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.

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.

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.

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

H1N1 (swine flu) weekly highlights: November 4 - 10, 2009

Sri Lanka, Pakistan, Slovakia, and St. Lucia reported their first H1N1 deaths, while Nigeria, the Republic of the Congo, Latvia, and Armenia reported their 1st cases of H1N1.

Last week, Ukraine (population 46 million) saw a first wave of H1N1 begin. Since last week's blog, the number infected has increased at least five-fold to 1.3 million sick and 174 dead. Neighboring Slovakia and Russia tightened their borders as Ukraine's outbreak spread.

The World Health Organization (WHO) reported that H1N1 has become the dominant influenza strain around the globe, as the number of deaths due to the virus passed 6,000 worldwide. In addition, the WHO has emphasized the need for doctors and veterinarians to work together to monitor animals as well as farm workers for H1N1 infection.

A pet cat in Iowa tested positive for H1N1. The cat is believed to have caught it from its owners.

Cases of H1N1 virus showing resistance to antiviral drugs are 'isolated and infrequent' according to the WHO.

Recent studies conducted by the California Department of Public Health have shown that H1N1 has disproportionately affected younger individuals, however people who are obese or elderly have a higher risk of death if they become infected.

A new study shows a benefit of combining H1N1 and seasonal influenza vaccines.

HealthMap is now providing Massachusetts state data for the new Google flu clinic finder.

Photo: http://www.google.com/hostednews/afp/article/ALeqM5h00CIlceU0saqI6YM40N2ty4Huxw

H1N1 (swine flu) weekly highlights: October 28 - November 3, 2009

Afghanistan, Ukraine, Moldova, Croatia, Belarus, Slovenia, Austria, and the Canadian provinces of Newfoundland and Yukon reported their first H1N1 deaths.

The World Health Organization (WHO) reported the number of global H1N1 deaths jumped to over 5,700 worldwide.

In other statements, WHO reiterated that the vaccines are safe, that one dose is sufficient for adults and children over 10, and that pregnant women should be vaccinated since they are a high-risk group.

Researchers at the annual meeting of the Infectious Diseases Society of America reported that influenza vaccination of pregnant women was "85 percent effective in preventing hospitalization in their infants under 6 months of age." The study also indicated babies of vaccinated women were bigger, healthier and less likely to be premature.

Following last week's declaration of a national emergency in the US, New York state and the city of Philadelphia made similar declarations. This allows hospitals and local governments freedoms from certain restrictions during the emergency. HHS Secretary Sebilius suspended additional regulations relating to H1N1 treatment.

Long lines and vaccine shortages plagued H1N1 vaccine clinics throughout the United States and Canada.

As the number of US children who have died of H1N1 climbed to 114 and 48 states reported widespread flu, the CDC noted that only half of people who most need immediate treatment for H1N1 swine flu are actually seeking it.

Photo courtesy of: http://www.latimes.com/features/health/la-me-swine-flu-clinics4-2009nov04,0,3665600.story?track=rss

H1N1 (swine flu) weekly highlights: October 21-27, 2009

Serbia, the Czech Republic, Turkey, Finland, Russia, and the U.S. state of North Dakota have all reported their first H1N1 deaths.

The World Health Organization (WHO) has reported that there have been 414,945 confirmed cases of H1N1 worldwide, and nearly 5,000 deaths.

The WHO's Director-General Margaret Chan also stated that the pandemic would reach its natural end when enough people had become immunized.

United States President Barack Obama declared H1N1 (swine flu) a national emergency, as the US death toll surpassed 1,000.

Also in the United States, manufacturing difficulties are delaying the delivery of the H1N1 vaccine. The CDC said that only 16.1 million out of an expected 30 million doses had been shipped. While H1N1 vaccine shipment is delayed, increases in school closures, hospitalization rates, and 11 more pediatric influenza-related deaths point to an intensifying pandemic throughout the US.

