Free 15 Day Trial Latest Updates Video Tutorials
Subscribe to Blog ,

Archive for the ‘Epidemiology’ Category

Cyclosporiasis in The United States

The following background information on Cyclosporiasis in the United States is abstracted from Gideon and the Gideon e-book series [1]   (Primary references are available on request)

Cyclosporiasis is the least common reportable protozoan infection in the United States.  In 2008, the reported disease rate among 10 states was 2.25 per 100,000 population.

The true incidence of food-borne cyclosporiasis in the United States has been estimated at 11,407 to 19,808 cases per year (15 hospitalizations), accounting for 0.1% of all food-borne illness. Approximately 42% of cases are imported.

1,110 individual cases of cyclosporiasis were reported during 1997 to 2008.  849 (76.5%) of the cases occurred in seven states, including 498 (44.9% of total) in Florida.  51.7% of cases with known travel history were autochthonous. {p 21471951}

No fatal cases were reported during 1998 to 2006.

Nine food-borne outbreaks (325 cases) of cyclosporiasis were reported during 1998 to 2002; 0 in 2007; 3 (66 total cases) in 2008; 1 (8 cases) in 2009; 0 in 2010.  Eleven   outbreaks (3,533 cases) related to imported food were reported during 1996 to 2014.

Reported disease rates have increased somewhat since 2012.  See graph:


Chronology of reported outbreaks:

  1. Outbreak (20 cases) among health-care workers at a hospital in Chicago, Illinois. Related to contaminated water
  1. Outbreak at a country club in New York State
  1. Outbreak in Florida associated with consumption of contaminated fresh raspberries.
  1. Multiple outbreaks (1,465 cases, 978 confirmed) in at least 15 states including New York (307), Florida (220), Massachusetts (170), New Jersey (103), South Carolina (38). Vehicles included raspberries and other fruit. The raspberries were imported from Guatemala and were thought to have been contaminated by water used in pesticide sprays.
  1. Outbreak (56 cases) at a hotel in Texas.
  1. Outbreaks (25 event-associated case clusters encompassing 370 cases) reported from eight states (California, Florida, Maryland, Nebraska, Nevada, Rhode Island, New York and Texas) and Canada (Ontario).
  1. Outbreaks (26 clusters encompassing 228 cases) reported from Virginia, Washington DC and Baltimore. Fresh basil and basil-pesto sauce implicated as the source. An additional 20 possible clusters (75 cases) were under investigation at the time.
  1. Outbreaks (over 1,700 cases during a five-month period) associated with raspberries, mesculun lettuce and basil. Fresh raspberries, imported from Guatemala were implicated in 19 of 21 outbreaks/ 70 sporadic cases confirmed in the United States and Canada during this period.
  1. Outbreak (57 cases) at a wedding in Massachusetts was associated with contaminated berries.
  1. Outbreaks (62 cases in 2outbreaks) in Missouri were associated with fresh basil, grown in either the United States of Mexico.
  1. Outbreak (54 cases) at a wedding in Philadelphia, Pennsylvania was ascribed to imported (Guatemalan) raspberries in a wedding cake. This was the fifth year that outbreaks associated with Guatemalan raspberries had occurred in North America during the spring months.
  1. Outbreak (96 cases) at a residential facility in Pennsylvania was associated with contaminated raw snow peas imported from Guatemala
  1. Outbreak (90 cases) in Illinois and Texas was caused by contaminated basil and spring mix salad.
  1. Outbreak (70 cases) in Florida
  1. Outbreak (100 cases) in Georgia among persons who had visited an aquarium
  1.  Outbreak (643 cases) involving multiple locations was related to contaminated bagged salad imported from Mexico.
  1. Outbreak (202 cases, including 49 in Texas) involved multiple locations.
  1. 2015. Outbreak (72 cases) in Texas
  1.  Outbreak (495 cases) in 30 states was related to ingestion of contaminated cilantro imported from Mexico.
  1.  Outbreak (72 cases) in Texas.


  1. Berger SA. Cyclosporiasis: Global Status, 2017. Gideon e-books.

Note featured on ProMED

Arboviruses in Queensland

As of 2017, Ross River disease and Barmah Forest disease continue to infect a considerable number of people in Queensland, Australia. In fact, rates of these two mosquito-borne viral infections in this state have changed little during the past 25 years. [1]   See graph:


  1. Berger SA. Infectious Diseases of Australia, 2017.  491 pages, 165 graphs, 2,982 references.  Gideon e-books,

Note featured on ProMED



Tetanus in Italy

Although the incidence of tetanus in Europe has been decreasing for many years, disease rates in Italy have changed little during the past two decades.  In fact, Italy currently accounts for most cases reported in the region. [1]  See graph:


  1. Berger S, 2017. Tetanus: Global Status. 528 pages, 812 graphs, 349 references. Gideon e-books,

Note featured in ProMED

Outbreaks of Non-tuberculous Mycobacterium Infection in the United States

To date, 114 known outbreaks of human infection by non-tuberculous mycobacteria (NTM) have been associated with medical / other invasive procedures.  37 of these (32%) have reported from the United States.  The following chronology is abstracted from the Gideon e-book series. [1]   Primary references are available from the author.

