From the ECDC Weekly Communicable Disease Threats Report, the US CDC, and the WHO:
- Marburg virus disease (MVD) outbreak in Rwanda: 42 days after the last patient tested negative for the virus twice, as per the usual protocol for ending these types of outbreaks, the outbreak was declared over on 20 December. This outbreak resulted in 66 cases, with 15 deaths, mostly from a single cluster linked to healthcare facilities that treated the index case. The MVD fatality rate ranges from 24% to 88%. In this outbreak, the fatality rate was lower at around 23%.
- Acute respiratory infections complicated by malaria: This is the name now given by the WHO to an initially undiagnosed disease outbreak reported in early December in the Kwango province of the DRC, in a remote region that requires a 48-hour road trip to be reached from the capital, Kinshasa. The WHO has concluded that the outbreak has been caused by a combination of multiple acute respiratory infections complicated by malaria, malnutrition and limited healthcare access. Children under five have been disproportionately affected. Most cases tested positive for malaria. Common respiratory viruses were also detected, such as influenza A (H1N1) and parainfluenza viruses, rhinoviruses, and SARS-CoV-2. Coordination and infection prevention and control measures are to be strengthened. Further details here: https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON547
- Global outbreak of mpox:
- Overall, the global epidemiological situation of clade I and clade II mpox is fairly stable.
- Outside the affected African countries, small household clusters of cases of MPXV clade Ib have been reported in the UK and Germany since October, the first US case was detected in November, and a case was reported in Belgium earlier this month. All index cases had travelled to affected areas in Africa.
- Avian influenza:
- The first case of bird flu was confirmed in New Zealand in an egg farm early December. However, this was not a case of the H5N1 type circulating among wildlife around the world, rather a case of H7N6, which is considered unlikely to be transmitted to mammals.
- H5 bird flu is widespread in wild birds worldwide and is causing outbreaks in poultry and US dairy cow. So far there is a total of 66 confirmed human cases of influenza A(H5N1) in the US. One severe case was confirmed on 13 December in Louisiana following exposure to sick and dead birds in backyard flocks. On 18 December, the Governor of California declared a state of emergency in the state to further expand monitoring and contain and mitigate the spread of H5N1.
- Human infections with avian influenza viruses remain rare and sporadic, with no evidence of sustained human-to-human transmission so far. According to the US CDC, the risk to the general population remains low.
A selection of other articles of interest:
Light effects on physiology? Behaviour needs to be factored in
As sunlight peaks in the Southern hemisphere and reaches its trough in the North, it is fitting to have a look at this article on the behavioural determinants of physiologically-relevant light exposure, and to consider the so-called non-visual effects of light, or non-image forming (NIF) responses to light, which include diverse functions such as alertness, mood, well-being, mental health, sleep, and circadian rhythms.
The article’s authors argue that the prevailing simplistic approach to light and its effects on physiology as a linear input-output relationship ignores that humans actively shape their light exposure through behaviour. This approach has often led to ambiguous, impractical and/or ineffective recommendations of which we are only too aware when trying to translate them to advice that is relevant to aircrews, for instance.
Humans do not perceive light passively, they modulate, craft and manipulate it, either shielding from it or seeking it in various ways. Individual behaviour, light “history” and “diet” need to be taken into account. These researchers propose a framework that looks at light exposure as an individual behaviour to meet specific, person-based needs. For more light on this topic: https://www.nature.com/articles/s44271-024-00159-5.pdf
More hope for objective measures for conditions whose diagnosis is mostly based on subjective reporting and assessment
The practice of certificatory medicine, including in aviation medicine, finds some of its greatest difficulties when having to assess risk based solely on subjective measures and reporting. Psychiatric conditions and drowsiness are two cases in point of great relevance for aviation.
An eyebrow-raising study published in JAMA Psychiatry suggests a role of inflammation in the development of psychiatric disorders. Inflammatory biomarkers (such as white blood cells and certain proteins) could in the future help to identify individuals at higher risk for mental health disorders. https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2822344
On a different note, this other article showcases generic, in-ear, dry-electrode earpieces to monitor drowsiness, a much more practical alternative to complex EEG wiring. https://www.nature.com/articles/s41467-024-48682-7
Interventions for misinformation
As in other fields, communicating topics relevant to airline medicine often implies having to face a barrage of widespread misinformation. To mitigate the dangers of misinformation, researchers have tried to come up with interventions to reduce people’s propensity to believe and share misinformation. The authors of this article propose a conceptual framework for misinformation interventions based on signal detection theory (SDT). SDT is a framework for measuring how people differentiate between patterns that bear information and those that are random.
According to SDT, there are two potential reasons why people may accept false information: they may be unable to distinguish between true and false information, or they may have a general tendency to accept information regardless of whether it is true or false. In SDT, the first case can be described as low truth sensitivity (or low discernment) and the second case as a low acceptance threshold. People seem to show lower acceptance thresholds for information that is congruent with their beliefs – the “myside” bias.
Three proximal factors can therefore lead people to believe or to share false information: (1) a low truth sensitivity, (2) a low overall threshold and (3) a myside bias.
These researchers suggest that before the development of any misinformation intervention, one should identify which of the three above proximal factors (or combination of factors) is responsible for the acceptance of misinformation in their area of application. However, and a bit disappointingly, they are aware that their recommendations may be harder to implement for interventions that retroactively target specific ideas or narratives (e.g., debunking). https://www.nature.com/articles/s41562-024-02021-4?utm_source=nathumbehav_etoc&utm_medium=email&utm_campaign=toc_41562_8_12&utm_content=20241220
On a still serious but perhaps lighter note you may want to have a go at this game to complement a stay-at-home New Year’s Eve party – the Bad News Game https://www.getbadnews.com/en
This is an online game devised by researchers at the Cambridge Social Decision-Making Lab at Cambridge University. “In Bad News, you take on the role of fake newsmonger. The goal of the game is to expose the tactics and manipulation techniques that are used to mislead people and build up a following. Bad News works as a psychological “vaccine” against disinformation: playing it builds cognitive resistance against common forms of manipulation that you may encounter online.” You can try and use impersonation, emotion, polarization, conspiracy, discrediting or trolling, and check how far your credibility and follower attraction goes. Fun and educational.
However, if you find this game too boring or slightly disturbing, and if it doesn’t make you laugh, consider this:
Laughing for dry eyes
Dry eye sensation is not uncommon when flying, especially among contact lens wearers and in relation with the relatively dry cabin environment. Artificial tears with 0.1% sodium hyaluronic acid relieve ocular discomfort and stabilise the tear film. This is especially important for persons with dry eye syndrome or other chronic conditions causing dry eyes.
Evidence suggests that laughter therapy may alleviate depression, anxiety, stress, and chronic pain, while strengthening immune function. Laughter therapy includes various interventions designed to provoke laughter and smiling such as laughter exercises, comedy movies or games.
In this study laughter exercise was non-inferior to artificial tears in relieving subjective symptoms in patients with dry eye disease. If you’re curious, follow the link to read more about the study and to watch a video with laughter exercise instructions https://www.bmj.com/content/386/bmj-2024-080474
Wishing you All a Happy New Year, laughter and smiles for 2025!
Dr Rui Pombal
IATA Medical Advisor