Blog 2010 Year-End Special Issue

Here at HealthMap, we are often focused on outbreaks happening right now. As the new year approaches, we reflect on some of the outbreaks of 2010.

Where were you when...

Polio was imported into Tajikistan (April 23)
2010 saw two set-backs in the continuing effort to eradicate polio. The WHO announced the first importation of poliovirus in the WHO European Region since it was certified polio-free in 2002 and polio spread through Central Africa (see below).  120 cases of acute flaccid paralysis were reported in mid-April, prompting the Tajikistan government to notify WHO of an outbreak. By late July, 430 cases had been confirmed, and 7 confirmed cases in the Russian confederation. The outbreak continues, particularly in neighboring countries, despite vaccination campaigns to prevent additional cases.

Polio in Angola (July 17) spread to Central Africa (August 17)
By 2005, only Nigeria, India, Pakistan and Afghanistan suffered from endemic polio. However, many Hausa in Northern Nigeria resisted a polio vaccination campaign due to fears that it might spread other diseases or cause young women to become infertile. Since then, polio has regained a foot-hold, re-establishing itself in countries previously declared free of the disease. Angola, having re-established sustained transmission in 2009 saw an outbreak in 2010 that spread to neighboring countries, including the Democratic Republic of Congo, where it continues to spread.

Cholera broke out in Haiti  (October 21)
Much of Haiti’s infrastructure was destroyed in the large earthquake that struck the capital Port-au-Prince on January 12, 2010. Even prior to the earthquake, only 12% of Haitians had treated, piped water and 17% access to adequate sanitation. Emergency aid teams went to help injured people but also sought to contain outbreaks of any diseases that might emerge with large numbers of internally displaced people living in temporary shelters. Since there hadn’t been an outbreak of Cholera in Haiti for over 100 years, few expected or prepared for such a contingency. Hypotheses abound as to the origin of the outbreak. Haitians rioted because UN Peacekeepers may have brought in the disease.  A Haitian Voodoo association reports 45 people have been murdered after accusations of using black magic to spread the outbreak.. Although we may never know the specific source, genome sequencing of the strain has made clear that international travel played a role.  Furthermore, a population made vulnerable by natural disaster sows fertile ground for disease transmission. HealthMap’s updated info on Haiti available here.

Vancouver Olympics brought measles to British Columbia, and the World Cup exported it from South Africa to Argentina
International travel was again linked to disease transmission as cases of measles in Vancouver were linked to an outbreak in Australia. South Africa exported cases of measles to Argentina during the World Cup. HealthMap, along with partners such as BioDiaspora, continue to provide highly specific surveillance for outbreak threats during mass gatherings.

Dengue Spread north in 2010
After more than 50 years without Dengue cases, Key West, Florida began seeing a return of the disease early in the year. By mid-July, the CDC confirmed 39 cases, and announced that 5% of Key West residents had likely been exposed to the Dengue virus. July brought a confirmed case in Marion county followed by additional cases in Central Florida. In August, Florida’s Broward County Health Department announced a confirmed case of Dengue in a woman who had not left the county for weeks.  

While the United States was seeing a return of Dengue in Florida, France saw it’s 1st non-imported case on the mainland in Nice, Provence-Alpes-Côte d'Azur. This also marked the first locally transmitted incidence of the disease in Europe in more than 80 years.

New Collaboration, the Return of Influenza, and FMD in S Korea

New Collaboration Announcement
HealthMap is now collaborating with the PathoSystems Resource Integration Center (PATRIC). The goal of PATRIC is to develop bioinformatics resources for the research and countermeasures-development communities based on genomics data. This is part of the biomedical research community’s work to integrate vital information on pathogens, to provide key resources and tools to scientists, and to help researchers to analyze genomic, proteomic and other data arising from infectious disease research. PATRIC provides rich data and analysis tools for all bacterial species in the selected NIAID category A-C priority pathogens list.

