24 August 2012

Army Public Health Weekly Update

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

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

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

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

should not be construed or interpreted as being

endorsed by the US Army Medical Department.

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Contents

U.S. MILITARY

 DoD, VA gather to study airborne health hazards

 Ectopic pregnancy, active component, U.S. Armed Forces, 2002-2011

 Insomnia exacerbates PTSD, research shows

GLOBAL

 Close contact with young people at risk of suicide has no effect

 Have vaccines, will travel

 Infections among homeless could fuel wider epidemics: study

 New tool screens antimalarials for resistance

INFLUENZA

 CDC: Weekly Influenza Surveillance Report

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

 Google.org: Flu Trends

 Interim guidance for enhanced influenza surveillance: Additional specimen collection for 

detection of influenza A (H3N2) variant virus infections

 Naval Health Research Center: Febrile Respiratory Illness Surveillance Update

 U.S.: 2012-2013 influenza season vaccine

VETERINARY/FOOD SAFETY

 U.S.: Multistate outbreak of Salmonella Typhimurium infections linked to cantaloupe

 USDA eyes whether tainted beef entered food supply

WELLNESS

 A childhood need for immediate gratification predicts adult obesity

 Coming next: Using an app as prescribed

 Decline in circumcisions could prove costly
DoD Influenza 

Vaccination Policies

All of the Seasonal 

influenza Service messages 

& policies have been 

released are available on 

the MILVAX website. A 

copy of the Army seasonal 

influenza vaccination 

program ALARACT and 

implementation guidelines 

is also available on the 

MILVAX website.

Seasonal Influenza 

Vaccine Curriculum

The 2012-13 Seasonal 

Influenza Vaccine 

Curriculum is a fivemodule online course that 

provides healthcare 

personnel with 

comprehensive information 

concerning the influenza 

vaccine. The course 

prepares healthcare 

personnel to administer 

influenza vaccinations and 

perform required 

administrative tasks in 

support of the DoD's 

Influenza Vaccination 

Program. 

 Father's age seen as crucial to baby's disease risk

 Gut bacteria increase pre-diabetes risk

 How well you sleep may hinge on race

 Scientists ID cancer-causing agent in smokeless tobacco

 Tap water use in neti pot tied to rare, fatal brain infection

USAFRICOM

 Angola: Health sector to vaccinate over 5000 children against measles

 Democratic Republic of Congo: Ebola, WHO update

 Sierra Leone cholera death toll rises to 217

USCENTCOM

 Afghanistan: Study shows malaria is over-diagnosed

 Syria: Number of displaced people grows as violence continues, says UN agency

 Yemen: Time running out for solution to water crisis

USEUCOM

 France: A cluster of meningococcal disease caused by rifampicin-resistant C meningococci, 

April 2012

 Germany: Cancer survival after the fall of the Iron Curtain

 Greece's latest crisis: Rising HIV cases

 Spain: Firefighters tackle wildfire blaze

 United Kingdom: Drug user's anthrax infection death

USNORTHCOM

 U.S.: Chickenpox down 80 percent since 2000

 U.S.: Huge fire burns to edge of 3 small Calif. towns

 U.S.: Nearly half of U.S. doctors struggle with burnout: study

 U.S.: Tattoo ink linked to serious skin infections

 U.S.: Tropical diseases - the new plague of poverty

 U.S.: West Nile virus (WNV) activity reported to ArboNET, by county, United States, 2012 (as of 

August 21, 2012)

USPACOM

 India: Chikungunya, suspected

 Indonesia: Growing concern over hepatitis

 New immune-deficiency illness emerging in East Asia

 Taiwan: CDC reports six new cases of severe enterovirus

USSOUTHCOM

 Caribbean: Tropical Storm Isaac getting better organized

 Dominican Republic: 300 hospitalized with suspected cholera
Twenty-first Interim 

Report of the 

Committee on Acute 

Exposure Guideline 

Levels

Extremely hazardous 

substances (EHSs) can be 

released accidentally as a 

result of chemical spills, 

industrial explosions, fire, 

or accidents involving 

railroad cars or trucks 

transporting EHSs, or they 

can be released 

intentionally through 

terrorist activities. These 

substances can also be 

released by improper 

storage or handling. 

