RABIES - SYRIA: REQUEST FOR INFORMATION
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Date: Thu 28 Mar 2013
Source: Global Alliance for Rabies Control [edited]
http://www.rabiescontrol.net/news/news- ... s-day.html
In some provinces in Syria, rabies is an increasing concern in a deteriorating political climate. This year [2013], Spana-Syria conducted a campaign of free dog vaccination at its premises in the Faculty of Veterinary Medicine, Al Baath University, Hama, vaccinating strays as well as owned dogs.
Over 1000 animals were vaccinated. The group also raised awareness about the dangers of rabies by distributing posters and leaflets and an illustrated story for children. Professor Darem Tabbaa, Director of Spana-Syria, said that the information they distributed helped healthcare personnel, policy makers, scientists, school teachers and students, small children and villagers to be more aware of the risk of dog bites and the dangers of rabies.
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[There is little doubt that rabies circulation in animals, especially dogs, is increasing in Syria, with an expected increased risk of rabies in the human population too.
Rabies in dogs seems widespread, as is apparent from information gathered on the Israeli side of the Syrian border (David D. et al. Emergence of dog rabies in the northern region of Israel. Epidemiol Infect. 2009;137:544-8).
A map of lab-confirmed rabies cases in Israel, 2012, shows that almost all rabid dogs were found close to the border with Syria http://www.agri.huji.ac.il/~yakobson/ra ... a2012.html.
The following information on rabies in dogs in Syria was found via the OIE WAHID interface (http://www.oie.int/wahis_2/public/wahid ... lsituation):
2005 - 16 outbreaks 21 dogs
2006 - 2008 no data available
2009 - 2 outbreaks, 6 dogs
2010 - 4 outbreaks, 3 cattle, 2 dogs
2011 - 7 outbreaks, 6 dogs, 6 cattle
2012 - 4 outbreaks, 9 dogs
During the 4 years of 2008-2011, 16 human cases were reported to the OIE; data for 2012 are not yet available. - Mods.AS,EP
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/3aLZ.]
Aktuelle Epidemien im Nahen und Mittleren Osten
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Leishmaniasen in der Türkei ex Syrien
LEISHMANIASIS - SYRIA (03): TURKEY ex SYRIA
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Date: Tue 9 Apr 2013
Source: PRWeb [edited]
http://www.prweb.com/releases/uossm-med ... 613745.htm
UOSSM [Union of Syrian Medical Relief Organizations] calls on the World Health organization (WHO) and the international medical agencies to assist the local health care providers and public health centers inside Syria and on the Turkish border in treating the escalating number of leishmania in Northern Syria, and to support the local health centers in their efforts to control the spread of the disease. According to Today's Zaman, "Approximately 100 000 people have been infected with the leishmaniasis in the past 2 years after civil war broke out in Syria, compared with before the conflict when the number of cases in Syria had been reduced to 3000-4000."
The increase in the number of cases of _Leishmania_ in Turkey, impose an additional dimension to the crisis, making the outbreak on the verge of being regional public health crisis "The increase in the number of patients suffering from the disease is alarming not only for Syria but for Turkey as well since leishmaniasis has also reached Turkey" (http://www.todayszaman.com/news-310925- ... order.html).
According to WHO, leishmaniasis is a poverty-related disease, and is associated with malnutrition, displacement, poor housing, illiteracy, gender discrimination, weakness of the immune system, and lack of resources. Leishmaniasis is also linked to environmental changes (http://www.who.int/leishmaniasis/burden ... index.html).
Mr Daher Zidan, pharmacist and project manager in UOSSM, has been working on the collecting and analyzing data, said, "The sharp increase in the number of reported cases of leishmaniasis in Aleppo and Idlib provinces, denotes the re-emerging of the disease, that is directly linked to the extensive annihilation of public health infrastructure, and the abandonment of Syrian local authorities from municipal maintenance and services." Added that, "The majority of those cases were reported in areas that are heavily affected by the conflict, and areas with high poverty and inaccessibility to good sanitation, due to water shortage and garbage build up that amplifies the growth of the sand fly." Mr Zidan briefly stated the major recommendation to control the spread of _Leishmania_, " As transmission involves sand fly bites to human and injection of the protozoal parasite, this makes our major priority the elimination of this fly, in addition to implementing other preventive and control measures. This is beside an extensive treatment and creation of specialized centers to control leishmaniasis."
The UOSSM has initiated a well-organized program directed to treat the old and new cases of leishmaniasis, and coordinate the local municipal services for better spray and application of insecticide to get rid of the sand fly. The UOSSM has estimated that the budget needed to treat and control leishmaniasis is about [USD] 180 000, and urges the WHO and International medical and humanitarian organizations to contribute, in order to eradicate _Leishmania_ from the region.
UOSSM views the _Leishmania_ outbreak as a regional public health crisis that necessitates collaborative efforts between local and international public health providers.
The UOSSM is a coalition of humanitarian, non-governmental, and independent organizations, created following the deadly events in Syria, to provide medical and humanitarian aid to Syrians. UOSSM was established by 14 medical and relief organizations, and includes hundreds of physicians of mainly Syrian origin distributed in the United States, Canada, Europe, and in different Arab countries.
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[It is no surprise that the number of cases increase and that the infection is spreading into Turkey with the flow of refugees. Leishmaniasis will also be seen in refugees in Jordan and Lebanon. Children are particularly vulnerable. ProMED-mail follows the outbreak closely and will be happy to received further information. - Mod.EP
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/3aLZ.]
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Date: Tue 9 Apr 2013
Source: PRWeb [edited]
http://www.prweb.com/releases/uossm-med ... 613745.htm
UOSSM [Union of Syrian Medical Relief Organizations] calls on the World Health organization (WHO) and the international medical agencies to assist the local health care providers and public health centers inside Syria and on the Turkish border in treating the escalating number of leishmania in Northern Syria, and to support the local health centers in their efforts to control the spread of the disease. According to Today's Zaman, "Approximately 100 000 people have been infected with the leishmaniasis in the past 2 years after civil war broke out in Syria, compared with before the conflict when the number of cases in Syria had been reduced to 3000-4000."
The increase in the number of cases of _Leishmania_ in Turkey, impose an additional dimension to the crisis, making the outbreak on the verge of being regional public health crisis "The increase in the number of patients suffering from the disease is alarming not only for Syria but for Turkey as well since leishmaniasis has also reached Turkey" (http://www.todayszaman.com/news-310925- ... order.html).
According to WHO, leishmaniasis is a poverty-related disease, and is associated with malnutrition, displacement, poor housing, illiteracy, gender discrimination, weakness of the immune system, and lack of resources. Leishmaniasis is also linked to environmental changes (http://www.who.int/leishmaniasis/burden ... index.html).
Mr Daher Zidan, pharmacist and project manager in UOSSM, has been working on the collecting and analyzing data, said, "The sharp increase in the number of reported cases of leishmaniasis in Aleppo and Idlib provinces, denotes the re-emerging of the disease, that is directly linked to the extensive annihilation of public health infrastructure, and the abandonment of Syrian local authorities from municipal maintenance and services." Added that, "The majority of those cases were reported in areas that are heavily affected by the conflict, and areas with high poverty and inaccessibility to good sanitation, due to water shortage and garbage build up that amplifies the growth of the sand fly." Mr Zidan briefly stated the major recommendation to control the spread of _Leishmania_, " As transmission involves sand fly bites to human and injection of the protozoal parasite, this makes our major priority the elimination of this fly, in addition to implementing other preventive and control measures. This is beside an extensive treatment and creation of specialized centers to control leishmaniasis."
The UOSSM has initiated a well-organized program directed to treat the old and new cases of leishmaniasis, and coordinate the local municipal services for better spray and application of insecticide to get rid of the sand fly. The UOSSM has estimated that the budget needed to treat and control leishmaniasis is about [USD] 180 000, and urges the WHO and International medical and humanitarian organizations to contribute, in order to eradicate _Leishmania_ from the region.
UOSSM views the _Leishmania_ outbreak as a regional public health crisis that necessitates collaborative efforts between local and international public health providers.
The UOSSM is a coalition of humanitarian, non-governmental, and independent organizations, created following the deadly events in Syria, to provide medical and humanitarian aid to Syrians. UOSSM was established by 14 medical and relief organizations, and includes hundreds of physicians of mainly Syrian origin distributed in the United States, Canada, Europe, and in different Arab countries.
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[It is no surprise that the number of cases increase and that the infection is spreading into Turkey with the flow of refugees. Leishmaniasis will also be seen in refugees in Jordan and Lebanon. Children are particularly vulnerable. ProMED-mail follows the outbreak closely and will be happy to received further information. - Mod.EP
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/3aLZ.]
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Leishmaniasen in Syrien
LEISHMANIASIS - SYRIA (04): COMMENT ON CANINE RESERVOIR
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Date: Mon 15 Apr 2013
From: Merritt Clifton <anmlpepl@whidbey.com> [edited]
Syria does not have a large dog population, free-roaming or otherwise, as dogs have been culturally considered unclean and have been frequently shot or poisoned.
Turkey, however, has been historically rather tolerant of free-roaming dogs and instituted a national dog sterilization program 10 years ago to replace shooting or poisoning street dogs. Unfortunately, the sterilization program has not been very well managed in much of the nation, so much of Turkey still has abundant street dogs.
Jordan and Lebanon have far fewer free-roaming dogs but are nonetheless much more tolerant of dogs than Syria.
This sets up the possibility that, whereas dogs are sometimes implicated in transmitting leishmaniasis to humans, in this situation, human refugees may be inadvertently bringing the sand flies that carry leishmaniasis into more frequent contact with the dogs of Turkey, Jordan, and Lebanon, and the pet keepers and humane communities of those nations may, accordingly, need to escalate vigilance against leishmaniasis, after having not worried about it much for many years.
