In addition, levels of antibodies to SARS Co-V were significantly lower in the workers who remained asymptomatic than in those who fell ill, the article says. “These observations suggest that the extent of exposure to SARS in persons who remained asymptomatic may have been lower, possibly resulting in a lower viral load of SARS-CoV, associated with less severe symptoms,” the report states. This possible association needs to be tested in animal studies, the authors add. Three earlier studies turned up no evidence of asymptomatic SARS infections, while two studies in Hong Kong did find some cases, though the rates were lower than in this study, the researchers say. The investigators found no difference between the pneumonic SARS patients and the asymptomatic workers in age, glove use, handwashing, and closeness or time of contact with SARS patients. However, three of the six asymptomatic workers had worn N95 masks, whereas only 8% of the pneumonic SARS patients had used masks, a significant difference. The initial cases at the hospital involved three patients admitted to three wards in early March 2003, before the SARS coronavirus (Co-V) was identified. The first patient brought SARS from Hong Kong, and the second patient was the first patient’s nurse. The third patient was admitted for other health problems, but shared a room with patient 2 and became infected. Of the 80 workers, 45 (56%) had positive serum samples for antibodies to SARS Co-V. Thirty-seven of the 45 (82%) were classified as having pneumonic SARS, 2 (4%) as having subclinical SARS, and 6 (13%) as having asymptomatic infection, the report says. Patient 1 arrived Mar 1. By Mar 6, healthcare workers were using N95 masks, gowns, and gloves when nursing patient 1 and any other suspected SARS patients. But since SARS was not suspected in patients 2 and 3, workers caring for them initially did not use protection. Jul 7, 2005 (CIDRAP News) Some healthcare workers who were exposed to SARS (severe acute respiratory syndrome) early in the epidemic became infected without ever falling ill, according to a recent report in Emerging Infectious Diseases. The researchers identified 105 staff members who had worked in the three affected hospital wards between Mar 1 and 22 and had contact with any of the three patients. Eighty of these responded to a questionnaire and consented to a serologic test. Six of 80 (7.5%) healthcare workers exposed to SARS patients in a Singapore hospital had asymptomatic infections, according to the report by Annelies Wilder-Smith of Tan Tock Seng Hospital in Singapore and her colleagues with National Healthcare Group and Singapore General Hospital. They studied healthcare workers exposed to patients with SARS in the first 22 days of the outbreak, before the hospital began infection control measures. Because the cases occurred before SARS diagnostic tests were available, the researchers could not determine whether the asymptomatic workers had shed the SARS virus during their infection. Wilder-Smith A, Teleman MD, Heng BH, et al. Asymptomatic SARS coronavirus infection among healthcare workers, Singapore. Emerg Infect Dis 2005;11(7):1142-5 [Full text]
Month: November 2020
Aug 11, 2005 (CIDRAP News) – Both the United Nations Food and Agriculture Organization (FAO) and the World Organization for Animal Health (OIE) have said in the past day that Tibet has reported its first cases of avian influenza in poultry.Zhang Zhongjun, an FAO official in the Beijing office, said the China Agriculture Ministry informed his organization of the outbreak this morning, according to the Associated Press (AP). The OIE likewise received notification of the outbreak within the past day (see below).OIE Director-General Bernard Vallat told Reuters it was likely the disease was highly pathogenic so probably represents H5N1 infection, although the actual report from Tibet identified the infection only as H5. The affected farm, near Tibetan capital Lhasa, reported 133 dead chickens.More than 2,600 more birds in the area have been culled as a containment effort, say several sources. In addition, Carolyn Benigno, an FAO animal health officer in Bangkok, told Kyodo News that the infected areas have been sealed off and/or disinfected, plus a vaccination effort has begun.Two other areas of China, the Xinjiang and Qinghai provinces, had previously reported avian flu, the latter resulting in the killing of over 6,000 migratory birds.No human cases of avian flu have been reported in China.See also:OIE notification http://www.oie.int/downld/AVIAN%20INFLUENZA/China%20(Tibet)%20HPAI.pdf
Since Roche is the only manufacturer of the drug, generic Tamiflu doesn’t exist, said David Elder, head of the Food and Drug Adminstration’s Office of Enforcement, as quoted by Agence France-Presse (AFP). Information on the packages was in Chinese, but it was unclear where the drugs came from, Elder reported. Asian suppliers sent them to individuals who ordered them online, Roxanne Hercules of US Customs and Border Protection told the AP. He added, “There’s been so much excitement about stockpiling of antivirals, that this is going to be the silver bullet, this is going to be the solution to the whole problem. There are uncertainties we have to start communicating, and we haven’t done that.” Stohr said studies show the drug protects about 70% of people from the flu if they take it before being infected, but only about 40% benefit it they take the drug within 48 hours after infection. Nations are investing far more in stockpiling Tamiflu than