The National Advisory 

Committee developed 

Acute Exposure Guideline 

Levels for approximately 

270 EHSs.

U.S. MILITARY

DoD, VA gather to study airborne health hazards

22 August - At least 1,000 veterans have fallen ill with mysterious symptoms they say were 

caused by poisonous pollutants from open-air burn pits, fires and clean-up operations in 

Iraq and Afghanistan. Now, the Defense and Veterans Affairs departments are hoping to 

widen their understanding of war-zone toxins and ultimately help suffering troops. The 

departments this week are holding closed-door meetings in Washington to discuss and 

debate deployment-related airborne pollution. Organizers hope the Joint VA-DoD Airborne 

Hazards Symposium will “inform current practices and improve future efforts in 

environmental exposure assessment, clinical surveillance, medical testing and research, 

ultimately improving the health of veterans and service members,” according to the 

symposium agenda. Among the topics under scrutiny is whether troops should receive 

baseline tests of how well their lungs work before and after deployment, as some 

researchers have recommended. Army Times

Ectopic pregnancy, active component, U.S. Armed 

Forces, 2002-2011

July 2012 - Ectopic pregnancy (EP) is a rare adverse outcome in which a fertilized egg 

implants and develops outside of the uterus. Life-threatening cases of EP among deployed 

U.S. service members have been described. During 2002- 2011, among active component 

females younger than 49, 1,245 EPs were diagnosed and treated as indicated by diagnostic 

and procedure codes recorded in electronic medical records. Annual numbers of EPs ranged 

from 91 to 151. During the period EP affected 0.64 percent of all pregnancies, with higher 

proportions among servicewomen in their 30s and of black, non-Hispanic race/ ethnicity. As 

compared with civilians, service members had the same percentage of pregnancies that 

were ectopic but had lower proportions of EPs that were treated medically (with 

methotrexate) rather than surgically. Medical Surveillance Monthly Report

Insomnia exacerbates PTSD, research shows

20 August - To treat troops suffering from post-traumatic stress disorder, doctors must first 

treat the sleep disorders that often accompany PTSD, researchers say. Sleep problems afflict 

roughly 90 percent of returning veterans, said Col. Carl Castro, director of Military 

Operational Medicine Research Program at Fort Detrick, Md. While not everyone with a 

sleep problem has PTSD, sleep problems are one of PTSD’s most common and most 

treatable symptoms. Left untreated, a sleep problem can lead to depression and addictive 

disorders and complicate a PTSD patient’s recovery, said Anne Germain, a sleep researcher 

at the University of Pittsburgh Medical Center whose work is funded by the Army. Insomnia 

is the most important factor influencing speed and accuracy in cognitive motor function, 

according to Army-funded research announced Aug. 15. Army Times Prime LOOK FOR 

ACCESSIBLE VERSION

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GLOBAL

Close contact with young people at risk of suicide has no 

effect

22 August - Researchers, doctors and patients tend to agree that during the high-risk 

period after an attempted suicide, the treatment of choice is close contact, follow-up and 

personal interaction in order to prevent a tragic repeat. Now, however, new research shows 

that this strategy does not work... Researchers from Mental Health Services in the Capital 

Region of Denmark and the University of Copenhagen have just concluded a large study on 

the effect of an assertive outreach and intervention programme for young people after an 

attempted suicide. The surprising conclusion is that increased attention and support for the 

patient do not have a significant effect. EurekAlert!

Have vaccines, will travel

20 August - Good health is a key ingredient to making the most of globe-trotting 

adventures and vaccinations can play a role in avoiding getting sick while traveling abroad. 

Most people are familiar with the standard vaccinations needed to protect people from 

illnesses like measles, mumps and rubella, but additional vaccinations may be 

recommended for specific destinations. The Centers for Disease Control recommends 

visiting a doctor four to six weeks prior to travel to receive any necessary vaccinations. The 

CDC divides travel vaccinations into those that are routine, recommended and required. 

Routine vaccinations are those recommended as standard for children and adults regardless 

of travel status. Recommended vaccinations are intended to protect travelers from illness 

present in other parts of the world and to prevent the spread of infectious diseases across 

international borders. Specific vaccinations recommended vary depending on the age and 

health status of the traveler, as well as where they will be traveling to, the season of travel 

and whether or not they will be visiting rural areas. More information can be found at the 

CDC’s destinations page, which includes a breakdown of recommended vaccines by 

location. MHS

Infections among homeless could fuel wider epidemics: 

study

19 August - Homeless people across the world have 

dramatically higher rates of infection with tuberculosis (TB), 

HIV and hepatitis C and could fuel community epidemics that 

cost governments dear, a study showed on Monday. With an 

estimated 650,000 homeless people in the United States and 

around 380,000 in Britain, experts said high levels of infection would not only cause yet 

more poverty and distress for those without homes, but could also become a wider 

problem. "Infections in homeless people can lead to community infections and are 

associated with malnutrition, long periods of homelessness and high use of medical 
services," said Seena Fazel, a senior research fellow in clinical science at the University of 

Oxford who led the study. Fazel and his team analyzed more than 40 research papers on 

levels of HIV, hepatitis C and TB among homeless people from 1984 to 2012. Medline Plus

New tool screens antimalarials for resistance

22 August - Researchers at the Medicines for Malaria Venture (MMV), a public-private 

nonprofit group in Geneva, today released a framework that it will use to assess malaria 

drugs in development for the risk of resistance. The group published its findings in an early 

online edition of Malaria Journal. The system is a test cascade of six steps based on three 

experimental procedures that allows investigators to classify the compound resistance risk 

profiles as low, elevated, or major, according the report. The major rating signifies that the 

compound faces preexisting resistance or is likely to select new clinically significant 

resistance mechanisms, and in the absence of mitigating factors the major classification 

would bar further development. Tim Wells, MMV's chief scientific officer, said in a press 

release that profiling MMV's drug development portfolio as early as possible will help 

ensure that none will face resistance. "This will also help us cost-effectively accelerate the 

drug development process and be prepared in advance with a full resistance profile, which 

is required by regulatory authorities before a new drug can be approved, he added. 

