Army Public Health Weekly Update, 26 March 2021

Date Published: 3/26/2021
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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

    COVID-19 Remote Patient Monitoring pilot marks initial successes

    22 March- March 2021 marks a grim milestone: the one-year anniversary of the COVID-19 pandemic. Even as the total number of U.S. COVID-19 deaths exceeds 525,000, overall case numbers and mortality rates are expected to continue to decline. To help keep these favorable trends going, the Military Health System must continue to ensure COVID-19 and other high-risk patients get the care they need while protecting them from potential exposure to the coronavirus, hospital-acquired infections, and other potential health threats. Virtual health and other digital health technologies are an essential part of care delivery going forward for all patients, and especially the most vulnerable. These technologies have come into their own during the pandemic by enabling continuity of care anytime, anywhere while keeping beneficiaries and clinicians safely separated. One especially important area of development has been remote patient monitoring – also known as remote health monitoring – which uses digital health technology to track patient symptoms outside medical facilities. As the MHS plans for care delivery for the rest of the pandemic and life thereafter, it is reviewing lessons learned from the many innovative technology systems it has launched. One such system is the MHS COVID-19 Remote Patient Monitoring pilot, which has the potential to help transform how the MHS delivers inpatient and outpatient care to beneficiaries and help them more safely and effectively manage COVID-19 and other chronic diseases outside health care facilities. DVIDS External Link

    U.S. MILITARY

    Army dietitian uses nutritional care to fight COVID-19

    23 March- Army Capt. Melissa Shaffer, a registered dietitian-nutritionist at Blanchfield Army Community Hospital at Fort Campbell in Kentucky, doesn't swab nasal cavities to test for COVID-19 or administer COVID-19 vaccines. In the fight against COVID-19, her mission is to oversee the nutritional needs and special diets of all military healthcare beneficiaries admitted to the hospital - including those with COVID-19. As a certified nutrition support clinician, she was specifically trained to work with critically ill patients, and is part of the hospital treatment team for a critically ill COVID-19 patient. Air Force retiree Gino Garcia can testify to the importance of her role at the hospital, as spent about two months in Blanchfield's intensive care unit where a team of healthcare professionals worked together to help him recover from the deadly disease. When he first arrived, his doctors noticed he wasn't able to oxygenate his blood so they decided he would benefit from being intubated and placed on a ventilator. A ventilator is a life-support machine that uses a tube inserted into the trachea through the mouth or nose that forces air into the lungs, artificially breathing for a patient who cannot adequately breathe on their own. "The last thing I remember was that I had COVID and that I went through [the hospital] doors to be taken care of like any other patient. After that I don't have any other memories," said Garcia. Now in recovery, Garcia referred to his time on the ventilator as "lights out" because he had no recollection of the month prior when the ventilator, his care team, his family's love and many prayers were at work to help him beat COVID-19. Shaffer was responsible for the nutrition care needs of Garcia, which she coordinated with other medical specialists involved with his care. "Nutrition plays an important role with the recovery of critically ill patients. Since Mister Garcia was ventilated and sedated he couldn't eat on his own," said Shaffer. "You have to feed critically ill patients who are ventilated with enteral tube-feeding and you have to consider the formula, the rate, and the type of feeding you are going to give them." Shaffer used predictive equations to calculate his energy needs and started Garcia out on a continuous feed of a no fiber, high protein formula to meet all of his nutrition needs. She gave him additional protein supplements so he wouldn't lose a lot of lean body mass while he was hospitalized and also evaluated his medications. Health.mil External Link

    Army rolls out latest combat fitness test with different scoring tiers for male, female soldiers

    22 March- The Army has for a third time in three years adjusted its long-awaited, combat-driven fitness test to include new scoring tiers for male and female soldiers meant to acknowledge their "biological differences," top service officials announced Monday. The Army will begin testing its soldiers on the Army Combat Fitness Test version 3.0 in April, Sgt. Maj. Of the Army Michael Grinston told reporters. The test's new version will include new gender-based performance scoring tiers and the permanent implementation of the plank as an option for the six-event test. The changes come as Army officials work to alleviate concerns raised by lawmakers that past versions of the ACFT were unfair to women, who posted a sub-50% pass rate of the Crossfit-style evaluation. In January, Congress halted the Army from fully implementing the ACFT until it was adjusted and studied by an independent group to ensure it did not favor men. The new scoring system has not been finalized, but planning calls for the creation of five performance tiers for each gender, said Army Maj. Gen. Lonnie Hibbard, who leads the Army Center of Initial Military Training, which has spearheaded ACFT efforts. The revised test would create a platinum tier for soldiers who scored within the top 1% of their gender on the ACFT. It also creates a gold tier for those scoring in the top 10% of their gender, a silver tier for those scoring in the top 25%, a bronze tier for those scoring within the top 50% and a green tier for those who score in the bottom 50% among passing grades within their gender. Stripes External Link

