14 December 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

 As Army thins its ranks, unfit miss the cut

 Substance use disorders in the U.S. Armed Forces, 2000-2011

GLOBAL

 HHS offers some forecasts on medical countermeasures

 Japan tops list of healthiest countries

 Life expectancy rises around the world, study finds

 New SARS-like virus infects both humans and animals

INFLUENZA

 Armed Forces Health Surveillance Center: DoD Influenza Surveillance Summary

 CDC: Weekly Influenza Surveillance Report

 DoD Global Laboratory-Based Influenza Surveillance Program

 Early-season rise in U.S. flu activity continues

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

 Google.org: Flu Trends

 Naval Health Research Center: Febrile Respiratory Illness Surveillance Update

 Study finds influenza C in kids hospitalized with pneumonia

 Study finds substantial flu virus shedding even without symptoms

 USAPHC: U.S. Army Influenza Activity Report

 PANDEMIC AND AVIAN INFLUENZA

 Public health infrastructure key to fighting pandemics, outbreaks: review

VETERINARY/FOOD SAFETY

 Beef’s raw edges

 New tests could hamper food outbreak detection

 Service dogs pick up scent of diabetes danger

 U.S., China agree to continue cooperation on food safety
Potential Health 

Risks to DOD FiringRange Personnel 

from Recurrent Lead 

Exposure

The Department of 

Defense (DOD) asked the 

National Research Council 

to evaluate potential health 

risks from recurrent lead 

exposure of firing-range 

personnel. This document 

will help to inform 

decisions about setting 

new air exposure limits for 

lead on firing ranges, 

about whether to 

implement limits for 

surface contamination, and 

about how to design leadsurveillance programs for 

range personnel 

appropriately.

WELLNESS

 Brief dynamic vs. supportive therapy for mild-to-moderate depression

 Calorie tracking apps may help boost weight loss

 How well do you rise from sitting on the floor?

 Stress-resilience/susceptibility traced to neurons in reward circuit

 Think yourself well

USAFRICOM

 Nigeria: EU expresses concern over outbreak of polio

 Republic of Congo: Torrential rains kill 13, displace hundreds

 Yellow fever in Sudan - update

 Yellow fever in the Republic of Congo

USCENTCOM

 Chief Army Nurse visits Afghanistan

 Early warning disease surveillance after a flood emergency — Pakistan, 2010

USEUCOM

 Portugal: Madeira dengue fever outbreak tops 2,000 cases

 United Kingdom: Norovirus outbreak 'could hit 750,000 people'

USNORTHCOM

 2012 West Nile virus update

 Drug-resistant C. difficile bug traced to source in US and Canadian hospitals

 FDA review of tobacco products grinds to a halt

 Traffic deaths at lowest point in 62 years

USPACOM

 Disasters: Asia’s 2012 figures and trends

 Philippines: Toll from typhoon above 700 and likely to rise, authorities say

USSOUTHCOM

 Cholera outbreak in Cuba kept mostly quiet

 UN unveils cholera elimination plan for Haiti, Dominican Republic

U.S. MILITARY

As Army thins its ranks, unfit miss the cut

11 December - Under intense pressure to trim its budget, the Army is dismissing a rising 

number of soldiers who do not meet its fitness standards, drawing from a growing pool of 

troops grappling with obesity. Obesity is now the leading cause of ineligibility for people 

who want to join the Army, according to military officials, who see expanding waistlines in 

the warrior corps as a national security concern. Between 1998 and 2010, the number of 
Mosquito-borne 

Disease Poster

A new poster on mosquitoborne diseases and their 

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active-duty military personnel deemed overweight or obese more than tripled. In 2010, 

86,186 troops, or 5.3 percent of the force, received at least one clinical diagnosis as 

overweight or obese, according to the Armed Forces Health Surveillance Center... During 

the first 10 months of this year, the Army kicked out 1,625 soldiers for being out of shape, 

about 15 times the number discharged for that reason in 2007, the peak of wartime 

deployment cycles. Early Bird

Substance use disorders in the U.S. Armed Forces, 2000-

2011

November 2012 - Drug misuse is associated with serious health consequences and has 

detrimental effects on military readiness. During 2000 to 2011, 70,104 service members 

received an incident diagnosis of a substance use disorder (SUD) (excluding alcohol and 

tobacco-related disorders). Incidence rates declined with increasing age, time in service, 

rank, and number of combat deployments. Service members in a combat occupation had 

1.2 times the rate of individuals in a health care or administration/supply occupation.

Medical Surveillance Monthly Report

top of page...

