Army Public Health Weekly Update, 24 September 2021

Date Published: 9/24/2021
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​​​The Army Public Health Update is a collection of articles taken from public sources to offer awareness of current health issues and the media coverage given to them. The articles do not necessarily represent U.S. Army Medical Command opinions, views, policy, or guidance, and should not be construed or interpreted as being endorsed by the U.S. Army Medical Command.

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

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Table of Contents

    ANNOUNCMENTS 

    DOD marks 10-Year anniversary of 'Don't Ask, Don't Tell' repeal

    20 September- Today marks the 10-year anniversary of the "don't ask, don't tell" repeal, which ended the 17-year military personnel policy enforced by the Defense Department and the military services. "The 10th anniversary today of the repeal of 'don't ask, don't tell' reminds us that when we strive for greater inclusivity, we help strengthen our nation's defenses. By insisting on standards of merit and allowing to serve in uniform all those who are qualified, we avail ourselves of more talent, better leaders and innovative solutions to the security challenges we face around the world.  "We are also reminded today that we have more work to do, particularly as it relates to righting old wrongs. No veteran should bear a less than honorable discharge based solely on sexual orientation or gender identity. "As secretary of defense, I am committed to improving diversity, equity and inclusion across the force. It makes us more representative of the nation we defend. It makes us wiser. And, without question, it makes us stronger. On behalf of the entire department, I thank our LGBTQ+ service members — and your families — for the service you render each and every day." Austin said those who believe they were unjustly discharged or retain an error in a service record, should contact the military department's Board for Correction of Military/Naval Records or Discharge Review Board.   Virginia S. Penrod, acting undersecretary of defense for personnel and readiness, spoke at a Center for a New American Security event today. She was the DOD's chairperson for the implementation of the repeal in 2011. Defense.gov External Link

    U.S. to lift international travel restrictions for the vaccinated

    21 September- The White House announced new rules on Monday aimed at opening the country to far more visitors, saying it will soon lift blanket travel restrictions on international visitors as long as they can show that they've been vaccinated. The new rules will take effect in early November and will also subject visitors to new testing and contact-tracing procedures. Jeff Zients, the White House coronavirus response coordinator, said the new system would focus on whether an individual has been vaccinated rather than banning visitors from entire countries. “We know vaccines are effective including against the delta variant, and vaccines are the best line of defense against covid," Zients said. “So this vaccination requirement of course is the best tool we have in our arsenal to keep people safe and prevent the spread of the virus." The announcement is part of a stepped-up effort by the Biden administration to require people to get vaccinated and reward those who do. Recent changes include ordering all companies with more than 100 employees to require that their workers be vaccinated or get weekly coronavirus tests. Federal workers, service members and nearly all health workers will have to be vaccinated. The fate of the Biden presidency relies on whether these measures work and the country returns to some semblance of normalcy, aides and Democratic strategists say. The delta variant surge has significantly changed the president's calculus on what he is willing to do to reopen the country, including widespread mandates which President Biden had initially said would be unnecessary. Monday's announcement, which European allies have demanded for months, leaves some crucial questions unanswered. Chief among them is how U.S. airlines will be able to tell if a foreigner is vaccinated and whether this new system will involve some kind of “vaccine passport" arrangement. “The process and means for travelers to demonstrate vaccination status will be released by early November when this plan begins to be implemented," White House spokesman Kevin Munoz said via email. The Washington Post External Link

    U.S. MILITARY

    6 things to know about the Army's new mandatory COVID-19 vaccine policy

    17 September- On September 14, 2021, the Army announced its plan to comply with the Secretary of Defense's order requiring all Service members to be fully vaccinated against COVID-19. The Army has made COVID-19 vaccines part of our normal medical readiness requirements and began mandatory COVID-19 vaccinations of Soldiers using the FDA approved Pfizer-BioNTech/Comirnaty vaccine. This is a readiness, health and welfare priority for the total Army. In a news release, Lt. Gen. R. Scott Dingle — U.S. Army Surgeon General — reiterated that the rise of the highly transmissible Delta variant has significantly increased risk to our Soldiers and the Army mission. Vaccination helps prevent transmission to others and provides individuals with protection from severe illness, hospitalization and death. Commanders, command sergeants major, first sergeants and officers in Command Select List positions who do not have an approved exemption and are not pending an exemption request will be suspended from command, notified of pending relief from duties, counseled, and provided the opportunity to be vaccinated before they are subject to being removed from their positions by a general officer. Officers and noncommissioned officers senior enlisted Soldiers who have been selected and are waiting to assume CSL command, key billet or nominative sergeant major positions will likewise be subject to removal from the list for those assignments should they refuse to be vaccinated without a pending or approved exemption. Army.mil External Link

