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

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.

Leptospirosis Outbreaks, Toxic Sludge and a Historic Victory!

Spotlight News of the Week:
Leptospirosis Outbreaks around the World

Leptospirosis outbreak leads to state of emergency in Nicaragua
Nicaragua has declared a national state of emergency due to a spike in cases and deaths from leptospirosis. Leptospirosis is typically spread through contact with water or plants that have been contaminated by the urine of infected animals (most often rodents). Recent heavy rains and flooding have created ideal condition for its spread. So far, 146 cases and 16 deaths have been confirmed with more cases and deaths suspected. Untreated, it can lead to kidney damage, meningitis, liver failure, respiratory distress, and death. Leptospirosis is rare in the United States with half of the 100-200 cases each year occurring in Hawaii. In the US and Canada, leptospirosis is more often a veterinary disease; diagnoses have increased substantially in dogs during the last decade.

Leptospirosis in El Eulma, Algeria *Picture Source: Sawt El Ahrar
Another leptospirosis outbreak has been reported in city of El Eulma, Algeria. To date, 4 deaths and 75 cases have been confirmed with up to 100 total cases suspected. Investigators report that rat urine was found in mixed with the groundwater in wells, including that of a mosque in the region. The epidemic has increased concern, reaching the front page of the official website of El Eulma in the form of the political cartoon at the top of our blog. The heading above repeats the finding that rat urine has been discovered in well water. The man says “well water” while the rat, which is leaving a door marked “WC,” says “house water.”

Additional News Highlights:

Toxic Sludge Disaster in Hungary
On Monday, October 4th, 2010 the villages of Kolontar and Devecser in Western Hungary were devastated by a flood of a toxic red sludge from a reservoir at the Ajkai Timfoldgyar alumina plant in Ajka. A state of emergency was declared the following day as the death count from the sludge, a waste product in aluminum production containing heavy metals, rose to three and ecological concerns increased for the Marcal, Raba, and Danube rivers. Since then, 9 people have been confirmed dead and more than 150 injured due to the toxic deluge. A team of environmental scientists and toxicologists have been deployed to aid in the clean-up efforts of over 15 sq. miles of land. While residents were allowed to return to what was left of their homes on October 15th, the alumina plant at the source of the spill reopened. The state of emergency has been extended until December 31st for the affected towns, which have been declared “ecological disaster zones.”

Rinderpest joins smallpox in history books
For only the second time in human history, a viral disease has been eradicated worldwide. The UN’s Food Animal Organization (FAO) announced last week that it would suspend tracking efforts for Rinderpest because the disease has been eradicated. Rinderpest is possibly the most important veterinary disease in history. This viral disease kills the vast majority of infected cattle. Devastating losses in the 1700s motivated France’s establishment of the world’s first school of veterinary medicine to teach control methods; most European countries quickly followed suit. When Rinderpest entered sub-Saharan Africa in the late 1800s, 80-90% of all cattle died leading to famine and destabilization that left the region “weak in the face of European colonization.” FAO launched the Global Rinderpest Eradication Programme in 1994, and the virus was last detected in 2001 in wild buffaloes in Kenya’s Meru National Park. The official declaration of eradication will come from the OIE in 2011.

Leishmaniasis in Afghanistan
On Friday, WHO officials highlighted an ongoing outbreak of Leishmaniasis in their first global report on neglected diseases. An ongoing outbreak in Herat as well as the dramatic increase of cases in Kabul has alarmed health officials. Leishmaniasis causes severe skin sores that often leave substantial scarring. The visceral form of Leishmaniasis is less common but is often fatal. It is transmitted through bites from sand flies. Leishmaniasis is extremely rare in the United States, but military personnel deployed to the Persian Gulf and to Southwest/Central Asia have been diagnosed with it after returning to the US.

Typhoon-related Melioidosis Outbreak in Taiwan results in 1 death
On October 15th, Kaohsiung City health officials reported 7 confirmed cases of melioidosis, including 1 death, in the aftermath of the Abigail van typhoon that swept through Taiwan in mid-September. The death occurred in a 82 year old with underlying conditions of hypertension and diabetes. Melioidosis is caused by the bacterium Burkholderia pseudomallei and is endemic in tropical countries in Southeast Asia. Its incidence increases during the rainy season and melioidosis often affects adults who have chronic underlying diseases, especially diabetes mellitus. Interestingly, the disease burden for Taiwan this year was relatively light compared to previous years, when between July and September 2005, 40 cases of melioidosis were identified after Typhoon Haitang swept through the region.

Update on KPC in Brazil’s Federal District
In the capital city of Brazil, the Department of Health has acknowledged an increase (English translation) of hospital related bacterial infections, triggering warnings and widespread concern amongst patients and clinics alike. The bacteria has been identified as Klebsiella Pneumoniae Carbapenemase (KPC). The Secretary of Health for the Federal District announced on October 16th that the number of suspected cases of KPC has ballooned to 135 in the Federal District alone, and now a total of 16 hospitals (9 public hospitals and 7 private hospitals) within the Federal District have been identified as hosts of KPC.

Spotlight News of the Week

Spotlight News of the week:

Polio re-emerges in north-east Afghanistan for the first time in over 10 years:
A new case of polio was identified in the north-east Afghan province of Kunduz bordering Tajikistan, a region that had been polio-free for over a decade. It was initially believed that the source of transmission came from neighboring Tajikistan that is currently experiencing a large polio outbreak. However, it is now believed that the virus may have been carried over by recent refugee immigration from flood-ravaged Pakistan. In response, the Afghanistan Ministry of Health has launched a large-scale vaccination campaign with plans to vaccinate 1.5 million children in five nearby provinces from September 5-7.

What was once a highly infectious and fatal disease that left countless children irreversibly paralyzed, polio is now eradicated from most of the world and remains endemic in only four countries: Afghanistan, India, Nigeria, and Pakistan. Although aggressive vaccination campaigns have decreased the number of cases worldwide by 99% from 350,000 in 1988 to 483 in 2001, the number has since hovered around 1,000 each year.

Additional News highlights

Anthrax in Bangladesh:
Bangladesh has been experiencing an anthrax outbreak among humans and cattle. At least 327 people have been infected, and India is concerned that animals moving across the shared border could bring the disease to Punjab or Haryana.

West Nile Virus in Europe:
Many European countries have seen West Nile Virus cases recently. Although the virus has been seen in Europe before, it is rare in many countries. Greece is seeing widespread cases for the first time with 15 dead and 158 sick. Russia’s southern Volgograd region has had 206 cases and 5 deaths since July 16. Romania has 7 cases and 2 deaths. Hungary first saw the virus in 2003 and now reports two patients being treated. Western Turkey currently has 4 cases and reports 3 deaths. Sicily has reported 49 cases in horses.

Cholera in Cameroon:
Cameroon is facing its worst outbreak of cholera in a decade. Since May 2010 the Health Ministry of Cameroon has confirmed over 5,500 cases and 350 deaths due to cholera in the Nord and Extreme-Nord regions of the country. UNICEF has launched a communications campaign to spread prevention and awareness messages to over 1.6 million school children at risk in a region with limited access to latrines and clean drinking water.