Army Public Health Weekly Update, 17 July 2020

Date Published: 7/17/2020
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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

    2020 Army Public Health Course - Virtual

    The 2020 Army Public Health Course will be held on a virtual platform, using CVR Microsoft Teams, from 3 - 7 August 2020. This year's course is designed to provide Public Health Professionals an opportunity to keep abreast of the most current public health topics and services through its 2020 theme, 'Unifying the Public Health Enterprise'. Now modeled across the capabilities and functions of the 10 Essential Public Health Services, the DOD's public health assets will synchronize efforts in order to maintain continuity in the delivery of its services.  To adapt to current changes in the Public Health Enterprise, its governance, and the ever changing operational landscape, the Army Public Health Course also serves as a platform to synergize strategic, operational and tactical efforts.  Here, the Army's public health framework will be further defined and real-time use of its strategies implemented. APHC

    COVID-19 FAQs

    Check out our Frequently Asked Questions (FAQs) about COVID-19. APHC

    Heat Illness Resources

    Heat illnesses occur year round in training environments and increase significantly in warmer weather.

    Risk factors for heat illness include:

    - Environment: high temperature, high humidity, wind, solar load, repeated hot/humid days

    - Mission: high exertion/intensity, heavy loads/gear, repeated strenuous days

    - Individual: acclimatization status, poor fitness (2 mile run >16 minutes for males, >19 minutes for females), BMI >26, age <20 or >40, poor hydration/nutrition status, minor illness (fever, skin rash, sunburn, or poison ivy), medication (antihistamines, decongestants, some blood pressure medications, some psychiatric drugs), alcohol use in the past 24 hours, sleep deprived, highly motivated

    Click the link to access heat illness prevention products. APHC

    U.S. MILITARY

    Applying COVID-19 innovations to the future of MHS medicine

    14 July- "I would do anything to help my patients" and "I look forward to business as usual after COVID-19" – declarations many Military Health System providers worldwide would wholeheartedly agree with during the coronavirus pandemic. We give our best every day to ensure infected and non-infected alike get the treatment they need. As we envision health care in a post-pandemic world, we can't ignore that COVID-19 has already irrevocably changed how we deliver care and will continue to do so. We must use the terrible clarity these unprecedented circumstances provide to honestly evaluate our tools and practices, and apply that wisdom to make real, lasting improvements to health care. This mindset of embracing innovation for the sake of our patients is already a hallmark of MHS providers. We find creative, clinically sound ways to treat our patients no matter the obstacle. We are also in a prime position to lead by example in keeping the best of what we're learning during COVID-19. The MHS is one of the largest health care systems in the world and has the tools, experience, logistical capacity and operational flexibility to do what many other health systems cannot. Our experience with global, 24/7, life-and-death medical crises means we can lead in innovation when it's most needed. Health.mil External Link

    DHA's new app assists providers with treating infectious diseases

    10 July- Health care providers worldwide are challenged with navigating the amount of emerging COVID-19 information and guidance, all while caring for patients. The Defense Health Agency's new Antimicrobial Stewardship mobile app expedites access to information at the point-of-care and supports standardization of care across the Military Health System. The app is available for mobile or desktop device at https://mobile.health.mil/asp. This progressive web application provides faster updates to content and function than traditional apps. Contents include general prescribing guidelines for common infectious diseases by conditions and organisms, access to facility-specific antibiograms, and useful tools such as clinical calculators, links to knowledge bases, and national organization guidelines. Specific to COVID-19 are general clinical information, guided clinical protocols, return-to-the-workplace or release-from-quarantine information, health care provider exposure assessment, and specialty consultation contact information. Education and protocols support care in both the outpatient and inpatient settings; and updated COVID-19 triaging and testing information is included. "The application started off as an idea in 2017 to make a mobile app displaying the local antibiogram," said Air Force Capt. (Dr.) Kevin Loudermilk, internal medicine department, 959th Medical Group. "I connected with Dr. (Twee) Sim from the DHA Antimicrobial Stewardship Program, and the app took off. It's the perfect platform to ensure our health care providers receive the most up-to-date information at the point-of-care, and that has been particularly true during the current pandemic." The app has become a resource and tool for health care providers treating patients for infectious diseases. Over a one month period the app has been used by over 1,300 providers, with an average use session lasting over 5 minutes. Health.mil External Link

    DoD needs blood plasma donations from recovered COVID-19 patients

    14 July- The Defense Department wants to collect 8,000 units of plasma from patients who have recovered from COVID-19 -- part of a nationwide effort to study the effectiveness of convalescent plasma as a treatment for the potentially fatal illness. DoD officials have pledged to collect the amount by Sept. 30, 2020, to boost research on therapies against the virus and treat those with the illness. "We may want to ask you to stick your arm out and donate blood," Chairman of the Joint Chiefs of Staff Army Gen. Mark Milley said in a virtual town hall in late May. "What that can then do is help others who are severely ill, and if we can do that, then we'll be on a good path toward getting some really powerful therapeutics." The Food and Drug Administration approved convalescent plasma as an investigational therapy in March for those hospitalized with the illness, and more than 35,000 patients in the U.S. have received it. But there is no data that proves "definitively" that convalescent plasma works. More study is needed to determine what role it can play in treating the coronavirus, according to Dr. Janet Woodcock, director of the Center for Drug Evaluation and Research at the FDA. Still, she added, "there have been encouraging reports and a lot of mechanistic reasoning that in fact convalescent plasma may be helpful." "These studies are being done as we speak ... we need donors. Blood drives are ongoing, and the U.S. government will be trying to accelerate these drives for convalescent plasma," Woodcock said in a call with reporters Monday. Military.com External Link

