Delaware #DE | Health officials issue warning about increasing number of #overdose #deaths linked to #fentanyl

The Department of Health and Social Services (DHSS) and the Department of Safety and Homeland Security (DSHS) are issuing a warning about an increasing number of overdose deaths in Delaware related to the use of fentanyl, a synthetic painkiller that is 50 to 100 times more potent than heroin.

“Since early February, the Delaware Division of Forensic Science has confirmed 15 cases of overdose deaths that have involved the use of fentanyl. In only four of those cases, was the presence of heroin confirmed as well. The increasing number of deaths related to the ingestion of fentanyl is quite concerning,” DSHS Secretary Lewis Schiliro said.

“We are issuing our highest warning,” DHSS Secretary Rita Landgraf said. “Fentanyl is here in Delaware and people are dying from it. In some cases, it appears that individuals thought they were using heroin, which is deadly in its own right, but were ingesting fentanyl instead. With the extreme potency of fentanyl, one single use clearly is costing too many people their lives.”

Secretary Landgraf urged individuals struggling with addiction to call DHSS’ 24/7 Crisis Services at 1-800-652-2929 in New Castle County, or 1-800-345-6785 in Kent and Sussex counties to be connected to treatment. If individuals see someone overdosing, they should call 911. Under Delaware’s Good Samaritan Law, people who call 911 to report an overdose cannot be prosecuted for low-level drug crimes.

The Division of Forensic Science reported that the 15 overdose deaths involving fentanyl occurred between Feb. 8 and June 3 of this year. Twelve cases were in New Castle County, two in Kent and one in Sussex. Fourteen of the 15 cases involved men. The ages ranged from 20 to 62.

When a user ingests fentanyl or fentanyl-laced heroin, it affects the central nervous system and brain. Because it is such a powerful opiate, users often have trouble breathing or can stop breathing as the drug sedates them. If someone is too drowsy to answer questions, is having difficulty breathing, or appears to be so asleep they cannot be awakened, call 911 immediately.

Last year, the Division of Forensic Science confirmed 11 overdose deaths in Delaware related to fentanyl-tainted heroin. Because illicit fentanyl can come in white powder form like heroin, users don’t know if fentanyl is mixed in or if the drug packet contains only fentanyl. Exposure to fentanyl, even in small quantities, can be fatal.

#Thailand | Confirmed #MERS case

On 18 June 2015, the National IHR Focal Point of Thailand notified WHO of the country’s first confirmed case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV).

Details of the case are as follows:

The case is a 75-year-old, Omani male that travelled from Oman to Thailand to seek medical care. The patient, who has comorbidities, developed symptoms on 10 June and was admitted to hospital in Oman. As symptoms did not improve, he decided to travel to Thailand to seek treatment. He took a flight with three family members and arrived in Bangkok on 15 June. Neither the patient nor his family members reported fever upon arrival in Thailand. He was admitted to hospital on 15 June and tested positive for MERS-CoV on 18 June. On 18 June, the patient and his three family members were transferred to another health care facility where they were put in isolation. Currently, the patient is in stable condition.

Public health response

National health authorities in Thailand are implementing the following public health measures:

  • reviewing and strengthening infection prevention and control measures at the hospital where the patient was initially admitted,
  • carrying out contact tracing of household and healthcare contacts,
  • activating the Emergency Operation Center as well as the preparedness and response units.

Information on this event is also being shared between the two concerned countries, Thailand and Oman.

Global situation

Globally, since September 2012, WHO has been notified of 1,334 laboratory-confirmed cases of infection with MERS-CoV, including at least 471 related deaths.

WHO advice

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for acute respiratory infections and to carefully review any unusual patterns.

Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. It is not always possible to identify patients with MERS-CoV early because like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, health-care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when performing aerosol generating procedures.

Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease from MERS‐CoV infection. Therefore, these people should avoid close contact with animals, particularly camels, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating. General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to.

Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.

WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.

South #Korea | 12 additional cases of #MERS reported bringing total number of cases to 149

In the past two days, 12 additional cases of Middle East Respiratory Syndrome (MERS) have been reported by South Korean health authorities.

According to preliminary information, they include:

* A patient who had contact with a confirmed case in the emergency room of Samsung Medical Center on May 27;
* A patient who had contact with another confirmed case in the out-patient clinic of a hospital on June 8;
* A healthcare worker who had contact with another confirmed case in Konyang University Hospital on June 3;
* A patient who had contact with another confirmed case in Dae-Cheong Hospital from May 22 to 28; and
* A patient who had contact with another confirmed case in Konkuk University Medical Centre on June 6.