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Merritt Clifton
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[ProMED-mail thanks Merritt Clifton for his comment.
Cutaneous leishmaniasis (CL) is caused by _Leishmania tropica_, and 30 000 cases were reported in 2008 in Syria (Alvar J et al. and the WHO Leishmaniasis Control Team. Leishmaniasis Worldwide and Global Estimates of Its Incidence. PLoS One. 2012; 7(5): e35671).
Visceral leishmaniasis (VL) is rare but is found from Aleppo and towards the Turkish border. The reservoir for _L. tropica_ is small rodents and for _L. infantum_, it is dogs.
In Turkey, there has been a considerable reduction in the number of reported cases since 1995 onwards (Zeyrek FY et al. Serodiagnosis of anthroponotic cutaneous leishmaniasis (ACL) caused by _Leishmania tropica_ in Sanliurfa Province, Turkey, where ACL is highly endemic. Clin Vaccine Immunol 2007;14:1409-15).
A recent upsurge of CL cases in the southeastern Anatolia Region is attributed to the environmental impact of a big irrigation project (Guneydogu Anadolu Projesi-GAP) [Ok UZ et al. Leishmaniasis in Turkey. Acta Trop 2002;84:43-8).
Some CL cases are attributed to _L. infantum_ in the eastern Mediterranean region. The main reservoirs are dogs and humans.
In Jordan, outbreaks of CL have been reported every year for the past 5 years: in Aqaba (2006 and 2007), North Agwar (2008) and South Shuneh (2004 and 2005) with 100-200 cases. Severe underreporting of CL is suspected; between 2001 and 2003, an estimated incidence was 47 times higher than the officially reported number of cases (Mosleh IM et al. (2008). Cutaneous leishmaniasis in the Jordanian side of the Jordan Valley: severe under-reporting and consequences on public health management. Trop Med Int Health 2008;13:855-60).
The main reservoir for _L. infantum is dogs and for _L. major_, small rodents (_Psammomys obesus_, _Meriones libycus_). - Mod.EP
HealthMap/ProMED-mail maps for Syria, Turkey, and Jordan can be accessed at: http://healthmap.org/r/3aLZ, http://healthmap.org/r/1Cfs, and http://healthmap.org/r/1CMW, respectively.
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/3aLZ.]
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Date: Mon 15 Apr 2013
From: Merritt Clifton <anmlpepl@whidbey.com> [edited]
Syria does not have a large dog population, free-roaming or otherwise, as dogs have been culturally considered unclean and have been frequently shot or poisoned.
Turkey, however, has been historically rather tolerant of free-roaming dogs and instituted a national dog sterilization program 10 years ago to replace shooting or poisoning street dogs. Unfortunately, the sterilization program has not been very well managed in much of the nation, so much of Turkey still has abundant street dogs.
Jordan and Lebanon have far fewer free-roaming dogs but are nonetheless much more tolerant of dogs than Syria.
This sets up the possibility that, whereas dogs are sometimes implicated in transmitting leishmaniasis to humans, in this situation, human refugees may be inadvertently bringing the sand flies that carry leishmaniasis into more frequent contact with the dogs of Turkey, Jordan, and Lebanon, and the pet keepers and humane communities of those nations may, accordingly, need to escalate vigilance against leishmaniasis, after having not worried about it much for many years.
--
Merritt Clifton
Editor, Animal People
P.O. Box 960
Clinton, WA 98236
http://www.animalpeoplenews.org
<anmlpepl@whidbey.com>
[ProMED-mail thanks Merritt Clifton for his comment.
Cutaneous leishmaniasis (CL) is caused by _Leishmania tropica_, and 30 000 cases were reported in 2008 in Syria (Alvar J et al. and the WHO Leishmaniasis Control Team. Leishmaniasis Worldwide and Global Estimates of Its Incidence. PLoS One. 2012; 7(5): e35671).
Visceral leishmaniasis (VL) is rare but is found from Aleppo and towards the Turkish border. The reservoir for _L. tropica_ is small rodents and for _L. infantum_, it is dogs.
In Turkey, there has been a considerable reduction in the number of reported cases since 1995 onwards (Zeyrek FY et al. Serodiagnosis of anthroponotic cutaneous leishmaniasis (ACL) caused by _Leishmania tropica_ in Sanliurfa Province, Turkey, where ACL is highly endemic. Clin Vaccine Immunol 2007;14:1409-15).
A recent upsurge of CL cases in the southeastern Anatolia Region is attributed to the environmental impact of a big irrigation project (Guneydogu Anadolu Projesi-GAP) [Ok UZ et al. Leishmaniasis in Turkey. Acta Trop 2002;84:43-8).
Some CL cases are attributed to _L. infantum_ in the eastern Mediterranean region. The main reservoirs are dogs and humans.
In Jordan, outbreaks of CL have been reported every year for the past 5 years: in Aqaba (2006 and 2007), North Agwar (2008) and South Shuneh (2004 and 2005) with 100-200 cases. Severe underreporting of CL is suspected; between 2001 and 2003, an estimated incidence was 47 times higher than the officially reported number of cases (Mosleh IM et al. (2008). Cutaneous leishmaniasis in the Jordanian side of the Jordan Valley: severe under-reporting and consequences on public health management. Trop Med Int Health 2008;13:855-60).
The main reservoir for _L. infantum is dogs and for _L. major_, small rodents (_Psammomys obesus_, _Meriones libycus_). - Mod.EP
HealthMap/ProMED-mail maps for Syria, Turkey, and Jordan can be accessed at: http://healthmap.org/r/3aLZ, http://healthmap.org/r/1Cfs, and http://healthmap.org/r/1CMW, respectively.
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/3aLZ.]
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Denguefieber in Saudi Arabien
DENGUE/DHF UPDATE (35): MIDDLE EAST
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Saudi Arabia (Jeddah). 30 Apr 2013. Dengue approximately 300 cases. Increasing.
http://www.theglobaldispatch.com/jeddah ... 13-to-300/
[Maps of Saudi Arabia can be accessed at http://www.lib.utexas.edu/maps/middle_e ... l_2003.pdf and http://healthmap.org/r/6NuS. - Mod.TY]
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Saudi Arabia (Jeddah). 30 Apr 2013. Dengue approximately 300 cases. Increasing.
http://www.theglobaldispatch.com/jeddah ... 13-to-300/
[Maps of Saudi Arabia can be accessed at http://www.lib.utexas.edu/maps/middle_e ... l_2003.pdf and http://healthmap.org/r/6NuS. - Mod.TY]
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Denguefieber in Saudi Arabien
DENGUE/DHF UPDATE (38): MIDDLE EAST
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Saudi Arabia (Jeddah). 8 May 2013. Dengue 150 cases per week; deaths last week [week of 1 May 2013] 4. Increasing.
http://www.saudigazette.com.sa/index.cf ... 0508164750
[Maps of Saudi Arabia can be accessed at http://www.lib.utexas.edu/maps/middle_e ... l_2003.pdf and http://healthmap.org/r/6NuS. - Mod.TY]
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Saudi Arabia (Jeddah). 8 May 2013. Dengue 150 cases per week; deaths last week [week of 1 May 2013] 4. Increasing.
http://www.saudigazette.com.sa/index.cf ... 0508164750
[Maps of Saudi Arabia can be accessed at http://www.lib.utexas.edu/maps/middle_e ... l_2003.pdf and http://healthmap.org/r/6NuS. - Mod.TY]
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Malaria in Saudi Arabien
MALARIA - SAUDI ARABIA
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Date: Sat 25 May 2013
Source: ArabNews [edited]
http://arabnews.com/news/452844
According to the Health Ministry, there have been 2788 cases of malaria diagnosed in the Kingdom of Saudi Arabia since 2011.
Most malaria victims come from the Tahama (Tihamah) region like Jazan and Al Qunfutha. Most cases occur during the rainy season and about 97 percent originate outside the Kingdom.
The [Tihamah] region and Jazan are some of the most crucial areas for malaria in the Kingdom and are not covered by the control program because of poor roads, communication difficulties, and lack of manpower. But the situation has improved with the registration of 59 cases in Jazan at 80 percent [presumably originating outside the Kingdom] and Aseer at 13.04 percent [presumably originating outside the Kingdom], while the other areas didn't register any cases.
The rise in the number of cases started in January [2013] in all areas and began to fall in March. It is expected to rise again in October and continue until December, especially in Jazan. Statistics show there is a decline in the number of malaria cases beginning in March and reaching lowest rates between May to September, and rising in October.
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[Saudi Arabia reported nearly 3000 cases of malaria in 2011 where more than 95 percent were imported cases (see World Malaria Report 2012, country profile for Saudi Arabia; http://www.who.int/malaria/publications ... ofiles.pdf).
If the 2788 cases reported here cover 2012 and 2013 up to now, the trend is decreasing compared to the 2011 World Malaria Report numbers.
The cases were all in the South Western area where the WHO estimates the annual incidence rate to be not more than 0.1 cases per 1000 population annually.
Jazan is an industrial center (see below) and it must be assumed that many migrant workers come from malaria endemic areas and may give rise to local transmission as has lately been seen in Greece and Dubai (see previous ProMED reports cited below).
The Tahama (Tihamah) region refers to the Red Sea coastal plain of Arabia from the Gulf of Aqaba to the Bab el Mandeb Strait (http://en.wikipedia.org/wiki/File:Tihamah.png).
Al Qunfutha is located on the Red Sea Coast halfway between Jeddah and the border of Yemen.
