Army Public Health Weekly Update, 16 April 2021

Date Published: 4/16/2021
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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 U.S. Army Medical Command opinions, views, policy, or guidance, and should not be construed or interpreted as being endorsed by the U.S. Army Medical Command.

The Army Public Health Weekly Update does not analyze the information as to its strategic or tactical impact on the U.S. Army and is not a medical intelligence product. Medical intelligence is available from the National Center for Medical Intelligence External Link .  

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Table of Contents

    ANNOUNCMENTS 

    Defense Health Officials Provide a COVID-19 Update to Media

    8 April- PRESS SECRETARY JOHN F. KIRBY: Good morning, everybody, and welcome to our briefing this morning focused on COVID vaccinations in overseas destinations and locations. That's what we're hoping to provide some context on for you this morning. And to help us out, we're very pleased and delighted to have representatives from each of the services, and of course, as you all know, you know General Place quite well, the director of Defense Health Agency. He's going to shortly provide you with an update on vaccine distribution to DOD personnel, again, with a focus on OCONUS (Overseas) vaccination efforts to our troops and -- and beneficiaries. And he's being joined this morning by Army Major General Jill Faris, the interim G357 U.S. Army Medical Command; Navy Rear Admiral Gayle Shaffer, deputy surgeon general of the United States Navy; and Air Force Major General Robert Miller, director of medical operations, Office of the Surgeon General. After they each have a -- a few moments to provide you some context, and then we'll open it up for -- for some -- some Q&A with them. Defense.gov External Link

    Joint CDC and FDA Statement on Johnson & Johnson COVID-19 Vaccine

    13 April- As of April 12, more than 6.8 million doses of the Johnson & Johnson (Janssen ) vaccine have been administered in the U.S. CDC and FDA are reviewing data involving six reported U.S. cases of a rare and severe type of blood clot in individuals after receiving the J&J vaccine. In these cases, a type of blood clot called cerebral venous sinus thrombosis (CVST) was seen in combination with low levels of blood platelets (thrombocytopenia). All six cases occurred among women between the ages of 18 and 48, and symptoms occurred 6 to 13 days after vaccination. Treatment of this specific type of blood clot is different from the treatment that might typically be administered. Usually, an anticoagulant drug called heparin is used to treat blood clots. In this setting, administration of heparin may be dangerous, and alternative treatments need to be given. CDC External Link

    Join Us! Third COVID-19 Townhall Update with Major General George Appenzeller

    13 April- Please also join us on the following Tuesdays at 12:00 p.m. EDT for additional COVID-19 Townhall updates! On the dates listed below, Military OneSource will host DHA experts, allowing them the opportunity to address various topics related to COVID-19, such as:

    - Available vaccines and their distribution, safety, and efficacy

    - Scheduling appointments within the Military Health System

    - Guidance on continued protective measures to slow the spread of the virus

    - Personal/real positive outcomes from vaccines

    Join us here on the following dates as well, from 12:00 to 12:30:

    - April 13, 2021

    - April 27, 2021

    - May 11, 2021

    - May 25, 2021

    - June 8, 2021

    - June 22, 2021 Health.mil  External Link

    U.S. MILITARY

    DOD prioritizing COVID-19 vaccinations to those deployed

    8 April- The Defense Department is rapidly administering COVID-19 vaccines in a tiered priority process to service members, DOD contractors and civilians and their families who are stationed overseas and who wish to have them, said DOD health leaders. Army Lt. Gen. Ronald J. Place, director, Defense Health Agency; Army Maj. Gen. Jill K. Faris, deputy surgeon general, Army National Guard; Navy Rear Adm. Gayle Shaffer, deputy surgeon general, U.S. Navy; and Air Force Maj. Gen. Robert I. Miller, director of medical operations, office of the surgeon general, U.S. Air Force, spoke at a Pentagon media update today. Place said deployed personnel are being prioritized because of limited availability to receive vaccinations from local health care providers. Of all doses the department has received, 14% are set aside for overseas locations. "That's significant because the OCONUS population is 7% of our eligible population," he said, referring to personnel who are outside the continental U.S. "That said if you're a service member stationed overseas, or a family member likewise stationed overseas and you haven't received a vaccine, and you don't know when you'll be able to, these numbers mean nothing. And it's understandably frustrating," Place said. Place said that part of the reason for not getting shots in arms as quickly as the department would have liked, is because of the loss of about 15 million doses of the Johnson & Johnson dosages. Those doses were reportedly contaminated at a Baltimore factory about a week ago and are therefore unusable. Defense.gov External Link

