The bite of a mosquito

New professional website

2011-08-26T10:08:00.002-04:00

I created a new professional website at:

http://kmagori.weebly.com

One subpage of this website also allows you to follow the most recent news on my Twitter feed.

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

2008-08-21T22:02:00.001-04:00

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.

Imported case of chikungunya reported in Bologna, Italy

2008-08-12T12:09:00.001-04:00

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).

Human West Nile cases increasing in the US

2008-08-07T15:21:00.001-04:00

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.

Three more cases of chikungunya found in Singapore

2008-08-04T16:55:00.001-04:00

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.

Poll: Chikungunya in the South-Eastern United States

2008-07-23T08:05:00.001-04:00

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.

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

2008-07-07T15:25:00.001-04:00

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.

Latest update on West Nile situation in North America

2008-06-12T09:27:00.001-04:00

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.

Yellow fever in Central African Republic

2008-05-22T12:50:00.001-04:00

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.

First case of West Nile fever in Texas in 2008

2008-05-19T13:33:00.001-04:00

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.

News focus on Aedes albopictus in current issue of Science

2008-05-16T16:38:00.001-04:00

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.

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

2008-05-15T12:00:00.001-04:00

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.

Dengue epidemic raging on in Rio de Janeiro

2008-05-14T17:27:00.001-04:00

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.

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

2008-05-07T17:24:00.001-04:00

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

2008-05-07T13:04:00.001-04:00

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.

Breaking news: Chikungunya back in Kerala

2008-04-09T14:05:00.001-04:00

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.

More information on the dengue outbreak in Rio de Janiero

2008-04-07T17:11:00.001-04:00

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.

Dengue situation worsening in Rio de Janiero

2008-04-03T14:46:00.001-04:00

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.

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

2008-04-02T16:19:00.001-04:00

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 Combining Mosquito Vector and Human Disease Data for Improved Assessment of Spatial West Nile Virus Disease Risk
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 First Isolation of West Nile Virus in the Caribbean
Am J Trop Med Hyg 2008 78: 666-668.

[Abstract] [Full Text] [PDF]

William K. Reisen, Ying Fang, AND Aaron C. Brault Limited Interdecadal Variation in Mosquito (Diptera: Culicidae) and Avian Host Competence for Western Equine Encephalomyelitis Virus (Togaviridae: Alphavirus)
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 Rocky Mountain Spotted Fever in Argentina
Am J Trop Med Hyg 2008 78: 687-692.

[Abstract] [Full Text] [PDF]

Fungi vs insects 1:0

2008-03-26T11:06:00.001-04:00

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.

More on the dengue outbreak in Rio de Janeiro

2008-03-25T17:15:00.001-04:00

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.

Dengue outbreak in Brazil

2008-03-24T12:00:00.001-04:00

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.

ICEID 2008

2008-03-20T17:14:00.001-04:00

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).

Chikungunya outbreak in Sri Lanka rages on

2008-03-14T13:04:00.000-04:00

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.

African Horse Sickness outbreak reported in South Africa

2008-03-13T16:11:00.001-04:00

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

2008-03-13T15:57:00.001-04:00

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.

Malaria model predicts successful malaria eradication in regions of mesoendemic transmission

2008-03-12T14:12:00.001-04:00

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

2008-03-12T12:03:00.001-04:00

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.

Immunohistochemistry suggested to differentiate between yellow fever and dengue

2008-03-10T17:20:00.001-04:00

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

2008-03-10T16:57:00.001-04:00

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

2008-03-10T14:39:00.001-04:00

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.

African Swine Fever kills hundreds of pigs in Tanzania

2008-03-07T17:01:00.001-05:00

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

2008-03-07T16:52:00.001-05:00

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

2008-03-07T16:37:00.001-05:00

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.

Indirect evidence for excess deaths due to chikungunya infection

2008-03-05T15:30:00.001-05:00

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

2008-03-05T13:39:00.001-05:00

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.

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

2008-01-28T14:32:00.000-05:00

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]

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

2008-01-23T15:12:00.000-05:00

[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

2008-01-23T15:09:00.000-05:00

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

2008-01-23T15:08:00.000-05:00

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

2008-01-23T15:05:00.000-05:00

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)

2008-01-23T15:04:00.000-05:00

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)

2008-01-23T15:03:00.000-05:00

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]

PRO/AH/EDR> Yellow fever - Brazil (05): conf.

