Rates of human Trypanosomiasis in Kenya are relatively low in contrast to surrounding countries – see graphs [1].

Although both disease incidence and rates per 100,000 are highest in Uganda and Sudan, most cases affecting tourists have been acquired in Tanzania.

The following background data on Trypanosomiasis in Kenya are abstracted from Gideon www.GideonOnline.com and the Gideon e-book series [2,3] (Primary references available on request)

Time and Place:
- African sleeping sickness first entered Kenya from Uganda in 1901.
- By 1965 Gambian sleeping sickness had virtually disappeared from Kenya, and was replaced by Rhodesian sleeping sickness.
- The disease is reported from the western region, and is relatively common in the Lambwe Valley, Nyanza region.
- As of 2004, endemic areas consisted of Bungoma, Busia and Teso districts (Ugandan border area).
– 912 cases of sleeping sickness were reported in the Lambwe Valley during 1959 to 1984

700,000 persons are considered at risk.

In one study, 100% of trypanosomiasis patients were found to be co-infected with malaria, 64.5% with helminthosis, 22.5% typhoid, 16.1% urinary tract infections, 12.9% HIV and 3.2% tuberculosis (2000 to 2009).

Exported cases:
1991 – An American national acquired trypanosomiasis following travel through Tanzania, Kenya and Rwanda.
1996 – A Mexican tourist acquired trypanosomiasis in Kenya.

The endemic species is Trypanosoma brucei rhodesiense.

The local vectors are Glossina pallidipes, G. swynnertoni and G. fuscipes ssp. fuscipes.

Trypanosoma brucei was detected in horses on a farm in Thika (1994 publication)

Prevalence surveys:
2.5% of domestic dogs in Busia and Teso Districts (2003 publication)
1% of livestock in Busia District (2011 publication)

Notable outbreaks:
1964 – An outbreak of African trypanosomiasis was reported in Alego, Central Nyanza, in 1964.
1980 to 1984 – An outbreak of African trypanosomiasis was reported in the Lambwe Valley.

References:
1. Gideon graph tool at http://www.GIDEONonline.com/wp/wp-content/uploads/Gideon-Graphs.pps
2. Berger SA. Infectious Diseases of Kenya, 2012. 404 pp, 61 graphs, 1741 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-kenya/
3. Berger SA. African Trypanosomiasis: Global Status, 2012. 53 pp, 37 graphs, 567 references. Gideon e-books, http://www.gideononline.com/ebooks/disease/african-trypanosomiasis-global-status/

The incidence of Lyme disease has been increasing in the United Kingdom since reporting began, with highest rates in Scotland. In the following graph I’ve contrasted these rates with those of the Uhnited States. [1]

Reference:
1. Gideon graph tool at http://www.GIDEONonline.com/wp/wp-content/uploads/Gideon-Graphs.pps

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Southeast Asia continues to account for the most of the global leprosy burden, with more than 50% of the world’s cases reported from India. In the following graph, I’ve compared regional data with those of India. [1]

References:
1. Graph tutorial at: http://www.GIDEONonline.com/wp/wp-content/uploads/Gideon-Graphs.pps

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As of December 2011, most cases of human infection by H5N1 Influenza virus were reported in Cambodia, China, Egypt, Indonesia, Thailand and Vietnam. In the following graph [1], note that successive peaks were reported by Vietnam and Indonesia, followed by increasing activity in Egypt during recent years.

The second graph [1] illustrates the fact that a disproportionately high case fatality rate has been reported among cases occurring in Indonesia.

References:
1. Graph tutorial at: http://www.GIDEONonline.com/wp/wp-content/uploads/Gideon-Graphs.pps

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The following background notes on toxoplasmosis in Australia and New Zealand are abstracted from Gideon www.GideonOnline.com and the Gideon e-book series. [1-3]

Australia:
An estimated 520 to 650 babies are born with congenital toxoplasmosis each year.

Prevalence surveys:
3.7% of encephalitis cases in Australia (221 cases reported, 1990 to 2007)

Seroprevalence surveys:
35% of pregnant women in Western Australia; 23% to 45% in Melbourne; 23% in South Australia; 26% in Queensland
50% of feral cats in Tasmania (1997 publication)
67% of captive common brushtail possums (Trichosurus vulpecula, 2008 publication)
15.5% of Western grey kangaroos in the Perth region (2009 publication)
5% of wild brush-tailed rock-wallaby populations in southeast Queensland (2010 publication)
0% of Australian fur seals (Arctocephalus pusillus doriferus, 2007 to 2009)

Cases of human infection have been ascribed to ingestion of poorly-cooked kangaroo meat.

