Hendra Virus Outbreak, Polio Crisis in Pakistan, Egypt Link in E. coli Outbreaks, La Crosse Encephalitis and Rabies

Hendra Virus in Queensland and NSW
Eight people have potentially been exposed to the deadly Hendra virus outside of Brisbane, Australia after a horse that died was confirmed to be positive for the disease. It’s believed that horses become infected after eating food contaminated by flying fox (bats of the genus Pteropus found in Australia) urine, saliva, or birth fluids.  Humans can acquire the disease after having contact with respiratory secretions or blood from infected horses. Of 7 people ever diagnosed with Hendra virus only 3 have survived.  In response to the confirmed Hendra horse death, the area’s mayor has issued that flying fox bats in the area of Kerry and Beaudesert, Queensland be culled despite their protected status.

It was also discovered today that a 2nd horse was infected with the Hendra virus in Wollongbar, New South Wales, and has since been euthanized. The case is unrelated to the horse that died in Queensland earlier this week on June 28th.  

The Polio Crisis in Pakistan
Yesterday, another polio case was discovered in Pakistan’s Khuzdar district, bringing this year’s total to at least 57 for the country. Although Pakistan is now just one of four countries still with endemic polio transmission, the other three countries have reported much lower disease burdens - with 11 cases in Nigeria, 5 in India, and 4 in Afghanistan for the same period. Most concerning is the discovery of cases in regions within the country long-believed to be polio-free. Last week, a 2 year old was found to have polio in Diamer District of northern Pakistan, an area that has not reported cases for over 12 years. Many believe that internal displacement, problem with the vaccine cold chain, and refusal by parents to have their children vaccinated as a result of misinformation have all contributed to the resurgence of cases within the country. Pakistan now is subjected to much international pressure as many European countries are considering imposing travel restrictions on Pakistani citizens and the World Bank has warned that it will convert a grant on polio vaccination for the country into a loan if Pakistan fails to eradicate by 2012.

Egyptian seeds named as source of German and French E. coli outbreaks
Investigators at the European Food Safety Authority have found a common link in Germany’s and France’s recent E. coli outbreaks: contaminated fenugreek seeds originating in Egypt. German health officials have confirmed the farm at the center of the outbreak had received fenugreek seeds from Egypt. Experts warn that additional contaminated seeds are likely still in circulation and may lead to additional outbreaks. The death toll from the German outbreak has risen to 50 (48 in Germany, 1 in Sweden and 1 in the US); over 4,000 were sickened.

La Crosse Encephalitis case in North Carolina
Although West Nile Virus gets much of the press, mosquitoes carry other diseases as well. This week, North Carolina saw its first confirmed case of La Crosse Encephalitis this summer. Like West Nile Virus, most people who are infected with La Crosse Encephalitis do not become ill. In a small number of people the infection affects the nervous system  and can lead to seizures, coma, and paralysis. North Carolina has one of the highest rates of La Crosse Encephalitis in the US.

Rabies in Azerbaijan
In the Sheki region of Azerbaijan there was an outbreak of rabies among domestic animals. Measures have been taken to remove the infected animals which were infected by attacking  wolves. Ten animals have been slaughtered while another 8 are suspected to be infected with the virus. In addition, a human case of rabies has been identified in the same village. That person was one of five injured and possibly infected when the attack occurred on June 8. According to the deputy chief physician of the Central Hospital of Sheki, the villager underwent treatment for approximately 20 days with no results.

В Шекинском районе отмечена эпидемия бешенства среди домашнего скота, проводятся мероприятия по  уничтожению зараженных животных. Причиной возникновения болезни стало нападение на домашний скот  диких животных.  В селе было уничтожено свыше 10 животных, а у 8 животных есть вероятность заражения бешенством.

Кроме того, в селе Кунжут отмечен случай заражения бешенством человека. Житель села является одним из  5 человек, подвергшихся нападению волков 8 июня.

По словам заместителя главного врача Центральной больницы Шекинского района, проводящееся около 20 дней лечение не дало никаких результатов.

Scarlet Fever Kills 2 in Hong Kong, Undiagnosed Disease Strikes Bihar, and More Breaking News

Scarlet Fever Kills Two Children in Hong Kong
A new strain of Scarlet Fever is spreading through Hong Kong. In the past three weeks, two children, a 15-year-old boy and a 7-year-old-girl, became the city’s first fatal victims in the last 10 years. Since January, 419 cases have been confirmed in Hong Kong with 142 cases in the first weeks of June.

Scarlet Fever is caused by the Streptococcus pyogenes bacteria and mostly affects children ages 2-8. The disease causes a fever, sore throat and a rash on the neck, face and tongue, and eventually spreads across the entire body.  Scarlet Fever is typically treated with antibiotics that are very effective, but this new strain is actually a mutation of the Streptococcus bacteria and is resistant to several antibiotics. A physician from the Hong Kong Medical Association encourage doctors who are treating children infected with the disease to try alternative antibiotics before the disease spreads even more.