in developing vaccines that might offer protection from a pandemic virus, Klaus Stohr, head of the WHO’s global influenza program, told Bloomberg in an interview in Washington, DC. “These are people who are trying to profit from heightened concerns about bird flu in this country,” Elder said. Customs officials said the first package was intercepted Nov 26 at a mail facility near San Francisco International Airport, the Associated Press (AP) reported. Agents have seized 51 more packages since then, each containing up to 50 counterfeit capsules labeled as “generic Tamiflu,” the report said. Dec 20, 2005 (CIDRAP News) US customs agents have seized more than 50 shipments of fake oseltamivir (Tamiflu), the antiviral drug being stockpiled in preparation for a possible influenza pandemic, according to reports published yesterday. “Globally it’s unbalanced,” Stohr said. “There would be more bang for the buck if more were invested globally in pandemic vaccine development.” The capsules contained none of oseltamivir’s active ingredients, and officials were running tests to learn what they did contain, the AP reported. Elder said initial tests pointed to vitamin C. In related news, the World Health Organization’s (WHO’s) top flu expert warned Dec 16 that governments are counting too heavily on Tamiflu to protect their populations from a flu pandemic, according to Bloomberg News. “At this point, we haven’t found anything harmful,” Elder told AFP. “The harm comes from people believing they are being protected from the flu. They are not getting the benefit they expect.” In November President Bush asked Congress for $1 billion to spend on antiviral drugs, as part of his $7.1 billion request for pandemic preparedness. This week the House voted to appropriate $3.8 billion for pandemic preparations, but left it to the administration to decide how much of that to spend on antivirals. The House-passed bill was awaiting action by the Senate.
Feb 8, 2006 (CIDRAP News) – Chinese officials today reported the country’s 11th human case of H5N1 avian influenza, in a 26-year-old woman from an area where no poultry outbreaks have been reported, according to news services.The woman, surnamed Lin, is from Zhangpu County in Fujian province, according to an Agence France-Presse report today. She tested positive for the virus after being hospitalized Jan 10 with fever and pneumonia, AFP reported, citing the Chinese news service Xinhua as its source.In addition, China announced its first new poultry outbreak in a month has occurred in the northern province of Shanxi, Bloomberg News reported today. The deaths of about 15,000 chickens on Feb 2 and 3 led to culling of 187,000, the Associated Press (AP) reported. The Chinese government told the AP it has killed about 22.5 million birds in the past year in efforts to stop the H5N1 virus.In Iraq, meanwhile, a World Health Organization (WHO) team is investigating the situation in the north, where one human case has been confirmed and more are suspected, and a possible human case has been reported in the south.A 15-year-old girl who died Jan 17 had the country’s first confirmed case. Samples from her 39-year-old uncle, who died Jan 27, tested positive in a local laboratory, and confirmatory test results are awaited.In an update yesterday, the WHO said its team in northern Iraq was seeking ways to strengthen local capacity to test for H5N1 and to hasten sample shipment to WHO labs, because transporting patient samples to outside labs has proved difficult. In addition, biosafety standards in local and national laboratories must be improved, the agency said.Major poultry culling efforts were under way in the outbreak region. Culling teams traveled from house to house in the Kurdish north, “chasing chickens, ducks, geese and turkeys around backyards and stuffing them into bags as villagers looked on,” Reuters news service reported yesterday.The WHO said more capacity for poultry testing is needed in order to focus the culling. Training is under way to improve veterinary labs and surveillance.Authorities who initially thought the H5N1 outbreak might be confined to Kurdish northern Iraq are facing the possibility of a human case in Omara in southern Iraq. A 13-year-old boy fell ill on Feb 1 and died Feb 5 of severe pneumonia, the WHO said. No poultry deaths have been reported in the area, but pet birds in the victim’s home died around the time the boy fell ill.Reports about the suspected case conflicted. An AP report published yesterday described the victim as a 14-year-old named Muhannad Radhi Zaouri, but a Reuters report listed him as a 24-year-old.Police cars and ambulances traversed Omara today, and people used loudspeakers to notify residents to kill their birds, Reuters reported. In addition, mosques were issuing warnings to residents to cull their poultry.In Hong Kong today, authorities banned the raising of chickens, ducks, geese, pigeons, and quail in backyards, in an effort to prevent the spread of H5N1, Bloomberg News reported. Residents will be fined up to US $12,900 for violating the rule, which takes effect Feb 13. The decision came in the wake of news that a fifth bird had tested positive for the H5N1 virus in Hong Kong.See also: WHO statement on Iraq investigationhttp://www.who.int/csr/don/2006_02_07/en/index.html
