influenza cases: Five hospitalized influenza cases were reported to USAPHC in week 11. 

90 hospitalized cases have been reported during this influenza season, 78 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 11.

 Viral specimens: 272 of 1066 (26%) laboratory specimens tested were positive for 
8

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

the influenza positive specimens were from ERMC (35%); 24% were from SRMC, and 

22% from PRMC.USAPHC U.S. Army Influenza Activity Report

top of page...

VETERINARY/FOOD SAFETY

According to CPSI reports of foodborne-illness outbreaks 

decline by 40%

27 March - Foodborne illness outbreaks are trending downward, according to a new review 

of outbreaks by the nonprofit Center for Science in the Public Interest. From 2001 to 2010, 

the latest 10-year period for which data is available, outbreaks related to E. coli, Salmonella,

and other dangerous pathogens appear to have decreased by more than 40 percent. Better 

food safety practices, notably the adoption of Hazard Analysis and Critical Control Points 

(HACCP) programs in the meat, poultry, and seafood industries, may have contributed to 

the decline, says CSPI. But the group cautions that incomplete reporting of outbreaks by 

understaffed and financially stretched public health agencies may also influence the data.

Food Safety

Congress passes bill to avert meat inspector furloughs

22 March - The House on Thursday passed a continuing resolution that will head off 

furloughs for U.S. meat inspectors that would have taken place this summer as a result of 

the sequester... The legislation will allow for the reallocation of $55 million in funds from 

other parts of the U.S. Department of Agriculture to the agency’s Food Safety and 

Inspection Service. This means that federal meat and poultry inspectors will not face 

furloughs and, consequently, meat plants will keep running without pause through the 

summer (meat and poultry plants can only operate when a federal inspector is present).

Food Safety News

Kenya: Insecticide-treated nets protect livestock and 

boost milk yields in UN pilot projects

27 March - Insecticide-treated mosquito and fly nets encircling livestock pens in small farms 

in western Kenya are proving to be an effective means of killing disease-carrying pests and 

boosting milk yields, the United Nations today reported, as well as contributing to fewer 

people being bitten at home. "The nets are environmentally safe and have drastically cut the 

number of flies, mosquitoes and other disease-transmitting insect vectors by close to 90 per 

cent," the UN Food and Agriculture Organization (FAO) said in a statement, referring to a 

project in Kisii, Kenya, in the country's western highlands. The nets have also cut down the 

cases of mastitis, a bacterial disease that can be spread by flies as well as poor hygiene 

during milking, according to FAO. allAfrica

top of page...
9

WELLNESS

Brain differences seen in people with migraines

26 March - People who suffer migraines may have certain structural differences in painrelated areas of the brain, a new study suggests. Using MRI scans, researchers found that in 

specific brain regions related to pain processing, migraine sufferers showed a thinner and 

smaller cortex compared to headache-free adults. The cortex refers to the outer layer of the 

brain. It's not clear what it all means. But the researchers suspect that certain aspects of 

brain development may make some people more vulnerable to developing migraines -- and 

that migraine attacks create further changes in the brain. Medline Plus

Employers try to spur healthy behaviors with health plan 

rewards

26 March - As employers try to nudge employees toward healthy behaviors, a growing 

number are taking aim at the medical expense accounts linked to the health plans they offer 

their workers. And, increasingly, the hefty financial contributions employers are dangling in 

front of employees are dependent on certain conditions, such whether employees keep 

their blood pressure in check, for example, or agree to work with a health coach to manage 

their diabetes. Along with cash and reduced premiums, the contributions are one more way 

employers are trying to boost participation in health programs. NPR

Liquid drops could replace allergy shots

27 March - In Europe, some allergy sufferers are given 

sublingual immunotherapy, or allergy drops, to treat their 

symptoms. These tiny drops of purified allergens - such as 

pollen or dust mites - are placed under the tongue as an 

alternative to weekly allergy shots. The drops work like a 

vaccine, slowly increasing the body's tolerance to the allergen. The Food and Drug 

