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Archive for the ‘Epidemiology’ Category

Schistosomiasis in The Philippines

The following is abstracted from reference [1] and the Gideon web application .  Primary references are available on request.

Schistosomiasis was first reported in the Philippines in 1906, and as of 1921, an estimated 25,000 to 30,000 people were infested.  During 1944 to 1945, 1,700 cases were reported among American and Australian military personnel serving in the Philippines.

An estimated 300,000 Filipinos were infested as of 1948.  By 1970, the disease was known  to be epidemic to 24 provinces.; and as of 1975, 5 million persons were considered at risk and approximately 1 million infected.  By 2002, an estimated 800,000 were infested and 6.7 million at risk; and as of 2010, an estimated 560,000 were infested.

Reported incidence and mortality data are summarized in the following graph:

In recent years, cases have been reported from Mindoro Oriental and Sorsogon in Southern Luzon; the provinces of North, East and Western Samar; LeyteBohol in Eastern Visayas; all of Mindanao with the exception of Misamis Oriental, Davao Oriental and Maguindanao.

Schistosomiasis is most common among males, and individuals ages > 19 years.  

Notable outbreaks were reported in Davao del Sur in 2000 (222 cases as of October – most in Digos- Igpit, Colorado, and Matti barangays); and in Palo, Leyte in 2011 (99 cases)

Infestation by Schistoma japonicum is common among dogs, field water buffaloes (Carabao) and rats on Leyte.  The local snail reservoir is Oncomelania hupensis quadrasi 


  1. Berger S. Infectious Diseases of the Philippines, 2017. 342 pages, 93 graphs, 1,035 references. Gideon Informatics

Tick-borne Encephalitis in the Baltic Region

Rates of Tick-borne encephalitis reported by Estonia, Latvia and Lithuania have been strikingly similar for the past two decades.  See graph [1] :

This phenomenon seems to have begun only after dissolution of the former Soviet Union, and could reflect similar ecology, weather or other regional factors.


Graphs on Graphs

Note featured in ProMED

Hepatitis E in the United Kingdom

A recent posting in ProMED discussed the threat of Hepatitis E related to pork products imported into the United Kingdom from France, Germany and the Netherlands.  Indeed, all countries concerned have been reporting increasing rates for this disease in recent years – see graph [1]  :


  1. GIDEON Graphs Tool

Note featured on ProMED



Travel-Related African Trypanosomiasis

During January 1970 to May 2017, 138 case reports of travel-related trypanosomiasis were published in the medical literature.  In 49 cases (36%) the patients were identified as Europeans, and in 49 (37%) the disease was acquired in Tanzania.  A chronology of these events follows below [1].

African Trypanosomiasis – A Chronology of Travel-Related Cases

Year               Patient From                              Infected In                         Cases (#)

