Logistics navigating risky waters

Iran’s retaliatory airstrikes on US military bases in several Gulf Cooperation Council (GCC) countries, along with restrictions on cargo passing through the Strait of Hormuz, have disrupted global trade. Major carriers have ceased using this key route, which handles about 20% of global oil trade. Rerouting vessels around the Cape of Good Hope has added days to delivery times. Air freight costs have surged and capacity has tightened, affecting the delivery of important cargo, including some medical devices.

In the current situation, global research firm Fitch Solutions outlines three scenarios for the medical sector amid the ongoing Gulf conflict: A short-lived escalation would increase supply chain and logistics pressure for medical devices in GCC markets, with limited global impact. Disruption in the Strait of Hormuz would hike energy prices, raising manufacturing and distribution costs, particularly in Asia and Europe due to their reliance on imported energy.

Under a prolonged, large-scale conflict, disruptions would expand from regional to global, delaying capital equipment procurement and pressuring manufacturers’ margins. Extended disruption in the strait would make logistics challenges more structural, with persistent rerouting, reduced carrier presence in high-risk routes and tighter air cargo capacity affecting the global market. Import-reliant regions across Asia, the Middle East and Africa would face longer lead times, higher costs and more frequent shortages of critical components and finished devices.

Sustained high oil and LNG prices would further increase production and distribution costs, especially in Europe and Asia, while squeezing public funds and limiting healthcare budgets. Hospitals, particularly in emerging markets, may defer non-essential capital spending such as imaging upgrades while prioritizing essential supplies and maintenance. For manufacturers, rising input costs and ongoing upheavals would compress margins and push efforts to diversify supply chains, including more regional production and multisourcing to reduce reliance on key routes.

Escalating conflict disrupts humanitarian supply routes

Major aid groups continue to support war-affected populations, but ongoing conflict and blocked routes are delaying deliveries. Humanitarian organization Direct Relief  said escalating hostilities are straining health systems and limiting transport of supplies. Over the past year, it has delivered more than US$100 million in medical aid and grants to healthcare partners across the Middle East and neighboring countries.

As fighting continues and populations move, hospitals report rising patient demand. At the same time, fuel shortages, damaged infrastructure, and constrained supply chains are limiting care. Armed conflict places dual pressure on healthcare systems, increasing demand while reducing capacity due to damaged facilities and interrupted supply routes.

In the current Gulf conflict, facilities report fuel shortages affecting generators and essential equipment, limited medicines and supplies, and higher demand for trauma and surgical care. Services such as dialysis, oncology, maternal health, and immunization are also being affected. Mass displacement compounds the crisis as patient volumes rise.

Airspace restrictions and flight cancellations are delaying cargo routes used for humanitarian shipments, while key pharmaceutical transit hubs face operational issues. Maritime tensions are also affecting shipping through the Strait of Hormuz, according to Direct Relief.

Unstable transport routes often force aid groups to reroute shipments to keep medicines safe, traceable, and compliant with regulations. Continued instability could extend supply constraints beyond the conflict zone and affect neighboring humanitarian programs.

Direct Relief works with licensed providers and local partners across the region while maintaining medical stockpiles in Europe and the Middle East, allowing it to respond quickly when supply routes reopen.

Tensions fuel a surge of health threats

The World Health Organization (WHO) said the ongoing Middle East conflict is burdening health systems as injuries and displacement rise, attacks on healthcare continue, and public health risks grow.

Within ten days of the hostilities, casualties have risen sharply. Iran has reported thousands of deaths and injuries, while Lebanon has recorded hundreds of deaths and thousands of injuries. Israel has also reported multiple fatalities and injuries, with numbers expected to increase as the fighting continues.

The conflict is also affecting life-saving services. Since February 28, WHO has verified 18 attacks on healthcare in Iran, resulting in eight deaths among health workers. In Lebanon, 25 attacks have caused 16 deaths and 29 injuries. These incidents are reducing access to care when it is most needed.

Public health risks are increasing as displacement grows. More than 100,000 people in Iran have relocated, while up to 700,000 in Lebanon are internally displaced, many in crowded shelters with limited access to safe water, sanitation, and hygiene. This raises the risk of respiratory and diarrheal diseases, especially among women and children.

Environmental risks are also rising. In Iran, petroleum fires and damaged infrastructure have exposed communities to toxic pollutants that can affect air, water, and food safety.

Access to healthcare is becoming more limited. In Lebanon, 49 primary healthcare centers and five hospitals have closed following evacuation orders, reducing essential services. In the occupied Palestinian territory, movement restrictions are delaying ambulances and mobile clinics in the West Bank. In Gaza, medical evacuations remain suspended since February 28, while hospitals are buckling under pressure due to shortages of medicines, supplies, and fuel, which is being rationed for critical services.

Airspace restrictions have slowed the movement of medical supplies from WHO’s logistics hub in Dubai. More than 50 emergency supply requests, intended to support over 1.5 million people across 25 countries, are delayed, creating backlogs. Priority shipments include supplies for Gaza via Al Arish, Egypt, as well as Lebanon and Afghanistan.

The escalation comes as humanitarian needs in the Eastern Mediterranean were already high. About 115 million people require assistance, nearly half of the global total, while health emergency appeals remain 70% underfunded, according to WHO. It added that without stronger healthcare safeguards and funding, vulnerable populations and fragile health systems will continue to struggle.

Dr Rosnawati Binti Yahya

Spokesperson: Dr Rosnawati Binti Yahya, Consultant Nephrologist and Kidney Transplantation Physician, Sunway Medical Centre (SMC)

Chronic Kidney Disease (CKD) is often described as a “quiet disease”, one that progresses silently until damage is advanced. The worldwide prevalence of CKD shows that women develop the condition at a rate of 11.8% while men develop it at a rate of 10.4%.[1] The Malaysian data shows the same distribution pattern because women have a 14% prevalence rate slightly exceeding men at 12%.[2]

The gender gap is not always obvious in day-to-day practice. “What we consistently see is that the majority of CKD is still driven by metabolic conditions like diabetes and hypertension, and these affect men and women in fairly similar numbers,”explains Dr Rosnawati.

