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14 June 2013

Army Public Health Weekly Update

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

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

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

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

should not be construed or interpreted as being

endorsed by the US Army Medical Department.

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Contents

U.S. MILITARY

 Military doctors urged to refuse force-feeding at Guantanamo

 Tuberculosis trends in the U.S. Armed Forces, active component, 1998-2012

GLOBAL

 AIDS drugs halve HIV risk for intravenous drug users in study

 Air pollution can trigger heart arrhythmias: study

 Big multiple sclerosis breakthrough

 MERS coronavirus has potential to cause pandemic: WHO

 New discovery may protect against broad spectrum of diseases

 Scan predicts whether therapy or meds will best lift depression

 Six out of ten people on Earth still lack access to flush toilets, adequate sanitation

INFLUENZA

 CDC: Weekly Influenza Surveillance Report

 DoD Global Laboratory-Based Influenza Surveillance Program

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

 FDA approves Sanofi's four-strain flu shot

 Google.org: Flu Trends

 Naval Health Research Center: Febrile Respiratory Illness Surveillance Update

 PANDEMIC AND AVIAN INFLUENZA

 Federal officials weigh H7N9 vaccine options

 WHO proposes new pandemic flu alert levels

VETERINARY/FOOD SAFETY

 97 sickened in Hepatitis A outbreak linked to frozen berries

 Commissaries to sell Japanese produce again, 2 years after nuke disaster

 Faster method to identify Salmonella strains

 Fukushima-derived radioactivity in seafood poses minimal health risks

 Scientists say new study shows pig health hurt by GMO feed
2

TG 358: Army Guide 

to Weight 

Management

Technical Guide (TG) 358 

provides U.S. Army leaders, 

Soldiers, and their families 

with resources to assist 

them in improving their 

personal nutritional fitness 

and weight management.

Classified Version of 

the Weekly Update

An Army Public Health

Weekly Update is available 

with articles classified up to 

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http://phc.army.smil.mil

Look under Hot Topics & 

Current Issues.

To access this version, you 

will need a SECRET

clearance and a SIPRNet 

account.

WELLNESS

 Few wash hands properly, study finds

 How accurate are fitness trackers?

 How hospital workers solve patient-safety problems on their own

 Short walks “could cut diabetes risk in older people”

 Study shows pill prevents H.I.V. among drug addicts

USAFRICOM

 Ghana: Rabies outbreak kills two in Brong Ahafo

 Kenya: Ministry fights dengue fever

 Tanzania: Caution as all mosquitoes now spread elephantiasis

 Uganda: Uganda running out of ARVs, HIV test kits

 Zimbabwe: Zim children facing increasing levels of malnutrition and stunting

USCENTCOM

 Pakistan: Measles deaths, 8 June 2013

 Saudis report three more MERS-CoV cases, one fatal

USEUCOM

 Ireland: First Irish leprosy case reported in Republic of Ireland

 Spanish austerity cuts put lives at risk, study finds

 U.K.: Britain to regulate e-cigarettes as medicine from 2016

 U.K.: Public Health England to launch largest cancer database

USNORTHCOM

 U.S.: Chicago tactics put major dent in killing trend

 U.S. drops bid to block sales of morning-after pill

 U.S.: Multistate investigation of suspected infections following steroid injections

 U.S.: Program cuts use of antibiotics in kids

 U.S.: Nationwide shortage of doxycycline: resources for providers and recommendations for 

patient care

 U.S.: Supreme Court OKs patenting of human DNA if synthetic

USPACOM

 Asia's low fertility trap opens opportunities in IVF market

 India’s poorest women coerced into sterilization

 Marshall Islands: Drought situation report

 Singapore: Dengue outbreak worsens

 Thailand: Record dengue season predicted

USSOUTHCOM

 Haiti: UN warns 1.5 million people face severe hunger following weather shocks

 South America sees respiratory infection rise
3

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U.S. MILITARY

Military doctors urged to refuse force-feeding at 

Guantanamo

12 June - U.S. military doctors should refuse orders to force-feed hunger strikers at the 

Guantanamo detention camp because it violates their ethical obligations, two doctors and a 

medical ethics professor wrote in the New England Journal of Medicine on Wednesday. 

"Force-feeding a competent person is not the practice of medicine; it is aggravated assault," 

the trio said in an article posted on the website of the respected medical journal. Reuters

Tuberculosis trends in the U.S. Armed Forces, active 

component, 1998-2012

May 2013 - During the period from 1998 to 2012, there were 128 cases of confirmed TB 

disease. Most of the cases (93.0%) were pulmonary TB; nine (7.0%) of the reported cases 

were extrapulmonary TB. No service members diagnosed with TB were co-infected with HIV. 

