The HealthMap Blog is MOVING - Join Us at The Disease Daily!!

The HealthMap Blog is moving up in the world! HealthMap has always worked to provide you with the infectious disease outbreak news you need to know along with the geographic and timeline context for you to understand it. In January 2009, we started this blog to provide broader information on outbreaks occurring worldwide. Today we are excited to start The Disease Daily and HealthMap Local.

At The Disease Daily, we're expanding the coverage you've come to expect at the HealthMap blog.  We'll still provide you with the context you need to understand current outbreaks: "Does the report of a new tattoo infection mean there's a scary new disease?,” "Why is there an anthrax outbreak in China?," or "What's going on in the Somali refugee camps?"

In the upcoming weeks, we'll be greatly expanding our reporting beyond what you've seen here: more updates, deeper explanations of outbreaks, and even more extensive coverage. We've created a news section called Outbreaks 101 where we plan to breakdown basic but important questions like "How do you eradicate a disease forever?" or "Why do people need to be vaccinated for measles in a 'measles-free' country?" Have a question you want us to answer? E-mail us at DiseaseDaily@gmail.com and we'll put in on the list for future columns.

While you're checking out The Daily Disease on the new website, don't forget to click over to HealthMap Local to see what illnesses have been reported in your area.  With HealthMap Local, you can set your location and see what's happening near you, just like checking your local weather forecast online. 

Thank you to all of our blog followers! Your readership and support inspired The Daily Disease.  We hope you’ll continue to follow us. Please consider “liking” us on Facebook and “following” us on Twitter too!  

CDC Links Rare Bacterial Infection to Tattoos

September’s Emerging Infectious Diseases journal reports that two individuals’ tattoos were infected by a bacteria normally seen only in people with poor immune systems. In August 2009, an otherwise healthy adult sought medical care for pustules at the site of his new tattoo. When the infection did not respond well to antibiotics, the case was referred to the local public health department and an investigation by CDC and Washington State public health officials was launched.

Medical tests isolated Mycobacterium haemophilum,which can be difficult to treat, just like its Tuberculosis-causing relative. The lesions did not fully heal until March 2010. M. haemophilum does not normally cause the pustules seen in this case. They may have been due to the mode of infection, via tattooing needle. The authors report a second individual had identical symptoms and had been tattooed at the same shop, but tests failed to identify the organism.

An outbreak of M. haemophilum was earlier reported among 12 Swiss women who had their eyebrows tattooed as permanent makeup.  In addition to lengthy antibiotic treatment, 10 of them needed surgery.

Tattoo regulations vary widely in the United States. The tattoo establishment was operating within state safety and sanitation standards. Investigators believe the use of tap water to dilute the tattoo ink may have contributed to the infections. While this practice is permitted, the authors recommended the tattoo establishment use sterile water in the future. M. haemophilum was not found in samples of tap water or on any surfaces in the business, but previous studies have suggested water can be a vehicle for it. It is important to note that this study does not suggest the tap water was dangerous, simply that at some point the water used to dilute the ink could have picked up M. haemophilum which was then injected into the skin to cause the infection. Since M. haemophilum does not normally cause disease in healthy people, injecting it may be a necessary step in causing illness in people with health immune systems.

Traditionally, health officials have been concerned about the risk of blood-borne diseases during tattooing.  The widespread adoption of single-use needles has helped reduce this risk.  The difference in the story reported here is that M. haemophilum is common in the environment.  These infections were not due to transmission between clients.

For more information on tattoos and health, you can visit the CDC’s webpage on the topic.

Outbreak of Cutaneous Anthrax in Liaoning, China

As of yesterday, 30 patients, 3 of which have been confirmed,  in Haicheng City and Xiuyan County of Liaoning Province, were admitted to local hospitals with symptoms of cutaneous anthrax. All sick residents became infected after having recently slaughtered anthrax-infected cows. All sick animals were traced back to one village in Haicheng City where there had previously been an anthrax outbreak among animals. In the preliminary investigation, 4 sick animals were found, 2 of which died. Currently, no deaths have occurred and all patients are being treated at their local hospitals.

Anthrax is a common bacterial infection among hoofed-animals, but humans can become infected after close contact with sick animals or upon being exposed through 3 main routes - open wound, inhalation, or consumption of tainted meat. Cutaneous anthrax is relatively mild and individuals infected usually develop a sore or blister. Inhalation anthrax and gastrointestinal anthrax may lead to internal bleeding, shock, and tissue death.