1987     17 cases of Mycobacterium chelonae otitis media in Louisiana caused by contaminated water used by an ENT practice

1988    8 cases of Mycobacterium chelonae infection associated with a contaminated jet injector used in a Podiatry office.

1989 – 1990   16 cases of  Mycobacterium fortuitum respiratory tract colonization in Washington, D.C. among patients on an alcoholism rehabilitation ward

1991 *     6 cases of Mycobacterium fortuitum infection in Washington, related to contaminated electromyography needles

1995 – 1996    87 cases (in 16 states) of Mycobacterium abscessus soft tissue infection associated with use of a contaminated adrenal cortex extract

1998     6 cases of Mycobacterium mucogenicum  bacteremia among bone marrow transplant and oncology patients in Minnesota, related to use of  contaminated water in a hematology-oncology unit.

1999     10 cases of Mycobacterium abscessus arthritis  in Texas associated with  contaminated benzalkonium chloride used in injections.

2000 – 2001     110 cases of Mycobacterium fortuitum skin infection in California,  associated with contaminated footbaths at a nail salon.

2001  Outbreak of Mycobacterium chelonae keratitis in California, associated with laser in situ keratomileusis (LASIK) performed in an Ophthalmology clinic.

2001 – 2002   Outbreak of Mycobacterium simiae infections in a Texas hospital was associated with contaminated tap water.

2002 *     34 cases of Mycobacterium chelonae soft tissue infection in California,  associated with liposuction procedures.

2002    115 cases of Mycobacterium fortuitum  infection in California, associated with contaminated footbaths at a nail salon.

2002     11 cases of Mycobacterium abscessus soft tissue infections in New York City, associated with injection of cosmetic substances by unlicensed practitioners

2002 – 2003     4 cases of Mycobacterium chelonae infection in New Jersey,  associated with injection of contaminated methylene blue solution into patients undergoing rhytidectomies.

2003     3 cases of Mycobacterium goodii infections at a hospital in Colorado,  associated with contaminated surgical implants

2004     12 cases of Mycobacterium abscessus soft tissue infection, among Americans undergoing cosmetic surgery at various clinics in the Dominican Republic

2004     143 cases of Mycobacterium fortuitum                skin and soft tissue infections in California,  associated with a nail salon

2008     4 cases of Mycobacterium mucogenicum bacteremia in North Carolina,  among sickle-cell anemia patients

2008 – 2011     6 cases of Mycobacterium wolinskyi infection among patients on a cardiothoracic surgery unit in Minnesota.

2009 *     6 cases of Mycobacterium chelonae infection related to contaminated needles used in a tattoo parlor.

2009     2 cases of Mycobacterium haemophilum infection in Washington,  associated with a tattoo parlor.

2009     5 cases of Mycobacterium abscessus infection reported at a cystic fibrosis center in Washington.

2011 *     11 cases of Mycobacterium porcinum infection in Texas,  related to contaminated drinking water.

2011 *      3 cases of Mycobacterium bolletii/M. massiliense furunculosis in North Carolina,  associated with a nail salon.

2011 *     Outbreak of Mycobacterium abscessus infections in Florida,  associated with outpatient rhytidectomies.

2011 – 2012     19 cases of Mycobacterium chelonae involving multiple states, associated with contaminated needles used in tattoo parlors.

2011 – 2012     15 cases of infection due to rapidly-growing Mycobacterium species, among transplant recipients on a hematopoietic stem cell transplantation unit in Minnesota.

2012     19 cases of Mycobacterium abscessus infection, among cystic fibrosis patients at a hospital in Hawaii

2013     2 cases among patients at a North Carolina cosmetic surgery clinic, associated with fractionated CO2 laser resurfacing procedures

2013 – 2014     19 cases of Mycobacterium abscessus and Mycobacterium fortuitum infections among Americans who traveled to the Dominican Republic of cosmetic surgery.

2013 – 2015     95 cases of  Mycobacterium abscessus infection at a hospital in North Carolina, associated with contaminated tap water.

2013 – 2014     39 cases of  Mycobacterium abscessus infection among transplant recipients in California,  associated with a contaminated environmental water source.

2014     15 cases of Mycobacterium abscessus infection at a South Carolina hospital, associated with contact between equipment and contaminated tap water

2015      2 cases of Mycobacterium chelonae  keratitis in Ohio, associated with use of contaminated humidifier in a laser in situ keratomileusis (LASIK) clinic.

2015      9 cases of Mycobacterium abscessus odontogenic infections at a Georgia practice,  among children undergoing dental pulpotomy.

2015     Outbreaks of Mycobacterium chimaera infections in Switzerland, the Netherlands, Germany, the United Kingdom and the United States (Pennsylvania) associated with a contaminated heater-cooler water unit manufactured in Germany, and subsequently in the United Kingdom.

2016     58 cases of Mycobacterium abscessus wound infection in California, associated with use of contaminated water during root-canal surgery at a dental practice.


* year of publication



  1. Berger SA, 2017. Gideon Guide to Outbreaks. 1,181 pages, 5,170 tables, 47,454 references. Gideon e-books,

Note featured in ProMED

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: