Recent outbreaks highlight the fact that Hand, foot and mouth disease (HFM) is the second most commonly reported viral disease in Singapore. In fact, since 2001 rates of HFM have approached those of varicella. See graph.

The following data regarding Enteroviral infection in Singapore are extracted from GIDEON [primary reference available on request]

Enteroviruses are responsible for 0.2% of lower respiratory infection in the age group 0 to 20 years (1990 to 1994).

During 1996 to 1997, 44% of school children ages 5 to 12, and 50% of their mothers were found to be seropositive toward Enterovirus 71.
- Enterovirus 71 accounted for 71% of enteroviral isolates in 2000; 44.3% in 2001; 3.5% in 2002.

Epidemics of hemorrhagic conjunctivitis due to (more…)

As quoted by Steve in ProMED:

Travel-related episodes of endemic typhus are relatively uncommon.
The following chronology is abstracted from GIDEON

1997 (publication year) - Three Norwegian tourists acquired endemic typhus - in Guinea-Bissau, Crete and Thailand
1998 (publication year) - Three European travelers acquired endemic typhus in Indonesia.
1998 - Two Norwegians acquired endemic typhus - in China and Crete.
1999 - A Norwegian acquired endemic typhus in Malta
2001 (publication year) - A German tourist acquired murine typhus in Thailand.
2002 (publication year) - A traveler from Hong Kong acquired endemic typhus in China.
2003 - A Czech tourist acquired endemic typhus in Egypt.
2003 - A Japanese national developed endemic typhus in Vietnam.
2008 - Two Japanese nationals acquired endemic typhus overseas - one in Indonesia.

A recent outbreak highlights the fact that New Caledonia has one of the highest rates of leptospirosis in the Pacific region (see graph). In fact, in these islands, Leptospirosis is more common than Salmonellosis, Hepatitis A, Hepatitis B, Gonorrhea and Tuberculosis (see graph).

The following background information regarding Leptospirosis in New Caledonia is abstracted from GIDEON:

Leptospirosis is most common in west coast cattle-farming areas and rural Melanesian settings

• Disease rates are highest in the Bourail area.
• Disease rates peak during March to May.

Notes:

1. An average of 4 fatal cases are reported yearly.
2. 57 cases were diagnosed during 1983 to 1985.
3. 239 cases were reported during 2001 to 2005. The principal serogroups were Icterohaemorrhagiae (69%), Australis (8%), Pyrogenes (6%)

58% of cattle are seropositive.

The principal reservoirs in this country are rodents, pigs, horses and cattle.

The principal species are Leptospira serovars. Icterohaemorrhagiae, tarassovi, pyrogenes, canicola, australis and pomona.

• Serovar tarassovi accounts for 22% of cases, icterohaemorrhagiae 18% and pyrogenes 17%.

Notable outbreaks:
1989 - An outbreak (144 cases, 6 fatal) was reported, with 41% of the cases caused by serovar icterohaemorrhagiae.

Update: Also mentioned in ProMED

Appeared in ProMED:

The following background information on “newer” viral respiratory infections in Canada was abstracted from GIDEON:

Prevalence surveys

• Human matapneumovirus (HMPV) is found in 4.1 per cent of adults with community-acquired pneumonia (2005 publication).
• HMPV is found in 9.5 per cent of respiratory specimens from the community and 25 per cent of outbreaks; median age was 24 months (Calgary, 2007 publication).
• HMPV is found in 14.8 per cent of patients with acute respiratory tract infection (4 provinces, 2001 to 2002 influenza season).
• HMPV is found in 8 per cent of acute lower respiratory tract infections (Montreal, 2001).
• HMPV is found in 3.9 per cent of pediatric inpatients and outpatients (Alberta, 2002 to 2003).
• HMPV is found in 6 per cent of children below age 3 years hospitalized for acute respiratory tract infections (Quebec, 2001 to 2002).
• HMPV is found in 13.5 per cent of children aged under 5 years, 26.1 per cent of children aged 6 to 10 years, 32.3 per cent of children aged 11 to 15 years, 99.0 per cent of persons agd 16 to 30 years, 91.7 per cent of adults aged 31 to 60 years, 93.8 per cent of persons aged over 60 years in Saskatchewan seropositive (2007 publication).
• HMPV is found in 4 per cent of adults hospitalized with community-acquired pneumonia (Edmonton, 2008 publication).

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Health travel tips from Dr. Steve Berger, GIDEON’s medical advisor:

1. If you are planning a trip to any country, become aware of the local health situation, ongoing disease outbreaks, weather, emergency telephone numbers, availability of medicines you may be taking.
2. If you will be traveling to a tropical or developing country, consult a Travel Medicine Clinic for advice, vaccines and preventive medications.
3. Eat only well cooked foods, preferably in “clean” or “modern” facilities. Avoid eating fresh vegetables, exotic plants and animals and non-bottled water.
4. In areas where mosquito-borne diseases (malaria, dengue, etc) are endemic, use insect repellents and wear long-sleeved clothing appropriate to local weather.
5. Things to avoid: high-risk trauma which might result in “local” health care (injections, blood), unsafe sex, contact with animals.
6. If you feel ill following return home, consult an expert in Travel Medicine – bring a written itinerary which details dates of travel and return, exact places visited, foods eaten, health status of accompanying persons, vaccines and drugs received.

In an article about Viropharma’s Camvia’s treatment paradigm, there is a quote from Steve, GIDEON’s Chief Medical Advisor, who used GIDEON to provide information on warnings for Ganciclovir:

Dr Stephen Berger, Director of Geographic Medicine and of Clinical Microbiology at Tel Aviv Medical Center, said the current standard of care, oral ganciclovir is quite toxic, and has 41 toxicities and 14 drug to drug interactions. In addition to myelosuppression, other side-effects include hair-loss and anemia.