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Archive for the ‘Graphs’ Category

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

Tularemia Deaths in the United States

Although tularemia is more common than plague in the United States, the case-fatality rate is higher for the latter.  Deaths reported for both diseases have changed little in five decades, with the number of tularemia deaths similar to the number of plague deaths in most years.  See graphs

Plague Tularemia

Tularemia Deaths


  1. Berger SA. Infectious Diseases of the United States, 2015.  1,208 pages, 483 graphs, 13,730 references. Gideon e-books,

Fifth Disease in Japan

The following background material on Fifth Disease in Japan is abstracted from Gideon and reference 1   Primary references are available on request to the author.
Epidemics of Parvovirus B19 infection occurred in Japan every ten years prior to 1980, and every five years since 1981.  Most cases occur during spring and summer, with highest rates among children ages 5 to 9 years.   See graph:


Parvovirus B19 infection causes an estimated 107 fetal deaths and 21 hydrops fetalis cases per year (2014 publication)
Eight cases of transfusion-associated Parvovirus B19 infection were reported during 1999 to 2008.

Prevalence surveys:
10% of nonimmune hydrops fetalis cases (1994 publication)

Seroprevalence surveys:
67.9% of healthy residents of Kyushu and Okinawa (IgG, 2013 publication)

2% of children ages 0 to 9 in 1973 and 16% in 1984

67% ages 20 to 29 in 1973 and 20% in 1984

80% ages 30 to 39 in 1973 and 56% in 1984

33% of pregnant women in Miyagi Prefecture in 1987, and 46% in 1997

Published outbreaks:
1977 to 1981 – Outbreaks of erythema infectiosum were reported – including 395 cases in one district of Tokyo.
1985 (publication year) – An outbreak of erythema infectiosum was reported.
1986 to 1987- Outbreaks of erythema infectiosum were reported.
1993 (publication year) – An outbreak of erythema infectiosum was reported among hospital staff members.
2000 (publication year) – An outbreak (10 cases) of nosocomial Parvovirus B19 infection was reported.

1. Berger S. Infectious Diseases of Japan, 2015. 632 pages, 166 graphs, 3,706 references. Gideon e-book series,

Hepatitis A in Lebanon

Hepatitis A rates in Lebanon are similar to those reported in neighboring Israel during the 1990’s [see graph] 

In 1999 (arrow) Israel became the first country to introduce universal Hepatitis A vaccination, a policy which might help reverse the increasing incidence experienced by Lebanon. [1-3]


1. Berger SA. Infectious Diseases of Lebanon, 2015. 389 pages, 54 graphs, 1,569 references. Gideon e-books,

2. Berger SA. Hepatitis A: Global Status, 2015. 184 pages, 183 graphs, 1,775 references. Gideon e-books,


Hand, Foot and Mouth Disease in Singapore

Rates of Hand, Foot and Mouth disease (HFM) in Singapore exceed those of all other reporting countries in Asia.  In fact, HFM is at least as common as varicella in Singapore [1,2].  See graph:





1. Berger SA. Enterovirus Infections: Global Status, 2015. 102 pages, 67 graphs, 1,936 references. Gideon e-books,

2. Berger SA. Infectious Diseases of Singapore, 2015. 460 pages, 112 graphs, 1,964 references. Gideon e-books,

3. Gideon graph tool at

Note appears on ProMED

Ross River Virus in Queensland

Queensland accounts for approximately 50% of Ross River virus infections reported in Australia. Notwithstanding an increase in incidence during January to February 2015, rates in Queensland have remained fairly constant for over two decades. [1,2] See graph


1. Berger S. Infectious Diseases of Australia, 2015. 616 pages, 165 graphs, 3,941 references. Gideon e-books,
2. Berger S. Australo-Pacific Arboviruses: Global Status, 2015.

Note featured on ProMED

Pertussis: Global Trends in Incidence and Vaccine Uptake

Recent pertussis outbreaks are of concern, but should not overshadow a dramatic decrease in disease rates documented during the past three decades. [1] In the following chart, I’ve compared regional trends in pertussis reporting and W.H.O. estimates of vaccine uptake [2] Note that vaccine coverage has changed little since 1990.


2. Berger S. Pertussis: Global Status, 2013. 353 pages, 511 graphs, 648 references. Gideon e-books,

Trichinosis: Cross-border Episodes

A recent trichinosis outbreak in Belgium related to Spanish boar meat reflects the continued high incidence of trichinosis in Spain. In fact, trichinosis rates in Spain are comparable to those which have not been encountered in the United States for more than 50 years [1,2] – see graph.

Cross-border incidents of trichinosis are relatively uncommon. The following chronology, including cases related to importation or human travel, is abstracted from Gideon (primary references available on request)