1970  Switzerland multiple **  1
1970  United States multiple  2
1975  Sweden Gambia  1
1977  Switzerland multiple  1
1981  United States Tanzania  1
1986  United States Zambia  1
1990 *  Switzerland Rwanda   2
1991  United States multiple   1
1991  New Zealand multiple   1
1992  France Angola   1
1994*  France Rwanda   2
2004*  United Kingdom Ghana   1
1995*  Netherlands Zimbabwe   1
1995*  Netherlands Cameroon   1
1996  Mexico Kenya   1
1996  Italy D. R. Congo   1
1997  Brazil Angola   1
1997  France Rwanda   1
1998  Australia Tanzania   1
1999  United States Tanzania   3
1999  France Gabon   1
2000  South Africa Malawi   1
2000  United States Tanzania   1
2000  United Kingdom Tanzania   1
2000  United Kingdom Zambia   1
2000  France Guinea   2
2000  Germany N.A.   1
2000  Australia Tanzania   1
2001  Italy Tanzania   2
2001  Brazil  Angola   1
2001  Netherlands Tanzania   3
2001  United Kingdom Zambia   1
2001  United States Tanzania   4
2001  Norway Tanzania   1
2001  Germany Cameroon   1
2001  United Kingdom Tanzania   1
2001  United States Sudan   1
2001  United States Angola   1
2001  Belgium Tanzania   2
2001  Sweden Tanzania   1
2001  South Africa Tanzania   3
2002  United Kingdom Tanzania   1
2002  India Tanzania   1
2002  United States Tanzania   1
2002  Canada D. R. Congo   1
2002  France Gabon   1
2003  United Kingdom Tanzania   2
2004  South Africa Malawi   2
2004  United Kingdom Tanzania   2
2004  Netherlands Angola   1
2004  Italy Gabon   1
2004  Italy C.A.R.   1
2004  United States Tanzania   2
2005  United States Tanzania   1
2005  South Africa Malawi   2
2005  South Africa Zimbabwe   1
2005  Italy multiple   2
2006*  Netherlands Tanzania   1
2006  Italy D. R. Congo   1
2006  United States Tanzania   1
2006  South Africa Uganda   1
2007*  France multiple   2
2007  Canada Malawi   1
2007  South Africa Malawi   5
2007  United Kingdom Malawi   1
2007  Australia Malawi   2
2008  United Kingdom Tanzania   1
2008  United Kingdom Zambia   1
2008  Spain Eq. Guinea   1
2008  Netherlands Tanzania   1
2008  United States Tanzania   1
2008  South Africa Tanzania   1
2008  Canada  D. R. Congo   1
2008  South Africa Malawi   2
2008  Australia Uganda   1
2009*  France Gabon   1
2009*  Netherlands Angola   1
2009*  United Kingdom Tanzania   1
2009  Portugal Angola   1
2009  South Africa multiple   3
2009  United States Zimbabwe   1
2009  Israel Tanzania   1
2009  Germany Tanzania   1
2009  United States Tanzania   1
2009  Netherlands Tanzania   1
2009  Poland Uganda   1
2010  South Africa Zambia   1
2010  United States Cameroon   1
2010  United Kingdom Zimbabwe   1
2010  United Kingdom multiple   1
2010  Portugal Angola   1
2010  United States Zambia   1
2010  South Africa D. R. Congo   2
2010  South Africa Malawi   1
2012*  France Gabon   1
2012  Belgium Kenya   2
2012  Germany Kenya   1
2012  Sweden Tanzania   1
2012  United States Zimbabwe   1
2014*  Germany Cameroon   1
2015  Canada Zambia   1
2016*  Spain  Eq. Guinea   1
2016*  China Gabon   1
2016  United States multiple   1
2016  United States Uganda   1
2017  Netherlands Tanzania   1


*      year of publication

**     exposure in multiple / countries


Trypanosomiasis due to T. brucei gambiense entered Tanzania from Zaire in approximately 1902; T.b. rhodesiense from Mozambique in 1910.  As of 2004, transmission was reported in Kigoma (Kibondo and Kasulu districts), Tabora (Kigoma, Sikonge and Urambo districts), and Rukwa (Mpanda district).  Highest prevalence occurs in Arusha and Kigoma.   An estimated 1.5 million persons lived in endemic zones during the 1980’s.   For several decades, disease rates in Tanzania have paralleled those reported for Africa as a whole  (see graph) [2]



Prevalence surveys have demonstrated that 15.8% of cattle (Bos indicus) from traditional pastoral Maasai and managed Boran regions are infested; 0.7% in Monduli District, northern Tanzania.  The parasite has also been identified in 10.1% of domestic pigs in Mbulu, Arumeru and Dodoma; and in 0.010% of tsetse flies (Glossina swynnertoni and G. pallidipes) in Serengeti National Park.


  1. Berger SA. Gideon Guide to Cross Border Infections, 2017. 217 pages, 128 tables, 3,936 references Gideon e-books
  2. GIDEON – (user generated graphs tool)

Note featured in ProMed


South Sudan: Unknown Hemorrhagic Illness

Regarding an ongoing outbreak of hemorrhagic illness in South Sudan, a differential diagnosis list generated by Gideon [Global Infectious Disease & Epidemiology Network], includes 2 lesser-known pathogens which have been associated with single small clusters of hemorrhagic fever in Africa: Bas-Congo virus (rhabdovirus) and Lujo virus (arenavirus). In 2008, 4 of 5 patients died of Lujo virus infection in a South African hospital, following transfer of an index patient from Zambia. The following year, 2 of 3 villagers in DR Congo died in an outbreak of Bas Congo virus infection. If tests for other pathogens continue to be negative, these 2 agents might be considered.

