Date: Sun, 28 Aug 2016 05:40:15 +0200
By Marion THIBAUT

Vientiane, Aug 28, 2016 (AFP) - "Look at me, stay with us," the paramedics shout as a barely conscious motorcyclist is bundled into a volunteer ambulance in the Laotian capital Vientiane, where rampant drink driving brings nightly carnage to the roads.   It is a grim scene familiar the world over. 

But in Laos, an impoverished and authoritarian communist country with almost no state-funded medical services, these kind of vital lifesavers are volunteers and entirely funded by donations.   And they have never been more in demand.   By the time the crew arrive at a nearby hospital, the Japanese donated ambulance -- a right hand drive vehicle in a left hand drive nation -- has picked up two more injured on the way. Fresh calls for help are coming in all the time.

Founded in 2010 by a group of foreigners, "Vientiane Rescue" is a much needed lifeline for those in need of urgent medical care.    "Before we launched this service, after an accident the wounded were simply left on the roadside or taken away in tuk-tuks. That's obviously disastrous for those with fractures or trauma," explained S├ębastien Perret, a French national and former firefighter who helped found the group.   Poorly maintained roads, dilapidated vehicles, an increase in motorcycle use and the widespread prevalence of drink driving makes Vientiane one of Asia's most precarious capitals for road deaths.

- Years of rapid growth -
The government keeps few statistics, but Perret's group says demand for their services has jumped 30 percent in the last year alone.    "We undertake around 20 to 30 call outs a day. And in 90 percent of cases it is road accidents," he said.   There was a time when Vientiane was famed for its lack of cars.    Backpackers passing through the city in the 1990s would marvel at the wide, French-built boulevards devoid of heavy traffic, bicycles and tuk-tuks the main form of transport.

But years of rapid growth has seen the same streets filled with vehicles in recent years, many of them brand new SUVs and luxury cars driven by the country's communist party elite.    That wealth -- and the volunteer ambulances scooping victims up from the road -- are both a stark illustration of how public services in communist Laos are largely nascent or non-existent despite being one of Asia's fastest growing economies over the last decade.   In the 1990s the country's rulers abandoned free healthcare altogether, meaning ordinary citizens must fend for themselves when they get ill.

- Minimal health spend -
Since 2000, Laos' GDP has increased 12 times, reaching $12.3 billion in 2015.    But the country currently has one of the world's lowest spends on healthcare.    In recent years it has averaged just 0.5 percent of GDP according to the World Bank.    In contrast, similarly impoverished Cambodia spends 1.3 percent while fellow communist nations Vietnam and Cuba spend 3.8 percent and 10.6 percent of GDP respectively.

The Health Ministry in Laos, a country where all foreign journalists must be accompanied by a government minder, declined an AFP interview but did issue a brief statement via email.   In it they admitted there was a shortage of good healthcare.    "The main problems for hospitals in Laos is the lack of qualified staff, equipment, coaching and financial resources," the statement said.   But the ministry did not say whether there were any plans to increase healthcare spending or to tackle the issues in the coming years.   Volunteer groups plug some of the gaps, but even they face shortages.    At Vientiane Rescue bandages are washed and re-used, while several of their ambulances are crudely converted cars.

The service operates 24-hours a day, seven days a week and has also recently expanded into firefighting teams and specialists to counter drownings.   Most of those volunteering are students who are sent to Thailand for first aid training.   Mee Thevanh, 24, began volunteering after she was involved in a motorbike accident and had to make her own way to hospital.    "After that I decided to become a volunteer. I spend most of my nights here," she said in a short break between emergencies.    She admits that like many compatriots she used to regularly drink and drive. But no more.    "And I've calmed down since," she said.
Laos. - National
10 Aug 2016

Infections with the mosquito-borne dengue virus have led to a reported 9 deaths from 2300 confirmed cases in Laos during the country's ongoing rainy season, the country's Ministry of Health confirmed to local media Wednesday [10 Aug 2016]. The southern Lao province of Champassak recorded the highest toll nationwide, with some 7 deaths recorded from more than 1000 reported cases

<http://www.shanghaidaily.com/article/article_xinhua.aspx?id=332200>
Date: Mon, 7 Mar 2016 23:02:44 +0100

Washington, March 7, 2016 (AFP) - The United States issued a new travel warning for Laos on Monday after the latest shooting attacks against traffic on a road much used by international tourists.   Last month, Washington had already warned travellers to avoid the southeast Asian country's Xaisomboun province after roadside attacks left three dead.   Now the warning has been extended to Road 13, a major route between Luang Prabang to Vang Vieng, two of the country's most popular tourist destinations.   It cites "the unpredictable nature of the violence and the lack of official information regarding possible motives or a Lao government response."

These mystery gun attacks have killed one and injured nine, the State Department added, stressing that violence is also continuing in Xaisomboun province.   US embassy staff are banned from Road 13 from Kasi in Vientiane province to Phou Khoun junction in Luang Prabang province, 50 kilometers (31 miles) away.   Landlocked communist Laos is usually isolated, but in September it will host a summit the leaders of China, Japan, the United States and the 10-strong Association of Southeast Asian Nations.  
Date: Sat, 5 Mar 2016 13:25:31 +0100

Bangkok, March 5, 2016 (AFP) - Laos is the latest country to report a local transmission of Zika virus, according to the World Health Organization, as fears mount over the mosquito-borne illness that has been linked to birth defects.   Asia has seen only a sprinkling of cases of the virus, but a surge in Latin America this year has pushed the UN health agency to declare Zika a global health emergency.