GLOBAL

HHS offers some forecasts on medical countermeasures

11 December– A new report from the US Department of Health and Human Services (HHS) 

offers a few predictions on when certain new countermeasures against biological threats will 

become available, including a forecast for two novel influenza drugs and possibly a nextgeneration anthrax vaccine within the next 5 years. The 2012 Public Health Emergency 

Medical Countermeasures (PHEMCE) Implementation Plan outlines expected developments 

for the next few years for anthrax, smallpox, pandemic flu, botulism, and other bacterial and 

viral threats. It says HHS's Biomedical Advanced Research and Development Agency 

(BARDA) "will support advanced development of at least two drugs with novel mechanisms 

of action through Phase III clinical studies; two drugs are expected to be approved in the 

U.S." in fiscal years 2015 to 2017. The report also says that two more flu antivirals are 

expected to be approved in the long term, meaning in fiscal 2018 or later. CIDRAP

Japan tops list of healthiest countries

13 December - No one knows whether it’s their great diet, 

good health care or just great genes, but after two decades 

Japanese citizens are still the healthiest people in the 

world, according to a decades-long study on population 

health published today. The Global Burden of Disease 

Study 2010, a large-scale collaboration funded by the Bill and Melinda Gates Foundation to 

assess trends in health and disease in 187 countries, has released its rankings of the top 10 

countries with the highest healthy life expectancies. Healthy life expectancy is the number of 
Help 

Service members 

quit tobacco 

in the New Year!

New Year's is a great time 

for service members to 

make smoking or chewing 

tobacco a thing of the past. 

Quit Tobacco - Make 

Everyone Proud (QTMEP) is 

pleased to offer a 

collection of free materials 

for order and download to 

support military health 

professionals' tobacco 

cessation efforts. The 2013 

New Year's theme, 

"Overpower Tobacco", 

highlights the benefits of 

fitness to support tobacco 

cessation. 

Visit QTMEP's New Year's 

site for a downloadable 

poster, flyer, and web 

banners to help you 

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healthy living in 2013.

years that a person can expect to live in good health. It takes into account number of 

deaths as well as years of health lost to disability. The United States tied Norway for 29th

place in male healthy life expectancy and tied Estonia for 33rd place in highest female 

healthy life expectancy. ABC News

Life expectancy rises around the world, study finds

13 December - A sharp decline in deaths from malnutrition and diseases like measles and 

tuberculosis has caused a shift in global mortality patterns over the past 20 years, according 

to a new report, with far more of the world’s population now living into old age and dying 

from diseases more associated with rich countries, like cancer and heart disease. The shift 

reflects improvements in sanitation, medical services and access to food throughout the 

developing world, as well as the success of broad public health efforts like vaccine 

programs. The results are dramatic: infant mortality has declined by more than half between 

1990 and 2010, and malnutrition, the No. 1 risk factor for death and years of life lost in 

1990, has fallen to No. 8. At the same time, chronic diseases like cancer now account for 

about two out of every three deaths worldwide, up from just over half in 1990. Eight million 

people died of cancer in 2010, 38 percent more than in 1990. Diabetes claimed 1.3 million 

lives in 2010, double the number in 1990. New York Times

New SARS-like virus infects both humans and animals

12 December – A SARS-like virus discovered this summer in the Middle East may infect 

more than just humans. The pathogen, a close cousin to the one that caused the 2002 to 

2003 SARS outbreak, may also be able to infect cells from pigs and a wide range of bat 

species, researchers report today. The findings may help public health officials track the 

source of the outbreak and identify the role of wild animals and livestock in spreading the 

virus, researchers say. Epidemiologists also want to know which species of animals it is 

capable of infecting to keep the new coronavirus from spreading further. To determine what 

types of animals hCoV-EMC can infect, Drosten and colleagues infected cells from humans, 

pigs, and a wide variety of bats, the key natural reservoirs of coronaviruses. The new virus 

could infect all of these types of cells. Wired

top of page...

INFLUENZA

Armed Forces Health Surveillance Center: DoD Influenza 

Surveillance Summary

For the week ending 13 December 2012, 

 Throughout the MHS, Influenza-Like Illness (ILI) incidence rates decreased or remained 

the same compared to last week; the percent of all outpatient visits due to ILI increased 

slightly among the US Overall and EUCOM Other Beneficiaries.
Emergency 

Preparedness and 

Response

This page includes 

information on upcoming 

training and conference 

opportunities organized or 

sponsored by federal 

agencies or COCA partner 

organizations, which 

include non-federal 

organizations.

Classified Version of 

the Weekly Update

An Army Public Health

Weekly Update is available 

with articles classified up to 

the SECRET level from the 

USAPHC SIPRNet site: 

http://phc.army.smil.mil

Look under Hot Topics & 

Current Issues.