The Province of Jazan lies in the south west section of the Kingdom of Saudi Arabia. It has a population of approximately 1.2 million. Jazan is home to the Port of Jazan, Saudi Arabia's 3rd most important port on the Red Sea (http://en.wikipedia.org/wiki/Jazan_Economic_City). - Mod.EP
Maps of the Kingdom of Saudi Arabia can be seen at
http://www.susris.com/wp-content/upload ... _2003.jpeg and http://healthmap.org/r/70oa. - Sr.Tech.Ed.MJ]
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Date: Sat 25 May 2013
Source: ArabNews [edited]
http://arabnews.com/news/452844
According to the Health Ministry, there have been 2788 cases of malaria diagnosed in the Kingdom of Saudi Arabia since 2011.
Most malaria victims come from the Tahama (Tihamah) region like Jazan and Al Qunfutha. Most cases occur during the rainy season and about 97 percent originate outside the Kingdom.
The [Tihamah] region and Jazan are some of the most crucial areas for malaria in the Kingdom and are not covered by the control program because of poor roads, communication difficulties, and lack of manpower. But the situation has improved with the registration of 59 cases in Jazan at 80 percent [presumably originating outside the Kingdom] and Aseer at 13.04 percent [presumably originating outside the Kingdom], while the other areas didn't register any cases.
The rise in the number of cases started in January [2013] in all areas and began to fall in March. It is expected to rise again in October and continue until December, especially in Jazan. Statistics show there is a decline in the number of malaria cases beginning in March and reaching lowest rates between May to September, and rising in October.
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[Saudi Arabia reported nearly 3000 cases of malaria in 2011 where more than 95 percent were imported cases (see World Malaria Report 2012, country profile for Saudi Arabia; http://www.who.int/malaria/publications ... ofiles.pdf).
If the 2788 cases reported here cover 2012 and 2013 up to now, the trend is decreasing compared to the 2011 World Malaria Report numbers.
The cases were all in the South Western area where the WHO estimates the annual incidence rate to be not more than 0.1 cases per 1000 population annually.
Jazan is an industrial center (see below) and it must be assumed that many migrant workers come from malaria endemic areas and may give rise to local transmission as has lately been seen in Greece and Dubai (see previous ProMED reports cited below).
The Tahama (Tihamah) region refers to the Red Sea coastal plain of Arabia from the Gulf of Aqaba to the Bab el Mandeb Strait (http://en.wikipedia.org/wiki/File:Tihamah.png).
Al Qunfutha is located on the Red Sea Coast halfway between Jeddah and the border of Yemen.
The Province of Jazan lies in the south west section of the Kingdom of Saudi Arabia. It has a population of approximately 1.2 million. Jazan is home to the Port of Jazan, Saudi Arabia's 3rd most important port on the Red Sea (http://en.wikipedia.org/wiki/Jazan_Economic_City). - Mod.EP
Maps of the Kingdom of Saudi Arabia can be seen at
http://www.susris.com/wp-content/upload ... _2003.jpeg and http://healthmap.org/r/70oa. - Sr.Tech.Ed.MJ]
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HEALTH HAZARDS - SYRIA: EFFECTS OF WAR, CIVILIANS
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Date: Tue 4 Jun 2013
Source: BBC News [edited]
http://www.bbc.co.uk/news/health-22766084
The World Health Organization [WHO] is warning of an increased risk of disease epidemics in Syria and neighbouring countries as summer approaches. The WHO says outbreaks of diseases carried in water -- specifically hepatitis, typhoid, cholera, and dysentery -- are inevitable, given the severe disruption to Syria's health system.
Cases of diarrhoea and hepatitis-A have more than doubled since January [2013]. There have also been outbreaks of measles and typhoid [fever].
According to the WHO, at least 35 percent of the country's public hospitals are out of service, and in some areas, up to 70 percent of the health workforce has fled. Almost 4.25 million Syrians who have had to leave their homes are living in overcrowded, unsanitary conditions, with concerns about the provision of safe drinking water and safe sanitation.
"All the risk factors that enhance the transmission of communicable diseases in emergencies are present in the current crisis in Syria and its neighbouring countries," said Dr Jaouad Mahjour, director of the department for communicable diseases at the WHO's regional office for the Eastern Mediterranean. "We are anticipating a number of public health risks from water borne diseases, specifically hepatitis, typhoid [fever], cholera, and dysentery. Given the scale of population movement both inside Syria and across borders, together with deteriorating environmental health conditions, outbreaks are inevitable."
The WHO says cases of measles have reappeared in Syria, due to problems running national vaccination campaigns. The number of confirmed cases of measles in the 1st quarter of 2013 reached 139, compared with no cases in the whole of 2010 and 2011, says the WHO. There have also been reports of measles, tuberculosis, and cutaneous leishmaniasis -- a disease carried by insects -- among displaced Syrians in Jordan, Lebanon, Iraq, and Turkey.
"Jordan had previously reported zero cases of measles for 3 years, and was planning to officially declare that it was measles-free," said Dr Mahjour. "The situation will deteriorate if prevention and control measures are not scaled up soon."
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[War often disrupts a nation's private, as well as public health systems. A nation's public health system is a complex network of people, systems, and organizations, working at both the local and national levels, that is responsible for maintaining the health of its entire population, rather than individuals; unfortunately, this network is fragile and is easily disrupted during wartime. Mass migration of a nation's population both within its border, as well as across borders, occurs to avoid the hazards of warfare, which often leaves behind those too young, too old, or too weak to escape.
Loss of the nation's public and private healthcare professionals due to migration, compounded by destruction of medical facilities, loss of access to medical supplies, medications, and vaccines, severely limits provision of essential healthcare services. These deprivations, especially for the most vulnerable segments of the population, that is, the injured, the very young, pregnant women, the elderly, the chronically sick, and the disabled, may leave them more susceptible to lack of adequate nutrition, clean water, or sanitation, or environmental stresses such as the weather. Cross-border migration spreads these problems to neighboring nations. The effect of war on the health of a nation has been well-documented by Dr Jonathan Mann and colleagues in the Bosnian conflict in the 1900's (1).
Reference
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1. Mann J, Drucker E, Tarantola D, McCabe MP: The War Against Public Health. Medicine & Global Survival 1994; 1(3): 130-46. Available at http://www.ippnw.org/pdf/mgs/1-3-mann.pdf.
A HealthMap/ProMED-mail interactive map can be accessed at http://healthmap.org/r/3aLZ. - Mod.ML]
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Date: Tue 4 Jun 2013
Source: BBC News [edited]
http://www.bbc.co.uk/news/health-22766084
The World Health Organization [WHO] is warning of an increased risk of disease epidemics in Syria and neighbouring countries as summer approaches. The WHO says outbreaks of diseases carried in water -- specifically hepatitis, typhoid, cholera, and dysentery -- are inevitable, given the severe disruption to Syria's health system.
Cases of diarrhoea and hepatitis-A have more than doubled since January [2013]. There have also been outbreaks of measles and typhoid [fever].
According to the WHO, at least 35 percent of the country's public hospitals are out of service, and in some areas, up to 70 percent of the health workforce has fled. Almost 4.25 million Syrians who have had to leave their homes are living in overcrowded, unsanitary conditions, with concerns about the provision of safe drinking water and safe sanitation.
"All the risk factors that enhance the transmission of communicable diseases in emergencies are present in the current crisis in Syria and its neighbouring countries," said Dr Jaouad Mahjour, director of the department for communicable diseases at the WHO's regional office for the Eastern Mediterranean. "We are anticipating a number of public health risks from water borne diseases, specifically hepatitis, typhoid [fever], cholera, and dysentery. Given the scale of population movement both inside Syria and across borders, together with deteriorating environmental health conditions, outbreaks are inevitable."
The WHO says cases of measles have reappeared in Syria, due to problems running national vaccination campaigns. The number of confirmed cases of measles in the 1st quarter of 2013 reached 139, compared with no cases in the whole of 2010 and 2011, says the WHO. There have also been reports of measles, tuberculosis, and cutaneous leishmaniasis -- a disease carried by insects -- among displaced Syrians in Jordan, Lebanon, Iraq, and Turkey.
"Jordan had previously reported zero cases of measles for 3 years, and was planning to officially declare that it was measles-free," said Dr Mahjour. "The situation will deteriorate if prevention and control measures are not scaled up soon."
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[War often disrupts a nation's private, as well as public health systems. A nation's public health system is a complex network of people, systems, and organizations, working at both the local and national levels, that is responsible for maintaining the health of its entire population, rather than individuals; unfortunately, this network is fragile and is easily disrupted during wartime. Mass migration of a nation's population both within its border, as well as across borders, occurs to avoid the hazards of warfare, which often leaves behind those too young, too old, or too weak to escape.
Loss of the nation's public and private healthcare professionals due to migration, compounded by destruction of medical facilities, loss of access to medical supplies, medications, and vaccines, severely limits provision of essential healthcare services. These deprivations, especially for the most vulnerable segments of the population, that is, the injured, the very young, pregnant women, the elderly, the chronically sick, and the disabled, may leave them more susceptible to lack of adequate nutrition, clean water, or sanitation, or environmental stresses such as the weather. Cross-border migration spreads these problems to neighboring nations. The effect of war on the health of a nation has been well-documented by Dr Jonathan Mann and colleagues in the Bosnian conflict in the 1900's (1).
Reference
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1. Mann J, Drucker E, Tarantola D, McCabe MP: The War Against Public Health. Medicine & Global Survival 1994; 1(3): 130-46. Available at http://www.ippnw.org/pdf/mgs/1-3-mann.pdf.