In both the U.S. general and military populations, rates declined from 1998 to 2011; the 

decreasing trends in both populations were statistically significant. However, rates were 

consistently lower in the U.S. military than civilian population. During the surveillance period 

overall, the age-adjusted rate among U.S. military members was approximately one-fifth the 

rate among their civilian counterparts. Medical Surveillance Monthly Report

top of page...

GLOBAL

AIDS drugs halve HIV risk for intravenous drug users in 

study

12 June - A daily dose of powerful anti-HIV medicine helped cut the risk of infection with 

the AIDS virus by 49 percent in intravenous drug users in a Bangkok study that showed for 

the first time such a preventive step can work in this high-risk population. "This is a 

significant step forward for HIV prevention," said Dr. Jonathan Mermin, director of the U.S. 

Centers for Disease Control and Prevention, which helped conduct the clinical trial along 

with the Thailand Ministry of Health. The study, published on Wednesday in the journal 

Lancet, looked at the treatment approach known as pre-exposure prophylaxis, or PrEP, in 

which HIV treatments are given to uninfected people who are at high-risk for HIV infection. 

Reuters
4

Air pollution can trigger heart arrhythmias: study

13 June - For people with existing heart problems, exposure to high levels of air pollution 

can trigger the irregular heartbeats that may lead to a stroke or heart attack, according to a 

new study. Past research has linked air pollution to ventricular fibrillation, electrical 

confusion in the lower chambers of the heart which can cause sudden death. The new study 

also finds an association with atrial fibrillation (AF), erratic quivering in the heart's upper 

chambers and the most common type of irregular heartbeat. Reuters

Big multiple sclerosis breakthrough

4 June - A phase 1 clinical trial for the first treatment to reset the immune system of 

multiple sclerosis (MS) patients showed the therapy was safe and dramatically reduced 

patients’ immune systems’ reactivity to myelin by 50 to 75 percent, according to new 

Northwestern Medicine research. Northwestern University

MERS coronavirus has potential to cause pandemic: 

WHO

10 June - The World Health Organization on Monday urged health workers around the 

world to be on the alert for symptoms of the deadly Middle East respiratory syndrome 

coronavirus (MERS), which has the potential to circle the globe and cause a pandemic. The 

United Nations agency, which issued new, long-awaited guidance to countries on influenza 

pandemics, said the world was also in the same "alert phase" for two human strains of bird 

flu - H5N1, which emerged a decade ago, and H7N9, first detected in China in March.

Reuters

New discovery may protect against broad spectrum of 

diseases

6 June - Kenneth Keiler, an associate professor of biochemistry and molecular biology at 

Penn State, recently led a team to a discovery that targets and prevents bacteria from 

replicating in the body, thus preventing disease. The team isolated a process called “transtranslation,” which is the process by which bacteria replicates itself. The team found a way 

to block the bacterium’s synthesis machinery using RNA, halting the replication process of 

the bacteria. This approach could lead to new treatment methods for anthrax, tuberculosis, 

shigellosis and other bacterial diseases. BioPrep Watch

Scan predicts whether therapy or meds will best lift 

depression

12 June - Pre-treatment scans of brain activity predicted whether depressed patients would 

best achieve remission with an antidepressant medication or psychotherapy... Currently, 

determining whether a particular patient with depression would best respond to 

psychotherapy or medication is based on trial and error... [Researchers] compared brain 

circuit activity of patients who achieved remission following treatment with those who did 
5

not improve. Activity in one specific brain area emerged as a pivotal predictor of outcomes 

from two standard forms of depression treatment: cognitive behavior therapy (CBT) or 

escitalopram, a serotonin specific reuptake inhibitor (SSRI) antidepressant. If a patient's pretreatment resting brain activity was low in the front part of an area called the insula, on the 

right side of the brain, it signaled a significantly higher likelihood of remission with CBT and 

a poor response to escitalopram. Conversely, hyperactivity in the insula predicted remission 

with escitalopram and a poor response to CBT. NIH

Six out of ten people on Earth still lack access to flush 

toilets, adequate sanitation

4 June – ...[S]ix out of every ten people on Earth still do not have access to flush toilets or 

other adequate sanitation — measures that protect the user and the surrounding 

community from harmful health effects — according to a new study. The latest episode in 

the American Chemical Society’s (ACS) Global Challenges/Chemistry Solutions podcast series 

describes research concluding that the number of people without access to flush toilets or 

other adequate sanitation is almost double the previous estimate. Homeland Security News 

Wire

top of page...