As part of this new collaboration, HealthMap has created a visualization for each bacterial pathogen in PATRIC that is associated with an infectious disease. The visualizations are available through PATRIC’s Disease Overview pages to provide users with bacterial infectious disease data in proper context.  The customized HealthMap visualizations are available for PATRIC watchlist pathogens, which can be accessed via the Organism tab on the PATRIC site.

Influenza on the Increase in Europe
Over 300 people have been hospitalized with influenza in Britain, with a majority of cases being due to H1N1 Influenza A.  Northern France continues to see increasing numbers of influenza cases, and on December 22, 2010 two deaths due to H1N1 were announced. France’s Institute for Public Health also stated that influenza activity is near the epidemic threshold.

South Korea Fights Foot-and-Mouth Disease (FMD)
South Korea is working to stem the country’s worst ever outbreak of FMD. Since the 1st outbreak, reported on November 29, 2010, 56 cases have been reported and over 330,000 livestock culled. Two provinces have had confirmed cases (North Gyeongsang and Gyeonggi), and two have reports of suspected cases (Gangwon and Chungcheong).  A vaccination campaign has begun in five cities across the country in an effort to halt the spread of disease.

Whooping Cough, Guillain Barre, and Avian Influenza Making Headlines

Spotlight on Whooping Cough

This summer, CDC reported on a dramatic rise in whooping cough cases in California.  As of the most recent MMWR report, California has had 2,625 cases to date, a four-fold increase from last year’s 646 cases.   Although the illness is seldom serious in adults, whooping cough can be deadly in infants.  Communities across the United States have reported outbreaks and infant fatalities since the initial surge in California.  HealthMap has reported alerts in a dozen states in the last month alone.

Lack of vaccination was an obvious suspect.  Immunity to pertussis decreases with age, so adults vaccinated in their childhood may now be susceptible to whooping cough.  These adults could then pass it on to infants and children.  Furthermore, many of the early cases were in San Diego, which has a vocal anti-vaccine community.

While vaccination is clearly an important tool in fighting these outbreaks, two recent news stories highlight other concerns.  Researchers from Baylor College of Medicine recently investigated vaccine storage.  They found “one-quarter of 54 vaccine refrigerators in . . . community health centers had temperatures that dipped into the freezing range, most commonly at night and on weekends.”  When the pertussis vaccine freezes, its efficacy can be severely compromised.

Mutation of the pertussis bacteria could also decrease the effectiveness of the vaccine.  Years ago, Dutch researcher Dr. Frits Mooi raised the possibility of whooping cough adapting to evade the vaccine.  He believes a new type of pertussis is playing a role in the current outbreaks.  KPBS in San Diego has a thorough discussion of this idea along with another prominent researcher’s counter argument that increased awareness and diagnosis of whooping cough is adding to the reported cases.

The current surge in whooping cough cases is likely due to numerous factors.  Regardless of the underlying factors, vaccination remains a critical tool is protecting those most vulnerable to it.  The CDC recommends that all adults get a one-time booster of adolescent/adult tetanus-diphtheria-pertussis vaccine (Tdap).

Guillain Barre Syndrome in Mexico

The General Directorate of Epidemiology of the Federal Government in Mexico has issued an “epidemiological alert for outbreaks of acute flaccid paralysis” in Nayarit and Orizaba (Veracruz). There have been 7 cases in Nayarit and 23 in Orizaba. There have been two deaths registered so far. One of the deceased was diagnosed with Guillain Barre syndrome.
                  

Guillain-Barre syndrome (GBS) is a rare, but sometimes fatal, inflammatory disease that affects the peripheral nervous system and can leave its victims temporarily paralyzed. GBS typically affects people after a minor infection like a respiratory or gastrointestinal one. If GBS affects respiratory muscles, its effects can be fatal because those inflicted will no longer be able to breathe. First symptoms of GBS include tingling or weakness in the legs followed by a spread of the same feelings in the arms and upper body. This ascending spread can take weeks or happen in a matter of days.