A HealthMap/ProMED-mail interactive map can be accessed at http://healthmap.org/r/3aLZ. - Mod.ML]
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Leishmaniasen in Syrien
LEISHMANIASIS - SYRIA (05): (ALEPPO)
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Date: Wed 5 Jun 2013
Source: PLoS (Public Library of Science) Blogs [edited]
http://bit.ly/139BDPX
News Reports out of Syria indicate the emergence of epidemic cutaneous leishmaniasis [CL] in the besieged city of Aleppo, adding further to the misery there.
Even in the best of times the Syrian Arab Republic (Syria) has struggled with CL. We reported previously in PLoS Neglected Tropical Diseases that Old World or anthroponotic CL caused by _Leishmania tropica_ is endemic to Syria and elsewhere in the Middle East, North Africa, and Central Asia.
In the ancient northern Syrian city of Aleppo, CL has been present for hundreds of years (if not longer), where it is known as the "Aleppo evil", "Aleppo ulcer", "Aleppo boil", or "Aleppo button". Aleppo ulcer is a disfiguring condition that disproportionately occurs on the face, especially of young people. It typically lasts one or 2 years before the lesion heals spontaneously, and is often known locally as "one-year sore". However, in many cases specific anti-parasitic chemotherapy can hasten the healing process and improve clinical and cosmetic outcomes.
A major problem with one-year sore is that the scar can produce permanent disfigurement of the face. According to some experts working in Afghanistan, Old World CL is a cause of social isolation and stigma particularly among girls and young women who can be rendered unmarriageable. Mothers with CL may not be allowed to touch their children even though human to human contact does not transmit the infection.
Experts working on CL in Syria have written about the rise and fall and then a rise again in the incidence of the disease in the city of Aleppo. During the 1950s the number of cases of CL fell after an insecticide campaign aimed at controlling malaria, but it then rose again during the 1960s. However, CL was mostly controlled during the 1980s.
There was a subsequent increase after 1992, which has been attributed in part to inadequate garbage disposal and construction waste in areas undergoing development outside of the ancient city center. Garbage collection, open sewage, and poverty are notorious for promoting the habitats of _Phlebotomus_ sandflies that transmit Old World CL. Interestingly, a clinical trial conducted prior to the current civil conflict found that use of insecticide-treated bednets (ITNs) could prevent CL in Aleppo.
[Byline: Peter Hotez]
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[There have been several previous reports on an increased number of cutaneous leishmaniasis cases in Syria. See the ProMED postings listed below, and refer to the comments in archive no. 20130420.1660409.
There is no doubt that the areas of Syria affected by the civil war are experiencing an increase in cutaneous leishmaniasis and this will also be seen in the refugee camps in Jordan and Turkey. - Mod.EP
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/7cJV.]
************************************
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International Society for Infectious Diseases
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Date: Wed 5 Jun 2013
Source: PLoS (Public Library of Science) Blogs [edited]
http://bit.ly/139BDPX
News Reports out of Syria indicate the emergence of epidemic cutaneous leishmaniasis [CL] in the besieged city of Aleppo, adding further to the misery there.
Even in the best of times the Syrian Arab Republic (Syria) has struggled with CL. We reported previously in PLoS Neglected Tropical Diseases that Old World or anthroponotic CL caused by _Leishmania tropica_ is endemic to Syria and elsewhere in the Middle East, North Africa, and Central Asia.
In the ancient northern Syrian city of Aleppo, CL has been present for hundreds of years (if not longer), where it is known as the "Aleppo evil", "Aleppo ulcer", "Aleppo boil", or "Aleppo button". Aleppo ulcer is a disfiguring condition that disproportionately occurs on the face, especially of young people. It typically lasts one or 2 years before the lesion heals spontaneously, and is often known locally as "one-year sore". However, in many cases specific anti-parasitic chemotherapy can hasten the healing process and improve clinical and cosmetic outcomes.
A major problem with one-year sore is that the scar can produce permanent disfigurement of the face. According to some experts working in Afghanistan, Old World CL is a cause of social isolation and stigma particularly among girls and young women who can be rendered unmarriageable. Mothers with CL may not be allowed to touch their children even though human to human contact does not transmit the infection.
Experts working on CL in Syria have written about the rise and fall and then a rise again in the incidence of the disease in the city of Aleppo. During the 1950s the number of cases of CL fell after an insecticide campaign aimed at controlling malaria, but it then rose again during the 1960s. However, CL was mostly controlled during the 1980s.
There was a subsequent increase after 1992, which has been attributed in part to inadequate garbage disposal and construction waste in areas undergoing development outside of the ancient city center. Garbage collection, open sewage, and poverty are notorious for promoting the habitats of _Phlebotomus_ sandflies that transmit Old World CL. Interestingly, a clinical trial conducted prior to the current civil conflict found that use of insecticide-treated bednets (ITNs) could prevent CL in Aleppo.
[Byline: Peter Hotez]
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[There have been several previous reports on an increased number of cutaneous leishmaniasis cases in Syria. See the ProMED postings listed below, and refer to the comments in archive no. 20130420.1660409.
There is no doubt that the areas of Syria affected by the civil war are experiencing an increase in cutaneous leishmaniasis and this will also be seen in the refugee camps in Jordan and Turkey. - Mod.EP
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/7cJV.]
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Cholera in Syrien / Jordanien - Flüchtlingslager
CHOLERA, DIARRHEA AND DYSENTERY UPDATE (21)
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Diarrhea, Syrian refugee camp - Jordan (Mafraq Governorate)
Date: Mon 10 Jun 2013
Source: Ammon News [edited]
http://en.ammonnews.net/article.aspx?ar ... bdC8-e-2So
The Za'atari camp for Syrian refugees has witnessed a sharp increase in cases of epidemic diarrhea and gastrointenstinal infection symptoms among registered refugees in the past weeks, a health official said. The infection cases reached unprecedented numbers as hundreds of cases are being treated at local health clinics and hospitals near the camp in Mafraq [Mafraq Governorate], in north eastern Jordan.
The diarrhea and gastrointenstinal infections may be caused by consumption of polluted water and poor sanitary conditions in the camp that are exacerbated particularly in hot weather conditions in the summer.
Ministry of Health director of health care Dr Bassam Hijjawi warned of the dangers of the spread of the infections among refugees particularly in the summer, and called for more intensive health monitoring measures in the camp.
Hijjawi told Ammon News that hundreds of cases of infection are being registered every month of refugees suffering from the symptoms. On the causes of the infection, Hijjawi noted the crowded conditions in the camp, possible spoiled foods, and lack of health monitoring by international health agencies contribute to the spread of the illness.
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[Camps of internally or externally displaced people from civil wars and natural disasters are prime breeding grounds for illnesses, particularly gastrointestinal ones due to overcrowding, poor nutrition and the lack of both potable water and adequate sanitation.
An interactive map of Jordan can be found at http://healthmap.org/r/1CMW. - Mod.LL]
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Diarrhea, Syrian refugee camp - Jordan (Mafraq Governorate)
Date: Mon 10 Jun 2013
Source: Ammon News [edited]
http://en.ammonnews.net/article.aspx?ar ... bdC8-e-2So
The Za'atari camp for Syrian refugees has witnessed a sharp increase in cases of epidemic diarrhea and gastrointenstinal infection symptoms among registered refugees in the past weeks, a health official said. The infection cases reached unprecedented numbers as hundreds of cases are being treated at local health clinics and hospitals near the camp in Mafraq [Mafraq Governorate], in north eastern Jordan.
The diarrhea and gastrointenstinal infections may be caused by consumption of polluted water and poor sanitary conditions in the camp that are exacerbated particularly in hot weather conditions in the summer.
Ministry of Health director of health care Dr Bassam Hijjawi warned of the dangers of the spread of the infections among refugees particularly in the summer, and called for more intensive health monitoring measures in the camp.
Hijjawi told Ammon News that hundreds of cases of infection are being registered every month of refugees suffering from the symptoms. On the causes of the infection, Hijjawi noted the crowded conditions in the camp, possible spoiled foods, and lack of health monitoring by international health agencies contribute to the spread of the illness.
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[Camps of internally or externally displaced people from civil wars and natural disasters are prime breeding grounds for illnesses, particularly gastrointestinal ones due to overcrowding, poor nutrition and the lack of both potable water and adequate sanitation.
An interactive map of Jordan can be found at http://healthmap.org/r/1CMW. - Mod.LL]
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Denguefieber in Saudi Arabien
DENGUE/DHF UPDATE (50): ASIA, MIDDLE EAST
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Saudi Arabia (Jeddah). 14 Jun 2013. Dengue week of 9 Jun 2013, 252 new cases. Increasing.
http://www.zawya.com/story/Dengue_alert ... 614042325/
[Maps of Saudi Arabia can be accessed at http://www.lib.utexas.edu/maps/middle_e ... l_2003.pdf and http://healthmap.org/r/7lsk. - Mod.TY]
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Saudi Arabia (Jeddah). 14 Jun 2013. Dengue week of 9 Jun 2013, 252 new cases. Increasing.
http://www.zawya.com/story/Dengue_alert ... 614042325/
[Maps of Saudi Arabia can be accessed at http://www.lib.utexas.edu/maps/middle_e ... l_2003.pdf and http://healthmap.org/r/7lsk. - Mod.TY]
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Brucellose in Syrien
BRUCELLOSIS, HUMAN, LIVESTOCK - SYRIA
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[1]
Date: Mon 5 Aug 2013
Source: Damascus Bureau [in Arabic, trans. submitter JP, edited]
URL in Arabic characters
Herders in the countryside of Ma'arrat Numan, in Idlib province are facing the high cost of feed and the interruption of veterinary drug supplies. This interruption of veterinary drug supplies has contributed to the spread of _Brucella_ spp., which can also cause brucellosis among humans. Power outages have also led to the deterioration of the dairy and cheese vendor industry.