    Military medical teams are deploying again to battle COVID-19

    14 July- Military medical and support teams have begun deploying to sunbelt states hit hard by the resurgence of COVID-19, in an effort to relieve overburdened local hospital personnel as they did in New York and New Jersey in the early stages of the pandemic. At the request of the Federal Emergency Management Agency and the states, about 740 military personnel from the ArmyNavy and Air Force have been sent to Texas and California in recent days to help contain the spread of the virus, U.S. Army North said in a release Monday. "We are committed to assisting those in need as part of the ongoing whole-of-America response" to COVID-19, Lt. Gen. Laura J. Richardson, commander of U.S. Army North, said in a statement. For some on the medical teams, it is their second time on a backup mission to civilian hospitals. "It's an honor to be in San Antonio, Texas, providing care to patients alongside local hospital staff," said Army Capt. Sarah Kopaciewicz, a critical care nurse. "I was doing similar work, treating COVID-19-positive patients, at Joint Base Lewis-McChord in Washington state before being employed here" on an embed to the Christus Westover Hills Medical Center in San Antonio, she added, according to the U.S. Army North release. About 580 medical and support personnel from the Army and Navy are deploying to Texas, while another 160 from the Air Force are being sent to California, said U.S. Army North, which is overseeing the operation. Military.com External Link

    Military's COVID-19 cases growing at twice the nationwide rate

    11 July- More than 4,100 service members have tested positive for coronavirus since the July 1, according to the Defense Department's latest statistics, a rise of about 33 percent in the last 10 days. That is more than twice the rate of growth nationwide during the same period, 16 percent, as the U.S. more than once broke its daily records for new cases. There were three new deaths, all of contractors or civilians, during this period as well. Defense officials have attributed the recent rise in military cases both to increased testing and to the lifting of shelter-in-place orders in some force concentration areas, while expressing faith that local commanders are enforcing protective measures like social distancing and face covering for their troops. "While we are seeing some upticks in the same places there are upticks in the civilian sector, again, that is not necessarily overly surprising, in that we have been doing more testing," assistant defense secretary for health affairs Tom McCaffery told reporters July 1. "And we have been doing testing of those who are asymptomatic." The infection rate among service members is now 0.8 percent, compared to 0.9 nationwide. That is the closest the military's infection rate has come to the general public's in the U.S., and double what it was in mid-June. These most recent calculations by Military Times reflect the period between July 1 and July 10, rather than the previous weekly calculations published every Friday. DoD did not post its updated numbers on July 3, despite its current Monday-Wednesday-Friday schedule. Officials have pointed to states with spiking infection rates as possible contributors to new cases. "In general we are doing more testing, which can lead to more positive cases, which prompts more testing," Air Force spokesman Lt. Col. Malinda Singleton told Military Times in late June. "Many of our installations are in current hotspots (Texas, Arizona, Florida), which is also leading to an increase in positive cases." Military Times External Link

    SMA once again proposes pulling deep-fryers out of Army chow halls

    10 July- The sergeant major of the Army said Thursday that eating right may be more important for soldier fitness than the new Army Combat Fitness Test. But don't look for him to ban Burger King franchises on base. "Nutrition is to me, it's like the most important thing. ... You can ruin a good workout in one sitting, you know, with a meal," Sergeant Major of the Army Michael Grinston said during a Facebook Live event hosted by the Army and Air Force Exchange Service (AAFES). Grinston has been preaching the importance of the ACFT, which is scheduled to replace the Army Physical Fitness Test as the Army's new fitness standard Oct. 1. But the ACFT is only part of the fitness equation, he said, stressing his other initiative -- the Army Commitment to Overall Nutrition, or ACTION. "Holistic health and fitness and the healthy food initiative is equally as important -- or more -- than changing to the Army Combat Fitness Test," Grinston said. But that doesn't mean he is against fast food joints on post. "A lot of people ask me, 'Sergeant Major, why don't we just get rid of all the Burger Kings?'" he said. "I actually don't agree with that; my theory is we've got to make the right choices, and it's not about me taking away that choice. You have to make that decision. "My goal is that you make the right decision. Sometimes, you want a burger," he said. "It's OK. I'm not here to take away all this stuff and you go off the base." Military.com External Link

    GLOBAL

    A plasma shot could prevent coronavirus- But feds and makers won't act, scientists say

    10 July- It might be the next best thing to a coronavirus vaccine. Scientists have devised a way to use the antibody-rich blood plasma of COVID-19 survivors for an upper arm injection that they say could inoculate people against the virus for months. Using technology that's been proven effective in preventing other diseases such as hepatitis A, the injections would be administered to high-risk healthcare workers, nursing home patients, or even at public drive-through sites — potentially protecting millions of lives, the doctors and other experts say. The two scientists who spearheaded the proposal — an 83-year-old shingles researcher and his counterpart, an HIV gene therapy expert — have garnered widespread support from leading blood and immunology specialists, including those at the center of the nation's COVID-19 plasma research. But the idea exists only on paper. Federal officials have twice rejected requests to discuss the proposal, and pharmaceutical companies — even acknowledging the likely efficacy of the plan — have declined to design or manufacture the shots, according to a Times investigation. The lack of interest in launching development of immunity shots comes amid heightened scrutiny of the federal government's sluggish pandemic response. Los Angeles Times External Link