* Four cases who had contact with a confirmed case in Samsung Medical Center;
* A case who had contact with another confirmed case in Hallym University Medical Center;
* A case who had contact with another confirmed case in Dae-Cheong Hospital; and
* A case who travelled in the same ambulance with another confirmed case. The ambulance driver reported yesterday was also in the same ambulance.

To date, 149 MERS cases have been confirmed by South Korea while another case was exported to Mainland China.

South #Korea | 12 additional cases of #MERS reported bringing total number of cases in #outbreak to 138

12 additional cases of Middle East Respiratory Syndrome (MERS) were reported by South Korea.

According to the preliminary information of health authorities, the cases are:

* Two patients of the emergency department of Samsung Medical Center;
* A patient of Konyang University Hospital;
* Three patients of Dae-Cheong Hospital;
* An ambulance officer who was involved in the transportation of a confirmed case; and
* Five cases which are under investigation.

To date, 137 MERS cases have been confirmed by South Korea with  another case exported to Mainland China.

Following is the transcript of remarks made by the Secretary for Food and Health, Dr Ko Wing-man, after attending a radio programme today (June 13):

Reporter: Can you briefly explain the significance of the so-called fourth generation transmission of virus? Do you expect the number of suspected cases intercepted in Hong Kong will drop?

Secretary for Food and Health: Firstly, if the transmission in Korea continues, the risk of community outbreak will increase. Secondly, the confirmation of a fourth generation transmission case will further extend the observation period before we are sure that transmission in Korea has ceased. Looking at the number of confirmed cases of Middle East Respiratory Syndrome in Korea in the past several days, it appears that the number of cases has levelled off. But of course with the confirmation of any fourth generation case, we need to be cautious and further extend the horizon of observation.

Reporter: Any number of suspected cases of MERS?

Secretary for Food and Health: I hope the number of suspected cases will gradually drop after the issuance of Outbound Travel Alert on Korea. We know that many travel groups to Korea have cancelled. We expect the number of Hong Kong citizens travelling to Korea will drop and hopefully the number of suspected cases requiring isolation and testing will also drop in due course.

 

#UK | New #medal to recognize bravery of people who have helped combat #Ebola

The government has today (11 June 2015) set out the details of a new medal that will recognise the bravery and hard work of thousands of people who helped to tackle Ebola in West Africa.

The medal is expected to go to over 3,000 people who travelled from the UK to work in high risk areas to stop the spread of the disease.

This is the first time a medal has been created specifically to recognise those who have tackled a humanitarian crisis and is in recognition of the highly dangerous environment that workers were required to enter.

The medal has been designed by John Bergdahl, who has been an engraver for over 40 years and recently designed a new coin set to celebrate the birth of Prince George. Mr Bergdahl’s design was chosen following a competition run by the Royal Mint Advisory Committee. It shows a flame on a background depicting the Ebola virus – above this are the words “For Service” and below “Ebola Epidemic West Africa”.

The obverse bears a portrait of Her Majesty The Queen designed by Ian Rank-Broadley.

The medal will be awarded to military and civilian personnel who have been tackling Ebola on behalf of the UK in West Africa such as people from our armed forces, doctors and nurses from the NHS, laboratory specialists and members of the civil service and non-governmental organisations. Eligibility is set out in detail in a command paper published today.

The first awards of the medal will be made as early as this summer and will be ongoing thereafter. The Prime Minister will also host a summer reception to congratulate in person some of the recipients.

The Prime Minister David Cameron, said:

The Ebola outbreak was one of the most devastating epidemics of our generation but we managed to stop its spread thanks to the hard work of British people who travelled to West Africa.

As a result of their efforts, many lives were saved and the outbreak contained.

This medal is about paying tribute to those people. They put themselves at considerable personal risk and we owe them a debt of gratitude.

Secretary of State for Wales Stephen Crabb said:

Wales has some of the finest health workers and volunteers in the World and this medal is testament to the strength and commitment of NHS staff across Wales.

It is thanks to their tireless efforts that thousands of lives have been saved and incredible progress has been made towards eradicating the virus.

