A recent case in the Lake Fondi region reminds us that the potential for malaria transmission persists in Europe. In fact, sporadic reports of cryptic, airport- and locally-acquired malaria have appeared in the Italian literature in recent years. The following review of malaria in Italy was abstracted from GIDEON.

Historical background

• Malaria was eradicated from Sardinia during 1946 to 1950, through massive application (267 metric tons) of DDT.
• A single endemic case (Plasmodium vivax in Palma di Montechiaro, Sicily) was reported in 1956; with sporadic cases in the area of Palermo during 1962.
• The country was declared ‘malaria-free’ in 1970.
• A single case of autochthonous malaria (P. vivax) was reported in Maremma (Tuscany) in 1997 – Anopheles labranchiae was implicated as the vector.

Although disease rates have increased in recent years, imported malaria continues to be less common than in neighboring France and Switzerland.

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In view of a massive ongoing outbreak in Manila, the following chronology of published large outbreaks (>50 cases) of leptospirosis was abstracted from GIDEON. Outbreaks known to be associated with heavy rains or flooding are denoted by * A number of additional outbreaks have been associated with floods, but without specific mention of case numbers. Thus, a major outbreak in Krasnodar (Russia) in 1997 followed local flooding; as did epidemics in China during 1962 to 1963, 1966, 1973 to 1974 and 1984.

The Epidemiology module in GIDEON currently contains details of 8,910 Infectious Diseases outbreaks (Primary references are available on request)

Update: Reported in ProMED

A recent outbreak in Manila belies the fact that reported rates of leptospirosis in the Philippines had actually decreased in recent years. See graph:

The following additional background data are abstracted from GIDEON www.GideonOnline.com (primary references available on request):

Leptospirosis was first reported n the Philippines in 1932.
– 65 cases were documented in literature published during 1932 to 1970; 390 during 1971 to 1973; approxomately 840 during 1998 to 2001.
– Leptospirosis is common in flood-prone areas of urban setting such as Metro Manila.
– The average age of patients is 32 years, 87% of cases were males and 70% are outdoor workers.
– The case fatality rate is 12 to 14 percent.
– Rates in Cabatuan, Iloilo are estimated at 147 cases per 100,000 population (2007 publication).

Prevalence surveys:
5% of aseptic meningitis cases in Manila (1989 publication)

Seroprevalence surveys:
43.6% of rice farmers in Central Luzon (1988 publication)
0% of dogs (RMAT, 1970 to 1973)

The following serovars of Leptospira interrogans have been demonstrated among patients in the Manila area: poi, tarassovi, manilai, pyrogenes, australis, grippotyphosa, javanica and automnalis.

Notable outbreaks:
1976 to 1983 – An outbreak of leptospirosis was reported on a penal farm in Sablayan, Mindoro.
1999 – An outbreak (17 cases) of leptospirosis involved participants in an ‘iron-man contest’ – from Germany, Hong Kong and the Philippines.

Update: Posted in ProMED

A recent outbreak in Vilnius reminds us that Lithuania had reported the highest rates of trichinellosis in the Baltic region until 1999. Since 2000, disease rates in the area have been similar.

(This chart was generated using a user-driven Gideon menu, which contains over 35,000
base graphs.)

A recent outbreak in Australia serves as a classic exercise in Epidemiology. Although Queensland and New South Wales account for most cases of Ross River disease, rates per 100,000 are consistently highest in Northern Territory.

Update: Referenced in ProMED

A recent outbreak in Guanajato reminds us that brucellosis remains a very common disease in Mexico. In fact, current rates are comparable to those of Greece, and similar to rates that existed in the United States during the 1930’s and 1940’s. See graph:

The following background data on brucellosis in Mexico are abstracted from Gideon

Time and Place:
- Highest rates are found in Queretaro, Coahuila, Guanajuanto, Nuevo Leon, Chicuahua, Jalisco, Tamaulipas and Michoacan.
- 163 fatal cases were reported during 1978 to 1982
- Mortality rates were 0.04 per 100,000 in 1992; 0.01 per 100,000 in 1996 .

Seroprevalence surveys:
3.42% nationwide, ranging from 0.24% in Morelos, to 13.5% in Mexico State (1992 publication)
0.71% of blood donors in northeastern Mexico (2009 publication)
0.238% of equines in Tamaulipas (Brucella abortus, 2006 publication)
9.8% of goats on farms (Brucella melitensis). (Michoacan, 2007 publication)

Infecting species:
- Brucella melitensis, B. abortus and B. canis are found in Mexico.
- The predominant species is Brucella melitensis. (1968 to 1991)

Reservoirs:
- The caprine seropositivity rate was 20.7% in 1947.
- Highest rates of caprine disease are reported in Coahuila, Chihuahua, Jalisco and Zacatecas.
- Highest rates of bovine disease are reported in Chihuahua, Hidalgo and Guanajuato.
- 11.8% of stray dogs in Mexico City are infected by Brucella canis.

Vehicles:
- Most infections are acquired from unpasteurized milk, fresh cheese and other dairy products – primarily from goats (There are over 9 million goats in Mexico).
- More than 35% of cow milk is consumed unpasteurized – more than 85% of goat milk.

Update: Posted in ProMed

Regarding reports of a fatal case in Minnesota, Rocky Mountain spotted fever (RMSF) was the most common cause of arthropod-associated death in the United States for many years; but this “distinction” is now held by West Nile fever.

A recent outbreak related to imported snow peas belies the fact that shigellosis rates in Denmark and Norway have remained consistently low for more than two decades.

Update: reported in ProMED

A recent episode in Brescia is the latest of several outbreaks of viral gastroenteritis in Italy. The following background information is abstracted from GIDEON:

Primary references are available on request.

Prevalence surveys:
Adenoviruses account for 7% of pediatric hospitalizations in Rome for diarrhea, Rotavirus 18.2%, Astrovirus 1% (1987 to 1989)
Adenoviruses account for 17.6% of pediatric hospitalizations in Rome for diarrhea, Rotavirus 26.7%, non-polio Enteroviruses 8.5%, Coronaviruses 1.8%, Parvoviruses 0.9% (1985 publication)
Adenoviruses account for 6% of pediatric hospitalizations in Sicily for diarrhea, Rotavirus 25.1%, Astrovirus 7%, Norovirus 18.6% (2003)
Adenoviruses are found in 6.2% of pediatric patients with acute diarrhea (2005)
Noroviruses account for 10.4% of hospitalized pediatric gastroenteritis cases in northern Italy (2002)
Noroviruses were the most frequently involved viruses (23.7%) in sporadic acute diarrhea among hospitalized children and were more common in children >5 years (37%) than in children <5 years (10%). The frequency of Rotavirus, enteric Adenovirus and Astrovirus was 12.2%, 1.6% and 2.4%, respectively. (Brescia, 2007 publication)
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A recent episode of E. coli infection in Ontario belies the fact that onions are only rarely implicated in food-related disease outbreaks. As of June 2009, 8,471 infectious diseases outbreaks have been included in GIDEON. Onions were involved in only seven (0.08%) of these:

1983 – United States – Botulism – 28 – sauteed onions
1996 to 1997 – United States – Hepatitis A – 90 – green onions
1997 – United States – Cryptosporidiosis – 54 – green onions
1998 – United States – Hepatitis A – 43 – green onions
2003 – United States – Hepatitis A – 170 – green onions
2005 – Russia – Yersinia pseudotuberculosis – 33 – cabbage and onion salads.
2006 – United States – E. coli O157 – 99 – either green onions or shredded lettuce