29 April, 2011

Brucellosis in humans and cattle in Bashkortostan, Russia

In the region of Bashkortostan, in southern Russia, 248 cattle had to be put down because of an outbreak of brucellosis. In addition, there have been 7 confirmed human cases of infection.

Examinations currently point to cattle imported from Kalmykia as the source of infection. In Kalmykia, 40% of cattle have been infected with brucellosis. The cause and type of infection is being investigated by oversight agencies. Analysis of blood taken from individuals in the infected area showed that 7 people have the infection, although they are in good health. Doctors continue to investigate the source and health of individuals exposed to infected animals.

Brucellosis is primarily a cattle disease caused by the Brucella bacteria. Humans may become infected through eating contaminated meat/dairy, inhalation of the bacteria, or through a wound in the skin. Human to human transmission is very rare. Symptoms in humans include fever, abdominal pain and back pain. Also called “contagious abortion," Brucellosis can be a very costly disease to cattle producers in countries where vaccination programs are now in effect.

В Альшеевском районе Башкирии из-за вспышки бруцеллеза уничтожена мясная ферма, численностью 248 голов. Инфицированы семь человек.   Заражен полностью мясной скот, завезенный из Калмыкии. В Калмыки 40% скота заражено данной инфекцией. Причина инфицирования и тип инфекции выясняются надзорными службами. Анализ крови, взятый у людей, показал, что семь человек инфицированы, хотя они чувствуют себя хорошо. При 40 градусах вирус погибает. Сейчас врачи продолжают проверять состояние здоровья людей, контактировавших с зараженными животными.

28 April, 2011

Major Measles Outbreak in Europe, Failure to Vaccinate Seen as Cause

The World Health Organization (WHO) recently reported that measles cases are occurring at an alarming rate across Europe, with 6,500 cases having been reported in 33 countries between January to March of this year. France alone has seen 4,937 cases in this time period, including 1 death; France reported 5,000 cases during all of 2010. Similarly, Belgium has already reported 155 cases for this year, compared to the mere 40 cases for all of last year. Outbreaks have also been reported in Germany, Macedonia, the Netherlands, Norway, Romania, Russia, Switzerland, Turkey and Britain.

WHO says that the surge in cases is due to not enough children having received vaccination, especially those who are now between the ages of 10 and 19. As a result of the accumulation of unvaccinated children over the years, the herd immunity for the population has been lost and the disease can spread quickly among the susceptible, causing severe illness and sometimes death. When herd immunity is lost, those who are too young to be vaccinated are at much higher risk of catching the disease.  Indeed, 30% of France's cases occurred in children too young for the vaccine. Officials speculate that as a result of people not seeing the disease over the years, especially in early 2000, many have forgotten or do not know how severe measles can be and have failed to vaccinate their children. Some European communities do not vaccinate for religious or philosophical reasons, and migrant populations moving across borders may not receive vaccinations. Many have also blamed Wakefield’s completely discredited study in the 90s that linked the MMR vaccine to autism as a major contributor to the drops in vaccination rate.

Given the current capacity for global travel, such trends are worrisome and can lead to large-scale outbreaks. Health officials in New Jersey recently warned patrons of a Livingston restaurant that they may have been exposed to measles from two unvaccinated young women from France.  They visited the restaurant on April 10th and developed symptoms three days later. Similarly, nine measles cases in Utah were recently linked to an unvaccinated person who contracted the disease in Poland. Officials estimate the individual may have exposed up to 1,000 individuals earlier this month.

Measles, also known as rubeola, is a highly infectious viral illness spread by contact with droplets from the nose, mouth or throat of an infected person as a result of sneezing or coughing. Its symptoms include fever, coughing, red eyes, and a generalized rash all over the body.  Complications include pneumonia, acute encephalitis, corneal scarring, and even death. It is estimated that 90% of individuals without immunity who are exposed with the virus become infected. Immunization for measles is administered in the MMR vaccine that also targets mumps and rubella. WHO recommends 2 doses of MMR for all children.

