Army Public Health Weekly Update, 04 November 2022

Date Published: 11/4/2022
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​​​The Army Public Health Update is a collection of articles taken from public sources to offer awareness of current health issues and the media coverage given to them. The articles do not necessarily represent Defense Health Agency opinions, views, policy, or guidance, and should not be construed or interpreted as being endorsed by the Defense Health Agency.

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Table of Contents

    ​ANNOUNCEMENTS

    Cholera outbreak warning issued​​

    1 November- The first cholera outbreak in nearly three decades in Lebanon is currently spreading to every governorate in the country. Since the first case was confirmed on October 5, 2022, over 1,400 suspected cases have been reported across the country, including 381 laboratory-confirmed cases and 17 deaths. While the outbreak was initially confined to northern districts, it rapidly spread. Serotype Vibrio cholerae O1 El-Tor Ogawa was identified as the currently circulating cholera strain, similar to the one circulating in Syria, reported by the World Health Organization (WHO) on October 31, 2022. "Cholera is deadly but also preventable through vaccines and access to safe water and sanitation. In addition, it can be easily treated with timely oral rehydration or antibiotics for more severe cases," commented Dr. Abdinasir Abubakar, WHO Representative in Lebanon, in a press release. Given the shortage of both health staff and medical supplies in the country, WHO has provided two reference laboratories, three prisons, and 12 hospitals designated for cholera treatment with laboratory reagents, treatment kits, and rapid diagnostic tests, and deployed nurses and doctors as surge capacity to hospitals in the most affected areas. Despite global shortages in cholera vaccines, WHO is supporting the Ministry of Public Health to secure 600,000 doses of cholera vaccine. Additional efforts to ensure more doses are ongoing, given the outbreak's rapid spread. "The best way to prevent a cholera outbreak is to ensure people have access to clean water and appropriate sanitation and hygiene." "In the long term, we need to scale up global vaccine availability as part of a holistic strategy to prevent and stop cholera outbreaks worldwide," Dr. Abubakar emphasizes. Currently, there are three WHO pre-qualified oral cholera vaccines: Dukoral®, Shanchol™, and Euvichol®, mainly used for travelers.  All three vaccines require two doses for complete protection.​​ Precision Vaccinations External Link​​

    U.S. MILITARY

    At Fort Detrick be yourself with more skill: Leadership development cohort mentors next-gen leaders​​

    1 November- Once again, leaders from the Medical Research and Development (USMRDC) Command gathered at Fort Detrick's Building 1520 for a career-altering experience, Oct. 6, 2022. The Leadership Development Cohort Program, also known as the LDCP, consists of six seminars and two-professional one-on-one coaching sessions over eight-full days. The required interactions with senior leadership benchmarks lessons learned, tactics and techniques. The students hone their leadership skills and prepare for the future and greater responsibility within their organizations. “The future is bright,” said Col. Andy Nuce, commander of the U.S. Army Medical Materiel Development Activity (USAMMDA). “Communication is key.” Nuce described leadership attributes during his session with the cohort to help employees deal with transition and change. “It’s about how we navigate and communicate with the team that matters. Leaders should communicate openly and eliminate angst,” he said. In 2017, USAMMDA’s Training Council began the leadership development program. The LDCP is based on the U.S. Office of Personnel Management's Executive Core Qualifications to allow employees personal growth and development, and prepares them for career advancement with exposure to mentors and support systems that may lead to professional opportunities. “There are times when you want to be in the middle of everything and fix all the problems,” said, Kathleen Berst, deputy assistant director for acquisition and sustainment and acting deputy component acquisition executive at the Defense Health Agency during her session. “You shouldn’t try to control the uncontrollable. Control yourself and how you treat your team. Be honest and empathetic.” DVIDS External Link

    Award-winning USU Graduate Student Studies the Impact of Eating Disorders on Military Health​

