Army Public Health Weekly Update, 11 November 2022

Date Published: 11/11/2022
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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

    RSV alert identifies increased respiratory activity​

    5 November- The U.S. Centers for Disease Control and Prevention (CDC) published CDCHAN-00479 on November 4, 2022. This Health Alert Network Health Advisory concerns elevated respiratory disease incidence caused by multiple viruses, especially among children. The CDC confirmed it is tracking levels of respiratory syncytial virus (RSV), influenza, and rhinovirus/enterovirus that are higher than usual for this time of year. The co-circulation of RSV, influenza viruses, SARS-CoV-2, and others could stress healthcare systems from 2022 to 2023. While various flu shot and COVID-19 vaccine options are available, there are no U.S. FDA-approved RSV vaccines as of November 5, 2022. To prevent RSV-associated hospitalizations, eligible high-risk children should receive palivizumab treatment by AAP guidelines.​ In brief, the AAP says children eligible for palivizumab include infants prematurely born at less than 29 weeks gestation, children younger than two years of age with chronic lung disease or hemodynamically significant congenital heart disease, and children with suppressed immune systems or neuromuscular disorders. Furthermore, a recent announcement indicates the European Union approved Beyfort​us® (Nirsevimab) on November 4, 2022. Beyfortus is a single-dose, long-acting antibody that protects infants through their first RSV season. Precision Vaccinations​ ​External Link​​

    ​​U.S. MILITARY​

    Army suicides rates increased in 2021, decreasing in 2022​

    20 October- According to the recent DoD Annual Report on Suicide in the Military, total Army suicides increased in 2021 over calendar year 2020. However, the number has been decreasing in 2022. “One suicide is one too many, but I am encouraged that this year we have seen fewer suicides than last year,” said Secretary of the Army Christine E. Wormuth. “We will continue working to build positive command climates that can help prevent suicide, while also improving access to mental health resources. Our people remain our top priority and we are committed to taking care of them.” As of Sept. 30, 2022, the number of total Army suicides decreased by approximately 21% since Sept. 30, 2021. In addition, the number for family members also decreased by about 21%, and the number for Department of the Army civilian employees decreased by nearly 50%. This current trend indicates that initiatives that were implemented during the last couple of years, including ones that encourage help-seeking behavior, are helping to decrease the number of suicides.​ “We want our Soldiers to know that getting help is a sign of strength, not weakness,” said Gen. James C. McConville, Chief of Staff of the Army. “The Army’s goal is to make it as easy as possible for Soldiers to get the help they need.” During the past two years, the Army has increased prevention resources across the Total Army to combat suicide in its ranks, despite challenges such as COVID-19 and social-distancing precautions. Army initiatives include: New Army Suicide Prevention Policy – In the fourth quarter of calendar year 2022, the Army is scheduled to publish a new policy that encourages engaged leadership, updates roles and responsibilities, identifies resources available to leaders, updates reporting requirements, and provides guidance on structure and working groups, among other directives.​​ Army.mil External Link​​

    Department of the Army updates Total Army COVID-19 vaccination statistics​​​

    4 November- Maintaining readiness continues to be among the Army’s highest priorities, and the COVID 19 vaccine helps ensure Soldiers are ready. Beginning July 1, 2022, as directed by the Secretary of Defense, members of the Army National Guard and U.S. Army Reserve who have refused the lawful DOD COVID-19 vaccination requirements without a temporary or permanent exemption (to include a religious accommodation) may not participate in federally funded drills, training, and other duty nor receive payment or retirement credit. However, unit commanders may place unvaccinated reserve component Soldiers in an appropriate duty status for limited administrative purposes, such as receiving the vaccine, processing their exemption requests, or conducting separation procedures. Soldiers could receive compensation and retirement credit for these service days. Army policy allows Soldiers to submit requests for temporary (up to 365 days) or permanent medical exemptions through medical channels. Soldiers may also request an administrative exemption from the vaccine requirement. Administrative exemptions include requests for religious accommodations. Army officials review each request on an individual basis to determine whether an exemption is appropriate. Medical requests are reviewed primarily by healthcare providers, while religious accommodation requests include interviews with the Soldier’s chaplain, recommendations from the chain of command, as well as a public health and a legal review. All Soldiers who refuse the order to be vaccinated without an approved or pending exemption request are subject to certain adverse administrative actions, including flags, bars to continued service, and official reprimands. Soldiers who continue to refuse the vaccination order without an approved or pending exemption may also be subject to additional adverse administrative action, including separation. As the Army accesses and discharges Soldiers and continues to refine data tracking processes, the vaccination percentages will vary slightly.​​ Army.mil External Link​​

