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Archive for the ‘ProMED’ Category

Tick-borne Encephalitis in Switzerland

Rates (per 100,000) of tick-borne encephalitis in Switzerland have increased somewhat since the year 2000, and are currently higher than those reported by surrounding countries.  The following image was created by a tool in Gideon ( that converts incidence data into population rates and combines user-selected graphs into a single chart.

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Severe Fever and Thrombocytopenia Syndrome

Incidence data for Severe Fever and Thrombocytopenia Syndrome are displayed in the following chart [1]  In contrast with Japan, The Republic of Korea has experienced a dramatic increase in rates since the disease was first reported.




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Spotted Fever in Israel and the United States

Although Mediterranean spotted fever was commonly reported in Israel for several decades, rates have declined considerably in recent years.  In fact, the disease is currently less common than it’s American counterpart [1]   The following chart was generated using the Gideon multi-graph tool [1] :


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Hand Foot and Mouth Disease in Asia

Rates of Hand, Foot and Mouth disease (HFM) have been increasing in several Asian countries for the past decade [1] – see graph



  1. Berger S. Enterovirus Infections: Global Status, 2017.  139 pages, 67 graphs, 2,534 references. Gideon e-books

Enterovirus infections: Global Status

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Japanese Encephalitis in India

The idea that most cases of “acute encephalitis” in Uttar Pradesh are caused by diseases other than Japanese encephalitis is borne out by reporting statistics.  In the following chart, note the precipitous decline in “Japanese encephalitis” incidence which followed introduction of reporting for “Acute encephalitis” in 2008 (upper graph).  This phenomenon is even more striking for India as a whole (lower graph). [1,2]



  1. Berger S. Japanese Encephalitis: Global Status. 83 pages, 63 graphs, 1,034 references. Gideon e-books,
  2. Berger S. Infectious Diseases of India. 533 pages, 89 graphs, 5,763 references. Gideon e-books.

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Botulism in The United States

Rates of food-borne botulism in the United Sates have declined somewhat since the 1990’s, while those of infant botulism continue to increase. [1]  See graph


  1. Berger S. Botulism: Global Status, 99 pages, 90 graphs, 877 references, Gideon e-books

Botulism: Global Status

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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.

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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,

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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,

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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,

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