INFLUENZA

CDC: Weekly Influenza Surveillance Report

During week 22, 5.9% of all deaths reported through the 122-Cities Mortality Reporting 

System were due to P&I. This percentage was below the epidemic threshold of 6.8% for 

week 22. FluView

DoD Global Laboratory-Based Influenza Surveillance 

Program

 During Week 22, 16 specimens were received from 10 locations. Among those received, 

four specimens had testing completed from three locations. There were no viruses 

detected.

 To date this influenza season, 3,776 specimens have completed testing from 81 

locations, of which 1,074 were positive for influenza A (954 A(H3N2), 110 

A(H1N1)pdm09, five co-infections, and five A/not subtyped). 

 To date this influenza season, 368 specimens were positive for influenza B. Of these, 

there were 71 B/Yamagata, 19 B/Victoria, and two B & enterovirus co-infections. The 

lineage is pending or unknown for 276 specimens. 
6

 There have been 261 other respiratory viruses isolated (65 adenovirus, 91 RSV, 93 

parainfluenza, 10 enterovirus, and two rhinovirus/enterovirus) cumulatively this season. 

USAF School of Aerospace Medicine

European Centre for Disease Prevention and Control:

Weekly Influenza Surveillance Overview

For weeks 21 and 22/2013, all participating countries reported low-intensity transmission 

and almost all reported stable trends. Six countries tested 19 sentinel specimens, two of 

which were positive for influenza A(H1N1)pdm09 virus. In addition, 45 non-sentinel source 

specimens were found to be positive for influenza virus, 19 of which (42%) were type A and 

26 (58%) type B. No laboratory-confirmed severe influenza cases have been reported since 

week 21/2013. During the first influenza inter-season weeks of 2012–2013, influenza activity 

was low in Europe. Weekly Influenza Surveillance Overview

FDA approves Sanofi's four-strain flu shot

10 June - The US Food and Drug Administration (FDA) has approved Sanofi Pasteur's 

Fluzone Quadrivalent (four-strain) injectable flu vaccine, the company announced today. In 

March 2012 the FDA approved MedImmune's nasal-spray quadrivalent live-attenuated 

influenza vaccine, and in December the agency made GlaxoSmithKline's (GSK's) Fluarix 

Quadrivalent the first injectable four-strain flu vaccine approved for use in the United States. 

Sanofi's product becomes the second approved four-strain flu shot. Quadrivalent flu 

vaccines are designed to protect against both influenza B strains that can circulate in any 

given year. CIDRAP

Google.org: Flu Trends

13 June – Estimates of flu activity based on certain Internet search queries indicate 

moderate levels of flu activity in Chile, Argentina, and South Africa. Google.org Flu Trends

Naval Health Research Center: Febrile Respiratory 

Illness Surveillance Update 

For the week ending 8 June 2013:

 Influenza: No new cases of NHRC laboratory-confirmed influenza among U.S. military 

basic trainees.

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

or below expected values. NHRC Febrile Respiratory Illness Surveillance Update 
7

PANDEMIC AND AVIAN INFLUENZA

Federal officials weigh H7N9 vaccine options

11 June – Intensive federal deliberations are under way on whether to stockpile a vaccine 

against the H7N9 flu virus that emerged this spring in China, similar to the government's 

response to the H5N1 avian flu threat, health officials said today. In the meantime, vaccine 

companies are getting ready to produce enough vaccine for clinical trials, which are slated 

to begin in August, according to an update presented before the National Vaccine Advisory 

Committee (NVAC), an outside group that assists the US Department of Health and Human 

Services (HHS). The meeting was broadcast live on the Web. Robin Robinson, PhD, director 

of the HHS' Biomedical Advanced Research and Development Authority (BARDA) told the 

group that over the past 4 years federal health officials have used an assessment tool to 

weigh the risks of novel flu viruses and consider any steps to take with vaccine and other 

preparedness activities. CIDRAP

WHO proposes new pandemic flu alert levels

10 June – The World Health Organization (WHO) today proposed a new pandemic alert 

system, one that's designed to focus more on disease risk than geographic spread and to 

streamline communications to the public. At a media briefing in Geneva today, David 

Harper, CBE, special adviser to the WHO's assistant director-general for health, security, and 

environment, said the interim guidance reflects lessons learned during the 2009 H1N1 

pandemic, according to an Agence France-Presse (AFP) report. A few months into the 2009 

H1N1 pandemic the WHO faced tough questions from countries about its pandemic alert 

phases. During the 2009 World Health Assembly (WHA) some countries urged the WHO to 

go slow on declaring a full-scale pandemic, and they argued that pandemic phases should 

reflect the severity of the disease as well as its geographic spread. The pandemic plans of 

some member states had response actions, such as the purchase of pandemic vaccine, that 

were triggered by the WHO's pandemic phase declarations. CIDRAP

top of page...

