30 March, 2011

H1N1 on the Rise in Venezuela and Varicella in the Ukraine

Swine Flu Overwhelms Venezuela
Today, the Venezuelan government confirmed 415 cases of H1N1 influenza in Venezuela. This is twice as many cases as there were last week, meaning that the outbreak is quickly spreading throughout the country. Many schools such as ones in Mérida have closed in order to prevent the further spread of the disease. With about 900 other cases suspected in the country, public health officials recommend that Venezuelans get vaccinated as soon as possible.

Chickenpox in Ukraine
There have been many reports of children in nursery schools in Lviv, Ukraine having symptoms indicative of chickenpox. In one nursery, 10 children became ill, and an outbreak of chickenpox was declared. Chickenpox (varicella) is an acute viral infection transmitted by airborne droplets. Children most commonly affected are typically between the ages of 6 months and 7 years.

Из детских садов города Львова стали поступать сообщения от воспитателей и мам о том, что у детей появились все признаки ветрянки. В одном из садиков в группе заболели уже 10 детей. В этом детсаду врачи уже объявили об эпидемии ветрянки. Ветрянка (ветряная оспа) - острая вирусная инфекция, передающаяся воздушно-капельным путем. Заболевают ветрянкой, как правило, дети в возрасте от 6 месяцев до 7 лет.

23 March, 2011

Mysterious Deaths in Chiang Mai, Thailand

On February 7th, 2011, New Zealand news sources announced that a Wellington woman was dead and two others were seriously ill after returning from Chiang Mai, Thailand (a popular tourist destination in Northern Thailand). Food poisoning was initially suspected by authorities.

A press conference was held in Chiang Mai on March 8th after it was discovered that the New Zealand native had stayed at the Downtown Inn, in a room neighboring that of a Thai woman who was found dead on February 3rd. In addition, on February 19th, the bodies of an English couple were discovered inside the hotel. While Thai authorities stated that the investigation was ongoing, it was suspected that the deaths were coincidental.

On March 12th, additional information revealed that the tourist from New Zealand was infected with an echovirus, and likely died of myocarditis. Autopsies on the English husband and wife showed block arteries in both, which may have contributed to their deaths.

Travel warnings for Chiang Mai were issued via media outlets on March 18th after the deaths of an additional two people (an American woman and a French woman) were linked to recent travel to Chiang Mai.  It was also stated that the two died suddenly and had similar symptoms as the previous victims, including myocarditis. Speculations began to circulate about the possibility that the deaths were linked to eating at local food markets.

On March 21st, the death toll rose to seven when it was discovered that a 59 y.o. male, Canadian tourist that had used facilities at the Downtown Inn in Chiang Mai, died in early January.  As of March 23rd, no confirmation of a common viral infection or other cause has been given. The victims’ families continue to demand answers.

An Occurrence of Foot and Mouth Disease in Domestic Livestock in Russia

On March 21st, in the Trans-Baikal region, the State Veterinary Service received confirmation of an occurrence of Foot and Mouth Disease in domestic livestock in the village of Ust-Imalk, which borders Mongolia and China. The village is currently being quarantined and additional restrictive measures are being prepared.

Ust-Imalke has approximately 1,500 cattle, 2,900 sheep and 75 pigs. Of these, less than 10% of the cattle, and 1 pig have been infected to date. A re-vaccination campaign is currently underway in an effort to halt the outbreak. The preliminary suspected cause of the occurrence appears to be wild antelope migrating between Russia and Mongolia.

Вспышка ящура у домашних животных в Усть-Ималке.

Как сообщает пресс-служба администрации губернатора Забайкальского края, 21 марта Государственная ветеринарная служба края получила подтверждение вспышки ящура у домашних животных в селе Усть-Ималка Ононского района.  В настоящее время в селе введен карантин, готовятся документы о проведении ограничительных мероприятий.

Всего в Усть-Ималке насчитывается 1 518 голов крупного рогатого скота, 2 865 овец, 73 свиньи. Заболело 117 голов КРС (3 уже выздоровело), одна свинья. Падежа животных не зарагестрировано.

