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.

Australia Disbanding Outbreak Team and the Changing Face of HIV in China

http://healthmap.org/en/?ps=148  (Australia's alerts this year)

Australia to discontinue infectious disease investigation team:
Australia is one of very few industrialized nations without a national disease control center.  For the past 20 years, outbreak investigations have been preformed through the Master of Applied Epidemiology program at Australian National University (ANU).  Funding has run out, raising concerns among public health experts.  Professor Robert Douglas of ANU explained that the group played a role in “stemming the spread of about 200 epidemics, including severe acute respiratory syndrome (SARS), Hendra virus, the swine flu and food-borne infections.”  To see a map of outbreaks in Australia this year, please click here.

Cholera on Daru Island
A cholera outbreak in Papua New Guinea’s (PNG) Daru Island has Austalian official worried.  This outbreak is an extension of last year’s cholera outbreak in mainland PNG.   At least 16 people have died.   While 274 of the Torres Strait Islands are owned by Australia, Daru Island belongs to PNG.  Australia has enacted travel restrictions between the Torres Strait Islands and PNG to reduce the likelihood of cholera’s spread.  They have also sent emergency support to help combat the outbreak.

HIV in China
Recently, China released figures that as of September this year, there are 360,000 HIV positive cases in the country, among whom 130,000 have progressed to AIDS and 60,000 have died. Furthermore, HIV was the number one killer among all infectious disease-related deaths. In recent years, China has seen a shift in HIV demographic from high risk populations such as IV drug users and plasma sellers to the general population who contract the disease via heterosexual transmission. Multiple provinces and autonomous regions also reported this similar trend and an increase in HIV cases and deaths each year. While the country has made enormous strides over the years in reducing the stigma around the disease and promoting a message of tolerance and awareness through public education and propaganda, those infected with HIV still experience heavy discrimination and poor access to medical and social support. Just yesterday, in China’s first ever lawsuit over employment-discrimination against people who are HIV-positive, the court ruled against the defendant, citing that the city education bureau had correctly followed public service standards in assessing its teaching candidates.

Dengue in Brazil and Miami:
Since January 2010, Brazil has seen a 90% increase in deaths from Dengue as compared to the same period last year.  Many of the deaths have been from type 1 Dengue, which had been largely absent in Brazil since the 1990s. Health officials are particularly concerned about the dramatic increase in cases, as Brazil now enters its six-month rainy season. During this time frequent downpours cause standing water to become mosquito breeding ponds. The health ministry is launching a campaign to educate the public through TV and radio ads as well as through the distribution of flyers.

In other Dengue news, Miami has reported its 1st case of dengue fever in 50 years. This news comes 4 months after health authorities announced 1000 probable cases in Key West, FL. This news marks the likely resurgence of dengue in the state of Florida.

H1N1 Resurfaces:
In Harare, Zimbabwe 1 case of H1N1 has been confirmed  and 5 others are suspected. The public was notified of the cases via the state-owned Zimbabwe Broadcasting Corporation, which stated via the Deputy Minister of Child Health and Welfare Dr. Mombeshora that Zimbabwe possesses enough medicine to protect the public in the event of an H1N1 outbreak. For the combined areas of Harare, Masvingo, and Matabeleland North and South,  a total of 15,453 cases of H1N1 were suspected as of last Friday, November 5th.

Blog Special Edition: HealthMap's Increased Infectious Disease Surveillance for This Year's Hajj

http://healthmap.org/hajj/

Mass gatherings bring together people and pathogens (germs) from all over the world.  Such events present unique challenges to infectious disease surveillance.  Normally rare diseases may temporarily become common at the venue.  Highly contagious illnesses can spread quickly in crowded conditions. To help organizers anticipate potential threats, HealthMap and BioDiaspora have collaborated to determine where participants come from and then to increase surveillance of mass media on those parts of the world.  We published earlier on our efforts for the Vancouver Olympics, and some readers may recall our map for the FIFA World Cup.

This Sunday marks the start of the Hajj, the annual pilgrimage to Mecca, consisting of several rituals which symbolize the essential concepts of the Islamic faith.  Muslims from around the world are traveling to Saudi Arabia for the pilgrimage.  HealthMap and BioDiaspora have produced a map for this mass gathering: http://healthmap.org/hajj/

The map automatically shows alerts from the HealthMap dataset for any of the almost fifty countries whose populations are at least 50% Muslim.  You may turn on and off coloured layers showing the 10 countries with the most pilgrims, or all countries with at least 20,000 expected pilrgims.  As meningitis has historically been a concern during the Hajj, we have added a preset that shows any meningitis news stories in these countries.

Below, our anlaysts have summarized two interesting disease stories that could potentially impact this year’s Hajj.  Please see the map for many other news stories.

Viral conjunctivitis (aka pink eye) in Egypt.
Egypt has seen a recent outbreak of viral conjunctivits in a handful of schools primarily located in Matariya (NB: if you click on the link “Matariya” translates as “rain” in Google Translate) in the Nile delta region of Daqihiliya. While the Egyptian government is reporting that the epidemic is getting under control, the outbreak has spread as far south as Aswan. Moreover, a health official working in the region reported anonymously that the extent of the outbreak is much larger than is being discussed by the media or the governments in the region, particular Sudan and Uganda. Egypt’s outbreak led to school closures in Matariya, of which newspapers published accounts that were picked up by HealthMap. Viral conjunctivitis is not a dangerous disease, per se (it is caused by viruses that cause the common cold). However, because viral conjunctivitis is easily spread and the extent of the outbreak is unclear, this outbreak presents a risk to Hajj pilgrims due to the easy transmissability of the virus in the conditions that pilgrims will likely encounter during the ritual such as close living quarters and drinking from the waters of the Zamzam spring.

Dengue in Beit al Faqih, Yemen.
An epidemic of dengue fever has also been spreading through the city of Beit al Faqih, Yemen. The government has so far denied existence of the outbreak, leading some local doctors to threaten to report to the World Health Organization itself. Because of the lack of transparency, the number of cases and deaths due to the disease is unknown, as is the extent of the outbreak. Beit al Faqih is a small village, and given that this outbreak has been spreading for a number of weeks, it is likely to have moved beyond Beit al Faqih into other municipalities in Hodaida district in western Yemen. At least 20,000 pilgrims from Yemen are expected to participate in the Hajj this year; however there are concerns that Yeminis are crossing the Saudi border illegally, increasing the risk of transmitting the disease to Saudi Arabia during this mass pilgrimage.

Cholera spreading in Haiti, E. coli tainted cheese samples, Polio update in Congo, and Record dengue in Taiwan

Update on Cholera in Haiti:
In the past 24 hours, HealthMap has received a dramatic increase in media reports, blog reports and informal communications regarding new suspected cases of cholera.  Hurricane Tomas killed 20, and the drenching rains caused many latrines and septic systems to overflow, potentially helping spread the cholera outbreak south and west.  So far, at least 544 have died, ~8000 have been hospitalized and cholera has been confirmed in Port-au-Prince.  The capital now has at least 120 suspected cases of cholera;114 of them are in the densely populated slums of Cité Soleil.  Partners in Health is also deeply concerned by the spread.  One doctor with Samaritan’s Purse warned that the epidemic may be about to explode.  Please check http://www.healthmap.org/haiti/ for the latest information.  In addition to precisely mapping new reports of cholera, we are adding safe water installations and cholera treatment centers regularly.  If your organization has organization has facilities or cholera cases not on our map, please contact us through the “Outbreak missing?” feature.

Samples of Gouda Cheese Spread E. coli:
Bravo Farms Dutch Style Raw Milk Gouda Cheese tainted with E. coli is believed to be responsible for illnesses in numerous states.  Between October 5th and November 8th, Bravo Farms Dutch Style Raw Milk Gouda Cheese was sold and sampled at Costco stores in Arizona, California, Colorado, New Mexico and Nevada. So far, 25 people are sick in this outbreak. E. coli symptoms include bloody diarrhoea, stomach cramps and dehydration. The FDA recommends that anyone experiencing these symptoms should see a doctor immediately; in some occasions, E. coli can lead to kidney failure.

Confirmed Cases of Polio in Republic of Congo:
Last week, we reported a possible polio outbreak in Pointe-Noire, Congo where 8 deaths and 20 cases were suspected. This week, at least two confirmed cases of poliovirus Type I, 120 cases of acute flacid paralysis, and 58 deaths have been reported out of the region. Director-General of Health Alexis Dockekias described patients as presenting with flu-like symptoms, with paralysis beginning in the lower limbs and spreading to the upper limbs. Most of the cases have concentrated around the city of Pointe-Noire and have occurred in young adults ages 15 to 25 who are believed to not have been immunized at birth and thus completely susceptible to the disease. Guido Borghese, principal advisor for child survival and development for the UN’s West Africa office, believes the virus may have been imported from neighboring countries such as DR Congo or Angola and that the outbreak may be much more widespread. Plans are underway to launch a nationwide vaccination campaign to begin November 11th. The last indigenous case of polio was recorded for the Republic of Congo in 2000.

Total Dengue Case in Taiwan Break 1000 Mark this Past Week:
A total of 1031 cases of dengue have been reported for the island of Taiwan since August this year. Among these, 13 were cases of dengue hemorrhagic fever and 2 resulted in deaths. Over half of the cases, 589 total, have been attributed to Kaohsiung City, where the number of yellow fever mosquitoes and Asian Tiger mosquitoes, both transmitters of dengue, is more than 20 times that of other cities in Taiwan. Health department officials say that because no vaccine is present, most of the prevention and control efforts have been limited to attempts at killing these disease-carrying mosquitoes. Officials have set an ambitious goal of limiting the number of cases for this year to 1,500.

New polio outbreaks, Legionnaire’s in Madrid, and Dozens of students quarantined in China’s Guangxi Region

Polio update
In the past few weeks, polio cases have been reported in several countries. Polio is an extremely contagious viral disease. Although up to 95% of those infected show no signs, roughly 1% suffer paralytic polio. Once a worldwide scourge, polio is now endemic (continually present) in only four countries: Afghanistan, India, Nigeria and Pakistan. It is one of only two diseases with a global eradication program (the other is Guinea Worm Disease). The only diseases that have been globally eradicated are smallpox and rinderpest.
First, the good news: India has seen great progress toward its eradication goals, reporting only 39 cases in 2010 compared to 498 at this time last year. Unfortunately, flood ravaged Pakistan has seen an increase in polio cases this year. Also concerning are cases reported in non-endemic countries. Uganda reported a cluster of 5 pediatric polio cases last week. This week, a doctor in Pointe-Noire, Congo reported 8 deaths and 20 cases in a possible polio outbreak.

Legionnaire’s Disease in Madrid
Earlier this year, we discussed an outbreak of Legionnaires’ disease in Wales. A new outbreak has been identified in Spain’s capital of Madrid. The Ministry of Health reports 40 confirmed cases and 3 deaths to date due to Legionella. This disease usually appears as a pulmonary infection with symptoms of high fever and pneumonia. It is not spread from person to person, but typically spreads through contaminated water (from cooling-towers, whirlpools, aerosol sources). Officials in Madrid continue to investigate the source of the outbreak in an attempt to control it.

Paratyphoid A in Guangxi
A total of 107 people, including 84 students, have been diagnosed with Paratyphoid A fever in the Luocheng Mulao Autonomous County of Hechi City in the Guangxi Autonomous Region. Currently, 80 individuals are hospitalized, including 50 students under hospital quarantine. Most of the cases come from 2 middle schools and 1 high school in the county and although the incidence of new cases have begun to decline, investigators have not identified the source of the outbreak and the disease is not yet under complete control. The first case was identified in a 7 year old female student on September 20th but most of the cases occurred between October 17th and 24th, during which 46 cases were identified. Paratyphoid A is caused by the bacterium Salmonella paratyphi A and is most commonly transmitted via the fecal-oral route through contaminated water or food. The disease bears similar symptoms to typhoid fever, including sustained fever, abdominal pain and enlargement of the liver or spleen, but is caused by a different bacterium and is generally more benign.