27 July 2012

Army Public Health Weekly Update

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

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

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Contents

U.S. MILITARY

 Accused harassers' trial draws national interest

 Diarrhea outbreak during U.S. military training in El Salvador

 Mental disorders and mental health problems, active component, U.S. Armed Forces, 2000-

2011

 Military faces suicide ‘epidemic,’ Panetta tells Congress

 Pentagon’s $18 million tool for assessing traumatic brain injury fails to deliver

GLOBAL

 A new Body Shape Index predicts mortality hazard independently of Body Mass Index

 New approach to fighting malaria targets parasite, not mosquitoes

 New drug combination may shorten, simplify TB therapy

 Scientists say an HIV cure is within reach

 US donates extra $150 million to battle AIDS

 World's first dengue vaccine beats three virus strains

INFLUENZA

 All U.K. kids to get AstraZeneca's nasal flu vaccine

 CDC: Weekly Influenza Surveillance Report

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

 Four novel H3N2 cases linked to pigs in Indiana

 Mexico culls 3.8 million poultry in response to H7N3 outbreak

 Naval Health Research Center: Febrile Respiratory Illness Surveillance Update

 Study: Postpandemic influenza B unexpectedly severe in adults

VETERINARY/FOOD SAFETY

 Another Salmonella hatchery outbreak: 37 ill in 11 states

 Cargill beef tied to 33 person, 7 state Salmonella outbreak

 European E. coli outbreak sheds new light on treatment strategies
Public Health 

Command-South 

Begins Renovation

The $17.7 million 

remodeling and expansion 

of the laboratory building 

and administrative wing of 

Public Health CommandSouth began July 17 during 

a renovation ceremony 

held on the lawn of 

Building 2631, as Lt. Col. 

Deydre Teyhen passed the 

sledgehammer to Randall 

Nimocks with Austin’s J&J 

Maintenance Inc.

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Look under Hot Topics & 

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To access this version, you 

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 Might food become a vehicle for tropical disease?

WELLNESS

 A single pill could treat Alzheimer's, Parkinson's AND multiple sclerosis

 Hunter gatherer clue to obesity

 Symptoms of traumatic brain injury can persist for years

 The 10-minute workout, times three

USAFRICOM

 Africa: Researchers to test monthly vaginal ring for HIV prevention

 Democratic Republic of Congo: Cholera outbreaks

 South Africa: HIV awareness campaigns paying off

 Tanzania: Ferry boat death toll reaches 94

 Zimbabwe: Typhoid outbreak in city

USCENTCOM

 Egypt: Progress toward prevention and control of hepatitis C virus infection, 2001-2012

 Treating drug addicts costs Saudi Arabia SR 3.6 bn

 UAE: New cancer diagnostic units at Tawam Hospital

USEUCOM

 Technical Report: The climatic suitability for dengue transmission in continental Europe

 United Kingdom: Differences in hepatitis B infection rate between ethnic groups in antenatal 

women, May 2004 – Dec 2008

USNORTHCOM

 Airports most likely to spread infection: JFK, LAX, Honolulu

 Doctors call for new U.S. painkiller labels to stop abuse

 How fake cancer drugs entered U.S.

 New York City's proposed ban on big sugary sodas draws heated debate

 U.S. aims at 25 percent reduction in new HIV infections by 2015

 U.S.: CBO says healthcare ruling could save $84 billion

 U.S.: Rabies surge in some states might be due to heat

USPACOM

 China: Death toll from Beijing rainstorm climbs to 77

 India: 40 nuclear plant workers contaminated

 India: Congo fever has killed seven in state

 Western fast food tied to heart risks in Asia

USSOUTHCOM

 Brazil: Rocky Mountain spotted fever
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U.S. MILITARY

Accused harassers' trial draws national interest

22 July - Danny Chen was tall and lanky, a smart young man from New York who joined the 

Army after high school because it was his dream. That dream ended Oct. 3 when Chen, an 

Army private, died of a self-inflicted gunshot in a guard tower in Afghanistan. At a small 

combat outpost in Kandahar province, military authorities have said, Chen -- the son of 

Chinese immigrants -- was taunted, harassed and punished by fellow soldiers, in part, 

because of his ancestry... This week, the first of eight soldiers accused of driving Chen to 

suicide will stand trial on Fort Bragg... Documents explaining the charges against the 

soldiers detail an environment where officials said soldiers were allowed to haze and harass 

other soldiers. At least three other soldiers, all ranked lower than specialist, are listed as 

victims of various abuses at the hands of the soldiers. Military.com

Diarrhea outbreak during U.S. military training in El 

Salvador

18 July - Infectious diarrhea remains a major risk to deployed military units worldwide in 

addition to their impact on travelers and populations living in the developing world. This 

report describes an outbreak of diarrheal illness in the U.S. military’s 130th Maneuver 

Enhancement Brigade deployed in San Vicente, El Salvador during a training and 

humanitarian assistance mission... Personnel (n = 241) completed an epidemiological survey 

(87% response rate) and 67 (27%) reported diarrhea and/or vomiting during the past two 

weeks. The median duration of illness was reported to be 3 days (IQR 2–4 days) and 

abdominal pain was reported among 30 (49%) individuals. Presentation to the medical aid 

station was sought by (62%) individuals and 9 (15%) had to stop or significantly reduce 

work for at least one day. Microscopy and PCR analysis of 14 stool samples collected from 

previously symptomatic patients, Shigella (7), Cryptosporidium (5), and Cyclospora (4) were 

the most prevalent pathogens detected. Consumption of food from on-base local vendors 

