Recent tests on birds in Michigan, Maryland, and Pennsylvania identified the low-pathogenic “North American” strain of H5N1, and recent tests on wild northern pintail ducks in Montana confirmed the presence of H5N3, another mild strain. In late September, investigators found the virus in Illinois ducks when they collected samples from healthy migratory green-winged teals in Fulton County in west-central Illinois, the US Department of Agriculture (USDA) and the Department of the Interior (DOI) said in a news release. The samples were sent to the USDA National Veterinary Services Laboratory (NSVL) in Ames, Iowa, where 5 of 11 samples tested positive for H6N2. Initial screening results on Sep 29 indicated that H5 and N1 subtypes might be present, but further testing was needed to confirm the subtypes and assess the pathogenicity. The USDA said it’s not unusual for a specific subtype to be identified in initial screening tests but not be isolated in confirmatory testing, because the screening tests are so sensitive. In this case, rapid screening yielded weak positive results for the H5 and N1 subtypes, but confirmatory testing instead found the H6 and N2 subtypes. Previously announced genetic testing had already ruled out the presence of the highly pathogenic H5N1 strain. The birds were collected on Oct 8 as part of an expanded wild bird monitoring program involving the USDA, the DOI, and investigators from the lower 48 states. In an Oct 14 news release, the agencies said, “Initial tests confirm that these wild bird samples do not contain the highly pathogenic H5N1 strain that has spread through birds in Asia, Europe, and Africa. Initial test results indicate the presence of low-pathogenic avian influenza virus, which poses no threat to human health.” Last week, the USDA and DOI announced that investigators in Ohio had detected H5 and N1 subtypes in samples from apparently healthy wild northern pintail ducks in Ottawa County, in northern Ohio on the shores of Lake Erie. The ducks had been killed by a hunter. Oct 17 USDA-DOI news release on avian flu in Illinois ducks Low-pathogenic avian flu viruses often occur naturally in wild birds and cause only minor sickness or no noticeable signs of disease. They pose no risk to human health. However, low-pathogenic strains sometimes mutate into deadly strains. Thirty-five samples obtained from the ducks were screened at the Ohio Department of Agriculture Animal Disease Diagnostic Laboratory. Two of the samples were sent to the NVSL for confirmation, and one tested positive for both the H5 and N1 components, which could mean the duck was infected with either one H5N1 strain or two separate avian flu viruses. Oct 18, 2006 (CIDRAP News) Federal officials announced yesterday that final tests confirmed that a mild strain of H6N2 avian influenzanot the deadly H5N1 typewas found in green-winged teals in Illinois last month. Meanwhile, initial tests on wild ducks in Ohio also suggest a mild strain of avian flu. Oct 14 USDA-DOI news release on avian flu in Ohio ducks See also:
Jan 9, 2007 (CIDRAP News) – The US Food and Drug Administration (FDA) has approved a refrigerated form of FluMist, the nasal-spray influenza vaccine, which should be more convenient for providers than the current formulation, MedImmune Inc. announced yesterday.FluMist, a live attenuated vaccine first approved in 2003, is currently approved for use in healthy children and adults from ages 5 to 49 years.The new formulation will allow healthcare providers to store the vaccine in a refrigerator rather than a freezer as now required, said Frank M. Malinoski, MD, PhD, senior vice president of medical and scientific affairs at MedImmune, based in Gaithersburg, Md.”We recognize that the frozen storage presented difficulties for some physician practices as well as for providers who administer vaccine in places like schools, pharmacies, and grocery stores, and we are confident that this improvement will enhance access to this important vaccine,” he said in a news release.The new FluMist formulation, known in clinical studies as cold adapted influenza vaccine trivalent (CAIV-T), will be available for the 2007-08 flu season. MedImmune said the frozen and refrigerated formulations are free of preservatives, including thimerosal.In July 2006 MedImmune asked the FDA to expand the age indication for the vaccine to children as young as 1 year who do not have a history of wheezing or asthma. If the FDA approves the request, MedImmune said, production of CAIV-T would be increased for the 2007-08 season. The company said it hopes to ship its first doses in time for physicians to begin vaccinating patients as early as August.Phase 3 trial results that MedImmune submitted to the FDA in 2006 showed that FluMist was 55% more effective than an injectable vaccine in children aged 6 months to about 5 years, according to the MedImmune release. FluMist was more effective against flu viruses both well-matched and poorly matched to the vaccine in the 2004-05 flu season.However, a study in the Dec 14, 2006, issue of the New England Journal of Medicine suggested that in adults, FluMist was less effective against type B influenza than the injected vaccine in the 2004-05 season. Both vaccines had similar efficacy against influenza A in adults.See also:Jan 8 MedImmune press releaseMay 17 CIDRAP News story “Study: FluMist works better than shots in kids under 5″Ohmit SE, Victor JC, Rotthoff JR, et al. Prevention of antigenically drifted influenza by inactivated and live attenuated vaccines. N Engl J Med 2006;355(24):2513-22 [Full text]