    Future of Army Medicine critical to Soldier readiness, success

    7 April- Bayne-Jones Army Community Hospital celebrated the Army Medical Department Civilian Corps 25th Anniversary at the Joint Readiness Center and Fort Polk March 26. The ceremony and awards presentation celebrated the significant contributions of the BJACH civilian workforce. Guest speaker, J.M. (Jay) Harmon, deputy to the commanding general of the U.S. Army Medical Center of Excellence, said he was honored to take part in the celebration. A former colleague and mentor to Col. Jodi Dugai, BJACH commander, Harmon said he wanted to support her and her team during this event. "The Army Civilian Corps is one of the four cohorts that make up the Army along with commissioned, warrant and non-commissioned officers. I felt it was crucial to remind the civilian work force of the important role they play in Army medicine," he said. "The contributions they make providing healthcare for Soldiers and their Families on a daily basis is significant and should be recognized." While on the installation, Harmon spoke with Brig. Gen. David Doyle, JRTC and Fort Polk commanding general. The leaders discussed the increased opportunities to integrate Army medicine into maneuver and sustainment training operations. "I think the training that goes on here is what will prepare our warriors for the next battle and medical support is critical to the Soldiers' morale and welfare," Harmon said. "Integration of medical units and medical leadership in these training venues is crucial to success." Army.mil External Link

    New Army leader guide offers strategies for reducing Soldier injuries

    12 April- One of the challenges all Army leaders face is balancing readiness and training needs while preventing or reducing Soldier injuries. The Army Public Health Center recently released a guide for leaders offering specific recommendations and strategies to help leaders achieve the goal of injury reduction. "What Leaders Can Do to Increase Readiness" (referred to here as "the leader guide") contains eight recommendations targeting the top causes of Soldier medical non-readiness. It is intended to promote and facilitate leadership engagement in these strategies. Former Sergeant Major of the Army Raymond Chandler said the key to resiliency is engaged leadership at the first-line supervisor level. Engaged leaders are able to identify issues with their Soldiers' physical and mental well-being. Many times leaders are able to recognize these issues before the Soldiers themselves. This allows leaders to help guide Soldiers to the appropriate resource to address their needs. Sergeant Major of the Army Michael Grinston echoed this sentiment at the October 2020 gathering of the Association of the United States Army. "Our focus is on leadership and building cohesive teams," said Grinston. "'This Is My Squad' is about creating fit, disciplined and well-trained teams. It is about listening to and understanding our people. It's about showing compassion and empathy for all. Most importantly, it is about junior leaders creating positive energy, making decisions and taking action within their squads to support teammates." The importance of good communication is conveyed by the Army Leadership Model of Be, Know, Do. According to FM 6-22, the Army field manual on leader development, this model aligns the desired outcome of leader development activities and personnel practices to a common set of characteristics valued throughout the Army. Attributes are the desired internal characteristics of a leader – what the Army wants leaders to BE and KNOW. Competencies are skills and learnable behaviors the Army expects leaders to acquire, demonstrate, and continue to enhance – what the Army wants leaders to DO. DVIDS External Link

    GLOBAL

    Be proactive in looking for early signs of testicular cancer

    9 April- Testicular Cancer Week is an important time to remind service members to be proactive in their health. According to Navy Lt. Cmdr. (Dr.) Dorota Hawksworth, a urologist at Walter Reed National Military Medical Center, testicular cancer is very rare, but is most common amongst males between 15 and 34 years of age, the age bracket of many military members. Testicular cancer is a disease in which malignant cells form in the tissues of one or both testicles. While the diagnosis of cancer can be frightening, testicular cancer can usually be cured. "Many men have no known risk factors," said Hawksworth, "the known risk factors [for testicular cancer] can't be changed." These risk factors include a personal history of undescended testicle or prior testicular cancer, family history of testicular cancer, HIV infection, diagnosis of Klinefelter's disease, age, race, and ethnicity, Hawksworth noted. White males develop testicular cancer at a rate four times higher than that of Black males, according to cancer.gov. Testicular cancer can be detected early through screenings both at home and by a doctor. "Screening means looking for cancer before person has any symptoms. This process is performed differently, depending on the type of cancer," said Hawksworth. Testicular cancer however has no standard routine or screening. According to Hawksworth, most testicular cancers are found by a man or his partner, either by chance or by a self-screening. Self-exams should be performed monthly and in a warm environment such as a bath or shower to allow the scrotum to be more "relaxed," Hawksworth noted. Then each testis should be felt separately, using both hands to ensure that the contour is even and smooth with an egg-like shape with both testes about the same size. If during a self-exam a patient finds a nodule or hard mass on or around the testicle, a size change, or difference in one or both testes, pain, or if the patient "thinks" he feels something and is unsure, he should seek medical attention urgently. Health.mil External Link