    Babies' mysterious resilience to coronavirus intrigues scientists

    14 July- As the new coronavirus continues to burn through populations, studies are beginning to shed light on its impact on infants. And so far the findings have been promising for parents and researchers alike. The initial data suggest that infants make up a small fraction of people who have tested positive for COVID-19. A Centers for Disease Control and Prevention study released in April reported 398 infections in children under one year of age—roughly 0.3 percent of all U.S. cases at that time for which age was known. In addition, most of these cases appear mild in nature: a recent review published in the Italian Journal of Pediatrics that looked at infants up to the age of six months found that those who were infected would typically exhibit only a slight cough, runny nose or fever, which disappeared in a week or so. Other studies have suggested similar minor reactions. The question is: Why? One of the favored hypotheses focuses on how easily the new coronavirus can gain access to the body's tissues. Infection occurs when particles of the virus, SARS-CoV-2, enter human cells through a receptor called ACE2 and hijack those cells' machinery to make copies of themselves. These copies then invade new cells. The thinking is that infant cells have only a few ACE2 receptors, whereas those of an elderly person might harbor thousands. With fewer available points of entry in a baby, it could be harder for the virus to break in. Alternatively—and perhaps counterintuitively—an infant's immune system might simply be too immature to attack SARS-CoV-2. Given that most of the damage in severe COVID-19 cases seems to be caused by strong immune responses, that immaturity may work in babies' favor. The latter possibility could even explain a subtlety within the data: although infants appear resilient to COVID-19, they might be at a marginally higher risk than older children. Early data from China suggested that 10.6 percent of infected children younger than one had severe or critical illness—a rate that decreased dramatically with age. "It's a dance that takes place between the virus and our own immune system," says Rana Chakraborty, a pediatric infectious disease specialist at the Mayo Clinic. If the body's defenses react too little, the virus will be able to take over. An overreaction can be equally deadly, however. So children older than about one year of age might be in a sweet spot between infants, whose immune system has not yet fully kicked in, and adults, whose defenses are sometimes overzealous. Scientific American External Link

    'Concerning increase' of coronavirus-related inflammatory brain condition, study finds

    9 July- The widespread effects of COVID-19 include neurological disorders, and one study recently found that a fatal, inflammatory brain condition is increasing in prevalence due to the pandemic. The condition, called acute disseminated encephalomyelitis (ADEM), is rare, mostly affects children and is triggered by viral infections. A team of researchers from University College London usually sees about one adult patient with ADEM per month, but that rose to at least one per week during the study period, which researchers said is a "concerning increase." The experts said the higher-than-expected number of patients with neurological disorders did not always correlate with the severity of respiratory symptoms. The study was published Wednesday in the journal Brain. Fox News External Link

    COVID-19 UPDATE: Study suggests virus immunity disappears after 3 months leading to reinfection every year, like common colds

    13 July- Coronavirus reinfection may occur every year across the globe, suggested by a study, saying that COVID-19 immunity can disappear after three months. The new research claimed that annual coronavirus infection could happen, just like common cold or flu, creating the idea that the viral disease could be eliminated with the help of herd immunity, explained by Daily Mail.  More than ninety COVID-19 patients and healthcare workers at Guys's and St. Thomas' NHS foundation trust, examined by scientists at King's College London, were involved in the study. The researchers found antibody levels appearing three weeks after symptoms, and then vanishing later. "People are producing a reasonable antibody response to the virus, but it's waning over a short period of time and depending on how high your peak is, that determines how long the antibodies are staying," said the study's lead author, Dr. Katie Doores via Daily Mail. It was explained that the patients who had the most severe symptoms were the ones who developed the highest antibody levels, which lasted the longest. However, the findings also revealed that an effective vaccine for the virus may need to be redeveloped every year since the protection it provides may not be very long-lasting. Although this is the case, the study explained that the novel coronavirus can fight off again using T-cells, even if the antibody levels drop. Tech Times External Link

    Hospitals in Covid-19 hotspots are running out of remdesivir

    12 July- Dr. Eliot Godofsky doesn't have a single dose of remdesivir for his Covid-19 patients in South Florida. Hundreds of miles away in North Carolina, Dr. Cameron Wolfe has doses he does not need right now. Wolfe would love to share some of his remdesivir with doctors like Godofsky, given that it's the only drug authorized by the US Food and Drug Administration to treat Covid-19. But as coronavirus makes its way around the United States, with surges in some areas and declining numbers in others, there's no mechanism for hospitals to shift the drug where it's needed most. The federal government is overseeing distribution of remdesivir, and Wolfe, Godofsky and other physicians say the system needs an overhaul.Godofsky says he feels "handcuffed" not being able to give his patients in Bradenton, Florida, remdesivir, a drug that can speed recovery, and possibly reduce patients' risk of dying. "It's been very frustrating," said Godofsky, an infectious disease specialist. "Patients suffer and you just feel terrible." "This is nuts," said Wolfe, an infectious disease expert at Duke University Medical Center. "It's been really disturbing to watch how this has played out." Friday, a spokesperson for the US Department of Health and Human Services told CNN that in the coming week, allocations of remdesivir to states "will emphasize locations with large recent increases." The spokesperson gave amounts to be shipped to four hotspot states -- Arizona, California, Florida and Texas -- that are far smaller than the number of hospitalized patients in those states. The spokesperson also said the company hired to distribute remdesivir will reach out to each hospital that received the drug to confirm that it still needs it. The department "is committed to equitable and efficient distribution of the drug with the goal of reaching as many patients as possible across all states and U.S. territories," according to the spokesperson. CNN External Link

