Date: Mon 18 Feb 2019 3:33:02 PM AFT
Source: MENAFN/Afghan Times, AT News report [edited]
<https://menafn.com/1098138628/Afghanistan-New-polio-case-confirmed-in-Kandahar-days-after-nationwide-campaign-kicks-off>

One new polio case is just confirmed in southern Kandahar province, days after nationwide campaign against the crippling disease kicked off on [Mon 18 Feb 2019].  A 60-month-old boy from Ghorak district is infected by the poliovirus. This is the 2nd case reported in 2019, highlighting the ongoing risks of polio and the need for continued immunization, health officials said.  "From today [18 Feb 2019], polio vaccination teams will visit 5.8 million children under 5 years old in 195 high-risk districts of 21 provinces of West, Central, and Southeast regions of Afghanistan," said a statement issued by Ministry of Public Health (MoPH).

The Minister of Public Health Ferozuddin Feroz urged Afghan people to take the situation seriously and called on people to open doors to vaccinators in the upcoming campaign.  "We already have 2 cases reported from Kandahar this year [2019]. While there is polio anywhere in this country, all children are at risk. Polio will continue to fight for survival. Immunization is the only way to put an end to this virus. We urge the people of Kandahar and across the country to step up, open your doors and get your children vaccinated. We don't want to see any more children paralyzed by polio, and we need to work together to stop polio once and for all."

Polio is incurable and can paralyze children for life. The only way to prevent polio virus is to vaccinate all children with 2 drops of polio vaccine every time it is offered. Children are better protected with every additional dose of the vaccination. Repeated vaccination helps to build strong immunity of your child and the whole community.

The vaccination campaign will take place from [18-22 Feb 2019]. Parents should ensure their children are home and available to be vaccinated. All children under 5 should receive the polio vaccine, including children who are asleep, visiting other homes and new-borns, even if they have been immunized in the past. Children who miss the vaccination should visit their local health centre as soon as possible, where the vaccine is available free of charge. The polio vaccine is safe, even for sick and new-born children. It is very important these children get the vaccine, because they have lower immunity which makes them more susceptible to the virus. Polio vaccination has also been strongly endorsed by national and global Islamic scholars, the statement added.

Every country in the world except Pakistan, Nigeria, and Afghanistan has ended polio, highlighting the fact that the strategy and vaccines work Twenty-one Afghan children were infected by polio in 2018.
======================
[Sadly, transmission of the WPV continues in Pakistan and Afghanistan. Since the beginning of 2019 there have now been 6 cases confirmed, 4 in Pakistan and 2 in Afghanistan. The vaccination history of this child isn't included in this media report, but most likely the child was inadequately vaccinated at 60 months (5 years) of age. - ProMED Mod.MPP]

[HealthMap/ProMED map of Afghanistan:
<http://healthmap.org/promed/p/64942>]
Date: Tue 29 Jan 2019
Source: Afghanistan Times [edited]
<http://www.afghanistantimes.af/1st-polio-case-reported-in-afghanistan-in-2019/>

Afghanistan's 1st polio case in 2019 was reported in Kandahar province, where a 22-month-old girl from Spin Boldak district was infected by the poliovirus.

According to a statement the Minister of Public Health, Dr Ferozuddin Feroz said, 'this case indicates that the poliovirus is still transmitting in Kandahar and the South region. This child's life is now changed forever. It is really sad that she will never walk properly again, therefore I call upon all of you, our Muslim parents, caregivers, community elders, and health workers to work together to protect our innocent children against this disease and eradicate polio in our country.'

He said that polio is a crippling and potentially fatal infectious disease. There is no cure and the polio vaccine is the only safe and effective way to protect children. All children should be vaccinated against polio during each campaign, until they reach the age of 5. House-to-house vaccination is the only effective way to achieve polio eradication because it means every child has access to vaccination. This strategy has been implemented in all countries and has proven efficacy. However, if parents live in areas where there is no house-to-house campaign available, they should take their children to the local health facility for free polio vaccine.

The polio vaccine is safe, even for sick and new-born children. It is very important these children get the vaccine, because they have low immunity which makes them more susceptible to the virus.

Polio vaccination has also been strongly endorsed by national and global Islamic scholars, he added.

