Leptospirosis rates in nearby New Caledonia are even more striking, and exceed those of salmonellosis, hepatitis A, hepatitis B, gonorrhea, and tuberculosis.

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

Year	Cases (fatal)	Location	Details
1931	126	Portugal	ascribed to entry of rat urine into drinking fountain
1933 to 1934	86	Chile	the first identification of leptospirosis in Chile
1942 to 1944	120	United States	serovar. Automnalis , in Fort Bragg, North Carolina (thus "Fort Bragg Fever").
1950	50	United States	associated with pig contamination of a creek
1953	114	Japan	followed swimming in river contaminated by dogs
1964	61	United States	cattle contamination suspected
1980	104	Albania
1987	93	Republic of Korea *
1989	144 (6)	New Caledonia
1992	79	Cuba	affected primarily sugar cane cutters
1995	2,419 (48)	Nicaragua *
1996	1,425 (22)	Brazil
1996	326 (50)	Brazil
1997	562 (68)	India
1998	68	Honduras *
1998	2,000 (7)	Kazakhstan
1999	143 (28)	India *
1999	200 (19)	New Caledonia
1999	72	Peru	outbreak among military recruits
2000	157 (13)	Brazil
2000	80 (0)	Malaysia	associated with an international sporting event
2000	143	India *
2001	129 (0)	New Caledonia
2002	143 (11)	India
2003	80	Ecuador *
2003	204 (27)	India
2004	550 (75)	India
2004	141 (12)	Kenya	outbreak among high school students
2004	80	Russian Federation	followed swimming in a river
2005	65	Russian Federation	followed swimming in a river
2005	(100 fatal)	India *
2005	108 (16)	Guyana *
2006	258	India
2006	1,400 (31)	Thailand *
2006	150 (60)	India *
2007	100	Jamaica *
2007 (py)	1,516	India	(py = publication year )
2007	400	Argentina. *
2007	200 (25)	Dom. Republic *	2,539 cases were reported nationwide
2008	70	Guyana *
2008	135	New Caledonia *
2008	4,500 (1,150)	Sri Lanka *

Chronology of published large outbreaks (>50 cases) of leptospirosis abstracted from GIDEON
* Specifically noted to associated with flooding.

Update: Reported in ProMED

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

Update: Referenced in ProMED

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

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)
Noroviruses account for 48.4% of pediatric (below age 3) hospitalizations for diarrhea in Palermo (2004)
18.2% of retail bivalve mollusks in Rome are contaminated with Astrovirus, and 2.1% with Norovirus (2007 publication)

Norovirus infection was confirmed in a captive lion cub (Panthera leo) in Pistoia in 2004.

Notable outbreaks:
2000 – An outbreak (344 cases) of Norovirus gastroenteritis occurred at a tourist resort in the Gulf of Taranto. The presumed source of illness was drinking water. This was the first confirmed outbreak of NLV infection in Italy.
2002 – An outbreak (200 cases or more) of Norovirus gastroenteritis in southern Italy was caused by contaminated shellfish.
2003 – An outbreak (169 cases) of presumed Norovirus gastroenteritis was reported at a resort in central Italy.
2005 – An outbreak of Norovirus infection at a resuor in Puglia was ascribed to contamination of raw mussels and ice by tap water.
2006 – An outbreak (35 cases) of Norovirus infection was reported in a residential-care facility for the elderly in northern Italy.
2006 – An outbreak (700 cases or more) of Norovirus gastroenteritis was reported among passengers on a cruise ship from Rome to the United States.
2007 – An outbreak (2,860 cases) of gastroenteritis in Apulia due to Norovirus and Rotavirus was caused by contaminated water.
2008 – An outbreak (190 cases) of Norovirus infections was reported among French, Irish, Italian and Dutch immigrants to Lourdes.