    Kids' opioid poisonings fall with prescribing limits

    13 July- State-level policies to reduce opioid prescribing were associated with reductions in pediatric opioid poisonings, according to a time series analysis. In a study spanning 2005-2017, the number of prescription opioid poisonings in children did not change instantly when prescription drug monitoring programs (PDMPs) were implemented, but poisonings did significantly begin one month after they went into effect (-0.07 per million person-months, 95% CI -0.09 to -0.04), reported a group led by Michael S. Toce, MD, MS, of Boston Children's Hospital in Massachusetts. Immediate and substantial reductions, meanwhile, were seen in kids' prescription opioid poisonings after state-level pain clinic legislation -- such as laws limiting the number of opioids prescribed at sites or requiring substance training for prescribers -- was enacted (-6.22 per million person-months, 95% CI -8.98 to -3.47). But the impact of such laws did not continue to grow in later months, Toce and colleagues wrote in JAMA Pediatrics. Moreover, implementation of opioid prescribing guidelines did not appear to reduce pediatric poisonings, although skimpy data hampered that aspect of the group's analysis. "This isn't to say PDMPs are a panacea that is going to solve the opioid epidemic, but it does show that these policies largely drafted for adult patients can have effects on pediatric patients," Toce told MedPage Today. PDMPs and pain clinic legislation have been associated with reductions in adult overdose deaths. For example, Florida established a PDMP and outlawed opioid dispensing in physician offices. Subsequently, the number of oxycodone overdose deaths was cut in half by 2012, according to the CDC. MedPage Today External Link

    Report spotlights heavy pandemic toll on health workers

    14 July- An Amnesty International report released yesterday estimated that more than 3,000 healthcare workers (HCWs) in 79 countries have died from COVID-19, most of them in Russia, the United Kingdom (UK), and the United States, while others have been subject to discipline, violence, arrest, unfair or no pay, and discrimination. Governments and employers alike have retaliated against whistleblowers with arrests and firings of HCWs who have raised the alarm over their safety amid shortages of personal protective equipment (PPE), some of whom have faced violence and stigma from the public, the report said. HCWs often are highly exposed to the novel coronavirus at work, placing them at risk for infection, severe disease, and death. The report cites an International Council of Nurses' estimate that at least 230,000 HCWs have been sickened by COVID-19, and more than 600 nurses have died. The report said Russia has recorded the most HCW deaths—545—followed by the United Kingdom (540, including 260 social care workers), the United States (507), Brazil (351), Mexico (248), and Italy (188). More than a month ago, however, Kaiser Health News put the US total at almost 600. The report said, "The overall figure is likely to be a significant underestimate due to under-reporting, while accurate comparisons across countries are difficult due to differences in counting." CIDRAP External Link

    Rheumatoid arthritis drug tied to fewer deaths in COVID patients

    13 July- Two new studies have revealed that the rheumatoid arthritis drug tocilizumab is associated with lower death rates in COVID-19 patients receiving mechanical ventilation. Tocilizumab blocks interleukin-6 (IL-6), an inflammatory protein involved in a potential "cytokine storm" that can lead to respiratory failure in coronavirus patients. In the first single-center observational study, published late last week in Clinical Infectious Diseases, University of Michigan at Ann Arbor researchers found that tocilizumab was linked to a 45% reduction in risk of death (hazard ratio [HR], 0.55 (95% confidence interval [CI], 0.33 to 0.90) and improved status after adjusting for propensity score inverse probability weighting (IPTW). In the second study, researchers in Milan found that tocilizumab halved the death rate of coronavirus patients compared with standard care but lengthened hospital stays, according to a study last week in the Journal of Infection. CIDRAP External Link 

    Wearing masks to prevent COVID-19 spread: 'Cloth face coverings are one of the most powerful weapons we have to slow and stop the spread of the virus'

    15 July- Americans are increasingly adopting the use of cloth face masks to slow the spread of COVID-19, and the latest science may convince even more to do so. In an editorial published today in the Journal of the American Medical Association (JAMA), CDC reviewed the latest science and affirms that cloth face coverings are a critical tool in the fight against COVID-19 that could reduce the spread of the disease, particularly when used universally within communities. There is increasing evidence that cloth face coverings help prevent people who have COVID-19 from spreading the virus to others. "We are not defenseless against COVID-19," said CDC Director Dr. Robert R. Redfield. "Cloth face coverings are one of the most powerful weapons we have to slow and stop the spread of the virus – particularly when used universally within a community setting. All Americans have a responsibility to protect themselves, their families, and their communities." This review included two case studies out today, one from JAMA, showing that adherence to universal masking policies reduced SARS-CoV-2 transmission within a Boston hospital system, and one from CDC's Morbidity and Mortality Weekly Report (MMWR), showing that wearing a mask prevented the spread of infection from two hair stylists to their customers in Missouri. Outbreak News Today External Link

