September 30th, 2007
posted by Paul Rega, MD, FACEP September 30, 2007 @ 5:50 pm
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AP, 9/30/07: Maldives police have arrested two local men after a nail-packed bomb exploded in a busy park Saturday and wounded 12 foreign tourists, a government spokesman said Sunday.
Remains of the mobile phone and timer alleged to have detonated the nail bomb.
Government spokesman Mohamed Shareef said that police arrested the suspects hours after the blast. But no motive has been established yet, and it was unclear whether they would be charged.
“The Maldives has never had something like this before. We are taking this very seriously because tourism is our life blood,” Shareef said after the blast on Saturday.
The injured included two Britons, eight Chinese and two Japanese, all of whom suffered burns, Shareef said. All except the British couple, who sustained burns over 40 percent of their bodies, were discharged from hospital and immediately sent home, he said.
Shareef said Saturday was too early to say whether the bomb targeted the tourism industry or whether an Islamic jihadist organization was involved.
Some Western diplomats have expressed concern about the potential for violence in this Sunni Muslim country. Half the population is under 18, reasonably well-educated and with few prospects for good jobs. Some young people have turned to drug use, while others have embraced a conservative strain of Islam that had been virtually unheard of on the islands just a few years ago.
Attacks against the tourist trade are virtually unheard of, though there has been tension and occasional outbreaks of violence in recent years between opposition activists and government forces, who are controlled by President Maumoon Abdul Gayoom, who has ruled the country for 29 years.
The opposition Minivan News reported on its Web site that witnesses said they saw nails, presumably from the bomb, scattered in the park, which is located near the country’s army headquarters.
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NY Times, 9/30/07:
The recall, by the Topps Meat Company of Elizabeth, N.J., covers a wide range of frozen hamburger patties and other products manufactured over the last year and bearing a “sell by” date or “best used by” date between last Tuesday and Sept. 25, 2008, along with the United States Department of Agriculture designation EST 9748.
The voluntary recall, an expanded version of one issued last Tuesday for nearly 332,000 pounds of Topps beef, was the first in the 67-year history of Topps, one of the nation’s largest meat processing concerns. It was also one of the larger meat recalls of recent years, the Agriculture Department’s Food Safety Inspection Service said.
Amanda Eamich, a spokeswoman for the service, said the expanded recall was based on an additional sample of meat contaminated with the E. coli O157:H7 strain, as reported by the New York State Health Department; by findings of an inspection service safety assessment; and by new reports of illnesses under inquiry in New York, New Jersey, Connecticut, Florida, Indiana, Maine, Ohio and Pennsylvania.
In Florida, Scott P. Schlesinger, a lawyer for Samantha Safranek, 15, of Pembroke Pines, said she became ill after eating a Topps hamburger on Aug. 17, was hospitalized on Aug. 23, and underwent dialysis before recovering. He said federal and Florida health officials confirmed the E. coli link to Topps on Sept. 7, and he questioned why it took weeks to recall the products.
Claudia S. Hutton, a New York State Health Department spokeswoman, said that suspected cases of E. coli linked to Topps dated to July, but that none were confirmed until an Albany resident became ill this month and a Topps patty in his refrigerator was found by the Health Department to contain the E. coli strain.
E. coli O157:H7 is a food-borne bacterium that can cause bloody diarrhea and dehydration. It usually clears up within a week in adults, but can be deadly in infants, older people and those with compromised immune systems.
Geoffrey Livermore, Topps’s vice president of operations, said the recalled products were distributed to retail grocers and food service institutions throughout the United States over the past year. Based on consumption patterns, he said, the company believes most of the products have already been consumed, but he urged people to check their freezers and dispose of any meat covered by the recall.
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St. Louis Post-Dispatch, 9/30/07: Transportation officials on Saturday examined an American Airlines jet that was forced to make an emergency landing Friday afternoon at Lambert Field, but it was still unclear what caused a malfunction in the MD-80’s left engine.
The plane remains in a hangar at Lambert, where Federal Aviation Administration and National Transportation Safety Board officials are looking at the jet and interviewing the crew, American Airlines spokesman Tim Smith said Saturday.
