At least 30% of casualties on road in the country take a toll on lives of those in the age group of 15 to 25 years, says the recent WHO (World Health Organization) report. Ironically, the worst indicator of the report on road fatalities is that more than half of the accidents claim the lives of young wage-earners.

The traffic police department, while probing the factors responsible behind 11 major road mishaps cases that occurred within fortnight including Soraon, Industrial Area, Kaudhiyara and Mauaima and claimed 23 lives and left 27 others injured, found that most of deaths were of those in the age group of 16 to 33 years and five of them were wage-earners groups.

WHO report too revealed that the age profile of accident victims other than drivers during 2011 in the country was 25 to 65 years accounting for the largest share of 51.9% of total road accidents and casualties, followed by the 15-24 years age group comprising 30.3%.

The fact is that it's not HIV/AIDS or any other disease which is the major killer of productive youth across the globe but road accidents.

After witnessing road rage and casualties on city streets and highways, traffic police in the district have been monitoring road safety measures with a strict hand.

With intense checking, physical ability of drivers, including buses, tempos and auto underway, traffic police officials are also interacting with road users seeking their active cooperation to make roads more safe and sound.

Traffic inspector I P Singh said, "We have adapted strict implementation of traffic rules on city streets and measures for road safety have been taken in the same regard". He added that officials are maintaining a database on road accidents, as well as accident prevention measures at 'accident-prone areas' on city streets and connecting highways.

Efforts are also underway to improve the traffic scenario and errant drivers are being punished on spot. However, drivers are being taught lessons in responsible driving to minimise accidents of fatal and non-fatal kinds.

The ministry of road transport and highways has observed that road accidents on national highways constitute 31% of the total figure in the country. About 36% of total road fatalities every year occur on national highways.

Traffic police officials are still aiming to provide road safety education among masses, especially youngsters, and reach it to every commuter. "If we go through the reasons behind road accidents in fatal and non-fatal category, negligence on the part of driver was seen as the major reason," said a senior cop, adding "following traffic norms is the only solution to check accidents on roads. With over eight lakh vehicles running on streets, it is the responsibility of every driver to follow traffic rules and regulations in all circumstances" said the traffic inspector.

While the analysis of road accident data reveals that driver's fault was the single most common factor (78%) in road accidents, stress is being laid on educating drivers and making them aware of road safety norms.

The loss of the sole earning member of a family can be disastrous and all drivers must remember that, the latest report of road accidents in India compiled by the road transport and highways ministry said.

With intense checking, physical ability of drivers, including buses, tempos and auto underway, traffic police officials are also interacting with road users seeking their active cooperation to make roads more safe and sound. Efforts are also underway to improve the traffic scenario and errant drivers are being punished on spot

(source: timesofindia.indiatimes.com)

On World AIDS Day, WHO draws attention to the alarming rise of new HIV infections among men who have sex with men and transgender people in Asia.

MANILA, 30 NOVEMBER 2012 - On World AIDS Day (1 December), the World Health Organization (WHO) in the Western Pacific calls on governments to do more to combat the HIV epidemic among men who have sex with men and transgender people. Unless countries urgently expand access to health services for these key populations, the gains made against the epidemic over the last decade could be jeopardized.

"We need to strengthen our programmes to ensure that these key populations receive the support they need to protect themselves," says Dr Shin Young-soo, WHO Regional Director for the Western Pacific. "We need to scale up and improve sustained, comprehensive, effective and stigma-free HIV prevention efforts focusing on and working with men who have sex with men and transgender people."

The theme for World AIDS Day 2012 is: "Getting to Zero: Zero new HIV infections. Zero Discrimination. Zero AIDS-related deaths". The message relates to a world where people are protected from acquiring HIV and where people living with HIV are able to live long, healthy lives. All people in need should have access to:

- early diagnosis and life-saving antiretroviral treatment

- essential health commodities: male and female condoms, lubricants and clean needles and syringes for effective prevention of HIV transmission

- high-quality and stigma-free health-care and prevention services

According to the Joint United Nations Programme on HIV/AIDS 2012 (UNAIDS) Global Report: UNAIDS report on the global AIDS epidemic 2012, HIV epidemics in Asia and the Pacific remain largely concentrated among people who inject drugs, men who have sex with men and sex workers. Low-risk women are increasingly affected.

