1

23 February 2018

Army Public Health

Weekly Update

Army Public Health Center

US Military | Global | Influenza | VeterinaryFood Safety | Wellness | Contact Us

USAFRICOM | USCENTCOM | USEUCOM | USNORTHCOM | USPACOM | USSOUTHCOM

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Contents

US MILITARY

New Executive Order guarantees a year of mental healthcare after separation from service

Non-citizens can provide an untapped pool of military recruits experts say

The cliniciansrsquo role in building a system of care Army Behavioral Health since 2001

GLOBAL

Ethical dilemma over treating civilians injured in the battle for Mosul

Evidence-based guidelines for supportive care of patients with Ebola virus disease

Heart alert Pacemakers can be hacked new research shows

Single blood test can accurately detect Lyme Babesia and half dozen other tick-borne diseases

Studies note viral transfer doffing errors in Ebola PPE practice

Vaccine protects non-human primates against Ebola and Marburg viruses

INFLUENZA

ACIP reinstates FluMist for 2018-2019 flu season

AFHSB DoD Seasonal Influenza Surveillance Summary

APHC US Army Influenza Activity Report

CDC Flu View - Weekly US Influenza Surveillance Report

ECDC Flu News Europe

Human infection with avian influenza A(H7N4) virus ndash China

NHRC Operational Infectious Diseases - Weekly Surveillance Report

Outbreak of influenza and rhinovirus co-circulation among unvaccinated recruits US Coast

Guard Training Center Cape May NJ 24 Julyndash21 August 2016

Senate bill would jump-start universal flu vaccine efforts

USAFSAM amp DHA DoD Global Laboratory-Based Influenza Surveillance Program

WHO Influenza Update

VETERINARYFOOD SAFETY

Death toll from listeria outbreak in South Africa more than doubles to 172

FDA updates spice risk profile 7200 samples analyzed

Germany gives free rein to boar hunters to contain swine fever risk

Scientists develop a way to use a smartphone to prevent food poisoning

The Army Public Health Update is a collection of articles taken verbatim

from public sources to offer awareness of current health

issues and the media coverage given to them The articles do

not necessarily represent US Army Medical Department

opinions views policy or guidance and should not be construed or interpreted as

being endorsed by the US Army Medical Command

2

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WELLNESS

Counting calories is not the key to weight loss new study finds

DoD science blog highlights opioids research

Lead and other toxic metals found in e-cigarette lsquovaporsrsquo

Multistate outbreak of Salmonella I 4[5]12b- infections linked to kratom

Study finds link between physical fitness and brain health

Study seeks to end antidepressant debate the drugs do work

US FDA says recalls destroys certain kratom-containing dietary products

USAFRICOM

Democratic Republic of CongoUganda Diarrhea kills 26 Congolese refugees in Uganda infects

hundreds

Liberia Lassa fever

Malawi Malawi cholera cases pass 500 eight people dead

Mozambique Cholera

Nigeria Four meningococcal meningitis deaths reported in Niger State

Nigeria Nigerias Lassa fever total grows by 19 new cases

South Africa Cape Towns Day Zero moved back to July 9

USCENTCOM

Pakistan Study finds new superbug typhoid strain behind Pakistan outbreak

Saudi Arabia New Saudi MERS case linked to camels

USEUCOM

Europe WHO warns of soaring rates of measles in Europe

USNORTHCOM

US Black lung disease comes storming back in coal country

US Florida House declines debate on assault rifles calls porn a health risk

US NIOSH and NHCA present 2018 Safe-in-Sound Excellence in Hearing Loss Prevention

Awardstrade

US NIOSH study - Hearing loss prevalence in the health care and social assistance sector

US Prevalence of amyotrophic lateral sclerosis mdash United States 2014

USPACOM

Asia Another volcano just erupted in the ldquoRing of Firerdquo

China Doctors in China lead race to treat cancer by editing genes

USSOUTHCOM

South America South America records most yellow fever cases in decades

Venezuela Venezuelans report big weight losses in 2017 as hunger hits

3

Epi-tech Training

Improving your

Medical Event

Reporting Process

The next Epi-tech training

will be held

Tuesday 27 February 2018

Contact the Disease

Epidemiology Division for

more information and

registration instructions

US MILITARY

New Executive Order guarantees a year of mental

healthcare after separation from service

February 2018 - President Donald Trump has signed an executive order directing the DoD

VA and Homeland Security departments develop a plan to ensure that all new veterans

receive mental healthcare for at least one year following their separation from service The

plan that the three departments are tasked with developing must ensure that the 60 of

new veterans who currently do not qualify for enrollment in healthcare primarily due to lack

of verified service connection related to the medical issue will be able to access services for

mental health care for one year following their separation from service US Medicine

top of page

Non-citizens can provide an untapped pool of military

recruits experts say

20 February - As the Pentagon tries to increase troop numbers the military is accepting

recruits it would have rejected in years past A different option several experts say would

be to recruit troops who arent citizens hellip The military typically looks for recruits between

the ages of 18 and 30 who are physically fit have at least high school diplomas and dont

have arrest records -- the same people who are in demand in higher-paying private-sector

jobs according to Kelly Ward a professor at the National War College hellip In a 2015 paper

[Margaret] Stock and co-author Naomi Verdugo a former senior recruiting official for the

Army argues that with fewer native-born Americans looking to join the armed forces the

United States must eventually turn to its foreign-born population for military recruitment

The foreign-born population of the United States in 2015 was 432 million -- or 14 percent -

