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Archive for the ‘Epidemiology’ Category

Malaria in Brunei

Recently ProMED reported that two tourists from Singapore acquired Plasmodium knowlesi malaria in Brunei.

Malaria rates reported by both Brunei and Singapore have been strikingly similar since the 1990’s (see graph below) and Singapore has reported both autochthonous and imported cases of P. knowlesi infection since 2007.  During the 1950’s, Brunei reported low levels of malaria from the interior regions and coast adjacent to mountainous areas.  The predominant infecting species and vector were P. falciparum and Anopheles leucosphyrus, respectively. [1]

BruneiMalaria

Brunei was officially declared “malaria-free” by WHO in 1987.  A single publication reported a case of P. knowlesi malaria in this country in 2013.

Although official sources do not routinely recommend malaria prophylaxis for travelers, the recent report in ProMED suggests careful review of the current status of the disease in Brunei.

Reference:

Berger SA. Infectious Diseases of Brunei, 2015. 374 pages, 60 graphs, 1,448 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-brunei/

Update: Appeared in ProMED

Outbreak at Konkut University: MERS-CoV infection ?

An outbreak of pneumonia has been associated with The School of Veterinary Medicine at Konkut University.  This institution is surprisingly close to Konkut University Hospital, where a number of patients were recently treated for MERS CoV infection.   In the following campus map, the Veterinary School and Hospital are denoted by numbers 15 and 30, respectively; and number 12 identifies the Animal Science School.

Konkut

Significantly, a paper published by the school in 2007 suggests that at least some of the veterinary staff have been involved in work with camels. [1]

Have these patients been tested for MERS CoV infection?

 

Reference:
1. Abd El-Aty AM1, Goudah A, Shah SS, Shin HC, Shimoda M, Shim JH.  pharmacokinetic variables of moxifloxacin in healthy male camels following intravenous and intramuscular administration. J Vet Pharmacol Ther. 2007; 30:586-91

Arthropod-borne Viruses of Senegal

A recent outbreak of suspected viral infection in Kedougou Region (http://www.promedmail.org/direct.php?id=3626668) highlights the complexity of establishing a specific etiological agent in West Africa.  At least twenty arthropod-borne viruses are associated with known or suspected human infection in Senegal.  The following alphabetical list is abstracted from Gideon www.GideonOnline.com and the Gideon e-book series [1]   (Primary references are available from Dr. Berger on request)

Bagaza – Bagaza virus has been recovered from mosquitoes in Senegal (Aedes fowleri, Culex neavei, Cx. Poicilipes and Mansonia, Mimomyia hispida, M. lacustris, M. splendens and Aedeomyia africana.

Bangui – Bangui virus was identified in mosquitoes in the Senegal River basin in 1988.

Bunyamwera – Bunyamwera virus has been identified in mosquitoes in the Barkedji region.

Chandipura – Chandipura virus has been identified in mosquitoes in the Barkedji region, and in phlebotomines in the Kedougou district.

Chikungunya – Outbreaks of Chikungunya were reported in Senegal in 1966, 1977, 1982, 1988, 1992, 1996 and 1997.  In 2006, a cluster of six cases in France was reported among travelers returning from Senegal. The virus has been found in a variety of local mosquito species, notably Aedes furcifer-taylori, Ae. luteocephalus, Ae. dalzieli and Stegomyia (Aedes) aegypti. Additional vectors may include Ae. vittatus, Anopheles rufipes and An. coustani.

Dengue – An outbreak of dengue was reported in Senegal during 1927 to 1928; and circulation of the virus was subsequently confirmed in 1974 and during 1999 to 2000. An epizootic among monkeys was reported in 1981; and the first human case was reported in 1983 (from Casamance). Several human and monkey infections were reported in 1990. In 2009, a dengue outbreak (196 cases, 1 fatal) was reported – the first reports of human dengue in Senegal for two decades. Italy reported a case of dengue hemorrhagic fever, imported from Senegal, and cases of dengue fever have been confirmed among French military personnel serving in this country.

