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H5N1 http://crofsblogs.typepad.com/h5n1/ "Medicine is a social science, and politics is nothing else but medicine on a large scale"—Rudolf Virchow en-US 2016-07-01T16:23:02-07:00 Early thoughts on Zika in Guinea-Bissau http://crofsblogs.typepad.com/h5n1/2016/07/early-thoughts-on-zika-in-guinea-bissau.html When a serious outbreak hits a country I don't know much about, I follow a fairly standard procedure: Find the country's online media, find the ministry of health's website, and see what turns up. Precious little turned up for Guinea-Bissau,...
When a serious outbreak hits a country I don't know much about, I follow a fairly standard procedure: Find the country's online media, find the ministry of health's website, and see what turns up.

Precious little turned up for Guinea-Bissau, so I turned to WHO's country profile: Guinea-Bissau. Here's an excerpt:
Total population (2015) 1,844,000

Gross national income per capita (PPP international $, 2013) 1

Life expectancy at birth m/f (years, 2015) 57/60

Probability of dying under five (per 1 000 live births, 0) not available

Probability of dying between 15 and 60 years m/f (per 1 000 population, 2013) 393/325

Total expenditure on health per capita (Intl $, 2013) 79

Total expenditure on health as % of GDP (2013) 5.5
 Well, that explained the government website with a photo of the Minister of Public Health (Valentina Mendes), but no website for her ministry. A country of 1.844 million people, with a per capita income of one dollar, can't afford many frills.

The local online media on ABYZ News Links total just four, and like the media of most poor countries seem obsessed with local politics—usually portrayed as a conflict between men, not as a discussion of issues as trivial as public health.

This is very much like the online presence of governments like Haiti's and Guinea's, which rely on international support when diseases predictably break out. But that support never includes support for health communication, so that the local government can talk with its own people and the rest of the world about what's going on. Granted, on an income of one buck a year few citizens of Guinea-Bissau have so much as a flip-phone never mind a iPhone or laptop.

But a lot of people are online in the rest of the world, and if they were well informed about such outbreaks, they might put some pressure on their governments to render more assistance. In my decade-plus of following outbreaks, no poor country has seriously gone to the world with such an appeal. Instead governments wait for WHO, or MSF, or some other agency to twist donors' arms.

As the outbreaks arrive closer together, and climate change worsens them, some poor countries may start exploiting online media more effectively. But I suspect most poor countries' governments are very modest: They need only enough money coming in to ensure that their top politicians can retire to Paris or Miami on what's creamed off the incoming support. Their own people can fend for themselves.

Be that as it may, I'll try to follow this new development through whatever sources seem both reliable and reasonably close to the scene. If this really is Latin American Zika arriving in West Africa, it will be a true disaster: one that affects human beings who are already poor, black, and female, and therefore of no real concern to those who are are prosperous, white, and male.
 Corruption and health Maternal health Media Microcephaly Mosquito-borne diseases Neurological disorders Politics and health Poverty and health Public health Social determinants of health Travel & health Women's health Zika virus Crof 2016-07-01T16:23:02-07:00 Guinea-Bissau confirms three cases of Zika virus, government says http://crofsblogs.typepad.com/h5n1/2016/07/guinea-bissau-confirms-three-cases-of-zika-virus-government-says.html Thanks to Lucie Lecomte for sending the link to this Reuters report in the Daily Mail Online: Guinea-Bissau confirms three cases of Zika virus, government says. Guinea-Bissau has confirmed its first three cases of the Zika virus in a group...
Thanks to Lucie Lecomte for sending the link to this Reuters report in the Daily Mail Online: Guinea-Bissau confirms three cases of Zika virus, government says.

Guinea-Bissau has confirmed its first three cases of the Zika virus in a group of islands off the mainland and has set up an emergency committee to stop further transmission of the disease, the government said on Friday.

Experts have feared the tiny nation could become a gateway for Zika's spread to mainland West Africa, after an outbreak of the mosquito-borne virus was first recorded in the African island chain of Cape Verde late last year.

"The Health Minister has informed (the government) of three confirmed cases of Zika virus contamination located in the Bijagos Archipelago," read a government statement sent to reporters.

Zika is spreading through the Caribbean and Latin America. Only about 20 percent of infected cases display symptoms, which are usually mild and include fever, joint pain and conjunctivitis.

But the CDC says it can be spread from pregnant women to fetuses and has been linked to a birth defect called microcephaly, in which babies are born with abnormally small heads and sometimes brain damage.

Guinea-Bissau's government said it was establishing a committee headed by Prime Minister Baciro Dja that would impose a series of measures aimed at containing the disease.

The statement did not give the suspected origin of the three cases.

The World Health Organisation confirmed in May that Cape Verde's Zika strain was the same one found in Brazil, where more than 1,400 cases of microcephaly have been recorded in babies whose mothers were infected with the virus during pregnancy.

The Cape Verde islands are located nearly 600 km (370 miles) off Africa's western Atlantic coast, creating a geographical buffer with a West African region still reeling from the deadliest Ebola epidemic on record.

However, Guinea-Bissau's Bijagos Archipelago begins just a short boat ride from the mainland. The maze of islands and waterways have helped make the chronically unstable, coup-prone nation a major transit point for South American cocaine heading to Europe.
 Travel & health Zika virus Crof 2016-07-01T15:32:39-07:00 The importance of contraception to the Zika fight http://crofsblogs.typepad.com/h5n1/2016/07/the-importance-of-contraception-to-the-zika-fight.html Via The Atlantic: The Importance of Contraception to the Zika Fight. Excerpt: While mosquito control is still the most crucial way to slow this outbreak, there is some room for contraception to make a difference, both in preventing sexual transmission...
Via The Atlantic: The Importance of Contraception to the Zika Fight. Excerpt:

While mosquito control is still the most crucial way to slow this outbreak, there is some room for contraception to make a difference, both in preventing sexual transmission and in helping women delay pregnancy or avoid unintended pregnancies (and thus reduce the number of babies born with birth defects), whether they get it from a partner or a mosquito. For the best protection, experts say people need both condoms, to keep from spreading Zika sexually, and effective birth control, so even if a woman gets it anyway, there's no fetus to worry about.

However, the Zika funding bill that was recently passed by the House of Representatives only to be rejected by the Senate included an explicit provision that none of the $1.1 billion it included could be put toward Planned Parenthood, and provided no other money for contraception.

"I think it's amazing for people to have been told the number-one thing they should and could do is delay pregnancy but we're going to give you no support or no means for doing that," says Dawn Laguens, the executive vice president and chief experience officer at Planned Parenthood Federation of America.

"The contraceptive issue should not be avoided," Zahn adds.

In the United States, 45 percent of all pregnancies are unintended. In Puerto Rico, where Zika is hitting hard, that rate is 65 percent. The Centers for Disease Control and Prevention recommends that couples trying to get pregnant wait six months to do so if a man gets infected and has symptoms, and wait eight weeks if a woman has symptoms.

For people who've been traveling to areas with Zika, but didn't get symptoms, the agency still recommends waiting eight weeks before trying to get pregnant. But if it's accidental, well, those recommendations might not have been on the couple's radar.
 Culture and health Maternal health Microcephaly Mosquito-borne diseases Neurological disorders STDs Travel & health Women's health Zika virus Crof 2016-07-01T11:32:30-07:00 Brazil's Olympic catastrophe http://crofsblogs.typepad.com/h5n1/2016/07/brazils-olympic-catastrophe.html Via The New York Times, an article that puts Zika worries in perspective: Brazil's Olympic Catastrophe. After cataloging some of the problems, Vanessa Barbara goes on: How did everything get so messed up? Money is one problem. "The state is...
Via The New York Times, an article that puts Zika worries in perspective: Brazil's Olympic Catastrophe. After cataloging some of the problems, Vanessa Barbara goes on:

How did everything get so messed up? Money is one problem. "The state is bankrupt," Francisco Dornelles, the interim Rio governor, admitted in an interview with a magazine two weeks ago.

The incumbent governor, who has lymphoma, is on sick leave. Just before Christmas, he declared a "health system emergency" as hospitals closed units and money ran out for equipment, supplies and salaries. Months later, the state started delaying civil servants' salaries and pension checks.

Teachers have gone on strike and students have occupied dozens of schools in protest. The state already owes $21 billion to Brazil's federal government and $10 billion to public banks and international lenders. A budget shortfall of $5.5 billion is projected for this year. An $860 million loan has already been granted to help cover the cost of security at the Games.

