Nigeria: 40 Die From Lassa Fever Outbreak

By Ezra Ijioma, 22 February 2012

Forty people have died across the country from the outbreak of Lassa fever in the last six weeks. So far, 397 cases have been reported and all patients are to be treated free.
This was disclosed in a statement by the minister of Health, Prof. Onyebuchi Chukwu, yesterday.
The minister said that six of the dead were health workers (two doctors and four nurses) and that cases have been reported in 12 states Edo, Nasarawa, Plateau, Ebonyi, Taraba, Yobe, Ondo, Rivers, Gombe, Anambra, Delta and Lagos.
Out of the 397 cases reported, only 87 cases have been positively confirmed by medical officials. Chukwu narrated the case of a 28-year-old female corps member who completed her three weeks orientation in Rivers State but travelled home to visit her families in Afikpo and Abakiliki, capital of Ebonyi State, where she contracted the fever on January 1 and died two days later.
On what the Ministry is doing to contain the situation, Chukwu said adequate quantities of Ribavirin injections and tablets, the specific antiviral drug for Lassa fever, have been released to the affected states.
He also said that the ministry has deployed rapid response teams to all affected states and there is great emphasis on routine barrier nursing precautions.

He said, "Nigeria has the capability to diagnose Lassa fever and all the cases reported so far were confirmed by our laboratories."
Chukwu added that no travel restriction will be imposed on the affected areas but hotlines have been provided for health workers for expert advice. The numbers are: 08037154575, 08023214998, 08037879701 and 08023047101.
However, the minister of state for health, Dr. Muhammad Ali Pate, in a media conference yesterday, said the ministry has also distributed over 750,000 doses of Ribavirin doses of injection and tablets as well as safety gloves and protective vests for health workers.
He said that there are nine specialist centres across Nigeria where tests on Lassa fever can be done. Pate advised Nigerians not to panic as the government is responding promptly and effectively to the outbreak.
Lassa fever is a viral disease that attacks the liver, nervous system, spleen and kidney, causing them to bleed, hence the haemorrhagic fever. According to online encyclopaedia Wikipedia, Lassa fever was first described in 1969 in the town of Lassa, in Borno State, Nigeria, in the Yedseram river valley at the south end of Lake Chad. It is an infection that is endemic in West African countries of Liberia, Sierra Leone, Guinea and even Central African Republic and Congo DR. About 300,000-500,000 cases occur annually, with approximately 5,000 deaths. Symptoms of Lassa fever include fever, retrosternal pain (pain behind the chest wall), sore throat, back pain, cough, abdominal pain, vomiting, diarrhoea, conjunctivitis, facial swelling, proteinuria (protein in the urine), and mucosal bleeding, bleeding from the mouth, nose, vagina or gastrointestinal tract and low blood pressure.
The virus lives in rats and infects humans when they come in contact with these rats' urine and faeces. Pate explained that increasing awareness is being created for Nigerians to avoid rats and keep them away from stored food and drinking water. People living in rural areas or in crowded and unsanitary environment, where rats breed, are at the greatest risk.
However, health experts warn that Lassa fever can be contracted through body fluids like blood and excrements of infected persons.

http://allafrica.com/stories/201202220127.html

1.    What is the link to Crisis Management?

The link to crisis is that Lassa fever can be linked to 397 reported cases and up to 40 confirmed deaths in Nigeria. This causes it to be a health and public safety concern for the citizens of the affected areas.

2.    What stage of Crisis Management does the system appear to be at?

The system appears to be at a risk level. There are numerous deaths and cases reported due to this disease, however this sort of outbreak is not uncommon in these areas. This is something that the region has dealt with in the past and most likely will go through again.

3.    How well does the system appear to be handling the situation?

The system appears to be handling the situation adequately. Sufficient quantities of the vaccine are available and have been released to affected areas. There are also routine barrier nursing precautions put in place for better diagnosis.

4.    What level of crisis preparedness does the system appear to have?

The system appears to be quite prepared for this crisis as this is not the first time it’s happening. Hotlines have been setup and there are capabilities to effectively diagnose Lassa fever. There are 9 specialist centres across Nigeria so individuals have appropriate access. There is marketing awareness in place for Nigerians to avoid rats (source of outbreak) and keep them away from stored food and drinking water.

5.    What personal reactions/feelings does the description trigger in you?

This description triggers a little grief because even though we are in the 21^st century, we still get diseases caused by improper sanitary conditions. There is also anger involved because Lassa fever is already considered an endemic in the area and it surprises me as to why more has not been done to eradicate the entire problem.