    Children reported less infectious than adults with SARS-CoV-2

    12 April- According to research published by the Canadian Medical Association Journal on April 9, 2021, children may be less involved in spreading SARS-CoV-2 to other people. Compared with adults, the study authors wrote that children with nasopharyngeal swabs that tested positive for SARS-CoV-2 were less likely to grow the coronavirus in culture. They had higher cycle thresholds and lower viral concentrations suggesting that children are not the main drivers of SARS-CoV-2 transmission. Among 305 samples positive for SARS-CoV-2 by RT-PCR, 97 samples were from children aged ten years or younger, 78 were from children aged 11–17 years, and 130 were from adults (≥ 18 yr.).  Viral growth in culture was present in 31% of samples, including 18 (19%) samples from children ten years or younger, 18 (23%) from children aged 11–17 years, and 57 (44%) from adults (children v. adults, odds ratio 0.45, 95% confidence interval [CI] 0.28–0.72).  The cycle threshold was 25.1 (95% CI 17.7– 31.3) in children ten years or younger, 22.2 (95% CI 18.3–29.0) in children aged 11–17 years, and 18.7 (95% CI 17.9–30.4) in adults (p < 0.001).  The median TCID50/mL was significantly lower in children aged 11–17 years (316, interquartile range [IQR] 178–2125) than adults (5620, IQR 1171 to 17 800, p < 0.001). Cycle threshold was an accurate predictor of positive culture in both children and adults (area under the receiver-operator curve, 0.87, 95% CI 0.81–0.93 v. 0.89, 95% CI 0.83–0.96, p = 0.6). "Our findings have important public health and clinical implications," wrote principal investigator Dr. Jared Bullard, associate professor, pediatrics/child health and medical microbiology/infectious diseases, Max Rady College of Medicine, University of Manitoba, and associate medical director, Cadham Provincial Laboratory in Winnipeg, Manitoba.  "If younger children are less capable of transmitting infectious virus, daycare, in-person school and cautious, extracurricular activities may be safe to continue, and with lower risk to child care staff, educators and support staff than initially anticipated." No industry conflicts of interest were disclosed by fourteen researchers from multiple disciplines at the University of Manitoba, Cadham Provincial Laboratory, Manitoba Health and Seniors Care, and the Public Health Agency of Canada's National Microbiology Laboratory. Precision Vaccinations External Link

    Covid-19: U.S. agencies call for pause in Johnson & Johnson vaccine

    13 April- US health authorities are calling for a pause in the use of the Johnson & Johnson Covid-19 vaccine, after reports of extremely rare blood clotting cases. The Food and Drug Administration (FDA) said six cases in 6.8 million doses had been reported and it was acting "out of an abundance of caution". Johnson & Johnson said it was also delaying its vaccine rollout in Europe. The US move follows similar rare cases in the AstraZeneca vaccine, which has prompted some curbs in its use. The US has by far the most confirmed cases of Covid-19 - more than 31 million - with more than 562,000 deaths, another world high. The picture for the virus in the US is complicated, though, with some areas in the north seeing surges in infections, the south less, and with the figures not always reflecting inoculation numbers. The Johnson & Johnson jab was approved in the US on 27 February and its use has been more limited so far than that of the Pfizer-BioNTech and Moderna doses. Nevertheless, the government had hoped for hundreds of thousands of vaccinations of the jab every week as it is single-shot and its storage at common refrigerator temperatures makes it easier to distribute. It is also known as the Janssen vaccine, named after the Belgian company that makes it. South Africa became the first country in the world to administer the jab, and nearly 300,000 health workers have received it since mid-February. Health authorities there have not yet decided whether the roll out will continue. The vaccine is yet to be approved in the UK, although 30 million doses are on pre-order. The Department of Health said the rollout delay would not affect vaccine supplies in the UK, or derail the aim to offer a jab to all adults by the end of July. BBC News External Link

    Do sports/energy drinks enhance individual performance?

    12 April- Sports drinks claim that they "increase performance," "rehydrate," and "refuel." What does this mean and should you include them as part of your work out? What do sports drinks have in them? Sports drinks contain electrolytes and carbohydrates (energy or fuel source). Carbohydrates replace the energy used to fuel your workout. Dextrose and high-fructose corn syrup are two commonly used energy sources. Are all sports drinks the same? Many energy sports drinks are available, however the energy source used for sports drinks varies. For example, some contain dextrose, a rapid source of fuel, while others use high-fructose corn syrup, which fuels muscles more slowly than dextrose. The cost of sports drinks can also vary with some being more expensive than others based on the cost of ingredients (high-fructose corn syrup is cheaper to produce than dextrose). Absorption rates of sports drinks is also different, dextrose has two glucose molecules, while high fructose corn syrup consists of glucose and fructose. Muscles absorb glucose more quickly than fructose. So if you are looking to fuel more quickly you will want to choose a beverage that is made primarily of dextrose. Can sports drink increase your performance? When it comes to "increased performance," there is no agreement on the definition. However, the use of sports drinks as fuel during exercise has been associated with performing an activity for a longer period of time. Health.mil External Link