Photo courtesy of: http://commons.wikimedia.org/wiki/File:Anthrax_01.jpg

Drought Brings Famine and Disease to Horn of Africa

As the Horn of Africa – including Ethiopia, Somalia, Kenya, and Djibouti - faces its worst drought in over 50 years, thousands of Somali refugees seek shelter in the capital city of Mogadishu and in refugee camps in northeastern Kenya and southeastern Ethiopia. The Dadaab refugee camps in Kenya have swelled to a population of over 400,000, as Somalis walk for 15 to 20 days prior to arrival in search of food and water. The Dolo Ado camp in Ethiopia continues to see an average of 200-300 Somalis arrive each day.  In just the past 2 months, facing imminent starvation and death, an estimated 220,000 have fled their drought-stricken farms.

The situation in the Horn of Africa continues to worsen with confirmed cases of cholera and dengue in Somalia (including Mogadishu) and measles outbreaks in refugee camps (with the hardest hit being the Dolo Ado camp in Ethiopia). The United Nations (UN) has warned that the situation could become “unbearable,” as the famine is expected to spread throughout southern Somalia in the next 4-6 weeks.

In such an unstable region of the world, delivering aid is challenging, however international organizations are responding. For the first time in five years the UN airlifted emergency aid into Mogadishu, and an additional 800 metric tons of food is on its way to East Africa. Furthermore, the World Health Organization (WHO) has launched a vaccination campaign along the Kenya-Somalia border to protect over 200,000 malnourished children from diseases such as measles and polio. 

Visit the World Food Program’s Website at www.wfp.org to learn more about the ongoing humanitarian crisis in the Horn of Africa or to make a donation.

New England Journal of Medicine Reports on New Tick-borne Bacteria

Ticks are known for carrying Lyme disease, Rocky Mountain Spotted Fever, Babesia, among other diseases. Now, there’s a new bacteria on the list. Researchers at the Mayo Clinic in Minnesota and from public health departments in Minnesota and Wisconsin, have identified a new type of Ehrlichia which sickened at least four people in those states.

There are several Ehrlichia species, but the two common which sicken humans (Ehrlichia chaffeensis and Ehrlichia ewingii) are not found in the MidWest. The researchers isolated this new species through molecular, culture, and serologic methods on patient blood samples and harvested ticks.  They have named their discovery ehrlichia species Wisconsin. Patients reported symptoms similar to the previously known Ehrlichia spp.: fever, fatigue, and headache.

This discovery is particularly important since ehrlichiosis had not been previously identified in this part of the United States.  Now that physicians know to test for it, the number of cases identified will likely increase rapidly.  

Ticks typically feed on rodents and deer, so other mammals are likely part of the life cycle of this bacteria. Among the many emerging human disease threats, 75% have a link to animals. As animal populations move due to changes in their environments (be it construction on their habitat, climate changes, or anything else) diseases that have not previously been seen in humans may have the opportunity to make that leap.  Given the relatively mild symptoms of the new Ehrlichia species, it is difficult to know if the organism has simply been present but undiagnosed in humans for decades. Additional studies will help describe its epidemiology and give more context to a very interesting discovery.

Salmonella from Ground Turkey Leads to Widespread Recall in US

Salmonellosis has swept the nation, with 76 illnesses and 1 death identified across 26 states. Beginning March 9 and continuing into August, the U.S. Department of Agriculture and the Center for Disease Control have followed reports of foodborne illness caused by Salmonella Heidelberg across the country. Cases have sprung up from Massachusetts to Arizona, with the lone death occurring in Sacramento, California.

On July 29, the Food Safety and Inspection Service of the USDA issued an alert about possible contamination of ground turkey, but had not yet determined specific brands under investigation. Just days later, meat producer Cargill announced a voluntary recall of fresh and frozen ground turkey from its Arkansas plant, believed to be the source of the outbreak. Cargill has halted production while they investigate the cause of contamination and also issued an apology to those who fell ill. With 36 million pounds of ground turkey recalled, this is one of the largest food recalls ever.

The Salmonella Heidelberg strain at the center of the outbreak is resistant to many antibiotics, creating significant problems in treatment. Signs of infection with salmonella include abdominal cramps, vomiting, and diarrhea. Symptoms usually begin 12-72 hours after exposure and can last 4-7 days. As a precaution, the CDC reminds that ground turkey must be cooked to an internal temperature of 165 degrees Fahrenheit. Contaminated turkey, if properly cooked, will not cause illness.