To access this version, you 

will need a SECRET

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 Influenza activity is at moderate levels across the overseas DoD laboratory surveillance 

network, except in Europe where the activity remains low; sites reported variable cocirculation of influenza A/H1, A/H3, and B. Currently, circulating influenza strains are 

similar for all components of the 2012-2013 vaccine formulation based recent results of 

molecular characterization. The influenza vaccination coverage for the DoD (Active Duty 

component only) is 93%. AFHSC DoD Influenza Surveillance Summary

CDC: Weekly Influenza Surveillance Report

During week 48 (November 25-December 1), influenza activity increased in the U.S.

 Viral Surveillance: Of 5,511 specimens tested and reported by U.S. World Health 

Organization (WHO) and National Respiratory and Enteric Virus Surveillance System 

(NREVSS) collaborating laboratories during week 48, 1,139 (20.7%) were positive for 

influenza. 

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

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

 Influenza-associated Pediatric Deaths: Three influenza-associated pediatric deaths were 

reported. One of these deaths was associated with an influenza B virus and two were 

associated with influenza A viruses for which the subtype was not determined. FluView

DoD Global Laboratory-Based Influenza Surveillance 

Program

During week 48 (25 November – 1 December 2012), 61 specimens were collected and 

tested from 20 locations. There was one A(H1N1pdm09) at Luke AFB, AZ and 23 influenza 

A/H3 viruses detected (See Table 1 below). Results are preliminary and may change as more 

results are received. 

 The H3N2 specimens characterized by USAFSAM exhibited an overall HA protein 

identity of 97.8% - 99.1% and an overall NA protein identity of 98.7%-99.4% compared 

to A/Victoria/361/2011-like virus, the H3N2 component of the 2012-2013 vaccine 

formulation. 

 Since Week 47, there has been an increase in influenza A/H3 virus isolated by USAFSAM 

and CDC. The CDC reports recent testing on viruses collected since 1 October 2012: 

0.0% (0 of 122) of A/H3 viruses tested were resistant to oseltamivir/zanamivir (81 

influenza B and two A/(H1N1)pdm09 were also tested and none were resistant). 

 To date, 490 specimens have been submitted and tested from 51 locations of which 72 

were positive for influenza A (two co-infections of A/H3 & B, 65 A/H3, and five 

A(H1N1pdm09) and six were positive for influenza B. There have been 52 other 

respiratory viruses isolated (12 adenovirus, six RSV, four enterovirus, and 30 

parainfluenza). USAF School of Aerospace Medicine
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Early-season rise in U.S. flu activity continues

7 December - Influenza is widespread in eight US states, and some other indicators of an 

early flu season continue to rise, the Centers for Disease Control and Prevention (CDC) said 

today. The percentage of patients' respiratory samples testing positive for flu grew to 20.7% 

in the week ending Dec 1, up from 15.2% the week before. And, as before, the H3N2 strain 

continues to dominate, which can be a sign of a more severe flu season. The percentage of 

flu-positive specimens varied widely by region, from 6.2% in the Southwest to 33.5% in 

Midwestern states. Southern states also reported percentages above the national average... 

In contrast to the US situation, flu activity in the rest of the Northern Hemisphere has picked 

up only slowly, the World Health Organization (WHO) said in an update. CIDRAP

European Centre for Disease Prevention and Control:

Weekly Influenza Surveillance Overview

7 December - During week 48, all 28 countries reporting experienced low-intensity activity 

of influenza-like illness or acute respiratory infection.

 Of 520 sentinel specimens tested across 21 countries, 46 (8.8%) were positive for 

influenza virus. This is an increase compared with week 47/2012 when 3.1% of 

specimens were positive.

 Of the influenza virus detections in sentinel specimens since week 40/2012, 46% were 

type A and 54% were type B viruses. Of the A viruses subtyped, two thirds were A(H3) 

and one third were A(H1).

 The number of RSV detections continued to increase in week 48.

 No hospitalised laboratory-confirmed influenza cases were reported in week 48.

 The proportion of sentinel specimens positive for influenza virus has increased since the 

early weeks of the season, but there is still little epidemiological evidence of sustained 

influenza virus transmission in EU/EEA countries. Weekly Influenza Surveillance 

Overview

Google.org: Flu Trends

13 December – Estimates of flu activity based on Internet search queries indicate that the 

levels of flu activity in the northern hemisphere range from minimal in eastern Europe to 

high in the U.S. and Russia. Levels range from minimal to low in the southern hemisphere.

