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.

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

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

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

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


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


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

Visit and Vote for Flu Near You by HealthMap!

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!

H1N1 on the Rise in Venezuela and Varicella in the Ukraine

Swine Flu Overwhelms Venezuela
Today, the Venezuelan government confirmed 415 cases of H1N1 influenza in Venezuela. This is twice as many cases as there were last week, meaning that the outbreak is quickly spreading throughout the country. Many schools such as ones in Mérida have closed in order to prevent the further spread of the disease. With about 900 other cases suspected in the country, public health officials recommend that Venezuelans get vaccinated as soon as possible.

Chickenpox in Ukraine
There have been many reports of children in nursery schools in Lviv, Ukraine having symptoms indicative of chickenpox. In one nursery, 10 children became ill, and an outbreak of chickenpox was declared. Chickenpox (varicella) is an acute viral infection transmitted by airborne droplets. Children most commonly affected are typically between the ages of 6 months and 7 years.

Из детских садов города Львова стали поступать сообщения от воспитателей и мам о том, что у детей появились все признаки ветрянки. В одном из садиков в группе заболели уже 10 детей. В этом детсаду врачи уже объявили об эпидемии ветрянки. Ветрянка (ветряная оспа) - острая вирусная инфекция, передающаяся воздушно-капельным путем. Заболевают ветрянкой, как правило, дети в возрасте от 6 месяцев до 7 лет.

Flooding Brings Infectious Diseases; Foot and Mouth, and Influenza Updates

Flooding and Infectious Disease Risk Worldwide
Increased rainfall and flooding in many regions of the world have heightened the risk and concern over the transmission of water-borne diseases. Oftentimes during flooding, population displacement and contamination of water sources can lead to major outbreaks of diarrhea, dysentery and even cholera and typhoid fever. Risk of infection is also increased when victims, especially children, come in direct contact with polluted waters and develop wound infections, dermatitis, or conjunctivitis. In the long term, water disasters can leave pools of standing water that create optimal breeding grounds for mosquitoes and increase the risk of vector-borne illnesses such as dengue, malaria, and West Nile. Currently, the onslaught of rainfall and flooding have wreaked heavy damage and increased risk of disease outbreak in the regions of Brazil, Southeast Asia and Australia.

Brazil
Heavy rainfall in Brazil during this summer season, especially last week, has been extremely problematic causing severe flooding and landslides in Rio de Janeiro’s mountainous region. In just one day the region experienced 95% of the expected rainfall for the entire month of January. Cities like Teresopolis, Petropolis, and Nova Friburgo have been hit very hard with over 400 deaths so far.  As of today, January 18, the death toll in the country is at 677 with about 14,000 homeless due to the heavy rains. This is considered the worst disaster in Brazil’s history (in terms of deaths) surpassing the flood in Sao Paulo state in 1967, which killed 436 people. Government officials worry that these heavy rains could bring disease epidemics to Brazil. The Agency of Civil Defense began distributing vaccines for tetanus and diphtheria in an attempt to prevent infections.

Sri Lanka and Philippines
Heaviest rains in nearly a century and flooding in Sri Lanka has so far left 40 dead, 4 missing, and over 325,000 people displaced. More than 27,000 houses were damaged and victims were forced to evacuate to over 200 camps located on higher grounds. Although in the past days water levels have begun to recede and people are returning to their homes, they are faced with the risk of water-borne diseases in these regions. Those living in the temporary relief camps also remain at risk. Sri Lanka’s government is reportedly mobilizing resources and medical supplies to these areas and making an effort to strengthen the disease surveillance system to prevent any potential outbreaks. According to health ministry officials, so far no cases of such disease have been reported.

Severe flooding and landslides in Philippines have so far spanned 25 provinces and have left at least 50 people dead and 1.5 million people affected. In addition to washing away houses and destroying crops, the flooding may result in large-scale disease outbreaks. According to one rescue unit, one region has reportedly had several hundred cases of dysentery, although this has not been officially confirmed.

