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/

In recent years, reported rates of trichinosis in Mexico have decreased to levels which are comparable to those of the United States. In fact, Canada now reports the highest rates for North America (see graph). [1,2]

Chronology of trichinosis outbreaks in Mexico (primary reference available on request) [1,2]

Notable outbreaks:
1979 (publication year) – An outbreak was reported among family members in Naucalpan.
1981 (publication year) – An outbreak was reported in Villanueva, Zacatecas.
1984 (publication year) – Outbreaks were reported in Zacatecas.
1985 (publication year) – An outbreak was reported in Zacatecas.
1985 – An outbreak was reported in a government office in Federal District.
1986 (publication year) – An outbreak was reported in Durango.
1990 (publication year) – An outbreak (4 cases) among family members in Iztapalapa was caused by raw sausage.
1992 (publication year) – An outbreak (166 cases) in Delicias City, Chihuaha was caused by contaminated pork sausage.
1992 (publication year) – An outbreak (3 cases) among members of a family in Zapopan was related to consumption of raw pork.
1994 – An outbreak (7 cases) in France was associated with horsemeat imported from Mexico.
2001 (publication year) – An outbreak (5 symptomatic and 17 asymptomatic cases) was reported in Mexico State.

References:
1. Berger SA. Infectious Diseases of Mexico, 2010. 439 pp. Gideon e-books. http://www.gideononline.com/ebooks/country/infectious-diseases-of-mexico/
2. Berger SA. Trichinosis: Global Status, 2010. 81 pp. Gideon e-books. http://www.gideononline.com/ebooks/disease/trichinosis-global-status/

Although recent reports of Tick-borne encephalitis (TBE) in Croatia belie the fact that this disease has been steadily declining for five decades, the impact of TBE in Croatia is comparable to that of the main form of arthropod-borne encephalitis in the United States. See graph

TBE was first reported in Croatia in 1953, and mandatory reporting was instituted in 1987. There is only one natural focus in the northern part of the country, between the Sava and Drava Rivers. Alleged cases in Zadar and Pula, have not been certified. 75% of cases occur from May to July.

Approximately 20 cases per year are reported in Koprivnica-Krizevci County, characterized by a relatively mild illness without neurological residua.

References:
1. Berger SA. Infectious Diseases of Croatia, 2010. 356 pp. Gideon e-book series. http://www.gideononline.com/ebooks/country/infectious-diseases-of-croatia/
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/

The first cases of Lyme disease (LD) were recognized in Lyme, Connecticut in 1975. Although many assume that the condition is largely limited to the United States, LD has been reported in 63 countries as of 2010, with cases in Latin America, Asia, Europe and North Africa. Surprisingly, the world’s highest LD rates are reported in Slovenia, followed by the Baltic countries and Czech Republic (see graph). [1,2]

Borrelia burgdorferi was first isolated from patients in Slovenia in 1988, and from ticks in 1993.

Prevalence surveys:
7.7% to 46% of febrile illness following tick bite
45.5% of ticks in the Italy/Slovenia transborder territory (2008 publication)

Seroprevalence surveys:
15.4% of children and young adults in Slovenia (2000 publication)
23.8% of forestry workers (ELISA, 2002)

Infecting species:
– Borrelia burgdorferi, B. afzelii and B. garinii are encountered.
– B. afzelii accounts for the majority of isolates; however, B. garinii predominates among strains cultured from cerebrospinal fluid.
– B. bissettii has been isolated from humans with Lyme disease in Slovenia.
– Borrelia spielmanii (Borrelia A14S) has been implicated in cases of erythema chronicum migrans in Slovenia.

References:
1. Berger SA. Infectious Diseases of Slovenia, 2010, 373 pp. Gideon e-book series. http://www.gideononline.com/ebooks/country/infectious-diseases-of-slovenia/
2. Berger SA. Lyme disease: Global Status, 2010, 66 pp. Gideon e-book series. http://www.gideononline.com/ebooks/disease/lyme-disease-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/

A recent outbreak in Alcoy reminds us that rates of legionellosis have been increasing in Spain. The following background data are abstracted from the GIDEON e-book series. [1,2]

Graph 1 summarizes disease incidence and rates per 100,000 population.

Graph Notes:
1. 47 cases were reported in the Balearic Islands during 2001 to 2003.
2. 460 cases were reported among Spanish tourists during 2002 to 2006; 30 in 2005; 73 in 2006.
Individual years:
1993 – Included 57 cases in Cataluna
2003 – 5.82 per 100,000 in the Balearic Islands

As seen in Graph 2, this increase has also affected tourists in Spain.