Gabek Forest – Gabek Forest virus, a Phlebovirus, has been identified in sandflies (Phlebotomus species) in Senegal (1990 to 1995).

Koutango – Koutango virus (similar to Spondweni virus) has been identified in mosquitoes (Culex neavei) in the Barkedji region.

LeDantec – LeDantec virus is a rhabdovirus which is distinct from the vesicular stomatitis group 1. A single case of infection was reported in Senegal in 1965.

Ngari – Ngari virus has been identified in mosquitoes in the Barkedji region.  Two cases of Ngari virus infection were reported from Dakar,

O’nyong nyong – Although specific data are lacking for Senegal, circulation of O’nyong nyong virus is reported in this region of West Africa.

Rift Valley fever (RVF) – RVF virus was first isolated in West Africa in 1974, from Aedes (Aedimorphus) dalzieli in Senegal. Highest seroprevalence rates are found in the northwest and northcentral regions. Serological studies suggest that the disease was active in Diawara and Bakel (Eastern region) in 1998. Outbreaks were reported among goats, sheep and / or cattle in 2002, 2003, 2013 and 2014.  Carriage by mosquitoes and seroprevalence among sheep in the northern region increased during the 1990’s. Rift Valley virus was identified in mosquitoes in Barkedji in 1993, and re-emerged in 2002. A single isolated case of human Rift Valley fever was confirmed in a school teacher in Kedougou in 2012.

Rift Valley fever virus – seroprevalence surveys:

22.3% of Peul people of the North-central region

15.3% of the population in the Senegal River basin (1995 to 1996)

5% of children born after 1987, vs. 25.3% of the older population in Podor District (1999 publication)

5.2% of individuals in Diawara (1999)

2.9% of small ruminants tested in the Ferlo region (2003)

24.4% of sheep and goats in the Senegal River basin in 1988, 19.3% in 1989

17.2% of ungulates in the Senegal River Basin (1990)

3.8% of wild rodents, notably Rattus rattus, Mastomys huberti, A. niloticus and M. erythroleucus (2000 publication)

Semliki Forest – Semliki Forest virus has been recovered from mosquitoes (Aedes vittatus) and ticks (Rhipicephalus guilhoni) in Senegal.

Tataguine – Antibody toward Tataguine virus is found in 57% of the population.

Usutu – Zoonotic infection by Usutu virus has been identified in Senegal.

Wesselsbron – Seropositive humans were documented in Senegal during 1972 to 1975; and the virus itself has been identified in mosquitoes (Aedes vexans) in the Barkedji region.

West Nile – Seroprevalence rates for West Nile virus of 78.3% to 92% have been reported among horses. Infection of wild birds and dogs has also been identified. Vector mosquito species in this country are thought to include Culex neavei, Cx. tritaeniorhynchus, Cx. modestus, Cx. perfuscus group, Cx. poicilipes, Aedes vexans, Mimomyia hispida, Mi. lacustris, Mi. splendens, Aedeomyia africana and Mansonia uniformis

Yellow fever – Epidemics of yellow fever were reported in Senegal in 1768, 1769, 1778 to 1779 (50 deaths among Caucasians), 1814, 1816, 1828, 1830, 1837, 1840 to 1841, 1844, 1852, 1858, 1863, 1866, 1872, 1900 to 1901 (225 fatal cases) and 1923 to 1927. Aedes furcifer, A. metallicus and A. luteocephalus are involved in the wild vertebrate transmission cycle in this country. Yellow-fever activity among mosquitoes in Senegal has been used to monitor potential human disease in West Africa. Infected mosquitoes were identified during 1976 to 1979, 1983, 1987, 1989, 1990, 1992, 1993 and 2010.  Chronology of recent Yellow fever outbreaks in Senegal:

1965 – 243 cases were reported in Diourbel.

1965 to 1966 – 2,000 to 20,000 cases and 200 to 2,000 deaths were estimated.

1979 – Two French tourists contracted fatal yellow fever in Senegal.

