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Archive for the ‘Epidemiology’ Category

Leptospirosis in Israel

The following background information on Leptospirosis in Israel is abstracted from Gideon and the Gideon e-book series. [1,2] Primary references are available from the author.

Leptospirosis is most common in agricultural settlements of the Galilee, during the months of June to September.  Reported disease incidence reached a peak of 81 cases in 1962, but have since decreased considerably. 48 cases were reported during 2002 to 2008 – including 20 travel-related cases (15 of these acquired in southeast Asia).  Rates per 100,000 have been comparable to those reported in the United States for the past three decades (see graph) [3]

During 1970 to 1973, the main infecting serovars of Leptospira interrogans were grippotyphosa (41%) and hebdomadis (31%).  Serovars hardjohebdomadis and grippotyphosa accounted for 79% of cases during the 1970’s, and 32% during 1985 to 1999.  Serovar. icterohaemorrhagiae accounted for 2% during the 1970’s, and 29% during 1985 to 1999.

14 fatal cases of leptospirosis were reported during 1954 to 2017, the most recent in 1999.

The following chart summarizes five outbreaks of leptospirosis reported from Israel.


  1. Berger S.  Leptospirosis: Global Status, 2018.  223 pages , 177 graphs , 1,840 references. Gideon e-books,
  2. Berger S. Infectious Diseases of Israel, 2018. 481 pages , 238 graphs , 1,503 references. Gideon e-books,
  3. Gideon e-Gideon multi-graph tool,

Note featured in ProMED


Legionellosis in Italy

The following background data are abstracted from Gideon and the Gideon e-book series. [1,2]  (Primary references are available on request).

The first case of legionellosis in Italy was reported in 1981 (from Emilia Romagna), and passive surveillance was initiated in 1983.  Reported disease rates in Italy and surrounding countries have increased dramatically since 2000.  The rate of under-reporting for legionellosis in Italy is estimated at 21.4%

As seen in the following graph, parallel rate increases have been reported in the United States and Italy.  Disease rates in the latter are approximated five-fold those reported for the European Region as a whole, and 1.3-time higher than those reported in the United States.

Approximately 63% of cases are reported from Northern Italy (1983 to 1994); and Legionella pneumophila serogroup 1 is responsible for 94% of cases.  The male/female ratio for reported cases is 3.45/1;  and 56.6% of the patients are above age 49.

819 presumptive cases and 490 confirmed cases were registered during 1983 to March 1994, including 67 fatal cases during 1983 to 1990.  9,803 cases (11.8% fatal) were reported during 2000 to 2011.

During 1973 to 1987, 117 cases (6 fatal) were reported among tourists to Italian summer resorts.  During 2002 to 2007, the annual incidence of legionellosis among European travelers to Italy ranged from 96 to 143 cases.  Seven cases were reported among tourists in Rome during 1998 to 1999, and 10 cases in 2000.  In 2003, 64 internal (Italian) tourists acquired legionellosis within Italy.

The following screen-shots from Gideon summarize published outbreaks and surveys for legionellosis in Italy.

Italy:  Legionellosis Outbreaks


Italy: Legionellosis Prevalence Surveys


  1. Berger S. Legionellosis: Global Status, 2018. 134 pages , 111 graphs , 1,427 references. Gideon e-books,
  2. Berger S. Infectious Diseases of Italy, 2018. 500 pages , 116 graphs , 3,264 references. Gideon e-books,
  3. Gideon e-Gideon multi-graph tool,

Note featured in ProMED

Leishmaniasis in Palestine

In the following charts, I’ve compared reported incidence rates for cutaneous leishmaniasis in the two states which comprise Palestine.  Note that disease rates in  a third area (Gaza / West Bank) are two- to three-fold those reported by Israel and Jordan.  Significantly, current rates in Syria (per 100,000) are approximately one hundred-fold those of Israel (280 vs. 3 in 2016) [1,2]



  1. Berger S. Cutaneous and Mucosal Leishmaniasis: Global Status, 2018. 166 pages , 111 graphs , 1,681 references. Gideon e-books,
  2. Gideon e-Gideon multi-graph tool,

Note featured on ProMED

Campylobacteriosis in New Zealand

The following background information on campylobacteriosis in New Zealand is abstracted from Gideon and the Gideon e-book series. [1-2]  (primary references available on request)

The incidence of campylobacteriosis exceeds that of any other reportable disease in New Zealand.  In fact, Campylobacteriosis accounted for 42.5% of all notified cases of infectious disease in 2010.  Highest rates are reported during late spring and early summer (November to January).  Rates on South Island are correlated with lower socio-economic level, proportion of persons ages 25 to 44 and density of fresh food outlets. The Far North and much of the rural North Island report relatively low disease incidence during summer, with minimal inter-seasonal variation. Highest summer incidence and inter-seasonal variation are reported in Christchurch, Dunedin, much of the South Island, Wellington and Upper Hutt.  47% of campylobacteriosis cases are acquired from food, 28% direct animal contact, 7% overseas travel, 4% person-to-person transmission and 3% water-related.