(RR = 4.01, 95% CI = 1.53–10.5, p-value <0.001) and arriving on base within the past two 

weeks (RR = 2.79, 95% confidence [CI] = 1.35–5.76, p-value = 0.001) were associated with 

increased risk of developing diarrheal disease. The risk of infectious diarrhea is great among 

reserve military personnel during two week training exercises. The consumption of local 

food, prepared without proper monitoring, is a risk factor for deployed personnel 

developing diarrheal illness. PloS One

Mental disorders and mental health problems, active 

component, U.S. Armed Forces, 2000-2011

June 2012 - Mental disorders account for significant morbidity, health care utilization, 

disability, and attrition from military service; the health care burden associated with mental 

disorders has increased over the last several years. During the years 2000 through 2011, 

936,283 active component service members were diagnosed with at least one mental 

disorder. Annual counts and rates of incident diagnoses of mental disorders have increased 
by approximately 65 percent over the last twelve years; this overall increase is largely 

attributable to diagnoses of adjustment disorders, depressive and anxiety disorders, and 

post-traumatic stress disorder. Rates of incident mental disorder diagnoses were higher in 

females than males and in service members under 30 years of age. These findings reinforce 

previous reports that have documented a rise in demand for mental health services in the 

active component force and suggest that continued focus on detection and treatment for 

mental health issues is warranted. Medical Surveillance Monthly Report

Military faces suicide ‘epidemic,’ Panetta tells Congress

25 July - The U.S. military is experiencing a suicide “epidemic,” with as many as 206 service 

members having taken their own lives this year, Defense Secretary Leon Panetta told 

lawmakers today. There were 104 confirmed military suicides this year, along with 102 

investigations into potential suicides, Panetta testified before a joint hearing of the House of 

Representatives Armed Services Committee and the Committee on Veterans Affairs. 

Bloomberg

Pentagon’s $18 million tool for assessing traumatic brain 

injury fails to deliver

18 July - For at least two years the Military Health System has touted a software tool under 

development at a cost of more than $18 million as a way to help gather information about 

troops impaired by the signature wound of the wars in Afghanistan and Iraq -- traumatic 

brain injury, which results from exposure to roadside bombs. But a six-week probe by 

Nextgov shows this tool has nothing to do with the management or assessment of TBI 

cases. Nextgov

top of page...

GLOBAL

A new Body Shape Index predicts mortality hazard 

independently of Body Mass Index

18 July - Obesity, typically quantified in terms of Body Mass Index (BMI) exceeding 

threshold values, is considered a leading cause of premature death worldwide. For given 

body size (BMI), it is recognized that risk is also affected by body shape, particularly as a 

marker of abdominal fat deposits. Waist circumference (WC) is used as a risk indicator 

supplementary to BMI, but the high correlation of WC with BMI makes it hard to isolate the 

added value of WC... We developed A Body Shape Index (ABSI) based on WC adjusted for 

height and weight:

ABSI had little correlation with height, weight, or BMI. Death rates increased approximately 

exponentially with above average baseline ABSI... whereas elevated death rates were found 
for both high and low values of BMI and WC... The association of death rate with ABSI held 

even when adjusted for other known risk factors including smoking, diabetes, blood 

pressure, and serum cholesterol. ABSI correlation with mortality hazard held across the 

range of age, sex, and BMI, and for both white and black ethnicities (but not for Mexican 

ethnicity), and was not weakened by excluding deaths from the first 3 yr of follow-up. PLoS 

One

New approach to fighting malaria targets parasite, not 

mosquitoes

21 July - Attempts to control malaria — which kills about 1 

million people a year — have traditionally focused on the use 

of drugs to treat the disease and insecticides to kill mosquitoes. 

Now some scientists have devised a sneakier strategy: feed 

mosquitoes a genetically engineered bacterium that will kill the 

malaria parasite from within. Insecticides have a major flaw, said Marcelo Jacobs-Lorena, a 

malaria expert at Johns Hopkins University and an author of the new study. "When 

insecticides are used — say, inside of houses — many of the mosquitoes in the area get 

killed but some will always survive. It's a perfect way to select for resistance," he said. That's 

because the mosquitoes most resistant to insecticides will survive and have insecticideresistant offspring. The same problem exists for anti-malaria drugs... Ten years ago, his 

group was the first to show that mosquitoes could be genetically engineered to produce 

anti-malarial proteins in their guts, rendering them incapable of harboring the parasite. The 

idea was that the insects would be released into the wild and spread their new genes

around. Los Angeles Times

New drug combination may shorten, simplify TB therapy

25 July - A combination of an experimental drug, an unapproved antibiotic used for treating 

other infections and an established tuberculosis drug may provide a simpler, more rapid 

treatment for TB, according to results from a small pilot trial. The combined treatment 

eliminated 99% of the TB bacteria from the patients' bodies within two weeks in the study, 

which suggests that it may be possible to dramatically shorten treatment regimens. And 

because the regimen does not use any drugs that the TB bacterium has become resistant to 

or that interfere with HIV treatment, they could potentially be used to treat TB patients who 

are HIV-positive and those who have drug-resistant TB -- both of which are growing 

problems. Los Angeles Times

Scientists say an HIV cure is within reach

25 July - An influential group of scientists gathered this week at the International AIDS 

Conference in Washington is committing to a goal that just five years ago would have 

seemed ludicrous: to cure HIV. After studying the virus for more than 30 years and 

developing potent drugs that transformed the disease from a death sentence into a 

manageable chronic condition, a growing number of researchers now say the search for a 

cure should be a major research priority. While acknowledging substantial challenges, they 

argue that the effort is necessary because the epidemic cannot be contained through 
treatment and prevention alone. And recent medical and scientific advances — including 

the case of the first man definitively cured of the human immunodeficiency virus— offer 

proof that it’s possible. Spearheading this audacious challenge is the International AIDS 