    Department of Defense revises several Force Health Protection measures

    23 March- In line with recent updates from the Centers for Disease Control and Prevention, the Department of Defense has revised several Force Health Protection measures. The measures include guidance on quarantine and testing for DOD personnel and close contacts who have been fully vaccinated against COVID-19, deployment and redeployment guidance, reaffirmation of DOD mask use, and additional updated guidance focusing on protecting all DOD personnel. Dr. Terry Adirim, acting assistant secretary of defense for health affairs, said the changes to DOD/Military Health System policy not only align with the White House and CDC, but also serve as one more step back to normalcy. "These Force Health Protection changes demonstrate our continued commitment to our 9.6 million beneficiaries, and to maintaining a medically ready force," said Adirim. "These FHPs demonstrate the DOD's continued effort in battling COVID-19, while ensuring our service members are prepared to defend the nation. The measures are as follows: Force Health Protection 15Opens to a new webpage on the Defense website - Focusing on testing, the biggest change in this guidance is related to quarantine and associated testing requirements for vaccinated close contacts who meet CDC criteria. "When the close contact is an individual vaccinated with a Food and Drug Administration-authorized COVID-19 vaccine under emergency use authorization, quarantine and testing for close contacts is not required if the individual is fully vaccinated and up-to-date with the latest vaccine guidance, and has remained asymptomatic since the current COVID-19 exposure," explained Army Col. (Dr.) Jennifer Kishimori, director of chemical, biological, radiological, and nuclear medical countermeasures policy in the Office of the Assistant Secretary of Defense for Health Affairs. Health.mil External Link

    GLOBAL

    AstraZeneca vaccine is 79% effective against symptomatic Covid-19, company says

    22 March- AstraZeneca's Covid-19 vaccine showed 79% efficacy against symptomatic disease and 100% efficacy against severe disease and hospitalization in a new, US-based clinical trial, the company said Monday. The findings from the new Phase 3 trial, which included more than 32,000 participants, may boost confidence in the vaccine, which was originally developed by the University of Oxford. The trial showed that the vaccine was well-tolerated and identified no safety concerns, the company said. An independent committee "found no increased risk of thrombosis or events characterized by thrombosis among the 21,583 participants receiving at least one dose of the vaccine," according to AstraZeneca. The new data came from a Phase 3 clinical trial conducted in the US, Chile and Peru. AstraZeneca says it plans to submit the findings to a scientific journal for peer review. CNN External Link

    COVID-19 'long haulers' need dedicated clinics, experts say

    23 March- The United States should create multispecialty COVID-19 clinics dedicated to treating patients still experiencing serious multiorgan effects of infection well after recovery from acute illness, say the authors of a comprehensive review of literature on so-called coronavirus "long-haulers" published yesterday in Nature Medicine. The exact number of US long-haul COVID-19 cases is unknown, but the researchers said that many patients struggle in silence or become frustrated when their doctors don't consider that their symptoms could be related to their previous infection. The review, led by researchers at New York-Presbyterian/Columbia University Irving Medical Center, found that the cell damage, inflammatory immune response, abnormal blood clotting, and other complications of acute COVID-19 infection can leave in their wake long-term symptoms such as chest pain, shortness of breath, "brain fog," fatigue, joint pain, and posttraumatic stress disorder, all of which can compromise quality of life. The researchers detailed literature from the United States, Europe, and China on high percentages of long-haulers, or those with chronic or post–COVID-19 syndrome, who often have debilitating symptoms for more than 3 months. COVID-19 has been associated with diabetes, strokes, heart rhythm abnormalities, blood clots in the lungs, and other complications. For example, an observational study of 488 COVID-19 patients released from Michigan hospitals after 60 days who completed a phone survey found that 32.6% had lingering symptoms, including 18.9% who reported new or worsening symptoms. The most common issues were shortness of breath while walking up stairs (22.9%), cough (15.4%), and loss of smell or taste (13.1%). Similarly, 87.4% of 143 COVID-19 patients released from a hospital in Italy reported persistent symptoms, including fatigue (53.1%), shortness of breath (43.4%), joint pain (27.3%), and chest pain (21.7%), with 55% still experiencing at least three symptoms a mean of 60 days after symptom onset. And a study from France of 150 survivors of noncritical COVID-19 found that two-thirds reported persistent symptoms at 60 days follow-up, with one-third saying they felt worse than they did when their acute coronavirus symptoms began. In China, 6-month post-acute follow-up of 1,733 COVID-19 patients found at least one lingering symptom in 76%, with fatigue/muscle weakness in 63%, sleep problems in 26%, and anxiety/depression in 23%. About half of 349 patients who underwent high-resolution chest computed tomography showed at least one abnormal pattern. CIDRAP External Link

