Monday, May 23, 2016

International SOS Daily Digest Addressed Wildfire Health Concerns

International SOS released the updated information below in it's Daily Digest: 
Canada: Advisory: Potential health risks from wildfires in Fort McMurray region

In Brief

Parts of northern Alberta are experiencing poor air quality following regional wildfires. The city of Fort McMurray has been evacuated and sections of the city have been damaged by fire. As of late May, the conditions improved in areas north of Fort McMurray and mandatory evacuation order was lifted in some areas. Polluted air can cause symptoms such as wheezing, coughing, shortness of breath, irritation of the eyes and nose and can also aggravate existing heart and lung disease.
Advice
  • Avoid travel to Fort McMurray while the mandatory evacuation order remains in place; members in the vicinity of Fort McMurray should adhere to all instructions issued by the authorities.
  • Continue to monitor the situation via the Municipality of Wood Buffalo website and the International SOS Travel Security Alert.
During periods of high air pollution, people in affected areas, especially the elderly, young children, and those with underlying heart or lung disease, are advised to:
  • follow the advice of local authorities and evacuate when instructed to do so
  • minimise time outdoors
  • reduce physical exertion
  • keep windows and doors closed
  • consider using an air cleaning device
  • use air conditioner in ‘recirculate' mode
  • consider using a respirator (N95 mask) while outdoors (consult your doctor for an individual recommendation)
  • consult your medical practitioner if you experience symptoms.
More Detail
The area surrounding Fort McMurray has been significantly affected by smoke from forest fires in the region. The Canadian Government's Air Quality Health Impact (AQHI) scale has exceeded the maximum 10 which equates to a "Very High Risk" of adverse health effects. The severity of the air pollution will vary, depending on weather conditions, and the level of air pollution is projected to remain elevated for extended periods until the fires are brought under control. For the current air quality measurements, see the Government of Canada updates for the Fort McMurray area and a near real time map of fires in the region is available from NASA.
What are the health concerns of air pollution?
Generally, polluted air causes minor, acute health problems such as eye and nasal irritation and cough. Other symptoms include headache, nausea and vomiting. The chemicals and particles in polluted air can cause breathing passages to become temporarily inflamed, decrease lung capacity and result in wheezing, coughing, shortness of breath and even pain upon deep inhalation. It can also exacerbate chronic heart disease and existing respiratory conditions, like asthma and emphysema. Certain people, for reasons as yet unknown, are particularly sensitive to ozone even without any underlying risk factors.
Some groups are especially vulnerable to problems caused by polluted air. These include older people, children, and anyone with underlying chronic health problems such as heart disease, emphysema, bronchitis or asthma. Long-term exposure to pollution can result in reduced lung function, particularly in children.
For more information:

Friday, May 13, 2016

Canadian PM Trudeau Visits Ft. McMurray; What Health Concerns Await Returnees?

Canada's Prime Minister Justin Trudeau is visiting Fort McMurray today, working with local officials to have evacuate residents back in their homes sometime in the next two weeks. But fires continue to burn in the area, and many residents will return to little more than ash. 

The CDC notes that wildfire smoke, due to its mix of gas and tiny particles of organic matter can be especially irritating to lungs and eyes, and is know to worsen cardiac and respiratory diseases. Older individuals, individuals with chronic heart conditions, and those with asthma and other lung problems are most affected by wildfire smoke, but people of all ages and health statuses can be adversely affected. 

Paper dust masks, such as those available at hardware and home and garden stores, and even surgical masks are not designed to filter the small particles typical to wildfire smoke and will likely be ineffective in preventing smoke particle inhalation. 

Ash and smoke from burned homes and other man-made structures are usually even more hazardous than organic ash and smoke from wildfires. Ash and burned structure remains are generally not considered hazardous waste, however may still contain contaminants with serious risks, such as asbestos, industrial chemicals, flame-retardant chemicals, cancer causing arsenic, lead, and nickel, as well many other caustic and irritant substances. 

Adults should avoid direct contact with ash and residue. Children and pets should not be allowed in or around ash or smoke from burned structures, and little may be salvageable from such structures due to contamination

Sources for more guidance in handling ash:



Thursday, January 14, 2016

CDC May Issue Travel Warning for Expectant Moms

The CDC is considering a travel warning for pregnant women, advising them against traveling areas with Zika virus due to growing evidence of risks of fetal/infant microcepahly: http://www.cnn.com/2016/01/14/health/zika-pandemic-travel-warnings/index.html. 

