As of 25 December 2008, a total of 26 497 cases, including 1 518 deaths, have been reported by the Ministry of Health in Zimbabwe. Cases are now being reported from all 10 of the country’s provinces. Harare, particularly Budiriro suburb in the south west, accounts for the majority of cases, followed by Beitbridge in Matabeleland South and Mudzi in Mashonaland East. The current outbreak is the largest ever recorded in Zimbabwe and is not yet under control. In fact, the epidemiological week ending 20 December saw over 5 000 new cases – an increase in the number of weekly cases relative to previous weeks – and an increase in deaths outside treatment/health centres.

The overall Case Fatality Rate (CFR) has risen to 5.7% – far above the 1% which is normal in large outbreaks – and in some rural areas it has reached as high as 50%. Mortality outside of healthcare facilities remains very high. This is a clear indication that better case management and access to healthcare is needed – in particular an increased use of oral rehydration therapy with Oral Rehydration Salts in communities very early after onset of the disease.

The outbreak has taken on a subregional dimension with cases being reported from neighboring countries. In South Africa as of 26 December, 1 279 cumulative cases and 12 deaths (CFR of 0.9%) had been recorded, with the bulk of the cases (1 194) in the Limpopo area. Cases have also been reported in Botswana (Palm Tree).

The current situation is closely linked to the lack of safe drinking water, poor sanitation, declining health infrastructure, and reduced numbers of healthcare staff reporting to work. Other current risk factors include the commencement of the rainy season and the movement of people within the country, and possibly across borders, during the Christmas season. WHO, together with the Ministry of Health and partners from the health and Water and Sanitation clusters, has established a cholera outbreak response coordination unit in order to strengthen the reporting and early detection of cases, improve the response mechanism and access to healthcare and ensure proper case management. WHO has also deployed experts in public health, water and sanitation, logistics and social mobilization. In light of the extent and pace of expansion of the outbreak, reinforcing all control activities across the country is critical.

Given the current dynamic of the outbreak and the context of the collapsed health system, a cholera vaccination is not recommended. Moreover, the use of the internationally available WHO prequalified oral cholera vaccine is not recommended once an outbreak has started due to its 2-dose regimen and the time required to reach protective efficacy, high cost and the heavy logistics associated to its use. The use of the parenteral cholera vaccine has never been recommended by WHO due to its low protective efficacy and the occurrence of severe adverse events.

In controlling the spread of cholera WHO does not recommend any special restrictions to travel or trade to or from affected areas. However, neighboring countries are encouraged to reinforce their active surveillance and preparedness systems. Mass chemoprophylaxis is strongly discouraged, as it has no effect on the spread of cholera, can have adverse effects by increasing antimicrobial resistance and provides a false sense of security.

WHO

2 January 2009 — The Ministry of Health of the Democratic Republic of the Congo (DRC) is continuing to respond to the ongoing outbreak of Ebola haemorrhagic fever in the Mweka health zone, Province of Kasai Occidental with the support of a wide range of international partners.

As of 31st December there has been a total of 3 laboratory-confirmed cases of Ebola haemorrhagic fever. WHO is aware of 36 additional suspected cases including 12 deaths associated with this outbreak. A further 184 contacts have been identified and are being followed up.

Laboratory analysis was undertaken at the Institut National de Recherches Biomédicales (INRB) in Kinshasa , DRC , the Centre International de Recherches Médicales de Franceville (CIRMF), Gabon, and the National Institute for Communicable Diseases (NICD), South Africa.

The WHO Country Office, Regional Office and Headquarters are supporting the MoH in Kinshasa, in Kananga and in the field at the location of the outbreak. WHO has deployed five vehicles to the field and has sent outbreak response equipment and medical supplies. The local health authorities in the affected area are working closely with social mobilization experts to develop key information messages for the local communities.

The international response to the outbreak includes partners from Caritas (Belgium), the Congolese Red Cross (DRC) , Médecins Sans Frontières (Belgium), UNICEF, the United Nations Organization Mission in the Democratic Republic of the Congo (MONUC), and the World Food Programme (WFP) .