VETERINARY/FOOD SAFETY

97 sickened in Hepatitis A outbreak linked to frozen 

berries

13 June - At least 99 people in 8 states are now known to have 

been sickened in the ongoing hepatitis A outbreak tied to a 

frozen organic berry mix. That number is up from the 87 

illnesses reported Monday by the Centers for Disease Control 

and Prevention (CDC). The CDC now reports that 38 people 

have been hospitalized as a result of their infections. Illnesses have occurred in Arizona, 
8

California Colorado, Hawaii, Nevada, New Mexico, Utah and Washington. Patients report 

falling ill between March 16 and June 1, 2013. The virus has been traced back to a frozen 

berry mix distributed by Townsend Farms of Fairview, Oregon and sold at Costco and Harris 

Teeter stores. Food Safety News

Commissaries to sell Japanese produce again, 2 years 

after nuke disaster

7 June - Shoppers at base commissaries can look forward to fresher food at lower prices 

after officials decided it’s once again safe to stock produce aisle with foods from the parts 

of Japan that were affected by the 2011 Fukushima nuclear disaster. The release of radiation 

from the Fukushima Daiichi Nuclear Power Station, following a massive earthquake and 

tsunami on March 11, 2011, prompted the U.S. Department of Defense to cut deliveries of 

foods ranging from baked goods and eggs to fresh fruit, vegetables and processed items 

from 26 producers in northern Japan... [T]he last remaining bans — on food from the Kanto, 

Tohoku and Chubu regions — ended Thursday. Stars and Stripes

Faster method to identify Salmonella strains

4 June - ...A new approach may be able to reduce by more than half the time it takes health 

officials to identify Salmonella strains, according to researchers in Penn State’s College of 

Agricultural Sciences. The finding may significantly speed up the response to many 

outbreaks of foodborne illness, allowing epidemiological investigators to identify the exact 

strains of Salmonella that make people sick and to find more quickly — and eliminate — the 

source of the disease. Homeland Security News Wire

Fukushima-derived radioactivity in seafood poses 

minimal health risks

5 June - Researchers find that the likely doses of radioactivity ingested by humans 

consuming fish contaminated by radioactive radiation escaping from the debilitated 

Fukushima reactors fish, are comparable to, or less than, the radiological dosages associated 

with other commonly consumed foods, many medical treatments, air travel, and other 

background sources. Homeland Security New Wire

Scientists say new study shows pig health hurt by GMO 

feed

11 June - Pigs fed a diet of only genetically modified 

grain showed markedly higher stomach inflammation 

than pigs who dined on conventional feed, according to a 

new study by a team of Australian scientists and U.S. 

researchers. The study adds to an intensifying public 

debate over the impact of genetically modified crops, which are widely used by U.S. and 

Latin American farmers and in many other countries around the world... Researchers said 

there were no differences seen between pigs fed the GM and non-GM diets for feed intake, 

weight gain, mortality, and routine blood biochemistry measurements. Reuters

top of page...
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WELLNESS

Few wash hands properly, study finds

11 June - Did you wash your hands properly after you used the toilet? Probably not, a new 

study suggests. Researchers discreetly watched 3,749 people, 60 percent of them women, 

after they used public toilets in a Michigan college town. Overall, 10.3 percent did not wash 

their hands at all, and 22.8 percent used no soap. The remainder did use soap, but only 5.3 

percent washed for longer than 15 seconds, soap or no soap. According to the Centers for 

Disease Control and Prevention, proper washing means rubbing vigorously with soap and 

water for at least 20 seconds. Men did worse than women — almost 15 percent of them did 

not wash at all, compared with 7.1 percent of women. New York Times

How accurate are fitness trackers?

12 June - ...[A]t-home users can choose from a variety of devices, 

sold under such brand names as Fitbit and Nike+ FuelBand... For 

his experiment, Dr. Meckes gathered 16 adult volunteers and 

fitted each with three different monitors, two worn on the hip and 

one around the arm. The volunteers also donned portable masks 

that measure oxygen consumption, the gold standard in determining energy output... All 

three of the devices accurately measured energy expenditure when the volunteers walked 

briskly, Dr. Meckes and his colleagues found; their estimates closely matched those of the 

oxygen-consumption monitor. But the devices were far less reliable in tracking the energy 

costs of light-intensity activities like standing or cleaning, often misinterpreting them as 

physical immobility. Only the calorie cost of typing was overestimated, and only by the 

armband monitor, which considered the arm movements involved to be far more dynamic 

than they actually are. New York Times

How hospital workers solve patient-safety problems on 

their own

11 June - Dr. Michael Gardam... couldn’t find a way to persuade his fellow health-care 

workers to wash their hands before touching patients... Rather than using the traditional 

approach of educating people about the need to wash their hands, he engaged his coworkers with talk of “positive deviance” and urged them to come up with their own 

solutions for infection control. Handwashing rates climbed to 87 per cent from a low of 30 

per cent. Gardam’s team then used the same method to tackle other chronic problems that 

compromised patient safety, such as in-hospital falls and bedsores. Now, other hospitals –

including some in the United States – are turning to Gardam for advice. Globe and Mail