    Winter wave of coronavirus 'could be worse than first'

    14 July- The UK could see about 120,000 new coronavirus deaths in a second wave of infections this winter, scientists say. Asked to model a "reasonable" worst-case scenario, they suggest a range between 24,500 and 251,000 of virus-related deaths in hospitals alone, peaking in January and February. To date, there have been 44,830 official deaths in the UK, but this has slowed with 1,100 in July. The estimate does not take into account any lockdowns, treatments or vaccines. And the scientists say: "The risk... could be reduced if we take action immediately". The report, requested by the UK's chief scientific adviser, Sir Patrick Vallance, stresses there is still a high degree of uncertainty over how the coronavirus pandemic will play out this winter. But research suggests the virus can survive longer in colder conditions and is more likely to spread when people spend more time indoors. And experts are concerned the NHS will be under extreme pressure, not just from a resurgence of coronavirus but also from seasonal flu and a backlog of regular, non-coronavirus workload. BBC External Link

    INFLUENZA

    CDC: Flu View- Weekly U.S. Influenza Surveillance Report

    2019-2020 Influenza Season Week 27, ending July 4, 2020:

    Influenza-Associated Hospitalizations: The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts all age population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in the Emerging Infections Program (EIP) states and Influenza Hospitalization Surveillance Project (IHSP) states. As in previous seasons, patients admitted for laboratory-confirmed influenza-related hospitalization after April 30, 2020 will not be included in FluSurv-NET. Data on patients admitted through April 30, 2020 will continue to be updated as additional information is received.

    Pneumonia and Influenza (P&I) Mortality Surveillance: Based on National Center for Health Statistics (NCHS) mortality surveillance data available on July 9, 2020, 5.0% of the deaths occurring during the week ending July 4, 2020 (week 27) were due to P&I. This percentage is below the epidemic threshold of 5.8% for week 27. Weekly mortality surveillance data include a combination of machine coded and manually coded causes of death collected from death certificates. Percentages of deaths due to pneumonia and influenza (P&I) are higher among manually coded records than more rapidly available machine coded records. Due to the additional time needed for manual coding, the initially reported P&I percentages may increase as more data are received and processed and for week 27 this may push the percentage of P&I deaths above the epidemic threshold.

    Influenza-Associated Pediatric Mortality: No influenza-associated pediatric deaths occurring during the 2019-2020 season were reported to CDC during week 27. A total of 185 influenza-associated pediatric deaths occurring during the 2019-2020 season have been reported to CDC. CDC External Link

    WHO: Influenza Update

    06 July 2020 - Update number 371, based on data up to 21 June 2020:

    - The current influenza surveillance data should be interpreted with caution as the ongoing COVID-19 pandemic might have influenced to varying extents health seeking behaviors, staffing/routines (including case definitions and sampling strategies) in sentinel sites, testing priorities and capacities in Member States as well as reporting of surveillance data. The various hygiene and physical distancing measures implemented by Member States to reduce SARS-CoV-2 virus transmission might also have played a role in mitigating influenza virus transmission.

    - Globally, influenza activity was reported at lower levels than expected for this time of the year. In the temperate zone of the northern hemisphere, influenza activity returned to inter-seasonal levels while in the temperate zones of the southern hemisphere, the influenza season has not commenced.

    - In the Caribbean and Central American countries, no influenza detections were reported in most reporting countries. Severe acute respiratory infection (SARI) activity was reported at an extraordinary level in Honduras.

    - In tropical South American and tropical Africa, there were no or sporadic influenza virus detections across reporting countries.

    - In Southern Asia and South East Asia, no influenza detections were reported.

    - Worldwide, seasonal influenza A viruses accounted for the majority of detections. WHO External Link

    VETERINARY/FOOD SAFETY

    Fatal Listeria outbreak linked to trout in the Netherlands

    10 July- At least two people have died in a Listeria outbreak linked to chilled smoked trout fillets in the Netherlands. All six sick people have been hospitalized and two died from their infections. Another person has died but no information about the cause of death was given. Patients became ill between the beginning of February and mid-June. Their age range is 42 to 85 years old with a median of 78 years old. The outbreak was reported by the National Institute for Public Health and the Environment (RIVM) and the Wageningen Food Safety Research (WFSR) institute, who jointly monitor clustering of Listeria isolates from patients and foods, when only three people were affected.  As part of listeriosis reporting, several fish consumption questions are usually asked. This information is currently available for five the outbreak patients. They all ate fish while four of them stated smoked fish and one explicitly mentioned trout. In the third week of June, four products were recalled — smoked trout fillets from Vis Marine, Albert Heijn and two fish items from Bond Seafood. Shelf life dates ranged from June 20 to July 5. Food Safety News External Link