Все животные были вакцинированы против ящура, в настоящее время проводится ревакцинация. Предварительной причиной вспышки заболевания названы дикие антилопы-дзерены, мигрирующие между Россией и Монголией.

18 March, 2011

Meningitis in Ghana and the US, Avian Influenza in Bangladesh, and Plague in Madagascar

Meningitis in Ghana and the United States
Fifteen people have died from meningitis in Ghana’s Upper West Region with over 100 cases reported. Ghana is located in the Meningitis Belt of sub-Saharan Africa where the highest rates of bacterial meningitis are seen. Although vaccines exist for meningococcal meningitis, many in the Meningitis Belt are unvaccinated.

In the United States, young adults are considered to be at the greatest risk.  This week, a college student at Ohio State University and a high school student in Elizabethton, Tennessee died.  Meningococcal meningitis has been confirmed in the former and is suspected in the latter.  Also, an Oregon high school student is in critical condition with confirmed meningococcal meningitis.  A second possible case has also been identified.  According to the CDC, the US has between 1,000 and 1,200 cases each year.  The CDC has more information on the vaccine here.

Human Cases of Avian Influenza in Bangladesh
Two cases avian influenza (H5N1) have been reported in the Kamalapur area of Dhaka.  The first case is a one year old girl and second is a 2 year old boy.  The boy was diagnosed after increased surveillance following the identification of the girl’s illness.  The only other human case of H5N1 in Bangladesh was in 2008 in the same area as the current two cases.

Plague Continues to Spread in Madagascar
Since early February 2011 deaths from both pneumonic and bubonic plague have been occurring in Northern Madagascar. As of February 23rd a total of 45 cases had been detected in the country with 23 deaths. It is thought that plague initially spread as locals mistook symptoms of plague for influenza. It was only after 3 people in one family died in the district of Ambilobe that doctors were alerted. In a report dated March 15th, additional deaths were reported from the Antananarivo region. While plague typically occurs yearly in Madagascar’s Central Highlands, the current outbreak is occurring in a region where the disease is not endemic. In areas affected, homes are being sanitized, and preventative treatment is being given to those who have had contact with plague victims.

15 March, 2011

The Great Tohoku Earthquake and Tsunami

On March 11th, 2011 a magnitude 8.9 earthquake struck just off the coast or Japan’s Miyagi prefecture, 231 miles northeast of Tokyo. The largest ever recorded in Japan and fifth largest in the world, it reportedly shifted the earth’s axis by 4 inches and moved the mainland of Japan 8 feet. Within an hour after the earthquake, a devastating 30-foot tsunami struck the coast, sweeping away cars, trains, and buildings. The water traveled up to 6 miles inland in Miyagi prefecture. While the official death toll stands at 1,898 at the time of this writing, the actual toll is expected to be far higher. [Edit: The official toll is now 2475  3373.]  The Japan Times reports there are over 10,000 dead or missing. The cast majority of the deaths are due to the tsunami rather than the earthquake itself. New satellite images give a sense of the destruction caused by the powerful tsunami.

The initials risks from an earthquake and a tsunami are drowning and trauma. Once the immediate emergency has passed, the primary health concerns are from lack of clean water, safe food, and adequate sanitation. Japan’s strong infrastructure and extensive disaster planning should reduce these threats substantially. Nevertheless, respiratory diseases like colds and influenza may spread rapidly in crowded shelters. The cold weather combined with stress may leave some people more susceptible to infection. Survivors are also at risk if they lack access to their usual medications for chronic conditions like diabetes or heart disease.

Also of public health interest, the Japanese government soon declared a state of emergency near the hard-hit city of Sendai for the Fukushima Daiichi nuclear power plant due to cooling equipment failure and rising pressure inside multiple reactors. Residents have been evacuated in a 20 kilometer radius around the power plant as a precaution, and plans were underway to distribute iodine tablets to prevent thyroid cancer from radiation poisoning if substantial radiation is released from the plants. The situation at the nuclear power plants remains very fluid. [Edit: Since the writing of this blog, elevated radiation has been detected after an explosion at Daiichi, but the likely health effects are not yet clear.]