    Hang on to that COVID-19 vaccination card -- it's important

    23 March- Proof of vaccination may allow us to begin resuming our normal activities in the near future. Photos that display the COVID-19 vaccination card like a badge of honor have been making the rounds on social media for months, but the card is more than fodder for selfies, it could be your ticket to freedom in the coming months -- so it should be protected as such. The precious paper card contains vital information including the brand of vaccine you received and the dates you were immunized. According to public health experts, it's crucial to keep that information handy in case you need it to prove your vaccination status, or to streamline possible future booster shots. Vaccination records can likely eventually be replaced if they are lost or damaged, but it is especially important to take good care of your vaccination records during this pandemic, when the country's health care systems are stretched thin. "A vaccination card is a tool that people can use to declare that they have some level of protection against COVID," said John Brownstein, Ph.D., an ABC News contributor and epidemiologist at Boston Children's Hospital. "Being able to assess immunity to COVID is a critical part of trying to resume our daily lives." ABC External Link

    Multi-dose, nasal spray COVID-19 vaccine under development

    22 March- Maryland-based Altimmune, Inc. announced it had retained Summit Biosciences to manufacture a metered nasal spray presentation of AdCOVID, its intranasal COVID-19 vaccine candidate. While traditional vaccines delivered by an intramuscular injection can stimulate systemic immunity as measured in the blood, they have not been shown to induce mucosal immunity in the nasal cavity, which may be critical for blocking the transmission of the coronavirus. AdCOVID is designed to deliver vaccines directly to the site of viral entry and replication to stimulate mucosal and cellular immunity in the nasal cavity and respiratory tract, thereby potentially offering an important early defense against the SARS-CoV-2 virus. "We expect this device may be a convenient and efficient option when vaccinating patients in high-demand settings where our vaccine candidate's anticipated room temperature stability profile will also be important," said Vipin K. Garg, President, and CEO of Altimmune, in a press statement. "In addition, Altimmune will continue to produce a single dose presentation of AdCOVID to provide alternative forms of administration." AdCOVID is an adenovirus-vector vaccine designed to stimulate a broad immune response following a single vaccination that includes systemic immunity (neutralizing antibody) and local immunity (mucosal IgA and resident memory T cells) in the nasal cavity and respiratory tract. Precision Vaccinations External Link 

    Psychedelic health: How Mydecine Innovations Group is shaping the future of PTSD treatment

    22 March- Many people who have lived through a traumatic event such as a natural disaster or a serious accident experience some level of post-traumatic stress disorder (PTSD). It can result in symptoms ranging from anxiety to self-harm. PTSD commonly impacts those who have faced war and combat, often leaving veterans struggling with mental health. A staggering report by the Department of Veterans Affairs revealed that every 72 seconds in the United States, a veteran takes their own life. Despite how common and serious this condition can be, treatments are limited and there isn't a single pharmaceutical drug on the market to treat it. Mydecine Innovations Group (CSE:MYCO) (OTC:MYCOF) (FSE:0NFA) is working to change this. The emerging biopharma and life sciences company has been quietly working to build what might be one of the most innovative health products in recent years. They are using cutting edge clinical research to unlock the healing powers of psychedelics and turning what was once thought of as "alternative treatments'' into the future of modern medicine. Tech Times External Link