Society, which developed a research agenda in collaboration with more than 40 scientists 

led by French virologist Francoise Barre-Sinoussi, who won the Nobel Prize in physiology or 

medicine in 2008 for her role in the discovery of HIV. Among the tasks: investigating where 

and how the virus can hide out in the body and studying the immune response of the select 

group of people who are naturally immune to HIV. Morris Daily Herald

US donates extra $150 million to battle AIDS

23 July - Science now has the tools to slash the spread of HIV even without a vaccine — and 

the U.S. is donating an extra $150 million to help poor countries put them in place, the 

Obama administration told the world's largest AIDS conference Monday. "We want to get to 

the end of AIDS," declared the top U.S. HIV researcher, Dr. Anthony Fauci of the National 

Institutes of Health. How long it takes depends on how quickly the world can adopt those 

tools, he said — including getting more of the millions of untreated people onto life-saving 

drugs that come with the bonus of keeping them from infecting others. "No promises, no 

dates, but we know it can happen," Fauci told the International AIDS Conference. Boston 

Globe

World's first dengue vaccine beats three virus strains

25 July - The world's first vaccine against dengue, developed by French drugmaker Sanofi 

SA, has shown the ability to protect against disease caused by three of four virus strains in a 

keenly awaited clinical trial in Thailand. Sanofi said on Wednesday the proof of efficacy was 

a key milestone in the 70-year quest to develop a viable dengue shot, adding the results 

also confirmed the safety profile of the vaccine candidate. Other drug companies are also 

working on dengue vaccines but Sanofi's product is several years ahead. Reuters

top of page...

INFLUENZA

All U.K. kids to get AstraZeneca's nasal flu vaccine

25 July - Britain is to extend its seasonal flu vaccination 

program to all children, free of charge, becoming the first 

country in the world to do so, the Department of Health said on 

Wednesday. Children will get AstraZeneca's nasal spray vaccine 

rather than injections under the new scheme, which is expected 

to cost more than 100 million pounds ($155 million) a year and cover to up to 9 million 

children once it is fully established. The roll-out is likely to take some time, however, since 

the drugmaker will not have the capacity to deliver enough new vaccine until 2014 at the 
earliest. Health experts broadly welcomed the move but said it would be important to keep 

up constant monitoring of responses and work ahead of time to ensure the plan is accepted 

by the public. Peter Openshaw of the centre for respiratory infection at Imperial College 

London said although there were "areas of debate" about vaccinating healthy children as 

well those in high-risk groups, he nevertheless strongly supported the plan. "Not only would 

it protect children against flu but it would also reduce the circulation of flu in the population 

and ... protect those at high risk of severe disease," he said. Reuters

CDC: Weekly Influenza Surveillance Report

During week 28 (week ending 14 July), 6.0% of all deaths reported through the 122-Cities 

Mortality Reporting System were due to P&I. This percentage was below the epidemic 

threshold of 6.7% for week 28. FluView

European Centre for Disease Prevention and Control:

Weekly Influenza Surveillance Overview

During weeks 27-28 (2-15 July 2012), all reporting countries stated they were experiencing 

no activity or only sporadic activity of influenza-like illness. Weekly Influenza Surveillance 

Overview

Four novel H3N2 cases linked to pigs in Indiana

25 July - Four people who exhibited pigs at a recent county fair in Indiana were infected 

with a novel swine-origin H3N2 influenza strain, raising the number of such cases reported 

in the past year to 17, according to Indiana health officials. The four patients had illnesses 

resembling typical seasonal flu and have all recovered, according to Pam Pontones, MA, 

Indiana's state epidemiologist. They showed pigs at the LaPorte County Fair in northwestern 

Indiana, which was held Jul 8 to 14. None of the patients were seriously ill or hospitalized, 

Pontones told CIDRAP News. She said the patients were a variety of ages, but for 

confidentiality reasons she declined to disclose their specific ages or other details about 

them. The same H3N2 variant—which was previously dubbed H3N2v—was found in all 12 

pigs shown at the fair that were randomly selected for testing, according to Denise Derrer, a 

spokeswoman for the Indiana State Board of Animal Health (BOAH). All the human patients 

worked closely with swine, Pontones said, adding, "We have not identified any cases that 

appeared to be transmitted person to person. All four appeared to have direct swine 

contact, which facilitated transmission." CIDRAP

Mexico culls 3.8 million poultry in response to H7N3 

outbreak

25 July - Mexico has now culled about 3.8 million poultry to stop the spread of H7N3 avian 

flu in Jalisco state, the nation's health agency said in a report today to the World 

Organization for Animal Health (OIE). Mexico's National Food Quality, Food Safety and 

Health Service has tested 32,108 samples obtained from 363 at-risk poultry farms and has 

identified 35 H7N3 isolates. The farms house about 17 million birds. About 15 million doses 

of H7N3 vaccine will arrive this week as part of the country's infection control plan, 
according to a story today from the Spanish-language news agency EFE. About 4.9 million 

birds have either died from the disease or been culled since the outbreak began about a 

month ago, the story said. Yesterday the Wall Street Journal reported that a rise in egg and 

poultry prices caused by the outbreak contributed to Mexico's highest inflation rate in 18 

months. CIDRAP

Naval Health Research Center: Febrile Respiratory 

Illness Surveillance Update 

For the week ending 21 July 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 

Study: Postpandemic influenza B unexpectedly severe in 

adults

25 July - Although 2009 H1N1 influenza A (pH1N1) infections have gained more notoriety, 

influenza B infections, often thought of as mild illnesses in adults, can be just as severe, say 

results of a Spanish study in the Journal of Infection. Fifty adult patients with laboratoryconfirmed influenza B and 80 with pH1N1 who were hospitalized or were followed as 

outpatients because of pregnancy or solid-organ transplant were studied prospectively 

during the postpandemic 2010-11 flu season to compare features, severity, and outcomes. 

Median age of the flu B patients was 34 and of the pH1N1 patients 39. Disease was 

considered severe in 32 (64%) of flu B and in 55 (68%) of pH1N1 cases (P = 0.57). Five (10%) 

of the flu B and 14 (17.5%) of the pH1N1 patients were admitted to the intensive care unit 

(P = 0.23). Fourteen (28%) of the flu B patients and 30 (37.5%) of the pH1N1 patients had 

pneumonia (P = 0.26); in the pneumonia patients, bacterial co-infection was present in 5 

(37.7%) with flu B and 4 (13.3%) with pH1N1 (P = 0.11). Overall, 5 (10%) flu B patients and 

13 (16.3%) pH1N1 patients died (P = 0.31); the outcome was worse in those with 

pneumonia: 4 (28.5%) of the flu B pneumonia patients and 12 (40%) of the pH1N1 

pneumonia patients died (P = 0.46). CIDRAP

top of page...
VETERINARY/FOOD SAFETY

Another Salmonella hatchery outbreak: 37 ill in 11 states

23 July - The Centers for Disease Control and Prevention 

announced Monday that 37 people in 11 states have 

reportedly been infected with the same strain of 

Salmonella Hadar. The number of ill persons identified in 

each state is as follows: Arizona (2), California (1), 

Colorado (3), Idaho (5), Illinois (2), Oregon (5), Tennessee (2), Texas (1), Utah (5), Washington 

(9), and Wyoming (2). Of those known to be sick, eight have been hospitalized and no 

deaths have been reported. Health authorities said 37 percent of those sickened are 

children 10 years of age or younger. "Epidemiologic, laboratory and traceback findings have 

linked this outbreak of human Salmonella infections to contact with live poultry from 

Hatchery B in Idaho," said CDC in a release Monday. "Mail-order hatcheries, agricultural 

feed stores, and others that sell or display chicks, ducklings, and other live poultry should 

provide health-related information to owners and potential purchasers of these birds prior 

to the point of purchase. This should include information about the risk of acquiring a 

Salmonella infection from contact with live poultry." Food Safety News

Cargill beef tied to 33 person, 7 state Salmonella 

outbreak

24 July - A Salmonella Enteritidis outbreak linked to Cargill ground beef is affecting 33 

people in 7 Northeastern states, the Centers for Disease Control and Prevention said 

Monday, a day after the company recalled nearly 30,000 pounds of product. According to 

CDC, 11 of those connected to the outbreak have been hospitalized and no deaths have 

been reported. An investigation by state, local and federal public health agencies has 

zeroed in on ground beef processed by Cargill Meat Solutions at a single facility in 

Pennsylvania as the likely source of the outbreak. Authorities were able to conclusively link 

illnesses in five case patients to ground beef products produced at the Cargill meat 

establishment (EST. 9400) after state labs found the outbreak strain in two separate leftover 

ground beef samples from patient homes. CDC said that the different agencies would 

continue coordinating with one another and using PulseNet to identify ill people connected 

to the outbreak. So far, the illness count for each state is: Maine (1), Massachusetts (3), New 

Hampshire (2), New York (14), Rhode Island (1), Virginia (2) and Vermont (10). Illness onset 

dates range from June 6 to June 26 and those sickened range from 12 years to 101 years 

old. More than half are female. Food Safety News

European E. coli outbreak sheds new light on treatment 

strategies

25 July - It is an accepted fact among medical experts that an E. coli infection should not be 

treated with antibiotics, as these drugs may worsen illness. But a new review of strategies 

used to treat victims of last year's European E. coli outbreak shows that a combination of 
two or more antibiotics may have helped patients recover from hemolytic uremic syndrome 

(HUS) - a potentially fatal complication of E. coli infection. The 2011 outbreak, centered in 

Northern Germany, was characterized by an unusually high number of HUS cases. Out of 

more than 4,000 people sickened by the E. coli O104:H4 bacteria, 22 percent developed this 

life-threatening condition. By contrast, E. coli O157:H7, the most common Shiga toxinproducing E. coli (STEC) in the United States progresses into HUS in 5 to 10 percent of 

patients. HUS occurs when the Shiga toxins released by E. coli bacteria damage blood 

vessels, preventing adequate blood flow as red blood cells get clogged in the vessels. 

Deprived of blood, the kidney cannot perform its function of expelling toxins through 

urine. Food Safety News

Might food become a vehicle for tropical disease?

24 July - It's highly unlikely, but if high in an African 

mango tree a bat dropped its guano on fruit and it was 

harvested and went unwashed on a 747 to America, you 

could end up with a deadly tropical foodborne illness 

characterized by bleeding through the eye socket. These 

are the possibilities that are considered at the International Association for Food Protection, 

which is meeting this week at the Rhode Island State Convention Center. It's where food 

professionals come to learn about the World Health Organization's (WHO's) Global 

Foodborne Infections Network, or PulseNet International, which keeps track of threats most 

of us don't even want to think about. It's where you come to learn about "unusual 

Salmonella serotypes" emerging out of Southeast Asia or new foodborne pathogens like E. 

coli O104:H4. These are the sessions attended by the people from the Centers for Disease 

Control and Prevention in Atlanta who will show up in bug suits if anything really goes 

badly in America. Food Safety News

top of page...