Diabetes and hypertension are biggest culprits

Up to 86% of CKD cases in kidney centres are caused by metabolic disease. The Malaysian Dialysis and Transplant 2023 Registry data shows that diabetes and hypertension are the main causes of kidney failure, accounting for 56% and 30% of cases respectively. [3] The two conditions operate in the background to gradually damage the kidneys through multiple years without showing any apparent signs.

What remains concerning is that so many people find out about their kidney condition too late. Many only discover they have CKD when kidney function has already declined significantly, sometimes just when dialysis becomes an immediate necessity.“This is why screening is important. The first three stages of CKD are usually asymptomatic. If you wait for symptoms, you are already late,” Dr Rosnawati emphasises.

Gender factor in autoimmune disease

While kidney disease can affect anyone, women are more like to experience autoimmune-related kidney conditions. One of the most common is lupus nephritis, a complication of systemic lupus erythematosus (SLE). Although rarer in men, the symptoms and kidney damage are often more severe when it occurs.

“SLE mainly affects women, with female-to-male ratios as high as 9 to 1.[4] When it involves the kidneys, women still make up most cases,” says Dr Rosnawati.

Oversight on symptoms

Dr Rosnawati shares one of the reasons CKD remains underdiagnosed, particularly among women, is that its symptoms are easily dismissed. Symptoms are frequently mistaken for everyday life or hormonal changes, such as persistent tiredness or fatigue that is usually blamed on being too busy with household, work or childcare; lethargy that is often dismissed as anaemia, menstrual symptoms or tiredness; frequent night-time urination which some women attribute it to weakened pelvic floor muscles after childbirth; and swelling in the legs, ankles or face, which may be dismissed as fluid retention.

“Women often normalize these symptoms. They assume it is stress, ageing, or hormones instead of kidney disease,” she says. However, she shares some red flag symptoms that could indicate CKD such as changes in urination (frequency, color, or foamy urine), loss of appetite or nausea or high blood pressure that is hard to control.

Blood test results can be misleading, especially for women. Creatinine levels, a primary indicator of kidney function, are directly affected by muscle mass. She urges women not to rely on numbers alone but to ask their doctor what those numbers really mean for them.

“Since women generally have less muscle than men, a ‘normal’ creatinine level might still mask early kidney issues. A reading of 90 may be fine for a large man, but in a petite woman, it could signal reduced kidney reserve,” explains Dr Rosnawati.

Female life stages that leave long-term imprint on kidney health

Pregnancy and menopause are two life events that can increase a woman’s risk of future kidney problems. Complications like preeclampsia and gestational diabetes indicate persistent vascular or metabolic issues, raising the risk of hypertension, proteinuria, and CKD two to four times. After menopause, lower oestrogen further reduces kidneys and blood vessels protection, potentially accelerating disease progression.

“Additionally, polycystic ovary syndrome (PCOS) has emerged as a significant but under-recognised risk factor. It is closely linked to insulin resistance, obesity, and metabolic syndrome. It can also lead to diabetes and high blood pressure earlier in life, both major causes of kidney damage over time,” Dr Rosnawati adds.

Dr Rosnawati stresses the importance of getting blood pressure and blood sugar tests every year. “Just because blood pressure or blood sugar normalises at one stage of life does not mean the risk disappears. Women need long-term follow-up, even if they feel well,” she says.

Early warnings and simple tests

For women, especially those with diabetes, high blood pressure, obesity, autoimmune disease, or a history of pregnancy complications, early screening for kidney disease is not optional, it is essential. Just three simple tests can catch trouble early:

• A blood test for kidney function
• A urine test for protein (preferably a urine albumin-to-creatinine ratio)
• A blood pressure check

“Protein in the urine is one of the earliest signs of kidney damage, yet many dipstick tests miss it. Early detection changes everything as there are so many treatment options available. With the right treatment, kidney decline can also be slowed dramatically,” says Dr Rosnawati.

“Our goal is preservation. If we can reduce the kidney decline from 10% a year to just 2%, many patients may never need dialysis,” she explains.

CKD develops quietly, often going unnoticed until it is advanced. Therefore, recognising the signs early and taking prompt action is important. For women who look after others, remember that your health is the foundation of the care you provide. Hence, prioritising your own health is essential, not selfish.

“Even if you feel fine, get checked. Do not wait for symptoms. If your blood tests are ‘normal’ but something still feels off, ask your doctor about your kidneys,” urges Dr Rosnawati.

*****
References:

[1] https://www.sciencedirect.com/science/article/pii/S2157171621000666

[2] https://nkf.org.my/wp-content/uploads/2018/09/nkf-may13_1.pdf

[3]https://msn.org.my/nrr/wp-content/uploads/2024/12/FinalChapter-2_HooiChoo-Najdah-Jasmine-v2_ong28-Oct-2024_v5.pdf

[4]https://www.openaccessjournals.com/articles/epidemiology-of-systemic-lupus-erythematosus-prevalence-incidence-and-risk-factors.pdf

Related: Nipah Virus triggers health alerts in Asia

The patient was a woman between 40 and 50 years old from Naogaon District. She initially experienced fever, headache, muscle cramps, loss of appetite, weakness, and vomiting. Her condition later worsened with excessive salivation, disorientation, and convulsions. On 27 January, she lost consciousness and was referred to a tertiary hospital. She was admitted on 28 January, samples were collected by the Nipah surveillance team, and she died the same day.

Following laboratory confirmation, an outbreak investigation team that included One Health stakeholders began field investigations on 30 January. Health authorities identified 35 contact persons, including household, community, and hospital contacts. Six contacts who developed symptoms provided samples for testing, and all tested negative for Nipah virus. As of 3 February, no additional cases have been detected, and all identified contacts remain under monitoring.

WHO said Bangladesh continues to report small Nipah virus outbreaks at different times of the year, with cases occurring most often between December and April. This period coincides with the harvesting and consumption of raw date palm sap. Bangladesh reported its first Nipah virus infection in 2001 and has recorded human cases almost every year since. In 2025, the country reported four laboratory-confirmed fatal cases.

The Ministry of Health and Family Welfare has implemented public health measures in response to the case. WHO assessed the overall public health risk posed by Nipah virus as low at the national, regional, and global levels. The organization also said the risk of international spread remains low.