Google.org Flu Trends

Naval Health Research Center: Febrile Respiratory 

Illness Surveillance Update 

For the week ending 8 December 2011:

Adenovirus 

Type 14 adenovirus cases continue at MCRD Parris Island, though FRI rates remain low.
FRI surveillance at all eight U.S. military basic training centers indicated FRI rates were at or 

below expected values. NHRC Febrile Respiratory Illness Surveillance Update 

Study finds influenza C in kids hospitalized with 

pneumonia

7 December - Influenza C generally isn't thought to be a cause clinically significant disease, 

but a study in Italian children who were seen in the emergency department for pneumonia 

found the virus in five children, with a disease severity that resembled influenza A... Of 391 

children included in the study, influenza C was identified in 5 (1.3%). Influenza A was 

detected in 26 children, and influenza B was found in 3. Influenza C was found only during 

two of the four seasons: 2008-09 and 2009-10. CIDRAP

Study finds substantial flu virus shedding even without 

symptoms

12 December - In a German study, 30% of patients' tested positive for flu the day before 

symptoms developed, and asymptomatic patients had about the same viral loads as sick 

patients, according to a report yesterday in PLoS One. Investigators conducted a 

prospective household study using data from 2007 to 2011 in Berlin and Munich. They 

analyzed data from 122 index patients and 320 household contacts, of whom 67 became 

secondary flu case-patients. Of the 189 case-patients, 12 had seasonal H1N1 flu, 19 had 

H3N2, 98 had pandemic 2009 H1N1, and 60 had influenza B. Nine (14%) of 65 unvaccinated 

secondary case-patients—all adults—were asymptomatic. Viral loads in patients' nasal 

specimens peaked on day 1, 2, or 3 for all flu strains, then declined steadily till days 7 

through 9. On the day before symptom onset, 12 of 40 specimens (30%) were positive. Viral 

load in six asymptomatic patients was similar to that in those having symptoms. 

Infectiousness, as measured by viral culture, lasted 4 to 6 days after symptom onset, and 

viral load did not seem to be influenced by antiviral therapy, age, or vaccination status, the 

team found. They conclude, "Asymptomatic/subclinical infections occur infrequently, but 

may be associated with substantial amounts of viral shedding." CIDRAP

USAPHC: U.S. Army Influenza Activity Report

1 December – Every state is now reporting influenza activity. Although the season is starting 

early, there is insufficient data to draw conclusions about severity. Circulating viruses appear 

well-matched to vaccine.

 ILI Activity: Army incident ILI outpatient visits in week 48 were 21% higher than the 

same week last year.

 Influenza cases: Two hospitalized influenza cases were reported in DRSi in week 48, and 

a total of 13 hospitalized cases have been reported during this influenza season.

 Acute Respiratory Disease at BCT sites: ARDS rates remain lower at all Army BCT sites 

compared to the same period last year.
 Viral specimens: During week 48, 212 of 856 (25%) clinical specimens tested were 

positive for respiratory pathogens. Influenza A and RSV are the main viruses currently 

circulating. USAPHC U.S. Army Influenza Activity Report

PANDEMIC AND AVIAN INFLUENZA

Public health infrastructure key to fighting pandemics, 

outbreaks: review

A breakdown or absence of public health infrastructure was by far the No. 1 driving factor in 

recent infectious disease outbreaks of international concern, such as the 2009 H1N1 

pandemic and polio, cholera, and yellow fever epidemics, according to a review of nearly 

400 outbreaks. A team of US scientists reviewed 197 internationally significant outbreaks 

from 1996 through 2009 and identified driving factors that contributed to each. They found 

that a breakdown or absence of public health infrastructure was the driving factor in 39.5% 

of the outbreaks, and that all other driving factors—such as climate change, urbanization, 

and international travel and trade—accounted for less than 10% of outbreaks. They 

conclude: "We suggest a central role for development agencies in pandemic prevention and 

highlight three critical policy issues." The team suggests that agencies (1) develop policies 

that deal with different stages of emergence, from spillover and localized outbreaks to 

pandemic spread, (2) use a systems approach to pandemic prevention that addresses 

pathogen dynamics at the intersection of people and their environment, and (3) shift 

funding from short-term emergency funds to a longer-term strategy. CIDRAP

top of page...

VETERINARY/FOOD SAFETY

Beef’s raw edges

9 December - ...“If you look at tonnage, 80 percent of the total of all the antibiotics we use 

in the states is used in meat animals,” [Jason Newland, director of the Children Mercy’s] said.