WELLNESS

A single pill could treat Alzheimer's, Parkinson's AND 

multiple sclerosis

24 July - One pill with the potential to treat conditions including Alzheimer’s disease, 

multiple sclerosis and strokes has been unveiled by scientists. Given early enough, it may 

even be able to stop full-blown Alzheimer’s from taking hold. It works by dampening down 

the inflammation thought to be at least partly to blame for many degenerative brain 

conditions, as well damage caused by head injuries and strokes. Animal tests have been 

encouraging and the pill has been given to humans for the first time, although the results 

have yet to be released. Early results from animal studies suggest it could be effective 

against a plethora of devastating brain conditions. They include Alzheimer's and Parkinson's 
disease, multiple sclerosis (MS), motor neurone disease, frontotemporal dementia, and 

complications from traumatic brain injury. Two of the drugs, known as MW151 and MW189, 

have been patented by US scientists at Northwestern University in Chicago. They work by 

blocking excess production of damaging immune system signaling molecules called proinflammatory cytokines. Daily Mail

Hunter gatherer clue to obesity

25 July - The idea that exercise is more important than diet 

in the fight against obesity has been contradicted by new 

research. A study of the Hadza tribe, who still exist as 

hunter gatherers, suggests the amount of calories we need 

is a fixed human characteristic. This suggests Westerners 

are growing obese through over-eating rather than having inactive lifestyles, say scientists.

One in 10 people will be obese by 2015. And, nearly one in three of the worldwide 

population is expected to be overweight, according to figures from the World Health 

Organization. The Western lifestyle is thought to be largely to blame for the obesity 

"epidemic". BBC News

Symptoms of traumatic brain injury can persist for years

18 July - Doctors have long thought that if you ding your head playing sports or in an 

automobile accident, the concussive effects — headaches, dizziness, memory problems —

would fade away with a little rest. But a new study out of the University of Oklahoma

suggests that the symptoms of combat-related traumatic brain injury can last for years 

without decreasing in intensity. The study, which was presented at the annual meeting of 

the American Headache Society last month, looked at 500 veterans of the wars in Iraq and 

Afghanistan who, between June 2008 and April 2011, had screened positive for traumatic 

brain injury during deployment. The veterans were being treated at a special traumatic brain 

injury clinic at the Oklahoma City Veterans Affairs Medical Center. New York Times

The 10-minute workout, times three

25 July - ...As it turned out, exercise was helpful in 

controlling blood pressure, but breaking up the 

workout into three short sessions was significantly more 

effective than the single half-hour session. “The 

fractionized exercise led to lower average 24-hour 

blood pressure readings,” Dr. Gaesser says. It also resulted in lower blood pressure “load,” or 

the number of incidences during the day when a volunteer’s blood pressure spiked above 

140/90. Lowering blood pressure load is important, he points out, because a relatively high 

load “seems to be an indicator that someone with prehypertension is likely to progress” to 

full-blown, clinically high blood pressure. Over all, the results “are really encouraging,” he 

says. “For people who think that 30 minutes of exercise is too hard or takes up too much 

time, we can say, just do 10 minutes” three times during the day. And, conversely, if 

someone is tempted to dismiss a mere 10 minutes of walking as too meager to be 
meaningful, “it seems clear that, at least for blood pressure control, fractionized exercise is 

actually more effective” than a single 30-minute bout. New York Times

top of page...

USAFRICOM

Africa: Researchers to test monthly vaginal ring for HIV 

prevention

24 July - Two large clinical trials in Africa are ramping up to test the effectiveness of a 

vaginal ring that releases an HIV-fighting drug for a month or more, offering women at high 

risk a discreet way to protect themselves from the virus that causes AIDS. The studies will 

test the effectiveness of a vaginal ring containing the antiretroviral drug dapivirine in 

thousands of women in several African countries to evaluate its ability to prevent new HIV 

infections and its long-term safety. If effective, the ring will add "a long-acting, femaleinitiated technology to the existing toolkit of HIV prevention options," said Dr. Zeda 

Rosenberg, chief executive officer of International Partnership for Microbicides (IPM), a 

nonprofit group founded by Rosenberg which is developing the ring. Reuters

Democratic Republic of Congo: Cholera outbreaks

23 July - The Democratic Republic of Congo (DRC) has reported a sharp increase in the 

number of cholera cases in the armed conflict area of North Kivu. According to the report, 

368 new cases were reported from epidemiological week 24 (11-17 June) to epidemiological 

week 26 (25 June-1 July). The most affected areas include Birambizo, Goma, Karisimbi, 

Kiroshe, Mutwanga, Mweso and Rwanguba. There is concern that the security situation may 

increase difficulty in accessing the health-care facilities and could increase the number of 

severe and fatal cases. The current armed conflict in North Kivu also poses a risk of 

international spread of the disease to neighbouring countries such as Burundi, Rwanda, 

South Sudan and Uganda. WHO

South Africa: HIV awareness campaigns paying off 

24 July - A new survey shows that South African HIV/AIDS awareness campaigns have been 

a big success. There’s more testing, condom use and male circumcision. The findings were 

released Tuesday at the 19th International AIDS Conference in Washington. South Africa has 

been one of the countries hardest hit by the epidemic. Some 5.2 million people were 

believed HIV positive in 2008. That was more than 10-and-a-half-percent of the population.

VOA

Tanzania: Ferry boat death toll reaches 94

25 July – The death toll in last week's MV Skagit boat accident in Zanzibar reached 94, after 

16 more bodies were recovered in different parts of Unguja Island and Bagamoyo in Coast 
Region. Minister of State in Zanzibar Second Vice-President's Office, Mr Mohamed Aboud 

Mohamed, told journalists that 11 bodies were recovered along shores on Unguja and five 

were found in Bagamoyo. "Bodies that were recovered along shores in Bagamoyo will be 

buried at the area," the minister explained. Earlier, the Zanzibar Police Force spokesperson, 

Inspector Mohamed Mhina, said 11 bodies that were recovered in Zanzibar were buried in 

one area in the outskirts of Zanzibar town. allAfrica

Zimbabwe: Typhoid outbreak in city

26 July - A typhoid outbreak has hit Harare and Chitungwiza, with at least 111 confirmed 

cases by yesterday. City officials attributed the outbreak to water shortages in the city and 

its satellite towns of Chitungwiza, Norton, Ruwa and Epworth. Typhoid fever, also known as 

typhoid, is a common worldwide bacterial disease, transmitted by the ingestion of food or 

water contaminated with the faeces of an infected person. Chitungwiza, Norton, Ruwa and 