The fiscal disaster could be attributed to many factors, including a national economic crisis — but the huge expansion of the government payroll and reckless spending for the Olympics are likely causes.

However, the mayor of the capital, Eduardo Paes, claimed that City Hall is in good financial shape and that the fiscal situation would not affect Olympic preparations.

So if it's not only money, maybe the problem is also politics. Brazil is, of course, having a major political crisis. The president, Dilma Rousseff, was forced to step aside on May 12 because of allegations that she manipulated the state budget. The political turmoil has paralyzed the country and frozen the economy. Decisions on important reforms and infrastructure projects are being delayed, and the uncertainty has discouraged investment. But Leonardo Picciani, who took over as sports minister after Ms. Rousseff's suspension, asserts that the Games will be "fantastic." Almost everything was ready by the time he took up his post, he claims.

Mr. Picciani has also tried to minimize concerns over the mosquito-borne Zika virus, declaring that all the proper preventive measures are in place. That hasn't stopped athletes like Jason Day, the world's No. 1 ranked golfer, from announcing that they're skipping the Olympics because of Zika. In an open letter last month, 150 prominent doctors, bioethicists and scientists from around the world asked for the Olympics to be moved or postponed because of the Zika epidemic.

In Brazil, these concerns are generally greeted with scorn. First, August is the middle of winter here, so the weather will be drier and cooler, meaning fewer mosquitoes.

Second — and more important — the virus seems like a relatively minor problem: According to one calculation, in Rio a woman is more than 10 times more likely to be raped than catch Zika. (Men are more likely to be shot to death.)
 Climate and health Corruption and health Healthcare systems Mass gatherings and health Politics and health Public health Social disruption Violence Zika virus Crof 2016-07-01T07:59:52-07:00 Microcephaly in Brazil: 1,638 cases confirmed by MOH http://crofsblogs.typepad.com/h5n1/2016/07/microcephaly-in-brazil-1638-cases-confirmed-by-moh.html Via the Brazilian Ministry of Health: Microcefalia: 1.638 casos confirmados pelo Ministério da Saúde. [Microcephaly: 1,638 cases confirmed by MOH] Edited excerpt from the Google translation: The Ministry of Health released, on Thursday (30), new microcephaly data. By 25 June,...
Via the Brazilian Ministry of Health: Microcefalia: 1.638 casos confirmados pelo Ministério da Saúde. [Microcephaly: 1,638 cases confirmed by MOH] Edited excerpt from the Google translation:

The Ministry of Health released, on Thursday (30), new microcephaly data. By 25 June, it confirmed 1,638 cases of microcephaly and other nervous system disorders, suggestive of congenital infection throughout the country. Another 3,061 suspected cases of microcephaly across the country remain under investigation by the Ministry of Health and the states.

Since the beginning of the investigation, in October last year, 8,165 cases were reported to the Ministry of Health. Of these, 3,466 were discarded after testing normal, or because they have microcephaly or malformations confirmed from noninfectious causes. They were also discarded for not meeting the case definition.

Of the total confirmed cases, 270 were confirmed by specific laboratory criteria for Zika virus. The Ministry of Health, however, points out that this figure does not adequately represent the total number of cases related to the virus. The ministry considers that Zika infected most of the mothers who had babies with a final diagnosis of microcephaly. The 1,638 confirmed cases in Brazil occurred in 582 municipalities located in all Brazilian states and the Federal District.

In relation to deaths in the same period, there were 328 suspected deaths of microcephaly and/or alteration of the central nervous system after birth or during pregnancy (miscarriage or stillbirth) in the country. This represents 4% of the total reported cases. Of these, 87 were confirmed as microcephaly and/or alteration of the central nervous system. Another 184 are still under investigation and 57 were discarded.

 Child mortality Maternal health Medical testing Microcephaly Mosquito-borne diseases Neurological disorders Public health Zika virus Crof 2016-07-01T07:27:18-07:00 Yellow fever in Angola: Are we repeating the mistakes of Ebola? http://crofsblogs.typepad.com/h5n1/2016/07/yellow-fever-in-angola-are-we-repeating-the-mistakes-of-ebola.html Thanks to Dr. Joanne Liu for tweeting the link to this Thomson Reuters opinion piece: Yellow fever in Angola: Are we repeating the mistakes of Ebola? Excerpt: Imagine. A deadly disease is stalking terrified mothers, fathers, children and grandparents. People...
Thanks to Dr. Joanne Liu for tweeting the link to this Thomson Reuters opinion piece: Yellow fever in Angola: Are we repeating the mistakes of Ebola? Excerpt:

Imagine. A deadly disease is stalking terrified mothers, fathers, children and grandparents. People are sick. Many are dying. An information vacuum is overflowing with rumour and misinformation. Suspicion and lack of trust are rife. Hospitals and health centres are overwhelmed even though many of the sick are reluctant to seek medical help. Families believe the best thing for loved ones is care at home. As things spiral out of control, the rest of the world goes about its business.

Sound familiar? This was the dangerous cocktail that helped fuel the Ebola crisis in West Africa, which killed more than 11,000 people and took more than two years to contain. Disturbingly, these same conditions seem to be emerging in Angola, where an outbreak of yellow fever is threatening to surge out of control.

The current yellow fever outbreak began in Angola in December 2015. Since then it has grown and spread further. Today, more than five months on, some 2,900 suspected cases have been recorded and 328 people have died. The disease has already spread, including to the Democratic Republic of the Congo, China and Kenya, and suspected cases are being investigated in other countries.

Anyone familiar with the West Africa Ebola crisis might be experiencing some déjà vu.

Three important lessons emerged from the West African Ebola crisis. First, invest in local health systems and community surveillance. Second, engage local communities in developing and driving the response. Third, early response targeted to local circumstances is critical.

But it is hard to see how these lessons are being applied in response to Angola's yellow fever outbreak.

Angola, like the countries affected by Ebola, has emerged from a long and devastating civil war. Despite significant gains made since 2000, life expectancy is under 50, and infant mortality rates are among the highest in the world. Health infrastructure is centred in major cities, leaving many rural communities with little or no access.

Yellow fever vaccine campaigns have lagged consistently behind the spread of the disease this year, and limited surveillance has resulted in poor visualization and understanding of its spread. As a result, vaccine campaigns have struggled to contain the disease. All of Angola's 18 provinces are now reporting suspected cases.

Weak health surveillance, particularly in rural areas, is aggravated by a lack of trust and poor access to health care services, with much of the population relying on traditional medicine or private clinics.

Where surveillance is happening, it is often hampered by a lack of laboratory capacity, which, in turn, delays any response. Here we can see that a country's limited ability to detect and declare yellow fever cases is hampering the operation, just as it did in the first 12 months of the Ebola response.

Limited community engagement in Angola is mirroring early miss-steps in the Ebola response. Lack of community trust and misunderstanding of how to prevent and treat Ebola drove much of the early spread of the virus in West Africa. Now, in Angola, false rumours and misinformation about vaccines are severely curbing community participation in urgently needed mass vaccination campaigns. Coverage is patchy, allowing the virus to continue to spread.
 Culture and health Ebola Health communication Healthcare systems Medical logistics Medical testing Mosquito-borne diseases Politics and health Public health Surveillance Vaccination Vaccines Yellow fever Crof 2016-07-01T07:12:14-07:00 Brexit and science: Seven days later http://crofsblogs.typepad.com/h5n1/2016/07/brexit-and-science-seven-days-later.html Via Nature News & Comment: Brexit and science: Seven days later. Excerpt: In the week since UK voters chose to leave the European Union, the consequences for science continue to play out. Reports have surfaced that some EU scientists are...
Via Nature News & Comment: Brexit and science: Seven days later. Excerpt:

In the week since UK voters chose to leave the European Union, the consequences for science continue to play out. Reports have surfaced that some EU scientists are reconsidering offers to work in the United Kingdom, and that British scientists could start being cut out of grant applications made with colleagues on the continent.

And contributing to the confused state of UK politics, Boris Johnson — a prominent 'Leave' campaigner — announced on 30 June that he was dropping out of the race to replace David Cameron as prime minister.

Anecdotal reports of racist incidents linked to the referendum vote have also emerged across the nation. At an event in Parliament on 28 June, Robert Parker, chief executive of the Royal Society of Chemistry in Cambridge, said that some of his staff had been told on the street to "go home" after the Brexit vote. On Twitter, George Freeman, UK minister for life sciences, called Parker's report "appalling and totally unacceptable".

