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

2011-08-15T17:24:00.000-04:00

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

2011-08-12T15:21:00.000-04:00

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

2011-08-12T10:57:00.000-04:00

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

2011-08-11T09:53:00.000-04:00

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

2011-08-05T11:37:00.000-04:00

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

2011-08-04T15:27:00.002-04:00

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

2011-08-04T12:19:00.000-04:00

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

2011-08-03T16:41:00.001-04:00

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

2011-07-28T12:11:00.000-04:00

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?

2011-07-28T10:09:00.000-04:00

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

2011-07-26T16:53:00.002-04:00

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

2011-07-22T16:45:00.000-04:00

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

2011-07-20T13:37:00.000-04:00

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

2011-07-15T12:53:00.000-04:00

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

2011-07-13T14:45:00.000-04:00

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

2011-07-08T14:24:00.000-04:00

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.

Hendra Virus Outbreak, Polio Crisis in Pakistan, Egypt Link in E. coli Outbreaks, La Crosse Encephalitis and Rabies

2011-07-01T17:26:00.000-04:00

Hendra Virus in Queensland and NSW
Eight people have potentially been exposed to the deadly Hendra virus outside of Brisbane, Australia after a horse that died was confirmed to be positive for the disease. It’s believed that horses become infected after eating food contaminated by flying fox (bats of the genus Pteropus found in Australia) urine, saliva, or birth fluids. Humans can acquire the disease after having contact with respiratory secretions or blood from infected horses. Of 7 people ever diagnosed with Hendra virus only 3 have survived. In response to the confirmed Hendra horse death, the area’s mayor has issued that flying fox bats in the area of Kerry and Beaudesert, Queensland be culled despite their protected status.

It was also discovered today that a 2nd horse was infected with the Hendra virus in Wollongbar, New South Wales, and has since been euthanized. The case is unrelated to the horse that died in Queensland earlier this week on June 28th.

The Polio Crisis in Pakistan
Yesterday, another polio case was discovered in Pakistan’s Khuzdar district, bringing this year’s total to at least 57 for the country. Although Pakistan is now just one of four countries still with endemic polio transmission, the other three countries have reported much lower disease burdens - with 11 cases in Nigeria, 5 in India, and 4 in Afghanistan for the same period. Most concerning is the discovery of cases in regions within the country long-believed to be polio-free. Last week, a 2 year old was found to have polio in Diamer District of northern Pakistan, an area that has not reported cases for over 12 years. Many believe that internal displacement, problem with the vaccine cold chain, and refusal by parents to have their children vaccinated as a result of misinformation have all contributed to the resurgence of cases within the country. Pakistan now is subjected to much international pressure as many European countries are considering imposing travel restrictions on Pakistani citizens and the World Bank has warned that it will convert a grant on polio vaccination for the country into a loan if Pakistan fails to eradicate by 2012.

Egyptian seeds named as source of German and French E. coli outbreaks
Investigators at the European Food Safety Authority have found a common link in Germany’s and France’s recent E. coli outbreaks: contaminated fenugreek seeds originating in Egypt. German health officials have confirmed the farm at the center of the outbreak had received fenugreek seeds from Egypt. Experts warn that additional contaminated seeds are likely still in circulation and may lead to additional outbreaks. The death toll from the German outbreak has risen to 50 (48 in Germany, 1 in Sweden and 1 in the US); over 4,000 were sickened.

La Crosse Encephalitis case in North Carolina
Although West Nile Virus gets much of the press, mosquitoes carry other diseases as well. This week, North Carolina saw its first confirmed case of La Crosse Encephalitis this summer. Like West Nile Virus, most people who are infected with La Crosse Encephalitis do not become ill. In a small number of people the infection affects the nervous system and can lead to seizures, coma, and paralysis. North Carolina has one of the highest rates of La Crosse Encephalitis in the US.

Rabies in Azerbaijan
In the Sheki region of Azerbaijan there was an outbreak of rabies among domestic animals. Measures have been taken to remove the infected animals which were infected by attacking wolves. Ten animals have been slaughtered while another 8 are suspected to be infected with the virus. In addition, a human case of rabies has been identified in the same village. That person was one of five injured and possibly infected when the attack occurred on June 8. According to the deputy chief physician of the Central Hospital of Sheki, the villager underwent treatment for approximately 20 days with no results.