Administration has yet not approved these drops for use in the United States, but new 

evidence published this week by the Journal of the American Medical Association could 

pave the way for American pharmaceutical companies. CNN

New prostate cancer tests could reduce false alarms

26 March - Sophisticated new prostate cancer tests are coming to market that might 

supplement the unreliable P.S.A. test, potentially saving tens of thousands of men each year 

from unnecessary biopsies, operations and radiation treatments. Some of the tests are 

aimed at reducing the false alarms, and accompanying anxiety, caused by elevated P.S.A. 

readings. Others, intended for use after a definitive diagnosis, examine the genetic workings 

of the cancer to distinguish dangerous tumors that need treatment from slow-growing ones 

that might be left alone. The tests could provide a way out of the bitter debate over 

whether healthy men should be screened for prostate cancer. New York Times
10

Online dating for people with sexually transmitted 

infections

28 March - ... For those with incurable sexually transmitted 

infections (STIs), are tailored websites the answer for people 

nervous of telling potential partners about their condition? 

The past decade has witnessed the growth of niche dating 

websites - from Amish to Zombie enthusiasts - but a 

particularly burgeoning sector has been the proliferation of STI dating websites. Now there 

are so many, there are Top 10 lists. Many have taglines such as "Stay positive! Find Love, 

Support and Happiness" or "Plenty of Positive Fish". Some sites, such as H-YPE or H-Date, 

are aimed specifically at people with the most common types of incurable STIs, such as 

herpes and HPV, which causes genital warts... The rise in these dating sites coincides with 

increasing rates of STIs. BBC News

top of page...

USAFRICOM

Africa: Climate change likely to worsen threat of 

diarrheal disease in Botswana, arid African countries

26 March - In a National Science Foundation funded study, Kathleen Alexander, an associate 

professor of wildlife at Virginia Tech, found that climate drives a large part of diarrheal 

disease and increases the threat of climate change for vulnerable communities... Alexander 

and colleagues analyzed data on diarrheal disease from 1974, eight years after Botswana 

gained independence from British rule, through 2003... Botswana is an arid, landlocked 

country in southern Africa with a subtropical climate of distinct wet and dry seasons. 

Alexander and her co-authors evaluated monthly reports of diarrheal disease among 

patients treated at Botswana health facilities since 1974 and compared that data with 

climatic variables over that same period. "Our analysis suggests that forecasted climate 

change increases in temperature and decreases in precipitation for the region are likely to 

increase dry season diarrheal disease incidence, while diarrheal disease incidence in the wet 

season is likely to decline," Alexander explained. EurekAlert!

Africa: Weaknesses persist in immunization systems

20 March - Immunization systems in Africa still have supply, financing, and sustainability 

issues and need urgent attention from country leaders to reach the region's health goals, 

African experts said yesterday. Three vaccine and infectious disease experts from the 

University of Cape Town in South Africa raised their concerns in a policy forum in Public 

Library of Science (PLoS) Medicine. Though they commended African countries for their 
11

progress with immunization systems, they said that outbreaks of diseases such as polio and 

measles as well as high vaccine dropout rates point to failures within the system. They 

noted that wide intra- and inter-country differences mean vaccines aren't reaching large 

numbers of African children and others are receiving suboptimal doses. CIDRAP

Rwanda: Congolese refugee camps in Rwanda “full”

27 March - Camps in Rwanda hosting thousands of 

refugees from the Democratic Republic of Congo (DRC) 

are running out of space following an influx of people 

fleeing insecurity in eastern DRC, says a senior 

government official... At least 25,000 Congolese entered 

Rwanda from eastern DRC in 2012, according to the 

Rwandan government. The influx added to the approximately 43,000 refugees - mainly 

Congolese - already in the country. The ministry noted that there are some refugees willing 

to be relocated to other places in Rwanda due to security concerns. IRIN

top of page...