Fears of fracture

In the wake of the vote, scientists immediately voiced fears over jobs, funding and collaborations. The nation remains a full member of the European Union, and will continue to be one as it negotiates an exit. But is in unclear how long the break-up process will take, and the uncertainty is already causing problems.

Robert Lechler, president of the Academy of Medical Sciences and a medical researcher at King's College London, said in a press conference on 29 June that three "key recruitments" that are close to being finalized at King's are "all now at risk". This, he said, was "because these are people from continental Europe who are questioning whether they are prepared to take a risk on coming to the United Kingdom, entirely on the basis of this referendum vote".

Lechler would not provide names, but said that all three were due to take on senior roles in biomedical engineering and neuroscience. The referendum vote "is the most serious threat and challenge to UK research in my lifetime," he said at the press conference, which took place at the Science Media Centre in London.

"We're not going to stop brilliant people from coming to work in our universities and science institutes," UK science minister Jo Johnson said in a speech on 30 June. After the speech he told Nature that "EU academics and students are welcome here, and their rights are unaffected as we stand today."

But he would not say whether they would be able to remain under the same conditions in future. "There's a negotiation that will take place, and I can't pre-empt any of that," he said.
 Healthcare systems Politics and health Public health Research issues Science Travel & health Crof 2016-07-01T07:04:42-07:00 Seven-year efficacy of RTS,S/AS01 malaria vaccine among young African children http://crofsblogs.typepad.com/h5n1/2016/07/seven-year-efficacy-of-rtssas01-malaria-vaccine-among-young-african-children-nejm.html Via NEJM: Seven-Year Efficacy of RTS,S/AS01 Malaria Vaccine among Young African Children. The abstract: BACKGROUND The candidate malaria vaccine RTS,S/AS01 is being evaluated in order to inform a decision regarding its inclusion in routine vaccination schedules. METHODS We conducted 7...
Via NEJM: Seven-Year Efficacy of RTS,S/AS01 Malaria Vaccine among Young African Children. The abstract:

BACKGROUND

The candidate malaria vaccine RTS,S/AS01 is being evaluated in order to inform a decision regarding its inclusion in routine vaccination schedules.

METHODS

We conducted 7 years of follow-up in children who had been randomly assigned, at 5 to 17 months of age, to receive three doses of either the RTS,S/AS01 vaccine or a rabies (control) vaccine. The end point was clinical malaria (temperature of ≥37.5°C and infection with Plasmodium falciparum of >2500 parasites per cubic millimeter). In an analysis that was not prespecified, the malaria exposure of each child was estimated with the use of information on the prevalence of malaria among residents within a 1-km radius of the child's home. Vaccine efficacy was defined as 1 minus the hazard ratio or the incidence-rate ratio, multiplied by 100, in the RTS,S/AS01 group versus the control group.

RESULTS

Over 7 years of follow-up, we identified 1002 episodes of clinical malaria among 223 children randomly assigned to the RTS,S/AS01 group and 992 episodes among 224 children randomly assigned to the control group. The vaccine efficacy, as assessed by negative binomial regression, was 4.4% (95% confidence interval [CI], −17.0 to 21.9; P=0.66) in the intention-to-treat analysis and 7.0% (95% CI, −14.5 to 24.6; P=0.52) in the per-protocol analysis. Vaccine efficacy waned over time (P=0.006 for the interaction between vaccination and time), including negative efficacy during the fifth year among children with higher-than-average exposure to malaria parasites (intention-to-treat analysis: −43.5%; 95% CI, −100.3 to −2.8 [P=0.03]; per-protocol analysis: −56.8%; 95% CI, −118.7 to −12.3 [P=0.008]).

CONCLUSIONS

A three-dose vaccination with RTS,S/AS01 was initially protective against clinical malaria, but this result was offset by rebound in later years in areas with higher-than-average exposure to malaria parasites.
 Malaria Medical testing Vaccines Crof 2016-07-01T06:56:26-07:00 ECDC epidemiological update: Outbreaks of Zika virus and complications potentially related to the Zika virus infection http://crofsblogs.typepad.com/h5n1/2016/07/ecdc-epidemiological-update-outbreaks-of-zika-virus-and-complication-potentially-related-to-the-zika-virus-infection.html ECDC has published Epidemiological update: Outbreaks of Zika virus and complications potentially linked to the Zika virus infection. Excerpt: EU/EEA and EU Outermost Regions and Territories As of 17 June 2016, ECDC has recorded 838 imported cases in 20 EU/EEA...
ECDC has published Epidemiological update: Outbreaks of Zika virus and complications potentially linked to the Zika virus infection. Excerpt:

EU/EEA and EU Outermost Regions and Territories

As of 17 June 2016, ECDC has recorded 838 imported cases in 20 EU/EEA countries. The number of imported cases reported is not based on a systematic reporting surveillance system and cannot be considered exhaustive.

EU's Outermost Regions and Territories:

Martinique: As of 16 June 2016, 30 000 suspected cases have been reported, an increase of 1 070 since last week. The weekly number of cases has been stable over the last four weeks.

French Guiana: As of 16 June 2016, 7 830 suspected cases have been detected, an increase of 290 since last week. The weekly number of cases has been decreasing over the last three weeks.

Guadeloupe: As of 16 June 2016, 13 030 suspected cases have been detected, an increase of 2 840 suspected cases since last week. The weekly number of cases is continuously increasing.

St Martin: As of 16 June 2016, 830 suspected cases have been detected, an increase of 140 suspected cases since last week. The weekly number of cases is still reported as very high.

St Barthélemy: As of 16 June 2016, 70 suspected cases have been detected, an increase of 17 suspected cases since last week. The weekly number of cases is still increasing.

Update on microcephaly and/or central nervous system (CNS) malformations potentially associated with Zika virus infection

As of 15 June 2016, microcephaly and other central nervous system (CNS) malformations associated with Zika virus infection or suggestive of congenital infection have been reported by twelve countries or territories. In the EU, Spain (2) and Slovenia (1) reported congenital malformations associated with Zika virus infection after travel in the affected areas.

Thirteen countries and territories worldwide reported an increased incidence of Guillain-Barré syndrome (GBS) and/or laboratory confirmation of a Zika virus infection among GBS cases.

Brazil: Between October 2015 and 11 June 2016, Brazil has reported 7 936 suspected cases of microcephaly and other nervous system disorders suggestive of congenital infection; this is an increase of 106 cases since the last update; 1 581 are confirmed cases of microcephaly, 226 of which are laboratory-confirmed for Zika virus infection.
 Guillain-Barré syndrome Maternal health Medical testing Microcephaly Mosquito-borne diseases Neurological disorders Travel & health Zika virus Crof 2016-07-01T06:48:01-07:00 Saudi Arabia: No new MERS cases, two recoveries as of noon July 1 http://crofsblogs.typepad.com/h5n1/2016/07/saudi-arabia-no-new-mers-cases-two-recoveries-as-of-noon-july-1.html Via the KSA MOH Command and Control Center: MOH: 'No New Corona Cases Recorded. A 48-year-old Saudi man in Taif and a 27-year-old Saudi female healthcare worker in Riyadh have recovered. No deaths are reported. The MERS numbers are becoming...

Via the KSA MOH Command and Control Center: MOH: 'No New Corona Cases Recorded. A 48-year-old Saudi man in Taif and a 27-year-old Saudi female healthcare worker in Riyadh have recovered. No deaths are reported.

The MERS numbers are becoming confused. The chart above shows 16 cases under care, 799 recoveries, 598 deaths, and 1,413 total. But on the statistics page, we're told 13 cases are under care, 797 have recovered, 600 have died, and the total is 1,397 plus 32 asymptomatic cases. I have no idea which numbers to believe, if either.
 Healthcare-associated infections MERS Nosocomial infections Crof 2016-07-01T06:39:57-07:00 Angola: 23 dead in undiagnosed outbreak http://crofsblogs.typepad.com/h5n1/2016/07/angola-23-dead-in-undiagnosed-outbreak.html Via the Cuban website Vigilancia en Salud Pública, a report from Novo Jornal: Mueren 23 personas en una aldea angoleña víctima de una deconocida enfermedad. [23 persons die in Angolan village, victims of an unknown disease] The report, with my...
Via the Cuban website Vigilancia en Salud Pública, a report from Novo Jornal: Mueren 23 personas en una aldea angoleña víctima de una deconocida enfermedad. [23 persons die in Angolan village, victims of an unknown disease] The report, with my translation:

Al menos 23 personas murieron en la aldea de Luassingua, comuna de Longa, provincia angoleña de Cuando Cubango, víctimas de una desconocida enfermedad que afecta la zona desde hace cuatro meses.

