H5N1

Hong Kong: Two imported dengue cases

Via the Centre for Health Protection: Two linked imported cases of dengue fever investigated. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health is investigating two imported and related cases of dengue fever and has urged people to guard against the disease.      

The first patient is a 42-year-old man who developed fever, headache, myalgia, arthralgia and retro-orbital pain since May 5. He was admitted to a private hospital on May 8. The second patient is his 10-year-old daughter, who developed similar symptoms since May 9. She was admitted to the same private hospital on May 10. They have recovered and were discharged on May 13.        

Their blood samples tested positive for the dengue virus and antibodies against the dengue virus.        

The CHP's investigation revealed that they had travelled to Bali, Indonesia, and both were bitten by mosquitoes. The travelling period of the male patient was from April 27 to May 5 while the girl travelled from April 25 to May 5.        

The CHP will follow up on the cases.      

There have been 29 confirmed cases of dengue fever in 2013 as of today (May 14), and they were all imported. Last year 53 cases of imported dengue fever were reported to the CHP, with no local cases.

Australia: Dengue fever warning after recent rainfalls

Via The Cairns Post in northern Queensland: Dengue fever warning after recent rainfalls. Excerpt:

Health authorities are warning residents to remain vigilant against dengue fever after recent rains in Cairns returnedperfect conditions for mosquito breeding. 

There have been 128 confirmed cases of the virus in the current Far Northern outbreaks and crews have combed about 12,000 properties since December trying to stamp it out. 

The Aedes aegypti mosquito, which carries dengue fever, mostly lays its eggs in water-catching containers around built-up areas such as homes and businesses. 

The director of entomology at Tropical Public Health Service, Dr Greg Devine, says people should re-check their properties immediately if they haven't already. 

"Most people are very good but the fact is it's hard to keep your yard clear of breeding sites for the whole sustained period of the breeding season," Dr Devine said. 

The Dengue Action Response Team has found pot plant bases are the most common breeding sites and should be checked for water regularly. 

Plastic sheets and tarps, boats, tyres, buckets and whitegoods left outdoors can also trap water and hatch thousands of dengue-carrying mosquitoes at a time. 

Dr Devine said although cooler temperatures and the end of the wet season looming meant the Aedes aegypti would be less likely to breed, the risk of transmission was not yet gone. 

"The occasional case is still appearing and it's pretty well disseminated so it can pop up anywhere at any time." 

The Whitfield outbreak, which has been renamed the Cairns outbreak because of its wide spread, has now reached 96 confirmed cases.

Climate changes could bring malaria to the UK

Via The Observer: Climate changes could bring malaria to the UK. Excerpt:

Leading health experts are urging the government to take action against the growing threat that mosquito-borne diseases, including potentially fatal malaria, could soon arrive in the UK. 

The disturbing recommendation to "act now before it is too late" is being made as a growing body of evidence indicates that what were once thought of as tropical diseases are being found ever closer to the UK. 

Health experts meeting at the annual public health conference of the Chartered Institute of Environmental Health later this week will hear that rising incidences of a growing list of pest-borne diseases are now a "serious" cause for concern in the UK. 

The conference will be told that it would be complacent to think that diseases such as dengue fever, malaria and Crimean-Congo haemorrhagic fever, now present on the European continent but once considered "exotic and confined to faraway places", will not emerge in the UK. 

"With predicted changes to climate in the UK, characterised by warming and wetter summers providing perfect breeding grounds for a number of pest-borne diseases, we need to consider some robust public health measures to minimise the potential outbreaks," said Julie Barratt, director of the CIEH. 

The government's Health Protection Agency commissioned research, published last year, which claimed that "it is likely that the range and activity of many ticks and mosquitoes will increase across the UK by the 2080s". 

However, experts are now warning that there is a risk that the threat to the UK is more imminent. Dengue was detected in France and Croatia in 2010 and malaria was reported in Greece in 2011.

Australia: Not only dengue, but also chikungunya

Via The Global Dispatch.com: Queensland Health battles mosquito borne diseases: first dengue fever, now chikungunya fever. Excerpt:

Queensland Health has been in a battle with the mosquito borne viral disease, dengue fever since November 2012, in which more than 100 people have been stricken with the virus in Cairns.      

Outbreaks of dengue have most recently been reported in Innisfail (April 2), Townsville (April 5) and Ingham (April 19). 

This has prompted Queensland Health to respond to the dengue fever outbreaks in North Queensland through Dengue Action Response Teams (DART). 

They treat or destroy breeding sites, work with residents to control mosquitoes and help curb the spread of the virus and educate the public on prevention. 

In addition to the dengue fever issue, Cairns.com.au is reporting two cases of the mosquito-borne disease chikungunya have been confirmed in Cairns. 

Tests this week revealed two people who recently returned from Papua New Guinea had contracted chikungunya, which includes symptoms such as fever, prolonged joint and muscle pain, headaches, rash and fatigue, the website reports. 