May 8, 2006 (CIDRAP News) – US officials have closed the investigation into the nation’s latest case of bovine spongiform encephalopathy (BSE), or mad cow disease, without finding the infected cow’s origins.John Clifford, the US Department of Agriculture’s chief veterinary officer, announced the end of the investigation into the Alabama case on May 2.The USDA Animal and Plant Health Inspection Service (APHIS) had been trying to learn since mid-March where the Alabama cow came from so it could trace other cattle that might have been exposed to the same feed the cow ate in early years. Cattle are believed to contract the disease by eating contaminated feed.”APHIS’s investigation did not reveal the BSE-positive animal’s herd of origin,” Clifford said in a written statement. “However, this was not entirely unexpected due to the age of the animal, along with its lack of identifying brands, tattoos and tags. Experience worldwide has shown that it is highly unusual to find BSE in more than one animal in a herd or an infected animal’s offspring.”The cow, described as a red crossbreed, was euthanized and tested in March after it was found unable to walk. After a veterinarian took a sample for testing, the cow was buried on the farm, but officials later dug up the carcass to determine its age. They concluded that it was more than 10 years old and therefore was born before the government’s 1997 ban on use of cattle protein in feed for cattle and other ruminant animals.Clifford said APHIS and Alabama officials investigated 36 farms and five auction houses and conducted DNA tests in a hunt for relatives of the infected cow. They found none besides than the cow’s two latest calves. The most recent calf was found on the same farm as its mother and is now being held for observation at APHIS’s national laboratory in Ames, Iowa. The other calf died last year, he said. An Associated Press report said that calf was buried in a landfill.The Food and Drug Administration (FDA) investigated feed mills that might have supplied feed to the cow after the 1997 feed ban, Clifford reported. “This investigation found that all local feed mills that handle prohibited material have been and continue to be in compliance with the FDA’s feed ban,” he said.The Alabama cow was the nation’s third BSE case. On the basis of tests of more than 700,000 cattle over the past 2 years, the USDA recently estimated that another four to seven cases could exist in the United States.See also:May 2 statement by John Clifford of USDAMar 13 CIDRAP News story “Alabama cow positive for BSE”
Nov 20, 2006 (CIDRAP News) – The Department of Health and Human Services (HHS) has released a new medical care guide to help community leaders plan for and respond to mass casualty events such as an influenza pandemic or a terrorist nuclear attack.The guide, published by the HHS Agency for Healthcare Research and Quality (AHRQ), describes an array of shortages healthcare workers will face, such as of hospital beds and ambulances, and gives specific recommendations for planners, such as providing offsite care and using taxis, buses, and private cars to transport sick or injured patients.”To be effective in their planning efforts, local, state, and regional leaders need to be aware of the latest research, tools, and models available,” said AHRQ Director Carolyn Clancy, MD, in a Nov 16 AHRQ press release. “With the publication of this new community planning guide, our nation’s preparation and response efforts are strengthened by bringing needed focus on advance planning for mass casualty events.”The guide expands on an earlier AHRQ publication, released in April 2005, which outlined altered standards of medical care in a mass casualty setting. The new document, a collaboration between AHRQ and the Office of Public Health Emergency Preparedness, consists of papers written by experts on six topics: ethical considerations, legal issues, prehospital care, hospital and acute care, alternative care sites, and palliative care.Several potential problem areas are highlighted, such as a complex emergency medical services (EMS) system and lack of standardized EMS disaster training. The guide emphasizes that hospitals will face surge capacity problems, especially since many emergency and trauma services are already at or near full capacity. To handle the overflow, the AHRQ recommends that officials start making plans to provide care in alternate locations such as mobile medical facilities and nonhospital buildings.The report provides planning checklists and tips for making wise use of limited medical resources. For example, the section on alternative care sites describes how difficult it would be to provide oxygen and suggests a possible solution.A centerpiece of the report is a case study on pandemic influenza. The authors list preparations for and responses to each stage of a pandemic, from the current prepandemic period to increased and sustained transmission in the United States. For example, during the worst stage of a pandemic, the authors suggest a “bed czar” be appointed to monitor the supply of hospital beds and equipment and make assignments based on availability.The guide is available on the AHRQ Web site, and print copies will be available in early 2007.See also:Nov 2006 AHRQ report “Providing mass medical care with scarce resources: a community planning guide”http://archive.ahrq.gov/research/mce/April 2005 AHRQ report “Altered standards of care in mass casualty events”http://archive.ahrq.gov/research/altstand/
