Army Public Health Weekly Update, 18 September 2020

Date Published: 9/18/2020
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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

    What to do if your pet tests positive for the virus that causes COVID-19

    10 September- ...Depending on how sick your pet is, your veterinarian may recommend that your pet be isolated at home, instead of staying in the hospital.  Some pets did not show any signs of illness, but those pets that did get sick all had mild disease that could be taken care of at home. If your veterinarian recommends home isolation and you are able to care for your pet at home, follow this advice to protect yourself and others. 

    - Keep your pet at home, except to get medical care

    - Talk with your veterinarian regularly. Call before you take your pet to the veterinary clinic. Be sure to alert your veterinarian if your pet has trouble breathing, or if you think it is an emergency.

    - While most pets appear to show only mild symptoms or no symptoms, we are still learning about how they are affected by the virus. Even if your pet appears to be feeling better, avoid the following activities until your veterinarian determines that it is safe for your pet to do so or your pet has met the guidance to end their isolation:

    - Visits to veterinary hospitals, without calling the veterinarian first

    - Visits to human healthcare facilities or schools

    - Visits to parks (including dog parks), markets, or other gatherings such as festivals

    - Visits to the groomer, including mobile grooming salons

    - Visits to pet daycares or boarding facilities

    - Other outings such as playdates, hikes, or visiting other homes, with or without pets

    - Using dog walkers or pet-sitters that live outside your home CDC External Link

    U.S. MILITARY

    Army issues new memo about protecting bases from climate change

    15 September- The U.S. Army is so worried about climate change, which it has identified as a national security threat, that it issued a new directive Sept. 11 requiring planners and managers to establish resilience measures against natural disasters, according to a service news release. Recent natural disasters, from California wildfires to hurricanes in the Southeast, have posed threats to Army operations and installations, resulting in the service's move to safeguard valuable assets and minimize the impact on readiness. Under the new directive, Army installations will be provided with instructions to strengthen resilience against natural disasters, which include but are not limited to flooding, drought, desertification, rising sea levels, extreme heat and thawing permafrost, said Stephen Dornbos, science and technology policy fellow in the Office of the Assistant Secretary of the Army for Installations, Energy and Environment, or ASA (IE&E).  "Climate change has already had a big impact on Army installation infrastructure and threatens to degrade mission readiness. I think it's going to continue to have an increasingly large impact going forward," Dornbos, who served as professor of geosciences at the University of Wisconsin-Milwaukee for 15 years, said in a statement. "There are a lot of concerns about wildfires in California and energy supply being threatened," he added. "There are adaptation strategies that installations could use to better prepare themselves." Congress already requires military posts to consider climate threats in infrastructure planning and design, according to the release. The new Army directive directs installation commanders to develop emergency plans for extreme weather events and to add climate change projection analysis tool results to infrastructure plans, policies and procedures. Military.com External Link

    Army Marshals resources to aid in race for coronavirus vaccine

    14 September- Agi Hajduczki, a research scientist at the Walter Reed Army Institute of Infectious Diseases, opens a large freezer and takes out boxes of DNA. She is part of a team making a COVID-19 vaccine. Hajduczki places a small, clear plastic tray under a piece of white paper on the table of her lab. The tray is dimpled. Pale yellow fluid can be seen under the dozens of dimples. Some of the dimples are clearly more yellow than others. "More yellow means more protein," she explains. "So we're basically trying to get mammalian cells to generate this protein for us, which would then eventually be used as the vaccine in a clinical trial so it kind of looks like the spike, the way it does in the real virus." The idea is that the immune system would get to know this protein — through the vaccine — and when the real virus hits, the immune system would know how to fight it. Hajduczki became fascinated with viruses as a young girl in Hungary, watching her pathologist mother work on AIDS victims back in the early 1980s. "So even, you know, when the world didn't necessarily know about that this virus is happening like that was our dinner table conversation," she says. Now she has a young daughter, and has brought her to the lab during this pandemic, because like many parents around the country, Hajduczki and her husband are scrambling between work and childcare duties. Her voice breaks when she talks about the effect the virus is having on her work and family life. NPR External Link