Graph Notes:
1. 281 cases were acquired by foreign tourists in Spain during 1987 to 1995 – 67% of these from Great Britain. 37% of these were acquired in the Balearic Islands.
2. 627 cases were acquired by foreign tourists in Spain during 1989 to 2001.
3. 6,411 cases of legionellosis were reported during 1999 to 2004 – 565 (9%) involving Spanish travelers, and 426 involving foreign travelers in Spain.
4. 73 travel-associated cases were reported in 2006; 68 in 2007.
Individual years:
2003 – Included nine Spanish citizens touring within Spain.

Legionellosis accounts for 3% of community-acquired pneumonia in Palma de Mallorca (1992 to 1994)

Outbreaks – an overview:
- 1989 to 1998 – 55 outbreaks of legionellosis were reported – 36 of these associated with tourism, 11 nosocomial and 8 community-acquired.
- A single hotel in Benidorm was implicated in the infection of 3 tourists in 1989, 1 in 1990, 2 in 1995, 1 in 1996; 3 in 1997; 8 (1 fatal) in 1998.
- 1990 to 1991 – 54 outbreaks involving 805 cases (and additional 1,358 sporadic cases) were reported.
- 1990 to 2004 – 118 outbreaks involving 690 patients were reported in Catalonia – 35.6% involving water towers, and 14.4% involving water distribution systems in public buildings.
- 1999 to 2001 – Four outbreaks affected over 160 people in Alcoy.
- 2000 – Seven outbreaks were reported – 4 of these nosocomial. An additional 4 clusters were reported among tourists to Spain.
- 2000 – Girona reported 32 cases (3 fatal); Barcelona 48 (1 fatal); Vigo 30 (4 fatal) and Alcala de Henares 249 (11 fatal).
- 2001 to 2003 – 135 cases (10 fatal) in 46 clusters were acquired by European travelers to Spain, including 85 in 2002
- 1999 to 2003 – Eight outbreaks (approximately 300 cases) were reported in Alcoy, Alicante.
- 2003 – 55 outbreaks (247 cases) were reported.

Notable outbreaks:
1973 – An outbreak (89 cases, 3 fatal) was associated with a hotel in Benidorm.
1978 (publication year) – An outbreak (2 fatal cases) was associated with a hotel in Benidorm.
1983 – An outbreak (35 cases) in Valencia was related to contaminated shower heads and toilet tanks.
1984 (publication year) – An outbreak was reported in Los Castillejos.
1984 – An outbreak (32 cases) was reported among Dutch tourists at a hotel in Pineda de Mar (Barcelona region, Spain).
1988 – An outbreak (56 cases) was reported in Barcelona.
1992 (publication year) – An outbreak (6 cases) in a private apartment building in Zaragoza was associated with potable water.
1992 (publication year) – An outbreak was reported in a hospital in Badalona.
1993 – An outbreak (4 British tourists and 1 French tourist) was reported at a hotel in Spain.
1994 – An outbreak (20 cases) was reported in L’Espluga de Francoli, Tarragona.
1996 – An outbreak (260 cases, 197 hospitalized, 14 fatal) was reported in Madrid region (Alcala de Henares). This was the largest outbreak reported in Europe to date.
1996 – An outbreak (4 cases) was reported among British tourists at a hotel in Minorca.
1998 – An outbreak (3 cases, all fatal) was reported in a hospital in Zaragoza.
1999 – An outbreak (6 cases) was reported among foreign tourists to a spa in Cestona (Guipuzcoa Province).
1999 – An outbreak (7 cases, 1 fatal) was associated with a hotel outbreak in Benidorm.
2000 – An outbreak (70 cases, 2 fatal) was reported in Alcoy (Valencia region).
2000 – An outbreak (28 cases) was associated with a cooling tower in the region of a hospital in Vigo (Galicia).
2000 – An outbreak (54 cases, 17 hospitalized, 3 fatal) was reported in the “La Barceloneta” district of Barcelona.
2001 (publication year) – An outbreak (2 cases, both fatal) was reported among mechanics working on a cargo ship in the port of Barcelona.
2001 – An outbreak of 751 clinical cases (449 confirmed, 2 fatal) was reported in Santa Maria de Gracia (Murcia) – the world’s largest recorded outbreak to that time. The source of infection was an outdoor hospital cooling tower.
2001 – An outbreak (18 cases, 3 fatal) was reported from a hospital in Pamplona. A contaminated hot water system was implicated.
2002 – An outbreak (124 cases, 2 fatal) in Matara, Catalonia was related to a local cooling tower.
2003 – Outbreaks (25 total cases, 1 fatal) were reported in Valencia.
2003 – An outbreak (4 cases) was reported at a spa on Tenerife. An additional suspect case was reported in a Venezuelan visitor to the spa.
2004 – An outbreak (28 confirmed cases, 1 fatal) was reported at a hospital in Zaragoza. Contaminated cooling towers were implicated.
2004 – An outbreak (33 cases, 2 fatal) in Vallarca, Barcelona was caused by a contaminated air conditioning system at a private clinic.
2005 – An outbreak (19 cases, 3 fatal) was reported in Barcelona.
2005 – An outbreak (28 cases, including 21 foreigners – 0 fatal) was associated with a shopping center in Torrevieja.
2005 – An outbreak (55 cases, 3 fatal) was associated with a cooling tower in Catalonia.
2006 – An outbreak (146 cases, 0 fatal) in Pamplona was ascribed to contaminated cooling towers.
2006 – An outbreak (5 cases) was reported among ceramic workers in Castellon.
2006 – An outbreak (12 cases) in Catalonia was related to a contaminated mist machine.
2007 (publication year) – An outbreak of Legionnaires’ disease was reported among immunosuppressed patients at a cancer centre in Barcelona.
2007 to 2008 – An outbreak (3 cases) on a hospital surgical ward was associated with a contaminated oxygen humidifier.