Notes to editors

About the medal

  • The Committee on the Grant of Honours, Decorations and Medals recommended specific eligibility criteria to Her Majesty The Queen, who graciously approved them.
  • Eligible personnel, including civil servants, the military, UK Med, Public Health England, Stabilisation Unit, Conflict Humanitarian and Security Department (CHASE) Operations Team, UK nationals who worked for DFID-funded NGOs supporting government efforts who served at least 21 days of continuous service (or 30 days of accumulated service) within the geographical territories of Sierra Leone, Liberia, Guinea and their territorial waters, would automatically receive the medal.
  • The medal will be sent to most people automatically, but a few people who have not gone as part of the UK government effort will need to nominate themselves.
  • This new medal has been introduced following approval by Her Majesty The Queen and the Honours and Decorations Committee.
  • The medal will be manufactured in the UK by Worcestershire Medal Service and will be awarded to those eligible continuously from the summer.

About UK government response to Ebola

  • £427 million has been committed to the effort by UK government. Our contribution has included supporting more than half of all the beds available for Ebola patients in Sierra Leone, funded over 100 burial teams, trained 4,000 frontline staff, provided three labs to test one third of all samples collected nationally and delivered over one million PPE suits and 150 vehicles.

#France | Touraine et Cazeneuve engagent la modernisation du #secours à personne et de l’aide #médicale #urgente

A la demande du Président de la République, le gouvernement a lancé en octobre 2013 une mission de l’Inspection générale des affaires sociales (IGAS) et de l’Inspection générale de l’administration (IGA) pour évaluer l’efficacité du secours à personne et de l’aide médicale urgente, et la qualité de la coordination entre les services d’aide médicale d’urgence (SAMU) et les services départementaux d’incendie et de secours (SDIS).

Cette mission a rendu son rapport en juillet 2014.

Marisol TOURAINE, ministre des Affaires sociales, de la Santé et des Droits des femmes, et Bernard CAZENEUVE, ministre de l’Intérieur, ont demandé à la direction générale de l’offre de soins (DGOS) et à la direction générale de la sécurité civile et de la gestion de crises (DGSCGC) d’engager sur cette base la nécessaire modernisation du secours à personne et de l’aide médicale urgente, en veillant à améliorer la qualité du service rendu aux usagers et en favorisant la coopération des acteurs.

Une circulaire et un arrêté, signés par les deux ministres, viennent préciser les conditions dans lesquelles ces objectifs seront mis en œuvre par les préfets et les directeurs généraux des agences régionales de santé (ARS).

Les ministres tiennent à souligner la grande qualité du travail conduit par les acteurs et les services impliqués. Ce nouveau cadre crée les conditions d’une meilleure coopération entre urgentistes et sapeurs-pompiers, dont le gouvernement salue l’engagement et le dévouement quotidiens au service de nos concitoyens.

#India | #Heatwave has hit #vulnerable members of the public such as street children particularly hard

India’s deadly heatwave shows that countries need to switch from disaster management to managing the risks, in line with the new Sendai Framework for Disaster Risk Reduction, according to one of the country’s leading experts on development.

“The Sendai Framework for Disaster Risk Reduction cannot be implemented in Asia without addressing the increasing risk of heatwave. Any Regional Implementation Plan for Asia must draw from the Ahmedabad experience. No national landscape of risk can be drawn out in Asia without including heatwave risk,” Mr. Mihir R. Bhatt, Head of the All India Disaster Mitigation Institute.

While the overall is bleak, the northwestern city of Ahmedabad, where Mr. Bhatt’s institute is based, has emerged as a role model for curbing the impact of heatwaves.

More than 2,400 people reportedly have died in India over recent as temperatures soared above 40 degrees Celsius. The real toll is likely to be much higher, given that heat-related illness is often recorded inaccurately and figures from rural areas are hard to obtain. While the true extent of the loss of health, livelihoods, and business is still uncertain, it is clear that the impact could have been reduced.

“Extreme heat events are responsible for more deaths annually than hurricanes, lightning, tornadoes, floods and earthquakes combined. Numerous studies have documented that human-induced climate change has increased the frequency and severity of heat waves across the globe,” Mr. Bhatt claimed on the sidelines of UNISDR’s Asia Partnership meeting in Bangkok.