HIV prevention coverage remains inadequate for men who have sex with men. There is low coverage in the Philippines and Viet Nam at 25%. Although China reported more than 75% coverage of such programmes, and a survey of Singaporean and Vietnamese men who have sex with men revealed a high rate of condom use (75%), HIV infection among men who have sex with men across the region continues to grow. This requires governments to re-assess the effectiveness and quality of existing interventions.

In 2011, an estimated 1.3 million people were living with HIV in the 37 countries and areas of the WHO Western Pacific Region, with 80 000 deaths attributed to AIDS. However, the number of people newly infected with HIV declined from 150 000 per year in 2000 to 130 000 in 2011.

In Cambodia, Malaysia and Papua New Guinea, the rate of new HIV infections fell by more than 25% between 2001 and 2011. On the other hand, in the Philippines, the rate of new HIV infections increased by more than 25% per year during the same period. In China, new HIV infections increased among men who have sex with men, while declining among people who inject drugs and remaining low among sex workers.

Globally, 8 million people, or 54% of those in need, were receiving antiretroviral therapy in 2011. In the Western Pacific, only Cambodia reached more than 80% coverage of antiretroviral therapy. In Papua New Guinea, more than 60% of people who needed the therapy were receiving it in 2011. Effective implementation of programmes to halt mother-to-child transmission resulted in a 36% decrease in the number of children born with HIV in the Pacific between 2009 and 2011. In Asia, there was a 12% decrease in new HIV infections among children over the same period.

"This shows that the acceleration of our response is producing results for people," says Dr Shin. "In particular, the early detection of HIV infections in pregnant women and the availability of antiretroviral medication to prevent mother-to-child transmission have significantly increased the number of children born free of HIV in the Region, and cleaner blood supplies and better hospital infection control have dramatically cut the number of people being infected through blood or unclean injecting equipment."

To achieve and sustain access to HIV prevention, treatment, care and support services for people in need in the Region by 2015, WHO in the Western Pacific has identified five critical issues and recommended actions:

- Increase coverage of effective, evidence- and rights-based prevention interventions, including HIV testing and counselling, among people who inject drugs, sex workers, men who have sex with men and transgender people.

- Renew commitments to achieve and sustain universal access to early diagnosis and antiretroviral treatment. Early antiretroviral treatment administered to an HIV-infected person who is in a sexual partnership with an uninfected person can prevent HIV transmission by 96%. Harnessing the benefit will require concerted efforts for early diagnosis and treatment.

- Integrate HIV-related services, such as prevention of mother-to-child transmission and treatment of tuberculosis/HIV and hepatitis/HIV co-infections, into the broader health system.

- Strengthen systems for detection, management and surveillance of sexually transmitted infections and link these to comprehensive HIV prevention strategies.

- Use data from HIV surveillance systems more effectively to trigger programmatic actions that ensure service availability, accessibility, effectiveness, coverage and quality

In 2011, WHO Member States adopted the WHO global health sector strategy on HIV/AIDS 2011-2015, which promotes a long-term, sustainable HIV response by strengthening health and community systems, tackling the social determinants of health that both drive the epidemic and hinder response, protecting and promoting human rights and promoting gender equity.

(source: solomontimes.com)

Governments, civil society groups, and people with AIDS in Africa marked World AIDS Day on Saturday, with growing optimism for an AIDS-free generation as reports are showing the epidemic has stabilized.

Civilians gathered in public places to mark the day when the world remembers lives lost through the epidemic. From stadiums to small market centers and churches, hope registered as many who had gone public with their status gathered and proclaimed that the disease is no-longer a "death sentence."

"As we remember those who have succumbed to this disease, we must resolve today that we must win this war about HIV/AIDS. If we lose it, humanity stands the risk of being wiped out," said Kalonzo Musyoka, Kenya's Vice President in Nakuru town, where he unveiled Kenya's Equity Tribunal, an anti-discrimination panel for people living with HIV.

Think you know Africa? Take our geography quiz.

Kenya is the first country in the world to launch such a tribunal that will enforce laws and regulations to eliminate discrimination against people living with HIV, according to Mr. Musyoka. It will address discrimination due to HIV such as dismissal from employment or denial of services.

"This is a bold step towards eliminating stigma and looking after the rights of the people," said Musyoka.