--
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Julio Pinto
UN Food and Agriculture Organization (FAO)
<julio.pinto@fao.org>
******
[2]
Date: Thu 1 Aug 2013
Source: WHO Regional Situation Report: Syrian Arab Republic, Jordan, Lebanon, Iraq [edited]
http://www.emro.who.int/images/stories/ ... g_edit.pdf
Between 23 Jun 2013 until 13 Jul 2013, 336 cases of brucellosis in humans have been reported by the WHO Early Warning Alert and Response System (EWARS).
--
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UN Food and Agriculture Organization (FAO)
<julio.pinto@fao.org>
******
[3]
Date: Fri 5 Jul 2013
Source: FAO/WFP (World Food Programme) Crop and Food Security Assessment - Syrian Arab Republic [edited]
http://www.fao.org/docrep/018/aq113e/aq113e.pdf
As a result of the current unrest in the Syrian Arab Republic, the government's veterinary service has become significantly eroded. Vaccines are in short supply and sanctions prohibit imports. Most private companies that were producing prophylactic medications have gone out of business, because of damage to their premises and because of the difficulty to import. Due to higher prices, more Syrian Arab Republic livestock are being sold in Jordan, Lebanon, Turkey, and Iraq.
With the virtual loss of veterinary services within the Syrian Arab Republic, livestock diseases are at risk to be transmitted to neighbouring countries, thereby posing potentially serious regional animal health problems.
--
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Julio Pinto
UN Food and Agriculture Organization (FAO)
<julio.pinto@fao.org>
[Brucellosis is endemic in much of the Middle East. Civil war-related erosion of programs for livestock health will certainly lead to increased brucellosis in the animals and subsequent spread to humans from direct livestock contact and/or ingestion of unpasteurized dairy products. Given the political situation in Syria, one wonders how the diagnosis of brucellosis in people was made. - Mod.LL
Item 3 provides data not seen before; of particular concern is the information about the deterioration of the Syrian veterinary services and their disturbed activities combined with increased exports of live animals. This may have led to the spread of infectious animal diseases within Syria. One of such diseases, suspected to be circulating in Syria without
being noticed/controlled/reported, is the cattle disease Lumpy skin disease (LSD). The reported increased export of Syrian livestock to other coutnries in the region (4 are named) may explain the spread of LSD in some of them. LSD has already been reported from Lebanon, Jordan, Israel, and the Palestinian authority. - Mod.AS
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/3aLZ, http://healthmap.org/r/3aLZ.]
.................................................ll/mj/sh
*************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
[1]
Date: Mon 5 Aug 2013
Source: Damascus Bureau [in Arabic, trans. submitter JP, edited]
URL in Arabic characters
Herders in the countryside of Ma'arrat Numan, in Idlib province are facing the high cost of feed and the interruption of veterinary drug supplies. This interruption of veterinary drug supplies has contributed to the spread of _Brucella_ spp., which can also cause brucellosis among humans. Power outages have also led to the deterioration of the dairy and cheese vendor industry.
--
communicated by:
Julio Pinto
UN Food and Agriculture Organization (FAO)
<julio.pinto@fao.org>
******
[2]
Date: Thu 1 Aug 2013
Source: WHO Regional Situation Report: Syrian Arab Republic, Jordan, Lebanon, Iraq [edited]
http://www.emro.who.int/images/stories/ ... g_edit.pdf
Between 23 Jun 2013 until 13 Jul 2013, 336 cases of brucellosis in humans have been reported by the WHO Early Warning Alert and Response System (EWARS).
--
communicated by:
Julio Pinto
UN Food and Agriculture Organization (FAO)
<julio.pinto@fao.org>
******
[3]
Date: Fri 5 Jul 2013
Source: FAO/WFP (World Food Programme) Crop and Food Security Assessment - Syrian Arab Republic [edited]
http://www.fao.org/docrep/018/aq113e/aq113e.pdf
As a result of the current unrest in the Syrian Arab Republic, the government's veterinary service has become significantly eroded. Vaccines are in short supply and sanctions prohibit imports. Most private companies that were producing prophylactic medications have gone out of business, because of damage to their premises and because of the difficulty to import. Due to higher prices, more Syrian Arab Republic livestock are being sold in Jordan, Lebanon, Turkey, and Iraq.
With the virtual loss of veterinary services within the Syrian Arab Republic, livestock diseases are at risk to be transmitted to neighbouring countries, thereby posing potentially serious regional animal health problems.
--
communicated by:
Julio Pinto
UN Food and Agriculture Organization (FAO)
<julio.pinto@fao.org>
[Brucellosis is endemic in much of the Middle East. Civil war-related erosion of programs for livestock health will certainly lead to increased brucellosis in the animals and subsequent spread to humans from direct livestock contact and/or ingestion of unpasteurized dairy products. Given the political situation in Syria, one wonders how the diagnosis of brucellosis in people was made. - Mod.LL
Item 3 provides data not seen before; of particular concern is the information about the deterioration of the Syrian veterinary services and their disturbed activities combined with increased exports of live animals. This may have led to the spread of infectious animal diseases within Syria. One of such diseases, suspected to be circulating in Syria without
being noticed/controlled/reported, is the cattle disease Lumpy skin disease (LSD). The reported increased export of Syrian livestock to other coutnries in the region (4 are named) may explain the spread of LSD in some of them. LSD has already been reported from Lebanon, Jordan, Israel, and the Palestinian authority. - Mod.AS
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/3aLZ, http://healthmap.org/r/3aLZ.]
.................................................ll/mj/sh
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Leishmaniasen in der Türkei ex Syrien
LEISHMANIASIS - SYRIA (07): TURKEY ex SYRIA, REFUGEE CAMPS
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Date: Sat 31 Aug 2013
Source: IRIN [edited]
http://www.irinnews.org/report/98670/le ... rder-towns
Leishmaniasis could fuel refugee resentment in Turkey's border towns
--------------------------------------------------------------------
Squirming in the doctor's chair as he braced for a shot in the forearm, the wide-eyed boy was no different from scores of other refugee children who have shuffled into Dr Tayfur Savas's clinic in southern Turkey over the past 2 years, seeking treatment for a skin disease called leishmaniasis.
But his mother's words have stayed with Savas ever since. "These scars are a shame," Savas recalls her telling him. "People think he's infectious. Our neighbours don't want to breathe the same air. "She said people were refusing to sit by her son on the bus," he said, recalling the 4 black, crater-like lesions which ran along the boy's forearm.
Savas said it was the 1st time he had heard of Syrian refugees being stigmatized in Turkey for the illnesses they carry, and a cautionary tale about the urgency of tackling communicable diseases on both sides of the border. "Health issues can become social issues," Savas told IRIN. "We don't want to risk worsening relations between Turks and refugees; it is a tense situation already."
One of the most widespread communicable diseases among Syrian refugees has been cutaneous (skin-related) leishmaniasis, a vector-borne parasite that is spread from human to human by sandflies, especially in unsanitary or crowded conditions. It features large, permanently-disfiguring sores.
This summer [2013], as the World Health Organization (WHO) warned of the near collapse of the Syrian health system, it acknowledged that hepatitis, typhoid, cholera, and leishmaniasis have increasingly spread largely unchecked inside Syria and among refugee populations.
Unlike visceral leishmaniasis, cutaneous leishmaniasis typically is not life threatening, and has not raised the same alarm bells as many other diseases. But "it is extremely stigmatizing, and is especially catastrophic for young girls, who may become unmarriageable because of the disfiguring scars it can leave on the face and body," said Peter Hotez, dean of the National School of Tropical Medicine at the Texas-based Baylor College of Medicine. "It also looks extremely infectious, and people who don't know about the disease are likely to fear infected people when they see the lesions."
Known as "the Aleppo Evil", the disease's medieval nickname belies the fact that -- while it has been endemic in Syria and the Middle East for centuries -- it has largely been constrained to regions surrounding the northern city, Syria's 2nd largest. "But this is also a disease that is linked closely to human migration," says Hotez. "Refugees are sleeping outdoors where they have no protection from sandflies, populations are moving through Aleppo that have no previous exposure to the disease, and access to health care is nonexistent. It creates a perfect storm that allows 'the Aleppo Evil' to take hold."
An August [2013] report by the Turkish Medical Association warned that border regions were caught unprepared for leishmaniasis this summer, suggesting the country "lacked an early warning system" and needed to implement more systematic insecticide spraying and other precautionary measures in the future.
While Turkey's health response to leishmaniasis has involved the treatment of 10s of thousands of patients in state-run camps and hospitals this year [2013], much of the burden for treating the disease inside Turkey has fallen on poorly supplied clinics, staffed by Syrian doctors and nurses, in border towns. "Access to free health care is a guarantee for the 200 000 people inside the camps," said a spokesperson for Ankara's Disaster and Emergency Management Directorate (AFAD).
But outside the camps, Syrians "have been struggling to get treatment," said Saban Alagoz, general secretary of the Gaziantep and Kilis Medical Association. "The government and doctors' associations have just begun to respond to this problem," he said, detailing the opening of a special leishmaniasis clinic that was established in Gaziantep this year for non-camp refugees. He estimated that Turkish doctors in the southern towns of Gaziantep and Kilis have treated just under 10 000 cases of the disease this summer. "Leishmaniasis has not crossed over in large numbers to the Turkish population, but the problem is many Syrians still don't have access to treatment," he said.
Many Syrians cannot afford to pay for the injections which treat leishmaniasis, and seek out clinics run by a patchwork of Syrian aid groups and activists that treat refugees for free. Turkish hospitals as a rule do not charge for emergency care for registered refugees, but often charge for medicines and non-life threatening operations.