As in humans, bacteria growing inside animals that are given antibiotics can develop a 

resistance to the medicines, Newland explained. That resistant bacteria can then be 

transferred to the soil through animal waste. During severe storms, such as the EF5 tornado 

which killed 161 people in Joplin, that contaminated soil can end up in open wounds, and 

even modern medicine is challenged in combating the serious infections that can occur... A 

yearlong investigation by The Kansas City Star found a multimillion-dollar-a-year 

pharmaceutical arms race in the beef industry is not just about curing sick cows. It’s also 

about fattening cattle cheaply and quickly, driven in part by efforts to maximize profits, 

according to food safety advocates. In fact, the same number of cattle today are producing 

twice as much meat as they did in the 1950s because of genetics, drugs and more efficient 

processing. Kansas City Star
New tests could hamper food outbreak detection

11 December - New tests that promise to speed up diagnosis of food 

poisoning pose an unexpected problem: They could make it more 

difficult to identify dangerous outbreaks like the one that sickened 

people who ate a variety of Trader Joe's peanut butter this fall. The new 

tests could reach medical laboratories as early as next year, an exciting 

development for patients. They could shave a few days off the time needed to tell whether 

E. coli, salmonella or other foodborne bacteria caused a patient's illness, allowing faster 

treatment of sometimes deadly diseases. The problem: These new tests can't detect crucial 

differences between different subtypes of bacteria, as today's tests can. And that fingerprint 

is what states and the federal government use to match sick people to a contaminated 

food. Huffington Post

Service dogs pick up scent of diabetes danger 

10 December - ... Diabetic, or hypoglycemic, "alert dogs" are a growing class of service dogs 

best known for guiding the visually impaired, sniffing out drugs and bombs, or providing 

mobility assistance for people with severe disabilities. Most recently, they have been trained 

to sniff out cancer and oncoming seizures. Toni Eames, president of International 

Association of Assistance Dog Partners, estimates there are over 30,000 assistance dogs 

working in the U.S., including dogs that have been trained by individuals. The dog's 

accuracy and speed can beat medical devices, such as glucose meters and continuous 

glucose monitors, according to doctors, owners and trainers. With their acute sense of 

smell, the dogs—mostly retrievers—are able to react to a scent that researchers haven't yet 

identified. Wall Street Journal

U.S., China agree to continue cooperation on food safety

11 December - The U.S. Food and Drug Administration (FDA) announced today that it has 

renewed an agreement with the General Administration of Quality Supervision, Inspection, 

and Quarantine of China (AQSIQ) to enhance cooperation between the U.S. and China on 

food and feed safety. The two countries entered into the original agreement in 2007, and 

today’s announcement extends the agreement for an additional five years.

The agreement includes:

 enhancement of FDA’s ability to identify high-risk food products entering the United 

States from China

 collaboration to facilitate inspections of facilities that process and produce food

 a focus on high-risk foods frequently exported from China to the United States, 

including canned and acidified foods, pet food and aquaculture

 the creation of processes for FDA to accept relevant, verified information from AQSIQ 

regarding registration and certification. FDA

top of page...
WELLNESS

Brief dynamic vs. supportive therapy for mild-tomoderate depression

10 December - ... The patients in this study had a mixture of diagnoses and had focal 

problems or life events that were presumably driving or contributing to their depressive 

symptoms. Within this population, brief dynamic therapy was the superior treatment for 

patients with moderate symptoms. Journal Watch

Calorie tracking apps may help boost weight loss

11 December - A new study published in the Archives of Internal 

Medicine concludes that a mobile app can help boost weight loss, 

if it's used as part of a more comprehensive strategy. Researchers 

at Northwestern University studied about 70 overweight men. 

Their average age was 58, so they weren't exactly born with smart 

phones in their hands. Some of the men were asked to log their eating and activity using 

old-fashioned pen and pad. Others were given a mobile app, and their behaviors were 

monitored by a coach who provided short, telephone-based check-in sessions periodically 

during the study. In addition, all of the participants were offered group classes in nutrition 

and behavior change. So who did best? The men who used the mobile app and attended 80 

percent of the health education classes. NPR

How well do you rise from sitting on the floor?

13 December - The ability to sit and then rise from the floor is a strong predictor of the risk 

of death in middle-aged and elderly people, according to a new study. The sitting-rising test 

reveals a person's level of musculoskeletal fitness, explained Dr. Claudio Gil Araujo and 

colleagues at the Clinimex Exercise Medicine Clinic in Rio de Janeiro, Brazil. Their study 

included more than 2,000 men and women, aged 51 to 80, who were told to sit on the floor 

and then try to rise, using only the minimum amount of support -- such as a hand or knee -

- they needed. They were also told not to worry about how fast they did the test. The 

participants were ranked on a score of zero to 10. People who scored 10 did not use any 

support to sit or rise from the floor. After doing the sitting-rising test, the participants were 

followed for an average of about six years. During the follow-up period, nearly 8 percent of 

the participants died. Most of those deaths occurred among people with low test scores. 