Cited on ProMED

Measles in Cambodia

Major outbreaks of measles were reported in Cambodia during the 1980’s.  As vaccination uptake steadily increased to levels in excess of 90%, disease incidence in the country is currently similar to the low rates reported by neighboring countries [1,2]  See graphs [3]:






  1. Berger SA. Measles: Global Status, 2016. 429 pp, 537 graphs, 3,928 references. Gideon e-books,
  2. Berger SA. Infectious Diseases of Cambodia, 2016. 425 pp, 54 graphs, 2,029 references. Gideon e-books,
  3. Gideon Graphs Tool at:

Hand, Foot and Mouth Disease in Singapore

Highest rates of Hand, foot and mouth disease (HFM) in Asia are reported by Singapore and Macao.  In fact, the incidence of HFM in Singapore is even higher than that of the more familiar dengue fever. [1,2]






  1. Berger SA. Infectious Diseases of Singapore, 2016. 461 pages, 112 graphs, 2073 references. Gideon e-books,
  2. See Gideon Graphs Tool at:


Yellow Fever and Fame

Infectious Diseases continually shape human history, often through their impact on leaders in Science, Politics, War, Religion, Industry and Art. The death of a King, President or Pope from plague or malaria can affect us all, and serves as a useful paradigm in the appreciation of these conditions. For many, yellow fever (YF) remains a “rare tropical disease” which (as in the current Angolan outbreak) periodically erupts in the developing world. Few realize that major YF outbreaks were recorded in the United States, Spain, Italy and even England into the early twentieth century. A chronology of outbreaks beyond The Tropics appears below.

A list of notables who died of YF includes Benjamin Latrobe, the architect who designed the United States Capitol Building, and Henry Lehman, the financier who founded Lehman Brothers. Both contracted the disease in New Orleans, respectively in 1820 and 1855. Heads of State who died of YF included Haitian President Alexandre Petion (died 1818) and Thomas Dundas, Governor of Guadeloupe (died 1794). Non-fatal attacks appear in the biographies of American President Zachary Taylor, Texas President Anson Jones and Chilean Supreme Director, Bernardo O’Higgins.

Other victims of YF included Cyrus McCormick, Thomas Nast, Donald Meek, John James Audubon and Alexander Selkirk. McCormick, inventor of the mechanical reaper, acquired the infection in Virginia at the age of 5. Nast, a legendary political cartoonist, was stricken in Ecuador in 1902; and Meek an iconic character actor, was rendered permanently bald after surviving Yellow fever during the Spanish American War. Audubon survived an attack of YF in 1803, after emigrating to Philadelphia from Haiti. That year, outbreaks of the disease were reported in both. Alexander Selkirk, the Scottish castaway who served as inspiration for Robinson Crusoe, died of YF during Navy service in West Africa (1721).   Indeed, military activity often exposes famous people to “exotic” diseases. Thus, British war hero Horatio Nelson suffered a nonfatal attack of YF in Cuba in 1780; and Samuel Nicholas, first Commander of the United States Marines, died during an outbreak in Philadelphia in 1790. A number of former Civil War Generals succumbed to the disease, including Charles Griffin (1867), Cyrus Hamlin (1867), John Bell Hood (1879) and Edward Ord (1883).

To date, over 500 health-care workers have died during the Ebola epidemic in West Africa; and it is no surprise that several notable victims of Yellow fever have been scientists working with the disease itself. Physicians John Conrad Otto, Philip Syng Physick and Benjamin Rush all survived attacks of YF while working in Philadelphia. Medical personnel who died of YF included doctors Jesse Willam Lazear (1900) and James Carroll (1907), and nurse Clara Maass (1901), who succumbed after purposely exposing themselves to the bites of infected mosquitoes in Cuba. Other physicians who died of YF (country – year of death) included Francois Carlo Antommarchi (Cuba – 1838), personal physician to Napoleon Bonaparte; Richard Bayley (New York -1801), the first Chief Health Officer of New York City; and Paul A. Lewis (Brazil – 1929). In 1928, Hideo Noguchi and William Alexander Young both died of Yellow fever while studying the disease in Ghana.