Nipah virus infection is a zoonotic disease that spreads to humans through infected animals such as fruit bats or through food contaminated with saliva, urine, or excreta, and it can also transmit between people through close contact. Fruit bats, also called flying foxes of the Pteropus species, serve as the natural hosts. The incubation period usually ranges from three to 14 days, though rare cases have extended up to 45 days. Laboratory confirmation relies on a combination of tests during acute and recovery phases, including RT-PCR from bodily fluids and antibody detection using ELISA. Human infections range from no symptoms to acute respiratory illness and fatal encephalitis. Early symptoms include fever, headache, muscle pain, vomiting, and sore throat, followed in severe cases by dizziness, altered consciousness, neurological signs, pneumonia, acute respiratory distress, seizures, and rapid progression to coma within one to two days. – WHO

Kerala cases highlight localized risk

Recent Nipah virus (NiV) cases in India have once again put the disease in the public eye, despite outbreaks remaining largely localized. The latest report from the Indian government confirmed two NiV cases since December last year, with all contacts of the affected individuals quarantined and tested. Previously, between May 17 and July 12, 2025, Kerala state reported four confirmed cases, including two deaths, across Malappuram and Palakkad districts, marking the first-ever detection in Palakkad. Health officials said none of the cases appear linked to one another, suggesting independent spillover events from fruit bats, the natural reservoir of NiV.

According to the World Health Organization (WHO), NiV is a bat-borne zoonotic virus that can spread to humans through contact with infected animals such as bats or pigs, consumption of contaminated food, and, less commonly, direct human-to-human contact. Symptoms range from fever, headache, and respiratory issues to severe neurological complications, including encephalitis, seizures, and coma. Fatality rates in outbreaks across South and Southeast Asia have ranged from 40 to 100 percent, depending on healthcare access and early intervention.

Kerala has experienced nine outbreaks since 2018, with varying severity. The 2025 cases follow a pattern observed in previous years, though authorities emphasize that the overall risk to the broader national and regional population remains low. Despite the limited geographic spread, recurring spillover events underscore the ongoing risk in Kerala and highlight the potential for NiV to emerge in other Indian states where fruit bats have tested positive for the virus.

The Kerala state government implemented immediate public health measures, including emergency coordination meetings, contact tracing of 723 individuals, route mapping of confirmed cases, and special alerts for hospitals in affected districts. Authorities also advised the public to limit non-essential visits to healthcare facilities and follow strict hygiene protocols.

WHO continues to coordinate with Indian health authorities, stressing awareness of risk factors, preventive measures, and early case detection. With no licensed vaccine or treatment available, WHO recommends boiling fresh date palm sap, thoroughly washing and peeling fruit, avoiding areas where bats roost, practicing good hand hygiene, and using protective measures in healthcare and animal-handling settings.

Recent media coverage of NiV reflects concerns about its high mortality and potential to spread through bat-to-human and limited human-to-human transmission. Even though the risk of international spread is considered low, many Asian countries are keeping a close watch on the potential spread of the disease. Several countries have begun taking steps to boost prevention measures, including rigid airport entry screenings modeled after Covid-19 protocols, along with ongoing public hygiene campaigns, to minimize the risk of infection among their populations.

Thailand tightens airport screening; no reported cases

Over in Thailand, the country’s Public Health Ministry has confirmed no Nipah cases in the country but has increased screening measures for air passengers arriving from India’s West Bengal state. Dr Sophon Iamsirithavorn, deputy permanent secretary for public health, and Dr Jurai Wongsawat, director-general of the Department of Disease Control, said passengers from West Bengal will undergo body temperature checks, provide personal and travel information, and receive health warning cards after flights land at Suvarnabhumi, Don Mueang, and Phuket airports. Passengers developing symptoms are advised to call the 1422 hotline for quarantine and verification. All suspected cases tested so far have been negative.

Dr Jurai said these measures apply only to West Bengal, as Indian authorities have contained the outbreak within the state. Thai health officials also noted that while some fruit bats in Thailand carry a strong strain of the virus, the greater risk comes from infected travelers. Authorities have banned pig farms in areas where the virus has been detected in bats to prevent transmission to humans. There is currently no vaccine or treatment for NiV infection.

Screening continues for visitors from affected countries, focusing on those with fever, respiratory symptoms, or recent travel to outbreak areas. Recent outbreaks in Bangladesh and India are under control, with no evidence of the virus in nearby countries.
As per recent reports, Health officials at Suvarnabhumi Airport have not detected any symptomatic passengers. Airport director Kittipong Kittikajorn said the measures follow international standards, allowing early detection while minimizing disruption. Authorities are also reviewing travel histories for arrivals from designated surveillance areas. Enhanced screening will continue to prevent possible importation of NiV into Thailand.

Nipah virus is a highly pathogenic zoonotic RNA virus that spreads through fruit bats, infected pigs, and human-to-human contact. It can cause severe respiratory illness and fatal encephalitis, with death rates ranging from 40 to 75%. The virus was first detected in humans in Malaysia in 1998 and later in Singapore in 1999, with more than 750 cases confirmed worldwide. Outbreaks have occurred in Bangladesh, India, Malaysia, the Philippines, and Singapore, with seasonal outbreaks in Bangladesh from December to May during date palm sap harvesting, and most infections in India reported in Kerala, often linked to hospital-based transmission. Fruit bats that carry the virus are found across Asia, the South Pacific, and Australia.Symptoms typically appear four to 14 days after infection and include fever, headache, cough, sore throat, and difficulty breathing. Severe cases may lead to brain swelling, confusion, drowsiness, seizures, and coma within 24 to 48 hours. People can become infected through direct contact with infected animals, consuming food or drinks contaminated by animals, or close contact with the body fluids of an infected person. Initial animal-to-human transmission, or spillover, often occurs through contaminated fruit or raw date palm sap, and once infected, the virus can spread between humans.

— Source: CDC

Taiwan moves to upgrade NiV alert level; warns against fruit bats

Taiwan has also taken precautionary measures in response to the Kerala outbreak. The country’s Health Ministry recommended upgrading NiV to a Category 5 infectious disease, citing growing concern after the recent cases in India.