High abortion rates are reported among pregnant Tasmanian ewes, which are infected through ingestion of cat feces.
- Toxoplasmosis has been demonstrated among humpbacked dolphins (Sousa chinensis) stranded in Queensland; and in common wombats (Vombatus ursinus)
- Toxoplasmosis has been reported in kakariki (Cyanoramphus spp.)

Notable outbreaks:
1984 (publication year) – An outbreak (5 cases) of toxoplasmosis among members of a Lebanese family in Australia was ascribed to contaminated Kibbi (a traditional meat dish)

New Zealand:
164 primary maternal infections are estimated annually, with resultant infection of 66 fetuses.
– The maternal seroconversion rate is 0.62% per year.

Seroprevalence surveys:
33% of pregnant women in Auckland (IgG, 2000)
42.9% of healthy blood donors in Waikato (2007 publication)
85% of ewes (2006 to 2009)

Toxoplasmosis has been documented in wallabies (Macropus eugenii, Macropus rufogriseus) exported to the United States from New Zealand.

References:
1. Berger SA. Infectious Diseases of Australia, 2011. 503 pp, 158 graphs, 2460 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-australia/
2. Berger SA. Infectious Diseases of New Zealand, 2011. 399 pp, 132 graphs, 1199 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-new-zealand/
3. Berger SA. Toxoplasmosis: Global Status, 2011. 92 pp, 74 graphs, 950 references. http://www.gideononline.com/ebooks/disease/toxoplasmosis-global-status/

Rates of botulism in Germany have changed little since the 1980′s – as depicted in the following graph: [1, 2].

Of historic interest, the world’s first botulism outbreak was reported in this country. In 1793, thirteen residents of Wildbad acquired the disease from tainted sausage – thus the term “botulism” (Latin, botulus = sausage). [1,2]

References:
1. Berger S. Infectious Diseases of Germany, 2011. 488 pp, 145 graphs, 1906 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-germany/
2. Berger S. Botulism: Global Status, 2011. 80 pp, 86 graphs, 510 references. Gideon e-books, http://www.gideononline.com/ebooks/disease/botulism-global-status/

Although the “rickettsiosis” reported in Michoacan could represent Rocky Mountain spotted fever, the extent and location of this outbreak suggests a diagnosis of Endemic typhus. In the following graph, I’ve compared the incidence of these two diseases in Mexico.

In fact, six Rickettsiae (including Coxiella burnetii, a related taxon) are reported in Mexico. The following summary is abstracted from Gideon www.GideonOnline.com and references 1-3. (primary references available on request)

Rickettsia felis:
Rickettsia felis infection was first identified in the Yucatan in 1996, where the organism has subsequently been identified in both humans and fleas.
- Infected fleas have also been recovered from flying squirrels in Mexico.
- Four cases were documented in the Yucatan to 2006.
- Eight cases (3 fatal) of “spotted fevers” were reported in the Yucatan during 2006 to 2007.
Prevalence surveys:
20% of Ctenocephalides felis fleas in Yucatan (2002 publication)
Seroprevalence surveys:
5% of healthy persons in Yucatan (1999)

Epidemic typhus:
– 7,353 fatal cases of epidemic typhus were reported during 1893 to 1907.
– 1,220 cases (707 fatal) were reported during 1939 to 1943.
– The average incidence during 1959 to 1961 was 146 cases per year.
– 64 cases (14 fatal) were reported during 1960 to 1963.
– A total of three outbreaks were reported during the 1980′s – two in Chiapas and one in Mexico State.
Prevalence surveys:
0% of body lice from prisoners and homeless persons in Mexico City (2009 publication)
Notable outbreaks:
1951 – An outbreak (737 fatal cases) was reported.
1966 – An outbreak (10 cases, 0 fatal) was reported in Zoyatlan de Juarez.
1966 to 1967 – An outbreak (18 cases, 3 fatal) was reported in Minas Viejas (Mexico State).
1967 – An outbreak (40 cases, 1 fatal) in Atlacomulco, Mexico State, originated from a patient with Brill-Zinsser disease.
1983 – An outbreak (102 cases, 0 fatal) was reported in Mexico State