    VA's active coronavirus cases decline, but deaths continue to mount

    15 September- Active coronavirus cases in the Veterans Affairs health care system are at their lowest levels in nearly three months, but the department remains on pace to add another 600 deaths from the illness by the end of the month. As of Monday evening, VA officials reported 2,945 active cases of coronavirus at 135 medical centers across the country. The figure marked a full week of fewer than 3,000 current cases at VA facilities for the first time since last June, and a decrease of more than 26 percent fewer cases than one month ago. VA officials have said they see the fluctuating case counts as an unreliable measure of the department's response to the ongoing pandemic. Instead, they point to monthly hospitalization rates as a more relevant figure. So far in September, about 17 percent of positive coronavirus diagnoses have resulted in hospitalizations, up slightly from the 16 percent in August but roughly in line with the average since early summer. At the start of the pandemic in March and April, those rates were 38 percent and 24 percent. However, even as active cases have dropped in the VA system in recent weeks, the number of deaths related to the virus continues to rise. About 300 patient deaths from complications related to coronavirus have been announced since the start of September. VA officials reported 820 deaths in August, the deadliest month of the pandemic so far. Military Times External Link

    VA joins Army in major DOD suicide prevention research

    15 September- An ongoing Defense Department-directed epidemiological study recently got a helping hand that could help generate actionable recommendations to reduce military suicides. A new memorandum of agreement on the Study to Assess Risk & Resilience in Service members, or STARRS, was inked July 27 to help produce actionable information for senior military leaders, said Col. Sheila Seitz, the STARRS deputy director and Army Reserve advisor. "This is something the Army cares about," she said. The VA is the newest member of the group that includes the Army, Office of the Assistant Secretary of Defense for Health Affairs, and the National Institute of Mental Health, or NIMH. The Army serves as the operational and management support arm of STARRS, the largest mental health study ever conducted on military personnel. "We're excited to partner with the Department of Defense and the National Institute on Mental Health on this major research effort aimed at preventing suicides," said Richard A. Stone, M.D., Veterans Health Administration executive in charge. "Many Veterans experience a difficult transition from the military. This research will promote data-sharing between DOD and VA and thereby provide us with critical information to help these Veterans." "It also promises to inform our outreach to Veterans who have not yet used VA health care," he said. STARRS is meant to "increase the resiliency of our Soldiers, so that they are mission ready as much as possible. But it's also important to help our Soldiers for Life," she said. "That is why partnering with the VA is so important, because of our commitment to all Soldiers -- not just ones currently serving." As part of that commitment, the Army and NIMH established STARRS in 2009. Since then, a coalition of researchers from the Uniformed Services University of the Health Sciences, or USU; Harvard University; University of Michigan; and the University of California-San Diego have compiled data to form relevant and actionable research to help address current and future needs of the military and published more than 100 articles in scientific journals and publications, said Kenneth Cox, the Army's science liaison for the STARRS research team. Connecting Vets External Link

    GLOBAL

    Coronavirus: Monoclonal antibodies to begin UK trial

    14 September- A new antibody treatment is to be trialed on Covid-19 patients in UK hospitals. Monoclonal antibodies, which are potent, laboratory-made antibodies, will be given to about 2,000 people to see if they are effective against coronavirus. It forms part of the UK Recovery Trial, which found that a cheap steroid called dexamethasone could save lives. The first patients will be given the new drugs in the coming weeks. Prof Martin Landray from the University of Oxford, who is co-leading the Recovery Trial, said: "This is the first type of treatment that's targeted for this specific virus. "There are lots of good reasons for thinking it might well be effective - stopping the virus from reproducing, stopping the virus from causing damage, improving survival for patients. "We need to know, and the way to know is to do the trials that will tell us whether that hope turns into reality." Antibodies could be described as the "warriors" of the immune system. When coronavirus infects your body, antibodies attach to the spikes of the virus, blocking it from entering your cells. But we produce many different types of antibodies - the most potent are called neutralizing antibodies. So scientists "sieve" through them to find the one that's best at sticking to the spike. The chosen antibody is multiplied in the lab, and produced in huge quantities. This is then given to patients, immediately boosting their immune response. BBC News External Link

    Coronavirus: WHO reports record daily rise in new infections

    14 September- The World Health Organization (WHO) has recorded a record one-day rise in the number of new coronavirus infections, with 307,930 reported over 24 hours. The agency said that deaths rose by more than 5,500, bringing the global total to 917,417. The biggest increases in infections were reported in India, the US and Brazil. Worldwide there have been more than 28 million confirmed cases, half of which have been in the Americas. The previous one-day record for new cases was on 6 September when the WHO reported 306,857 new infections. According to the WHO, India reported 94,372 new cases on Sunday, followed by the US with 45,523 and Brazil with 43,718. More than 1,000 new deaths were recorded in the US and India while Brazil said 874 people had died from Covid-19 related illness in the past 24 hours. India has the second largest number of confirmed cases in the world, behind the US. Last week it reported nearly two million Covid-19 cases in August, the highest monthly tally in the world since the pandemic began. BBC News External Link