Taiwan’s Center for Disease Control and Prevention (CDC) Deputy Director General Lin Min-Cheng said fruit bats are the primary carriers, adding that harvesting date palm sap poses a particular risk if consumed raw, as bats are attracted to the sap at night and may contaminate it.
Meanwhile, officials advised avoiding travel to areas with active NiV transmission, maintaining good hygiene, washing fruit thoroughly, and using protective equipment such as gloves, masks, and clothing when handling sick animals. Travelers should exercise caution when drinking coconut juice or consuming fruit that may have been contaminated by bats.

Hospitals are urged to enforce strict infection control measures to prevent exposure to the blood, bodily fluids, or waste of infected patients. Healthcare workers and visitors should clean and disinfect their hands with soap or alcohol-based sanitizers after contact.

Cambodia urges vigilance, practical preventive measures

On its end, Cambodia has likewise increased surveillance while confirming the presence of the virus in local bat populations. The Ministry of Health said the country has not detected any human cases but emphasized vigilance, noting the virulence of the disease. To prevent infection, Cambodia’s health authorities advised frequent handwashing, avoiding contact with bats, rodents, and infected swine, and maintaining hygiene after visiting farms. Suspected animal outbreaks should prompt immediate quarantine, with infected animals culled and properly buried or cremated. Protective gloves and clothing should be used when handling sick animals, animal waste, or infected people, including during slaughter, disposal, and direct contact.

Philippines ready to monitor cases; advises well-cooked food

The Philippines has confirmed its readiness to test for NiV and monitor potential cases. According to news reports, Health Assistant Secretary Albert Domingo said the country has experience handling the virus, explaining that 17 cases were reported in Sultan Kudarat in 2014. Sultan Kudarat is a province in the SOCCSKSARGEN region in Mindanao. Domingo said that bats are the most common source of the virus, but other animals, including pigs and horses, can also become infected and transmit it. He urged the public to consume meat approved by the National Meat Inspection Service (NMIS) and to always cook food thoroughly.

WHO warns against respiratory virus

As the cold season takes hold in Asia, the World Health Organization (WHO) has reported a rise in acute respiratory infections, highlighting human metapneumovirus, or hMPV, alongside other common respiratory pathogens. In its early January 2025 Disease Outbreak News, WHO noted that seasonal influenza, respiratory syncytial virus, and mycoplasma pneumoniae are driving increased infections across several Asian countries, as well as in parts of Central America, the Caribbean, and Africa.

hMPV is not a new virus. First identified in 2001, it typically circulates during the cold season and produces symptoms similar to the common cold. In some cases, however, it can lead to more severe illness such as bronchitis or pneumonia. WHO stated that infants, the elderly, and people with weakened immune systems are most vulnerable to complications.

To reduce risk, WHO advised people in cold-season regions to take standard precautions, particularly for those at higher risk. Individuals with mild symptoms should stay home and rest to avoid spreading infections, while those with severe or complicated symptoms should seek prompt medical care. Preventive measures such as wearing masks in crowded or poorly ventilated spaces, covering coughs and sneezes, frequent handwashing, and keeping vaccinations up to date in consultation with healthcare providers were also recommended.

Super flu: The strain that causes the health panic

A new flu variant, H3N2 subclade K, is a mutation of the common influenza A subtype. According to the Cleveland Clinic, flu symptoms usually appear suddenly and can include fever, chills, body aches, cough, headache, sore throat, nasal congestion, and tiredness. In children, symptoms may also include diarrhea or vomiting.

The Philippines prompts calls for vaccination

The Philippines is experiencing a rise in cases of the so-called “super flu,” according to the Department of Health (DOH). As of December 2025, 77 cases of influenza A(H3N2) subclade K were confirmed nationwide, part of 326 influenza A infections successfully sequenced from January to November 2025. Of 92 total A(H3N2) cases, subclade K accounted for nearly 84%.

Related: New flu variant detected in the Philippines; no immediate threat

The National Capital Region (NCR) recorded the highest number of subclade K cases with 23, followed by the Calabarzon Region and the Cordillera Administrative Region, each with 16.

Authorities said the increase is not a cause for alarm, adding that most patients have recovered and no deaths were reported. They clarified that super flu is a variant of influenza A, not a new disease, and its symptoms such as cough, cold, fever, and body aches are similar to those of the common flu.

Health experts warned that subclade K can be more aggressive due to mutations that may lead to serious complications affecting the heart and brain. The WHO’s Risk Assessment, as of December 10, 2025, indicated no evidence of increased severity among subclade K cases. The WHO also emphasized that vaccination remains effective in preventing severe illness and hospitalization.

Infectious disease specialist Dr Rontgene Solante urged the public to get updated flu vaccines to improve protection, particularly for the elderly and people with comorbidities, noting that vaccines should be available by February or March. He also encouraged people to wear masks in high-risk areas as an added precaution.

Indonesia up in arms against “Super Flu” spread

Across Indonesia, health authorities are on high alert on report of cases of the “super flu”. The H3N2 influenza A subclade K, first detected globally in late 2025, has prompted airports, cities, and provinces to tighten monitoring and precautions.

At Bali’s I Gusti Ngurah Rai International Airport, thermal scanners and thermo guns from the COVID-19 era have been reactivated, and medical staff are ready to assess passengers showing symptoms. Airport management has briefed personnel on the virus and coordinated closely with the Health Ministry to prevent potential outbreaks.

In Jakarta, authorities are monitoring travelers returning from the New Year holiday, particularly those arriving from abroad. Certain cities have implemented strict screening procedures, including temperature checks and early detection measures, while strengthening hospitals and community health centers to handle respiratory cases. Preventive measures are also being encouraged.

It has been reported that between August and December 2025, Indonesia confirmed 62 cases across eight provinces, with East Java, South Kalimantan, and West Java recording the highest numbers. Women and children made up most of the cases. The country also reported its first death linked to subclade K in a Bandung hospital, highlighting the need for ongoing vigilance and preventive measures as authorities continue monitoring the virus.

The revised EU regulation  eliminates the last intentional uses of mercury and contributes to the goal of a toxic-free environment. It requires dental filling materials to be mercury-free, except in cases deemed medically necessary by a practitioner. Member States needing more time to adapt can apply a temporary derogation until 30 June 2026.

The regulation also covers other mercury-containing products, including certain types of lamps, which must be phased out by 31 December 2025 or 2026 depending on the category, to be replaced by less toxic alternatives like LEDs. Guidance on reducing mercury emissions from crematoria will be published by the European Commission (EC) by the end of 2025.