    1 November- “What do eating disorders have to do with the military?” Graduate student Megan Parker hears this question often when new acquaintances learn about her Ph.D. research focus at the Uniformed Services University of the Health Sciences School of Medicine. Parker, a fourth-year Medical and Clinical Psychology (MCP) student, who was recently awarded the 2022 Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF) Fellowship, works under the mentorship of Dr. Marian Tanofsky-Kraff investigating disordered eating in children and adolescents. “That is a good question,” she says, acknowledging that many people think that medical research in the military focuses only on battlefield medicine topics such as combat surgery, acute care, or PTSD treatment. But, according to her mentor, the rates of eating disorders are likely higher among service members compared with the civilian population. Tanofsky-Kraff explains that fitness standards may place susceptible individuals at risk for engaging in disordered eating behaviors. Moreover, the high-stress nature of service can also be a potent risk for eating disorders. Eating disorders also affect military dependents. “People in the military have families,” Parker says, noting that military dependents often suffer from eating disorders, and that stressors unique to military family life (frequent moves, parental deployments) may increase the likelihood of unhealthy eating behaviors in the children of military parents. Eating disorders are a health and readiness issue for the military, whether it is active duty military members or their family members who are suffering. USU Pulse External Link​​

    Extremity trauma and amputation center of excellence joins DHA​​

    27 October- The Extremity Trauma and Amputation Center of Excellence joined the Defense Health Agency as the latest addition to the organization on Oct. 23. The EACE is now the fifth center of excellence within the DHA Research and Engineering Directorate. The transition to DHA aligns with the Department of Defense’s move to streamline military medical systems for health and improved health services for over 9.6 million beneficiaries. In 2009, the National Defense Authorization Act directed the DOD and the Department of Veterans Affairs to jointly establish a center of excellence in the mitigation, treatment, and rehabilitation of traumatic extremity injuries and amputations. Since its official launch in 2011, the EACE has supported cutting-edge medical care for all service members and other beneficiaries with extremity trauma, including amputations. The agency’s mission is to lead the advancement of extremity trauma-related research and clinical practice innovations to optimize outcomes of service members and veterans, while also meeting the needs of the combatant commands and the Military Health System. “We provide comprehensive clinical policy, education programs, research translation, and functional outcomes analysis to support the clinical continuum of care to bring our patients to a maximum level of function post-injury,” said John Shero, the executive director of EACE. “Our transition to the DHA enhances our ability to synchronize programs, clinical professionals, and research across the service branches and with the VA.” As part of the EACE Research and Surveillance Division, multidisciplinary teams of researchers are embedded within military hospitals and clinics, offering unique perspectives to support both patients and health care providers. “Having our research teams embedded in military hospitals and clinics makes us ideally situated to conduct a wide variety of research activities across the scientific continuum, while at the same time improving the timeliness and effectiveness of translating knowledge and materiel products to frontline clinicians and the care they provide,” said Dr. Christopher Dearth, chief of research and surveillance at EACE. “This ‘bench-to-bedside’ approach allows us to support health care providers with delivering the highest quality care to service members and veterans with extremity trauma.” Health.mil External Link