Only two people who scored 10 on the test died. U.S. News and World Report

Stress-resilience/susceptibility traced to neurons in 

reward circuit

13 December - A specific pattern of neuronal firing in a brain reward circuit instantly 

rendered mice vulnerable to depression-like behavior induced by acute severe stress, a 

study supported by the National Institutes of Health has found. When researchers used a 
high-tech method to mimic the pattern, previously resilient mice instantly succumbed to a 

depression-like syndrome of social withdrawal and reduced pleasure-seeking -- they 

avoided other animals and lost their sweet tooth. When the firing pattern was inhibited in 

vulnerable mice, they instantly became resilient. NIH

Think yourself well

8 December – ...[R]espectable research has demonstrated that those 

who frequently experience positive emotions live longer and healthier 

lives. They have fewer heart attacks, for example, and fewer colds too.

Why this happens, though, is only slowly becoming understood. What is 

needed is an experiment that points out specific and measurable ways 

in which such emotions alter an individual’s biology. And a study 

published in Psychological Science, by Barbara Fredrickson and Bethany 

Kok at the University of North Carolina at Chapel Hill, does precisely 

that. Dr Fredrickson and Dr Kok concentrated their attentions on the 

vagus nerve. This nerve (illustrated right, in an early anatomical 

drawing) starts in the brain and runs, via numerous branches, to several 

thoracic and abdominal organs including the heart. Among its jobs is to 

send signals telling that organ to slow down during moments of calm 

and safety. How effectively the vagus nerve is working can be tracked 

by monitoring someone’s heart rate as he breathes in and out. Healthy 

vagal function is reflected in a subtle increase in heart rate while 

breathing in and a subtle decrease while breathing out. The difference 

yields an index of vagal tone, and the value of this index is known to be connected with 

health. Low values are, for example, linked to inflammation and heart attacks. ...[R]ecent 

work that showed something else about the vagal-tone index: people with high tone are 

better than those with low at stopping bad feelings getting overblown. They also show 

more positive emotions in general. This may provide the missing link between emotional 

well-being and physical health. Economist

top of page...

USAFRICOM

Nigeria: EU expresses concern over outbreak of polio

12 December - The European Union yesterday expressed its concern over the latest 

outbreak of wild polio virus in Nigeria. The Kaduna State government recently recorded 10 

cases of wild polio virus in Birnin Gwari, Ikara, Igabi, Kubau and Zaria local government 

areas of the state. The Head of the EU Delegation to Nigeria, Dr David Macrae, raised the 

concern at a forum with reporters in Abuja on the operations of the EU in Nigeria and the 

West African sub-region. Macrae who expressed the union's determination to support the 

immunisation process in Northern Nigeria to curb the spread of the disease, noted that 

there was need for access to potable water in the affected areas. allAfrica
Republic of Congo: Torrential rains kill 13, displace 

hundreds

13 December - Torrential rains have killed at least 13 people, 

injured 29 and displaced hundreds in districts south of 

Brazzaville, the capital of the Republic of Congo, say officials. 

The heavy rains came on 8-9 December. "After the rains, we 

sent rescue services, who were able to recover nine bodies. The 

[Congolese] Red Cross recovered four bodies of people who had drowned," said Maurel 

Kihounzou, the mayor of the first district of Makélékélé, south of the capital. The seventh 

district of Mfilou was also affected, according to a 10 December report from the 

government, which noted that houses collapsed under the pressure of the flood waters, 

killing several people as they slept. Some 564 families had also been left without shelter, 

according to Clément Essiéké, the minister of humanitarian action. IRIN

Yellow fever in Sudan - update

6 December - As of 4 December, a total of 732 suspected cases of yellow fever, including 

165 deaths have been reported in 33 out of 64 localities in Darfur. Laboratory results have 

confirmed yellow fever by IgM ELISA test and PCR in 40 clinical samples... Currently, the 

Federal Ministry of Health is organizing an emergency mass vaccination campaign against 

yellow fever. WHO

Yellow fever in the Republic of Congo

12 December - The Ministry of Health of the Republic of Congo is launching an emergency 

mass-vaccination campaign against yellow fever in Ewo District in Cuvette-Ouest region, 

beginning next week. The emergency vaccination campaign aims to cover approximately 

35,000 people in three health districts of Mbama, Ewo and Okoyo, all of which belong to the 

administrative district of Ewo. The emergency vaccination campaign is being carried out 

after recent confirmation of a case with yellow fever virus infection that occurred in October 

2012. The case was identified through the national surveillance programme for yellow fever. 

WHO

top of page...

