The HealthMap Blog is MOVING - Join Us at The Disease Daily!!

The HealthMap Blog is moving up in the world! HealthMap has always worked to provide you with the infectious disease outbreak news you need to know along with the geographic and timeline context for you to understand it. In January 2009, we started this blog to provide broader information on outbreaks occurring worldwide. Today we are excited to start The Disease Daily and HealthMap Local.

At The Disease Daily, we're expanding the coverage you've come to expect at the HealthMap blog.  We'll still provide you with the context you need to understand current outbreaks: "Does the report of a new tattoo infection mean there's a scary new disease?,” "Why is there an anthrax outbreak in China?," or "What's going on in the Somali refugee camps?"

In the upcoming weeks, we'll be greatly expanding our reporting beyond what you've seen here: more updates, deeper explanations of outbreaks, and even more extensive coverage. We've created a news section called Outbreaks 101 where we plan to breakdown basic but important questions like "How do you eradicate a disease forever?" or "Why do people need to be vaccinated for measles in a 'measles-free' country?" Have a question you want us to answer? E-mail us at DiseaseDaily@gmail.com and we'll put in on the list for future columns.

While you're checking out The Daily Disease on the new website, don't forget to click over to HealthMap Local to see what illnesses have been reported in your area.  With HealthMap Local, you can set your location and see what's happening near you, just like checking your local weather forecast online. 

Thank you to all of our blog followers! Your readership and support inspired The Daily Disease.  We hope you’ll continue to follow us. Please consider “liking” us on Facebook and “following” us on Twitter too!  

New England Journal of Medicine Reports on New Tick-borne Bacteria

Ticks are known for carrying Lyme disease, Rocky Mountain Spotted Fever, Babesia, among other diseases. Now, there’s a new bacteria on the list. Researchers at the Mayo Clinic in Minnesota and from public health departments in Minnesota and Wisconsin, have identified a new type of Ehrlichia which sickened at least four people in those states.

There are several Ehrlichia species, but the two common which sicken humans (Ehrlichia chaffeensis and Ehrlichia ewingii) are not found in the MidWest. The researchers isolated this new species through molecular, culture, and serologic methods on patient blood samples and harvested ticks.  They have named their discovery ehrlichia species Wisconsin. Patients reported symptoms similar to the previously known Ehrlichia spp.: fever, fatigue, and headache.

This discovery is particularly important since ehrlichiosis had not been previously identified in this part of the United States.  Now that physicians know to test for it, the number of cases identified will likely increase rapidly.  

Ticks typically feed on rodents and deer, so other mammals are likely part of the life cycle of this bacteria. Among the many emerging human disease threats, 75% have a link to animals. As animal populations move due to changes in their environments (be it construction on their habitat, climate changes, or anything else) diseases that have not previously been seen in humans may have the opportunity to make that leap.  Given the relatively mild symptoms of the new Ehrlichia species, it is difficult to know if the organism has simply been present but undiagnosed in humans for decades. Additional studies will help describe its epidemiology and give more context to a very interesting discovery.

Salmonella from Ground Turkey Leads to Widespread Recall in US

Salmonellosis has swept the nation, with 76 illnesses and 1 death identified across 26 states. Beginning March 9 and continuing into August, the U.S. Department of Agriculture and the Center for Disease Control have followed reports of foodborne illness caused by Salmonella Heidelberg across the country. Cases have sprung up from Massachusetts to Arizona, with the lone death occurring in Sacramento, California.

On July 29, the Food Safety and Inspection Service of the USDA issued an alert about possible contamination of ground turkey, but had not yet determined specific brands under investigation. Just days later, meat producer Cargill announced a voluntary recall of fresh and frozen ground turkey from its Arkansas plant, believed to be the source of the outbreak. Cargill has halted production while they investigate the cause of contamination and also issued an apology to those who fell ill. With 36 million pounds of ground turkey recalled, this is one of the largest food recalls ever.

The Salmonella Heidelberg strain at the center of the outbreak is resistant to many antibiotics, creating significant problems in treatment. Signs of infection with salmonella include abdominal cramps, vomiting, and diarrhea. Symptoms usually begin 12-72 hours after exposure and can last 4-7 days. As a precaution, the CDC reminds that ground turkey must be cooked to an internal temperature of 165 degrees Fahrenheit. Contaminated turkey, if properly cooked, will not cause illness.