- according to the Pew Research Center That number is expected to increase and the

foreign-born population may reach 15 percent in 2025 according to the Census Bureau UPI

top of page

The cliniciansrsquo role in building a system of care Army

Behavioral Health since 2001

February 2018 - hellip The transformation of Army behavioral health care has encompassed all

aspects of the treatment system but it has been led by clinicians working at the local and

headquarters levels Although many challenges remain todayrsquos outpatient system is more

efficient and effective For example Army medical facilities are now able to meet more of

the total demand for outpatient behavioral health care of its beneficiaries 77 in

September 2017 compared with a low of 59 in January 2013 based on Army Strategic

Management System data as of December 1 2017 With a better organized outpatient

system clinicians have less frequently relied on costly and stigmatizing inpatient care

Soldiers required 40 fewer inpatient bed days in 2016 than they did in 2012 based on

4

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the Weekly Update

An Army Public Health

Weekly Update is available

with articles classified up to

the SECRET level from the

USAPHC SIPRNet site

httpphcarmysmilmil

Look under Hot Topics amp

Current Issues

To access this version you

will need a SECRET

clearance and a SIPRNet

account

Links

A-Z Index

About APHC

Army Public Health

Weekly Update Archives

Medical Surveillance

Monthly Report

Medical Threat Briefings

(AKO)

Request APHC Services

APHC Resource Materials

APHC Homepage

APHC Training

Contact APHC

Military Health System Management and Reporting Tool (M2) data as of July 1 2017

Federal Practitioner

top of page

GLOBAL

Ethical dilemma over treating civilians injured in the

battle for Mosul

16 February - Under the Geneva Conventions warring parties

are responsible for providing medical care to civilians in the

territory they control But what happens if the warring parties

dont have the will or the capacity to treat the civilian

casualties Or if they could not care less about the civilians

Thats a question that erupted in Iraq late in 2016 when the

Iraqi military launched a massive military offensive to retake the city of Mosul from ISIS hellip

The Iraqi Army was ready for the battle hellip But what the Iraqi Army lacked was a plan for

how to provide medical care to civilians who were bound to be injured during the assault hellip

The World Health Organization feared a massive humanitarian disaster So they stepped in

and tried to set up an emergency medical system to treat civilian casualties hellip WHO

proposed embedding humanitarian health-care workers with the Iraqi military hellip WHOs

plan raised serious questions about the neutrality and impartiality of humanitarian aid

groups Aid groups fear that if they appear to be working for one side in a war that they

become a legitimate target NPR

top of page

Evidence-based guidelines for supportive care of patients

with Ebola virus disease

17 February - The 2013ndash16 Ebola virus disease outbreak in west Africa was associated with

unprecedented challenges in the provision of care to patients with Ebola virus disease

including absence of pre-existing isolation and treatment facilities patients reluctance to

present for medical care and limitations in the provision of supportive medical care Case

fatality rates in west Africa were initially greater than 70 but decreased with

improvements in supportive care To inform optimal care in a future outbreak of Ebola virus

disease we employed the Grading of Recommendations Assessment Development and

Evaluation (GRADE) methodology to develop evidence-based guidelines for the delivery of

supportive care to patients admitted to Ebola treatment units Key recommendations

include administration of oral and as necessary intravenous hydration systematic

monitoring of vital signs and volume status availability of key biochemical testing adequate

staffing ratios and availability of analgesics including opioids for pain relief The Lancet

top of page

5

Heart alert Pacemakers can be hacked new research

shows

21 February - A new study is warning that pacemakers and other electrical medical devices

could be targeted by hackers for political financial or personal gain While there have been

no reports of malicious hacking or malware attacks affecting cardiac devices research hellip

shows that is indeed a possibility mdash and has been for over a decade For better protection

the Food and Drug Administration has guidelines in place for the security of medical

devices along with several legislative proposals in Congress hellip Patients with pacemakers

could be vulnerable when batteries are overworked or depleted which can lead to a device

being unable to deliver therapies during life-threatening attacks For patients with devices

that pump the heart it is possible for hackers to interrupt wireless communications

Fox News

top of page

Single blood test can accurately detect Lyme Babesia and

half dozen other tick-borne diseases

20 February - A new blood test called the Tick-Borne Disease Serochip (TBD Serochip)

promises to revolutionize the diagnosis of tick-borne disease by offering a single test to

identify and distinguish between Borrelia burgdorferi the pathogen responsible for Lyme

disease and seven other tick-borne pathogens hellip The researchers hellip sought to improve on

existing tests for tick-borne diseases (TBDs) which have limited diagnostic accuracy and

cannot test for more than one infection simultaneously hellip The TBD Serochip can

simultaneously test for the presence of antibodies in blood to more than 170000 individual

protein fragments Version 10 can identify exposure to eight tick-borne pathogens present

in the US hellip As new tick-borne infectious agents are discovered the TBD-Serochip will be

modified to target themndasha process the researchers say can be done in less than four weeks

Outbreak News Today

top of page

Studies note viral transfer doffing errors in Ebola PPE

practice

19 February - In two new studies in Clinical Infectious Diseases researchers from Georgia

assess doffing (taking off) of personal protective equipment (PPE) for Ebola disease noting

viral transfer to inner gloves and errors that could lead to contamination The first study

involved 10 healthcare workers (HCWs) experienced in Ebola care donning and doffing PPE

following biocontainment unit protocols that incorporate trained observer guidance and

alcohol-based hand rub (ABHR) After the HCWs performed a patient care task they

removed their PPE and the investigators sampled inner glove faces hands and scrubs for

virus and they also tested environmental sites using a visible fluorescent marker The

researchers found no presence of the enveloped phage (one with an outer coating) except

for low levels on the scrubs of one HCW The nonenveloped phage however was detected