Jul 5, 2007 (CIDRAP News) Experts have concluded that the Atlanta man whose case of drug-resistant tuberculosis triggered an international health scare in May has a less dangerous form of the disease than was previously believed. The change in Speaker’s diagnosis was good news for him and his fellow airline passengers. But the lengthy Jul 3 news conference pointed up the lack of a foolproof test for distinguishing between MDR and XDR TB and put the CDC on the defensive concerning its testing procedures and response to the situation. May 29 CIDRAP News story “Airline trips by resistant-TB patient trigger alert” Cohen said the CDC became formally involved in the situation on May 18, when Georgia public health officials told the agency that a patient with MDR TB had traveled out of the country. The CDC began trying to locate Speaker at that point, though XDR TB wasn’t diagnosed until May 22, according to the CDC timetable of the episode. Much of the news conference focused on testing issues. The CDC concluded Speaker had XDR TB after testing a bronchoscopy sample that had been taken in March at an Atlanta hospital, said Dr. Mitchell Cohen, director of the CDC’s Coordinating Center for Infectious Diseases. The test involved the “agar proportion method,” which is approved by the Clinical Laboratory Standards Institute, he said. Against public health officials’ advice, Speaker, 31, flew from Atlanta to Paris for his wedding and honeymoon on May 12, when he was believed to have MDR TB. After learning on May 18 of his trip, the CDC tried to locate him and warn him not to travel on commercial flights because of the risk of exposing others, according to an agency timetable of the events. On May 22 a CDC test indicated he had XDR TB. The patient, Andrew Speaker, has multidrug-resistant tuberculosis (MDR TB), not extensively drug-resistant TB (XDR TB), experts from the Centers for Disease Control and Prevention (CDC) and National Jewish Medical and Research Center (NJMRC) reported at a press conference on Jul 3. A few days later, on May 29, the CDC publicly announced the incident in an effort to alert people who had flown on the same transatlantic flights as Speaker so they could be tested for TB. Soon afterward, Speaker was flown to National Jewish Medical and Research Center in Denver, which specializes in treating respiratory diseases. Previously, Speaker’s doctors were considering removing part of one of his lungs to cure him. Now, said Daley, “We’ve put surgery on hold for the time being while we build a strong treatment regimen with drugs that we didn’t have available before.” “This discrepancy or discordance of results happens all the time in drug susceptibility testing, including reference labs,” he added. “It’s not a new thing. It’s a frustration that we have to deal with. I don’t know why the first result at the CDC showed XDR TB and ours did not. There are a number of ways this can happen.” Speaker, in a statement read at the news conference by NJMRC spokesman William Allstetter, described himself as “incredibly relieved” by the change in diagnosis. “The truth is that my condition is the same as it was in early May, back before there was a huge health scare,” he said. He has been described as not yet having any symptoms of the slow-growing infection, which was discovered as a result of an injury-related x-ray last January. “This was repeated at the CDC and they confirmed our findings of multidrug resistant disease,” Daley said. However, he said NJMRC is still waiting for test results on a sample taken from the bronchoscopy specimen in March. The cure rate for fully susceptible TB is 95% to 97%, versus about 70% for MDR TB, Cohen reported. “With XDR, the chances of being cured are probably 30 to 40%,” he said. He added, “Many people out there who may have been exposed have been hearing that no drugs are available. . . . Now we know that there is something we can do for them.” “The original sample is no longer available for retesting. All subsequent samples from induced sputums have shown MDR [TB],” Cohen added. Daley said NJMRC used three types of tests, including the agar proportion method, on at least three samples from Speaker. “Out of all the cultures doing it three different ways, the results were consistent,” he said. “We were very sure of our results that this is MDR, not XDR.” In response to a question, Cohen at one point said the test that led to the XDR TB diagnosis actually revealed a mix of MDR and XDR strains, with XDR the smaller proportion. He added that the test does not yield a “yes or no answer” and is very complicated, in part because of how slowly TB organisms grow. In response to questions, both Cohen and Daley repeatedly affirmed that the public health response is the same for MDR and XDR TB. “From a clinical perspective this [difference] is important, but from a public health perspective, no, there’s no difference between MDR and XDR,” said Daley. The CDC still wants those who were on transatlantic flights with Speaker to get follow-up TB tests, Cohen said. The agency previously recommended that those passengers undergo initial skin or blood tests and then be retested 8 to 10 weeks later, since an initial positive test could reflect an earlier exposure to TB. CDC transcript of Jul 3 teleconferencehttp://www.cdc.gov/media/transcripts/2007/t070703.htm Dr. Charles Daley of NJMRC said the earlier XDR diagnosis indicated that only two drugs would be likely to help Speaker, but the change to MDR means several more may work. “We went from at the end of May basically two drugs to now all but three or four,” he said. The finding means it will be easier to treat him because more drugs are likely to work, but the CDC would have issued an international alert even if it had known the true diagnosis when Speaker was traveling in Europe, potentially exposing other airline passengers to the deadly disease, officials said. Cohen noted that MDR TB is resistant to the most commonly used drugs (isoniazid and rifampin) and can be spread to others. “Therefore