At least 23 persons have died in the village of Luassignua, Longa commune, in the Angolan province of Cuando Cubango, victims of an unknown disease that has affected the region for four months.

Las autoridades sanitarias de Cuito Cuanavale, municipio al que pertenece la comarca, fueron notificadas e investigan el origen de la patología, dijo el administrador comunal de Longa, citado por el diario Novo Jornal.

The health authorities of Cuito Cuanavale, the municipality that the village is part of, were notified and are investigating the source of the disease, according to the Longa commune administrator as reported in the daily Novo Jornal.

Explicó que se hicieron diligencias para desplegar un equipo de técnicos especializados de salud en la localidad, donde el miedo al contagio afectó la asistencia a aulas de muchos niños.

He explained that steps were taken to deploy a team of health specialists in the locality, where the fear of infection has affected many children's attendance in classes.

Preocupado con el abandono escolar, el administrador refirió que la administración comunal movilizó fuerzas, junto a autoridades tradicionales y entidades religiosas, para que las familias aseguren el regreso de los pequeños a los estudios.

Worried about the students' absence, the administrator asked the commune administration to mobilize, along with traditional authorities and religious groups, so families would ensure their children's return to school.

Novo Jornal indica que dolores de cabeza y fiebres altas son síntomas comunes de la extraña enfermedad que perturba al poblado de Cuando Cubango, a 825 kilómetros al sureste de Luanda.

Novo Jornal says headaches and high fevers are common symptoms of the strange disease that worries the community of Cuando Cubango, 825 km south of Luanda.
 Education and health Health communication Medical testing Undiagnosed outbreaks Crof 2016-07-01T06:30:00-07:00 Syria: A health crisis too great to ignore http://crofsblogs.typepad.com/h5n1/2016/07/syria-a-health-crisis-too-great-to-ignore.html An editorial in The Lancet: Syria: a health crisis too great to ignore. Last week, the Independent International Commission of Inquiry on the Syrian Arab Republic gave an evidence update to the 32nd session of the UN Human Rights Council...
An editorial in The Lancet: Syria: a health crisis too great to ignore.

Last week, the Independent International Commission of Inquiry on the Syrian Arab Republic gave an evidence update to the 32nd session of the UN Human Rights Council in Geneva, Switzerland. It reported that the Syrian Government was conducting daily air strikes in the country amid indiscriminate attacks by militant groups, including ISIS.

Paulo Pinheiro, chair of the Commission, said that schools, hospitals, mosques, and water stations "are all being turned into rubble" and tens of thousands of people were trapped between front lines and international borders. He noted that the attacks on medical facilities have left access to health care impossible in some areas and, since the start of the conflict 5 years ago, 700 doctors and medical workers have been killed, many in air strikes.

As the needs of civilians in Syria increase, medical assistance is being decimated and, in many cases, deliberately targeted. On June 8, two more hospitals were attacked. Aerial strikes damaged the al-Bayan trauma facility and al-Hakim paediatric hospital in opposition-controlled areas of Aleppo. Both facilities are now out of service, according to Physicians for Human Rights (PHR) and their partners on the ground. In total, PHR has documented 365 attacks on 259 medical facilities during the Syrian conflict.

Violence against civilians continues, including the deliberate targeting of some minority groups. On June 15, the same Independent Commission on Syria released a report on ISIS's crimes against the Yazidis in Syria. It concludes that ISIS has committed, and continues to commit, genocide against the Yazidis through not only killings but also sexual slavery, enslavement, torture, and inhumane and degrading treatment.

Attacks on medical personnel, facilities, and civilians in conflicts are unacceptable, and they are war crimes. What has become frighteningly apparent is that such crimes are a prevailing and increasing feature of the Syrian conflict. The UN Security Council and international community need to return to the negotiating table to find solutions for peace, stability, and upholding of humanitarian law in this war-devastated nation. The horrors of Syria are too great to ignore.
 Health security Healthcare systems Occupational health & safety Politics and health Psychosocial issues and health Public health Social determinants of health Social disruption Stress and health Violence War and health Crof 2016-07-01T06:12:29-07:00 US: CDC reports more Zika-related birth defects http://crofsblogs.typepad.com/h5n1/2016/06/us-cdc-reports-more-zika-related-birth-defects.html Via Reuters: More U.S. babies with Zika-related birth defects reported by health agency. Three more babies have been born in the United States with birth defects likely linked to Zika virus infections, while another lost pregnancy was linked to the...
Via Reuters: More U.S. babies with Zika-related birth defects reported by health agency.

Three more babies have been born in the United States with birth defects likely linked to Zika virus infections, while another lost pregnancy was linked to the virus, according to figures updated by health officials on Thursday.

That brings the U.S. totals, as of June 23, to seven babies with microcephaly or other Zika-related birth defects such as serious brain abnormalities, and five lost pregnancies from either miscarriage, stillbirth or termination.

The figures were listed in a U.S. Zika pregnancy registry created earlier this month by the Centers for Disease Control and Prevention (CDC).

The registry compiles poor outcomes of pregnancies with laboratory evidence of possible Zika virus infection in the 50 states and the District of Columbia. The agency is currently monitoring 287 pregnant women with any laboratory evidence of Zika infection, not including those in U.S. territories such as Puerto Rico.

Zika has caused concern throughout the Americas due to an alarming rise in cases of the birth defect known as microcephaly and other severe fetal brain abnormalities linked to the mosquito-borne virus reported in Brazil, the country hardest hit by the outbreak. Infants with microcephaly tend to have abnormally small heads and may experience potentially disabling developmental problems.

Brazil has confirmed more than 1,400 cases of microcephaly in babies whose mothers were infected with Zika during pregnancy in the current outbreak.

More than 900 U.S. Zika cases reported so far have all involved people who contracted the virus outside the United States in areas with active Zika outbreaks, or were infected through unprotected sex with an infected partner.

There have not yet been any cases reported of local transmission of the virus in the United States, but health experts expect local transmission to occur with the onset of mosquito season, especially in Gulf Coast states such as Florida and Texas.

The CDC plans to issue updated reports each Thursday to ensure that information about pregnancy outcomes linked with the Zika virus is publicly available.
 Maternal health Microcephaly Mosquito-borne diseases Neurological disorders Surveillance Travel & health Zika virus Crof 2016-06-30T20:44:48-07:00 Some unwelcome climate news http://crofsblogs.typepad.com/h5n1/2016/06/some-unwelcome-climate-news.html It's one thing to get a Pineapple Express: a stream of warm Pacific storms running up from Hawaii to dump winter rain on the BC coast. But this post from Robert Scribbler's blog sounds like something out of a cli-fi...
It's one thing to get a Pineapple Express: a stream of warm Pacific storms running up from Hawaii to dump winter rain on the BC coast. But this post from Robert Scribbler's blog sounds like something out of a cli-fi novel:  Gigantic Gravity Waves to Mix Summer With Winter? Wrecked Jet Stream Now Runs From Pole-to-Pole. Excerpt:

The big trough today begins near the Northern Hemisphere Pole. It pulls Arctic air down over Eastern Siberia and into a Pacific Ocean storm track. There, a second big dip in the Jet Stream pulls a crazy loop of this upper air flow further south. And here is where things get really weird — for the upper level river of air that began in the Arctic then makes a jump directly across the Equator.

But our story of a wayward Jet Stream doesn't end there. The upper level air flow that originated near the North Pole joins with a building Southern Hemisphere Jet Stream ridge pattern over the Southeast Pacific. Feeding into very strong upper level winds, it turns southward into a high amplitude wave that crosses the Horn of South America and slams itself, carrying with it a big pulse of extreme warmth, into the upper level airs over Western Antarctica.

A Climate Change-Driven Loss of Seasonal Integrity?

Like many extreme events resulting from human-forced climate change — this co-mingling of upper level airs from one Hemisphere with another is pretty fracking strange. Historically, the Tropics — which produce the tallest and thickest air mass in the world — have served as a mostly impenetrable barrier to upper level winds moving from one Hemisphere to another.

