MERS-CoV Primary Care Algorithm

For MERS-CoV Primary Car Algorithm, you can refer below:

MERS-CoV Case Definitions

Patients should be evaluated for MERS-CoV infection in consultation with the state and local health departments. You can find more information, at CDC’s here:

Patient Under Investigation (PUI)

A person who has both clinical features and an epidemiologic risk should be considered a patient under investigation (PUI) based on one of the following scenarios:

Severe illness:

• Fever and pneumonia or acute respiratory distress syndrome based on clinical or radiological evidence, AND
• A History of travel from countries in or near the Arabian Peninsula within 14 days before symptoms onset, or close contact with a asymptomatic traveler who developed fever and acute respiratory illness (not necessarily pneumonia) within 14 days after traveling from countries in or near the Arabian Peninsula, OR
• A History of being in healthcare facility as a patient, worker, or visitor in the Republic of Korea within 14 days before symptoms onset, OR
• A member of a cluster of patients with severe acute respiratory illness (e.g. fever and pneumonia requiring hospitalization) of unknown etiology in which MERS-CoV is being evaluated, in consultation with state and local health departments in the US.

Milder illness

• Fever and symptom of respiratory illness not necessarily pneumonia (cough, shortness of breath) AND a history of being in a healthcare facility as a patient, worker or visitor within 14 days before symptoms onset in a country or territory in or near the Arabian Peninsula in which recent healthcare-associated cases of MERS have been identified
• Fever or symptoms of respiratory illness not necessarily pneumonia (cough, shortness of breath) AND close contact with a confirmed MERS case while the case was ill.

The above criteria serve as guidance for testing; however, patients should be evaluated and discussed with public health departments on a case-by-case basis if their clinical presentation or exposure history is equivocal (e.g., uncertain history of health care exposure).

Confirmed Case

A confirmed case is defined when a person has laboratory confirmation of MERS-CoV infection. Confirmatory laboratory testing requires a positive PCR on at least two specific genomic targets or a single positive target with sequencing on a second.

Probable Case

A probable case is defined when a PUI has absent or inconclusive laboratory results for MERS-CoV infection who is a close contact of a laboratory-confirmed MERS-CoV case. Examples of laboratory results that may be considered inconclusive include a positive test on a single PCR target, a positive test with an assay that has limited performance data available, or a negative test on an inadequate specimen.

Notes:

Countries considered in the Arabian Peninsula and neighboring include: Bahrain; Iraq; Iran; Israel, the West Bank, and Gaza; Jordan; Kuwait; Lebanon; Oman; Qatar; Saudi Arabia; Syria; the United Arab Emirates (UAE); and Yemen.

Close contact is defined as: 

• Being within approximately 6 feet (2 meters) or within the room or care area for a prolonged period of time (e.g., healthcare personnel, household members) while not wearing recommended personal protective equipment (i.e., gowns, gloves, respirator, eye protection, or
• Having direct contact with infectious secretions (e.g., being coughed on) while not wearing recommended personal protective equipment (i.e., gowns, gloves, respirator, eye protection.
• Data to inform the definition of close contact are limited. At this time, brief interactions, such as walking by a person, are considered low risk and do not constitute close contact.

MERS-CoV Brief Update

Until now, according to WHO and affected countries’ health authorities, there are at least 87 laboratory confirmed cases of MERS-CoV in Seoul, South Korea since May 20, with 6 fatalities. Most cases were either acquired during hospitalization or through close personal contact (health care providers and family members) or with someone who was infected at the hospital. The lates on June 2015 there are currently 2,000 people under quarantine.

There is no travel restrictions into or out of South Korea. Temperature screening at International airports and entry ports is commonly exercised at country level.

While we are continuing our surveillance closely to provide regular updates, we encourage you all to to emphasize the following precaution you can take:

1. All travelers are advised to practice personal hygiene such as frequent hand washing, especially before eating or drinking.
2. Avoid touching your face with your hands while traveling.
3. Don’t start travel if you are ill.
4. If you happen to sit near a person with a persistent cough or looks ill, don’t hesitate to ask to be reseated.
5. See a doctor if you develop a fever and respiratory illness symptoms, such as cough or shortness of breath, within 14 days after you have been to an affected area or in close contact with an infected person.

How Much We Need Carbohydrate

The Dietary Guidelines for Americans recommends that carbohydrates make up 45 to 65 percent of your total daily calories. So, if you get 2,000 kilo calories a day, between 900 and 1,300 kilo calories should be from carbohydrates. That translates to between 225 and 325 grams of carbohydrates a day.

Do carbohydrates make you fat?

Eating too much will lead to weight gain, regardless of what foods you get your energy from. Yet while low carb diets have had much publicity, gram for gram carbohydrates contain less calories than fat, protein and alcohol:

• 1g carbohydrate contains 3.75 calories.
• 1g protein contains 4 calories.
• 1g fat contains 9 calories.
• 1g alcohol contains 7 calories.

