H5N1

Resurgence of scarlet fever in China: A 13-year population-based surveillance study

Via The Lancet Infectious Diseases: Resurgence of scarlet fever in China: a 13-year population-based surveillance study. The summary:

Background 

A re-emergence of scarlet fever has been noted in Hong Kong, South Korea, and England, UK, since 2008. China also had a sudden increase in the incidence of the disease in 2011. In this study, we aimed to assess the epidemiological changes before and after the upsurge. We also aimed to explore the reasons for the upsurge in disease in 2011, the epidemiological factors that contributed to it, and assess how these could be managed to prevent future epidemics. 

Methods 

In this observational study, we extracted the epidemiological data for all cases of scarlet fever between 2004 and 2016 in China from the Chinese Public Health Science Data Center, the official website of National Health Commission of the People's Republic of China, and the National Notifiable Infectious Disease Surveillance System. These data had been collected from 31 provinces and regions in China and included geographical, seasonal, and patient demographic information. We used descriptive statistical methods and joinpoint regression to examine the spatiotemporal patterns and annual percentage change in incidence of the upsurge of disease across China. 

Findings 

Between Jan 1, 2004, and Dec 31, 2016, 502 723 cases of scarlet fever, with ten fatalities, were reported in China, resulting in an annualised average incidence of 2·8807 per 100 000 people. The annual average incidence increased from 1·457 per 100 000 people in 2004 to 4·7638 per 100 000 people in 2011 (incidence rate ratio [IRR] 3·27, 95% CI 3·22–3·32; p<0·0001), peaking in 2015 (5·0092 per 100 000 people). The annual incidence after the 2011 upsurge of scarlet fever, between 2011 and 2016, was twice the average annual incidence reported between 2004 and 2010 (4·0125 vs 1·9105 per 100 000 people; IRR 2·07, 95% CI 2·06–2·09; p<0·0001). 

Most cases were distributed in the north, northeast, and northwest of the country. Semi-annual patterns were observed in May–June and November–December. The median age at onset of disease was 6 years, with the annual highest incidence observed in children aged 6 years (49·4675 per 100 000 people). The incidence among boys and men was 1·54 greater than that among girls and women before the upsurge, and 1·51 times greater after the upsurge (p<0·0001 for both). The median time from disease onset to reporting of the disease was shorter after the upsurge in disease than before (3 days vs 4 days; p=0·001).  

Interpretation 

To our knowledge, this is the largest epidemiological study of scarlet fever worldwide. The patterns of infection across the country were similar before and after the 2011 upsurge, but the incidence of disease was substantially higher after 2011. Prevention and control strategies being implemented in response to this threat include improving disease surveillance and emergency response systems. In particular, the school absenteeism and symptom monitoring and early-warning system will contribute to the early diagnosis and report of the scarlet fever. This approach will help combat scarlet fever and other childhood infectious diseases in China.

Infectious diseases kill 2,198 in China in December

Via the National Health and Family Planning Commission: Infectious diseases kill 2,198 in China in December.

A total of 2,198 people died as a result of infectious diseases on the Chinese mainland in December 2017, official data showed. 

According to the National Health and Family Planning Commission, there were 699,850 cases of infectious diseases reported on the mainland in December.  

One person died from plague while no cases of cholera were reported in December. 

Plague and cholera are classified as Class A infectious diseases, the most serious classification on China's Law on the Prevention and Treatment of Infectious Diseases. 

A total of 294,397 cases were classified as Class B infectious diseases, resulting in 2,187 deaths. Viral hepatitis, tuberculosis, syphilis, gonorrhoea as well as scarlet fever accounted for 93 percent of these cases. 

Category C diseases caused 10 deaths in December. Infectious diarrhea, influenza, foot and mouth disease were the most prevalent in this category, accounting for 93 percent of cases. 

Resurgence of scarlet fever in England, 2014–16: A population-based surveillance study

Via The Lancet Infectious Diseases: Resurgence of scarlet fever in England, 2014–16: a population-based surveillance study. The summary:

Background 

After decades of decreasing scarlet fever incidence, a dramatic increase was seen in England beginning in 2014. Investigations were launched to assess clinical and epidemiological patterns and identify potential causes. 

Methods 

In this population-based surveillance study, we analysed statutory scarlet fever notifications held by Public Health England from 1911 to 2016 in England and Wales to identify periods of sudden escalation of scarlet fever. Characteristics of cases and outbreaks in England including frequency of complications and hospital admissions were assessed and compared with the pre-upsurge period. Isolates from throat swabs were obtained and were emm typed. 