Mercury, a highly toxic substance used in industrial processes and various products, poses serious risks to human health and the environment. To further restrict its use in the EU, the EC adopted a proposal on 14 July 2023 to revise the Mercury Regulation.

The revised regulation builds on the existing 2017 Mercury Regulation, which covers the full lifecycle of mercury, from primary mining to final disposal of mercury waste.

Meanwhile, at the Minamata Convention, several countries, including the US, have pushed for a global ban on mercury dental fillings by 2030. US Health Secretary Robert F. Kennedy Jr. raised the concern on the continued use of mercury in dentistry despite available safe alternatives.

Mercury, recognized by the World Health Organization (WHO) as a major public health hazard, has already been restricted in some nations, prohibiting its use in fillings; however, others continue to allow its use.

A few African nations proposed a stricter approach, calling for a ban on producing, importing, and exporting mercury-based dental fillings starting in 2030. Some countries, including Britain, India, and Iran, opposed the move, citing costs and the durability of alternatives.

The Minamata Convention, in force since 2017, requires signatories to gradually eliminate mercury in dental applications while addressing safe disposal.

Flu rages across Asia, schools suspend classes

In Asia, reports of influenza cases are rising. For countries like the Philippines, it is the downside of the incoming holiday season when the weather turns cooler, while for others like Thailand, the rainy season brings similar health concerns. It is, however, apparent that viral illnesses remain health threats that need to be addressed, managed, and treated.

In the Philippines, onsite classes have been suspended in Metro Manila amid a rise in flu-like illnesses. The Department of Education (DepEd) in the National Capital Region (NCR) has halted face-to-face classes in public schools on October 13 and 14 due to an increase in influenza-like illnesses among students and staff. Several major universities across Metro Manila have also declared health breaks or temporarily shifted to online learning as flu and influenza-like cases spread through campuses.

The Department of Health (DOH) clarified that there is currently no outbreak or epidemic in the NCR. Health Secretary Teodoro Herbosa explained during a public hearing that the rise in flu-like cases remains within expected levels for the season, or the “BER” months. He said there are around 133,000 recorded cases so far, still below last year’s 135,000. Herbosa noted that influenza-like illnesses can be caused by different viruses and are common during the colder months leading to the year’s end. He reminded the public that the ongoing increase is part of the regular flu season cycle.

Japan is also facing a flu surge, with an unusually early and severe influenza season prompting health authorities to declare a nationwide epidemic after infections shuttered more than a hundred schools.

Related: Japan’s flu cases surge; travel warnings and treatment options take focus 

The Ministry of Health, Labor and Welfare reported over 6,000 influenza cases from around 3,000 medical institutions as of October 10, surpassing the epidemic threshold.

Okinawa and Tokyo are currently reporting the highest infection rates. Surveillance data show Okinawa averaging more than 12 patients per institution, while Tokyo and Kagoshima have also seen sharp increases. The flu season, which typically begins in late November, has arrived roughly five weeks early.

Reports indicate that more than 135 schools, kindergartens, and childcare centers have temporarily closed in the past two weeks, with one Yamagata school suspending classes after most of its pupils fell ill. Nature also reported that 287 patients have been hospitalized so far, more than half of them children under 14. Hospitals across Japan are seeing crowded outpatient departments and rising demand for antiviral treatments. Experts are urging vaccination, mask use in crowded places, and early medical consultation. Health officials have yet to release details on which influenza strains are circulating but warned that Japan’s early outbreak could spread to other parts of Asia and Europe in the coming weeks.

Meanwhile, Thailand earlier cautioned its population against rising influenza, respiratory syncytial virus (RSV), and dengue cases at the onset of the rainy season. The country’s Public Health Ministry has raised an alert over the rise in cases, with children identified as the most vulnerable group. The warning follows a marked increase in respiratory illnesses recorded between September 7 and 13.
Health officials reported 30,055 new influenza cases and 3,454 new RSV infections during the week, pushing the total influenza tally since January to more than 555,000 cases and 59 deaths. Data from the Department of Disease Control show that flu infections are most common among children aged 5 to 9, while RSV predominantly affects those aged 0 to 4.

Influenza usually presents with high fever, chills, muscle pain, and dry cough, while RSV can cause more severe breathing difficulties and wheezing in younger patients. Officials are urging the public to remain cautious as the rainy season continues to drive viral spread. Dr. Direk Khampaen, Deputy Director-General of the Department of Disease Control, advised wearing masks in crowded places, frequent handwashing, avoiding close contact with sick individuals, and keeping ill children at home to limit transmission.

Malaysia: cases, lessons and expert advice

Over in Malaysia, thousands of students have been reported to be affected by the flu. Recently, an estimated 6,000 students have contracted influenza, prompting the temporary closure of some schools for safety reasons, according to an education ministry official. Director-General Mohd Azam Ahmad said on October 13 that the ministry was drawing on its experience from the Covid-19 pandemic to manage the situation. He added that schools had been advised to enforce preventive measures, including mask use and minimizing large gatherings among students.

While he did not specify the number of schools affected, infections have been confirmed in several parts of the country. The Health Ministry recently reported a sharp increase in influenza clusters, rising to 97 nationwide from 14 the previous week, with most occurring in schools and kindergartens.

By figures, influenza affects an estimated 5 to 15% of the population each year, leading to thousands of severe illnesses and deaths. Though many regard the flu as a seasonal inconvenience, it remains a significant public health concern responsible for millions of serious cases and annual fatalities worldwide.

Dr. Megat Razeem Bin Abdul Razak, Consultant Physician, Respiratory Physician, and Interventional Pulmonologist, as well as Dr. Noor Zehan Binti Abdul Rahim, Consultant Paediatrician and Paediatric Respiratory Specialist from Sunway Medical Centre, Sunway City (SMC), provide insights into how influenza affects adults and children differently and highlight the importance of proactive measures to curb its spread.

According to Dr. Megat, cases often spike during school holiday terms when more Malaysians return from overseas, bringing the virus home. With flu spreading easily through air droplets and close contact, places like schools, offices, and public transport have become hotspots for infection.

