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  • Kebijakan Kesehatan Indonesia

    Riyadh, Dhaka to sign health pact

    The Kingdom and Bangladesh will soon sign a Memorandum-of-Understanding (MoU) to strengthen their mutual cooperation in various functions in the health sector.

    The decision to draft a MOU was taken on Sunday during a meeting held here between Health Minister Dr. Abdullah Al-Rabeeah and his Bangladesh counterpart Mohammed Nasim.

    Areas of the proposed agreement would include medical collaboration for training, research, exchange of experts, recruitment of doctors and health professionals from Bangladesh and medical education.

    The visiting minister sought the Kingdom's help to secure accreditation for different post-graduate medical education degrees (MD, MS, and FCPS) awarded by Bangladesh, which are yet to be recognized by the Saudi government. "The existing limitations bar the Bangladeshi post-graduate doctors from being accepted as specialist doctors, and force them to accept lower salaries than doctors with similar qualifications from other countries," the minister noted.

    During the bilateral meeting, both ministers agreed to enhance cooperation in the health sector through sharing experiences, training and research collaboration of medical practitioners of both countries for the improvement of the citizens of both nations. Explaining the recent initiatives taken for the improvement in the health sector in Bangladesh under the leadership of Prime Minister Sheikh Hasina, the Bangladesh health minister sought the support of the government of Saudi Arabia to recruit more doctors, nurses and other health professionals from Bangladesh.

    Agreeing to consider these proposals by the Bangladesh health minister, the Saudi health minister underlined the need for regular and increased interaction between health professionals of both countries to enhance better understanding about the need for health services.

    The Saudi side also expressed willingness to receive medical doctors for training modules in Saudi hospitals while they are pursuing a higher degree in Bangladesh. "This would improve understanding and collaboration between the two countries and benefit Bangladesh doctors who may pursue future careers in Saudi Arabia subsequently to gain experience," the visiting minister said.

    Informing of the massive health reforms undertaken in the Kingdom in an expansion program, Health Minister Al-Rabeeah expressed interest in hiring qualified graduate nurses under the new programs.

    Al-Rabeeah hoped to visit Bangladesh at a convenient time in response to the invitation of Bangladesh health minister. A luncheon was hosted by Saudi health minister in honor of the Bangladesh health minister.

    Before the bilateral meeting, the Bangladesh health minister also had a meeting with Dr. Sulaiman Al-Emran, acting secretary general of Saudi Commission of Health Specialties, sole body for accreditation and licensing of medical doctors and other health professionals in the Kingdom.

    The Saudi Commission agreed to send its doctors as external examiners of Bangladesh medical degrees such as MS and MD as well as for the attachment in premier medical institutions in Bangladesh. The commission's officials also agreed to undertake a visit to Dhaka soon to see for themselves the medical education, training and services facilities.

    The visiting minister attended a reception hosted in his honor by the expatriate Bangladesh community at the Riyadh Palace Hotel here on Saturday.

    In the afternoon, Nasim left for Geneva to attend a two-day meeting on e-health standardization at the World Health Organization (WHO).

    According to Deputy Health Secretary Sayedul Islam Bangladesh would highlight the successful introduction of e-health services in the country. Bangladesh has been successfully using different software to collect use and store data, Sayedul said, adding that WHO officials will be shown how the Bangladeshi system would be helpful for other countries to exchange data. Seeking anonymity, a ministry official said Bangladesh would get a prize and official recognition from the WHO for successfully introducing e-health in the country.

    Besides senior officials from the MOH, Bangladesh Ambassador Mohammed Shahidul Islam, Neazuddin Miah, Secretary, Ministry of Health and Family Welfare, Professor Pran Gopal Datta, Vice Chancellor of Bangabandhu Sheikh Mujib Medical University, Professor Abu Shafi Ahemd Amin, President of Bangladesh Medical and Dental Council (BMDC) and Nazrul Islam, Director General (West Asia) of the Ministry of Foreign Affairs were also present.

    sumber: www.arabnews.com

     

    Egypt Confirms 38 Swine Flu Deaths

    Egypt confirmed Sunday 38 death cases of A/H1N1 virus, known as swine flu, since the beginning of last December, the Egyptian Health Ministry said in a statement.

    "The ministry has detected 339,483 cases with 318 diagnosed as carrying the virus since last Dec. 1, and 38 of them died," health minister Maha al-Rabat said in the statement.

    The ministry will announce twice a week on the new developments, the statement added.