(CIDRAP Source Weekly Briefing) – Ask people which private sector most needs to be prepared for a pandemic, and I bet they will tell you healthcare. Such a conclusion is understandable given the grim vision of a pandemic with its untold numbers of severely sick and dying people in communities all across the world.If only it could be that simple.Today’s global just-in-time economy completely blurs the boundaries between business sectors. How will healthcare facilities, for example, provide care to influenza patients as well as people with such conditions as cancer, heart attacks, and stroke if the following things occur.Pharmaceutical and medical device companies can’t manufacture and deliver drugs and medical supplies?Institutional food suppliers can’t obtain and deliver food?Utilities can’t sustain electrical service, and diesel-powered electric generators run out of fuel?Deciding on the most important sector for pandemic preparedness is about as sensible as trying to answer the classic chicken-and-egg question. The sustainability of any one sector depends on the sustainability of many sectors.I’m convinced the early bellwethers of how we respond to an unfolding pandemic, however, will be the international transportation industry and the financial markets.Our dependence on transportationThe importance of the international transportation industry seems obvious. If governments close borders around the world to try to stop early transmission of the virus, the use of planes, ships, and even trucks will screech to a dead halt. Next up: the strangulation of the global just-in-time economy. The 80% of pharmaceutical products made offshore that we depend on every day in this country will be in very short supply very quickly. One can begin to imagine the collateral damage that disrupting international trade and travel will level on our modern developed-world society.If governments decide to close borders, which I think would be a mistake, we’ll be out of options. The best you can do is plan now for the possibility.The financial sector and public confidenceWhile I believe the performance of the international transportation industry early in the next influenza pandemic will directly affect how many other sectors function throughout the first wave, I have no doubt that society’s confidence in our collective ability to handle and even survive a pandemic will be linked to the performance of the financial markets. Banks, exchanges, clearing organizations, payment system processors, and broker dealers are the gears and grease that make possible our everyday financial transactions at places like the grocery store or shopping center. Financial services provide the governments of the world a means for supporting and maintaining their economies.If, in the first hours to days of the pandemic, we see governments, investor institutions, hedge funds, and even individual investors move assets to perceived safer investment positions, society will likely react with a sense of panic. And if the markets themselves cannot perform critical functions because of a lack of business continuity preparedness, the psychology of society will be shaken. This tipping point, when many perceive that government and leading businesses are not prepared to help us get through the pandemic, will make the week in New Orleans following Hurricane Katrina seem rather mild.Fortunately, industry regulators are paying attention to the pandemic preparedness of the United States’ financial sector. A report released this week by the US Government Accountability Office (GAO) does these things:Says organizations that form the backbone of the US financial industry need to do more to prepareUrges federal regulators to set deadlines for these organizations to complete pandemic plansLays out a series of steps the financial sector must address to improve sustainability during a pandemicThe report is a must read for any business preparedness professional. (See Influenza Update story, “GAO says financial markets not ready for a pandemic.”)In addition, the US Security and Exchange Commission (SEC) is beginning to work with the Securities Industry and Financial Markets Association (SIFMA) to plan a 4-week exercise that will begin in September 2007. The exercise will be modeled after one that ran in October and November 2006 in the United Kingdom, which involved more than 70 organizations and about 3,500 staff members from all areas of the British financial world.Bottom line for businessUnfortunately, the fate of international trade and travel during a pandemic will depend on whether governments decide to close borders. If that happens, there may be little you can do about it at the time. But the financial market, if it prepares, is another story.Whatever business you are in, you’ll need a functional financial market during a pandemic. In fact, I believe our entire society’s perception of how we are doing, from the earliest days of the pandemic right through the last wave of illness, will be tied to a financial market that can function. A “run on the bank”—as occurred during the Great Depression—or an inability to service public and private transactions in the early days of the pandemic, will shake society’s confidence and undermine faith in government and business leaders who step forward to lead the public through the course of the pandemic.Every company in the financial sector must support the SEC and SIFMA 4-week exercise this fall. Only through efforts like this exercise can we identify the big gaps in our preparedness planning and fix them before real catastrophe strikes. Such preparedness efforts are critical and must be successful. If we do not support them, we will have no one to blame but ourselves when financial markets wilt during the pandemic and chaos reigns.
