I’m in the process of building a timeline infographic that tracks the progress of the still to be named Wuhan Coronavirus. It’s early days and I’ve a bit to research but here is a preview of where we are at with the virus in the early hours of the 21st January 2020.
Sources:
FluTrackers.com. 2019-nCov Confirmed Case List by Country and Province – Total = 222 (as of 8am ET)
An old ‘soldiers-five’ on Mefloquine. When I first thought I was given Mefloquine I wasn’t sure where to look first. I initially got some good and some bad information. I’m not the tree of knowledge on Mefloquine but here is a suggested reading list and resource guide concerning Mefloquine. I’ve focused on veterans because that is my lived experience. Remember, this is a guide only. Consult your doctor.
Last updated 7th October 2019
World Health Organisation
8th August 1989: World Health Organisation. The original warning from WHO way back in 1989.
Consumer Medicine Information
9th October 2017: The Consumer Medicine Information guide for Lariam (linked here: 171009_ConsumerMedicineInformation_Roche_Lariam). A veteran mate has underlined the important health warnings.
Mefloquine Articles (non-specific)
27th April 1996: New Scientist. Malaria pill stands accused – Lariam fends off malaria more effectively than any other drug, but growing evidence of disturbing side effects may soon land its manufacturer in court (via 960427_Article_NewScientist_Mefloquine). Thanks to the veteran mate who sent this through. He was given Lariam in 1994 and 1999 without the serious side-effects.
Mefloquine Articles for Veterans
27th January 2003: CBS News. The Dark Side Of Lariam. How Dangerous Is It? One of the first ‘deep-dives’ into mefloquine by a news outlet. Discusses the Fort Bragg suicide cluster where mefloquine was a factor.
19th September 2013: CBS News. Elite Army units to stop taking anti-malarial drug. The US Army’s Special Forces banned from using mefloquine in 2013.
25th September 2013: Huffpost. Mefloquine: The Military’s Suicide Pill. Dr Remington Nevin writes about mefloquine including the 2013 FDA’s ‘black-box’ warning. The world is waking up to the dangers of mefloquine. Dr Nevin is one of the leading experts in the field.
12th October 2014: Army Technology. Mefloquine – the military’s deadly malaria treatment. Dr Remington Nevin discusses the downside to mefloquine including his own personal deployment experience with the drug.
11th August 2016: Military Times. Malaria drug causes brain damage that mimics PTSD: case study. A different take on mefloquine exposure from the USA.
22nd August 2016: Australian Broadcasting Corporation. Defence force admits soldier shouldn’t have been included in East Timor anti-malaria drug trial. One of the first articles I read. Also includes a link to a 2016 7.30 Report about the Australian mefloquine/tafenoquine trials.
30th August 2018: The Irish Times. Vivid nightmares and suicidal thoughts – ex-soldiers blame drug for destroyed lives. An Irish perspective. With a standing Army of approximately 10,000 they have still administered Lariam to approx. 5,500 – 6,000 over the years.
Podcasts
12th June 2019: The Medical Republic. TMR podcast: Can this anti-malarial drug really cause “brain damage”? Thanks to my GP, Dr Mary Lamond for sending this to me. Along with other subjects the podcast covers mefloquine/tafenoquine exposure and its risks in simple language.
Books
23rd January 2014: ‘The Answer to the Riddle Is Me’ by David Stuart MacLean. The Washington Post book review can be found here.
Official Mefloquine Sites (Information & Policy)
Last accessed 7th October 2019: Department of Defence (Australia). Mefloquine. An excellent resource. One of the first sites I visited. Mefloquine Loading Doses are also explained.
Experts
Dr Remington Nevin (USA). Possibly the leading expert in the field of Quinism in 2019 when I suspected my exposure. US Army (Major – Retired). A Vermont-based physician epidemiologist and expert consultant in the adverse effects of antimalarial drugs, particularly mefloquine and tafenoquine.
If you or someone you know needs help, please phone Lifeline on 131 114, Kids Helpline on 1800 55 1800, Beyond Blue on 1300 224 636 or Open Arms on 1800 011 046.