6

on 2 HCWs scrubs 1 HCWs hands and 7 HCWs inner gloves Neither phage was detected

on environmental samples hellip In the second study the investigators used video to identify

errors among 11 HCWs who participated in simulations under the same conditions as the

first study They identified 51 doffing errors with hand hygiene mistakes and missteps in

removing the powered air-purifying respirator topping the list

CIDRAP News Scan (third item)

top of page

Vaccine protects non-human primates against Ebola and

Marburg viruses

21 February - A new prophylactic vaccine was immunogenic and effective against multiple

filoviruses including Ebola and Marburg in monkeys according to a study yesterday in

PLoS One The vaccine which expresses glycoproteins from Ebola virus (EBOV) Sudan virus

(SUDV) Tai Forest virus (TAFV) and Marburg virus (MARV) is being investigated as a

universal filovirus vaccine Unlike ring vaccines which have been used during filovirus

outbreaks a single-prophylactic vaccine could be introduced in childhood and offer life-

long protection hellip A multivalent filovirus vaccine would be optimal for prophylactic

administration for example of populations who are deemed to be at risk of geographical or

occupational exposure and also for aid workers and other professionals who may be called

into filovirus endemic regions the authors concluded The results from our studies

combined with clinical data indicate that a prophylactic multivalent filovirus vaccine is a

realistic goal CIDRAP News Scan (third item)

top of page

INFLUENZA

ACIP reinstates FluMist for 2018-2019 flu season

21 February - After a 2-year absence FluMist is back on the 2018-2019 influenza vaccine

schedule following a vote from the CDC Advisory Committee on Immunization Practices

(ACIP) here The panel also gave a unanimous endorsement to the Heplisav-B vaccine

against hepatitis B virus ACIP members voted 12-2 to include the live attenuated influenza

vaccine (LAIV) as an option for influenza vaccination for persons for whom it is

appropriate in the 2018-2019 influenza season MedPage Today

top of page

AFHSB DoD Seasonal Influenza Surveillance Summary

For Week 6

NORTHCOM Influenza activity continued to decrease in several states but

remained moderate to high in many states especially in the South

EUCOM Influenza activity decreased to minimal in the United Kingdom and Spain

7

but remained similar to last week for other EUCOM countries Italy continued to

have moderate activity

PACOM Influenza activity in PACOM continued to vary by country but remained

high in the Republic of Korea during week 06

CENTCOM and AFRICOM Influenza activity decreased to moderate in Afghanistan

and remained minimal in other CENTCOM locations with available data

SOUTHCOM Influenza activity remained minimal in Honduras for week 06

DHA -Armed Forces Health Surveillance Branch

top of page

APHC US Army Influenza Activity Report

For the week ending 10 February 2018 (week 6)

The overall number of specimens submitted continues to decrease in week 6 however the

number of influenza-associated hospitalizations remains relatively steady in the non-AD

population The number of hospitalizations this season is 205 higher than the same time

last season with 125 so far reported this season compared to 41 reported this time last

season Although the number of influenza A positive specimens has decreased by 14 since

last week the number of positive influenza B specimens has remained steady It is possible

to become ill with the flu more than once in a flu season given the many strains circulating

throughout the population Therefore recommendations are still in place to take personal

precautions to avoid getting sick and plan for several more weeks of flu season APHC

top of page

CDC Flu View - Weekly US Influenza Surveillance

Report

During week 6 (February 4-10 2018) influenza activity remained elevated in the United

States

Viral Surveillance The most frequently identified influenza virus subtype reported

by public health laboratories during week 6 was influenza A(H3) The percentage of

respiratory specimens testing positive for influenza in clinical laboratories remained

elevated

Pneumonia and Influenza Mortality The proportion of deaths attributed to

pneumonia and influenza (PampI) was above the system-specific epidemic threshold

in the National Center for Health Statistics (NCHS) Mortality Surveillance System

Influenza-associated Pediatric Deaths Twenty-two influenza-associated pediatric

deaths were reported CDC

top of page

ECDC Flu News Europe

Week 62018 (5-11 February 2018)

Influenza activity was widespread in the majority of reporting countries

8

Both influenza virus types A and B were co-circulating with a higher proportion of

type B viruses Different proportions of circulating influenza virus types and A

subtypes were observed between countries

Of the individuals sampled on presenting with ILI or ARI to sentinel primary

healthcare sites 51 tested positive for influenza viruses The detection rate

decreased compared to the previous week (55)

The majority of severe cases reported this season are due to influenza B and occur

in persons above the age of 15 years In confirmed influenza cases in ICU similar

numbers of cases were infected with influenza A or influenza B In laboratory

confirmed cases reported in wards other than ICU influenza B was detected

approximately twice as frequently as influenza A and mainly in the gt65 age group

WHO is convening the Vaccine Composition Meeting on 19ndash21 February to decide

on the composition of the 2018ndash2019 Northern hemisphere vaccine

European Center for Disease Prevention and ControlWHO

top of page

Human infection with avian influenza A(H7N4) virus ndash

China

22 February - On 14 February 2018 the National Health and Family Planning Commission

(NHFPC) of China notified the World Health Organization (WHO) of one case of human

infection with avian influenza A(H7N4) virus This is the first human case of avian influenza