    Dreading post-pandemic crowds and social situations? Exposure therapy can help

    7 April- As a clinical psychologist, I've marveled at how my patients' worries have shifted as the pandemic has dragged on. Initially, when we naively believed the coronavirus would be a short-term stressor, my patients' fears focused on day-to-day survival: How do I get toilet paper? How do I keep my kid from touching her face? Several months in, the focus has shifted to anxiety about decisions: Should I send my kid to school? Should I return to the office? Now that more people are getting vaccinated and a return to somewhat-normal life is on the horizon, my patients' anxieties have morphed once again, with many of them fretting about how they will reenter public life after having avoided it for a year. While they've been outwardly rejoicing about the world reopening, they've been privately panicking. Despite the fact that the pandemic has generally been an anxiety-provoking experience, it has resulted in less anxiety and dread for many people in some parts of their lives. "Covid-19 protocols not only officially sanctioned, but specifically encouraged, avoidance of the outside world," said Simon Rego, chief of psychology and director of psychology training at Montefiore Medical Center in New York. This officially sanctioned avoidance came as a relief to those who dread certain aspects of public life, such as large crowds, socializing or exposure to germs; they could now avoid anxiety-provoking triggers in the name of public health. Avoidance is a four-letter word in the form of therapy I practice: cognitive behavioral therapy. That's because although avoidance minimizes anxiety and dread in the short-term, it maintains it in the long-term. "Avoidance prevents a person from learning that catastrophe most likely won't occur, and even if things go badly, they would find a way to cope and get through the situation," said Jonathan Abramowitz, a psychology professor and director of the Anxiety and Stress Disorders Clinic at the University of North Carolina at Chapel Hill. For example, people who are anxious about social gatherings will never learn that they can successfully navigate such events and will continue to steer clear of them. The Washington Post External Link 

    Emergency COVID-19 vaccine review meeting scheduled for April 14th

    13 April- A joint media briefing conducted by three leaders from the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA) was held at 10 a.m. ET on April 13, 2021, discussing the 'pause- recommendation' for the experimental Johnson & Johnson - Janssen COVID-19 Vaccine. Held on the FDA's YouTube page, this emergency media briefing was led by Dr. Janet Woodcock, acting FDA Commissioner, Peter Marks, M.D., Ph.D., director of the FDA's Center for Biologics Evaluation and Research, and Anne Schuchat, M.D., principal deputy director, CDC. During this digital session, various questions were submitted by the media to these leaders. Each response was reasoned and appropriate, given the nature of the six cases related to Thrombotic Thrombocytopenia and life-threatening pulmonary embolism and other emboli after receiving a Janssen COVID-19 vaccination. Since authorized by the FDA in March 2021, the Janssen vaccines have been administered about six million times. The primary action plan focuses on an emergency meeting of the CDC's Advisory Committee on Immunization Practices (ACIP), scheduled for April 14, 2021, from 1:30 p.m. to 4:00 p.m. ET. No registration is required to attend this open-to-the-public virtual ACIP meeting. Additionally, the FDA and CDC teams are in contact with the European Medicines Agency, which launched its review of the Janssen COVID-19 Vaccine on April 9, 2021. Regarding the vaccine risk-benefit debate, the Winton Center at the University of Cambridge recently offered this statement: 'All medical treatments have potential harms as well as potential benefits, and it's important to be able to weigh these against each other.' 'With vaccines, the benefits are particularly complex as they can involve benefits to others as well as to ourselves - and the harms can feel particularly acute because we take vaccines when we are healthy, as a preventative measure.' Precision Vaccinations  External Link

    More young people are getting hospitalized as a 'stickier,' more infectious coronavirus strain becomes dominant

    12 April- What used to be a mysterious new variant first detected in the UK is now the most dominant coronavirus strain in the US. And unlike the original strain of the novel coronavirus, the more contagious B.1.1.7 strain is hitting young people particularly hard. "(Covid-19) cases and emergency room visits are up," said Dr. Rochelle Walensky, director of the US Centers for Disease Control and Prevention. "We are seeing these increases in younger adults, most of whom have not yet been vaccinated." Now doctors say many young people are suffering Covid-19 complications they didn't expect. And it's time to ditch the belief that only older adults or people with pre-existing conditions are at risk of severe Covid-19.  Viruses mutate all the time, and most mutations aren't very important. But if the mutations are significant, they can lead to dangerous new variants of a virus. "The B.1.1.7 variant has mutations that allow it to bind more" to cells, said Dr. Jonathan Reiner, a CNN medical analyst and professor of medicine and surgery at George Washington University. "Think of this mutation as making the virus stickier." Coronavirus latches onto cells with its spike proteins -- the spikes surrounding the surface of the virus. CNN External Link

    Some Covid-19 long haulers say vaccines may be relieving their symptoms- Researchers are looking into it