Epworth receive water from Harare whose water treatment plant is facing mechanical 

problems. The majority of the cases are in Chitungwiza where at least 83 people were 

treated for the disease. Harare had 28 confirmed cases, with 25 of them occurring at a 

supermarket in the Avenues area, while three were in Mabvuku/Tafara suburb. City health 

services director Dr Prosper Chonzi said the supermarket has since been barred from selling 

fresh, raw and cooked foods. "We are still tracing the customers who bought food from the 

supermarket," he said. "We have a full outbreak response team in Mabvuku and Tafara. We 

have stationed a doctor at Mabvuku clinic to attend to the cases." Dr Chonzi said six of the 

affected people were detained at the Beatrice Infectious Diseases Hospital. He said the 

majority of the cases were treated and discharged depending on the severity of their 

conditions. All Africa

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USCENTCOM

Egypt: Progress toward prevention and control of 

hepatitis C virus infection, 2001-2012

27 July - Worldwide, 130–170 million persons are living with chronic hepatitis C virus (HCV) 

infection (1), which, if left untreated, can result in cirrhosis and liver cancer. Egypt has the 

largest burden of HCV infection in the world, with a 10% prevalence of chronic HCV 

infection among persons aged 15–59 years (2). HCV transmission in Egypt is associated 

primarily with inadequate infection control during medical and dental care procedures (3,4). 

In response, the Egyptian Ministry of Health and Population (MOHP) in 2001 implemented a 

program to reduce health-care–associated HCV transmission and in 2008 launched a 

program to provide care and treatment. This report describes the progress of these 

programs, identifies deficiencies, and recommends enhancements, including the 

establishment of a comprehensive national viral hepatitis control program. Morbidity and 

Mortality Weekly Report
Treating drug addicts costs Saudi Arabia SR 3.6 bn 

24 July - The Kingdom spent more than SR 3.6 billion treating around 150,000 narcotic 

addicts annually, according to a study by the Riyadh Chamber of Commerce and Industry's 

Center of Information, Research and Studies. The study reviewed the negative impact of 

narcotics on the national economy in addition to losses in productivity and manpower. The 

study also revealed that in 2000 the Kingdom confiscated more than 254.8 tons of narcotics 

smuggled into the country. It pointed out that due to a national crackdown, the amount of 

confiscated drugs was reduced to 12.3 tons in 2006. The study, called 'The Role of Social 

Responsibility in Preventing Narcotics', shed light on the fact that drug-related offenses are 

becoming one of the major issues the national economy faces as they could threaten the 

future development of the country. If the responsibility of treating addicts lies with health 

care institutes, the study added, preventing drug-related offenses lies with social entities 

such as individuals, schools, universities, mosques, the media and research centers. Narcotic 

addictions, according to the study, cannot be combated individually and although treating 

them is important, prevention is equally important as it better serves the national economy. 

The research said treatment and rehabilitation costs are very high. The benefits from 

treatment programs are minimal because the majority of addicts are unemployed and only 

18 percent of them seek treatment, said the study. Zawya

UAE: New cancer diagnostic units at Tawam Hospital

22 July - Tawam Hospital, a leading medical facility in the country, has acquired latest 

endoscopy technologies for more accurate diagnosis for cancer patients in the country. Two 

units of the innovative devices, including confocal laser endomicroscopy and single balloon 

enteroscopy, have been installed at the hospital. These units are known for safety, feasibility 

and excellent diagnostic abilities. The technologies allow three-dimensional reconstructions 

of complex objects in the human body. Dr Mazen Taha, Gastroenterology Consultant, said 

physicians at the hospital are now able to get a clearer picture of whether cancer or another 

disease is present and in return, reduce the number of unnecessary biopsies and false 

negatives. The endoscopy unit at the hospital, which operates in affiliation with Johns 

Hopkins Medicines, is a leading diagnostic centre in the country. In 2011, the unit 

performed over 3,300 endoscopies, including more than 2,170 lower and upper 

endoscopies. In the first quarter of this year, the hospital’s endoscopy team have completed 

over 1,800 consultations. The team performs up to 20 procedures per day and to cope with 

such demand, they work six days a week. Zawya

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USEUCOM

Technical Report: The climatic suitability for dengue 

transmission in continental Europe

July 2012 - The global incidence of dengue has increased over the past fifty years. Although 

the main mosquito vector for dengue is Aedes aegypti, the species Aedes albopictus, which 

is present in continental Europe, has also been shown to be capable of transmitting dengue, 

and in 2010, sporadic dengue transmission occurred in continental Europe. This project 

assesses which areas in Europe could be most amenable for dengue transmission. Data on 

the global distribution of Aedes aegypti, Aedes albopictus, and cases of dengue were 

collected. Using datasets for climate, environmental conditions, geography, and population 

density, mathematical modelling (nonlinear discriminant analysis) was conducted to assess 

the areas of Europe most climatically suitable for Ae. aegypti, Ae. albopictus, and dengue 

transmission. ECDC

United Kingdom: Differences in hepatitis B infection rate 

between ethnic groups in antenatal women, May 2004 –

Dec 2008

26 July - Hepatitis B virus (HBV) is a major cause of morbidity and mortality worldwide. 

Although the United Kingdom (UK) prevalence of HBV is low, it is increasing. There is some 

evidence that the rate of infection is much higher in some populations living in Britain of 

non-white ethnicity or who were not born in Britain, compared with the British-born white 

population. We examined the prevalence of HBV infection in pregnant women through 

hepatitis B surface antigen (HBsAg) or e-antigen (HBeAg) in Birmingham UK between May 

2004 and December 2008 and the effect of ethnicity on the relative risk of infection. There 

was a significant increase in the number of antenatal HBV infections detected over the study 

period from 106 cases in 2005 to 161 cases in 2008 (p=0.037). Women who define 

themselves as of black African, non-British white and Pakistani ethnicity had a markedly 

elevated rate of HBV infection (relative risk (RR): 11.25, 5.87 and 2.33 respectively) compared 

to the England average. Health organisations that serve populations with a high or 

increasing proportion of women originating from intermediate and high HBV prevalence 

areas of the world such as Africa, some parts of Europe and Asia, should anticipate a need 

for perinatal and postnatal prophylaxis to children born to HBV infected mothers. 

