Drought Brings Famine and Disease to Horn of Africa

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.

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.

Possible Link in US Measles Cases and Dolphin Deaths Declared to be "Unusual Mortality Event"

Measles Outbreaks in 3 US States May Be Linked

Public health officials in Orange County Florida are reporting that tourists from Texas, Minnesota and Michigan have been diagnosed with measles after visiting Orlando. A CDC investigation suggests an air show may be a common link between several cases.  Since no cases have ben identified in Florida, it is possible a visitor from overseas infected people attending the air show.  In Texas, an 11-month old was diagnosed in Houston, while two adult cases in the Fort Worth area are the first in 17 years. The infant and one of the adult cases are believed to have been infected in Orlando. In Minnesota, 15 measles cases have been confirmed: 1 case likely came from Florida, 1 from India, and the others are linked to a case imported from Kenya.

Measles is highly contagious among the unvaccinated. Houston saw large outbreaks in the 1980s and 1990s when the immunization rate was quite low (58%). Many Texas news sources are reporting much higher coverage among kindergartners in surrounding communities. Abilene, for example, reports a 99% coverage rate.  High levels of immunity should diminish the risk of an outbreak. In Minneapolis, public health workers are meeting resistance to vaccination by some in the large Somali community. One doctor said in his experience as many as 70% of Somali families are avoiding the vaccines. Overall, Minnesota has seen a decline in vaccination rates. At 76.95%, the state has fallen from 7th to 20th place in the most recent survey of US states.

This week, a CDC report warned “measles importations and transmission from imported cases continue to pose a threat to U.S. residents.” In January and February, 28 import-associated cases were reported. Although measles was eliminated in the US, international travel poses the constant risk of reintroduction and establishment. Where immunization coverage is low, a single introduced case can lead to the return of the disease. For every 1,000 children who get measles, one or two will die.

Sea Turtles and Dolphins Washing up Dead Along Gulf of Mexico

Scientists are continuing to perform necropsies in an effort to determine what has caused the deaths of over 400 baby dolphins since February 2010 in the Gulf of Mexico.  The National Oceanic and Atmospheric Administration (NOAA) declared the deaths “an unusual mortality event” that has caused a significant loss of the marine mammal. While many are quick to blame the April 2010 BP oil spill, scientists have not yet been able to determine the cause of the deaths.

In addition to an increased number of dolphin deaths, over 100 endangered sea turtles (Kemp’s Ridley and Loggerhead) have died or been stranded along the shores of the Gulf since the beginning of 2011.  Tests are being conducted to determine the cause of the turtle deaths, which may be due to harmful algae blooms common in the Gulf of Mexico.

African Swine Fever, Meningitis C, Measles, and more Infectious Disease News from Around the Globe

African Swine Fever in Ukraine
Ukraine is hoping to prevent an outbreak of African swine fever. "[Across the border] in Russia. . . the epidemic of the disease is already out of control.” Ukraine is taking preventative measures to avoid the spread of the disease.  All pigs will be vaccinated, and meat markets will be closed. In the coming days, residents of neighboring villages must relinquish their pigs for slaughter. As compensation, they will receive 75 rubles per kilogram of body weight.

На сегодняшний день Украина находится под угрозой африканской чумы свиней.  «В России, практически на границе с Украиной, эпидемия этого заболевания уже вышла из-под контроля. Cоответствующие службы из регионов, находящихся в зоне риска, должны принять профилактические меры для предупреждения распространения заболевания по территории Украины и провести вакцинация всего поголовья свиней. Кроме того, устранить места стихийной торговли мясными продуктами, а также определить специальные места для проведения забоя свиней, если заболевание проявится на территории Украины.

Meningitis C in France
France is launching a vaccination campaign, aimed at students, due to the increase in Meningitis C cases in Lille.  Though the case count in the general population is still low (0.36 per 100 000), the student population is facing a higher and more serious case count (7 per 100 000).  France feels there is a great need for the campaign as 10% of meningitis C cases are fatal.

La France lance une campagne de vaccination contre la méningite C.  La campagne est visée aux étudiants universitaires à cause de l’augmentation des cas de méningite C a l’Université de Lille.  Pendant que le taux pour la population générale reste plutôt bas, a 0.36 cas pour 100 000, la population étudiante a 7 cas pour 100 000, ce qui est plutôt sérieux.  