the public health actions that CDC took in this case . . . are sound and appropriate,” he said, adding that the World Health Organization’s recommendations regarding TB and airline travel are the same for MDR and XDR forms. In his statement, Speaker acknowledged that health authorities must take difficult steps to protect the public at times, but added, “With great power comes great responsibility. In the future I hope they realize the terrible chilling effect they can have when they come after someone and their family on a personal level. They can, in a few days, destroy an entire family’s reputation, ability to make a living, and good name.” Speaker has had several negative sputum smear tests for TB, suggesting that his chance of spreading the disease to others is fairly low, according to the NJMRC. He is still under an isolation order from Denver public health authorities, officials at the news conference said. He also expressed hope that the change in his diagnosis will calm the fears of those who flew with him and that the whole episode will focus more attention on TB, which he said accounts for a quarter of the world’s preventable deaths. Cohen stressed that although MDR TB is less dangerous than XDR, it is still difficult to treat, requiring 2 years of “relatively toxic” drug treatment. “It’s very different from drug-susceptible TB,” he said. See also: Daley later disagreed about the test showing both MDR and XDR strains. “They did not find XDR and MDR really in the specimen,” he said. “It’s a very technical and complicated test and in trying to simplify it, I’m not sure that happened.” But Speaker and his wife changed their itinerary to elude health authorities and, after several flights in Europe, flew from Prague to Montreal. They then rented a car and re-entered the United States. The CDC finally located him on May 25 and ordered him into isolation, the first such action by the agency since 1963. CDC’s XDR TB pagehttp://www.cdc.gov/tb/xdrtb/
Aug 16, 2007 (CIDRAP News) – Three years ago President Bush directed the Department of Homeland Security (DHS) to consolidate biosurveillance data to improve the nation’s ability to detect bioterrorism and other infectious disease threats, but federal auditors warned this week that leadership problems have seriously hampered the program.Problems surrounding the implementation of the $14.3 million program, called the National Bio-Surveillance Integration System (NBIS), were detailed in a 38-page report by the DHS Inspector General’s office that was posted on the agency’s Web site 3 days ago.The program is a massive information technology project that will combine biosurveillance information from 14 federal agencies as well as several industry and other outside sources, according to the report. The NBIS is designed to sift through a large amount of data to enable analysts to quickly recognize biological attacks on a range of targets and provide early warning of possible pandemics.”NBIS, a key element of DHS’ bioprotection program, is falling short of its objectives,” the report states.Though the program began with a clear mandate and strong support, implementation efforts have suffered from numerous shifts within DHS departments, the report says. The system initially flourished under the agency’s science and technology department, but lost momentum less than a year later when DHS transferred program responsibilities to its information analysis and infrastructure department. Delays in hiring and lack of office space and staffing stalled progress on the system.In a subsequent shift, the NBIS was placed under the department of the chief medical officer, where the focus on situational awareness was reduced and the program became more medical-based and less willing to share information, the report says. Under the new arrangement, the NBIS benefited from more senior-level support, which helped beef up staffing and bring in additional contractor expertise.But as a result of all the management changes, the NBIS has not developed adequate planning documents, and the development of interagency partnerships—crucial for incorporating data into the system—has languished, the report asserts. “For example, without clear program milestones, NBIS managers have been unable to track accomplishments of program activities or monitor progress toward meeting long-term goals,” it states.NBIS has not yet acquired the federal data it needs to test and further develop the system, the Inspector General’s Office found.Another key problem has been a lack of guidance for NBIS contractors, the report says. For example, when the contractors were developing the system, DHS made it difficult for them to seek user feedback from the analysts who will be working with the system.The report says the date set for the NBIS to begin initial operations was pushed back to June-July 2007, which could delay the contractor’s scheduled March 2008 delivery of the system and add $2.8 million to the project’s price tag. DHS projects NBIS will be fully operational by September 2008.Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University, said problems with the NBIS are frustrating, Newsday reported 2 days ago.”All of this was supposed to be fast-tracked. Yet we find ourselves 6 years after 9/11, wrestling with basic challenges in terms of information-sharing and interagency coordination,” he told Newsday.In an accompanying letter responding to the inspector general’s report, Jeffrey Runge, MD, DHS’s chief medical officer, agreed with most of the findings, but made several clarifications. He wrote that his department has already made progress toward hiring more staff and has hired a contractor to establish a master schedule to monitor workflow. Runge also said his department has secured the participation of more NBIS partners.
