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.

Superbug Gonorrhea, Type-3 Polio in Pakistan, and Food Poisoning in Ukranian Summer Camps

Antibiotic resistant gonorrhea detected
A new gonorrhea “superbug” has hit Japan. This new strain, named H041, is reportedly resistant to all existing antibiotics.  Gonorrhea, a sexually transmitted disease, is not fatal but is is extremely widespread causing approximately 340 million cases annually worldwide. In the United States, the CDC reports that gonorrhea developed resistance to certain antibiotics (penicillin and tetracycline) as early as the 1980s. While no cases of H041 have been identified outside of Japan, the prevalence of gonorrhea and its increasing antibiotic resistance give reason for concern. Gonorrhea can cause pain during intercourse, scarring of the reproductive tract, increased susceptibility to HIV, and if left untreated, infertility.  

Type-3 Polio Detected in Pakistan
Lab testing confirmed a child in Pakistan’s Khyber Agency, Federally Administered Tribal Area was infected with wild poliovirus type 3 (WPV3). This discovery has important implications for polio eradication of this strain as the last WPV3 case in Asia was in November 2010. Of the three polio strains, WPV1 is the most widespread, WPV2 has been eradicated, and WPV3 is primarily in Asia where cases have been declining. The detection of WPV3 raises the spectre of its potential spread to other parts of Asia. Pakistan is one of only four remaining polio-endemic countries. For current data on global polio cases this year, visit the Global Polio Eradication Initiative.

Food Poisoning in Ukrainian Summer Camps
At the "Albatros” summer camp in Sevastepol, 78 children and 6 teachers have been hospitalized with food poisoning. According to preliminary data, the children ate “low-quality” food, which tends to include products served that have been inadequately refrigerated during summer months. Most all of those affected suffered only mild symptoms and are expected to recover quickly.

Two other regions - Zaporozhyea and Chernihiv – have reported similar cases in summer camps with children suffering from acute intestinal infections and symptoms of foodborne disease. A total of 34 children (18 and 16 respectively from the regions) required hospitalization and or medical care.

В оздоровительном лагере «Альбатрос» под Севастополем отравились 78 детей из России Отравившиеся дети были госпитализированы в инфекционную больницу Севастополя. По предварительным данным, дети употребили некачественные продукты питания. Состояние детей - легкой и средней степени тяжести.

Запорожская область, с подозрением на острую кишечную инфекцию в инфекционное отделение было госпитализировано 6 детей, которые находились на отдыхе в детском оздоровительном заведении «Салют» г. Приморск Запорожской области. Дети получили адекватное лечение.
Черниговская область, в детском спортивно-оздоровительному лагере «Колос» в с. Бигач Менского района Черниговской области выявлен 21 ребенок с признаками пищевой токсикоинфекции. Из них 16 госпитализированы в инфекционное отделение Черниговской областной детской больницы. Остальным предоставлена необходима медицинская помощь.

Updates on H1N1, C. difficile, Hepatitis C, Malaria, and West Nile Virus

H1N1 returns to India
With the return of monsoon season, beginning late May or early June, H1N1 influenza has returned to India. In the southwestern state of Kerala, 17 cases were confirmed this week in the Pathanamthitta and Alapphuzha districts. The Alapphuza district alone has seen 25 cases since the start of the monsoon season. Across Kerala, dozens are under quarantine, both at home and in hospitals, in efforts to stem the spread of the disease.

Elsewhere in India, in the northwestern state of Rajasthan, officials confirmed the state’s first death from H1N1. As a precaution, extensive screening efforts are being made in the Jhalawar district, the home of the victim.

C. difficile Outbreak Continues in Ontario
The C. difficile outbreak in the Niagara region of Ontario continues to escalate. Since the first outbreak was declared in May at St. Catharines, outbreaks occurred at 3 more area hospitals, for a total of 66 cases and 16 deaths. The affected hospitals include Greater Niagara General Hospital, Welland Hospital, and Hotel Dieu Shaver Health and Rehabilitation Center. Residents and politicians questioned how the Niagara Health System (NHS) handled the situation and criticized that the public was not alerted earlier. Many protested outside Niagara General Hospital.

Meanwhile, over 100 miles/170 kilometers away from the Niagara region, a 5th site in Ontario has reported an outbreak of C. difficile. Guelph General Hospital reported 11 cases over the past 2 months, a dramatic increase from the usual 1-2 cases per month. However, as 2 weeks have passed without a new case, the Guelph outbreak is likely waning and may be declared over within a few weeks.

Hepatitis C cases Increase Across Wisconsin
There are six counties in northern and central Wisconsin that are investigating why the number of Hepatitis C cases in the population under 30 has significantly increased in the last few years.

Currently, the CDC is collaborating with health officials from Wood, Lincoln, Oneida, Portage, Langlade and Marathon counties to try to identify the issue. Reports from 2004 to 2008 indicate that the six-county region had an average of 12.2 cases per year. However, in 2009 and 2010 this same region averaged 27 cases per year (a 120% increase!)

Hepatitis C is a viral disease the causes to inflammation of the liver. Symptoms can vary considerably and tend to be insignificant for those recently infected with the virus. Some people get jaundice, upper right abdominal pain, swelling, dark urine, fatigue, fever or itching. There are many ways to contract Hepatitis C including sexual contact with someone who is already infected, using contaminated needles, and receiving a tattoo from contaminated needles and receiving blood or organs from someone who is infected.

Unlike other strains of Hepatitis like A and B, there is no vaccine to protect people from being infected with Hepatitis C and its effects can be serious and even fatal. The reason some health officials believe that the cases in this northern region of Wisconsin are increasing is that more and more people are using injection drugs. The public health departments are trying to increase awareness and encouraging people to protect themselves and seek medical attention if they believe they have been infected.

Malaria in Pune
Along with an increase in H1N1, monsoon season in India brings malaria.  There have been 73 cases of malaria identified in the Pimpri-Chinchwad area.  Public health officials are taking a firm stance; indicating that "strong action" will be taken should mosquito larva be found in private residences.  Meanwhile, industrial and commercial areas are being fumigated in an effort to reduce the prevalence of malaria carrying mosquitoes.  

Central Pennsylvania Watches out for West Nile
Dauphin, Franklin, York, Lancaster, Cumberland and Lebanon counties in central Pennsylvania have been looking out for West Nile virus cases as the number of mosquitoes in the area has unusually increased.

As of July 6, there have been four cases in Dauphin and Cumberland counties as well as other confirmed cases in the other counties. Health officials are trying to set mosquito traps in the area and warn and educate the public to protect themselves as the hot and dry summer season continues.