    The statement also warned susceptible population which includes those younger than two years and above 65 years, patients suffering respiratory diseases, diabetes and pregnant women to make urgent test once they feel the symptoms of the ordinary flu.

    A/H1N1 has become so common that it has been categorized under the seasonal influenza by the World Health Organization since 2010, according to the statement.

    Former health minister Mohamed Awad Tag-Eddin said at a press conference last week that the virus is growing increasingly active in the northern Hemisphere including Egypt.

    source: english.cri.cn

     

    Drug-resistant diseases grow as threat to public health

    (RNN) - An increasing risk from drug-resistant diseases threatens to wipe out decades of medical progress, according to a study by the Centers for Disease Control and Prevention.

    The study showed that resistant microbes kill at least 23,000 people each year and complicate treatment and recovery for 2 million more.

    Health professionals characterize the threat as the largest challenge facing modern medicine.

    "We are approaching a cliff," said Michael Bell, deputy director of CDC's Division of Healthcare Quality Promotion in a news release. "If we don't take steps to slow or stop drug resistance, we will fall back to a time when simple infections killed people."

    When faced with "superbugs," physicians must resort to second- and third-line treatments, which may be more expensive or toxic for patients.

    Resistant infections are also costly to the healthcare system. The CDC estimates the care costs from these diseases are as high as $20 billion a year and lost productivity as high as $35 billion a year.

    The rise of resistant infections also threatens patients who receive advanced therapies, such as joint replacements, organ transplants and cancer treatments. Antibiotics are key to fighting their infections.

    "If the ability to effectively treat those infections is lost, the ability to safely offer people many of the life-saving and life-improving modern medical advances will be lost with it," the CDC stated.

    Plan of attack

    Bacteria naturally develop resistance to antibiotics over time through use - and misuse - of antibiotics, CDC researchers noted.

    "Every time antibiotics are used in any setting, bacteria evolve by developing resistance. This process can happen with alarming speed," said Dr. Steve Solomon, director of CDC's Office of Antimicrobial Resistance.

    The agency said as many as 50 percent of the antibiotics prescribed for humans are not needed or misused. Much of the antibiotics used in farm animals are also unnecessary.

    Drug-resistant microbes can be traced to the 1940s, according to the World Health Organization. The first one, staphylococcus aureus, was discovered four years after the mass production of penicillin in 1943.

    Superbugs are a worldwide problem. For instance, a resistant tuberculosis strain is gaining ground, particularly in areas of the former Soviet Union, according to the WHO.

    The CDC has developed four plans of attack to fight these diseases: preventing the spread of resistant infections, tracking resistance patterns, improving the use of current antibiotics and developing new antibiotics and tests.

    "Because antibiotic resistance occurs as part of a natural process in which bacteria evolve, it can be slowed but not completely stopped," the CDC stated. "Therefore, new antibiotics always will be needed to keep up with resistant bacteria, as will new tests to track the development of resistance."

    The public can help by getting immunized, handling food safely, using antibiotics as prescribed and practicing basic hygiene such as washing hands.

    Patients should dispose of any antibiotic remnants properly, with the best option being taking unwanted medicine to a drug take-back program. The Drug Enforcement Administration's Drug Take-Back Day is April 1.

    The FDA also has developed advice for how to best dispose of an assortment of drugs.

    Food supply issues

    Animals used in food are given antibiotics to prevent and treat disease, as well as make these animals gain weight faster with less feed.

    According to a PBS report, "small doses of antibiotics administered daily would make most animals gain as much as 3 percent more weight than they otherwise would."

    The drugs are added to the animals' feed and sometimes to the drinking water. But their overuse, experts say, is likely compromising human health, as drug-resistant microbes can be transferred from animals to the humans who eat them.

    The countries of the European Union have forbidden the use of antibiotics to promote animal growth.

    The U.S. Food and Drug Administration has released a voluntary plan, along with industry, to phase out antibiotic use in farm animals to bolster production.

    Some question whether the FDA is doing enough to protect the food supply.

    The Natural Resources Defense Council noted that a decade-long FDA assessment classified 18 of the 30 feed additives as having a "high risk" of exposing the public to drug-resistant bacteria through the food supply, in a report the environmental advocacy group released late last month.

    "The FDA concluded in their review that at least 26 of the reviewed feed additives do not satisfy even the safety standards set by FDA in 1973," the report stated.