Currently, Afghanistan, Pakistan, and Nigeria are the only 3 remaining polio-endemic countries in the world. There were 21 cases reported in Afghanistan in 2018. Of these, 15 cases were in the Southern region, while 6 cases were in the Eastern region. There is a polio vaccination campaign carried out in the Southern and Eastern regions of Afghanistan, parents should ensure their children are home and available to be vaccinated.
==========================
[The wording of the media report above suggests that the date of onset of paralysis of this case was in 2019, but it is possible onset was in late 2018. Clarification of the date of onset would be greatly appreciated.

Kandahar province is located in the Southwestern region of Afghanistan (see <https://www.researchgate.net/figure/Regions-of-Afghanistan_fig1_284510443> for a map of regions in Afghanistan and <http://www.afghana.com/GetLocal/Afghanistan/Provinces.htm> for a map of provinces in Afghanistan). It shares a border with Balochistan Pakistan.

In last week's global update, there was mention of 7 positive environmental samples in Afghanistan collected on 26 Dec 2018, that identified 3 of the 7 coming from Kandahar province, confirming that the WPV1 was actively circulating in the province (see Poliomyelitis update (08): global (Pakistan, Nigeria), WHO (Mozambique) http://promedmail.org/post/20190125.6277951). - ProMED Mod.MPP]

[HealthMap/ProMED-mail map of Afghanistan:
<http://healthmap.org/promed/p/32936>]
Date: Thu 24 Jan 2019
Source: Tolo News [edited]
<https://www.tolonews.com/afghanistan/90-soldiers-contracted-q-fever-while-serving-helmand>

At least 90 British military personnel have been diagnosed with confirmed cases of Q fever after serving in Helmand, Afghanistan. According to a UK military news outlet, Forces Network, a consultant in infectious diseases and tropical medicine told to the Central London Country Court on [Tue 22 Jan 2019], that 90 confirmed cases of Q fever had been recorded among British soldiers who had served in Helmand.

Lieutenant Colonel Mark Bailey's testimony was heard in the case of a private with 2nd Battalion, the Mercian Regiment, who said his life has been ruined after he contracted the disease while in Helmand in 2011/2012. During his tour, his lawyers said [the private] was in contact with goats and sheep and "was often required to take cover and jump through ditches and crawl along the ground -- coming into contact with animal products and excrement." The soldier was medically discharged from the Army in 2014 because of his Q fever and chronic fatigue symptoms.

Humans can catch Q fever by breathing in dust from the secretions of infected farm animals such as sheep, cattle, and goats.

Bailey, who specializes in infectious diseases and tropical medicine, and a national expert in Q fever said he has 90 military and 10 civilian cases in his care after they were referred to him. He confirmed the 90 had served in Helmand and said the number of military cases "built up from 2008", Forces Network reported. Bailey told the court: "We have seen no new cases since 2014 from Afghanistan. Occasionally we get other military cases from other locations. Cyprus most recently."

Bailey said he had seen "one British soldier who very, very nearly died" as a result of Q fever and subsequent complications, but there have been no UK deaths in his group.
====================
[Q fever is due to _Coxiella burnetii_, an obligate intracellular rickettsia-like bacterial pathogen. It is highly resistant to drying and heat, which enables the bacteria to survive for long periods in the environment. Its survival is attributed to a small cell variant of the organism that is part of its biphasic developmental cycle. Q fever is a zoonosis. Domestic ungulates such as sheep, cattle, and goats serve as the reservoir of infection for humans. The organism is shed in urine, feces, milk, and especially birthing products; intermittent high-level shedding occurs at the time of parturition, with millions of bacteria being released per gram of placenta.

Humans usually become infected by inhaling aerosolized organisms. Acute symptoms of a flu-like illness usually develop within 2-3 weeks of exposure, although as many as half of humans infected with _C. burnetii_ do not show symptoms (<http://www.cdc.gov/qfever/symptoms/index.html>). Although most persons with acute Q fever infection recover, others may experience serious illness with complications that may include pneumonia, granulomatous hepatitis, endocarditis (especially in patients with previous cardiac valvulopathy), myocarditis, and central nervous system involvement. Pregnant women who are infected may be at risk for pre-term delivery or miscarriage.