2008-01-23T15:02:00.000-05:00

Date: 15 Jan 2008
Source: O Globo newspaper [in Portuguese, trans. & summ. by Mod.JW]
<http://www.oglobo.com>

The Ministry of Health confirmed on 14 Jan 2008 a 3rd case of YF
in Brazil, and 2nd death since the end of 2007. The fatal case was
a 24-year-old male who reportedly contracted the disease in the
rural area of Goianesa, 150km from the Goias state capital, Goiania,
where he died on 2 Jan 2008 after 5 days in hospital in the
capital. [It is not reported whether he was in a ward screened
against mosquitoes. Mod. JW].

So far in 2008 there have been 26 suspected cases reported, of whom
3 are confirmed, 6 excluded, and 17 are pending lab results. Most
of the cases originated in Goias state.

Brazil informed WHO on 27 Dec 2007 that monkeys were dying of YF
in Brazil. The WHO website now recommends international
tourists visiting affected areas in Brazil get vaccinated against
YF. By Fri 18 Jan 2008, the Ministry of Health will have
distributed 2.2 million doses of YF vaccine to the states of Goias,
Minas Gerais, South Mato Grosso & the Federal District (Brasilia).

At Congonhas airport in Sao Paulo state, a major airline hub
for Brazil, an average of 1000 passengers per day are lining up for
free YF vaccinations [which only take effect after 10 days. ?Mod.JW].

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

[In this age of real-time PCR (polymerase chain reaction) tests,
the 2-week delay in lab confirming YF cases seems excessive, but
the authorities need to be doubly sure of their results in view of
the probable impact on trade and tourism of an urban epidemic
breaking out over Carnaval, the 1st week in February. - 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]

PRO/AH/EDR> Yellow fever - Brazil (04): susp.

2008-01-23T15:01:00.000-05:00

Date: Wed 9 Jan 2007
Source: Folha Online [in Portuguese, trans. & summ. Mod.TY, edited]
< http://www1.folha.uol.com.br/folha/cotidiano/ult95u361826.shtml>

A suspected yellow fever death was registered in Parana [ex Goias. - Mod.TY]
---------------------------------------------------
The Parana Health Secretariat on Wednesday [9 Dec 2007] received
notification of the death of a man in Maringa who is a suspected
yellow fever [case and] who died on Tuesday [8 Jan 2007]. However,
the symptoms presented by this patient, according to the agency, are
the same as cases of hantavirus infection, yellow fever, dengue and
leptospirosis. Although laboratory tests are being done with urgency,
due to their complexity it will take 15 days to get the results.

According to the agency, the suspicion of yellow fever in this case
was brought up because the patient was in a [yellow fever] risk area,
in the city of Caldas Novas in Goias, between 20 Dec [2007] and 1 Jan
[2008].

According to the Secretariat [of Health] no cases of yellow fever
have been reported in the state [of Parana]. Routine vaccination in
the state will be maintained for travelers who go to endemic
[Brazilian yellow fever] areas (northern region, and the states of
Maranhao and Minas Gerais) and transitional regions (western Parana,
Santa Catarina, Piaui and Sao Paulo, as well as for Latin American
countries.

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

[The incubation period (time from inoculation of the virus by the
mosquito vector to the 1st appearance of symptoms) for yellow fever
virus infections is 3-6 days. Assuming that the patient was ill
several days before his death, the time of acquisition of the virus
fits within the dates when the patient was in Goias, where a
suspected yellow fever outbreak in monkeys was occurring.

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 (03)

2008-01-23T15:00:00.000-05:00

Date: Wed 9 Jan 2008
Source: Xinhua Net [edited]
<http://news.xinhuanet.com/english/2008-01/10/content_7398360.htm >

Brazilian government denies risk of yellow fever outbreak
---------------------
Brazil's Minister of Health Jose Gomes Temporao denied on Wednesday
[9 Jan 2007] the risk of a yellow fever (YF) outbreak in the country.
"The situation is absolutely under control," said Temporao, stressing
that the country has not had a confirmed case of yellow fever in an
urban area since 1942. Most cases identified during the period took
place in the rainforest region.

The health minister said the local secretariats of health are
monitoring eventual cases in the states.

On Tuesday [8 Jan 2008], a man, 38, a 2nd patient allegedly infected
with the disease died in the federal capital of Brasilia. He had been
in hospital for a week, after developing the symptoms of fever, such
as jaundice, vomiting and kidney failure. But it is reported that no
yellow fever case has been confirmed yet. The physicians who took
care of the man in Brasilia said the cause of his death will only be
confirmed next week, following tests to be held on the patient's body.

According to the reports, the man had spent the end-of-year holidays
in a tourist city in the neighboring state of Goias, midwestern
Brazil, which led the Ministry of Health to recommend the vaccination
of citizens and visitors in 18 Brazilian states. However, Temporao
added, there is no need to carry out a mass vaccination campaign in
those states, as the population of urban areas are not endangered.