Notable victims of Yellow fever have also included three painters, a chess master, four authors / journalists, and two co-conspirators in the Lincoln assassination. A full listing and additional background data are available on a free website which I maintain at   The site is interactive. Users can explore the medical history of over 22,000 “VIP’s” (and 130 famous animals) ; or generate lists based on disease, profession and year of death. Although specific diagnoses are derived primarily from biographies, which are often speculative or biased, entries are regularly updated as additional information becomes available. The author will value feedback and suggestions.

A Chronology of Yellow Fever Outbreaks Beyond The Tropics [1,2]

1730 – An outbreak (2,200 fatal cases) was reported in Cadiz, Spain (with subsequent outbreaks in 1731, 1736, 1764, 1800, 1802, 1805, 1810, 1813, 1819 and 1821.) 
1793 – An outbreak (4,044 fatal cases) of yellow fever was reported in Philadelphia, Pennsylvania.
1794 – An outbreak (360 fatal cases) was reported in Baltimore, Maryland.
1796 – An outbreak was reported in New Orleans, Louisiana.
1798 – Outbreaks were reported in Philadelphia, Pennsylvania (3,506 fatal cases) , New Haven, Connecticut and New York City.
1800 – An outbreak (1,197 fatal cases) was reported in Baltimore, Maryland.
1800 – An outbreak (60,000 fatal cases) was reported in Spain.
1802 – An outbreak was reported in Brest, France.
1803 – Outbreaks (606 fatal cases) were reported in New York City and Philadelphia, Pennsylvania.
1804 – An outbreak (2,000 cases, 650 fatal) of yellow fever was reported in Livorno, Italy.
1804 – Outbreaks were reported in Gibraltar and Alicante, Spain.1808 – An outbreak was reported in Georgia (U.S.).
1819 – An outbreak was reported in Cadiz, Spain.
1820 – An outbreak was reported in Savannah, Georgia.
1821 – An outbreak (20,000 fatal cases = one-sixth of the population) was reported in Barcelona following introduction by a ship from Cuba.
1823 – An outbreak was reported in Lisbon, Portugal.
1828 – An outbreak (5,383 cases, 1,183 fatal) was reported in Gibraltar.
1857 – An outbreak was reported in Oporto and Lisbon, Portugal.
1870 – An outbreak (1,235 fatal cases) in Barcelona was related to a ship arriving from Cuba.
1838 to 1839 – An outbreak was reported in Charleston, South Carolina.
1839 – An outbreak (250 fatal cases – 5% of the population) was reported in Galveston, Texas.
1852 – An outbreak was reported in Charleston, South Carolina.
1852 – An outbreak was reported in Southampton, England.
1855 – An outbreak was reported in Virginia.
1861 – An outbreak (40 cases, 26 fatal) was reported in Saint-Nazaire, France.
1862 – An outbreak was reported in Wilmington, North Carolina.
1863 – An outbreak was reported in Shreveport, Louisiana.
1865 – Outbreaks (27 cases, 17 fatal) were reported in Wales, and in Swansea, England (imported from Cuba).
1867 – An outbreak (1,150 fatal cases) of yellow fever was reported in Galveston, Texas.
1873 – An outbreak was reported in Shreveport, Louisiana.
1873 to 1875 – An outbreak was reported in Pensacola, Florida.
1876 – An outbreak was reported in Savannah, Georgia.
1877 – An outbreak was reported in Port Royal, South Carolina.
1878 to 1879 – Outbreaks of yellow fever were reported in Mississippi , Memphis, Tennessee and New Orleans, Louisiana (4,046 fatal cases).
1882 – An outbreak was reported in Pensacola, Florida.
1887 to 1888 – An outbreak was reported in Florida.
1888 – An outbreak of yellow fever was reported in Mississippi
1905 – Outbreaks were reported in New Orleans, Louisiana (8,399 cases) and Pensacola Florida.
1909 – An outbreak was reported on a ship arriving to Saint Nazaire, France from Martinique – with no secondary spread to the port.