    Regeneron and Roche's antibody cocktail shown helping in COVID-19 cases

    23 March- New late-stage trial data show Regeneron and Roche's antibody cocktail against COVID-19 cut hospitalization or death by 70% versus a placebo in non-hospitalized patients, the Swiss drug maker said on Tuesday. The shot, consisting of casirivimab and imdevimab antibodies developed by Regeneron with financial help from the U.S. government, also met all key secondary endpoints in the phase III trial with 4,567 participants, including reducing symptom duration to 10 days from 14, Roche said. Roche, which is making the drug at plants in California and which is responsible for sales outside the United States, and Regeneron are expecting hundreds of millions in sales in 2021 from the drug, including $260 million alone to the U.S. government in the first quarter. "New infections continue to rise globally with over three million reported cases last week, so this investigational antibody cocktail may offer hope as a potential new therapy to high-risk patients - particularly in light of recent evidence showing that casirivimab and imdevimab together retain activity against key emerging variants," Roche Chief Medical Officer Levi Garraway said. Reuters External Link

    Sinovac says its COVID-19 vaccine is safe for children as young as 3

    23 March- Sinovac said its COVID-19 vaccine is safe in children ages 3-17, based on preliminary data, and it has submitted the data to Chinese drug regulators. More than 70 million shots of Sinovac's vaccine have been given worldwide, including in China. China has approved its use in adults but it has not yet been used in children, because their immune systems may respond differently to the vaccine. Fox News External Link

    INFLUENZA

    CDC: Weekly U.S. Influenza Surveillance Report

    Key Updates for Week 10, ending March 13, 2021:

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

    Influenza-Associated Pediatric Mortality- No influenza-associated pediatric deaths were reported to CDC during week 10. CDC External Link

    WHO: Influenza update

    15 March 2021, based on data up to 28 February 2021:

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

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

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

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

    - In the Caribbean and Central American countries, no influenza detections were reported. Severe acute respiratory infection (SARI) activity was low in most reporting countries but increased in Jamaica.

    - In tropical South America, sporadic detections were reported in Colombia.

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

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

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

    - Worldwide, influenza A and B were detected in similar proportions. WHO External Link

    VETERINARY/FOOD SAFETY

    Children sick in Norway after drinking raw milk

    23 March- Almost 20 children in Norway have fallen sick after a farm visit that included drinking unpasteurized, raw milk. Health officials reported 17 people became ill after the farm trip, including 16 children aged 3 to 5 years old. Most were infected with Campylobacter but a few patients were also diagnosed with infections from the parasite Cryptosporidium after contact with animals. The children fell ill after the farm visit in Viken, a county in Eastern Norway, where they were served raw, unpasteurized milk as part of their packed lunch. Pasteurization kills bacteria, viruses and parasites often found in raw milk. The Norwegian Food Safety Authority (Mattilsynet) and the Norwegian Institute of Public Health (Folkehelseinstituttet) recommend that children, pregnant women, the elderly and those with weakened immune systems avoid drinking raw milk, because infections can have serious consequences for them. Food Safety News External Link

    Turkey wraps now on recall list because of Listeria fears

    22 March- MG Foods is expanding its recall of dozens of sandwiches to include three turkey wraps because of potential contamination with Listeria monocytogenes. The initial recall was March 10. The products were distributed between March 3 and March 5. They were packaged in clear plastic wedges and plastic wrap, according to a company recall notice posted by the Food and Drug Administration.  It can take up to 70 days after exposure for symptoms of Listeria infection to develop, therefore anyone who has eaten or handled any of the recalled products should monitor themselves for symptoms during the coming weeks. Some of the products are packaged under the Fresh ToYou brand. The recall covers wraps and sandwiches sold exclusively via vending machines and micro-markets in business locations in Georgia, North Carolina, South Carolina, and West Virginia. No illnesses have been reported as of the posting of the expanded recall notice. Food Safety News External Link

    WELLNESS

    Is it safe to go back to group exercise class at the gym?

