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.

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

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

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

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

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

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

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

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

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

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