    Sundial Herbal Products recalled for unapproved drugs and misbranding

    10 July- Sundial Herbal Products are being recalled for unapproved drugs to be in compliance with FDA Drug Regulations. These recalled products are misbranded because they have labeling claims that could result in delay of appropriate treatment by a healthcare provider. Because these dietary supplements are unapproved, their safety and efficacy have not been established. No illnesses or adverse reactions have been reported by the company to date. The recall headline states that "recall is required by the order." All products used as Sundial Herbs can be identified with the "Sundial" label. They were sold in brown glass bottles, boxes, zip lock bags, and  paper bags wit clear viewing windows. They were distributed nationwide or statewide through the Sundial Herb website or any other website. They were also sold through store pick up at 3609 Boston Road in the Bronx, New York City.
    You can see the long list of recalled products at the FDA web site. They include Tenadam Herb, White Pond Lily, Mango Leaf, Red Water Grass, Dog Blood, Ethiopian Traditional Talba (Flaxseed Meal Cereal), Fever Grass, Mojo Bush, Bread Nut, Bliss Wiss, Flu-Allergies/Hay Fever, Asthma, Arthritis, Chaney Root, and Mahogany Bark, among others. No pictures of the recalled products are available. Food Poisoning Bulletin External Link

    WELLNESS

    Bright outdoor lights tied to less sleep, more anxiety in teenagers

    13 July- Artificial outdoor light at night may disrupt adolescents' sleep and raise the risk for psychiatric disorders, a new study suggests. Researchers tracked the intensity of outdoor light in representative urban and rural areas across the country using satellite data from the National Oceanic and Atmospheric Administration. They interviewed more than 10,123 adolescents living in these neighborhoods about their sleep patterns, and assessed mental disorders using well-validated structured scales. They also interviewed the parents of more than 6,000 of the teenagers about their children. The study, in JAMA Psychiatry, found that the more intense the lighting in your neighborhood, the more sleep was disrupted and the greater the risk for depression and anxiety. After adjustment for other factors such as sex, race, parental education and population density, they found that compared with the teenagers in the one-quarter of neighborhoods with the lowest levels of outdoor light, those in the highest went to bed, on average, 29 minutes later and reported 11 fewer minutes of sleep. Adolescents living in the most intensely lit neighborhoods had a 19 percent increased risk for bipolar illness, and a 7 percent increased risk for depression. The study is observational, and does not prove cause and effect. The senior author, Kathleen R. Merikangas, a senior investigator with the National Institute of Mental Health, said that future policy changes could make a difference. In the meantime, she said, "At least as individuals, we ought to try to minimize exposure to light at night." The New York Times External Link

    USAFRICOM

    South Africa: Coronavirus- Bans alcohol sales again to combat Covid-19

    13 July- South Africa has introduced new restrictions, including another ban on alcohol sales, to help contain the spread of coronavirus. A night-time curfew has been imposed, and the wearing of masks outdoors is now compulsory. President Cyril Ramaphosa said the alcohol ban - South Africa's second this year - would take pressure off the national healthcare system. It comes as total infections exceed a quarter of a million. Deaths resulting from coronavirus have also risen to more than 4,000, and government projections estimate this could rise to 50,000 by the end of the year. South Africa remains the hardest-hit country on the continent, and earlier this week recorded its highest-ever single-day increase in cases. Nearly half of them were in Gauteng, a province that's become the outbreak epicenter. In a public address, Mr. Ramaphosa acknowledged "most" people had taken action to help prevent the spread, but he said there were still some who acted "without any responsibility to respect and protect each other". BBC News External Link

    South Africa: Reports additional almost 9,000 COVID-19 cases, puts total over 200K

    7 July- The South Africa National Institute for Communicable Diseases (NICD) reported an additional 8975 COVID-19 cases in the past 24 hours, putting the country total over the 200,000 case mark. Of the 205,721 total cases as of July 6, two-thirds of the cases are reported from Gauteng and Western Cape provinces with 66,891 and 70,938 cases, respectively. In the past day, nearly 34,000 tests were performed giving it a positive rate of more than 26 percent. In addition, 111 more COVID-19 related deaths were reported: 17 from Limpopo, 9 from the Eastern Cape, 35 from the Western Cape and 50 from Gauteng.  This brings the total national deaths to 3,310. More than 2100 total deaths are reported from Western Cape province. The 205,000 COVID-19 cases in South Africa makes up more than half of the 489,000 total confirmed cases on the African continent. Outbreak News Today External Link

    USCENTCOM

    Middle East: MERS coronavirus update- 61 cases reported in first half of 2020

    4 July- Global health officials have reported 61 Middle East respiratory syndrome coronavirus (MERS-CoV) cases since the beginning of the year. The cases have been reported in Saudi Arabia (57), United Arab Emirates (2) and Qatar (1). Riyadh accounted for 25 of Saudi Arabia's cases. 20 deaths have been reported in Saudi Arabia. Since April 2012 and as of 2 July 2020, 2,577 cases of MERS-CoV, including 935 deaths, have been reported by health authorities worldwide. Typical MERS symptoms include fever, cough and shortness of breath. Pneumonia is common, but not always present. Gastrointestinal symptoms, including diarrhea, have also been reported. Some laboratory-confirmed cases of MERS-CoV infection are reported as asymptomatic, meaning that they do not have any clinical symptoms, yet they are positive for MERS-CoV infection following a laboratory test. Most of these asymptomatic cases have been detected following aggressive contact tracing of a laboratory-confirmed case. Outbreak News Today External Link 