    The NRDC, which based its report on data the FDA released as part of a Freedom of Information Act request, also criticized the agency for making its antibiotics reduction voluntary.

    A coalition of meat producers, however, questions the danger of antibiotics use.

    It characterizes the health risks of antibiotics in meat as "negligible," according to a 2012 news release from the National Chicken Council. They claim that antibiotics are needed, and the restrictions of the drugs' use is more stringent that the use of antibiotics in humans.

    source: www.live5news.com

     

    WHO: Imminent global cancer 'disaster' reflects aging, lifestyle factors

    Cancer cases are expected to surge 57% worldwide in the next 20 years, an imminent "human disaster" that will require a renewed focus on prevention to combat, according to the World Health Organization.

    The World Cancer Report, produced by the WHO's specialized cancer agency and released on World Cancer Day, predicts new cancer cases will rise from an estimated 14 million annually in 2012 to 22 million within two decades. Over the same period, cancer deaths are predicted to rise from 8.2 million a year to 13 million.

    The rising incidence of cancer, brought about chiefly by growing, aging populations worldwide, will require a heavier focus on preventive public health policies, said Christopher Wild, director of the International Agency for Research on Cancer.

    "We cannot treat our way out of the cancer problem," he said. "More commitment to prevention and early detection is desperately needed in order to complement improved treatments and address the alarming rise in cancer burden globally."

    The report notes that the rocketing cost of responding to the "cancer burden" -- in 2010, the economic cost of the disease worldwide was estimated at $1.16 trillion -- is hurting the economies of rich countries and beyond the means of poor ones.

    The report said about half of all cancers were preventable and could have been avoided if current medical knowledge was acted upon. The disease could be tackled by addressing lifestyle factors, such as smoking, alcohol consumption, diet and exercise; adopting screening programs; or, in the case of infection-triggered cancers such as cervical and liver cancers, through vaccines.

    "I know the report said we can't treat our way out of (the cancer problem) but there are major things we can do," said Dr. David Decker who works in oncology at Florida Hospital in Orlando. "Virtually 80 or 90 percent of lung cancers are caused by smoking. I know stopping smoking is not easy for people, but it does seem like a pretty simple way to reduce the numbers."

    "The cancer rates are not going up for shocking reasons, but for reasons that are easier to understand, and if we improve overall health, there are things we can do to prevent this from happening," Decker said.

    Cutting smoking rates would have a significant impact, as lung cancer remained the most commonly diagnosed cancer (1.8 million cases a year, or 13% of total cancer diagnoses) and the deadliest, accounting for about one-fifth (1.6 million) of all cancer deaths worldwide.

    There is a silver lining to the report, some experts said: It may lend urgency to the fight against cancer. Countries such as the United States present examples of success stories stemming from legislation and financial resources devoted to cancer prevention.

    "The good news is, in (the United States), cancer mortality is trending downward, and that would be more true if you make an age adjustment," said Dr. Walter Curran, chairman of the Department of Radiation Oncology at Emory University's School of Medicine in Atlanta.

    "Since we have an aging population, the cancer rate increases, and if you adjust for the aging of America, the cancer rate is declining notably."

    Curran said a typical 20-year-old American who doesn't smoke, "who has a good diet and a healthy lifestyle, someone with moderate alcohol consumption and who takes preventive health measures like regularly seeing a doctor and getting exercise -- their chance of cancer is significantly less than someone who for example lives in a developing country in Africa right now."

    However, the United States is dealing with an obesity epidemic -- the rates of adults who are considered obese has doubled since the 1970s -- and drinking excessively is still the No.3 cause of lifestyle-related death.

    Smoking is still the leading cause of preventable death in the United States. However, when the U.S. Surgeon General linked tobacco to lung cancer 50 years ago, more than 40% of the adult population smoked; now it's about 19%.

    Public health initiatives have also made a difference in smoking rates. The report eventually spurred local governments to make it harder for a smoker to find a place to practice their habit. Many restaurants, bars, and even public parks ban smoking.

    National leadership gave state governments license to raise taxes on cigarettes so much that people quit because they could no longer afford their habit.

    Money from the federal tobacco lawsuit settlement went into smoking cessation programs and gave farmers incentives to grow crops other than tobacco. The FCC banned persuasive cigarette ads that may have encouraged young people to smoke.

    Smoking rates remain high in Asia and Africa. China -- where one-third of the world's cigarettes are smoked, according to the World Health Organization -- only recently moved to ban indoor public smoking.