25 April, 2011

World Malaria Day


25 April 2011: World Malaria Day

Today is the fourth annual World Malaria Day. On this date in 2000, leaders from 44 malaria-affected African countries signed the Abuja Declaration pledging to cut their malaria deaths in half by 2010. Although much more effort will be required, many countries show substantial progress. The WHO-commissioned World malaria report 2010 notes insecticide-treated mosquito nets and indoor residual spraying have been very helpful in protecting people from malaria. [For a brief summary of the report click here.]

The report notes several accomplishments. Eleven African countries reduced by half confirmed malaria cases or malaria admissions and deaths over the past decade. In addition, 32 of the 56 malaria-endemic countries outside Africa reduced their cases by half. Morocco and Turkmenistan eliminated malaria in 2009. Also in 2009, the WHO European Region reported no cases of Plasmodium falciparum malaria for the first time.

Despite the good news, Dr Margaret Chan, Director-General of the World Health Organization, warns:
“Progress, on every front, at every level, is fragile. Malaria is an extremely complex disease that has been causing deaths and social disruption since the beginning of recorded human history. This is a disease that can take full advantage of any lapse in investment, vigilance, or control.”

Indeed, malaria continues to be in the headlines (see more at http://healthmap.org/malaria):

  • A travel ban was put into place on March 28th between Queensland and Papua New Guinea through the Torres Strait due to a malaria outbreak.
  • The United Kingdom has issues a warning to travelers that they need to remember to take their anti-malarials while on holiday. The UK has seen a 30% jump in cases in the past two years, and when asked,  85% of them reported not taking the medications.
  • Due to unrest in the past several years, the Yala Province of Thailand has seen an increase in malaria cases from 30 per year to 3000 per year. In January - March 2011 2320 cases had been confirmed.
  • 11 people have died and 909 cases have been confirmed in Goromonzi West, Zimbabwe. Malaria is the biggest killer of children under 5 in Zimbabwe.
  • Following March flooding in Jeddah, Saudi Arabia, 4 cases of malaria have been confirmed
  • China reports 11 deaths from malaria in 3 months

21 April, 2011

14 Hospitalized with Suspected Anthrax in Tajikistan

Suspected Anthrax Infections in Tajikistan

At least 14 people have been hospitalized with suspected anthrax in the Sogdiana region of Tajikistan.

In late March, a resident of the village (Kayirma, Shahristan District) discovered the death of four of his cows. A day later, similar cases of animal deaths were reported in a number of other farms in Kayirma. Epidemiologists reported that the cattle died of anthrax. In order to prevent the spread of this occurrence, a decision was made to close down all the meat markets in Istaravshan region.

A total of 17 affected animals were identified, and promptly slaughtered. The owners and everyone in contact with the infected cattle were hospitalized.

Anthrax is an acute infectious disease that commonly infects wild and domesticated mammals that ingest or inhale the spores while grazing. Infection in humans typically occurs in individuals closest to the animals, during slaughtering, meat processing, or by contact with animal products such as leather, fur, and wool.

По меньшей мере, 14 человек госпитализировано в Согдийской области на юге Таджикистана с подозрением на заболевание сибирской язвой.

Со слов работника СЭС, очаг инфекции был зарегистрирован в поселке Кайирма, Шахристанского района области. В конце марта, с утра жительница поселка обнаружила гибель 4 своих коров. Днем позже аналогичные случаи гибели животных были отмечены в ряде других хозяйств «Кайирмы».

Прибывшие на место работники санэпиднадзора установили, что скот погиб от сибирской язвы. В целях недопущения эпидемии решением комиссии из числа сотрудников СЭС и ветеринарной службы были закрыты все мясные рынки на территории Истаравшанского района.

В качестве справки следует заметить, что сибирская язва – это острая инфекционная болезнь. Источник инфекции: домашние животные (крупный рогатый скот, овцы, козы, свиньи). Заражение человека может наступать при уходе за больными животными, убое скота, обработке мяса, а также при контакте с продуктами животноводства (шкуры, кожи, меховые изделия, шерсть, щетина).