The tribunal is one of the measures African countries are taking to end exclusion for people with HIV. In the continent, AIDS-related deaths have fallen by 32 percent in the last six years, according to the UNAIDS 2012 Global Epidemic Report. The report also noted that new infections are on the decline: In Sub-Saharan Africa, the most affected region, an estimated 1.8 million were infected in 2011 compared to 2.4-million in 2001.

"We have moved from despair to hope. Far fewer people are dying from AIDS. Twenty-five countries have reduced new infections by more than 50 percent. I want these results in every country," said Michael Sibidé, UNAIDS executive director in a message for World AIDS Day.

Analysts say the gains are resulting from sustained investment around the epidemic and politicians who are also joining the fight and showing leadership, with presidents declaring it a national disaster in several countries.

Many more people are now using condoms and sterile needles. Governments have also put more people on antiretroviral treatment (ARVs) and taken services to prevent mother-to-child transmission (PMTCT) in villages. In Kenya, PMTCT services have reduced infections in babies by 60 percent. Prevention groups are also putting more emphasis on prevention practices such a male circumcision.

"The efforts that have been put in place are bearing fruits, so if we put in more efforts, we can go to zero infections," says Professor Mohammed Karama, an epidemiologist at the Kenya Medical Research Institute. "We believe the HIV/AIDS has stabilized epidemiologically. This is a result of multiple approaches. It is the people getting to know their status, the prevention of people who are positive to avoid the transmission to other people. The use of condoms had also helped among discordant couples."

However, with the celebrations, some advocates are concerned the challenge ahead is being underestimated. Global advocacy group ONE, for example, said 6.6 million of the 15 million who need ARVs have no access, new infections every year stand at 2.5 million globally, and funding for ARVs has leveled off limiting the growth of prevention and treatment programs.

(source: www.csmonitor.com)

With 67 percent of Indonesian males over 15 years old smoking, and about a quarter of boys aged 13 to 15 hooked on cigarettes, officials and activists hope that a recent increase in the tobacco excise will be the first step toward rolling back the country's nicotine addiction.

The government announced on Tuesday that it would increase the excise by an average of 8.5 percent next year to boost state revenue and also discourage people from taking up the unhealthy habit.

"We welcome the government's plan," said Tubagus Haryo Karbyanto, chief campaigner for the National Commission on Tobacco Control (Komnas PT).

"Our cigarette prices are so low that even children can afford to buy them. That's why the smoking epidemic is so massive."

Cigarettes sell for about $1 a pack in Indonesia, far less than in neighboring countries such as Malaysia and Thailand, where a pack goes for $3 to $4. In developed countries like the United States and Australia, cigarettes can cost upward of $10 per pack. Even the excise on cigarettes, which is currently less than 40 percent, is extremely low by regional standards.

Tubagus said that raising cigarette taxes was the fastest way to curb smoking, particularly among children and low-income families.

"Besides, the tax will not affect the cigarette companies, because they will pass on [the cost] to their customers," he said.

The Global Adult Tobacco Survey released this year ranked Indonesians as the heaviest smokers in the world, with 67 percent of all male citizens over 15 years old lighting up consistently. According to the WHO, about a quarter of Indonesian boys aged 13 to 15 also smoke.

Tubagus urged the government to amend the law on taxes and excises, which stipulates that the tobacco excises can be raised up to 57 percent, while that for alcoholic drinks can be set at 80 percent.

"Cigarettes should be treated the same as alcoholic beverages to get better results," he said.

However, Health Minister Nafsiah Mboi argued that the 8.5 percent increase was initiated to avoid resistance from tobacco farmers and lobbyists.

"Don't just look at the quantity. It's better to do it gradually than face resistance," she said.

The Indonesian tobacco industry employs millions and is one of world's largest cigarette-producing markets, with about 6 percent of the government's revenue coming from cigarette excise.

The powerful tobacco lobby has been actively campaigning to block regulations that would restrict sales.

Activists say that despite creating more state revenue, the industry absorbs money from families in lower income brackets, trapping them in a cycle of poverty.

A recent survey by the University of Indonesia's Demographic Institute found that 57 percent of Indonesian households bought cigarettes, and that cigarettes were the country's second-largest expense after rice. According to the survey, the average household spends Rp 36.5 million ($3,800) every 10 years on cigarettes.

Indonesia is among a handful of countries that has refused to sign an international tobacco control treaty.

Nafsiah said Jakarta would soon sign the UN Framework Convention on Tobacco Control, but did not give a time frame.

"We'll keep pushing. I want it by the end of this year. But it's hard because we should consider all stakeholders," she said.