Jan 7, 2009 (CIDRAP News) – Hong Kong health officials reported today that the H9N2 avian influenza virus that recently infected a 2-month-old girl from mainland China has not acquired any genes from human-adapted flu viruses, implying that it is unlikely to pose a major danger to humans.In a news release, the Centre for Health Protection (CHP) in Hong Kong’s Department of Health said genetic sequencing has shown that all the virus’s genes are of avian origin.”DNA sequences of the genes concerned show that they are of avian origin, and reassortment with genes of human influenza origin has not been found,” an anonymous CHP spokesman said in the release.”The epidemiological and genetic findings so far suggest that the H9N2 virus has shown no signs of increased risk for human-to-human transmission,” he said.The spokesman said the virus is very similar to an H9N2 virus isolated from a 9-month-old girl in Hong Kong in 2007. He added that the virus has been found to be sensitive to the antiviral drugs oseltamivir and amantadine.H9N2 viruses are distinct from the deadly Asian strain of H5N1 but are regarded as having the potential to evolve into a pandemic strain. The current case is the fifth H9N2 infection reported in Hong Kong since 1999, all of them in infants and young children who had mild illnesses and recovered.The 2-month-old girl, from Shenzhen in southern China, is still being treated in Hong Kong’s Tuen Mun Hospital for another disease, the CHP said. The H9N2 virus was not found in nasopharyngeal samples taken from the girl on Jan 2, the statement said.In other developments, the World Health Organization (WHO) today recognized two human H5N1 cases reported by Asian governments yesterday, one in China and one in Vietnam.The Chinese case involved a 19-year-old woman from Beijing who fell ill Dec 24 and died Jan 5, the WHO said in a statement. China has had 31 H5N1 cases, 21 of them fatal.The patient in Vietnam is an 8-year-old girl from Thanh Hoa province who became ill Dec 27 and is in stable condition, the WHO confirmed. Vietnam has had 107 H5N1 cases with 52 deaths.Echoing earlier reports, the WHO said both patients had had contact with poultry before they got sick.The two cases raised the WHO’s global H5N1 count to 393 cases with 248 deaths. The agency classified the two illnesses as 2008 cases, raising the total for the year to 42 cases with 31 deaths. That represents a case-fatality rate of 74%.Vietnam’s agriculture ministry has confirmed an H5N1 outbreak among poultry in Thanh Hoa province, the home of the sick 8-year-old, according to a Reuters report published today.About 400 chickens in Ba Thuoc district, where the girl lives, died of the disease, the report said. District authorities in Ba Thuoc, about 94 miles south of Hanoi, have slaughtered nearly 8,000 chickens in efforts to stop the outbreak, Reuters reported.Thanh Hoa is the second province in 2 weeks to report an H5N1 outbreak in poultry, having been preceded by Thai Nguyen, north of Hanoi, the story said.See also: Hong Kong news release on H9N2 casehttp://www.dh.gov.hk/english/press/2009/090107-2.htmlWHO report on Vietnam casehttp://www.who.int/csr/don/2009_01_07/en/index.htmlWHO report on Chinese casehttp://www.who.int/csr/don/2009_01_07a/en/index.html
International Workshop on Cultural Routes: “Olive Routes” as a Model of European Value, Heritage and Sustainable Development
On the occasion of marking the presidency of the Republic of Croatia in the Council of Europe and the presidency of the Central European Initiative in 2018, the Ministry of Tourism organizes an international workshop on cultural routes with an emphasis on route “Olive Routes” as a model of European value, heritage and sustainable development. The workshop will be held from 14 to 16 November 2018 in Mali Lošinj at the Hotel Bellevue.The participants of this workshop are international experts and representatives of the Croatian Ministries of Culture, Tourism, Foreign and European Affairs, representatives of the Central European Initiative, cultural routes of the Council of Europe, numerous cultural and tourist institutions and local initiatives. This event is also an opportunity to present innovative approaches to the diversification of cultural and tourism products and to encourage initiatives that promote European heritage, sustainable tourism and local development. Attached is the application form, as well as the workshop program.Attachment:Application formWORKSHOP PROGRAM The “Cultural Routes of the Olive Tree” as a model for Europe’s values, heritage and sustainable development
