H5N1

US: Typhus epidemic spreads across LA, health officials say

Via CNN, a disturbing report from one of the greatest cities in the world's richest country: Typhus epidemic spreads across LA, health officials say. Excerpt:

A rise in typhus, a bacterial disease spread by lice or fleas, has hit the Los Angeles area, and public health officials are sounding the alarm.  

As of Monday, there have been 57 cases of flea-borne typhus in Los Angeles County, the county Department of Public Health said. 

On Thursday, the department announced that officials are investigating an outbreak of flea-borne typhus in downtown Los Angeles, and they are working with the city to implement environmental safety measures to help reduce the spread of the disease.

Between July and September, the county identified nine cases of flea-borne typhus associated with downtown Los Angeles, and six of those cases were in people experiencing homelessness, according to the county. 

"Although typhus normally occurs throughout LA County, we are observing several cases in the downtown Los Angeles area," Dr. Muntu Davis, the county's health officer, said in Thursday's announcement. 

"We encourage pet owners to practice safe flea control and encourage all cities in the county to ensure maintenance of their trash clean-up and rodent control activities," he said. 

On Friday, one city in the county -- Pasadena -- reported epidemic levels of typhus fever. This year, 20 Pasadena residents have been confirmed to have typhus fever, up from the expected one to five cases per year, according to the Pasadena Public Health Department.

Finland: Domestic ticks now carry even more pathogens

Via Yle Uutiset: Domestic ticks now carry even more pathogens. Excerpt:

Turku University researchers have discovered additional dangerous bacteria on ticks found in southwest Finland. In addition to the already-familiar Borrellia bacteria behind Lyme disease and the virus that causes TBE encephalitis, the scientists also found traces of Rikettsia and Anaplasma bacteria never observed before in Finland. 

The two new strains of bacteria are however familiar. Jari Hänninen of the University of Turku’s Archipelago Research Institute says the find didn’t come unexpected, as the bacteria were already found in several of Finland’s neighbouring countries.  

“One of the Rikettsia diseases is typhus, an epidemic of which brought Napoleon’s army to its knees,” he says. 

Rikettsia is transmitted to humans via external parasites like lice, fleas or ticks and are the pathogen responsible for typhus and spotted fever.

Refugee crisis demands European Union-wide surveillance

A long, thoughtful, and informative editorial in Eurosurveillance: Refugee crisis demands European Union-wide surveillance! Excerpt:

The conflicts in the Middle-East and instability in Libya and some parts of Asia and Africa have resulted in a dramatic influx of refugees to the European Union (EU) in recent years. In the first nine months of 2015, more than 600,000 applications for asylum were filed in the EU. With no prospect of change of the international context in the near future, it is likely that the influx of refugees into the EU will continue and may even increase in coming months. 

We have witnessed numerous large displacements of populations in recent years and ‘Refugee health’ has become an area of concern for national and international, governmental and non-governmental organisations. Much has been learned from responding to these humanitarian crises. 

Although refugees are facing a similar spectrum of non-communicable diseases to those experienced by the indigenous population of their countries of origin, trauma and injuries, sexual and reproductive health issues, violence and psychosocial disorders are among the most frequent health problems refugees encounter. Disruption of healthcare delivery systems in their countries of origin and limited access to healthcare during their journey result in the interruption of treatments often required for the control of chronic diseases. 

Refugee populations entering the EU/European Economic Area (EEA), and particularly children, are at risk of exposure to infectious diseases in the same way as other EU residents, and in some cases may be more vulnerable because of the interruption of public health programmes, notably for immunisation, in their country of origin, as well as through various barriers to access healthcare such as language, culture etc. It is therefore important that they benefit from protection from infectious diseases, including those prevented through routine vaccinations. 

In addition, these refugees may be at specific risk for certain infectious diseases in relation to their country of origin, countries traversed during their migration, and the conditions they experienced during their mostly difficult journeys. 

It is important to note that refugees should not be seen as representing a threat to Europeans regarding infectious diseases, but rather as being themselves vulnerable for such diseases. For example, poor living conditions and close contact in crowded shelters and refugee camps may increase the risk for the spread of lice and/or fleas, which in rare cases can carry diseases such as louse-borne diseases (relapsing fever due to Borrelia recurrentis, trench fever due to Bartonella quintana, epidemic typhus due to Rickettsia prowazekii), murine typhus and mites (scabies). 

In recent months, sporadic cases of louse-borne relapsing fever (LBRF) have been reported in Belgium, Finland, Germany and the Netherlands among migrants from Eritrea, Somalia and Sudan. LBRF is a disease transmitted by body lice that caused major epidemics in the first half of the 20th century in Europe and is known to have occurred occasionally among homeless people in recent years, without spreading to the general population. 

Recent reports from Italy indicate that transmission of LBRF is likely to have occurred in shelters for refugees in the EU, resulting in the risk of cross-border spread as refugees are frequently moving to other countries. Media are reporting outbreaks of scabies and diarrhoea, notably in Calais, France, in relation to poor housing and hygiene conditions.

India: Japanese encephalitis claims 52 lives in Assam

Thanks to Marvin Speciner for alerting me this story. Via NDTV, a PTI report: Japanese Encephalitis Claims 52 Lives in Assam. Excerpt:

GUWAHATI:  Altogether 52 people have died and 318 others have been affected by Japanese Encephalitis this year in Assam with the disease assuming alarming trend during recent months in the state. 

Among the worst affected districts are Dibrugarh, Tinsukia, Sibsagar, Golaghat, Dhemaji and Kamrup (Rural) with 52 deaths and 318 others testing positive since January this year, a senior Health department official said today. 

The highest number of eight deaths has been reported from Sibsagar followed by six each in Dibrugarh and Jorhat districts and five in Nalbari since last month. 

He said in some districts, cases of acute encephalitis have also been included leading to inflated data but these were not cases of Japanese Encephalitis. 

Tinsukia has the highest of 29 positive cases followed by Dibrugarh with 28, Golaghat with 24, Dhemaji with with 22, Kamrup (Rural) with 21, Barpeta with 17 and Darrang and Cachar with 15 each, he said. 

The state Health department has taken measures to check the disease. The steps include reserving five to six beds in each district hospital and five beds in the medical colleges for the affected patients. 

All districts have been directed to ensure proper investigations and treatment with diagnostic kits provided to the hospitals, the official said. 

Adequate medicines are available, while awareness meetings are being held in all the districts and medicated mosquito nets are being provided in the rural areas. Regular fogging is being carried out under the prescribed guidelines.

Meanwhile, FluTrackers has a remarkable thread on the current encephalitis outbreak, including the likelihood that "acute encephalitis syndrome" results from scrub typhus.

Five quarantine islands

Via the remarkable Hakai Magazine, Five Islands We Are Really Sick Of. Excerpt:

Before antibiotics, there were quarantine islands. From their beginnings as a desperate response to the Black Death, to their heyday during waves of 19th-century immigration, to their surprising denouement as close-knit communities, these five quarantine islands tell the story of our uneasy relationship with disease—and with those afflicted. 

Santa Maria di Nazareth, Italy 

The Black Death brought unprecedented suffering to Europe, but also unprecedented procedures for pandemic response. The plague first reached Italy’s Mediterranean ports in 1347, and panicked officials in Venice isolated ships coming from infected ports for quaranta giorni—a “quarantine” of 40 days—the length likely inspired by the 40 days Jesus wandered the desert while tempted by Satan. In 1377, officials near the town of Ragusa—modern-day Dubrovnik—used islands to isolate sick ship passengers. Venice eventually followed suit, co-opting Santa Maria di Nazareth, an island in Venice’s lagoon, as the first island with a comprehensive quarantine station. The name Nazareth gave rise to lazaretto (after Lazarus, the biblical character raised from the dead), a word that is still used for communities isolated by sickness. 

Partridge Island, Canada 

Something called a coffin ship is bound to be horrifying, but for victims of the 1840s Irish potato famine, these floating, disease-ridden death traps offered a possible version of deliverance: hope of a better life across the ocean. Even knowing that up to three in 10 passengers would likely die of starvation or diseases such as typhus before setting foot in their new home, the voyage was, for many, a risk worth taking. Canada and other countries, including Australia and New Zealand, readied for the influx of immigrants. New Brunswick’s Partridge Island, Canada’s oldest quarantine island, processed nearly 15,000 of the approximately 100,000 Irish refugees to British North America in 1847. It would be another century before a vaccine put the last nail in typhus’s coffin, and, with this and other medical advances, the Partridge Island quarantine station officially closed in 1942.

Disease outbreaks predicted in flood-ravaged Balkans

Via The Lancet: Disease outbreaks predicted in flood-ravaged Balkans. Excerpt:

Communities in the Balkans devastated by the worst floods the region has seen in more than a century are now facing the threat of lethal disease as waters recede. 

At least 50 people have been killed with the death toll expected to rise as hundreds of people are still unaccounted for. Tens of thousands of people have been made homeless as towns and villages were submerged in Serbia, Bosnia, and parts of Croatia. 

But with the rains having stopped, temperatures rising, riverbanks clotted with dead livestock, and contaminated water supplies, health officials say an almost perfect breeding ground for disease and sickness has been created. 

Radovan Cekanac, an epidemiologist at the Serbian Military Medical Academy, told The Lancet: “There is a real risk of infectious diseases being spread and possibly at epidemic levels.” 

Health officials in the affected countries have admitted that conditions are such that it is highly unlikely there will not be an outbreak of some disease. A toxic mix of chemicals and waste was left in many areas after industrial plants and companies were flooded. This debris has been mixed in with the rotting corpses of livestock that failed to escape the deluge as well as now-decaying food from homes and shops. Doctors have identified several specific diseases people could be at risk of, including enterocolitis, typhus, hepatitis, and West Nile disease. Cekanac told The Lancet: “The higher temperatures of recent days will make areas humid and create good conditions for mosquitoes.

“A spread of the West Nile virus is a real risk. We've had it before, but under these circumstances we could see an epidemic.” 

The Veterinary Faculty in the Serbian capital Belgrade, which is monitoring the situation, said it had teams in areas worst affected by the floods controlling mosquitoes and larvae. But he admitted to The Lancet: “Such prevention measures are very good, but the flooded area is huge and it will be very hard to check the entire area.”

US: Typhus case reported near Polliwog Park in Manhattan Beach

Thanks to Krisztian Magori for tweeting the link to this KABC-TV report: Typhus case reported near Polliwog Park in Manhattan Beach. Excerpt:

A case of endemic typhus fever was reported in a neighborhood around Polliwog Park in Manhattan Beach, police announced Thursday. 

The L.A. County Department of Public Health contacted the Manhattan Beach Police Department about the case on Thursday. 

County health officials posted information about precautions when dealing with wildlife and domestic pets. 

Typhus fever is a bacterial infection generally transmitted by fleas, ticks, lice and mites, or by inhaling infected dust. It's prevalent in port cities and coastal regions with rodents, according to the Centers for Disease Control and Prevention, as well as in tropical and subtropical areas. 

Symptoms usually develop within one to two weeks after becoming infected. Fever, headache, malaise, nausea and vomiting are common symptoms. A rash may develop at the site of a flea or tick bite, according to the CDC.

Thailand: Cool weather brings risk of scrub typhus

Via the Bangkok Post, a December 11 report: Cool weather brings risk of contracting deadly disease. Excerpt:

The temperature is falling in some parts of Thailand. For you people who like cold weather and plan to head up to the mountainous North, please beware of scrub typhus. 

Scrub typhus may occur after people are exposed to areas with vegetation where rodents live. The disorder is transmitted through the bite of mites that live on rodents, thereby causing an infection. 

This mite-borne infectious disease is prevalent in northern and northeastern areas of Thailand during the rainy season and when the weather is cool. 

About 10-12 days after being bitten by infected mites, travellers may develop a fever. They may be also experience headaches, muscle pain, cough, rash and red eyes. If they exhibit these symptoms, they should seek professional help immediately. And they should make sure that their healthcare providers are informed that they have travelled to a region where scrub typhus may be present. 

One of the most important symptoms that may be useful for doctors in diagnosing the disease is black eschar, which looks like a cigarette burn, on the area that was bitten. 

Some patients unfortunately get complications associated with the disease that can lead to death. These complications include inflammation of lung tissue, an acute inflammation of the brain and inflammation of the heart. 

According to the Bureau of Epidemiology, Department of Disease Control, under the Ministry of Public Health, from January to early November this year some 7,412 patients with scrub typhus have been reported and four of them died.

Sandy's aftermath: Leptospirosis, typhus, and plague?

Via Mother Nature Network: Has Hurricane Sandy forced diseased rats out of the subway? Excerpt:

As New Yorkers woke up to massive power outages, burning homes, the closure of major transportation arteries, downed trees, streets awash with water and an utterly crippled public transit system, there’s still more to worry about.   

New York City’s infamous rodent population.   

Although nobody has taken an exact count, it’s generally estimated that there are more rats than inhabitants (8.3 million) in the city that never sleeps, with some estimates going as high as 32 million. 

Horror stories of colossal, teeming rat populations residing deep in the belly of the subway system is a bit of a myth, but many of the tunnels and stations are still pretty packed with rats, earning the city the distinction of Worst Rat City in the World. And with Hurricane Sandy’s deposit of massive amounts of water into the subterranean system, many of the rodents may be flooded out of their underground abodes.   

All five subway tubes beneath the East River between Lower Manhattan and Brooklyn and the Steinway tube between Midtown and Queens are filled with water, water that needs to be pumped since it won’t recede on its own. Where will the rats go? 

Rick Ostfeld of the Cary Institute of Ecosystem Studies in Milbrook, N.Y., told the Huffington Post, "Rats are incredibly good swimmers, and they can climb." He adds that they will escape the floods and head for safer ground, such as apartments and other buildings by humans.   

According to the U.S. Fish & Wildlife Service:   

•Rats can climb brick walls, trees, and telephone poles, and walk across telephone lines. 

•Rats can safely fall from a height of 50 feet. 

•Rats can jump three feet in the air from a flat surface and leap more than four feet horizontally. 

•Some species of rats can swim more than a mile in open water, and can tread water for up to three days. 

•Some species of rats can travel through sewer pipes and dive through water plumbing traps.

Ostfeld notes that the result of a deluge of displaced rats looking for dry shelter could result a rise in infectious diseases carried by urban rats, including leptospirosis, hantavirus, typhus, salmonella and even the plague.

The other day I saw a rat on the edge of our local park; I wasn't worried, because the park also has a family of barred owls who must consider rats pretty tasty. Still, flushing millions of rats out of New York's subterranean world is more likely to be a problem for New York people than a bonanza for New York owls.

India: After scrub typhus, encephalitis takes lives of four kids in a family

Via Daily Bhaskar, a DNA report: After scrub typhus, encephalitis takes lives of four kids in a family. 

Jaipur: After scrub typhus hit Alwar district and claimed lives, the encephalitis disease claimed four lives — all children of a single family in the district. 

Significantly, all deaths took place within a span of two days. The latest victim, fourth child died on Monday at JK Lone Hospital, and apparently six more children of the family are undergoing treatment at the very hospital. 

All the children are of three brothers, living in a joint family. Among the six, two children’s condition are critical and have been admitted in Intensive Care Unit (ICU) of JK Lone Hospital. 

Encephalitis is an inflammation of the brain, but it usually refers to brain inflammation caused by a virus. It’s a rare disease that occurs in approximately 0.5 per 100,000 individuals — and most common among children. 

The two children of the family, Kali and Dipu died on Saturday in Alwar’s Bansoor village. While two-year-old Nachita died when she was being brought to JK Lone. The fourth, three-year-old Nitika succumbed on Saturday. The 10-month-old Sunny is admitted to hospital. 

Medical superintendent SD Sharma told DNA, “The symptoms are of encephalitis which is a viral disease like dengue and it spreads fast. The report of the deceased girl would come tomorrow. We have also formed a six-member committee to inquire and report on the cases,” added Dr Sharma. 

A resident doctor told DNA that this year, Alwar is a region of encephalitis and several such cases got admitted in the hospital so far.