Photo courtesy of: http://www.flickr.com/photos/voght/2441818832/

Cerebrospinal Meningitis Outbreak in Ghana Leaves 5 Dead

An outbreak of CSM, commonly known as cerebrospinal meningitis, in the New Nsuta community of Obuasi Municipality in Ghana, has killed 5 and infected 17 individuals. It has not yet been established how the disease broke out in the area. Fearful residents are urging local health officials to immediately immunize them, and the Ministry of Health is working to dispatch vaccines to the area, although the strain has yet to be identified. Meningitis is an infection that causes inflammation of the brain and spinal membrane and can be caused by a variety of viruses and bacteria. The outbreak has reportedly taken a toll on businesses in the area, as patrons are pulling out. Last year’s meningitis outbreak in northern Ghana resulted in 54 cases and 27 deaths.

“Unusual Cluster” of Deadly Meningitis in New Zealand

Health care professionals on New Zealand’s South Island have been told to be extra vigilant after 4 cases of a rare and aggressive type of meningitis (Neisseria meningitidis type C) were confirmed.  One patient has died (a well-known construction company CEO and father of three), and three others remain hospitalized. The individuals hospitalized include a colleague of the deceased CEO, a Christchurch woman in her 40s, and a toddler in a Dunedin Hospital. All are expected to make a full recovery. What has made this outbreak particularly unusual is the confirmation by public health officials that there is nothing linking the two men with the woman or toddler.

Anyone with suspected infection with meningococcal disease should seek immediate medical attention. Symptoms can develop quickly and include nausea, fever, headache, stiff neck, vomiting, and sensitivity to light. 

World Hepatitis Day

Today is World Hepatitis Day. Since 2008, World Hepatitis Day has worked to increase public and media interest through thousands of events worldwide.

Hepatitis is the inflammation of the liver, generally caused by a viral infection. There are 5 different types of viral hepatitis, differentiated by the letters A, B, C, D, and E. While hepatitis A and E are caused by ingestion of contaminated food or water, the remaining types are spread by contact with infected body fluids. Common means of transmission include sexual contact, blood transfusions of infected blood, shared needles, or through childbirth. Symptoms of hepatitis may include yellowing of the skin and eyes (jaundice), extreme fatigue, nausea, vomiting, and abdominal pain; however, infections are often asymptomatic and individuals may be infected for years without showing signs. Hepatitis B and C may lead to chronic liver disease and can be fatal.

Hepatitis is currently a prominent cause of death in South/Southeast Asia, where it kills more people than any other communicable disease- more than dengue, malaria, and HIV/AIDS combined over the past 10 years. In fact, nearly one-quarter of the global disease burden of hepatitis B and C lies in just 11 countries: Bangladesh, Bhutan, Burma, East Timor, India, Indonesia, Maldives, Nepal, North Korea, Sri Lanka and Thailand. Experts predict over 5 million deaths in the region over the next decade.

Perhaps most importantly, World Hepatitis Day focuses on the importance of prevention and increased access to treatment. Currently, hepatitis B can be prevented through a 3-dose vaccination series. Hepatitis A can also be prevented with vaccination, or through careful hand-washing and hygiene practices, as can hepatitis E. Unlike other types, hepatitis B is often chronic and can never be considered “cured,” but can be controlled through careful treatment.

28 Dead this Month from “Malaria” in Mali?

According to a Chinese news article, a malaria outbreak currently underway in Mopti, Mali has claimed 28 lives since the first death occurred in early July. Mopti, a significant tourist region in the West African country, is completely surrounded by rivers and hence dubbed the “Venice of Mali.” The report claimed that during this rainy season, villagers have been directly drinking from the flooded rivers, thus “causing malaria to spread quickly in the area.” However, malaria is transmitted through bites from mosquitoes infected with the Plasmodium parasite and not from drinking contaminated water. Healthmap is therefore dubious of the accuracy of this report and suspect the reporter might have confused malaria with cholera. French news reports from earlier this month describe a cholera outbreak in Mopti and Timbuktu. Nevertheless, Mali does have a high burden of malaria.  According to the 2010 WHO malaria report, Mali had 2,331 malarial deaths and 1,633,423 suspected cases in 2009 (the last year reported).  Healthmap will continue to monitor for any clarification updates.