    Hispanic Service Members exemplify hard work and selfless service

    16 September- Army Col. Edgar Arroyo commands Irwin Army Community Hospital, at Fort Riley, in Kansas. Air Force Col. Sandra Nestor directs the nurse corps at the Air Force Surgeon General's office at Joint Base Andrews­-Naval Air Facility Washington, in Maryland. And Navy Capt. Eugenio Lujan runs the professional education programs at Naval Medical Center San Diego, in California. The three officers have different health care specialties and serve in different military services in different parts of the county. Yet, like thousands of other service members across the military medical community, they share a common Hispanic heritage, which they say shaped the personal values and life goals that led them to a life of military service. Americans observe Hispanic Heritage Month between September 15 and October 15 to acknowledge, honor, and highlight the histories, cultures, and contributions of people with ancestry from Spain, Mexico, the Caribbean, and Central and South America. The Defense Health Agency joins in the Hispanic Heritage Month celebration in the defense community by honoring the contributions of its Hispanic members and highlighting these three stand-out service members whose selfless service to the country is a testament to their heritage and family values. Arroyo, Nestor, and Lujan are just a few among many service members who exemplify Hispanic grit and selfless service. They all say family values and life experiences led to their desire to serve, influencing their decision to join the military. Despite acknowledging that differences - such as Arroyo's Spanish accent­ sometimes create challenges at work, overall, they agree that the military has grown as an enterprise in inclusion and equal opportunity. "I have always noticed diversity in the military community - that's one of the things that I love," said Nestor. "I believe cultural awareness is growing exponentially." Health.mil External Link

    Military Health System offers help before and after natural disasters

    17 September- On August 29, Hurricane Ida - with its 15-mile wide eye-wall - slammed into the Louisiana coast, causing floods, destroying homes and cutting off electricity for millions of residents. It was 16 years to the day after catastrophic Hurricane Katrina hit the same low-lying regions of Louisiana, Mississippi and Alabama. Hurricane Ida's landfall was just one in a series of storms that have struck the southeast during an especially devastating hurricane season. And it comes in a year when floodswildfires and blizzards have damaged and disrupted regions across the country. The series of natural disasters serves as constant reminder that daily routines can be upended at any moment. The risks often vary by region. Those living in the Rocky Mountains, Texas, and the West Coast are at particular risk of wildfires with the peak season running from May through October. While more wildfires occur in Eastern and Central states, according to the National Interagency Fire Center, wildfires in Western states are larger and burn more acreage. People who live along the Atlantic and Gulf Coasts face the possibility of a hurricane making landfall between June and November. Fortunately, our active dutyGuard and Reserves plan for, prepare for and respond to these other natural disasters on a regular basis. And the Military Health System also provides support in coordination with the Federal Emergency Management Agency, U.S. Coast Guard, U.S. Public Health Service, American Red Cross and others - part of the whole-of-government response to natural disasters. TRICARE plays an important role before, during and after natural disasters, specifically with regard to disaster alerts and accessing emergency prescription refills. TRICARE experts recommend first signing up for disaster alerts. These alerts are sent via text and email, and give updated information from federal agencies and departments, state and local governments, and the news and other media. Health.mil External Link

    Resources to help those left behind in wake of suicide

    14 September- Suicide is not an individual act but an action that reverberates like a shockwave impacting all those in its wake. "Suicide doesn't just affect the person who completes the act. It affects people within their circle of friends, their family members, the unit, and the entire organization," said Lt. Col. Osceola Evans, Chief of Behavioral Health, Blanchfield Army Community Hospital and Installation Director of Psychological Health on Fort Campbell, Kentucky. Evans said suicide is a very serious problem that is affecting our society in America. It is the second leading cause of death among young people and the tenth leading cause of death in the nation. For those grieving the loss of a loved one, friend or co-worker, it is important to take care of themselves. There are support groups available to loss survivors when they are ready to discuss their loss. Writing a letter to a lost loved one allows them to say the things they didn't get to say before their loss. Evans shared his own struggle after he experienced losing someone to suicide and what he did to cope. "I reached out for help to talk with the chaplain due to some of the feelings I was having. Some of those feelings included confusion, anger, and guilt. Those feelings are normal and it helped for me to talk with someone about that. And there are people who are available to help you as well," said Evans. "So if you have been affected by someone who completed suicide, there is help available as you process the feelings related to that. These are all very serious issues and you do not have to go through this alone. "The National Suicide Prevention Lifeline, which provides free and confidential support to people in suicidal crisis or emotional distress, also features information on its website for loss survivors and how to support someone who has lost a loved one. Whether it is seeking help personally, for someone else or needing to know how to help, they are available by telephone at 1-800-273-TALK (8255), by text at 838255, or chat through the website https://suicidepreventionlifeline.org. DVIDS External Link

