Flooding Brings Infectious Diseases; Foot and Mouth, and Influenza Updates

Flooding and Infectious Disease Risk Worldwide
Increased rainfall and flooding in many regions of the world have heightened the risk and concern over the transmission of water-borne diseases. Oftentimes during flooding, population displacement and contamination of water sources can lead to major outbreaks of diarrhea, dysentery and even cholera and typhoid fever. Risk of infection is also increased when victims, especially children, come in direct contact with polluted waters and develop wound infections, dermatitis, or conjunctivitis. In the long term, water disasters can leave pools of standing water that create optimal breeding grounds for mosquitoes and increase the risk of vector-borne illnesses such as dengue, malaria, and West Nile. Currently, the onslaught of rainfall and flooding have wreaked heavy damage and increased risk of disease outbreak in the regions of Brazil, Southeast Asia and Australia.

Brazil
Heavy rainfall in Brazil during this summer season, especially last week, has been extremely problematic causing severe flooding and landslides in Rio de Janeiro’s mountainous region. In just one day the region experienced 95% of the expected rainfall for the entire month of January. Cities like Teresopolis, Petropolis, and Nova Friburgo have been hit very hard with over 400 deaths so far.  As of today, January 18, the death toll in the country is at 677 with about 14,000 homeless due to the heavy rains. This is considered the worst disaster in Brazil’s history (in terms of deaths) surpassing the flood in Sao Paulo state in 1967, which killed 436 people. Government officials worry that these heavy rains could bring disease epidemics to Brazil. The Agency of Civil Defense began distributing vaccines for tetanus and diphtheria in an attempt to prevent infections.

Sri Lanka and Philippines
Heaviest rains in nearly a century and flooding in Sri Lanka has so far left 40 dead, 4 missing, and over 325,000 people displaced. More than 27,000 houses were damaged and victims were forced to evacuate to over 200 camps located on higher grounds. Although in the past days water levels have begun to recede and people are returning to their homes, they are faced with the risk of water-borne diseases in these regions. Those living in the temporary relief camps also remain at risk. Sri Lanka’s government is reportedly mobilizing resources and medical supplies to these areas and making an effort to strengthen the disease surveillance system to prevent any potential outbreaks. According to health ministry officials, so far no cases of such disease have been reported.

Severe flooding and landslides in Philippines have so far spanned 25 provinces and have left at least 50 people dead and 1.5 million people affected. In addition to washing away houses and destroying crops, the flooding may result in large-scale disease outbreaks. According to one rescue unit, one region has reportedly had several hundred cases of dysentery, although this has not been officially confirmed.

Queensland
In the aftermath of the worst flooding seen in Queensland in centuries, health authorities warn of the potential of infectious disease infections. Already, several cases of melioidosis, which has not been reported in Brisbane since the 1974 floods, have surfaced and large amounts of pooled water could potentially result in a surge in mosquito numbers, leading to increased risk of mosquito-borne illnesses such as Ross River virus and dengue fever. Fecal contamination of water from sewage and the possible spoilage of food from when the power was cut raises concern over food-borne illnesses such as E.coli and salmonella. Many Queensland clinics have already seen an influx of patients seeking tetanus vaccines as a precautionary measure. Although health officials say there has not yet been a rise in gastrointestinal cases, they expect the number of patients with infections to swell if food, water, and sanitation continues to be compromised.

Foot and Mouth Outbreaks
South Korea’s worst-ever outbreak of Foot and Mouth continued as a new case was discovered at a pig farm in Yesan, 134 kilometers south of Seoul.  With meat prices soaring, losses exceeding $1 billion, and extensive culling of livestock representing decades of breeding and care, South Korea is facing a social and economic disaster.  There is widespread belief that North Korea is also suffering from a Foot and Mouth outbreak, but details are limited.  Bulgaria has reported a second outbreak and Vietnam has detected Foot and Mouth in Ha Giang. An outbreak of Foot and Mouth disease has also been reported in Gwanda, Zimbabwe. Local officials say the cause is the lack of fences, which therefore allow cattle to mix with infected wildlife. A vaccination campaign has begun, however the high cost of the vaccine adds difficulties to this effort to stop the spread of disease.

H1N1 and Seasonal Influenza Spreading in the Balkans
A fatal case of H1N1 has been recorded in Banat, Serbia, and 26 others are reported to be infected throughout the country. Montenegro reported a second death and registered 100 cases of the H1N1 virus. In addition, a woman in northern Bosnia died, bringing the total number of deaths from H1N1 this season to 4. Albania reports 17 cases of H1N1, and Croatia reports 300 cases with 3 deaths. Romania registered a third death of H1N1 since the beginning of the year.

