Thursday, August 21, 2008

First West Nile cases of the year confirmed in New York City

The New York Department of Health and Mental Hygiene confirmed that two New Yorkers tested positive for West Nile. The two patients, a 73 year-old woman in Queens and a 60-year old man in Bronx became ill in late July and were hospitalized in early August with encephalitis and meningitis, respectively. Both patients are recovering, the woman still in the hospital, while the man has already been discharged. While the man had left New York City recently, and thus could have been infected elsewhere, the woman have not left the Big Apple in a long time. According to the NYC-DHMH, last year, there were 18 confirmed cases of West Nile, and three of these patients died. Citywide vector surveillance shows an increased percentage of West Nile-positive mosquito pools relative to last year's numbers. This year, WN-positive mosquito pools have been found in Brooklyn, Queens, Bronx and Staten Island, with most positive pools in Queens and Staten Island. Numbers can be found here. Accordingly, the NYC-DHMH is conducting larvicide [probably Bti] in parts of Staten Island, the Queens and the Bronx, as well as adulticide treatments in Brooklyn, Queens and Staten Island.

Tuesday, August 12, 2008

Imported case of chikungunya reported in Bologna, Italy

EmiliaNet and ProMedMail reports a confirmed imported case of chikungunya in a 50 year old Italian of Sri Lankan origin in Bologna, Italy. The imported case was detected following the patients visit to his doctor and his admission to Maggiore Hospital in Bologna with high fever, joint pains and widespread malaise. The symptoms started on August 1 2008, one day after his return from Sri Lanka. A chikungunya epidemic is raging on in Sri Lanka, with 10000-15000 cases reported in June in Ratnapura district alone. According to the reports the patients condition is stable, and he will be discharged during the day. Considering that the viraemic period of chikungunya is 2-6 days , I find it curious that he's not held in the hospital for isolation to prevent the dissemination of the disease.
Very prudently, a regional protocol was implemented to eliminate mosquito larvae (and hopefully adults) within a radius of 100 meters from the locations where the patient stayed between his arrival to Bologna and his hospitalization.

Hopefully, the swift and commendable reaction of the Italian authorities will be sufficient to avoid the recurrence of the chikungunya epidemic that occured in Emilio-Romagna last year. However, this case might be just the tip of the iceberg as many mildly symptomatic cases might not get reported. This coincides with the seasonal increase of the local Aedes albopictus population. This imported case  re-emphasizes the threat of chikungunya emergence in all areas with competent vector species and climatic conditions (e.g. the South-Eastern United States).


Thursday, August 7, 2008

Human West Nile cases increasing in the US

Human West Nile cases are increasing according to ArboNet and ProMedMail (see figure). The total number of cases reported nearly doubled during the last week, and a similar trend is expected in the coming weeks. However, the total number of cases this year is significantly reduced compared to last year, and there were only two fatalities so far this year. At the same time, the Canadian Cooperative Wildlife Health Center reported 26 West Nile-positive birds in Ontario. Nebraska, Nevada and Ohio reported their first confirmed human West Nile cases this year in the last few weeks.


Monday, August 4, 2008

Three more cases of chikungunya found in Singapore

Three more cases of chikungunya have been found in Singapore, reports ProMedMail based on the People's Daily Online. The total number of chikungunya cases so far has been 48 in 2008.  The three new cases involve 2 foreign workers and a local delivery driver. Local transmission of the virus is assumed, as the patients have not left Singapore recently. The two foreign workers are treated in hospital, but the Singaporean driver was allowed to return to work.The Ministry of Health is carrying out active case detection in the location of these cases. The press release on the website of the Ministry of Health of Singapore also reveals that mosquito breeding sites have been found in the premises of 10 factories in the area, and the mosquito control has been initiated. The first case of chikungunya was reported in Singapore in January 2008. Mod TY on ProMedMail adds that the continuing chikungunya activity in Singapore, in spite of active efforts of breeding site reductions, represents a risk of introduction to countries which have significant populations of competent Aedes mosquitoes (such as the US), due to the significance of Singapore in terms of international trade and travel. Interestingly, the location of chikungunya cases mentioned in the report (Kranji Way) is quite close to the city of Johor Bahru in Malaysia. One would not be surprised to see additional chikungunya cases in that city.






Wednesday, July 23, 2008

Poll: Chikungunya in the South-Eastern United States

Do you think a chikungunya epidemic is credible threat in the South-Eastern United States?

On one hand, a competent vectors (Aedes albopictus) is present, climatic conditions are favorable, and international tourism offers plenty of opportunities for the importation of this disease. However, the human density is low compared to parts of the world where chikungunya epidemics occured, and the American lifestyle (driving cars, air-conditioning and window screens) limits the contact with vectors.

Please indicate your opinion using the online poll on the right. I will report back on its results.


Monday, July 7, 2008

First isolation of WNV in the Caribbean from sentinel chickens and mosquitoes

ProMedMail carries an interesting report on the first isolation of WNV from IgM seropositive sentinel chickens and mosquitoes in Puerto Rico (see the original paper in the American Journal of Tropical Medicine and Hygiene as well as in the Pan American Journal of Public Health). According to these sources, seroconversions started on June 4th 2007, peaked at 45% during June and July, and then fell steeply in August to 2%. However, seroconversions continued to occur at a low rate (2-6%) until October. Quite surprisingly, the article states that only 3 out of 4370 previously analyzed blood samples from dead birds, horses, pigs, monkeys and people were seropositive for IgG antibodies. Thus, sentinel chickens seem to be a highly valuable tool to detect the local activity of West Nile virus. ProMedMail also refers to an earlier review article in the Pan American Journal of Public Health on the spread of West Nile in Latin America. That paper invokes an interesting hypothesis for the apparent lack of human and equine cases of neuroinvasive West Nile in Latin America. They conjecture that a virulent strain of West Nile would be less likely to reach South America as it inhibits the reservoir bird to complete its difficult journey through the Caribbean. Apparently, a similar pattern is documented for St Louis Encephalitis virus where South American strains are less viremogenic than North American strains.


Thursday, June 12, 2008

Latest update on West Nile situation in North America

In Canada, no human cases or seropositive dead birds were reported so far this year. However, in the US, according to CDC and ProMedMail,  5 states (Arizona, Mississippi, Oklahoma, Tennessee and Texas) reported a total of 8 West Nile cases in humans up to the 10th of June 2008. Six of these cases were classified as West Nile fever while 2 were neuroinvasive. Fortunately, no fatalities occurred so far. On ArboNet, the most recent case appears to be in May 2008 (21st epidemiological week) in Texas. Additionally, Alabama reported an equine infection (March 2008, 10th epidemiological week), while California and South Carolina reported WN-positive dead birds (the latest confirmed cases on the 22nd and 18th week, respectively). California and Florida reported WN seroconversion in sentinel animals (5th and 12th week, respectively). West Nile-positive mosquito pools have been reported from California (21st week), Illinois (23rd week), Indiana (23rd week), Louisiana (23rd week) and Texas (22nd week).Weeks given are the latest week for which West Nile positive pools have been found for that state.  Louisiana had a total of 251 positive mosquito pools reported up to 9th June 2008.



Thursday, May 22, 2008

Yellow fever in Central African Republic

The WHO EPR Disease Outbreak News and ProMedMail reported 2 laboratory confirmed cases of yellow fever on the 15th May 2008 in Bozoum sub-prefecture, Ouham-Pende Prefecture of the Central African Republic. The Ministry of Health initiated an epidemiological investigation, and requested 64 931 doses of yellow fever vaccine from the Global Emergency Stockpile of Yellow Fever Vaccine, which is funded by the GAVI Alliance. The target population in the Bozoum sub-prefecture was estimated to be 55 035 people, which the Ministry of Health plans to vaccinate during a 3-day campaign starting on the 26th May. Mod. CP in the ProMedMail report notes that it would be important to know whether the 2 laboratory confirmed cases were isolated cases or potentially represent the start of an urban epidemic.
Hopefully the global emergency stockpile which was depleted in February following mass immunizations in South America have been adequately replenished to be able to provide supplies.

Monday, May 19, 2008

First case of West Nile fever in Texas in 2008

The first case of West Nile Fever in 2008 has been reported in Texas, Montgomery County, according to ProMedMail and the Houston Chronicle. The report states that although West Nile season typically starts in the summer, with mid-August through
mid-September being peak months because they're the hottest and driest months, it is not unusual to see cases as early as March and as late as December. However, one wonders how many cases of asymptomatic or mild West Nile infections must have been already gone unreported in the same area, given that 80% of infected people do not have any symptoms, and whether this early start signals an increased West Nile activity for Texas this year. Last year, Texas reported 170 neuroinvasive and 90 fever cases, and 17 deaths, according to state health records. The Centers for Disease Control and Prevention map of West Nile virus activity (as of 6 May 2008;  http://www.cdc.gov/ncidod/dvbid/westnile/Mapsactivity/surv&control08Maps.htm) as well as ArboNet shows that 2 human cases have been reported in Mississippi, one in Arizona, and one in Tennessee.

