Published reports are summarized below. (primary references are available on request)

2001 – A patient in the Netherlands developed West Nile fever following a trip to Israel.
2002 – Cases acquired in the United States were reported in France, Denmark (2 cases), Mexico; Czech Republic
2003 – Cases acquired in the United States were reported in Germany (2 cases); Canada; the Netherlands.
2003 (publication year) – Cases acquired in Israel and Canada were reported in Denmark.
2003 – A case acquired in Canada was reported in the Netherlands.
2003 – Cases acquired in the United States were reported in France (3 cases), the Netherlands (3 cases), and Germany (2 cases).
2004 – Cases acquired in the United States were reported in Germany 36; Netherlands; and Uruguay.
2004 – 2 cases of West Nile Virus infection were confirmed in Ireland. In both instances, the patients had recently visited Portugal.
2005 – Cases acquired in the United States were reported in Japan.
2005 – An Irish traveler acquired West Nile fever in the United States.
2005 – 4 cases reported in France had been acquired in Djibouti.
2006 – A Spanish missionary acquired West Nile fever in Nicaragua.
2007 – 2 British travelers developed West Nile fever while visiting Canada.

Reference
Berger SA. West Nile fever: Global Status, 2010. GIDEON e-book series

Posted in ProMED

References:
1. Berger SA. Infectious Diseases of Argentina, 2010. 410 pp. Gideon e-book series. http://www.gideononline.com/ebooks/country/infectious-diseases-of-argentina/
2. Berger SA. Infectious Diseases of the United States, 2010. 996 pp. http://www.gideononline.com/ebooks/country/infectious-diseases-of-the-united-states/
3. Berger SA. Ornithosis: Global Status, 2010. 36 pp. Gideon e-book series. http://www.gideononline.com/ebooks/disease/ornithosis-global-status/

Borrelia burgdorferi was first isolated from patients in Slovenia in 1988, and from ticks in 1993.

Prevalence surveys:
7.7% to 46% of febrile illness following tick bite
45.5% of ticks in the Italy/Slovenia transborder territory (2008 publication)

Seroprevalence surveys:
15.4% of children and young adults in Slovenia (2000 publication)
23.8% of forestry workers (ELISA, 2002)

Infecting species:
– Borrelia burgdorferi, B. afzelii and B. garinii are encountered.
– B. afzelii accounts for the majority of isolates; however, B. garinii predominates among strains cultured from cerebrospinal fluid.
– B. bissettii has been isolated from humans with Lyme disease in Slovenia.
– Borrelia spielmanii (Borrelia A14S) has been implicated in cases of erythema chronicum migrans in Slovenia.

References:
1. Berger SA. Infectious Diseases of Slovenia, 2010, 373 pp. Gideon e-book series. http://www.gideononline.com/ebooks/country/infectious-diseases-of-slovenia/
2. Berger SA. Lyme disease: Global Status, 2010, 66 pp. Gideon e-book series. http://www.gideononline.com/ebooks/disease/lyme-disease-global-status/

Seroprevalence surveys:
21.0% of non-institutionalized Americans – with highest rates among US-born individuals, males, non-Hispanic whites, and individuals residing in the Midwest and/or in metropolitan areas (1988 to 1994)
13.6% of destitute and 15% of homeless persons in Los Angeles (2000)
2.1% of blood donors (1992 publication)
29.3% of patients with chronic liver disease (Cincinnati, Ohio, 1995 to 2006)
23% to 26% of veterinarians treating swine, compared to 18% of a control group of blood donors (1999)
10.9% of swine workers in North Carolina (2002 publication)
77% of wild rats in Maryland (1997)
73.5% of Norway rats in Baltimore (2005 to 2006)
90% of Norway rats in Hawaii (1986)
44% of Norway rats in Louisiana (1995)

References:
1. Berger SA. Infectious Diseases of the United States, 996 pp. 2010, Gideon e-books http://www.gideononline.com/ebooks/country/infectious-diseases-of-the-united-states/
2. Berger SA. Hepatitis D, E and G: Global Status, 92 pp. 2010, Gideon e-books http://www.gideononline.com/ebooks/disease/hepatitis-d-e-and-g-global-status/

Update: Posted in ProMED

The following background data on TBE in Sweden are abstracted from Gideon. Primary references are available on request.