USCENTCOM

Pakistan: Measles outbreak: 12 more children die in Dir, 

North Waziristan

28 March - At least 12 children have died because of measles in North Waziristan and 

Timergara, Lower Dir, while a large number are said to be infected. The exact number of 

deaths and those infected with measles in North Waziristan could not be ascertained 

because of the curfew imposed since the suicide attack on Esha check post, which claimed 

the lives of 17 security personnel and wounded 40 others. However, reports from the 

troubled region indicate two children from Dossali and Lora Mandi died due to the 

unavailability of medicines on Tuesday... Over 24 children have died because of the disease 

since the beginning of the year. Express Tribune

Pakistan security force blocks attack on polio vaccination 

team

27 March - Pakistani authorities thwarted a plan to attack a polio vaccination team near 

Karachi yesterday, arresting nine suspects, The News International, a newspaper based in 

Karachi, reported today. Pakistan Rangers, a paramilitary force that contains members of the 

Pakistan Army, interrupted the attempt in the Sultanabad area of Karachi and raided five 

different areas of the city, netting 30 suspects and recovering arms from some. Some of the 

armed militants were intimidating the polio team with aerial fire, but the troops intervened, 

according to the report... In other developments, some female polio vaccination workers in 
12

the Swat district of Khyber Pakhtunkhwa province, located in the northwestern part of 

Pakistan near the border with Afghanistan, are refusing security escorts... One of the 

vaccinators told the Tribune that having police accompany vaccinators makes them more 

visible and susceptible to attacks. CIDRAP News Scan 

Syria’s brain drain – another twist to the country’s crisis

26 March - The exodus of educated and skilled Syrians is increasingly depleting the 

country’s workforce and the quality of its health services, already strained by two years of 

conflict. “The phenomenon is ongoing and growing,” said regional humanitarian 

coordinator Radhouane Nouicer. The flight of professionals has affected the bureaucracy, 

educational institutions and factories - but nowhere is the impact felt more than in the 

medical sector. Late last year, the World Health Organization said all of the country’s nine 

psychiatrists and more than half the doctors in Homs had left the country. Clinics run by the 

Syrian Arab Red Crescent are short of surgeons and other medical experts. IRIN

top of page...

USEUCOM

Europe: Drug-resistant TB threatens Europe

22 March - In wealthy regions of the world like Western Europe, the infectious disease 

tuberculosis often has been seen as a health problem of the past - a deadly bacterial illness, 

but one that can be cured with antibiotic treatment. Now health experts say drug-resistant 

tuberculosis is on the rise: the numbers in Britain increased by 25 percent last year, and in 

Eastern Europe about one-third of all new TB cases are resistant to the key front-line drugs. 

The Olallo Project in Central London was set up to help homeless people from Central and 

Eastern Europe get back on their feet by helping them find a place to live and get a job. The 

charity has evolved, though, to serve another pressing need - tackling tuberculosis among 

Britain’s migrant community. VOA

European Union in "denial" that sick economy costs 

lives, health experts say

26 March - Europe's financial crisis is costing lives, with suicides and infectious diseases on 

the rise, yet politicians are not addressing the problem, health experts said on Wednesday. 

Deep budget cuts and growing unemployment are tipping more people into depression, 

and falling incomes mean fewer people can see their doctors or afford to buy medicines. 

The result has been a reversal since 2007 of a long-term decline in suicide rates, coupled 

with worrying outbreaks of diseases including HIV - and even malaria - in Greece, according 

to an major analysis of European health in The Lancet journal. Reuters
13

United Kingdom: Food vouchers to provide emergency 

help but prevent spending on alcohol

26 March - "Food stamps" arrive in Britain next month, when tens of thousands of 

vulnerable people will be issued with food vouchers in lieu of money to tide them over 

short-term financial crises. Rather than, as now, offering a cash loan, most councils will from 

April offer new applicants who qualify for emergency assistance a one-off voucher 

redeemable for goods such as food and nappies. Many of the 150 local authorities in 

England running welfare schemes have confirmed that they will issue the vouchers in the 

form of payment cards, which will be blocked or monitored to prevent the holder using 

them for alcohol, cigarettes or gambling. Several plan to issue charity food parcels to 

people applying for crisis help, and are preparing to give cash grants to food banks to 

enable them to take on full-time staff and increase opening hours. Economist

United Kingdom: Swansea measles epidemic - MMR 

vaccine take-up disappointment

27 March - Health officials say they are very disappointed in 

the uptake of the MMR vaccine in an area at the centre of a 

measles epidemic. Public Health Wales said only 100 of the 

3,800 susceptible children aged over two in the Swansea 

area had the vaccine last week. At that rate, it will take two 

years to vaccinate all those at risk. So far there are 432 cases of measles in total and of 

those 116 have been reported in the last week alone. Parents have been warned the 

outbreak could spread to other parts of Wales with fears it could top 1,000 cases. Public 