Although tsunami warnings were issued in over 50 countries, the effects were limited. In the United States tsunami-related damages to  California and Hawaii’s harbors is in the tens of  millions. Santa Cruz and Crescent City, California and Brookings, Oregon also sustained damages from 6-8 foot waves.

HealthMap has increased surveillance efforts and will be following the events in Japan as they unfold. A map focusing on public health occurrences in Japan as a result of this natural disaster has been created and can be viewed at www.healthmap.org/japan

For additional crisis resources or to donate Japan’s Red Cross, you may visit the 2011 Japanese Earthquake and Tsunami resource page.

10 March, 2011

HealthMap increasing disease surveillance for growing Libyan refugee crisis

**Go to HealthMap.org/Libya for constantly updated health information**

Inspired by uprisings in neighboring Tunisia and Egypt, Libyans began protesting against Muammar Gaddafi on February 15th.  Gadaffi responded with violent military action, leading UN Secretary General Ban Ki-moon to express his outrage one week later.  The UN Security Council has called for a war crimes investigation.  Despite limited communications and access by journalists, reports of violent confrontations have emerged on a daily basis, and over 200,000 Libyans and foreign worker are leaving the country.  

The International Organization for Migration reports refugees are fleeing to Tunisia (at least 112,000 people of 40 different nationalities), Egypt (at least 98,000 from 24 countries), and Niger (2,000 to 3,000).  The large numbers and lack of resources available at the borders make for a “logistical nightmare.”  The World Health Organization warns of the potential for disease outbreaks among refugees gathered along the Tunisia-Libya border.

In partnership with CrisisMappers, HealthMap has created a special page to monitor this ongoing crisis.  We currently are showing public health related articles for Libya and the near-by countries receiving refugees.  We also show the location of health facilities in Libya.  As information becomes available we will add data layers.

Monica Onyango describes a Complex Humanitarian Emergency (CHE) as “a situation in which prevailing conditions threaten the lives of a portion of the population who … [cannot] obtain the minimum subsistence requirement and are dependent on external humanitarian assistance for survival.”  The growing population of refugees along the borders is likely to become a CHE if it isn’t already.  The four biggest killers in CHEs are measles, diarrheal diseases, acute respiratory infections, and malaria.  Scattered reports of diarrhea, conjunctivitis, and skin infections have surfaced already.  HealthMap will be increasing surveillance for any reports on disease outbreaks.  For those interested in learning more about CHEs, the CDC published guidelines for dealing with them in 1992.

09 March, 2011

Rio de Janeiro: Carnival 2011

The much-anticipated Carnival in Brazil comes to an end today, March 8th, better known in the United States as “Fat Tuesday”.  After four days of wild celebration, partygoers prepare themselves for 40 days of Lent until Easter. Carnival is an opportunity to not only let loose before Lent, but also for Brazilians to celebrate their culture with music, dancing and fun.  Carnival in Brazil is all about excess, lack of inhibition, and celebrations.

This giant celebration takes months and months of planning.  For the Samba schools that perform in the Samba stadium “Sambodromo”, dance moves must be choreographed, music written and rehearsed and elaborate costumes designed. These parades attract millions of spectators, both from Brazil and the rest of the world, as the biggest and best Samba schools show off their costumes and dance moves that have taken nearly all year to put together. Rio de Janeiro residents flood the streets to have their own neighborhood celebrations for Carnival, creating an euphoric atmosphere throughout the tropical city.

Behind the Carnival scenes, there is a lot of planning and preparation that takes places in the Brazilian Health Ministry. Brazil, well known for being a pioneer in HIV/AIDS awareness, increases its enthusiastic and aggressive HIV/AIDS preventions campaign during this 2011 Carnival season. During Carnival this year, the Brazilian Health Ministry distributed 89 million free condoms, which is 26 million more than last year. In addition, HIV/AIDS prevention announcements will be displayed extensively on television, radio and Internet advertisements throughout Carnival in an attempt to target and educate as many people as possible.