Time and Place:
Disease rates peak during July to August.
- Natural foci are found throughout the southern and middle parts of Sweden up to the counties of Varmland and Dalarna and further north along the Baltic sea.
- Cases are identified on the Stockholm archipelago, the middle and eastern parts of lake Malaren close to Stockholm, the coastal area of the Baltic sea from Stockholm further south to the city of Kalmar and the islands of Oland and Gotland.
- Highest incidence is found on the East Coast, (particularly on the Stockholm archipelago), the eastern region of Lake Malaren and the Gotland Island region.
- The first cases in Skane were reported in 2001. Six cases were reported in the region to 2006.
- 65.3% of cases reported during 1992 to 1996 were acquired in Stockholm, 15.2% in Sodermanland, 6% from Ostergotland or Gotland, and 4.9% from other countries (primarily Finland).
- 402 cases of TBE were registered during 1955 to 1993, with a case/fatality rate of 0.5%. During this period, the disease rate in Stockholm County was 3.4 per 100,000 per year.
- 71% of cases in 2001 were reported from Stockholm, Uppsala and Sodermanland.
- 56% of cases in 2003 were from Stockholm, 15% from Sodermanland and 6% from Uppsala.
- In 2007, TBE virus was the most common agent of viral meningitis in Sweden, accounting for 37.4% of cases.

The male/female ratio among TBE patients is is 2.1/1; and the median patient age is 41.5 years.

Exported cases:
Tick-borne encephalitis was documented in a Swedish national in England (1991 publication).
An American traveler acquired Tick-borne encephalitis in Sweden in 2006.

Prevalence surveys:
21% of adult aseptic meningitis in Northern Stockholm (1999 and 2004)

Seroprevalence surveys:
4% to 22% in endemic areas, and 5% Stockholm
3.5% on the island of Asp (Southeast Sweden) in 1991; 12% in 2002
0.8% of persons in northeastern Skane are seropositive.

Tick-borne encephalitis virus has been identified in Ixodes ricinus found on migrating passerine birds.

References:

1. Berger SA. Infectious Diseases of Sweden, 2010, 417 pp. Gideon e-book series http://www.gideononline.com/ebooks/country/infectious-diseases-of-sweden/

2. Berger SA. Tick-borne Encephalitis: Global Status, 2010, 52 pp. Gideon e-book series http://www.gideononline.com/ebooks/disease/tick-borne-encephalitis-global-status/

Time and Place:
- Japanese encephalitis was first reported in Vietnam in 1960.
- Most cases of Japanese encephalitis in Vietnam occur in the South during the rainy and early dry season; and in the north during late summer and autumn.
- 61,729,000 persons (73% of the population) live in areas of risk.

Vaccine Schedule:
BCG – birth
DTwP – 2, 3, 4 months
HepB – birth; 2, 4 months; [since 2003]
Japanese encephalitis – 12, 13, 25 months; Part of country [selected HRD]
Measles (monovalent) – 9 months
OPV – 2, 3, 4 months
TT – pregnant women; CBAW (15-35) in some areas
Typhoid – 3-10 years; Part of country [selected HRD]
Vitamin A – 6-11, 12-17, 18-24, 31-36 months

WHO estimates for vaccine coverage decreased slightly from 95% in 2006, to 88% in 2008 (see graph).

The incidence of Japanese encephalitis has decreased dramatically during the past three decades – from a peak of 4,935 cases in 1985, to only 558 cases in 2000.
– 9,574 cases were reported during 1986 to 1990; 6,981 during 1991 to 1996.
– 68 cases were officially reported in 2009.
– Annual mortality from the disease has varied from 60 to 150 cases.

Incidence and Prevalence:
- Japanese encephalitis accounted for 67% of acute childhood encephalitis in Hanoi during the summer of 1995.
- The annual incidence among children in Southern Vietnam is 4.6% (2007 publication)
- A recent outbreak was centered in Ha Bac and Hai Hung.
- Eight children died of presumed Japanese encephalitis in Kien Giang Province in 1999.
- 200 cases were reported in the northern region during May to June, 2005.