6.    What advice would you offer to those involved?

I would get foreign health related bodies involved in order to help eliminate this disease since it is already an endemic in the region. More education and more screening stations should be set up in order to allow earlier diagnosis in regards to this disease. There also needs to be government intervention in order to improve sanitary conditions for its citizens.

War, neglect leave 500,000 Afghans homeless: Amnesty

KABUL: Half a million Afghans displaced by war have been left homeless and struggling to survive because of government and international neglect, Amnesty International said on Thursday.
Around 400 people join makeshift shelters around the country every day, Amnesty said in a report entitled “Fleeing war, finding misery”, based on three years of research.
The Afghan government estimates that more than 40 people froze to death this winter, the harshest in 15 years, with at least 28 children dying in camps around Kabul.
The government is “not only looking the other way but even preventing help from reaching them” in an attempt to avoid making the settlements permanent, Amnesty researcher Horia Mosadiq said.
“Local officials restrict aid efforts because they want to pretend that these people are going to go away. This is a largely hidden but horrific humanitarian and human rights crisis,” she said.
The report calls on the government to remove conditions placed on humanitarian aid and on international donors to “ensure that their humanitarian assistance addresses the needs of internally displaced people”.
Kabul alone houses up to 35,000 displaced persons in 30 slum areas around the city, according to the report.
Slum residents told Amnesty that they had fled their homes to escape the escalating war which has seen the number of civilian deaths rise steadily to a record of more than 3,000 in 2011, according to UN figures.
Most of the casualties are caused by Taliban insurgents, but many displaced Afghans told Amnesty that they fled their homes in fear of Nato bombardment and to avoid being used as human shields by the militants.
Nato has some 130,000 troops in Afghanistan supporting the government of President Hamid Karzai against an insurgency led by remnants of the Islamist Taliban regime overthrown by a US-led invasion in 2001.
“Afghans have real grounds to feel less secure now than at any point in the last 10 years,” said Mosadiq.
“International and Afghan forces should address the impact of conflict on civilians, including displacement. The Taliban must also look to protect civilians, by ensuring humanitarian access to the areas they control.” Food is scarce in the camps and children in slum communities have little access to education, according to the report.
“Since we came there is no assistance or anything; the family has not eaten anything for the past two days,” a camp dweller named Zarin told Amnesty.
Most women give birth in difficult and unsanitary conditions without skilled attendants, increasing the risk of maternal and infant death in a country ranked among the world’s worst places for maternal health, the report said.
With housing scarce and expensive in the main cities, families who flee the war construct makeshift dwellings from mud, poles, plywood and plastic sheeting that give them little protection from the cold in winter and heat in summer.
“I don’t know which problem I should talk about – school, unemployment, not having proper housing, food, health – when my children are getting sick and I have to pay for the doctor – it’s everything,” said Fatima, a woman in her 20s living in a Kabul camp.
The report calls on the government to protect displaced people against forced eviction, guarantee their children access to primary education and allow them to be issued with identity cards so they can exercise their legal rights.
The head of the UN refugee agency Antonio Guterres said this month that UNHCR was overhauling its strategy in a bid to stop returning Afghans from becoming destitute, and to focus on sustainable reintegration.-AFP

http://www.dawn.com/2012/02/24/war-neglect-leave-500000-afghans-homeless-amnesty-2.html 

1.    What is the link to Crisis Management?

Even though this case is linked to war, the relation with crisis management cannot be ignored. 500,000 Afghani’s have been displaced due to war and are left homeless and struggling due to the unsafe conditions and conflict within the region.

2.    What stage of Crisis Management does the system appear to be at?

This issue is at a crisis stage based on the sheer volume of individuals affected by it. More than 40 people froze to death in the winter. There doesn’t appear to be access to safe sanitations with individuals making make shift housing. There is limited access to food and water, and no contingency plan is set up for those forced into displacement.

3.    How well does the system appear to be handling the situation?

From Amnesty International’s report, the system seems to not be handling the situation well at all. The government is looking the other way in an effort to prevent permanent settlements hoping that the problem would go away. There is a full out humanitarian crisis going on with no potential end in sight.

4.    What level of crisis preparedness does the system appear to have?

There is no level of crisis preparedness in the system at this point. The government has done nothing in order to address the problem and seems to be avoiding it altogether. Internal displacement is a major issue in this country and requires urgent attention.

5.    What personal reactions/feelings does the description trigger in you?

The personal reactions are sorrow and grief. There is no access to safe areas for these individuals. There is limited access to safe water and food. In the long term there is no education (for children displaced) or healthcare, and there is constant fear of being used as human shields. To top it off, there is no assistance offered to these dislocated individuals.