Enteroccocus at University Hospital Vaudois, Switzerland
Vancomycine resistant enteroccocus has been found at the University Hospital Vaudois in Lausanne, Switzerland.  All patients, confirmed or suspected of carrying enteroccocus have been grouped together on the 15th floor, which is no longer taking admissions. Enteroccoci are gram-positive bacteria that can cause urinary tract infections, bacterial endocarditis and meningitis.

Le Centre Hospitalier Université Vaudois est touché par entérocoques résistant à la Vancomycine.  Tous les patients qui sont suspects ou bien porteurs de l’entérocoques sont réunis sur le 15ème étage pour une durée indéterminée. L’entérocoques est une bactérie anaérobie qui peut provoquer les infections du canal urinaire, l’endocardite et la méningite.  

Measles in Geneva, Switzerland and Rhônes-Alpes, France
Twenty-six cases of measles have been identified since January 2011.  This is the biggest outbreak of measles in the canton of Geneva since 2008.  The majority of cases in Switzerland and in the neighboring French region are adults who have not been vaccinated.

Dans le canton de Genève, 26 cas de rougeole se sont identifiés depuis janvier 2011.  Ceci est la plus grande flambée de rougeole depuis 2008.  La plupart de cas sont les adultes qui n’ont pas été vacciné contre le rougeole.  

Avian Influenza Update: Bangladesh (poultry), India (ducks), Cambodia (humans), Indonesia (poultry and human) and Vietnam (poultry; human case ruled out)
In addition to the ongoing outbreaks of avian influenza in South Korea and Japan, three other Asian countries reported outbreaks.  In Rajshahi, Bangladesh, 8,600 chickens were culled as outbreaks continue to be detected around Dhaka and Rangpur.  India confirmed an outbreak in Agartala, Tripura leading to the culling of 3,000 ducks.  It is India’s first outbreak since June 2010.

Cambodia recorded two human deaths last week as doctors worry about the possibility of an outbreak.  WHO has not yet confirmed the recent deaths, but a five-year-old girl died there earlier this month.  In Garut, Indonesia, the sudden death of 600 chickens has been attributed to avian influenza.  Additionally, 14 villagers have severe flu symptoms but the cause of their illnesses has not been determined.  In Vietnam, tests have ruled out avian influenza infection after a girl with suspect symptoms died at the Hue Central Hospital. Outbreaks among poultry have been reported in three Vietnamese provinces.

Conjunctivitis Clusters in Brazil
Over the last week over 150 cases of conjunctivitis were reported in the city of Goioerê (located in Parana State), with 52 of those cases occurring over the weekend. At about 29,000 inhabitants the city of Goioerê is considered relatively small and any outbreak of this magnitude is cause for city officials to be alarmed,  and in addition the highly contagious nature of conjunctivitis, the ministry of health is concerned about containing this outbreak. All inhabitants of Goioerê are encouraged to wash their hands frequently, and not to stay in enclosed (non-ventilated) housing with large gatherings of people.

Influenza Closes Russian Schools, Cholera Cases Found in NYC, and White Nose Syndrome Spreads

Epidemic of Influenza in Russia.
An epidemic of influenza has been spreading throughout Russia. Nearly 60 regions in Russia have been severely affected. In Moscow, since January 31st, all elementary and middle schools have been closed in hopes of preventing the further spread of the disease. Every week around 160,000 people are becoming ill, and about 450 are being hospitalised every day.


Почти в 60 российских регионах зафиксирована эпидемия гриппа. 31 января из-за эпидемии гриппа и ОРВИ во всех столичных школах были приостановлены занятия у 1-8 классов. Городские власти решили ввести карантин в учебных заведениях в качестве превентивной меры, чтобы обезопасить детей. Cейчас еженедельно заболевают около 160 тысяч москвичей, госпитализируется около 450 человек в день.


Measles Getting a Foothold in Auckland?
On January 11th, an individual infected with measles flew from Brisbane to Auckland, triggering a public health warning over potential exposure to other passengers.  In the month since that flight, 12 additional cases have been diagnosed in Auckland.  Public health officials now fear the outbreak will spread.  Only some of the 12 cases were on the flight or had known contacts on the flight, suggesting measles is now circulating in the community.