Exported cases
- An Australian soldier acquired Japanese encephalitis in Vietnam (reported in 1975).
- In 2006, an Italian traveler developed Japanese encephalitis (nonfatal) after returning from Vietnam.
- In 2008, an American tourist contracted Japanese encephalitis (nonfatal) while in Vietnam and Cambodia.

Related diseases:
- A new arbovirus, tentatively named “Nam Dinh virus,” was implicated in several cases of encephalitis in Ha Noi and Ha Tay in 2003, and in Bac Giang Province in 2004.

References:
1. Berger SA. Infectious Diseases of Vietnam, 2010, 382 pp. Gideon e-book series, http://www.gideononline.com/ebooks/country/infectious-diseases-of-vietnam/
2. Berger SA. Japanese Encephalitis: Global Status, 2010, 51 pp. Gideon e-book series, http://www.gideononline.com/ebooks/disease/japanese-encephalitis-global-status/

Update: Posted in ProMED

Graph 1 summarizes disease incidence and rates per 100,000 population.

Graph Notes:
1. 47 cases were reported in the Balearic Islands during 2001 to 2003.
2. 460 cases were reported among Spanish tourists during 2002 to 2006; 30 in 2005; 73 in 2006.
Individual years:
1993 – Included 57 cases in Cataluna
2003 – 5.82 per 100,000 in the Balearic Islands

As seen in Graph 2, this increase has also affected tourists in Spain.

Graph Notes:
1. 281 cases were acquired by foreign tourists in Spain during 1987 to 1995 – 67% of these from Great Britain. 37% of these were acquired in the Balearic Islands.
2. 627 cases were acquired by foreign tourists in Spain during 1989 to 2001.
3. 6,411 cases of legionellosis were reported during 1999 to 2004 – 565 (9%) involving Spanish travelers, and 426 involving foreign travelers in Spain.
4. 73 travel-associated cases were reported in 2006; 68 in 2007.
Individual years:
2003 – Included nine Spanish citizens touring within Spain.

Legionellosis accounts for 3% of community-acquired pneumonia in Palma de Mallorca (1992 to 1994)

Outbreaks – an overview:
- 1989 to 1998 – 55 outbreaks of legionellosis were reported – 36 of these associated with tourism, 11 nosocomial and 8 community-acquired.
- A single hotel in Benidorm was implicated in the infection of 3 tourists in 1989, 1 in 1990, 2 in 1995, 1 in 1996; 3 in 1997; 8 (1 fatal) in 1998.
- 1990 to 1991 – 54 outbreaks involving 805 cases (and additional 1,358 sporadic cases) were reported.
- 1990 to 2004 – 118 outbreaks involving 690 patients were reported in Catalonia – 35.6% involving water towers, and 14.4% involving water distribution systems in public buildings.
- 1999 to 2001 – Four outbreaks affected over 160 people in Alcoy.
- 2000 – Seven outbreaks were reported – 4 of these nosocomial. An additional 4 clusters were reported among tourists to Spain.
- 2000 – Girona reported 32 cases (3 fatal); Barcelona 48 (1 fatal); Vigo 30 (4 fatal) and Alcala de Henares 249 (11 fatal).
- 2001 to 2003 – 135 cases (10 fatal) in 46 clusters were acquired by European travelers to Spain, including 85 in 2002
- 1999 to 2003 – Eight outbreaks (approximately 300 cases) were reported in Alcoy, Alicante.
- 2003 – 55 outbreaks (247 cases) were reported.