    Experts discover smallest antibody named Ab8--It could block COVID-19 and is more effective

    15 September- Scientists discovered a new antibody that could possibly neutralize COVID-19 by preventing it from entering the human cells. Researchers from the University of Pittsburgh School of Medicine claimed that their discovery is a breakthrough when it comes to coronavirus' treatment and prevention. They said that it is the world's smallest biological molecule that neutralizes explicitly the SARS-CoV-2, which causes the novel coronavirus. The researchers used the tiny antibody, ten times smaller than a normal antibody, to develop a drug called "Ab8"--to be used against SARS-CoV-2 as a prophylactic and therapeutical medicine. Scientists administered the drug to hamsters and mice and found out that it is highly effective in preventing COVID-19 infections. Its tiny size allows it to pass through alternative routes inside the human body, including inhalation, making it more effective. What's more is that it does not bind to human cells, meaning the drug won't negatively affect people. The University of North Carolina at Chapel Hill (UNC), University of Columbia, University of Saskatchewan, and University of Texas Medical Branch (UTMB) already evaluated Ab8's effectiveness.  "Ab8 not only has potential as a therapy for COVID-19, but it also could be used to keep people from getting SARS-CoV-2 infections," said M.D. John Mellors, study's co-author and chief of the Division of Infectious Disease at UPMC and Pitt.  He added that larger antibodies have been effective against other infectious diseases, giving the world a hope that they could also cure and prevent COVID-19 infections. Tech Times External Link 

    I got a trial Covid-19 vaccine- Do I still have to wear a mask?

    15 September- My wife and I are participating in a clinical trial for a Covid-19 vaccine. We had no antibodies before we received the vaccine, but we now have a lot of them, according to two independent tests. Presumably we are like millions of others who have recovered from Covid-19 and have these antibodies, and so are immune for some time. At what point can I feel comfortable, ethically, not wearing a mask, being with others who haven't had Covid, eating at a restaurant, going to a bar, traveling to locations with restrictions on "hot spot" visitors and the like? I don't want to be an "immune elite," but I do want to begin a normal life again. Perhaps I have "earned" this by taking a risk and getting the vaccine? And perhaps others have "earned" this for having caught and recovered from the coronavirus? First, thanks for volunteering for the clinical trial. We all owe a great deal to the many people around the world who are participating. But let's not get out over our serological skis. If an antibody assay proved that you were immune to the coronavirus, there wouldn't be any need to subject vaccine candidates to Phase III trials, which assess not just safety but also efficacy. Currently no vaccines for SARS-CoV-2 have completed these trials, which would establish that they significantly reduce a recipient's chances of infection. The F.D.A. has said that approval will require a vaccine to show that it prevents infection or reduces its severity in at least 50 percent of those who receive it. Antibody results themselves wouldn't suffice, according to F.D.A. guidance, because it isn't yet known which antibodies at what levels are protective. Let's review a few more factual considerations. Specific antibodies target specific segments ("epitopes") of a protein. The major American vaccine candidates, which focus on the coronavirus's spike protein, might not give you as rich a complement of antibodies as those produced by someone who had actually been infected with the virus; the virus is more than its spikes. And acquired immunity doesn't just arise from the antibodies in our serum; it involves white blood cells, such as killer T cells, that have been, in effect, trained to deal with the threat. As my medical colleagues remind me, recovered Covid-19 patients might be expected to have levels of cellular immunity that some vaccines may not trigger. (A few vaccines, notably one for HPV, may produce a better immune response than natural infection does, but usually it's the other way around.) Going by available data, one well-funded vaccine candidate seems to produce only a weak cellular response. It might still work wonderfully well, but results in the test tube are no substitute for results in the field. And what's expected of a good vaccine is that it would reduce your odds of infection (albeit in ways that, once vaccination is widespread, could lead to herd immunity), not that it would eliminate them. The New York Times External Link 

    Lilly's Covid-19 antibody helps some patients rid their systems of virus sooner in early analysis