Queensland
In the aftermath of the worst flooding seen in Queensland in centuries, health authorities warn of the potential of infectious disease infections. Already, several cases of melioidosis, which has not been reported in Brisbane since the 1974 floods, have surfaced and large amounts of pooled water could potentially result in a surge in mosquito numbers, leading to increased risk of mosquito-borne illnesses such as Ross River virus and dengue fever. Fecal contamination of water from sewage and the possible spoilage of food from when the power was cut raises concern over food-borne illnesses such as E.coli and salmonella. Many Queensland clinics have already seen an influx of patients seeking tetanus vaccines as a precautionary measure. Although health officials say there has not yet been a rise in gastrointestinal cases, they expect the number of patients with infections to swell if food, water, and sanitation continues to be compromised.

Foot and Mouth Outbreaks
South Korea’s worst-ever outbreak of Foot and Mouth continued as a new case was discovered at a pig farm in Yesan, 134 kilometers south of Seoul.  With meat prices soaring, losses exceeding $1 billion, and extensive culling of livestock representing decades of breeding and care, South Korea is facing a social and economic disaster.  There is widespread belief that North Korea is also suffering from a Foot and Mouth outbreak, but details are limited.  Bulgaria has reported a second outbreak and Vietnam has detected Foot and Mouth in Ha Giang. An outbreak of Foot and Mouth disease has also been reported in Gwanda, Zimbabwe. Local officials say the cause is the lack of fences, which therefore allow cattle to mix with infected wildlife. A vaccination campaign has begun, however the high cost of the vaccine adds difficulties to this effort to stop the spread of disease.

H1N1 and Seasonal Influenza Spreading in the Balkans
A fatal case of H1N1 has been recorded in Banat, Serbia, and 26 others are reported to be infected throughout the country. Montenegro reported a second death and registered 100 cases of the H1N1 virus. In addition, a woman in northern Bosnia died, bringing the total number of deaths from H1N1 this season to 4. Albania reports 17 cases of H1N1, and Croatia reports 300 cases with 3 deaths. Romania registered a third death of H1N1 since the beginning of the year.

HealthMap New England Journal of Medicine Publication

The HealthMap team recently published Information Technology and Global Surveillance of Cases of 2009 H1N1 Influenza in the New England Journal of Medicine (NEJM). The online paper includes three interactive figures* and demonstrates how informal data can be used to understand epidemiological trends of infectious diseases.

(*Figure 1 shows the worldwide spread of the H1N1 virus, Figure 2 shows a timeline of informal reporting of cases worldwide, and Figure 3 shows the relationship between GDP and time lag between suspected and confirmed case reports)

During the 2009 H1N1 influenza pandemic, nontraditional surveillance sources such as Internet news sources provided new public health data. Collectively, these sources overcame certain limitations of traditional surveillance systems, including reporting delays, inconsistent population coverage, and a poor sensitivity to detect emerging diseases. In May 2009, in collaboration with NEJM and as part of the NEJM’s H1N1 Influenza Center (http://h1n1.nejm.org), HealthMap created an H1N1 interactive map (available at www.healthmap.org/nejm) displaying these reports to enhance the situational awareness of public health professionals, clinicians, and the general public regarding the global spread of 2009 H1N1 influenza infection. Visitors to the site could filter reports according to suspected or confirmed cases or deaths and view a chosen time interval to show the spread of disease. During the two major waves of the H1N1 pandemic, HealthMap collected more than 87,000 reports from both informal and official sources (43,738 reports during the first wave of infection, from April 1 to August 29, 2009, and 43,366 reports during the second wave of infection, from August 30 to December 31, 2009). These reports formed the dataset used in the analyses of this latest paper.

Overall, the 2009 H1N1 influenza pandemic presented an important test of new disease-surveillance systems. The use of data that were collected, coded, and analyzed through the NEJM’s HealthMap system shows how such systems, which were built largely around readily available informal sources, can provide both early warnings and an ongoing operating picture of the patterns of disease spread.

Citation for the publication can be found here.

H1N1 (swine flu) weekly highlights: December 2 - December 8, 2009

The World Health Organization (WHO) reports that "Disease activity has peaked and is declining in North America and has either recently peaked or is currently peaking in much of western and northern Europe." In other good news, WHO also reports no signs of widespread resistance to Tamiflu.