Photo courtesy of: http://www.flickr.com/photos/voght/2441818832/

Cerebrospinal Meningitis Outbreak in Ghana Leaves 5 Dead

An outbreak of CSM, commonly known as cerebrospinal meningitis, in the New Nsuta community of Obuasi Municipality in Ghana, has killed 5 and infected 17 individuals. It has not yet been established how the disease broke out in the area. Fearful residents are urging local health officials to immediately immunize them, and the Ministry of Health is working to dispatch vaccines to the area, although the strain has yet to be identified. Meningitis is an infection that causes inflammation of the brain and spinal membrane and can be caused by a variety of viruses and bacteria. The outbreak has reportedly taken a toll on businesses in the area, as patrons are pulling out. Last year’s meningitis outbreak in northern Ghana resulted in 54 cases and 27 deaths.

“Unusual Cluster” of Deadly Meningitis in New Zealand

Health care professionals on New Zealand’s South Island have been told to be extra vigilant after 4 cases of a rare and aggressive type of meningitis (Neisseria meningitidis type C) were confirmed.  One patient has died (a well-known construction company CEO and father of three), and three others remain hospitalized. The individuals hospitalized include a colleague of the deceased CEO, a Christchurch woman in her 40s, and a toddler in a Dunedin Hospital. All are expected to make a full recovery. What has made this outbreak particularly unusual is the confirmation by public health officials that there is nothing linking the two men with the woman or toddler.

Anyone with suspected infection with meningococcal disease should seek immediate medical attention. Symptoms can develop quickly and include nausea, fever, headache, stiff neck, vomiting, and sensitivity to light. 

World Hepatitis Day

Today is World Hepatitis Day. Since 2008, World Hepatitis Day has worked to increase public and media interest through thousands of events worldwide.

Hepatitis is the inflammation of the liver, generally caused by a viral infection. There are 5 different types of viral hepatitis, differentiated by the letters A, B, C, D, and E. While hepatitis A and E are caused by ingestion of contaminated food or water, the remaining types are spread by contact with infected body fluids. Common means of transmission include sexual contact, blood transfusions of infected blood, shared needles, or through childbirth. Symptoms of hepatitis may include yellowing of the skin and eyes (jaundice), extreme fatigue, nausea, vomiting, and abdominal pain; however, infections are often asymptomatic and individuals may be infected for years without showing signs. Hepatitis B and C may lead to chronic liver disease and can be fatal.

Hepatitis is currently a prominent cause of death in South/Southeast Asia, where it kills more people than any other communicable disease- more than dengue, malaria, and HIV/AIDS combined over the past 10 years. In fact, nearly one-quarter of the global disease burden of hepatitis B and C lies in just 11 countries: Bangladesh, Bhutan, Burma, East Timor, India, Indonesia, Maldives, Nepal, North Korea, Sri Lanka and Thailand. Experts predict over 5 million deaths in the region over the next decade.

Perhaps most importantly, World Hepatitis Day focuses on the importance of prevention and increased access to treatment. Currently, hepatitis B can be prevented through a 3-dose vaccination series. Hepatitis A can also be prevented with vaccination, or through careful hand-washing and hygiene practices, as can hepatitis E. Unlike other types, hepatitis B is often chronic and can never be considered “cured,” but can be controlled through careful treatment.

Updates on H1N1, C. difficile, Hepatitis C, Malaria, and West Nile Virus

H1N1 returns to India
With the return of monsoon season, beginning late May or early June, H1N1 influenza has returned to India. In the southwestern state of Kerala, 17 cases were confirmed this week in the Pathanamthitta and Alapphuzha districts. The Alapphuza district alone has seen 25 cases since the start of the monsoon season. Across Kerala, dozens are under quarantine, both at home and in hospitals, in efforts to stem the spread of the disease.

Elsewhere in India, in the northwestern state of Rajasthan, officials confirmed the state’s first death from H1N1. As a precaution, extensive screening efforts are being made in the Jhalawar district, the home of the victim.

C. difficile Outbreak Continues in Ontario
The C. difficile outbreak in the Niagara region of Ontario continues to escalate. Since the first outbreak was declared in May at St. Catharines, outbreaks occurred at 3 more area hospitals, for a total of 66 cases and 16 deaths. The affected hospitals include Greater Niagara General Hospital, Welland Hospital, and Hotel Dieu Shaver Health and Rehabilitation Center. Residents and politicians questioned how the Niagara Health System (NHS) handled the situation and criticized that the public was not alerted earlier. Many protested outside Niagara General Hospital.

Meanwhile, over 100 miles/170 kilometers away from the Niagara region, a 5th site in Ontario has reported an outbreak of C. difficile. Guelph General Hospital reported 11 cases over the past 2 months, a dramatic increase from the usual 1-2 cases per month. However, as 2 weeks have passed without a new case, the Guelph outbreak is likely waning and may be declared over within a few weeks.

