29 June, 2011

Salmonella Outbreak: United States

Multi-State Salmonella Outbreak in US
Officials from the Food and Drug Administration believe sprouts from northern Idaho are the likely cause of a recent outbreak of salmonellosis. So far, 20 cases have been reported in Idaho, Washington, Montana, North Dakota, and New Jersey. The FDA warns not to eat alfalfa or spicy sprouts labeled “Evergreen Produce” or “Evergreen Produce Inc.” Evergreen Produce has not yet recalled the sprouts but has stopped producing and distributing them.

The bacteria Salmonella can cause an infection in humans known as salmonellosis. Symptoms include diarrhea, fever, and abdominal cramps, starting 12 to 72 hours after infection. The illness usually lasts 4 to 7 days, and often resolves without treatment. Some severe cases require hospitalization; persons especially at risk of severe symptoms are infants, the elderly, and those with compromised immune systems. To prevent salmonellosis, practice food safety hygiene and avoid recalled produce.

Though this outbreak is not related to the recent E. coli outbreak in Europe that has killed 48 people and sickened 4,000 others, sprouts are at the heart of both. Raw sprouts frequently are linked to foodborne illness because they are grown in moist, warm conditions favored by certain bacteria.

24 June, 2011

Q Fever in the US; H1N1 in Argentina; Scarlet Fever Spreads Throughout Asia

Two Q Fever Outbreaks in the US
Q fever is caused by a bacteria (Coxiella burnetii) primarily found in sheep, goats, and cattle. Infected animals secrete the bacteria in milk, urine, feces, and amniotic fluids when giving birth. Humans typically become infected by inhalation of the bacteria present in barnyard dust, dried birth fluids, or feces. Other routes of transmission include tick bites and ingestion of unpasteurized dairy products. Human-to-human transmission is rare.

Currently, two Q fever outbreaks are ongoing in the United States. In Livingston County, Michigan three cases have been reported, and are associated with the consumption of raw milk products. Local public health officials are reminding consumers of the importance of only consuming pasteurized dairy products.

In the states of Washington and Montana, eleven people have been diagnosed with Q fever after having contact with infected goats. (Six cases in Washington and 5 in Montana) The goats were part of a now quarantined herd in central Washington that was later sold to a livestock operator in Montana. The investigation into this multi-state outbreak is ongoing.

Swine Flu Hits Mendoza, Argentina
As the weather becomes colder, Mendoza, well known for it’s delicious wines, is experiencing a Swine Flu outbreak. On June 22, the Mendoza government finally confirmed that there is indeed an outbreak in the city with 54 confirmed cases and 1 death. Health officials are urging people in the province to become vaccinated against H1N1 as only 41% are currently registered as being vaccinated. The government hopes to contain this outbreak before it spreads to other cities like Santa Fe and Corrientes.

Scarlet Fever Continues to Spread Throughout Asia
Earlier this week, we reported that a mutated strain of the bacteria that causes scarlet fever resulted in 2 deaths and a record number of cases in Hong Kong for this year. On Tuesday, authorities closed a kindergarten after early testing suggested another suspect death in a 5 year old boy. As of June 22nd, Hong Kong has reported 494 cases. Although scarlet fever occurs every year and is endemic to most of Southeast Asia, this year’s epidemic has been particularly severe. Shanghai reported 771 cases in the last month alone - a 13-fold increase compared to the same period last year, although the mutated strain has not been found to be the cause. The epidemic in Hong Kong has also caused growing concern in Macau, where 49 cases have already been reported, and also in nearby Thailand, where authorities are making all effort to assuage public fear in spite of the 524 cases that have already been reported for this year. Experts believe that with the onset of school breaking for the summer, the rate of infection could taper off as a result of reduced contact among children.

21 June, 2011

Scarlet Fever Kills 2 in Hong Kong, Undiagnosed Disease Strikes Bihar, and More Breaking News

Scarlet Fever Kills Two Children in Hong Kong
A new strain of Scarlet Fever is spreading through Hong Kong. In the past three weeks, two children, a 15-year-old boy and a 7-year-old-girl, became the city’s first fatal victims in the last 10 years. Since January, 419 cases have been confirmed in Hong Kong with 142 cases in the first weeks of June.