    GLOBAL

    AI-Based platform EvoWalk can now help muscle-impaired patients to walk again using stimulation device: How it works

    21 September- Evolution Devices, a health company focused on digital-physical therapy, has launched EvoWalk. The platform uses artificial intelligence that will give hope to those people who have trouble walking. The focus of the EvoWalk platform relies on incorporating smart therapeutic devices with remote physical treatment for muscle-impaired patients. Evolution Devices developed EvoWalk, an advanced AI-based platform that can help patients with walking paralysis to walk again. According to the official website of Evolution Devices, the EvoWalk platform is a digital-physical therapy solution that makes use of AI for the stimulation process. The device collects data from the patient and gives the much-needed electrotherapy to those who have walking paralysis. This platform aims to stimulate the person's muscles so that he/she could walk again and control the movement. This week, the health startup begins rolling out the pilot test for the EvoWalk program. It also aims to raise enough funds for such a cause. At the time of writing, there is already $74,800 for the total reservation for Evolution Devices. Tech Times External Link

    Did the USA under-forecast monoclonal antibody treatment demand?

    21 September- Florida Governor Ron S. DeSantis Tweeted late on September 20, 2021, 'Since Florida opened monoclonal antibody (mAbs) treatment sites in August, 100,000 Floridians have received treatments and COVID-19 hospital admissions have fallen by over 60%.' And, 'COVID hospital census has declined for 28 consecutive days, with COVID-19 related ER visits declining by over 70%.' However, the 46th Governor of Florida continued Tweeting by stating, 'Florida's treatments (have recently been) cut by more than 50%.' This reduction is counter to Florida's Board of Medicine decision to support mAbs treatments on August 5, 2021. Governor DeSantis's concerns are related to the U.S. Department of Health and Human Services' (HHS) decision to issue a Public Health Emergency update of September 13, 2021, announcing a revised State/territory-coordinated distribution system for Monoclonal Antibody Therapeutics. Monoclonal antibodies that target the spike protein have shown clinical benefits in treating SARS-CoV-2 coronavirus infection. HHS stated 'it had transitioned away from a direct ordering process products from AmerisourceBergen. And transitioning to a state/territory-coordinated distribution system gives health departments maximum flexibility to get these critical drugs where they are needed most.' In the future, 'HHS will determine the weekly amount of mAb products each state and territory receives based on COVID-19 case burden and mAb utilization.' HHS published mABS distributions for the week of September 13, 2021, at this link. Precision Vaccinations External Link

    FDA advisors OK Pfizer COVID booster for seniors, high-risk groups

    17 September- Federal vaccine advisors today approved a third booster dose of Pfizer-BioNTech's COVID-19 vaccine on an emergency use basis, but only for the most vulnerable groups, which includes those age 65 and older and people at high risk of severe disease. The final vote passed unanimously on an 18 to 0 vote. An initial vote on broader third doses in those age 16 and older failed 16 to 2, based on questions about safety and whether third doses would do much to decrease transmission. The nonbinding decision from the Food and Drug Administration (FDA) Vaccines and Related Biological Products Advisory Committee (VRBPAC) will influence how the White House rolls out booster doses next week, part of stepped-up efforts to tamp down the nation's Delta (B1617.2) variant surge. The booster dose would be given 6 months after receiving the second dose. In the middle of August, federal health officials approved a third dose of Pfizer-BioNTech COVID-19 vaccine for people who are moderately or severely immunocompromised. Some developed countries such as Israel and the United Kingdom have already launched third doses across broad parts of their populations. CIDRAP External Link