The convention calls for restrictions on advertising, promotion and sponsorship of tobacco products and bans sales of cigarettes to minors.

(source: www.thejakartaglobe.com)

Indonesia to increase Tobacco Excise Tax by 8.5% in Y 2013

The Indonesian government sets to raise Tobacco tariffs by an average 8.5% next year in efforts to increase state revenue and also discourage people from taking up the health-risking habit, local media reported here Wednesday.

Indonesian Finance Minister Agus Martowardojo quoted by the Jakarta Globe Wednesday as saying that the government expects revenue from tobacco excise will rise to 88.02-T Rupiah, some US$9.17-B, year fro, 9.80-T Rupiah, about US$8.31-B this year.

Indonesia is Southeast Asia's largest economy and one of the world's largest Tobacco markets, with liberal advertising and low taxes.

Due to weak law enforcement, no minimum age has been set for buying cigarettes. Efforts to reduce advertising, promotion and sponsorship of Tobacco products have failed to significantly curb the number of smokers.

About 70% of adult males smoke in Indonesia, which provides jobs to millions of industry workers.

(source: www.livetradingnews.com)

A biomedical engineering professor and director of several Duke organizations that apply an engineering framework to the world's great health inequities, Robert Malkin has made himself known—both at Duke and across the planet. Malkin's "Pratt Pouch," a ketchup-like packet that facilitates the prevention of mother-to-child transmission of HIV, was recently named one the World Health Organization's "Top 10 Most Innovative Technologies," and was recently selected as an awardee of the "Saving Lives at Birth" Grand Challenge. In light of the upcoming World AIDS Day, Towerview's Matthew Chase sat down with Malkin to discuss the role that biomedical engineers play in the field of global health.

Can you briefly explain how the Pratt Pouch works, and describe its design process?

The idea is that a mother who is HIV-positive would, if given no other HIV intervention, have an HIV-positive child, and then there would be no hope for curing the AIDS/HIV problem because each generation would simply inherit it from their parents. That cycle can be broken with pharmaceuticals. The problem is mothers... who end up delivering at home for any reason—because they go into labor very late or the labor is very quick, or they are many, many, many hours from a hospital—they don't have access to the drugs for their child. And you do need to provide a drug to both the mother and the child to give you the highest probability of preventing the transmission of the disease from the mother to the child.

So the Pratt Pouch allows the mother to take the meds home with her, and if for whatever reason she can't make it home to the clinic in time to have her baby there, she can just tear open the pouch and drip the medication into the child's mouth, preventing the child from becoming HIV-positive, and then later on go back into the clinic and pick up a more consistent and steady set of meds for the child to prevent longer-term exposure and transmission to the disease. So essentially it's a drug delivery system that allows the medication to be preserved so that the mother can deliver it to her baby appropriately and safely to her baby at home.

As you transition from design to implementation, what challenges are you facing?

We've been meeting with Ministers of Health of Tanzania, Zambia, Uganda, Ecuador, Namibia and Kenya to see whether they'd be interested in using the pouch in their systems, but there are many significant problems. First of all, we're only looking to solve the problem for the very hard-to-reach mothers. Any mother who is near the clinic should go to the clinic to have the baby.... They often, even at those very remote sites, have some access to midwives or other traditional birthing assistants, but that does not mean they have access to medication. Those traditional birthing assistants are, in some locations, allowed to distribute medications; and in other locations, they're not.

So that's the first hurdle: how are we going to get medicine, legally, to somebody who actually distributes it to the mother, very far from a hospital or clinic or pharmacy? So for example, in Uganda, traditional birthing assistants and something called community health distributors are permitted to distribute certain medications. And so for Uganda, what we're looking for is permission to add another medication to their list, and then those mothers whose status is known to be positive could have access to this medication through community health distributors.

In other places, like Tanzania, there is no authority given to community health workers or traditional birthing assistants to distribute medication, so in Tanzania we are looking at these vans which drive out from clinics to these very remote sites—sometimes 5 to 10 hours from the site, the pharmacy—with health workers once a month. So once a month they go to this very remote village which is when they do all of the antenatal care...to try to prevent the transmission.

In Ecuador, it's completely different: there are enough clinics, but these clinics are relatively remote. So there is no question of legality: these are regular clinics, they are staffed by nurses who definitely have the authority to distribute, but they're relatively remote, so the issue we are facing there is just training: how do we get the training all the way out to the end of the system there?