Speaking inside the hot, crowded halls of an apartment-turned clinic in the dusty border town of Kilis, Hasan al-Mallouhi of the Syrian Expatriate Medical Association (SEMA) said the number of leishmaniasis patients at his clinic ranges from "4-10 patients a day, though the number is sometimes as high as 30. Anger can suddenly explode in unexpected ways. It's just another reason we need to get this under control." For 4 months, the SEMA-run clinic was the sole medical provider to nearly 3000 refugees who camped in makeshift tents pitched in a municipal park at the centre of the town. "These people can't even pay for real tents. So, of course, they can't go to the hospital for medicines," said al-Mallouhi. The group said its stocks of Glucantime, the most common medicine used against leishmaniasis, had been kept afloat by donations from the international medical charity Medecins Sans Frontieres [Doctors Without Borders].
Government authorities this month [August 2013] cleared out the makeshift camp and transferred its inhabitants to a new camp near the town. "But our clinic is still full every day," al-Mallouhi said. "Now we're seeing people staying elsewhere in the town unable to afford any medical treatment, so they come to us for help."
At a clinic run by the Union of Syrian Medical Relief Organizations (UOSSM) in the border town of Reyhanli, treating leishmaniasis has become even more difficult, as stocks have dried up and need has grown inside Syria. Daher Zidan, the clinic's head pharmacist, said the group this year sent enough Glucantime to treat several thousand leishmaniasis patients to the group's field hospital in Bab al-Hawa, just across the border. But UOSSM says it does not have enough medicine to treat the roughly 10 patients arriving daily in Reyhanli. "We know the problem is more urgent inside Syria, so we send medicine there when we have it," Zidan said.
Because Glucantime contains toxins, it cannot be purchased over the counter in Turkey, and Syrian doctors are not allowed to acquire the medicine by Turkish law. At a clinic perched above a car garage elsewhere in Reyhanli, Dr Fatma Salah says those restrictions led her to the unusual step of sourcing Glucantime from pharmacies inside Syria.
"Now that supply has dried up," she said, noting that some sympathetic Turkish doctors have supplied small batches of the medicine on the side to help make up the shortage. "Still, for 2 months we haven't had the ability to treat the 5 or so people who come in for leishmaniasis every day. We're now focused on just getting painkillers, sanitary supplies, very basic things," she said.
The burden on already overwhelmed Syrian clinics is sure to increase as more refugees flood into Turkey. The UN estimates that as many as one million refugees may be living in Turkey by the end of the year [2013], straining health systems, housing prices and social tensions. AFAD currently houses just over 200 000 in camps, and a spokesperson said it will have trouble assisting the additional 300 000 refugees who are already in Turkey but do not live in camps. "We're working on getting more free treatment to people outside the camps for measles and leishmaniasis," said Alagoz, who nonetheless acknowledged that capacity for free treatment was highly unlikely to meet demand. "Right now, we're mostly working on understanding just how big this problem is."
The government has not yet taken preventative steps, such as indoor spraying or the distribution of insecticide-treated bednets, he added.
A study by the Turkish charity Support to Life (STL) warned in August [2013] that as savings run dry and families are no longer able to independently pay for their own medical expenses, the material and medical needs of urban refugees already living in Turkey is also likely to grow exponentially.
As demand among Syrians for free health care rises, many Turks say they are unsure if hospitals should change their policy of charging for care. "We've given enough to refugees here," said Selma Doganer, a high school teacher in Antakya. Doganer suggested international aid organizations, not Ankara, should pay future bills. "Syrians may think our prime minister will pay for everything. But we are paying much of the bill."
If the capacity of clinics to treat the communicable diseases of Syrians does not grow with demand, the spread of the disease might add another dimension to already strained tensions. Most of those tensions have been attributed to ethnic fault lines between Sunni refugees and large populations of Alawite and Alevi Turks who live along the border. But even without sectarian differences, foreigners are often the 1st to take the blame when something goes wrong.
Savas, the doctor, points to the Reyhanli bombing, when over 50 people in the border town died this May: "Reyhanli is a Sunni town, but suddenly they began to blame the refugees for everything that happened. Anger can suddenly explode in unexpected ways." He suggests that leishmaniasis, with its visible, infectious-looking sores, will not help the problem. "It's just another reason we need to get this under control," he said. Hotez, the US academic, agrees: "It's one of the most stigmatizing diseases you can have."
[Byline: Noah Blaser]
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[It has been expected that cutaneous leishmaniasis (CL) would increase in the camps hosting refugees from Syria. The problem is expected to exist as well in Jordan, Lebanon and Iraq (see posting from 17 Jul 2013 on Syrian refugees in Iraq). The article clearly illustrates the stain on the health system and the inadequate resources available in the refugee camps.
ProMED just published a review of potential emerging diseases as a result of the conflict in Syria (Infectious disease risk from the Syrian conflict: Petersen E, Baekeland S, Memish ZA, Leblebicioglu H. Int J Infect Dis. 2013 17(9):e666-7). CL is high on the list of emerging infections in the refugee camps, as are measles, influenza, MERS-CoV and gastrointestinal infections. - Mod.EP
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1Cfs.]
**********************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
Date: Sat 31 Aug 2013
Source: IRIN [edited]
http://www.irinnews.org/report/98670/le ... rder-towns
Leishmaniasis could fuel refugee resentment in Turkey's border towns
--------------------------------------------------------------------
Squirming in the doctor's chair as he braced for a shot in the forearm, the wide-eyed boy was no different from scores of other refugee children who have shuffled into Dr Tayfur Savas's clinic in southern Turkey over the past 2 years, seeking treatment for a skin disease called leishmaniasis.
But his mother's words have stayed with Savas ever since. "These scars are a shame," Savas recalls her telling him. "People think he's infectious. Our neighbours don't want to breathe the same air. "She said people were refusing to sit by her son on the bus," he said, recalling the 4 black, crater-like lesions which ran along the boy's forearm.
Savas said it was the 1st time he had heard of Syrian refugees being stigmatized in Turkey for the illnesses they carry, and a cautionary tale about the urgency of tackling communicable diseases on both sides of the border. "Health issues can become social issues," Savas told IRIN. "We don't want to risk worsening relations between Turks and refugees; it is a tense situation already."
One of the most widespread communicable diseases among Syrian refugees has been cutaneous (skin-related) leishmaniasis, a vector-borne parasite that is spread from human to human by sandflies, especially in unsanitary or crowded conditions. It features large, permanently-disfiguring sores.
This summer [2013], as the World Health Organization (WHO) warned of the near collapse of the Syrian health system, it acknowledged that hepatitis, typhoid, cholera, and leishmaniasis have increasingly spread largely unchecked inside Syria and among refugee populations.
Unlike visceral leishmaniasis, cutaneous leishmaniasis typically is not life threatening, and has not raised the same alarm bells as many other diseases. But "it is extremely stigmatizing, and is especially catastrophic for young girls, who may become unmarriageable because of the disfiguring scars it can leave on the face and body," said Peter Hotez, dean of the National School of Tropical Medicine at the Texas-based Baylor College of Medicine. "It also looks extremely infectious, and people who don't know about the disease are likely to fear infected people when they see the lesions."
Known as "the Aleppo Evil", the disease's medieval nickname belies the fact that -- while it has been endemic in Syria and the Middle East for centuries -- it has largely been constrained to regions surrounding the northern city, Syria's 2nd largest. "But this is also a disease that is linked closely to human migration," says Hotez. "Refugees are sleeping outdoors where they have no protection from sandflies, populations are moving through Aleppo that have no previous exposure to the disease, and access to health care is nonexistent. It creates a perfect storm that allows 'the Aleppo Evil' to take hold."
An August [2013] report by the Turkish Medical Association warned that border regions were caught unprepared for leishmaniasis this summer, suggesting the country "lacked an early warning system" and needed to implement more systematic insecticide spraying and other precautionary measures in the future.
While Turkey's health response to leishmaniasis has involved the treatment of 10s of thousands of patients in state-run camps and hospitals this year [2013], much of the burden for treating the disease inside Turkey has fallen on poorly supplied clinics, staffed by Syrian doctors and nurses, in border towns. "Access to free health care is a guarantee for the 200 000 people inside the camps," said a spokesperson for Ankara's Disaster and Emergency Management Directorate (AFAD).
But outside the camps, Syrians "have been struggling to get treatment," said Saban Alagoz, general secretary of the Gaziantep and Kilis Medical Association. "The government and doctors' associations have just begun to respond to this problem," he said, detailing the opening of a special leishmaniasis clinic that was established in Gaziantep this year for non-camp refugees. He estimated that Turkish doctors in the southern towns of Gaziantep and Kilis have treated just under 10 000 cases of the disease this summer. "Leishmaniasis has not crossed over in large numbers to the Turkish population, but the problem is many Syrians still don't have access to treatment," he said.
Many Syrians cannot afford to pay for the injections which treat leishmaniasis, and seek out clinics run by a patchwork of Syrian aid groups and activists that treat refugees for free. Turkish hospitals as a rule do not charge for emergency care for registered refugees, but often charge for medicines and non-life threatening operations.
Speaking inside the hot, crowded halls of an apartment-turned clinic in the dusty border town of Kilis, Hasan al-Mallouhi of the Syrian Expatriate Medical Association (SEMA) said the number of leishmaniasis patients at his clinic ranges from "4-10 patients a day, though the number is sometimes as high as 30. Anger can suddenly explode in unexpected ways. It's just another reason we need to get this under control." For 4 months, the SEMA-run clinic was the sole medical provider to nearly 3000 refugees who camped in makeshift tents pitched in a municipal park at the centre of the town. "These people can't even pay for real tents. So, of course, they can't go to the hospital for medicines," said al-Mallouhi. The group said its stocks of Glucantime, the most common medicine used against leishmaniasis, had been kept afloat by donations from the international medical charity Medecins Sans Frontieres [Doctors Without Borders].