Avian Influenza Returns

In recent weeks, avian influenza has returned to news headlines in several countries. On November 19^th, a new human case of H5N1 was confirmed in a woman from Hong Kong. This case marks the 21^st case of human infection in Hong Kong SAR China to date. After laboratory tests confirmed the patient contracted the virus while visiting mainland China, and no additional cases were found, Hong Kong lowered its bird flu alert level from “serious” to “alert.”

Egypt reported a confirmed case of H5N1 in a female patient from Gharbia Governorate on December 4^th. The patient died on December 2^nd, becoming the 37^th death in Egypt out of the country’s 113 cases to date.

Most recently, on December 9^th, a female from Bandung, West Java, Indonesia was confirmed as the latest human case of H5N1. Of the 171 cases of H5N1, avian influenza, in Indonesia to date, 141 have been fatal.

Vietnam and South Korea both have recently reported avian influenza outbreaks in wild birds, however no human cases have been associated with either of these new outbreaks. 

Undiagnosed Illness in Uganda, Measles in Argentina, and HealthMap at the ISDS Conference

Scientists work to identify the illness that has killed 38 people in northern Uganda. http://www.google.com/hostednews/afp/article/ALeqM5hgmieXl3QCUDRkdH0Z12UD704bFg?docId=CNG.6a0a014a69f4ce1afd31a8eefff9f2b8.441

Possible pneumonic plague in Northern Uganda Leaves 38 Dead

Last week, we reported that a mysterious illness had left 13 dead in northern Uganda. This week, the death toll has risen to 38 with dozens hospitalized, yet officials are still uncertain as to the cause, although tentative testing have confirmed it as pneumonic plague. Ebola, typhoid and several other diseases have been ruled out. The first case was identified in early November and since, over 90 people have been treated.  Symptoms include severe headaches and dizziness and eventually bloody diarrhea and vomiting. Officials say the disease has been detected in five districts in the northern part of the country. However, with vast impoverishment and inadequate health facilities, it may take weeks before response teams arrive and implement control efforts.

Alert for Measles in Buenos Aires

After 12 years without a registered case of measles in Buenos Aires, 17 cases have been reported since August.  The minister of health has helped initiate a national vaccination campaign in hopes of preventing the further spread of this disease. The province of Buenos Aires expects to be rid of the virus soon.

HealthMap at the 9th Annual ISDS Conference

Several HealthMap team members gave oral presentations at the International Society for Disease Surveillance’s 9th annual conference in Park City, Utah last week. In addition, HealthMap had a table where conference attendees could learn more about the system and sign-up to receive our free daily email alerts. The following oral presentations were given by members of our group (please email us for more information about any of these abstracts, or if interested in receiving our customizable email alerts):

Emily Chan - - Forecasting High Priority Surveillance Regions: a Socioeconomic Model
Annie Gatewood-Hoen - - Effect of Expanded Recommendations for Pediatric Seasonal Influenza Vaccination: An International Comparison
Sumiko Mekaru - - Anticipatory Surveillance for Mass Gatherings: A Novel Application of Mass Media Surveillance
Rumi Chunara - - OutbreakMD: Tracking and Identifying Disease Outbreaks in Post-earthquake Haiti

HealthMap at the National Design Triennial: Why Design Now? At the Smithsonian Cooper-Hewitt, National Design Museum through January 2011

“Inaugurated in 2000, the Triennial program seeks out and presents the most innovative designs at the center of contemporary culture. In this fourth exhibition in the series, the National Design Triennial will explore the work of designers addressing human and environmental problems across many fields of the design practice, from architecture and products to fashion, graphics, new media, and landscapes.”

As part of the Why Design Now? National Design Triennial’s Health Category, HealthMap provides visualizations of surveillance data in a user-friendly manner, facilitates early disease detection, and provides a tool for public awareness and involvement.

