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Archive for the ‘Outbreaks’ Category

Japanese Encephalitis in India

Outbreaks in Japanese encephalitis (JE) / Acute encephalitis syndrome (AES) have been reported from Assam and Uttar Pradesh in recent weeks.  Since 2008, official reports from India do distinguish between these two entities.  The following chart [1] indicates that although India has experienced increasing rates for both JE and AES on a national level,  incidence has not increased in these two states. [2,3]

 

References:
1. Gideon e-Gideon multi-graph tool,   https://www.gideononline.com/cases/multi-graphs/
2. Berger S. Infectious Diseases of India, 2019. 620 pages , 109 graphs , 6,807 references. Gideon e-books, https://www.gideononline.com/ebooks/country/infectious-diseases-of-india/
3. Berger S. Japanese Encephalitis: Global Status, 2019. 100 pages , 66 graphs , 1,208 references.  Gideon e-books, https://www.gideononline.com/ebooks/disease/japanese-encephalitis-global-status/

Histoplasmosis in Travelers

In 2019, several Canadian tourists acquired histoplasmosis while exploring caves in Cuba.  The Gideon database maintains an ongoing record of all cross-border Infectious Diseases events, including importation of animals and foods associated with zoonotic disease. [1-3]

As of 2019, 76 episodes of histoplasmosis had been associated with travel, involving at least 574 individual cases (8 fatal).  18 of these events were related to cave exposure, including two involving caves in Cuba.  Four publications described acquisition of histoplasmosis by Canadian travelers – two involving cave exposure.

In the following screen-shot, the frame to the left displays an interactive chronicle of cross-border histoplasmosis.  Users can sort data by year of event, country of exposure / origin, etc.  In this example I’ve selected “Setting” in order to study cases related to “cave exposure.”  Additional details and electronically-linked references appear when the user clicks on “Show event notes”

References:

  1. Gideon Online.  www.GideonOnline.com
  2. Berger S. Histoplasmosis: Global Status, 2019. Gideon e-books, https://www.gideononline.com/ebooks/disease/histoplasmosis-global-status/
  3. Berger S. GIDEON Guide to Cross Border Infections, 2019. 256 pages, 134 tables, 4,543 references.  https://www.gideononline.com/ebooks/travel/

Note featured on ProMED

Bolivian Hemorrhagic Fever

In 2019, a small outbreak of Bolivian hemorrhagic fever was reported at a hospital in La Paz, Bolivia.  The following background data on Bolivian hemorrhagic fever are abstracted from Gideon www.GideonOnline.com and the Gideon e-book series. [1,2]  Primary references are available from the author.

Bolivian hemorrhagic fever (BHF) is caused by Machupo virus (Arenaviridae, Tacaribe complex, Mammarenavirus).  The disease was initially described in 1959 as a sporadic hemorrhagic illness in rural areas of Beni department, eastern Bolivia; and the virus itself was first identified in 1963.  BHF is most common during April to July in the upper savanna region of Beni.  Principal exposure occurs through rodents (Calomys callosus) which enter homes in endemic areas.

BHF is one of several human Arenaviruses diseases reported in the Americas: Argentine hemorrhagic fever (Junin virus), Brazilian hemorrhagic fever (Sabia virus), Lymphocytic choriomeningitis, Venezuelan hemorrhagic fever (Guanarito virus) and Whitewater Arroyo virus infection.  (At least two related diseases are reported in Africa: Lassa fever and Lujo virus infection)

Infection of C. callosus results in asymptomatic viral shedding in saliva, urine, and feces; 50% of experimentally infected C. callosus are chronically viremic and shed virus in their bodily excretions or secretions.  C. callosus acquires the virus after birth, and start shedding it through their urine and saliva while suckling.  When mice acquire the virus as adults, they may develop immunity and no longer shed the virus.

Although the infectious dose of Machupo virus in humans is unknown, exposed persons may become infected by inhaling virus in aerosolized secretions or excretions of infected rodents, ingestion of food contaminated with rodent excreta, or by direct contact of excreta with abraded skin or oropharyngeal mucous membranes. Nosocomial and human-to-human spread have been documented.  Hospital contact with a patient has resulted in person-to-person spread of Machupo virus to nursing and pathology laboratory staff.