You've recently publicly spoken out against interventions that merely provide donations of medical equipment to developing countries. Given that this ideology may seem somewhat counter-intuitive, can you explain this belief?

I am a strong believer that donations do not help, at least in the realm of medical equipment. And just to give you a couple of quick facts, the Director-General of the World Health Organization, Margaret Chan, stated that 70 percent of critical donated equipment does not work, and 30-40 percent never worked. And in fact there is an interesting study that came out last year that found that 60 percent of donated equipment is known broken at the time of donation. I don't know exactly what the right number is—our data show that the number is around 40 percent, actually—but the problem is if you go into these hospitals you see huge piles of donated, unused medical equipment. And there's a cost associated with that, not only in terms of square feet in a building, which could be used for patient care, but also the proper disposal of medical equipment is not cheap. The hospital across the street here is using $100 to $200 per piece of medical equipment to dispose of the equipment.... And so every time you donate something which doesn't contribute to the hospital, you're placing a burden on that hospital.

The other end of the scale is that it's really, really hard to donate something and make it work. We just completed a study... of almost 1,000 pieces of donated, not-used equipment.... And less than 50 percent of it is working two years later. Think about this for a minute: If I donated you a computer, but the keyboard was in Thai, or the keyboard was in Khmer, and so was the manual, could you really operate your computer, if every screen came up in Cyrillic or Mandarin? You know, we deal with populations all the time who don't speak English, or English is their fourth or fifth language, so that's one issue.

Or they simply can't get the supplies.... If I give you a washing machine, but you can't find laundry detergent, is there really any value to the donation of the washing machine? Of course, that was just a metaphor—medical devices have much more complicated supplies that are required. And also broken parts; everything breaks, but you can't find the replacement parts.... And so for all of these reasons it is very hard to donate medical equipment and make it work.

What do you think of the role that biomedical engineers currently play in the global health community? Do you feel that your profession is under-represented?

Well the answer to this is very simple—just think about the last time you went to the doctor. Probably within about 10 minutes of being called back, they had weighed you, taken your temperature, probably your blood pressure and they may have taken a blood sample, which would have to be sent off to a lab somewhere.... Every single one of those measurements—and you're only 10 minutes into your visit at the doctor—has required a piece of medical equipment.

The fact of the matter is that when you go into a developing world clinic, almost none of those things work. Simple things like taking your blood pressure may be impossible, taking your weight may be impossible, taking a blood sample and sending it off to a lab might be a dream. And so I think it's very clear that biomedical engineers have a critical role for the future of global health, and I think we're taking up the challenge. I think it's slow, and I think the reason is fairly clear. Compared to other areas of biomedical engineering, there is relatively little funding for addressing global health challenges.

But I don't think that's the only reason: I also think we're relatively late to the game. Public health officials have been working on questions of malaria for probably 100 years or even more, not that they have ignored biomedical engineers in addressing that—remember that building dams and other things is also a key part to fighting malaria. But biomedical engineers are relatively late to the game. It's only in the past 30 or 40 years that you've seen biomedical engineers at all, and probably only in the past 10 to 20 that you've seen biomedical engineers focusing on global health.... And I think another issue its that, unlike the public health professionals which have realized for many, many years that they have to be on the ground to address the problem, biomedical engineers are just getting there, where we have key partnership in key locations on the ground.... Even the concept that an engineer would benefit from rotating through a developing world site for 5 to 10 months—or even 5 to 10 weeks for that matter—which is common in public health professionals that are interested in global health issues, even that concept is relatively new. So I think we need to give it some more time before we really develop a full head of steam in this area.

Four years ago, you accepted a role as a representative to the Executive Board of the World Health Organization. What was that experience been like, and in general what role should the WHO play in addressing global health challenges in upcoming years?

There are a few things that you need to understand to understand the role of the WHO. First of all, I was surprised—and I will take full blame for being ignorant—I was surprised at how political of an organization it is. It really is an organization of nations who are trying to cooperate and collaborate to solve these global health challenges, and there really is a huge range of views on these issues. So you end up with a really political body.