    USEUCOM

    Iceland: Syphilis cases double

    13 July- The Iceland Directorate of Health reports a substantial increase in sexually transmitted infections, with syphilis cases more than doubling during the first six months of 2020. From January to June this year, Iceland has reported 43 syphilis cases while cases of gonorrhea are also up during the first half of the year. Most syphilis and gonorrhea cases have been reported in males. Chlamydia remains the most frequently diagnosed sexually transmitted disease in Iceland with 834 cases confirmed in the first half of the year, a number similar to previous years. Women make up about 56% of those infected. Outbreak News Today External Link

    Russia: Trichinosis sends 10 people to the hospital after eating undercooked bear

    12 July- Russian officials report Thursday that 10 people from Altai Republic, near the Mongolian border, were hospitalized with trichinosis after consuming undercooked bear cub. The regional office of Rospotrebnadzor said, "Not all bears, of course, are infected with Trichinella. But this sometimes happens, there were simply no such massive cases. We are in control of the situation." Earlier, Russians were advised to avoid contact with raw meat and animal blood in Altai, so as not to get infected with bubonic plague. As the infectious disease doctor Ivan Konovalov stated , outbreaks of the plague periodically occur in Russia, where the traditions of local peoples include eating raw animal meat. He emphasized that there is a vaccine against the plague pathogen. Outbreak News Today External Link

    USINDOPACOM

    Australia: Grapples with new surge in COVID-19 cases

    14 July- Australia is seeing a new surge in coronavirus cases. The chief health officer for Victoria state, where the city of Melbourne is located, announced 270 new cases on Tuesday, following an increase of 177 on Monday. Brett Sutton said 28 of the new cases had been linked to a known outbreak, but that the rest were still being investigated. Last week, Melbourne reimposed strict public health emergency measures, establishing a "hard boundary" around the city and the closing of its borders with New South Wales in an effort to stop the spread of the disease. "We have over 1,800 active cases in Victoria," Sutton said. "That's a really significant number of people with coronavirus, and it does mean that in the next fortnight we're going to see a number of people who will require hospital." He said the state's surge in cases will result in at least 200 people requiring hospital care within the next two weeks. "There's often 10% to 20% of all coronavirus infections who require hospitalization, so that's a couple of hundred individuals at least," Sutton said, according to The Age newspaper. NPR External Link

    Singapore: Dengue cases top 17,000, more than 2019 total, enforcement and penalties

    14 July- For the fifth week in a row, Singapore surpassed 1,000 dengue fever cases, in fact, last week saw 1678 cases, by far a new weekly record. Through July 13, officials have reported 17,249 total dengue cases, more than the total cases in all of 2019 (15,998). Experts have been predicting for weeks that the total number of cases this year will exceed the 22,170 cases reported in 2013. So far, 16 dengue related fatalities have been recorded. The National Environment Agency (NEA) says urgent collective action must be taken by the public to remove any stagnant water in their homes and immediate surroundings. This is to destroy any mosquito breeding habitats and break the cycle of dengue transmission. Starting Wednesday, NEA says enhanced penalties will be imposed for households, construction sites and Town Councils found to be breeding mosquitoes to help better safeguard public health and protect every individual in the community. Outbreak News Today External Link

    Vietnam: Diphtheria outbreak- 68 cases in the Central Highlands region, vaccination campaign launched

    12 July- In a follow-up on the diphtheria outbreak in Central Highlands province, the Vietnamese Ministry of Health coordinated with the People's Committee of Gia Lai Province to organize a vaccination campaign against diphtheria epidemic in 4 provinces in the Central Highlands region, including: Dak Lak, Gia Lai, Kon Tum and Dak Nong. The campaign to vaccinate against diphtheria all people who are 2 months of age or older. Accordingly, children from 2 months of age to 18 months of age are given 1 5-in-1 vaccine; children from 19 months to 48 months of age: 01 DPT vaccine and people aged 48 months or older: 2 Td vaccinations (the second dose is 01 month apart from the first vaccine). Prof. Dr. Nguyen Thanh Long, Acting Minister of Health said, "To urgently control diphtheria epidemic in the Central Highlands region; The Ministry of Health has implemented drastically measures to respond to epidemics such as: sending mobile anti-epidemic teams to support localities, strengthening surveillance and detection of cases, contact cases and organizations. isolation, treatment of cases and preventive treatment for people in risk areas. "One of the most effective and most effective diphtheria prevention measures is the diphtheria vaccine for comprehensive and sustainable prevention of diphtheria. On that basis, the Ministry of Health has issued a plan to vaccinate against diphtheria in four provinces of Dak Lak, Gia Lai, Kon Tum and Dak Nong. This is a large-scale anti-diphtheria plan in Vietnam." Outbreak News Today External Link

    USNORTHCOM

    Mexico: COVID-19 in Mexico: 'The most dangerous country for doctors'