Eurosurveillance

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USNORTHCOM

Airports most likely to spread infection: JFK, LAX, 

Honolulu

25 July - When the next big epidemic of infectious disease strikes 

the United States, it will travel most quickly from airports in New 

York and Los Angeles, a new study suggests. But the third most 

"influential spreader" among U.S. airports may come as a bit of a 

surprise: It's Honolulu International Airport, say researchers from 

MIT. The researchers used a model that looks at traffic numbers and connections among 

airports but also the movements of individual travelers as they go from airport to airport --

and linger for layovers. A video shows how those connections might spread a new flu virus 

or the next SARS in the early days of an outbreak starting at any of the airport locations. 

Honolulu made the top three because its sends people out over great distances, east and 

west, and because it connects with "massive hubs," the scientists write in the journal 

PLosOne. But Atlanta's Hartsfield-Jackson, the world's busiest airport only came in 8th: 

That's because it often sends passengers to small regional airports -- so they aren't as likely 

to spread any viruses they pick up to the rest of the world. USA Today

Doctors call for new U.S. painkiller labels to stop abuse

26 July - U.S. health regulators should change the prescription guidelines for opioid 

painkillers to prevent more people abusing the powerful and addictive medicines, urged a 

group of medical and public health experts. Thirty-seven doctors, researchers and public 

health officials signed a petition to the Food and Drug Administration, asking it to revise the 

prescription label for opioid painkillers. They want to prohibit use of the drugs for moderate 

pain, add a maximum daily dose, and only allow patients to take them for up to 90 days 

unless they are being treated for cancer-related pain. Changing the label would not limit 

how doctors prescribe painkillers. But it would stop pharmaceutical companies like Purdue 

Pharma, Endo Health Solutions Inc and Pfizer Inc from promoting the drugs for nonapproved uses. Some researchers say aggressive marketing by drug companies has fueled 

overprescribing of opioids like oxycodone and methadone, synthetic versions of opium that 

are currently used to treat moderate or severe pain but are also highly addictive. Overdose 

from prescription drugs is now the leading cause of accidental death in the country, 

eclipsing car crashes and the combined impact of cocaine and heroin. The Centers for 

Disease Control and Prevention says the problem has become an epidemic. Fox News

How fake cancer drugs entered U.S.

26 July - From the outskirts of Winnipeg, Kris Thorkelson's Canada Drugs grew to become a 

vital link for American consumers stung by high drug prices. The Internet pharmacy had by 

the middle part of the last decade filled millions of U.S. prescriptions with low-cost, 

Canadian supplies of everything from Pfizer Inc.'s PFE +1.03%cholesterol pill Lipitor to 

GlaxoSmithKline GSK +1.34%PLC's asthma treatment Advair. But as Mr. Thorkelson's 
company grew into a larger enterprise spanning three continents, so did the risks of 

counterfeit drugs. In the final months of 2011, companies controlled by Mr. Thorkelson's 

Canada Drugs Group of Cos. sold two batches of fake Avastin, a cancer drug, to U.S. 

doctors, according to company documents reviewed by The Wall Street Journal, interviews 

with former employees and business associates, and people familiar with a federal probe 

examining the company's dealings. "The Avastin case was a watershed moment for law 

enforcement to recognize that this is not a problem that can be restricted to one part of the 

world," said Ronald Noble, secretary-general of the international police organization 

Interpol. "It let the U.S. know it's not immune to [counterfeit drugs]." The appearance of fake 

Avastin was widely publicized after the U.S. Food and Drug Administration warned in 

February that the counterfeits may have entered the U.S. supply chain. The Wall Street 

Journal

New York City's proposed ban on big sugary sodas draws 

heated debate

24 July - New York Mayor Michael Bloomberg's proposed ban 

on large sodas is expected to pass in September, but that didn't 

deter hundreds who showed up on Tuesday either to praise the 

measure as a way to battle obesity or oppose it as pointless 

and unfair. The proposal before the city Board of Health, the 

first of its kind in the nation, would limit servings of sugary drinks to 16 ounces (473 ml) 

at most restaurants, theaters, delis, vending carts and stadium concessions. With the 

Board of Health filled with Bloomberg appointees, the proposal is expected to pass 

when it is put to a vote on September 13. Reuters

U.S. aims at 25 percent reduction in new HIV infections 

by 2015 

24 July - The United States is aiming to reduce the number of new HIV infections by 25 

percent by 2015. A top U.S. health official told the International AIDS Conference the goal is 

part of a national HIV-prevention strategy that other countries should also develop. 

