Update on Chiang Mai Mystery Deaths; Ukraine Leptospirosis Cases; and Legionella in Latvia

Undiagnosed Deaths in Chiang Mai Possibly Due to Insecticide
As written in a March 23, 2011 HealthMap blog entry, there have been seven mysterious deaths since January 2011 linked to Chiang Mai, Thailand’s Downtown Inn. The undiagnosed deaths prompted travel warnings to be issued for the popular tourist destination, and led authorities to investigate many different potential causes (mushroom poisoning, toxic seaweed, and pure coincidence to name a few).

New findings released by a New Zealand news investigation team suggests the tourist deaths are connected, and due to a toxic bed bug insecticide. Small traces of the insecticide Chlorpyrifos were found in the hotel rooms where the victims had stayed. While additional test samples have been sent to the US Centers for Disease Control as well as Osaka University in Japan, other pesticides are now being looked at, as health officials work to determine the cause of the deaths.

Leptospirosis in Ukraine
For the first time in 10 years, leptospirosis has returned to the capital of Ukraine. Kiev officials have confirmed cases of leptospirosis in individuals who had gone swimming in a local pond.

Leptospirosis is a dangerous infectious disease that is accompanied by fever, possible liver damage and often requires intensive care treatment. Leptospirosis is sometimes found in fresh water that has been contaminated by animal urine, and primarily occurs in warmer climates. As a general rule, pond beaches in the Ukraine should be decontaminated before swimming is allowed.

Несистемное и очень некачественное проведение малых гидротехнических работ и дератизации (уничтожения грызунов) на киевских пляжах ставит под угрозу здоровье и даже жизнь людей. Так, впервые за 11 лет после последнего зафиксированного случая заболевания, в столицу вернулся лептоспироз.

Это опасное инфекционное заболевание, которое сопровождается волнообразной лихорадкой, поражением печени и, чаще всего, требует реанимационного лечения. Лептоспироз, преимущественно, попадает в воду с мочой больных домашних животных и крыс. Вот почему борьба с грызунами в зонах отдыха людей особо актуальна накануне открытия пляжного сезона.
«В 2010 году были случаи заболевания лептоспирозом и даже уже в 2011. И это на водоемах с официальными пляжами.

Legionnaires' Disease in Latvia
According to the Latvian Centre of Infectology (LTSI) since last autumn, the country has experienced extended cases of the acute infectious disease, legionellosis (or Legionnaires' disease). This month, Latvia has confirmed the death of one individual due to Legionella.

Experts have determined that all cases of infection have occurred in apartment buildings. This is typically the case for Legionnaires’ disease, as it prospers in humid, confined, and heavily populated spaces.

According to the Mayo Clinic:

“Legionnaires' disease primarily affects the lungs, it occasionally can cause infections in wounds and in other parts of the body, including the heart.”

“A mild form of Legionnaires' disease — known as Pontiac fever — may produce symptoms including fever, chills, headache and muscle aches. Pontiac fever doesn't infect your lungs, and symptoms usually clear within two to five days.”

По информации Латвийского центра инфектологии (ЛЦИ), начиная с осени прошлого года по стране стало резко распространяться опасное острое инфекционное заболевание легионеллез ("болезнь легионеров"). В этом году в результате этой болезни уже скончался один человек.
Как отмечает NRA, эксперты установили, что все случаи заражения произошли в квартирах многоквартирных домов.

Легионеллез (питтсбургская пневмония, понтиакская лихорадка, легионелла-инфекция) — редкое острое инфекционное заболевание. Заболевание протекает, как правило, с выраженной лихорадкой, общей интоксикацией, поражением легких, центральной нервной системы, органов пищеварения, возможно развитие синдрома полиорганной недостаточности.

Legionnella at the Playboy Mansion, Meningitis in the Ukraine and on US college campuses, Cholera update, and Chlamydia in New Brunswick

Meningitis in Ukraine
On February 11th, in Zakarpatie, about 60 people were hospitalized, suspected of having the deadly disease - meningitis. Most of the patients are associated with a local Roma camp. The town is in a panic and many are afraid of becoming infected from the Roma people. Parents are not letting their children outside and most others are trying to stay indoors.  “Everybody is scared, the same as last year during the outbreak of the swine flu.” Locals say that the Roma district had suffered from meningitis in the past, but do not recall such a widespread event.

It is suspected that an epidemic of meningitis has the potential to touch other parts of Ukraine. On January 28, in Svyatoshynskyi district of Kiev, a second-grade boy died from meningitis while other children were infected.

The most common symptoms of viral meningitis are high fever, vomiting and headache. Meningitis can be life-threatening and is therefore classified as a medical emergency.

На Закарпатье уже госпитализировано около 60 пациентов с подозрением на смертельную болезнь - менингококк. Большинство заболевших - это представители местного цыганского табора.

В городе паника - люди боятся заразиться от цыган. Местные не пускают детей на улицу и сами стараются меньше выходить. "Все перепуганы, как в прошлом году во время эпидемии "свиного гриппа".   Местные говорят, что в ромском районе и раньше болели менингитом, но такой мощной эпидемии не припоминают.

Похоже эпидемия менингококка может затронуть всю Украину. 28 января в Святошинском районе Киева от менингита умер второклассник. Признаки вирусного менингита - температура до 40, рвота, головная боль.  