    8 April- Jessamyn Smyth hopes that two shots in the arm may be what finally delivers her from a year in which the lasting effects of Covid-19 wreaked chaos in her life. Smyth says that after coming down with an acute infection in March 2020, she continued experiencing a constellation of health issues. For months, she has suffered from breathlessness, irregular and rapid heartbeat, diarrhea, and unusual skin rashes. Like many "long haulers," Smyth's fatigue was a constant "knock-down-pass-out-for-15-hours pathological exhaustion," she explained in an email to CNN. A writer and humanities professor in Holyoke, Massachusetts, she had difficulty even recalling basic words she used every day, such as "punctuation." Her life as a scholar and an avid swimmer had crumbled.  "In the end, I lost two jobs, the end of my mother's cognitive life and her transition into dementia care, a partner and home, all financial security—and, I feared, my life and identity as an endurance swimmer (and) athlete," she said. But then she got her vaccine. Within a couple of weeks, her fatigue and cognitive issues were "noticeably better," she said. Her rashes were gone. And after her second Pfizer dose, on February 24, her symptoms kept improving. Stories like Smyth's are gathering steam on social media, offering a tantalizing possibility when specialized clinics don't seem to have the answers for how to treat them. A portion of long haulers could be having vaccine-induced relief. If so, it could be a game-changer for the growing number of people experiencing long-term health issues and even disability; 10% to 30% of those who contract Covid-19 experience long-term symptoms, according to the National Institutes of Health. However, experts aren't yet certain about the science on why this could be happening or how long patients' improvement might last. In Smyth's case, her resting heart rate, which she had often clocked at 150 beats per minute post-Covid, was back to the strong, slow throb of an endurance athlete, around 50 to 60. (Most healthy adults have resting heart rates between 60 and 100, with those on the lower end having greater protection against heart attacks, according to Harvard Medical School). "My skin was different. My brain was different. I began to feel like myself for the first time in a year," she said. Judy Dodd is another Covid-19 long hauler, sick for a year, who is suddenly improving after her Pfizer vaccination. She might be back to 90% of how she felt before she got sick, she says. CNN External Link

    Unusual treatment shows promise for kids with brain tumors

    12 April- For decades, a deadly type of childhood cancer has eluded science's best tools. Now doctors have made progress with an unusual treatment: Dripping millions of copies of a virus directly into kids' brains to infect their tumors and spur an immune system attack. A dozen children treated this way lived more than twice as long as similar patients have in the past, doctors reported Saturday at an American Association for Cancer Research conference and in the New England Journal of Medicine. Although most of them eventually died of their disease, a few are alive and well several years after treatment -- something virtually unheard of in this situation. "This is the first step, a critical step," said the study's leader, Dr. Gregory Friedman, a childhood cancer specialist at the University of Alabama at Birmingham. "Our goal is to improve on this," possibly by trying it when patients are first diagnosed or by combining it with other therapies to boost the immune system, he said. The patients in the study were given the experimental approach after they failed other treatments. The study involved gliomas, which account for 8% to 10% of childhood brain tumors. They're usually treated with surgery, chemotherapy or radiation but they often recur. Once they do, survival averages just under six months. In such cases, the immune system has lost the ability to recognize and attack the cancer, so scientists have been seeking ways to make the tumor a fresh target. They turned to the herpes virus, which causes cold sores and spurs a strong immune system response. A suburban Philadelphia company called Treovir developed a treatment by genetically modifying the virus so it would infect only cancer cells. Fox News External Link

    INFLUENZA

    CDC: Weekly U.S. Influenza Surveillance Report

    Key Updates for Week 13, ending April 3, 2021-

    Influenza-Associated Hospitalizations: The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in 14 states and represents approximately 9% of the U.S. population.

    Influenza-Associated Pediatric Mortality: No influenza-associated pediatric deaths were reported to CDC during week 13. CDC External Link

    WHO: Influenza update

    29 March 2021, based on data up to 14 March 2021:

    - The current influenza surveillance data should be interpreted with caution as the ongoing COVID-19 pandemic has influenced to varying extents health seeking behaviors, staffing/routines in sentinel sites, as well as testing priorities and capacities in Member States. The various hygiene and physical distancing measures implemented by Member States to reduce SARS-CoV-2 virus transmission have likely played a role in reducing influenza virus transmission.

    - Globally, despite continued or even increased testing for influenza in some countries, influenza activity remained at lower levels than expected for this time of the year.

    - In the temperate zone of the northern hemisphere, influenza activity remained below baseline, though sporadic detections of influenza A and B viruses continued to be reported in some countries.

    - In the temperate zone of the southern hemisphere, influenza activity was reported at inter-seasonal level.

    - In the Caribbean and Central American countries, no influenza detections were reported.

    - In tropical South America, no influenza but low levels of detection of other respiratory viruses (ORVs) were reported in some countries.

    - In tropical Africa, influenza activity was reported in some reporting countries in Western and Eastern Africa in recent weeks.

    - In Southern Asia, sporadic influenza detections were reported in India and Nepal.

    - In South East Asia, influenza A(H3N2) detections continued to be reported in Lao People's Democratic Republic (PDR).