    New DHA region to support health care across three combatant commands​

    26 October- In a culmination of a years-long process, the Defense Health Agency welcomed military hospitals and clinics in Europe and the Middle East to a new DHA region as the final major organizational change that establishes the DHA as the Department of Defense’s lead agency responsible for health care delivery across U.S. military brick-and-mortar hospitals and clinics worldwide. U.S. Army Lt. Gen. (Dr.) Ronald Place, director of the DHA, presided over a ceremony in Germany Oct. 25, establishing the DHA Region Europe. The region oversees health care delivery for more than 135,000 beneficiaries currently enrolled in military hospitals and clinics in Iceland, the United Kingdom, Belgium, Germany, Spain, Italy, Greece, Turkey, Bahrain, and Kuwait. They support service, joint, and multi-national combined activities, programs, and operations across three U.S. combatant commands–U.S. European Command, U.S. Central Command, and U.S. Africa Command. “Today, we’re welcoming the military medical facilities throughout the entire EUCOM and CENTCOM areas of responsibility, and also continuing our support to AFRICOM AOR, even though we don’t have fixed facilities there,” said Place during the ceremony in Garmisch, Germany. “This transition is different in that it represents three combatant command areas of responsibility, and it represents communities where we deliver a much larger percentage of the overall medical care.” Led by U.S. Army Brig. Gen. Clinton K. Murray, director of the DHAR-E, the region comprises 29 medical facilities providing health care to U.S. Army, U.S. Navy, U.S. Marine Corps, U.S. Air Force, U.S. Coast Guard, and U.S. Space Force service members, their families, and military retiree families. The establishment of DHAR-E will increase overall access to care for beneficiaries and improve coordination and standardization across the Military Health System. The agency will also provide more opportunities for military medical providers to get the training they need. Murray said, “Why we’re here is because we’re a power projection platform, and that’s who we support. We need a ready medical force and a ready medical force to support three combatant commands.” Following the National Defense Authorization Act for fiscal year 2017, DHA started the process to assume responsibility for the administration and man​agement of military hospitals and clinics throughout the world. By establishing the DHAR-E, DHA and military service branches can tailor health care delivery and medical readiness to their warfighters. “As beneficiaries witness this transition, the changes may not be immediately evident. But, over time, they’ll see more and more common processes, whether that’s from the value of a common health record at every military hospital or clinic and dental treatment facility, or a simplified means to access care,” said Place. “The medical leaders here and throughout these combatant commands will make that happen. And the Defense Health Agency, as an entity, is here to support you.” Place recognized that each medical facility and installation “has a unique mission, unique characteristic, geography, and history. And you understand the ‘ground truth’ of health care in your community,” he added. He​alth.mil External Link

    Telementoring opens virtual doors to provider learning, expert support​​

    28 October- A unique video conference mentoring program allows health care providers to connect, learn from, and support one another about pain management. In turn, they improve their skills to better support their patients, upholding the Defense Health Agency’s mission to ensure a medically ready force and ready medical force. In addition to a variety of virtual telehealth options, DHA offers telementoring options designed to connect patient care teams with specialists. That model allows for care teams to interact directly with subject matter experts for advice, guidance, and support from expert teams, or to leverage their learning opportunities and grow professionally.​ The ECHO Program for Pain is one example of a DHA telementoring program. Short for the Extension for Community Health Care Outcomes, ECHO is an educational program the University of New Mexico developed in 2003 to expand access to pain specialty care. Since then, it has been replicated at other entities globally, including DHA. DHA’s ECHO Program for Pain intends “to bring subject matter experts and health care providers together via videoconferencing to learn and share knowledge,” said U.S. Air Force Lt. Col. Jennifer Varney, DHA’s chief of the Pain Management Clinical Support Service. It “uses a ‘hub-and-spoke’ model with eight hubs located at strategic interdisciplinary pain clinics across the Military Health System,” she added, referencing a process that resembles a bicycle wheel, with a hub serving as the central location and spokes representing telementoring connections to providers. Varney explained that each hub at DHA’s ECHO Program for Pain comprises specialty providers available for consultation and to conduct learning sessions with providers from the spokes, which could comprise any military hospitals or clinics, at least once a week. “Health care providers—including primary care managers, physical therapists, nurse case managers, and others from the spokes—can utilize the ECHO hub sessions convenient for them,” she said. “The sessions allow for the subject matter experts to provide a continuing medical education learning activity as well as a case study of a patient who may benefit from the interdisciplinary presentation.” Varney added that the ECHO program is a core component of the Stepped Care Model for Pain Management that Patient Centered Medical Home teams use. The model uses evidence-based treatments to manage pain, seeking to prevent acute pain from becoming chronic. ECHO aims to help treat or provide information and support for “any chronic pain condition in which the primary care manager or health care team may need assistance to treat,” said Varney.​​ Health.mil External Link​​