Chlamydia Epidemic in New Brunswick
New Brunswick has issued a warning over the growing number of cases of chlamydia, particularly among youths.  “If you are under 30 and you are breathing you need a chlamydia test," stated the deputy chief medical officer.  Although over 1,800 New Brunswick youths have been diagnosed, a focus group has revealed that most youths in New Brunswick are unaware of the risks infection poses.  Chlamydia is a sexually transmitted disease that can lead to infertility in both women and men if untreated (although sterility is a very rare complication in men).  Having chlamydia also increases the likelihood of becoming infected with HIV if exposed to it.

Cholera Spreading in Ghana, Côte d’Ivoire and Papau New Guinea
The number of deaths in Greater Accra, Ghana from cholera has risen to six with 505 cases recorded as of February 14.  The 1st case was reported on January 10, and the number of cases has continued to rise despite the government’s efforts to combat the outbreak by offering free treatment to those affected and undertaking a public education campaign.

Eleven are now dead and 252 cases suspected due to a cholera outbreak in Côte d’Ivoire’s capital of Abidjan.  The epidemic began in Adjame on January 21 and is being attributed to garbage piling up throughout the city. An educational campaign as well as free treatment of cases are both being conducted in an attempt to stop the outbreak.

Cholera cases continue to be recorded in Papau New Guinea (PNG) due to a lack of government funding and an initially poor response to the outbreak. Over 10,000 cases and 483 deaths have been recorded in 7 of 19 PNG provinces since the outbreak began in September 2009.

Playboy Mansion Hit with Legionnaires’ Disease
On February 3, Hugh Hefner hosted a fundraiser for Jenny McCarthy's Generation Rescue Autism Foundation at the infamous Playboy Mansion in Holmby Hills in California. Unfortunately, many of his guests became very sick within 24 to 48 hours after leaving the event with severe flu-like symptoms such as coughs, chills, fevers, and respiratory infections. Investigators discovered that these people were experiencing a mild form of Legionnaire’s Disease, Pontiac Fever. So far, 170 people have been reported with the disease.

Pontiac Fever is a respiratory infection caused by the Legionnella bacteria, which is typically found in water-delivery systems such as shower heads, hot tubs and air conditioners. The Playboy Mansion spread may be linked to a fog machine. Symptoms usually persist for 8-10 days, but resolve themselves without any antibiotics.

The Playboy Mansion is only one of various DOMAINfest Global Conference locations in Santa Monica under investigation for helping spread the disease.

Meningitis on campus
Two US universities have seen meningitis cases recently.  In New York, a St. Lawrence University junior has been diagnosed with bacterial meningitis.  At St. Lawrence, approximately 95% of the students have been vaccinated.  At Texas A&M, a 20-year old junior living off-campus died of bacterial meningitis on Friday.  He was the second student this academic year to be infected at Texas A&M.  Texas’ one-year old law requiring meningococcal vaccination does not apply to students living off-campus.  

Pneumoccal and meningococcal meningitis are the most common forms of bacterial meningitis.  The pnemococcal vaccine routinely given to children under 2.   The Advisory Committee on Immunization Practices (ACIP) recommends everyone between 11-18 years of age be vaccinated against meningococcal meningitis.  According to the National Meningitis Association, there are 1500 cases of bacterial meningitis every year.  Many states and schools require the vaccine for incoming freshman.  For more information on the vaccine, visit the CDC’s site.

New polio outbreaks, Legionnaire’s in Madrid, and Dozens of students quarantined in China’s Guangxi Region

Polio update
In the past few weeks, polio cases have been reported in several countries. Polio is an extremely contagious viral disease. Although up to 95% of those infected show no signs, roughly 1% suffer paralytic polio. Once a worldwide scourge, polio is now endemic (continually present) in only four countries: Afghanistan, India, Nigeria and Pakistan. It is one of only two diseases with a global eradication program (the other is Guinea Worm Disease). The only diseases that have been globally eradicated are smallpox and rinderpest.
First, the good news: India has seen great progress toward its eradication goals, reporting only 39 cases in 2010 compared to 498 at this time last year. Unfortunately, flood ravaged Pakistan has seen an increase in polio cases this year. Also concerning are cases reported in non-endemic countries. Uganda reported a cluster of 5 pediatric polio cases last week. This week, a doctor in Pointe-Noire, Congo reported 8 deaths and 20 cases in a possible polio outbreak.

Legionnaire’s Disease in Madrid
Earlier this year, we discussed an outbreak of Legionnaires’ disease in Wales. A new outbreak has been identified in Spain’s capital of Madrid. The Ministry of Health reports 40 confirmed cases and 3 deaths to date due to Legionella. This disease usually appears as a pulmonary infection with symptoms of high fever and pneumonia. It is not spread from person to person, but typically spreads through contaminated water (from cooling-towers, whirlpools, aerosol sources). Officials in Madrid continue to investigate the source of the outbreak in an attempt to control it.

Paratyphoid A in Guangxi
A total of 107 people, including 84 students, have been diagnosed with Paratyphoid A fever in the Luocheng Mulao Autonomous County of Hechi City in the Guangxi Autonomous Region. Currently, 80 individuals are hospitalized, including 50 students under hospital quarantine. Most of the cases come from 2 middle schools and 1 high school in the county and although the incidence of new cases have begun to decline, investigators have not identified the source of the outbreak and the disease is not yet under complete control. The first case was identified in a 7 year old female student on September 20th but most of the cases occurred between October 17th and 24th, during which 46 cases were identified. Paratyphoid A is caused by the bacterium Salmonella paratyphi A and is most commonly transmitted via the fecal-oral route through contaminated water or food. The disease bears similar symptoms to typhoid fever, including sustained fever, abdominal pain and enlargement of the liver or spleen, but is caused by a different bacterium and is generally more benign.