1995 – Cases reported in Ribo-Escale and Guente-Pate Districts (vicinity of Koungheul).

1996 – Highest number of cases for any country (30.2% of the world’s total), including an epidemic centered at Kaffine town. {p 9855398}

2001 – Three cases were reported in Kedougou District (Health Ministry report not included in WHO data).

2002 – An outbreak (78 cases, 11 fatal) was reported – with 18 cases in Diourbel and Ziguinchor regions, and 60 cases in Touba, Mbacke and Bambey districts, Diourbel region; Gossas and Fatick districts, Fatick region; Tambacounda district in Tambacounda region; Louga, Koulda and Dakar regions.

2005 – Activity was reported in Tambacounda region (Goudiri, Kadira)

2010 – Two Senegalese fishermen acquired yellow fever in Gambia.

2011 – Three cases were reported in Kedougou and Saraya Health districts, near the borders with Mali and Guinea Conakry.

Zika – There is evidence for the occurrence of yearly epizootics of Zika virus infection in Senegal. In 2008, two American scientists contracted Zika in the country. Natural infection has been identified in two local primate species, Cercopithecus aethiops and Erythrocebus patas; and in 1.82% of mosquito pools (2011).

Zinga – Zinga virus, a variant of RVF virus, has been identified in humans and mosquitoes in Senegal.

 

Reference:

  1. Berger SA. Infectious Diseases of Senegal, 2015. 449 pages, 55 graphs, 1,864 references.  Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-senegal/

Tularemia Deaths in the United States

Although tularemia is more common than plague in the United States, the case-fatality rate is higher for the latter.  Deaths reported for both diseases have changed little in five decades, with the number of tularemia deaths similar to the number of plague deaths in most years.  See graphs

Plague Tularemia

Tularemia Deaths

Reference:

  1. Berger SA. Infectious Diseases of the United States, 2015.  1,208 pages, 483 graphs, 13,730 references. Gideon e-books, www.gideononline.com/ebooks/country/infectious-diseases-of-the-united-states/

A Chronology of Legionellosis Outbreaks in the United States

The following chronology of significant legionellosis outbreaks in the United States is abstracted from Gideon www.GideonOnline.com and the Gideon e-book series. [1,2]   (Primary references available on request)

1949 – An outbreak of presumed Pontiac fever among steam-condenser cleaners was confirmed retrospectively.

1957 – An outbreak (78 cases, 2 fatal) of legionellosis at a packing plant in Austin, Minnesota was confirmed retrospectively.

1965 – An outbreak (81 cases) at a psychiatric hospital in Washington, D.C. was confirmed retrospectively.

1968 – An outbreak of relatively mild legionellosis was associated with a Health Department building in Pontiac, Michigan (thus, “Pontiac fever”).

1974 – An outbreak during a convention of the Independent Order of Odd Fellows in Philadelphia was reported retrospectively in 1978.

1976 – An outbreak (221 cases, 34 fatal) during an American Legion convention in Philadelphia was traced to a contaminated hotel air conditioning system (thus, “Legionnaires’ disease”).

1977 – Outbreaks were reported in Vermont (16 cases, 14 fatal) and Tennessee (27 cases, 3 fatal).

1977 – An outbreak (6 cases) was reported at a medical center in Ohio.

1977 to 1978 – An outbreak (49 cases, 15 fatal) was reported in a medical center in California.

1978 – An outbreak (44 cases) at a hospital in Tennessee was associated with a contaminated air conditioner cooling tower.

1978 – An outbreak (8 cases) was reported at a country club in Georgia.

1979 (publication year) – An outbreak (39 cases) in Indiana may have been related to a local cooling tower.

1979 – An outbreak (13 cases) was associated with a hotel in Wisconsin.

1980 (publication year) – An outbreak of nosocomial legionellosis was reported at a hospital in Pittsburgh, Pennsylvania.

1980 – An outbreak (14 cases) was reported among building site workers in San Francisco, California.

1980 – Outbreaks (85 cases in 2 outbreaks) were reported at a medical center in Burlington, Vermont.