A(H7N4) infection to be reported worldwide The case-patient was a 68-year-old woman

from Jiangsu Province with pre-existing coronary heart disease and hypertension and she

developed symptoms on 25 December 2017 Seven days later she was admitted to a local

hospital for treatment of severe pneumonia and was discharged after 21 days On 12

February the Chinese Center for Disease Control and Prevention (China CDC) confirmed

that the case-patientrsquos samples were positive for avian influenza A(H7N4) The case-

patient had reported a history of exposure to live poultry before onset of symptoms WHO

top of page

NHRC Operational Infectious Diseases - Weekly

Surveillance Report

15 February - Febrile respiratory illness cases

Military Recruits - 44 positive of 63 tested

CDC Border Infectious Disease Surveillance and Zika Surveillance - 121 positive of

201 tested

DoD Beneficiaries ndash 19 positive of 33 tested Naval Health Research Center

top of page

9

Outbreak of influenza and rhinovirus co-circulation

among unvaccinated recruits US Coast Guard Training

Center Cape May NJ 24 Julyndash21 August 2016

January 2018 - Military and Coast Guard recruits are particularly susceptible to respiratory

infections Although seasonal influenza vaccinations are mandatory for recruits the vaccine

expires annually in June On 29 July 2016 the US Coast Guard Training Center Cape May

NJ identified an increase in febrile respiratory illness (FRI) among recruits During 24 Julyndash21

August a total of 115 recruits reported symptoms A total of 74 recruits tested positive for

respiratory infections influenza A (H3) (n=34) rhinovirus (n=28) influenzarhinovirus co-

infection (n=11) and adenovirusrhinovirus co-infection (n=1) while 41 recruits had no

laboratory-confirmed specimen but were considered suspected cases Only one recruit

reported receiving the seasonal influenza vaccine within the previous 12 months Influenza

predominated during 24 Julyndash6 August whereas rhinovirus predominated during 7 Augustndash

20 August Medical Surveillance Monthly Report

top of page

Senate bill would jump-start universal flu vaccine efforts

19 February - hellip [A] group of US senators last week unveiled a proposal to invest $1 billion

in research over the next 5 years to create a universal flu vaccine that would provide lifetime

protection against a range of influenza strains hellip The [Ed] Markey press release pointed to

the mounting number deaths and hospitalizations this season plus the toll the disease

takes on the nations pocketbook and workforce The flu costs the nation $104 billion in

direct medical costs annually and $87 billion in total economic burden yet our current

investment is significantly lacking it said CIDRAP

top of page

USAFSAM amp DHA DoD Global Laboratory-Based

Influenza Surveillance Program

During 28 January - 10 February 2018 (Surveillance Weeks 5 amp 6 a total of 1616

specimens were collected and received from 68 locations Results were finalized for

1361 specimens from 67 locations The percent influenza positive for Week 5 and 6

were 45 and 42 respectively The influenza percent positive for the season is

approximately 36

Canadarsquos Sentinel Practitioner Surveillance Network (SPSN) has released their

interim 2017-2018 vaccine estimate (VE) report for influenza A(H3N2) and influenza

B hellip The overall adjusted VE was 42 while VE against influenza A(H3N2) and

influenza B were 17 and 55 respectively

US Air Force School of Aerospace Medicine amp Defense Health Agency

top of page

10

WHO Influenza Update

19 February - Influenza activity remained high in the temperate zone of the northern

hemisphere while in the temperate zone of the southern hemisphere activity was at inter-

seasonal levels Worldwide influenza A accounted still for the majority of influenza

detections but influenza B (mostly B-Yamagata lineage) increased in recent weeks

Up to now the majority of countries which are in the influenza season reported influenza-

like illness reaching moderate levels in comparison with previous years with few reaching

levels exceeding those of previous years Some countries however have reported levels of

hospitalization and ICU admissions reaching or exceeding peak levels of previous influenza

seasons WHO

top of page

VETERINARYFOOD SAFETY

Death toll from listeria outbreak in South Africa more

than doubles to 172

22 February - The death toll from an outbreak of the food-borne disease listeria in South

Africa has more than doubled from previous numbers given in January to 172 deaths the

government said on Thursday The National Institute of Communicable Diseases (NICD) said

915 cases of the disease have been confirmed since January last year up from the previous

figures given last month of 61 deaths and 720 confirmed outbreaks The government said

the source of the outbreak was still unknown Reuters

top of page

FDA updates spice risk profile 7200 samples analyzed

21 February - hellip Earlier this month the FDA announced the availability of an updated risk

profile on pathogens and filth in spice The 2017 Risk Profile Pathogens and Filth in Spices

(2017) includes data from an FDA survey that evaluated Salmonella prevalence and aerobic

plate counts in packaged dried spices offered for sale at retail establishments in the US The

survey showed that the prevalence of Salmonella in nine out of 11 types of retail spices in

the US was significantly lower than that for shipments of spices at import according to a

summary published by the National Law Review The findings from the study were based on

more than 7000 retail samples of 11 different spice types that were collected November

2013-September 2014 and October 2014-March 2015 The FDA pointed out that the

findings from its recently published survey are consistent with public comments from the

domestic food industry stating that responsible manufacturers apply a pathogen reduction

treatment to many spices after they enter the US but prior to retail sale Food Safety News

top of page

11

Germany gives free rein to boar hunters to contain swine

fever risk

21 February - Germany issued a decree on Wednesday to allow hunters to shoot wild boar

year-round to stop the animals which can carry African swine fever from passing the

deadly infection on to farm pigs While no case has yet been detected in Germanyrsquos wild

boar population the spread of the disease in eastern Europe is causing immense concern in