19 April, 2011

White-nose syndrome spreads, Foot and Mouth Returns to S. Korea, and Avian Influenza In Ostriches

White-nose syndrome reaches Nova Scotia and spreads in the United States
A Hunts County, Nova Scotia bat has tested positive for white-nose syndrome. The finding makes Nova Scotia the 4th Canadian province to see signs of the devastating disease. While spread primarily from bat-to-bat and not harmful to humans, Canadian authorities are urging residents to stay out of caves and old mines that are home to bat populations. Humans may inadvertently carry fungal spores that cause the disease into caves by way of clothing or caving gear.  

First seen in caves outside of Albany, New York in 2006, white-nose syndrome has spread rapidly west to Oklahoma, north into Canada, and south to the state of North Carolina. With the recent confirmation of the disease in Trigg County, Kentucky, 16 US states have now been affected.

White nose syndrome has been the cause of over 1 million bat deaths in Eastern North America, and bat declines have exceeded 70 percent in severely affected areas of New England. The total population of the little brown bat has declined so dramatically that the species may become extinct in the region within 20 years.

Foot and mouth returns to South Korea
Just 5 days after South Korea declared the end of their foot and mouth outbreak, six pigs were diagnosed with the disease.  All the pigs were on the same farm in Yeongcheon, N. Gyeongsang province.  Earlier, South Korea had chosen to vaccinate its animals against foot and mouth in an attempt to control the epidemic.  Countries generally prefer to eliminate outbreaks by culling and restricting animal movements because it take longer to regain certification as “foot and mouth free” if vaccinations are used.  The detection of the disease is a blow to South Korea; the epidemic has already led to losses totalling 2.6 billion US dollars.

Ostrich meat trade interrupted by flu outbreak
An outbreak of avian influenza on an ostrich farm in Oudtshoorn, Western Cape, South Africa had led to a ban on all exports of the product..  South Africa accounts for over 80% of the world’s ostrich meat production.  In an attempt to control the outbreak, 5,000 birds have been culled.  If the infection is contained, ostrich meat exports may resume next month.

13 April, 2011

Drug resistant bug review: NDM-1 in New Delhi’s sewage, WHO calls to action, recent outbreaks of antibiotic resistant bacteria

Last summer, media around the world reported on a newly discovered gene that provides bacteria the ability to evade almost all antibiotics (see our August 2010 blog). Researchers named it NDM-1 after New Delhi because it was thought to have originated there. Antibiotic resistant bacteria are often associated with hospital acquired infections; the frequent use of antibiotics in healthcare settings can enhance the development of resistance. Local politicians in New Delhi were outraged at the perceived smear of their city and denied that New Delhi was the source. Some of them also noted that many of the reported European cases had not been in hospital or at a clinic while in India.

The Lancet Infectious Diseases has now published online a study which examined 171 sewage samples and 50 water samples from throughout New Delhi. Samples from Cardiff, Wales were also evaluated as a control. None of the Welsh samples produced bacteria with the NDM-1 resistance gene. Among the New Delhi samples, however, 51 of the sewage and 2 of the water samples grew NDM-1 bacteria. The implications are important. Bacteria with the NDM-1 resistance gene appear to be not only widespread in New Delhi’s sewage but also present in some water samples, potentially explaining cases among Europeans who had travelled to India but had not sought medical treatment while there. A week after the study’s publication, India’s National Centre for Disease Control stated they would perform their own study on the presence of antibiotic resistant bacteria.

This past World Health Day (April 7th), the World Health Organization called on nations to fight antibiotic resistance. The WHO statement notes: “The world is on the brink of losing these miracle cures. . . . the R&D pipeline for new antimicrobials has practically run dry.” The threat of resistance is as old as the drugs themselves. During his 1945 Nobel Prize acceptance speech, penicillin discoverer Alexander Fleming warned of the risk of penicillin-resistance in bacteria if inadequate doses were used. Failure to complete a course of antibiotics may leave some bacteria weakened but not dead. The surviving bacteria can then produce entire populations of bacteria which are resistant to that drug.