Friday, May 16, 2008

News focus on Aedes albopictus in current issue of Science

There is an excellent News Focus article on the global spread of Aedes albopictus  by Martin Enserink in the current issue of Science. The article gives the historical background of the spread of this mosquito, and highlights its potential public health consequences. Admirably, a clear distinction is made in regards to Aedes aegypti, the yellow fever mosquito. It's very interesting to see the differences in the judgment of different experts (notably Duane Gubler and Didier Fontanille) in terms of the level of risk attributed to Aedes albopictus. One aspect that I was lacking from this article was raising the possibility of a chikungunya outbreak in the South-Eastern United States. Nonetheless, this article is an excellent read and is highly recommended for anyone interested in mosquitoes and the diseases they spread.


Thursday, May 15, 2008

Predictive study for Ross River Virus infections in the Darwin area of Australia published

Susan P Jacups of Charles Darwin University, Darwin, Australia publishes an elegant study in the upcoming issue of Tropical Medicine and International Health about predictive indicators for Ross River virus infection in the Darwin area of tropical North-Eastern Australia. Ross River virus is an Alphavirus, a close relative of chikungunya and Barmah Forest Virus, causing  similar symptoms of fever, joint pain and rash. The study is based on the statistical analysis of laboratory confirmed cases of RRV infection between 1991 and 2006 as well as climatic, tidal and mosquito data collected from 11 trap sites weekly in the study area. The authors identified the best predictors of RRV infections using three multivariate Poisson models. The best global model included rainfall, minimum temperature and the average monthly trap numbers of three implicated mosquito species populations (Culex annulirostris, Aedes vigilax, Aedes notoscriptus), and explained 63.5% of the deviance while predicting disease accurately. The model also indicated that predicted anthropogenic global climatic changes may increase RRV infections. My favourite point is that the predictors in the global model, since they all have a lag time of either 1 or 3 months, can be used as an early-warning system for potential RRV outbreaks. Such location-specific early-warning systems are badly needed for other vector-borne diseases, such as e.g. West Nile, dengue and chikungunya.


Wednesday, May 14, 2008

Dengue epidemic raging on in Rio de Janeiro

This years dengue epidemic is raging on in Rio de Janiero, with 76,385 cases reported in the city alone until 9th May this year, according to ProMedMail (see also here). In the whole state of Rio, 134,643 cases have been reported so far. In the state of Rio, 106 deaths occured due to dengue, with 3 additional cases between 4th and 10th May. 64 of these deaths occured in Rio de Janeiro.

At the same time, the governor of the state Rio Grande do Norte declared a state of emergency due to the 19,157 dengue cases, 78 DHF cases and 2 deaths reported until 3rd May this year in 154 cities in the state.


Wednesday, May 7, 2008

New issue of the American Journal of Tropical Medicine and Hygiene available

The 2008 May issue of the American Journal of Tropical Medicine and Hygiene is now available.
Particular papers of interest (to me) are:


Management of Travelers with Fever and Exanthema, Notably Dengue and Chikungunya Infections
Patrick Hochedez, Ana Canestri, Amélie Guihot, Ségolène Brichler, François Bricaire, AND Eric Caumes
Am J Trop Med Hyg 2008;78 710-713
http://www.ajtmh.org/cgi/content/abstract/78/5/710


Evaluation of Mosquito Densoviruses for Controlling Aedes aegypti (Diptera: Culicidae): Variation in Efficiency due to Virus Strain and Geographic Origin of Mosquitoes
Supanee Hirunkanokpun, Jonathan O. Carlson, AND Pattamaporn Kittayapong
Am J Trop Med Hyg 2008;78 784-790
http://www.ajtmh.org/cgi/content/abstract/78/5/784

Experimental West Nile Virus Infection in Jungle Crows (Corvus macrorhynchos)
Hiroaki Shirafuji, Katsushi Kanehira, Masanori Kubo, Tomoyuki Shibahara, AND Tsugihiko Kamio
Am J Trop Med Hyg 2008;78 838-842
http://www.ajtmh.org/cgi/content/abstract/78/5/838

Yellow fever in Peru and Ecuador

Two cases of sylvan yellow fever have been reported between 20-26 April 2008 in Peru, according to ProMedMail, based on the Epidemiological Bulletin of the Ministry of Health of Peru. The 1st case was a 23-year-old unvaccinated man from the Loreto department, while the 2nd case is a 21-year-old man of unknown vaccination status from Tocache Nuevo (Tocache district and province), San Martin department. He became ill between 6-12 Apr 2008. Since the beginning of 2008, there were 13 reported yellow fever cases in Peru, including 3 confirmed mortalities, 6 probable, and 4 discarded cases. Mod TY of ProMedMail asserts that from a public health point of view, it is fortunate that the reported sylvan yellow fever cases didn't spread into a major urban yellow fever outbreak.

Also, the CDC updated its yellow fever risk map for Ecaudor, following the recommendation of the Ecaudor Ministry of Health of yellow fever vaccination for all travelers to the following provinces in the Amazon Basin: Morona-Santiago, Napo, Orellana, Pastaza,
Sucumbios, and Zamora-Chinchipe.  This is in addition to the current recommendation for yellow fever vaccination for travelers going to areas along the eastern slopes and to the east of the Andes Mountains. At present, yellow fever vaccination is only required for travelers entering Ecuador if they are greater than one year of age and if they are coming from a country in the yellow fever endemic zone.




Wednesday, April 9, 2008

Breaking news: Chikungunya back in Kerala

ProMedMail reports based on the Thaindian News, that 6 cases of chikungunya have been confirmed in Vatakara and 9 cases confirmed in Maruthonkara, both in Kozhikode district, in the northern part of Kerala state, India. The outbreak was reported Tuesday (04/08/2008), following heavy and untimely rains. The index case appear to be a person who travelled from Tamil Nadu [Is there an outbreak as well in Tamil Nadu? No report on that available.] A high density of Aedes aegypti mosquitoes was noted at the location of the outbreak, and a campaing to reduce the mosquito density has been initiated. According to the report, Kozhikode district, specifically the town of Kodenchery reported a large number of cases last year.

According to another report in the same journal, Poonam Khetrapal Singh, the deputy regional director of WHO SEARO (South-East Asian Region), the chikungunya outbreaks in Kerala in the last two years is directly attributable to climate change. The report claims that 100 fatalities and more than 100,000 [or rather 1,000,000] chikungunya cases occured in Kerala state. Kerala State put together an action plan to control disease, with each district allocated 500,000 Rs for prevention.

These news are very disconcerting as last year the first cases in Kerala have been reported more than a month later than this year. Unless vector control campaigns are much more successful than previously, another huge outbreak of chikungunya in the region is expected this year. This will also enable the importation of chikungunya to Europe and the US, where transmission by local Aedes albopictus is a real possibility.

Click here to see the location of these outbreaks.

Monday, April 7, 2008

More information on the dengue outbreak in Rio de Janiero

During the weekend, CNN ran two additional articles on the dengue outbreak in Rio de Janiero containing some additional information. According to the first report, 2000 soldiers and firefighters joined the fight against dengue, some of them going door-to-door to educate the public about source-reduction. Additional to the 67 fatalities already reported, 58 suspected deaths are also investigated. An average of 1.4 cases of dengue are reported per minute (that's 2016 cases per day). 400 patients are admitted to one of the field hospitals, of which 65% have dengue. The reported fatalities are also broken down with 21 due to DHF, 14 due to DSS, while 32 due to the 'more common form of the disease' [possibly these cases do not satisfy all the requirements of the WHO DHF/DSS classification]. According to an article in the newspaper O Globo and ProMedMail, the public health infrastructure in Rio de Janeiro has collapsed under the pressure of the dengue outbreak, amplified by an influx of patients from the countryside. CNN also reports of the difficulty in vector control in Caxias neighborhood of Rio, which is ruled by drug dealers who don't let authorities and outsiders into their territory. Residents are feeling neglected and probably in need of basic public health services.

Thursday, April 3, 2008

Dengue situation worsening in Rio de Janiero

CNN carries today a tragic report on the worsening dengue situation in Rio de Janeiro, Brazil. According to the report, the number of dengue fever cases this year has reached 57,010 , while the number of DHF cases exceeded 513. There were 67 deaths connected to dengue so far, with more than half of those in children below the age of 13. Judged by the report, the public health infrastructure is clearly overwhelmed, with patients transported to 3 military field hospitals near the city (see shocking images at the same CNN report). Authorities are considering to invite assistance from Cuba, where physicians are very experienced at treating dengue. Average hospital waits range from 8 to 28 hrs at different hospitals in the city. Earlier this week, the government also asked other Brazilian states to send hundreds of their physicians to help save the population in Rio. The Brazilian army is also contributing to the efforts. I would encourage any reader of the blog from the region to submit their firsthand reports.