“The family accommodation market is constantly growing. Last year, 7,6 million arrivals were recorded, with an increase of 10%, the number of overnight stays also increased by 6,2% to 43,3 million. But we should not focus only on raising numbers, but on investing in quality. Namely, with the importance for tourism and small business in general, family accommodation is a key medium for creating and transmitting the identity of our destinations, ” pointed out the director of the Tourism Department of the Croatian Chamber of Commerce Ana Klarić at the 5th Family Accommodation Forum, which is being organized by the Croatian Chamber of Commerce this year in Split from March 29 to 30. As part of the Forum, the awards “Tourist Flower – Quality for Croatia” were awarded to the best renters in 11 categories. The main focus of the fifth edition of the Family Accommodation Forum is on raising quality. During the two days of the Forum, participants will be able to learn how to improve different segments of the offer, from luxury private accommodation and interior design to investing in professional photography and serving a superb breakfast. “Considering that the Split-Dalmatia County has the largest number of family accommodation in Croatia, we have launched numerous trainings and counseling centers in order to increase the quality of the offer. We do all this because we believe that it is necessary to help family accommodation to raise quality, have a better marketing presence, better distribution and to keep pace with new tourist and market trends., said the director of the Split-Dalmatia County Tourist Board, Joško Stella. State Secretary at the Ministry of Tourism Tonči Glavina said that family accommodation must become an internationally recognized product, in line with the principles of green tourism and intended for targeted market niches for most of the year. “To achieve this, it is necessary to provide support to renters to develop through investment. That is why, in cooperation with HBOR, we have prepared a microcredit program for private renters, for which great interest has been expressed. Our goal is to provide financial support for the arrangement of accommodation capacities to all natural persons who are registered for renting rooms, apartments, holiday homes or camps. This will ultimately result in equalizing quality, achieving better service in private accommodation and raising the competitiveness of Croatian tourism. “, said Glavina, adding that such a step should introduce us to the top 20 tourist countries in the world. The loans offer unique conditions of only 2 percent interest for amounts up to HRK 375 thousand, with a repayment period of up to 10 years. The head of the Service for Economy, Tourism, International and European Funds of the City of Split, Ela Žižić, stated that the Forum is primarily of an educational nature, but it is also important for the exchange of knowledge and experience. “It is important to network, learn from the best and implement measures to increase quality, taking into account the latest trends in tourism markets. This makes us even better and more competitive as a tourist destination. “, said Žižić. Director of the Tourism Department of the Croatian Chamber of Commerce Ana Klarić Awarded the best renters They were declared the best accommodation on the coast Apartments Mediterraneo on the island of Capri, the title for best accommodation in the city is gone The Pearl of the Danube from Vukovar, was declared the best accommodation for the family Villa More in Lovran, the best accommodation for an active vacation is Villa Maslina in Buzet, and for a wellness holiday Little Villa Rebecca from Gornja Dubrava. Villa Milica from Pula was declared the best eco accommodation, Villa Covri from Brtonigla is the most original accommodation, Stancija Rušeti from Oprtalj is the best accommodation in nature, a Holiday house Sobol the best accommodation in rural tourism. Apartments Sabina from Fužine were chosen as the best family accommodation in 2019, as well as the best accommodation for staying with pets.