    22 March- Indoor fitness classes, which often result in heavy breathing in poorly ventilated rooms, can be risky. Here's a guide to help you decide if your gym is doing enough to prevent the spread of Covid-19. Last summer, a 37-year-old fitness instructor in Hawaii taught a spin class to 10 people. He was perched on a bike in the front of the room, facing his students as he shouted instructions and encouragement. The doors and windows were closed, but three large floor fans created a breeze to keep everyone cool. As a precaution against Covid-19, all the bikes were spaced at least six feet apart. (At the time, the gym didn't require people to wear masks.) But just four hours after class, the instructor began feeling fatigued. By the morning he had chills, body aches, a cough and other respiratory symptoms. Soon, he tested positive for the coronavirus, and eventually, everyone who attended his class that day tested positive, too. The outbreak didn't stop there, though. A 46-year-old fitness instructor who attended the spin class went on to infect another 11 people during personal training sessions and kickboxing classes over the next few days, before falling ill himself and landing in intensive care. The case of the Hawaii spin instructor was alarming because of the efficiency with which the virus left his respiratory tract and swirled around the enclosed classroom, reaching every person in the room. Among epidemiologists, that's known as a 100 percent attack rate, and it's a lesson in why group fitness classes, which often encourage high-energy huffing and puffing in poorly ventilated classrooms, present such a daunting challenge to infection control. At the same time, most public health experts agree that the drop in physical activity and weight gain that many people experienced during a year of pandemic living presents another set of risks to human health, and that communities need to find a balance between infection control and allowing people to return to their favorite fitness activities. The New York Times External Link

    USAFRICOM

    Nigeria reports 30 additional confirmed Lassa fever cases

    21 March- The Nigeria Centre for Disease Control (NCDC) reported 30 confirmed Lassa fever cases the week ending March 14, bringing the country total to 191 for the year to date. These were reported from seven States (Edo, Ondo, Kaduna, Taraba, Ebonyi, Plateau and Bauchi). Officials also reported six deaths. From Jan 1 to Mar 14, 42 deaths from confirmed cases have been reported for a CFR of 22 percent. Of all confirmed cases, 79% are from Edo (46%), Ondo (24%) and Taraba (9%) States. 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

    Saudi Arabia health officials report two additional MERS cases in Riyadh

    12 March- In a follow-up report on Middle East respiratory syndrome coronavirus (MERS-CoV) situation in Saudi Arabia in 2021, on Thursday, the Saudi Arabia Ministry of Health (MOH) reported two additional cases in people from Riyadh City. The first patient is a 57-year-old man from Riyadh who had contact with camels and the second patient is a 56-year-old female from Riyadh with no contact with camels. This brings the country total of MERS cases to seven for 2021. The World Health Organization (WHO) says MERS-CoV  is a virus transferred to humans from infected dromedary camels. It is a zoonotic virus, meaning it is transmitted between animals and people, and it is contractible through direct or indirect contact with infected animals. MERS-CoV has been identified in dromedaries in several countries in the Middle East, Africa and South Asia. In total, 27 countries have reported cases since 2012, leading to 858 known deaths due to the infection and related complications. Human-to-human transmission is possible, but only a few such transmissions have been found among family members living in the same household. In health care settings, however, human-to-human transmission appears to be more frequent. Outbreak News Today External Link

    USEUCOM

    Covid: Paris lockdown as France fears third wave

    20 March- The French capital is set to go into a month-long Covid lockdown as the country fears a third wave. Some 21 million people in 16 areas of France will be placed under the measures from midnight on Friday. These measures will not be as strict as the previous lockdown, Prime Minister Jean Castex said, with people allowed to exercise outdoors. France has recorded more than 35,000 new infections within the past 24 hours. Mr. Castex said a "third wave" of infections in the country was looking increasingly likely. The situation in Paris is particularly worrying with 1,200 people in intensive care there, more than at the peak of the second wave in November, Health Minister Olivier Véran said. Under the new measures, non-essential businesses will be forced to close, but schools will remain open, along with hairdressers if they follow a "particular sanitary protocol". Government spokesman Gabriel Attal stressed there would be differences with the two earlier lockdowns and said further details would be given of which business could stay open or would have to shut. BBC News External Link

    Finland reports two CVST cases, suspends AstraZeneca vaccine use

    21 March- On Saturday, the Finnish Medicines Agency Fimea reported two cases of cerebral venous sinus thrombosis (clots in the vessels draining blood from the brain) within 4–10 days of receiving the AstraZeneca COVID-19 vaccine. Both patients had medical risk factors for blood clots, and the analysis of the cases is still incomplete. As a precautionary measure, the Finnish Institute for Health and Welfare (THL) has decided to suspend the use of the AstraZeneca vaccine in Finland until more information on the cases is available and possible causality can be determined. The suspension is effective immediately. The situation will be assessed during the coming week, and vaccinations with the AstraZeneca vaccine can continue at the earliest on March 29. THL will report on its findings without delay. Vaccinations with other vaccines will continue normally. The National Advisory Committee on Vaccines (KRAR), appointed by THL, is in favour of limiting the use of the AstraZeneca vaccine as the analysis of the cases is incomplete. In its report released on March 18, the European Medicines Agency (EMA) assesses that the benefits of the AstraZeneca COVID-19 vaccine continue to outweigh the risks of side effects. Outbreak News Today External Link