    - Worldwide, influenza B detections accounted for the majority of the very low numbers of detections reported. WHO External Link

    VETERINARY/FOOD SAFETY

    Algeria: Brucellosis sickens dozens after drinking goats milk

    11 April- Algerian media is reporting an outbreak of brucellosis in Batna. According to the report, 31 people were infected with brucellosis in the municipality of Ares after consuming goat's milk. This followed the discovery of a focus of the disease that infected 119 goats from a herd of 155. Brucellosis is a contagious disease of animals that also affects humans. The disease is also known as Bang's Disease. In humans, it's known as Undulant Fever. The Brucella species are named for their primary hosts: Brucella melitensis is found mostly is goats, sheep and camels, B. abortus is a pathogen of cattle, B. suis is found primarily in swine and B. canis is found in dogs. The more common ways people get infected with brucellosis include: First, individuals that work with infected animals that have not been vaccinated against brucellosis. This would include farmers, slaughterhouse workers and veterinarians. They get infected through direct contact or aerosols produced by the infected animal tissue. B. abortus and B. suis are most common. The second way is through ingesting unpasteurized dairy products. Outbreak News Today External Link 

    Herbal medicine linked to Danish Salmonella outbreak

    12 April- A Salmonella outbreak in Denmark affecting 25 people has been traced to a brand of herbal supplement, according to food safety officials. The majority fell sick in March and Orkla Care A/S, the seller of the implicated products, has issued a recall of several batches. The Statens Serum Institut (SSI), Danish Medicines Agency, the Danish Veterinary and Food Administration (Fødevarestyrelsen) and DTU Food Institute investigated the outbreak. Earlier this past week, SSI revealed that 23 people had been infected by the same type of Salmonella Typhimurium between mid-November and March. The update features two more patients bringing the total to 25. They are aged 2 to 92 years old and live across the country. In total, 13 are women and 12 are men. Fourteen people have needed hospital treatment. Food Safety News External Link

    Warning issued over raw milk in Western New York

    7 April- New York State Department of Agriculture and Markets Commissioner Richard A. Ball is warning consumers not to consume unpasteurized, raw milk from Happy Hollow Dairy Farm because of possible Listeria monocytogenes contamination. Happy Hollow Dairy Farm is in Springville, NY. The warning comes after a sample of the milk collected by an inspector from the department was discovered to be contaminated with Listeria monocytogenes. On April 1 the producer was notified of a preliminary positive test result. Further laboratory testing, completed April 6 confirmed the presence of Listeria monocytogenes in the raw milk sample. The producer is now prohibited from selling raw milk until subsequent sampling indicates that its product is free of harmful bacteria. The department recommends that any consumers who purchased raw milk from Happy Hollow Dairy Farm immediately dispose of it. As of the posting of this recall, there have been no illnesses reported. Food Safety News External Link

    WELLNESS

    Excessive drinking rose during the pandemic- Here are ways to cut back

    12 April- For most of her life, Andrea Carbone, a 51-year-old paralegal living in Florida, wasn't a big drinker. But when the pandemic struck, she worried constantly about her job, her health and the safety of her children. While many people were able to work from home last year, Ms. Carbone was required to go into the office. Some mornings she would cry in her car as she drove along deserted roads and highways to get to her office in downtown Tampa, which looked, she said, "like a ghost town." As her stress levels soared, so did her alcohol intake. Before the pandemic, Ms. Carbone would have a glass of red wine with dinner most nights. But by May, her intake had climbed substantially. "I noticed I was having a glass of wine as soon as I got home, then a glass with dinner, then we'd sit down to watch TV and I'd have another glass or two," she said. "By the end of the night I was drinking a bottle." Ms. Carbone is far from alone. The widespread fear, frustration and social isolation surrounding the tumultuous events of the past year — the pandemic, civil unrest, political upheaval — caused stress levels to skyrocket, with many people increasing their alcohol intake. Women and parents of young children seem to have been hit particularly hard. A nationwide survey commissioned by the American Psychological Association in February found that one in four adults reported drinking more this past year to manage their stress. That rate more than doubled among those who had children between the ages of 5 and 7. Another study published in JAMA Network Open in October found that Americans increased the frequency of their alcohol consumption by 14 percent compared to a year earlier. But the same study found a 41 percent increase in the number of days on which women drank heavily, defined as having four or more drinks in a couple of hours. "Women have disproportionately left the labor force entirely compared to men; they have disproportionately taken on the work around the house, the child care, and the child's education," said Michael S. Pollard, the lead author of the JAMA study and a senior sociologist at the RAND Corporation. "So, it stands to reason that women would increase their alcohol use disproportionately as well." The New York Times External Link

