World Rabies Day and Other Highlights

Spotlight News of the Week

World Rabies Day
Tuesday, September 28, 2010 marked World Rabies Day, a day meant to raise awareness about the impact of human and animal rabies. While rabies does not pose an imminent threat for many, worldwide an estimated 55,000 people die annually of the virus - a rate of one person every ten minutes. Over 99% of human rabies deaths occur after exposure to rabid dogs. In just the past week, rabies has made headline news in several parts of the world:

• The popular tourist island of Bali is currently undergoing a mass vaccination campaign, as rabies has killed 93 people since 2008.
• A recent report highlighted that rabies kills approximately 100 people a year in Nepal.
• Five children have died, bringing the total number of rabies deaths to twenty, in an indigenous jungle community of Peru. It is estimated that over 3,500 people have been bitten by vampire bats, however post-exposure prophylaxis is limited, and some indigenous people have reportedly refused treatment.
• Gauteng, South Africa is on high alert after a young girl from Soweto died of suspected rabies on September 25th.
• Vietnam is re-examining dog consumption as rabies cases are on the rise.

Additional News Highlights

New mosquito-borne threat in France
After the first native cases of Dengue were reported in Metropolitan France, a new disease has emerged. The first two native cases of Chikungunya in Metropolitan France were reported. Authorities expect the arrival of cold weather will curtail the threat as the mosquito population dies off. Chikungunya is a viral disease that can cause debilitating illness with fever, joint pain, muscle pain, and vomiting.

First Case of West Nile Virus in Humans in Cádiz, Andalucía
A 60-year-old man in Puerto Real, Cádiz in Andalucía, Spain was admitted to the hospital with symptoms of Meningitis. Doctors then discovered that he was infected with West Nile Virus. This is the first human case in Andalucía.

Widespread Chicken Pox in São Paulo
This past week, cities in the interior of São Paulo state in Brazil are experiencing an outbreak of Varicela (Chicken Pox). Cities affected include Mogi Mirim, Monte Mor, São José do Rio Preto and Taubaté. One source attributes this surge of chicken pox cases to the recent dry weather in the affected areas.

Pneumonic Plague Outbreak in Tibet, 1 dead
Five cases of pneumonic plague, including one death, were recently identified in Nyingchi prefecture located in Tibet’s southwestern region. Tibet’s health department has announced that anyone who visited Nyingchi after September 18th should seek medical care, especially those displaying flu-like symptoms common to plague. The Chinese government currently reports the outbreak to be controlled and close contacts of the victims have been quarantined, although the source is still unknown. Plague is endemic in Tibet and commonly transmitted via flea-carrying rodents such as the region’s widely-prevalent marmot. The previous pneumonic plague outbreak in Tibet occurred in September 2008 where two people died.

Spotlight News of the Week

Spotlight News of the Week

Dengue in France
On 13 September, France reported its first case of indigenous Dengue. Five days later, it confirmed a second; both cases are in Nice. Another 6 or 7 cases are under investigation. Although the French territories of Mayotte, Guadeloupe, and Martinique have had major dengue outbreaks since August, metropolitan France is not a country where Dengue normally occurs (see HealthMap’s Dengue Map collaboration with CDC to see which parts of the world are high-risk). Four departments in southern France have a mosquito capable of carrying Dengue. France has begun aggressive spraying efforts to prevent Dengue from becoming established in the area, an unlikely even according to officials.

Additional News Highlights

Salmonella Outbreak Linked to Duck Eggs in Great Britain and Northern Ireland
UK’s Health Protection Agency (HPA) announced recently that it is investigating a surge in Salmonella Typhimurium DT8 cases linked to consumption of duck products, especially duck eggs, which may have been responsible for one death. A total of 63 confirmed cases have been reported in Great Britain so far this year, a significant spike from the 34 cases reported for 2008 and 47 in 2009. A similar outbreak is currently under investigation in Ireland, where 24 cases associated with consumption of duck eggs from small backyard flocks and private farms have been reported since the start of 2010.

A Legionnaire’s Mystery in Wales
Earlier this month, numerous media outlets reported the 6 September death of a 64 year old Welsh woman and 11 additional diagnoses of Legionnaire’s disease in South Wales. As the outbreak grew to 14 cases, investigators noted a cluster of illnesses in the Heads of the Valleys corridor, and focused on an industrial facility with large air conditioning systems. A cooling tower was ordered closed in Dowlais, Methyr Tydfil on 10 September, with 17 cases, 2 deaths, and 4 cases under investigation. On 13 September, a second company's cooling tower was closed. A third was closed on 13 September. As of 20 September, the outbreak is associated with 2 deaths and 22 cases, with an additional 2 Legionnaire’s deaths ruled unrelated to the outbreak. Four towers have been closed and no source has been identified.

Japanese encephalitis in Asia
Japanese encephalitis is a mosquito-borne virus which can produce an acute encephalitis leading to seizures, coma or death. An ongoing encephalitis outbreak in Gorakhpur, Uttar Pradesh, India has now claimed 319 lives, mostly children. While some news sources attribute all of these deaths to Japanese encephalitis, others report cases due to both Japanese encephalitis and to a water-borne enterovirus . Also this week, South Korean authorities have reported the first case of Japanese encephalitis in the conutry this year. While both India and South Korea have historically had outbreaks (see CDC’s distribution map), South Korea’s vaccination campaigns have lead to a great reduction in cases and deaths.