References:
1. Berger SA. Infectious Diseases of Spain, 516 pp. Gideon Informatics, Inc. 2010, http://www.gideononline.com/ebooks/country/infectious-diseases-of-spain/
2. Berger SA. Legionellosis: Global Status, 84 pp. Gideon Informatics, Inc. 2010, http://www.gideononline.com/ebooks/disease/legionellosis-global-status/

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.

Although increasing numbers of malaria cases have been reported in Ireland in recent years, disease rates for Northern Ireland and the United Kingdom as a whole have actually declined. [1,2]

References:
1. Berger SA. Infectious Diseases of Ireland and Northern Ireland, 2010. Gideon e-book series, 437 pp. http://www.gideononline.com/ebooks/country/infectious-diseases-of-ireland-and-northern-ireland/
2. Berger SA. Malaria: Global Status, 2010. Gideon e-boon series, 378 pp. http://www.gideononline.com/ebooks/disease/malaria-global-status/

Regarding recent TBE activity in Altai and Omsk, a total of 26 human zoonoses are transmitted by ticks. Thirteen of these occur in Russia: [1]

Anaplasmosis
Astrakhan fever
Babesiosis
Crimean-Congo hemorrhagic fever
Japanese spotted fever
Lyme disease
North Asian tick typhus
Omsk hemorrhagic fever
Powassan
Relapsing fever
Rickettsial Spotted fevers (ie, Rickettsia slovaca infection)
Tick-borne encephalitis
Tularemia

References:
1. Berger SA. Infectious Diseases of the Russian Federation. 2010, Gideon e-book series, 461 pp. http://www.gideononline.com/ebooks/country/infectious-diseases-of-the-russian-federation/

The following backround data on dengue in Egypt are abstracted from the GIDEON e-book series. [1,2]

Historical background:
– Outbreaks of dengue were reported in Cairo and Alexandria during 1799; and in Port Said in 1871.
– Subsequent cases were reported in Cairo and the sea ports in 1880; and in the Nile delta in 1889.
– Dengue fever was widespread during the first half of the 20th century.
– A decline in transmission was recorded in Egypt after 1940, and was ascribed to rapid decrease of Stegomyia (Aedes) aegypti populations with the introduction of DDT during and after the Second World War.

Notable outbreaks:
1928 – An outbreak (70 fatal cases) was reported.
1937 – An outbreak (50 fatal cases) was reported.

References:
1. Berger SA. Infectious Diseases of Egypt. 2010, Gideon Informatics, Inc., 367 pp. http://www.gideononline.com/ebooks/country/infectious-diseases-of-egypt/
2. Berger SA. Dengue: Global Status. 2010, Gideon Informatics, Inc., 191 pp. http://www.gideononline.com/ebooks/disease/dengue-global-status/