    How online therapy can help improve your mental health

    8 April- Sometimes, the weight of the world can really start to get to you and you may decide to seek out therapy. Regardless of the reason for choosing to see a therapist, it's important to have readily accessible options. Due to lockdowns and ongoing COVID-19 pandemic, it may be more difficult to book an appointment with the therapist in person. At- risk or reluctant patients may prefer to seek remote virtual therapy from the comfort of their own homes. Technology and teleconferencing methods have evolved considerably over the past couple of years, making remote doctor's appointments/wellness checks/therapy sessions a possibility for those who may benefit from them. Teletherapy/online therapy is an effective method for seeing a therapist online. What are the benefits of online therapy? Online/virtual therapy is both affordable and comprehensive. While each individual insurance company varies on whether they'll cover it or not, virtual therapy sessions can be inexpensive. A typical session might cost $30 or $40 or be available via some sort of monthly plan. There are several types of therapy that work well online. A few the most common are psychotherapy, psychodynamic therapy, and cognitive behavioral therapy. Other types of therapy are also typically available. Tech Times External Link

    USAFRICOM

    Avian influenza outbreak in Nigeria

    10 April- The Nigeria Centre for Disease Control (NCDC) reports an outbreak of highly pathogenic avian influenza (HPAI) H5N1 in poultry on 30 farms from seven states in Nigeria. The affected states include Kano, Plateau, Bauchi, Gombe, Nasarawa, Kaduna and the Niger States. In addition the European Centre for Disease Prevention and Control (ECDC) reports: As of 28 March 2021, 83 human nasopharyngeal/oropharyngeal samples have been collected from contacts of confirmed birds in four states: Kano (27), Bauchi (19), Gombe (19), and Plateau (18). All contacts were farmers, farmworkers, bird-handlers, and traders, and all were asymptomatic. Of the 83 collected samples, 64 samples were analyzed using real-time RT-PCR (rRT-PCR). From the 64 analyzed samples, seven were positive for influenza A virus, including six samples of influenza A(H5) neuraminidase (NA) remains undetermined) and one sample of unsubtypable influenza A virus. These seven confirmed samples have been reported in Kano (four) and Plateau (three) states and have been shipped to the WHO Collaborating Centre in the US for further characterization. Outbreak News Today External Link

    USCENTCOM

    COVID-19 pandemic situation in Iraq continues to be quite concerning

    8 April- The World Health Organization (WHO) reports a sustained increase in the number of reported cases since the first weeks of 2021. During the last week of March, the Iraqi Ministry of Health reported 41,140 new cases of COVID-19 infections, which represents 6.76% increase compared with the week prior, and 251 new deaths with a 22.44% increase compared to the previous week. During the week, the positivity rate was 15 percent, marking continuity of community transmission1 of the COVID-19 pandemic. Iraq has reported more than 900,000 total cases in the pandemic, including 14,600 deaths. Outbreak News Today External Link

    USEUCOM

    Covid: People 45 or over in England invited to book vaccine

    13 April- People aged 45 or over in England will now be invited to get a Covid jab, Health Secretary Matt Hancock has said. The vaccination programme would then move on to everyone aged 40 or over "in line with supplies", he added. Appointments can be made on the NHS booking website, which temporarily crashed on Tuesday morning when it opened up to the new age group. First Minister Nicola Sturgeon also confirmed over-45s would start to get invites in Scotland this week. Unlike in England, appointments there will be allocated and there are no plans to introduce an online booking service. In Northern Ireland, people aged 40-45 are eligible to get a Covid vaccine, while in some areas in Wales 40-49 year-olds are being invited. BBC News External Link

    COVID-19 vaccine in Sweden: Nine out of ten say they will most certainly or probably will say yes

    7 April- On a monthly basis, the Swedish Public Health Agency asks residents about their attitude to vaccination against covid-19. The questions are about attitudes towards vaccination against covid-19 but also, among other things, about practical conditions regarding vaccination. This month's survey shows that 69 percent will definitely say yes to vaccination and another 22 percent will probably do so. Among those who probably intend to say yes, have many questions or concerns. Five percent state that they would say no, while 4 percent did not decide. Protecting others is a strong driving force in all groups, while the motive to vaccinate oneself to protect oneself is higher among the elderly. That there are questions and thoughts in a proportion of those who responded is expected and something you see in other vaccinations. The survey is an important basis in the work of reaching out to everyone with the offer of vaccination, says Anders Tegnell, state epidemiologist. The study was carried out during the period 11 to 22 March before the announcement that Astra Zeneca's vaccine should only be given to people aged 65 and over. Any effects of the changed information on who should be offered that particular vaccine are judged to be reflected in next month's survey. The sample is representative of the population, the survey was sent to close to 3,500 participants and had a response rate of 89 percent. Outbreak News Today External Link