I keep emphasizing that we need to start respecting ourselves, our culture, history, heritage, identity, way of life and culture in order to be respected by others.If we look through the prism of tourism, the main word and motive of travel is authenticity, ie getting to know new ways and culture of living. It was through that prism in Senj that they started branding the national cultural heritage and revitalizing the almost forgotten Senj Red Riding Hood or from miles as they call it Little Red Riding Hood.The project called “Little Red Riding Hood” is an interdisciplinary multi-year project of the creative and cultural industry with the inevitable segment of preservation, presentation and branding of national cultural heritage. The Red Riding Hood from Senj draws its roots from the Illyrian costume, and in today’s exhibition in the Nehaj Fortress it is worn by an Uskok ensign. With this project, the jewel of the heritage of the city of Senj and Croatia is presented to the general public in a way that according to the original hat template, in a series of workshops in the public open space of squares and streets throughout Croatia, parts of the hat (patchwork) are sewn in such large numbers the biggest Red Riding Hood cap.The project officially starts in Senj, on Senj’s White Waterfront on August 16, 08, at 2017 am, and will later take place in stages, will include selected participants with a sensibility for art, history and preservation of national cultural heritage – and will last for three years. The initiator and author of the project is the Senj artist Marija Zudenigo, and she has already expressed her love for the city with two notable volunteer projects for Senj, “Senjska Balonarij” which marked the great 10th anniversary of this Mediterranean city and “Senjska Fregata” – launching 3000 paper boats to the port of Senj, June 1000, 4.6.2016, in honor of the city of Senj, to preserve the Adriatic and the Mediterranean. “My thinking is moving in the direction of setting up an art platform that would achieve the interest of the audience on social networks and beyond through a series of projects designed in this way based on the historical artifacts of the city of Senj. My wish is to create an emotional connection with the future visitor and to awaken the intention to visit the city at some point. Such projects are imagined to be realized through the contribution of individuals and their free will to participate in them and thus become a visible factor of change.”Maria Zudenigo points out.Great project and tourist story that I must definitely be one of the main motives of the city of Senj. But there are many challenges, first and foremost the Senj hat should once again be positioned among the citizens of Senj and acquire the habit of using and making it. Only when the local population accepts the revitalization and re-wearing of the Senj hat, can the day-to-day development of branding begin, so that the whole story is credible and the Senj hat is proudly spoken about.Nehaj Fortress, SenjThis is exactly one of the first goals of this three-year project, as Zudenigo points out and adds that the Uskok hat practically does not exist except on the stone plastic from the head of the Uskok and as an exhibit in the museum. “The ostrich has never been talked about or interpreted, but we want to revive it because we are certainly talking about a very valuable national cultural heritage. The idea is to assemble these patchouli (pieces of canvas) from all over Croatia in order to make one big Uskok hat that will complete the entire Nehaj Fortress in Senj. One piece of canvas 50cmx50cm will come from each part of Croatia, which would then be combined into one large Uskok hat. By the way, the Uskok hat is usable and wearable even in today’s fashion expressions and trends. Also, the hat is of Illyrian origin and Illyrian costume which means that this story lasts from the Neolithic to the present day. We are going step by step and we will see where this story will take us, I sincerely hope that soon the Uskok hat will become a recognizable symbol of Senj.“Concludes Zudenigo.Citizens of Senj, friends of Senj and tourists who will meet on Senj’s White waterfront at 16 am on Wednesday, August 10, will attend the event – a performance that will start a large interdisciplinary project “Little Red Riding Hood” – sewing Senj’s Little Red Riding Hood hat.
