Regarding a recent case in the Netherlands posted in ProMED, several instances of imported West Nile fever have been reported in recent years.

Published reports are summarized below. (primary references are available on request)

2001 – A patient in the Netherlands developed West Nile fever following a trip to Israel.
2002 – Cases acquired in the United States were reported in France, Denmark (2 cases), Mexico; Czech Republic
2003 – Cases acquired in the United States were reported in Germany (2 cases); Canada; the Netherlands.
2003 (publication year) – Cases acquired in Israel and Canada were reported in Denmark.
2003 – A case acquired in Canada was reported in the Netherlands.
2003 – Cases acquired in the United States were reported in France (3 cases), the Netherlands (3 cases), and Germany (2 cases).
2004 – Cases acquired in the United States were reported in Germany 36; Netherlands; and Uruguay.
2004 – 2 cases of West Nile Virus infection were confirmed in Ireland. In both instances, the patients had recently visited Portugal.
2005 – Cases acquired in the United States were reported in Japan.
2005 – An Irish traveler acquired West Nile fever in the United States.
2005 – 4 cases reported in France had been acquired in Djibouti.
2006 – A Spanish missionary acquired West Nile fever in Nicaragua.
2007 – 2 British travelers developed West Nile fever while visiting Canada.

Reference
Berger SA. West Nile fever: Global Status, 2010. GIDEON e-book series

Posted in ProMED

Although less-recognized that other forms of viral hepatitis, several studies have suggested that Hepatitis E infection is common in the United States. [1,2]

Seroprevalence surveys:
21.0% of non-institutionalized Americans – with highest rates among US-born individuals, males, non-Hispanic whites, and individuals residing in the Midwest and/or in metropolitan areas (1988 to 1994)
13.6% of destitute and 15% of homeless persons in Los Angeles (2000)
2.1% of blood donors (1992 publication)
29.3% of patients with chronic liver disease (Cincinnati, Ohio, 1995 to 2006)
23% to 26% of veterinarians treating swine, compared to 18% of a control group of blood donors (1999)
10.9% of swine workers in North Carolina (2002 publication)
77% of wild rats in Maryland (1997)
73.5% of Norway rats in Baltimore (2005 to 2006)
90% of Norway rats in Hawaii (1986)
44% of Norway rats in Louisiana (1995)

References:
1. Berger SA. Infectious Diseases of the United States, 996 pp. 2010, Gideon e-books http://www.gideononline.com/ebooks/country/infectious-diseases-of-the-united-states/
2. Berger SA. Hepatitis D, E and G: Global Status, 92 pp. 2010, Gideon e-books http://www.gideononline.com/ebooks/disease/hepatitis-d-e-and-g-global-status/

Update: Posted in ProMED

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

Recently, a man in New South Wales acquired eosinophilic meningitis (angiostrongyliasis) after ingesting a slug.

The 1st Australian case of human angiostrongyliasis was reported in 1971, in Brisbane.

At first, sporadic cases were reported only from coastal Queensland, northern New South Wales.

Four cases were reported in Victoria to 1999 (3 of these imported from Fiji; one fatal case).

Seropositivity is common among aboriginals.

Reservoirs:
The parasite has been identified in dogs in Sydney as well as in grey-headed fruit bats (Pteropus poliocephalus) Bennett’s wallaby (Macropus rufogriseus) rufous bettongs (Aepyprymnus rufescens) and captive tamarins (Sanguinus spp).

Further information regarding this, and all other diseases endemic to Australia, is available in Infectious Diseases of Australia. Los Angeles, Gideon Informatics, 2010. 488 pp. [edited] www.gideononline.com/ebooks/country/infectious-diseases-of-australia/

Update: Published in ProMED

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

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.