Health Wales (PHW) said the epidemic was spreading at an "alarming rate" and that 51 

people have been hospitalised so far. BBC News

United Kingdom: Young cancer deaths 'halved in last 30 

years'

24 March - The number of teenagers and young adults dying from cancer in the UK has 

halved since the 1970s, according to a report from Cancer Research UK. Deaths fell from 

about 580 per year to 300 in this age group while the largest drop was in those with 

leukaemia. More specialised treatments are likely to be behind the trend, the report said.

However, a teenage cancer expert said more young people should be enrolled on clinical 

trials. Cancer remains the main cause of death from any disease in teenagers and young 

adults. Only transport accidents account for more deaths in this age group. BBC

top of page...
14

USNORTHCOM

EPA: More than half of US streams and rivers in poor 

shape

26 March - The U.S. Environmental Protection Agency says 55 percent of the streams and 

rivers in the United States are in poor condition for aquatic life. The EPA surveyed thousands 

of kilometers of waterways and found increased levels of mercury and bacteria. Also found 

were excessive levels of nitrogen and phosphorus, which create too much algae, a plant that 

uses up oxygen that fish need. Additionally, the EPA says many of the waterways lack 

enough vegetation to prevent flooding, erosion and pollution. The EPA says healthy streams 

and rivers are vital sources of drinking water and recreation and play a critical role in the 

economy. VOA

FDA approves first Botulism antitoxin for use in 

neutralizing all seven known botulinum nerve toxin 

serotypes 

22 March - Product to be stored in Strategic National Stockpile for emergency 

preparedness and responses. The U.S. Food and Drug Administration announced today that 

it has approved Botulism Antitoxin Heptavalent (A, B, C, D, E, F, G)-(Equine) to treat patients 

showing signs of botulism following documented or suspected exposure to botulinum 

neurotoxin. The product is derived from horse plasma and contains a mixture of antibody 

fragments that neutralize all of the seven botulinum nerve toxin serotypes known to cause 

botulism... “This product approval meets an urgent unmet medical need for the treatment 

of sporadic cases of life-threatening botulism and provides a medical countermeasure 

should botulinum nerve toxins be used in a terrorism event,” said Karen Midthun, M.D., 

director of the FDA’s Center for Biologics Evaluation and Research. FDA

U.S. agency puts poison prevention in spotlight

24 March - Parents and caregivers can help reduce the risk of 

accidental poisonings by storing pesticides and household 

chemicals in locked cabinets out of children's reach, experts say. 

Each year, more than 145,000 reports made to U.S. poison 

control centers involve pesticides and disinfectants, according 

to the U.S. Environmental Protection Agency (EPA). That includes about 65,000 children 

aged 5 and younger who are accidentally exposed to pesticides each year. More than 

10,000 of those incidents involve mouse and rat poisons, the EPA pointed out in a news 

release issued during National Poison Prevention Week, March 17-23. Medline Plus
15

U.S.: Increase in reported coccidioidomycosis — United 

States, 1998–2011

29 March - Coccidioidomycosis, also known as valley fever, is an infection caused by 

inhalation of Coccidioides spp. spores. This soil-dwelling fungus is endemic to arid regions 

of Mexico, Central and South America, and the southwestern United States... [T]he incidence 

of reported coccidioidomycosis increased substantially during this period, from 5.3 per 

100,000 population in the endemic area (Arizona, California, Nevada, New Mexico, and 

Utah) in 1998 to 42.6 per 100,000 in 2011. Health-care providers should be aware of this 

increasingly common infection when treating persons with influenza-like illness or 

pneumonia who live in or have traveled to endemic areas. Morbidity and Mortality Weekly 