“The most vulnerable groups are slum dwellers, outside workers, the elderly and the very young. However, there has yet to be further research done on the impacts to street vendors, beggars, traffic police and hawkers. In India a street is also a place of work for millions. As a result, almost all day, and most nights, citizens work on streets of Indian cities and are impacted by heatwaves,” he underlined.

There has been progress, however, in several key areas, he said.

One is the improved accuracy and timeliness of heatwave forecasting over the past four years by the India Meteorological Department. He also cited local-level efforts to curb the impact of heatwaves which, while rare, have proven their effectiveness.

“The Ahmedabad Municipal Corporation health team in Gujarat, India, has worked with Indian Institute of Public Health and Natural Resources Defence Council teams for over three years to make India’s first heatwave action plan, which is also rare for Asia,” said Mr. Bhatt.

“The plan lays out actions that the citizens, the public and private institution, and the enabling policy makers can take to reduce the negative impact of heatwaves on citizens. The plan has performed over the years and reduced the impact. Last year fewer citizens died due to heatwave in Ahmedabad and even less suffered health issues. Drinking more water, standing under shade, are some of the key actions. But do our cities offer such facilities to common citizens?”

Ahmedabad’s Heat Action Plan is exactly the kind of measure called for in the Sendai Framework, a 15-year global roadmap agreed by UN member states at the World Conference on Disaster Risk Reduction in Japan in March. Addressing the health impacts of natural hazards is a key part of the framework.

The Indian Institute of Public Health and the Natural Resources Defence Council are working hand in hand to spread Ahmedabad’s methods to other cities. Not only because of the heatwave – such efforts also help to improve public health more broadly.

“For example, ambulance services are now located strategically in places where many calls for help are issued. Hospitals receive warnings when extreme temperatures are forecast and now have extra ice packs on hand, and drinking water stations and awareness-building materials are distributed throughout Ahmedabad. The tradition of parabadi, or public drinking water facility, is being revived,” said Mr. Bhatt.

The Ahmedabad strategy is four-pronged, starting with public information campaigns about the risks of heat illness and preventive measures. This year, the city has deployed new media such as mobile messaging and WhatsApp alongside more traditional means such as wall posters and inter-personal communication.

Secondly, a warning system maps out what actions various government agencies should take. The third step involves training healthcare workers to respond better to heat illness. The fourth is about adapting the physical plan of the city to cope: mapping high-risk areas, making potable water easily accessible and building temporary cooling spaces during periods of extreme heat.

“A disaster is also a creative moment in the life of a nation,” Mr. Bhatt underlined. “How to turn this ongoing and increasing loss of life and livelihoods into the world’s largest national strategy for heatwave preparedness that not only protects citizen from the impact of heat but in fact reduces the impact itself?”

Over 2,400 citizens have lost their lives over the past two weeks due to lack of preparedness to face the heatwave. However it is likely this figure is much higher as heat related illness is often recorded inaccurately and figures from rural areas are hard to attain. It is suggested that it normally takes a month after the heatwave to get a true picture of the impact. Loss of health, livelihoods, and business is yet to be calculated, but it is clear this could have been avoided. The United Nations Office for Disaster Risk Reduction (UNISDR) interviewed Mihir R. Bhatt, Head of All India Disaster Mitigation Institute and Chair of Duryog Nivaran at ISDR IAP Meeting of 2015 in Bangkok to explain what heat waves are, how they are impacting India and possible solutions that can be incorporated in implementing Sendai Framework for Disaster Risk Reduction in Asia.

UNISDR: What is a heat wave?

Mihir R. Bhatt: Heat waves are present in countries throughout the world and are broadly defined as periods of abnormal heat. Definitions vary, in part because a heat wave is measured relative to the usual weather in the area and relative to normal temperatures of the season. In the past three to four decades there has globally been an increased trend in high-humidity heat waves. Extreme heat events are responsible for more deaths annually than hurricanes, lightning, tornadoes, floods and earthquakes combined. Numerous studies have documental that human induced climate change has increased the frequency and severity of heat waves across the globe. Extreme Heat can lead to dangerous, even deadly, health consequences, including heat stress and heatstroke. In India a heat wave is declared when there is a departure of between 40C to 50C from the normal temperature while a “severe heatwave” refers to a departure of more than 60C or temperatures above 450C . At these temperatures, chances of a heatstroke, a possibly fatal illness which results from the overheating of the human body, are high for the citizens out under the sun

UNISDR: How are heat waves affecting India?