    'Long COVID' affects 1 in 10 kids, Israel survey finds

    14 September- Approximately 1 in 10 Israeli children experienced lasting COVID-19 symptoms after recovering from their illnesses, according to the country's Health Ministry. Findings from a phone survey conducted from late May-June 2021 drew from 13,834 parents of kids aged 3-18 who recovered from COVID-19. Results indicated 11.2% of the kids experienced "some symptoms after recovery," however the figure dropped to 1.8% to 4.6% six months following acute illness, depending on the child's age. The Health Ministry-led survey also found that older children were more likely to experience long COVID; 1.8% of kids ages 3-6 saw lasting symptoms whereas 4.6% of those ages 12-18 endured such effects. What's more, participants aged 12-18 who experienced a symptomatic course of COVID-19 were more likely to develop long COVID, compared to those who had asymptomatic confirmed COVID-19, at 5.6% versus 3.5%, respectively. The findings didn't disclose specific symptoms. "Based on the cumulative findings worldwide, it is evident that the coronavirus has long-term effects not only on the adult population but also among children," the translated findings read. "The reported long-term morbidity rate means that there are thousands of children in Israel with long-term symptoms." Fox News External Link

    Oral antiviral may prevent and treat mild COVID-19

    20 September- Nova Scotia-based Appili Therapeutics Inc. announced today it entered into an agreement with FUJIFILM Toyama Chemical Co., Ltd. ("FFTC"), which will provide $1 million in funding for its Phase 3 PRESECO clinical trial of the broad-spectrum oral antiviral Avigan® / Reeqonus™ (favipiravir) tablets for the potential treatment and prevention of COVID-19. PRESECO is investigating the safety and efficacy of Avigan / Reeqonus in the early treatment of adults infected with COVID-19. The enrollment targets for PRESECO and the viral shedding sub-study were recently increased to include COVID-19 variant cases. Avigan / Reeqonus is a selective inhibitor of viral RNA-dependent RNA polymerase with potent antiviral activity against single-stranded RNA viruses, including human coronaviruses. Avigan (favipiravir) was developed initially by FFTC and approved in Japan as a treatment for pandemic influenza. Separately, Glenmark Pharmaceuticals announced on September 15, 2021, the successful completion of its prospective, open-label, multicentre, single-arm, Post Marketing Surveillance (PMS) study on Favipiravir (FabiFlu®) in India. The time for fever resolution was four days, while the time for a clinical cure was seven days. The PMS study commenced in July 2020 to evaluate the safety and efficacy of Favipiravir in mild to moderate COVID-19 in over 1,000 patients. Precision Vaccinations External Link

    Scientists examine kids' unique immune systems as more fall victim to Covid

    19 September- Eighteen months into the Covid-19 pandemic, with the Delta variant fueling a massive resurgence of disease, many hospitals are hitting a heartbreaking new low. They're now losing babies to the coronavirus. The first reported Covid-related death of a newborn occurred in Orange County, Florida, and an infant has died in Mississippi. Merced County in California lost a child under a year old in late August. "It's so hard to see kids suffer," said Dr. Paul Offit, an expert on infectious diseases at Children's Hospital of Philadelphia, which — like other pediatric hospitals around the country — has been inundated with Covid patients. Until the delta variant laid siege this summer, nearly all children seemed to be spared from the worst ravages of Covid, for reasons scientists didn't totally understand. Although there's no evidence the delta variant causes more severe disease, the virus is so infectious that children are being hospitalized in large numbers — mostly in states with low vaccination rates. Nearly 30% of Covid infections reported for the week that ended Sept. 9 were in children, according to the American Academy of Pediatrics. Doctors diagnosed more than 243,000 cases in children in the same week, bringing the total number of Covid infections in kids under 18 since the onset of the pandemic to 5.3 million, with at least 534 deaths. CNN External Link

    Study: Allergic reactions to mRNA COVID vaccines rare, manageable

    20 September- Allergic reactions to COVID-19 mRNA vaccines are rare and usually mild, according to a study late last week in JAMA Network Open. Stanford University researchers led the study of 22 reported allergic reactions to the first 38,895 doses of the Pfizer/BioNTech and Moderna COVID-19 vaccines given to healthcare workers from Dec 18, 2020, to Jan 26, 2021 (less than six hundredths of a percent). Of all vaccinations, 80.6% were of the Pfizer vaccine, while 18.7% were of Moderna. The study population was 60% women, 64% White, 2% Black, 20% Asian, 16% younger than 50 years, and 54% aged 70 and older. According to the national Vaccine Adverse Event Reporting System (VAERS), the rate of severe vaccine-related anaphylaxis, or a serious allergic reaction that requires hospitalization, is 4.7 per million for the Pfizer vaccine and 2.5 per million for Moderna. But the authors noted that VAERS tends not to capture mild or moderate allergic reactions to vaccines. CIDRAP External Link