Japanese Encephalitis Suspected as Unknown Disease in Bihar
A team of experts from the Union Health Ministry and Regional Malaria Research Institute (RMRI) team is investigating an “unknown disease” killing children in the Muzaffarpur region of Bihar, a state in India. The disease has caused the death of 26 children in the last seven days and affected over 35 others. It is believed to be Japanese Encephalitis. Some of the symptoms include high fever, memory loss, convulsions, falling in and out of consciousness, and eventually coma. Hopefully once the disease can be confirmed, health officials will be able to take the necessary precautions to prevent more children from becoming victims.

Rabies PEP Failure
A patient in Mumbai, India is now in a coma after becoming infected with rabies despite completing the recommended postexposure prophylaxis (PEP) regimen following a dog bite. A 2nd patient is also in a coma with the deadly virus after failing to complete the PEP series of vaccinations. (PEP typically consists of one dose of immune globulin and four doses of rabies vaccine over a 14-day period.) PEP is usually highly effective, however in a small percentage of patients the vaccine series may not build up enough of an immune response. It is also important that PEP be administered promptly after a rabies exposure and that the schedule of doses is followed. According to the WHO, India sees 25,000-30,000 deaths due to rabies each year.

Mumps Outbreaks in Vancouver
The British Columbia Centre for Disease Control has issued a health alert for mumps in Vancouver.  Although the number of cases has not been released, it is reportedly the largest outbreak since 2008 when almost 200 people were diagnosed.  Earlier this year, Whistler saw a mumps outbreak as well.  HealthMap will update this story as more details become available.

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.

Undiagnosed Disease in Yemen, H5N1 in Hong Kong and Possible Ebola in Uganda

Mysterious outbreak in Hodaida Province (Yemen): Affecting Thousands, Five Dead
While originally reported as a dengue fever in our earlier blog post on the subject, an epidemic of what appears to be an unknown disease continues to spread in western Yemen. Unconfirmed newspaper reports state the epidemic emerged approximately one month ago, reportedly disproportionately affecting women and children. Schools have been adversely affected in a number of towns due to both student and teacher absentees, as the illness and fear of it spread in the region. Attempts by the government to calm the situation do not appear to be working.

Known in Yemen as “Al Mukrifas” (المكرفس), most of its spread has been south of the province’s capital in rural areas in and around Zabid, Beit al Faqih, Jebel Ras, Al Jurrasi (Translates incorrectly as “Surgical” in Google Translate) and Al Khawkhah (which translates incorrectly as “nectarine in Google Translate). Reports vary, but up to 4 have died in Al Khawkhah and up to 5 in Jebel Ras. Symptoms include those similar to Dengue fever and an unspecfied “German fever”, including caugh, headache, swelling of the face and joints, myalgias and, occasionally, bleeding under the skin. Medical treatment has so far been supportive.

Avian Influenza Case in Hong Kong
Hong Kong reported its first diagnosis of H5N1 (avian influenza) since 2003.  The 59 year old female patient had recently returned from a trip to mainland China where she visited Shanghai, Nanjing and Hangzhou. The patient is reportedly slightly improved but still in serious condition, and China has stated that no human cases have been detected in the cities she visited.  The report triggered concern in Taiwan and the Philippines.  

Possible Ebola Outbreak in Uganda
Last week, a Ugandan newspaper reported a mystery illness had caused 13 deaths in Abim and Agago districts in the north.  The article quoted a local health official who said that Ebola, Marburg, and Lassa had been ruled out through lab work.  The similarity to Ebola has been noted in subsequent articles.  We will continue to monitor the situation and report on any official diagnosis in this outbreak.

Six Die After Eating Endangered Turtle Meat
Six people died, including 4 children, and more than 90 became ill after consuming meat from the endangered hawksbill turtle. The deaths were a result of poisoning from biotoxins in turtle flesh that has no known antidote. This event occurred in late-October on the Island of Murilo, Micronesia.  Authorities have advised residents not to consume turtles or their eggs.

Whooping Cough Cases Rising Throughout U.S.
In the past week, we have received alerts about whooping cough in numerous states, including Indiana, Iowa, Kentucky, Michigan, Missouri, New York, North Carolina,  Oregon, and Pennsylvania.  Los Angeles County is reportedly having their highest number of cases ever, with more than a quarter of this year’s cases coming in the last month.  Whooping cough is a very contagious respiratory disease caused by Bordetella pertussis.  Infants are particularly vulnerable; about half of infected infants require hospitalization and 1 in 100 hospitalized infants die from it.  Whooping cough can be prevented by vaccination but over time adults may lose that protection.  The CDC recommends that adults get a booster when they receive their tetanus booster.  New parents and grandparents should make sure they are up to date on their vaccinations.

Rabies in Guangdong
It was recently reported that from January to October of this year, 228 people have died from rabies bites in Guangdong Province in Southern China. Most cases occurred among young children and older individuals in rural areas as a result of bites from rabid dogs. The report stated that 90% of the individuals who died did not seek care after being bitten. Surprisingly, over 50% of the cases did not come from bites by stray dogs, but by dogs from their own homes or neighboring homes. Experts say that in rural villages, domestic dogs frequently run loose and come in close contact with other dogs, causing the transmission of the rabies virus to be especially high. However, owners never suspect that their own dogs can become infected and do not take any necessary precautions. Vaccines exist to protect both animals and humans from the virus.