Resistance to antimalaria drugs is a major concern among global health officials in light of 

reports from Cambodia of resistance to artemisinin, a key component in the battle against 

malaria. CIDRAP News Scan

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INFLUENZA

CDC: Weekly Influenza Surveillance Report

During week 32 (week ending 11 August 2012), From July 12 through August 16, 2012, a 

total of 224 infections with influenza A (H3N2) variant (H3N2v) viruses have been reported 

in eight states (Hawaii [1], Illinois [3], Indiana [138], Michigan [1], Ohio [72], Pennsylvania [4], 

West Virginia [3], and Wisconsin [2]). So far during the current outbreaks, eight confirmed 

cases have been hospitalized as a result of their illness; no deaths have occurred. At this 

time no ongoing human-to-human transmission has been identified. Public health and 

agriculture officials are investigating the extent of disease among humans and swine, and 

additional cases are likely to be identified as the investigation continues. Because of 

reporting deadlines, the state totals reported by CDC may not always be consistent with 

those reported by state health departments. If there is a discrepancy between these two 

counts, data from the state health departments should be used as the most accurate 

number. FluView
European Centre for Disease Prevention and Control:

Weekly Influenza Surveillance Overview

During weeks 31-32 (30 July-12 August 2012), all reporting countries experienced lowintensity influenza activity and decreasing or stable trends. Weekly Influenza Surveillance 

Overview

Google.org: Flu Trends

23 August – Estimates of flu activity based on flu-related Internet search queries indicate 

that the level of flu activity in the United States ranges from minimal to low. Google.org Flu 

Trends

Interim guidance for enhanced influenza surveillance: 

Additional specimen collection for detection of influenza 

A (H3N2) variant virus infections

20 August - In light of the increasing numbers of cases of H3N2 variant virus (H3N2v) and 

increasing numbers of states reporting H3N2v cases, states should consider expanding 

surveillance to include rRT-PCR testing of specimens from ILINet providers statewide, and of 

specimens collected from people with unusual or severe presentations of ILI. States should 

also consider collection of specimens from outbreaks of ILI among children in child-care 

and school settings, since these settings have been associated with person-to-person 

H3N2v virus transmission in 2011. CDC will continue to evaluate new information as it 

becomes available and will update this guidance as needed. CDC

Naval Health Research Center: Febrile Respiratory 

Illness Surveillance Update 

For the week ending 18 August 2012:

Adenovirus 

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

centers by mid-November 2011 (week 45). 

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

markedly since vaccine was reintroduced. 

 A MSMR paper on the initial impact of adenovirus vaccine resumption was recently 

published.

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

below expected values. NHRC Febrile Respiratory Illness Surveillance Update 
U.S.: 2012-2013 influenza season vaccine

21 August - ... U.S. influenza vaccines for 2012-13 will contain: A/California/7/2009 (H1N1)-

like, A/Victoria/361/2011 (H3N2)-like, and B/Wisconsin/1/2010-like (Yamagata lineage) 

antigens. The influenza A(H3N2) and B antigens differ from the respective 2010-11 and 

2011-12 seasonal vaccine antigens (3). The influenza A(H1N1) vaccine virus strain is derived 

from an influenza A(H1N1)pdm09 (2009[H1N1]) virus and was included in the 2009(H1N1) 

monovalent pandemic vaccine as well as the 2010-11 and 2011-12 seasonal vaccines.

ProMED-mail

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VETERINARY/FOOD SAFETY

U.S.: Multistate outbreak of Salmonella Typhimurium 

infections linked to cantaloupe

23 August - A total of 178 individuals infected with the outbreak strain of Salmonella

Typhimurium have been reported from 21 states. The 37 new cases are from 13 states: 

Alabama (6), Georgia (2), Illinois (4), Indiana (5), Kentucky (6), Massachusetts (2), Minnesota 

(1), Mississippi (3), Missouri (3), New Jersey (1), Ohio (1), Texas (1), and Wisconsin (2). Since 

the last update cases have been reported from one additional state, Massachusetts. Among 

121 persons for whom information is available, illness onset dates range from July 7, 2012 

to August 9, 2012. Ill persons range in age from less than 1 year to 100 years, with a median 

age of 48 years. Fifty-nine percent of ill persons are female. Among 121 persons with 

available information, 62 (51%) reported being hospitalized. Two deaths have been reported 

in Kentucky. Illnesses that occurred after July 31, 2012 might not yet be reported due to the 

time it takes between when a person becomes ill and when the illness is reported. CDC