MRB: Heat waves are a significant health concern in India, extreme heat hazards are projected to increase in frequency and severity with climate change.

UNISDR: Who is measuring heat waves?

MRB: The India Meteorological Department has been making more accurate and timely heatwave predictions in India over the past four years. A big forward step is taken. The Intergovernmental Panel on Climate Change (IPCC) Special Report on “Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation (SREX) report had concluded that more heatwaves will occur and especially in cities. The Fifth Assessment Report (AR5) Outreach Event in Dehradun by Central Himalayan Environment Association (CHEA) and Kolkata by Jadavpur University in March 2015 also indicated more frequent heatwaves in India’s cities.

UNISDR: Which groups are most vulnerable to heat waves?

MRB: The most vulnerable groups are slum dwellers, outdoor workers, the elderly and the very young. However, there has yet to be further research done on the impacts to street vendors, beggars, traffic police and hawkers. In India a street is also a place of work for millions. As a result, almost all day, and most nights, citizens work on streets of Indian cities and are impacted by heatwaves. Also, children and homeless are another group that suffers from a heatwave.

UNISDR: How has Ahmedabad responded to heat waves?

MRB: The Ahmedabad Municipal Corporation (AMC) health team in Gujarat, India, has worked with Indian Institute of Public Health (IIPH) and Natural Resources Defense Council (NRDC) teams for over 3 years to make India’s first heatwave action plan which is also rare for Asia. The plan lays out actions that the citizens, the public and private institutions, and the enabling policy makers can take to reduce the negative impact of heatwaves on citizens. The plan has performed over the years and reduced the impact. Last year less citizens died due to heatwave in Ahmedabad and even less suffered health issues. Drinking more water, standing under shade, are some of the key actions. But do our cities offer such facilities to common citizens? The AMC has now institutionalized heatwave planning and put it on its annual plan and budget. Ahmedabad is India’s first city to have a heatwave plan. NRDC is taking this idea to other cities with IIPH.

UNISDR: What is included in the heat wave plan?

MRB: The Ahmedabad Municipal Corporation (AMC) is rapidly improving the city’s public health infrastructure in response to the unique Heatwave Action Plan project’s recommendations. For example, ambulance services are now located strategically in places where many calls for help are issued. Hospitals receive warnings when extreme temperatures are forecast and now have extra ice packs on hand, and drinking water stations and awareness-building materials are distributed throughout Ahmedabad. Traditions of parabadi or pubic drinking water facility is being revived.

The Heat Action Plan is a four-pronged strategy and almost any city in India can take up. The first involves a communications outreach which informs citizens about the risk of heat illness and preventive measures to take. This year, new media such as mobile messaging service, WhatsApp, are used as a dissemination channel along with more traditional means such as wall posters and inter-personal communication.

The second involves a warning system in the case of a heatwave with actionables mapped out for various governmental agencies. Who will do what, when, and how is clear to key individuals and units of key departments. The third important step involves training health care professionals—public and some private—to better respond to heat illness while the fourth involves adapting the physical plan of the city to better cope with heat: mapping high-risk areas, making potable water easily accessible and building temporary cooling spaces during periods of extreme heat. The plan is revised as each new lesson is learned.

UNISDR: Is this enough?

MRB: To start with. But in the end what we need is development focused heatwave plans that manage heatwave risk, build resilience, and promote ecosystem based pro-poor urban planning.

UNISDR: Does the rest of the world have heat wave plans?

MRB: Strengthening public authorities to deal with excessive heat are the global norm. After the 2003 heat wave in France, which killed almost 15,000 people, the French government formulated a heat health watch warning system, a nationwide system of combating heat illness in case of abnormally hot weather. Some studies estimates that during the 2006 heat wave, 4,400 deaths were avoided as a result of this system being in place. In India we do not have such nation wide studies.

Similarly, the National Workshop on Scaling up Successful Heat Action Plan from Ahmedabad to other parts of India, where the Mayor and Commissioner of AMC were congratulated, attracted interest from the city of Nagpur in Maharashtra where later in the month a Round Table was held and more cities in Maharashtra turned up to prepare for Ahmedabad-like heatwave plan.

Over 40 mayors at the recent event in Delhi, organized by UN Habitat, Cities Network Campaign, and Climate and Development Knowledge Network (CDKN), titled, South Asia City Summit, showed interest in Ahmedabad’s heatwave plan. The session, Scaling up Successful Heat Action Plan from Ahmedabad to other parts of India concluded that Smart Cities are Heatwave Safe Cities.