    The report's authors suggested governments take similar legislative approaches to those they had taken against tobacco in attempting to reduce consumption of alcohol and sugary drinks, and in limiting exposure to occupational and environmental carcinogens, including air pollution.

    According to the report, the next two most common diagnoses were for breast (1.7 million, 11.9%) and large bowel cancer (1.4 million, 9.7%). Liver (800,000 or 9.1%) and stomach cancer (700,000 or 8.8%) were responsible for the most deaths after lung cancer.

    "The rise of cancer worldwide is a major obstacle to human development and well-being," said Wild, the International Agency for Research on Cancer director. "These new figures and projections send a strong signal that immediate action is needed to confront this human disaster, which touches every community worldwide."

    The report said the growing cancer burden would disproportionately hit developing countries -- which had the least resources to deal with the problem -- due to their populations growing, living longer and becoming increasingly susceptible to cancers associated with industrialized lifestyles.

    More than 60% of the world's cases and about 70% of the world's cancer deaths occurred in Africa, Asia, and Central and South America.

    "In the developing world, we are really at the beginning of understanding how serious the cancer problem is in these countries," said Emory School of Medicine's Curran.

    Cancers related to the HIV epidemic in developing countries and the spread of Hepatitis C are also on the rise, but so too is the general age of the population in developing counties. When you now have the potential to live long enough to see your grandchildren -- something that was not true even a decade ago in many developing countries -- your risk of having cancer is going to go up.

    "When life expectancy get better, cancer rates will go up and so will cancer fatalities," Curran said.

    Governments needed to appreciate that screening and early detection programs were "an investment rather than a cost," said Bernard Stewart, co-editor of the report -- and low-tech approaches had proven successful in some developing countries.

    The World Cancer Report, which is published about once every five years, involved a collaboration of around 250 scientists from more than 40 countries. Tuesday is World Cancer Day.

    source: edition.cnn.com

     

    With population approaching U.S., Indonesia revives birth control

    Indonesian President Susilo Bambang Yudhoyono wants families to stop at two children to prevent a burgeoning population overwhelming schools and services. Asih, a cleaner in Tangerang, near Jakarta, is stopping at seven.

    "In my family, we always had a lot of children, and as long as we still had something to eat, why do family planning?" said Asih, 35. "Now I have two children in primary school and more that will have to go in the next few years and I have no money to pay school fees. Seven kids are enough."

    Facing slower investment and one of the highest youth unemployment rates in the Asia-Pacific region, the government is concerned the demographic dividend that attracts companies seeking a young, cheap workforce will become an economic time bomb. As Indonesia's growth slows, the world's fourth-most- populous nation isn't generating enough quality jobs to keep up with the population, the International Labour Organization said.

    That prospect has brought the revival of a birth-control program begun 46 years ago by former President Suharto, who managed to halve the fertility rate to about 2.6, where it's been stuck ever since. The government wants to cut the rate to the replacement level of 2.1 within two years to prevent the 250 million population doubling by 2060.

    "We have to go back to the policies of the Suharto era, to make strong campaigns and bring the fertility rate down," said M Sairi Hasbullah, head of Indonesia's statistics bureau for East Java province. "It's not going to be easy to provide food, education, health facilities and infrastructure for 500 million people. It's a big danger for Indonesia."

    The government increased the budget for family planning programs almost fourfold since 2006, to 2.6 trillion rupiah ($214 million) in 2013, funding everything from training rural midwives via text messages, to persuading Muslim clerics to encourage vasectomies. The measures extend efforts dating back to 1968, when Suharto set up the National Family Planning Institute to provide advice and contraceptives.

    While Southeast Asia's largest economy is trying to slow population growth, other countries in the region are trying to increase it. Singapore offers cash handouts and extended maternity leave to encourage its citizens to have more kids, while China has loosened its 34-year-old one-child policy that has saddled the nation with an aging labor force.

    "Indonesia is seen by other countries as an opportunity because of its population," said Aris Ananta, who has published books on Indonesian demographics and is currently a senior research fellow at the Institute of Southeast Asian Studies in Singapore. "It's an asset. The government is shifting its responsibilities if it's blaming population growth" for a failure to provide enough infrastructure or jobs, he said.

    About 19.6 percent of Indonesian youths between the ages of 15 and 24 were jobless in 2012, compared with about 16 percent in the Philippines, according to the ILO. Unemployment, inflation and the so-called youth bulge, a phenomenon where a large share of the population is comprised of children and young adults, contributed to the Arab Spring protests that ousted leaders in Tunisia, Libya and Egypt in 2011.