But I'll tell you another thing that you need to think about when you think about the WHO: the entire budget is like $850 million. My son's school district has a larger budget to serve the county that we live in than the WHO has to serve the entire globe. So this is actually a very small organization, and yet the challenges are enormous. From the point of view of medical equipment, which is really what I know and have interacted the most with the WHO, there basically is now one person at WHO who is focused on medical equipment, exclusively. So of the entire globe, there is one person. As you can imagine, this is a very talented person, but a huge amount of responsibility for a small amount of staff. So I would like to be able to say that the WHO is going to play a very critical role in health care technology, but the reality of the matter is that they are a relatively small player. I think that companies, nongovernmental organizations and private sector actors, like universities, are going to play a much, much larger role moving forward than the WHO is just able to.

I really want to encourage undergraduates to get involved in global health—they can make a difference right now, they don't need to wait until they have an MD or a biomedical engineering Ph.D. or something like that. There are lots of programs on campus right now—from DukeEngage to the global health certificate and many others—that they can get involved in right now to make a difference.

(source: www.dukechronicle.com)

The reporting of four more novel coronavirus infections in recent weeks, raising the total to six, has prompted the World Health Organization (WHO) to suggest that governments consider a major escalation of testing for the virus, a potentially burdensome undertaking.

In a Nov 23 statement, the WHO reported three new cases, with one death, in Saudi Arabia and one new case in Qatar. The latest Saudi Arabian cases included two in the same household, but it was not known if person-to-person transmission was involved.

The global case count since the virus emerged in June has reached six, of which two were fatal. The latest cases noted by the WHO apparently include two that were reported earlier by Saudi health officials and the news media.

Until more is known, the WHO statement said, "It is prudent to consider that the virus is likely more widely distributed than just the two countries which have identified cases. Member States should consider testing of patients with unexplained pneumonias for the new coronavirus even in the absence of travel or other associations with the two affected countries."

The European Centre for Disease Prevention and Control (ECDC), in a risk assessment released today, said it was considering the implications of the WHO recommendation and commented that increasing testing to that extent would probably be burdensome for European countries.

The novel coronavirus, a relative of the SARS (severe acute respiratory syndrome) virus, emerged in June, but it was not publicly announced until late September.

The first case was in a 60-year-old Saudi Arabian man who died in a Jeddah hospital Jun 24. The second case struck a Qatari man who fell ill in early September and was flown to London, where he apparently remains hospitalized. Both patients had pneumonia and acute renal failure.

A Saudi health official reported the third case on Nov 4, in a Saudi man in Riyadh who had been critically ill but was recovering. The fourth case, as reported Nov 21 by a Saudi newspaper quoting government sources, involved another Saudi man who was hospitalized in Riyadh and was said to be improving.

The Nov 23 WHO statement gave few details on the latest four cases, but it said two of the patients came from the same family and household and had similar symptoms. One of the patients died and the other recovered, the agency said.

Further, two more members of the same family were sick with similar symptoms, and one of them died, the WHO said. Test results for the deceased family member are pending, and the other patient, who is recovering, tested negative.

Investigations concerning the source of infection, the route of exposure, and the possibility of human-to-human transmission are ongoing, the WHO said.

The latest Qatari patient got sick in October and was flown to Germany, where he was hospitalized and received intensive care but eventually recovered and was discharged this week, according to Germany's Robert Koch Institute.

In a Nov 23 statement, the institute said the patient was treated for 4 weeks at a hospital in North Rhine–Westfalia. No illnesses have been reported among hospital personnel, though an investigation of the patient's contacts is ongoing.

The institute said samples taken while the patient was still in Qatar were tested in the United Kingdom and found to be positive.

The WHO in its statement did not list specific reasons for its suggestion that the novel virus may exist in countries other than just Saudi Arabia and neighboring Qatar.

In response to a query on the topic today, WHO spokesman Glenn Thomas told CIDRAP News via e-mail, "This is based on the fact that the cases confirmed to date are geographically far apart, and that investigations are still ongoing into the characteristics of this novel coronavirus."

The ECDC, in its statement today, noted that the possibility of person-to-person transmission in the Saudi Arabian family case cluster has not been excluded. It added, "There is indication that some cases had a history of visits to farms prior to illness, but no details are available concerning the kind of farms or related animal contact."

The agency said healthcare workers who treat people from the Middle East who have severe respiratory infections may be at risk for infection with the novel virus. It's possible, though, that the infections are more widespread, as suggested by the WHO, and seroepidemiologic studies are needed to investigate the possibility of mild and asymptomatic cases, the EU agency said.