    Two dose version of Johnson & Johnson shot 94% effective against Covid-19, study finds

    21 September- A two-dose version of Johnson & Johnson's coronavirus vaccine provides 94% protection against symptomatic infection, the company said Tuesday -- making a two-dose regimen of J&J's Janssen vaccine comparable to a two-dose regimen of Moderna's or Pfizer's. Plus, the company said, adding a booster dose to a single shot of the vaccine raised immunity even more, and should also protect people strongly against infection. The company released some details of three studies looking at various aspects of its Janssen vaccine, and said that, taken together, they showed the vaccine provided long-lasting protection that could be boosted with an extra shot. "Our large real-world-evidence and Phase 3 studies confirm that the single-shot Johnson & Johnson vaccine provides strong and long-lasting protection against COVID-19-related hospitalizations," Dr. Mathai Mammen, global head of Janssen Research & Development, said in a statement. "Our single-shot vaccine generates strong immune responses and long-lasting immune memory. And, when a booster of the Johnson & Johnson COVID-19 vaccine is given, the strength of protection against COVID-19 further increases." Johnson & Johnson's single-dose vaccine was given emergency use authorization by the US Food and Drug Administration on February 27. It has been given to about 14.8 million Americans, according to the US Centers for Disease Control and Prevention. CNN External Link

    INFLUENZA

    CDC: Weekly U.S. Influenza Surveillance Report

    2020-2021 Influenza Season for Week 36, ending September 11, 2021:

    Influenza-Associated Hospitalizations- The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in 14 states and represents approximately 9% of the U.S. population. As in previous seasons, patients admitted for laboratory-confirmed influenza-related hospitalization after April 30, 2021, will not be included in FluSurv-NET. Data on patients admitted through April 30, 2021, will continue to be updated as additional information is received.

    Influenza-Associated Pediatric Mortality- No influenza-associated pediatric deaths were reported to CDC during week 36. CDC External Link

    VETERINARY/FOOD SAFETY

    Green Field Farms Dairy recalls chocolate milk in nine states over lab results

    21 September- Green Field Farms Dairy of Fredericksburg, OH, has announced a recall of 1,242 units of its whole chocolate milk product because a laboratory analysis indicated the product was not effectively pasteurized. Pasteurization kills harmful bacteria, parasites and viruses. The affected milk was distributed in Ohio, Indiana, Kentucky, Maryland, New Jersey, New York, Pennsylvania, Virginia, Delaware and Washington D.C. from Sept. 7 through Sept. 16, 2021. There is concern that consumers may have the milk in their homes because it has a date code of Sept. 29. No other identifying codes were included in the company's recall notice, which was posted by the Food and Drug Administration. The issue was discovered during routine product testing conducted by the Ohio Department of Agriculture. As of the posting of this recall, there have been no reports of illness involving the recalled products. Consumers who have purchased this product should return it to the place of purchase to receive a refund. Food Safety News External Link

    Outbreak linked to shrimp ends; consumers urged to check freezers

    22 September- Officials say a Salmonella Weltevreden outbreak linked to imported, cooked, frozen shrimp is over, but they are concerned some consumers may have the shrimp on hand. As of Sept. 21 the Centers for Disease Control and Prevention declared the outbreak over. At least nine people in four states were sickened. The last illness onset date was July 17, 2021. Based on the Food and Drug Administration's completed traceback investigation and sample results, frozen cooked shrimp manufactured by Avanti Frozen Foods of India were linked to this outbreak. Some have expiration dates reaching through 2022. “The FDA worked with Avanti Frozen Foods of India to ensure that potentially contaminated frozen cooked shrimp were removed from the market. On Aug. 13, 2021, Avanti Frozen Foods of India expanded its recall of frozen cooked shrimp to include frozen cooked shrimp products imported into the U.S. from November 2020 to May 2021," according to the FDA. In March 2021, a shipment of Avanti Frozen Foods shrimp that was found to be contaminated with Salmonella at import was destroyed. Avanti Frozen Foods was added to Import Alert 16-81 , which allows FDA to detain products at import without physical examination because of the presence of Salmonella. On June 25, 2021, Avanti Frozen Foods recalled  additional lots of frozen cooked shrimp. Food Safety News External Link