Cholera continues in West Africa
A cholera epidemic that began in Nigeria has spread to Cameroon, Chad, and Niger. In Chad nearly 40 people have died, and 600 are reported sick. Cameroon reports 7013 cases and 458 deaths. In Yobe State, Nigeria treatment facilities are overwhelmed with patients being treated on bare floors and plastic mats. Over half of the patients are children under the age of 10 that contracted cholera by drinking from contaminated wells and ponds. The Ministry of Health in Nigeria continues to distribute drugs and intravenous fluids in an effort to halt the spread of the epidemic.

Spotlight News of the Week

New Bunyavirus in China
A series of curious tick-borne related cases and deaths were recently reported out of Shangcheng County in Henan Province. Patients all display symptoms indicative of HGA, an infectious disease known to be caused by a bacterium and transmitted via tick bites. However, what was isolated from these patients was not a bacterium, but a new type of virus currently dubbed as a “New Bunyavirus,” which scientists believe to be the cause of these suspect HGA cases and deaths. Scientists have also named this HGA-like disease “fever-associated thrombocytopenia syndrome.” Currently, over 120 suspect HGA cases have been reported for Henan in 2010, 87 suspect cases and 5 suspect deaths were reported for 2009 and as many as 557 cases and 18 deaths since 2007. Perhaps most worrisome has been the delay in communication of this situation to the public, as nearby provinces of Shandong, Hubei, Shanxi have all reported numerous cases and deaths since 2006. While health officials have deemed the disease “not very deadly” and have asked the public to therefore not worry, it still remains to be seen whether current control efforts against ticks will be effective in stopping the spread of this new virus and disease that currently has no effective treatment.

Additional News Highlights

First Dengue case in France
Although 18 Dengue deaths have been reported in the French overseas territories of Martinique and Guadeloupe, the case reported in Nice is the first case in mainland France. Local authorities have warned residents to avoid mosquito bites.

NDM-1 (the “Superbug”) found in 3 US states
The NDM-1 gene which gives bacteria resistance to many strong antibiotics (see our 17 Aug 2010 blog) has been found in California, Illinois, and Massachusetts. In all cases, the patients had recently been to India and received medical attention there.

Monkeypox on the rise in DRC
On August 30th, The Proceedings of the National Academy of Sciences published an interesting study on monkeypox in DR Congo. The smallpox vaccine protects against monkeypox, but the eradication of smallpox means that children no longer are vaccinated against it (and are therefore susceptible to monkeypox). Rimoin et al report that cases of monkeypox have surged in recent decades. This study is not the first to identify an unexpected benefit of the smallpox vaccine. In a very preliminary study published earlier this year, Weinstein et al found immunologic evidence that the smallpox vaccine may provide some protection against HIV infection and progression.

Spotlight News of the Week

Spotlight News of the week:

Polio re-emerges in north-east Afghanistan for the first time in over 10 years:
A new case of polio was identified in the north-east Afghan province of Kunduz bordering Tajikistan, a region that had been polio-free for over a decade. It was initially believed that the source of transmission came from neighboring Tajikistan that is currently experiencing a large polio outbreak. However, it is now believed that the virus may have been carried over by recent refugee immigration from flood-ravaged Pakistan. In response, the Afghanistan Ministry of Health has launched a large-scale vaccination campaign with plans to vaccinate 1.5 million children in five nearby provinces from September 5-7.

What was once a highly infectious and fatal disease that left countless children irreversibly paralyzed, polio is now eradicated from most of the world and remains endemic in only four countries: Afghanistan, India, Nigeria, and Pakistan. Although aggressive vaccination campaigns have decreased the number of cases worldwide by 99% from 350,000 in 1988 to 483 in 2001, the number has since hovered around 1,000 each year.

Additional News highlights

Anthrax in Bangladesh:
Bangladesh has been experiencing an anthrax outbreak among humans and cattle. At least 327 people have been infected, and India is concerned that animals moving across the shared border could bring the disease to Punjab or Haryana.

West Nile Virus in Europe:
Many European countries have seen West Nile Virus cases recently. Although the virus has been seen in Europe before, it is rare in many countries. Greece is seeing widespread cases for the first time with 15 dead and 158 sick. Russia’s southern Volgograd region has had 206 cases and 5 deaths since July 16. Romania has 7 cases and 2 deaths. Hungary first saw the virus in 2003 and now reports two patients being treated. Western Turkey currently has 4 cases and reports 3 deaths. Sicily has reported 49 cases in horses.

Cholera in Cameroon:
Cameroon is facing its worst outbreak of cholera in a decade. Since May 2010 the Health Ministry of Cameroon has confirmed over 5,500 cases and 350 deaths due to cholera in the Nord and Extreme-Nord regions of the country. UNICEF has launched a communications campaign to spread prevention and awareness messages to over 1.6 million school children at risk in a region with limited access to latrines and clean drinking water.