The World Health Organization (WHO) and the Pan American Health Organization (PAHO) have already issued warnings. For the complete PDF document, visit: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&Itemid=&gid=32405&lang=en

Monday, January 11, 2016

As Zika Virus Spreads, Will It Become the New Swine Flu of Texas?

The CDC has confirmed a diagnosis of Zika virus in a Houston, Texas (Harris County) patient who recently visited Latin America. Typical Zika symptoms include fever, rash, muscle and joint pain, headache, pain behind the eyes, conjunctivitis, and vomiting. The virus is spread through bites from the Aedes mosquito, which are also associated with Dengue Fever and other vector born illnesses.

According to the CDC, illness from Zika is usually mild and lasts several days to a week. Severe effects requiring hospitalization is not common and deaths are rare. However, Zika has been linked to microcephaly in exposed fetuses.

In 2009, Texas public officials panicked over an outbreak of H1N1 Swine Flu, cancelling public sporting events and closing schools. Many organizations and municipalities untook massive vaccination programs. Of course, the loss of even a single life is tragic, but however well-intentioned, health panics may result in "disaster fatigue" and public mistrust with a tendency to discount or disbelieve future health warnings.Will Zika virus cause similar public overreaction? Possibly; media coverage is increasing.  

Currently, no vaccine exists for Zika virus, but as stated above, it usually causes mild symptoms. However, it is becoming more widespread in Central and South American, especially Brazil, and travelers may wish to consider preventive measures. Prevention involves avoidance of exposure to mosquito bites, and should be taken especially seriously by pregnant women.

See also:

Thursday, February 16, 2012

Alabama U.S. Hand Foot and Mouth Disease Outbreak Monitored

ALABAMA, U.S— The Alabama Health Department is monitoring an outbreak of Hand, Foot, and Mouth Disease (HFMD), a contagious viral illness identified by the Centers for Disease Control and Prevention (CDC) as due to the Coxsackie A6 virus (CVA6). HFMD is not unusual, but the Coxsackie A6 viral strain is new to the U.S. Symptoms include fever, hand and foot rash, mouth sores, and dehydration. Pneumonia, Meningitis, or Encephalitis are rare complications. There is no specific treatment for HFMD.
CVA6 caused an HFMD outbreak in Finland in 2008, and the CDC notes that CVA6 infections “may be emerging as a new and major cause of epidemic HFMD”.

Sources:
1.      HealthWatch: 14 cases of new strain of Hand, Foot, and Mouth Disease in Alabama
2.      AL Health Dept: Cases of Hand, Foot and Mouth Disease on Rise
3.      Österback R, Vuorinen T, Linna M, Susi P, Hyypiä, Waris M. Coxackievirus A6 and hand, foot, and mouth disease, Finland. Emerg Infect Dis [serial on the Internet]. 2009 Sep [February 16, 2012]. Available from http://wwwnc.cdc.gov/eid/article/15/9/09-0438.htm

More information:

Monday, September 20, 2010

Cambodian Anti-Traffick Laws Hurt AIDS Efforts Despite UN Award

PHNOM PENH, CAMBODIA – Cambodia’s 2008 anti-human trafficking laws which also outlawed prostitution hinder efforts to reduce rates of HIV infection, according to the United Nations (UN). Officials and AIDS service providers say Cambodia’s “changes in the legal and policy environment” drive sex workers underground, making it difficult for health workers to serve them. Even when sex workers are located, health providers risk arrest for providing condoms and sexual health information.

Nonetheless, Cambodia won the UN’s Millennium Development Goals Award for sharply decreasing its rate of HIV infection from 2 % to 0.7 %. Over the last 10 years, Cambodia introduced a 100% Condom Use policy for all sex workers. In addition, 90% of people needing anti-viral drugs receive them.

SOURCE:
Cambodia Wins Award From United Nations For Cutting HIV/AIDS
http://www.monstersandcritics.com/news/health/news/article_1585656.php/Cambodia-wins-award-from-United-Nations-for-cutting-HIV-AIDS

Monday, July 19, 2010

Polio Cases Rise in Angola



World Health Organization (WHO) data indicate a growing outbreak of wild poliovirus type 1 (WPV1) in Angola since January 2010. All new cases are in the capital Luanda or in previously polio-free areas— Bie, Bengo, Huambo, Lunda Norte and Lunda Sul. Risk of international transmission is high, according to WHO.

At a seminar on “The Role of Mass Media Toward Fighting Polio in Angola”, Minister of Health Dr José Vieira Dias Van-Dúnem announced an “Emergency Plan to Stop Transmission of Polio in Angola”. The plan increases oral vaccinations in high-risk areas beginning August 2010 and increases information dissemination in remote areas.