Today, the problem of resistance is complex. In many countries, antibiotics are taken without a prescription (53% of Indians do so). Antibiotics in sewage (present either by flushing unused pills down the toilet or by excreting trace amounts of antibiotics through regular biologic function) also promote resistance by exposing bacteria to low levels of these drugs. People living in poverty (in both developing and developed nations) may take enough pills to feel better and then save the rest for future use, a false but understandable economy. Sometimes disasters or changes in international funding disrupt the supply of drugs to those who are on long-term antimicrobial medications. For example, a new case of tuberculosis is often treated for six months. If disaster, civil war, or manufacturing delays interrupt a patient’s treatment, he is not only at risk for a relapse, he is also more likely to develop drug resistant tuberculosis. Additionally, few new antibiotics are being researched, both because it is hard and because other medications are far more profitable.

A review of outbreaks recently mapped by HealthMap shows MRSA (Methicillin-Resistant Staphylococcus aureus) outbreaks in a UK hospital and a Chicago school. Over 350 cases of CRKP (Carbapenem-Resistant Klebsiella pneumoniae) were reported in Los Angeles County nursing homes, while a hospital in Ireland also saw cases of CRKP. A Scottish hospital has been battling VRE (Vancomycin-Resistant Enterovirus). Antiviral resistance is also a problem; Delaware reported 4 cases of Tamiflu-resistant influenza in March.  

Antibiotic resistance is a growing problem that will require international efforts and extensive patient cooperation to combat. For more information on antibiotic resistance, check out the CDC’s or the WHO’s web pages on the topic.  To see outbreaks of antibiotic resistant infections since the identification of NDM-1 last August, go to http://healthmap.org/resistance.

08 April, 2011

Possible Link in US Measles Cases and Dolphin Deaths Declared to be "Unusual Mortality Event"

Measles Outbreaks in 3 US States May Be Linked

Public health officials in Orange County Florida are reporting that tourists from Texas, Minnesota and Michigan have been diagnosed with measles after visiting Orlando. A CDC investigation suggests an air show may be a common link between several cases.  Since no cases have ben identified in Florida, it is possible a visitor from overseas infected people attending the air show.  In Texas, an 11-month old was diagnosed in Houston, while two adult cases in the Fort Worth area are the first in 17 years. The infant and one of the adult cases are believed to have been infected in Orlando. In Minnesota, 15 measles cases have been confirmed: 1 case likely came from Florida, 1 from India, and the others are linked to a case imported from Kenya.

Measles is highly contagious among the unvaccinated. Houston saw large outbreaks in the 1980s and 1990s when the immunization rate was quite low (58%). Many Texas news sources are reporting much higher coverage among kindergartners in surrounding communities. Abilene, for example, reports a 99% coverage rate.  High levels of immunity should diminish the risk of an outbreak. In Minneapolis, public health workers are meeting resistance to vaccination by some in the large Somali community. One doctor said in his experience as many as 70% of Somali families are avoiding the vaccines. Overall, Minnesota has seen a decline in vaccination rates. At 76.95%, the state has fallen from 7th to 20th place in the most recent survey of US states.

This week, a CDC report warned “measles importations and transmission from imported cases continue to pose a threat to U.S. residents.” In January and February, 28 import-associated cases were reported. Although measles was eliminated in the US, international travel poses the constant risk of reintroduction and establishment. Where immunization coverage is low, a single introduced case can lead to the return of the disease. For every 1,000 children who get measles, one or two will die.