But as the Poles have warmed due to human-forced climate change, the Hemispherical Jet Streams have moved out of the Middle Latitudes more and more. More and more it has invaded regions both within the Polar zone and within the Tropics. Now, it appears that the old dividing lines are so weak that flows of upper level air between Hemispheres can be exchanged.

That's bad news for seasonality. Prevention of mixing of air between Hemispheres by the thick, hot tropical air mass is what has generated a strong division between Summer and Winter during the Holocene Climate Epoch.

However, erode that boundary and you get more Summer heat spilling over into the Winter zone and vice versa. You get this weather-destabilizing and extreme weather generating mixing of seasons that is all part of a very difficult to deal with 'Death of Winter' type scenario.

If even partially true, this does not bode well for global health.
 Climate and health Global health Crof 2016-06-30T10:22:09-07:00 WHO: Yellow fever situation report, June 30 http://crofsblogs.typepad.com/h5n1/2016/06/who-yellow-fever-situation-report-june-30.html WHO has published its weekly Yellow fever situation report for June 30. Click or tap through to download the full report. Excerpt from the summary: Angola: 3464 suspected cases In Angola, as of 24 June 2016 a total of 3464...
WHO has published its weekly Yellow fever situation report for June 30. Click or tap through to download the full report. Excerpt from the summary:

Angola: 3464 suspected cases

In Angola, as of 24 June 2016 a total of 3464 suspected cases have been reported, of which 868 are confirmed. The total number of reported deaths is 353, of which 116 were reported among confirmed cases. Suspected cases have been reported in all 18 provinces and confirmed cases have been reported in 16 provinces and 79 of 125 reporting districts.

Mass vaccination campaigns first began in Luanda and have now expanded to cover most of the other affected parts of Angola. Recently, the campaigns have focused on border areas. Despite extensive vaccination efforts circulation of the virus persists.

Democratic Republic of the Congo: 1307 suspected cases

As of 23 June, in the Democratic Republic of The Congo (DRC), the total number of notified suspected cases is 1307, with 68 confirmed cases and 75 reported deaths. Cases have been reported in 22 health zones in five provinces. Of the 68 confirmed cases, 59 were imported from Angola, two are sylvatic (not related to the outbreak) and seven are autochthonous.

Surveillance efforts have increased and vaccination campaigns in DRC have centred on affected zones in Kinshasa and Kongo Central.

The risk of spread

Two additional countries have reported confirmed yellow fever cases imported from Angola: Kenya (two cases) and People's Republic of China (11 cases). These cases highlight the risk of international spread through non-immunised travellers.

Seven countries (Brazil, Chad, Colombia, Ghana, Guinea, Peru and Uganda) are currently reporting yellow fever outbreaks or sporadic cases not linked to the Angolan outbreak.

Vaccination

WHO Strategic Advisory Group of Experts (SAGE) on Immunization reviewed existing evidence that demonstrates that using a fifth of a standard vaccine dose would still provide protection against the disease for at least 12 months and possibly longer. This approach, known as fractional dosing, is under consideration as a short-term measure, in the context of a potential vaccine shortage in emergencies.
 Mosquito-borne diseases Surveillance Travel & health Vaccination Vaccines Yellow fever Crof 2016-06-30T09:23:30-07:00 Sweden: Fifty Stockholm heart patients hit by superbug http://crofsblogs.typepad.com/h5n1/2016/06/sweden-fifty-stockholm-heart-patients-hit-by-superbug.html Via TheLocal.se, an alarming report: Fifty Stockholm heart patients hit by superbug. Excerpt: A potentially deadly antibiotic-resistant bacteria has spread to more than 50 heart patients at Karolinska University Hospital in Solna, Stockholm. Four of the 52 patients affected have...
Via TheLocal.se, an alarming report: Fifty Stockholm heart patients hit by superbug. Excerpt:

A potentially deadly antibiotic-resistant bacteria has spread to more than 50 heart patients at Karolinska University Hospital in Solna, Stockholm.

Four of the 52 patients affected have died, and the hospital believes an antibiotic-resistant strain of the Klebsiella pneumoniae bacteria was the cause of death in at least one case.

The outbreak was discovered this spring but is believed to have begun in the autumn. All of the patients affected had undergone open heart surgery at the Thorax Clinic in Solna.

"We have put in place a range of measures and hope now to have stopped the spread, since we haven't seen any new cases for two to three weeks," chief physician Elda Sparrelid told news agency TT.

The hospital has not yet fully ascertained whether the patients died as a result of the outbreak.

"It's not so easy to conclude as these are patients who were very sick for different reasons, but we do have strong suspicions in at least one case," she said.

The strain of Klebsiella pneumoniae at Karolinska contains ESBL, an enzyme that can break down antibiotics.

Most of the patients affected have carried the bacteria without suffering unduly, since the bacteria itself does not generally make people sick. If however they need any treatment requiring antibiotics doctors could find that these no longer work.

The hospital has tightened its hygiene procedures since discovering the outbreak earlier this year.
 Antibiotic resistance Healthcare-associated infections Infection control Klebsiella Nosocomial infections Crof 2016-06-30T08:40:22-07:00 Eurosurveillance: Detection of Zika virus RNA up to two months after symptom onset http://crofsblogs.typepad.com/h5n1/2016/06/eurosurveillance-detection-of-zika-virus-rna-up-to-two-months-after-symptom-onset.html Via Eurosurveillance: Detection of Zika virus RNA in who blook of imported Zika virus disease cases up to 2 months after symptom onset, Israel, December 2015 to April 2016. The abstract: Zika virus RNA presence in serum, whole-blood and urine...
Via Eurosurveillance: Detection of Zika virus RNA in who blook of imported Zika virus disease cases up to 2 months after symptom onset, Israel, December 2015 to April 2016. The abstract:

Zika virus RNA presence in serum, whole-blood and urine samples from six Israeli travellers symptomatic for Zika virus disease was examined. Whole-blood samples were positive for as late as 2 months (58 days) post-symptom onset, longer than for urine (26 days) and serum (3 days). These findings suggest the utility of whole blood in Zika infection diagnosis.
 Medical testing Travel & health Zika virus Crof 2016-06-30T07:41:23-07:00 Zika virus fight 'likely not to succeed' without more money http://crofsblogs.typepad.com/h5n1/2016/06/zika-virus-fight-likely-not-to-succeed-without-more-money.html Via STAT, a Bloomberg.com report: Zika Virus Fight 'Likely Not to Succeed' Without More Money. Excerpt: More than five months after U.S. President Barack Obama requested $1.9 billion to fight the Zika epidemic, members of Congress are going home to...
Via STAT, a Bloomberg.com report: Zika Virus Fight 'Likely Not to Succeed' Without More Money. Excerpt:

More than five months after U.S. President Barack Obama requested $1.9 billion to fight the Zika epidemic, members of Congress are going home to July 4 barbecues without approving a spending bill. While Washington's dysfunction is predictable given the current electoral climate, less noticed has been the global inertia facing efforts to combat the mosquito-borne disease.

The World Health Organization has only $7.9 million dedicated to fight Zika, which is spreading in 60 countries and blamed for more than 1,600 serious birth defects, mostly in Brazil. The planet has never seen a mosquito-borne virus that causes microcephaly, resulting in babies born with small heads and brain damage. In the Americas, Zika is racing through populations that have never been exposed before and thus haven't developed any natural immunity.

To put the lack of funding in perspective: The three-month Olympic torch relay that ends with the start of the games in Rio de Janeiro this summer, sponsored by the Coca-Cola Co., Nissan Motor Co., and Brazil's Banco Bradesco SA, has a bigger budget than the WHO's strategy to fight Zika over two years.

"Activities proposed by WHO and its partners have been underfunded to date, and without sufficient funding the response is likely not to succeed," the WHO wrote in its Zika Strategic Response Plan.

One lesson from the Ebola epidemic in West Africa is that the world must respond swiftly to outbreaks, said Anne Schuchat, principal deputy director of the U.S. Centers for Disease Control. "We need the world to surge, and we can't wait for all the politics and all the issues to get worked out," Schuchat said in an interview earlier this month. While health authorities are responding with the money they have, no surge has materialized. "It's a little bit stalled right now, in terms of that real response."
 Economics and health Microcephaly Mosquito-borne diseases Neurological disorders Politics and health Zika virus Crof 2016-06-30T07:28:43-07:00 WHO: Zika situation report, June 30 http://crofsblogs.typepad.com/h5n1/2016/06/who-zika-situation-report-june-30.html WHO has published its weekly Zika situation report for June 30. Click or tap through to download the full report. The summary: • As of 29 June 2016, 61 countries and territories report continuing mosquito-borne transmission of which: • 47...
WHO has published its weekly Zika situation report for June 30. Click or tap through to download the full report. The summary:

• As of 29 June 2016, 61 countries and territories report continuing mosquito-borne transmission of which:

• 47 countries are experiencing a first outbreak of Zika virus since 2015, with no previous evidence of circulation, and with ongoing transmission by mosquitos.

