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All photographs—colour or black and white—should be , along with the required text and any supporting material for online publication. Please select Photograph as the article type. If a digital camera is used please set it to the highest possible quality setting and submit images as JPEG files. If you are using a film camera please submit an 8 × 11 inch glossy print to in the post. The entries will be judged by editors and there will be a £300 prize for winning entries. The deadline for entries is Nov 7, 2016. So share your photos with and : we look forward to looking at the stories you capture.
As a result of an unusual clustering of cases of microcephaly and Guillain-Barré syndrome, WHO declared the 2015–16 Zika nicotinic acetylcholine receptor outbreak in the Americas a “public health emergency of international concern”. As part of its strategic response to the outbreak, WHO is leading normative work to mitigate the potential impact on pregnant women, newborn babies, and other at-risk populations. Last week, WHO launched an updated version of its guidance on pregnancy care in the context of Zika virus infection. The guidance covers recommendations for preventing maternal Zika virus infection, antenatal care and management of women with infection, and care for all pregnant women with possible exposure to Zika virus through residence in or travel to an affected area.
Identification of the dead is fundamental for countless ethical and humanitarian reasons and a sometimes ignored legal obligation. Without identification, survivors are destined to the uncertainty of whether their loved ones are dead or alive, and children, spouses, parents, and siblings can suffer administrative, civil, and social repercussions. The deployment of pathologists and forensic scientists for the collection of medical and biological data from bodies—and from living relatives—to achieve identification, is a standard, quasi-automatic procedure in disaster settings. However, this procedure has not taken place for the victims of the Mediterranean sea crossings in the past years. Although the death toll is difficult to estimate, Italy, Malta, Greece, and Spain have buried in their cemeteries over 20 000 men, women, and children who died during crossings on crowded, unsafe, and frequently abandoned boats when fleeing from war. About 60% of these victims remain unidentified, yet no action has been taken.
Current WHO guidelines for the detection of meningococcal disease outbreaks in the meningitis belt in Africa define suspected meningitis as sudden onset of fever (>38·5°C rectal or 38·0°C axillary) and one of the following signs: neck stiffness, flaccid neck (infants), bulging fontanelle (infants), convulsion, or other meningeal signs. Although these signs are classic for meningitis, they were used when the predominant causal pathogen of these outbreaks was serogroup A (NmA). After widespread implementation of vaccination with MenAfriVac (NmA conjugate vaccine), the number of outbreaks caused by this strain has decreased with a relative or absolute increase in disease caused by other strains and other bacterial species. The change in epidemiology is likely to affect clinical presentation, and review of clinical management guidelines for the subregion is urgently needed. Because confirmation of the cause of most cases during these outbreaks is difficult due to resource constraints, lessons can be learnt from disease caused by similar strains in locations where resources for evaluation and monitoring are better. In a report from the UK, an outbreak of W135 was observed between July, 2015, and January, 2016, in 15 adolescents who did not have any direct epidemiological, temporal, or spatial links. All these patients presented predominantly with gastrointestinal symptoms. A clinical diagnosis of meningitis was confirmed from cerebrospinal fluid in only one of the 15 patients. Septicaemia was reported in ten of 15 patients, two patients had septic arthritis, two had pneumonia, and one presented with sore throat, fatigue, and lethargy. The outcome of illness was fatal in six of the 15 patients. All culture isolates were subsequently confirmed as W.2A (a surrogate marker for the hypervirulent sequence type 11 clonal complex), apart from one patient who had pneumonia (serotyped as NT/NT/NT). Laboratory-confirmed group W invasive meningococcal disease has increased in the UK from 19 cases in 2008–09 to 176 cases in 2014–15. The unusual presentation of invasive meningococcal disease caused by group W has also been reported in Chile, with eight fatalities in 14 cases.