    16 September- A drug being developed by Eli Lilly helped sick patients rid their systems of the virus that causes Covid-19 sooner and may have prevented them from landing in the hospital, according to newly released data. The drug is what is known as a monoclonal antibody, which experts view as being among the most likely technologies to help treat Covid-19. It's a manufactured version of the antibodies that the body uses as part of its response to a virus.  "This is a good start," said Eric Topol, the director and founder of the Scripps Research Translational Institute. "A lot is pinned not only on Lilly but on the whole family of these [monoclonal antibodies], because even though they're expensive and they're not going to make a gajillion doses, they could make a big difference in the whole landscape of the pandemic." Lilly, which is developing the drug with the biotechnology firm Abcellera, tested three doses of its antibody against placebo in a trial enrolling about 450 patients recently diagnosed with mild to moderate Covid-19. The middle dose, 2,800 mg, met the trial's primary goal of significantly reducing patients' levels of SARS-CoV-2 after 11 days. But other doses of the drug did not meet that goal, including a higher dose of 7,000 mg and a lower one of 700 mg. That could raise the risk that the benefit was due to chance, because normally one expects a medicine to become more effective as the dose increases, known as a dose response. STAT News External Link

    More evidence points to bars adding to COVID-19 spread

    15 September- A report from the Centers of Disease Control and Prevention (CDC) last week showed that people with COVID-19 were twice as likely to have visited an indoor dining establishment in the weeks prior to symptom onset, and now a new analysis of cell phone data from the Washington Post shows that states that reopened bars saw a doubling of COVID-19 cases 3 weeks later. The data show that foot traffic to bars was followed by a rise in cases, and in Colorado and Louisiana—some of the few states that make contact tracing data public—20% of all cases can be traced to bars and restaurants. Indoor dining, especially when capacity is capped at 25%, appears to be less of a problem than bars. But in bars, physical distancing is harder to control, and people talk more and louder when alcohol is consumed, which could contribute to the production of more virus aerosols. States have been uneven in their regulations concerning bars and restaurants. In Pennsylvania, a federal judge has ruled that Governor Tom Wolf's mandated closing of indoor businesses was unconstitutional, as were limitations on gatherings. The judge said the closings violated the First Amendment. As has been the trend in the last few weeks, the United States reported 33,826 new COVID-19 cases yesterday, and 418 deaths, according to the Johns Hopkins COVID-19 tracker. The country has seemed to plateau at around 30,000 new cases per day. In total, US officials have reported 6,590,827 cases and 195,386 deaths. CIDRAP External Link

    To limit COVID-19, Navajo leader says: 'Listen to your public health professionals'

    15 September- Earlier this year, the Navajo Nation Reservation was a major hot spot for coronavirus cases. Now, it's seen a day without a single positive case. It's a turning point in its battle against the virus. Navajo Nation President Jonathan Nez attributes that to Navajo leaders and citizens heeding the advice of public health officials. "All we did as leaders and public health professionals is we accepted [the] recommendations from the CDC, NIH," Nez says. "We took one step more, putting those recommendations into public health emergency orders, making them law." A few new cases have popped up on the Navajo Nation since last week, when it reported a 24-hour period without any. In May, its per capita infection rate was one of the highest in the country. Nez tells All Things Considered that the Navajo Nation has given 99,000 residents COVID-19 tests — that's more than 50% of its total population. There have been about 10,000 positive cases. NPR External Link

    Uncontrolled blood pressure on rise in US: Study

    12 September- A recent study representative of the U.S. population found that uncontrolled blood pressure rose by 10% in 2017-18 compared to several years prior. Researchers from the University of Alabama published their findings on Wednesday in the JAMA Network. Hypertension, or high blood pressure, is a common, but dangerous condition, according to the Centers for Disease Control and Prevention (CDC). It increases the risk of heart disease and stroke, and the CDC says those with hypertension "might be at an increased risk for severe illness from COVID-19," though the study authors said it's uncertain. The researchers used data from the U.S. National Health and Nutrition Examination Survey to assess any changes in blood pressure control among U.S. adults with hypertension from 1999 through 2018. A hypertensive state was defined as systolic blood pressure (top number) over 140 mm Hg and diastolic figure (bottom number) higher than 90mm Hg. According to Healthline, systolic pressure "refers to the amount of pressure in your arteries during the contraction of your heart muscle," whereas diastolic pressure, the bottom number, "refers to your blood pressure when your heart muscle is between beats." Of more than 18,000 adults with hypertension, the proportion with blood pressure control increased from nearly 32% in 1999-2000 to almost 49% by 2007-08. Researchers said blood pressure control then stabilized through to 2013-14 at nearly 54% before dropping to less than 44% by 2017-18. When researchers applied more stringent blood pressure guidelines released in 2017 from the American College of Cardiology and American Heart Association (listing hypertension as a reading of 130/80mmHg or higher), they found that just 19% of U.S. adults had their blood pressure under control. Federal recommendations suggest annual blood pressure screenings for adults over 40, and for younger adults at-risk. Fox News External Link