Assistant Secretary for Health Howard Koh told delegates from around the world that 

national strategies are critical to reducing the spread of AIDS. "National strategies outline a 

framework for responding to AIDS in ways that reflect the country's unique epidemiology, 

disease burden and trends," said Koh. "And they demonstrate importance of country 

ownership and the need to maximize the efficiency and effectiveness of HIV/AIDS 

programs." He said the United States would achieve the 25 percent reduction over the next 

three years by treating people who already have the virus, and by increasing the proportion 

who know that they have HIV. It is estimated that one in five do not their status. VOA

U.S.: CBO says healthcare ruling could save $84 billion

24 July - Last month's Supreme Court ruling that upheld President Barack Obama's 2010 

healthcare law could save the U.S. government some $84 billion over 11 years, the nonpartisan Congressional Budget Office said on Tuesday. The savings would come primarily 
from a portion of the ruling giving the states an escape hatch from the law's expanded 

program of healthcare coverage for the poor. That expansion of the Medicaid program 

would be funded mostly by the federal government, but eventually states would have to 

pick up a portion of that cost. The CBO also estimated that 3 million uninsured people who 

would have received Medicaid coverage under the law before the ruling now will remain 

with no insurance. The law, considered Obama's signature domestic policy achievement, 

aimed to extend medical coverage to more than 30 million uninsured Americans. Reuters

U.S.: Rabies surge in some states might be due to heat

26 July - This summer, some sensational encounters 

between rabid wildlife and people have been making 

headlines across the country... Is rabies on the rise this 

summer? Raw surveillance data always needs to be taken 

with a grain of salt, but the answer seems to be yes. Many 

U.S. states — particularly in Texas and the Great Plains, but also in such far-flung locales as 

New Mexico, Colorado, Arkansas, and Maine — are reporting larger-than-usual numbers of 

wild animals testing positive for rabies. It’s possible that these increases might be due to 

improved surveillance, or to a cyclical pattern of rabies infection rates in certain species of 

animals. But health officials also point to 2012’s particularly mild winter. Higher-thanaverage temperatures likely led common rabies vectors like raccoons and skunks, normally 

dormant during the cold months, to become more active — which would thereby increase 

the opportunity for contact between infected and uninfected animals, both within and 

among species. Wired Science

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USPACOM

China: Death toll from Beijing rainstorm climbs to 77

26 July - The death toll from rain-triggered disasters and accidents on Saturday in the 

Chinese capital climbed to 77 after more bodies were recovered, the Beijing flood control 

headquarters said Thursday. Of the 77 victims, 66 have been identified, including five 

people who died while carrying out rescue work, Pan Anjun, a spokesman for the 

headquarters, said Thursday night. Of the other 61 victims -- 36 men and 25 women -- 46 

drowned, five were electrocuted, three died in housing collapses, two by mudslide, two by 

traumatic shock, two from being hit by falling objects and one was struck by lightning, Pan 

said. He said a further sharp increase in the death toll is not likely because the search for 

missing persons is drawing to an end. "But we will not give up searching just yet," Pan said. 

Most of the bodies were found in suburban districts, including 38 bodies that were 

recovered in the hardest-hit Fangshan district, he said. Xinhua
India: 40 nuclear plant workers contaminated

24 July - More than 40 workers at a nuclear power station 

in northern India have been exposed to tritium radiation in 

two separate leaks in the past five weeks, company 

managers said on Tuesday. The first accident occurred on 

June 23 when 38 people were exposed during 

maintenance work on a coolant channel at the Rajasthan Atomic Power Station in 

Rawatbhata, senior plant manager Vinod Kumar told AFP. Two of them received radiation 

doses equivalent to the annual permissible limit, he said, but all those involved have 

returned to work. In a second incident last Thursday, another four maintenance workers at 

the plant were exposed to tritium radiation while they were repairing a faulty seal on a pipe. 

New York Daily News

India: Congo fever has killed seven in state

20 July - Crimean-Congo Hemorrhagic Fever (CCHF) has claimed seven lives in Gujarat. And 

according to the state government, about 18 people have been affected by CCHF... The 

government's reply stated that mammal and tick infection was common in sites of 

agriculture. Farm animals needed to be de-ticked before they are transported or delivered 

for slaughter. The government said that personal tick-avoidance measures had been 

recommended, such as the use of insect repellents, adequate clothing and body inspection 

for adherent ticks. The government said that the animal husbandry department had been 

roped in for implementing precautionary measures in areas where tick infestation had been 

reported. Areas where CCHF cases are reported are being thoroughly checked and made 

free of tick infestation, the government said. Times of India

Western fast food tied to heart risks in Asia

20 July - Even relatively clean-living Singaporeans who regularly eat burgers, fries and other 

staples of U.S.-style fast food are at raised risk of diabetes and significantly more likely than 

peers to die of heart disease, according to a new study. With globalization, fast food -

widely regarded as nutritionally poor - has become commonplace in East and Southeast 

Asia. But there's been little research into the effects of western junk food on the health of 

non-western populations, especially those transitioning to more-prosperous lifestyles.

"Many cultures welcome (western fast food) because it's a sign they're developing their 

economies," said Andrew Odegaard, from the University of Minnesota School of Public 

Health, who led the new study published in the journal Circulation. "But while it may be 

desirable from a cultural standpoint, from a health perspective there may be a cost," he told 

Reuters Health. Odegaard's team, which included researchers in the school of public health 

at the National University of Singapore, based their study on more than 60,000 

Singaporeans of Chinese descent, who were interviewed in the 1990s, then followed for 

about a decade. Reuters

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USSOUTHCOM

Brazil: Rocky Mountain spotted fever

24 July - The Epidemiological Surveillance section, Department of Health, City Hall, Nova 

Odessa, released last Wed 18 Jul [2012] confirmation from the Instituto Adolfo Lutz of the 

1st case of Rocky Mountain spotted fever in the city in 2012. The case was registered in 

Jardim Sso Jorge, and all the residences of the district will receive a visit from health workers 

with guidelines about the disease. In addition, the Health Surveillance and Zoonosis Sector 

reinforced the warning to all residents of the city on the risks of entering riverside green 

areas inhabited by capybaras or other large animals. ProMED-mail

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