    12 July- Mexico just recently surpassed the United Kingdom as #7 on the list of countries with the most COVID-19 cases (295,268 and 34,730 deaths as of this writing). However, a statistic that is arguably more alarming in Mexico is the mortality of doctors and other health workers in the country is the highest in the world. A Vital Signs Mexico publication, The Pandemic in Mexico-Dimension of Tragedy states–2.6 percent of the deaths recorded in Mexico by Covid-19 are in medical personnel. There is no other country in the world that has such a high death rate of this type. In the United States the proportion is 0.54 percent; in China 0.50 percent and in the UK 0.40 percent. As of June 16, 32,388 infected health workers were reported. The figure is equivalent to 21.3 percent of the total number of cases that existed in Mexico at the time. This equates to two of every 10 positive cases correspond to medical personnel. The causes of the troubling issue in Mexico has been linked to lack of Personal Protective Equipment (PPE) in facilities and a shortage of doctors (the Saludiario report states "a deficit of at least 200,000 doctors that existed since before the pandemic has led to extensive and exhausting working days for those responsible for providing care"). Outbreak News Today External Link 

    U.S.: Colorado- Plague infected squirrel detected in central Colorado

    12 July- Health officials in Jefferson County, CO have reported a plague positive squirrel in the town of Morrison, less than 20 miles from Denver.  This is the first case of plague (organism is Yersinia pestis) in the county this year. Health officials note that humans may be infected with plague through bites from infected fleas, by the cough from an infected animal or by direct contact (e.g., through a bite) with blood or tissues of infected animals. Cats are highly susceptible to plague and may die if not treated promptly with antibiotics. Cats can contract plague from flea bites, a rodent scratch/bite or ingestion of a rodent. Dogs are not as susceptible to plague; however, they may pick up and carry plague-infected rodent fleas. Pet owners who suspect their pets are ill should consult a veterinarian. All pet owners who live close to wild animal populations, such as prairie dog colonies or other known wildlife habitats, should consult their veterinarian about flea control for their pets to help prevent the transfer of fleas to humans. Symptoms of plague may include sudden onset of high fever, chills, headache, nausea and extreme pain and swelling of lymph nodes, occurring within two to seven days after exposure. Plague can be effectively treated with antibiotics when diagnosed early. Anyone experiencing these symptoms should consult a physician. Outbreak News Today External Link

    U.S.: Florida- Coronavirus- Sets new state daily case record of 15,299

    12 July- Florida has registered a state record of 15,299 new coronavirus cases in 24 hours - around a quarter of all of the United States' daily infections.
    The state, with just 7% of the US population, surpassed the previous daily record held by California. Florida, which began lifting coronavirus restrictions in May, has proved vulnerable due to tourism and an elderly population. Its figures eclipse the worst daily rates seen in New York in April. Florida also registered an additional 45 deaths. The state would rank fourth in the world for new cases if it were a country, according to a Reuters analysis. More than 40 hospitals in Florida say their intensive care facilities are at full capacity. The latest figures were released a day after Walt Disney World in Orlando, Florida reopened, but with safety measures including mask-wearing and widespread use of sanitiser. The caseload in Florida has continued to rise despite Republican Governor Ron DeSantis ordering some bars to close again last month. The top adviser on the White House coronavirus taskforce, Dr. Anthony Fauci, had criticized lockdown easing in the state, saying the data on infections did not support the move. Mr. DeSantis has also declined to make mask-wearing obligatory. BBC External Link

    U.S.: Florida- Dengue- 3 additional locally transmitted cases reported in Monroe County

    12 July- In a follow-up on the dengue fever situation in south Florida, the Florida Department of Health in Monroe County are reporting three additional locally transmitted dengue fever infections. This brings the number of  autochthonous dengue cases to 14 in Monroe County (Florida Keys) and 15 total in the state in 2020. Dengue can present as a severe flu-like illness with severe muscle aches and pain, fever and sometimes a rash. Usually, there are no respiratory symptoms. Symptoms of Dengue will appear within 14 days after being bitten by an infected mosquito. Dengue fever is not contagious but is transmitted by the bite of an infected Aedes aegypti mosquito. The emergence of these Dengue cases reinforces the importance for the public to prevent insect bites and to take basic precautions to help limit exposure. These measures include intact windows and screens and the use of air conditioning, keeping the area around your residence free from containers that collect water, wearing protective clothing and the appropriate use of insect repellents. Outbreak News Today External Link

    USSOUTHCOM

    Brazil: H1N2v influenza case reported in Paraná State

    10 July- According to a World Health Organization (WHO) report Thursday, a human infection with Influenza A(H1N2) variant virus (A(H1N2)v) has been reported in an individual in Brazil. The patient is a 22-year-old female, with no comorbidities, worked in a swine slaughterhouse in Ibiporã Municipality, Paraná State, and developed an influenza-like illness on 12 April 2020. The patient initially sought medical care on 14 April and a respiratory specimen was obtained on 16 April as part of routine surveillance activities. The patient was treated with oseltamivir, was not hospitalized and has recovered. The virus was confirmed using a real-time RT-PCR test. Further genetic and phenotypic characterization of the virus from the patient is ongoing. On 26 June 2020, local authorities started a retrospective and prospective investigation in the slaughterhouse in Ibiporã Municipality and other municipalities where the slaughterhouse workers live. According to the preliminary epidemiological investigation, a second individual who also worked at the slaughterhouse developed respiratory symptoms during the same timeframe as the confirmed case, but no sample was collected from this person. No other suspected cases amongst contacts of the confirmed case have been identified. Outbreak News Today External Link