Unlike the common cold, influenza hits harder, bringing high fever, sore throat, body aches, and extreme fatigue. “For most, it’s unpleasant but manageable. But for the elderly, pregnant women, young children, and those with chronic conditions like asthma or heart disease, it can turn serious fast,” says Dr. Megat. Complications like pneumonia and respiratory failure can be life-threatening, making early treatment critical.

The challenge is that flu symptoms often mimic COVID-19 and other viral infections. “That’s why testing is important for the right diagnosis,” Dr. Megat explains. Warning signs of severe flu include a fever lasting more than three to four days, dehydration, nausea, vomiting, or diarrhea. “Antiviral medication works best within 48 hours. After five to seven days, complications like bacterial pneumonia can set in,” he warns.

Children at greater risk

Influenza can strike anyone, but young children, especially those under five, are among the most vulnerable. Their immune systems are still developing, making them more prone to severe symptoms compared to older family members. “Influenza can progress rapidly in children, which is why early intervention is crucial to prevent long-term complications that may impact their future lung function,” warns Dr. Noor Zehan.
Severe flu cases in children can lead to pneumonia, dehydration, and, in rare cases, infections affecting the brain or heart, such as encephalitis or myocarditis. Symptoms like high fever, body aches, cough, and fatigue should never be dismissed as just another childhood illness. “If symptoms persist beyond 48 hours or fever doesn’t subside with medication, parents should seek medical attention immediately,” she advises. Difficulty breathing, persistent vomiting, and signs of dehydration are red flags that require urgent care.

Flu vaccination to prevent serious illness

Despite its effectiveness, flu vaccination is often misunderstood. “The flu vaccine is safe and recommended for children as young as six months old,” affirms Dr. Noor Zehan. “It significantly reduces the risk of severe illness and hospitalisation.” She urges parents to ignore myths that the vaccine causes the flu. “It contains inactivated or weakened virus strains, meaning any mild symptoms post-vaccination are part of the body’s natural immune response.”

Beyond immediate flu risks, repeated influenza infections can have long-term effects. “Repeated inflammation from the flu can increase a child’s risk of developing asthma in the future,” warns Dr. Noor Zehan. Children typically experience up to six upper respiratory tract infections per year, but frequent, severe infections may indicate a higher risk. “Regular flu vaccinations and proper asthma management are essential in reducing this risk.”

“Vaccination remains the best defence,” says Dr. Megat. “Fortunately, my patients cooperate in getting vaccinated, and I’m glad awareness has grown, especially after Barbie Hsu’s passing. I’m also encouraged by the government’s initiative to provide vaccines for the elderly and high-risk groups.”

For frequent travellers, particularly to winter destinations, extra precautions are key. Dr. Megat recommends annual vaccination and advising doctors about travel plans, as flu strains vary by region. “Practicing good hand hygiene and avoiding crowded places whenever possible is essential,” he adds. Wearing masks, maintaining a healthy lifestyle, and carrying hand sanitisers can further reduce infection risk.

Protecting children in schools and homes

Prevention must start early, with schools and daycare centres being common flu hotspots. “Schools should encourage regular handwashing, ensure good ventilation, provide nutritious food, and arrange outdoor activities to strengthen children’s immune systems,” suggests Dr. Noor Zehan. Teaching children to cover their mouths when sneezing and washing hands frequently can help reduce spread.

Parents should also remember that flu can spread before symptoms appear, making prevention even more critical. Dr. Noor Zehan says, “Protecting ourselves and our children from the flu is a shared responsibility. Prevention is always better than cure.”

For fans of Korean dramas (K-dramas), the protagonists — their favorite actors or “biases” — often seem to embody our fantasies of a perfect world, where a perfect relationship leads to a perfect life. But what if these K-drama heroes are actually struggling with illness or facing personal hardships in real life? That realization could break the hearts of their devoted fans.

Popular K-drama actor Lee Dong-gun, known for his roles in Lovers in Paris, Sweet 18, Stained Glass, and Hello Mr. Right, recently opened up about facing a serious health challenge. The 45-year-old actor and singer revealed during his appearance on SBS’s My Little Old Boy that he has been diagnosed with ankylosing spondylitis, a chronic inflammatory disease that affects the spine and can cause bones to fuse over time. The revelation came after Lee sought medical help for persistent eye pain and recurring uveitis, an inflammation of the middle layer of eye tissue. Tests later showed severe inflammation in his sacroiliac joint, confirming the diagnosis.

What is AS?

According to the Mayo Clinic, ankylosing spondylitis, also called axial spondyloarthritis, is an inflammatory disease that can cause the bones of the spine to fuse, leading to stiffness, reduced flexibility, and a hunched posture. In severe cases, it can also affect the ribs and make deep breathing difficult. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIH) reports that the condition may extend beyond the spine to other joints such as the hips, knees, and ankles. The Spondylitis Association of America notes that rheumatologists typically diagnose the disease through a combination of X-rays, blood tests (including HLA-B27), and a detailed review of the patient’s medical and family history.

The World Health Organization (WHO) stated that the prevalence of ankylosing spondylitis varies across regions, affecting about 23.8 per 10,000 people in Europe, 16.7 in Asia, 31.9 in North America, 10.2 in Latin America, and 7.4 in Africa. WHO also projects that cases of ankylosing spondylitis and other musculoskeletal disorders could rise by at least 50% between 2020 and 2050.

Ankylosing spondylitis is considered a relatively rare condition, affecting roughly one in every 1,000 people, according to Harvard Health. Although its exact cause remains unclear, it often runs in families, suggesting a genetic link. The disease most commonly develops in otherwise healthy young men, who are about ten times more likely to be affected than women. While symptoms typically appear between the ages of 20 and 40, cases can also occur in children.

Tell-tale signs

Screengrab from SBS Entertainment

As the saying goes, the eyes are the windows of the soul—and often, of one’s health. For actor Lee Dong-gun and others living with ankylosing spondylitis, inflammation can extend beyond the spine, most commonly affecting the eyes. According to the National Institutes of Health (NIH), the disease usually begins in early adulthood and can cause recurring back pain, stiffness, and loss of flexibility. Some patients, aside from uveitis, or eye inflammation, also suffer with skin conditions like psoriasis and gut problems such as inflammatory bowel disease. Other symptoms include fatigue, joint pain in the ribs or knees, and difficulty taking deep breaths. Health direct Australia adds that the pain and stiffness typically last for more than three months, worsen at night or during rest, and improve with physical activity.