    WELLNESS

    Suicide is preventable and should be treated like a health problem

    20 September- Suicide is a health issue that needs to be treated to reduce risks – similar to the way heart disease needs treatment to prevent a heart attack, said Air Force Tech. Sgt. Alexander Silva, non-commissioned officer in charge of the Mental Health Clinic, 316th Medical Squadron, Joint Base Anacostia-Bolling in Washington, D.C. "Suicide can be prevented," Silva said, and should be destigmatized within our entire culture. "There is no single cause and that's the biggest takeaway." One-quarter of all Americans will experience a mental health issue, but "don't think they are doomed to die by suicide," Silva said. He spoke at a Sept. 16 Defense Health Agency event at headquarters in Falls Church, Virginia, part of awareness events that were held throughout National Suicide Prevention Week corresponding to World Suicide Prevention Day, which is recognized annually on Sept. 10. He was speaking in his capacity as a representative of a suicide prevention organization. Health factors often play a role in suicide, especially after life-changing events such as chronic pain from a car accident, Silva said. While many think of depression as a trigger for suicide, Silva emphasized that "anxiety is a major factor," as are substance use disorders, posttraumatic stress disorder, and personality disorders. "It's not just depression." However, "those in mental health care have a much lower risk of suicide" than those who are not, he said. Noting that there is "a lot of circumstantial evidence" about suicide that has been compiled over the last few decades, Silva said: "Hopefully, we can move toward harder, empirical evidence in an attempt to decrease suicide rates. Health.mil External Link

    USAFRICOM

    Nigeria reports four new confirmed Lassa fever cases, 3 deaths

    19 September- The Nigeria Centre for Disease Control (NCDC) reported an additional four confirmed Lassa fever cases the week ending September 12, including three deaths among the confirmed cases. This brings the cumulative total confirmed cases this year to 369, including 76 deaths (20.6% CFR). In total for 2021, 14 States have recorded at least one confirmed case across 62 Local Government Areas. Nearly 85 percent of the confirmed cases have been reported from three states: Edo (45%), Ondo (34%) and Taraba (5%). In 2020, 1078 confirmed cases and 225 deaths were reported during the same period. Lassa fever is an acute viral hemorrhagic fever (VHF) caused by the Lassa virus. The natural reservoir for the virus is the Mastomys natalensis rodent (commonly known as the multimammate rat). Lassa fever remains a major public health challenge in West Africa with Nigeria bearing the highest burden. Lassa fever occurs throughout the year but more cases are recorded during the dry season i.e. November through May. Outbreak News Today External Link

    USCENTCOM

    Iraq: Crimean-Congo hemorrhagic fever death reported in Mosul

    15 September- Health officials in Iraq are reporting the death of a person working as a butcher in Mosul city due to infection with Crimean-Congo hemorrhagic fever (CCHF), according to a Shafaq News report (computer translated). The Director of the Veterinary Hospital, Dr. Uday Al-Abadi said that quarantine was imposed on a number of people that had been in contact with the deceased in a hospital. He added that "we have fogged the meat market in Ras Al-Jada, on the right side of Mosul, because the butcher works there, and we hope that no new cases will be recorded." The mayor of Mosul, Zuhair Al-Araji, said that this case is the first of its kind recorded in Mosul. He pointed out that this is an issue of great concern and we will impose strict penalties on any butcher who slaughters livestock outside the authorized slaughterhouse. He explained that the penalties would reach prison and the imposition of financial fines to prevent the spread of CCHF in the city of Mosul. Crimean-Congo hemorrhagic fever is a widespread disease caused by a tick-borne virus (Nairovirus) of the Bunyaviridae family. The CCHF virus causes severe viral hemorrhagic fever outbreaks, with a case fatality rate of 10–40%. Animals become infected by the bite of infected ticks and the virus remains in their bloodstream for about one week after infection, allowing the tick-animal-tick cycle to continue when another tick bites. Although a number of tick genera are capable of becoming infected with CCHF virus, ticks of the genus Hyalomma are the principal vector. The CCHF virus is transmitted to people either by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, such as agricultural workers, slaughterhouse workers and veterinarians. Human-to-human transmission is possible. Outbreak News Today External Link