In view of a massive ongoing outbreak in Manila, the following chronology of published large outbreaks (>50 cases) of leptospirosis was abstracted from GIDEON. Outbreaks known to be associated with heavy rains or flooding are denoted by * A number of additional outbreaks have been associated with floods, but without specific mention of case numbers. Thus, a major outbreak in Krasnodar (Russia) in 1997 followed local flooding; as did epidemics in China during 1962 to 1963, 1966, 1973 to 1974 and 1984.

The Epidemiology module in GIDEON currently contains details of 8,910 Infectious Diseases outbreaks (Primary references are available on request)

Update: Reported in ProMED

A recent outbreak in Manila belies the fact that reported rates of leptospirosis in the Philippines had actually decreased in recent years. See graph:

The following additional background data are abstracted from GIDEON www.GideonOnline.com (primary references available on request):

Leptospirosis was first reported n the Philippines in 1932.
– 65 cases were documented in literature published during 1932 to 1970; 390 during 1971 to 1973; approxomately 840 during 1998 to 2001.
– Leptospirosis is common in flood-prone areas of urban setting such as Metro Manila.
– The average age of patients is 32 years, 87% of cases were males and 70% are outdoor workers.
– The case fatality rate is 12 to 14 percent.
– Rates in Cabatuan, Iloilo are estimated at 147 cases per 100,000 population (2007 publication).

Prevalence surveys:
5% of aseptic meningitis cases in Manila (1989 publication)

Seroprevalence surveys:
43.6% of rice farmers in Central Luzon (1988 publication)
0% of dogs (RMAT, 1970 to 1973)

The following serovars of Leptospira interrogans have been demonstrated among patients in the Manila area: poi, tarassovi, manilai, pyrogenes, australis, grippotyphosa, javanica and automnalis.

Notable outbreaks:
1976 to 1983 – An outbreak of leptospirosis was reported on a penal farm in Sablayan, Mindoro.
1999 – An outbreak (17 cases) of leptospirosis involved participants in an ‘iron-man contest’ – from Germany, Hong Kong and the Philippines.

Update: Posted in ProMED

A recent outbreak in Australia serves as a classic exercise in Epidemiology. Although Queensland and New South Wales account for most cases of Ross River disease, rates per 100,000 are consistently highest in Northern Territory.

Update: Referenced in ProMED

A recent outbreak in Guanajato reminds us that brucellosis remains a very common disease in Mexico. In fact, current rates are comparable to those of Greece, and similar to rates that existed in the United States during the 1930′s and 1940′s. See graph:

The following background data on brucellosis in Mexico are abstracted from Gideon

Time and Place:
- Highest rates are found in Queretaro, Coahuila, Guanajuanto, Nuevo Leon, Chicuahua, Jalisco, Tamaulipas and Michoacan.
- 163 fatal cases were reported during 1978 to 1982
- Mortality rates were 0.04 per 100,000 in 1992; 0.01 per 100,000 in 1996 .

Seroprevalence surveys:
3.42% nationwide, ranging from 0.24% in Morelos, to 13.5% in Mexico State (1992 publication)
0.71% of blood donors in northeastern Mexico (2009 publication)
0.238% of equines in Tamaulipas (Brucella abortus, 2006 publication)
9.8% of goats on farms (Brucella melitensis). (Michoacan, 2007 publication)

Infecting species:
- Brucella melitensis, B. abortus and B. canis are found in Mexico.
- The predominant species is Brucella melitensis. (1968 to 1991)

Reservoirs:
- The caprine seropositivity rate was 20.7% in 1947.
- Highest rates of caprine disease are reported in Coahuila, Chihuahua, Jalisco and Zacatecas.
- Highest rates of bovine disease are reported in Chihuahua, Hidalgo and Guanajuato.
- 11.8% of stray dogs in Mexico City are infected by Brucella canis.

Vehicles:
- Most infections are acquired from unpasteurized milk, fresh cheese and other dairy products – primarily from goats (There are over 9 million goats in Mexico).
- More than 35% of cow milk is consumed unpasteurized – more than 85% of goat milk.

Update: Posted in ProMed