USDA eyes whether tainted beef entered food supply

21 August - Federal regulators who shut down a Central California slaughterhouse after 

receiving an animal welfare video were investigating Tuesday whether beef from sick cows 

reached the human food supply. The video appears to show workers bungling the slaughter 

of cows struggling to walk and even stand. Under federal regulations, sick animals cannot 

be slaughtered for human consumption. The investigation will determine whether sick cows 

were slaughtered and whether meat products from the company should be recalled, a 

spokesman for the USDA Food Safety Inspection Service said. The agency suspended 

operations Monday at Central Valley Meat Co. in Hanford after receiving the video Friday 

from the animal welfare group Compassion Over Killing. NPR

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WELLNESS

A childhood need for immediate gratification predicts 

adult obesity

17 August - In what has become known as "the 

marshmallow test" of delayed gratification, researchers 

in the 1960s developed a novel way to measure selfcontrol among children. Having recruited preschoolers 

from a university daycare, scientists presented each 

child with one marshmallow. They were then told they could either eat the one they had or 

wait an unspecified amount of time and be rewarded with an additional marshmallow... 

Researchers sent surveys to 306 participants in the original gratification study in two followup mailings... Women generally reported a lower BMI than men, but how long the children 

were able to hold off gratification had an even stronger link to weight than did sex. For 

every minute that a child postponed gratification, the researchers noticed a 0.2-point 

decrease in BMI among the grown participants. Atlantic

Coming next: Using an app as prescribed

19 August - Before long, your doctor may be telling you to download two apps and call her 

in the morning. Smartphone apps already fill the roles of television remotes, bike 

speedometers and flashlights. Soon they may also act as medical devices, helping patients 

monitor their heart rate or manage their diabetes, and be paid for by insurance. The idea of 

medically prescribed apps excites some people in the health care industry, who see them as 

a starting point for even more sophisticated applications that might otherwise never be 

built. But first, a range of issues — around vetting, paying for and monitoring the proper 

use of such apps — needs to be worked out. New York Times

Decline in circumcisions could prove costly

21 August - Fewer boys are being circumcised these days, and that could add to health 

costs down the road. Over the past two decades, circumcision rates in the U.S. have fallen to 

55 percent from a peak of about 79 percent. Insurance coverage for the procedure has also 

fallen — particularly under Medicaid — and is a factor in the decline. Yet three separate 

studies have found that circumcision reduces the risks of infection with HIV, leading the 

World Health Organization to recommend it in places where HIV risk runs high. Kenya, for 

one, is turning to circumcision of adult men to curb the spread of the virus there.

Circumcision also reduces the risk of infection with genital herpes virus and human 

papillomavirus. The practice can also reduce urinary tract infections in young boys. Later on, 

men's female sex partners are less likely to develop some infections if the guys are 

circumcised. NPR
Father's age seen as crucial to baby's disease risk

22 August - A father's age, not a mother's, when a baby is 

conceived is the single largest factor in the risk of passing on 

new gene mutations to children and may help explain why 

childhood autism rates are rising, scientists said on 

Wednesday. In a study which turns conventional thinking on 

its head, researchers sequenced the genomes of 78 Icelandic families with children 

diagnosed with autism or schizophrenia and found a father's age was crucial to the genetic 

risk of such disorders. "Conventional wisdom has been to blame developmental disorders of 

children on the age of mothers," said Kari Stefansson, chief executive of the private firm 

deCODE Genetics in Reykjavik, whose work was published in the journal Nature. "(But) our 

results all point to the possibility that as a man ages, the number of hereditary mutations in 

his sperm increases." Medline Plus

Gut bacteria increase pre-diabetes risk 

16 August - Certain bacteria in the human gut seem to be associated with pre-diabetes, a 

condition marked by a constellation of risk factors that often precedes the on-set of fullblown type 2 diabetes in humans. The finding is part of an effort to discover the role of 

trillions of bacteria or microbiota that live in our bodies. According to Brandi Cantarel, the 

number of bacteria living happily inside us outnumbers human cells by an astounding 10-1.