Hepatitis C cases Increase Across Wisconsin
There are six counties in northern and central Wisconsin that are investigating why the number of Hepatitis C cases in the population under 30 has significantly increased in the last few years.

Currently, the CDC is collaborating with health officials from Wood, Lincoln, Oneida, Portage, Langlade and Marathon counties to try to identify the issue. Reports from 2004 to 2008 indicate that the six-county region had an average of 12.2 cases per year. However, in 2009 and 2010 this same region averaged 27 cases per year (a 120% increase!)

Hepatitis C is a viral disease the causes to inflammation of the liver. Symptoms can vary considerably and tend to be insignificant for those recently infected with the virus. Some people get jaundice, upper right abdominal pain, swelling, dark urine, fatigue, fever or itching. There are many ways to contract Hepatitis C including sexual contact with someone who is already infected, using contaminated needles, and receiving a tattoo from contaminated needles and receiving blood or organs from someone who is infected.

Unlike other strains of Hepatitis like A and B, there is no vaccine to protect people from being infected with Hepatitis C and its effects can be serious and even fatal. The reason some health officials believe that the cases in this northern region of Wisconsin are increasing is that more and more people are using injection drugs. The public health departments are trying to increase awareness and encouraging people to protect themselves and seek medical attention if they believe they have been infected.

Malaria in Pune
Along with an increase in H1N1, monsoon season in India brings malaria.  There have been 73 cases of malaria identified in the Pimpri-Chinchwad area.  Public health officials are taking a firm stance; indicating that "strong action" will be taken should mosquito larva be found in private residences.  Meanwhile, industrial and commercial areas are being fumigated in an effort to reduce the prevalence of malaria carrying mosquitoes.  

Central Pennsylvania Watches out for West Nile
Dauphin, Franklin, York, Lancaster, Cumberland and Lebanon counties in central Pennsylvania have been looking out for West Nile virus cases as the number of mosquitoes in the area has unusually increased.

As of July 6, there have been four cases in Dauphin and Cumberland counties as well as other confirmed cases in the other counties. Health officials are trying to set mosquito traps in the area and warn and educate the public to protect themselves as the hot and dry summer season continues.

Salmonella Outbreak: United States

Multi-State Salmonella Outbreak in US
Officials from the Food and Drug Administration believe sprouts from northern Idaho are the likely cause of a recent outbreak of salmonellosis. So far, 20 cases have been reported in Idaho, Washington, Montana, North Dakota, and New Jersey. The FDA warns not to eat alfalfa or spicy sprouts labeled “Evergreen Produce” or “Evergreen Produce Inc.” Evergreen Produce has not yet recalled the sprouts but has stopped producing and distributing them.

The bacteria Salmonella can cause an infection in humans known as salmonellosis. Symptoms include diarrhea, fever, and abdominal cramps, starting 12 to 72 hours after infection. The illness usually lasts 4 to 7 days, and often resolves without treatment. Some severe cases require hospitalization; persons especially at risk of severe symptoms are infants, the elderly, and those with compromised immune systems. To prevent salmonellosis, practice food safety hygiene and avoid recalled produce.

Though this outbreak is not related to the recent E. coli outbreak in Europe that has killed 48 people and sickened 4,000 others, sprouts are at the heart of both. Raw sprouts frequently are linked to foodborne illness because they are grown in moist, warm conditions favored by certain bacteria.

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.

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.

E. coli in France and Sweden: Unrelated to Germany Outbreak

E. coli Outbreak Affects Children in France
Seven children in the Nord Pas-de-Calais region of France are currently in the hospital being treated for an E. coli infection. Health officials are linking this outbreak to frozen hamburger patties made by the company Lidl as four of the children consumed these patties before becoming ill. These children range from 18 months to 8 years of age and are all being treated for hemolytic uremic syndrome (HUS), which is a kind of kidney failure related to E. coli.

Although it has been confirmed that this E. coli strain is not related to the same one that has killed 38 people in Germany, one in Sweden and affected over 3,000, people in France are still very concerned. It appears that the “Steak Country” boxes of meat have been expired since May 12, which maybe have led to the outbreak. French health authorities have recalled the hamburger meat in hopes to prevent more people from becoming sick.

Dog Show in Sweden Spreads EHEC
After attending a dog show in Norrköping, Sweden in the first weekend of June, two Swedes are confirmed as being infected with enterohemorrhagic Escherichia coli (EHEC). The dog show had about 120 participants, so health officials are expecting many more cases stemming from this event. In addition, several dogs have come down with stomach pains, which may mean that they were infected as well. The National Food Administration and the Swedish Institute for Communicable Disease Control are trying to determine the outbreak source.