Also on Tuesday, another patient developed the symptoms of the
disease in the capital city of Minas Gerais, southeastern Brazil, and
was taken to a hospital in the region. The alleged spread of the
disease generated a rush to local health centers, where people join
long queues to take the vaccine that help immunize against yellow
fever within 10 days.

[Byline: An Lu, editor]

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

[Given the importance of these 2 suspected cases, confirmation that
they are YF cases or not is urgent. ProMED requests information
concerning the lab test results when they become available. How to
respond in this situation is delicate for the Ministry of Health. It
should be remembered that Brazil has suffered dengue epidemics in
many parts of the country in 2007, so there are abundant populations
of _Aedes aegypti_, which is the mosquito vector of both dengue and
of yellow fever viruses. If the cases are confirmed as YF, a vigorous
vaccination campaign with its attendant publicity is warranted,
despite adverse effects on tourism that it might engender in the
run-up to carnival. If this turns out to be a false alarm but is
widely publicized, the economic damage from loss of tourist visits
could be considerable.

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

******
[2]
Date: Wed 9 Jan 2007
Source: Diario da Manha [in Portuguese, trans. Mod.MPP, edited]
<http://www.dm.com.br/ultimas.php?id=46765>

Victim began/caught fever in Brasilia, allege family members
-----------------
Family members of the patient, who died yesterday [8 Jan 2008] from
suspected yellow fever, questioned the thesis of health authorities
that he was infected during a trip to Pirenopolis (Goania State),
during the New Year vacation. They argue that he began to fall ill
one day before arriving in that city, a very rapid reaction, given
the incubation period of the disease, which is between 3 and 5 days.
Because of this, the family does not preclude the possibility that he
had already been infected before travelling. Another reason the
family suspects that he could have been infected in Brasilia is the
fact that he travelled with a group of various friends, but only he
was infected.

For the Ministry of Health, nevertheless, the possibility of
infection in Brasilia is totally discarded. "If he was infected, it
occurred during the trip,"affirmed the secretary of Surveillance of
the Ministry of Health, Gerson Penna. He justified his conviction:
"There have not been reports of infected monkeys (in the capital)".
The patient was admitted on Friday [4 Jan 2008] with fever and joint
pains. He arrived in the afternoon, lucid, and at night was on a
ventilator. The 38-year-old administrator died on Tuesday [8 Jan
2008]. Results from an autopsy should be ready by Friday [11 Jan
2008].

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

[ProMED awaits results of the autopsy and confirmation (or not) of YF
virus infection as the cause of death. - Mod.TY]

******
[3]
Date: Thu 10 Jan 2008
Source: Yahoo Noticias [in Spanish, trans. & summ. Mod.TY, edited]
< http://es.noticias.yahoo.com/ap/20080109/twl-ams-med-brasil-fiebre-amarilla-1be00ca.html>

The Brazilian Minister of Health said on Wednesday [9 Jan 2008] that
there is no risk of a yellow fever epidemic despite an outbreak that
caused the deaths of 2 Brazilians this past week.

Jose Gomes Temporao [the Minister of Health] said that there is no
reason to be alarmed because the deaths happened [infectious were
acquired] in rural, not urban, areas, and there there was ample
availability of vaccine stocks produced by the Oswaldo Cruz
Founation, a governmental organization in Rio [de Janeiro].

"The situation is totally under control. There is no epidemic risk,"
said Temporao during a press conference. Given everything, the
Ministry of Health has requested that the Foundation double its usual
vaccine production with 10 days advance notice.

There have been some complaints that there was not enough vaccine
available at dispensaries in Brasilia. The Foundation sent an
additional 250 000 doses to Brasilia on Wednesday [09 Jan 2008],
although Temporao insisted that precautions were adequate.

"There have been no urban cases of yellow fever in Brazil since 1992,
just sylvan ["jungle"] cases," said Temporao. "There is no necessity
to carry out massive vaccination. There is no epidemic. What we are
doing is sufficient."

******
[4]
Date: Wed 9 Jan 2008
Source: Yahoo Noticias [in Spanish, trans. & summ. Mod.TY, edited]
<http://es.noticias.yahoo.com/efe/20080109/tsc-brasil-intensifica-una-campana-contr-539a483.html >

Brazil has intensified its yellow fever prevention campaign and sent
out an international alert after a small number of cases of the
disease, but the Minister denied today [9 Jan 2008] that there is an
epidemic risk.