Germany whose pork industry has seen huge growth in exports to countries including

China A government spokesman said the cabinetrsquos decision was taken to bring about a

ldquosignificant reductionrdquo in the wild boar population and contain the risk of farm pigs being

infected Reuters

top of page

Scientists develop a way to use a smartphone to prevent

food poisoning

19 February - Food scientists at the University of Massachusetts

Amherst have come up with a technique they say could make it

a lot easier to avoid food poisoning The main piece of

equipment Your smartphone hellip and a smartphone app that

uses a $30 microscope attachment The device works in

conjunction with a chemically-coated chip that binds to

bacteria even in tiny amounts Dipping the chip into contaminated water for half an hour

will reveal bacteria as Adam Salhaney an undergraduate in Hes lab demonstrated You

can take this microscope attachment for any smart phone Salhaney said hellip and you can

clip it right onto the camera After pointing the microscope at a gold chip theyd coated

with salmonella Salhaney enlarged an image with a number of black dots set against the

gold background of the chip The dots were bacteria hellip They hope consumers will

eventually buy the testing kit for their own kitchens It could also prove useful after natural

disasters to test drinking water NPR

top of page

WELLNESS

Counting calories is not the key to weight loss new study

finds

20 February - hellip [A] new study hellip found that people who cut back on added sugar refined

grains and highly processed foods while concentrating on eating plenty of vegetables and

whole foods mdash without worrying about counting calories or limiting portion sizes mdash lost

significant amounts of weight over the course of a year The strategy worked for people

whether they followed diets that were mostly low in fat or mostly low in carbohydrates And

12

their success did not appear to be influenced by their genetics a finding that casts doubt on

the increasingly popular idea that different diets should be recommended to people based

on their DNA makeup The research lends strong support to the notion that diet quality not

quantity is what helps people lose and manage their weight most easily in the long run

The New York Times

top of page

DoD science blog highlights opioids research

21 February - The US Department of Defense Science Blog featured an article Feb 16 that

highlights opioids research by Michael Feasel PhD of the Armys Edgewood Chemical

Biological Center with support from the Defense Threat Reduction hellip trying to determine

how to treat exposure to carfentanil an especially powerful opioid that poses a risk to both

civilians and warfighters according to the article The drug naloxone can reverse the

effects of the narcotic but carfentanil is so potent that larger doses of naloxone may be

required to counter its effects hellip Higher-potency versions of naloxone are available

however the Food and Drug Administration has not seen a need to get them approved for

human use until now These ultra-potent opioid exposures are not only a chemical defense

issue but they are also a public health issue Feasel says in the article

Occupational Health and Safety

top of page

Lead and other toxic metals found in e-cigarette lsquovaporsrsquo

21 February - Significant amounts of toxic metals including lead leak from some e-

cigarette heating coils and are present in the aerosols inhaled by users hellip In the study

published online in Environmental Health Perspectives on February 21 the scientists

examined e-cigarette devices owned by a sample of 56 users They found that significant

numbers of the devices generated aerosols with potentially unsafe levels of lead chromium

manganese andor nickel Chronic inhalation of these metals has been linked to lung liver

immune cardiovascular and brain damage and even cancers The Food and Drug

Administration has the authority to regulate e-cigarettes but is still considering how to do

so Johns Hopkins Bloomberg School of Public Health News

top of page

Multistate outbreak of Salmonella I 4[5]12b-

infections linked to kratom

20 February - As of February 16 2018 28 people infected with the outbreak strain of

Salmonella I 4[5]12b- have been reported from 20 states hellip [Whole genome sequencing

(WGS)] performed on isolates from ill people were closely relatedly genetically This means

that people in this outbreak are more likely to share a common source of infection As of

February 16 2018 28 people infected with the outbreak strain of Salmonella I 4[5]12b-

have been reported from 20 states hellip Epidemiologic evidence indicates that kratom is a

likely source of this multistate outbreak Kratom is a plant consumed for its stimulant effects

13

and as an opioid substitute Kratom is also known as Thang Kakuam Thom Ketom and

Biak CDC recommends that people not consume kratom in any form The investigation

indicates that kratom products could be contaminated with Salmonella and could make

people sick hellip hellip At this time CDC recommends that people not consume kratom in any

form CDC

top of page

Study finds link between physical fitness and brain

health

20 February - A new study adds evidence to the argument that

exercise can help preserve brain health particularly in the aging

brain Unlike many studies that look for a connection

between exercise and brain health this one [tested] the

participantsrsquo maximum oxygen consumption during aerobic

exercise (known as the V02 max test The study included 81

participants [T]heir brains were examined with a type of brain scan called diffusion tensor

imaging (DTI) that reveals the health of the brainrsquos white matter hellip The first [result] was that

lower levels of aerobic fitness hellip were linked with weaker white matter in certain parts of the

MCI participantsrsquo brains hellip The second result was that the MCI participants with lower

aerobic fitness and weaker white matter also performed worse on the memory and

reasoning tests Taken together the results suggest that greater physical fitness correlates

with healthier white matter which in turn correlates with better memory and reasoning

abilities even for those already suffering from a level of cognitive impairment Forbes

top of page

Study seeks to end antidepressant debate the drugs do

work

21 February - A vast research study that sought to settle a long-standing debate about

whether or not anti-depressant drugs really work has found they are indeed effective in

relieving acute depression in adults The international study - a meta-analysis pooling

results of 522 trials covering 21 commonly-used antidepressants and almost 120000

patients - uncovered a range of outcomes with some drugs proving more effective than

others and some having fewer side effects But all 21 drugs - including both off-patent

generic and newer patented drugs - were more effective than placebos or dummy pills the

results showed Reuters

top of page

US FDA says recalls destroys certain kratom-

containing dietary products

21 February - The US Food and Drug Administration on Wednesday said it recalled and

destroyed a large volume of kratom-containing dietary supplements made by a company in