Cantarel is a researcher at the Institute for Genome Science at the University of Maryland 

School of Medicine in Baltimore. “With all that extra stuff, let’s say genetic material in our 

bodies that doesn’t come from us, it comes from other sources, we think it has to be doing 

something," said Cantarel. "Right?” According to Cantarel, scientists believe there are over 

7,000 strains of more than 1,000 different species of bacteria that live in the digestive tract, 

most of them in the gut or small intestine, which play a role in human health. Many of the 

trillions of microbes are helpful; without them, for example, we couldn’t digest food 

properly. But experts say bacteria that are out of balance could be harmful. Researchers 

have identified 26 microbes that researchers say may be negatively associated with prediabetes or metabolic syndrome. VOA

How well you sleep may hinge on race

20 August - ... The idea that race or ethnicity might help determine how well people sleep is 

relatively new among sleep researchers. But in the few short years that epidemiologists, 

demographers and psychologists have been studying the link, they have repeatedly come 

to the same conclusion: In the United States, at least, sleep is not colorblind. Non-Hispanic 

whites get more and better-quality sleep than people of other races, studies repeatedly 

show. Blacks are the most likely to get shorter, more restless sleep. What researchers don’t 

yet know is why. New York Times
Scientists ID cancer-causing agent in smokeless tobacco

22 August - Scientists have linked a specific ingredient in smokeless tobacco products to an 

increased risk for oral cancer, in research using rodents. The culprit, found in such products 

as chewing tobacco and snuff, is a nitrosamine compound called (S)-NNN. Nitrosamines in 

tobacco are considered to be cancer-causing, according to the U.S. National Cancer 

Institute. Authors of the new study acknowledge that such compounds are found in many 

foods, including beer and bacon. But they say that levels are much higher in smokeless 

tobacco products, leading them to suggest that the U.S. government should therefore ban 

or regulate (S)-NNN. The researchers are scheduled to present their findings Wednesday at 

the American Chemical Society annual meeting, in Philadelphia. Medline Plus

Tap water use in neti pot tied to rare, fatal brain infection

23 August - Two people in Louisiana died last year from a rare brain infection contracted 

after using neti pots containing tap water to flush their sinuses. The infection, known as 

primary amebic meningoencephalitis, occurs after water containing the amoeba Naegleria 

fowleri enters the nose and travels through the olfactory nerve into the brain. This is the first 

time tap water and neti pots have been connected to infection with N. fowleri, according to 

a report appearing online Aug. 23 in Clinical Infectious Diseases. Health Day

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USAFRICOM

Angola: Health sector to vaccinate over 5000 children 

against measles

22 August - Some 5.271 children, aged from six months to 15 years, will be vaccinated 

against measles vaccine in the central Kwanza Sul province. This is part of the campaign 

happening on 17-23 August, aimed at fighting against the referred disease. Speaking to 

Angop on Wednesday, the head of the local public health for pandemic diseases control, 

Maria Lussinga said that the campaign is happening without any constraints and the 

parents are cooperating in taking their children to posts stationed for the vaccination of the 

minors. According to her, the campaign is happening due to cases of the disease recorded 

in the districts of Wako Kungo and Seles, thus, encouraging the local health authorities to 

promote this kind of action so as to prevent the expansion of the disease in these localities.

All Africa

Democratic Republic of Congo: Ebola, WHO update

21 August - As of 20 August 2012, a total of 15 (13 probable and 2 confirmed) cases with 10 

deaths have been reported in Province Orientale in Eastern DRC. The reported cases and 

deaths have occurred in 3 health zones as follows: 12 cases and 8 deaths in Isiro, including 

three (3) health care workers who have died; 2 cases and 1 death in Pawa; and 1 fatal case in 

Dungu. The Congolese Ministry of Health has convened a National Task Force and is 
working with several partners including WHO, UNICEF, Médecins sans Frontières (MSF) 

Suisse, MSF Belgique and the United States Centres for Disease Control and Prevention 

(CDC). Similar Task Forces have been established at provincial and district levels to oversee 

and guide the response. A joint MoH, WHO and MSF emergency response team is in the 

field to conduct a detailed epidemiological investigation and support case management. 

Control activities that are being carried out include active case finding and contact tracing, 

enhanced surveillance, case management, public information and social mobilization, and 

reinforcing infection control practices...WHO does not recommend that any travel or trade 

restrictions be applied to Democratic Republic of Congo. WHO

Sierra Leone cholera death toll rises to 217

23 August - Humanitarian officials say the death toll from a cholera outbreak in Sierra Leone 

has risen to 217 people. Oxfam said Thursday that the death rates in the West African 

country are almost double emergency thresholds. Nearly 12,000 cases already have been 

reported and Oxfam said the number of people affected is "likely to increase significantly in 

the next month." Aid groups say there has been a spike in reported cholera cases since midJuly and the onset of the rainy season. Some 82 deaths have been reported in neighboring 