    Wildfire smoke wreaks havoc on respiratory and immune systems

    11 September- Across much of the Western United States, residents continue to endure the current wildfire season, which has firefighters battling nearly 100 large active wildfires that have already burned nearly 5 million acres. And where there's fire, there's smoke that blanketed several western cities this week. This smoke has resulted in reduced air quality and contributed to a host of associated health risks that mirror COVID-19 symptoms. For Pacific Northwest residents, the smoke from these fires and the ongoing COVID-19 pandemic have led to an increased the number of respiratory and cardiovascular ailments. At Naval Hospital Bremerton, staff continue efforts to help stop the spread of COVID-19. Staff and beneficiaries there remain aware that prevailing winds have pushed wildfire smoke over more densely populated areas, which can cause coughing, wheezing, and difficulty breathing, and aggravate existing conditions. "Staff and patients should do their best to avoid prolonged exposure to the smoke due to the fact that it can irritate the eyes, nose, throat and lungs," said Navy Hospital Corpsman 1st Class Omar Garcia-Argueta, Internal Medicine & Specialty Clinics. State and country health advisory alerts on diminished air quality have been posted and shared to alert local populations, with NHB also taking a lead to assess those in need. "The smoke can exacerbate any existing underlying condition," said Navy Cmdr. Robert Uniszkiewicz, NHB/NMRTC Bremerton COVID-19 lead and public health emergency officer, acknowledging that both COVID-19 and wildfire smoke can damage a person's respiratory and immune systems. The Washington State Emergency Management Division indicate those sensitive to wildfire smoke exposure include people with heart and lung disease, existing respiratory infections, diabetes, stroke survivors, infants, children, pregnant women, and people over 65 years of age. "Patients and staff who will be impacted the most are those who have been diagnosed with cardio-respiratory diseases such as asthma, COPD (chronic obstructive pulmonary disease), pulmonary fibrosis, or heart disease," explained Garcia-Argueta. "Asthma and COPD patients in particular should ensure that they are taking their maintenance medications as prescribed by their providers. Smoke may also impact pregnant women, the elderly population, and children. These patients and staff members should consult with their health care providers regarding specific precautions." Health.mil External Link 

    INFLUENZA

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

    2019-2020 Influenza Season Week 36, ending September 5, 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.

    Pneumonia and Influenza (P&I) Mortality Surveillance: Based on National Center for Health Statistics (NCHS) mortality surveillance data available on September 10, 2020, 5.4% of the deaths occurring during the week ending September 5, 2020 (week 36) were due to P&I. This percentage is below the epidemic threshold of 5.5% for week 36.

    Influenza-Associated Pediatric Mortality: No influenza-associated pediatric deaths occurring during the 2019-2020 season were reported to CDC during week 36. CDC External Link

    Flu vaccine essential during COVID-19 pandemic

    14 September- Influenza (flu) season is upon us. In the United States, flu season lasts through the fall and winter. While influenza viruses circulate year-round, most flu activity peaks between December and February, but can last as late as May. Not only are we entering flu season, we are in the thick of the COVID-19 pandemic, further stressing the importance of the flu vaccine. The vaccine could help reduce the overall impact of contagious respiratory illnesses on the population and decrease the burden on the health care system during the overlapping flu season and COVID-19 pandemic. While the COVID-19 and influenza viruses are different, symptoms of the two can look the same, making it difficult to differentiate between them based on symptoms alone. Capt. Lisa Pearse, Navy Region Hawaii Public Health Emergency Officer from Navy Medicine Readiness and Training Command Pearl Harbor said, "Both can cause high fevers, body aches and headaches. COVID is more likely to cause a cough and shortness of breath, but those symptoms could also occur with influenza. Lab testing may be required to tell them apart. One specific difference is that only COVID causes a loss of smell or taste." While there is no vaccine for COVID-19 yet, the flu shot can help reduce the risk of illness, hospitalization and death from an influenza infection., "The very best thing you can do to prevent influenza is to get your flu shot!" emphasized Pearse. You may have options when it comes to where and when you can get your flu shot. DVIDS External Link 

    WHO: Influenza Update

    14 September 2020 - Update number 376, based on data up to 01 September 2020:

    - The current influenza surveillance data should be interpreted with caution as the ongoing COVID-19 pandemic have 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, influenza activity was reported at lower levels than expected for this time of the year. In the temperate zones of the southern hemisphere, the influenza season has not started. Despite continued or even increased testing for influenza in some countries in the southern hemisphere, very few influenza detections were reported.