    GLOBAL

    Dementia Immunotherapy Vaccine May Proceed in Phase 1/2a Study​​​

    31 October- Alzamend Neuro, Inc. announced today the receipt of a "Study May Proceed" letter from the U.S. FDA for a phase I/IIA clinical trial under its Investigational New Drug ("IND") application for ALZN002 to treat mild to moderate dementia of the Alzheimer's type. ALZN002 is a proprietary "active" immunotherapy product, which means it is produced by each patient's immune system. It consists of autologous dendritic cells ("DCs"), which are activated white blood cells taken from each patient that is then engineered outside of the body to attack Alzheimer's-related amyloid-beta proteins. These DCs are pulsed with a novel amyloid-beta peptide designed to bolster the ability of the patient's immune system to combat Alzheimer's. "There remains a need to develop new therapies that alter the progression of Alzheimer's and prevent, reverse or slow neurodegeneration and cognitive decline," said Stephan Jackman, Chief Executive Officer of Alzamend, in a press release on October 31, 2022. "We strongly believe that the ALZN002 patient-specific immunotherapeutic vaccine has the potential to achieve these objectives and bring aid to the millions of Americans afflicted with this devastating disease." "We are advancing the process and expect that the first patient will be dosed in the first quarter of 2023." The goal of this treatment approach is to foster tolerance to treatment for safety purposes while stimulating the immune system to reduce the brain's beta-amyloid protein burden, resulting in reduced Alzheimer's signs and symptoms. Multiple pre-clinical studies have been conducted using a transgenic (or genetically modified) mouse model of Alzheimer's disease at the University of South Florida and Charles River Laboratories that reported encouraging Alzheimer's disease-related measurements and neurobehavioral effects.​ Precision Vaccinations External Link

    FDA advisers meet on racial disparities in pulse oximeters​​​

    ​​1 November- The clip-on devices that use light to measure oxygen levels in the blood are getting a closer look from U.S. regulators after recent studies suggest they don’t work as well for patients of color. The devices, called pulse oximeters, usually snap onto a finger and are widely used in hospitals across the globe to help guide treatment. At-home versions became popular during the COVID-19 pandemic. But several recent studies have raised concerns that the pigmentation in people’s skin can throw off the readings. In 2021, the Food and Drug Administration issued a warning about possible inaccuracies after a study found the devices tended to overestimate Black patients’ oxygen levels. “The fact that such a commonly used device could have any discrepancy at all was shocking to me,” said Michael Sjoding, a University of Michigan pulmonologist who led the study. “I make a lot of medical decisions based on this device.”​ The FDA has convened a panel of experts to meet Tuesday to discuss “ongoing concerns” about the devices, recommendations for patients and doctors, and ways to gauge accuracy. Jeff Shuren, director of the FDA’s Center for Devices and Radiological Health, called racial disparities in these devices “of great public health importance” at the beginning of the meeting Tuesday. He stressed the need to make sure medical devices are safe and effective for all the groups who use them. AP News External Link

    How do PFAS enter our bodies? Emory researchers want to find out​​

    ​​2 November- “Forever chemicals,” a class of substances widely used in cookware, food wrappers and other products are thought to be in the blood of nearly all U.S. residents and have been linked to serious health problems. Now, a group of Emory University researchers have received $250,000 in federal funding to investigate how the chemicals — also known as PFAS — get into our bodies. The Environmental Protection Agency announced last week that the team from Emory’s Rollins School of Public Health and the School of Medicine will receive funding for the next two years to investigate how people are exposed to the chemicals. The research comes amid a larger effort to effort to rein in PFAS pollution and understand the health and environmental threats posed by the chemicals, which President Joe Biden’s administration has made a top priority.​ Several PFAS — also known as polyfluoroalkyl and perfluoroalkyl substances — have been linked to cancers, immune system suppression and elevated cholesterol. Research has shown that pregnant women can pass PFAS chemicals to their children through breastfeeding, and the chemicals have been tied to delayed infant and fetal growth, as well as decreased vaccine response in children. The new research will build on the results of a previous study which focused on a group of African American women and their children living in the Atlanta area, said Prinn Panuwet, an assistant professor of environmental health at Emory involved in both efforts.​​ AJC External Link​​

    Racial disparities in COVID drug prescribing persistent but lessening​

    28 October- Today two studies in Morbidity and Mortality Weekly Report describe patterns of COVID-19 outpatient therapy by race and social vulnerability, one finding persistent racial disparities in Paxlovid prescribing through July 2022, and the other showing more equitable dispensing of two antivirals by ZIP code after implementation of a US Department of Health and Human Services (HHS) program. The Centers for Disease Control and Prevention (CDC) COVID-19 Emergency Response Team led the first study, which used electronic health record data from 692,580 COVID-19 patients 20 years and older at 30 sites to assess the prescribing patterns of four COVID-19 drugs to patients by race from January to July 2022. Of all patients, 22.2% were 65 years and older, 60.5% were women, 68.2% were White, and 79.6% were non-Hispanic. The drugs included the oral antiviral drugs nirmatrelvir/ritonavir (Paxlovid) and molnupiravir (Lagevrio), the intravenous antiviral remdesivir (Veklury), and the monoclonal antibody bebtelovimab. The overall percentage of COVID-19 patients treated with Paxlovid was 11.7%, rising from 0.6% in January to 20.2% in April to 34.3% in July. Molnupiravir, remdesivir, and bebtelovimab were used far less often, at 1.0%, 0.7%, and 2.7%, respectively, and their prescribing varied little over time (range, 0.4% to 5.0%). The proportion treated with Paxlovid surpassed 11.7% for patients aged 50 and older and those who were White, non-Hispanic, undergoing cancer treatment, and taking corticosteroids or immunosuppressive drugs, and those who had underlying medical conditions, except chronic kidney disease, cirrhosis, congestive heart failure, and dementia. Bebtelovimab was used more often than Paxlovid in patients with an organ transplant. CIDRAP External Link​​

    Researchers Develop a Novel 3D-Bioprinted Blood Vessels to Cure Cardiovascular Diseases​​

    27 October- Any condition that has an impact on the circulatory system is referred to as cardiovascular disease (CVD). This category includes a number of conditions, particularly peripheral vascular illnesses and diseases of the heart, brain, and kidney vessels.  In persons with CVD, blood arteries that carry blood, oxygen, and nutrients may shrink or get clogged, which can cause a variety of problems. Unfortunately, most CVDs typically result in death. According to the World Health Organization (WHO), CVDS are the leading cause of death in the world, taking the lives of at least 17.9 million people. To solve these concerns, researchers at the Brigham and Women's Hospital have enhanced 3D bioprinting of vascular tissues with mechanical and functional characteristics, as reported first by Interesting Engineering. ​ The group created a double-network hydrogel bioink by using the crosslinking properties of natural polymers that can print conduits in live tissue.  These conduits displayed several significant physiological characteristics of blood vessels in addition to strong vasoconstriction, vasodilation, perfusability, and barrier performance comparable to natural vasculature, as per the claims of the study. The printed vessels mimic a majority of the mechanics of native vessels, according to the corresponding senior author, Y. Shrike Zhang, Ph.D., of the Division of Engineering in Medicine. "This research demonstrates the potential for such conduits to serve as vascular models for grafts in vascular surgeries, other disease studies, and broad biomedical applications," Zhang said in a press release statement. ​​Tech Times External Link​​

    INFLUENZA

    CDC: Weekly U.S. Influenza Surveillance Report

    Key Updates for Week 42, ending October 22, 2022:

    - Influenza activity continues to increase. Regions 4 (southeast) and 6 (south-central) are reporting the highest levels of flu activity.

    - The first influenza-associated pediatric death of the 2022-2023 season was reported this week.

    - CDC estimates that, so far this season, there have been at least 880,000 flu illnesses, 6,900 hospitalizations, and 360 deaths from flu.

    - The cumulative hospitalization rate in the FluSurv-NET system is higher than the rate observed in week 42 during previous seasons going back to 2010-2011.

    - An annual flu vaccine is the best way to protect against flu. Vaccination helps prevent infection and can also prevent serious outcomes in people who get vaccinated but still get sick with flu.

    - CDC recommends that everyone ages 6 months and older get a flu vaccine annually.

    - There are also prescription flu antiviral drugs that can be used to treat flu illness; those need to be started as early as possible. CDC External Link​​

    VETERINARY/FOOD SAFETY

    Hundreds of consumers filed complaints thinking their illnesses were caused by Jif​

    2 November- According to documents from the Food and Drug Administration, the agency received hundreds of complaints about illnesses related to Jif peanut butter and an outbreak of Salmonella infections earlier this year. However, the Centers for Disease Control and Prevention reported only 21 confirmed patients across 17 states in its official outbreak tally. It is not unusual for CDC numbers to fall short of FDA complaints because of the illness verification process. The FDA documents, obtained by Phyllis Entis of eFoodAlert, show that the agency received 319 complaints of illnesses consumers thought to be linked to Jif peanut butter from the Lexington, KY, production plant linked to the outbreak. The complaints were received beginning in mid-February and extending to mid-October. The CDC declared the outbreak over on July 27 with confirmed illness onsets running from Feb. 19 through May 23. All of the patients reported eating Jif peanut butter. The Jif brand is owned and produced by the J.M. Smucker Company. On May 20 the company recalled more than 9.5 million cases of various Jif brand peanut butter products that were distributed nationwide. All were produced at the Lexington, KY, facility. There were dozens of related recalls by other companies who used the recalled Jif products in their own products. The FDA has reported that there were problems with at least two peanut roasters at the production plant. “On 2/17-18/22, you identified a breach in the (redacted) systems, which contaminated the (redacted) roasters (redacted) and (redacted). Based on your investigation, the breach was determined to be an approximately 1-inch opening in the (redacted) gasket and had existed since the installations of roasters (redacted) and (redacted). “Peanut butter produced using roasters (redacted) and (redacted) had been distributed since November 2021. You did not take any measures to alert consumers and/or recall the contaminated peanut butter distributed between December 2021 and February 2022. Additionally, you did not report this event to the FDA’s Reportable Food Registry,” according to an FDA document. Food Safety ​News External Link

    Retailer list updated for cheeses traced to outbreak of infections from Listeria​​

    1 November- The Food and Drug Administration has updated information on its investigation into an outbreak of infections from Listeria monocytogenes associated with Brie and Camembert cheeses to include additional retailers that received the recalled products. The outbreak has sickened at least six people from coast to coast with five having required hospitalization, according to the Centers for Disease Control and Prevention. Old Europe Cheese Inc. distributed the products nationwide and some of them have best-by dates extending into December. The company packaged the cheeses under 25 different name brands including Trader Joe’s, Fresh Thyme, Prestige and Block & Barrel, according to the Food and Drug Administration. The company initially recalled some cheeses on Sept. 30 and expanded the recall on Oct. 5... “The source of potential contamination has been identified and Old Europe Cheese is taking active measures to eliminate it. Production of these products has been stopped and will not restart until the company has full confidence in the effectiveness of the applied measures,” the FDA has previously reported. Food Safety News External Link​​

    WELLNESS

    Three viruses pose a threat this winter-Here’s how to prepare.​

    2 November- Three respiratory viruses — covid, flu and respiratory syncytial virus (RSV) — are all expected to surge this fall and winter, once again straining hospitals. While this won't disrupt the lives of most Americans as in the previous two winters, the time to gird ourselves and the health-care system is now. Some children's hospitals are already over capacity <https://www.washingtonpost.com/health/2022/10/21/rsv-children-hospital-capacity/?itid=lk_inline_manual_5>  because of an unprecedented wave of severe RSV infections. Before covid, virtually every child <https://www.cdc.gov/rsv/high-risk/infants-young-children.html>  contracted RSV by age 2, but masking, distancing and other mitigation pandemic measures have led to an immunity gap, leaving far more kids than usual with little to no protection against RSV. The vast majority of kids who contract RSV will have mild, cold like symptoms, but some can develop inflammation in their lungs and become very ill. In pre-covid years, the virus caused an estimated 58,000 annual pediatric hospitalizations <https://www.cdc.gov/rsv/high-risk/infants-young-children.html>  among children under age 5. That number is on track to being much higher this year. RSV also affects adults, killing about 14,000 Americans 65 and over <https://www.niaid.nih.gov/diseases-conditions/respiratory-syncytial-virus-rsv>  annually. The same concerns apply to influenza. The 2017-2018 period was a particularly bad flu season, resulting in 710,000 hospitalizations <https://www.cdc.gov/flu/about/burden/index.html>  and 52,000 deaths. This year could portend similar numbers. Last week, the Centers for Disease Control and Prevention reported <https://www.washingtonpost.com/health/2022/10/28/flu-season-2022-cdc/?itid=lk_inline_manual_10>  that not since the 2009 swine flu have there been so many Americans hospitalized for influenza so early in the season. What about covid? While I don't expect a tsunami mirroring last winter's omicron surge, covid infections will almost certainly rise in the coming weeks, with a subsequent uptick in hospitalizations and deaths. BA.5 remains the dominant variant, but its BQ.1 and BQ.1.1 offshoots already make up more <https://covid.cdc.gov/covid-data-tracker/#variant-proportions>  than a quarter of new infections and will displace BA.5 in the next few weeks. The Washington Post External Link​​

    USAFRICOM

    In Africa's monkeypox outbreak, sickness and death go undetected​​​

    31 October- At a village clinic in central Congo, separated from the world by a tangle of waterways and forests, six-year-old Angelika Lifafu grips her dress and screams as nurses in protective suits pick at one of hundreds of boils that trouble her delicate skin. Her uncle, 12-year-old Lisungi Lifafu, sits at the foot of her bed, facing away from the sunlight that pours through the doorway and pains his swollen, weeping eyes. When nurses approach, he raises his chin, but cannot look up. The children have monkeypox, a disease first detected in Congo 50 years ago, but cases of which have spiked in West and Central Africa since 2019. The illness received little attention until it spread worldwide this year, infecting 77,000 people. Global health bodies have counted far fewer cases in Africa during the current outbreak than in Europe and the United States, which snapped up the limited number of vaccines this year when the illness arrived at their shores. But the outbreak, and death toll, in Congo could be much greater than recorded in official statistics, Reuters reporting shows, in large part because testing in underequipped, rural areas is so limited and effective medicines are unavailable. During a six-day trip to the remote region of Tshopo this month, Reuters reporters found about 20 monkeypox patients, including two who had died, whose cases were not recorded until reporters visited. None of them, including Angelika and Lisungi, had access to vaccines or anti-viral drugs. Reuters External Link​​

    USCENTCOM

    Cholera in Lebanon: Outbreak update October 29​​

    30 October- Still less than a month since the first cholera case was reported in Lebanon, the first such case in nearly thirty years, the Ministry of Public Health (MoPH) updated the situation on Saturday: As of October 29, 1,409 cumulative (suspected and confirmed) cholera cases have been reported, which includes 381 confirmed cases. Health officials put the death toll due to cholera at 17. Serotype Vibrio Cholerae O1 El-Tor Ogawa was identified as the currently circulating cholera strain in Lebanon, similar to the one circulating in the region. Nearly a half of suspected and confirmed cases are reported in children under the age of 15, while 26 percent are in children under the age of five. Outbreak News Today External Link​​

    USEUCOM

    Spain reports doubling of Shigella in 2022​​

    29 October- The Carlos III Health Institute in Spain reports a doubling in Shigella cases in 2022 year to date compared to 2021. They report 203 cases of the infection have been reported so far this year, compared to the 99 that were recorded in 2021. According to Miguel Ángel Goenaga, spokesman for the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), “Traditionally it was related to trips to countries with less developed hygiene conditions. The means of contagion used to be through interpersonal contact, contact with surfaces and objects where the bacteria were, or ingestion of contaminated food or water. But sexual contact can also be a route of transmission and it is gaining weight in recent years. The group of cases that have appeared lately are more related to this last mode of transmission”. In February, the European Center for Disease Control (ECDC) issued an alert on the detection throughout Europe of an increase in cases of shigellosis, especially among men who have sex with men. Specifically, the European body warned of an increase in infections in this group by Shigella sonnei , which also showed resistance to available antibiotics. Outbreak News Today External Link​​

    USINDOPACOM

    Apple: Chinese workers flee Covid lockdown at iPhone factory​

    30 October- Workers have broken out of Apple's largest iPhone assembly factory in China after a Covid outbreak forced staff to lockdown at the workplace. Video shared online showed about 10 people jumping a fence outside the plant, owned by manufacturer Foxconn, in the central city of Zhengzhou. Chinese people and businesses are continuing to grapple with President Xi Jinping's rigid zero-Covid policy. It is not clear how many cases of Covid have been identified at the factory. However in the last week, Zhengzhou, the capital of China's Henan province, reported 167 locally transmitted infections - up from 97 the week before, according to Reuters news agency. The city of about 10 million people was partially locked down as a result, as China continues to use strict lockdown measures to deal with Covid​. Foxconn, which acts as a supplier to US-based Apple, has hundreds of thousands of workers at its Zhengzhou complex and has not provided an official count of how many are infected. The Taiwan-based company claimed on Sunday that it would not stop workers from leaving. BBC News External Link​​​​

    USNORTHCOM

    U.S.: Viral infections like RSV, the flu, and COVID have one Southern California county declaring a pediatric health emergency. It’s far from alone​

    1 November- California’s Orange County has declared a health emergency due to an overwhelming surge in respiratory illness that’s pushing pediatric hospitals to their limits. Sky-high numbers of young patients are seeking emergency-room care in area children’s hospitals for RSV, the flu, flu-like illnesses, and, to a lesser extent, COVID, the OC Health Care Agency said Monday. The emergency declaration will allow the county to receive help from the state and federal governments, and to seek aid from nearby counties. RSV, or respiratory syncytial virus infection, is a common virus that hospitalizes thousands of infants and young children each year, though it can also pose a risk to the elderly. Symptoms can range from mild cold-like ailments like sneezing, sore throat, fever, and stuffy nose to pneumonia, which can prove fatal. Patients can quickly take a turn for the worst. Children’s Hospital of Orange County is seeing upwards of 400 children in its emergency department daily—a record high—and is using all available space to meet demands. It has activated a command center within the hospital to manage the high patient load, a spokesperson told Fortune in a Tuesday statement. Southern California is far from alone, with hospitals all across North America experiencing similar struggles—and some even considering outdoor tents to house patients and calling in the National Guard for help. Dr. James Stein, chief medical officer of Children’s Hospital Los Angeles, said his hospital is doing its best to accept transfers of respiratory patients from nearby hospitals that are overwhelmed, but is struggling itself. “This increase in RSV and other respiratory illnesses has stretched our capacity in the emergency department,” he told Fortune in a statement. Fortune.com External Link​​​​

    USSOUTHCOM

    Bird Flu Cases Confirmed in Asia​​

    29 October- According to recent Hong Kong and Vietnam reports, avian influenza infections in humans have continued in 2022. According to a Ministry of Health (MOH) news release last week, Vietnam reported the country's first H5 case since February 2014. Vietnam has reported 128 human avian flu cases since 2003. From 2003 to 2009, the country confirmed 112 cases, including 57 fatal ones, according to World Health Organization data. And Hong Kong's Centre for Health Protection (CHP) confirmed H5N6 avian influenza infection in a young boy living in Nanning in Guangxi province, which borders northern Vietnam. "All novel influenza A infections, including H5N6, are notifiable infectious diseases in Hong Kong," a spokesman for the CHP stated on October 21, 2022. From 2014 to date, 81 human cases of avian influenza A(H5N6) have been reported by Mainland health authorities. Avian influenza is caused by those influenza viruses that mainly affect birds and poultry, such as chickens or ducks.​ Clinical presentation of avian influenza in humans may range from flu-like symptoms (e.g., fever, cough, sore throat, muscle aches) to severe respiratory illness (e.g., chest infection). The public may visit the CHP's webpages for more information. The U.S. government has approved a vaccine for one type of bird flu virus and could distribute it if a person-to-person avian influenza outbreak occurs.  However, the annual flu shot would not offer protection from these avian influenzas. Additional avian influenza news and vaccine developments are posted at PrecisionVaccinations.com/Avian.​ Precision Vaccinations External Link​​