6.    What advice would you offer to those involved?

The government should offer protection and some sort of aide to the individuals displaced due to war. A long term contingency plan needs to be prepared for all that are displaced – including medical care, education for children, and an integration program so they can reintegrate into society. Lastly, there needs to be fewer restrictions placed on international aide so that the affected individuals can have access to essential items.

Air in India among the world's most deadly

New Delhi, February 05, 2012

First Published: 00:12 IST(5/2/2012)

Last Updated: 17:22 IST(8/2/2012)

Pollution in India

India has unhealthiest air in the world, a new study says, confirming the fear that air quality was getting worse because of urbanisation. Of the 132 countries ranked by scientists at Yale and Columbia Universities for the Environment Performance Index (EPI) 2012, India ranks dead last on the parameter - Air (effects on human health) - much behind neighbours such as China, Pakistan, Nepal and Bangladesh.

Even Bangladesh had a score of 13.66 as compared to India's 3.71. "It (the study) tells us that we are heading towards environmental hell to achieve high economic growth," said Anumita Roy Chowdhury, executive director of the Centre for Science and Environment. Not just air pollution, the study listed India among world's worst environment performers with a rank of 125, down from 119 it held two years ago. Only Kuwait, Yemen, South Africa, Kazakhstan and Uzbekistan, Turkmenistan and Iraq were ranked lower. India's neighbour Nepal was ranked 38, Bangladesh 115 and Pakistan 120.
The study used satellite data to measure air pollution concentrations, unlike the pollution watchdog Central Pollution Control Board (CPCB) that does ground monitoring.




"Rising vehicular traffic and increasing industry in and around cities is the cause," said CPCB chairperson S P Gautam. According to the Society of Indian Automobile Manufacturers, India's auto production has doubled from 7 million units in fiscal year 2004 to over 14 million units in year 2010 largely on the back of a buoyant domestic market. Vehicle exhaust has witnessed eight-fold increased in 20 years and industrial pollution four times in the same period, both contributing to over 90% of country's air pollution. "The economy has grown two and a half times over the past two decades but pollution control and civil services have not kept pace," says the planning commission's 12th five year plan working group report on environment.
The US-based Health Effects Institute in 2010 found that each year, air pollution killed 3,000 people in Delhi, which had particulate matter four times above the national standard. Symptoms include wheezing and coughing, or feeling stressed out or distracted more than usual.

http://www.hindustantimes.com/Entertainment/Wellness/Air-in-India-among-the-world-s-most-deadly/Article1-806916.aspx

1.    What is the link to Crisis Management?

The quality of air in India has been declared as the unhealthiest air in the world. The quality of air has worsened compared to two years ago and has been attributed to urbanisation. In 2010, 3000 individuals in Delhi alone died due to air pollution, because air pollution is four times above the national standard.

2.    What stage of Crisis Management does the system appear to be at?

The system appears to be at crisis stage however there does not seem to be much public concern about this. The quality of air is known as the cause to trigger asthma, chronic bronchitis, decreased lunch function, irregular heart beat and premature death in people with heart or lung disease.

3.    How well does the system appear to be handling the situation?

The system does not appear to be handling the situation well. As mentioned, the quality of air in India became worse compared to that 2 years ago. This is due to rising vehicular traffic and increasing industry in and around cities in the cause. There appears to be more concern regarding economic growth rather than controlling environmental damage.

4.    What level of crisis preparedness does the system appear to have?

There is presently no level of crisis preparedness in the system. In fact situations seem to be worsening - auto production has doubled while vehicle exhaust has increased 8 fold in 20 years. The concern right now appears to be more on economical growth and there is barely any sense of environmental health.

5.    What personal reactions/feelings does the description trigger in you?

It makes me very upset because people are dying and there is nothing being done about that. There seems to be more concern regarding economic growth than the quality of life and health of the citizens of India. There should be an equal balance between monetary gains and healthy choices because right now it appears that the rich are benefiting from this and the poor individuals are the ones suffering.

6.    What advice would you offer to those involved?

There are a lot of people involved in this case. There should be a commission set up regarding environment and health safety. A collaboration needs to be reached between economical growth and environmental safety because at present its appears that human health and the environment are being compromised for economic growth.

