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Archive for the ‘Graphs’ Category

Hand, Foot and Mouth Disease in Singapore

Highest rates of Hand, foot and mouth disease (HFM) in Asia are reported by Singapore and Macao.  In fact, the incidence of HFM in Singapore is even higher than that of the more familiar dengue fever. [1,2]






  1. Berger SA. Infectious Diseases of Singapore, 2016. 461 pages, 112 graphs, 2073 references. Gideon e-books,
  2. See Gideon Graphs Tool at:


Lyme Disease in the United Kingdom

The following background data on Lyme disease in the United Kingdom were abstracted from Gideon and the Gideon e-book series.  [1,2] Primary references are available on request.

Time and Place:

Lyme disease is reported from East Anglia, Scotland, Wales, Yorkshire and Northern Ireland.  Highest incidence is associated with popular holiday destinations such as Exmoor, the New Forest, the South Downs, parts of Wiltshire and Berkshire, Thetford Forest, the Lake District, the Yorkshire moors and the Highlands and Islands of Scotland.  “Hot spots” for the disease include the New Forest and the Southwest region.  45% of reports originate in three contiguous counties in southern England:  Hampshire, Wiltshire and Dorset.  This area includes foci in and near the New Forest and Salisbury Plain. Other counties with a relatively high incidence include Devon and Somerset in southwestern England; and Norfolk in East Anglia.


Reporting rates in the United Kingdom are approximately 39% of true incidence (2011).  Case reports peak in the third quarter of each year, which accounts for 48% of all cases.

In the following graphs, I’ve contrasted case numbers and rates per 100,000 in the United Kingdom, with those reported in Ireland and the United States.  Note that highest disease incidence in the United Kingdom is reported from England and Wales;  and highest rates per 100,000 from Scotland.  Reported rates in the United States are approximately 2.5-fold those of Scotland.


Infections due to Borrelia burgdorferi, B. afzelii and B. garinii are identified.

Borrelia valaisiana and B. afzelii have been identified in ticks in Scotland.


Prevalence surveys:

23% of patients referred to an infectious disease unit for suspected Lyme disease (2006 to 2010)

2.3% of dog ticks in the United Kingdom (2009)

4.2% of ticks (Ixodes ricinus) in England (2014 publication)

0.5% of pet-dog ticks (2012 publication)

0% of tick larvae, 2.14% of nymphs and 0% of adults in South London parks (2015 publication)

8.6% of ticks in the Scottish Highlands (both B. afzelii and B. burgdorferi, 1997)

37% of ticks in wooded areas of southern Wales

8.6% of Highland ticks in Scotland (Borrelia burgdorferi, 1997)
5.6% of questing tick nymphs in Scotland (Borrelia burgdorferi, 2012 publication)
11.9% of grey squirrels in Scotland (Sciurus carolinensis, 2015 publication)

Seroprevalence surveys:

2.5% to 4.0% of blood donors in South England

0% to 0.5% of blood donors in the inner-city

25% of forestry workers in endemic areas (1989 publication)

14.3% of farmers in Northern Ireland (1990 publication)

6.5% of individuals in the Scottish Highlands (2004 to 2006)

23% of wild deer in England and Wales (2012 publication)


Grey squirrels (Sciurus carolinensis Gmelin) and pheasants (Phasianus colchicus Linneaus) 18 are important hosts for Ixodes ricinus, and may serve as amplifying hosts for Borrelia burgdorferi in this country.

Seropositive horses are found in most parts of the U.K.

Note featured on ProMed


  1. Berger SA. Lyme Disease: Global Status, 2016. 87 pages, 67 graphs, 1037 references. Gideon ebooks,
  2. Berger SA. Infectious Diseases of the United Kingdom, 2016. 1317 pages, 971 graphs, 4,932 references. Gideon ebooks,

Infectious Diseases of the United Kingdom

Lyme Disease Rates in Finland

A recent report on ProMed that Lyme disease is an under-reported disease in Finland is disturbing.  Officially-reported rates have been increasing rapidly since the year 2000, and already exceed those of the United States by more than three-hundred percent !  [1,2]  See graph



  1. Berger S. Lyme Disease – Global Status, 2016. 83 pages, 66 graphs, 882 references. Gideon ebooks,
  2. Berger S. Infectious Diseases of Finland, 2016. 482 pages, 130 graphs, 2,035 references. Gideon e-books,

Tick-Borne Encephalitis in the Czech Republic

Rates of Tick-borne encephalitis (TBE) in the Czech Republic are similar to those reported by Austria during the 1970’s. [1,2]   Following the institution of mass vaccination by Austria in 1981, TBE rates decreased to levels experienced in neighboring countries. [3] Enhanced administration of TBE vaccine might also prove effective for the Czech Republic.


1. Berger SA. Tick-Borne Encephalitis: Global Status, 2015. 65 pages, 45 graphs, 564 references. Gideon e-books,

2. Berger SA. Infectious Diseases of the Czech Republic, 2015. 497 pages, 143 graphs, 2,097 references. Gideon e-books,


Diphtheria in Latvia

Following a regional epidemic during the 1990’s, Latvia has continued to experience a high incidence of diphtheria. [1]  This phenomenon is difficult to explain on the basis of poor vaccine uptake. The following graph compares W.H.O. estimates of vaccination (DPT3) coverage with diphtheria rates reported in Estonia, Latvia and Lithuania. [2]



1. Berger SA. Infectious Diseases of Latvia, 2015. 436 pages, 103 graphs, 1,497 references. Gideon e-books,

2. Berger SA. Diphtheria – Global Status, 2015. 333 pages, 445 graphs, 374 references. Gideon e-books,



Note featured on ProMED


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]


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.


Berger SA. Infectious Diseases of Brunei, 2015. 374 pages, 60 graphs, 1,448 references. Gideon e-books,

Update: Appeared in ProMED

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


  1. Berger SA. Infectious Diseases of the United States, 2015.  1,208 pages, 483 graphs, 13,730 references. Gideon e-books,

Fifth Disease in Japan

The following background material on Fifth Disease in Japan is abstracted from Gideon 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:


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.

1. Berger S. Infectious Diseases of Japan, 2015. 632 pages, 166 graphs, 3,706 references. Gideon e-book series,

Hepatitis A in Lebanon

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

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]


1. Berger SA. Infectious Diseases of Lebanon, 2015. 389 pages, 54 graphs, 1,569 references. Gideon e-books,

2. Berger SA. Hepatitis A: Global Status, 2015. 184 pages, 183 graphs, 1,775 references. Gideon e-books,


Hand, Foot and Mouth Disease in Singapore

Rates of Hand, Foot and Mouth disease (HFM) in Singapore exceed those of all other reporting countries in Asia.  In fact, HFM is at least as common as varicella in Singapore [1,2].  See graph:





1. Berger SA. Enterovirus Infections: Global Status, 2015. 102 pages, 67 graphs, 1,936 references. Gideon e-books,

2. Berger SA. Infectious Diseases of Singapore, 2015. 460 pages, 112 graphs, 1,964 references. Gideon e-books,

3. Gideon graph tool at

Note appears on ProMED