14

Missouri Kratom is a natural plant grown in parts of Asia that advocates say can help ease

pain and reduce symptoms of opioid withdrawal but which critics say can lead to addiction

and death The FDA has long been skeptical of the benefits of kratom having placed import

alerts on the substance in 2012 and 2014 There are currently no FDA-approved therapeutic

uses of kratom The regulator has earlier said it was aware of 36 deaths associated with the

plant however declined to say over what period the deaths occurred The regulator said it is

recalling all kratom-containing dietary supplements distributed under the brand names

Botany Bay Enhance Your Life and Divinity The brands are manufactured by Divinity

Products Distribution of Grain Valley Missouri Reuters

top of page

USAFRICOM

Democratic Republic of CongoUganda Diarrhea kills 26

Congolese refugees in Uganda infects hundreds

22 February - Twenty-six refugees from the Democratic Republic of Congo have died in a

camp in Uganda from acute diarrhea and hundreds more cases have been registered an

official from the United Nations refugee agency UNHCR said on Thursday The East African

countryrsquos refugee population has risen sharply recently as people flood in from eastern

Congo where resurgent ethnic and inter-communal violence has uprooted hundreds of

thousands Duniya Aslam Khan spokeswoman for the UNHCR in Uganda said health

workers from the World Health Organisation UN childrenrsquos fund UNICEF and Medecins

Sans Frontieres had identified ldquoacute watery diarrheardquo in camps in western Uganda She said

the condition had already killed 26 refugees from Feb 15 to 19 while 424 cases were being

treated Reuters

top of page

Liberia Lassa fever

22 February - On 9 January 2018 a patient from Guinea with fever neck pain body pain and

vomiting was admitted to a hospital in Ganta in Nimba County Liberia The patient was

treated with Ribavirin until her death on 11 January 2018 Prior to hospitalization in

Liberia she sought medical care at a health facility in hellip Guinea where she was treated for

typhoid and malaria On 10 January 2018 a specimen was collected and tested positive for

Lassa Lassa fever is endemic in Liberia From 1 January 2017 through 23 January 2018 91

suspected cases were reported from six counties WHO

top of page

Malawi Malawi cholera cases pass 500 eight people

dead

19 February - Cholera cases in Malawi have tripled and four more people have died the

Ministry of Health said on Monday a month after the spread of the disease from Zambia

15

was thought to have been contained Ministry of Health spokesman Joshua Malango said

the number of cases had increased to 527 from 157 recorded in January and that deaths

had doubled from four to eight He said new cases continued to emerge in Central and

Northern Malawi districts including the administrative capital Lilongwe where 10 new cases

were recorded at the weekend Reuters

top of page

Mozambique Cholera 19 February - On 27 October 2017 the Ministry of Health in Mozambique notified WHO of

an outbreak of cholera From 14 August 2017 through 11 February 2018 1799 cases and

one death (case fatality rate = 006) of cholera were reported from the two provinces

Nampula (1580 cases) and Cabo Delgado (219 cases) Underreporting of the number of

cases and deaths is likely hellip Case incidence peaked in mid-November with 252 cases

reported in one week this peak was followed by a rapid decrease in reported cases A slow

increase in the number of cases reported has been observed since late December 2017 hellip In

2018 so far the weekly number of cases have fluctuated between 30 and 60 cases WHO

top of page

Nigeria Four meningococcal meningitis deaths reported

in Niger State

22 February - According to Nigerian health authorities yesterday 31 meningitis C cases

were reported in Niger State including four fatalities local media reports Health

Commissioner Dr Mustapha Jibril said the cases were reported in two councilsndashMagama

(27 cases) and Katcha (4) The health ministry has activated all outbreak response

mechanisms Jibril also noted that there could be a more severe outbreak and higher

mortality rate due to the intensely hot weather Cerebrospinal meningitis outbreaks usually

occur in the dry season due to low humidity and dusty conditions and end with the onset of

the rainy season Outbreak News Today

top of page

Nigeria Nigerias Lassa fever total grows by 19 new cases

20 February - The World Health Organization (WHO) Regional Office for Africa said there

were 19 new cases including 6 deaths reported last week during Nigerias ongoing Lassa

fever outbreak Between Jan 1 and Feb 11 of this year there have been 615 suspected Lassa

fever cases and 57 deaths with a case-fatality rate of 93 Of the suspected cases 193

have been confirmed of which 47 were fatal In confirmed cases the case-fatality rate is

239 Though Lassa fever is usually transmitted to humans by rats 14 health care workers

have contracted the disease from sick patients during this outbreak Four of the health care

worked have died Lassa fever is endemic in Nigeria but this outbreak is unusually large in

size the WHO said The virus which can cause hemorrhagic symptoms that mimic Ebola is

spread through contact with infected rats or via the bodily fluids of an infected person

CIDRAP News Scan (third item)