    Indonesia's labor force will grow 11.2 percent this decade through 2020, while its population will increase about 11.5 percent, according to Bank of America Corp. The high proportion of young adults — about 50 percent of Indonesians are aged below 30 — has attracted companies such as L'Oreal SA, the world's largest cosmetics maker, which opened its biggest factory globally in West Java in 2012 to supply products to Southeast Asia.

    source: azstarnet.com

     

    H7N9: Bird Flu - What to expect?

    The H7N9 Influenza outbreak in the People's Republic of China has been classified by the European Centres of Disease Control as a "significant long-term threat". The World Health Organization has asked for "vigilance". Once again, are we to sit back and watch a potentially disastrous virus spin out of control?

    Remember the Swine Flu outbreak, or Influenza A H1N1 in 2009? Remember the response from the World Health Organization? To remind our readers, no quarantine was imposed, no travel restrictions, just "vigilance" while the WHO informed us about the stages the pandemic was passing through until it became a pandemic. The pharmaceutical companies meanwhile rubbed their hands in glee as vaccines were sold, to the tune of millions upon millions of dollars and the more widespread the pandemic became, the more vaccines they sold, and thereafter medicines to reduce the symptoms of the virus once caught.

    Now in the People's Republic of China we are witnessing a highly pathogenic strain of Bird Flu (the same type of flu which killed between 50 and 100 million people after the First World War - Spanish flu), namely H7N9. Known as a strain which affected poultry, the virus appeared in early 2013 in the People's Republic of China and disappeared during the summer, reappearing again as the weather became cooler in the Autumn and winter.

    To date H7N9 has produced some 220 cases and 55 deaths, rendering the vast majority of victims in critical condition and the death rate indicates some 25 per cent of cases - a quarter of all those infected have died, placing this strain on a level with the Black Death (Bubonic plague) in medieval times.

    While the WHO is claiming that there has been no evidence of sustained human-to-human transmission, and while the majority of cases are among humans with a history of exposure to poultry (in poultry markets or breeding poultry at home), it is also true that some cases are among those who have no history of exposure to poultry.

    With the Chinese New Year looming at the end of January, and with the World Health Organization once again sitting back and watching, like some perverted voyeur, let us wait and see what happens. Obviously, yet again, there is nothing anyone can do about it, because if our health authorities relegate themselves to vigilance and inaction, all we can do is sit back and wait, to become infected with a deadly virus, or not. And if not, what about next time?

    One thing the scientific community agrees upon: it will happen, a deadly strain of the Influenza virus will mutate and will create a deadly pandemic. It is not a question of if, but when. If the World Health Organization were more proactive, then there would not be so much to worry about.

    It is almost as if the pharmaceutical lobby is asking for a pandemic to spread across the world, so that the pharma companies can make billions out of selling their "products" (as they name them). Surely that could never happen? Or could it?

    source: english.pravda.ru

     

    US expands TB control program to Jakarta

    US Embassy Chargé d'Affaires Kristen Bauer and the Jakarta administration on Monday launched the Community Empowerment of People against Tuberculosis (CEPAT) health program in Jakarta. The program supports community-based outreach and care for Tuberculosis (TB) via the US Agency for International Development (USAID).

    "USAID's CEPAT program supports Indonesian organizations and local communities to combat TB and to save lives," said Bauer in a statement made available to The Jakarta Post on Tuesday.

    She said the US was partnering with the Health Ministry and was committed to supporting its TB program.

    "Together, we will ensure more people are diagnosed, and support TB-positive patients in completing their treatment," Bauer said.

    To increase the number of people who are tested, treated and cured for TB in Jakarta, the US supports several Indonesian organizations including Jaringan Kesehatan/Kesejahteraan Masyarakat (JKM).

    The Family Welfare Movement team, or Tim Penggerak Pembinaan Kesejahteraan Keluarga (PKK) of Jakarta Special Province (DKI) hosted today's event to demonstrate its support of the work to fight TB in Jakarta.

    Indonesia remains among the top five countries globally with the highest incidence of TB. There are around 450,000 new TB cases and 65,000 TB-related deaths in Indonesia every year. Multi-drug resistant strains of TB are on the rise. Approximately 30 percent of Indonesia's estimated TB cases are not detected, and many patients are diagnosed late.