В Шекинском районе отмечена эпидемия бешенства среди домашнего скота, проводятся мероприятия по уничтожению зараженных животных. Причиной возникновения болезни стало нападение на домашний скот диких животных. В селе было уничтожено свыше 10 животных, а у 8 животных есть вероятность заражения бешенством.

Кроме того, в селе Кунжут отмечен случай заражения бешенством человека. Житель села является одним из 5 человек, подвергшихся нападению волков 8 июня.

По словам заместителя главного врача Центральной больницы Шекинского района, проводящееся около 20 дней лечение не дало никаких результатов.

Salmonella Outbreak: United States

2011-06-29T15:19:00.000-04:00

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.

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

2011-06-24T14:08:00.002-04:00

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.

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

2011-06-21T15:55:00.001-04:00

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.

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

2011-06-17T18:56:00.000-04:00

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.

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

2011-06-14T19:26:00.000-04:00

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.

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

2011-06-10T18:25:00.000-04:00

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.

AIDS: Thirty Years Later

2011-06-06T17:22:00.000-04:00

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.

E. coli update: More cases, Strain is new, Source unknown, Trade bans, Spain furious

2011-06-02T15:16:00.002-04:00

The number of cases in Europe’s E. coli outbreak continues to rise. More than 2,000 people have been infected and 18 have died (17 in Germany and 1 in Sweden). Denis Coulombier, head of surveillance and response for the European Center for Disease Prevention and Control, said health experts are shocked by the outbreak’s size. Today, WHO stated 10 countries have reported cases to the organization’s Europe branch: Austria, Denmark, France, Germany, Netherlands, Norway, Spain, Sweden, Switzerland and the United Kingdom. According to media reports, the Czech Republic also has a case. ~~Two~~ Three US cases have been reported in people who had recently visited Germany.

A WHO spokesperson stated "This is a unique strain that has never been isolated from patients before.” German and Chinese scientists sequencing the genome reported it was new (you may download the analysis at ftp://ftp.genomics.org.cn/pub/Ecoli_TY-2482), but a US CDC scientist has suggested the strain may have been seen earlier in a single case in Korea. Regardless of the newness of the strain, its resistance to 14 antibiotics is quite worrying.

The source of the outbreak remains unknown. German authorities initially suggested Spanish cucumbers were a possible culprit, but they have since been cleared. Unfortunately for Spanish farmers, the economic damage cannot be undone. Spain is considering legal action against Germany; it believes there was inadequate evidence to implicate Spanish cucumbers. Russia initially blocked vegetable imports from Spain and Germany, but it is now banning all European Union produce, a move the European Commission condemned as unnecessarily extreme.

German officials are discouraging consumption of raw vegetables. Individuals who have recently traveled to Germany and become sick (especially with bloody diarrhea) should seek medical care and report their travel history to their physician.

Visit and Vote for Flu Near You by HealthMap!

2011-05-31T11:17:00.000-04:00

In response to the CDC Flu App Challenge asking for innovative uses of technology to raise awareness of influenza and/or educate consumers on ways to prevent and treat the flu, we have submitted Flu Near You by HealthMap. You can visit the live version of our submission here or go to the challenge page to watch the video demonstrating the features. Please VOTE for us!

http://fluapp.challenge.gov/submissions/3041-flu-near-you-by-healthmap

Flu Near You by HealthMap provides a comprehensive real-time visualization of influenza activity, news, and resources for the United States.

You can see the level of flu activity in your state by checking out current CDC reported flu activity or Google Flu Trends. You can also see CDC collected flu vaccination rates for your state.

When you click on your state, below the map, we list official public health flu resources and real-time updated flu news alerts for that state. On the right, the graph shows more detailed information by date.

Click on play to see how the data changes over time.

CDC collects some flu surveillance data at the regional level. You can explore that, too.

Think you have the flu? Let us know! We’ll track the number of reports and provide real-time data based on the public’s responses.

This flu season, stay healthy and stay informed through Flu Near You by HealthMap.

Remember to vote for us! Thank you!

Summary of e. coli outbreak in Germany; Chickenpox in Ukraine; United States deals with equine herpes outbreak

2011-05-25T15:31:00.000-04:00

E. Coli Spreads in Northern Germany
An outbreak of a serious strain of Escherichia coli (E. coli) is spreading throughout Germany, mostly among young females.