Guinea, while other cases have been seen in Mali and Niger. CBS News

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USCENTCOM

Afghanistan: Study shows malaria is over-diagnosed

17 August - ... [R]esearchers from the London School of Hygiene and Tropical Medicine and 

Afghanistan-based research organizations looked at 22 primary care clinics in two Afghan 

provinces to see what proportion of patients suspected of having malaria were accurately 

treated. They compared diagnoses and treatment outlined in 2357 patients’ records to 

blood samples and found that many of the patients had tested negative for the parasite, yet 

were still being treated. The problem with this, the researchers said, is that serious nonmalarial illnesses go untreated, malaria drugs are wasted, and the cost effectiveness of the 

malaria diagnostic tests is reduced... According to the study, of 415 patients diagnosed with 

malaria based on symptoms, 412 were actually negative, and had been given malaria 

medication anyway. Only one percent was diagnosed and treated accurately (meaning the 

patients had malaria and were treated for malaria). In contrast, in that same clinic, a second 

group was diagnosed using microscopy. From this group, 63 percent (127/202) was 

diagnosed and treated accurately. An improvement, but that still means that 37 percent of 

that population received malaria medication without being infected. Health Map
Syria: Number of displaced people grows as violence 

continues, says UN agency

17 August - The humanitarian crisis generated by the ongoing Syrian conflict is rapidly 

growing as refugees from the Middle Eastern country continue to flee the ongoing violence 

and spill over into neighbouring areas, the United Nations refugee agency said today. 

According to the Office of the UN High Commissioner for Refugees (UNHCR), the amount 

of registered refugees seeking sanctuary in Lebanon, Turkey, Jordan and Iraq has grown by 

over 12,000 – increasing from 157,577 to 170,116 in just the past three days... Meanwhile, 

the World Health Organization (WHO) today warned that a lack of access to medical 

facilities, compounded with severe staffing shortages in hospitals, was further aggravating 

the Syrian health care system. Speaking at a press briefing in Geneva, WHO’s Director of the 

Department of Emergency Risk Management and Humanitarian Response, Dr. Richard 

Brennan, said that the UN health agency would continue to support four mobile clinics, 

serving approximately 90,000 people in the governorates of Rural Damascus and Homs. UN 

News Centre

Yemen: Time running out for solution to water crisis

13 August - ... Water and sanitation are chronic problems in Yemen, where, on average, 

each Yemeni only has access to about 140cu.m. of water per year for all uses. (The Middle 

East average is about 1,000cu.m. per person per year.) In recent years, the government of 

former President Ali Abdullah Saleh had taken strides to improve water access in Yemen, 

but the political turbulence that arose from last year’s uprising has pushed water down the 

new government’s list of priorities, according to aid workers and a government employee.

IRIN

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USEUCOM

France: A cluster of meningococcal disease caused by 

rifampicin-resistant C meningococci, April 2012 

23 August - In April 2012, a cluster of two cases of meningococcal disease caused by 

rifampicin-resistant C meningococci was reported in the Champagne-Ardenne region, 

France. The two cases occurred in a student population living in the same town but studying 

at different schools. Bacteriological and epidemiological investigations of cases have shown 

that the isolates of both cases were non-differentiable. Eurosurveillance

Germany: Cancer survival after the fall of the Iron 

Curtain 

23 August - Data from the 1970s and 1980s show that people affected by cancer survived 

significantly longer in West Germany than cancer patients behind the Iron Curtain. Looking 

at a diagnosis period from 1984 to 1985 in the former German Democratic Republic, 28 
percent of colorectal cancer patients, 46 percent of prostate cancer patients, and 52 percent 

of breast cancer patients survived the first five years after diagnosis. By contrast, 5-year 

survival rates for people in West Germany affected by these types of cancer were 44 

percent, 68 percent, and 68 percent in the years from 1979 to 1983 already. EurekAlert!

Greece's latest crisis: Rising HIV cases

27 July - One of the alarming consequences of the 

financial crisis in Greece appears to be a sharp rise in the 

rate of HIV infection. The country, which is struggling 

through a historic debt crisis and a deep recession, still has 

one of the lowest HIV infection rates in Europe. But budget 

cuts to health and social services seem to be driving a recent and dramatic increase, 

especially among injecting drug users. About 20 recovering drug users gather daily at the 

Off Club, an outpatient community center in central Athens. On a recent day, one is making 

lunch wearing a surgical mask and gloves. "We assume that everyone here either has AIDS 

or hepatitis C, so we have to be careful," says center director Panagiotis Saivanides. NPR

Spain: Firefighters tackle wildfire blaze

20 August - Firefighters in Spain tackle a forest fire overnight in Torneros de Jamuz near 

León. With hot and dry conditions, Spain is having its worst wildfires in a decade. More than 

50,000 hectares of land have been destroyed in the first five months of 2012. Although 

firefighters managed to contain the blaze, officials say the fire is still active. Guardian

United Kingdom: Drug user's anthrax infection death

17 August - A drug user has died after being infected with anthrax, health experts have said.

The Health Protection Agency said that a person who injected drugs died in hospital in 

Blackpool. The news comes after a spate of cases in Europe since early June. The HPA said 

the source of the infection is presumed to be contaminated heroin. The HPA said it is 

"unclear" whether the case in Blackpool and another case in Scotland - which was confirmed 

at the end of July - are linked to the European outbreak... Since June there have been seven 

confirmed cases of the infection - one in Scotland, three in Germany, two in Denmark, and

one in France. The Press Association

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USNORTHCOM

U.S.: Chickenpox down 80 percent since 2000

20 August - Signaling the retreat of a childhood rite of passage, the incidence of chickenpox

in the United States fell by 80 percent from 2000 to 2010, the Centers for Disease Control 

and Prevention reported last week. The decline results from widespread use of the 

chickenpox vaccine, researchers said. From 2000 to 2005, a period when a single dose of 

vaccine was recommended for children 12 to 18 months old and for older unvaccinated 
children, cases fell by 43 percent. The decline steepened once a second dose was 

recommended in 2006, with incidence falling 72 percent in the second half of the decade. 