At the time I was finalising my papers to join the Australian Army.
I had no idea about anti-malarials. Malaria is not endemic in Australia so it is understandable I missed this update. On the 8th August 1989 the World Health Organization issued an alert on the “adverse effects of the antimalarial drug Mefloquine”.
Here is the full link: 1989_WHO_Mefloquine
The World Health Organisation updated its Ebola virus disease – Democratic Republic of the Congo Disease Outbreak News on Wednesday with numbers to Tuesday. The DR Congo Ministry of Health updated its numbers today with data to Wednesday presenting some new numbers including the invalidation of eight previously reported community deaths which occurred pre-outbreak.
Ian Mackay has broken down the numbers for us in an easy tweet. They are:
#Ebola numbers for 22MAY2018 from DRC MOH…
Those numbers in a infographic which details the cases/fatalities by territory (rather than Health Zone). Iboko Health Zone lies within Bikoro Territory:
The World Health Organisation data via its latest Disease Outbreak News. Ebola virus disease – Democratic Republic of the Congo. Excerpt:
On 8 May 2018, the Ministry of Health (MoH) of the Democratic Republic of the Congo declared an outbreak of Ebola virus disease (EVD). This is the ninth outbreak of Ebola virus disease over the last four decades in the country, with the most recent outbreak occurring in May 2017.
Since the last Disease Outbreak News on 17 May 2018, an additional fourteen cases with four deaths have been reported. On 21 May 2018, eight new suspected cases were reported, including six cases in Iboko Health Zone and two cases in Wangata Health Zone. On 20 May, seven cases (reported previously) in Iboko Health Zone have been confirmed. Recently available information has enabled the classification of some cases to be updated.
As of 21 May 2018, a cumulative total of 58 Ebola virus disease (EVD) cases, including 27 deaths (case fatality rate = 47%), have been reported from three health zones in Equateur Province. The total includes 28 confirmed, 21 probable and 9 suspected cases from the three health zones: Bikoro (n=29; ten confirmed and 19 probable), Iboko (n=22; fourteen confirmed, two probable and six suspected cases) and Wangata (n=7; four confirmed and three suspected case). Of the four confirmed cases in Wangata, two have an epidemiological link with a probable case in Bikoro from April 2018. As of 21 May, over 600 contacts have been identified and are being followed-up and monitored field investigations are ongoing to determine the index case. Three health care workers were among the 58 cases reported.
The World Health Organisation has updated its Ebola virus disease – Democratic Republic of the Congo Disease Outbreak News which include Epidemic Curve chart and a map illustrating the Health Zones impacted.
Currently there are 40-cases in Bikoro Territory (2-confirmed, 20-probable & 18-suspect) and I’ve assumed that all 23 reported fatalities have occurred in that territory based on the most recent reporting although this has not been confirmed by the WHO in this update.
Note: If all the 23 fatalities have occurred in Bikoro Territory that puts the CFR at 57.5%. However, if all the fatalities have occurred in the smaller Bikoro Health Zone the CFR then spikes to 65.7%. There have also been four cases reported in Wangata Territory including two brothers who travelled to Bikoro for a wedding. This places those four within the environs of Mbandaka, a city of 1.2 to 1.5-million.
WHO are also reporting three Health Care Workers among the 44 infected without providing any further information.
All the cases to date have occurred in Equateur Province which is represented in the infographic below:
The World Health Organisation data via Ebola virus disease – Democratic Republic of the Congo. Excerpt:
Since the last Disease Outbreak News on 14 May 2018, an additional five cases, including one laboratory-confirmed case from the city of Mbandaka, Wangata health zone, have been notified by the country’s Ministry of Health. Wangata health zone is one of three health zones in Mbandaka City, which has a population of approximately 1.5 million people. Recently available information has enabled the classification of some cases to be updated1.