Choosing Carbohydrates Wisely

Carbohydrates are an essential part of a healthy diet, and they also provide many important nutrients. Still, not all carbs are created equal. Here's how to make healthy carbohydrates work in a balanced diet:

• Start to put the good carbs into your body: Complex Starchy and fibrous carbs that have not been altered or processed
• Emphasize fiber-rich fruits and vegetables. Aim for whole fresh, frozen and canned fruits and vegetables without added sugar. Also, whole fruits and vegetables add fiber and water in bulk, which help you feel fuller on fewer calories.
• Choose whole grains. Whole grains are better sources of fiber and other important nutrients, such as selenium, potassium and magnesium, than are refined grains. Refined grains go through a process that strips out parts of the grain — along with some of the nutrients and fiber.
• Stick to low-fat dairy products. Milk, cheese, yogurt and other dairy products are good sources of calcium and protein, plus many other vitamins and minerals. Choose the low-fat versions, though, to help limit calories and saturated fat. And beware of dairy products that have added sugar.
• Eat more beans and legumes. Legumes, which include beans, peas and lentils, are among the most versatile and nutritious foods available. Legumes are typically low in fat; contain no cholesterol; and are high in folate, potassium, iron and magnesium. They also have beneficial fats and soluble and insoluble fiber. Because they're a good source of protein, legumes can be a healthy substitute for meat, which has more saturated fat and cholesterol.
• Limit added sugar. Added sugar probably isn't harmful in small amounts. But there's no health advantage to consuming any amount of added sugar. In fact, too much added sugar, and in some cases naturally occurring sugar, can lead to such health problems as tooth decay, poor nutrition and weight gain.
• Remember: If your goal is fat reduction, sugar is your worst enemy!

So choose your carbohydrates wisely. Limit foods with added sugars and refined grains, such as sugary drinks, desserts and candy, which are packed with calories but low in nutrition. Instead, go for fruits, vegetables and whole grains.

Carbohydrate

Carbohydrate is an organic molecules typically classified according to their structure. Structurally speaking, there are two types of carbohydrates: simple carbohydrate and complex carbohydrate.

Simple carbohydrates are smaller, more easily processed molecules known as mono- and disaccharides since they contain either one sugar molecule or two sugar molecules linked together and very few essential vitamins and minerals. Sugar is the simplest form of carbohydrates. Including table sugar, fruit juice, milk, yogurt, honey, molasses, maple syrup and brown sugar.

Complex carbohydrates, on the other hand, are called polysaccharides since they have more than two sugar groups linked together, packed with fiber, vitamins and minerals. Examples include Starchy carbohydrates - brown rice, baked and sweet potatoes, oatmeal, brown pastas and whole grains. And Fibrous carbohydrates include asparagus, broccoli, cauliflower, onions, mushrooms, spinach and peppers and can also be found in most varieties of dark green leafy vegetables.

Carbohydrates often get a bad rap, especially when it comes to weight gain. But carbohydrates aren't all bad. Because of their numerous health benefits, carbohydrates have a rightful place in your diet. Carbohydrates are necessary to your health, because every cell in your body uses them for energy. In fact, your brain can only use carbohydrates for energy.

Unfortunately, over-consumption of sugar, high-fructose corn syrup and other highly refined carbohydrates has been associated with a higher incidence of diabetes, cardiovascular disease, and even breast cancer. Eating refined carbs can, over time, result in almost uncontrollable sugar cravings. In fact, according to the World Health Organization, sugars and other simple carbohydrates are a leading factor in the worldwide obesity epidemic.

With the popularity of low-carb diets, many people are afraid to eat any carbohydrates. It is important to distinguish between the health-robbing effects of simple sugars and other carbs, and the health-giving properties of complex carbohydrates.

The Difference Between Complex Carbohydrate And Simple Carbohydrate

All carbohydrates form glucose when digested. Glucose is transported around the body via blood and taken into cells to be converted into energy.

The pancreas gland in your abdomen secretes the hormone insulin, which controls the uptake of glucose by your cells.

If you have any excess glucose, this is converted into glycogen – which is stored in the liver or in fat around the body. When your body needs more energy, a second hormone called glucagon is secreted by the pancreas. This converts the glycogen back into glucose, which is then released into your bloodstream for your cells to use.

This means the body's glucose (sugar) metabolism is a cycle of glucose, insulin and glucagon reactions.

• The slower the release of glucose and hormones, the more stable and sustainable the energy levels of the body.
• The more refined the carbohydrate, the faster the glucose is released into your blood. This can cause peaks and drops in your blood sugar level and less stable energy levels in the body.

 Complex carbohydrates provide a slower and more sustained release of energy than simple carbohydrates. Thus, they contribute to long-term good health, appetite control and sustained energy levels.

The chart below compares the glycemic response (i.e., the rise in blood glucose levels) between eating a high-GI food (glucose) and a low-GI food (beans). Notice how with glucose (red area), blood glucose rises quickly and peaks shortly after ingestion.

Tuberculosis

Major effort is needed related to tuberculosis (TB) that since three million out of an estimated nine million new TB cases were not getting the proper treatment. World tuberculosis awareness today declare it remains a top infectious killer. In 2013, TB is accounted for 1.5 million deaths across the world and the largest number of new TB cases occurred in South-East Asia and Western Pacific Regions, accounting for 56% cases globally.