Update: Quoted in ProMED

Time and Place:
Peak incidence is reported during the summer, with 47% of cases from July to August.
- The disease is most common in Arizona, California, Colorado and Oregon.
- Sporadic cases are reported from Idaho, Kansas, Montana, Nebraska, New Mexico, Oklahoma, Texas, Utah, Washington and Wyoming.
- Most cases occur in the Cascade, Rocky Mountain, San Bernadino and Sierra Nevada ranges.
- 40% of cases occur in tourists to endemic areas (1977 to 2000).

Washington and Oregon reported 30 cases during 1965 to 1978.
- Washington reported 24 cases during 1991 to 1994.
- California reported 173 cases during 1964 to 1989; Oregon 73; Washington 27; Arizona 74; Texas 25; Idaho 13; New Mexico 15; Oklahoma 2.
- California reported 3 to 18 cases yearly during 1985 to 2002.
- Texas reported 13 cases during 1990 to the first half of 1994.
- Five cases were reported in the Lake Tahoe region of California in 2005, 3 during the summer of 2006.

Incidence:
- Tick-borne relapsing fever is reportable in Arizona, California, Colorado, Idaho, New Mexico, Nevada, Texas, Utah and Washington.
- 450 cases (300 confirmed and 150 probable) were reported by 11 western states during 1977 to January 2000. Only one fatal case was reported during this period – a neonate born to an infected mother.
- 285 cases were reported by California, Colorado, Idaho, Texas and Washington during 1985 to 1996.
- There is evidence for the existence of Borrelia turicatae in Florida.

An American tourist acquired relapsing fever in Israel (1988 publication).

Infecting species:
- Borrelia hermsii (vector Ornithodoros hermsi) and B. coriaceae in the western region
- B. turicatae (vector O. turicatae) in the southwest
- B. parkeri (vector O. parkeri) in the west
- B. mazzottii (vector O. talaje) in the south.

Notes regarding transmission:
- Ornithodoros hermsi is nocturnal and feeds within 20 to 90 minutes – thus, patients rarely recall the tick bite.
- B. hermsii is maintained in small sylvatic rodents, notably chipmunks (Tamias spp.) and pine squirrels (Tamiascuirus spp.) above 1,000 meters’ elevation.
- Antibodies to Borrelia hermsii are present in 5.4% of big brown bats (Eptesicus fuscus). (Georgia, 2007 publication)
- Borellia turicatae has been detected in dogs in texas. (2007 publication) 10

Notable outbreaks:
All of the following outbreaks were associated with tick (Ornithodoros spp.) infestations of rodent nests in cabins.
1968 – An outbreak was reported in Spokane County, Washington.
1973 – Outbreaks (62 clinical cases, 16 confirmed) were reported in Grand Canyon National Park, Arizona.
1989 – An outbreak (6 cases) was reported in San Bernardino County, California.
1990 to 1991 – Outbreaks (24 cases, 14 confirmed) were reported in Grand Canyon National Park, Arizona. No outbreaks were reported in this area during 1992 to 1999.
1995 – An outbreak (23 family members) was reported among campers in Colorado.
2002 – An outbreak (5 cases) of Borrelia hermsii infection was associated with a cabin in western Montana. Infected ticks (Ornithodoros hermsi) were identified at the time.
2002 – An outbreak was associated with a family gathering in New Mexico.

Update: Quoted in ProMED

We may assume that decreasing rates are the result of excellent vaccine coverage, which currently exceeds 90% for all countries in the region. See graph:

Update: posted in ProMED

there were at least 10 human cases in the Volga delta between
1963 & 1968, and that human seropositivity rates of up to 8 percent
were found in European Russia & Western Siberia (see ProMED post West
Nile virus - former Soviet Union: background 20060908.2548)

Prevalence surveys:
22.57% of FUO in Guwahti, Assam (2008 publication)
3.2% of febrile patients and 7.0% of febrile patients with jaundice in Delhi (1966). 32 cases were confirmed in the region during 2000 to 2001.
23.81% of patients hospitalized for febrile jaundice in Kolkata.