From 4 April through 15 May 2018, a cumulative total of 44 Ebola virus disease (EVD) cases including 23 deaths (CFR = 52%) have been reported from three health zones in Equateur Province. The total includes three confirmed, 20 probable and 21 suspected cases from the three health zones, Bikoro (n=35; two confirmed, 18 probable and 15 suspected cases), Iboko (n=5; two probable and three suspect cases) and Wangata (n=4; one confirmed, and three suspect cases). Of the four cases in Wangata, two have an epidemiological link with a probable case in Bikoro from April 2018. As of 15 May, 527 contacts have been identified and are being followed-up and monitored. Three health care workers were among the 44 cases reported. Figure 1 shows the date of notification (date of illness onset not yet available for most cases) for 27 cases with available data from 5 May through 15 May 2018. Figure 2 shows the location of cases by health zone.
The World Health Organization has updated its Disease Outbreak News (DON) on the Ebola outbreak which has data updated to the 13th May 2018. I missed the initial DON but the most recent news is both good and bad. Good in that WHO has immediately ramped up efforts to stem this latest outbreak including deploying the Ebola vaccine but also bad because the two probable cases in the Wangata territory are on the outskirts of a large population centre (Mbandaka – population 1.2-million).
The DON breaks down the cases by Health Zones. Currently those cases listed in Bikoro and Ikoko Health Zones lie within Bikoro Territory while the Wangata Territory encompasses the city of Mbandaka and surrounds. The Case Fatality Rate for Bikoro Territory is 51.3%. All the cases so far have occurred in Equateur Province. Infographic below:
The data for this infographic was supplied by the World Health Organization via Disease Outbreak News 14 May 2018 – Ebola virus disease – Democratic Republic of the Congo. Excerpt:
Since the publication of the first Disease Outbreak News on the Ebola outbreak in Equateur province, Democratic Republic of the Congo on 10 May 2018, an additional seven suspected cases have been notified by the country’s Ministry of Health. Importantly, since the last update, cases have been reviewed and reclassified, and some discarded.
From 4 April through 13 May 2018, a total of 39 Ebola virus disease cases have been reported, including 19 deaths (case fatality rate = 49%) and three health care workers. Cases were reported from the Bikoro health zone (n=29; two confirmed, 20 probable and 7 suspected cases), Iboko health zone (n=8; three probable and five suspected cases) and Wangata health zone (n=2; two probable cases). To date, 393 contacts have been identified and are being followed-up. Wangata health zone is adjacent to the provincial port city of Mbandaka (population 1.2 million). Response teams on the ground are in the process of verifying information on reported cases. Case numbers will be revised as further information becomes available.
After a six month sabbatical I’m dipping my toe back into Random Analytics (and by default my passion for amateur epidemiology).
Last week the World Health Organisation released its latest Ebola Situation Report – 15 July 2015 which has demonstrated that although the disease has stopped it momentous attrition within West Africa it hasn’t entirely gone away. As we learnt from the initial outbreak in late 2013 one case can turn into many hundreds, then many thousands and finally some tens of thousands in a very short space of time.
The WHO notes:
There were 30 confirmed cases of Ebola virus disease (EVD) reported in the week to 12 July: 13 in Guinea, 3 in Liberia, and 14 in Sierra Leone. Although the total number of confirmed cases is the same as the previous week, there has been a shift in the foci of transmission. For the first time in several months, most cases were reported from Conakry and Freetown, the capitals of Guinea and Sierra Leone, respectively. All 9 of the cases reported from Conakry and all 10 of the cases reported from Freetown were either registered contacts of a previous case or have an established epidemiological link to a known chain of transmission. One of the 30 cases reported in the week to 12 July arose from a yet unknown source of infection. However, a substantial proportion of cases (7 of 30: 23%) continue to be identified as EVD-positive only after post-mortem testing. This suggests that although improvements to case investigation are increasing our understanding of chains of transmission, contact tracing, which aims to minimise transmission by identifying symptoms among contacts at the earliest stage of infection, is still a challenge in several areas.
As the following chart demonstrates the 2013-15 West African Ebola Zaire outbreak has eclipsed all previous Ebola events.
Even as the disease has left the pages of most Western newspapers and television screens the scale of the event and the ongoing transmission is still frightening. Consider just these three data points:
Not all of us have forgotten West Africa.