Short walks “could cut diabetes risk in older people”

12 June - A 15-minute walk after each meal could prevent older people developing type-2 

diabetes, a study has found. The post-meal walks control blood sugar as well as one long 
10

walk, research by George Washington University suggested. Elevated blood sugar after 

meals could increase the risk of type-2 diabetes, so resting after eating "is the worst thing 

you can do,” the study said. Diabetes UK said there were "small differences" between 

exercise routines - but any activity was beneficial. The US study was the first to test short 

bouts of exercise in the "risky period" following meals, when blood sugar can rise rapidly, 

lead author Loretta DiPietro said. BBC News

Study shows pill prevents H.I.V. among drug addicts

12 June - Drug-injecting addicts who took a daily antiretroviral pill were half as likely to 

become infected with H.I.V. as those who did not, a major new study has found, providing 

the final piece of evidence that such treatments can prevent AIDS in every group at risk. 

Earlier clinical trials showed that the therapy can sharply reduce the risk of H.I.V. 

transmission from mother to child, and in gay and bisexual men and heterosexuals. New 

York Times

top of page...

USAFRICOM

Ghana: Rabies outbreak kills two in Brong Ahafo

12 June - Two people died from a rabies outbreak in the Asunafo North and Asunafo South 

Districts in the Brong Ahafo Region between February and April this year. Dr Kenneth 

Gbeddy, Brong Ahafo Regional Director of Veterinary Service in an interview with the Ghana 

News Agency in Sunyani on Wednesday said the two, a man and a woman were the victims, 

but did not disclose their districts. He said veterinary officers were undertaking vaccination 

exercises to bring the situation under control, adding that, last year, two people also died 

from rabies in the Tano North District and Tano South District of the Region. Ghana 

Business News

Kenya: Ministry fights dengue fever

10 June - Ministry of Health and Kenya Red Cross Mombasa officials led a Dengue fever 

sensitisation programme in Shimanzi Railways estate Makande, Mombasa at the weekend. 

The region is prone to mosquito infestation due to its proximity to the Kibarani dumping 

site, a bushy environment and the Indian Ocean. Red Cross officials in charge of the 

programme, Gregory Okal, said they cleared the bushes and sprayed insecticide in the 

houses in the estate. Speaking to the Star during the activity, Okal said Mombasa has 115 

confirmed cases of Dengue fever and 356 results awaited from a comprehensive laboratory 

test in Nairobi. "As the Red cross we have taken this early preventive measure because 

Dengue is still rampant in Mombasa despite the assurance from experts that it has been 

contained," he said. allAfrica
11

Tanzania: Caution as all mosquitoes now spread 

elephantiasis

12 June - As Dar es Salaam and Mwanza regions prepare for the start of a mass drug 

administering campaign against bilharzia and lymphatic filariasis (elephantiasis), health 

experts have cautioned the public to be more vigilant now that it has been found that all 

mosquitoes spread elephantiasis. Speaking during a sensitisation workshop for news editors 

and journalists in Dar es Salaam yesterday, the National Neglected Tropical Diseases (NTD) 

Coordinator, Dr Upendo Mwingira, said in the past, only the culex mosquito was known to 

spread elephantiasis. Recent studies, however, have shown that even anopheles mosquitoes 

can, which in the local context means that a huge chunk of the country's population is now 

vulnerable to elephantiasis. allAfrica

Uganda: Uganda running out of ARVs, HIV test kits

12 June - Uganda has run out of most antiretroviral drugs (ARVs), HIV testing kits, drugs to 

treat opportunistic infections and several crucial diagnostic tools for HIV care, according to 

a recent Ministry of Health stock status report. The report, posted by the ministry on 27 

May, listed the status of medical supplies as of 1 May. It reported that central stocks of a 

number of first- and second-line ARVs, paediatric ARV formulations and HIV test kits were 

either out or below the minimum stock levels in country's three government warehouses. 