Things to watch in 2011: avian influenza, foot and mouth disease, and animal die-off events

Avian Influenza in Egypt

On December 29th a WHO report confirmed two additional cases of avian influenza (H5N1) in Egypt, one of which has died. The report confirms 115 cases to date for Egypt with 38 total deaths. An earlier report, from December 28th, discusses yet another case in Egypt in the Sharqia Governorate. This 116th case has not yet been confirmed by the WHO. In more recent news, two more cases were reported along with an additional death. This recent news if confirmed would bring the case total to 118 and deaths to 40.

FMD in South Korea
Five of South Korea’s nine provinces have now been affected by the country’s worst ever Foot and Mouth Disease outbreak. Despite quarantine efforts put into place when the outbreak began on November 29, 2010, 85 cases have been confirmed as of January 4th, 2011. The country has begun a massive vaccination campaign with over 500,000 livestock slated to be vaccinated to include livestock in FMD-free areas. Use of the vaccine is typically reserved as a last resort due to high cost and additional time that it will now take for South Korea to regain “FMD-Free” status. The OIE has additional report information, including a map of confirmed outbreaks.

Bird die-off Arkansas
Scientists are continuing to investigate a die-off of an estimated 5,000 red-winged blackbirds, grackles and starlings that occurred shortly before midnight in Beebe, Arkansas on December 31, 2010. Initial examinations showed acute physical trauma and no signs of chronic or infectious disease. Some speculate that the incident may have been due to a lightning strike or high-altitude hail. Laboratory tests are underway, but may take weeks to provide any answers.

Fish die-off Arkansas
In what is said to be an unrelated event, an estimated 100,000 drum fish were found dead in a stretch of the Arkansas river in Ozark, Arkansas. Ozark is around 125 miles west of Beebe where on December 31st ~5,000 birds were found dead shortly before midnight. It has been suggested that the massive fish die-off was due to infectious disease, as only one species was primarily affected. Laboratory tests are being conducted on fish collected from the site, however results may not be available for up to 30 days.

Blog 2010 Year-End Special Issue

Here at HealthMap, we are often focused on outbreaks happening right now. As the new year approaches, we reflect on some of the outbreaks of 2010.

Where were you when...

Polio was imported into Tajikistan (April 23)
2010 saw two set-backs in the continuing effort to eradicate polio. The WHO announced the first importation of poliovirus in the WHO European Region since it was certified polio-free in 2002 and polio spread through Central Africa (see below).  120 cases of acute flaccid paralysis were reported in mid-April, prompting the Tajikistan government to notify WHO of an outbreak. By late July, 430 cases had been confirmed, and 7 confirmed cases in the Russian confederation. The outbreak continues, particularly in neighboring countries, despite vaccination campaigns to prevent additional cases.

Polio in Angola (July 17) spread to Central Africa (August 17)
By 2005, only Nigeria, India, Pakistan and Afghanistan suffered from endemic polio. However, many Hausa in Northern Nigeria resisted a polio vaccination campaign due to fears that it might spread other diseases or cause young women to become infertile. Since then, polio has regained a foot-hold, re-establishing itself in countries previously declared free of the disease. Angola, having re-established sustained transmission in 2009 saw an outbreak in 2010 that spread to neighboring countries, including the Democratic Republic of Congo, where it continues to spread.

Cholera broke out in Haiti  (October 21)
Much of Haiti’s infrastructure was destroyed in the large earthquake that struck the capital Port-au-Prince on January 12, 2010. Even prior to the earthquake, only 12% of Haitians had treated, piped water and 17% access to adequate sanitation. Emergency aid teams went to help injured people but also sought to contain outbreaks of any diseases that might emerge with large numbers of internally displaced people living in temporary shelters. Since there hadn’t been an outbreak of Cholera in Haiti for over 100 years, few expected or prepared for such a contingency. Hypotheses abound as to the origin of the outbreak. Haitians rioted because UN Peacekeepers may have brought in the disease.  A Haitian Voodoo association reports 45 people have been murdered after accusations of using black magic to spread the outbreak.. Although we may never know the specific source, genome sequencing of the strain has made clear that international travel played a role.  Furthermore, a population made vulnerable by natural disaster sows fertile ground for disease transmission. HealthMap’s updated info on Haiti available here.

Vancouver Olympics brought measles to British Columbia, and the World Cup exported it from South Africa to Argentina
International travel was again linked to disease transmission as cases of measles in Vancouver were linked to an outbreak in Australia. South Africa exported cases of measles to Argentina during the World Cup. HealthMap, along with partners such as BioDiaspora, continue to provide highly specific surveillance for outbreak threats during mass gatherings.

