Marburg Confirmed in Uganda ( H5N1) One person has died of the Marburg Virus Disease, health minister Dr Ruth Aceng has said. Addressing a news conference in Kampala today, Aceng said the confirmation follows laboratory tests conducted by Uganda Virus Institute. Go to article

Troubling Thoughts on Plague in Madagascar ( Contagions) Initially, it seemed like just another, now annual, outbreak.  Plague is endemic in Madagascar, producing about 400 infections per year. As of October 13, there were 684 cases infections with 57 deaths. Four days later (the weekend update), the case number jumped to 804 cases and 74 deaths for a 9.3% mortality rate and pneumonic plague reached 74% of cases.  Go to article

878 Cases of Plague Reported (80 Deaths) ( Avian Flu Diary) Madagascar's MOH has updated their plague statistics page adding 73 cases and 6 deaths since their last updated tally on Monday. The situation of the plague epidemic currently affects 39 Districts, in 17 regions of Madagascar. Go to article

Domestic Preparedness & Response

Puerto Rico After Maria: Update, October 19 ( H5N1) Electricity has been restored to 21.6% of the island.  4,734 persons are still in shelters. 64 hospitals are operating; 45 of them have electricity. Go to article

Global Health Security

Public Health Progress in Haiti ( ASTMH) Although the attention of the Haitian public and international community has understandably turned to the recurrent political challenges facing the country and recovery from Hurricane Matthew, it is important that public health stakeholders take stock of progress made, remaining gaps, and fundamental public health priorities. Go to article

See also: Strengthening National Disease Surveillance and Response--Haiti, 2010-2015 ( ASTMH) Haiti's health system has faced many challenges over the years, with competing health priorities in the context of chronic financial and human resource limitations. As a result, the existing notifiable disease surveillance system was unable to provide the most basic epidemiologic data for public health decision-making and action.  Go to article

See also: Applying a New Framework for Public Health Systems Recovery Following Emergencies and Disasters: The Example of Haiti Following a Major Earthquake and Cholera Outbreak ( ASTMH) Emergencies can often directly impact health systems of an affected region or country, especially in resource-constrained areas. Health system recovery following an emergency is a complex and dynamic process. Go to article

Studies Show Rise in Drug-Resistant TB in India, China ( CIDRAP) A systematic review and meta-analysis of previously published studies reveals a significant rise in drug-resistant pulmonary tuberculosis prevalence in India over the past 2 decades, researchers reported yesterday in BMC Infectious Diseases. Go to article

Chaotic Response to Somali Bombing Cost Lives, Medics Say ( Reuters) Medics who rushed to help victims of a huge bomb explosion in the Somali capital Mogadishu that killed more than 300 people say the country's threadbare emergency services have been pushed beyond their limit. Go to article

Evaluation of ECDC Ebola Development in Guinea ( ECDC) Following a request from the US CDC and WHO Europe, ECDC initiated its first major international field operation, with a total of 62 experts mobilised by ECDC and deployed through WHO/GOARN to support the international Ebola response in Guinea. Go to article

Assessment of National Public Health and Reference Laboratory, Accra, Ghana, Within Framework of Global Health Security ( Emerging Infectious Diseases) The Second Year of Life project of the GHSA aims to improve immunization systems and strengthen measles and rubella surveillance, including building laboratory capacity. A new laboratory assessment tool was developed by the CDC to assess the national laboratory in Ghana to improve molecular surveillance for measles and rubella. Go to article

Enhancing Laboratory Response Network Capacity in South Korea ( Emerging Infectious Diseases) Laboratory Response Network laboratories help protect populations from biological and chemical public health threats. We examined the role of LRN biological laboratories in enhancing capacity to detect and respond to public health infectious disease emergencies in South Korea. Go to article

Medicine & Public Health

Telehealth ( The New England Journal of Medicine) Telehealth, a term used interchangeably with telemedicine, has been defined as the use of medical information that is exchanged from one site to another through electronic communication to improve a patient's health. The purpose of this article is to present policy-relevant trends in telehealth adoption, to describe the state of the telehealth evidence base, and to assist physicians, other health care professionals, and researchers in identifying key priorities for telehealth research. Go to article

Mitigating the Mental and Physical Health Consequences of Hurricane Harvey ( The JAMA Network) The complexity of the disaster risk landscape and the exposure of large human populations to prolonged and potentially traumatizing events were on full display during Hurricane Harvey. During the 5 days of Hurricane Harvey, more than 33 trillion gallons of rain fell on Texas and Louisiana and set a continental US record for rainfall at 51.88 in (131.78 cm). Among 13 million persons directly affected by the storm, more than 22,000 were rescued from floodwaters, an estimated 32,000 displaced survivors were temporarily housed in shelters, and at least 450,000 will apply for FEMA disaster assistance. Go to article

Science & Technology

Climate Change and Vector-Borne Disease of Public Health Significance ( FEMS Microbiology Letters) There has been much debate as to whether or not climate change will have, or has had, any significant effect on risk from vector-borne diseases. The debate on the former has focused on the degree to which occurrence and levels of risk of vector-borne diseases are determined by climate-dependent or independent factors, while the debate on the latter has focused on whether changes in disease incidence are due to climate at all, and/or are attributable to recent climate change. Go to article

Smallpox Could Again Be a Serious Threat ( Slate) SynBioBeta, which bills itself as the world's premier forum for innovators and investors interested in synthetic biology, concluded its 6th annual conference in San Francisco earlier this month. Companies from across the country and from around the world delivered presentations on how they are finding biological solutions to human problems. Go to article

Machine Learning: Calculating Disease ( Nature) Machine learning might identify patients earlier, predict their outcomes better, and assign them more efficiently to appropriate clinical trials. Go to article

Enhanced Proofreading Governs CRISPR-Cas9 Targeting Accuracy ( Nature) The RNA-guided CRISPR-Cas9 nuclease from Streptococcus pyogenes (SpCas9) has been widely repurposed for genome editing. High-fidelity (SpCas9-HF1) and enhanced specificity (eSpCas9(1.1)) variants exhibit substantially reduced off-target cleavage in human cells, but the mechanism of target discrimination and the potential to further improve fidelity are unknown. Go to article

Will the World's Most Worrying Flu Virus Go Pandemic? ( The Atlantic) The CDC keeps a Most Wanted list for flu viruses. The agency evaluates every potentially dangerous strain, and gives them 2 scores out of 10--one reflecting how likely they are to trigger a pandemic, and another that measures how bad that pandemic would be. At the top of the list, with scores of 6.5 for emergence and 7.5 for impact, is H7N9. Go to article