• 14 countries reported evidence of Zika virus transmission between 2007 and 2014, with ongoing transmission.

• In addition, four countries or territories have reported evidence of Zika virus transmission between 2007 and 2014, without ongoing transmission: Cook Islands, French Polynesia, ISLA DE PASCUA – Chile and YAP (Federated States of Micronesia).

• Ten countries have reported evidence of person-to-person transmission of Zika virus, probably via a sexual route.

• In the week to 29 June 2016, no new country or territory has reported mosquito-borne Zika virus transmission.

•  As of 29 June 2016, microcephaly and other central nervous system (CNS) malformations potentially associated with Zika virus infection or suggestive of congenital infection have been reported by thirteen countries or territories. Three of those countries reported microcephaly cases born from mothers with a recent travel history to Zika affected countries in Latin America.

• As of 16 June, the United States Centers for Disease Control and Prevention (US-CDC) reported four live born infants with birth defects and four pregnancy losses with birth defects with laboratory evidence of possible Zika virus infection. In addition, a baby with microcephaly was born in the United States of America to a mother who is a resident of Haiti.

• On 20 June 2016, French Guiana reported the first case of congenital microcephaly associated with Zika virus infection in a pregnant woman. Microcephaly in the fetus has been diagnosed through ultrasound, and the amniotic fluid tested positive for Zika virus by RT-PCR.

• In the context of Zika virus circulation, 14 countries and territories worldwide have reported an increased incidence of Guillain-Barré syndrome (GBS) and/or laboratory confirmation of a Zika virus infection among GBS cases.

• Zika infection was diagnosed in one patient with GBS and six others are under investigation in Guadeloupe.

• Based on research to date, there is scientific consensus that Zika virus is a cause of microcephaly and GBS.

• Sequencing of the virus that causes the Zika outbreak in Cabo Verde showed that the virus is of the Asian lineage and the same as the one that circulates in Brazil.

• The third meeting of the Emergency Committee (EC) convened by the Director-General under the International Health Regulations (2005) regarding microcephaly, other neurological disorders and Zika virus was held by on 14 June 2016.

• The global Strategic Response Framework launched by the World Health Organization (WHO) in February 2016 encompasses surveillance, response activities and research. An interim report has been published on some of the key activities being undertaken jointly by WHO and international, regional and national partners in response to this public health emergency. A revised strategy for the period of July 2016 to December 2017 was published on 17 June.

• WHO has developed new advice and information on diverse topics in the context of Zika virus. WHO's latest information materials, news and resources to support corporate and programmatic risk communication, and community engagement are available online.
 Guillain-Barré syndrome Maternal health Microcephaly Mosquito-borne diseases Neurological disorders STDs Zika virus Crof 2016-06-30T07:23:15-07:00 Study on Zika could change Brazil's microcephaly protocol http://crofsblogs.typepad.com/h5n1/2016/06/study-on-zika-could-change-brazils-microcephaly-protocol.html Via globo.com: Estudo sobre zika pode levar Brasil a mudar protocolo de microcefalia. [Study on Zika could move Brazil to change microcephaly protocol] Edited excerpt from the Google translation: The Ministry of Health is considering changing the protocol of care...
Via globo.com: Estudo sobre zika pode levar Brasil a mudar protocolo de microcefalia. [Study on Zika could move Brazil to change microcephaly protocol] Edited excerpt from the Google translation:

The Ministry of Health is considering changing the protocol of care for infants born with possible damage from the Zika virus. The change was prompted by a study published on Wednesday (29) in The Lancet magazine, which found that 20% of babies born with Zika related problems have normal-sized heads.

This means that a smaller skull, featuring microcephaly, and a history of rash during pregnancy are not sufficient to detect which babies were actually affected by the Zika virus.

Today, babies with a head circumference less than 32 cm are classified as suspected cases of Zika-related microcephaly. But that could change, according to a statement issued by the Ministry of Health on Wednesday.

Taking into account the results of the study - which was commissioned by the ministry itself - Brazil may include other symptoms and neurological disorders as criteria for screening of babies, regardless of the presence of microcephaly.

 Maternal health Medical testing Microcephaly Mosquito-borne diseases Neurological disorders Zika virus Crof 2016-06-30T06:50:24-07:00


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Kathy Lawson, 66 years old, employed by Retired. She lives in Fort Wayne, Indiana. She is a 1968 graduate of Carroll High School. Online, Kathy goes by the aliases shashely and shashely50.


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Hotel Kyriad Perpignan Nord, East Pyrenees (department)
- Free WiFi and free parking
Main amenities
- 76 guestrooms
- Near the beach
- Bar/lounge
- 24-hour front desk
- Air conditioning
- Daily housekeeping
- Arcade/game room
- Computer station
- Self-serve laundry
- Multilingual staff
- Free newspapers in the lobby
- TV in common area
For families
- Free cribs/infant beds
- Connecting/adjoining rooms available
- Private bathroom
- Separate dining area
- Daily housekeeping
- Laundry facilities
What's around
- Le Castillet (7 mi / 11.3 km)
- St. Jacques Church (7.8 mi / 12.6 km)
- Palace of the Kings of Majorca (8.1 mi / 13.1 km)
- Stade Gilbert Brutus (4.6 mi / 7.4 km)
- Forteresse de Salses (5.3 mi / 8.6 km)
Basic hotel in need of some decoration and modernisation. Very pleasant staff. Just off…
Loved this hotel and for a bargain price.The staff were really friendly and spoke…
Hotel Kyriad Perpignan Nord, East Pyrenees (department)
Hotel Info: 866-539-8117from $45
- Standard room with two single beds
- Standard room with double bed
Also popular with travelers from the USA
At a glance
Key facts
Hotel size
- This hotel has 76 rooms
- This hotel is arranged over 1 floor
- Check-in time starts at 2 PM
- Check-out time is noon
- Express check-in/out
Required at check in
- Credit card or cash deposit required
- Government-issued photo ID required
- Minimum check-in age is 18
Travelling with others
- Children (12 years old and younger) stay free when occupying the parent or guardian's room, using existing bedding
- Pets allowed *
- Restrictions apply *
- Free WiFi in public areas
- Free WiFi in rooms
- Free self parking
- Free RV/bus/truck parking
Other information
- Resort fee included
Nearby Two Star East Pyrenees (department) hotels
In the hotel
- Breakfast (surcharge)
- Bar/lounge
- Arcade/game room
- Computer station
- 24-hour front desk
- Laundry facilities
- Free newspapers in lobby
- Multilingual staff
- Number of buildings/towers - 1
- Year Built 1990
- Television in common areas
- Accessible bathroom
- In-room accessibility
- Roll-in shower
In the room
- In-room climate control (air conditioning)
- Air conditioning
- Coffee/tea maker
- Slippers
- Iron/ironing board (on request)
- Blackout drapes/curtains
- Premium bedding
- Pillowtop mattress
- Separate dining area
- Private bathroom
- Shower only
- Hair dryer
- Satellite TV channels
- Desk
- Free WiFi
- Phone
- Free bottled water
- Daily housekeeping
- Connecting/adjoining rooms available
Top East Pyrenees (department) hotels
Recently reviewed hotels in East Pyrenees (department)
- Hôtel Le Mas des CitronniersFrom
"Beautiful little town with lots of history. Wish we had planned a longer stay."May 31, 2016
- Grand Hotel du GolfeFrom
"Experienced a bit of frustration finding the hotel using our GPS with address given. The hotel needs to correct this. Otherwise the facilities were lovely. Beware breakfast is…"May 29, 2016
- Auberge du RouaFrom
"Very short stay, a a relatively small room..a quite and nice location..hotel restaurant is very good but expensive (we would expect less expensive wines in this part of France and…"May 27, 2016
- Hotel des ElmesFrom
"Charming little hotel right across from two cove-like beaches. Nothing much within easy walking distance but there's a little cafe on the beach and the hotel has a restaurant with…"May 23, 2016
Nearby hotels
Special features
DiningBar - Onsite bar.
- Bicycle rentals nearby
- Ecotours nearby
- Golf lessons available nearby
- Golfing nearby
- Hiking/biking trails nearby
- Kayaking nearby
- Mountain biking nearby
- Parasailing nearby
- Rafting nearby
- Sailing nearby
- Scooter/moped rentals nearby
- Skydiving nearby
- Surfing/boogie boarding nearby
- Water skiing nearby
- Windsurfing nearby
Hotel Kyriad Perpignan Nord, East Pyrenees (department)'s small print
Also known as
- Hotel Kyriad Perpignan Nord
- Kyriad Perpignan Nord
The property has connecting/adjoining rooms, which are subject to availability and can be requested by contacting the property using the number on the booking confirmation.
Pet-friendly rooms can be requested by contacting the property at the number on the booking confirmation.
This property does not have elevators.
Mandatory fees
The charges below are included in the total price displayed:
- Resort fee
Optional extras
Breakfast is offered for an extra charge of EUR 8.00 per person (approximately)
Pets are allowed for an extra charge of EUR 5.00 per pet, per night
We have included all charges provided to us by this hotel. However, charges can vary, for example, based on length of stay or the room you book.
Recent reviews
Good 3.6 /5 from 98 reviews
Very nice hotel and friendly staff.Though on a busy road it's easy to get to and from.Cant fault it as a one night stop off but wouldn't stay longer.Would definitely use again.
Is the description of this hotel not correct? Tell us