    We need to increase research into psychedelics for veterans with PTSD​​

    4 November- Last year marked both the 20th anniversary of 9/11 and the tragic fall of Kabul, Afghanistan; the beginning and end of a 20-year war that will forever define the current generation. We stand here today at an important inflection point as a nation. A generation of men and women who bravely volunteered to protect their beloved nation had a simple expectation that this nation would in turn always protect them. Currently, we are failing these veterans. After 20 years of mental and physical scars, thousands of veterans are forced to travel to other countries to receive life-saving mental health treatments coming in the unexpected form of psychedelics. Why is this happening? These past 20 years of war have created more than 2.5 million veterans. In this time, rates of post-traumatic stress disorder and addiction have remained at record high levels. At least 500,000 veterans have been diagnosed with PTSD during the Global War on Terrorism and at least 10 times as many veterans have taken their own lives than have died in combat. Hundreds of thousands also struggle with major physical ailments, traumatic brain injury and toxic exposure from burn pits. A large percentage struggle to get medical coverage because they cannot prove the issues are connected to their military service. Those who are treated, have become one of the most medicated generations of veterans ever. This is our nation’s report card.​​ Military Times ​​External Link

    GLOBAL

    Don’t bother with dietary supplements for heart health, study says​​

    7 November- Six supplements that people commonly take for heart health don’t help lower “bad” cholesterol or improve cardiovascular health, according to a study published Sunday, but statins did. Some people believe that common dietary supplements – fish oil, garlic, cinnamon, turmeric, plant sterols and red yeast rice – will lower their “bad” cholesterol. “Bad” cholesterol, known in the medical community as low-density lipoproteins or LDL, can cause the buildup of fatty deposits in the arteries. The fatty deposits can block the flow of oxygen and blood that the heart needs to work and the blockage can lead to a heart attack or stroke. For this study, which was presented at the American Heart Association’s Scientific Sessions 2022 and simultaneously published in the Journal of the American College of Cardiology, researchers compared the impact of these particular supplements to the impact of a low dose of a statin – a cholesterol-lowering medication – or a placebo, which does nothing.​ Researchers made this comparison in a randomized, single-blind clinical trial that involved 190 adults with no prior history of cardiovascular disease. Study participants were ages 40 to 75, and different groups got a low-dose statin called rosuvastatin, a placebo, fish oil, cinnamon, garlic, turmeric, plant sterols or red yeast rice for 28 days. The statin had the greatest impact and significantly lowered LDL compared with the supplements and placebo. CNN External Link​​

    ​Healthy living means staying active indoors during the cold weather months​​

    30 October- Winter is coming — but that doesn’t mean your workout or fitness routine has to suffer. As the weather turns colder and allows fewer daylight hours, many people may find it more challenging to stay active, but there are helpful tips to stay physically active indoors.  "The good news is that every bit of physical activity can provide health benefits," the Centers for Disease Control and Prevention (CDC) notes on its website. "The key is to move more and sit less throughout the day … And there are many ways to be active wherever you live." Being physically active improves sleep, reduces stress and anxiety and improves balance and mood, per the CDC. A consistent exercise regimen is also associated with reducing depression; it also helps to maintain weight and reduce the risk of obesity, heart disease and type 2 diabetes; and it can lower blood pressure, the agency added. "All healthy adults aged 18–65 years should participate in moderate intensity aerobic physical activity for a minimum of 30 minutes [for] five days per week, or vigorous intensity aerobic activity for a minimum of 20 minutes [for] three days per week," according to the American College of Sports Medicine (ACSM). ​Fox News External Link