Findings 

Data were retrieved for our analysis between Jan 1, 1911, and Dec 31, 2016. Population rates of scarlet fever increased by a factor of three between 2013 and 2014 from 8·2 to 27·2 per 100 000 (rate ratio [RR] 3·34, 95% CI 3·23–3·45; p<0·0001); further increases were observed in 2015 (30·6 per 100 000) and in 2016 (33·2 per 100 000), which reached the highest number of cases (19 206) and rate of scarlet fever notifcation since 1967. The median age of cases in 2014 was 4 years (IQR 3–7) with an incidence of 186 per 100 000 children under age 10 years. 

All parts of England saw an increase in incidence, with 620 outbreaks reported in 2016. Hospital admissions for scarlet fever increased by 97% between 2013 and 2016; one in 40 cases were admitted for management of the condition or potential complications. 

Analysis of strains (n=303) identified a diversity of emm types with emm3 (43%), emm12 (15%), emm1 (11%), and emm4 (9%) being the most common. Longitudinal analysis identified 4-yearly periodicity in population incidence of scarlet fever but of consistently lower magnitude than the current escalation. 

Interpretation 

England is experiencing an unprecedented rise in scarlet fever with the highest incidence for nearly 50 years. Reasons for this escalation are unclear and identifying these remains a public health priority.

Hong Kong: Heightened vigilance warranted amid further increase in scarlet fever activity

Via the Centre for Health Protection: Heightened vigilance warranted amid further increase in scarlet fever activity.

The Centre for Health Protection (CHP) of the Department of Health today (December 4) appealed to parents, schools/institutions and healthcare professionals for heightened vigilance against scarlet fever (SF) as its activity sharply increased last week and has reached a very high level.        

According to the CHP's surveillance data, the weekly number of SF cases increased from 48 in the week of November 19 to 94 in the last week (week of November 26). Regarding SF outbreaks in schools/institutions, as of December 3, eight outbreaks (five kindergartens/child care centres and three primary schools) affecting 22 pupils/children were recorded in November.

"While SF has occurred throughout the year locally, a seasonal pattern for SF in Hong Kong with higher activity was observed from May to June and from November to March in the past few years. The activity of SF has increased again since November this year. Based on the past epidemiological pattern, we expect that the SF activity will remain at a higher level in the coming few months. Parents have to take extra care of their children in maintaining strict personal, hand and environmental hygiene," a spokesman for the CHP said.        

A total of 1 947 cases were reported in the first 11 months of 2017, representing a marked increase from the figures for the same period in 2016 (1 244 cases) and 2015 (1 060 cases). The epidemiological features of the cases in 2017 were similar to those in previous years. 

The 1 947 SF cases reported this year comprised 1 156 males and 791 females aged from 2 months to 43 years (median: 5 years), nearly all of whom (1 863, 95.7 per cent) were under 10 years. Most presented with mild illnesses. Among them, 695 cases (35.7 per cent) required hospitalisation. While one severe case reported in March required admission to an intensive care unit, no deaths have been recorded so far.

Resurgence of scarlet fever in England, 2014–16: A population-based surveillance study

Via The Lancet Infectious Diseases: Resurgence of scarlet fever in England, 2014–16: a population-based surveillance study. The summary:

Background 

After decades of decreasing scarlet fever incidence, a dramatic increase was seen in England beginning in 2014. Investigations were launched to assess clinical and epidemiological patterns and identify potential causes. 

Methods 

In this population-based surveillance study, we analysed statutory scarlet fever notifications held by Public Health England from 1911 to 2016 in England and Wales to identify periods of sudden escalation of scarlet fever. Characteristics of cases and outbreaks in England including frequency of complications and hospital admissions were assessed and compared with the pre-upsurge period. Isolates from throat swabs were obtained and were emm typed. 

Findings 

Data were retrieved for our analysis between Jan 1, 1911, and Dec 31, 2016. Population rates of scarlet fever increased by a factor of three between 2013 and 2014 from 8·2 to 27·2 per 100 000 (rate ratio [RR] 3·34, 95% CI 3·23–3·45; p<0·0001); further increases were observed in 2015 (30·6 per 100 000) and in 2016 (33·2 per 100 000), which reached the highest number of cases (19 206) and rate of scarlet fever notification since 1967. The median age of cases in 2014 was 4 years (IQR 3–7) with an incidence of 186 per 100 000 children under age 10 years. 

All parts of England saw an increase in incidence, with 620 outbreaks reported in 2016. Hospital admissions for scarlet fever increased by 97% between 2013 and 2016; one in 40 cases were admitted for management of the condition or potential complications. Analysis of strains (n=303) identified a diversity of emm types with emm3 (43%), emm12 (15%), emm1 (11%), and emm4 (9%) being the most common. Longitudinal analysis identified 4-yearly periodicity in population incidence of scarlet fever but of consistently lower magnitude than the current escalation. 