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"I realize now that I did things wrong," Dr. de Jong, 58, said from
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The six teams of doctors and nurses provided assisted deaths, either by lethal injection or by administering a lethal cocktail of drugs, to patients whose own doctors have refused to help them die.
"Some of them start crying on the phone," De Jong said.
"They seemed happy that, finally, someone is listening to them,"
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Nick de Jong
Sheridan College
T.J. de Jong
Leiden University
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NautaDutilh N.V
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Misja de Jong
Fruitpartner BV


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Carleton of Oak Park
1110 Pleasant Street, Oak Park, IL 60302, USA – Great location - show map
Excellent location — rated 9/10! (score from 274 reviews)
Real guests • Real stays • Real opinions
|Room type
|Economy Room
|Standard Room
|Double Room with Two Double Beds
|King Room
6 reasons to choose Carleton of Oak Park
Low rates
4 properties in Oak Park
Manage your bookings online
The staff speak English
Booking is safe
Facilities of Carleton of Oak Park Great facilities! Review score, 8.1
Pets are not allowed.
Food & Drink
- Restaurant
- Bar
Free! Free public parking is possible at a location nearby (reservation is not needed).
- Room service
- 24-hour front desk
- Luggage storage
- ATM/cash machine on site
- Laundry
- Dry cleaning
- Meeting/banquet facilities
- Fax/photocopying
- Newspapers
- Non-smoking rooms
- Family rooms
- Heating
- Non-smoking throughout
- Air conditioning
Languages spoken
- Polish
- Spanish
- English
15:00 - 21:00 hours
Until 11:00 hours
Cancellation and prepayment policies vary according to room type. Please enter the dates of your stay and check the conditions of your required room.
Children and extra beds
All children are welcome.
One child under 14 years stays free of charge when using existing beds.
One older child or adult is charged USD 10 per night in an extra bed.
The maximum number of extra beds/children's cots permitted in a room is 1.
Any type of extra bed or child's cot/crib is upon request and needs to be confirmed by management.
Supplements are not calculated automatically in the total costs and will have to be paid for separately during your stay.
Pets are not allowed.
Cards accepted at this property
Hover over the cards for more info.
1 appealing option:
- Godfrey Hotel Chicago has a review score of 9
Please note that the "Economy Room" is located in a building separate from the hotel. This building has guest rooms with exterior entrances.
Guests are required to show a photo identification and credit card upon check-in. Please note that all Special Requests are subject to availability and additional charges may apply.


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Glu Mobile
Glu Mobile (NASDAQ:GLUU) is a leading global developer and publisher of free-to-play games for smartphone and tablet devices. Glu is focused on creating compelling original IP games such as GUN BROS, DEER HUNTER, BLOOD & GLORY, and SAMURAI VS. ZOMBIES DEFENSE on a wide range of platforms including iOS, Android, Windows Phone and MAC OS. Glu's unique technology platform enables its titles to be accessible to a broad audience of consumers globally. Founded in 2001, Glu is headquartered in San Francisco with teams outside Seattle and in Canada, China, India, Korea and Russia. Consumers can find high-quality entertainment created exclusively for their mobile devices wherever they see the 'g' character logo or at www.glu.com.
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Off Roading & Green Laning RSS Feed 2.2.4 2016-07-01T15:09:16Z Off Roading & Green Laning • off road clubs in staffs Bigags Off Roading & Green Laning Bigags http://www.disco4.com/forum/post1672936.html?#1672936 2016-06-25T22:00:05Z 2016-06-25T22:00:05Z Author: Bigags
 Subject: off road clubs in staffs
Posted: 25th Jun 2016 11:00 pm (GMT 1)

 are there any off road clubs i can join in the staffordshire area?

 not ever done any in my d3 but really fancy taking it. its a manual 05 plate.

 did a landrover experience and iv got the bug. any essential mods i need to do?

 thanks in advance

view forum post
 Off Roading & Green Laning • LRE Scotland bagged a munro galwaygreen Off Roading & Green Laning galwaygreen http://www.disco4.com/forum/post1669918.html?#1669918 2016-06-19T21:40:17Z 2016-06-19T21:40:17Z Author: galwaygreen
 Subject: LRE Scotland bagged a munro
Posted: 19th Jun 2016 10:40 pm (GMT 1)

 been on the trec day today...up a mountain,,,,870 metres fantastic stuff..,,they claim a munro but I think they may have their sums wrong.

view forum post


text:
Thursday, November 3, 2005
August 24, 2005
Cascade Locks City Councilor Rob Brostoff was charged with DUII on Saturday night after cruising near the site of the white supremacist rally.
According to sheriff reports, Brostoff was stopped for erratic driving and failed field sobriety tests. He was then transported to the Hood River County Courthouse where he registered a .26 on the intoxilyzer. That is more than three times the .08 legal drinking limit. Brostoff was then booked into NORCOR and held overnight.
On Monday, Brostoff declined to comment on the legal matter upon the advice of his attorney. He has served on the council since being appointed in July of 2000. Brostoff was subsequently voted into office that same fall and re-elected in November of 2004.
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|Name: _________________________
|Period: ___________________
This test consists of 15 multiple choice questions and 5 short answer questions.
Multiple Choice Questions
1. What did the Frenchman who interviewed John want him to do?
(a) Speak against the United States.
(b) Escape.
(c) Offer classified information.
(d) Tell the truth about being a prisoner.
2. Where did Jack ask to have his change of command ceremony?
(a) In Hanoi.
(b) Back in the United States.
(c) In a private ceremony in his living room.
(d) On the USS Oriskany.
3. Early releases told Jack that John about all of the following except what?
(a) He was now fine.
(b) He signed a confession.
(c) He was wounded.
(d) He was brave.
4. How did Bob react to John's actions?
(a) He refused to talk with him.
(b) He told John he was forever indebted to him.
(c) He responded in a humorous manner.
(d) He punched John.
5. What happened when the enemy came near John?
(a) He panicked and froze.
(b) He continued forward to release his bombs.
(c) He evaded them and flew away.
(d) He shot them down.
6. What did John do when he joined the other soldiers after solitary?
(a) Cried.
(b) Laughed.
(c) Talked non-stop.
(d) Asked them to leave him alone.
7. Who helped the family when John's wife was struggling?
(a) A neighbor who was in love with her.
(b) Navy families around her.
(c) John.
(d) John's parents.
8. What caused John the most dismay?
(a) He didn't want to disappoint his father.
(b) He was upset at how his family suffered.
(c) He didn't like seeing his fellow soldiers ill.
(d) He wished he could show the Vietnamese that he was really a fine man.
9. How did the Vietnamese want people to think they treated the prisoners?
(a) As slaves.
(b) With respect.
(c) Fairly.
(d) Harshly.
10. How many Americans were prisoners with John?
(a) 20.
(b) Over 80.
(c) 5.
(d) He was the only one.
11. What did John and his friends start up in Meridian, Mississippi?
(a) The Key Fess Yacht Club.
(b) The Meridian Gospel Church.
(c) An acting troupe.
(d) A band.
12. How did John feel about the soldiers who tried to escape and participated in forms of resistance?
(a) He wished he had their bravery.
(b) They were like lanterns leading the way with their honor, courage, and faith.
(c) He thought they were stupid.
(d) He was angry at them because everyone was punished for their thoughtless actions.
13. How did John feel when his chance of action didn't come to fruition?
(a) He was relieved.
(b) He was frustrated that they settled the situation peaceably.
(c) He was angry that they had to waste their time there.
(d) It whetted his appetite for action.
14. What information did John give his interrogators?
(a) He didn't tell them anything.
(b) No important information.
(c) He pretended to speak another language.
(d) He confessed everything.
15. Why did the Vietnamese take John to the hospital?
(a) He asked them to.
(b) It was common protocol for prisoners of war.
(c) They found out his father was an Admiral.
(d) They didn't.
Short Answer Questions
1. How were the prisoners treated up to the end of 1969?
2. What happened after John's actions during the Christmas Eve service in 1968?
3. What did Jack do to ensure his son's release?
4. What did the guard draw in the dirt at Christmas?
5. What did John do while in solitary?
This section contains 559 words
(approx. 2 pages at 300 words per page)