Flight 1400, bound for Chicago’s O’Hare International Airport with 137 passengers and five crew members aboard, was forced to return to Lambert after the engine malfunctioned. The jet made a bumpy but injury-free landing about 30 minutes after it took off from Lambert.
The airplane’s left engine caught fire during flight. The jet’s fire extinguishing and retardant system was activated to quash flames. Fire crews on the runway put out remaining sparks, officials said. Passengers exited the plane on a stairway. No one was hurt.
After the plane is released by transportation officials, both of the aircraft’s engines will be taken to an airline facility in Tulsa, Okla., for examination.
Airport and airline officials said Friday’s emergency procedures were handled properly.
“It’s obviously disconcerting to passengers to be involved in a situation like this, but the good thing is that all of the training and procedures went according to plan and the crew did a superb job,” Smith said.
Smith said it was unclear whether a 15-minute delay before the plane’s takeoff had anything to do with the engine that caught fire. A passenger on the plane told the Post-Dispatch the pilot had announced the jet had a problem with a starter valve that needed to be replaced.
The aircraft did not have any previous mechanical problems, Smith said.
The plane took off at 1:12 p.m. and landed at 1:44 p.m. Passengers boarded a later flight, which landed in Chicago about 6 p.m.
The MD-80 is the most commonly used plane in American’s fleet, Smith said, and the engines are replaced several times over the jet’s lifespan.
The plane is designed to fly with only one engine during emergencies, but the flight is not as smooth.
Several passengers described how the flight lurched and moved sharply after the engine malfunction.
Because the plane was operating with only one engine, the crew needed to use a combination of reverse thrust, brakes and flaps to avoid turning and skidding during landing, Smith said.
Such a landing is much more jarring than a landing with two functioning engines.
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Cincinnati’s WCPO-TV (9/28) reports that “thousands of cheerleaders are getting hurt each year,” a problem that “many medical experts think…will only escalate as more kids participate and [as] routines” continue to become “more complex and dangerous.” According to Dr. Tim Kremchek, of Beacon Orthopaedics & Sports Medicine, “These injuries are on the rise. Some of these injuries can be catastrophic and life altering, so we have to take it seriously.”
A Consumer Product Safety Commission study from 1999 reported that “21,000 emergency department visits due to cheerleading,” with “[t]hat number jump[ing] to over 28,000 in 2004.” Kremchek noted that “the most common injuries are to ankles and knees.” He said that “[c]heerleading needs to be taken seriously. People need to understand it. It needs to be put in the system, it needs to be treated as a sport.”
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ProMEDmail, 9/28/07: The NM Department of Health reports that an East Mountain woman is
the state’s 5th confirmed case of human bubonic plague in 2007.
The 58-year-old woman’s plague was confirmed on the night of 27 Sep
2007. She is currently hospitalized and recovering, according to the
department. The 4 other cases of plague confirmed in the state in
2007 occurred in Santa Fe, Torrance, San Juan, and Bernalillo
counties. A Bernalillo County boy died of the disease in June 2007.
Health Department officials are currently working with the
Albuquerque Environmental health department to determine where the
East Mountain woman may have contracted the disease. “We are
determining whether others are at risk, alerting physicians that
plague is in the area, and providing information to neighbors in a
door-to-door educational campaign,” state epidemiologist Mack Sewell
said in a news release.
Previous plague cases in 2007 have been associated with flea bites,
according to the health department. Sewell suggests that people use a
flea control product on their pets to minimize the likelihood off
introducing fleas to their environments.
New Mexico experienced 8 human plague cases in 2006, 2 of them fatal;
4 cases were reported in 2005. There [were] no reported cases of
human plague in 2004.
There have been 255 cases of human plague in New Mexico since 1949
with 33 deaths. Most New Mexico human plague cases have occurred in
the 7 northern counties of Bernalillo, McKinley, Rio Arriba, San
Miguel, Sandoval, Santa Fe, and Taos
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…1918, Tokyo falls victim to a mammoth typhoon that kills over 1,600 and displaces 139,000 inhabitants.
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…1972, in Rust Stasie, S. Africa a passenger train derails at top speed killing 48 .
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…1983, a truck bomb in front of the US embassy is detonated resulting in 241 American and Lebanese deaths.