    - In the temperate zone of the northern hemisphere, influenza activity remained below inter-seasonal levels.

    - In the Caribbean and Central American countries, no influenza detections were reported. Severe acute respiratory infection (SARI) activity, likely due to COVID-19, appeared to decrease in some reporting countries.

    - In tropical South America, tropical Africa and Southern Asia there were sporadic or no influenza detections across reporting countries.

    - In South East Asia, influenza A(H3N2) virus detections were reported in Cambodia.

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

    VETERINARY/FOOD SAFETY

    Canada posts new patient count in onion outbreak; nothing new reported by U.S. for two weeks

    14 September- As of this afternoon there have been 506 confirmed cases of Salmonella Newport illness in Canada linked to a Salmonella outbreak associated with onions. Officials in the U.S. have not posted an outbreak update since Sept. 1. The total in Canada has increased by 49 people since the most recent update from the Public Health Agency of Canada on Aug. 31. The 506 confirmed patients are spread across several Canadian provinces — British Columbia has 116; Alberta 292; Saskatchewan 34; Manitoba 25; Ontario 14; Quebec 24; and Prince Edward Island 1. On the U.S. side of the border, according to a Sept. 1 update, there are at least 1,012 sick people across 47 states with Salmonella infections linked to onions. Thomson International, Inc., of Bakersfield, CA, shipped the implicated onions and has initiated recalls in both countries. Other companies that use Thomson as a supplier have also recalled onions and related products. Investigations by the Canadian Food Inspection Agency and the U.S. Food and Drug Administration initially showed a link between the illnesses and red onions, but because of the way onions are grown, harvested, and packed other onion types, such as white, yellow, or sweet yellow, are also likely to be contaminated. Public health officials in the United States report that 34 illness clusters have been identified in 13 states of the implicated states. Information was collected on 23 of the 34 clusters at restaurants and grocery stores. Information from these clusters shows that many ill people ate red onions and other types of onions. Investigations conducted by U.S. state and federal officials determined that all 23 restaurants and grocery stores specifically identified as having served or sold red, yellow, or white onions. Seventeen of the 23  (74 percent) served red onions, 13 (57 percent) served yellow onions, and 10 (43 percent) served white onions. Of those patients interviewed so far in the United States, 90 percent report they specifically remember eating onions or foods containing onions during the days before they developed symptoms of Salmonella infection. Thomson International, Inc., of Bakersfield, California, as a likely source of red onions. Due to the way onions are grown and harvested, other onion types, such as white, yellow, or sweet yellow, are also likely to be contaminated. Food Safety News External Link

    Mushroom poisoning behind most outbreaks in China

    15 September- Poisonous mushrooms were the most common cause of outbreaks in China during a 14-year period, according to a study. Researchers looked at data reported to the National Foodborne Disease Outbreak Surveillance System from 2003 to 2017 and published findings in the journal Food Control. A total of 19,517 outbreaks, which resulted in 235,754 illnesses, 107,470 hospitalizations, and 1,457 deaths, were recorded during the period.  Of the 13,307 outbreaks with known etiology, almost a third were caused by poisonous mushrooms, followed by Vibrio parahaemolyticus at 11 percent while the percentage linked to saponin, Salmonella, nitrite, pesticides, Staphylococcus aureus and Bacillus cereus were all in single figures. Of 13,305 outbreaks associated with a single food category, fungi – mainly poisonous mushrooms – were most commonly implicated, followed by meats, vegetables, aquatic animals, condiments, poisonous plants such as saponin, tung oil or seed and aconite, as well as grains such as rice and noodles. Among almost 19,000 outbreaks with reported settings, nearly half were associated with food prepared in a household, followed by less than a quarter with food made in a restaurant, and less than a fifth prepared in a canteen. "Analysis of foodborne disease outbreaks can provide insight into the most important causative agents and sources of foodborne disease, and assist public health agencies determine the high-risk etiology and food pairs, specific points of contamination and settings to reduce foodborne disease illnesses," said researchers. Food Safety News External Link 