Hendra Virus Confirmed in Queensland Dog

The Australian Animal Health Laboratory has confirmed the first case of Hendra virus in a dog. Hendra virus has only been found naturally within the flying fox bat, horse, and human. This case is the first to be found within a dog outside of a laboratory. The male kelpie showed no signs of disease, but tested positive for antibodies and likely contracted the virus from a positive horse on the property already under quarantine near Beaudesert, Queensland. It has not yet been confirmed if humans can become infected from animals other than horses but the risk is likely low. Researchers and pet-owners fear an evolving disease that can spread more readily from different species.

Hendra virus continues to appear in Queensland and New South Wales, Australia. Most recently, the virus was found in a horse in Chinchilla, Queensland.  This is also the first case west of the Great Diving Range. Over the past month, 10 horses in Queensland and 4 in New South Wales have died or have been euthanized. It is estimated that a total of 57 people have been exposed and are being monitored and tested for Hendra virus.

1st ever Hantavirus death in Peru & Mexico’s 1st measles case since 2007

Photo credit: r.i.c.h.

Hantavirus blamed for death in Peru
A 29-year-old woman is Peru’s first ever Hanatavirus death.  The woman worked as a tour guide Iquitos, the largest city in the Peruvian rainforest.  Health officials are warning people to wear a mask when cleaning rooms that have been closed up for a long period of time.

Hantavirus can cause severe respiratory disease.  It is present on the feces of many species of mice.  Humans may become infected when they clean mouse droppings.  Hence, a face mask is recommended when sweeping or cleaning any location that has mouse droppings.

First case of measles in Mexico since 2007
An 18-month-old French girl who recently arrived in Mexico has been diagnosed with measles. Health officials are trying to locate the other passengers who were aboard her plane, and the Mexico City neighborhood where she is staying is under quarantine. The 2007 case of measles was in a traveler; no Mexican national has been diagnosed with measles in Mexico since 2004.

The case is yet another example of the risks of low vaccination rates in other countries. Recent measles cases in Boston, Massachusetts were linked to a French consulate worker. The United Kingdom believes its surge in cases is due to contact with people in France and other European countries where outbreaks have been spreading.

Polio returns to Nigeria, South Sudan's Nodding Disease, & Poisoning outbreak triggers countrywide alcohol ban

Photo credit: Julien Harneis via Flikr

Polio Threatens Nigeria After Progress
UNICEF has detected 20 new polio cases in northern Nigeria. These cases threaten to erase the substantial progress Nigeria has made in eliminating the disease. The country reduced polio deaths from 338 to 21 from between 2009 and 2010, but a wild-type poliovirus has now bed reported in six Nigerian state.  

In 2003, Kano state refused to participate in a polio vaccination campaign after a few Muslim leaders stated the vaccines were actually anti-fertility drugs. Eventually health workers were able to allay the fears of parents. Then in 2005, 69 cases of polio were found to be due to the live virus in the oral vaccine drop, triggering a new wave of suspicion and fear of vaccination. The World Health Organization has worked closely with local leaders to achieve a high rate of vaccination and drop Kano state’s polio case count to only 1 in 2010. The new cases are in Borno, Jigawa, Kano, Kebbi, Sokoto, and Yobe.  WHO has pledged to eliminate polio worldwide by 2012, a goal that will now be even harder to achieve.

Nodding Syndrome in South Sudan
A mysterious disease continues to grow in three African countries, including recently independent South Sudan. Nodding syndrome, named for the uncontrollable nodding that occurs, impairs physical growth, cognitive development and ultimately leads to premature death The characteristic nodding arises from seizures that cause lapses in neck muscle tone, letting the head fall forward. Seizures appear to be triggered by the act of chewing; thus, children have difficulty eating and eventually suffer from malnutrition and stunted growth. The disease is progressive and fatal, usually first appearing between ages 5 and 15.

Though first documented in 1962, the cause of nodding syndrome remains elusive. Experts have theorized environmental causes (such as toxic residue from ammunition in war zones), genetic factors, or dietary customs are to blame. Other possibilities include Onchocerca volvulus, the parasite responsible for river blindness, or a vitamin deficiency.  The disease also exists in parts of Uganda and Tanzania but no linking factors have yet been found between the countries, meaning experts are still unsure of the true cause of nodding syndrome.