"The situation is absolutely under control. There is no risk of an
epidemic; there are no urban yellow fever cases in Brazil," said
Health Minister Jose Gomes Temporao in a press conference. The
reported cases are only sylvatic. "The health authorities are
accompanying, vaccinating and informing adequately," he said.

Yesterday [8 Jan 2008] a Brazilian man died of this infectious viral
disease and there is a new case reported from Minas Gerais (in the
southeast).

Temporao admitted that the ministry is studying 8 other possible cases

This disease has killed 161 people in Brazil in the last 12 years, of
349 registered [yellow fever] cases. All of these fatalities were
Brazilians who were not vaccinated and went into forested areas where
the disease [virus] is endemic, said the Minister, who indicated that
the numbers of cases has declined [in recent years]. In 2000 there
were 40 fatalities, 23 in 2003, 2 in 2006 and 5 in 2007 he explained.
"There is no need for massive vaccination," he indicated.

He insisted that people who do not go into areas of risk do not need
to be vaccinated, since the urban transmission cycle has been
eradicated since 1942.

Meanwhile, hundreds of people have lined up at health centers in
Brasilia, Goiania and various other cities to get vaccinated.

In various localities in Goiania the deaths of at least 80 monkeys,
apparently victims of sylvan [yellow fever], have been documented and
classified by the Ministry as "sentinel episodes" which permit
preventive action to be taken.

This morning [9 Jan 2007], the health authorities of Minas Gerais
reported that a 48-year-old cattleman was admitted to a hospital in
Belo Horizonte with symptoms of the disease that he contracted in the
Amazonian state of Acre, near the Bolivian border.

Temporao confirmed that he requested that the Ministries of External
Relation and Tourism alerted diplomats, tourists and others who
travel to Brazil that they be vaccinated at least 10 days before
their travel [to Brazil].

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

[The Minas Gerais suspected YF case illustrates the risk of transport
of YF virus in infected individuals from a YF virus endemic area in
far western Brazil to the eastern part of the country, or
potentially, internationally. The recent leap of chikungunya virus
from India to Italy is a vivid demonstration of how infected
individuals can establish outbreaks in new localities where abundant
vector mosquito populations exist (see archive no. 20071210.3980). -
Mod.TY]

PRO/EDR> Dengue/DHF update 2008 (02) – Honduras

2008-01-23T14:53:00.000-05:00

Date: Tue 6 Jan 2007
Source: Yahoo Noticias, Salud [in Spanish, trans. & summ. Mod.TY, edited]
<http://espanol.news.yahoo.com/s/ap/080106/salud/amc_med_honduras_dengue>

In 2007, 15 people died and more than 29 112 were affected [infected]
by dengue in Honduras, authorities reported on Sunday [4 Jan 2008].

In 2006, the number of fatal victims of this disease was 9, and there
were 7800 affected [by it].

In 2007, 4156 DHF cases were registered nationally.

"We cannot hide the significant increase in dengue [cases] in the
country in the past year [2007]," the Minister of Health, Jenny Meza,
told the press.

This situation [the increase in dengue cases] occurred despite the
army units, public employees and students having circulated in the
neighborhoods of the main cities of the country to help remove scrap
metal, fumigate houses and destroy _Aedes aegypti_ dengue virus
mosquito vector breeding sites.

The government constantly asks the population to eliminate standing
water in their homes, specifically in bowls, bottles, tires and
flower vases, where this insect breeds.

Official statistics indicate that in 6 years, more than 60 000 dengue
cases have been registered in Honduras.

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

[It would be interesting to know how successful the campaign has been
in eliminating or reducing _Aedes aegypti_ breeding sites and whether
lessons were learned that would improve vector control efforts in the
coming year. Given the increase in numbers of dengue cases in 2007,
these efforts were not as successful as the Honduras health
authorities had hoped.

An interactive ProMED health map showing Honduras and its location in
Central America can be accessed at:
< http://healthmap.org/promed?v=14.8,-86.6,5>.
- Mod.TY]

PRO/EDR> Dengue/DHF update 2008 (02) – Venezuela

2008-01-23T14:52:00.000-05:00

Date: Tue 6 Jan 2008
Source: El Universal [in Spanish, trans. & summ. Mod.TY, edited]
< http://noticias.eluniversal.com/2008/01/06/pol_art_aragua-declarada-zon_661002.shtml>

The Director of Epidemiological Services of the Health Corporation in
the state of Aragua, Luis Dorta, announced that the central area was
closed in 2007 "as an alert zone" due to the proliferation of dengue
virus [transmission] and said that a continuation of the increase in
the number of cases could result in an epidemic this year [2008].

He pointed out, however, that the meteorological conditions during
the next months are favorable for combating the virus, [the mosquito
vectors of which] reproduce in containers of clean water. "We hope
that as we enter summer, the season in which there is no rain, we can
combat the problem."