There is currently an outbreak of chikungunya in Papua New Guinea that has affected at least 3000 people. This has prompted authorities to issue a warning to the public and spray for mosquitoes in the neighborhoods where the two patients live.

ECDC: Threat report for week 14

ECDC has published Monitoring current threats, week 14/2013. Click through for the PDF and many links. Apart from detailed information on seasonal flu, the Swansea measles outbreak, and Madeira's dengue, it has this to say about H7N9:

On 31 March 2013, the Chinese authorities announced the identification of a novel influenza A virus, A(H7H9), in three seriously ill people from two provinces presenting with respiratory infections. When testing for the influenza virus, the Chinese Center for Disease Control and Prevention identified genes from both A(H7N9) and A(H9N2) viruses, thus indicating a novel reassortant avian influenza A virus. 

By 5 April 2013, 16 cases were confirmed, including six deaths. In its initial assessment of the situation, the ECDC rapid risk assessment concludes that the risk of the spread of the virus in Europe can be considered low at this stage. 

There is currently no evidence of sustained human-to-human transmission of the influenza A(H7N9) virus. 

ECDC continues to monitor the situation closely. More cases are expected to be reported.

Dengue: Much worse than you thought

Via Nature: The global distribution and burden of dengue. The full article is behind a paywall, but here's the abstract:

Dengue is a systemic viral infection transmitted between humans by Aedes mosquitoes. For some patients, dengue is a life-threatening illness. There are currently no licensed vaccines or specific therapeutics, and substantial vector control efforts have not stopped its rapid emergence and global spread. The contemporary worldwide distribution of the risk of dengue virus infection4 and its public health burden are poorly known. 

Here we undertake an exhaustive assembly of known records of dengue occurrence worldwide, and use a formal modelling framework to map the global distribution of dengue risk. We then pair the resulting risk map with detailed longitudinal information from dengue cohort studies and population surfaces to infer the public health burden of dengue in 2010. 

We predict dengue to be ubiquitous throughout the tropics, with local spatial variations in risk influenced strongly by rainfall, temperature and the degree of urbanization. 

Using cartographic approaches, we estimate there to be 390 million (95% credible interval 284–528) dengue infections per year, of which 96 million (67–136) manifest apparently (any level of clinical or subclinical severity). This infection total is more than three times the dengue burden estimate of the World Health Organization. 

Stratification of our estimates by country allows comparison with national dengue reporting, after taking into account the probability of an apparent infection being formally reported. The most notable differences are discussed. 

These new risk maps and infection estimates provide novel insights into the global, regional and national public health burden imposed by dengue. We anticipate that they will provide a starting point for a wider discussion about the global impact of this disease and will help to guide improvements in disease control strategies using vaccine, drug and vector control methods, and in their economic evaluation.

Macau: Govt not flapping amid new H7N9 fears

Via Macau News.com.mo, an April 5 report: Govt not flapping amid new avian virus fears. Excerpt:

Inspections of the city’s poultry, parks and bird habitats have been strengthened amid fears over the potentially fatal H7N9 virus that was discovered in the mainland recently, but locally there was nothing to worry about, Ng Peng In, administration committee member of the Civic and Municipal Affairs Bureau (IACM), said on Wednesday.   

The bureau oversees the city’s food and animal inspection and control. 

Ng made the comment during a press conference at the Sao Domingos Municipal Market Activities Centre about a string of upcoming activities in conjunction with other government bureaus and local associations to promote dengue fever prevention.   

Ng said that while the bureau needed to check on what grounds some nearby regions said there was a possibility of an outbreak, he believed that the spread of the new virus might be related to the movement of migratory birds.   

Chan Tan Mui, who heads the Health Bureau’s Chronic Diseases Prevention and Health Promotion Unit, added that the Health Bureau would keep a close eye on the situation by beefing up frontline medical staff’s awareness of suspected cases, urging the public to take preventive measures and maintain a healthy immune system which was also a way to ward off the virus.   

“As people are concerned about the new bird flu, they shouldn’t neglect the dangers of dengue fever too,” Chan was quoted by The Macau Post Daily as saying. Chan also said that after the last few days’ rain people needed to remember to clear still water in which mosquitoes breed and lay eggs.

India: Dengue fever and hepatitis in Idukki district, Kerala state

Via Manorama Online: Dengue fever and hepatitis in Idukki district. Excerpt:

Idukki: Cases of dengue fever and hepatitis are reported from various places in Idukki district . More than 50  patients are hospitalized with dengue fever in Adimali whereas 20 patients are confirmed with  hepatitis in Thodupuzha. 

Epidemics detected in the border villages of  Kerala- Tamilnadu two weeks back have started spreading to various places in Idukki district. Reports say that dengue fever is spreading at alarming rate in many places. More than 50 persons were diagnosed with dengue fever in Adimali, Vellathooval and Mankulam areas in a week period. 

Eighteen persons are undergoing treatment  at Taluk hospital in Adimali  whereas  infected people are being brought to private hospitals of  Adimali, Kothamangalam, and Kolenchery. Health department informed that though cases are still being reported from across the district, treatment facilities have been arranged for the affected patients. 