Tourists are an epidemiologically important population, both because of their mobility and potential to be exposed to diseases outside their home country, and because of the possibility that they can serve as disease carriers from one country to another. In the last 10 years or so, the tourism sector has repeatedly faced similar threats, including Ebola, chikungunya fever and zika virus, but never on such a scale. One of the world’s largest and most important tourism fairs, the ITB in Germany, was canceled at the last minute on the grounds that it wanted to protect the health of exhibitors and visitors. Both exhibitors and visitors are tourism professionals who have sent a worrying message to the tourism market around the world in this way. Tourism is by nature an economic branch in which many participants are involved, and the health care system has an important place in the organizational chain of the Republic of Croatia. In the overall situation, such an approach should be a step forward in the presentation of Croatia as a healthy country full of life. b) The key health risk factors during the trip are: destination, duration of the trip, purpose of the trip, tourist behavior, as well as safety of (local) health care, accommodation standards, food and water quality and sanitary and hygienic properties of the destination environment. Late last week, Tourism Minister Gary Cappelli made a rather reassuring announcement that no major disruptions were actually expected: “Further spread of coronavirus in Croatia and the rest of Europe is difficult to project, but is expected to affect first-quarter tourism results, although not too much, because in that quarter the tourist traffic is weaker, and the share in the total annual income from tourism is about five percent ”. Author: Andreja Gazdek, ProConcept Yes, that is the answer to our question from the title. The UNWTO’s position on tourist health safety was defined two decades ago and can be found in the WTO Handbook “Tourist Safety, Practical Destination Measures”, and is divided into two main segments: This statement did not calm down, nor did it meet with the approval of the tourism sector, because the sales offices of both large and small tourism entities are fighting for every guest in the pre-season, and the main season that should bring the most revenue will be sold as Last minute. good. Gone are the days when Last Minute had a higher price than the regular one. The Corona virus has brought unrest to the world economy, a decline in the value of companies, an apparent decline in the exchange of goods and services. We all know that the epidemic will subside in the end and pass… unfortunately not without consequences. It will leave behind many economic systems weakened, or even destroyed. Many stocks have now reached values lower than in 2008 when the collapse of world stock markets and the banking system severely shook and devastated many economies. We can only predict the consequent damage, because a similar situation for the currently set global economic model is a novelty for everyone. a) Health risks associated with travel are a common problem and responsibility of all those involved in tourism (health care, tourism industry and tourists) We all know that the epidemic will subside in the end and pass without consequences. We can only predict the consequential damage, because this situation is a novelty for everyone for the currently set global economic model. A reliable and safe health care system in such emergencies is an extremely important factor in choosing a tourist destination for your next trip. Croatia is a safe country, with a developed system of medical care. The responsibility for the health of all participants in tourism must be taken by the entire community. The evolving epidemiology of the disease, the growing prevalence of antimicrobial drugs and the development of new vaccines and prophylactic treatment have contributed to the creation of constant needs for monitoring the movement of tourists. This is precisely the reason why the epidemiological services of many countries, including Croatia, had a very clear picture of how the corona virus will cross national borders, and how to proceed as soon as the first case of infection is recorded. The current controlled development of the situation with the corona virus in Croatia is a big plus for Croatian tourism and an excellent promotion of the Croatian health system. Igor Rudan stated on Sunday’s NU2 show: “If such a virus entered a dysfunctional state, then it could not be stopped” – which actually shows that the Croatian health care system is organized, professional. The Ministry of Tourism and the CNTB should refine the existing promotional campaigns in this direction. The media and public figures should support these views in all ways, and instead of spreading panic and sensationalist black headlines, they should turn the situation in a positive direction, create an atmosphere of optimism, and a safe oasis for tourists from Croatia. On the other hand, the Minister of Health Vili Beroš is in excellent control of the situation, he is very well acquainted with all segments of the system that participates in the prevention and implementation of health care. Despite the initial criticisms leveled at him, which were probably the result of global hysteria over the corona virus, tensions have eased significantly and it is very clear that things are under control. Destinations where accommodation, hygiene and sanitation, medical care and water quality are of a high standard pose relatively few serious risks to the health of tourists, other than those with pre-existing illness. The same is true for business travelers and tourists who visit most major cities and tourist centers and stay in quality accommodation. In contrast, destinations where accommodation is of poor quality, hygiene and sanitation are inadequate, medical services do not exist, and clean water is not available, can pose serious risks to the health of tourists. In light of the large number of medical staff who have left the country, we are probably only now becoming aware of how important it is to keep this system healthy and operational. Croatian tourism, which accounts for almost 20% of GDP, is a sensitive industry that needs the support of the entire social system and a stable political situation in order to function.