Ahmedabad has shown a pathway for towns and cities of India. At the Third UN World Conference on Disaster Risk Reduction in Sendai, Japan, the Ahmedabad Heat Action Plan was showcased as a finalist for the prestigious Munich RE Foundation RISK Award alongside 20 other “best proposals” out of 145 submissions from 62 countries. In many ways the heatwave plan shows how the Sendai Framework for Disaster Risk Reduction is already owned and implemented by city authorities.

Cities across the world have protected citizens with a wide range of measures such as tree plantation on city roads for shade, enforcing building bye-laws for overhangs to shade walls and windows, and increasing structures for individuals on duty such as traffic police or street cleaner. Such measures are also taken in Indian cities but at much smaller scale than the heatwave challenge demands.

UNISDR: A last word?

MRB: A disaster is also a creative moment in the life of a nation. And so are heatwaves for India. How to turn this ongoing and increasing loss of life and livelihoods into the world’s largest national strategy for heatwave preparedness that not only protects citizen from the impact of heat but in fact reduces the impact itself?

The Sendai Framework for Disaster Risk Reduction cannot be implemented in Asia without addressing the increasing risk of heatwave. Any Regional Implementation Plan for Asia must draw from the Ahmedabad experience. No national landscape of risk can be drawn out in Asia without including heatwave risk.

I am sure at the upcoming Asian Ministerial Conference of Disaster Risk Reduction in 2016 Delhi over two dozen cities across Asia will come up to share their heatwave preparedness plan experience.

(Mihir R. Bhatt leads All India Disaster Mitigation Institute in Ahmedabad and is Chair of Duryog Nivaran in South Asia).

Michigan #MI | State confirms first cases of highly pathogenic #avian #influenza in free-ranging geese #HPAI

The Michigan departments of Natural Resources (DNR) and Agriculture and Rural Development (MDARD) today announced the state’s first confirmed cases of highly pathogenic avian influenza (HPAI) H5N2 in the state.

The disease was found in free-ranging Canada geese in Macomb County. Avian influenza is a virus that can infect both free-ranging and domestic poultry such as chickens, turkeys, quail and geese.

Three goslings collected last week in Sterling Heights were delivered to the DNR’s Wildlife Disease Laboratory for necropsy. Initial testing was performed at Michigan State University’s Diagnostic Center for Population and Animal Health in Lansing. These tests were positive and the samples were forwarded to the U.S. Department of Agriculture’s National Veterinary Services Lab in Ames, Iowa, for final confirmation. MDARD and the DNR received confirmation Saturday, June 6, that the goslings were infected with highly pathogenic avian influenza, subtype H5N2.

The U.S. Centers for Disease Control and Prevention considers the risk to people from these HPAI viruses to be low. To date, no human HPAI infections have been detected in the United States. Avian influenza is not a food safety concern and no birds or bird products infected with HPAI will enter the food chain.

Michigan is the 21st state to report a case of HPAI since December 2014. In the other 20 states, the virus has been found in captive wild birds or free-ranging birds, backyard flocks, and commercial flocks. Michigan also becomes the 6th state to detect in wild or free-ranging birds only. To date, there are 226 detections of HPAI across the country (affecting approximately 50 million birds), with Iowa and Minnesota experiencing the most cases.

“While this is disappointing news that the H5N2 virus has been found in Michigan’s free-ranging bird population, it was not unexpected given avian influenza has been found in a number of our neighboring states and Ontario,” said MDARD Director Jamie Clover Adams.

Clover Adams stressed that avian influenza has not been identified in Michigan’s domestic poultry flocks.

“MDARD will continue to work hand-in-hand with our backyard and commercial poultry farmers to conduct surveillance testing and provide education along with Michigan State University’s Extension on implementing and stepping up on-farm biosecurity practices to protect the health of Michigan’s domestic poultry,” she said.

Keith Creagh, DNR Director, said the state’s chief focus now is preventing the disease’s spread in wildlife and its transmission to domestic poultry.

“This confirmed positive finding of highly pathogenic avian influenza prompts several steps that are informed by Michigan’s Surveillance and Response Plan for HPAI in free-ranging wildlife,” said Creagh. “The DNR and MDARD are working with other experts and taking advantage of every available resource to ensure a swift, appropriate response that limits the spread of HPAI.”