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16

South Africa Cape Towns Day Zero moved back to

July 9

21 February - Residents of the South African city of Cape Town are breathing a little easier

as city officials have moved back Day Zero when municipal drinking water supplies would

be largely turned off to July 9 It had been April 12 as of last month but water conservation

by the residents has slowed the decline of key reservoirs Alderman Ian Neilson the citys

executive deputy mayor wrote in a statement titled Defeating Day Zero is in sight if we

sustain our water-saving efforts Occupational Health and Safety

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USCENTCOM

Pakistan Study finds new superbug typhoid strain

behind Pakistan outbreak

20 February - An outbreak of typhoid fever in Pakistan is being caused by an extensively

drug resistant ldquosuperbugrdquo strain a sign that treatment options for the bacterial disease are

running out scientists said on Tuesday Researchers from Britainrsquos Wellcome Sanger

Institute who analyzed the genetics of the typhoid strain found it had mutated and acquired

an extra piece of DNA to become resistant to multiple antibiotics An outbreak of drug-

resistant typhoid that began in Hyderabad in Pakistan in November 2016 is still spreading

according to experts from Aga Khan University who worked with the Sanger team hellip The

researcher found the bacterial strain causing the outbreak is now resistant to five antibiotics

in total more than seen in any outbreak before Reuters

top of page

Saudi Arabia New Saudi MERS case linked to camels

19 February - The Saudi Arabian Ministry of Health (MOH) confirmed one new case of

MERS-CoV on Feb 17 The MOH has issued only sporadic updates this month and this is the

second update in 3 weeks A 74-year-old Saudi woman from Rafha was diagnosed as having

MERS-CoV (Middle East respiratory syndrome coronavirus) She is in stable condition The

probable source of her infection is indirect contact with camels a likely risk factor for the

virus The new case brings Saudi Arabias MERS totals since 2012 to 1796 including 731

deaths Five people are still being treated for their infections the MOH said

CIDRAP News Scan (first item)

top of page

17

USEUCOM

Europe WHO warns of soaring rates of measles in

Europe

20 February - Europe has seen a big surge in measles cases in 2017 which the World Health

Organization says is a tragedy after a record low of 5273 cases in 2016 Cases increased

four-fold with more than 20000 people affected and 35 deaths Fifteen European region

countries including the UK had large outbreaks Measles cases were highest in Romania

Italy and Ukraine People shunning vaccination is part of the problem say experts hellip The

WHO says there have been declines in overall routine immunisation coverage as well as

consistently low coverage among some marginalised groups and interruptions in vaccine

supply or underperforming disease surveillance systems BBC News

top of page

USNORTHCOM

US Black lung disease comes storming back in coal

country

22 February - Federal investigators this month identified the largest cluster of advanced

black lung cases ever officially recorded More than 400 coal miners frequenting three

clinics in southwestern Virginia between 2013 and 2017 were found to have complicated

black lung disease an extreme form characterized by dense masses of scar tissue in the

lungs The cluster hellip adds to a growing body of evidence that a new black lung epidemic is

emerging in central Appalachia hellip Scientists have linked the new wave of lung disease to

miners breathing in more silica dust the likely result of a decades-long shift toward mining

thinner coal seams that require cutting into the surrounding rock Silica dust from

pulverized rock can damage lungs faster than coal dust alone The New York Times

top of page

US Florida House declines debate on assault rifles

calls porn a health risk

21 February - As high school students who survived the shooting in Parkland Fla travel to

the state Capitol to demand action on guns lawmakers offered a glimpse of the battle they

face In Tuesdays session which opened with prayer for the community of Marjory

Stoneman Douglas High School where 17 students and staff were killed last week Florida

House lawmakers declined to open debate on a bill that would ban assault weapons and

large-capacity ammunition magazines The motion to debate the bill introduced by a

Democrat required a two-thirds vote and failed Thirty-six lawmakers supported it while 71

18

voted no Its merits were not considered

In that same session lawmakers supported a bill that declares pornography a public health

risk That bill recognizes public health risk created by pornography amp acknowledges need

for education prevention research amp policy change to protect citizens of this state NPR

top of page

US NIOSH and NHCA present 2018 Safe-in-Sound

Excellence in Hearing Loss Prevention Awardstrade

15 February - The National Institute for Occupational Safety and Health (NIOSH) in

partnership with the National Hearing Conservation Association (NHCA) is pleased to

announce the US Armyrsquos Tactical Communications and Protective System (TCAPS) as the

recipient of the 2018 Safe-in-Sound Excellence in Hearing Loss Prevention Awardtrade hellip Safe-

in-Sound awards honor those that have contributed to the prevention of noise-induced

hearing loss and tinnitus through effective practices or innovations directed to those who

are exposed to noise at work This yearrsquos award recognizes the US Armyrsquos TCAPS system for

being successful in obtaining authority to evaluate and procure commercial off the shelf

Hearing Protection Devices (HPDs) to designated Dismounted Infantry Soldiers The

program developed new and innovative procedures to procure test deliver and train users

on new active hearing protection devices The success of the TCAPS program represents a

recognition by the Army of the importance of hearing protection and communication

among the force NIOSH

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US NIOSH study - Hearing loss prevalence in the

health care and social assistance sector

20 February - A new study from the National Institute for Occupational Safety and Health

(NIOSH) breaks down the prevalence of hearing loss experienced by workers in the Health

Care and Social Assistance (HSA) sector The overall prevalence of hearing loss among

noise-exposed exposed workers was found to be 19 while some subsectors within the