Data Sources
[1] WHO. Ebola Situation Report – 15 July 2015. Accessed 17 July 2015.
The World Health Organisation (WHO) has updated it latest advice on the Ebola Outbreak. Ebola Response Roadmap Situation Report 7 November 2014. Summary:
A total of 13 268 confirmed, probable and suspected cases of Ebola virus disease (EVD) have been reported in six currently affected countries (Guinea, Liberia, Mali, Sierra Leone, Spain, the United States of America) and two previously affected countries (Nigeria, Senegal) up to the end of 4 November 2014. There have been 4960 reported deaths.
Following the WHO Ebola Response Roadmap structure, country reports fall into two categories: 1) those with widespread and intense transmission (Guinea, Liberia, and Sierra Leone); and 2) those with or that have had an initial case or cases, or with localized transmission (Mali, Nigeria, Senegal, Spain, and the United States of America).
Here are three charts/infographics of the West African Outbreak with data confirmed by WHO to 5 November 2014.
The West African Ebola Outbreak (2013-2014) infographic details the cases, fatalities, provisional Case Fatality Rate (CFR) and health spend per capita in 2012 $USD.
The data point of interest for me in the past fortnight has been the revision in numbers that WHO has provided. In the most recent update case numbers in Sierra Leone have been significantly revised down, while in Liberia where cases are on the apparent wane the numbers were revised upwards. Data for Mali has been included in this update.
The West African Ebola Outbreak (by Nation) chart looks at the split between those recovered or still in treatment (highlighted by flag) and those deceased (in red).
A data point of interest here is the case difference between Sierra Leone and Guinea yet a similar amount of deaths. Provisional CFR is Sierra Leone is 23.2% compared to Guinea which is a much higher 59.9%. Surely that can’t be correct?
The West African EVD Outbreak – All Cases/Fatalities by month details the epidemiological curve of the outbreak from March 2014 when the first cases and deaths became apparent. Each column is visualised by the flag of the eight impacted countries. Note: Due to revisions in late October as provided by WHO I have finalised the October numbers as at 2 November.
The data point of interest in the last chart is the epidemic curve differences between cases (still rising) and deaths (decreasing). I would have expected that both should increase or decrease in tandem. I suspect missing data would account for the anomaly.
Summary
I’ll update and post my charts again when the data becomes available for the entirety of November. In the meantime if you want to keep across the West African outbreak detail via some alternate sources then I would recommend Crawford Kilian and for more regular epidemiological posts Maia Majumder, MPH and Ian Mackay, PhD.
Data Sources
[1] World Bank. Health expenditure per capita (current US$). Accessed 8 November 2014.
[2] World Health Organisation. WHO: Ebola Response Roadmap Situation Report 7 November 2014. Accessed 8 November 2014.
The World Health Organisation (WHO) has updated it latest advice on the Ebola Outbreak. Ebola Response Roadmap Situation Report 22 October 2014. Summary:
Summary
A total of 9936 confirmed, probably, and suspected cases of Ebola virus disease (EVD) have been reported in five affected countries (Guinea, Liberia, Sierra Leone, Spain, and the United States of America) and two previously affected countries (Nigeria and Senegal) up to the end of 19 October. A total of 4877 deaths have been reported.
The outbreaks of EVD in Senegal and Nigeria were declared over on 17 October and 19 October 2014, respectively.
EVD transmission remains persistent and widespread in Guinea, Liberia, and Sierra Leone. All but one administrative district in Liberia and all administrative districts in Sierra Leone have now reported at least one confirmed or probably case of EVD since the outbreak began. Cases of EVD transmission remain lowest in Guinea, but case numbers are still very high in absolute terms. Transmission remains intense in the capital cities of the three most affected countries. Case numbers continue to be under-reported, especially from the Liberian capital Monrovia.
Of the countries with localized transmission, both Spain and the United States continue to monitor potential contacts. On 21 October the single patient with EVD in Spain tested negative for the disease for a second time. Spain will be declared free of EVD 42 days after the date of the second negative test unless a new case arises during that period.