Risk factors

Ankylosing spondylitis can be influenced by several risk factors. The World Health Organization (WHO) reports that the condition usually begins in late adolescence or early adulthood and occurs more frequently in men. The National Institutes of Health (NIH) explains that heredity plays a significant role, as those with a family history of the disease are more prone to developing it. Most patients experience symptoms before the age of 45, though it can also appear in childhood or adolescence. Individuals with Crohn’s disease, ulcerative colitis, or psoriasis face an increased likelihood of developing ankylosing spondylitis.

Treatment and management

There is currently no cure for ankylosing spondylitis, but proper treatment can help ease symptoms and slow the disease’s progression. The Spondylitis Association of America (SAA) states that while no single therapy works for everyone, medications, particularly newer biologic drugs, have shown promise in reducing inflammation and potentially delaying spinal damage. The National Institutes of Health (NIH) recommends a combination of exercise, physical or occupational therapy, and pain- or inflammation-relieving medications to maintain mobility and posture. The Asia Pacific League of Associations for Rheumatology (APLAR) also advises practical self-care measures, such as using hot or cold pads, maintaining good posture, choosing a medium-firm bed, limiting pillow use, quitting smoking, and wearing orthotics for foot or heel discomfort.

From cultural relevance to breaking the stigma

In many countries, tattoos are seen as fashion statements and personal expression, especially among the youth. While reflecting social trends that value individuality, they also carry cultural weight, marking honor, rites of passage, and connections to heritage. Designs often symbolize identity and tradition, showing that tattooing is both a matter of style and a way of preserving collective memory.

Nevertheless, in some cultures, tattoos still carry a stigma due to their association with underground circles. The recent landmark ruling in South Korea marks a step toward breaking that perception.

The country has lifted a decades-old restriction on tattooing, passing the Tattooist Act [1] to legalize the practice by nonmedical professionals for the first time in 33 years. Approved by an overwhelming majority in the National Assembly, the law removes tattooing from its long-standing legal gray zone, where thousands of artists had operated without protection despite its popularity. It overturns a 1992 Supreme Court ruling that classified tattooing as a medical procedure limited to licensed doctors.

Under the new system, aspiring tattooists must pass a national exam and obtain a license, while meeting requirements for hygiene training, recordkeeping, and parental consent for minors. Semi-permanent makeup is included in the new definition of tattooing acts, though tattoo removal remains restricted to medical professionals.

Lawmakers described the measure as a way to safeguard public health while granting legitimacy to tattooists, and industry leaders welcomed it as a historic moment that could bring South Korea’s tattoo culture to the global stage. The law will take effect after a two-year preparation period, with transitional provisions for existing practitioners.

Meanwhile, the Ministry of Health and Welfare has indicated that doctors, oriental medicine practitioners, and dentists may still be allowed to perform tattoos without a license under future ordinances.

Tattoo bias in the workplace and other sectors

The workplace [2] remains one of the most visible arenas where tattoo stigma endures, often influencing hiring decisions and career advancement. While tattoos are increasingly accepted, perceptions vary across generations, with some employers still reluctant to hire candidates who “get inked”.

Research suggests that in fields such as finance or corporate services, customers and clients may view tattooed employees as less professional or trustworthy, adding another layer of bias that workers must navigate.

In healthcare, the stigma takes a different form. People with tattoos are often subject to a temporary waiting period before donating blood [3] not because tattoos make them ineligible, but because of the potential risk of blood-borne infections introduced during the tattooing process. Even with modern hygiene practices, unsterilized needles can transmit viruses such as Hepatitis B, Hepatitis C, and HIV.

To safeguard recipients, blood services [4] impose a three-month deferral, allowing time for any potential infections to become detectable. Although all donations are screened, no test is completely foolproof, making the precautionary window essential.

This medical caution, while rooted in safety, contributes to the broader perception of tattoos as a health risk.

Studies, regulations target tattoo ink risks

A new study has found bacterial contamination in about 35% of commercial tattoo and permanent makeup inks sold in the US, raising concerns about infection risks.

The research [5] , published in Applied and Environmental Microbiology by the American Society for Microbiology, reported the presence of both aerobic and anaerobic bacteria in sealed and unopened ink bottles. It is the first study to confirm anaerobic bacteria in tattoo inks.

Corresponding author Seong-Jae “Peter” Kim, a microbiologist with the US Food and Drug Administration’s National Center for Toxicological Research in Arkansas, said the results suggest contaminated inks could be a source of infection once injected into the skin. He noted that product labels claiming sterility did not guarantee the absence of bacteria.

Researchers tested 75 tattoo inks from 14 manufacturers, using oxygen-rich incubators to detect aerobic bacteria and oxygen-free anaerobic chambers to identify anaerobes. About one-third of the products showed contamination, regardless of brand or labeling.

Kim said tattoo-related complications have increased alongside the practice’s rising popularity, with microbial infections only one part of the risk. He added that immunologic complications, such as allergic reactions, and toxic responses remain significant concerns.

While the US study points to microbial risks, regulatory responses are also emerging abroad. In Karnataka, India, Health Minister Dinesh Gundu Rao announced plans to regulate tattoo parlors [6] after the state Food Safety Department found 22 types of metals in tattoo ink samples. The government will also write to the Centre seeking national guidelines and push for tattoo inks to be classified as cosmetic products to ensure tighter oversight.

Rao said the regulations aim to address health risks posed by heavy metals and microbial contamination, which experts warn can enter the body through the skin and cause diseases. The state government is also considering inspections to enforce compliance and prevent unsafe inks from entering the market.

Together, the US findings and Karnataka’s regulatory measures underscore a growing international focus on tattoo ink safety, an issue gaining urgency as tattooing continues to expand in popularity worldwide.

Mixed evidence emerges on tattoos and cancer risk

Along the same vein, researchers from the University of Southern Denmark, working with colleagues from the University of Helsinki, have reported evidence that tattoo ink may increase the risk of skin and lymphoma cancers. The study [7] based on data from more than 5,900 Danish twins, found that tattooed individuals were more frequently diagnosed with these cancers compared to those without tattoos.

