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Archive for the ‘Graphs’ Category

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


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:


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

Tick-Borne Encephalitis in the Czech Republic

Rates of Tick-borne encephalitis (TBE) in the Czech Republic are similar to those reported by Austria during the 1970’s. [1,2]   Following the institution of mass vaccination by Austria in 1981, TBE rates decreased to levels experienced in neighboring countries. [3] Enhanced administration of TBE vaccine might also prove effective for the Czech Republic.


1. Berger SA. Tick-Borne Encephalitis: Global Status, 2015. 65 pages, 45 graphs, 564 references. Gideon e-books,

2. Berger SA. Infectious Diseases of the Czech Republic, 2015. 497 pages, 143 graphs, 2,097 references. Gideon e-books,


Diphtheria in Latvia

Following a regional epidemic during the 1990’s, Latvia has continued to experience a high incidence of diphtheria. [1]  This phenomenon is difficult to explain on the basis of poor vaccine uptake. The following graph compares W.H.O. estimates of vaccination (DPT3) coverage with diphtheria rates reported in Estonia, Latvia and Lithuania. [2]



1. Berger SA. Infectious Diseases of Latvia, 2015. 436 pages, 103 graphs, 1,497 references. Gideon e-books,

2. Berger SA. Diphtheria – Global Status, 2015. 333 pages, 445 graphs, 374 references. Gideon e-books,



Note featured on ProMED


Malaria in Brunei

Recently ProMED reported that two tourists from Singapore acquired Plasmodium knowlesi malaria in Brunei.

Malaria rates reported by both Brunei and Singapore have been strikingly similar since the 1990’s (see graph below) and Singapore has reported both autochthonous and imported cases of P. knowlesi infection since 2007.  During the 1950’s, Brunei reported low levels of malaria from the interior regions and coast adjacent to mountainous areas.  The predominant infecting species and vector were P. falciparum and Anopheles leucosphyrus, respectively. [1]


Brunei was officially declared “malaria-free” by WHO in 1987.  A single publication reported a case of P. knowlesi malaria in this country in 2013.

Although official sources do not routinely recommend malaria prophylaxis for travelers, the recent report in ProMED suggests careful review of the current status of the disease in Brunei.


Berger SA. Infectious Diseases of Brunei, 2015. 374 pages, 60 graphs, 1,448 references. Gideon e-books,

Update: Appeared in ProMED