More cases of hepatitis are reported from Thodupuzha and surrounding places. Sixteen patients are affected with hepatitis A while four patients are diagnosed with hepatitis B. Besides, blood samples of around 30 persons suspected with symptoms were sent for testing.

Brazil: Dengue cases in Minas Gerais already exceed the 2012 total

This is amazing and disturbing. Via Folha de São Paulo: Notificações de dengue em Minas Gerais já superam o total de 2012. [Dengue reports in Minas Gerais state now exceed the 2012 total] Excerpt, with my translation:

As cidades de Minas Gerais registraram um aumento de 30 mil casos notificados de dengue apenas na última semana. As notificações saltaram de 93 mil para 120 mil casos, o que já ultrapassa os 115 mil registros ao longo de todo o ano passado. 

The cities of Minas Gerais have recorded an increase of 30,000 dengue cases in just the last week. The reports soared from 93,000 to 120,000, exceeding the 115,000 cases recorded in all of 2012.

Em Minas, 237 cidades tem alto índice de transmissão da doença. 

In Minas, 237 cities have a high index of dengue transmission.

Uma das situações preocupantes é a de Uberaba (471 km de Belo Horizonte). A cidade registrou 11.432 casos e nove óbitos apenas neste primeiro trimestre. Em Uberlândia (540 km de Belo Horizonte) já foram registradas 2.996 notificações, com duas mortes, ante os 350 casos de todo o ano passado. 

One of the worrying situations is that of Uberaba (471 km from Belo Horizonte). The city recorded 11,432 cases and 9 deaths in just the first three months of this year. In Uberlandia (540 km from Belo Horizonte), 2,996 cases have been recorded, with 2 deaths, compared to 350 cases in all of the past year.

Segundo boletim da Secretaria de Estado da Saúde de Minas, divulgado no último dia 23, já são 24 mortes confirmadas por dengue com complicação, sendo oito em Uberaba e duas em Uberlândia. As demais cidades com vítimas fatais são em Ituiutaba (dois casos), Carangola, Frei Gaspar, Buritizeiro, Ipanema, Teófilo Otoni, Pirapetinga, Pirapora e São Geraldo do Baixo. 

According to a bulletin of the Minas State Secretariat of Health, released on March 23, 24 deaths from dengue with complications, with 8 in Uberaba and 2 in Uberlandia. Other cities with fatal cases include Ituiutaba (2 cases), Carangola, Frei Gasper, Buritizeiro, Ipanema, Teófile Otoni, Pirapetinga, Pirapora, and São Geraldo do Baixo.

A febre hemorrágica da dengue vitimou duas pessoas em Montes Claros, uma em Uberaba e uma em São João da Ponte.

Hemorrhagic dengue has killed two persons in Montes Claros, one in Uberaba, and one in São João da Ponte.

As Wikipedia will tell you if you click on the link above, Minas Gerais is a very big state of about 20,000,000 people, with 5.5 million in the capital Belo Horizonte. Uberaba has over 300,000 people; Uberlandia has almost 2.4 million.

This is a big outbreak in big cities of a big state in a very big country, and North America's media have nothing to say about it.

Costa Rica: Dengue cases quadruple

Via Prensa Latina: Cuadruplicados casos de dengue en Costa Rica. [Dengue cases in Costa Rica quadruple] Excerpt, with my translation:

Los casos de dengue casi se cuadruplicaron este año en Costa Rica hasta la fecha, con relación a 2012, al contabilizar cinco mil 615 casos, la cifra más alta del último decenio, se informó hoy. 

Dengue cases in Costa Rica have nearly quadrupled so far this year compared to 2012, with 5,615 cases—the highest number in the past decade, it was reported today.

La jefa de Vigilancia Epidemiológica de la Caja Costarricense del Seguro Social (CCSS), Xiomara Badilla, calificó la situación como preocupante pues las cifras evidencian el impacto de la enfermedad viral aguda en la actual temporada seca, lo que pudiera empeorar con la llegada de la época lluviosa de mayo. 

The chief of Epidemiological Surveillance of the Costa Rican Bureau of Social Security, Xiomara Badilla, described the situation as worrying because the numbers reflect the impact of the acute viral disease in the current dry season; this could worsen with the arrival of the rainy season in May.

Enfatizó la especialista que la institución intensificará las acciones de prevención, vigilancia y atención de pacientes a fin de evitar mayores complicaciones como resultado de la enfermedad, que ya se reporta en todo el país. 

She emphasized that the institution will intensify its prevention, surveillance and patient care to prevent major complications as a result of the disease, which is now reported to be nationwide.

Hasta el momento doce casos han sido diagnosticados con la cepa del dengue hemorrágico, el más peligroso para la vida, no obstante, las autoridades no reportan muertes por esa causa.

At the moment 12 cases have been diagnosed as hemorrhagic or severe dengue, the most life-threatening strain; nevertheless, authorities have not reported any deaths from this cause.