HSA had up to 31 prevalence of hearing loss hellip Hearing loss is the third most common

chronic physical condition in the United States Although a smaller percentage of workers in

the Health Care and Social Assistance sector are exposed to hazardous noise ndash unlike

industries like Mining or Construction ndashNIOSH researchers found that some subsectors in

the HSA had higher than expected prevalences of hearing loss for an industry that has had

assumed ldquolow-exposurerdquo to noise hellip Most of the HSA subsector prevalence estimates

ranged from 14 to 18 but the Medical and Diagnostic Laboratories subsector had 31

prevalence and the Offices of All Other Miscellaneous Health Practitioners had a 24

prevalence The Child Day Care Services subsector also had a 52 higher risk than the

reference industry NIOSH

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19

US Prevalence of amyotrophic lateral sclerosis mdash

United States 2014

23 February - hellip Amyotrophic lateral sclerosis (ALS) commonly known as Lou Gehrigrsquos

disease is a progressive and fatal neuromuscular disease Familial ALS a hereditary form of

the disease accounts for 5ndash10 of cases the remaining sporadic cases have no clearly

defined etiology A total of 15927 persons were identified as having definite ALS across

three national databases (Medicare Veterans Health Administration and Veterans Benefits

Administration) and through web portal registration for 2014 The estimated ALS prevalence

for 2014 was 50 cases per 100000 population the same as 2013 estimate

Morbidity and Mortality Weekly Report

top of page

USPACOM

Asia Another volcano just erupted in the ldquoRing of Firerdquo

19 February - A massive column of smoke and ash shot nearly

10 miles into the sky above Sumatra Monday morning as

Mount Sinabung one of three currently active volcanos in

Indonesia began erupting Itrsquos the latest rumble in whatrsquos

already been a very rowdy couple of months along the Ring

of Fire the geological region that follows the 25000-mile

perimeter of the Pacific Ocean hellip No fatalities or injuries were reported after Mondayrsquos

eruption Over in the Philippines Mount Mayon which began erupting on January 13 and

forced 75000 to flee saw another eruption of ash and lava on Monday Mount Kusatsu-

Shirane 100 miles northwest of Tokyo also erupted in January leaving one soldier dead in

an avalanche and injured a dozen at a ski resort Indonesiarsquos Mount Agung which has been

spewing ash since November also had four distinct eruptions MSNcom

top of page

China Doctors in China lead race to treat cancer by

editing genes

21 February - hellip China is starting to pull ahead of other parts of the world mdash maybe for the

time mdash in regards to biomedicine says Hallam Stevens an anthropologist at the Nanyang

Technological University in Singapore who studies Chinese bioscience Theyve been really

investing heavily in it over the last couple of decades and its starting to pay off in a big

way The treatment [Shixiu] Wu is testing involves taking a sample of blood from each

patient A lab at a biotech company two hours away by bullet train extracts T cells from the

blood Scientists then use CRISPR to knock out a gene in the T cells known as PD-1 This

engineering feat modifies the T cells so that they zero in on and attack the cancer cells

20

once theyre infused back into each patient hellip Its still too early to draw firm conclusions

about how effective the treatment will be or what the full extent of side effects from it

Deng is one of just 21 patients with advanced incurable cancer of the esophagus that Wu

has treated so far with CRISPR-edited T cells But Wu says about 40 percent of the patients

appear to have responded One patient is still alive almost a year later NPR

top of page

USSOUTHCOM

South America South America records most yellow fever

cases in decades

19 February - A new report from the Pan American Health Organization (PAHO) documents

yellow fever cases in animals and humans from January 2016 through January 2018 in South

America showing the most cases reported in decades Seven countriesmdashBolivia Brazil

Colombia Ecuador French Guiana Peru and Surinamemdashreported yellow fever activity in

the last 2 years with Brazil hosting the majority of cases since that country began

experiencing the current outbreak at the end of 2016 Only Brazil and Peru have reported

cases in 2018 As noted in the Feb 16 report Brazils Ministry of Health confirmed 941

human cases since Jul 1 2016 which includes 284 deaths Sao Paulo Minas Gerais and Rio

de Janeiro have reported the most cases All confirmed cases correspond to areas with

documented epizootic cases in non-human primates PAHO said CIDRAP

top of page

Venezuela Venezuelans report big weight losses in 2017

as hunger hits

21 February - Venezuelans reported losing on average 11 kilograms (24 lbs) in body weight

last year and almost 90 percent now live in poverty according to a new university study on

the impact of a devastating economic crisis and food shortages The annual survey

published on Wednesday by three universities is one of the most closely-followed

assessments of Venezuelansrsquo well-being amid a government information vacuum and shows

a steady rise in poverty and hunger in recent years Over 60 percent of Venezuelans

surveyed said that during the previous three months they had woken up hungry because

they did not have enough money to buy food About a quarter of the population was eating

two or less meals a day the study showed Reuters

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21

US Military | Global | Influenza | VeterinaryFood Safety | Wellness | Contact Us

USAFRICOM | USCENTCOM | USEUCOM | USNORTHCOM | USPACOM | USSOUTHCOM

The Army Public Health Weekly Update does not analyze the information as to its strategic or tactical impact on the US Army and is not a medical

intelligence product Medical intelligence is available from the National Center for Medical Intelligence

External Links The appearance of external hyperlinks does not constitute endorsement by the US Army of this Web site or the information products

or services contained therein For other than authorized activities such as military exchanges and MWR sites the US Army does not exercise any

editorial control over the information you may find at these locations Such links are provided consistent with the stated purpose of this product

Although we avoid links to sites that may be blocked all sites may not be accessible from all locations While we verify the links at the time of

publication we cannot guarantee that they will be active in the future

Articles appearing in the Update do not necessarily represent US Army Medical Command opinionsviews policy or guidance and should not be

construed or interpreted as being endorsed by the US Army Medical Command

The Army Public Health Weekly Update is published by the Public Health Information Directorate Army Public Health Center