The following graph compares the yearly reported incidence of six diseases associated with diarrhea.  Note that giardiasis is more common than salmonellosis, shigellosis and VTEC (verotoxin-producing Escherichia coli) infections in this country.  Significantly, 2,056 patients were hospitalized for Guillain-Barre syndrome (a condition which often complicated campylobacteriosis) during 1988 to 2010.  Decreasing rates of campylobacteriosis since 2007 were ascribed to efficient disease control among poultry.

In the second graph, I’ve contrasted rates of campylobacteriosis in New Zealand with those of other English-speaking countries.


  1. Berger S. Infectious Diseases of New Zealand, 2018. 496 pages , 240 graphs , 839 references.  Gideon e-books,
  2. Berger S. Campylobacteriosis – Global Status, 2018. 150 pages , 100 graphs , 1,529 references. Gideon e-books,
  3. Gideon e-Gideon multi-graph tool,



Zoonotic Disease Deaths in the United States

With the exception of salmonellosis, deaths from Rocky Mountain spotted fever (RMSF) * have exceeded those of other reportable zoonoses in the United States for most of the past six decades. [1,2]    Rabies was the predominant cause of zoonotic death prior to 1950; Lyme disease and West Nile fever since 2000.

* Since 2010, reporting of “Rocky Mountain spotted fever” has been broadened to include related diseases –  under the heading “Spotted fever rickettsiosis”



1. Berger S. Infectious Diseases of the United States, 2018. 3,166 pages , 510 graphs , 17,038 references. Gideon e-books,

2. Gideon e-Gideon multi-graph tool,

Escherichia Coli Enteritis in Ireland

Rates of disease due to Verotoxin-producing Escherichia coli (VTEC) in Ireland have increased dramatically since 2010, and are currently eight-fold those reported in the United States.  Significantly, corresponding rates of hemolytic-uremic syndrome and E. coli O157 infection in Ireland have changed little during this period. [1-3]


  1. Berger S. Escherichia coli Diarrhea: Global Status, 2018. 232 pages , 157 graphs , 4,551 references. Gideon e-books,
  2. Berger S. Infectious Diseases of Ireland and Northern Ireland, 2018.  416 pages , 224 graphs , 713 references. Gideon e-books,
  3. Gideon e-Gideon multi-graph tool,

Disease Outbreaks due to Sprouts

As of June, 2018 the Gideon database ( chronicles 22,777 published Infectious Diseases outbreaks.  Sprouts were implicated in 13.4% of outbreaks which specify a disease vehicle (5.2% of salmonellosis outbreaks).  Salmonellae were responsible for 83% of outbreaks associated with sprouts.  The remainder were caused by Escherichia coli, Listeria monocytogenes or Bacillus cereus. [1]


1 Berger S. Gideon Guide to Outbreaks, 2018. 2,011 pages, 5,272 tables, 51,622 references. Gideon e-books,

Japanese Encephalitis in Assam State

Since 2008, data regarding Japanese Encephalitis in India have distinguished between Japanese encephalitis [JE] and Acute encephalitis syndrome [AES].  Cases of the latter have been variously ascribed to Chandipura, enteroviral infection, scrub typhus and lychee fruit intoxication.  [1,2]    In 1963, 22% of individuals in Assam (Lakhimpur and Darrang districts) were seropositive toward JE virus.  Surveys conducted during 2006 to 2014 found that Japanese encephalitis was responsible for 30% to 78% of acute encephalitis cases in Assam.  A study published in 2007 found that 19.3% of patients with Japanese encephalitis in Assam State have concurrent neurocysticercosis.  In the following chart, I’ve compared reported incidence for these two conditions in India and in Assam State. [3]


  1. Berger SA. Japanese Encephalitis: Global Status, 2018. 96 pages , 66 graphs , 1,120 references  Gideon e-books,
  2. Berger SA. Infectious Diseases of India, 2018. 585 pages , 96 graphs , 6,487 references. Gideon e-books,
  3. Gideon e-Gideon multi-graph tool,

Note featured on ProMED

Mayaro Virus Disease and Travel

As of April, 2018 eleven cases of travel-associated Mayaro virus infection have been reported (see chart below). [1,2]  The current report on ProMED is the third to have originated in Peru.  A user-generated Gideon chart comparing the clinical features of several mosquito-borne viral diseases of Peru (Dengue, Chikungunya, Oropouche, Mayaro, Group C viruses and Zika) is also displayed.

                                                            Note:  Group C  zoonotic viruses of Peru = Ataqui, Iataya, Murutucu, Caraparu and Apeu


  1. Berger SA. Gideon Guide to Cross Border Infections, 2018. 237 pages, 133 tables, 4,061 references. Gideon e-books,
  2. Berger SA. Infectious Diseases of Peru, 2018. 367 pages, 100 graphs, 1,089 references. Gideon e-books,

Malaria Rates in Central America

Although CDC declared that there is no risk for malaria to American travelers in Costa Rica as of 2014, six of eleven cases reported by the latter in 2017 were classified as “autochthonous”. [1]  For much of the past fifty years, Costa Rica has reported the lowest rates of malaria in Central America; and rates for the entire region have decreased dramatically since 2000 [2,3]


  2. Berger SA. Malaria: Global Status, 2018. 497 pages, 557 graphs, 4,802 references. Gideon e-books,
  3. Berger SA. Infectious Diseases of Costa Rica, 2018. 328 pages, 120 graphs, 371 references. Gideon e-books,

Note featured on ProMED