Report

U.S.: Kids' meals at most restaurant chains fail nutrition 

test, consumer group says 

28 March - The menus offered to children by most U.S. restaurant chains have too many 

calories, too much salt or fat, and often not a hint of vegetables or fruit, according to a 

study by the Center for Science in the Public Interest. The group, which has agitated for 

everything from healthier popcorn at the movies to calorie labeling in supermarkets, found 

that among almost 3,500 combinations surveyed, kids' meals failed to meet nutritional 

standards 97 percent of the time. That was a marginal improvement over 2008 when such 

meals failed to meet standards 99 percent of the time. Huffington Post

U.S.: Meningitis outbreak - New York City advises 

vaccines for all gay men

23 March - A deadly meningitis outbreak among gay men in New York City just got more 

serious, officials said today. Two men died of meningitis during the first two months of the 

year, raising the total number of cases to 22, with 3 of the last 5 cases resulting in death. 

The city's Department of Health upgraded its response to recommend vaccinations for all 

gay men throughout the city, regardless of HIV status and geographical location. Medical 

Daily

U.S.: Norovirus is now the leading cause of severe 

gastroenteritis in US children 

21 March - Norovirus is now the leading cause of acute gastroenteritis among children less 

than 5 years of age who seek medical care, according to a new study published in the New 

England Journal of Medicine. Norovirus was responsible for nearly 1 million pediatric 

medical care visits for 2009 and 2010 in the United States, amounting to hundreds of 

millions of dollars in treatment costs each year. CDC
16

U.S.: Prevention and control of meningococcal disease: 

Recommendations of the Advisory Committee on 

Immunization Practices (ACIP)

22 March - ... As a comprehensive summary of previously published recommendations, this 

report does not contain any new recommendations; it is intended for use by clinicians as a 

resource. ACIP recommends routine vaccination with a quadrivalent meningococcal 

conjugate vaccine (MenACWY) for adolescents aged 11 or 12 years, with a booster dose at 

age 16 years. ACIP also recommends routine vaccination for persons at increased risk for 

meningococcal disease... Guidelines for antimicrobial chemoprophylaxis and for evaluation 

and management of suspected outbreaks of meningococcal disease also are provided. 

Morbidity and Mortality Weekly Report

U.S.: Unfit for work - the startling rise of disability in 

America

22 March - In the past three decades, the number of Americans who are on disability has 

skyrocketed. The rise has come even as medical advances have allowed many more people 

to remain on the job, and new laws have banned workplace discrimination against the 

disabled. Every month, 14 million people now get a disability check from the government. 

The federal government spends more money each year on cash payments for disabled 

former workers than it spends on food stamps and welfare combined. Yet people relying on 

disability payments are often overlooked in discussions of the social safety net. People on 

federal disability do not work. Yet because they are not technically part of the labor force, 

they are not counted among the unemployed. In other words, people on disability don't 

show up in any of the places we usually look to see how the economy is doing. But the story 

of these programs -- who goes on them, and why, and what happens after that -- is, to a 

large extent, the story of the U.S. economy. It's the story not only of an aging workforce, but 

also of a hidden, increasingly expensive safety net. NPR

top of page...

USPACOM

Australia: Drug-resistant tuberculosis knocks at 

Australia’s door

25 March - Australia’s first death from XDR-TB — extensively drug-resistant tuberculosis,

which is nearly incurable — has alarmed health officials and added new heat to a debate 

over how to treat immigrants with dangerous diseases. That debate echoes one on the 

United States’ southern border. A long string of small Australian islands — bits of what was 

once a land bridge — mingle with islands belonging to Papua New Guinea, one of the 
17

world’s poorest nations. One of those islands, Daru, has a major TB outbreak in its 

shantytowns. Australia used to have two TB clinics on its islands, but closed them in 2011 

and sent many patients back to Daru, instead offering foreign aid to help them be treated at 

home. New York Times

China's "black clinics" flourish as government debates 

health reform

27 March - A one-room shack with a single, bare light bulb on a non-descript Beijing side 

street is 29-year-old Chinese migrant worker Zhang Xuefang's best recourse to medical 

care. Not recognized as a Beijing resident, she does not qualify for cheaper healthcare at 

government hospitals, and her hometown is too far away to take advantage of medical 

subsidizes there. Like millions of other migrant workers, Zhang, on whose labor China's 

economic boom depends, is forced into a seedy and unregulated world of back ally "black 

clinics" if she falls ill. The issue highlights the two-tier nature of China's overburdened health 

care system and goes to the heart of a heated debate about how to reform the contentious 