Alcohol Ban in Ecuador After Poisoning
The Ecuadorian government has imposed a 72-hour ban on the purchase, sale or consumption of alcohol. After drinking adulterated alcohol, 21 people have died and  105 people are receiving medical treatment. Los Rios province has seen 19 deaths, while Tungurahua ans Azuay provinces have reported one death each. Public Health Minister, David Chiriboga reported that investigators analyzed 28 barrels of alcohol (each with 55 gallons) and found methanol, a toxic alcohol. Methanol is produced if the alcohol is not distilled properly.

Some methanol poisoning symptoms include abdominal pain, blurred vision, nausea, vomiting and also difficulty breathing. Although these symptoms can also be confused with drinking too much, it is advised that anyone in Ecuador experiencing such symptoms be aware that it may be due to methanol poisoning.

Chiriboga hopes that the 72-hour ban will give the government enough time to discover the source of this poisoning and contain it. Health officials encourage anyone who feels nausea or experiences vomiting to immediately seek medical attention in order to prevent the situation from spiraling even more out of control.

Cholera in DRC, Massive Diarrheal Outbreak in China, & Lyssavirus in Australia

Poster by UNICEF

Cholera Hits Hard in the Democratic Republic of Congo

Cholera continues to affect the Democratic Republic of Congo, with 192 deaths and over 3,000 cases reported by the United Nations. The outbreak began in March in Kisangani and has spread along the Congo River to several provinces and the capital city Kinshasa. The Bandundu province has been especially hard hit, with 1,271 cases and 72 deaths.

Cholera is an acute intestinal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. The bacterium then produces an enterotoxin that causes extreme diarrhea and can rapidly lead to dehydration and death. Cholera is especially dangerous for children and can be fatal in a matter of hours. However, it can be successfully treated with oral rehydration therapy or with intravenous rehydration. Since the outbreak began, UNICEF has provided 2,700 liters of intravenous solution and 20,000 sachets of oral rehydration salts to health centers. The United Nations Stabilization Mission to the Democratic Republic of Congo and the Office for Coordination of Humanitarian affairs have provided additional logistical support so that supplies can reach affected areas.

Cholera is considered a key indicator of social development because it can be prevented with adequate sewage systems and water treatment facilities. However, it remains a problem in much of the developing world. Outbreaks have recently occurred in Haiti, Ghana, Nepal, and Nigeria, in addition to the DR Congo.

Hundreds of Thousands of Possible Cases Linked to Polluted Water Source in Huangchuan County

Since mid-June, Huangchuan County of Henan Province in China has seen a sharp rise in diarrhea cases, exceeding the capacity of local hospitals and causing many pharmacies to run out of medication. Despite initial claims that the increased diarrheal incidence was simply due to humid weather, dirty food, and aging water plant facilities, officials have since admitted that the tap water was contaminated from its unclean water source in the heavily polluted Xiaohuanghe River. Although the county stopped using this river as a water source four years ago as a result of its heavy pollution, a recent drought that dried up the previously used reservoirs forced the county to return to pulling water from the river using a water plant built in 1979 and had been out of use since 2008. Residents describe their tap water as “disgusting…yellow-black, and sometimes had dead mosquitoes…in it.” Recently, it was discovered that duck farms scattered along the river had been dumping duck excrement and dead animals directly into the river.

While 294 cases have been reported in this period, it is believed that some 100,000 individuals may have been sickened by the dirty drinking water. This discrepancy is partially due to failure to report many cases seen at local clinics. One physician reported that many patients have long-standing post-cure symptoms such as nausea and flatulence. While no one may know just how many people became ill, it appears that the number of new cases each day have slowly begun to decline.

Lyssavirus in Melbourne, Victoria

Australian Bat Lyssavirus has been detected in a colony of fruit bats in Yarra Bend Park, which is in the Melbourne suburb of Kew.  Lyssavirus is related to rabies and produces similar neurological symptoms: change in behaviour, paralysis, seizures. The only two humans cases have ever reported were in Queensland in 1996 and 1998; both resulted in death.  It has not been identified in any other animals, and humans can avoid the disease simply by not interacting with bats.

Australian Bat Lyssavirus is a completely different disease from Hendra virus, which is also bat-associated.  A Hendra virus outbreak in Queensland has led to calls from some of the public to cull the bat population.  The idea has been utterly dismissed by public health authorities; culling or relocating the bats would stress the urban bat population and thereby increase shedding of the virus, leading to more, not fewer, cases. Additionally, the flying foxes in question are critical for seed dispersal and pollination of many important plants and crops.