1975 – An outbreak (125 cases) of trichinosis in France was traced to horse meat imported from Poland.
1976 (publication year) – An outbreak (6 cases) in Paris was associated with travel to Egypt.
1985 – Outbreaks (1,073 cases, 2 fatal) in France were caused by horse meat imported from Germany and the United States.
1986 (publication year) – An outbreak (20 cases) among Gurkha soldiers serving in Hong Kong was associated with a barbecue.
1986 – An outbreak (2 cases) was reported among French-Vietnamese nationals who had eaten pork sausages at a diplomatic reception in Laos.
1990 – An outbreak (90 cases) among Southeast Asian refugees in the United States and Canada was associated with uncooked commercial pork served at a wedding in Des Moines, Iowa. This was the fourth outbreak reported since 1975 among Southeast Asian refugees in North America.
1992 – The world’s first case of human infection by Trichinella pseudospiralis was reported in New Zealand – probably acquired in Tasmania, Australia.
1982 – An outbreak (1,000 cases or more) was reported in the southern region of Lebanon – including six cases hospitalized in Israel.
1993 – An outbreak (538 cases) in France was traced to the meat of a single horse imported from Canada.
1994 – An outbreak (7 cases) in France was associated with horsemeat imported from Mexico.
1995 (publication year) – An outbreak (8 cases) in Germany and the former Yugoslavia involved family members who had shared smoked ham.
1995 to 1996 – A single case of trichinosis was reported in Japan – acquired during travel to Poland.
1997 – A Japanese traveler acquired trichinosis from smoked bear meat while in China.
1998 – An outbreak (404 cases, 37 hospitalized) in the France was related to consumption of meat from horse which had been imported from Yugoslavia.
1998 – An outbreak (92 cases, 0 fatal) in Italy was ascribed to imported Polish horsemeat.
1998 to 1999 – An outbreak (44 cases) in Germany was ascribed to raw smoked sausage (mettwurst) imported from Spain.
1999 – An outbreak (8 cases) among Yugoslavian immigrants in the United Kingdom was ascribed to salami imported from Serbia.
2000 (publication year) – An outbreak (25 cases) was reported among travelers returning to Singapore from a neighboring country.
2000 – An outbreak (8 cases) in England and Wales was ascribed to ingestion of imported meat products.
2001 – An outbreak (7 cases, none fatal) among Eastern European immigrants living in Rome was ascribed to imported pork sausage.
2002 – An outbreak (3 cases) in Germany was caused by infested smoked wild boar meat imported by travelers from Romania.
2002 – An outbreak (30 cases, 0 fatal) was reported among Thai workers in the Israel who had ingested the meat of a wild pig.
2003 (publication year) – An outbreak in Germany was reported among members of a family from Bosnia.
2003 (publication year) – A Japanese national acquired trichinosis in Kenya.
2004 – An expatriate developed Trichinella britovi infection in France from barbecued leg of jackal (Canis aureus) eaten in Algeria.
2004 – Two of the three cases of Trichinosis reported in the Czech Republic had been acquired in Poland and Macedonia.
2004 – An expatriate from New Zealand acquired trichinosis in Laos.
2004 – An outbreak (7 cases) of trichinellosis was reported Danes who had eaten home-made sausage purchased in Romania.
2004 (publication year) – An outbreak (2 cases) was reported in the Netherlands among family members who has consumed infested pork in Montenegro.
2005 – An outbreak (9 cases) of Trichinella nativa infection among French hunters in Canada was caused by contaminated bear meat. Eight additional cases were reported among persons in France who shared imported meat.
2006 – An outbreak (49 cases) in China was related to meat imported from Laos.
2007 – An outbreak (214 cases) in Poland was ascribed to contaminated raw sausage. Five cases in Germany, two in Ireland and 1 in Denmark were related to travel in the area of the outbreak.
2007 – An outbreak (21 cases) of Trichinella britovi infection among persons in Spain and Sweden was related to Spanish wild boar sausage.
2007 – An outbreak (3 cases) in Germany was caused by contaminated cured sausage eaten in Romania.
2008 – An outbreak (4 cases, 0 fatal) of trichinosis in Italy was reported among persons who had ingested infested pork in Romania.
2008 – An outbreak (8 cases) of human trichinosis associated with ingestion of raw soft-shelled turtles (Pelodiscus sinensis) was reported in Taiwan, including two cases exported to Japan. The pathogen in this case may have been Trichinella papuae.
2009 – An outbreak (3 cases) of trichinosis was reported among French nationals who had ingested warthog ham in Senegal.
2009 – An outbreak (5 cases) was reported among French tourists who ingested the meat of a grizzly bear while on a boating trip in Canada.
2009 – An outbreak of trichinosis among boar hunters in Bosnia was associated with a case hospitalized in Switzerland.
2010 – A case in Scotland was ascribed to ingestion of meat imported from France.
2011 (publication year) – A Thai worker acquired Trichinella papuae trichinosis from wild boar meat in Malaysia.

1. Berger SA. Infectious Diseases of Spain, 2014. 623 pages, 194 graphs, 3,844 references. Gideon e-books.
2. Berger SA. Trichinosis: Global Status, 2014. 90 pages, 73 graphs, 894 references. Gideon e-books.

Measles: Still A Problem Despite Four Decades of Progress

Although measles rates have declined dramatically during the past four decades, a recent upsurge reflects sub-optimal enforcement of vaccination in many countries. In the following graphs, I’ve summarized reported measles incidence and estimated vaccine uptake by region. Note that vaccination rates remain below 80% in three W.H.O. regions (African, Eastern Mediterranean and Southeast Asian), while they exceed 90% in the other three (European, American and Western Pacific) [1.2]


1. Berger S. Measles: Global Status, 2014. 415 pages, 537 graphs, 3,376 references. Gideon e-books,
2. Berger S. Infectious Diseases of the World, 2014. 1333 pages, 397 graphs, 26,187 references. Gideon e-books,

Also quoted in ProMED

Campylobacteriosis in Iceland

A recent posting in ProMED belies the fact that Iceland reports the lowest rates of campylobacteriosis in that region of Europe. [1-2] See graph [3] Note that an earlier outbreak (436 cases) was reported in 1999.


1. Berger SA. Infectious Diseases of Iceland, 2014 371 pages, 75 graphs, 1,455 references. Gideon e-books,
2. Berger SA. Campylobacteriosis: Global Status, 2014 104 pages, 96 graphs, 1,073 references. Gideon e-books,
3. Gideon graph tool at