    Household contact, sex among risk factors in monkeypox cases in kids, teens​​

    ​​4 November- In a study today in Morbidity and Mortality Weekly Report, researchers detail 83 confirmed monkeypox cases among US children and teens, noting household contact in younger kids and sex in teens as the major risk factors. From May 17 to Sep 24, a total 25,038 Americans were diagnosed as having monkeypox, the report said, the vast majority being adult men who have sex with men (MSM).​​ Researchers from the Centers for Disease Control and Prevention (CDC) and their state partners confirmed that 83 cases, or 0.3% of the national total, were among children 18 and younger, including 28 children aged 0 to 12 years and 55 adolescents aged 13 to 17 years. Among children in the younger age-group, 64% were boys, and most had direct skin-to-skin contact with an adult with monkeypox who was caring for the child in a household setting, the authors said. Among the teens, 89% were boys, and 66% were presumed to contract the virus during MSM sexual contact. Only 16 girls were confirmed to have contracted the virus. Black children made up 47% of the 83 patients, with Latinos making up 35%. "Most (89%) were not hospitalized, none received intensive care unit (ICU)–level care, and none died. Monkeypox in children and adolescents remains rare in the United States," the authors said.​ CIDRAP External Link​​

    Humans may have abnormalities in the future due to excessive use of technology, research claims​​

    3 November- According to a study commissioned by TollFreeForwarding, excessive use of technology can lead to abnormalities. Researchers worked with a 3D designer to produce images of a "future human" with physical problems brought on by regular technological use. Scientists gave the 3D model the moniker "Mindy." As reported first by Interesting Engineering, the team examined scientific studies and professional viewpoints on the subject, focusing on the detrimental impacts technology can have on the human body, particularly over an extended length of time. According to the researchers, Mindy would eventually develop a bent back. This resulted from people using modern technology devices excessively, which changed the way they stood and sat. They claim that looking down at a smartphone or up at a computer screen all the time could cause tension on various body components, causing an arched back and spinal misalignment. "Spending hours looking down at your phone strains your neck and throws your spine off balance. Consequently, the muscles in your neck have to expend extra effort to support your head," Caleb Backe, a health and wellness expert at Maple Holistics, said in a statement.  Additionally, he noted how long periods spent in front of a computer can cause the torso to pull away from the hips rather than remain vertically straight.​ Tech Times​ External Link

    Magic-mushroom drug can treat severe depression, trial suggests​​​

    3 November- A drug based on a compound in hallucinogenic mushrooms can improve the symptoms of severe depression for up to 12 weeks, a trial shows. A 25mg tablet of psilocybin puts patients in a dreamlike state, making psychological therapy more likely to succeed. But the short-term side-effects could be frightening and support must always be on hand, the researchers said. Experts say larger studies with a much longer follow-up are still needed. An estimated 100 million people worldwide have serious clinical depression that does not respond to any available treatments - 30% attempt suicide. Scientists have been studying the effects of psilocybin on mental-health disorders for years. Recent studies have been promising but too short to assess lasting effects. In this latest trial, published in the New England Journal of Medicine, 1mg, 10mg and 25mg doses were tested on a total of 233 people from 10 countries in Europe and North America, with 25mg giving the best results. BBCExternal Link

    New VA study finds Paxlovid may cut the risk of long COVID​

    8 November- It's well-documented that Paxlovid — a 5-day course of antiviral pills from Pfizer — can reduce the risk of hospitalization in COVID-19 patients who are more likely to develop severe illness. Now, researchers from the Veterans Health Administration find that taking the medication may also reduce the risks of later developing long COVID, according to a new study that was posted online this weekend and has not yet undergone peer review. "We've already known for some time now that Paxlovid reduces the risk of acute problems," says Dr. Ziyad Al-Aly, chief of research and development at the VA Saint Louis Healthcare System, and co-author of the study, "Now we are adding the observation that Paxlovid also reduces the risk of long COVID." The drug, which has been available in the U.S. for almost a year, is provided for free by the federal government at pharmacies across the country. It requires a prescription, and patients with COVID-19 must start it within five days of symptom onset. In the study, long COVID was defined as developing one or more symptoms — including heart issues, blood disorders, fatigue and trouble breathing — one to three months after testing positive. By these metrics, patients that took Paxlovid were 26% less likely to develop long COVID. To get to this finding, the researchers combed through electronic health records from more than 56,000 patients in the VA health system who tested positive for COVID-19 between March and June 2022, and had at least one risk factor for severe disease. They compared health outcomes of 9,000 patients that had taken Paxlovid early in their course of illness, with 47,000 patients that had not. The benefits of taking Paxlovid didn't just apply to those who were unvaccinated. Patients who were vaccinated or boosted, or had repeat COVID-19 infections, had a similar reduction in the risk of developing long COVID, the study found.​ NPR External Link​​

    ​Novavax says Omicron shot shows strong immune response as second booster​​

    8 November- Vaccine maker Novavax Inc. (NVAX.O) said on Tuesday its COVID-19 shot retooled against the Omicron BA.1 variant showed a strong immune response as the fourth dose and met the main goal of strain change in a late-stage study. Data showed the shot, NVX-CoV2515, produced 1.6 times the amount of neutralizing antibodies in people who had previously not been exposed to COVID-19 compared to Novavax's original coronavirus vaccine. The trial included Novavax's so-called bivalent vaccine, the BA.1-tailored shot and its prototype vaccine. Novavax says the results from the study showed its Omicron-tailored shot can be changed to target a new variant vaccine if necessary. It added the bivalent vaccine -- aimed at combating the BA.1 version of Omicron and the original virus strain first detected in China -- did not show any benefit over its BA.1-tailored shot or its prototype vaccine. Meanwhile, the prototype vaccine produced a broad immune response against the original strain of the virus as well as both BA.1 and BA.5 Omicron variants, data showed, but the company did not disclose details about the levels of antibodies produced in the study. Reuters External Link​​​​​​

    ​INFLUENZA

    U.S. flu hospitalizations highest in 10 years, officials say​​v

    ​4 November- An early fall spike in influenza cases has pushed U.S. hospitalization rates for the illness to the highest in a decade for this time of year, U.S. health officials said on Friday, noting that vaccination rates are down. The rising flu cases come alongside pressure on hospitals from respiratory syncytial virus (RSV) and COVID cases, officials said, urging people to get vaccinated and offering to assist states that may need additional support. "There's no doubt we will face some challenges this winter," U.S. Department of Health and Human Services' Assistant Secretary for Preparedness and Response Dawn O’Connell told reporters, adding that the flu season so far does not seem more severe but has arrived earlier than is typical. Reuters External Link​​

    ​VETERINARY/FOOD SAFETY

    Brie recalled over Listeria concerns​

    4 November- Swiss American Inc. is recalling brie cheeses because of potential Listeria monocytogenes contamination. The products were distributed to wholesale accounts in Louisiana, Maine, Missouri, North Carolina and New York. According to the Food and Drug Administration, the recall was initiated on Sept. 30 and is ongoing. there is concern that consumers may still have the cheese n their homes because of its long shelf life, which extends to Dec. 14.​ Food Safety News External Link

    Nestlé edible cookie dough recalled after consumers find plastic film in product​​

    ​​4 November- Nestlé USA is recalling certain Edible Chocolate Chip Cookie Dough tubs from NESTLÉ® TOLL HOUSE® because of the potential presence of soft plastic film. According to the announcement published by the Food and Drug Administration, the company took this action after consumers contacted Nestlé USA about this issue. The recall is isolated to three batches of Edible Chocolate Chip Cookie Dough tubs from NESTLÉ® TOLL HOUSE® that were produced Aug. 1-3, 2022. These products were distributed to retailers nationwide. There is concern that consumers may have frozen the dough for future use because of its long shelf life when frozen. Consumers should check any cookie dough they have for the recalled codes and expiration dates.​ Food Safety News External Link​​

    WELLNESS

    Winter can increase the risk of heart attack - Tips to stay safe!​​

    3 November- Winters can be troublesome for people suffering from heart disease, thereby increasing cardiovascular events, such as heart attacks, arrhythmia, heart failure, etc. Heart problems can often lead to emergency hospitalization, involving substantial medical expenses. In such a situation, a care health insurance plan can be your ideal option that is budget-friendly and sufficient to manage your medical expenses. During winters, human bodies undergo various biological and physiological adjustments to function impeccably. Cold weather can constrict coronary arteries and blood vessels, thereby increasing blood pressure levels. Besides, the primary reason for such heart attacks is our sedentary lifestyles, unhealthy diets, stress and higher pollution levels. However, to keep your heart healthy and fit during winters, here are some of the effective tips:

    -Avoid excessive alcohol consumption and smoking: Excessive alcohol consumption can heat up your body to a greater extent, adversely affecting your health. Since the body adjusts to the temperature slowly, it is wise to drink in moderation. Moreover, smoking should be completely avoided because it is one of the prime contributors to heart failure or diseases.

    -Try to stay warm: Cold weather conditions can temporarily narrow down your blood vessels. Hence, it is essential to dress in warm clothes before going out. Similarly if your body gets overheated, you need to remove the layer until you expel sufficient heat from the body. 

    -Don't skip exercise: An inactive lifestyle is a prime contributing factor to diseases like diabetes and hypertension. However, it may be dangerous to step out early in winter. So, doing indoor exercises, such as yoga, pilates, and more, can benefit you.

    -Stress management: Engaging in activities like painting or gardening will help you release stress. In addition, you can try meditation and yoga at home. Finally, proper sleep cycles will allow you to manage stress efficiently.​ Tech Times External Link​​

    USAFRICOM

    Updated HAN Issued for Uganda's Sudan Ebolavirus Outbreak​​​

    8 November- The U.S. Centers for Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) Health Update yesterday as a follow-up to a HAN Health Advisory (CDCHAN-00477) focused on the recent Ebola virus disease (EVD) outbreak in the Republic of Uganda. As of November 5, 2022, a total of 132 confirmed cases of EVD have been identified in Uganda, with a 39% case fatality rate. The new HAN Update (CDCHAN-00480) serves to inform public health departments, public health laboratories, and clinicians in the U.S. about the ongoing outbreak of EVD in Uganda caused by the Sudan ebolavirus (SUDV). As of November 8, 2022, no suspect or confirmed EVD cases related to this outbreak have been reported in the United States (U.S.) or other countries outside of Uganda to date. Travel volume from Uganda to the U.S. is low, and there are no direct flights from Uganda to the U.S. Since October 7, 2022, U.S.-bound air passengers who have been to Uganda in the last 21 days are being redirected to five U.S. airports where they undergo entry health screenings as part of a layered mitigation approach that, in combination with other public health measures already in place to detect ill arriving travelers, are designed to reduce the risk of introduction and spread of disease in the U.S. However, as a precaution, because of increasing EVD cases in Uganda, the CDC is communicating with public health departments, public health laboratories, and healthcare workers to raise awareness of this outbreak and the potential for importation of cases. Given the early non-specific symptoms of EVD, all patients should be asked about their recent travel history. EVD should be included as a differential in patients with travel to Uganda in the past 21 days who have clinical symptoms such as fever, headache, muscle, and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, or unexplained bleeding. If EVD is suspected, the patient(s) should be isolated in a private room with a private bathroom or covered bedside commode.​ Precision Vaccinations External Link​​

    ​USCENTCOM

    Lebanon cholera update, WHO Regional Director’s statement on cholera outbreaks​​

    6 November- The Lebanon Ministry of Health reports in an update today that the cholera outbreak that began in early October has expanded to 2709 total (suspected and confirmed) cholera cases, including 436 confirmed cases. The cholera death toll now stands at 18. WHO Regional Director for the Eastern Mediterranean, Dr. Ahmed Al Mandhari released a statement on cholera last week: After decades without a single case of cholera, the outbreaks that have been recently declared in Lebanon and Syria mark an unwelcome comeback in those countries.  In fact, this is part of a worsening pattern across the Region, and the globe, as 8 of the 22 countries in our Region are grappling with outbreaks of cholera and acute watery diarrhea. Moreover, there are now 29 cholera outbreaks worldwide – the highest number on record. We know that cholera can cross borders, placing neighboring countries at increased risk and heightening the need for urgent control. This is a wake-up call for all of us. Cholera can spread rapidly in our Region, driven by the multiple complex humanitarian and health emergencies, prolonged conflict, poor water and sanitation infrastructure and deteriorating economic conditions. Additionally, climate change has contributed to the resurgence of cholera, and we see this evidence in several countries hit by extreme climate events like floods, droughts and cyclones. Droughts, which are increasingly common across our Region, reduce access to clean water and create the ideal environment for cholera to spread. Outbreak News Today External Link​​