Government authorities this month [August 2013] cleared out the makeshift camp and transferred its inhabitants to a new camp near the town. "But our clinic is still full every day," al-Mallouhi said. "Now we're seeing people staying elsewhere in the town unable to afford any medical treatment, so they come to us for help."
At a clinic run by the Union of Syrian Medical Relief Organizations (UOSSM) in the border town of Reyhanli, treating leishmaniasis has become even more difficult, as stocks have dried up and need has grown inside Syria. Daher Zidan, the clinic's head pharmacist, said the group this year sent enough Glucantime to treat several thousand leishmaniasis patients to the group's field hospital in Bab al-Hawa, just across the border. But UOSSM says it does not have enough medicine to treat the roughly 10 patients arriving daily in Reyhanli. "We know the problem is more urgent inside Syria, so we send medicine there when we have it," Zidan said.
Because Glucantime contains toxins, it cannot be purchased over the counter in Turkey, and Syrian doctors are not allowed to acquire the medicine by Turkish law. At a clinic perched above a car garage elsewhere in Reyhanli, Dr Fatma Salah says those restrictions led her to the unusual step of sourcing Glucantime from pharmacies inside Syria.
"Now that supply has dried up," she said, noting that some sympathetic Turkish doctors have supplied small batches of the medicine on the side to help make up the shortage. "Still, for 2 months we haven't had the ability to treat the 5 or so people who come in for leishmaniasis every day. We're now focused on just getting painkillers, sanitary supplies, very basic things," she said.
The burden on already overwhelmed Syrian clinics is sure to increase as more refugees flood into Turkey. The UN estimates that as many as one million refugees may be living in Turkey by the end of the year [2013], straining health systems, housing prices and social tensions. AFAD currently houses just over 200 000 in camps, and a spokesperson said it will have trouble assisting the additional 300 000 refugees who are already in Turkey but do not live in camps. "We're working on getting more free treatment to people outside the camps for measles and leishmaniasis," said Alagoz, who nonetheless acknowledged that capacity for free treatment was highly unlikely to meet demand. "Right now, we're mostly working on understanding just how big this problem is."
The government has not yet taken preventative steps, such as indoor spraying or the distribution of insecticide-treated bednets, he added.
A study by the Turkish charity Support to Life (STL) warned in August [2013] that as savings run dry and families are no longer able to independently pay for their own medical expenses, the material and medical needs of urban refugees already living in Turkey is also likely to grow exponentially.
As demand among Syrians for free health care rises, many Turks say they are unsure if hospitals should change their policy of charging for care. "We've given enough to refugees here," said Selma Doganer, a high school teacher in Antakya. Doganer suggested international aid organizations, not Ankara, should pay future bills. "Syrians may think our prime minister will pay for everything. But we are paying much of the bill."
If the capacity of clinics to treat the communicable diseases of Syrians does not grow with demand, the spread of the disease might add another dimension to already strained tensions. Most of those tensions have been attributed to ethnic fault lines between Sunni refugees and large populations of Alawite and Alevi Turks who live along the border. But even without sectarian differences, foreigners are often the 1st to take the blame when something goes wrong.
Savas, the doctor, points to the Reyhanli bombing, when over 50 people in the border town died this May: "Reyhanli is a Sunni town, but suddenly they began to blame the refugees for everything that happened. Anger can suddenly explode in unexpected ways." He suggests that leishmaniasis, with its visible, infectious-looking sores, will not help the problem. "It's just another reason we need to get this under control," he said. Hotez, the US academic, agrees: "It's one of the most stigmatizing diseases you can have."
[Byline: Noah Blaser]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[It has been expected that cutaneous leishmaniasis (CL) would increase in the camps hosting refugees from Syria. The problem is expected to exist as well in Jordan, Lebanon and Iraq (see posting from 17 Jul 2013 on Syrian refugees in Iraq). The article clearly illustrates the stain on the health system and the inadequate resources available in the refugee camps.
ProMED just published a review of potential emerging diseases as a result of the conflict in Syria (Infectious disease risk from the Syrian conflict: Petersen E, Baekeland S, Memish ZA, Leblebicioglu H. Int J Infect Dis. 2013 17(9):e666-7). CL is high on the list of emerging infections in the refugee camps, as are measles, influenza, MERS-CoV and gastrointestinal infections. - Mod.EP
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1Cfs.]
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Tollwut in Israel
RABIES, ANIMAL - ISRAEL: NORTHEAST, DOG-MEDIATED, HUMAN EXPOSURE SUSPECTED
**************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
Date: Mon 9 Sep 2013
Source: Times of Israel [edited]
http://www.timesofisrael.com/idf-search ... ed-rabies/
According to the IDF [Israel Defense Forces], a soldier, whose identity has yet to be determined, dropped off a wounded black puppy on 28 Aug 2013 at a veterinary clinic in the Golan Heights town of Katzrin then returned to an army base in the area. The puppy was later found to have contracted rabies.
Following the diagnosis, the Health Ministry immediately notified the IDF, requesting that the army track down the soldier, who authorities believe may be in need of critical treatment.
Once the rabies virus penetrates a subject's body, he or she must be vaccinated as soon as possible before the virus can make its way to the nervous system. If the subject is not vaccinated in time, symptoms will begin to develop, ultimately leading to the subject's death, as there is currently no effective treatment for the disease once it has spread.
As of Monday [9 Sep 2013], authorities said the soldier had yet to be located. In 1996, an IDF soldier died of rabies after he was bitten in his sleep by an infected wild [small, unidentified] animal.
The Health Ministry urged anyone who may have been in contact with the puppy to seek medical assistance as soon as possible. The ministry further advised individuals who had been in contact with another rabid canine, a large German shepherd belonging to a family in the northern town of Sha'al, to seek immediate assistance as well.
[Byline: Adiv Sterman]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[The Israeli Ministry of Health is engaged in a rigorous effort to locate the person (soldier) who may have been exposed to the puppy at the beginning of its clinical rabies phase; reportedly, the animal died on 7 Sep 2013, about 10 days after its last contact with the person. The whole event took place on the Golan heights in north-east Israel bordering Lebanon, Syria, and north-west Jordan, a region witnessing an exacerbation of canine rabies during the recent 4 years.
The epidemiology of rabies in Israel has undergone a striking change since 2009, namely a significant increase in dog-mediated rabies in the north-east. The implementation of a fox-targeted oral vaccination programme (ORV), starting during the late 1990's, has almost eliminated fox-mediated rabies, which had been predominant for decades. The recent deterioration, affecting NE Israel where stray dogs and jackals have become the predominant rabies vectors, can be explained by the results of investigations carried out by the Kimron Veterinary Institute (KVI) during 2004-2007.
Rabies virus isolates from foxes and dogs were found to differ in their molecular characterization, suggesting 2 distinct, separate lineages (see reference below). The transition from fox-mediated to dog-mediated rabies, combined with the high prevalence of canine rabies (also called "urban rabies") in Syria and Jordan and with lamentably interrupted control upon the stray dog population in Israel, is of great concern to public health because of the close contact between dogs and the human population. Jackals, unlike foxes, seem to be susceptible to the same virus lineage as dogs.
Syria, Jordan, and other countries in the Middle East are long known to be infected by dog-mediated rabies and do not apply oral vaccination.
Implementing ORV in a single country within a rabies-stricken region lacking efficient control systems is liable to difficulties. This was predicted by experts during the 1990's, indicating the vital need for coordinated regional effort.
Since the beginning of 2013, there have been a total of 23 lab-confirmed rabies cases in animals (16 dogs, 4 cows, one horse, one wolf, one jackal). Their static map is available at http://www.vetserv.moag.gov.il/NR/rdonl ... _26813.pdf. A dynamic map providing details of each case is available at http://tinyurl.com/qcr8bnd.
The deteriorating conditions in war-stricken Syria are obviously contributing to the animal health situation on the Golan Heights. According to a recent FAO report, "Animal vaccination has also stopped in Syria, yet desperate farmers are selling their livestock outside the country. Cases of rabies, bovine TB, and severe afflictions such as lumpy skin disease have already spread from Syria to neighbouring countries in what the FAO calls "a serious regional animal-health problem waiting to explode;" see at http://www.newscientist.com/article/dn2 ... imDejbIbjE (thanks to Correspondent Susan Baekeland).
Israel's State Veterinary Services (Ministry of Agriculture) have intensified their efforts to vaccinate all domestic dogs on the Golan heights. Free-of charge revaccinations have been added to the regular owners' paid annual vaccinations. Domestic livestock (cattle, sheep, goats, horses) have been vaccinated as well.
The last human case of rabies in Israel occurred in 2003. A Bedouin woman, 58, died of rabies in Be'er Sheva's Soroka Hospital on 9 May 2003 after being bitten by a cat 6-8 weeks earlier (see 20030511.1170).
Reference:
D. David, N. Dveres, B. A. Yakobson & I. Davidson. Emergence of dog rabies in the Northern region of Israel. Epidemiol. Infect. (2009), 137, 544-548. - Mod.AS
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1z-1.]
**************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
Date: Mon 9 Sep 2013
Source: Times of Israel [edited]
http://www.timesofisrael.com/idf-search ... ed-rabies/
According to the IDF [Israel Defense Forces], a soldier, whose identity has yet to be determined, dropped off a wounded black puppy on 28 Aug 2013 at a veterinary clinic in the Golan Heights town of Katzrin then returned to an army base in the area. The puppy was later found to have contracted rabies.