In 1994, fatal secondary infection of six family members in Magdalena, Bolivia from a single naturally acquired infection further suggested the potential for person-to-person transmission.

During December 2003 to January 2004, a small focus of hemorrhagic fever was reported in the area of Cochabamba. A second Arenavirus, Chapare virus, was recovered from one patient with fatal infection.

Early clinical manifestations consist of nonspecific signs and symptoms including fever, headache, fatigue, myalgia, and arthralgia.  Within seven days patients may develop hemorrhagic signs, including bleeding from the oral and nasal mucosa and from the bronchopulmonary, gastrointestinal, and genitourinary tracts. Case fatality rates range from 5% to 30%.

Ribavirin has been used successfully in several cases of BHF.  The recommended adult regimen is: 2.0 g IV, followed by 1.0 g IV Q6h X 4 days, and then 0.5 g Q8h X 6 days

Note that the etiologic agent and clinical features of BHF are similar to those of Argentine hemorrhagic fever (AHF).  Neurological signs are more common in AHF, while hemorrhagic diatheses are more common in BHF.  A vaccine available for AHF could theoretically be effective against BHF as well.

References:

  1. Berger S. American Hemorrhagic Fevers: Global Status, 2019. Gideon e-books,  https://www.gideononline.com/ebooks/disease/american-hemorrhagic-fevers-global-status/
  2. Berger S. Infectious Diseases of Bolivia, 2019. 342 pages, 87 graphs, 495 references.  https://www.gideononline.com/ebooks/country/infectious-diseases-of-bolivia/

Note featured on ProMED

 

Measles: Correlation of Vaccine Uptake with Disease Rates

The following is a country-by-country analysis of measles reporting trends vs. vaccine uptake.  For purposes of consistency, incidence data and population statistics used to calculate rates per 100,000 will be limited to those published by the World Health Organization (WHO).  Resultant graphs were generated by Gideon and abstracted from the Gideon e-book series [1,2]  True estimates of vaccination update statistics are those published by WHO, in most cases available only since 1980.  Data published by the countries themselves were not used, to avoid possible bias or inconsistency when comparing data among countries. Historical disease data which precede 1980 have also been appended to graphs to further appreciate the impact of vaccination.

The reader will note that in virtually all cases, the presumed impact of vaccine uptake on disease incidence occurs when vaccine uptake exceeds 80%, and again when rates increase beyond 90%.   As such, the few countries which have not achieved 80% uptake, or have consistently reported >90% uptake since 1980 are excluded.  Graphs are not included for countries for which data are not reported, or reported only sporadically.

Individual graphs for 135 countries are presented below in alphabetical order.  In 127 (94%) of these, a clear relationship seems to exist between increasing vaccine uptake and decreasing rates of measles.  In eight cases, temporary “spikes” in disease incidence were reported during years of high vaccine uptake: Japan, Jordan, Republic of Korea, Seychelles, Solomon Islands, South Africa, Sri Lanka and Syria.

I have not attempted to perform a statistical analysis of this phenomenon, and cannot say with certainty that a confounding (third) factor does not exist.  Nevertheless, these graphs appear to indicate a favorable effect of vaccination on measles incidence.

Measles Vaccine Uptake vs. Disease rates (per 100,000)

References:

  1. Gideon e-Gideon multi-graph tool,   https://www.gideononline.com/cases/multi-graphs/
  2. Berger S. Measles: Global Status, 2019. 548 pages , 538 graphs , 5,779 references. Gideon e-books,  https://www.gideononline.com/ebooks/disease/measles-global-status/

Leptospirosis in Israel

The following background information on Leptospirosis in Israel is abstracted from Gideon www.GideonOnline.com 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.

