Archive for the ‘Outbreaks’ Category

Diagnosis Support for Ebola through GIDEON

Thursday, October 30th, 2014

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

Tuesday, October 28th, 2014

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 ?

Wednesday, September 17th, 2014

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

Wednesday, September 17th, 2014

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

Wednesday, August 6th, 2014

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

Outbreaks of Non-tubercuous Mycobacterial Infection in the United States

Wednesday, July 23rd, 2014

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

Bacterial Diarrhea in Australia

Wednesday, February 26th, 2014

Notwithstanding recent outbreaks among men-who-have-sex-with-men, the incidence of shigellosis in Australia has remained remarkably constant for over eighty years. In the following graph I’ve contrasted disease rates in Australia and New Zealand with those reported in the United States. [1-3]

ShigANU

In fact, most other forms of bacterial diarrhea have become far more common than shigellosis in Australia – see graph:

AustDiarrhea

References:
1. Berger SA. Infectious Diseases of Australia, 2014. 575 pages, 163 graphs, 3,658 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-australia/
2. Berger SA. Shigellosis: Global Status, 2014.
162 pages, 199 graphs, 1,076 references. Gideon e-books, http://www.gideononline.com/ebooks/disease/shigellosis-global-status/
3. Gideon graph tool – http://cdn.gideononline.com/wp/wp-content/uploads/Gideon-Graphs.pps

Hepatitis A in Asian Russia

Saturday, December 14th, 2013

Reprted rates of Hepatiis A for Uzbekistan and bordering countries are strinkingly similar, and somewhat higher of those for the Russian Federation. [1,2] See graph [3]:

HepAUzbek

References:
1. Berger SA. Infectious Diseases of Uzbekistan, 2013. 354 pages, 74 graphs, 69 references.
http://www.gideononline.com/ebooks/disease/hepatitis-a-global-status/
2. Berger SA. Hepatitis A: Global Status, 2013. 169 pages, 182 graphs, 1274 references. http://www.gideononline.com/ebooks/disease/hepatitis-a-global-status/
3. Gideon Graph Tool, see tutorial at http://www.GIDEONonline.com/wp/wp-content/uploads/Gideon-Graphs.pps

Note featured on ProMED

Typhoid Fever Outbreaks in the United States

Monday, May 6th, 2013

The following background data are abstracted from Gideon www.GideonOnline.com and the Gideon e-book series. [1,2]

60 outbreaks of typhoid were reported during 1960 to 1999 – 54 of these (total 957 cases, 4 fatal) following exposure within the United States. Five drinking water-associated outbreaks of typhoid were reported during 1971 to 2006.

The best known clusters of typhoid fever in history were those ascribed to Mary Mallon (“Typhoid Mary”), a chronic carrier who was responsible for 9 outbreaks (54 cases, 4 fatal) in the New York area during 1900 to 1915.

A chronology of notable outbreaks:
1843 – Outbreaks of typhoid were reported in New York City and Boston.
1898 – An outbreak of typhoid was reported in Florida.
1909 – An outbreak of typhoid was reported in an “infant asylum” in Baltimore, Maryland.
1911 – An outbreak of typhoid was reported in Yakima, Washington.
1913 (publication year) – An outbreak of typhoid was reported in Illinois.
1913 (publication year) – An outbreak of paratyphoid fever in Massachusetts was ascribed to contaminated milk.
1936 (publication year) – An outbreak in Philadelphia, Pennsylvania was associated with a supper.
1937 (publication year) – An outbreak was reported in Michigan.
1947 – An outbreak (4 cases) of typhoid in Alaska was associated with a commercial air flight.
1953 (publication year) – An outbreak of typhoid was reported in rural New York.
1956 – An outbreak of typhoid was reported in the Midwest.
1959 – An outbreak of typhoid was reported among migrant workers in Virginia.
1964 – An outbreak of typhoid fever was reported in Atlanta, Georgia.
1967 – An outbreak (31 cases) was reported among students at a university in California.
1970 – An outbreak (81 cases) of typhoid was reported among passengers aboard a British ship traveling to Canada and the United States.
1972 to 1973 – An outbreak (1,515 cases, 39 fatal) was reported in Mexico City in 1972; with an additional 667 cases during January to June 1973. A related outbreak (80 cases) was reported in the United States.
1973 – An outbreak (230 cases) of typhoid in Dade Country, Florida may have originated from water contaminated by a typhoid carrier.
1981 – An outbreak (80 cases) of typhoid at a restaurant in Texas was associated with contaminated “barbacoa” (a mixture of muscle, lips, ears, tongue, and eyes from steamed bovine heads).
1981 – An outbreak (6 cases) on an Indian reservation was linked to a typhoid carrier.
1981 – An outbreak (18 cases, 0 fatal) of typhoid in Michigan was assumed to be related to a typhoid carrier.
1986 – An outbreak at a restaurant in Maryland was caused by contaminated shrimp. {p 3384930}
1989 – An outbreak (43 cases) of typhoid at a hotel in New York was ascribed to contaminated orange juice.
1990 – An outbreak (17 cases) of food-borne typhoid followed a family gathering in Washington State. {p 2120571}
1990 – An outbreak (24 cases, 16 confirmed) was associated with a family picnic in Maryland.
1998 to 1999 – An outbreak (16 cases or more) of typhoid in Florida was ascribed to frozen mamey (a tropical fruit) imported from Honduras and Guatemala.
2000 – An outbreak (7 cases) in Indiana, Ohio and Kentucky occurred among men who have sex with men.
2000 – An outbreak (7 cases) of typhoid in New York City was traced to an infected restaurant employee.
2005 – An outbreak (2 cases) of typhoid in New York City was related to a carrier from Haiti.
2009 – An outbreak (3 cases) of typhoid was reported in Tennessee.
2010 – An outbreak (12 cases) of typhoid in California and Nevada was ascribed to ingestion of contaminated mamey fruit pulp imported from Guatemala.

References:
1. Berger SA. Infectious Diseases of the United States, 2013. 1119 pages, 470 graphs, 11030 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-the-united-states/
2. Berger SA. Typhoid and Enteric Fever: Global Status, 2013. 258 pages, 401 graphs, 728 references. Gideon e-books, http://www.gideononline.com/ebooks/disease/typhoid-and-enteric-fever-global-status/

Note featured on ProMED

Vaccination Uptake in Afghanistan

Tuesday, January 1st, 2013

Although childhood vaccination has registered considerable success during the past three decades, Afghanistan continues to lag behind other nations in the region. In the following charts I have contrasted WHO estimates of vaccine uptake in Afghanstan with those of bordering countries. [1-3]

Afghan-Vaccines

References:
1. Berger SA. Infectious Diseases of Afghanistan, 2012. 326 pages, 37 graphs, 1239 references. Gideon e-books, http://www.gideononline.com/ebooks/disease/pertussis-global-status/
3. Gideon Graph Tool, see tutorial at http://www.GIDEONonline.com/wp/wp-content/uploads/Gideon-Graphs.pps

Note featured on ProMED