IRIN

Zimbabwe: Zim children facing increasing levels of 

malnutrition and stunting

11 June - The UN World Food Programme (WFP) has warned that Zimbabwe's children, a 

third of whom have already been left stunted as a result of malnutrition, are still at serious 

and increasing levels of risk. In a report issued earlier this year on the state of food security 

in Zimbabwe, the WFP highlights how malnutrition is an ongoing problem. The report 

quotes figures released late last year by the Zimbabwe National Security Agency and Inner 

City Fund International. According to the latest Demographic and Health Survey of 2012, 

one in every three Zimbabwean children is stunted as a result of malnutrition. The WFP says 

the prevalence of stunting among Zimbabwe's children, caused by lack of proper nutrition, 

has continued to rise since 2009. allAfrica

top of page...

USCENTCOM

Pakistan: Measles deaths, 8 June 2013

8 June - Measles claimed the lives of two more babies in Punjab during the last 24 hours. Of 

them one died at Children’s Hospital in Lahore and the other in Allied Hospital, Faisalabad, a 

health department spokesman said. He said a total of 201 new measles cases were reported 

all over the province during the last 24 hours, including 40 in Lahore alone. ReliefWeb
12

Saudis report three more MERS-CoV cases, one fatal

12 June – Saudi Arabia, epicenter of MERS-CoV (Middle East respiratory syndrome 

coronavirus) outbreaks, reported three more cases today, one of them fatal, while media 

reports said French authorities ruled out two suspected cases. Meanwhile, a Canadian 

expert who recently traveled to Saudi Arabia to help investigate the cases there said more 

international collaboration will be needed to figure out the source of the virus, according to 

a Canadian Press report. CIDRAP

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USEUCOM

Ireland: First Irish leprosy case reported in Republic of 

Ireland

10 June - The first recorded case of leprosy in modern times was reported to the health 

authorities in the Irish Republic earlier this year, it has emerged. The patient is a Brazilian 

who has been living in Ireland for several years. He had suffered a recurrence of his leprosy 

having first contracted it in Brazil, 10 years ago. Dr Connor Gallagher said it was a case that 

"one might have expected to encounter in the Middle Ages - not in a busy surgery in 

County Meath". The GP registrar who examined the man said he suffered from tuberculous 

leprosy or sarcoidosis. "The risk of contagion in new cases is small. However global 

eradication in recent years has proven difficult," he wrote in a medical magazine. BBC

Spanish austerity cuts put lives at risk, study finds

13 June - Austerity cuts in Spain could lead to the effective dismantling of large parts of its 

healthcare system and significantly damage the health of the population, according to a 

study published on Thursday. Researchers who analyzed the situation warned that if 

nothing was done to reverse the trend, Spain risked spiraling health problems and could see 

increases in infectious diseases such as tuberculosis and the virus that causes AIDS... The 

study published in the British medical Journal (BMJ) found that Spain's national budget cuts 

of almost 14 percent and regional budget cuts of up to 10 percent in health and social 

services in 2012 have coincided with increased demands for care, particularly from the 

elderly, disabled and mentally ill. The researchers also noted increases in depression, 

alcohol-related disorders and suicides in Spain since the financial crisis hit and 

unemployment increased. Reuters

U.K.: Britain to regulate e-cigarettes as medicine from 

2016

12 June - Britain is to regulate electronic cigarettes as non-prescription medicines from 

2016 in an attempt to improve quality, though the country's drugs watchdog said they 

would still be sold in convenience stores. Healthcare authorities around the world are 
13

grappling with how to deal with the battery-driven devices, which allow users to inhale 

nicotine-laced vapor and are increasingly popular as an apparently less harmful alternative 

to smoking. Reuters

U.K.: Public Health England to launch largest cancer 

database

12 June - The world's largest database of cancer patients is being set up in England in an 

attempt to revolutionise care, Public Health England has announced. It will collate all the 

available data on each of the 350,000 new tumours detected in the country each year. The 

aim is to use the register to help usher in an era of "personalised medicine" that will see 

treatments matched to the exact type of cancer a patient has. Experts said it was "great 

news". BBC

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USNORTHCOM

U.S.: Chicago tactics put major dent in killing trend

11 June - A year after this city drew new attention for soaring gun violence and gang 

bloodshed, creating a political test for Mayor Rahm Emanuel in President Obama’s 

hometown, Chicago has witnessed a drop in shootings and crime. Killings this year have 

dipped to a level not seen since the early 1960s... In recent months, as many as 400 officers 

a day, working overtime, have been dispatched to just 20 small zones deemed the city’s 

most dangerous. The police say they are tamping down retaliatory shootings between gang 

factions by using a comprehensive analysis of the city’s tens of thousands of suspected 

gang members, the turf they claim and their rivalries. The police are also focusing on more 

than 400 people they have identified as having associations that make them the most likely 

to be involved in a murder, as a victim or an offender. New York Times

U.S. drops bid to block sales of morning-after pill

10 June - The US administration says it will no longer seek to block over-the-counter sales 

of emergency contraception to women and girls of all ages. This means that anyone will 

soon be able to buy the Plan B morning-after pill without a prescription. The justice 

department had fought against a federal judge's order seeking to lift current age and sales 

limits. The move is seen as a breakthrough in the 12-year battle to make emergency 

contraception universally available. Under current laws, only girls aged 15 and older can 

purchase the morning-after pill without a prescription. However in April, US district judge 