Notable outbreaks:
1973 – An outbreak (89 cases, 3 fatal) was associated with a hotel in Benidorm.
1978 (publication year) – An outbreak (2 fatal cases) was associated with a hotel in Benidorm.
1983 – An outbreak (35 cases) in Valencia was related to contaminated shower heads and toilet tanks.
1984 (publication year) – An outbreak was reported in Los Castillejos.
1984 – An outbreak (32 cases) was reported among Dutch tourists at a hotel in Pineda de Mar (Barcelona region, Spain).
1988 – An outbreak (56 cases) was reported in Barcelona.
1992 (publication year) – An outbreak (6 cases) in a private apartment building in Zaragoza was associated with potable water.
1992 (publication year) – An outbreak was reported in a hospital in Badalona.
1993 – An outbreak (4 British tourists and 1 French tourist) was reported at a hotel in Spain.
1994 – An outbreak (20 cases) was reported in L’Espluga de Francoli, Tarragona.
1996 – An outbreak (260 cases, 197 hospitalized, 14 fatal) was reported in Madrid region (Alcala de Henares). This was the largest outbreak reported in Europe to date.
1996 – An outbreak (4 cases) was reported among British tourists at a hotel in Minorca.
1998 – An outbreak (3 cases, all fatal) was reported in a hospital in Zaragoza.
1999 – An outbreak (6 cases) was reported among foreign tourists to a spa in Cestona (Guipuzcoa Province).
1999 – An outbreak (7 cases, 1 fatal) was associated with a hotel outbreak in Benidorm.
2000 – An outbreak (70 cases, 2 fatal) was reported in Alcoy (Valencia region).
2000 – An outbreak (28 cases) was associated with a cooling tower in the region of a hospital in Vigo (Galicia).
2000 – An outbreak (54 cases, 17 hospitalized, 3 fatal) was reported in the “La Barceloneta” district of Barcelona.
2001 (publication year) – An outbreak (2 cases, both fatal) was reported among mechanics working on a cargo ship in the port of Barcelona.
2001 – An outbreak of 751 clinical cases (449 confirmed, 2 fatal) was reported in Santa Maria de Gracia (Murcia) – the world’s largest recorded outbreak to that time. The source of infection was an outdoor hospital cooling tower.
2001 – An outbreak (18 cases, 3 fatal) was reported from a hospital in Pamplona. A contaminated hot water system was implicated.
2002 – An outbreak (124 cases, 2 fatal) in Matara, Catalonia was related to a local cooling tower.
2003 – Outbreaks (25 total cases, 1 fatal) were reported in Valencia.
2003 – An outbreak (4 cases) was reported at a spa on Tenerife. An additional suspect case was reported in a Venezuelan visitor to the spa.
2004 – An outbreak (28 confirmed cases, 1 fatal) was reported at a hospital in Zaragoza. Contaminated cooling towers were implicated.
2004 – An outbreak (33 cases, 2 fatal) in Vallarca, Barcelona was caused by a contaminated air conditioning system at a private clinic.
2005 – An outbreak (19 cases, 3 fatal) was reported in Barcelona.
2005 – An outbreak (28 cases, including 21 foreigners – 0 fatal) was associated with a shopping center in Torrevieja.
2005 – An outbreak (55 cases, 3 fatal) was associated with a cooling tower in Catalonia.
2006 – An outbreak (146 cases, 0 fatal) in Pamplona was ascribed to contaminated cooling towers.
2006 – An outbreak (5 cases) was reported among ceramic workers in Castellon.
2006 – An outbreak (12 cases) in Catalonia was related to a contaminated mist machine.
2007 (publication year) – An outbreak of Legionnaires’ disease was reported among immunosuppressed patients at a cancer centre in Barcelona.
2007 to 2008 – An outbreak (3 cases) on a hospital surgical ward was associated with a contaminated oxygen humidifier.

References:
1. Berger SA. Infectious Diseases of Spain, 516 pp. Gideon Informatics, Inc. 2010, http://www.gideononline.com/ebooks/country/infectious-diseases-of-spain/
2. Berger SA. Legionellosis: Global Status, 84 pp. Gideon Informatics, Inc. 2010, http://www.gideononline.com/ebooks/disease/legionellosis-global-status/

Time and Place:
Visceral leishmaniasis is most common in the southern region.
- Seroprevalence among dogs in this region is lowest during April, peaking during October.
- A restricted focus has been identified in the Piorat region of northeastern Spain.
- A single autochthonous case has been reported from Minorca.

Graph Notes:
1. 1,180 hospitalizations were reported for leishmaniasis during 1999 to 2003 (0.4 per 100,000 population).
2. 11 cases (0 fatal) were identified among immunocompetent children in southern Madrid during 1994 to 2007.
3. 60 deaths were ascribed to leishmaniasis during 1980 to 1994.
4. In 2005, three cases were reported among Romanian workers returning from Spain.