Scarlet Fever is caused by the Streptococcus pyogenes bacteria and mostly affects children ages 2-8. The disease causes a fever, sore throat and a rash on the neck, face and tongue, and eventually spreads across the entire body.  Scarlet Fever is typically treated with antibiotics that are very effective, but this new strain is actually a mutation of the Streptococcus bacteria and is resistant to several antibiotics. A physician from the Hong Kong Medical Association encourage doctors who are treating children infected with the disease to try alternative antibiotics before the disease spreads even more.

Japanese Encephalitis Suspected as Unknown Disease in Bihar
A team of experts from the Union Health Ministry and Regional Malaria Research Institute (RMRI) team is investigating an “unknown disease” killing children in the Muzaffarpur region of Bihar, a state in India. The disease has caused the death of 26 children in the last seven days and affected over 35 others. It is believed to be Japanese Encephalitis. Some of the symptoms include high fever, memory loss, convulsions, falling in and out of consciousness, and eventually coma. Hopefully once the disease can be confirmed, health officials will be able to take the necessary precautions to prevent more children from becoming victims.

Rabies PEP Failure
A patient in Mumbai, India is now in a coma after becoming infected with rabies despite completing the recommended postexposure prophylaxis (PEP) regimen following a dog bite. A 2nd patient is also in a coma with the deadly virus after failing to complete the PEP series of vaccinations. (PEP typically consists of one dose of immune globulin and four doses of rabies vaccine over a 14-day period.) PEP is usually highly effective, however in a small percentage of patients the vaccine series may not build up enough of an immune response. It is also important that PEP be administered promptly after a rabies exposure and that the schedule of doses is followed. According to the WHO, India sees 25,000-30,000 deaths due to rabies each year.

Mumps Outbreaks in Vancouver
The British Columbia Centre for Disease Control has issued a health alert for mumps in Vancouver.  Although the number of cases has not been released, it is reportedly the largest outbreak since 2008 when almost 200 people were diagnosed.  Earlier this year, Whistler saw a mumps outbreak as well.  HealthMap will update this story as more details become available.

17 June, 2011

E. coli in France and Sweden: Unrelated to Germany Outbreak

E. coli Outbreak Affects Children in France
Seven children in the Nord Pas-de-Calais region of France are currently in the hospital being treated for an E. coli infection. Health officials are linking this outbreak to frozen hamburger patties made by the company Lidl as four of the children consumed these patties before becoming ill. These children range from 18 months to 8 years of age and are all being treated for hemolytic uremic syndrome (HUS), which is a kind of kidney failure related to E. coli.

Although it has been confirmed that this E. coli strain is not related to the same one that has killed 38 people in Germany, one in Sweden and affected over 3,000, people in France are still very concerned. It appears that the “Steak Country” boxes of meat have been expired since May 12, which maybe have led to the outbreak. French health authorities have recalled the hamburger meat in hopes to prevent more people from becoming sick.

Dog Show in Sweden Spreads EHEC
After attending a dog show in Norrköping, Sweden in the first weekend of June, two Swedes are confirmed as being infected with enterohemorrhagic Escherichia coli (EHEC). The dog show had about 120 participants, so health officials are expecting many more cases stemming from this event. In addition, several dogs have come down with stomach pains, which may mean that they were infected as well. The National Food Administration and the Swedish Institute for Communicable Disease Control are trying to determine the outbreak source.

14 June, 2011

N. Dakota Sees Measles; C. difficile in Ontario Hospital; Girl Survives Rabies

Measles in North Dakota after 24 years
Today, Cass County, North Dakota confirmed its very first case of measles since 1987. The Cass County health department says the case is a 50-year-old man who was not previously vaccinated for measles.  This man appeared to have caught the virus while traveling on an airplane and was not actually in North Dakota while it was contagious so more cases are not anticipated in the state.

Measles, also known as rubeola, is a highly communicable respiratory infection caused by a paramyxovirus. The incubation period for measles is anywhere from six to nineteen days, infectivity from two to four days, and then come symptoms such as runny nose, cough, fever and a rash. Measles can be a very serious infection and even lead to death.

Since this case confirmation, health officials are encouraging North Dakota residents to become vaccinated. Currently, the state’s MMR (measles, mumps and rubella) vaccination rate is nearly 94%. This is slightly higher than the national vaccination rate average of 90%. However, people born before 1957 were not routinely vaccinated so they may be more at risk for contracting these diseases.