On 22 October 2014, WHO convened the third Emergency Committee on Ebola under the International Health Regulations (2005).
Here are three charts or infographics of the West African Outbreak with data confirmed by WHO to 18/19 October 2014.
The West African Ebola Outbreak (2013-2014) infographic details the cases, fatalities, the provisional Case Fatality Rate (CFR) and health spend per capita in 2012 $USD.
Midway through October the biggest data find for me has been the difference between the index cases in Senegal and the United States. Lots of similarities but IMO four very important differences:
The West African Ebola Outbreak (by Nation) chart looks at the split between those recovered or still in treatment and those deceased. As per the latest update from WHO there is an element of underreporting going on in the worst impacted countries (Liberia, Sierra Leone and Guinea).
The West African EVD Outbreak – All Cases/Fatalities by month details the epidemiological curve of the outbreak from March 2014 when the first cases and deaths became apparent. Each column is visualised by the flags of the seven impacted countries.
The mid-month data-find from this chart is that the epidemic curve in relation to deaths continues to increase month on month yet the case load seems to be pulling back. All the anecdotal evidence coming out of West Africa points to an increasing, rather than a decreasing case load as individuals, families and population centres avoid health care facilities. In past months, the case load mid-month would be approximately equal to the previous month. Best case scenario would be that West Africa is getting on top of the disease but the facts-on-the-ground don’t support this. I’d expect to see some revisions to the data in coming weeks and months.
Summary
I’ll update and post my charts again when the data becomes available for the entirety of October. In the meantime if you want to keep across the West African outbreak detail via some alternate sources then I would recommend Crawford Kilian and for more regular epidemiological posts Maia Majumder, MPH and Ian Mackay, PhD.
Data Sources
[1] World Bank. Health expenditure per capita (current US$). Accessed 23 October 2014.
[2] World Health Organisation. WHO: Ebola Response Roadmap Situation Report 22 October 2014. Accessed 23 October 2014.
Back at the end of September when the Thomas Eric Duncan Ebola case was first diagnosed in Texas and hit the headlines Ebola went from being an African issue to become an American problem. Social media exploded on the subject, Twitter mentions on Ebola tripled overnight and news agencies across the Western world struggled to keep up with the renewed interest.
Most of the analysis has been very good but some of the commentary has been downright crazy.
CNN did a story on how some US Republicans are calling for stronger border controls by linking Ebola with ISIS. As crazy as the idea of mixing the Ebola and ISIS narrative is CNN itself asked the same question prompting The Independent to write ‘The Isis of biological agents?’: CNN is asking the stupid Ebola questions.
Stupid is as stupid does is not just reserved for the United States. In my own country of Australia a recently returned nurse was hospitalised on fears she may have contracted the disease after registering a mild fever. This incident had Bob Katter, the federal member for Capricornia suggesting a ban on people travelling to Australia from West Africa and calling for all returning Health Care Workers to be put into government isolation upon their return (the nurse in question was actually in self-imposed home isolation).
Anyway, I thought the debate on the one case in the United States against the 8,398 in Western Africa (as per the most recent WHO update) was worth putting in context. An infographic:
The West African Ebola Outbreak – Cases by Country is a look at the six countries impacted by the disease with data to 7/8 October 2014. Each individual country is represented by their flag and the size of their flag is a percentile proportion of total cases.
As you can see Liberia has 48.5% of all cases, followed by Sierra Leone (35.1%), Guinea (16.1%) and Nigeria (0.2%). Both the USA and Spain have one case each which equates to 0.000119% of all cases and too small to be represented by a flag.
The story of Thomas Eric Duncan is tragic and the entry of a disease like Ebola into the West is scary but we need to get some context on how bad the situation is.
To the Lost
Data Sources
[1] Hooten, C. ‘The Isis of biological agents?’: CNN is asking the stupid Ebola questions. The Independent. 7 October 2014. Accessed 12 October 2014.
[2] World Health Organisation. WHO: Ebola Response Roadmap Situation Report 10 October 2014. Accessed 12 October 2014.
Random Analytica 