    WELLNESS

    Craving sugar during a pandemic? Here's how to tame your sweet tooth

    14 September- During a global pandemic or even more moderately stressful life circumstances, we often turn to comforting sugary and carb-rich indulgences that may help to calm us down. Now for the bad news. New recommendations that will inform soon-to-be-released US dietary guidelines reveal we should further limit the amount of sugar we consume. This guidance will come at a time when many of us may be looking to indulge our sweet tooth more than ever. First, some sugar basics: Not all sugars are created equal and need to be limited to the same degree. Natural sugars are present in nutritious foods like fruit and milk in the form of fructose and lactose. These foods deliver important nutrients — such as fiber, protein, vitamins and minerals — that play a role in a healthy diet. Added sugars are another story. They are sugars or sweeteners that are added to foods or beverages during processing or preparation. They contribute calories, without any essential nutrients.  The average American gets about 13% of their total calories from added sugars, but new recommendations call for that average to be cut by about half, according to a recently issued report from the 2020 Dietary Guidelines Advisory Committee — a group of experts charged with providing science-based recommendations every five years. The 2020 committee recommended a limit of no more than 6% of calories coming from added sugars, with ranges from 3% at the lowest calorie levels and up to 8% at the highest calorie levels (which vary based on age, gender, activity level and body weight). The committee also recommended that children younger than age 2 should avoid any foods and beverages with added sugars. CNN External Link 

    USAFRICOM

    Cholera outbreak in Ethiopia nears 15K cases

    14 September- UN health officials are reporting nearly 15,000 cholera cases since an outbreak began in April 2019 in Telemt woreda, Amhara Region. Through Sep. 6, a cumulative total of 14,728 cases with 257 deaths (case fatality ratio 1.7%) reported (Since the beginning of the year, more than 11,000 cases and at least 175 associated deaths have been reported). The highest number of cases were reported from SNNPR followed by Oromia regions. Of the 604 stool samples tested since the start of the outbreak, 266 were culture positive for Vibrio cholera 01 Ogawa. The ongoing cholera outbreak in Ethiopia remains of concern, although there has been a declining trend in the past several weeks. However, the recent flooding across much of the region may reverse this trend, with nearly one million people displaced into situations with inadequate sanitation and poor access to safe drinking water, which could enhance further transmission, leading to more widespread outbreaks. Outbreak News Today External Link

    Sudan polio outbreak now at 21 cases

    13 September- The Federal Ministry of Health (FMoH) in Sudan has confirmed 21 confirmed cases of vaccine-derived poliovirus (cVDPV2) in 10 states. The first case was reported in South Darfur in March. The cases are all linked to the cVDPV2 currently circulating in Chad. The initial investigation of the two first cases indicated these cases were linked to cVDPV2s from the CHA-NDJ-1 emergence group, which was first detected in October 2019 and is currently circulating in Chad and Cameroon, according to the World Health Organization. The government is planning two rounds of national vaccination campaigns targeting 8.6 million children under five years of age to ensure they are protected against polio. The first round will start on 4 October and the second round will take place during the first week of November. Sudan's last reported wild poliovirus case was in March 2009 and the country was announced polio-free in 2015 by WHO. Outbreak News Today External Link

    USCENTCOM

    Why polio continues to be a health risk in Pakistan

    15 September- After Africa was declared polio-free last month, Afghanistan and Pakistan are now the only countries in the world where the disease is found. Why is polio surging in Pakistan and what can be done to curb the disease? Saira Qadir was only 11 months old when she contracted the polio virus. Now 44, she lives in Rawalpinidi city, near the capital Islamabad. Qadir told DW that when they were kids, all her siblings received the polio vaccine except her. Apparently, it was a case of parental negligence that resulted in her being infected with the crippling disease. Last month, the independent Africa Regional Certification Commission (ARCC) for Polio Eradication officially declared that the 47 countries in the UN World Health Organization (WHO) African Region are free of the virus, with no cases reported for four years. "This is a momentous milestone for Africa. Now future generations of African children can live free of wild polio," said Dr. Matshidiso Moeti, WHO Regional Director for Africa. The disease is now only found in two countries — Afghanistan and Pakistan — with the latter struggling to cope with a surge in cases over the past few months. The Muslim-majority South Asian country has registered 68 polio cases since the start of the year. The disease, which mainly affects children under the age of five, can infect the spinal cord, causing paralysis. DW External Link

    USEUCOM

    Chronic Wasting Disease (CWD) reported in Norway reindeer

    13 September- The Norwegian Veterinary Institute reported Thursday of a confirmed case of Chronic Wasting Disease (CWD) in a wild reindeer shot during the ordinary hunt on the Hardanger plateau in central southern Norway. This is the first case of classical CWD in reindeer identified outside the Nordfjella zone 1, where the disease was first detected in 2016. Two types of CWD prions have been identified in Norway. In wild reindeer, this prion seems to be contagious (classical CWD) as opposed to seven cases in moose and one red deer where it has probably occurred spontaneously in older animals (atypical CWD). CWD is a deadly prion disease for cervids, but has never been detected in humans. Since 2016, more than 100,000 cervids have been tested for CWD in Norway. From Hardangervidda, 3520 wild reindeer have been tested and found to be CWD negative. Of these, 518 have been tested already in 2020 without positive findings. Outbreak News Today External Link