Chickenpox cases decreased most in children ages 1 through 9, who were most likely to get 

the vaccine, according to the C.D.C. After 2006, chickenpox decreased especially 

prominently in children ages 5 through 9, the group most likely to have gotten a second 

dose during that period. The C.D.C. previously reported significant decreases in chickenpox 

from 1995 to 2000, with incidence falling by 70 to 85 percent in three communities selected 

for surveillance. New York Times

U.S.: Huge fire burns to edge of 3 small Calif. towns

20 August - Aided by a shift in wind direction, firefighters 

made a stand against a huge lightning-sparked wildfire 

burning on the edge of three small Northern California 

towns. The blaze, which grew to more than 25 square miles 

late Monday continued to threaten thousands of homes, as 

fearful residents sought safety miles away at an emergency shelter. "All we can do is pray," 

evacuee Jerry Nottingham told reporters. Still, with more firefighters arriving on the scene 

and shifting winds helping to keep the blaze away from homes, officials said fire crews were 

able to improve their lines around the wildfire. "We definitely made some good progress 

today building around this fire," state fire spokesman Daniel Berlant said late Monday. The 

fast-moving Ponderosa Fire was one of many burning across the West, where lightning, dry 

temperatures and gusting winds have brought an early start to fire season. ABC News

U.S.: Nearly half of U.S. doctors struggle with burnout: 

study

21 August - Job burnout strikes doctors more often than it does other employed people in 

the United States, according to a national survey that included more than 7,000 doctors.

More than four in 10 U.S. physicians said they were emotionally exhausted or felt a high 

degree of cynicism, or "depersonalization," toward their patients, said researchers whose 

findings appeared in the Archives of Internal Medicine. "The high rate of burnout has 

consequences not only for the individual physicians, but also for the patients they are caring 

for," said Tait Shanafelt of the Mayo Clinic in Rochester, Minnesota, who led the research.

Previous studies have shown that burned-out doctors are more prone to thinking about 

suicide and to making medical errors than their peers, Shanafelt added. Reuters

U.S.: Tattoo ink linked to serious skin infections

23 August - If you're going to take a walk on the wild side and get a tattoo, it could get 

even wilder than you planned. Federal and state health investigators have identified five 

clusters of skin infections linked to tattoos. Now it's true that infection risks from tattoos are 

not exactly new or unknown. In fact, tattoo parlors are licensed and regulated in many 

jurisdictions to minimize the risk of trouble for people getting "inked." But those 

precautions would have been of no help to at least 14 people infected during tattooing in 

New York last year. Investigators figured out the source of the germs was the ink itself. And 

that may be just the tip of the tattoo needle. NPR
U.S.: Tropical diseases - the new plague of poverty

18 August – In the United States, 2.8 million children are living in 

households with incomes of less than $2 per person per day, a 

benchmark more often applied to developing countries. An 

additional 20 million Americans live in extreme poverty... Poverty 

takes many tolls, but in the United States, one of the most tragic 

has been its tight link with a group of infections known as the neglected tropical diseases, 

which we ordinarily think of as confined to developing countries. Outbreaks of dengue 

fever, a mosquito-transmitted viral infection that is endemic to Mexico and Central America, 

have been reported in South Texas. Then there is cysticercosis, a parasitic infection caused 

by a larval pork tapeworm that leads to seizures and epilepsy; toxocariasis, another parasitic 

infection that causes asthma and neurological problems; cutaneous leishmaniasis, a 

disfiguring skin infection transmitted by sand flies; and murine typhus, a bacterial infection 

transmitted by fleas and often linked to rodent infestations. Among the more frightening is 

Chagas disease. Transmitted by a “kissing bug” that resembles a cockroach but with the 

ability to feed on human blood, it is a leading cause of heart failure and sudden death 

throughout Latin America. It is an especially virulent scourge among pregnant women, who 

can pass the disease on to their babies. New York Times

U.S.: West Nile virus (WNV) activity reported to 

ArboNET, by county, United States, 2012 (as of August 

21, 2012)

CDC

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USPACOM

India: Chikungunya, suspected

23 August - Chikungunya [virus infection] is suspected to have resurfaced in Ganjam district 

with several persons in Boxipalli village reporting its clinical symptoms. It can only be 

confirmed after laboratory tests, doctors said on Tuesday [21 Aug 2012] after visiting 