1981 – An outbreak (29 cases, 1 fatal) of community-acquired legionellosis was reported in Iowa.

1981 – An outbreak (34 cases) of Pontiac fever was associated with a whirlpool at a social club in Vermont.

1981 – An outbreak (317 cases) of Pontiac fever due to Legionella feeleii was reported in an automobile plant.

1981 – An outbreak (12 cases) was associated with a single hotel on St. Croix (US Virgin Islands).

1982 – An outbreak (14 cases) of Pontiac fever in Michigan due to Legionella pneumophila serogroup 6 was related to a whirlpool.

1982 – An outbreak (7 cases) in a hospital in New York was associated with a contaminated hot water system.

1983 – An outbreak (15 cases) at a hospital in Rhode Island was associated with a cooling tower.

1983 to 1984 – An outbreak (5 cases) of waterborne Legionella bozemanii infection in New York was reported among immunosuppressed patients.

1984 – An outbreak of Pontiac fever was associated with a cooling tower in an office building in Manhattan, New York.

1985 – An outbreak (14 cases, 3 fatal) followed a church banquet in Michigan.

1986 – An outbreak (27 cases, 2 fatal) was associated with a retail store in Maryland.

1986 – An outbreak (26 cases, 2 fatal) in Wisconsin was associated with a cooling tower.

1988 – An outbreak (34 cases) of Pontiac fever due to Legionella anisa in a California hotel was related to a contaminated fountain.

1989 – An outbreak (33 cases, 2 fatal) of legionnaire’s disease was caused by a contaminated mist machine in a retail store in Louisiana.

1989 – An outbreak of Legionella dumoffii sternal-wound infections in a California hospital was due to postoperative topical exposure to contaminated tap water.

1992 – An outbreak (5 cases) was associated with conventions held at a hotel in the Orlando, Florida, region was ascribed to a contaminated fountain the hotel lobby.

1992 – An outbreak was reported in an intensive care unit.

1993 – Outbreaks (45 cases in 3 outbreaks) in Massachusetts (11 cases), Rhode Island (17 cases) and Michigan (17 cases) were associated with contaminated cooling towers.

1994 – Outbreaks (50 cases) reported during nine cruises aboard a single ship were ascribed to an on-board whirlpool spa.

1994 – An outbreak (28 cases) was reported at a hospital in Connecticut. 81

1994 – An outbreak (29 cases) in Delaware was related to contaminated hospital cooling towers.

1996 – An outbreak (15 cases) was associated with exposure to a hot tub on display in a store in Virginia.

1987 to 1996 – An outbreak (25 cases) of nosocomial legionellosis among transplant cases may have begun as early as 1979.

1995 – An outbreak (22 cases) in Pennsylvania was associated with contaminated hospital cooling towers.

1998 – An outbreak (45 cases) of Pontiac fever was ascribed to a whirlpool at a Wisconsin hotel.

1998 – An outbreak (11 cases, 3 fatal) was associated with a hospital in New York.

1999 – An outbreak (29 cases) in Delaware was ascribed to contaminated cooling towers.

1999 – An outbreak (22 cases of Pontiac fever and 2 of Legionnaire’s disease) was reported at a hotel in Georgia.

1999 – An outbreak (3 cases) was reported among workers at a postal facility in Illinois.

1999 – An outbreak (5 cases, 3 fatal) occurred among patients at a hospital in Maryland.

2000 – Cases of Legionella longbeachae infection were acquired from potting soil in California, Oregon, and Washington.

2000 – An outbreak (20 cases) of Pontiac fever was associated with a hotel whirlpool in Wisconsin.

2000 – An outbreak (15 cases) of Pontiac fever was reported in a sugar beet processing plant in Minnesota.

2000 (publication year) – An outbreak (12 cases) of Legionella micdadei infection was reported among transplant recipients at a hospital.

2001 – An outbreak (10 cases, 4 confirmed, 1 fatal) at an automobile plant in Cleveland, Ohio was traced to a contaminated cooling tower.

2001 to 2008 – An outbreak (35 cases) was reported among residents of a condominium complex in Las Vegas, Nevada.

2002 – An outbreak (16 cases) was reported at a prison in Connecticut.

2002 – An outbreak (5 confirmed cases) was reported at a nursing home in Pennsylvania.

2002 – An outbreak (14 cases) was reported at a building complex in Vermont. 106

2002 – An outbreak (117 cases) of Pontiac fever due to Legionella anisa was reported among patrons at a restaurant in Tennessee.

2002 – An outbreak (68 cases) of Pontiac fever was reported at a hotel spa in Illinois.

2002 – An outbreak (3 cases) was reported among Danish tourists to St. Croix (US Virgin Islands).

2003 to 2004 – An outbreak (8 cases) at a hotel in Maryland was associated with potable water.

2004 – An outbreak (107 cases of Pontiac fever and 6 of legionnaire’s disease) was reported among guests at a hotel in Oklahoma.

2004 – An outbreak (7 cases) of legionellosis was reported at a long term care facility.

2005 – An outbreak (3 cases) of legionellosis was reported at a resort condominium in Maryland.

2005 – An outbreak (12 cases)  at a hospital in New York was ascribed to a contaminated cooling tower.

2005 – An outbreak (2 cases) occurred among men attending an American Legion convention at a hotel in Pennsylvania.

2005 – An outbreak (15 cases, 1 fatal) in South Dakota was related to an ornamental fountain in a restaurant.

2008 – An outbreak (10 cases) was reported at a senior citizen housing facility in New York.

2008 – An outbreak (8 cases, 3 fatal) was reported at a hospital in New Jersey.

2008 to 2010 – An outbreak (9 cases) of legionellosis was reported at a resort in Cozumel, Mexico among tourists from the United States and the Netherlands.

2009 (publication year) – An outbreak (2 cases) of legionellosis in a hospital was related to a contaminated ornamental water fountain.

2009 – An outbreak (4 cases) was reported at a hospital in Georgia.

2009 to 2010 – Outbreaks (52 cases in 12 outbreaks) were associated with contaminated lakes, streams or reservoirs.

2010 – An outbreak (8 cases) in Wisconsin was associated with a decorative fountain in a hospital.

2010 – Outbreaks were reported at an Air National Guard base in Michigan (31 cases) 130 131 and a hospital in Wisconsin (6 cases).

2010 to 2011 – An outbreak (5 cases) was reported among tourists at two resort hotels in the US Virgin Islands.

2011 – An outbreak (200 cases, estimated) of presumed Pontiac fever was reported among guests from multiple countries attending a social gathering in California, U.S.A.

2011 – An outbreak (11 cases, 1 fatal) at a hospital in Ohio was related to contaminated water.

2011 – Outbreaks were associated with hotels in Nevada (6 cases) 138 and Maryland (3 cases, 1 fatal) ; and a shredder in New York State (5 cases).

2011 – An outbreak (3 cases, 1 fatal) was reported in Florida.

2011 to 2012 – An outbreak (22 definite and probable cases, 6 fatal) in a hospital in Pittsburgh, Pennsylvania was related to a potable water system.

2012 – An outbreak was reported in Oregon.

2012 – Outbreaks were associated with hotels in New York State (6 cases) , Pennsylvania 145 and Chicago, Illinois (10 cases, 3 fatal) 146 147 ; a hospital in Pittsburgh, Pennsylvania ; and a contaminated water system at a condominium complex in Maryland.

2013 – Outbreaks were reported in Ohio (retirement community, 39 cases, 6 fatal) , Alabama (nursing home, 11 cases, 0 fatal) , Milwaukee, Pennsylvania (6 cases related to an outpatient-lobby fountain) , Wisconsin (31 cases) and Detroit, Michigan (35 cases).

2014 (publication year) – An outbreak (29 cases) Legionnaire’s disease and Pontiac fever was reported at a military base.

2014 (publication year) – Outbreaks (2 outbreaks) were reported in a geriatric center and high-rise residence for seniors in New Jersey.

2014 – Outbreaks were reported in a hematology / oncology unit in Alabama (9 cases, 2 fatal) , a nursing and rehabilitation facility in North Carolina (8 cases) and a softball tournament in Alabama (40 cases).

2015 – An outbreak (3 cases) was associated with a motel in Washington State.

2015 – An outbreak (100 cases, 10 fatal – to August 7) in New York City was associated with contaminated cooling towers.

 

References:

  1. Berger SA. Infectious Diseases of the United States, 2015. 1208 pages, 483 graphs, 13370 references. Gideon ebooks, http://www.gideononline.com/ebooks/country/infectious-diseases-of-the-united-states/
  2. Berger SA. Legionellosis: Global Status, 2015.  99 pages, 110 graphgs, 1009 references. Gideon ebooks, http://www.gideononline.com/ebooks/disease/legionellosis-global-status/

Webinar replay and GIDEON demo

Dr Steve Berger presents a background on Infectious Diseases and using GIDEON as a decision support tool during a webinar earlier today.

Fifth Disease in Japan

The following background material on Fifth Disease in Japan is abstracted from Gideon www.GideonOnline.com and reference 1   Primary references are available on request to the author.
Epidemics of Parvovirus B19 infection occurred in Japan every ten years prior to 1980, and every five years since 1981.  Most cases occur during spring and summer, with highest rates among children ages 5 to 9 years.   See graph:

japan1

Parvovirus B19 infection causes an estimated 107 fetal deaths and 21 hydrops fetalis cases per year (2014 publication)
Eight cases of transfusion-associated Parvovirus B19 infection were reported during 1999 to 2008.

Prevalence surveys:
10% of nonimmune hydrops fetalis cases (1994 publication)

Seroprevalence surveys:
67.9% of healthy residents of Kyushu and Okinawa (IgG, 2013 publication)

2% of children ages 0 to 9 in 1973 and 16% in 1984

67% ages 20 to 29 in 1973 and 20% in 1984

80% ages 30 to 39 in 1973 and 56% in 1984

33% of pregnant women in Miyagi Prefecture in 1987, and 46% in 1997

Published outbreaks:
1977 to 1981 – Outbreaks of erythema infectiosum were reported – including 395 cases in one district of Tokyo.
1985 (publication year) – An outbreak of erythema infectiosum was reported.
1986 to 1987- Outbreaks of erythema infectiosum were reported.
1993 (publication year) – An outbreak of erythema infectiosum was reported among hospital staff members.
2000 (publication year) – An outbreak (10 cases) of nosocomial Parvovirus B19 infection was reported.

References:
1. Berger S. Infectious Diseases of Japan, 2015. 632 pages, 166 graphs, 3,706 references. Gideon e-book series, http://www.gideononline.com/ebooks/country/infectious-diseases-of-japan/

Lassa Fever and Travel

As of 2015, at least 57 cases of Lassa virus infection associated with travel have been reported.  The following chronology is abstracted from Gideon www.GideonOnline.com.  (I’ve also included a 2008 episode involving Lujo virus, a related pathogen).  Primary references are available on request

1969 – Lassa fever was first described when three American nurses working at Lassa, Nigeria contracted the illness.  Two died and the third was flown to America for treatment.
1971 – A nurse and physician from United Kingdom developed nonfatal Lassa fever in Sierra Leone.
1972 – A nurse from United Kingdom developed nonfatal Lassa fever in Sierra Leone.
1974 – A German physician contracted Lassa fever (nonfatal) in Nigeria.
1975 – An American aid worker developed nonfatal Lassa fever in Sierra Leone.
1975 – A physician was treated in the United Kingdom for Lassa fever acquired in Nigeria.
1976 – A Peace Corps worker returned to the United States from Sierra Leone with Lassa fever.
1976 – An engineer with Lassa fever (non-fatal) acquired in Nigeria was treated in the United Kingdom.
1980 – A case of Lassa fever (nonfatal) acquired in Burkina Faso was reported in the Netherlands.
1981 to 1982 – Two cases of Lassa fever acquired from Nigeria were treated in the United Kingdom.
1984 – A British geologist developed nonfatal Lassa fever in Sierra Leone.
1985 – A British nurse developed nonfatal Lassa fever in Sierra Leone.
1987 – A case of Lassa fever (nonfatal) was reported in Israel – an engineer who had been in Liberia and Sierra Leone.
1987 – A traveler developed Lassa fever in 1987 after returning to Japan.
1989 – A Canadian agricultural specialist developed Lassa fever (nonfatal) in Nigeria.
1989 – An engineer died in the United States of Lassa fever contracted in Nigeria.
1999 – A woman died of Lassa fever after returning to Germany from the Ivory Coast.
2000 – A Nigerian national died of Lassa fever after transfer to Germany for treatment.
2000 – A case of Lassa fever (fatal) from Sierra Leone was reported in the Netherlands.
2000 – A student died of Lassa fever in Germany after traveling through Burkina Faso, Ivory Coast and Ghana.
2000 – A British national acquired Lassa fever in Sierra Leone, and died while under treatment in England.
2000 to 2001 – Four Ghanaian soldiers serving in Sierra Leone contracted Lassa fever.
2003 – A British national acquired Lassa fever in Sierra Leone, and was treated successfully in the U.K.
2004 – A man died of Lassa fever in the United States following a trip to Liberia and Sierra Leone.
2004 – A case of Lassa fever (nonfatal) from West Africa was treated in the United Kingdom.
2005 – Two Pakistani soldiers died of Lassa fever in Liberia.
2006 – A man was hospitalized with Lassa fever in Germany, following travel to Sierra Leone.
2008 – An outbreak (5 cases, 4 fatal) of Lujo virus infection in South Africa followed hospitalization of an index patient from Zambia.
2009 – Two men died of Lassa fever in England  – one following travel to Nigeria , and one following travel to Mali.
2010 – An American traveler acquired Lassa fever in Liberia, and a South African civil engineer died of Lassa Fever in Sierra Leone.
2011 – A Swedish woman acquired Lassa fever in West Africa.
2014 – An outbreak (14 cases, 1 fatal) was reported in Liberia, including 11 cases among United Nations peace-keeping personnel.
2014 – An American traveler acquired Lassa fever (non-fatal) in West Africa.

 

Hepatitis A in Lebanon

Hepatitis A rates in Lebanon are similar to those reported in neighboring Israel during the 1990’s [see graph] 
HepAIsrLeb

In 1999 (arrow) Israel became the first country to introduce universal Hepatitis A vaccination, a policy which might help reverse the increasing incidence experienced by Lebanon. [1-3]

References:

1. Berger SA. Infectious Diseases of Lebanon, 2015. 389 pages, 54 graphs, 1,569 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-lebanon/

2. Berger SA. Hepatitis A: Global Status, 2015. 184 pages, 183 graphs, 1,775 references. Gideon e-books, http://www.gideononline.com/ebooks/disease/hepatitis-a-global-status/

3. http://www.gideononline.com/wp/wp-content/uploads/Gideon-Graphs.pps

Gaza: H5N1 Influenza and Population Density

A recent ProMED posting (Avian influenza (80): Palestinian Auth (GZ) HPAI H5N1, spread, RFI) states that, “The Gaza strip is one of the most dense[ly] populated territories on earth.” The population density of Gaza is 5,046 inhabitants per sq km. Compare this to Boston (5,115 per sq km). Indeed, the Israeli town of Sderot, the prime target for bombs and missiles from Gaza, boasts 5,367 inhabitants per sq km. Needless to say, other regions and cities in Asia are far more crowded than Gaza.

Gaza City, has the highest population density within the Gaza Strip itself, with 11,456 per sq km. But my own city, Ramat Gan, exceeds even this number, with 11,971 per sq km. Despite their higher population densities, Boston and Ramat Gan have not experienced H5N1 influenza; indeed, population numbers are not relevant to this strain, since human-to-human transmission is rare.

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