Meningitis in Ghana and the US, Avian Influenza in Bangladesh, and Plague in Madagascar

Meningitis in Ghana and the United States
Fifteen people have died from meningitis in Ghana’s Upper West Region with over 100 cases reported. Ghana is located in the Meningitis Belt of sub-Saharan Africa where the highest rates of bacterial meningitis are seen. Although vaccines exist for meningococcal meningitis, many in the Meningitis Belt are unvaccinated.

In the United States, young adults are considered to be at the greatest risk.  This week, a college student at Ohio State University and a high school student in Elizabethton, Tennessee died.  Meningococcal meningitis has been confirmed in the former and is suspected in the latter.  Also, an Oregon high school student is in critical condition with confirmed meningococcal meningitis.  A second possible case has also been identified.  According to the CDC, the US has between 1,000 and 1,200 cases each year.  The CDC has more information on the vaccine here.

Human Cases of Avian Influenza in Bangladesh
Two cases avian influenza (H5N1) have been reported in the Kamalapur area of Dhaka.  The first case is a one year old girl and second is a 2 year old boy.  The boy was diagnosed after increased surveillance following the identification of the girl’s illness.  The only other human case of H5N1 in Bangladesh was in 2008 in the same area as the current two cases.

Plague Continues to Spread in Madagascar
Since early February 2011 deaths from both pneumonic and bubonic plague have been occurring in Northern Madagascar. As of February 23rd a total of 45 cases had been detected in the country with 23 deaths. It is thought that plague initially spread as locals mistook symptoms of plague for influenza. It was only after 3 people in one family died in the district of Ambilobe that doctors were alerted. In a report dated March 15th, additional deaths were reported from the Antananarivo region. While plague typically occurs yearly in Madagascar’s Central Highlands, the current outbreak is occurring in a region where the disease is not endemic. In areas affected, homes are being sanitized, and preventative treatment is being given to those who have had contact with plague victims.

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

Spotlight News of the Week

Japanese Encephalitis outbreak causes 215 deaths in India, mostly children:
This year’s Japanese Encephalitis season came earlier and deadlier to India than previous years. Officials report that since July, 215 people have died from the disease, most of them children and occurred in the Gorakhpur district of Uttar Pradesh. Local health officials worry that the number of encephalitis patients may reach at least 3,500 with a case-fatality rate of 20% while over 70 million children are at risk of the disease. As Japanese Encephalitis is transmitted by mosquitoes, the heavy rain and flooding brought in by the arrival of monsoon season have only exacerbated the severity of the outbreak. Hospitals are currently heavily under-staffed and have expressed frustration by the government’s inadequate response.

Additional New Highlights:

UPDATE - Salmonella outbreak in eggs linked to chicken feed:

The source of the Salmonella that led to a massive recall of eggs in the US is now believed to be contaminated feed. However, the feed is believed to have been sent to only the two egg facilities under investigation.

Plague spreads to Bolivia:

The infamous bubonic plague that caused a panic and killed 3 people in Peru has spread to Bolivia. Eight people are suffering from the disease in Apolo, a small town on the border with Peru. Last Tuesday, August 24, Bolivia officially declared a health alert after a 14 year old boy died from the bubonic plague.

Plaguing Peru (Spanish language version now available)

This July, Peru experienced its first ever-recorded cases of pneumonic plague. How did the pneumonic plague make its way into Trujillo, Peru? A 29-year-old woman living in Mariposa Leyva in the Ascope province was brought to Trujillo’s Resident Teaching Hospital showing flu-like symptoms (fever, aches…etc). Doctors first thought she was sick with either pneumonia or the infamous H1N1 flu. They unsuccessfully treated her for both. As her symptoms worsened, the woman’s resident physician also began showing similar symptoms, followed soon after by a 4th-year medical student at the Universidad Nacional de Trujillo who also worked in the hospital. Although the patient tested negative for pneumonic plague, the medical student tested positive.

The local press was informed of a possible outbreak of pneumonic plague in the region.

Since April, eleven cases of bubonic plague were confirmed and another 20 suspected in Peru. Bubonic plague is not as deadly as pneumonic, but can quickly manifest into pneumonic plague, which is highly communicable. Bubonic and pneumonic plague are caused by the same bacteria. Bubonic plague is associated with swollen lymph nodes ("buboes") while pneumonic plague occurs when the infection is in the lungs. Despite local authorities' efforts to prevent further spread of the plague, a teenager with Down syndrome became infected with bubonic plague and died, the only fatality to date. The number of pneumonic plague cases only rose to 4, with the last being a 5-year-old boy who lived with the first woman who became ill. In total, 31 cases of bubonic and pneumonic plague have been reported.

In order to prevent the further spread of these two plagues, authorities acted quickly to rid the region of La Libertad of any fleas that could carry the disease. Fortunately, the plagues are reportedly now controlled. On August 2, Oscar Ugarte, the minister of health in Peru declared that the plague (both bubonic and pneumonic) has been effectively contained.

For more information on plague please visit:

HealthMap

World Health Organization

Centers for Disease Control and Prevention

La Peste en Perú

En el mes de julio, Perú tuvó su primer caso registrado de peste neumónica. ¿Cómo surgió la peste neumónica en Trujillo, Perú? Una mujer de 29 años que vive en Mariposa Leyva en la provincia de Ascope fue llevada al Hospital Residente de Trujillo con síntomas de tipo gripal (fiebre, dolores ... etc). Los médicos primero pensaron que ella estaba enferma con neumonía o la gripe H1N1. Se la trató sin éxito para ambos. A medida que sus síntomas empeoraron, el médico residente que trataba a la mujer también empenzó a mostrar síntomas similares, seguido poco después por un estudiante de medicina del 4 º año en la Universidad Nacional de Trujillo, que también trabajaba en el hospital. Aunque el paciente haya arrojado resultados negativos para la peste neumónica, el estudiante de medicina dio positivo. La prensa local fue rapidamente informada de un posible brote de peste neumónica en la región.

Desde abril, once casos de peste bubónica fueron confirmados y otros veinte sospechosos en Perú. La peste bubónica no es tan mortal como la neumónica, pero rápidamente se puede manifestar en la peste neumónica, que es altamente transmisible. Bubónica y neumónica son causadas por la misma bacteria. La peste bubónica se asocia con inflamación de los ganglios linfáticos ("bubas"), mientras que la peste neumónica se produce cuando esta infección está en los pulmones. A pesar de los esfuerzos de las autoridades locales para evitar una mayor propagación de la peste, un adolescente con síndrome de Down se infectaró con la peste bubónica y murió, fue el único hasta ahora. El número de casos de peste neumónica sólo se elevó a 4, con el último de ellos un niño de 5 años, que vivía con la primera mujer que se enfermó. En total, 31 casos de peste bubónica y neumónica han sido reportados.

Para evitar una mayor propagación de estas duas plagas, las autoridades actuaron rápidamente para librar a la región de La Libertad de cualquier pulgas que podrían llevar la enfermedad. Afortunadamente, se informa que las plagas, actualmente estan a bajo de control. El 2 de agosto, Oscar Ugarte, ministro de salud en Perú declaró que la plagas (tanto bubónica y neumónica), han sido realmente contenidas.