Sea Turtles and Dolphins Washing up Dead Along Gulf of Mexico

Scientists are continuing to perform necropsies in an effort to determine what has caused the deaths of over 400 baby dolphins since February 2010 in the Gulf of Mexico.  The National Oceanic and Atmospheric Administration (NOAA) declared the deaths “an unusual mortality event” that has caused a significant loss of the marine mammal. While many are quick to blame the April 2010 BP oil spill, scientists have not yet been able to determine the cause of the deaths.

In addition to an increased number of dolphin deaths, over 100 endangered sea turtles (Kemp’s Ridley and Loggerhead) have died or been stranded along the shores of the Gulf since the beginning of 2011.  Tests are being conducted to determine the cause of the turtle deaths, which may be due to harmful algae blooms common in the Gulf of Mexico.

07 April, 2011

Possible Libya Border Camp Outbreak, Gastroenteritis in Ukraine, and Newcastle Disease Hits Israel

Possible Disease Outbreak in Tunisia-Libya Border Camp

On April 4th, a Chinese reporter was barred from entering one of the 4 refugee camps located 5 to 10 miles away from Ras Ajdir along the Tunisia-Libya border. The reason provided by the guide of the camp was that there was an ongoing outbreak within the camp. This particular camp reportedly contains around 15,000 refugees, the real number is unknown as people enter and leave everyday. The reporter observed that outside the camp, the pile-up of discarded tents had begun to emit a foul odor. The truthfulness of this outbreak is unknown and difficult to verify, although outbreaks of skin diseases and eye infections have previously been reported out of the area. Sanitation, clean water and food supply also remain an ever-present challenge.

39 Children with Gastroenteritis in Ukraine

The number of children hospitalized in Donetsk, Ukraine has increased from 30 to 39 with acute intestinal infection believed to be the cause.

The head of the Department of Health, a part of the Donetsk City Council, told reporters on Tuesday that 30 children under the age of 3 were hospitalized with a diagnosis of "food poisoning," as all hospitalized children consumed dairy products.

Local epidemiologists carried collected food samples for testing of bacterial contamination. This infection is typically of light to mild severity in children and subsides after a few days.

Число госпитализированных в Донецке детей с острой кишечной инфекцией выросло с 30 до 39, сообщает в среду пресс-служба МЧС Украины.

Начальник управления здравоохранения Донецкого городского совета Геннадий Нефедов сообщил во вторник журналистам, что 30 детей в возрасте до трех лет попали в больницы Донецка с диагнозом "отравление" . Все госпитализированные дети употребляли продукцию молочной кухни
Заболевание детей проходит в средней и легкой степеней тяжести.

Специалисты городского санитарно-эпидемиологического надзора проводят комплекс санитарно-гигиенических и противоэпидемических мер, отобраны пробы пищевых продуктов молочной кухни для бактериологического исследования, результаты которых планируется получить 6 апреля.

Newcastle Disease Strikes Israel

Poultry producers in Israel are battling an outbreak of Newcastle disease that has cost more than $8.7M USD to date.

As reported on Monday, Secretary of the Association of Poultry Farmers, Yaakov Cohen, stated that this has affected more than 70 farms across Israel. As a result chickens, turkeys and guinea fowl of the affected farms must be destroyed and the farms must be placed under quarantine.

Newcastle disease primarily affects domestic and wild birds, although the disease can cause conjunctivitis and influenza-like-illness in humans exposed to infected birds.

The Poultry Growers Association noted that, despite this occurrence, no shortage of meat or eggs in the coming Passover holiday would occur.

Вспышка болезни Ньюкасла причинила ущерб на сумму более 30 миллионов шекелей. Пострадали израильские производители птицы.

Как сообщил в понедельник секретарь Ассоциации птицеводов Яаков Коэн, пострадали более 70 хозяйств. Там подлежат уничтожении все куры, индейки и цесарки, а фермы помещены под карантин.

Хотя болезнь поражает птиц, она не оказывает никакого воздействия на человеческий организм.
Ассоциация производителей птицы отмечает, что, несмотря на произошедшее, никакой нехватки мяса или яиц в предстоящий праздник Песах не будет.