What is tuberculosis? 

Tuberculosis is caused by Mycobacterium Tuberculosis that most often affect the lungs. It spreads from person to person through the air contact and can be transmitted through cough, sneeze or spit from an infected person.

Are you at risk?

It is very important to know your risk factors of tuberculosis as follows:

• All age groups are at risk but TB mostly affects young adults in their productive years 
• People with compromised immune system (i.e. people with HIV-positive) 
• Tobacco use greatly increases the risk of TB

What are the symptoms?
These are the common symptoms of TB:

• Cough with sputum and blood at times
• Chest pains
• Weakness
• Weight loss
• Fever
• Night sweats

The symptoms may be mild for many months even if you have developed active TB. To ensure for having tuberculosis you can have sputum smear microscopy test or other TB test. The test is important for further treatment.

Facts of Tuberculosis

• Tuberculosis (TB) is second only to HIV/AIDS as the greatest killer worldwide.
• In 2013, 9 million people fell ill with TB and 1.5 million died from the disease.
• In 2013, an estimated 550.000 children became ill with TB and 80 000 HIV-negative children died of TB
• Over 95% of TB deaths occur in low- and middle-income countries, and it is among the top 5 causes of death for women aged 15 to 44.
• TB is a leading killer of HIV-positive people causing one fourth of all HIV-related deaths.
• Globally in 2013, an estimated 480.000 people developed multidrug resistant TB (MDR-TB).
• The TB death rate dropped 45% between 1990 and 2013.
• An estimated 37 million lives were saved through TB diagnosis and treatment between 2000 and 2013.

Know your risk factors, and admit yourself to do TB test for preventive measure and treatment. Let’s celebrate World TB Day 2015 by actively take part in promoting awareness and take action to reduce the transmission of Tuberculosis around the world.

Tuberculosis is curable and preventable! 

Dengue Fever

Definition

Dengue Fever is a disease caused by the Dengue virus. The virus is primarily transmitted to human body by an infected female Aedes mosquito, more particularly Aedes Aegypti. Those mosquitoes typically breed in standing water of mostly man-made containers in or close to the home. Aedes aegypti is a daytime feeder; its peak biting periods are early in the morning and in the evening before dusk. Female Aedes aegypti bites multiple people during each feeding period.

Prevention

One of prevention is by killing mosquitoes through fogging and mosquito repellents. However it is not an absolute method of prevention since neither of these will affect the larvae stage. The most appropriate method to prevent dengue fever is by eradicating the larvae as follows:

• Drain water storage containers (tub, drum, etc) every week.
• Close water storage containers tightly after use to avoid any mosquitoes from entering and breeding.
• Change water in flower vases and pots every day.
• Discard or bury any plastic containers, bottles, cans, or any used items which could collect rainwater.
• In the event that it is not possible to drain the water weekly from reservoirs or storage containers, sprinkle larvacide (i.e. Abate powder) into the water to kill the larvae. Repeat this once every 2-3 months. 

Another alternative prevention is keeping larvae-eating guppy fish in the storage containers, and of course continuously and actively observe, monitor, and eradicate the larvae.

Meanwhile, there are some activities that might keep you and your family away from adult mosquitoes, include:

• Install mosquito nets on windows or other ventilation,
• Eliminate places for adult mosquitoes to hide, such as clothes hanging on the backs of chairs, doors, etc.
• Provides sufficient room ventilation and lighting.
• Use mosquito nets around bed when sleeping.

Measles

What is Measles? 

Measles is a highly contagious, serious respiratory disease caused by a virus. it is associated with children but can also be transferred to adults.  The measles virus normally grows in the cells that line the back of the throat and lungs.

What are the signs and symptoms of Measles? 

• High fever 10 to 12 days after exposure to the virus, and lasts four to seven days (38.3 C and above)
• Cough
• Runny nose
• Red and watery eyes
• Small white spots inside the cheeks
• Cough that may lasts for 10 days
• Skin rashes (Starts on the face below the hairline and upper neck and spreads up to hands and feet)

How is it transmitted? 

• The highly contagious virus is spread by coughing and sneezing 
• Close personal contact or direct contact with infected nose or throat secretions
• The virus remains active and contagious in the air or on infected surfaces for up to two hours
• It can be transmitted by an infected person from four days prior to the onset of rash to four days after the rash erupts 

Treatment & prevention

There is no specific antiviral treatment exists for measles virus.  However, good nutrition, adequate fluid intake and treatment of dehydration are very important to prevent severe complications of measles.  All children in developing countries diagnosed with measles should receive two doses of vitamin A supplements, given 24 hours apart. This vitamin is to prevent eye damage and blindness. Vitamin A supplements have been shown to reduce the number of deaths from measles by 50%.

The most effective preventive measure is vaccination, that is safe and inexpensive.  Hand washing and cough etiquette are also important to prevent the spread of measles. And it is encourage to avoid crowded places when outbreak occurs.