Dorta stated that during the past year [2007], 3518 cases of dengue
fever were registered, of which 156 were DHF. With respect to these
cases, he pointed out that for every 21 dengue cases, one was DHF. He
stated that in the last 5 months of the year [2007], 8 deaths caused
by this disease were registered, of which 6 were children under 10 years old.

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

[A map showing the Venezuelan states, including the location of
Aragua, can be accessed at:
<http://www.crwflags.com/FOTW/FLAGS/ve(.html>.
- Mod.TY]

PRO/EDR> Dengue/DHF update 2008 (02) – Brazil

2008-01-23T14:49:00.002-05:00

Date: Wed 8 Jan 2008
Source: Folha Online [in Portuguese, trans. & summ. Mod.TY, edited]
< http://www1.folha.uol.com.br/folha/cotidiano/ult95u361474.shtml>

In Para, 3 people died with symptoms of dengue hemorrhagic fever
(DHF) within the past 8 days. One of these ill individuals was from
Belem and the other 2 from Redencao (southern part of the state). In
the region, another 5 persons died with similar symptoms since November [2007].

The situation indicates that there is an outbreak of dengue in the
region, according to Rodolfo Skrivan, Director of the regional public
hospital of Araguaia, located in Redencao. The hospital receives
patients from the other 14 nearby municipalities.

"Dengue is seasonal. In some seasons of the year, there is greater
[dengue] incidence. The peak of illnesses was anticipated in February
or March, the rainy season. This worried us because, since we had
anticipated it, it might have been worse," the director stated.

The agency affirmed that it would send a team to Redencao to analyze
the situation. But, according to the adjunct secretary [of health]
with portfolio, Walter Amoras, the quantity of cases can not be
classified as an outbreak since the cases are scattered over 15
cities in the southern part of the state. "This indicates that the
municipalities are not taking a lesson from the situation. They are
not educating the public correctly."

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

[Dealing with the occurrence of dengue requires more than simply
educating the public. - Mod.LJS]

[A map of Brazil showing the location of Para, as well as the other
states, can be located at
<http://www.lib.utexas.edu/maps/americas/brazil.jpg>.
- Mod.TY]

************************************************************
Date: Wed 9 Jan 2007
Source: Extra Online [in Portuguese, trans. & summ. Mod.TY, edited]
< http://extra.globo.com/rio/plantao/2008/01/09/rjtv_82_casos_de_dengue_em_9_dias_no_rio327947436.asp>

In the past 9 days, from Tuesday of last week [1 Jan 2008] through
this Wednesday [9 Jan 2007], 82 cases of dengue have been registered
in Rio de Janeiro. The number of dengue cases is being brought up to
date. This Wednesday [9 Jan 2007] the Municipal Secretary of Health
indicated that in 2007, 23 585 dengue cases were confirmed.

In the 1st 9 days of 2008, 82 people had dengue disease. As of
Tuesday [1 Jan 2008], only 14 of them had been [laboratory?] confirmed.

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

******************************************************************
Date: Mon 5 Jan 2007
Source: Diario do Nordeste in Portuguese, trans. & summ. Mod.TY, edited]
<http://diariodonordeste.globo.com/materia.asp?codigo=501274 >

Ceara had 9.8 percent of the nation's dengue cases, with notification
of 24 793 cases of classical dengue.

72 new cases of dengue were registered in the state of Ceara, with 3
DHF cases and 69 classical dengue fever cases during the 1st week of
2008, according to the Weekly Epidemiology Dengue Bulletin released
yesterday [4 Jan 2007] by the Secretariat of Health of the state (SESA).

The number of deaths did not change, remaining at 10 confirmed cases.

In Ceara state, DHF has now reached 295 confirmed cases versus 292
the week before. In total, 651 cases were notified, of which 318 were
discarded [negative for dengue], and 38 were still being
investigated, according to SESA.

In Fortaleza, 118 DHF cases were confirmed, with one death. "We are
investigating 16 suspected deaths, which have still not been
confirmed," stated Dr. Manoel Fonseca, Coordinator of Health
Promotion and Protection of SESA.

Sobral municipality is in 2nd place, with 47 confirmed cases of DHF
and 3 deaths, and Caucaia is in 3rd place, with 20 [DHF] cases and one death.

The 1st bulletin of 2008 confirmed a total of 24 793 cases in 167
municipalities in Ceara. In the last week of last year [2007], there
were 24 724 confirmed cases of classical dengue. Fortaleza led [in
numbers of cases] in the dengue epidemic, with 11 687 cases of
confirmed classical dengue, "50 percent of all the cases," stated
Fonseca. In 2nd place was Sobral, with 1753 cases.