Laos joined a total of 41 countries that have reported local transmissions of the virus since the beginning the year, a WHO report said.    Health authorities in Laos, a rural Communist country with minimal infrastructure, were not available to comment.  Neighbouring Thailand reported one case last month of a 22-year-old who contracted the illness domestically and has since recovered.   Thailand's health ministry urged the public not to panic, saying there have been an average of five cases per year since 2012 with no outbreaks.

The sickness is carried by the Aedes aegypti mosquito, which also spreads dengue fever.   It breeds in tropical areas, including Southeast Asia, which has seen a spike in cases of dengue in recent months and most often causes mild, flu-like symptoms. A growing body of evidence suggests Zika can also trigger microcephaly, a severe deformation of the brain among new-borns, in babies born to mothers infected while pregnant.

Brazil was first to sound the alarm on the apparent link with birth defects.   It has since become the hardest hit country, with an estimated 1.5 million cases of active Zika transmission and 641 confirmed cases of microcephaly.  On Friday scientists in the United States said they found the first concrete evidence of a link between the virus and the birth defect, which has so far been circumstantial.  The findings may help to identify drugs to prevent or cure the Zika virus, which currently lacks a vaccine or specific treatment.
Date: 25 Feb 2016
Source: WHO Global Alert and Response, Disease Outbreak News [edited]
<http://www.who.int/csr/don/25-february-2016-polio-lao/en/>

Between [6 and 16 Feb 2016], the National IHR Focal Point (NFP) of Lao People's Democratic Republic (PDR) notified WHO of 3 additional cases of vaccine-derived poliovirus type 1 (VDPV1).

Details of the new cases:
- The 1st case is a 15-month-old female from Phonhoung district, Vientiane Province. The patient developed paralysis on [8 Jan 2016].
- The 2nd case is a 44-year-old female from Feuang district, Vientiane Province. The patient developed paralysis on [11 Jan 2016].

Neither of the 2 cases received oral polio vaccine (OPV). On [3 Feb 2016], the National Institute of Infectious Diseases, Japan reported that stool samples for both cases tested positive for type 1 circulating vaccine-derived polio virus (cVDPV1). There is no epidemiological link between the 2 cases.

The 3rd case is an 18-year-old male from Meun district, Vientiane Province. The case developed paralysis on [3 Jan 2016]. Test results for his stool specimen are pending; however, the specimen was considered to be "inadequate" since it was collected more than 14 days after the onset of paralysis. A stool sample collected from a close contact tested positive for VDPV1; the case is classified as cVDPV1 based on the epidemiological link and the contact's positive stool sample.

Of note is that these new cVDPV1 isolates are genetically linked but have considerable genetic differences with the previous Laos cVDPV1 isolates from the current outbreak. The new findings suggest that more than one strain of cVDPV1 may have emerged separately and co-circulated in Laos without being detected.

To date, the total number of confirmed cVDPV1 cases in this outbreak is 10. Furthermore, since the beginning of the outbreak, circulating cVDPV1 has been isolated from the stools of 23 healthy contacts in the provinces of Bolikhamxay, Xaisomboun and Vientiane.

After the reports of a number of cVDPV1 positive cases in previously healthy contacts, enhanced surveillance is maintained nationally, especially in the newly affected districts. The WHO Regional Office for the Western Pacific is also communicating information on the event and response activities with the neighboring countries.

Since the detection of the 1st confirmed cVDPV1 in Lao PDR in October 2015, outbreak response activities have been conducted nationwide, including supplementary immunization activities (SIAs) between December 2015 and January 2016. A polio outbreak response plan was drafted, and emergency operations centers have been activated at the national and provincial levels to coordinate response efforts. Enhanced surveillance is being carried out throughout the country, including daily zero-reporting of AFP cases. Active case finding is ongoing in high-risk districts, including a retrospective review of hospital and health centre records.

The outbreak response, including a series of SIAs, is being conducted as planned, targeting all children aged under 15 years as well as people of all ages in districts where high-risk groups are present.

The reported cases of cVDPV1 indicate that the level of population immunity in the affected areas is low, and there is a risk of further spread of this strain. It is likely that the cVDPV1 strain has been circulating for several months in these areas. Based on experiences from previous similar events, it is expected that additional cases will be reported. However, if the supplementary immunization activities cover the target population effectively, the risk of international spread from Lao PDR is expected to be low. WHO continues to monitor the epidemiological situation and conduct risk assessments based on the latest available information.

WHO's International Travel and Health recommends that all travellers to polio-affected areas be fully vaccinated against polio. Residents (and visitors for more than 4 weeks) from infected areas should receive an additional dose of OPV or inactivated polio vaccine (IPV) within 4 weeks to 12 months of travel.

WHO's International Travel and Health recommends that all travellers to polio-affected areas be fully vaccinated against polio. Residents (and visitors for more than 4 weeks) from infected areas should receive an additional dose of OPV or inactivated polio vaccine (IPV) within 4 weeks to 12 months of travel.

The temporary recommendations issued in November 2015 by the WHO Director-General following the advice of an Emergency Committee convened under the International Health Regulations (2005) to limit the international spread of poliovirus from countries affected by cVDPVs remain in effect. In line with these recommendations, any country infected by cVDPV should declare the outbreak as a national public health emergency and consider vaccination of all international travellers. For the latest report on the Temporary Recommendations, see related links.
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[The HealthMap/ProMED-mail map of Laos can be found at:
<http://healthmap.org/promed/p/146>. - ProMED Mod.MPP]
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