    Last year, USAID recognized Indonesia's global leadership in the fight against TB in ceremonies in Washington DC and Jakarta, highlighting Indonesia's progress in achieving its Millennium Development Goals for TB.

    The CEPAT program works with communities and local organizations to reach people who live in urban slums, displaced and mobile populations and people with reduced immunity due to malnourishment or HIV infection.

    CEPAT works in DKI Jakarta, West Java, East Java, West Nusa Tenggara, North Sumatra, West Sumatra, Papua, and West Papua provinces.(ebf)

    source: www.thejakartapost.com

     

    China ‘downgrades’ bird flu description as ‘infectious’ – H7N9 cases spike ahead of Lunar New Year

    BEIJING: China has reportedly downgraded H7N9 bird flu in humans, dropping its description as "infectious" in new guidelines on how to deal with the disease, even as new cases spike with the onset of winter. The National Health and Family Planning Commission described it as a "communicable acute respiratory disease" in its 2014 diagnosis and treatment protocols. In the 2013 version it was considered as an "infectious disease". The Beijing Times yesterday quoted an unnamed Beijing disease control centre official saying that health authorities decided to "make the downgrade" on the basis that nearly a year of analysis had shown H7N9 was "not strongly infectious". The H7N9 human outbreak began in China in February 2013 and reignited fears that a bird flu virus could mutate to become easily transmissible between people, potentially triggering a pandemic.

    The guidelines come as human cases undergo a seasonal spike, with 95 cases confirmed in mainland China so far this month according to an AFP tally of reports by local authorities. More than half have been in the eastern province of Zhejiang, with 24 in Guangdong in the south. So far seven patients have died in mainland China this year. That compares with 144 confirmed cases, including 46 deaths, in the whole of 2013 according to official statistics. It was not clear whether the rise in cases and decrease in fatality rate so far are due to the virus becoming more widespread and possibly less severe, or detection and treatment improving.

    Cases and deaths dropped significantly after the end of June, but have begun to pick up with the onset of winter. "So far, most cases have been sporadic and there were some cluster outbreaks among family members," the commission said in the guidelines. "But there is no evidence of sustained human-to-human transmission yet," it said, although it added that "limited" and "unsustained" infections could not be ruled out. In the past China has been accused of trying to cover up disease, particularly Severe Acute Respiratory Syndrome (SARS), which killed about 800 people around the world in 2003. The World Health Organization (WHO) has more recently praised its openness and response to the outbreaks of bird flu. WHO spokesman Gregory Hartl told AFP: "There's been an increase in the number of cases, not deaths. The deaths haven't increased that much. "This is winter, and all influenza viruses disseminate much more easily, much more widely, in winter, so it is not unexpected to see more cases," he said. The health commission guidelines shortened the disease's incubation period from seven days to three to four days, and the Beijing Times said hospitals would reduce the quarantine time for suspected exposures accordingly.

    The health commission also inserted the phrase "particularly the elderly" in its description of those vulnerable to the virus, who it specifies are those who have had contact with poultry or have been to a live poultry market in the week before showing symptoms. A spate of bird flu cases since the beginning of the year in China has experts watching closely as millions of people and poultry are on the move ahead of the Lunar New Year holiday, the world's largest annual human migration. China has reported more than 50 H7N9 infections in 2014 after the strain jumped from birds to people for the first time last year. The virus remains hard to catch and most cases have been linked to contact with poultry, but scientists worry that could change if it mutates into a form that allows it to spread easily among people. For those who track influenza, the holiday, which begins Jan. 31, is always worrying because it comes during the winter months when flu typically rages. Add that to hundreds of millions of people – and often birds – crammed together on buses and other forms of transportation going home, and it's always a bit of a gamble.

    China estimates 3.6 billion trips will be taken over the holiday season. "This is the first winter we've seen H7N9. We are in uncharted territory," said Gregory Hartl, World Health Organization spokesman in Geneva. "We have seen an upstart in cases, which we are attributing basically to the fact that it's winter. That combined with a lot of movement of people in crowded trains with chickens could give rise to a lot more infections, but we've also seen in past years where it hasn't." The first H7N9 cases were reported in late March near Shanghai, and more than 200 others have since been identified, including some 50 deaths. A 31-year-old doctor became one of the latest fatalities, raising fears he may have been infected at the hospital where he worked, but none of his patients or other close contacts have reported flu symptoms, according to the Shanghai Municipal Commission of Health and Family Planning. — AFP

    source: news.kuwaittimes.net