Wednesday, April 2, 2008

New issue of the American Journal of Tropical Medicine and Hygiene published

A new issue of the American Journal of Tropical Medicine and Hygiene has been published. I wish UGA would have a subscription for it such that I could access the articles as they come out. It has a number of interesting articles, but I 'd just like to highlight a few here:

Ephantus J. Muturi, Peter Burgess, AND Robert J. Novak
Malaria Vector Management: Where Have We Come From and Where Are We Headed?
Am J Trop Med Hyg 2008 78: 536-537. [Full Text] [PDF] 
          Anna M. Winters, Bethany G. Bolling, Barry J. Beaty, Carol D. Blair, Rebecca J. Eisen, Andrew M. Meyer, W. John Pape, hester     G. Moore, AND Lars Eisen
          Am J Trop Med Hyg 2008 78: 654-665. [Abstract] [Full Text] [PDF] 
Roberto Barrera, Elizabeth Hunsperger, Jorge L. Muñoz-Jordán, Manuel Amador, Annette Diaz, Joshua Smith, Kovi Bessoff, Manuela Beltran, Edgardo Vergne, Mark Verduin, Amy Lambert, AND Wellington Sun
Am J Trop Med Hyg 2008 78: 666-668.
[Abstract] [Full Text] [PDF] 

William K. Reisen, Ying Fang, AND Aaron C. Brault
Am J Trop Med Hyg 2008 78: 681-686.
[Abstract] [Full Text] [PDF] 

Christopher D. Paddock, Susana Fernandez, Gustavo A. Echenique, John W. Sumner, Will K. Reeves, Sherif R. Zaki, AND Carlos E. Remondegui
Am J Trop Med Hyg 2008 78: 687-692.
[Abstract] [Full Text] [PDF] 



Wednesday, March 26, 2008

Fungi vs insects 1:0

In a recent paper in Heredity, Alex Kraaijeveld and Charles Godfray show that Drosophila melanogaster has little chance in developing resistance to fungal pathogens such as Beauveria bassiana. This is significant as the same fungi and the related Metarhizium anisopliae are targeted to be used as biopesticides against disease vectoring mosquitoes (such as Anopheles) and other insect pests. In this paper, in a long-term artificial selection experiment for 15 generations, selected flies did not have higher overall fitness after infection compared with control lines. However, late-life fecundity increased in the selected lines, which may indicate evolved tolerance of the fungal pathogen. Nonetheless, this increase was balanced by decreased early-life fecundity in the selected lines. More importantly, in the absence of fungal infection, selected lines had lower overall fitness than control flies. In general, the paper demonstrated that Drosophila have a weak selection response to the fungal infection. If this is true to insects in general and to mosquitoes in particular, this might suggest that resistance to such fungal pesticides will not evolve easily and rapidly. This might give  us just another novel tool for vector control, which is badly needed to reduce vector-borne diseases globally.

Tuesday, March 25, 2008

More on the dengue outbreak in Rio de Janeiro

News of a large dengue outbreak are starting to circulate on the Internet. PromedMail reported today that in addition to the 47 confirmed mortalities due to dengue in Rio de Janeiro since the start of the year, an additional 49 cases of death are suspected to be due to the disease. Bloomberg.com also reports that 2053 dengue cases have been reported on a single day (March 20, 2008), which is much higher (cc. 84) cases per hour than was previously reported (51 cases of dengue per hour). This outbreak is very alarming, and surely overwhelms the public health infrastructure of the city. In the same report, Edmilson Migovski, a professor of infectious diseases at the Federal University of Rio de Janeiro is quoted saying that part of the reason of this large outbreak is that  the 'virus is becoming more virulent'. Although I haven't seen any report of any dengue serotypes evolving higher virulence, Prof. Migovski might have meant that DHF/DSS is occuring due to pre-existing herd immunity to heterologous serotypes in the population. It would be interesting to know what is the dominant serotype of this outbreak. The Asian variant of DEN-2 is known to cause more serious disease as well as DHF/DSS.


Monday, March 24, 2008

Dengue outbreak in Brazil

CNN reports that there is a dengue outbreak in Rio de Janeiro, that has already affected 32,000 people [possibly reported dengue fever cases] and claimed at least 47 lives [probably since the start of this year]. The number of deaths is already higher than it was in 2002, the last officially recognized epidemic year. According to the Federal Health Minister, Jose Gomes Temporao, 51 new cases are reported every hour [I can only imagine how much this can overburned the health system]. A crisis center will open today  in Rio state to coordinate response from federal, state government and the armed forces to combat the disease.

Although ProMedMail doesn't have a corresponding report, PAHO has a similar news item with more information. It seems that while the number of dengue cases nationally is 40% less than last year [probably due to a lack of a huge outbreak like last year in Paraguay], the dengue prevalence has more than doubled this year compared to last year in Rio de Janeiro.


Thursday, March 20, 2008

ICEID 2008

On March 18th, I visited the International Conference of Emerging Infectious Diseases (ICEID 2008) in the Hyatts Regency Hotel, in Atlanta, GA. Even though I was only able to attend half a day of this conference, I felt that it was incredibly useful and highly worth the trip from Athens to Atlanta. In general, the meeting was very well organized, with several concurrent sessions in the morning. I was able to attend 3 sessions on arboviral disease.

At first, Thomas Monath from the Kleiner Perkins Caufield and Byers Pandemic and Biodefense Fund talked about the challenges and possible solutions of dengue control. Tom Monath has been a major force behind the development of dengue vaccines, personally working on the ChimeriVax dengue vaccine at Acambis. He gave a thorough introduction to dengue and then summarized the status of the dengue vaccines under development. He mentioned that there is a lot of genetic plasticity within dengue serotypes, which was unknown to me. Also, he acknowledged that there is a prolonged convalescence period even for dengue fever, characterized by weakness and fatigue, which is usually not included in the burden of disease studies. He featured a highly useful and intuitive diagram showing the variety of societal, economic, ecological and evolutionary components that lead to the increasing incidence and geographic range of dengue. In terms of the US, he acknowledged that dengue is present in south Texas, and has the potential to spread further north. On one of his maps, northern Argentina was shown to have Aedes aegypti, which I wasn't aware of either (although not surprising given the proximity of Paraguay and Brazil). He also warned about the widespread distribution of Aedes albopictus in the US, which is although less capable vector of dengue as Aedes aegypti is, could nonetheless drive an epidemic in Hawaii in 2001. He mentioned that Aedes albopictus might be present on the west coast of the US, however, this is not mentioned in the recent paper on the distribution of Aedes albopictus (although I might have misunderstood).

Friday, March 14, 2008

Chikungunya outbreak in Sri Lanka rages on

ProMedMail reports that the chikungunya outbreak in Sri Lanka is ongoing. The number of cases mentioned is the same as in an earlier report.  The importance raising of public awareness and insanitary conditions [ample breeding sites] are cited in the current report. While these are undoubtedly important, I hope that the response to the epidemic is not left solely to the affected public. Isolation of infectious patients from bites of susceptible mosquitoes and immediate and major reduction of the adult and larval mosquito population by all available means is the only solution, unless the authorities want to let the epidemic run its course.


Thursday, March 13, 2008

African Horse Sickness outbreak reported in South Africa

ProMedMail reports that there is an outbreak of African Horse Sickness in Gauteng, KwaZulu-Natal and the Eastern Cape of South Africa.
Mod AS. adds that African Horse Sickness is endemic and seasonal in these areas. Authorities have imposed an embargo on the movement of horses into the province. African Horse Sickness is caused by an orbivirus, which is phylogenetically similar to bluetongue virus, and is vectored by the same Culicoides biting midges (e.g. C. imicola) that spread bluetongue. This is a life-threatening disease with fever, internal bleeding, attacking the internal organs, and causes high rates of mortality. It is therefore understandable that the EU placed a ban on importing horses from the affected area a few years ago. I suppose the European horse industry does not want to have it's own bluetongue.

West Nile virus detected in birds in San Diego

According to ProMedMail, West Nile virus was found in 6 birds in San Diego County, California. This is unusual as evidence of viral infection in birds usually doesn't show up until the summer or fall. Fifteen cases have been reported in humans in 2007, 14 of them in people aged over 50. [Actually, ArboNET reports 16 total human cases in San Diego County, California in 2007 up to March 4, 2008]. The report mentions that mosquitoes usually die off in the winter, but a wet winter and a warm spring may have helped them survive in recent months. While this might be true, it is also possible that WNV is maintained by direct transmission between birds during the winter period. Interestingly, looking at reports of WNV-positive birds in 2007 in California, a few cases occured as early as January and February. Undoubtedly, human cases were only reported starting in June. Interestingly, WNV-positive mosquitoes appeared in earnest in July as well, while a few were reported in January [a warm spell?] and May. This could support the idea that cases of West Nile in birds are due to direct transmission between birds, and not vector-borne. Agreeing with Mod TY in the ProMedMail report, it would be very interesting (and important) to know whether there are any WNV-positive mosquito pools in San Diego County at the moment.