Pfizer reaches out to women after birth control recall

BOSTON — Pfizer Inc is reaching out directly to women consumers to warn them about its U.S. recall of one million packets of birth control pills as concerns mounted that a manufacturing error could raise the risk of unplanned pregnancies. The world's largest drugmaker recalled 14 lots of Lo/Ovral-28 and 14 lots of the generic counterpart Norgestrel and Ethinyl Estradiol late on Tuesday, prompting panicked exchanges on social media like Twitter. Litigators began soliciting new clients who may have suffered health problems or unplanned pregnancy as a result. "Unfortunately, this manufacturing error diminishes people's confidence in an extremely important and safe method of contraception," said Dr. Vanessa Cullins, vice president for external medical affairs at Planned Parenthood Federation of America. Cullins noted this version of birth control has been in use for decades and remains safe and effective. Pfizer said on Wednesday that the error may have been limited to 30 packets of the birth control pills, in which the "placebo" tablets taken at the beginning of a woman's menstrual cycle were placed in the wrong order with the pills that contain the contraceptive's active ingredient. The placebo pills, which are different color from the active tablets, were placed in the blister pack out of order during the automated packaging process in a few random packets manufactured throughout 2011, company spokeswoman Kristen Neese said. Pfizer was alerted to the problem when a consumer noticed a discolored pill in the middle of a pack, she said. All lots possibly affected were recalled, the problem was fixed and prevention measures are now in place, she said. The company is now using social media and video messages on its own website to notify women of the recall. But even if the error was more limited, women who took pills from any of the recalled lots should use a non-hormonal form of birth control immediately, experts said. "If pills come from those lots, she should consider those pills ineffective from the standpoint of preventing pregnancy," Cullins said. "She is at risk of ovulation, of eggs being released and of becoming pregnant." Pfizer manufactures and packages the birth control pill, but it is sold by Akrimax Pharmaceuticals. The pills were distributed nationwide with no specific geographic concentration, Pfizer said. Expiration dates on the affected packs range from July 2013 to March 2014. Dr. Natasha Johnson, a gynecologist at Brigham and Women's Hospital, a teaching affiliate of Harvard Medical School, said most women these days take generic forms of birth control pills. She called the affected brands "fairly popular, well tolerated pills." The Pfizer recall comes on the heels of increased attention surrounding birth control and possible health risks. In recent months, U.S. health advisers have recommended stricter labels on a more widely used, newer generation of birth control pills, based on data showing they may put women at a higher risk of dangerous blood clots. They include Bayer AG's popular Yaz and Yasmin tablets. A new federal rule requiring religious universities and other affiliated institutions to provide free birth control coverage has also drawn fresh opposition from religious groups.


www.msnbc.msn.com/id/46227973/ns/health-womens_health/t/pfizer-reaches-out-women-after-birth-control-recall/#.TzLnGfmcWls


1.       What is the link to Crisis Management?
The link to crisis management is that a drug which is used by millions of women was packaged incorrectly. The consequences of this packaging error are unwanted pregnancies and loss of consumer faith in the manufacturing of important medications.

2.      What stage of Crisis Management does the system appear to be at?
This issue would be classified as something between a risk and a crisis. Packages of the birth control pills were already distributed to the general public making them vulnerable to the risk of having an unwanted pregnancy. However all products of the affected lot were recalled and no reported pregnancies had occurred due to this error. However this system failure brings into account a potentially larger problem regarding mislabelled/mis-packaged drugs.

3.      How well does the system appear to be handling the situation?

The system appeared to handle the situation really well. When the issue was discovered all the affected lots were recalled and information was provided on the company's website regarding what the consumers should be doing. However, there is no clear inclination of a formal apology by the company's CEO in regards to this error.

4.      What level of crisis preparedness does the system appear to have?
I highly doubt that the company was prepared for a crisis such as this. This type of crisis would not have been planned for because processes would be in place to prevent something like this from occurring. Also in the recent history, there haven’t been issues such as birth control mislabelling. Due to no historical background issues relating to this particular drug, the system was not really prepared for it.

5.      What personal reactions/feelings does the description trigger in you?
This is a debatable issue. When a company chooses to provide products as critical as birth control pills, it should make sure each lot is as safe as the lot before it. Unlike side effects of other medication, if this medication proves ineffective then the consequence is an unwanted pregnancy. It is understandable that drug manufacturers make these products for a profit, but it is important to also realize the moral obligations that these companies have towards society.

6.      What advice would you offer to those involved?
For the women involved, use a backup beside birth control pills. Also be up to date regarding recalls of medical products that you use. For Pfizer, independent double checks need to be put in place because if this error was noticed later then they would be facing a lot of lawsuits and severe reputation damage.