Update: CCHF Patient In Scotland Dies

 

Global Distribution of CCHF – Credit WHO

 

# 6612

 

News this morning from the UK press that the 38-year old man who flew into Glasgow, Scotland earlier this week from the Middle East infected with CCHF (see Crimean-Congo Hemorrhagic Fever Patient Isolated In Glasgow) has died overnight.

 

This report from the Independent, after which, I’ll have more.

 

Patient with rare fever dies in UK hospital

Lucinda Cameron  - Saturday 06 October 2012

A man being treated for Crimean-Congo haemorrhagic fever after returning to the UK from Afghanistan has died.

 

It is the first laboratory-confirmed case of CCHF in the UK, according to the Health Protection Agency (HPA).

 

Other passengers who sat close to him on an aircraft are undergoing daily health checks.

(Continue . . . )

 

 

Although originally hospitalized at Gartnavel General Hospital's Brownlee Centre, the unidentified patient was transferred yesterday to a high bio-security unit at London's Royal Free Hospital yesterday.

 

The following statement from the HPA was released yesterday, before the patient’s death.

 

Confirmed case of Crimean Congo Haemorrhagic Fever in the UK

5 October 2012

The Health Protection Agency (HPA) is aware of a laboratory confirmed case of Crimean-Congo Haemorrhagic Fever (CCHF) in a UK traveller who has recently returned from Afghanistan. The patient has been transferred from Glasgow, Scotland to the high security infectious diseases unit at the Royal Free hospital in London using specialist air transport.

CCHF is a serious viral disease which infects a range of domestic and wild animals. Humans are usually infected directly from the blood or body fluids of infected animals or via tick bites. The disease is endemic in many countries in Africa, parts of Europe, the Middle East and Asia.

CCHF can be acquired from an infected patient, but this requires direct contact with their blood or body fluids Therefore, there is no risk to the general population. As a precautionary measure, close contacts of the patient including hospital staff involved in the patient’s care have been contacted and will be monitored.

The HPA is providing public health, diagnostic and other support to the teams currently handling this incident.

This is the first laboratory-confirmed case of CCHF in the United Kingdom.

Information about the Crimean-Congo Haemorrhagic Fever is available on the HPA website. 

Information about the geographical distribution of CCHF is available on the HPA website.

Further information about the transmission of CCHF is available on the HPA website.

Information on CCHF is available from the World Health Organization (WHO) website [external link].

Visit the Royal Free Hospital website [external link].

 

While the risk that this virus has been spread to others is considered low, the HPA will monitor close contacts of this patient for the next two weeks looking for any signs of infection.

»» Read More

ECDC: Mapping Disease Vectors

 

 

# 6332

 

 

While unlikely to gladden the hearts of travel agents around the globe, the ECDC, through the European Network for Arthropod Vector Surveillance for Human Public Health (VBORNET), has released a new set of maps showing the prevalence of various tick species in Europe.

 

These maps, along with similar maps generated for exotic and invasive mosquitoes and for Plebotomine sandflies, gain new importance as the threat of vector-borne illnesses increase across Europe.

 

First the release information and links to the maps, and then I’ll return with more on the growing threat of arthropod carried diseases in Europe.

 

ECDC launches maps on the distribution of tick species in Europe

17 May 2012

ECDC

ECDC, through the VBORNET network, publishes regularly on its website maps on exotic mosquitoes and on phlebetomines  - to provide the ECDC stakeholders and the general public with the most updated information on vector distribution. The maps are updated and improved quarterly.

 

For the first time maps on the distribution of tick species are presented, covering four tick species: Dermacentor reticulates, Hyalomma marginatum, Ixodes persulcatus, Ixodes ricinus. Another improvement is that from now on the maps on phlebotomines are provided at a finer level of geographical detail:  at the administrative level NUTS3 instead of NUTS1 level.

 

The vector distribution maps are the outcome of collaborative work of the VBORNET network and are based on collecting existing data by the network members. VBORNET is a network of medical entomologists and public health experts, funded by the European Centre for Disease Prevention and Control (ECDC).

 

ECDC, through the VBORNET network, continues to  improve the data collection for the maps: the VBORNET network is therefore looking for vector-borne disease experts who are interested in data sharing and networking (experts can contact VBORNET at vbornet@ecdc.europa.eu).

See and download latest maps on vector distribution (updated 16 May 2012):
VBORNET maps – Tick species
VBORNET maps - Mosquitoes
VBORNET maps – Phlebotomines/Sandflies

 

 

In Europe ticks are known to carry and transmit a variety of diseases, including Crimean Congo hemorrhagic fever, Borreliosis, Tick-borne encephalitis, Tick-borne relapsing fever, Tularaemia, and Rickettsios.

 

And with changes in the climate, the range of ticks and the pattern of disease spread is likely to evolve over time.

 

The ECDC provides communication toolkits, designed for a variety of recipients, on tick-borne illnesses.

 

Communication toolkit on tick-borne diseases

This communication toolkit, developed by ECDC, includes template materials such as posters, leaflets, factsheets, etc. for different audiences with information on tick-borne diseases and preventive measures. The aim of the toolkit is to assist public health authorities in Member States in the development of strategies and communication materials to raise awareness on prevention and control of tick-borne diseases.