Although most of the strains of E. coli are relatively harmless, the enterohaemorrhagic E. coli (EHEC) strain is a particularly serious one because it can be fatal. EHEC is typically transmitted through contaminated foods such as undercooked or raw meat. EHEC symptoms include stomach cramping and diarrhea and eventually hemorrhagic colitis or bloody diarrhea. If untreated, EHEC can lead to anemia and kidney failure.

Germany authorities have confirmed three deaths from EHEC so far. The first death was an 83-year-old woman in Lower Saxony who was admitted to the hospital on May 15th. The second confirmed death was an 89-year-old woman in Schleswig Holstein. Finally, the third victim was a 24-year-old woman in Bremen who died on Monday the 23rd. Some investigators think that the reason why this outbreak is affecting more women is that it is spreading in contaminated lettuce.

Ten people have been hospitalized in Frankfurt with another 50 experiencing mild symptoms. In Hamburg, another forty patients are being treated for EHEC as well. Other cases have been confirmed in the Northern part of Germany including Rostock, Lower Saxony, Bremen and Schleswig Holstein. There are up to 600 suspected cases across Germany.

Health Authorities are currently re-examining food deliveries and some company food canteens have been closed since Friday. People are strongly encouraged to wash their hands more than usual and to thoroughly cook all food.

Chickenpox in Ukraine
Many children around the world become infected with chickenpox. However, there has been an increase in the number of patients with chickenpox in many regions of Ukraine. With 6,500 recorded cases of chickenpox in children since the beginning of 2011, Kiev has had three times the number of infections than during the same period in 2010 when less than 2,000 cases were recorded.

The NIH describes chickenpox as a classic childhood disease. “A child or adult with chickenpox may develop hundreds of itchy, fluid-filled blisters that burst and form crusts. Chickenpox is caused by a virus… In most cases, it is enough to keep children comfortable while their own bodies fight the illness.”

В Украине свирепствует ветрянка. Рост числа больных ветряной оспой сейчас констатируют в каждом регионе. Так, только в Киеве с начала этого года больных киевлян зафиксировано втрое больше, чем за такой же период 2010-го. Сейчас в Киеве 6500 зараженных ветряной оспой детей, за такой же период в прошлом году не было и 2 тысяч.

Equine Herpes Outbreak in Western States
Several horses have become sick with Equine Herpes Virus (EHV-1) and Equine Herpes Myeloencephalopahy (EHM) after attending a horse show in Utah. The National Cutting Horse Association Western National Championships ran from April 27th to May 8th in Ogden, Utah. The U.S.D.A. Animal and Plant Health Inspection Service reported that any horse owners who brought horses to Ogden have been warned about the spread of EHV-1.

EHV-1 is a highly contagious disease that affects horses and causes Rhinopneumonitis (respiratory problems), abortions, and myeloencephalopathy. All of the horses that have died or are being treated for EHV-1 have been vaccinated for Rhinopneumonitis, but the strain going around is actually immune to the vaccine, making it particularly dangerous. EHV-1 can be directly transmitted from horse to horse, but also through contaminated equipments, feed and tack.

As of Saturday, there have been 16 confirmed cases of EHV-1 in California, one in Texas, two in Idaho, one in New Mexico, two in Oregon, five in Utah, nine in Colorado, one in Arizona, and five in Washington state. Montana, Kansas, Nebraska, South Dakota, North Dakota, Oklahoma, Nevada and Wyoming are all on high alert about the outbreak, but are yet to report any confirmed cases. The outbreak has also spread to Alberta, Canada. As of May 21, there were three confirmed cases and eight suspected ones in Alberta.

This outbreak is very serious and horse owners in the West are warned to be cautious and restrict travel. Several horse shows have been cancelled in hopes of limiting the spread of the virus.

Uganda's Ebola Outbreak Update: New suspect cases as others ruled out

2011-05-21T13:02:00.000-04:00

As noted in our previous blog, a 12 year old girl who died at Bombo Military Hospital in Uganda tested positive for Ebola. Since then suspected cases have been reported in Buigiri, Gombe, and Nakaseke and Luwero districts. This video of a news report from Uganda’s NTV states the the case in Buigiri was actually malaria, and the cases suspected in Gombe were due to food poisoning.