Wednesday, March 12, 2008

Malaria model predicts successful malaria eradication in regions of mesoendemic transmission

Bob Snow and his colleagues, Ricardo Augas, Lisa White and M. Gabriela M. Gomes published a very interesting study in PLOS One predicting that malaria could be successfully eradicated in regions of mesoendemic transmission (areas with infection prevalence between 11% and 50%, see here) if prevalence of the disease could be brought below a certain threshold. The authors used a classical SIRI-type epidemiological model, where recovered hosts can become infected but not infectious for the second time, and recovered hosts can lose their immunity over time. The authors parameterized this model using clinical data from eight endemic regions in Sub-Saharan Africa. The model predicts a regime of bistability of endemic and malaria-free states, induced by a shorter estimated infectious period for clinical infections, in regions of mesoendemic transmission. These two states are separated by a threshold of prevalence (total number of cases), predicting that malaria can be eradicated in these areas if the number of cases can be kept below a certain level by a combination of interventions. This result is definitely encouraging as both e.g. India, South-America as well as some parts of sub-Saharan Africa belong to the hypo- and mesoendemic region (see this figure). I haven't read the paper thoroughly yet, but it's definitely in my pile. However, just by glimpsing at it, I see that the epidemiological model only follows hosts and not vectors (vectors are implicitly assumed as part of the force of infection). My opinion is that the inclusion of vectors might make the disease dynamics more complex, as well as more realistic. Since the predictions of this paper are so important for public health programmes that aim to control malaria, I would suggest to look at the effect of vectors on the dynamics as well.

Interesting videos about selfish genetic elements on YouTube

Enthusiastic master students of Tom van Dooren and Ken Kraaijeveld at the Institute of Biology in Leiden, the Netherlands produced interesting ideo materials on selfish genetic elements, which they made available on YouTube. The 14 videos feature such selfish genetic elements as B-chromosomes, transposable element, selfish sex chromosomes and meiotic drive (although I didn't see this one). The videos are all below 10 minutes in length, and make a good effort in introducing these elements. Since selfish genetic elements have been proposed to drive genes that make mosquitoes (e.g. Aedes aegypti) refractory to pathogens (e.g. dengue), these videos could be of interest to researchers working on vector-borne diseases. There is also a movie included more generally on Mendelian inheritance and selfish genetic elements, as well as on how to turn Powerpoint presentations into such movies. I think this a very nice project. My only criticism is that the graphical resolution of some of the movies is inadequate (see e.g. the movie on how to make movies from presentations), which is possibly due to the difficulty in capturing high-resolution movies with limited infrastructure.




Monday, March 10, 2008

Immunohistochemistry suggested to differentiate between yellow fever and dengue

The recent yellow fever epidemic in Paraguay with a number of urban cases highlighted the importance of differentiating between dengue and yellow fever in areas where these two Flaviviruses cocirculate. Dr. C.J. Peters at the University of Texas Medical Branch suggested on ProMedMail to use immunohistochemistry for this purpose. Immunohistochemistry localizes the antigens (virus) of the specific disease by presenting labeled antibodies. This method works in fixed tissues which are much easier to obtain from outbreaks in remote locations than fresh tissue or blood samples. He also lists a number of examples when such a method was shown to be effective for yellow fever.
This method seems to be low-tech and efficient, probably cheap method, which I, coming from Hungary, can appreciate.

Uric acid produced by Plasmodium kicks the immune system into lethal overdrive in malaria

PLOS Pathogens just published a very interesting paper by Orengo and others at the Department of Medical Parasitology of the New York University School of Medicine and the Department of Biochemistry and Molecular Pharmacology at the University of Massachusetts Medical School on how Plasmodium-infested red blood cells accumulate high concentrations of hypoxanthine. This is degraded into uric acid upon the rupture of these red blood cells, which is a danger signal for the immune system, inducing the production of inflammatory cytokine TNF (tumor necrosis factor) from dendritic cells in a mouse model. Possibly because of my limited knowledge of malaria pathology, it was a surprise to me that the real danger seems to be the malaria-induced inflammatory response. This is quite similar to dengue haemmorrhagic fever or shock syndrome, which I wasn't aware before.

Two people died of DHF on Tonga; Dengue spreading in NE Queensland

Dengue haemorrhagic fever has claimed the lives of a 23-year old man and an infant during the last week, reports ProMedMail. According to local sources, the number of dengue fever cases tripled relative to last year, with more than 200 cases [over an uncertain period]. Interestingly, the report states that the epidemic occurred between June and December. Recommendations to the public in the report include using mosquito nets, which might not have much effect as Aedes aegypti is a day-biting mosquito.

The same report announces that the number of dengue cases in Port Douglas, North Queensland, Australia reached 14, despite control efforts by mosquito trapping and spraying. As usual, residents are urged to remove potential breeding sites. The report includes interesting notes of previous outbreaks with 30 cases in Cairns in 2003 and a large outbreak of 500 cases in 1997-98 in the same area. I noticed that the link at the end of the report is erroneous. The proper link is <http://www.health.qld.gov.au/dengue>. Interestingly, this local health authority website seems to be out-of-date, showing only 6 cases in total for the current outbreak.

Friday, March 7, 2008

African Swine Fever kills hundreds of pigs in Tanzania

ProMEDMail reports that African Swine Fever, a febrile disease transmitted by ticks in Africa, has killed hundreds of pigs at two locations in Tanzania. The case fatality rate of this disease is close to 100%. In this case, 20% of susceptible animals died so far at these locations. The ProMEDMail commentary adds that these two locations are in different provinces which raises the question about their connection epidemiologically.



Chikungunya spreading in Sri Lanka

It seems that Chikungunya is spreading fast in Sri Lanka, according to ProMEDMail and the Daily News. So far 150 patients have been reported, of which some have been confirmed (presumably by ELISA). Authorities are giving the usual advice to the public to eliminate breeding site, which will not help them in the short run as adult infectious mosquitoes are flying around. According to the knowledgeable comment of Mod TY on ProMEDMail, this is the first report of local transmission of chikungunya in Sri Lanka in 2008. However, in January 2008 an imported case of chikungunya to Hong Kong was originated in Sri Lanka, indicating that transmission has occured in Sri Lanka prior to this report. Hopefully India will be spared from chikungunya this year, unlike in 2006 and 2007. If not, imported cases during the Northern Hemisphere summer will have the potential to start another local epidemic such as the one that occurred in Italy in 2007 in regions of Europe and the US where Aedes albopictus is prevalent.


Yellow fever vaccination campaign nearing its end in Paraguay

ProMEDMail reports, based on this WHO update that more than 1.27 million people have been vaccinated in 18 states of Paraguay. This means 83% of the population in Ascunsion and 75% of the people at the Central Department have been vaccinated against yellow fever.
This is great news, which basically means an end to the threat of a potentially disastrous yellow fever epidemic in Paraguay.
However, at the same time they report that the number of confirmed cases has risen by 5, leading to a total number of cases of 21, and a total of 5 fatalities during the outbreak. 12 suspected cases are still under evaluation. The WHO update also reports that officials from Brazil, Paraguay, Uruguay, Venezuela, Bolivia and Peru agreed to coordinate and monitor yellow fever immunization for the populations of border areas, with the support of PAHO. While this is very promising, I hope that this program will be extended to other populations not living in the border areas. Also, the officials reiterated breeding site reductions as the preferred method to combat Aedes mosquitoes and yellow fever (and dengue). While I don't doubt that breeding site reductions can be very effective, I hope that integration with other forms of vector control will be considered, or at least breeding site reduction will target rare, but highly productive breeding sites.



Wednesday, March 5, 2008

Indirect evidence for excess deaths due to chikungunya infection

The current issue of Emerging Infectious Diseases carries an article by Dileep Mavalankar and coauthors at the Indian Institute of Management, Ahmedabad, India. The article, reported by PromedMail as well claims that 3056 more deaths than expected that occured in 2006 in Ahmedabad, India are due to the chikungunya epidemic. The authors arrived at this conclusion by estimating the expected number of deaths in 2006 based on the number of deaths reported in 2002-2005, and comparing it with the actual number of cases reported. About 2944 additional deaths occured in the period August-November when the chikungunya epidemic was at its height in 2006 in the city.  Statistically significant difference was shown between the observed number of deaths and the expected number of deaths for July, August and September of 2006. Overall, 60,777 suspected chikungunya cases were reported in 2006 in Ahmedabad. The authors generalize this case-fatality-ratio of around 5% to the chikungunya epidemic in the whole of India in 2006 with 1.39 million suspected cases, estimating around 50,000 [see the ProMedMail report] deaths due to chikungunya infection in the whole of India in 2006. [According to my calculation, 70,000 deaths would be more appropriate estimate for a CFR of 5% with 1.39 million cases] It seems reasonable to assume some mortality with any infection in the elderly or immuno-compromised patients, as the article claims. However, no mechanism has been found so far by which chikungunya infection would lead to mortality in itself. Another recent article in the Virology Journal shows that the chikungunya virus produces acute arthritis by large area of necrosis and collagenosis or fibrosis, damaging the cartilage and connective metabolism and releasing the degraded products from the tissue, increasing levels of proline, hydroxyproline and mucopolysaccharides in affected patients. Whether this mechanism in itself is life-threatening in elderly or immunocompromised patients, or other opportunistic infections cause the mortality, seems to be an open question.