USCENTCOM

Chief Army Nurse visits Afghanistan

11 December - Maj. Gen. Jimmie O. Keenan, the commanding 

general of U.S. Army Public Health Command, and chief of the 

Army Nurse Corps, met with medical providers at Bagram 

Airfield, Afghanistan, Dec. 8. The visit included updates from 

critical care nurses attached to Charlie Company, 6th Battalion, 

101st Combat Aviation Brigade, plus Airmen from 455th Air Expeditionary Wing at the Craig
Joint Theater Hospital, and various medical detachments. The command team also met with 

chief nurses across theater via teleconference to discuss various issues.... Addressing 

Soldiers of the 791st Preventive Medicine Detachment, Command Sgt. Major Gerald C. Ecker 

of U.S. Army Public Health Command, praised the unit for their work. Ecker described PM as 

"forward thinking medicine" and "stealth health." Though often a forgotten science, PM 

provides mission-essential force health protection and has gained respect across the Army. 

Army.mil

Early warning disease surveillance after a flood 

emergency — Pakistan, 2010

14 December - During July–August 2010, Pakistan experienced extreme flooding that 

affected approximately 18 million persons. In response to the emergency, Pakistan's 

Ministry of Health and the World Health Organization (WHO) enhanced an existing disease 

early warning system (DEWS) for outbreak detection and response... Daily disease counts 

were reported from health facilities in four provinces containing 98% of the flood-affected 

population. During July 29, 2010–September 15, 2010, approximately 5.6 million new patient 

visits were reported. The most frequent conditions reported were skin diseases (18.3%), 

acute respiratory infection (15.1%), and acute diarrhea (13.3%). A total of 130 outbreak 

alerts were documented, of which 115 (88.5%) were for acute watery diarrhea (AWD) 

(suspected cholera). Of these, 55 alerts (47.8%) had at least one microbiological sample with 

confirmed cholera. Overall, DEWS was useful in detecting outbreaks, but it was limited by 

problems with data quality. Morbidity and Mortality Weekly Report

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USEUCOM

Portugal: Madeira dengue fever outbreak tops 2,000 

cases

13 December - In what is the first sustained transmission of dengue fever on the European 

continent in nine decades, Portuguese health authorities report that the Madeira Island 

dengue outbreak has topped 2,000 cases since its beginning in early October, according to 

a European Centre for Disease Prevention and Control (ECDC) news release Dec. 13. 

According to the Portuguese Ministry of Health, as of Dec. 9, there has been 2,050 cases of 

dengue infection from the Autonomous Region of Madeira. This total is up from 1,993 cases 

reported four days prior. During the current outbreak than began Oct. 3, 12 people required 

hospitalization for their illness. Although the vast majority of the cases were in the local 

population, the number of European tourists to the island contracting the mosquito borne 

viral disease has continued to rise. Global Dispatch
United Kingdom: Norovirus outbreak 'could hit 750,000 

people'

13 December - More than 750,000 people could be affected

by an outbreak of norovirus in the UK, the Health Protection 

Agency (HPA) has said. There have been 2,630 confirmed 

reports of norovirus so far this season, but for every reported 

case there were likely to be a further 288 unreported 

sufferers, the HPA said. It means 757,440 people could be affected by the stomach bug – a 

72% increase so far this season. The HPA said: "Laboratory-confirmed reports represent only 

a small proportion of the actual amount of norovirus activity in the community, because the 

vast majority of affected people do not access healthcare services as a result of their illness." 

Among those affected are passengers on board a cruise liner in the Baltic, who have been 

confined to their rooms and warned not to leave the ship. Guardian

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USNORTHCOM

2012 West Nile virus update

11 December - As of December 11, 2012, 48 states have reported West Nile virus infections 

in people, birds, or mosquitoes. A total of 5,387 cases of West Nile virus disease in people, 

including 243 deaths, have been reported to CDC. Of these, 2,734 (51%) were classified as 

neuroinvasive disease (such as meningitis or encephalitis) and 2,653 (49%) were classified as 

non-neuroinvasive disease. The 5,387 cases reported thus far in 2012 is the highest number 

of West Nile virus disease cases reported to CDC through the second week in December 

since 2003. Eighty percent of the cases have been reported from 13 states (Texas, California, 

Louisiana, Illinois, Mississippi, South Dakota, Michigan, Oklahoma, Nebraska, Colorado, 

Arizona, Ohio, and New York) and a third of all cases have been reported from Texas. CDC

Drug-resistant C. difficile bug traced to source in US and 

Canadian hospitals

9 December - A lethal drug-resistant bug that spread rapidly around the world and killed 

tens of thousands of people has been traced to hospitals in the US and Canada. British 

researchers used powerful genetic techniques to reconstruct Clostridium difficile's route as 

it circled the globe, and identified four separate waves that brought the bug to Britain. In all 

but one instance, the pathogen crossed the Atlantic. The detailed map of the epidemic 

shows that two highly virulent strains emerged independently in North America after the 

pathogens evolved resistance to a frontline antibiotic in wide use at the time. The genetic 

sleuthing demonstrates the extraordinary information that scientists can glean from the 