Nevertheless, the WHO has clearly stated it is too soon to call the pandemic over. The global death toll from H1N1 rose to 8,768 as Cyprus, Albania, and the Gaza Strip recorded their 1st H1N1 deaths. The Netherlands saw their first Tamiflu-resistant death.

In the United States, only half of all states reported widespread flu activity, down from 43 states only two weeks ago. England reported new cases were half of the previous week's number.


* Please note that this post will conclude our weekly H1N1 blogs. While the pandemic is far from over, reports of first cases and deaths are less common as H1N1 has spread throughout much of the globe. Numerous H1N1 vaccines have been developed in countries all over the world, and the vaccine shortages seen earlier this year have abated.

HealthMap continues to track H1N1 and all other infectious diseases at http://www.healthmap.org. For the latest disease alerts, you can also follow us on twitter. We hope the H1N1 blogs have been informative and helpful.


Photo courtesy of: http://www.washingtonpost.com/wp-dyn/content/article/2009/12/04/AR2009120402611.html?hpid=sec-health

H1N1 (swine flu) weekly highlights: November 25 - December 1, 2009

Montenegro and Libya reported their 1st H1N1 deaths.

South Korea reported a suspect case of H1N1 reinfection in a young girl.

Reports have stated that the United States has likely reached its peak for H1N1, as only 32 of 50 states are now reporting widespread influenza activity.

While H1N1 may have peaked in parts of the Northern hemisphere, the number of deaths worldwide jumped by over 1,000 during the past week, reaching more than 7,800.

Transmission of the virus remains high in East Asia and Canada.

A large outbreak of H1N1 had been feared to occur during this year's Haj season, however only 73 cases and five deaths were reported.

The US Centers for Disease Control (CDC) reported an increase in serious pneumococcal infections associated with H1N1 cases in the United States. The CDC also released new figures stating that as many as 34 million may have already been infected.

Finland confirmed human-to-pig transmission of the H1N1 virus, while a pig herd in Indonesia was also reported to be infected.

Photo: http://www.google.com/hostednews/afp/article/ALeqM5igd_tCu9zIdryTTRkslBF6I39nxw

H1N1 (swine flu) Weekly Highlights: November 18 - 24, 2009

Somalia reported its 1st cases of H1N1, while Lithuania, Switzerland, Macedonia, Maldives, Madagascar, Romania, Estonia, and Denmark reported their 1st deaths.

The World Health Organization (WHO) tallied over 525,000 H1N1 cases and about 6,750 deaths worldwide.

As the US Centers for Disease Control (CDC) reported decreased flu activity in all regions of the US, the WHO noted the eastward spread of H1N1 across Europe and Asia.

Four H1N1 related deaths have been reported among pilgrims for the Hajj which starts on the 26th.

As immunization campaigns continue in over 40 countries, the WHO reiterated the safety of the H1N1 vaccine, adding that investigation into 40 post-vaccine deaths (among the over 65 million doses given in 16 countries alone) has found no association between the vaccine and the documented fatalities.

In a development not unexpected among experts, Tamiflu-resistant H1N1 clusters emerged among hospitalized patients with severe underlying medical conditions in Wales and North Carolina.

Norwegian scientists announced detection of a mutated H1N1 virus that may allow infection deeper into the airways leading to more severe disease. Hong Kong then reported the same mutation, and Finland saw it in July. The WHO subsequently stated that a similar mutation had been observed in six other countries as early as April. Despite the mutations, the H1N1 vaccine is still effective.

A single batch of H1N1 vaccine in Canada has been pulled after a higher than usual rate of severe allergic reactions.

CDC has confirmed a rare second H1N1 infection in the same individual in West Virginia.

In a study of US Army personnel, those who received the 2008 seasonal flu vaccine were 45% less likely to contract H1N1 and 62% less likely to be hospitalized if infected.

Photo source: http://www.examiner.com/x-29691-Boulder-Healthy-Living-Examiner~y2009m11d24-H1N1-Swine-Flu-Symptoms-Is-someone-on-your-flight-showing-flu-signs