C. difficile Hits St. Catharines, Ontario Hospital
An outbreak of the deadly C. difficile bacteria was declared on May 28th, 2011 at the Niagara Health Systems’ St. Catharines General in Ontario, Canada. To date there have been 30 confirmed cases and 5 deaths (a 6th death was confirmed, however contracted the disease outside of the facility) associated with the outbreak with 19 still hospitalized.

Clostridium difficile commonly develops in health-care settings in elderly patients and those taking certain antibiotics. The infection can spread from person-to-person, on contaminated equipment, or on the hands of doctors, nurses, and other providers. Symptoms of infection include watery diarrhea, fever, loss of appetite, and nausea.

As part of standard outbreak control measures, the Niagara Health System has implemented increased hand-washing and closer monitoring of antibiotic use at the Hospital. Strict restrictions have also been placed on visitors. The hours open to visitors have been reduced, and visitors to the hospital are not allowed to visit multiple patient rooms.  

Eight-year Old Girl Survives Rabies without Vaccination
Eight-year old Precious Reynolds became just the 6th person in the world to have survived a rabies bite without receiving vaccination. The little girl was scratched on the arms by a feral cat near her school. However, because her symptoms began mildly as a stomachache and only later progressed to paralysis in her throat and pain in her neck and back, she did not receive any rabies shots, which are only effective if administered immediately after exposure.

It was not until she was admitted to UC Davis Children’s Hospital that tests confirmed a rabies infection, by which point she had also developed encephalitis. The medical team treated her with a regimen known as the Milwaukee Protocol, which first puts the patient into a medically-induced coma and then administers antiviral drugs. This treatment was responsible for the recovery of all 6 people who survived without vaccination.

Rabies is a viral disease transmitted to humans via bites by infected animals, most often dogs, cats, or bats. Prior to 2004, the virus was 100% lethal in humans without vaccination.

10 June, 2011

Source of e. coli Outbreak Discovered; Meningitis Vaccine Reduces Cases; Fungal Infection Strikes Joplin, MO

Germany: It’s the sprouts. We mean it this time.
First it was cucumbers (Spanish), then it was sprouts. Then it was cucumbers (German) and now officials say it truly was the sprouts. Although lab tests failed to find the E. coli on plants at the farm which produced the sprouts, the strain was isolated on leftover sprouts from a family which became ill. At the moment, the European Centre for Disease Prevention and Control reports that 3086 people became ill. Media reports state 33 have died (all German except for 1 Swede). The United States and Canada also reported cases suspected to be associated with the outbreak. Over a quarter of cases experienced the severe form of the infection,  Hemolytic Uremic Syndrome. This strain has been unusually severe, with doctors noting neurologic damage in many patients.

In the end, traditional epidemiological studies examining foods consumed and events attended by both sick and healthy individuals showed many of the infected ate at restaurants and cafeterias supplied by one organic sprout farm. From there, investigators were eventually able to track down sprouts that test positive for the strain. Those interested in reading about the methods and challenges of investigating an outbreak of foodborne illness may enjoy this post.

The outbreak has been devastating to farmers. While Spanish cucumber farmers were the first to feel the impact, consumers soon began to avoid all produce as no single source was quickly identified.

The German E. coli outbreak has sparked increased news reporting of E. coli cases, even those not linked to the outbreak. The Netherlands, Thailand and Finland all reported finding E. coli. In Tennessee, a two year old girl has died and 8 are believed to be ill from E. coli.

Meningitis Vaccine Project (MVP) Reduces Cases
World Health Organization (WHO) data on the MenAfriVac vaccine distributed in Meningitis Belt countries show a massive decrease in cases in Burkina Faso, Mali and Niger.  The Serum Institute, based in India, developed MenAfriVac against meningitis A, which has been very common throughout the infamous Meningitis Belt.  They began distribution for 50 U.S. cents a dose six months ago.  In the 2011 meningitis season, Burkina Faso confirmed 4 cases (compared to 66 this time in 2010), Niger also reported 4 cases (compared to 219 last year) and Mali had no reported cases (10 cases the previous year). These dramatic decreases are promising for the fight against meningitis. The MVP hopes to immunize 250 million people in Africa between 2010 and 2015.