The solider likely suffers from Q fever-associated chronic fatigue. The following related to post-Q fever fatigue syndrome is extracted from Melgar TA, Bauler TJ, Lutwick LI. Q fever in man: A one health paradigm disease. In, The Principles and Practice of Q Fever, Simoes JCC, Anastacio SF, da Silva GJ (eds), Nova Science Publishers, 2017, pp 1-24:

"Up to 20% of patients with acute Q fever report chronic fatigue more than a year later. Most of these cases meet the CDC criteria for chronic fatigue syndrome. Other symptoms include night sweats, nausea, headache, myalgia, enlarged lymph nodes, arthralgia, insomnia, depression, decreased concentration and short term memory impairment. The pathogenesis is not clear although there is evidence that genetic factors may play a role and _C. burnetii_ antigens and DNA can be found in patients' macrophages for up to 12 years and in one case 70 years after acute infection (1,2). Treatment is focused on chronic fatigue including exercise therapy and cognitive behavior therapy. There are no current recommendations for antimicrobial therapy for Q fever-associated chronic fatigue although case reports and one study demonstrated improvement with antimicrobials (3). A large placebo controlled randomized trial in the Netherlands (4,5) reported some non-sustained improvement was found with cognitive-behavioral therapy but not with long term doxycycline.

References
----------
1. Marmion BP, Sukocheva O, Storm PA, et al. Q fever: persistence of antigenic non-viable cell residues of _Coxiella burnetii_ in the host - implications for post Q fever infection fatigue syndrome and other chronic sequelae. QJM 2009; 102(10): 673-84; abstract available at <https://www.ncbi.nlm.nih.gov/pubmed/19556396>.
2. Sukocheva OA, Marmion BP, Storm PA, et al. Long-term persistence after acute Q fever of non-infectious _Coxiella burnetii_ cell components, including antigens. QJM 2010; 103(11): 847-63; abstract available at <https://www.ncbi.nlm.nih.gov/pubmed/20639288>.
3. Arashima Y, Kato K, Komiya T, et al. Improvement of chronic nonspecific symptoms by long-term minocycline treatment in Japanese patients with _Coxiella burnetii_ infection considered to have post-Q fever fatigue syndrome. Intern Med 2004; 43(1): 49-54; <https://www.jstage.jst.go.jp/article/internalmedicine/43/1/43_1_49/_article>.
4. Keijmel SP, Delsing CE, Bleigenberg G, et al. Effectiveness of long-term doxycycline treatment and cognitive-behavioral therapy on fatigue severity in patients with Q fever fatigue syndrome (Qure study): a randomized controlled trial. Clin Infect Did 2017; 64(8): 998-1005; <https://academic.oup.com/cid/article/64/8/998/3056564>.
5. Raijmakers RPH, Keijmel SP, Breukers EMC, et al. Long-term effect of cognitive behavioural therapy and doxycycline treatment for patients with Q fever fatigue syndrome: one-year follow-up of the Qure study. J Psychosom Res 2019; 116: 62-7; <https://www.sciencedirect.com/science/article/pii/S0022399918308183>.

Helmand is one of the 34 provinces of Afghanistan, in the south of the country. It can be seen on a map at
<https://en.wikipedia.org/wiki/Helmand_Province>. - ProMED Mod.LL]

[HealthMap/ProMED-mail map of Afghanistan:
<http://healthmap.org/promed/p/21324>]
Date: Fri, 11 Jan 2019 04:14:22 +0100
By Laurent ABADIE

Kabul, Jan 11, 2019 (AFP) - Standing in his garden in Kabul, Baz Mohammad Kochi oversees the drilling of a new well more than 100 metres deep after his first water reservoir dried up. He is not alone.   A shortage of rain and snow, a booming population and wasteful consumption have drained the Afghan capital's water basin and sparked a race to the bottom as households and businesses bore deeper and deeper wells in search of the precious resource.   "The water level has dropped so much that it is now necessary to reach other underground basins 100 metres, even 120 metres" deep, says well digger Mohammad Aman as his dilapidated machine pierces the ochre earth in Kochi's yard.    Every year 80 million cubic metres (2.8 billion cubic feet) of water are extracted from Kabul's aquifers -- nearly double the natural recharge rate through precipitation, according to utility Afghanistan Urban Water Supply and Sewerage Corporation.