"hukou" system of household registration, a cornerstone of government policy for decades 

which essentially legalizes discrimination between urban and rural residents. The hukou 

system, which dates to 1958, has split China's 1.3 billion people along urban-rural lines, 

preventing many of the roughly 800 million Chinese who are registered as rural residents 

from settling in cities and enjoying basic urban welfare and services. Reuters

India: Cashless treatment for road accident victims

27 March - Union Minister of Road Transport and Highways C.P. Joshi unveiled a pilot 

project on Tuesday under which road accident victims would be provided cashless 

treatment, an initiative that could bring down the high rate of fatalities in the country... 

Under the scheme, cashless treatment of up to Rs. 30,000 would be provided to the victims 

during the first two days of treatment at 51 hospitals identified on the route at CGHS rates.

A maximum of 10 ambulances would be stationed at a distance of about 20 km of each 

other to respond to an accident within six to seven minutes and take the victims to a 

nominated hospital. Hindu

India: Sex discrimination begins in the womb

27 March - Women in India are more likely to get prenatal care when pregnant with boys, 

according to groundbreaking research that has implications for girls’ health and survival. 

The study... suggests sex discrimination begins in the womb in male-dominated societies... 

In studying the national health-survey data of more than 30,000 Indians, the researchers 

found that women pregnant with boys were more likely to go to prenatal medical 

appointments, take iron supplements, deliver the baby in a healthcare facility (as opposed 

to in the home) and receive tetanus shots... In India, while it’s illegal for a doctor to reveal 

the sex of an unborn baby or for a woman to have an abortion based on the baby’s sex, 

both practices are common, Lakdawala said. Michigan State University

top of page...
18

USSOUTHCOM

Belize: Hepatitis A

27 March - The Ministry of Health is investigating a cluster of 14 suspected cases of 

hepatitis A that have occurred over the last 3 weeks in Trio Village, Stann Creek District. One 

such case has been confirmed by laboratory testing. Hepatitis A is a food and waterborne 

disease with symptoms that may include yellowing of the eyes and skin, dark urine, lightcolored stool along with mild fever, vomiting, diarrhea and loss of appetite among others. 

This self-limiting disease can also be contracted from close contact with infected individuals. 

ProMED-mail

Paraguay: Dengue epidemic still out of control

27 March - The dengue epidemic in Paraguay continues uncontrollable with reports of 

1,122 hospitalizations and 39 deaths so far this year. The Directorate of Health Surveillance 

in the Ministry of Health issued a bulletin which recognizes that the disease continues to 

rise and said that in the last 24 hours were treated 1 763 suspected cases. The Central 

Department, near the capital, maintains the highest rate of patients, followed by Asunción 

and five other departments of this nation. Prensa Latina

top of page...

U.S. Military | Global | Influenza | Veterinary/Food Safety | Wellness | Contact Us

USAFRICOM | USCENTCOM | USEUCOM | USNORTHCOM | USPACOM | USSOUTHCOM

The Army Public Health Weekly Update does not analyze the information as to its strategic or tactical impact on the US Army and is not a medical 

intelligence product. Medical intelligence is available from the National Center for Medical Intelligence.

External Links: The appearance of external hyperlinks does not constitute endorsement by the U.S. Army of this Web site or the information, products, 

or services contained therein. For other than authorized activities such as military exchanges and MWR sites, the U.S. Army does not exercise any 

editorial control over the information you may find at these locations. Such links are provided consistent with the stated purpose of this product.

Although Health Information Operations avoids links to sites that may be blocked, all sites may not be accessible from all locations. While we verify the 

links at the time of publication, we cannot guarantee that they will be active in the future.

Articles appearing in the Update 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.

The Army Public Health Weekly Update is published by the Health Information Operations Program, Deputy Chief of Staff for Communication, United 

States Army Public Health Command.