WHO

I just returned from a mandated course on Weapons of Mass Destruction that is required for my NYS EMT recertification. It was a steaming pile of crap.

The “All Hazards” approach is the one being taught now. So, for the first 45 minutes we talked about how little money the US has offered Burma for cyclone relief and how the “government” failed the people of New Orleans. You see, all those people who had been cared for by the government for four generations were abandoned and they didn’t know enough to evacuate on their own.

So, the talk began with liberal politics and continued in that manner.

Explosives has been added to the list of Weapons of Mass Destruction. Follow me on this, it’s interesting. The instructor points to Oklahoma City, then moves to “We’ve all been exposed to WMD” as slides appear showing firearms. Yes, the Public Health weenies that consider firearms crimes as an epidemic have infected WMD training.

Columbine was a WMD event, apparently, though I somehow missed that announcement. Now I know because I took the NYS class.

Oh, and BTW, the people that died at the WTC did so because they were following their emergency plan. I guess Rick Rescorla was an idiot.

Essentially, the class was an exercise in attempting to conflate civilian incidents, including but not limited to haz mat incidents, with WMD attacks. Eric Rudolph came up as an example. Crazed bombers like him and Ted Kuzinscki are WMD for our purposes.

Curiously, the instructor maintained that there had never been an insurgent terrorist attack on US soil. I recalled for her the FALN attack on Congress in the late 1940′s and the Black Muslim attack in Washington in the 1970′s. I could have gone on but she wanted to talk about other matters.

We got the usual crap about bird flu and pandemics, without a mention that most people have lived through at least one flu pandemic.

And… as a final criticism, she managed to discuss car bombs without mentioning that both Oklahoma City and WTC I were VIED’s.

CDC

During week 10 (March 2 – 8, 2008), influenza activity continued to decrease in the United States.

One thousand nine hundred thirty-six (21.6%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories were positive for influenza.

The proportion of deaths attributed to pneumonia and influenza was above the epidemic threshold for the ninth consecutive week.

The proportion of outpatient visits for influenza-like illness (ILI) was above national baseline levels, while the proportion of outpatient visits for acute respiratory illness (ARI) was below national baseline levels. ILI decreased in eight of the nine regions compared to week 9, and fell below the region specific baseline in the Mid-Atlantic region, but remained above region-specific baselines in the remaining eight regions. The West North Central region reported ARI above its region-specific baseline.

Forty-two states reported widespread influenza activity; eight states reported regional influenza activity; the District of Columbia reported local influenza activity; and Puerto Rico reported sporadic influenza activity.

During week 10, 8.7% of all deaths reported through the 122 Cities Mortality Reporting System were reported as due to P&I. This percentage is above the epidemic threshold of 7.2% for week 10. Including week 10, P&I mortality has been above epidemic threshold for nine consecutive weeks.

Eight influenza-associated pediatric deaths were reported to CDC during week 10 [ME, MA, NJ, NM, PA(2), VA, and WI]. These deaths occurred between February 15 and March 2, 2008. One additional death from Illinois, confirmed during week 9, was not reported last week. Since September 30, 2007, CDC has received a total of 41 reports of influenza-associated pediatric deaths that occurred during the current season.

CDC

During week 8 (February 17 – 23, 2008), influenza activity decreased slightly in the United States.

Two thousand three hundred twenty-one (30.0%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories were positive for influenza.

The proportion of deaths attributed to pneumonia and influenza was above the epidemic threshold for the seventh consecutive week.

The proportion of outpatient visits for influenza-like illness (ILI) and acute respiratory illness (ARI) was above national baseline levels. ILI decreased in seven of the nine regions compared to week 7, and was above region-specific baselines in all nine regions. The East South Central, Mid-Atlantic, Mountain, New England, Pacific, South Atlantic and West North Central regions reported ARI at or above their region specific baselines.

Forty-nine states reported widespread influenza activity; one state reported regional influenza activity; and the District of Columbia reported local influenza activity.