References:

  1. Berger S.  Leptospirosis: Global Status, 2018.  223 pages , 177 graphs , 1,840 references. Gideon e-books,  https://www.gideononline.com/ebooks/disease/leptospirosis-global-status/
  2. Berger S. Infectious Diseases of Israel, 2018. 481 pages , 238 graphs , 1,503 references. Gideon e-books,  https://www.gideononline.com/ebooks/country/infectious-diseases-of-israel/
  3. Gideon e-Gideon multi-graph tool,  https://www.gideononline.com/cases/multi-graphs/

Note featured in ProMED

 

Disease Outbreaks due to Sprouts

As of June, 2018 the Gideon database (www.GideonOnline.com) 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]

References:

1 Berger S. Gideon Guide to Outbreaks, 2018. 2,011 pages, 5,272 tables, 51,622 references. Gideon e-books,  https://www.gideononline.com/ebooks/outbreaks/

New Video tutorials for Outbreaks, Surveys and Cross Border Events

Dr. Steve Berger has release new videos to review how to use the Outbreaks, Surveys and Cross Border Events Public Health features of GIDEON.

They are included below:

Norovirus Infection in South Korea

The following background information on Norovirus infection in South Korea was abstracted from Gideon and the Gideon e-book series. [1-3]  A computer-generated parsing program of PubMeD and ProMED identifies 22,521 published Infectious Diseases outbreaks.  735 of these outbreaks specify Norovirus as the disease agent.  South Korea accounts for 0.67% of all outbreaks, and for 1.5% of Norovirus outbreaks.  Details of the individual events are summarized in table 1.

Further analysis of these sources identified 59,774 prevalence / seroprevalence surveys.  745 of these surveys examine the prevalence of viral agents associated with gastroenteritis.  South Korea accounts for 18.6% of all Infectious Disease surveys, and 3.4% of surveys involving viral gastroenteritis. Details of surveys which examine Norovirus prevalence are summarized in table 2.

Primary references are available from the author.

References:

  1. Berger SA. Infectious Diseases of South Korea, 2018. 418 pages, 108 graphs, 2,260 references. Gideon e-books, https://www.gideononline.com/ebooks/country/infectious-diseases-of-south-korea/
  2. Berger SA. Gideon Guide to Outbreaks, 2018. 1,900 pages, 5,246 tables, 50,908 references.  https://www.gideononline.com/ebooks/outbreaks/
  3. Berger SA. Gideon Guide to Surveys, 2018. 4,028 pages, 10,229 tables, 53,802 references.  https://www.gideononline.com/ebooks/surveys/

 

Trichinosis from Bear Meat

356 published outbreaks of trichinosis are chronicled by Gideon (www.GideonOnline.com) .  Where relevant information is given, bear meat is specified as the food vehicle in 13.6% of these outbreaks – see chart below. [1,2]  (Additional details and primary references are available from Dr. Berger).

References:

  1. Berger SA. Gideon Guide to Outbreaks, 2017. 1818 pages, 5120 tables, 47454 references. Gideon e-books, https://www.gideononline.com/ebooks/outbreaks/
  2. Berger SA. Trichinosis: Global Status, 2017. 114 pages, 75 graphs, 1037 references. Gideon e-books, https://www.gideononline.com/ebooks/disease/trichinosis-global-status/

Note featured in ProMED

Public Health enhancement: Outbreak and Survey tables

Outbreak / Survey tables are new additions to GIDEON. The innovative design allows users to quickly scan and compare outbreaks / surveys according to year, setting, number of cases / deaths, affected population and other parameters. This is the cumulative result of a huge effort to convert over 20,000 outbreaks and 50,000 surveys in GIDEON from text format to a database. Cross border events have also undergone this transformation in Worldwide notes.

GIDEON is the first publication which gathers all infectious disease outbreaks and surveys into a single site – from ancient plagues to last week’s Zika statistics. Now these are much easier to read and analyze.

This is an excellent resource for experts and students in public health:

  • Sorting option allows for meaningful analysis
  • Ideal tool for studying the history of medicine, trends in disease evolution, diseases of all individual countries.
  • The tables can help prepare lecture handouts
  • Updated every few days and constantly evolving.

Sort the outbreaks / surveys by clicking on the top column heading. Additional notes and linked references are displayed where available once you click “Show notes” for all the rows, or click on the year to see the notes for a specific row.

Example

In the following example, data are displayed alphabetically by outbreak setting or region.
Outbreak tables

More

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