Despite Ceara being the state with the highest incidence of DHF in
the northeast, Manoel Fonseca clarified that there was a reduction in
the [case] fatality rate, which was over 8.7 percent in 2006, going
[down] to 3.3 percent last year [2007].

The doctor admitted, however, that in the last 3 years, the number of
dengue cases has remained high. "This year [2008], the cases will
still be high, now that we have 3 types of the virus: dengue 1, 2 and
3. In the interior, the outbreak of [dengue virus] 3 still may occur," he said.

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

***********************************************************************
Date: Tues 7 Jan 2008
Source: Aquidauana News [in Portuguese, trans. & summ. Mod.TY, edited]
< http://www.aquidauananews.com/index.php?action=news_view&news_id=119586>

The arrival of summer promises to bring big problems to the Brazilian
population in the next months. According to the data from the
Ministry of Health, there is a trend that will reach a record
[number] of dengue [cases].

Between January and September of the past year [2007], the number of
recorded [dengue] cases in the country was 50 percent above that of
2006. Just during this period, there were more than 480 000 [dengue
cases] registered, with 121 deaths. Given the control measures
carried out by the government, it is very likely that this year's
[2008] summer will surpass the outbreak of 2002, when 800 000
[dengue] cases were registered. This [projection is made] because
during this past winter, a period of little rain and [usually] fewer
cases, the [case] numbers did not fall.

Sao Paulo state is another area that worries the specialists.
Research carried out during the same period points out that the
region registered more than 64 000 [dengue] cases. Of the 645 Sao
Paulo [state] cities, 127 had indices of at least 300 cases
registered per 100 000 inhabitants. Small and medium-sized cities,
such as Sao Jose do Rio Preto and Bauru e Ribeirao Preto, have
suffered epidemics of this disease.

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

[It is difficult to make predictions with even a modicum of
precision. Estimating that dengue virus transmission will continue in
2008 is to state the obvious. Apparently, Brazil has gotten to the
same dengue outbreak situation as Central America and Southeast Asia,
with intense dengue virus transmission year after year. - Mod.LJS]

PRO/EDR> Dengue/DHF update 2008 (02) – Bolivia

2008-01-23T14:49:00.001-05:00

Date: Mon 5 Jan 2008
Source: ABS Digital [edited]
<http://www.abc.com.py/especiales/dengue/articulos.php?pid=383697>

At least 50 confirmed cases of dengue fever and about 500 suspects
were detected in central Bolivia after recent rains, flooding and
river flooding occurred in the area.

The person responsible for monitoring diseases at the Bolivian
Ministry of Health, Juan Carlos Arraya, told EFE that almost all the
patients are in the tropical region of Chapare, in the central
department of Cochabamba.

Arraya explained that for the moment, there is no person suffering
from dengue hemorrhagic fever, the most serious type of the disease.

Of the 9 departments of Bolivia [equivalent to states or provinces],
6 (Cochabamba, Beni, Santa Cruz, Potosi, Chuquisaca and La Paz) have
been affected by floods, rains and flooding in recent weeks -- in
many cases caused by the climatic phenomenon "La Nina" -- which
caused at least 8 deaths and 2 missing persons.

In 2007, there was one fatality from dengue hemorrhagic fever and
1930 affected by the classical variant of the disease.

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

[A map of Bolivia showing the departments can be accessed at:
< http://www.lib.utexas.edu/maps/americas/bolivia_pol_2006.jpg>.

PRO/EDR> Dengue/DHF update 2008 (02) – Philippines(Cavite)

2008-01-23T14:48:00.000-05:00

Date: Tue 8 Jan 2008
Source: WowPilippines [edited]
<http://luzon.wowphilippines.com/cavite/2008/01/08/bacoor-declares-dengue-outbreak/>

The municipal government of Bacoor, Cavite has declared a dengue
outbreak because of the growing number of people afflicted with the
disease, ABS-CBN News reported Tuesday [6 Jan 2008]. Based on
records, a total of 53 residents were admitted to hospitals due to
dengue from August last year [2007] up to this month [January 2008].
Of these patients, 5 died because of the disease.

[Byline: Glenrose]

--
Communicated by:
ProMED Rapporteur Brent Barrett

[A map of the Philippines showing Cavite Province on Luzon Island can
be accessed at:
<http://www.chanrobles.com/philippinemapofprovinces.htm>.
- Mod.TY]

PRO/EDR> Dengue/DHF update 2008 (02) - Cambodia

2008-01-23T14:47:00.000-05:00

Date: Sun 4 Jan 2008
Source: China View [edited]
<http://news.xinhuanet.com/english/2008-01/04/content_7365534.htm >

A total of 407 Cambodian people died out of some [40 000] dengue
fever cases in 2007, which scored a 10 percent death rate, health
official Ngan Chantha said here on Friday [4 Jan 2008].