  1. Berger SA. Yellow Fever: Global Status, 2016. 152 pates, 124 graphs, 983 references. Gideon e-books,
  2. Berger A. Infectious Diseases of the United States, 2016. 1,305 pages, 489 graphs, 15,433 references. Gideon e-books,

Update: Posted in ProMED

Lyme Disease in the United Kingdom

The following background data on Lyme disease in the United Kingdom were abstracted from Gideon and the Gideon e-book series.  [1,2] Primary references are available on request.

Time and Place:

Lyme disease is reported from East Anglia, Scotland, Wales, Yorkshire and Northern Ireland.  Highest incidence is associated with popular holiday destinations such as Exmoor, the New Forest, the South Downs, parts of Wiltshire and Berkshire, Thetford Forest, the Lake District, the Yorkshire moors and the Highlands and Islands of Scotland.  “Hot spots” for the disease include the New Forest and the Southwest region.  45% of reports originate in three contiguous counties in southern England:  Hampshire, Wiltshire and Dorset.  This area includes foci in and near the New Forest and Salisbury Plain. Other counties with a relatively high incidence include Devon and Somerset in southwestern England; and Norfolk in East Anglia.


Reporting rates in the United Kingdom are approximately 39% of true incidence (2011).  Case reports peak in the third quarter of each year, which accounts for 48% of all cases.

In the following graphs, I’ve contrasted case numbers and rates per 100,000 in the United Kingdom, with those reported in Ireland and the United States.  Note that highest disease incidence in the United Kingdom is reported from England and Wales;  and highest rates per 100,000 from Scotland.  Reported rates in the United States are approximately 2.5-fold those of Scotland.


Infections due to Borrelia burgdorferi, B. afzelii and B. garinii are identified.

Borrelia valaisiana and B. afzelii have been identified in ticks in Scotland.


Prevalence surveys:

23% of patients referred to an infectious disease unit for suspected Lyme disease (2006 to 2010)
2.3% of dog ticks in the United Kingdom (2009)
4.2% of ticks (Ixodes ricinus) in England (2014 publication)
0.5% of pet-dog ticks (2012 publication)
0% of tick larvae, 2.14% of nymphs and 0% of adults in South London parks (2015 publication)
8.6% of ticks in the Scottish Highlands (both B. afzelii and B. burgdorferi, 1997)
37% of ticks in wooded areas of southern Wales
8.6% of Highland ticks in Scotland (Borrelia burgdorferi, 1997)
5.6% of questing tick nymphs in Scotland (Borrelia burgdorferi, 2012 publication)
11.9% of grey squirrels in Scotland (Sciurus carolinensis, 2015 publication)

Seroprevalence surveys:

2.5% to 4.0% of blood donors in South England
0% to 0.5% of blood donors in the inner-city
25% of forestry workers in endemic areas (1989 publication)
14.3% of farmers in Northern Ireland (1990 publication)
6.5% of individuals in the Scottish Highlands (2004 to 2006)
23% of wild deer in England and Wales (2012 publication)


Grey squirrels (Sciurus carolinensis Gmelin) and pheasants (Phasianus colchicus Linneaus) 18 are important hosts for Ixodes ricinus, and may serve as amplifying hosts for Borrelia burgdorferi in this country.

Seropositive horses are found in most parts of the U.K.

Note featured on ProMed

1. Berger SA. Lyme Disease: Global Status, 2016. 87 pages, 67 graphs, 1037 references. Gideon ebooks,

2. Berger SA. Infectious Diseases of the United Kingdom, 2016. 1317 pages, 971 graphs, 4,932 references. Gideon ebooks,

Infectious Diseases of the United Kingdom

Lyme Disease Rates in Finland

A recent report on ProMed that Lyme disease is an under-reported disease in Finland is disturbing.  Officially-reported rates have been increasing rapidly since the year 2000, and already exceed those of the United States by more than three-hundred percent !  [1,2]  See graph



  1. Berger S. Lyme Disease – Global Status, 2016. 83 pages, 66 graphs, 882 references. Gideon ebooks,
  2. Berger S. Infectious Diseases of Finland, 2016. 482 pages, 130 graphs, 2,035 references. Gideon e-books