Leishmaniasis and HIV infection:
- 450 AIDS/Leishmania coinfections were reported nationwide during 1990 to 1995 (52.4% of the world’s total coinfections); 412 during 1996 to 1998; 1,099 as of 2001.
- 835 cases of HIV-Leishmania coinfection were reported during January 1990 to June 1998; 412 during January 1996 to June 1998; 1,099 during January 1990 to January 2001; 130 during January 2001 to December 2006.
- Spain accounted for 58% of all such coinfections in southwestern Europe during 1990 to 1998.
- 2.49% of AIDS patients in the Madrid region are coinfected with visceral leishmaniasis.
- 228 episodes of visceral leishmaniasis were diagnosed in 155 HIV-infected patients in Valencia and Murcia during 1988 to 2001.

Transmission through sharing of needles by injecting drug abusers has been reported.
- Approximately 30% of IVDA in southern Spain are seropositive.
- Evidence for Leishmania is found in 52% of discarded syringes collected in southern Madrid (1998) and 34% from southwestern Madrid (2000 to 2001).

Leishmania infantum has been identified in some cases of cutaneous and mucosal leishmaniasis.

Prevalence surveys:
2.4% of asymptomatic blood donors in Elvissa (Belearic Islands) have been found to have cryptic infection by ELISA – 7.6% by Western blot (2004 publication)
20.5% of wolves (Canis lupus), 14.1% of foxes (Vulpes vulpes), 28.6% of Egyptian mongooses (Herpestes ichneumon), 1 of 4 genets (Geneta geneta), and 1 of 4 Iberian lynxes (Lynx pardinus) (2008 publication)
29.4% of dogs in the Barcelona region (PCR, 2009 publication)
19.6% of seronegative blood samples in a canine blood bank. (Leishmanial DNA, Barcelona, 2008 publication)

Seroprevalence surveys:
3.1% of blood donors from the Balearic Islands. (Majorca, Formentera, and Minorca, 2008 publication)
4.9% of the general population in Castilla Leon, and 64.0% of HIV-positive patients (1996)
11.5% of children and 52.8% of adults in Alicante, southeastern region are skin test-positive (1997 to 1998)
5.25% of dogs in the Madrid area
7.8% of stray dogs in the Madrid region (1996 to 2006)
13% of dogs on Mallorca are infected; 3.7% in northwestern Spain (2004 publication)
30% of dogs in northeastern Spain (2006 publication)
22% of dogs in Crevillente town, Alicante (1999)
13.0% of dogs in the Alpujarras region of southeastern Spain – with highest rates in larger, older dogs which live outdoors (2006)
8.1% of dogs in the Madrid region (2006 to 2007)
5.3% of shelter dogs in central Spain (2010 publication)
3% of cats in Barcelona (2007 publication)
1.29% of cats in Madrid (2005 to 2006)
6.29% of cats in the northeastern Iberian Peninsula and Balearic Islands (2007 publication)

Leishmania infantum has been identified in captive wolves (Canis lupus) in northern Spain (2008 publication)

Vectors:
The vectors in Spain are Phlebotomus (Larroussius) ariasi and Ph. (La.) perniciosus.

References:
1. Berger SA. Infectious Diseases of Spain. http://www.gideononline.com/ebooks/country/infectious-diseases-of-spain/ , 516 pp. 2010, Gideon Informatics, Inc.
2. Berger SA. Visceral Leishmaniasis: Global Status. http://www.gideononline.com/ebooks/disease/visceral-leishmaniasis-global-status/ , 84 pp. 2010, Gideon Informatics, Inc.

References:
1. Berger SA. Infectious Diseases of Ireland and Northern Ireland, 2010. Gideon e-book series, 437 pp. http://www.gideononline.com/ebooks/country/infectious-diseases-of-ireland-and-northern-ireland/
2. Berger SA. Malaria: Global Status, 2010. Gideon e-boon series, 378 pp. http://www.gideononline.com/ebooks/disease/malaria-global-status/

Anaplasmosis
Astrakhan fever
Babesiosis
Crimean-Congo hemorrhagic fever
Japanese spotted fever
Lyme disease
North Asian tick typhus
Omsk hemorrhagic fever
Powassan
Relapsing fever
Rickettsial Spotted fevers (ie, Rickettsia slovaca infection)
Tick-borne encephalitis
Tularemia

References:
1. Berger SA. Infectious Diseases of the Russian Federation. 2010, Gideon e-book series, 461 pp. http://www.gideononline.com/ebooks/country/infectious-diseases-of-the-russian-federation/