Seroprevalence surveys:
8.8% in Chandigarh
21.74% in Varanasi.
16.6% of sewer workers in Pune (2004 publication)
19.1% of tribal peoples on the Nicobar and Andaman Islands – highest rates among the Shompens = 53.5% (1999 publication)
23.6% of schoolchildren on the Nicobar and Andaman Islands (2004 publication)
62.5% of agricultural workers, 39.4% of sewage workers, 37.5% of animal handlers, 27.3% of forest workers and 30.0% of butchers in the Andaman Islands (2006 publication)
32.73% of patients with FUO, 35.71% of farm workers, 39.47% of hepatitis patients and 0% of controls (Maharashtra, 2007 publication)
58% of rats in Madurai, Tamil Nadu (2007 publication)

The principal reservoirs in this country are rats, pigs, cattle, bandicoots, dogs and cats.

Infecting serovars:
The principal strains are Leptospira interrogans serovars. icterohaemorrhagiae, automnalis, pyrogenes, grippotyphosa, canicola, australis, javanica, sejroe, louisiana and pomona
- Serovars automnalis and icterohaemorrhagiae have been reported from the mainland.
- A single infection by serovar. javanica was reported in Madras in 1996 – the latter had previously been found only in bandicoots (Bandikota bengalensis).
- Leptospira interrogans serovar. Valbuzzi has been identified as a cause of hemorrhagic pneumonia in the Andaman Islands.
- Leptospira interrogans sensu stricto is the predominant infecting species in the Andaman islands. (2007 publication)

Notable outbreaks:
1986 (publication year) – An outbreak of Weil’s disease was reported in a food-fad commune.
1992 (publication year) – An outbreak (48 cases) in Madras followed a monsoon.
1993 – An outbreak (18 cases) of leptospirosis with pulmonary involvement was reported in north Andaman. This was the first report of pulmonary leptospirosis in India.
1997 – An outbreak (1,127 confirmed cases) was reported in Madras – 40.2% of these Leptospira interrogans serovar. icterohaemorrhagiae, 20.0% serovar. canicola and 14.9% serovar. automnalis.
1997 – Outbreaks (562 cases, total) were reported in Valsad (281 cases, 34 fatal) and Surat (281 cases, 34 fatal).
1999 – An outbreak (143 suspect cases, 28 confirmed cases, 11 fatal) in Orissa followed a cyclone. Serovars pomona, hebdomadis and canicola were identified.
2000 – An outbreak (18 children) in Mumbai followed local flooding.
2002 – An outbreak (16 fatal cases) was reported in south Gujarat.
2002 – Concrent outbreaks of leptospirosis and dengue were reported in Mumbai.
2002 (publication year) – An outbreak (74 cases) of Leptospira interrogans serovar. copenhageni infection was reported in Mumbai.
2002 – An outbreak (143 cases, 11 fatal) of Leptospira interrogans serovars. canicola, pomona and hebdomadis infection was reported in Orissa.
2003 – An outbreak (27 fatal cases and 177 under treatment) involved 131 villages in South Gujarat.
2003 (publication year) – An outbreak was reported in a nurses’ hostel in Chennai.
2004 – An outbreak (550 cases, 75 fatal) of suspected leptospirosis was reported in South Gujarat.
2005 – An outbreak (100 or more fatal cases) of suspected leptospirosis was reported in the area of Mumbai following local flooding.
2005 – An outbreak (49 cases) in Chittoor District, Andhra Pradesh was caused by contact with stagnant water.
2006 – An outbreak (258 cases) was reported in Karnatka.
2006 – An outbreak (11 cases, 1 fatal) was reported in Kerala.
2006 – An outbreak (150 cases or more, at least 60 fatal) was reported in Maharashtra.
2007 (publication year) – An outbreak (1,516 cases) was reported in Karnataka State.

Update: Posted in ProMED