Dengue Spread north in 2010
After more than 50 years without Dengue cases, Key West, Florida began seeing a return of the disease early in the year. By mid-July, the CDC confirmed 39 cases, and announced that 5% of Key West residents had likely been exposed to the Dengue virus. July brought a confirmed case in Marion county followed by additional cases in Central Florida. In August, Florida’s Broward County Health Department announced a confirmed case of Dengue in a woman who had not left the county for weeks.  

While the United States was seeing a return of Dengue in Florida, France saw it’s 1st non-imported case on the mainland in Nice, Provence-Alpes-Côte d'Azur. This also marked the first locally transmitted incidence of the disease in Europe in more than 80 years.

New Collaboration, the Return of Influenza, and FMD in S Korea

New Collaboration Announcement
HealthMap is now collaborating with the PathoSystems Resource Integration Center (PATRIC). The goal of PATRIC is to develop bioinformatics resources for the research and countermeasures-development communities based on genomics data. This is part of the biomedical research community’s work to integrate vital information on pathogens, to provide key resources and tools to scientists, and to help researchers to analyze genomic, proteomic and other data arising from infectious disease research. PATRIC provides rich data and analysis tools for all bacterial species in the selected NIAID category A-C priority pathogens list.

As part of this new collaboration, HealthMap has created a visualization for each bacterial pathogen in PATRIC that is associated with an infectious disease. The visualizations are available through PATRIC’s Disease Overview pages to provide users with bacterial infectious disease data in proper context.  The customized HealthMap visualizations are available for PATRIC watchlist pathogens, which can be accessed via the Organism tab on the PATRIC site.

Influenza on the Increase in Europe
Over 300 people have been hospitalized with influenza in Britain, with a majority of cases being due to H1N1 Influenza A.  Northern France continues to see increasing numbers of influenza cases, and on December 22, 2010 two deaths due to H1N1 were announced. France’s Institute for Public Health also stated that influenza activity is near the epidemic threshold.

South Korea Fights Foot-and-Mouth Disease (FMD)
South Korea is working to stem the country’s worst ever outbreak of FMD. Since the 1st outbreak, reported on November 29, 2010, 56 cases have been reported and over 330,000 livestock culled. Two provinces have had confirmed cases (North Gyeongsang and Gyeonggi), and two have reports of suspected cases (Gangwon and Chungcheong).  A vaccination campaign has begun in five cities across the country in an effort to halt the spread of disease.

Whooping Cough, Guillain Barre, and Avian Influenza Making Headlines

Spotlight on Whooping Cough

This summer, CDC reported on a dramatic rise in whooping cough cases in California.  As of the most recent MMWR report, California has had 2,625 cases to date, a four-fold increase from last year’s 646 cases.   Although the illness is seldom serious in adults, whooping cough can be deadly in infants.  Communities across the United States have reported outbreaks and infant fatalities since the initial surge in California.  HealthMap has reported alerts in a dozen states in the last month alone.

Lack of vaccination was an obvious suspect.  Immunity to pertussis decreases with age, so adults vaccinated in their childhood may now be susceptible to whooping cough.  These adults could then pass it on to infants and children.  Furthermore, many of the early cases were in San Diego, which has a vocal anti-vaccine community.

While vaccination is clearly an important tool in fighting these outbreaks, two recent news stories highlight other concerns.  Researchers from Baylor College of Medicine recently investigated vaccine storage.  They found “one-quarter of 54 vaccine refrigerators in . . . community health centers had temperatures that dipped into the freezing range, most commonly at night and on weekends.”  When the pertussis vaccine freezes, its efficacy can be severely compromised.

Mutation of the pertussis bacteria could also decrease the effectiveness of the vaccine.  Years ago, Dutch researcher Dr. Frits Mooi raised the possibility of whooping cough adapting to evade the vaccine.  He believes a new type of pertussis is playing a role in the current outbreaks.  KPBS in San Diego has a thorough discussion of this idea along with another prominent researcher’s counter argument that increased awareness and diagnosis of whooping cough is adding to the reported cases.

The current surge in whooping cough cases is likely due to numerous factors.  Regardless of the underlying factors, vaccination remains a critical tool is protecting those most vulnerable to it.  The CDC recommends that all adults get a one-time booster of adolescent/adult tetanus-diphtheria-pertussis vaccine (Tdap).

Guillain Barre Syndrome in Mexico

The General Directorate of Epidemiology of the Federal Government in Mexico has issued an “epidemiological alert for outbreaks of acute flaccid paralysis” in Nayarit and Orizaba (Veracruz). There have been 7 cases in Nayarit and 23 in Orizaba. There have been two deaths registered so far. One of the deceased was diagnosed with Guillain Barre syndrome.
                  