    USEUCOM

    Portugal is 'at the end of a pandemic phase': Chief epidemiologist

    20 September- The head of the Division of Epidemiology and Statistics (DSIA) of the Directorate-General for Health (DGS), Pedro Pinto Leite, said that Portugal is "at the end of a pandemic phase". He explained that the pandemic is on a "declining trend". There is an average of 195 cases per 100,000 inhabitants and a difference of 96% compared to the same period last year. The decrease in incidence is accompanied by a decrease in positivity, and despite the high intensity of testing, there are "less virus in circulation and fewer confirmed cases" of COVID-19. Also highlighted was a decrease in the number of admissions (15%), both in the ward and in Intensive Care Units, compared to the same period last year. As for mortality, the rate is fixed at 13 per one million inhabitants, below the threshold defined by the European Center for Disease Prevention and Control (ECDC), of 20 per one million inhabitants, with a decrease of 19% in relation to the same period of 2020. Outbreak News Today External Link

    USINDOPACOM

    Japan reports falling COVID-19 cases, Down 63 percent in 3 weeks

    20 September- Japan health officials continue reporting a decrease in COVID-19 cases as some 2,200 cases were reported today, falling below 3,000 for the first time in two months. "The number of newly infected people nationwide has decreased by about 63% in three weeks." according to Takaji Wakita, director of the National Institute of Infectious Diseases (NIID). Due to the spread of the highly infectious Delta variant, which was hit by the fifth wave from mid-July, spread nationwide in the wake of the rapid spread of infection in the Tokyo metropolitan area. It was the biggest epidemic ever, with more than 20,000 infected people reported daily nationwide. In Tokyo, 302 new coronavirus infections, its lowest figure since late June, was reported today. Officials with the Tokyo metropolitan government say, "Although the downward trend is continuing, we would like to ask people to remember that we are still in a state of emergency". The reason for the sharp decrease in the number of infected people is "complex". Experts cite the progress of vaccination and seasonal factors, but local governments are becoming more cautious about the rebound of infection caused by people's relaxation. Outbreak News Today External Link

    USNORTHCOM

    U.S.: Massachusetts- Reports 7th human West Nile virus case

    19 September- Massachusetts health officials an additional case of West Nile virus (WNV) in the state this year, the seventh to date. The latest case is reported in a woman in her 30s who was exposed to WNV in Bristol County. "This is our first West Nile virus case this year in someone under the age of 50," said Acting Public Health Commissioner Margret Cooke. "This is a reminder that although people over the age of 50 are at greater risk from West Nile virus, all ages can be affected. Risk from West Nile virus will continue until the first hard frost and people should remember to take steps to prevent mosquito bites anytime they are outdoors." In 2020, there were 11 human cases of WNV infection identified in Massachusetts. WNV is usually transmitted to humans through the bite of an infected mosquito. While WNV can infect people of all ages, people over the age of 50 are at higher risk for severe disease. Most people infected with WNV will have no symptoms. When present, WNV symptoms tend to include fever and flu-like illness. In rare cases, more severe illness can occur. Outbreak News Today External Link

    USSOUTHCOM

    Dominican Republic: A dozen children admitted to Santo Domingo hospital with dengue

    21 September- Twelve children were admitted over the weekend to the Robert Reid Cabral children's hospital, the director of the center, Clemente Terrero, reported on Monday. Currently the center has 14 children interned due to the disease. "The dengue situation continues to be active, at the weekend we admitted 12 patients, a total of four patients per day. We currently have 14 patients admitted to dengue wards, "said the director. Terrero pointed out that some of the children are in stable conditions and others are in intensive care, he did not specify the amount. "The situation so far is that dengue continues to be active in the country and in this hospital," he reiterated. The doctor indicated that most of the patients come from Bani, Azua, San Cristóbal and the National District. "That is where the dengue outbreak in the Dominican Republic is mostly located up to now," he said. According to the latest epidemiological bulletin of the General Directorate of Epidemiology in week 34, which runs from Sunday August 22 to Saturday 28, 92 probable cases of dengue were reported, 75 more cases than in the same period of 2020, when 17 were registered. Meanwhile, in the last four weeks, 314 cases have been reported, for a cumulative of 1,207 in the first eight months of the year, including 13 deaths. The report clarifies that these deaths have not yet been audited by the clinical audit committee. Regarding the place of residence, more than half of the cases correspond to the municipalities of Santo Domingo Este (193), El Distrito Nacional (140), Santo Domingo Norte (106), Santo Domingo Oeste (81) and Bani (73 ). Outbreak News Today External Link