Cholera in New York City
This week New York City officials confirmed 3 cases of cholera, the first diagnoses since the outbreak in Haiti started.  All the patients attended a wedding in the Dominican Republic in January.  New York City typically sees one imported case of cholera per year, and the risk of spread is negligible.


White Nose Syndrome Continues to Spread
Just one week after being discovered in Indiana, the deadly White Nose Syndrome (WNS) has been identified in bats located in an old Avery County mine and in a cave within Grandfather Mountain State Park in North Carolina. This discovery marks the first time WNS has been found in bats in North Carolina. The disease, first discovered in New York State in 2006, has spread North into Canada and South to Tennessee (a total of 16 states and 2 Canadian provinces have been affected to date). WNS has devastated bat populations throughout the United States with over one million bats killed due to mortality rates close to 100% in affected populations.


Swine Flu Causes Multiple Deaths in Hong Kong and Beijing
As China ushered in its Lunar New Year this past week, the city of Beijing has reported 11 new cases and 1 death due to H1N1 since February 2nd. So far in 2011, 195 cases and 4 deaths due to H1N1 have been confirmed for the city. Chinese New Year is a time of great excitement but also of public health concern due to the great amount of movement and travel among the population and also due to large group gatherings, both publicly and at home. During this holiday period, it was reported that people within Beijing sought outpatient care 263,000 times, a 17.4% increase from last year, and emergency care 110,000 times.


The Hong Kong Center for Health Protection also reported today that in the brief past two weeks, 9 individuals have died from H1N1 since January 24th. The Center’s director explained that H1N1 is the main virus circulating this flu season, causing rates of severe complications and care-seeking to be higher in comparison to the same time period last year. He predicts that the peak period for this flu season may continue until March. Since the H1N1 outbreak in 2009, Hong Kong has accumulated over 80 deaths.

Undiagnosed Illness in Uganda, Measles in Argentina, and HealthMap at the ISDS Conference

Scientists work to identify the illness that has killed 38 people in northern Uganda. http://www.google.com/hostednews/afp/article/ALeqM5hgmieXl3QCUDRkdH0Z12UD704bFg?docId=CNG.6a0a014a69f4ce1afd31a8eefff9f2b8.441

Possible pneumonic plague in Northern Uganda Leaves 38 Dead

Last week, we reported that a mysterious illness had left 13 dead in northern Uganda. This week, the death toll has risen to 38 with dozens hospitalized, yet officials are still uncertain as to the cause, although tentative testing have confirmed it as pneumonic plague. Ebola, typhoid and several other diseases have been ruled out. The first case was identified in early November and since, over 90 people have been treated.  Symptoms include severe headaches and dizziness and eventually bloody diarrhea and vomiting. Officials say the disease has been detected in five districts in the northern part of the country. However, with vast impoverishment and inadequate health facilities, it may take weeks before response teams arrive and implement control efforts.

Alert for Measles in Buenos Aires

After 12 years without a registered case of measles in Buenos Aires, 17 cases have been reported since August.  The minister of health has helped initiate a national vaccination campaign in hopes of preventing the further spread of this disease. The province of Buenos Aires expects to be rid of the virus soon.

HealthMap at the 9th Annual ISDS Conference

Several HealthMap team members gave oral presentations at the International Society for Disease Surveillance’s 9th annual conference in Park City, Utah last week. In addition, HealthMap had a table where conference attendees could learn more about the system and sign-up to receive our free daily email alerts. The following oral presentations were given by members of our group (please email us for more information about any of these abstracts, or if interested in receiving our customizable email alerts):

Emily Chan - - Forecasting High Priority Surveillance Regions: a Socioeconomic Model
Annie Gatewood-Hoen - - Effect of Expanded Recommendations for Pediatric Seasonal Influenza Vaccination: An International Comparison
Sumiko Mekaru - - Anticipatory Surveillance for Mass Gatherings: A Novel Application of Mass Media Surveillance
Rumi Chunara - - OutbreakMD: Tracking and Identifying Disease Outbreaks in Post-earthquake Haiti