Guillain-Barre syndrome (GBS) is a rare, but sometimes fatal, inflammatory disease that affects the peripheral nervous system and can leave its victims temporarily paralyzed. GBS typically affects people after a minor infection like a respiratory or gastrointestinal one. If GBS affects respiratory muscles, its effects can be fatal because those inflicted will no longer be able to breathe. First symptoms of GBS include tingling or weakness in the legs followed by a spread of the same feelings in the arms and upper body. This ascending spread can take weeks or happen in a matter of days.

Avian Influenza Returns

In recent weeks, avian influenza has returned to news headlines in several countries. On November 19^th, a new human case of H5N1 was confirmed in a woman from Hong Kong. This case marks the 21^st case of human infection in Hong Kong SAR China to date. After laboratory tests confirmed the patient contracted the virus while visiting mainland China, and no additional cases were found, Hong Kong lowered its bird flu alert level from “serious” to “alert.”

Egypt reported a confirmed case of H5N1 in a female patient from Gharbia Governorate on December 4^th. The patient died on December 2^nd, becoming the 37^th death in Egypt out of the country’s 113 cases to date.

Most recently, on December 9^th, a female from Bandung, West Java, Indonesia was confirmed as the latest human case of H5N1. Of the 171 cases of H5N1, avian influenza, in Indonesia to date, 141 have been fatal.

Vietnam and South Korea both have recently reported avian influenza outbreaks in wild birds, however no human cases have been associated with either of these new outbreaks. 

Undiagnosed Illness in Uganda, Measles in Argentina, and HealthMap at the ISDS Conference

Scientists work to identify the illness that has killed 38 people in northern Uganda. http://www.google.com/hostednews/afp/article/ALeqM5hgmieXl3QCUDRkdH0Z12UD704bFg?docId=CNG.6a0a014a69f4ce1afd31a8eefff9f2b8.441

Possible pneumonic plague in Northern Uganda Leaves 38 Dead

Last week, we reported that a mysterious illness had left 13 dead in northern Uganda. This week, the death toll has risen to 38 with dozens hospitalized, yet officials are still uncertain as to the cause, although tentative testing have confirmed it as pneumonic plague. Ebola, typhoid and several other diseases have been ruled out. The first case was identified in early November and since, over 90 people have been treated.  Symptoms include severe headaches and dizziness and eventually bloody diarrhea and vomiting. Officials say the disease has been detected in five districts in the northern part of the country. However, with vast impoverishment and inadequate health facilities, it may take weeks before response teams arrive and implement control efforts.

Alert for Measles in Buenos Aires

After 12 years without a registered case of measles in Buenos Aires, 17 cases have been reported since August.  The minister of health has helped initiate a national vaccination campaign in hopes of preventing the further spread of this disease. The province of Buenos Aires expects to be rid of the virus soon.

HealthMap at the 9th Annual ISDS Conference

Several HealthMap team members gave oral presentations at the International Society for Disease Surveillance’s 9th annual conference in Park City, Utah last week. In addition, HealthMap had a table where conference attendees could learn more about the system and sign-up to receive our free daily email alerts. The following oral presentations were given by members of our group (please email us for more information about any of these abstracts, or if interested in receiving our customizable email alerts):

Emily Chan - - Forecasting High Priority Surveillance Regions: a Socioeconomic Model
Annie Gatewood-Hoen - - Effect of Expanded Recommendations for Pediatric Seasonal Influenza Vaccination: An International Comparison
Sumiko Mekaru - - Anticipatory Surveillance for Mass Gatherings: A Novel Application of Mass Media Surveillance
Rumi Chunara - - OutbreakMD: Tracking and Identifying Disease Outbreaks in Post-earthquake Haiti

HealthMap at the National Design Triennial: Why Design Now? At the Smithsonian Cooper-Hewitt, National Design Museum through January 2011

“Inaugurated in 2000, the Triennial program seeks out and presents the most innovative designs at the center of contemporary culture. In this fourth exhibition in the series, the National Design Triennial will explore the work of designers addressing human and environmental problems across many fields of the design practice, from architecture and products to fashion, graphics, new media, and landscapes.”

As part of the Why Design Now? National Design Triennial’s Health Category, HealthMap provides visualizations of surveillance data in a user-friendly manner, facilitates early disease detection, and provides a tool for public awareness and involvement.

An audio commentary as well as additional information about the HealthMap exhibit at the Cooper-Hewitt is available by visiting the HealthMap Triennial page.