Edward Korman ruled that the drug should be made available over-the-counter and without 

age restrictions. ...US government lawyers had appealed against Judge Korman's ruling, 

arguing that he had exceeded his authority. But the justice department has now confirmed 

that the FDA will drop its appeal and prepare a plan to comply with the ruling. BBC News
14

U.S.: Multistate investigation of suspected infections 

following steroid injections

10 June - CDC is aware of reports of suspected infections among persons who received 

either 80mg/mL or 40mg/mL of preservative-free methylprednisolone acetate (MPA) 

produced by the Main Street Family Pharmacy in Newbern, Tennessee. As of June 10th, CDC 

is reporting 25 cases from four states - Arkansas, Florida, Illinois, and North Carolina. The 

majority of these persons developed skin and soft tissue infections of unclear etiology 

following intramuscular injection of this product. All products labeled as sterile have been 

voluntarily recalled by the pharmacy. On June 6, FDA reported detection of microbial 

contamination, including bacterial and fungal, in unopened vials of preservative-free MPA. 

Samples are being sent to CDC for further characterization. These findings emphasize the 

importance for providers to continue to ensure that all recalled products are no longer in 

use and returned promptly. CDC

U.S.: Program cuts use of antibiotics in kids

11 June - An educational intervention combined with regular feedback to pediatricians 

reduced inappropriate prescribing of antibiotics for children treated for respiratory 

infections in an outpatient setting, a randomized trial showed. Within the first year, the 

percentage of broad-spectrum antibiotics prescribed for any indication fell by an absolute 

12.5% in the intervention group compared with a drop of 5.8% in the usual-practice group, 

a significant difference (P=0.01), according to Jeffrey Gerber, MD, PhD, of the Children's 

Hospital of Philadelphia, and colleagues. That difference was largely driven by less use of 

antibiotics for pneumonia. MedPage Today

U.S.: Nationwide shortage of doxycycline: resources for 

providers and recommendations for patient care 

12 June - The Food and Drug Administration (FDA) originally reported a shortage of some 

forms of doxycycline (doxycycline hyclate) and unavailability of tetracycline on January 18, 

2013, caused by increased demand and manufacturing issues. FDA continues to report 

shortage from some, but not all, manufacturers of some dosages and forms of doxycycline 

hyclate and doxycycline monohydrate. FDA does not currently report a shortage of 

intravenous doxycycline hyclate or the oral suspension doxycycline calcium commonly used 

in pediatric patients... This notice provides advice on alternatives to doxycycline when 

available, as well as situations where there is no recommended alternative to doxycycline.

CDC
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U.S.: Supreme Court OKs patenting of human DNA if 

synthetic

13 June - In a first of its kind ruling on human genes, a unanimous 

U.S. Supreme Court on Thursday decided that synthetically 

produced genetic material can be patented but naturally occurring 

DNA extracted from the human body cannot... The contentious, 

uniquely 21st century question before the court was whether any 

human genes can ever be patented - meaning the holders have exclusive rights to their 

intellectual property for a defined period. Reuters

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USPACOM

Asia's low fertility trap opens opportunities in IVF 

market

13 June - A looming crisis in Asia as women delay giving birth, leading to low fertility rates 

that have dire implications for economic growth, is opening huge opportunities for the fastgrowing in-vitro fertilization (IVF) industry... Several countries such as Singapore, Japan and 

South Korea have fertility rates of less than 1.5 births per woman, a level experts consider 

very low. In contrast, the United States has a fertility rate of around 2.01 and Australia 1.9. 

Reuters

India’s poorest women coerced into sterilization

11 June - ... When it comes to family planning, women are on the front lines in India, which 

has carried out about 37 percent of the world’s female sterilizations. Government-imposed 

quotas and financial incentives for doctors mean 4.6 million women were sterilized last year, 

many for cash payments and many in the unsanitary and rudimentary conditions that 

greeted Devi. Vasectomies, by contrast, accounted for just 4 percent of all sterilizations... 