The state’s wildlife HPAI plan was developed by DNR’s Wildlife Division in 2006. The DNR already practices regular examination of carcasses from mortality events affecting birds and samples live-caught and hunter-harvested wild birds.

Guided by the wildlife HPAI plan, the DNR will:

• Create an avian influenza (AI) Core Area, a 10-mile radius around the confirmed positive cases.
• Create an AI Management Zone, including any counties that touch the AI Core Area. In this case, the AI Management Zone will include Macomb and Oakland counties.
• Change goose relocation activities. The DNR routinely relocates nuisance geese in southeast Michigan to other parts of the state. The AI Management Zone will be under quarantine and roundup/relocation within these counties will be prohibited, except for the purpose of additional testing.
• Continue goose roundup and relocation efforts in the rest of the state.
• Change goose relocation drop-off sites so none are within a 10-mile radius of a commercial poultry facility in Michigan.
• Heighten AI surveillance in the two-county AI Management Zone.
• Increase biosecurity measures for contractors who relocate geese and anybody handling geese, as well as for waterfowl banders.
• Continue statewide AI surveillance, which includes responding to suspicious dead animals, conduct sample testing of geese being relocated, banding ducks and geese, and testing hunter-harvested waterfowl.

With this type of highly pathogenic avian influenza, there may be an absence of many of the routine signs of illness in domestic poultry. Sudden death and high death losses are major indicators of HPAI. However, sick birds may experience neurological signs; difficulty walking; lack of appetite, energy or vocalization; significant drop in egg production; swollen combs, wattles, legs or head; diarrhea; or nasal discharge, sneezing or coughing.

Wild birds commonly have avian influenza and sometimes spread it to domestic birds through direct or indirect transmission. Ducks and geese are considered carriers; however, geese generally do not pass it on.

MDARD, the DNR, the Michigan Department of Health and Human Services, the U.S. Departments of Agriculture, Veterinary Services (USDA, VS) and Wildlife Services (USDA, WS) and Michigan State University (MSU) are working together to conduct avian influenza surveillance and to monitor health of poultry, livestock, wildlife and residents in Michigan. Residents who notice the death loss of three or more free-ranging birds should report it to DNR at 517-336-5030. If your domestic flock is experiencing severe illness or multiple death losses, contact MDARD at 800-292-3939 or for after-hours emergencies call 517-373-0440.

For more information, go to www.michigan.gov/avianinfluenza or www.michigan.gov/aviandiseases.

#China | Nine additional cases of avian influenza #H7N9 reported

The Centre for Health Protection (CHP) of the Department of Health (DH) today (June 12) received notification of 12 additional human cases of avian influenza A(H7N9) with onset of symptoms between April 24 and May 22 from the National Health and Family Planning Commission, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

The patients comprise six men and six women aged from 4 to 77, three of whom (one man and two women) have died. Four cases are from Zhejiang, three are from Jiangsu, three are from Anhui, one is from Fujian and one is from Beijing.

From 2013 to date, 653 human cases of avian influenza A(H7N9) have been reported by the Mainland health authorities. Regarding the third wave in the Mainland since November 2014, a total of 213 cases have been reported including 72 in Guangdong, 44 in Zhejiang, 41 in Fujian, 21 in Jiangsu, 11 in Anhui, seven in Xinjiang, seven in Shanghai, three in Jiangxi, two in Hunan, two in Shandong, one in Guizhou, one in Hubei and one in Beijing.

South #Korea | Four additional cases of #MERS brings total number of cases in #Korean outbreak to 125

Four additional cases of Middle East Respiratory Syndrome (MERS) were reported by South Korea.

According to health authorities, the four cases are:

* Three patients who had contact with a confirmed case in Samsung Medical Center from May 27 to 29; and
* One patient who had contact with the same confirmed case in Good Morning Hospital on May 27.

In addition, the authority confirmed the sources of infection of the five cases announced yesterday (June 11), they are:

* Two patients who had contact with the same confirmed case in Samsung Medical Center from May 27 to 29;
* Two patients who had contact with the same confirmed case in Good Morning Hospital from May 25 to 27; and
* One patient who had contact with another confirmed case in Bagae Hospital on May 31.

To date, 125 MERS cases have been reported by South Korea. In addition, another case was exported to Mainland China.

Be well. Practice big medicine.