An audio commentary as well as additional information about the HealthMap exhibit at the Cooper-Hewitt is available by visiting the HealthMap Triennial page.

Undiagnosed Disease in Yemen, H5N1 in Hong Kong and Possible Ebola in Uganda

Mysterious outbreak in Hodaida Province (Yemen): Affecting Thousands, Five Dead
While originally reported as a dengue fever in our earlier blog post on the subject, an epidemic of what appears to be an unknown disease continues to spread in western Yemen. Unconfirmed newspaper reports state the epidemic emerged approximately one month ago, reportedly disproportionately affecting women and children. Schools have been adversely affected in a number of towns due to both student and teacher absentees, as the illness and fear of it spread in the region. Attempts by the government to calm the situation do not appear to be working.

Known in Yemen as “Al Mukrifas” (المكرفس), most of its spread has been south of the province’s capital in rural areas in and around Zabid, Beit al Faqih, Jebel Ras, Al Jurrasi (Translates incorrectly as “Surgical” in Google Translate) and Al Khawkhah (which translates incorrectly as “nectarine in Google Translate). Reports vary, but up to 4 have died in Al Khawkhah and up to 5 in Jebel Ras. Symptoms include those similar to Dengue fever and an unspecfied “German fever”, including caugh, headache, swelling of the face and joints, myalgias and, occasionally, bleeding under the skin. Medical treatment has so far been supportive.

Avian Influenza Case in Hong Kong
Hong Kong reported its first diagnosis of H5N1 (avian influenza) since 2003.  The 59 year old female patient had recently returned from a trip to mainland China where she visited Shanghai, Nanjing and Hangzhou. The patient is reportedly slightly improved but still in serious condition, and China has stated that no human cases have been detected in the cities she visited.  The report triggered concern in Taiwan and the Philippines.  

Possible Ebola Outbreak in Uganda
Last week, a Ugandan newspaper reported a mystery illness had caused 13 deaths in Abim and Agago districts in the north.  The article quoted a local health official who said that Ebola, Marburg, and Lassa had been ruled out through lab work.  The similarity to Ebola has been noted in subsequent articles.  We will continue to monitor the situation and report on any official diagnosis in this outbreak.

Six Die After Eating Endangered Turtle Meat
Six people died, including 4 children, and more than 90 became ill after consuming meat from the endangered hawksbill turtle. The deaths were a result of poisoning from biotoxins in turtle flesh that has no known antidote. This event occurred in late-October on the Island of Murilo, Micronesia.  Authorities have advised residents not to consume turtles or their eggs.

Whooping Cough Cases Rising Throughout U.S.
In the past week, we have received alerts about whooping cough in numerous states, including Indiana, Iowa, Kentucky, Michigan, Missouri, New York, North Carolina,  Oregon, and Pennsylvania.  Los Angeles County is reportedly having their highest number of cases ever, with more than a quarter of this year’s cases coming in the last month.  Whooping cough is a very contagious respiratory disease caused by Bordetella pertussis.  Infants are particularly vulnerable; about half of infected infants require hospitalization and 1 in 100 hospitalized infants die from it.  Whooping cough can be prevented by vaccination but over time adults may lose that protection.  The CDC recommends that adults get a booster when they receive their tetanus booster.  New parents and grandparents should make sure they are up to date on their vaccinations.

Rabies in Guangdong
It was recently reported that from January to October of this year, 228 people have died from rabies bites in Guangdong Province in Southern China. Most cases occurred among young children and older individuals in rural areas as a result of bites from rabid dogs. The report stated that 90% of the individuals who died did not seek care after being bitten. Surprisingly, over 50% of the cases did not come from bites by stray dogs, but by dogs from their own homes or neighboring homes. Experts say that in rural villages, domestic dogs frequently run loose and come in close contact with other dogs, causing the transmission of the rabies virus to be especially high. However, owners never suspect that their own dogs can become infected and do not take any necessary precautions. Vaccines exist to protect both animals and humans from the virus.