Following the diagnosis, the Health Ministry immediately notified the IDF, requesting that the army track down the soldier, who authorities believe may be in need of critical treatment.
Once the rabies virus penetrates a subject's body, he or she must be vaccinated as soon as possible before the virus can make its way to the nervous system. If the subject is not vaccinated in time, symptoms will begin to develop, ultimately leading to the subject's death, as there is currently no effective treatment for the disease once it has spread.
As of Monday [9 Sep 2013], authorities said the soldier had yet to be located. In 1996, an IDF soldier died of rabies after he was bitten in his sleep by an infected wild [small, unidentified] animal.
The Health Ministry urged anyone who may have been in contact with the puppy to seek medical assistance as soon as possible. The ministry further advised individuals who had been in contact with another rabid canine, a large German shepherd belonging to a family in the northern town of Sha'al, to seek immediate assistance as well.
[Byline: Adiv Sterman]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[The Israeli Ministry of Health is engaged in a rigorous effort to locate the person (soldier) who may have been exposed to the puppy at the beginning of its clinical rabies phase; reportedly, the animal died on 7 Sep 2013, about 10 days after its last contact with the person. The whole event took place on the Golan heights in north-east Israel bordering Lebanon, Syria, and north-west Jordan, a region witnessing an exacerbation of canine rabies during the recent 4 years.
The epidemiology of rabies in Israel has undergone a striking change since 2009, namely a significant increase in dog-mediated rabies in the north-east. The implementation of a fox-targeted oral vaccination programme (ORV), starting during the late 1990's, has almost eliminated fox-mediated rabies, which had been predominant for decades. The recent deterioration, affecting NE Israel where stray dogs and jackals have become the predominant rabies vectors, can be explained by the results of investigations carried out by the Kimron Veterinary Institute (KVI) during 2004-2007.
Rabies virus isolates from foxes and dogs were found to differ in their molecular characterization, suggesting 2 distinct, separate lineages (see reference below). The transition from fox-mediated to dog-mediated rabies, combined with the high prevalence of canine rabies (also called "urban rabies") in Syria and Jordan and with lamentably interrupted control upon the stray dog population in Israel, is of great concern to public health because of the close contact between dogs and the human population. Jackals, unlike foxes, seem to be susceptible to the same virus lineage as dogs.
Syria, Jordan, and other countries in the Middle East are long known to be infected by dog-mediated rabies and do not apply oral vaccination.
Implementing ORV in a single country within a rabies-stricken region lacking efficient control systems is liable to difficulties. This was predicted by experts during the 1990's, indicating the vital need for coordinated regional effort.
Since the beginning of 2013, there have been a total of 23 lab-confirmed rabies cases in animals (16 dogs, 4 cows, one horse, one wolf, one jackal). Their static map is available at http://www.vetserv.moag.gov.il/NR/rdonl ... _26813.pdf. A dynamic map providing details of each case is available at http://tinyurl.com/qcr8bnd.
The deteriorating conditions in war-stricken Syria are obviously contributing to the animal health situation on the Golan Heights. According to a recent FAO report, "Animal vaccination has also stopped in Syria, yet desperate farmers are selling their livestock outside the country. Cases of rabies, bovine TB, and severe afflictions such as lumpy skin disease have already spread from Syria to neighbouring countries in what the FAO calls "a serious regional animal-health problem waiting to explode;" see at http://www.newscientist.com/article/dn2 ... imDejbIbjE (thanks to Correspondent Susan Baekeland).
Israel's State Veterinary Services (Ministry of Agriculture) have intensified their efforts to vaccinate all domestic dogs on the Golan heights. Free-of charge revaccinations have been added to the regular owners' paid annual vaccinations. Domestic livestock (cattle, sheep, goats, horses) have been vaccinated as well.
The last human case of rabies in Israel occurred in 2003. A Bedouin woman, 58, died of rabies in Be'er Sheva's Soroka Hospital on 9 May 2003 after being bitten by a cat 6-8 weeks earlier (see 20030511.1170).
Reference:
D. David, N. Dveres, B. A. Yakobson & I. Davidson. Emergence of dog rabies in the Northern region of Israel. Epidemiol. Infect. (2009), 137, 544-548. - Mod.AS
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1z-1.]
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Birgitt
- Moderator
- Beiträge: 35284
- Registriert: Di 2. Aug 2005, 22:52
- Wohnort: NRW / Südl. Rheinland
- Kontaktdaten:
Tollwut in Israel
RABIES, ANIMAL - ISRAEL (02): NORTHEAST, DOG-MEDIATED, HUMAN EXPOSURE SUSPECTED
*******************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
Date: Tue 10 Sep 2013
Source: Times of Israel [summ., edited]
http://www.timesofisrael.com/soldier-wh ... s-self-in/
An IDF [Israel Defense Forces] soldier who was being sought by authorities after bringing a rabies infected puppy to a veterinary clinic, checked in at a Health Ministry regional office along with 7 of his comrades after reports he was being searched for.
One of the group has already been tested for the deadly virus [see comment] and the rest will be tested later on Tuesday [10 Sep 2013], Ynet reported. None of the soldiers appeared to show any symptoms of rabies.
The Health Ministry and the IDF desperately searched for the soldier throughout Monday [9 Sep 2013] amid concerns that he may have been exposed to rabies and could have been infected by the virus.
According to the IDF, the soldier dropped off an injured black puppy on 28 Aug 2013 at a veterinary clinic in the Golan Heights town of Katzrin, then presumably returned to an army base in the area.
The puppy was later found to have contracted rabies.
Following the diagnosis, the Health Ministry immediately notified the IDF, requesting that the army track down the soldier, who authorities believed may have been in need of critical treatment.
Once the rabies virus penetrates a subject's body, he or she must be vaccinated as soon as possible before the virus can make its way to the nervous system. If the subject is not vaccinated in time, symptoms will begin to develop, ultimately leading to the subject's death, as there is currently no effective treatment for the disease once it has [started].
[Byline: Adiv Sterman, Stuart Winer]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[The information above on "testing" of the exposed person(s) for rabies is rather misleading. Unfortunately, the virus can be identified only after the onset of clinical disease or following autopsy. No tests are available to diagnose rabies infection in humans before the onset of clinical disease.
Reportedly, the soldier has been interviewed by the public health authorities about the timetable and the intensity of his contact with the puppy before delivering it to a veterinary clinic on 28 Aug 2013, and immediately received the prescribed post-exposure treatment, namely a combination of human rabies immune globulin (HRIG) and (HDCV) vaccine.
Procedures undertaken in relation to the other contacts were in line with the prevailing guidelines for the post-exposure prophylaxis of rabies in humans. - Mod.AS
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1z-1.]
*******************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
Date: Tue 10 Sep 2013
Source: Times of Israel [summ., edited]
http://www.timesofisrael.com/soldier-wh ... s-self-in/
An IDF [Israel Defense Forces] soldier who was being sought by authorities after bringing a rabies infected puppy to a veterinary clinic, checked in at a Health Ministry regional office along with 7 of his comrades after reports he was being searched for.
One of the group has already been tested for the deadly virus [see comment] and the rest will be tested later on Tuesday [10 Sep 2013], Ynet reported. None of the soldiers appeared to show any symptoms of rabies.
The Health Ministry and the IDF desperately searched for the soldier throughout Monday [9 Sep 2013] amid concerns that he may have been exposed to rabies and could have been infected by the virus.
According to the IDF, the soldier dropped off an injured black puppy on 28 Aug 2013 at a veterinary clinic in the Golan Heights town of Katzrin, then presumably returned to an army base in the area.
The puppy was later found to have contracted rabies.
Following the diagnosis, the Health Ministry immediately notified the IDF, requesting that the army track down the soldier, who authorities believed may have been in need of critical treatment.
Once the rabies virus penetrates a subject's body, he or she must be vaccinated as soon as possible before the virus can make its way to the nervous system. If the subject is not vaccinated in time, symptoms will begin to develop, ultimately leading to the subject's death, as there is currently no effective treatment for the disease once it has [started].
[Byline: Adiv Sterman, Stuart Winer]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[The information above on "testing" of the exposed person(s) for rabies is rather misleading. Unfortunately, the virus can be identified only after the onset of clinical disease or following autopsy. No tests are available to diagnose rabies infection in humans before the onset of clinical disease.
Reportedly, the soldier has been interviewed by the public health authorities about the timetable and the intensity of his contact with the puppy before delivering it to a veterinary clinic on 28 Aug 2013, and immediately received the prescribed post-exposure treatment, namely a combination of human rabies immune globulin (HRIG) and (HDCV) vaccine.
Procedures undertaken in relation to the other contacts were in line with the prevailing guidelines for the post-exposure prophylaxis of rabies in humans. - Mod.AS
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1z-1.]
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Birgitt
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- Beiträge: 35284
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- Kontaktdaten:
Denguefieber in Saudi Arabien
DENGUE/DHF UPDATE (77): MIDDLE EAST
*****************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
*****
- Saudi Arabia (Jeddah). 19 Sep 2013. Dengue more than 100 cases per month in previous months; Decreasing.
http://www.saudigazette.com.sa/index.cf ... 0919180899
[Maps of Saudi Arabia can be accessed at http://www.lib.utexas.edu/maps/middle_e ... l_2003.pdf and http://healthmap.org/r/7lsk. - Mod.TY]
*****************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
*****
- Saudi Arabia (Jeddah). 19 Sep 2013. Dengue more than 100 cases per month in previous months; Decreasing.
http://www.saudigazette.com.sa/index.cf ... 0919180899
[Maps of Saudi Arabia can be accessed at http://www.lib.utexas.edu/maps/middle_e ... l_2003.pdf and http://healthmap.org/r/7lsk. - Mod.TY]