During Ebola outbreaks, there are often media reports of suspected cases that are eventually diagnosed with a different disease. HealthMap will continue to report new suspected cases as well as information on those which have been ruled out.

Hope for HIV Vaccine; Ebola Strikes in Uganda

2011-05-18T17:34:00.001-04:00

HIV/AIDS Vaccine Shows Promise
A new HIV/AIDS vaccine may be in the works as research at an Oregon University has shown to prevent virus replication in monkeys.

Louis Picker, a researcher at Oregon Health Sciences University (OHSU), specifically in the Vaccine and Gene Therapy Institute (VGTI) has been working on developing a HIV/AIDS vaccine from genetically modified cytomegalovirus (CMV). CMV is a member of the Herpesviridae family and is most commonly associated with salivary glands in the body. CMV was used in this vaccine development because most people are already infected with CMV, although they show little to no symptoms. In addition, once an individual is infected with CMV they carry the virus for the rest of the life.

This new vaccine was tested on rhesus macaque monkeys at Oregon National Primate Research Center in Beaverton, Oregon. All of the moneys were infected with Simian Immunodeficiency Virus (SIV), the monkey form of Human Immunodeficiency Virus (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.

These results are extremely promising and hopeful for developing a vaccine for humans. The next step for Dr. Picker and his team will be to develop the current vaccine for human testing. If successful, this vaccine could prevent thousands of people in the United States from being infected each year.

Ebola Hits Uganda
Last week, a twelve-year old girl from Luwero died in the Bombo Military Hospital about 60 kilometers outside of Uganda’s capital, Kampala, from the deadly Ebola virus. Ebola was confirmed only after the girl’s blood sample tested positive for Ebola at the CDC in Atlanta.

Ebola virus is a viral genus in the Filoviridae family that causes Ebola hemorrhagic fever, which presents itself in patients by sudden symptoms of fever, malaise, muscle pain, headache, and pharynx inflammation. Rashes, red eyes, hiccups, and internal and external bleeding are also common in those suffering from Ebola. There are four types that affect humans: Ebola-Zaire, Ebola-Sudan, Ebola-Ivory Coast and Ebola-Bundibugyo virus. Unfortunately, there is no known cure for Ebola and the fatality rate is about 85%.

Uganda’s last outbreak of Ebola occurred in 2007, but wasn’t officially declared until February 20, 2008. There were 148 people ill and 37 of them died. In hopes of preventing a similar situation, nearly 40 people who may have been exposed to the young girl who died have been quarantined and monitored for any early Ebola symptoms. Government officials have said visitors to Uganda do not need to worry about possible contact with the virus since these people were quarantined early.

Update on Chiang Mai Mystery Deaths; Ukraine Leptospirosis Cases; and Legionella in Latvia

2011-05-13T17:39:00.000-04:00

Undiagnosed Deaths in Chiang Mai Possibly Due to Insecticide
As written in a March 23, 2011 HealthMap blog entry, there have been seven mysterious deaths since January 2011 linked to Chiang Mai, Thailand’s Downtown Inn. The undiagnosed deaths prompted travel warnings to be issued for the popular tourist destination, and led authorities to investigate many different potential causes (mushroom poisoning, toxic seaweed, and pure coincidence to name a few).

New findings released by a New Zealand news investigation team suggests the tourist deaths are connected, and due to a toxic bed bug insecticide. Small traces of the insecticide Chlorpyrifos were found in the hotel rooms where the victims had stayed. While additional test samples have been sent to the US Centers for Disease Control as well as Osaka University in Japan, other pesticides are now being looked at, as health officials work to determine the cause of the deaths.

Leptospirosis in Ukraine
For the first time in 10 years, leptospirosis has returned to the capital of Ukraine. Kiev officials have confirmed cases of leptospirosis in individuals who had gone swimming in a local pond.

Leptospirosis is a dangerous infectious disease that is accompanied by fever, possible liver damage and often requires intensive care treatment. Leptospirosis is sometimes found in fresh water that has been contaminated by animal urine, and primarily occurs in warmer climates. As a general rule, pond beaches in the Ukraine should be decontaminated before swimming is allowed.