Additional 4 cases of yellow fever confirmed in Paraguay

An additional 4 cases of yellow fever deaths have been confirmed in Paraguay by health authorities, according to a report on ProMedMail. All four cases occured in a jungle area in the department of San Pedro, 220 km from the capital Ascuncion and 400 km from Mato Grosso in Brazil. The total number of yellow fever cases confirmed in Paraguay during 2008 stands at 20, of which 10 people died. Of these 10 deaths, only 4 has been confirmed by autopsy, however the other 6 cases show similar clinical signs. The report claims that residents of San Pedro generally refuse the yellow fever vaccination in fear of its side-effects. In Paraguay, approximately 2 million people have been already immunized for free, and a vaccination campaign is continuing using an additional 1 million dose of vaccines that arrived to Paraguay during the last two month.


Monday, January 28, 2008

PRO/AH/EDR> Rift Valley fever - Sudan: WHO

Date: Tue 22 Jan 2008
Source: World Health Organization (WHO), CSR, Disease Outbreak News [edited]
< http://www.who.int/csr/don/2008_01_22/en/index.html>


Rift Valley fever in Sudan - WHO update
---------------------------------------
Human cases of Rift Valley fever (RVF) in Sudan have decreased continuously
in recent weeks. As of 15 Jan 2008, a cumulative total of 698 cases,
including 222 deaths, has been reported from 6 states (Gazeera, Kassala,
Khartoum, River Nile, Sinnar, and White Nile), yielding an overall CFR
[case fatality rate] of 32.4 per cent.

While active surveillance continues in all affected states, no new cases
have been reported since 5 Jan 2008. Only Gazeera state has reported cases
with date of onset in 2008, while several additional cases have been
reported retrospectively with date of onset in November or December 2007.
Several of the newly added cases evidence ocular presentation, which is
typically a late-occurring feature of RVF infection.

Case management related interventions and health education and vector
control efforts are continuing. WHO continues to support the Sudan Ministry
of Health in preparedness for viral haemorrhagic fever and other seasonal
outbreaks and in the procurement of essential supplies, enhancing
surveillance and training activities.

For more information, see the WHO RVF Fact Sheet at
<http://www.who.int/mediacentre/factsheets/fs207/en/index.html >, parts of
which are appended below.

--
communicated by:
ProMED-mail rapporteur Marianne Hopp

["Rift Valley Fever (RVF) is a viral zoonosis that primarily affects
animals but also has the capacity to infect humans. Infection can cause
severe disease in both animals and humans, leading to high rates of disease
and death. The disease also results in significant economic losses due to
death and abortion among RVF-infected livestock.

"RVF virus is a member of the _Phlebovirus_ genus, one of the 5 genera in
the family _Bunyaviridae_. The virus was 1st identified in 1931 during an
investigation into an epidemic among sheep on a farm in the Rift Valley of
Kenya. Since then, outbreaks have been reported in sub-Saharan and North
Africa. In 1997-1998, a major outbreak occurred in Kenya, Somalia and
Tanzania and in September 2000, RVF cases were confirmed in Saudi Arabia
and Yemen, marking the 1st reported occurrence of the disease outside the
African continent and raising concerns that it could extend to other parts
of Asia and Europe.

"The vast majority of human infections result from direct or indirect
contact with the blood or organs of infected animals. The virus can be
transmitted to humans through the handling of animal tissue during
slaughtering or butchering, assisting with animal births, conducting
veterinary procedures, or from the disposal of carcasses or fetuses.
Certain occupational groups such as herders, farmers, slaughterhouse
workers and veterinarians are therefore at higher risk of infection. The
virus infects humans through inoculation, for example via a wound from an
infected knife or through contact with broken skin, or through inhalation
of aerosols produced during the slaughter of infected animals. The aerosol
mode of transmission has also led to infection in laboratory workers.

"While most human cases are relatively mild, a small percentage of patients
develop a much more severe form of the disease. This usually appears as one
or more of 3 distinct syndromes: ocular (eye) disease (0.5-2 per cent of
patients), meningoencephalitis (less than 1 per cent) or haemorrhagic fever
(less than 1 per cent). The total case fatality rate has varied widely
between different epidemics but, overall, has been less than 1 per cent in
those documented. Most fatalities occur in patients who develop the
haemorrhagic icterus form.

"During an outbreak of RVF, close contact with animals, particularly with
their body fluids, either directly or via aerosols, has been identified as
the most significant risk factor for RVF virus infection. In the absence of
specific treatment and an effective human vaccine, raising awareness of the
risk factors of RVF infection as well as the protective measures
individuals can take to prevent mosquito bites, is the only way to reduce
human infection and deaths."

A map of the states of Sudan can be accessed at
<http://www.emro.who.int/sudan/Media/PDF/Sud-states-2006.pdf >. The number
of human cases previously confirmed by WHO was 601 on 19 Dec 2007. - Mod.CP]

Wednesday, January 23, 2008

Fwd: PRO/AH> ProMED BLUETONGUE - EUROPE (02): BTV-8, VACCINATION

[1] European Commission, vaccination

[On 16 Jan 2008, the European Commission hosted in Brussels a
conference on bluetongue in Europe. More than 350 experts met to
discuss the best ways of tackling this disease, with a particular
focus on vaccination as a prevention and control measure.

Conference participants included representatives from the Commission,
Member States, 3rd countries, international organisations and
stakeholder groups. Discussions also centered on technical and
economic aspects related to carrying out vaccination against
bluetongue, including trade considerations. Following presentations
on successful vaccination experiences in Member States and 3rd
countries, there was wide consensus that a mass vaccination strategy
in the affected Member States should be facilitated and that all
available vaccines should be used. We introduce the conclusions of
the conference, as published on the website of the European
Commission. - Mod.AS]

Date: Fri 18 Jan 2008
Source: Web-site European Commission [edited]
< http://ec.europa.eu/food/animal/diseases/controlmeasures/conclusions_bt_conf.pdf>


Conclusions: Conference on "Vaccination strategy against bluetongue",
Brussels, 16 Jan 2008
- -----------------------------------------------------

1. General
- - The Commission's political line, with regards to bluetongue has
been outlined today and is now clear: mass vaccination with all
available vaccines.
- - Estimating the actual losses due to bluetongue is difficult, but
the figures already provided suggest that they are substantial.
- - We now realise and acknowledge the very valuable expertise
gathered in the southern Member States previously affected by
bluetongue, and especially as regards the successful use of
vaccination using the 2 different types of vaccines.
- - It is clear that the use of both types of vaccines is better than
developing the disease.
- - We need to strike a balance between harmonisation and flexibility.
- - The OIE Code confirms that vaccination is the best solution for safe trade.
- - Solid and accurate standards for trade are provided in the OIE
Code but efforts should still be made as regards the OIE Manual.
- - Some stakeholders have suggested that the authorities should
consider the possibility that farmers administer the vaccine.
- - The local epidemiological situation largely influences the choice
of the most adequate type of vaccine and vaccination strategy.
- - It would be hard to justify adopting the same approach in
controlling the disease in 2008 as in 2007, given that vaccines
against BTV-1 and BTV-8 are now available.

2. The Disease and Its Control
- - We have gained a lot of expertise and knowledge of the disease in
recent years.
- - A particular European characteristic is the unprecedented waves of
bluetongue epidemics affecting in some cases high production areas.
- - We have learned that emergency mass vaccination is the most
efficient strategy, taking into account the current EU situation.
- - In principle, there is no scientific, economic or management
justification to exclude the use of any of the existing vaccines for
emergency vaccination.
- - This should be done within the existing EU legal framework for
bluetongue control and eradication, as is the case for any other
former list A diseases of the OIE.

3. The Vaccine
- - Sufficient and timely availability of vaccines for rapid
vaccination remains a concern. Vaccine supplies can now be ensured
taking into account all types of vaccines.
- - Control and direct supervision of the official veterinary services
should ensure correct vaccine administration.
- - Adequate surveillance and control mechanisms should be put in place.

4. Financial Aspects
- - The Community's co-financing for 2008 is covered in the framework
of emergency veterinary measures at the rate of 100 percent of the
costs of the purchase of the vaccine and 50 percent of the costs of
the administration, subject to certain ceilings.
- - The rest of the involved parties, and especially the Competent
Authorities of Member States, should immediately deploy the necessary
resources, including human resources.

5. Next Steps
- - Vaccination plans fulfilling all the necessary requirements should
be swiftly submitted by Member States.
- - The follow-up and evaluation of the results of this emergency
vaccination approach will be carried out in 2009.

- --
Communicated by:
ProMED-mail
<promed@promedmail.org >

************************************************************
[2] Questions and answers
Date: 18 Jan 2008
Source: Web-site European Commission [edited]
< http://ec.europa.eu/food/animal/diseases/controlmeasures/bt_qanda_en.pdf>


January 2008: Questions and Answers on bluetongue vaccination
- -------------------------------------------------------------
1. What is bluetongue?
Bluetongue is a non-contagious, insect-transmitted, viral disease of
domestic and wild ruminants. At present 24 serotypes of the virus are
recognised. The virulence and mortality rate of the different virus
strains vary considerably depending also on the infected species.

2. What are the advantages of vaccinating against bluetongue?
Vaccination is regarded as one of the most effective ways of
controlling and eventually eradicating bluetongue disease in affected
areas. It reduces clinical signs in affected animals resulting in
lower mortality and reduced economical losses, and it prevents the
spread of the disease amongst livestock.

3. What are the different vaccine options?
Vaccines against bluetongue can either be inactivated vaccines or
modified live virus (MLV) vaccines. Inactivated vaccines, when
administered in 2 separate doses, are able to fully protect animals
for a long period. Modified live vaccines generate protective
immunity after a single inoculation, and they have been proven
effective in preventing clinical BT in the areas where they are used.

4. Can Member States use vaccination against bluetongue?
Under EU legislation, Member States can apply vaccination as a
control measure against bluetongue. Member States that wish to carry
out a bluetongue vaccination campaign must inform the Commission.

5. What measures are set out for bluetongue vaccination in EU legislation?
In October 2007, Regulation (EC) No. 1266/2007 was adopted, setting
out more harmonised measures for the monitoring and control of
bluetongue. Under this Regulation, clear conditions are set out for
the movement of animals from bluetongue infected areas, including
those which have been vaccinated against the disease. The Regulation
clarifies the requirements for vaccinated animals and therefore makes
intra-community trade of vaccinated animals more feasible. Animals
vaccinated against bluetongue can only be moved if they meet certain
conditions established in Annex III of Regulation (EC) No. 1266/2007.
These conditions ensure that vaccinated animals are not viraemic
(i.e., that there is no virus in the bloodstream) and have already
developed a sufficient immune protection before being moved outside
the protection zone.

6. Is there financial support for bluetongue vaccination?
EU co-funding may be provided to cover certain costs of vaccination,
not only in emergency situations but also for long-term surveillance
and control activities and when vaccination is used with to eradicate
bluetongue.

7. Has vaccination against bluetongue already been carried out in
the EU, and what were the results?
Bluetongue vaccination has been successfully used in a number of
European countries which have been affected by the disease. Italy,
Spain, France and Portugal have all used vaccination as a means of
controlling and eradicating outbreaks of the bluetongue virus.

8. Why has vaccination not been carried out in all affected Member
States so far?
For certain strains of the bluetongue virus, including BTV8 which has
caused the outbreaks in Northern Europe, no vaccine has been
available up to now. However, the Commission has had close contacts
with the industry on this issue, and several producers have developed
or are currently developing a vaccine which could be used against BTV8.

9. Can vaccinated animals still carry the bluetongue virus?
Vaccination does not immediately protect the animal from infection if
there is a virus circulating. When the vaccines are administered to
uninfected animals, the onset of a protection is observed only after
a certain period, depending on the biological properties of the
vaccines. For this reason, EU legislation lays down movement
restrictions and/or controls for vaccinated animals to ensure that
they do not contribute to the spread of the disease.

10. Can vaccinated animals be distinguished from naturally infected animals?
No strategy is currently available to distinguish vaccinated from
infected animals on the basis of serology. However, PCR techniques
which can distinguish vaccines from field viruses have been
established and successfully used.

11. Are meat and milk products from infected or vaccinated animals
safe to eat, and do they have to be labelled as such?
Bluetongue does not affect humans, and there is no risk of the
disease being contracted or spread through meat or milk. The
vaccination of animals against bluetongue has no impact on their
products. Therefore, there is no reason why labelling requirements
should be introduced for meat and milk from bluetongue-vaccinated animals.

12. What are the trade implications (both intra-EU and vis-a-vis 3d
countries) of vaccination?
Regulation (EC) No. 1266/2007 brings EU rules with regard to the
movement of animals vaccinated against bluetongue more into line with
those of the World Organisation for Animal Health (OIE). Both the EU
and OIE accept vaccination as an effective way of controlling
bluetongue and vaccinated animals are considered safe for trade if
certain provisions (see above) are complied with.

More information on vaccination against bluetongue can be found on
the DG Health and Consumer Protection website:
<http://ec.europa.eu/food/animal/diseases/controlmeasures/bluetongue_en.htm >.

- --
Communicated by:
ProMED-mail
<promed@promedmail.org>

*********************************************************************
[3] UK, vaccination
Date: Fri 18 Jan 2008
Source: Farmers Weekly Interactive [edited]
<ttp://www.fwi.co.uk/Articles/2008/01/18/109049/vaccination-the-only-defence-against-bluetongue-says-iah.html>


Vaccination the only defence against bluetongue, says IAH
- ---------------------------------------------------------
Bluetongue disease could have a disastrous effect on the livestock
sector in Great Britain if it re-emerges with the same virulence
witnessed in northern Europe last year [2007]. The stark message on
the threat posed by bluetongue was issued by experts from the
Institute for Animal Health at a joint NFU (National Farmers
Union)/IAH (Institute of Animal Health) conference on the disease
held on Thursday (17 Jan 2008).

The message was clear: vaccination is the only protection and unless
a minimum of 80 percent country's ruminant livestock are vaccinated
then the economic consequences would be severe.

IAH bluetongue research leader Chris Oura was unequivocal in his
message. "I want to get the message across: This is a really serious
disease. 2007 is no reflection of what might happen in 2008."

He told the 85 NFU members attending that a relatively small outbreak
in Germany during 2006, although considered bad at the time, was
trivial compared to the 300 premises a day being infected at the peak
of the 2007 outbreak.

"We were lucky in 2007 we got it late so it didn't take hold. 2008
may be very different," said Dr Oura.

Belgium
- ----------
In Belgium last year [2007] the disease led to 41.9 percent mortality
in sheep, meaning that many producers there have now withdrawn from
sheep production. And in cattle many producers reported re-absorption
of foetuses, abortion, a general decline in animal health and
sterility of sires.

As it became apparent to those producers attending that vaccination
was the only real defence against this debilitating disease and its
severe economic consequences, focus turned to what shape a
vaccination strategy might take and whether a vaccine would be
available in sufficient quantities.

The DEFRA observer present confirmed that the department is
formulating a suitable strategy in conjunction with stakeholders and
experts at the IAH, but its direction would continue to be influenced
by the emergence of new cases unturned by the department's
surveillance work and the results of any pre-movement tests performed
for producers.

Vaccination
- ----------
However, vaccination will, almost certainly, be on a voluntary,
rather than compulsory, basis and producers inside the protection
zone would be the 1st to be offered the chance to protect stock.

Then, livestock in a "buffer zone" outside the protection zone
(probably about 20km [12.4-mile] wide) would be treated next and the
buffer zone would gradually edge west until England is covered.

However, no one in attendance could estimate how long it would take
to cover England or that the minimum 80 percent coverage needed to
ensure success would be achieved. Peer pressure and the role of the
media in conveying this important message was the put forward as the
only means of encouraging participation.

- --
Communicated by:
Sabine Zentis
Castleview Pedigree English Longhorns
Gut Laach
52385 Nideggen, Germany
<CVLonghorns@aol.com >

[In the meantime, a 9th European country has reported the
identification of BTV-8, namely Spain; its official OIE notification
is being posted by ProMED-mail separately. The other affected
countries are: Belgium, Netherlands, Germany, France, Luxembourg,
Denmark, the Czech Republic and Switzerland.

Switzerland, where 12 animals have been found infected in 2007, has
also decided to apply vaccination. The details are being discussed
between the federal authorities, the kantons and the animal breeders. - Mod.AS]

PRO/AH/EDR> Bluetongue - Europe (03): BTV-8, Spain, OIE

Date: 18 Jan 2008
Source: OIE WAHID Weekly Disease Information 2008 21(3) edited.
< http://www.oie.int/wahid-prod/public.php?page=weekly_report_index&admin=0>


Bluetongue, Spain
---------------------
Information received on 17 Jan 2008 from Dr. Lucio Ignacio Carbajo Goni
Subdirector General de Sanidad Animal
Direccion General de Ganaderia
Ministerio de Agricultura, Pesca y Alimentacion
Madrid, Spain

Summary
Report type: Immediate notification
Start date: 8 Jan 2008
Date of first confirmation of the event: 10 Jan 2008
Report date: 17 Jan 2008
Date submitted to OIE: 17 Jan 2008
Reason for notification:New strain of a listed disease
Manifestation of disease:Sub-clinical infection
Causal agent: Bluetongue virus
Serotype: 8

Nature of diagnosis: Laboratory (advanced)
This event pertains to: the whole country

New outbreaks
Outbreak 1 (LA 2008/1)
Ribamontan Al Monte, Solares, CANTABRIA
Date of start of the outbreak: 8 Jan 2008
Outbreak status: Continuing (or date resolved not provided)
Epidemiological unit: Farm

Species: Cattle
Susceptible: 194
Cases: 7
Deaths: 0
Destroyed: 0
Slaughtered: 0

Affected population: cattle farm
Summary of outbreaks:Total outbreaks: 1

Species Cattle
Apparent morbidity rate: 3.61 percent
Apparent mortality rate: 0.00 percent
Apparent case fatality rate: 0.00 percent
Proportion susceptible animals lost*: 0.00 percent
* Removed from the susceptible population through death, destruction
and/or slaughter

Epidemiology: Source of the outbreak(s) or origin
of infection: Unknown or inconclusive

Laboratorio Regional de Sanidad Animal de Cantabria (Local laboratory)
Species: Cattle
Test: PCR (reaccion en cadena de la polimerasa)
Test date: 10 Jan 2008
Result: Positive

Laboratorio Central de Sanidad Animal de Algete (National laboratory)
Species: Cattle
Test: PCR en tiempo real (real time PCR - Mod.PC]
Test date: 15 Jan 2008
Result: Positive

--
Communicated by:
Sabine Zentis
<http://www.cvlonghorns.de>

[This report represents an expansion of territory for the BTV-8
serotype into Spain, which has traditionally dealt with other
Bluetongue serotypes i.e. BTV-1 and BTV-4. It will be absolutely
fascinating to see how quickly this serotype spreads. The question of
how the infection arrived in Spain is also critically awaiting an
answer as there is quite a geographic gap between it's previous
distribution in France and the northern coast of Spain where it has
been newly identified.

Whittmann, Mellor and Bayliss published an interesting paper which
used BT-1 data in 2001. It indicated that Culicoides distribution can
be best predicted by the following climatic factors: minimum of the
monthly minimum temperatures, maximum of the monthly maximum
temperatures and the number of months per year with a mean
temperature 12.5 DEG C (54.5 DEG F). A similar analysis for the
spread of BT-8 could be instructive. See
<http://www.oie.int/eng/publicat/RT/2003/WITTMANN.PDF > for the complete paper.

An EU map of BTV restriction zones, updated on 14 Jan 2008, is available at
< http://ec.europa.eu/food/animal/diseases/controlmeasures/BlueTongue_RestrictedZones_2008.jpg>.
The outbreak location can be seen in the OIE WAHID refernce given above or at
< http://encarta.msn.com/map_701511426/Cantabria.html> - Mod.PC]

PRO/AH/EDR> Bluetongue - Europe: BTV-8, vaccination, vector-free period




Date: Thu 16 Jan 2008
Source: AGD. NL [trans. from Dutch Mod.AS, edited]
< http://www.agd.nl/1044335/Nieuws/Artikel/LNV-vrijwillige-vaccinatie-blauwtong.htm>


The [Dutch] Ministry of Agriculture pleas for a voluntary vaccination
against bluetongue. This has emerged during a meeting on bluetongue
in Brussels. "The introduction of compulsory vaccination must have a
clear reasoning; its necessity should be readily explainable in order
to convince the farmers". Past experience regarding compulsory
vaccination -- as related to IBR -- was rather negative; therefore, I
support voluntary vaccination", said Peter de Leeuw, chief
veterinarian in the Ministry of Agriculture.

De Leeuw regards the eradication of bluetongue virus to be the best
solution, provided this is achievable. "To attain this goal, a common
policy of affected countries is required, with the necessary
financial support secured for several years. Currently, these
conditions are not fulfilled".

The European Commission stated during the conference that a minimum
of 80 percent of the animals susceptible to bluetongue must be
vaccinated if financial support is anticipated. "I am convinced that
we, in the Netherlands, can achieve 80 percent even on a voluntary
basis", said De Leeuw.

A main question is the necessity to include in the plan the
vaccination against bluetongue of animals which are immune, since
they have already undergone infection. France has a different view on
this issue, since they see difficulties in the registration of
animals which have been infected. France supports a total, compulsory
vaccination scheme.

[Byline: Mariska Vermaas]

--
Communicated by:
ProMED-mail <promed@promedmail.org>

*****************************************************************
Date: Wed 16 Jan 2008
Source: Reuters [edited]
<http://uk.reuters.com/article/scienceNews/idUKL1614933720080116>


EU countries should order now a new vaccine to fight a resurgence
this year [2008] of bluetongue, the virus that ravaged northern
Europe's cattle and sheep in 2007, EU Health Commissioner Markos
Kyprianou said on Wednesday [16 Jan 2008].

Speaking at a one-day conference, Kyprianou said central EU funding
would meet the costs of buying the vaccine, likely to be available by
the spring, and half the costs of administration.

Several drugs companies have been developing the vaccine for the
particular strain of bluetongue that occurred last year [2007] in
northern Europe, serotype 8, one of 24 recognised strains. Until now,
no vaccine for that strain has been available.

The companies include Pfizer Inc., Intervet, now owned by U.S.
pharmaceutical company Schering-Plough Corp and Merial Ltd, a joint
venture between Merck & Co. and Sanofi-Aventis.

"In principle, 100 percent of the costs of the purchase of the
vaccine and 50 percent of the costs of the application of the vaccine
will be covered by the Community budget," he said.

That funding would be subject to certain ceilings that would be set
once the vaccine's final cost was known, Kyprianiou said, adding that
between 150 and 200 million doses would probably be needed for an
emergency vaccination campaign during 2008.

European Commission experts have estimated the cost of one vaccine
dose at around 0.50 euro (USD 0.742). While that price will probably
be fixed, administration costs vary widely across the EU's 27
countries, mainly due to differing vets' salaries.

Spread by midges, bluetongue had previously tended to occur in more
southerly parts of the European Union until 2006, when it moved much
further north. Last year [2007] was even worse, with more than 50 000
confirmed cases in 11 countries.

Apart from Italy, Portugal and Spain, which have a history of the
disease in other serotypes, countries affected by serotype 8 in 2007
were Belgium, Britain, Denmark, France, Germany, Luxembourg, the
Netherlands and Czech Republic [Switzerland, a European non-member,
was affected as well. - Mod.AS].

"The Commission now urges the member states concerned to complete ...
the necessary tendering procedures and place actual orders for the
vaccines which are now becoming available so that they are ready to
go when the time comes," Kyprianou said.

Bluetongue does not affect humans, and there is no risk of
contracting it by consuming milk or meat from infected animals.

The disease is characterised by inflammation of the mucous membranes,
congestion, swelling and haemorrhages. Sheep, rather than cattle, are
often the worst affected animals.

Bluetongue vaccination has been successfully used in a number of EU
countries that have been affected by the disease. Italy, Spain,
France and Portugal have all used vaccination. Vaccines against
bluetongue can either be inactive vaccines or modified live virus
(MLV) vaccines.

Inactivated vaccines, administered in 2 separate doses, can fully
protect animals for a long period, while MLVs create protective
immunity after a single inoculation.

[Byline: Jeremy Smith]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[Information on the incidence of new BTV-8 cases in Europe since the
middle of December is rather scanty and seems to lack accuracy.
According to EU's Animal Disease Notification System (ADNS, last
updated 11 Jan 2008, see at
<http://ec.europa.eu/food/animal/diseases/adns/table_11_2008/adns_110108_en.pdf >),
a total of 3 new cases have been recorded since 1 Jan 2008, all in
France. Are these indeed new cases, within the period which is
expected to be "non-vector"?!

Since the publication of Sabine Zentis' remarks concerning the need
for experts' and researchers' contributions (see in posting
20071219.4080), the scope of (publicly available) knowledge has not
widened. Enhanced research efforts addressing the epidemiology of
BTV-8 within the European realm, in particular related to its
entomological aspects, over-wintering mechanism and genetic
susceptibility, seem to still be needed. Animal breeders in 8
European countries have been severely affected by BTV-8 since its
initial discovery (Belgium, August 2006). Animal suffering is another issue.