DNA of infectious organisms. Within the next few years, rapid and real-time surveillance of 

pathogens is expected to become standard practice. Guardian
FDA review of tobacco products grinds to a halt

13 December - Tobacco companies have introduced almost no new cigarettes or smokeless 

tobacco products in the U.S. in more than 18 months because the federal government has 

prevented them from doing so, an Associated Press review has found. It's an unprecedented 

pause for an industry that historically has introduced dozens of new products annually, and 

reflects its increasingly uneasy relationship with the Food and Drug Administration, which in 

2009 began regulating tobacco. Officials at the FDA say applications for new products have 

languished because of "significant deficiencies" and because the agency is taking extra care 

in reviewing products that pose public health risks. Industry executives say cigarettes 

haven't changed in any meaningful way and the delays don't make sense. Yahoo! News

Traffic deaths at lowest point in 62 years

10 December - Deaths behind the wheel of an automobile fell last year to the lowest level 

since the Truman administration, but there was an increase in fatalities among bicyclists, 

pedestrians, motorcycle riders and big-rig truck drivers, according to federal figures 

released Monday. Overall, highway deaths dropped to 32,367, almost two percent lower 

than they were in 2010, and a 26 percent decline since a peak in 2005... The downward 

national trend began before the recession took some drivers off the roads, and it 

accelerated last year. It has been attributed to several factors, including increased use of air 

bags, seat belts and other vehicle safety features, improved roadway designs, and increasing 

awareness of the perils of driving drunk... The NHTSA data said the number of people killed 

in distraction-related accidents increased almost 2 percent, to 3,331, from 2010 to 2011. 

Federal and highway safety advocates said the increase may reflect better reporting of the 

distraction issue than an actual increase in fatalities. Washington Post

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USPACOM

Disasters: Asia’s 2012 figures and trends

11 December - The good news: fewer people died from natural 

disasters in Asia in 2012 than in previous years. The bad news: 

between January and October, natural disasters still claimed 

more lives here than anywhere else in the world - and experts 

predict the trend will continue as populations and industries 

expand in a region that already houses the world’s largest number of urban residents. 

“Cities are growing. There will be even more people and factories. If you think we have a 

problem now, we will have even more in the future,” said Jerry Velasquez, head of the AsiaPacific office for the UN Office for Disaster Risk Reduction (UNISDR). The agency estimates 

the number of people living in flood-prone urban areas in East Asia may reach 67 million by 

2060. IRIN
Philippines: Toll from typhoon above 700 and likely to 

rise, authorities say

11 December - The death toll from the destructive typhoon that savaged the southern 

Philippines last week has climbed above 700, authorities said Tuesday, warning that the final 

number may be much higher. Nearly 900 people are still unaccounted for in the aftermath 

of Typhoon Bopha, the strongest and deadliest storm to hit the Philippines this year, 

according to the country's emergency management agency. The numbers of dead and 

missing have risen drastically during the past several days as government officials have 

gathered information from isolated areas where the scale of the devastation was previously 

unknown. Both of the grim totals are likely to increase further this week, said Benito Ramos, 

head of the National Disaster Risk Reduction and Management Council, the emergency 

agency. Search and rescue efforts are continuing, he said, despite the declining chances of 

finding people alive... Hundreds of thousands of people are living in evacuation centers or 

relying on the government for other kinds of assistance, according to the national 

emergency agency. CNN

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USSOUTHCOM

Cholera outbreak in Cuba kept mostly quiet

9 December – Cuba, especially the eastern third of the island, is suffering an alarming 

outbreak of cholera, brewed in its decrepit water and sewer systems and fueled by 

Hurricane Sandy’s floods, according to residents. More than a dozen deaths have been 

reliably reported. Hospitals and prisons have been quarantined at times. Schools have been 

shut down, and so have restaurants and street kiosks... Cuba’s government has said nothing 

publicly about cholera since Aug. 28, when it announced that an outbreak in the eastern city 

of Manzanillo – the first in a century – had ended after 417 confirmed cases, three fatal. 

McClatchy

UN unveils cholera elimination plan for Haiti, 

Dominican Republic

12 December – United Nations (UN) officials yesterday launched a new initiative to 

eliminate cholera from Haiti and the Dominican Republic, using short-term measures such 

as targeted vaccine use and more permanent ones such as ensuring a clean drinking water 

supply. UN Secretary-General Ban Ki-moon announced the details at UN headquarters in 

New York City, according to a UN press release. The comprehensive plan has been 

anticipated by some global health experts, who have predicted that it would cost $2.2 

billion over the next decade and would include the biggest effort yet to improve Haiti's 

almost nonexistent water and sanitation system, thought to be a crucial step for halting the 

disease. CIDRAP

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