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Archive for the ‘Epidemiology’ Category

Measles: Still A Problem Despite Four Decades of Progress

Although measles rates have declined dramatically during the past four decades, a recent upsurge reflects sub-optimal enforcement of vaccination in many countries. In the following graphs, I’ve summarized reported measles incidence and estimated vaccine uptake by region. Note that vaccination rates remain below 80% in three W.H.O. regions (African, Eastern Mediterranean and Southeast Asian), while they exceed 90% in the other three (European, American and Western Pacific) [1.2]

MeaslesSummary

References:
1. Berger S. Measles: Global Status, 2014. 415 pages, 537 graphs, 3,376 references. Gideon e-books, http://www.gideononline.com/ebooks/disease/measles-global-status/
2. Berger S. Infectious Diseases of the World, 2014. 1333 pages, 397 graphs, 26,187 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-the-world/

Also quoted in ProMED

Diagnosis Support for Ebola through GIDEON

The Diagnosis module of Gideon is designed to generate a ranked differential diagnosis list for any Infectious Diseases scenario. In recent weeks, we’ve been running simulations of Ebola. The following link will access a Power Point “show” demonstrating one such scenario. Ebola case (Powerpoint)

Ebola Deaths in Perspective

Recent events in West Africa have largely eclipsed several other ongoing outbreaks on the global stage. For example, over 780,000 cases of Chikungunya have been reported in the western hemisphere in recent months, including 1,371 cases in the United States (vs. only 4 of Ebola). Obviously, the severity of Ebola far outweighs that of Chikungunya; thus, the ratio of reported Chikungunya cases to Ebola cases (772,069 / 10,141) is 76-to-1, the ratio of Ebola deaths to Chikungunya deaths (4,922 / 118) is 73-to-1.

Sadly, one ongoing epidemic which is more severe than Ebola in both disease numbers and mortality, receives little notice from the lay media. The last available publication on cholera in Haiti reported 780,541 cases (8,562 fatal) as compared to 10,041 (4,922 fatal) of Ebola. As of October 28, cases of both diseases had been reported in nine additional countries.

The following graph illustrates mortality figures for some ongoing Infectious Disease outbreaks (I’ve added SARS for historic impact). The lower row records the number of countries which reported cases originating in the outbreak epicenter.

Outbreak Deaths

Chikungunya – Coming to America ?

Chikungunya and Zika: Global Status

Chikunguna is hardly a “household” word in the United States; but we may all be talking about the disease very soon! This viral infection, transmitted by mosquitoes, is associated with high fever, rash and severe joint pains. Even after recovery, the pains may persist for many months. Originally described in Africa, the disease spread to Asia, causing an epidemic of over 1.5 million cases in India during 2006 to 2007. At one point, an Indian traveler carried the infection to Italy, resulting in hundreds of cases in the region of Ravenna.

During the first half of 2014, new outbreaks were reported in the South Pacific; and in a period of only five months, over 660,000 cases have occurred in the Caribbean, involving essentially all regional islands and several mainland countriues. Once a “rare tropical disease”, Chikungunya is now endemic to at least 75 countries. Few realize that the mosquitoes which transmit Chikungunya in Africa, India, Italy and the Caribbean are also found in Florida and Texas. 750 imported cases have already been reported on the U.S. mainland during 2014, and it may be only a matter of time until a mosquito bites one such case, and begins a chain of transmission to the local population (as occurred in Italy in 2007).

Chikungunya and Zika – Global Status, 2014 is the most up-to-date book on the subject of Chikungunya. (The volume also covers Zika, another emerging mosquito virus disease). The book presents a thorough review of global and country-specific epidemiology, as well as complete background information on the history and clinical features of Chikungunya, including 22 graphs and 1,626 linked references. The next updated version will be released in early 2015. Further specs are available at http://www.gideononline.com/ebooks/disease/chikungunya-and-zika-global-status/

Ebola – The Book

Ebola: Global StatusA disease which was relatively unknown to most people – and even most health care professionals – has suddenly become a household word throughout the world. As of September 2014, over 2,000 people have died in the largest recorded outbreak of Ebola. Ebola: Global Status, 2014, the most up-to-date book written on the disease, examines the history, clinical features and epidemiology of Ebola virus infection. A country-by-country chronology presents all aspects of Ebola, including a relatively obscure outbreak which occurred among monkeys in the Philippines, and later spread to Texas.

For further specs on Ebola: Global Status, 2014, see http://www.gideononline.com/ebooks/disease/ebola-global-status/ The next yearly update of the book will be released in early 2015.

Correction: The original text inadvertently stated that this was the only book on the subject. This has been re-edited to state that this is “the most up-to-date book written on the disease.”

Campylobacteriosis in Iceland

A recent posting in ProMED belies the fact that Iceland reports the lowest rates of campylobacteriosis in that region of Europe. [1-2] See graph [3] Note that an earlier outbreak (436 cases) was reported in 1999.

IcelandCampy

References:
1. Berger SA. Infectious Diseases of Iceland, 2014 371 pages, 75 graphs, 1,455 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-iceland/
2. Berger SA. Campylobacteriosis: Global Status, 2014 104 pages, 96 graphs, 1,073 references. Gideon e-books, http://www.gideononline.com/ebooks/disease/campylobacteriosis-global-status/
3. Gideon graph tool at http://www.gideononline.com/wp/wp-content/uploads/Gideon-Graphs.pps

Lyme Disease in New York

The incidence of Lyme disese in New York State has changed little over the years, in contrast to increasing rates reported on a national level. [1,2] See graph

LymeUSvNY

References:
1. Berger SA. Infectious Diseases of the United States, 2014. 1145 pages, 478 graphs, 12,294 references. Gideon e-books, LymeUSvNY“>http://www.gideononline.com/ebooks/country/infectious-diseases-of-the-united-states/
2. Berger SA. Lyme Disease: Global Status, 2014. 77 pages, 66 graphs, 786 references. Gideon e-books, http://www.gideononline.com/ebooks/disease/lyme-disease-global-status/

Note featured on ProMED

Outbreaks of Non-tubercuous Mycobacterial Infection in the United States

The following chronology of nosocomial mycobacteriosis 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.

1987 – An outbreak (17 cases) of Mycobacterium chelonae otitis media was caused by contaminated water used by an ENT practice in Louisiana.
1988 – An outbreak (8 cases) of foot infections due to Mycobacterium chelonae subspecies abscessus infections were associated with a jet injector used in a podiatric office.
1989 to 1990 – An outbreak (16 cases) of sputum colonization by Mycobacterium fortuitum was reported among patients on an alcoholism rehabilitation ward in Washington, D.C.
1991 (publication year) – An outbreak (6 cases) of Mycobacterium fortuitum infection in Washington was associated with contaminated electromyography needles.
1995 to 1996 – An outbreak (87 cases) of postinjection abscesses due to Mycobacterium abscessus in several states was ascribed to an adrenal cortex extract.
1998 – An outbreak (6 cases) of Mycobacterium mucogenicum bacteremia among bone marrow transplant and oncology patients in Minnesota was related to contaminated water.
1999 – An outbreak (10 cases) of intra- and periarticular Mycobacterium abscessus infection in Texas was caused by contaminated benzalkonium chloride used for injection.
2000 to 2001 – An outbreak (110 cases) of skin infections due to Mycobacterium fortuitum was caused by contaminated footbaths in California nail salons.
2001 – An outbreak of Mycobacterium chelonae keratitis in California was associated with laser in situ keratomileusis (LASIK).
2001 to 2002 – An outbreak of Mycobacterium simiae in a Texas hospital was related to contaminated tap water.
2002 – An outbreak (14 confirmed and 11 suspected cases) of soft tissue infections due to Mycobacterium abscessus followed injections of cosmetic substances administered by unlicensed practitioners in New York City.
2002 – An outbreak (115 cases or more) of cutaneous infection by Mycobacterium fortuitum was associated with a contaminated footbath in a nail salon in California.
2002 (publication year) – An outbreak (34 cases) of Mycobacterium chelonae soft tissue infection in California was associated with liposuction.
2002 to 2003 – An outbreak (4 cases) of Mycobacterium chelonae infection among patients undergoing rhytidectomies in New Jersey was caused by a contaminated methylene blue solution.
2003 – An outbreak (3 cases) of Mycobacterium goodii infection was associated with surgical implants in a Colorado hospital.
2004 – An outbreak (12 cases) among Americans of soft tissue infections caused by Mycobacterium abscessus following cosmetic surgery performed at various clinics in the Dominican Republic.
2004 – An outbreak (143 cases) of mycobacterial skin and soft tissue infection (presumed M. fortuitum) was reported among persons attending nail salons in California.
2008 – An outbreak (4 cases) of Mycobacterium mucogenicum bloodstream infections was reported among patients with sickle cell disease, in North Carolina.
2009 (publication year) – An outbreak (6 cases) of Mycobacterium chelonae infection was associated with a tattoo establishment.
2009 – An outbreak (2 cases, 1 confirmed) of Mycobacterium haemophilum skin infection was associated with a tattoo parlor in Washington State.
2011 (publication year) – An outbreak (3 cases) of Mycobacterium bolletii/M. massiliense furunculosis was associated with a nail salon in North Carolina.
2011 (publication year) – An outbreak of Mycobacterium abscessus infection was associated with outpatient rhytidectomies.
2011 – An outbreak (2 cases) of Mycobacterium haemophilum infection was reported among persons receiving tattoos in the Seattle, Washington region. {m 201108122444}
2011 (publication year) – An outbreak (11 cases) of Mycobacterium porcinum infection in a Texas hospital was related to contamination of drinking water.
2011 to 2012 – An outbreak (19 cases) of Mycobacterium chelonae infection involving multiple states was associated with contaminated ink used in tattoo parlors.
2011 to 2012 – An outbreak (15 cases) of infection by rapidly-growing mycobacteria was reported among pediatric hematopoietic cell transplant in a Minnesota hospital.
2013 – An outbreak (2 cases) of non-tuberculous mycobacterial infection was associated with fractionated CO2 laser resurfacing procedures performed at a clinic in North Carolina.
2013 to 2014 – An outbreak (19 cases) wound infection was reported among Americans who had traveled to the Dominican Republic for cosmetic surgery – including 12 due to Mycobacterium abscessus and 2 Mycobacterium fortuitum
2014 – An outbreak (15 cases, 4 fatal) of Mycobacterium abscessus infection in a South Carolina hospital was associated with contact of equipment with contaminated tap water.

References:
1. Berger SA. Infectious Diseases of the United States, 2014. 1145 pages, 478 graphs, 12,294 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-the-united-states/
2. Berger SA. Non-Tuberculous Mycobacteria: Global Status, 2014. 61 pages, 31 graphs, 584 references. Gideon e-books, http://www.gideononline.com/ebooks/disease/non-tuberculous-mycobacteria-global-status/

Note featured on ProMED

Crimean-Congo Hemorrhagic Fever and Travel

Reports of Crimean-Congo hemorrhagic fever (CCHF) related to travel are rare. The following chronology is abstracted from Gideon www.GideonOnline.com and the Gideon e-book series. [1]

1985 – South Africa ex. Democratic Republic of Congo (fatal).
1986 – South Africa ex. Tanzania (nonfatal)
1997 – An English traveler died of probable CCHF contracted in Zimbabwe.
2001 – A German tourist acquired Crimean-Congo hemorrhagic fever in Bulgaria.
2004 – A case of imported Crimean-Congo hemorrhagic fever (nonfatal) was reported in a traveler returning to France from Senegal. Infection in a second French national was diagnosed locally in Senegal.
2009 – An American soldier died in a hospital in Germany after contracting Crimean-Congo hemorrhagic fever in Afghanistan.
2011 – An outbreak (4 cases) in a Pakistan hospital was related to an index patient who had arrived from Afghanistan.
2012 – A patient died of Crimean-Congo hemorrhagic fever in Scotland following acquisition of the disease in Afghanistan.
2013 – A woman died of Crimean-Congo hemorrhagic fever in Uganda following contact with her infected husband in South Sudan.
2014 – A British traveler acquired Crimean-Congo hemorrhagic fever in Bulgaria.

Reference:
1. Berger SA. Crimean-Congo Hemorrhagic Fever: Global Status, 2014. 41 pages, 21 graphs, 658 references. Gideon e-books, http://www.gideononline.com/ebooks/disease/crimean-congo-hemorrhagic-fever-global-status/

Note featured on ProMED

Deaths from Rocky Mountain Spotted Fever

During 1961 to 1970, 207 deaths were ascribed to Rocky Mountain spotted fever (RMSF); and an estimated 612 patients died of the disease during 1983 to 1998. The highest mortality, 50 cases, was reported in 1970. In recent years, the case-fatality rate for RMSF has remained fairly constant at 0.4% to 0.8%. Among the tick-borne infections, Lyme disease has now eclipsed RMSF as a cause of death in the United States – see graph [1, 2]

TickDeaths

References:
1. Berger SA. Infectious Diseases of the United States, 2014. 1145 pages, 478 graphs, 12294 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-the-united-states/
2. Gideon graph tool – http://www.gideononline.com/wp/wp-content/uploads/Gideon-Graphs.pps

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