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West Nile virus (WNV) was first identified in Houston in 2002 (1). From 2002 through 2004, 6% of patients hospitalized with WNV infection were homeless (2), which raised concerns that the homeless population might be at increased risk for infection. This study was conducted to determine the seroprevalence of WNV in Houston’s homeless population after 2 transmission seasons and to determine risk factors for infection.
A cross-sectional survey was conducted by using convenience sampling of homeless shelters, soup kitchens, homeless camps, and mobile outreach organizations. Participants gave consent and were assigned a unique study number to preserve anonymity. An interviewer-administered questionnaire collected information on demographics, social and medical histories, housing status during the 2002 and 2003 WNV transmission seasons, length of time homeless, and outdoor exposures. The study was approved by the University of Texas Health Science Center at Houston Committee for the Protection of Human Subjects (HSC-SPH-03-111).
A Mini–Mental State Examination (MMSE) was performed to evaluate the cognitive status of the participant. Participants who scored <75% on the MMSE were considered cognitively impaired, and therefore their interview responses were excluded.
As incentive, participants were provided free onsite testing and counseling for HIV, hepatitis B, hepatitis C, and WNV infections. Blood samples were collected and later tested for WNV antibodies by immunoglobulin G (IgG) ELISA and hemagglutination inhibition (HI) test. Samples were considered WNV antibody–positive if both the IgG ELISA and HI assay gave positive reactions. Data were entered into a Microsoft (Redmond, WA, USA) Access database and analyzed by using Stata 8.0 (Stata Corp., College Station, TX, USA). WNV prevalence and risk of becoming infected were calculated for each variable. Univariate odds ratios (ORs) with p<0.25 were included in a logistic regression model. A backward stepwise approach was used to eliminate variables with p>0.10 to determine a final model. Interactions between variables were assessed for significance (p<0.10), and the Hosmer-Lemeshow goodness-of-fit statistic (3) was used to evaluate the fit of the final model.
During the spring of 2004, 424 participants were enrolled from 13 sites; 8 were excluded due to low MMSE scores. Of the 416 participants, 397 had complete interviews, adequate blood samples, and were included in the analysis. This sampling represents ≈4% of Houston’s estimated 10,000 homeless population (4).
Of the 397 participants, 27 were WNV positive (seroprevalence 6.8%; 95% confidence interval [CI] 4.5–9.7). Men represented 72% of the participants, with 8.4% found to be positive for WNV, compared with 2.7% of women (OR 3.3; 95% CI 0.96–11.0) (Table 1). The study population was 59% black, 30% white, and 11% “other” or not stated; 13% were of Hispanic ethnicity. Mean age was 42 years (range 18–69 years).
For both 2002 and 2003 transmission seasons, 278 (70%) participants reported having stable housing, and WNV seroprevalence was 4.7% (95% CI 2.5–7.9) (Table 2). For those who had unstable housing in both 2002 and 2003 (n = 45; 11%), we found a significantly higher WNV seroprevalence of 13.3% (OR 3.1, 95% CI 1.1–8.7). For those who reported being homeless >1 year (n = 73; 18%), seroprevalence for WNV was 16.4% (95% CI 8.8–27.0), with a significantly increased risk for WNV infection when compared with those who did not consider themselves homeless or were homeless <1 month (OR 3.2; 95% CI 1.3–7.7, p = 0.01). When asked about the average length of time spent outdoors during the summer and fall, 38% reported <6 hours per day (seroprevalence 2.0%), 38% reported >6–12 hours (seroprevalence 8.0%), and 24% reported >12 hours (seroprevalence 12.5%). There was a positive trend (p value for trend 0.002) between number of hours spent outside and increased risk for WNV infection. Current marijuana use was also associated with WNV infection (OR 2.5; 95% CI 1.0–6.0).
Univariate analysis identified the following variables as significantly (α<0.05) associated with risk for WNV infection: unstable housing in 2002 and 2003, being homeless >1 year, spending >6 hours outside per day during the summer and fall, and current marijuana use. The final logistic regression model identified the following independent risk factors (p<0.10) for WNV infection: being homeless >1 year (OR 3.8, p = 0.002), spending >6 hours outdoors (OR 4.3, p = 0.02), normally taking mosquito precautions (OR 2.8, p = 0.04), and current marijuana use (OR 2.4, p = 0.07). The Hosmer-Lemeshow goodness-of-fit-test statistic was 12.4 (p>0.19), which suggests that the model is a good fit. When interaction terms were entered into the model, the interaction between marijuana smoking and spending >6 hours outdoors was significant (likelihood ratio p = 0.04) and increased the strength of the association with WNV infection.