Photo courtesy of: http://www.campaignlive.co.uk/News/948015/Government-releases-new-set-swine-flu-ads/

H1N1 (swine flu) weekly highlights: October 14-20, 2009

Trinidad & Tobago and Iceland have reported their first H1N1 deaths.

The World Health Organization (WHO) has stated that the ongoing H1N1 pandemic remains a cause for concern because of its unpredictable nature, and announced that more than 4735 deaths can now be attributed to the virus. In addition, the WHO identified those most at risk and underscored the risk to the young and healthy. Doctors have been urged to treat suspect cases quickly, as the virus may cause viral pneumonia much more commonly than seasonal influenza.

The FDA has warned of online products purported to diagnose, prevent, treat or cure the H1N1 influenza virus.

The USDA's National Veterinary Services Laboratories have confirmed H1N1 in 3 pigs exhibited at the Minnesota State Fair (held Aug. 26-Sept. 1). These are the first pigs in the US diagnosed with pandemic H1N1.

The CDC announced that approximately 6 million doses of H1N1 vaccine have been shipped throughout the United States, however about 25% fewer doses than expected will be available this month because of delays in production.

A recent study from the University of California at Davis may explain why many people over the age of 60 carry antibodies or other types of immunity against the new virus.

The humanitarian agency World Vision, has warned that the spread of H1N1 to developing countries, without adequate means to track the outbreak or to treat those infected, could prove disastrous.


Photo courtesy of: http://www.u.tv/News/Teenager-with-swine-flu-dies/6191b85d-d897-4fae-80c4-28d4b5a0a7c6

H1N1 (swine flu) weekly highlights: September 30-October 6, 2009

• Bulgaria, China, and Portugal reported their first H1N1 deaths.

• Twenty-five states, counties and cities in the U.S. started receiving shipments of the H1N1 vaccine this week. Due to the limited quantities available, priority has generally gone to high risk groups such as healthcare workers and children. Australia also launched its mass H1N1 flu vaccination efforts earlier this week, its largest campaign ever.

• A Consumer Reports poll found that only about a third of Americans plan on definitely getting the H1N1 vaccine, while almost half are undecided. The WHO meanwhile reiterated its confidence in the H1N1 vaccine and encouraged mass vaccination.

• A new report warned of a potential hospital bed shortage in 15 states if 35% of Americans were to get H1N1.

• The CDC reported that bacterial co-infections are playing a role in the H1N1 influenza pandemic, finding that almost one third of a sample of patients who died in the past four months from H1N1 had bacterial infections that complicated their illnesses.

• Two studies on the 1918-1919 influenza pandemic were reported this week. One study found that children of women who were infected during the 1918 flu pandemic while in pregnancy were at greater risk of having heart disease later in life. Another found that aspirin misuse might have led to the high death toll during that pandemic.

• A study using data from Mexico found that hospital patients with laboratory-confirmed H1N1 were less likely to have received a flu shot last winter. These findings are the opposite of those from an unpublished Canadian study leaked last week.

Photo taken from: http://www.businessday.co.za/articles/Content.aspx?id=83266

H1N1 (swine flu) weekly highlights: September 23-29, 2009

• Germany, Cambodia, and Barbados reported their first H1N1 deaths as the global death toll approached 4,000.

• Unpublished research using Canadian data has reportedly found that individuals who received the seasonal flu vaccine last year are twice as likely to catch H1N1. The CDC has stated that it has not had similar findings in the US.

• WHO stated that regulatory authorities have licensed H1N1 vaccines in Australia, China, Hungary and the United States. Japan and several European countries will soon license vaccines.

• WHO reported that drug makers can only produce enough H1N1 vaccine each year for half the planet because they lack factory capacity.

• Researchers have reported that the injectable H1N1 vaccine is twice as protective as the inhaled nasal spray version of the vaccine.

Photo taken from: http://www.telegraph.co.uk/health/healthnews/5806751/Swine-flu-vaccine-to-be-given-to-entire-population.html