The team explained that tattoo ink does not remain confined to the skin but can migrate to the lymph nodes, a vital part of the immune system. Once there, the particles may trigger chronic inflammation, which over time could promote abnormal cell growth. Henrik Frederiksen, a clinical professor at the University of Southern Denmark, said their observations suggest that the immune system may treat ink particles as foreign substances, placing a constant strain on the body’s defenses.

Using twin data allowed researchers to better isolate the impact of tattoos by controlling for shared genetic and environmental factors. Jacob von Bornemann Hjelmborg, professor of biostatistics at the university, noted that this provided a stronger framework to examine whether tattoos themselves influence cancer risk.

The study also found that tattoo size was a significant factor. Individuals with tattoos larger than the palm of a hand had nearly three times the rate of lymphoma compared to those without tattoos, even after adjusting for age and the length of time since the tattoo was applied.

According to assistant professor Signe Bedsted Clemmensen, the findings suggest that the larger the tattoo and the longer it has been in place, the more ink accumulates in the lymph nodes, warranting further investigation into its long-term effects.

While the study did not identify a clear link between specific ink colors and cancer risk, researchers noted that previous studies have associated certain pigments with allergic reactions and other health issues. They emphasized the need for further research at the molecular level to determine how tattoo particles interact with the immune system over decades.

The Danish findings are reinforced by a separate Swedish study published in 2024, which also observed a link between tattoos and lymphoma. Researchers stressed that, given the growing popularity of tattoos, already common among younger generations, it is important to deepen understanding of their possible long-term health risks.

However, another study offers a contrasting perspective, suggesting that individuals with multiple tattoo sessions may face a lower risk of melanoma, or skin cancer.

Led by Jennifer Doherty of the University of Utah and published in the Journal of the National Cancer Institute, the study [8] examined 7,000 participants and reported that those with two or more sessions had reduced rates of both invasive and in situ melanoma. By contrast, people with only one tattoo session were more likely to develop melanoma, particularly in situ, though the reason remains unclear.

The team had initially expected tattoos to increase cancer risk due to ink-related carcinogens, pigment breakdown, and possible inflammation. Instead, the results showed a mixed pattern, with melanoma risk decreasing as the number of tattoo sessions increased.

Researchers suggested this could be linked to greater sun protection practices among tattooed individuals, a physical barrier effect of ink against ultraviolet radiation, or immune responses triggered by tattooing.

Experts cautioned that the findings do not mean tattoos prevent cancer and urged continued sun protection. They also noted that earlier research has associated tattoos with higher risks of certain blood cancers, underscoring the need for further study on how tattooing may influence cancer risk.

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Sources:
[1] https://www.nbcnews.com/world/asia/south-korea-passes-landmark-bill-legalize-tattoo-artists-rcna233838
[2] https://www.semanticscholar.org/paper/e35723676669f39d9957a59a40e53bcde09fc074
[3] ( https://www.medanta.org/patient-education-blog/mythbuster-can-you-donate-blood-with-a-tattoo )
[4] (https://www.redcross.org/local/pennsylvania/southeastern-pennsylvania/about-us/news-and-events/news/national-tattoo-day.html)
[5] (https://scitechdaily.com/safety-warning-35-of-tattoo-inks-tested-positive-for-harmful-bacteria/)
[6] (https://www.hindustantimes.com/cities/bengaluru-news/karnataka-plans-tattoo-parlour-regulations-after-tests-find-22-types-of-metals-in-ink-101740798533405.html )
[7] (https://scitechdaily.com/concerning-new-research-links-tattoo-ink-to-increased-cancer-risk/)
[8] ( https://attheu.utah.edu/science-technology/melanoma-less-common-in-individuals-with-several-tattoos/ )

The findings, published in two reports, World Mental Health Today and the Mental Health Atlas 2024, show that while some progress has been made in policy and service planning, significant gaps remain. WHO is urging governments to scale up investment and action ahead of the 2025 UN High-Level Meeting on noncommunicable diseases and mental health, scheduled for September in New York.

“Transforming mental health services is one of the most pressing public health challenges,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus, adding that “Investing in mental health means investing in people, communities, and economies, an investment no country can afford to neglect.”

Anxiety, depression affecting women

Anxiety and depression are the most common conditions, with women disproportionately affected. Mental health disorders are now the second leading cause of long-term disability worldwide. Taking one’s own life remains a devastating outcome, claiming an estimated 727,000 lives in 2021. It is one of the leading causes of death among young people, regardless of region or income level.

Global targets remain out of reach. The UN Sustainable Development Goal calls for a one-third reduction in suicide rates by 2030, but WHO projects that only a 12% reduction will be achieved on the current trajectory.

The economic burden of these conditions, specifically, depression and anxiety alone cost the global economy around US$1 trillion annually, mostly through lost productivity, the report said.

Gaps in investment and workforce

Despite growing awareness, investment in mental health has stagnated. Median government spending remains at just 2% of health budgets, unchanged since 2017. Disparities are glaring with high-income countries spend up to US$65 per person on mental health, while low-income countries spend as little as US$0.04.

The workforce shortage is equally severe. The global median stands at 13 mental health workers per 100,000 people, with extreme shortages in low- and middle-income nations.

Progress and stalled reform

Since 2020, many countries have updated mental health policies, adopted rights-based approaches, and expanded support during health emergencies. More than 80% now include mental health and psychosocial support in emergency responses, up from 39% in 2020. School-based initiatives, suicide prevention programs, and telehealth services are also expanding.

Yet legal reform has lagged. Fewer than half of countries have mental health laws in line with international human rights standards. Nearly half of psychiatric hospital admissions remain involuntary, and more than 20% last longer than a year. Only a small fraction of countries have shifted to fully community-based care, with inpatient institutions still dominating.

Access gaps persist, particularly in low-income countries where fewer than 10% of people with severe mental health conditions receive treatment, compared with more than 50% in wealthier nations.

Time to act

WHO stressed that countries remain far off track to meet the goals of its Comprehensive Mental Health Action Plan. It urged governments to intensify systemic reform through equitable financing, stronger legal protections, investment in the workforce, and a rapid shift to community-based, person-centered care. Without urgent action, the agency warned, millions will continue to face preventable suffering and the global economy will bear the cost.