"The fact that there have not been any expanding clusters of cases indicates that currently the risk for EU citizens to acquire these infections has not increased and remains very low, based on the current information," the ECDC said.

The ECDC statement evidenced some wariness about the WHO suggestion to consider testing patients with unexplained pneumonia even if they have no ties to Saudi Arabia or Qatar. The ECDC said it is considering the recommendation in relation to the potential burden of testing and the possibility of false-positive results.

For European countries, following the WHO testing suggestion probably would mean a "high" burden, the ECDC said. It estimated that EU countries have roughly 750,000 cases of community-acquired pneumonia of unknown cause each year.

(sumber: www.cidrap.umn.edu)

The World Health Organization has warned countries to heighten their surveillance for possible cases of infection with the new coronavirus, suggesting patients with unexplained pneumonias should be tested even if they don't have links to Saudi Arabia and Qatar.

The agency also suggested investigating clusters of severe respiratory infections, and clusters of such illnesses in health-care workers, regardless of where they happen in the world.

Up until now the WHO has said that testing for the new coronavirus should be restricted to patients with severe respiratory infections who had recently travelled to or who were residents of a country that had recorded cases. To date the only confirmed infections have been in Qatari and Saudi nationals.

That change in advice, the basis for which the WHO did not explain, raised eyebrows among some infectious diseases experts, who were quick to try to read between the lines.

"That suggests that they have the idea that it's more widespread. Where does that idea come from? What's the evidence?" wondered Dr. Ron Fouchier.

The Dutch virologist leads the laboratory which in June found that a new coronavirus — from the same general family as the virus that caused SARS — was behind the infection of the first identified case, a man from Jeddah, Saudi Arabia.

If the WHO has any evidence that the virus has spread further afield, it hasn't revealed it.

But its concern may stem from the fact that over three million Muslim pilgrims have recently returned to their home countries after attending this year's Hajj, which ended in late October.

The WHO's new advice was contained in a statement the agency released Friday in which it announced the global count of confirmed infections with the new virus has risen to six. Two of the confirmed cases have died. All six cases were male.

It also revealed that Saudi Arabia has reported a cluster of cases, with two men confirmed and two others under investigation. The four men shared a household in an undisclosed part of the country.

All four were sick around the same time, suffering similar symptoms, the WHO said. Of the two men under investigation, one died. Test results are still pending on samples taken from the man during his illness.

The other man survived and tested negative for the virus, the WHO said. But it did not disclose the type of test used or when the testing was done.

Until more information is known, it is not clear that the test result can be considered reliable, said Dr. Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota.

The reliability of the test could vary, depending on when the person was tested, what kind of test was used and the kind and calibre of the specimen being tested, he said.

"If the person had an illness similar to the other illnesses, then ... I believe that you'd have to consider that this test may have been a false negative," said Dr. Osterholm, adding testing the survivor's blood for antibodies would shed some light on the situation.

Both the changing WHO advice and the lack of clarity on the testing underscore a problem with this situation, both Dr. Osterholm and Dr. Fouchier suggested.

Very little about the cases is being publicly shared. And the international teams of scientists who travelled to Saudi Arabia to look for possible sources of the virus have released no information about their investigations.

Dr. Fouchier was front and centre in the laboratory effort during the 2003 SARS outbreak. It was his lab, at the Erasmus Medical Centre in Rotterdam, that proved what's called Koch's postulates — the test that confirmed that the newly identified coronavirus was actually causing the disease SARS.

During the early days of the SARS outbreak, the WHO rapidly put together a virtual network of laboratories, tapping into expertise around the world to combat the alarming new disease.

But this time? In the summer, Dr. Fouchier's lab identified and sequenced the new coronavirus and developed a test for it. But since then, it's been "radio silence," Dr. Fouchier said in an interview Friday.

"Everything I've heard since then has just come from the lay press, which is completely in contrast to how we acted back in the SARS era," he said.

"That was completely different during the SARS outbreak. We were all talking together, exchanging results and giving each other ideas about what to test, how to test, where to test. And none of that is happening now. We just have to rely that they're doing the right thing."

Officials in the know should be sharing more information, Dr. Osterholm agreed.

"At this point in any outbreak investigation, there clearly is more information that is known by health officials than likely has been shared," he said.

"But if there were ever a time for complete transparency, now is the time. We've learned that in the past and I'd hate to see us have to relearn the lesson again."

(source : www.theglobeandmail.com)