Kampong Cham province was the main place of dengue deaths because its
density of population was higher than other provinces, said the
official from the Health Ministry.

"The residents didn't clean the places around their houses and their
water tanks in a proper way, which caused tiger mosquitoes [_Aedes
albopictus_, although _Aedes aegypti_ doubtless is abundant there as
well. - Mod.TY] to transmit virus to people easily," he said. People
should pay more attention to their health care and sanitation, he said.

In 2007, the government spent about USD 3 million to contain the
epidemic, he said.

In addition, the World Health Organization, the World Bank, the Asian
Development Bank and other non-governmental organizations contributed
money to carry out the campaign, he added.

--
Communicated by:
PRO/MBDS <promed-mbds@promedmail.org>

[In the last PRO/MBDS posting on dengue in Cambodia, there were
reports of more than 38 000 cases and 389 deaths (see Dengue -
Cambodia (06) 20071019.3413). The above newswires increase the total
burden caused by dengue virus in Cambodia during 2007 to almost 40
000 cases and 407 deaths.

According to background data available on the World Health
Organization (WHO), Western Pacific Regional Office (WPRO) website,
the outbreak in 2007 was the largest ever documented outbreak of
dengue in Cambodia. The prior major epidemic year was 1998, when
there were approximately 16 000 reported cases (see
<http://www.wpro.who.int/sites/mvp/epidemiology/dengue/cam_profile.htm >
or the WHO Global Health Atlas, DengueNet database
(<http://www.who.int/globalatlas/dataQuery/default.asp>),
where 16 216 cases are reported). While it is highly likely that the
increased number of reported cases is somewhat influenced by marked
improvements in disease surveillance activities in the country, an
almost 3-fold rise in reported cases is highly significant. In
addition, the 10 percent case fatality rate (CFR) reported in 2007
was the highest CFR reported since 1991, when the reported CFR was 9 percent.

According to the WHO Global Health Atlas, DengueNet database
< http://www.who.int/globalatlas/dataQuery/default.asp>,
all 4 dengue serotypes were isolated during 2007, with dengue virus
type 3 (DEN-3) being the most prevalent, followed by dengue type 2
(DEN-2), followed by types 1 (DEN-1) and 4 (DEN-4).

For a map of Cambodia with provinces, see
<http://www.lib.utexas.edu/maps/middle_east_and_asia/cambodia_pol_97.jpg >.

Kampong Cham province is located in the central portion of the
country, just north/northeast of Phnom Penh, bordering Viet Nam on
the east. - Mod.MPP]

[ProMED thanks PD Dr med vet FVH Christian Griot; MPA Unibern
Direktor, Institut fur Viruskrankheiten und Immunprophylaxe,
Switzerland for providing a similar report of dengue in Cambodia. - Mod.TY]

PRO/AH/EDR> West Nile virus, equine, camel - United Arab Emirates

2008-01-23T14:31:00.005-05:00

Date: Fri, 18 Jan 2008
Source: The Horse [edited]
< http://www.thehorse.com/ViewArticle.aspx?ID=11186>

Antibodies to WNV common in Arab Emirate horses
-----------------------------------------------
Researchers found antibodies to West Nile virus (WNV) in nearly 20 per cent
of horses recently tested in the United Arab Emirates (UAE), according to
Ulrich Wernery, DVM, PhD, scientific director of the Central Veterinary
Research Laboratory in Dubai and author of the Dubai-based study published
in Wildlife Middle East [<http://wmenews.com/>].

The testing was initiated after one horse showed clinical signs of
encephalitis. "We were really astonished, especially to see only one
clinical case," Wernery said. "That means to us that we are dealing with a
very mild strain." The horse that showed clinical signs was treated and
recovered within a week.

A widespread survey of 750 horses in the UAE -- a country that previously
had no history of WNV -- was launched in late 2007 following diagnosis of
the index case in the city of Ghantoot. Results of the enzyme-linked
immunosorbent assay (ELISA) antibody test showed that 19.2 per cent of
these 750 horses had WNV antibodies. Within the immediate Ghantoot area, 84
per cent had antibodies for the disease. Serum from 11 Ghantoot horses was
sent to Cornell University College of Veterinary Medicine for further
testing, which revealed that all the horses in the sample had been exposed
to the virus at least 6 weeks prior to the survey. Exact numbers were not
released, but Wernery said all the horses showed "very high levels" of
antibodies.