    USINDOPACOM

    Dracunculus worm detected in Vietnamese man

    11 April- Officials in Vietnam reported a case of Dracunculus in a man with no travel history to Africa or any other endemic part of the world. This is the first case ever of a Dracunculus worm infection in Vietnam. The case is discussed in the April 2021 issue of the International Journal of Infectious Diseases. In July 2020, the Vietnamese public health surveillance system detected a hanging worm in a 23-year-old male patient. The Case Report states: The worms were retrieved from the lesions and microscopically examined in Vietnam, identifying structures compatible with Dracunculus spp. and L1-type larvae. A section of this parasite was sent to the Centers for Disease Control and Prevention (CDC) in Atlanta, United States, for confirmatory diagnosis of GW. The adult worm had cuticle structures compatible with Dracunculus parasites, although the length of L1 larvae was about 339 μm, substantially shorter than D. medinensis. DNA sequence analysis of the 18S small subunit rRNA gene confirmed that this parasite was not GW, and determined that the sample belonged to a Dracunculus sp. not previously reported in GenBank that clustered with the animal-infective Dracunculus insignis and Dracunculus lutrae, located in a different clade than D. medinensis. Guinea worm (GW) disease, caused by Dracunculus medinensis, is an almost eradicated waterborne zoonotic disease. The World Health Organization (WHO) currently lists GW as endemic in only five African countries. Outbreak News Today External Link

    Philippines report record daily COVID-19 deaths, FDA suspends AstraZeneca vaccines for individuals aged below 60

    9 April- The Philippines Department of Health (DOH) reported 401 new COVID-19 deaths Friday, a new daily record in fatalities on the archipelago since the beginning of the pandemic. In addition, health officials reported 12,225 new infections today, bringing the country's total cases to 840,554. The public is reminded to stay at home and to observe minimum health standards when going out. In related news, the DOH on Thursday adopted the recommendation of the Food and Drug Administration (FDA) to temporarily suspend the use of AstraZeneca vaccines for individuals aged below 60 years old, following recent reports of rare cases of blood clots with low platelets detected in some individuals inoculated with the vaccine. "We are aware of the recommendation of the European Medicines Agency (EMA) to list blood clots as very rare side effects of the AstraZeneca vaccine. While we have not seen such incidents in the country, the FDA has recommended to temporarily suspend the use of the vaccine for persons below 60 years old as we await results of the review being done by our local experts, as well as the official guidance of the WHO," FDA Director General Rolando Enrique Domingo said. "I want to emphasize that this temporary suspension DOES NOT MEAN that the vaccine is unsafe or ineffective—it just means that we are taking precautionary measures to ensure the safety of every Filipino. We continue to underscore that the benefits of vaccination continue to outweigh the risks and we urge everyone to get vaccinated when it's their turn," FDA Director General Domingo added. Outbreak News Today External Link

    USNORTHCOM

    U.S.: Measles case confirmed in Connecticut

    10 April- Connecticut state health officials report a confirmed case of measles in a Fairfield County child.  The child, who was not yet vaccinated against measles, acquired the infection while traveling internationally. "The single best way to protect yourself and your children from measles is to be vaccinated," said DPH Acting Commissioner Dr. Deidre Gifford. "While the COVID-19 pandemic has been happening, some children have fallen behind on their immunizations. This measles case is an important reminder that these vaccine-preventable diseases still pose a threat, and that we must protect children through on-time vaccination." Measles is a highly contagious disease that can spread quickly among unvaccinated people. However, the majority of people exposed to measles are not at-risk of developing the disease since most people have either been vaccinated or have had measles in the past, before vaccination became routine. While most people have had the measles vaccination, it's important for people to know their vaccination status and to be aware of the signs and symptoms of measles so they can get medical attention if needed. Symptoms of measles generally begin 7-14 days after exposure to an infected person. A typical case of measles begins with mild to moderate fever, cough, runny nose, red eyes (conjunctivitis), and sore throat.  Three to five days after the start of these symptoms, a red or reddish-brown rash appears, usually starting on a person's face at the hairline and spreading downward to the entire body. At the time the rash appears, a person's fever may spike to more than 104 degrees Fahrenheit. The rash typically lasts at least a few days and then disappears in the same order. People with measles may be contagious up to 4 days before the rash appears and for four days after the rash appears. Outbreak News Today External Link

    USSOUTHCOM

    Brazil dengue: Government must invest in adequate water systems to reduce mosquito habitats

    9 April- Dengue risk is exacerbated in highly populated areas of Brazil after extreme drought because of improvised water containers housing mosquitoes, suggests a new study in Lancet Planetary Health. The research was led by the London School of Hygiene & Tropical Medicine's (LSHTM) Centre on Climate Change & Planetary Health and Centre for the Mathematical Modelling of Infectious Diseases. Using advanced statistical modelling techniques, the team predicted the timing and intensity of dengue risk in Brazil from extreme weather patterns. The risk of dengue was high in urban areas three to five months after extreme drought. Extremely wet conditions increased dengue risk in the same month and up to three months later. In rural areas, dengue risk was more readily associated with very wet conditions. Dengue fever is caused by a virus carried by mosquitoes and is considered one of the top ten threats to global health. Brazil has the greatest number of dengue cases in the world, reporting more than two million cases of dengue in 2019 alone. Increasing levels of severe droughts and flooding episodes due to climate change has led to interruptions in water supply networks in Brazil. The improvised water storage containers used to combat this have become breeding grounds for mosquitoes. Outbreak News Today External Link