    USEUCOM

    Ukraine's Occupied City of Kherson Without Electricity, Water After Strike

    7 November- Ukraine's Russian-occupied city of Kherson was cut off from water and electricity supplies Sunday after an air strike and a key dam in the region was also damaged, local officials said. It is the first time that Kherson — which fell to Moscow's forces within days of their February offensive — has seen such a power cut. "In Kherson and a number of other areas in the region, there is temporarily no electricity or water supply," the city's Moscow-installed administration said on Telegram. It said it was the "result of an attack organized by the Ukrainian side on the Beryslav-Kakhovka highway that saw three concrete poles of high-voltage power lines damaged." Energy specialists were working to "quickly" resolve the issue, the Russian-backed authorities said, as they called on people to "remain calm." But the head of the regional administration, Yaroslav Yanushevych, blamed Russia for the power outages. He said that in Beryslav city around 1.5 kilometers (just under a mile) of electric power lines had been destroyed — cutting off power entirely because the "damage is quite extensive."​ "Probably, there will be no light in Beryslav until the city is completely de-occupied," he wrote on the Telegram social media platform. "It is impossible to promptly repair the lines — there is a lack of specialists, equipment, and the Russian invaders will not allow this to be done." News of the outage followed reports that the Kakhovka dam in the Russian-controlled region of Kherson was "damaged" by a Ukrainian strike. "Today at 10:00 a.m. there was a hit of six HIMARS rockets. Air defense units shot down five missiles, one hit a lock of the Kakhovka dam, which was damaged," Russian news agencies quoted local emergency services as saying. The RIA Novosti news agency quoted a local Moscow-backed official saying the damage was not "critical."​ The Moscow Times External Link​​

    ​​USINDOPACOM

    China's COVID epicenter shifts to Guangzhou as outbreaks widen​

    8 November- New coronavirus cases surged in Guangzhou and other Chinese cities, official data showed on Tuesday, with the global manufacturing hub becoming China's latest COVID-19 epicenter and testing the city's ability to avoid a Shanghai-style lockdown. Reuters External Link​​

    ​USNORTHCOM

    The rate of alcohol-related deaths in the U.S. rose 30% in the first year of COVID​​

    5 November- The rate of deaths that can be directly attributed to alcohol rose nearly 30% in the U.S. during the first year of the COVID-19 pandemic, according to new government data. The Centers for Disease Control and Prevention had already said the overall number of such deaths rose in 2020 and 2021. Two reports from the CDC this week provided further details on which groups have the highest death rates and which states are seeing the largest numbers. "Alcohol is often overlooked" as a public health problem, said Marissa Esser, who leads the CDC's alcohol program. "But it is a leading preventable cause of death." A report released Friday focused on more than a dozen kinds of "alcohol-induced" deaths that were wholly blamed on drinking. Examples include alcohol-caused liver or pancreas failure, alcohol poisoning, withdrawal and certain other diseases. There were more than 52,000 such deaths last year, up from 39,000 in 2019. The rate of such deaths had been increasing in the two decades before the pandemic, by 7% or less each year. In 2020, they rose 26%, to about 13 deaths per 100,000 Americans. That's the highest rate recorded in at least 40 years, said the study's lead author, Merianne Spencer.​ NPR External Link​​

    USSOUTHCOM​

    ​D​​en​gue in the Americas: 2.5 million cases reported to date, Brazil accounts for 87%​​​

    8 November- From the beginning of the year through October 8, WHO officials have reported a total of 2,499,358 cases of dengue in the Americas. The highest number of dengue cases in the region have been reported by the following countries: Brazil with 2,182,229 cases (87.3%), Nicaragua with 63,853 cases (2.6%), Peru with 60,869 cases (2.4%), Colombia with 50,688 cases (2.0%), and Mexico with 36,926 cases (1.5%). Half of the total cases were laboratory confirmed. A total of 1,135 deaths were reported in the region (CFR: 0.045%). At least nine countries in the region reported all four dengue virus serotypes (DENV 1, DENV 2, DENV 3, DENV 4) this year. Concerning related arboviral diseases, chikungunya and Zika, a total of 250,150 chikungunya cases were reported in 12 of the 52 countries and territories in the Region of the Americas, of which 125,264 were confirmed (50.1 %). 99 percent of the cases were reported from Brazil (247,537). 75 deaths were reported associated with chikungunya infection. A total of 31,443 of Zika have been reported in the Region of the Americas in 13 out of 52 countries and territories, including four deaths. Outbreak News Today External Link​​