"At the beginning we were shocked to see that many horses positive, but now
we are relieved (because) they are protected," Wernery said, cautioning
that this could not be considered lifelong immunity.

Wernery recommended that veterinarians vaccinate all horses traveling in or
out of the UAE -- particularly those in transit between the UAE and North
America -- regardless of their antibody levels.

About two-thirds of American horses have been vaccinated against WNV,
making a similar serosurvey in the United States unfeasible, said Frank
Hurtig, DVM, MBA, associate director of equine veterinary medical affairs
at Merial. However, an estimated 3-10 per cent of unvaccinated American
horses develop clinical signs of disease, he said, and 20-30 per cent of
those cases result in death.

Wernery said 30 per cent of UAE camels tested were also positive for WNV
antibodies. None of the camels have shown any clinical signs of encephalitis.

[byline: Christa Lest'e-Lasserre]

--
communicated by:
ProMED-mail rapporteur Joe Dudley

[Clinical signs of the neurologic disease caused by WNV in horses may
include anorexia, depression, ataxia, muscle twitches, partial paralysis,
impaired vision, head pressing, teeth grinding, aimless wandering,
convulsions, circling, and an inability to swallow. Attitudinal changes
including depression, somnolence, listlessness, apprehension, or periods of
hyperexcitability may be seen. Weakness, usually in the hind limbs, is
sometimes followed by paralysis. Coma and death may occur. Fever has been
seen in some but not all cases. Fatal hepatitis developed in one donkey
with neurologic signs in France.

However, the high incidence of sub-clinical inflections (manifested in the
high prevalence of seropositive horses) in the UAE is not that exceptional.
During an investigation in an equine research facility at the University of
California, Davis, in 2004, a (clinically) apparent to inapparent ratio of
1:4 among infected horses was seen. In 2005, when an equine infection
incidence of 62 per cent was seen, the apparent to inapparent ratio was of
1:17. See Carrie F Nielsen, William K Reisen, et al. High subclinical West
Nile virus incidence among nonvaccinated horses in Northern California
associated with low vector abundance and infection. Am J Trop Med Hyg 2008;
78(1): 45-52.

As to the findings in camels: these are known to be one of the mammal
species readily infected by WNV, though naturally occurring clinically
manifested cases are not known to this moderator. - Mod.AS

The United Arab Emirates can be located on the HealthMap/ProMED-mail
interactive map at <http://healthmap.org/promed?v=23.9,54.3,5 >. - CopyEd.MJ]

Fwd: PRO/AH/EDR> Subject: Yellow fever - Brazil (02): alert

2008-01-15T15:00:00.001-05:00

YELLOW FEVER - BRAZIL (02): ALERT

*********************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
< http://www.isid.org>

Date: 9 Jan 2008
Source: Newspaper O Globo, Brazil [in Portuguese, trans. & summ. by
Mod.JW, edited].
< http://oglobo.globo.com/pais/mat/2008/01/09/minas_registra_primeiro_caso_de_suspeita_de_febre_amarela-327934465.asp>

Brazil will today issue an international alert about yellow fever in
the light of the 2nd death of a Brazilian from YF in Brasilia, the
capital. Both cases were infected outside the capital, but
hospitalized in the city in the acute phase, potentially able to
infect the urban vector mosquito, _Aedes aegypti_, which is abundant
there.

Yesterday the Brazilian Ministry of Health asked the Ministries of
Tourism & of External Relations to advise all its embassies
worldwide, and international organizations, about the threat.
Diplomats and staff should be vaccinated.

Tourist agencies will be warned, and leaflets distributed at Brazil's
airports and bus stations, advising all tourists, international and
national, to get vaccinated. The Ministry of Tourism emphasizes that coastal Brazil,
the part most visited by tourists, is "practically free" of YF.

--
Communicated by:
ProMED-mail

[However, it should be remembered that in January 2000, an ecotourist
who had spent the New Year holiday in the interior of Goais state was
hospitalized with YF on her return to Rio de Janeiro, which was
suffering a dengue epidemic at the time. More than 22 000 cases of
dengue were recorded in the city of Rio de Janeiro last year (2007),
and the epidemic is continuing. Since the mosquito vector of dengue
is the same as that of urban YF, if YF patients start to arrive in
Rio hospitals, the potential for spread will be there.

Travelers should be vaccinated at least 10 days before entering
Brazil, to allow the vaccine to take full effect. The Brazilian
government is to be highly commended on issuing this international
alert, in spite of the possible negative impact on its tourist
industry. - Mod.JW ]