text:
Fishing reports from Lake Pontchartrain, Bayou Bonfouca, Tchefuncte River, Bayou Liberty, Rigolets, Pearl River, Bedico Creek, and more! - Homepage - Fishing reports from St. Tammany Parish
Fishing reports from Lake Pontchartrain, Bayou Bonfouca, Tchefuncte River, Bayou Liberty, Rigolets, Pearl River, Bedico Creek, and more!
June Fishing Forecast
Northshore Bass Series
NFR Store
Jeff Bruhl
The rivers and rain slowed at the end of May. The good is news is the Pearl River fell below eight feet on the Pearl River, La for the first time since winter. Panfish action has been good across the area. Tournaments are taking solid stringers to get a check.
read more!
Offseason Update 2016
Darren Digby
Whether the 2015 waterfowl season was boom or bust for you, any true duck hunter worth the mud on their waders is perpetually looking forward to the next season. Now that we've breached the 90-day mark in our countdown to the 2016 teal season, the itch is coming along and beginning to spread. Here are a few items going...
read more!
Wicked Winds
Taylor Valois
March has not been the kindest month this year to Louisiana anglers. Heavy rain downpours and hard Southeast winds have caused rivers and lakes to flood many areas including most here on the northshore. For Lake Ponchartrain these heavy winds and heavy rainstorms can make the clarity of the water as clear as.
read more!
Nick Church
On this Pond Hopping expedition I brought along my wife, my daughter and my youngest boy. This pond is on the service road on I-10 in between Fremeaux and Gause Blvd. If you are from the Northshore you have passed this pond many times in your travels through Slidell. It is a nice sized pond with a few houses from some local neighborhoods. The neat thing about this pond.
read more!
Right on cue! The redfish have moved onto the Causeway and anglers are finding limits of redfish along the concrete pylons. Plastics are working but live shrimp is better. When fishing plastics it always helps to tip the hook with shrimp. Matrix in the shrimp creole color and the new Shu-Shu Marsh Minnow in Victory Red are your best bets for finding reds. The redfish bite should continue throughout the month. Sheepshead and drum will also mix into your box when fishing with live shrimp.
The heat is on and the speckled trout are moving away from the bridges and into deeper, saltier water. Lake Borgne is full of shrimp right now and the gas rigs are where the actions at. Circle each rig and cover lot's of water. Concentrate on the shell bottoms that pepper the bottom of these rigs. Speckled trout and sheepshead should be plentiful. Live shrimp on a sliding cork or on a drop-shot rig is your best option.
"Take what she gives you"
"Liars and Lunkers tournament"
"Perch Run Carr Dr. Canal"
Top Dog Trout Round 2"
"Bayou Lacombe Area 1"
"Locked jaw bass this morning"
Pond Hoppin'
Keith Lusher Jr
Slidell angler Nick Church is no stranger to fishing the freshwater tributaries all across the North Shore of Lake Pontchartrain. Bayou Liberty, The Pearl River, Bayou Bonfouca, The Tchefuncte River, and Salt Bayou are all favorites of his when fishing from a boat. But recently, Nick's been venturing into less pressured waters.
ead more!
Lock One Kids
Fishing Tournament
Chad Hartzog
The 16th Annual Lock One Kid's Fishing Tournament will be held Sunday, July 24, 2016. The tournament is free for kids up to twelve (12) years old. All participants must be accompanied by a parent or guardian. Kids can fish from the bank or from a boat, launched at Lock One, on either side of the Lock. Kids can.
ead more!
Stocking the Fly Box
John Zeringue
On the last Northshore Fishing Report show on More Outdoors with Don Dubuc, Keith asked a good question that I could have filled the over a halfhour worth of progamming with: what are some flies to have for freshwater? Well I think I'll use this month's post
read more!
The Mechanics of Beginning
Andrew Green
Watch a great pitcher in baseball, a high percentage three point shooter in the NBA, a Grammy award winning actor, or an elite angler practice their craft. The best of the best in any sport or trade, the few who have mastered their craft, are mesmerizing to watch even if the observer isn't particularly interested in the sport or act. It doesn't take a die hard basketball fan to be impressed...
read more!
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Comments about 'Utah Jazz: 4 big men give Jazz plenty of options — and tough decisions, too'
- Oldest first
- Newest first
- Most recommended
Nice article Jody. Sounds like the bigs are ready to play! Ready to rumble! It get's me stoked for the up coming season! Go Jazz!
- 9:49 p.m. Oct. 6, 2012
- Like (2)
- Report abuse
Great that all four come to camp in good shape, but the article didn't exactly mention Derrick Favors defensive ability. That is what separates him from the other three. That is why he needs to be on the court during crunch time. His gradual progression as an offensive player is important, too, but he has already arrived as a standout defensive stopper. I can't wait to see the quicker Kanter in action also, but he still needs to play lots of backup minutes this year as he grows offensively and defensively. Milsap, as always, will be a solid Jazz player offensively with his various moves and put backs off offensive rebounds and also defensively with his quick hands (like Malone). Jefferson, hopefully, will be supportive of Favors playing some center this year since I see Favors as the probable starting center next year.
- 6:32 a.m. Oct. 7, 2012
- Like (3)
- Report abuse
Derrick Favors separates himself from the other three bigs with his defensive prowess in the paint. He deserves to finish games and probably start them as well as either the PF or center for the Jazz. Great to see all four have come to camp in good shape.
- 7:21 a.m. Oct. 7, 2012
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I do wish the Jazz to do the best that they can this year. I would be nice to have them have a real break out year where they do better than what pundits are predicting especially in an age where NBA teams like the Heat and Lakers try to load up on the best players that they can to guarantee championships. It does look like this strategy has worked for the Heat, but it sure would be nice to see a little guy (the Utah Jazz) beat the bullies down.
- 9:03 a.m. Oct. 7, 2012
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Being deep is a good problem. Everyone talks about the bigs but ALL of the positions have the problem. I would like to see them send Murph to the D-league right away so he can get lots of minutes to develope. He might be the dagger shooter the Jazz have been looking for.
- 9:46 a.m. Oct. 7, 2012
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Point taken. I could've mentioned Favors' defensive abilities. For him, I decided to focus on what he hoped to improve on. I'm sure there will be plenty of opportunities to discuss Favors' D, though. Thanks for the comments.
- 1:00 p.m. Oct. 7, 2012
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Corbin showed his hand in his comments. Corbin is also a free agent after this
season which means he will do whatever it takes to win every night and in this
league veterans win. Big Al and Millsap will be getting the bulk of the minutes
even though it would be better for the long term interests of the team for
Favors to get more minutes.
Count on another season of screaming for the bench players to get more minutes while Big Al witnesses all the pick and rolls sent his way......again.
- 9:23 p.m. Oct. 7, 2012
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I"m sayin maybe it's not that difficult to use 4 bigs. Maybe it's time to be the "baddest" defensive team in the West. How about we use all 20 fouls going forward. If you come to our house and try to go to the paint, you'll have to work hard... ! just sayin...
- 9:26 p.m. Oct. 7, 2012
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it doesn't matter who wins the first game of the season. What matters is who gets 14 wins in the playoffs. You don't play the players that are best today, you play the players who need PT to be able to produce that 14th win.
- 2:27 a.m. Oct. 12, 2012
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