In the Kabompo District, Zambia, Medical Officer Stephen Shajanika stated Angolan-Zambian cross-border activity poses a serious health threat. Zambian Minister of Health Kapembwa Simbao is currently responding to a measles outbreak in the country. Now through 24 July 2010, Zambian children will get both measles and polio immunizations in 30 districts bordering Angola and the Democratic Republic of Congo. Despite Simbao’s strong statement, the risk of polio transmission is unlikely to affect Angolan-Zambian relations for several reasons-- the number of cases is statistically low, the immunization responses appear sufficient, and Angola and Zambia sucessfully collaborated in a similar immunization effort in 2001-2002.

SOURCES

http://www.who.int/topics/poliomyelitis/en/

http://www.polioeradication.org/casecount.asp

http://www.lusakatimes.com/?p=27597

http://www.portalangop.co.ao/motix/en_us/noticias/saude/2010/6/28/Health-Ministry-creates-plan-stop-polio,c1d9f0ab-c755-4dac-bd92-46ce88cca7bd.html

http://www.reliefweb.int/rw/rwb.nsf/db900SID/VVOS-87HKPV?OpenDocument

http://www.portalangop.co.ao/motix/en_us/noticias/saude/2010/6/28/Angola-controls-cases-poliomyelitis,767a3595-a514-4491-8a81-c425b67af756.html


Thursday, January 14, 2010

High Rates of Crush Syndrome Likely

  • Two to 15% of earthquake survivors in Haiti are likely to develop Crush Syndrome. Half of those survivors are likely to develop acute kidney failure. About 50% of those individuals will need dialysis.[1]
  • Crush Syndrome is unusual in American and European medical practice,[2] and it is unlikely Western medical doctors assisting in Haiti will have extensive experience with the condition.
  • Haitian rescue and medical personnel are unlikely to be able to meet the immediate, in-the-field or longer term management needs of survivors with Crush Syndrome due to extensive damage to facilities and lack of equipment.
  • Haitian health services need immediate support with IV triage units for trapped survivors and long term support through mobile dialysis units.
BACKGROUND:
Crush injuries and crush syndrome are common following entrapment in a structural collapse. Crush injury is “compression of extremities or other parts of the body that causes muscle swelling and/or neurological disturbances”. Lower extremity injuries account for most crush injuries (74%), with injuries to the upper extremities (10%), and torso (9%) are less typical.
[3]

Crush Syndrome includes localized crush injury along with systemic effects, first described in 1941 after study of London aerial bombing survivors.
[4] Crushing lasting more than 1 hour and/or sudden release of a crushed body part can cause the syndrome which includes rhabdomyolysis, a condition in which crushed muscles break down and release toxic muscle cell components into the blood resulting in kidney failure, heart rhythm abnormalities, metabolic abnormalities, and other organ dysfunctions.[5] When infections or other medical conditions complicate crush-related kidney failure, the mortality rate is near 55%.

Best practices for crush injuries in the field pre-hospital including providing intravenous fluids (IV) before releasing the crushed body part, especially if entrapment has been longer than 4 hours. Failure to recognize and treat Crush Syndrome is common,
[6] especially during rescue efforts by non-medical personnel, and typically increases the death rate.

[1] Centers for Disease Control and Prevention (CDC) http://www.bt.cdc.gov/masscasualties/blastinjury-crush.asp
[2] Ian Greaves, Keith M. Porter, Consensus statement on crush injury and crush syndrome, Accident and Emergency Nursing, Volume 12, Issue 1, January 2004, Pages 47-52, ISSN 0965-2302, DOI: 10.1016/j.aaen.2003.05.001. (http://www.sciencedirect.com/science/article/B6W9C-49NRK2N-1/2/f147366677d0977c277fd6e3e44963ba)
[3] Centers for Disease Control and Prevention (CDC) http://www.bt.cdc.gov/masscasualties/blastinjury-crush.asp
[4] Bywaters and Beall, 1941. E.G.L. Bywaters and D. Beall, Crush injuries with impairment of renal function. BMJ 1 (1941), p. 427.
[5] Robert N. Reddix Jr., Robert A. Probe, Crush syndrome presenting three days after injury, Injury Extra, Volume 35, Issue 10, October 2004, Pages 73-75, ISSN 1572-3461, DOI: 10.1016/j.injury.2004.05.027.
(http://www.sciencedirect.com/science/article/B7CRN-4CT5YWS-1/2/b0213b1dd1f037550884d0482ca99fb9)
[6] A. Hussain, H.C. Kwak, I. Pallister, Crush syndrome: A comprehensive surgical strategy improves outcomes, Injury Extra, Volume 38, Issue 4, April 2007, Pages 111-112, ISSN 1572-3461, DOI: 10.1016/j.injury.2006.12.054. http://www.sciencedirect.com/science/article/B7CRN-4N4JNPB-12/2/1d74c6b122866766cf9b64a89900514e)

Haitian Quake Status Updates

Caveat: Single internal source, not independently corroborated.