    USINDOPACOM

    China reports human H5N6 avian influenza death in Guangxi

    22 March- Hong Kong health officials are monitoring a human case of avian influenza A(H5N6) in Guangxi in southern China. The case involved a 50-year-old man living in Hechi in Guangxi. He developed symptoms on February 16, and was admitted for treatment on February 17 due to severe pneumonia. The patient passed away on March 2. From 2014 to date, 30 human cases of avian influenza A(H5N6) have been reported by China mainland health authorities. Avian influenza is caused by those influenza viruses that mainly affect birds and poultry, such as chickens or ducks. Clinical presentation of avian influenza in humans includes eye infection (conjunctivitis), flu-like symptoms (e.g. fever, cough, sore throat, muscle aches) or severe respiratory illness (e.g. chest infection). The incubation period ranges from 7 to 10 days. The more virulent forms can result in respiratory failure, multi-organ failure and even death. People mainly become infected with avian influenza virus through contact with infected birds and poultry (live or dead) or their droppings, or contact with contaminated environments (such as wet markets and live poultry markets). Human-to-human transmission is inefficient. People in close contact with poultry are more susceptible to contracting avian influenza. The elderly, children and people with chronic illness have a higher risk of developing complications such as bronchitis and chest infection. Outbreak News Today External Link

    USNORTHCOM

    U.S.: Tularemia reported in Rhode Island rabbit

    19 March- Rhode Island Health and Agriculture (DEM) officials report a New England cottontail rabbit from Patience Island that tested positive for tularemia (Francisella tularensis) recently. Located off the northwest coast of Prudence Island in Portsmouth, Patience Island is currently home to a New England cottontail rabbit (NEC) population, a candidate species for Federal Endangered Species protection. These rabbits on Patience Island have been used as a source for stocking rabbits throughout their historic range from Maine south to New York. As part of this large-scale regional effort DEM staff annually trap rabbits to move to areas throughout the region to bolster declining NEC populations. All rabbits trapped on Patience Island are given a general health evaluation. On January 27, 2021 a male NEC was captured on Patience Island to be part of a restoration. This rabbit died on February 3, 2021 in captivity while being prepared for release. The rabbit was necropsied on February 4, 2021 and a positive test for tularemia was returned on March 3, 2021. Tularemia, or rabbit fever, is a highly contagious infectious bacteria that affects humans, pets, and a wide range of wildlife species, especially rabbits, squirrels, and other rodents. It is spread by biting flies, mosquitoes, ticks, as well as contact with infected animals. Tularemia can also be spread through inhalation or ingestion of bacteria particles, and as few as 10 to 50 particles can cause an infection. Tularemia is not known to be spread person to person. Tularemia is rare and only one human case has been reported in Rhode Island since 2008. Symptoms include fever, skin ulcers and enlargement of lymph nodes. Tularemia is a treatable infection; however, if left untreated it can be fatal to humans, pets, and wildlife. Outbreak News Today External Link

    USSOUTHCOM

    Chile tightens travel restrictions as record COVID-19 cases reported

    21 March- Minister of Health, Enrique Paris announced Saturday that new restrictions for travelers will be put in place. "We are very concerned about the circulation of new strains from abroad, for which we are going to tighten some measures for travelers," said Paris. The new restrictions, which were established considering the epidemiological situation of the country and internationally, will be applicable for travelers coming from anywhere in the world, as well as there will be some additional measures for travelers coming from Brazil. The measures in place for all travelers are compliance with the mandatory 10-day quarantine, without the possibility of exemption, once they arrive in Chile; isolation in health residence for 11 days for those who have a positive PCR test within the first 14 days of entering the country, in turn, travelers who have at least one or two symptoms of COVID-19 must attend a residence until it is discarded. Regarding travelers who come from Brazil or who have been in that country during the last 14 days, they must go to a Transit Hotel and can leave only if their CRP is negative. However, 10-day quarantine compliance is mandatory. Likewise, all the costs associated with their entry must be paid by the same traveler when taking out their health passport, at the time they take their plane to Chile. Outbreak News Today External Link