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 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.

Human Infections of Avian Influenza (H5N1) on the Rise in Central China

Since the beginning of 2009, eight cases of highly pathogenic human avian influenza have been reported in China. Three of the cases have been confirmed to be from central China’s Hunan province. However, individual cases have also been reported from nearby Shanxi, Shandong, and Guizhou provinces among others. It is suspected that China’s winter weather is aiding in the spread of the virus.

While exposure to sick or deceased poultry continues to be the main route that humans become infected, experts warn that H5N1 may evolve into a form that can be easily transmitted from person-to-person. Since the beginning of a pandemic cannot be predicted, all contacts of avian influenza cases are closely monitored to ensure that the disease does not spread. In addition, epidemiologic investigations are carried out in each case to determine the most likely source of infection so that the appropriate actions can be taken such as the culling of poultry.

Why such concern about the spread of one type of influenza? Of the 37 cases to date in China, 25 of them have been fatal. With a case fatality rate over 65% a pandemic of H5N1 would surely have a devastating impact around the globe.

Related Articles (additional articles available at www.HealthMap.org):

http://apex.oracle.com/pls/otn/f?p=2400:1001:5724127436830768::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1010,75901

http://www.who.int/csr/don/2009_01_27/en/index.html

http://en.epochtimes.com/n2/content/view/10648

http://www.straitstimes.com/Breaking%2BNews/Asia/Story/STIStory_332738.html