[A.K. Das, the surgeon at the clinic,] who spent three minutes on each operation, ran out of 

anesthetic with more than 10 patients to go, forcing him to use a weaker sedative. He said 

he’s paid an extra $2 per patient by the government for continuing to operate under these 

circumstances. In between each operation an assistant washed the scalpel in a tray filled 

with warm water. Bloomberg

Japan: Nationwide rubella epidemic — Japan, 2013

14 June - The primary purpose of rubella vaccination is to prevent congenital rubella virus 

infection, including CRS [congenital rubella syndrome]. In WPR [Western Pacific Region], the 

Immunization Technical Advisory Group endorsed a regional accelerated rubella control and 
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CRS prevention goal to decrease rubella incidence to <10 cases per million population and 

CRS incidence to <10 cases per million live births each year by 2015. In 2012, Japan 

reported 18.7 rubella cases per million population, a rate higher than the WPR annual 

incidence target. As of May 2013 (4 months into the year), the number of reported rubella 

cases is already double the total number of cases in 2012. Morbidity and Mortality Weekly 

Report

Marshall Islands: Drought situation report

11 June - A state of ‘drought’ disaster remains in effect in the Republic of the Marshall 

Islands (RMI). The state of ‘drought disaster proclaimed by the RMI President was reissued 

on 7 June and will remain in effect for an additional 30 days. Drought conditions on the 

affected islands and atolls remain unchanged. Humanitarian needs for the 6,384 people 

living on the affected islands and atolls are urgent. The most pressing humanitarian needs 

are for access to safe water and the growing need for food. The drought conditions have 

depleted water tanks and made groundwater unsuitable for human consumption due to 

high salinity. In addition, the drought has damaged or destroyed local food crops. ...There 

have been no significant outbreaks of diarrhoea, influenza-like illness and conjunctivitis 

reported since 1 May. However, on some atolls and islands there have been an increased 

number of cases of influenza-like illness reported in Lae, Likiep and Namu and of diarrhoea 

in Mejit. ReliefWeb/OCHA

Singapore: Dengue outbreak worsens

11 June - As weekly dengue-fever infections surge to a record, Singaporean health officials 

are stepping up efforts to beat back a tropical-disease outbreak that could become the citystate’s worst ever. More than 9,400 people here have been infected by the mosquito-borne 

dengue virus so far this year, resulting in two deaths, according to the National Environment 

Agency. Weekly counts surged to an all-time high of 820 cases in the week that ended June 

8, topping the previous record of 713 cases in 2005. Officials believe the severity of the 

current epidemic will surpass that of Singapore’s worst dengue outbreak that year, when 

authorities logged 14,006 confirmed cases. The number of deaths in 2005 ended at 27, a 

higher proportion than the current outbreak. Wall Street Journal

Thailand: Record dengue season predicted

12 June - With more than 40 deaths and almost 40,000 cases of dengue fever reported in 

Thailand so far this year, health experts are warning this could be the largest-ever epidemic. 

“About 25 years ago we had a dengue outbreak of around 170,000 cases,” Pornthep 

Siriwanarangsun, the director of Thailand’s Department of Disease Control, told IRIN. “This 

year, we expect 150,000 to 200,000 cases.” Up to 200 people could die in a worst-case 

scenario, he said. Even if dengue cases surpass the 1987 record, the death toll that year of 

more than 1,000 is unlikely to be exceeded owing to improved health care and preventive 

measures. IRIN

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USSOUTHCOM

Haiti: UN warns 1.5 million people face severe hunger 

following weather shocks

11 June – The United Nations food relief agency said it remained extremely concerned by 

the plight of 1.5 million people in Haiti who need food assistance, following extreme 

weather conditions and poor harvests. In addition to the 1.5 million people facing food 

insecurity, a further 6.7 million people in Haiti are struggling to meet their own food needs 

on a regular basis. Before the hurricane season, which runs from June to November, the 

World Food Programme (WFP) had pre-positioned emergency supplies to cover the needs 

of 300,000 people for two days with ready-to-use food and for four weeks with staple food 

rations. The agency also had established agreements with 15 partners and had begun 

emergency distribution to 200,000 beneficiaries through schools in the worst-affected 

communities. ReliefWeb

South America sees respiratory infection rise

12 June - Several South American countries are reporting high levels of acute respiratory 

infection levels, with increasing trends in most countries, but within expected levels for this 

time of year, the Pan American Health Organization (PAHO) reported today in its weekly 

update. So far respiratory syncytial virus (RSV) predominates in most countries, though the 

2009 H1N1 flu virus is dominant in Brazil. RSV and seasonal flu viruses, mainly H1N1, are 

cocirculating in some countries, including Argentina, Chile, Colombia, and Venezuela. 

Locations seeing RSV cocirculation with H3N2 include Bolivia (La Paz), Ecuador, and Peru. 

The World Health Organization (WHO) said in its most recent flu update that flu activity is 

starting to increase in South America and South Africa, but levels are still low in Oceania.

CIDRAP News Scan

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