Update on US Embassy Status:
Internal sources confirm one American official killed in the earthquake. The US Embassy compound is operating. The US Embassy is the only foreign embassy in Haiti not severely damaged or destroyed. However, the former embassy building is severely damaged. Most embassy employee residences are destroyed or severely damaged

Update on Haitian Business and Government:
The President of Citibank in Haiti was severely injured and flown to Santo Domingo
The Parliament building and National Palace are destroyed.

Update on Lodging:
All hotels are damaged or destroyed.

Update on Hospitals and Heath Care:
All Hospitals in Santo Domingo are full. Most of the hospitals in Port au Prince are damaged or destroyed

Casualty Estimates:
Early estimations are 40,000 to 50,000 dead, but that number is likely to reach 100,000.

Wednesday, January 13, 2010

Haitian National Palace Destroyed; Psychological Damage Highly Likely

Haiti's 12 January earthquake badly damaged most governmental buildings in the nation's capital of Port-au-Prince. The Haitian National Palace, which like the US White House is the both the residence of the country's President and a symbolic governmental seat, collapsed.

According to research on neighborhood destruction in New Orleans after Hurricane Katrina[1], massive building destruction and deconstruction results in “wrenching” mental and emotional distress. Similar research conducted after the 1983 earthquake in Italy indicated that serious long-term psychological distress correlates directly with the severity of environmental damage and financial loss[2]. In addition, the care and respect with which destroyed buildings are managed following a disaster can either mitigate or worsen public distress.

[1] Denhart, H. (2009) Deconstructing disaster: Psycho-social impact of building deconstruction in Post-Katrina New Orleans. Cities, Volume 26, Issue 4, August 2009, Pages 195-201. DOI:http://dx.doi.org/10.1016/j.cities.2009.04.003

[2] “Long Term Psychological Effects of Natural Disasters”. Reprinted from Psychosomatic Medicine 58:18-24 (1996) and available online at: http://www.psychosomaticmedicine.org/cgi/reprint/58/1/18.pdf



12 January Haiti Eathquake Shake Map
























The USGS Shake Intensity Map for the primary earthquake in Haiti. Additional information is available at: http://earthquake.usgs.gov/earthquakes/shakemap/global/shake/2010rja6/

Friday, August 7, 2009

India to Use Epidemic Diseases Act for H1N1, IFC Investment Not Affected

INDIA— In India, authorities issued new H1N1 guidelines following its first confirmed death from the virus—a 14 year old child from Pune, Maharashtra. The guidelines permit officials to use the Epidemic Diseases Act of 1897 to forcibly quarantine individuals suspected of being H1N1+.

The Epidemic Diseases Act of 1897 is of historical and political significant in Pune, where corrupt officials used it a century ago to evacuate Pune through brutal police action. It is somewhat likely reissuance of the Act will result in negative public opinion. In Maharashtra, where about one-fifth of India's total reported cases of H1N1 have originated, local officials will begin to check school children for signs of the virus.

Thus far, neither the reported H1N1 cases nor the reissuance of the Epidemic Diseases Act has negatively affected the World Bank’s private sector International Finance Corporation’s (IFC) plan to complete a multi-million dollar investment in Volkswagen India’s plant in Pune.

SOURCES:
http://www.voanews.com/english/2009-08-04-voa11.cfm

http://www.punemirror.in/index.aspx?page=article&sectid=2&contentid=2009080620090806001955578dff42f6e&sectxslt=

http://www.business-standard.com/india/news/ifc-to-spend-135-million-in-vw-pune-plant/366233/

Hong Kong and China H1N1 Update


H1N1 continues to spread dramatically in Hong Kong and nearby regions, with 234 new cases of swine flu this week alone, for a total of approximately 5000 confirmed cases in the region. Several patients are in serious to critical condition. Macao, Hong Kong’s immediate neighbor, reports 260 confirmed cases.

The Chinese mainland now has over 2000 confirmed cases, and the number cases grows by about 40 new disgnoses per day. Only 19 of the mainland cases were imported by travellers from other countries, possibly due to China's swift, strict, and controversial quarantines for suspected cases in non-nationals.
SOURCES: