Regarding a recent outbreak in Jujuy, recent rates of ornithoisis in Argentina are strikingly similar to those reported in the United States during the 1950′s. [1-3]

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/

Recent reports highlight the fact that Sweden has the highest rate of Tick-borne encephalitis (TBE) in Scandinavia, exceding even those of Russia in 2008. [1,2]

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/

Recent reports of Japanese encephalitis (JE) activity belie the fact that disease rates in Vietnam have decreased in recent years. [1,2]

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

Although leishmaniasis has generated increasing concern in Spain during recent years, the incidence of reported cases has changed little during the past 25 years. The following data are abstracted from the GIDEON e-book series [1,2].

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.

Kunjin virus (KUN) is similar Murray Valley encephalitis (MVE) virus; however, infection by KUN is generally milder than that with MVE, with a lower rate of encephalitis. KUN appears to have been responsible for some of the ‘Murray Valley encephalitis’ cases reported in 1974, and was implicated in an additional sporadic case in northern Victoria in 1984. KUN-is more widely distributed than MVE, and is found in most of tropical Australia, eastern Queensland, and occasionally southeastern Australia.

Notes for individual years:
1996 – Two cases in Queensland.
1997 – Two cases in Western Australia and two in Northern Territory. A presumptive case of KUN was reported in Pilbara, WA
2000 – Three in Western Australia and one in Northern Territory.
2001 – New South Wales, Northern Territory [2 cases] and Western Australia.
2003 – All cases reported from Queensland
2004 – 11 in Queensland and 1 in Victoria.
2005 – 1 in Queensland
2006 – 2 in Western Australia and 1 in Queensland

The vectors for KUN are Culex annulirostris, Cu. pseudovishnui and Cu. squamosis.

An extensive review of Australo-Pacific Arbovirus diseases is available in the ebook Australo-Pacific Arboviruses: Global Status

Update: posted in ProMED

Leptospirosis was first identified in Argentina in 1915.
- Most cases are reported from Greater Buenos Aires.
- 276 cases were diagnosed in the Greater Buenos Aires area during 1990 to 1999 – 43 of these characterized by pneumonia.
- 32 cases (6 fatal) were reported in Santa Fe during the first two months of 2010.

The following graphs depict incidence and case rates of Leptospirosis in Argentina, and contrast these data with those of surrounding countries:

Notes:
Individual years:
1998 – Included 53 cases in Santa Fe and 16 in Buenos Aires.
2001 – Included 63 cases in Santa Fe and 89 in Buenos Aires.
2005 – Three fatal.

Twelve serovars were identified in human infection during the 1970′s, with most cases due to serovars bratislava, icterohaemorrhagiae and butembo.
- 41% of infections during 1984 to 1994 were due to Leptospira interrogans canicola.

Seroprevalence surveys:
15.7% of the population, nationwide (1976 publication)
8.7% of healthy persons in Corrientes and 0.5% in Neuquen are seropositive (1979 publication)

Reservoirs:
The principal hosts in this country are rats, pigs and dogs.
- 25% to 40% of rats and 10% to 60% of dogs in Buenos Aires are seropositive – most often toward L. interrogans canicola and L. i. pyrogenes.
- Antibody toward serovars pomona, hebdomadis group, pyrogenes, tarassovi, and canicola has been demonstrated in healthy horses.

Notable outbreaks:
1976 – An outbreak (10 cases) in Buenos Aires followed swimming in a drainage canal contaminated by pigs.
1977 (publication year) – An outbreak was reported among children in Longchamps, Buenos Aires Province.
1998 – An outbreak (12 confirmed and 2 suspicious cases) in Santa Fe was related to water.
2004 – An outbreak (12 suspect cases, 1 fatal) was reported in Entre Rios.
2007 – An outbreak (400 cases or more) was reported in Santa Fe.

Although vaccination coverage for major infectious diseases in Haiti was below that of other countries in the region, recent WHO estimates had shown some improvement in recent years. Most recent data are summarized in the following chart:

Also check out GIDEON’s free ebook: Infectious Diseases of Haiti

A recent ProMED warning to backpackers is well taken – leptospirosis is a common disease in the Pacific region. In the following graphs I’ve compared disease rates for Australia and New Zealand with those of the United States.

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

As pointed out by ProMED, tuberculosis rates in Haiti were already highest in the region before the current disaster. In the following graph, I’ve contrasted reports for Haiti with those of neighboring countries.

Don’t forget to check out GIDEON’s free e-book: Infectious Diseases of Haiti

When the humanitarian disaster in Haiti began to unfold, we accelerated development of a comprehensive book on the diseases of that country. This will be one in a series of ebooks which present the status of all infectious diseases…in all individual countries. This ebook, Infectious Diseases of Haiti, 2010 edition, will be offered free of charge to all health professionals concerned with the current disaster.

There are 347 forms of human infectious disease in the world today – and 198 of these (more than half) are known to occur in Haiti. Sadly, one of the “side effects” of living in a poor and disaster-ridden economy is a lack of useful facts regarding the local status of individual diseases. GIDEON (Global Infectious Diseases and Epidemiology Online Network) is a Web-based application which follows diseases – both on a global level and within each country. Data are updated daily and are derived from all relevant journals, websites, Health Ministry reports and publications of the World Health Organization. The electronic book (ebook) is generated from information in the GIDEON database, and will serve as the first comprehensive review of infectious diseases in Haiti. Similar ebooks are now available by country and disease.

Download the 2010 edition for free in PDF, ePub or mobi format, via the following links:
PDF: Infectious Diseases of Haiti by GIDEON (314 pages, 36 graphs, 3.4MB, updated May 5, 2010)
ePub: Infectious Diseases of Haiti by GIDEON (1.1MB, updated May 5, 2010)
mobi: Infectious Diseases of Haiti by GIDEON (1.8MB, updated July 23, 2010)

Or view the PDF ebook using Google.

Also available on Amazon Kindle for $1 in the US: Infectious Diseases of Haiti – Kindle version