    USINDOPACOM

    Philippines COVID-19 cases top 269K, props to RITM

    15 September- Philippines health officials reported 3,544 new coronavirus disease 2019 (COVID-19) infections today, bringing the total cases to 269,407, making it the country with the 21st most cases globally, bypassing Germany. The majority of the newly announced cases are from the Metro Manila area, followed by Cavite, Rizal and Negros Occidental. The death toll is now at 4663, with the addition of 34 Tuesday. On Monday, country health authorities gave a hat tip to the  Research Institute for Tropical Medicine (RITM) for their lab testing volume since the outbreak began. The Institute tested a total of 254,846 samples corresponding to 214,209 unique individuals as of September 11, or more than 8 percent of the country's volume. In addition, RITM is responsible for validating testing methodologies for COVID-19 and other infectious diseases in the country. Outbreak News Today External Link

    Thailand dengue fever update: 55K cases reported to date

    15 September- The Thailand Bureau of Epidemiology in an update Monday are now reporting 55,004 total cases (38,653 dengue fever, 15,917 dengue hemorrhagic fever and 434 dengue shock syndrome cases) in all 77 provinces. 38 dengue related fatalities have been reported. Mae Hong Son, Rayong, Chaiyaphum, Nakhon Ratchasima and Khon Kaen provinces have reported the highest incidence of the mosquito borne disease. Dengue is a viral infection transmitted by the bite of an infected mosquito. There are four closely related but antigenically different serotypes of the virus that can cause dengue (DEN1, DEN 2, DEN 3, DEN 4). Dengue Fever (DF) – marked by an onset of sudden high fever, severe headache, pain behind the eyes, and pain in muscles and joints. Some may also have a rash and varying degree of bleeding from various parts of the body (including nose, mouth and gums or skin bruising).Dengue has a wide spectrum of infection outcome (asymptomatic to symptomatic). Symptomatic illness can vary from dengue fever (DF) to the more serious dengue hemorrhagic fever (DHF). Outbreak News Today External Link

    USNORTHCOM

    U.S.: Vibrio Vulnificus in Connecticut- Unusual number of infections prompt warning

    13 September- Connecticut state health officials have issued a warning for the public in shoreline areas about the potential dangers of exposure to salt or brackish water along Long Island Sound, due to an unusually high number of Vibrio vulnificus infections. Since July, five cases of Vibrio vulnificus infections have been reported to the Department of Public Health (one infection in July, four in August).  The patients are from Fairfield (1), Middlesex (1), and New Haven (3) counties and are between 49 – 85 years of age (median 73); 4 are male, 1 female. Two patients had septicemia (infection of the bloodstream) and three had serious wound infections. All five cases patients were hospitalized. No deaths have been reported. All five cases reported exposure to salt or brackish water during activities such as swimming, crabbing, and boating.  All five patients had pre-existing wounds or sustained new wounds during these activities which led to the Vibrio infections. Vibrio vulnificus infection is an extremely rare illness. In the past 10 years, between 2010 – 2019, only seven cases were reported in Connecticut. V. vulnificus can cause wound infections when open wounds are exposed to warm salt or brackish water (mix of salt and fresh water). The bacteria, once inside the body, can infect the bloodstream causing septicemia. People with a V. vulnificus infection can get seriously ill and need intensive care or limb amputation. About 1 in 5 people with this type of Vibrio infection die, sometimes within a day or two of becoming ill. People at greatest risk for illness from V. vulnificus are those with weakened immune systems and the elderly. Outbreak News Today External Link

    USSOUTHCOM

    Dengue fever cases up 22% in Federal District, Brazil

    13 September- The Health Department of the Federal District is reporting an increase in dengue fever cases over the first eight months of 2020. According to data contained in the epidemiological bulletin, 44,523 probable cases of dengue were reported through the end of August, a 22.1 percent increase over the number of cases during the same period in 2019. 43 dengue related fatalities have been recorded in Brazil's capital. According to the bulletin, Ceilândia is the region with the highest number of dengue cases, with 4,998. This is followed by the regions of Gama with 4,676 cases, and Santa Maria with 3,730. Brazil has reported 1,337,095 total dengue fever cases in 2020 to date, including 475 deaths. Outbreak News Today External Link