Несистемное и очень некачественное проведение малых гидротехнических работ и дератизации (уничтожения грызунов) на киевских пляжах ставит под угрозу здоровье и даже жизнь людей. Так, впервые за 11 лет после последнего зафиксированного случая заболевания, в столицу вернулся лептоспироз.

Это опасное инфекционное заболевание, которое сопровождается волнообразной лихорадкой, поражением печени и, чаще всего, требует реанимационного лечения. Лептоспироз, преимущественно, попадает в воду с мочой больных домашних животных и крыс. Вот почему борьба с грызунами в зонах отдыха людей особо актуальна накануне открытия пляжного сезона.
«В 2010 году были случаи заболевания лептоспирозом и даже уже в 2011. И это на водоемах с официальными пляжами.

Legionnaires' Disease in Latvia
According to the Latvian Centre of Infectology (LTSI) since last autumn, the country has experienced extended cases of the acute infectious disease, legionellosis (or Legionnaires' disease). This month, Latvia has confirmed the death of one individual due to Legionella.

Experts have determined that all cases of infection have occurred in apartment buildings. This is typically the case for Legionnaires’ disease, as it prospers in humid, confined, and heavily populated spaces.

According to the Mayo Clinic:

“Legionnaires' disease primarily affects the lungs, it occasionally can cause infections in wounds and in other parts of the body, including the heart.”

“A mild form of Legionnaires' disease — known as Pontiac fever — may produce symptoms including fever, chills, headache and muscle aches. Pontiac fever doesn't infect your lungs, and symptoms usually clear within two to five days.”

По информации Латвийского центра инфектологии (ЛЦИ), начиная с осени прошлого года по стране стало резко распространяться опасное острое инфекционное заболевание легионеллез ("болезнь легионеров"). В этом году в результате этой болезни уже скончался один человек.
Как отмечает NRA, эксперты установили, что все случаи заражения произошли в квартирах многоквартирных домов.

Легионеллез (питтсбургская пневмония, понтиакская лихорадка, легионелла-инфекция) — редкое острое инфекционное заболевание. Заболевание протекает, как правило, с выраженной лихорадкой, общей интоксикацией, поражением легких, центральной нервной системы, органов пищеварения, возможно развитие синдрома полиорганной недостаточности.

"Shocking" diphtheria death, and KPC alert in Uruguay

2011-05-06T12:23:00.000-04:00

“Shocking” diphtheria death in Autralia
A 22 year old Brisbane woman has died from diphtheria; it is believed she was unvaccinated. Diphtheria is a severe respiratory infection caused by Corynebacterium diphtheriae. The president of the Australia Medial Association noted "In the (early) 1900s it was the most common cause of death from an infectious disease." In fact, Alaska’s famous Iditarod Trail Sled Dog Race commemorates the heroic efforts of mushers and their sled dogs to relay diphtheria antitoxin from Anchorage to Nome during a 1925 outbreak. Today diphtheria is very rare in industrialized countries like Australia, but it remains a problem in many parts of the world including nations in Asia, Africa, the Middle East, and the former USSR. The diphtheria-pertussis-tetanus combination vaccine has been very effective in fighting the disease.

KPC Alert in Uruguay
In the last two months, three Uruguayan patients have died in Montevideo from the now well known antibiotic-resistant bacteria, KPC. Bacteria with the Klebsiella pneumoniae carbapenemases (KPC) enzyme are extremely dangerous because they are able to inactivate antibiotics such as penicillin, cephalosporin, aztreonam and carbapenems. This bacterium spreads quickly and results in death in about 50% of the cases. KPC infections were first publicized in 2001 at a hospital in North Carolina and then in New York City in 2003. KPC has spread worldwide to Israel, France and China. In the last year, infections have been reported in Argentina, Brazil, Columbia and now Uruguay.
The Pan American Health Organization (PAHO) has officially issued a warning for all countries to avoid possible KPC outbreaks.

Brucellosis in humans and cattle in Bashkortostan, Russia

2011-04-29T07:38:00.000-04:00

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.

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

2011-04-28T12:52:00.000-04:00

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.

World Malaria Day

2011-04-25T11:50:00.001-04:00

http://www.rollbackmalaria.org/worldmalariaday/

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

14 Hospitalized with Suspected Anthrax in Tajikistan

2011-04-21T11:17:00.000-04:00

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).