Boxipalli. "A team of doctors led by district malaria officer (DMO) Uma Shankar Mishra 

along with the paramedics visited Boxipalli on Monday [20 Aug 2012] and collected the 

blood samples," official sources said. The blood samples of 5 persons were sent to MKCG 

Medical College and Hospital. These samples will also be tested for malaria. An outbreak of 

chikungunya in Boxipalli, a predominantly fishing village, was reported 2 days ago [19 Aug 

2012], when a number of people were suffering from fever with joint pain. Doctors said 

during their visit they did not find any fever cases but people with joint pain. Fishermen had 

reported similar symptoms in May [2012] but the blood samples tested negative for 

chikungunya [virus infections]. However, 9 chikungunya cases were reported in Golabandh, 

another fishermen dominated village, in April [2012]. "Out of 22 blood samples from 

Golabandh, 9 tested positive," a senior doctor said. ProMED-mail

Indonesia: Growing concern over hepatitis

17 August - Poor awareness about hepatitis infections and a lack of treatment have made 

the disease a growing public health threat in Indonesia, say experts. An estimated 25 million 

Indonesians have either had hepatitis B or C, but only about 20 percent of them know, said 

Rino Gani, the chairman of the Indonesian Liver Research Association. Hepatitis is a viral 

infection with latent symptoms that can take decades to discover while it damages the liver. 

Impaired liver function makes it hard for the body to excrete waste or for blood to clot 

properly, which can be fatal in an accident or a complication from surgery. IRIN

New immune-deficiency illness emerging in East Asia

22 August - Investigators say they've identified an emerging immune-deficiency syndrome 

that is killing or sickening people in East Asia. Although human immunodeficiency virus 

(HIV) is not linked to the illness, the illnesses appear similar to what people with HIV often 

get, say the team from the U.S. National Institutes of Health. The new syndrome, which does 

not seem to pass from person to person, involves an immune-system antibody that blocks a 

molecule critical to fighting off infections and auto-immune diseases. The antibody works 

against a common protective molecule called interferon-gamma (IFN-gamma), triggering 

immunodeficiency in some adults, the research team said. People with the syndrome seem 

especially susceptible to infections caused by what are called opportunistic microbes, which 

can lie dormant in the body for years but are activated and multiply when the body's 

immune system is weakened. They're more likely to get diseases such as nontuberculous 

mycobacteria (NTM), a rare cousin to tuberculosis that can cause severe lung disease. 

Medline Plus
Taiwan: CDC reports six new cases of severe enterovirus

14 August - The Centers for Disease Control (CDC) reported six new cases of severe 

enterovirus in Taiwan on Tuesday, urging parents and caretakers to pay attention to 

symptoms that may indicate an infection. The patients, children between one month and 10 

years old, were all treated and discharged from hospital, said CDC Deputy Director-General 

Chou Jih-haw at a routine press briefing. Five of the children are from northern Taiwan and 

one -- an eight-month old girl -- is from an outlying island, he said. Statistics show that the 

enterovirus situation is more serious in the northern areas of the country, Chou said. Taiwan 

Headlines

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USSOUTHCOM

Caribbean: Tropical Storm Isaac getting better organized

22 August - Leaders across much of the Caribbean closed schools and government offices 

on Wednesday and urged people to stay at home as Tropical Storm Isaac swept toward the 

region, threatening to soon become a hurricane and perhaps eventually to menace Florida. 

The storm was 140 miles east of the French Caribbean island of Guadeloupe late 

Wednesday morning, with maximum sustained winds of 45 mph. Isaac was moving west at 

21 mph and was expected to become a hurricane by Thursday, according to the U.S.

National Hurricane Center... The storm's center was expected to move over the Leeward 

Islands on Wednesday evening, and forecasters said it is expected to hit the Dominican 

Republic, Haiti and Cuba as a hurricane later in the week. Isaac also poses a possible threat 

to Florida during next week's Republican National Convention in Tampa. Tropical storm 

warnings are in effect for Puerto Rico, the U.S. and British Virgin Islands and a swath of 

islands across the Caribbean including Martinique, Dominica, Guadeloupe, St. Martin, St. 

Kitts, Nevis, Antigua, Barbuda, Montserrat, Anguilla, Saba, St. Eustatius, St. Maarten, Culebra 

and Vieques. A hurricane watch is in effect for Puerto Rico, Vieques, Culebra, the U.S. and 

British Virgin Islands and the south coast of the Dominican Republic. USA Today

Dominican Republic: 300 hospitalized with suspected 

cholera

19 August - More than 300 people have been hospitalized in 

the Dominican Republic with suspected cholera symptoms 

over the past three days. The authorities have blamed this 

latest outbreak on the poor quality of drinking water. The 

country had a cholera epidemic last year. Fortunately, it was 

quickly curbed thanks to timely precautions, but the disease spilled across the border into 

neighboring Haiti where it claimed 7,000 lives. Voice of Russia

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