Interpretation 

England is experiencing an unprecedented rise in scarlet fever with the highest incidence for nearly 50 years. Reasons for this escalation are unclear and identifying these remains a public health priority.

See also Helen Branswell's report on this study in STAT.

Hong Kong: Heightened vigilance warranted under persistently high scarlet fever activity

Via the Centre for Health Protection: Heightened vigilance warranted under persistently high scarlet fever activity. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health today (July 4) appealed to parents, schools/institutions and healthcare professionals for heightened vigilance against scarlet fever (SF) as its activity has been increasing in the past few weeks. 

According to the CHP's surveillance data, the weekly number of SF cases increased from 38 in the week of June 4, 2017, to 49, 52 and 69 in the three subsequent weeks. Regarding SF outbreaks in schools/institutions, nine affecting 21 pupils/children were recorded in June.        

Of note, as of June 30, a total of 1,215 SF cases had been reported to the CHP in the first six months of 2017, representing a marked increase from the figures for the same period in 2016 (727 cases) and 2015 (674 cases).      

"The local SF activity is usually higher from November to March and from May to June. In view of the recent increase in SF activity, parents have to take extra care of their children in maintaining strict personal, hand and environmental hygiene," a spokesman for the CHP said.      

In addition, among the 1,215 SF cases reported to the CHP this year, they comprise 704 males and 511 females aged from 2 months to 43 years (median: 5 years), nearly all of which (1,170, 96.2 per cent) were under 10 years. Most presented with mild illnesses and clinical presentations were largely similar to cases in previous years. Among them, 431 cases (35.5 per cent) required hospitalisation. While one severe case reported in March required admission to an intensive care unit, no deaths have been recorded so far.      

"We will issue letters to doctors, hospitals and schools to alert them to the latest situation. Schools should promptly make a report to the CHP in case of an increase in respiratory illnesses or absentees for immediate epidemiological investigations and outbreak control," the spokesman said.      

SF is a bacterial infection caused by Group A Streptococcus. It mostly affects children. It is transmitted through either respiratory droplets or direct contact with infected respiratory secretions.      

It usually starts with a fever and sore throat. Headache, vomiting and abdominal pain may also occur. The tongue may have a distinctive strawberry-like (red and bumpy) appearance. A sandpaper texture-like rash would commonly begin on the first or second day of onset over the upper trunk and neck before spreading to the limbs. The rash is usually more prominent in armpits, elbows and groin areas. It usually subsides after one week and is followed by skin peeling over fingertips, toes and groin areas.      

SF is sometimes complicated with middle ear infection; throat abscess; chest infection; meningitis; bone or joint problems; damage to the kidneys, liver and heart; and, rarely, toxic shock syndrome. SF can be effectively treated by appropriate antibiotics. People suspected to have SF should consult a doctor promptly.

Hong Kong: Heightened vigilance warranted under persistently high scarlet fever activity

Via the Centre for Health Protection: Heightened vigilance warranted under persistently high scarlet fever activity. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health today (March 21) appealed to parents, schools/institutions and healthcare professionals for heightened vigilance against scarlet fever (SF) as its activity has been increasing in the past few weeks.   

According to the CHP's surveillance data, the weekly number of SF cases increased from 41 in the week of February 26, 2017, to 49 and 59 in the two subsequent weeks. Regarding SF outbreaks in schools/institutions, six affecting 12 pupils/children were recorded in the last three weeks.      

"The local SF activity is usually higher from November to February and from June to July. Of note, after the seasonal peak from December 2016 to January 2017, the SF activity increased again in the last few weeks and was higher than that in the same period in previous years. Parents should take extra care of their children in maintaining strict personal, hand and environmental hygiene," a spokesman for the CHP said.      

As of March 18, a total of 474 SF cases had been reported to the CHP in 2017, comprising 286 males and 188 females aged from 2 months to 31 years, nearly all of which (465, 98 per cent) were under 10. Most presented with mild illnesses and clinical presentations were largely similar to cases in previous years. Among them, 170 cases (36 per cent) have required hospitalisation. No severe cases requiring admission to an intensive care unit or deaths have been recorded so far.      

"We will issue letters to doctors, hospitals, schools and institutions to alert them to the latest situation. Schools should promptly report to the CHP in case of an increase in respiratory illnesses or absentees for immediate epidemiological investigations and outbreak control," the spokesman said.      

SF is a bacterial infection caused by Group A Streptococcus. It mostly affects children. It is transmitted through either respiratory droplets or direct contact with infected respiratory secretions.

Thoughts on Zika porn

Thanks to Andrew Noymer for tweeting: "So many distended mosquito abdomen pics in my timeline. It's like entomology porn or something." Porn indeed; it infests health reporting like Aedes aegypti in northeast Brazil, and it too needs to be stamped out.

Since I start looking at such Zika porn starting around 6:00 every morning, you'd think I'd be inured to it. But I'm not. However advanced a country may be, its media seem to think its readers won't understand reports on disease outbreaks without some shocker photo of a blood-gorged mosquito looking the size of a bald eagle:

Credit: Globo.com

Sometimes, just for variety's sake, they'll look for the yuck factor in photos like this one:

Credit: americanpest.net

And by all means we need as many photos as possible of the bellies of heavily pregnant women, just to remind dimwit readers what all the Zika fuss is about:

Credit: Scitechdaily.com

I could add any number of photos of microcephalic babies, preferably screaming in their mothers' ears, but enough is enough.

Outbreaks of almost every disease inspire similar porn. How many shots have I seen of wretched little Pakistani kids, their mouths squeezed open to receive a drop of polio vaccine? How many black people lying miserable on a cholera bed, with a hole thoughtfully designed to receive their copious evacuations? Or forlorn tots covered with measles spots? 

I see this as an attempt, perhaps even well-meant, to educate a healthy but ignorant public in the advanced countries on a subject they have been protected from by generations of good public health and really shitty public-health communication. Big, strapping 21st-century North Americans and Europeans are clueless about infectious diseases, and blithely fly off to countries where such diseases are rampant. All they know about pandemics is what they see in zombie movies.

Full disclosure: As a polio survivor, class of 1948, I'm fully aware of my status as a living fossil. In those days no one quibbled about vaccines—our parents had known classmates who died of measles or influenza or scarlet fever. Since then, half a century of familiarity with good health has bred contempt for the means of achieving it. That contempt, in turn, has bred a complacency that only a major gross-out factor can shake.

Even so, could some of the key editors in 21st-century media, whether print or online, mercifully forbid further use of these porn shots in illustrating stories about Zika and other diseases?

Red alert: Why is scarlet fever spreading across Britain?

Via The Guardian, a report that might help to explain the outbreak in Kashechewan in the post just below: Red alert: why is scarlet fever spreading across Britain? Excerpt:

The stuff of Victorian nightmares is marching through the country once again: cases of scarlet fever have hit a 50-year high. 

After barely 2,000 annual cases of the highly contagious illness in recent years, there were 17,586 in England and Wales in 2015. Particularly bad outbreaks have hit London, Yorkshire and the Midlands, and a “peak season” is expected over the next few weeks. Near my home in Norfolk, school classrooms have been disinfected after outbreaks, which most commonly affect two- to eight-year-olds. 

The reason for its return is baffling scientists, but the fever has taken an interesting journey since the 19th century. 

“The scarlet fever that would have been around in the Victorian era is a completely different beast to what we see now,” says Dr Theresa Lamagni, Public Health England (PHE)’s head of streptococcal infection surveillance. “It was a very severe infection that led to a lot of childhood deaths, but over the course of the last century its virulence diminished hugely.” 

The theory is that a bacterial pathogen evolves to become weaker over time because it will not be passed on if it rapidly kills its host, and scarlet fever was diminishing in force before the advent of the modern antibiotics that treat it today. There have been no recorded fatalities during the current outbreak. 

PHE’s analysis of the data has found that every four years or so there is a higher-than-average year for scarlet fever, but this “natural cycle” does not explain the current outbreak, according to Lamagni. 

There is no sign that the fever has developed an increased resistance to antibiotics, nor is it a virulent new strain. Scientists have analysed more than 400 “isolates” of the disease recorded by hospitals during the latest outbreak and found that they are the same as in previous years, and quite diverse (in other words, there is no dominant strain). 

“That was a bit of a surprise for us,” says Lamagni. “It doesn’t seem that the bugs themselves are giving us any clues as to what is happening.”

China: Infectious diseases in Beijing last week

Via the Beijing Municipal Health Bureau, a Google translated report: The Weekly Epidemiological (2013.04.29-2013.05.05).

Situation of the Epidemics 　　

2013 Week 18 (2013, April 29 to May 5, 2011), the city reported a total of 1934 cases of legal infectious diseases, 4 patients died (viral hepatitis). B infectious diseases were reported in 12 of 516 cases, the number of reported cases among the top five diseases were diarrhea, tuberculosis, viral hepatitis, scarlet fever and syphilis. Class C infectious diseases were reported in 1418 cases, the number of reported cases among the top three diseases were hand-foot-mouth disease, other infectious diarrhea and mumps. 　　

Focus of the Epidemic 　　

(A) measles 　　

21 cases reported this week 　　

(B) foot and mouth disease 　　

759 cases reported this week

The bureau also has an H7N9 page, accessible to Google Translate and Google Chrome, but it hasn't been updated since May 3, and most of the items are from April.