04 March, 2011

Measles Update, Chikungunya Appears in New Caledonia and More Infectious Disease News

40 Cases of Food-Borne Illness in Russia
Between January 12th and February 22nd a preschool in Rosinka, Russia recorded 40 cases of gastroenteritis. Upon further investigation the diagnosis was confirmed in 31 children. Following an examination of products used at the preschool, bacteria was detected in milk, yogurt and cottage cheese.

С 12 января по 22 февраля в дошкольном учреждении «Росинка» были зафиксированы 40 случаев с предварительным диагнозом ОКИ (острая кишечная инфекция). После обследований такой диагноз подтвердился у 31 ребенка. После проведенной экспертизы поставляемых продуктов в некоторых нашлись бактерии группы кишечной палочки. Так, данные бактерии были обнаружены в молоке, кефире и твороге. Кроме этого, кефир не проходил термической обработки, что так же могло сказаться на состоянии здоровья детей.

Measles in Review: USA, New Zealand, Angola, DR Congo
Measles is one of the leading causes of death in children and one of the most contagious diseases known.  Among susceptible people (those who are unvaccinated and never had it before), 90% who come into contact with a case will become infected.  Measles kills about 450 people (mostly children) on average every day.  It is preventable through vaccination.  In some part of the world, vaccination has never been widespread enough to prevent outbreaks.  Due to decreased levels of vaccination in places with formerly excellent coverage, measles is a re-emerging threat that has been in the news a great deal recently.  

On February 20th, a woman with measles traveled from London to Washington, DC’s Dulles International Airport (IAD).  She traveled around the city and two days later flew from Baltimore Washington International Airport (BWI)  to Albuquerque (ABQ), with a three hour layover at Denver International Airport (DIA).  Thousands of travelers may have been exposed.  Although Public Health officials are contacting individuals on the flights, susceptible people in those airport terminals could also have been infected.  The classic measles rash typically takes two weeks to develop, so the number of related cases is still unknown.

In a separate incident, a worker at the French Consulate in Boston was diagnosed with measles, triggering extensive vaccination efforts.  A second case has been confirmed and three more are suspected, including a professor at the University of Massachusetts in Boston.

Earlier this year, a traveler with measles flew from Dubai to Auckland, New Zealand.  Unfortunately, New Zealand has seen numerous cases subsequent to the flight.  Last week, an earthquake evacuation center in Christchurch had to be closed due to concerns about a measles at the shelter.

In areas of the world with greater malnutrition and additional diseases, measles remains deadly to children.  An ongoing outbreak in Angola has led 320 cases.  Nine have died and 170 are severely ill.  DR Congo has seen almost 4,000 cases since January.  Thirty one children are known to have died.

Chikungunya makes its debut in New Caledonia
New Caledonia’s first ever case of chikungunya was recorded this week.  The patient who remains anonymous according to French news, has since recovered.  The patient was contaminated while on vacation in Indonesia.  Chikungunya is a mosquito borne virus that has symptoms similar to those of dengue fever (fever, rash, joint pain).

Chikungunya en Nouvelle-Calédonie
Le premier cas de chikungunya en Nouvelle-Calédonie a été diagnostiqué cette semaine.  La patient a été contaminé pendant les vacances en Indonesie.   Le chikungunya est un virus, transmis par les moustiques, qui a des symptomes très similaires aux symptomes de la dengue (la fièvre, les rougeurs, douleurs des articulations).

Dengue in Miami, Florida
The 2nd locally-acquired case of dengue fever since November 2010 was confirmed this week in Miami-Dade county, Florida. Dengue is a disease spread by the mosquito Aedes aegypti. Health officials are encouraging residents to take precautions such as to clear areas of standing water (where mosquitoes are able to lay eggs) and to utilize insect repellent when outdoors.