Rare Fungal Infection Strikes Joplin Tornado Survivors
On May 22, 2011 much of Joplin, Missouri was destroyed when an EF-5 tornado ripped through the small town killing 151 in its path. (The EF-5 rating is the highest rating on the Enhanced Fujita tornado scale.) The storm ravaged a one-mile wide, thirteen-mile long path through Joplin, destroying 8000 homes and apartment complexes, and leaving thousands homeless.  The tornado that hit Joplin, MO is the deadliest twister to strike in the United States since modern record keeping began in 1950.

As if the people of Joplin haven’t suffered enough, a new threat has emerged, as a potentially lethal fungal infection has been contracted by at least 9 tornado survivors, killing 3. (The Jasper county coroner has so far stated that 1 was killed as a direct result of the fungal infection while the other two victims had other medical conditions that could have contributed to their deaths.)

Zygomycosis (also known as mucormycosis) is caused when commonly present fungi, found in soil and decaying vegetation, becomes embedded under the skin. These secondary skin-fungal infections are sometimes seen in survivors of mass trauma where multiple injuries and skin lacerations are treated as quickly as possible in makeshift emergency shelters (such as the 2004 Indonesian tsunami).  Doctors began seeing patients in Joplin with fungal infections a week after the tornado. Patients have visible mold growing in their wounds, and surgery is typically required to remove the dead tissue. Zygomycosis can also invade the brain, lungs, or sinuses, and generally kills half of its victims. Despite the severity of zygomycosis, it should be stressed that people should not panic. The infection does not spread from person to person and does not invade normal, intact skin.

06 June, 2011

AIDS: Thirty Years Later

On June 5, 1981 the first cases of Human Immunodeficiency Virus (HIV) were documented in a United States medical bulletin. 2011 marks the 30th anniversary of these 1st diagnosed cases of a virus that would become a global epidemic. Since its discovery in 1981, it is estimated that more than 20 million lives have been claimed by HIV (the virus that causes acquired immune deficiency syndrome (AIDS)), and according to the World Health Organization (WHO) another 5000 die each day while 7000 become newly infected.

Despite these grim figures, hope remains for the development of a vaccine. A recent HealthMap blog post gave an overview of new research findings out of the Oregon Health Sciences University, where researchers are working on development of a HIV/AIDS vaccine. The new vaccine was tested on rhesus macaque monkeys. The monkeys were infected with Simian Immunodeficiency Virus (SIV), the monkey form of HIV. This vaccine prevented infection in thirteen of the twenty-four monkeys who were originally infected with SIV for more than one year. These thirteen monkeys’ bodies controlled the replication of SIV to the point that highly sensitive tests could not find any traces of the virus. The next steps for the Oregon-based team will be to develop a vaccine for human testing.

33.3 million worldwide are currently living with HIV, and while a diagnosis of HIV used to be a death sentence, new antiretroviral therapy (ART) regimens are able to suppress the virus and slow the progression to AIDS. In addition, it was recently shown that ART is 96% effective in reducing HIV transmission where one partner has HIV. This is a crucial development, as sexual transmission accounts for 80% of new HIV infections.

According to the “AIDS at 30” report released June 3, 2011 by the Joint United Nations Program on HIV/AIDS (UNAIDS) a record number of people are now receiving ART in low- and middle-income countries thanks to many factors including the drop in price of ART over the past decade, newer drugs with fewer side effects (which improves patient adherence), and innovative programs that improve access to treatment. Despite the increase in ART utilization, another 9 million people were eligible for ART but were not receiving it. Even in wealthy, developed nations these highly effective medications are often difficult to obtain. This will certainly be one of many topics for discussion this week, as a United Nations General Assembly Special Session on HIV/AIDS is held June 8-10 in New York City.

It is hoped that international organizations and donor nations continue vigorous efforts to ensure that ART drugs are available and affordable to those in need. New science has shown that ART regimens can help us get ahead of the wave of new infections. The time to do this is now, as the global annual rate of new cases of HIV dropped over 25% over the last decade, and the exciting prospect remains that the epidemic could be stopped if all of the 34 million+ infected people could be treated. Ultimately, a vaccine or cure will be needed to halt this epidemic, and the “Berlin-patient,” (a man cured of HIV after receiving a stem cell transplant for a deadly form of leukemia) is living proof that this is possible.