The 3rd disease season is expected to commence in the due spring
2008, when large populations of susceptible animals may be exposed to
BTV-8 for the 1st time, particularly in areas such as Wales and
Scotland, but also in other vast regions. Their timely vaccination is
essential.

To help close the gap between gained information and its early field
utilization, ProMED-mail has offered its services for the early
publication of preliminary results, provided they address
field-related issues and are of a problem-solving nature.

An EU map of BTV restriction zones, updated on 14 Jan 2008, is available at
< http://ec.europa.eu/food/animal/diseases/controlmeasures/BlueTongue_RestrictedZones_2008.jpg>.
- Mod.AS]

PRO/EDR> Chikungunya (03)- Singapore

Date: Thu 17 Jan 2008
Source: Reuters Foundation AlertNet [edited]
<http://www.alertnet.org/thenews/newsdesk/SIN179469.htm >


The Ministry of Health said on Thursday [17 Jan 2008] 6 people in
Singapore have been infected by the mosquito-borne chikungunya virus.

"This is the 1st instance of local transmission of the disease.
Previous cases were imported, where patients caught the virus
overseas and brought it back to Singapore," a Ministry of Health
spokeswoman told Reuters.

To date, 2 patients have been admitted to the isolation ward of the
Communicable Disease Centre.

All 6 patients were living in close proximity to each other in the
southeastern part of the city-state. "It's still a localised
infection at the moment," she added.

The Ministry of Health has begun to screen people living or working
in the same area.

Chikungunya fever, like dengue fever, is a mosquito-borne disease,
characterised by sudden onset of fever, chills, headache, nausea,
vomiting, joint pain, back pain, and sometimes a rash. Most symptoms
last for 3-10 days, but joint pains may last for weeks to months.

The chikungunya virus was carried mostly by the _Aedes aegypti_
mosquito. It caused an epidemic that began in Kenya in 2004 and
spread to several Indian Ocean islands including the Comoros,
Mauritius, the Seychelles, Madagascar, Mayotte, and Reunion.

[Byline: Jennifer Tan; editing: Jeremy Laurence]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[Chikungunya virus continues to spread in Southeast Asia. This report
provides another example of chikungunya virus being introduced into
an area where there are sufficient populations of competent mosquito
vectors to permit local virus transmission, similar to, but not as
extensive as the outbreak in Italy during the summer of 2007 (see
ProMED-mail 20071210.3980).

The report indicates that chikungunya virus was mainly transmitted by
_Aedes aegypti_. It was not clear if the report was addressing
chikungunya virus transmission everywhere (with chikungunya virus
transmission by _Ae. albopictus_ involvement in some other places) or
specifically in Singapore. ProMED-mail would appreciate clarification
if any other mosquito vectors were involved in this small outbreak,
and information about any mosquito control measures being taken as
well as occurrence of any additional cases.

ProMED thanks Dan Silver for providing a similar report from Singapore.

An interactive HealthMap/ProMED-mail map of Singapore can be accessed at
<http://healthmap.org/promed?v=1.4,103.8,6>. - Mod.TY]

PRO/AH/EDR> Yellow fever - Brazil (07)


Date: Fri 18 Jan 2008
Source: Division of Global Migration and Quarantine
National Center for Preparedness, Detection, and Control of
Infectious Diseases [edited]
< http://wwwn.cdc.gov/travel/contentYellowFeverBrazil.aspx>


Outbreak Notice: Yellow Fever Alert for Brazil Situation Information
-------------------------------------------------------------------
On 8 Jan 2008, the Brazilian Ministry of Health (MOH) announced a
yellow fever (YF) disease alert for tourists and diplomats residing
in Brazil, due to a number of suspected and confirmed human yellow
fever cases during December 2007 and January 2008. As of 16 Jan 2008,
10 confirmed cases of yellow fever have been reported, including 7 deaths.

The Brazilian MOH alert states that travelers to "areas of risk" for
yellow fever should be vaccinated 10 days before going to such areas.
In addition to areas previously identified in CDC's guidance to
travelers, the Brazilian MOH has identified 2 additional states with
yellow fever risk: the northern part of Espiritu Santo and the
western part of Santa Catarina.

Brazil currently requires yellow fever vaccination for persons
entering Brazil from countries listed as endemic for yellow fever
(see Brazil country-specific requirements). The new yellow fever
vaccination recommendation by Brazil for travelers is to protect the
travelers' health in response to this recent situation.

Recommendations for Travelers
----------------------------------
Travelers are strongly advised to follow the CDC yellow fever
vaccination recommendations for Brazil, with the addition of the
northern part of Espiritu Santo state and the western part of Santa
Catarina state. The Federal District of Brasilia is also an endemic
area. The Brazilian MOH has recommended vaccination of travelers >6
months of age. Because of increased risk of severe adverse events
following vaccination among infants <9 months of age and among
travelers >60 years of age, CDC recommends that parents of infants <9
months and travelers >60 years should discuss with their physicians
the risks and benefits of vaccination for travel to Brazil.

Since yellow fever is spread by the bite of an infected mosquito,
travelers are also reminded to:
* Use insect repellent on exposed skin surfaces when outdoors,
particularly during the day.
* Repellents containing 30 percent to 50 percent DEET
(N,N-diethyl-m-toluamide) are recommended for adults. Lower
concentrations of DEET offer shorter-term protection and require more
frequent reapplication.
* Repellents containing picaridin are available in the United States
in formulations of up to 15 percent concentration, which require
frequent reapplication. Repellents with higher concentrations of
picaridin may be available in some regions outside the United States.
* For additional information regarding the use of repellent on
infants and children, please see the "Insect and Other Arthropod
Protection" in Traveling Safely with Infants and Children and the
"Children" section of CDC's Frequently Asked Questions about Repellent Use.
* Wear long-sleeved shirts and long pants when outdoors. Clothing
may also be sprayed with repellent containing permethrin or another
EPA-registered repellent for greater protection. (Remember: do not
use permethrin on skin.)

Additional Information
-------------------------
For more information about yellow fever risk and yellow fever
vaccine, see the following sections of CDC Health Information for
International Travel 2008:
* Yellow fever (including precautions and contraindications to vaccine)
* Yellow Fever Vaccine Requirements and Information on Malaria Risk
and Prophylaxis, by Country.

--
Communicated by:
ProMED-mail
<promed@promedmail.org.

[ProMED wishes the Brazilian MOH success with their considerable
efforts in preventing an urban YF outbreak, and will be watching as
the situation develops. Meanwhile, travelers should heed the MOH and
CDC's advice about vaccination and avoidance of mosquito bites.

An interactive ProMED health map of Brazil can be accessed at
<http://healthmap.org/promed?v=-10.8,-53.1,4 >. - Mod.TY]

PRO/AH/EDR> Yellow fever - Brazil (06)

Date: Wed 16 Jan 2008
Source: O Globo newspaper [in Portuguese, trans. & sum. Mod.JW, edited]
< http://oglobo.globo.com/pais/mat/2008/01/16/morre_mais_um_paciente_com_suspeita_de_febre_amarela-328044354.asp>


The Ministry of Health confirmed on 15 Jan 2008, 3 more deaths from
yellow fever (YF): 2 in Goias state and one in Parana state, bringing
the total of confirmed cases of YF in 2008 to 6, with 5 deaths, with
15 suspected cases still under investigation. This more than in any
year since 2003, when there were 64 cases with 23 deaths.

One of the fatal cases was an unvaccinated Spanish visitor, who died
after 2 days in hospital in Goiania on 12 Jan 2008, having been ill
for about 10 days in a house [in the city] where the vector mosquito,
_Aedes aegypti_, was found. The area has been fogged with
insecticide. The man contracted his infection at a farm in
Cristianopolis, 103 km (64 mi) from Goiania, where he had spent 15
days. [In an earlier report, his widow complained to the press that
they saw no YF warning or proof of vaccination check at Sao Paulo
international airport on their arrival on 25 Nov 2007, nor at
Salvador or Goiania airports on their travels since then.]

The Oswaldo Cruz Foundation, which produces YF vaccine, has suspended
all exports of the vaccine, and is doubling its production from 15 to
30 million doses this year (2008). It normally supplies 7 million
doses to the Pan American Health Organization (PAHO) for distribution
to other countries in the Americas.

--
Communicated by:
ProMED-mail
<promed@promedmail.org >

[The Ministry of Health insists that there is no urban YF epidemic
anywhere in Brazil, which is technically correct. However, it is
taking all the right steps to protect its at-risk population with the
vaccine, and warning international visitors. On 10 Jan 2008 the USA
Department of State issued an alert, in English, to all its citizens
in Brazil, advising them to get vaccinated, see
< http://www.embaixadaamericana.org.br>. - Mod.JW

An interactive ProMED health map of Brazil can be accessed at
<http://healthmap.org/promed?v=-10.8,-53.1,4 >. - Mod.TY]