We believe this is the first study to determine the prevalence of WNV in homeless adults and to determine risk factors for becoming infected among this high-risk urban population. Findings from this study will help public health authorities determine appropriate intervention and prevention strategies.
We found a seroprevalence of 6.8% in our sample of homeless persons, with a seroprevalence of 16.4% in persons reporting being homeless >1 year. Other studies have assessed the prevalence of WNV in general populations in the United States (5–10), with estimates of 0%–14%.
To our knowledge, this is the first report of WNV seroprevalence in a population with high-risk outdoor exposures. Only 3 studies have evaluated risk factors for infection in the United States and found that increased time outdoors (5,8), inconsistent use of mosquito repellant (5), and age (9) were predictors for infection. In Houston’s homeless population, spending >6 hours outside per day during the summer and fall and being homeless >1 year independently predicted risk for infection. Although being homeless >1 year was highly associated with increased time spent outdoors, this variable also independently predicted infection. This finding is important in a public health context because it highlights a strong potential for further cases of WNV infection in this population.
We found that regularly using mosquito precautions was associated with an increased risk for infection, which differs from the findings in New York (5). This finding was surprising since, in theory, use of mosquito precautions should reduce the risk for WNV infection. However, when asked about the types of mosquito precautions used, many participants reported methods that may be ineffective such as using candles or fire as a deterrent or swatting at mosquitoes. Education regarding appropriate preventive methods would be valuable in this population.
In addition, we found that marijuana use predicted WNV infection, which is difficult to explain. To our knowledge, this is the first report of marijuana use being a risk factor for WNV infection. Several explanations are possible, however: 1) this finding was due to chance, 2) persons using marijuana may spend more time outdoors between dusk and dawn when the Culex mosquito is most active, 3) the mosquito vector could be attracted to marijuana smoke, or 4) marijuana use could affect cognition, thereby preventing the user from interrupting a mosquito taking a blood meal. The relationship between marijuana use and WNV infection deserves further investigation.
For comparison, data on WNV prevalence in a nonhomeless population during the same time period and location would be useful. After the 2003 transmission season, a study at the University of Texas Health Science Center at Houston found a seroprevalence of 4.7% among 274 students, faculty, and staff (K. Murray, unpub. data).
This study provides important information on the magnitude and risk factors for WNV infection among homeless persons. Combining education with distribution of effective mosquito prevention aids such as mosquito repellent may help reduce the risk for WNV infection and other mosquitoborne diseases in this high-risk population.
We thank the participants and study sites for their contribution to this study and acknowledge the dedication and hard work of Lu-Yu Hwang, Jim Graham, Brian Howard, Chidi Okafor, Monica Sierra, Che Ornelas, Timberly Gilford, Don Hall, John Cleveland, Ken Meyer, Philip Lupo, Nancy Taylor, and the University of Texas General Clinical Research Center staff. We also thank Farzad Mostashari and the New York City Department of Health for sharing the questionnaire from the 1999 WNV serosurvey.
This study was funded by a contract with the Texas Department of State Health Services, and the University of Texas Health Science Center at Houston, General Clinical Research Center (NIH M01-RR 02558).
Ms Meyer is a doctoral candidate in epidemiology at the University of Texas Health Science Center at Houston, School of Public Health. Her current research involves genetic risk factors for prostate cancer.
Table 1. Participant demographics and WNV prevalence from the 2004 Houston Homeless Seroprevalence Study
Table 2. Self-reported social histories and prevalence of WNV infection from the 2004 Houston Homeless Seroprevalence Study
Meyer TE, Bull LM, Holmes KC, Pascua RF, da Rosa AT, Gutierrez CR, et al. West Nile virus infection among the homeless, Houston, Texas. Emerg Infect Dis [serial on the Internet]. 2007 Oct [date cited]. Available from http://www.cdc.gov/EID/content/13/10/1500.htm
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