As a result Kabul's water table has fallen at least 30 metres (100 feet) in recent years, says Asian Development Bank deputy country director Shanny Campbell.   Snow has fallen in the city this month but it is not nearly enough to solve the water shortage -- in some areas the level has dropped 20 metres in the past year.   "The problem we have in Kabul is the massive increase in population, impact of climate change and overall less precipitation and snowfall," Campbell explains.

Only around 20 percent of Kabul is connected to the city's piped water system, leaving many residents to ensure their own supply by digging wells that are often shared by several neighbours.   Others buy water from private companies, or, like Mohammad Nazir, fill up jerry cans at mosques or more than 400 public taps scattered around the city.   "There is no point turning on the taps -- there is no water here," says Nazir, 50, who lives on a hill where the ground is too hard to dig a well and the city's pipes do not reach.   "It's the worst year we've ever lived."

- Undrinkable -
Water is not only scarce in Kabul, but most of it is undrinkable, according to the National Environmental Protection Agency.     Around 70 percent of the city's groundwater is contaminated by waste and chemicals from leaky household septic tanks and industrial plants that can cause diarrhoea or other illnesses if the water is not boiled or purified properly.   Efforts to increase connections to the municipal piped water network and improve sanitation systems are under way.    But progress is slow as authorities struggle to keep up with demand in one of the fastest growing cities in the world. 

Kabul's population has more than doubled to around five million in the past 30 years, boosted by the arrival of people fleeing war and poverty.    It is expected to reach eight million by 2050, according to a report published in the Washington-based SAIS Review of International Affairs in 2017.    Improving living standards for many households also means more people are showering and washing cars than ever before.   A lack of public awareness about water conservation and no restrictions on its usage means much of it is wasted. 

While they try to work out how to replenish the city's subterranean reserves, authorities are using a television campaign and the influence of religious leaders to encourage households to save water.   "In our Friday sermons, we call on the faithful not to waste water," said Abdul Raouf, a member of the Ulema Council, the country's highest religious body.    As they wait for the first winter snow in the city, worshippers also pray "for this drought to end as soon as possible".   Even the Taliban are on board, issuing a statement to followers to "pray for rain".

- Quick fix -
Authorities are not waiting for divine intervention to fix Kabul's water problem.   With droughts, like the one affecting swathes of Afghanistan this year, expected to increase in severity and frequency as a result of climate change, a long-term solution is needed.    Among the options being explored by the ADB are "spreading basins" -- large ponds that trap rainwater long enough for it to seep into the soil and recharge aquifers.

The ADB is also looking at using "pumps to inject the water directly into" the basins and the construction of a dam on the outskirts of Kabul.   "The answer is not in one technology but in a mixture," Campbell said.    "Kabul is under a situation of water stress so we're looking for a solution with lower impact, lower cost technology that could fix the problem quickly."    That would be welcome news to Kochi, who cannot hide his relief as water gushes out his new well. He knows the borehole could dry up again soon.   "We have survived revolution and civil wars, the Taliban regime and suicide attacks, but this water shortage may force us to leave," Kochi says.   "There is no life without water."
Date: Tue, 20 Nov 2018 15:30:14 +0100

Kabul, Nov 20, 2018 (AFP) - At least 40 people were killed in an explosion at a meeting of top clerics in Kabul on Tuesday, officials said, in one of the deadliest attacks to strike the Afghan capital in months.   Another 60 people were wounded in the blast, health ministry spokesman Wahid Majroh said, which targeted an Ulema Council gathering at a wedding hall to mark the Prophet Mohammad's birthday.   "Initial information suggests it was caused by a suicide bomber," interior ministry spokesman Najib Danish said.    He said the number of dead and wounded was "more than 50" so far.   A manager of Uranus Wedding Palace, which also hosts political and religious functions, told AFP a suicide bomber blew himself up in the middle of the gathering.    "There are a lot of casualties -- I myself have counted 30 casualties," he told AFP on the condition of anonymity.
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