Endemic typhus:
Endemic typhus is reported in Guerrero, Hidalgo, Jalisco, Mexico, Michoacan, Nayarit, Nuevo Leon, Oaxaca, Puebla, Quertaro, Tamaulipas, Yucatan and Zacatecas States.
Seroprevalence surveys:
14% to 17% of blood donors in Mexico City (2004 publication)

Rocky Mountain spotted fever
In Mexico, this disease is known as fiebre machada.
– During 1930 to 1950, cases were reported from Coahuila, Durango, San Luis Potosi, Sinaloa and Sonora.
– Rocky Mountain spotted fever has been identified in the Yucatan since 2005.
– Cases continue to occur in Sonora as of 2010
– Mexico’s first fatal case was reported in the southwestern region in 2004.
– 52 cases were reported in Baja California during February to July, 2009.
Prevalence surveys:
40% of patients suspected of having dengue (Yucatan and Jalisco, 1993)
Seroprevalence surveys:
5.6% of persons in rural Yucatan are seropositive toward spotted fever-group rickettsiae (possibly the R. akari group, 1999 publication)
Vectors:
The local vector is Rhipicephalus sanguineus.
- Spotted fever-group rickettsiae have also been isolated from Amblyomma cajennense in Veracruz.
- Amblyomma imitator has been identified as a potential vector in Nueva Leon.
Notable outbreaks:
2009 – An outbreak (4 fatal cases) was reported in Baja California.

Rickettsialpox
– Two cases of rickettsialpox were documented in Yucatan in 2008.
– Evidence of canine infection has been reported in Yucatan (2009 publication)

Q fever:
Seroprevalence surveys:
2% of humans, 2% of cattle and 6% of goats and sheep (1952)
1.46% of cows (1950)
28% of the dairy cattle, 10% of beef cattle, 35% of goats and 40% of sheep (Nueva Leon, 2002 publication)

References:
1. Berger S. Infectious Diseases of Mexico, 2011. 446 pp, 128 graphs, 1,655 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-mexico/
2. Berger S. Endemic Typhus: Global Status, 2011. 65 pp, 90 graphs, 83 references. Gideon e-books,
http://www.gideononline.com/ebooks/disease/epidemic-typhus-global-status/
3. Graph tutorial at: http://www.GIDEONonline.com/wp/wp-content/uploads/Gideon-Graphs.pps

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Rates of Brucellosis in Argentina have been decreasing for over two decades, but continue to parallel those reported in the United States during the 1950′s. [1,2] See graph [3]:

References:
1. Berger SA. Infectious Diseases of Argentina, 2011. 417 pp, 96 graphs, 1516 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-argentina/
2. Berger SA. Brucellosis: Global Status, 2011. 125 pp, 135 graphs, 717 references. Gideon e-books, http://www.gideononline.com/ebooks/disease/brucellosis-global-status/
3. Gideon graph tool tutorial at: http://www.GIDEONonline.com/wp/wp-content/uploads/Gideon-Graphs.pps

Note featured on ProMED

The incidence of human rabies in Central America has been decreasing since 1995. [1,2] Rates in El Salvador exceed those of other countries in the region, and are strikingly similar to those reported by Thailand. See graphs [3]:

References:
l. Berger SA. Infectious Diseases of El Salvador, 2011. 350 pp, 80 graphs, 883 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-el-salvador/
2. Berger SA. Rabies: Global Status, 2011 publication. 366 pp, 546 graphs, 1056 references. Gideon e-books, http://www.gideononline.com/ebooks/disease/rabies-global-status/
3. Graph tutorial at: http://www.GIDEONonline.com/wp/wp-content/uploads/Gideon-Graphs.pps

Notwithstanding a recent series of outbreaks, rates of Hepatitis A in Mexico have changed little since 1984, and remain similar to those reported in the United States during the 1960′s and 1970′s (see graph). [1-3]

References:
1. Berger SA. Infectious Diseases of Mexico, 2011. 446 pp, 128 graphs, 1655 references. Gideon e-book series, http://www.gideononline.com/ebooks/country/infectious-diseases-of-mexico/
2. Berger SA. Hepatitis A: Global Status, 2011. 163 pp, 180 graphs, 1073 references. http://www.gideononline.com/ebooks/disease/hepatitis-a-global-status/
3. http://www.GIDEONonline.com/wp/wp-content/uploads/Gideon-Graphs.pps
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