One of the ECDC toolkits available for download

 

And it isn’t just ticks.

 

The list of mosquito-borne diseases that could in the future (or already do) threaten parts of Europe includes West Nile Virus, Dengue, Malaria, Yellow Fever, Chikungunya, Zika Virus, Yellow Fever, Ockelbo virus, and even Rift Valley Fever.

In 2010 the journal Eurosurveillance devoted an entire issue to The Threat Of Vector Borne Diseases, with perhaps the biggest threat outlined in Yellow fever and dengue: a threat to Europe? by P Reiter.

 

For more on the mosquito-borne threat to Europe you may wish to revisit last April’s ECDC: Status & Importance Of Invasive Mosquito Breeds In Europe and from last year, ECDC: Local Malaria Acquisition In Greece.

 

And while less commonly known, Visceral Leishmaniasis (VL) is the most serious of the sandfly-borne diseases in Europe. While it rarely causes symptoms in healthy individuals - it can pose a deadly threat to those with HIV or compromised immune systems.

 

With these new maps the ECDC not only hopes to alert the public as to how to prevent vector borne illness but to track the changes in their geographic range over time.

 

All of this highlights the fact that you don’t have to travel thousands of miles to some exotic tropical clime in order to be exposed to Dengue, Malaria, Borreliosis, or West Nile Virus.

 

While still relatively rare in Europe (and North America, as well), these diseases continue to make inroads, and over time are likely to  increase as serious threats to public health.

»» Read More

tick . . . tick . . . tick . . .

 

 

# 6247

 

 

While not greeted as warmly as the first robin of spring - in another sign of the change of seasons - this weekend after a trek in the woods I found my first tick of spring crawling up my pants leg.

 

With a near absence of winter this year across much of the southeast, insects – including disease vectoring ticks and mosquitoes – appear to be getting an earlier start this spring.

 

As you can see by the chart below, in the nymph stage, ticks are not much larger than a spec of dirt.  Tenacious hangers on to the skin, they can be easily missed when bathing. 

 

 

And the problem isn’t limited to the deep south.

 

A couple of weeks ago, Maryn McKenna – reporting from the ICEID conference, wrote about concerns over the upcoming Lyme season in the Northeast:

 

Acorns And Mice Driving Unusual Lyme Disease Risks (ICEID 2)

 

 

And even in the UK, the HPA has issued warnings about the upcoming `tick season’.

 

 

HPA advises public to be 'tick aware' to reduce the risk of Lyme disease

27 March 2012

The Health Protection Agency (HPA) is reminding people to be ‘tick aware’ this year and take sensible precautions to reduce their risk of Lyme disease, as Tick Bite Prevention Week (26 March – 1 April) begins.

 

Lyme disease is a bacterial infection which is transmitted by tick bites. Ticks are tiny spider-like creatures which can be found in forests, woodland, heaths, moorland areas and in suburban parkland. Most ticks do not carry the infection but any area in which ticks are present should be regarded as potential risk areas for acquiring Lyme disease. Late spring, early summer and autumn are peak times for tick bites and coincide with people venturing into the great outdoors in the warmer weather.

 

There were 905 laboratory-confirmed cases of Lyme disease reported to the HPA in England and Wales in 2010. The majority of cases (741) were acquired in the UK rather than overseas, with 86 per cent of these (637) identified among residents in the south of England (the South West, South East and London).

 

However, not all cases of Lyme disease are confirmed by laboratory testing and, as in previous years, the overall number of Lyme disease cases in England and Wales is estimated at between 2,000 and 3,000 cases a year. Incidence of Lyme disease acquired in England and Wales remains low compared to in some other European countries or in North America.

 

(Continue . . .)

 

 

 

The CDC’s Division of Vector-Borne Diseases (DVBD)  recommends taking the following steps to prevent tick borne infections:

 

Preventing Tick Bites

While it is a good idea to take preventive measures against ticks year-round, be extra vigilant in warmer months (April-September) when ticks are most active.

Avoid Direct Contact with Ticks

• Avoid wooded and bushy areas with high grass and leaf litter.
• Walk in the center of trails.

Repel Ticks with DEET or Permethrin

• Use repellents that contain 20% or more DEET (N, N-diethyl-m-toluamide) on the exposed skin for protection that lasts up to several hours. Always follow product instructions. Parents should apply this product to their children, avoiding hands, eyes, and mouth.
• Use products that contain permethrin on clothing. Treat clothing and gear, such as boots, pants, socks and tents. It remains protective through several washings. Pre-treated clothing is available and remains protective for up to 70 washings.
• Other repellents registered by the Environmental Protection Agency (EPA) may be found at http://cfpub.epa.gov/oppref/insect/.

Find and Remove Ticks from Your Body

• Bathe or shower as soon as possible after coming indoors (preferably within two hours) to wash off and more easily find ticks that are crawling on you.
• Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body upon return from tick-infested areas. Parents should check their children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and especially in their hair.
• Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats, and day packs. Tumble clothes in a dryer on high heat for an hour to kill remaining ticks.

 

With more than 20,000 new cases of Lyme disease reported each year, and undoubtedly many others that go unreported or undiagnosed, Lyme is one of the fastest growing emerging infectious diseases in the country.

 

But Lyme is not the only tick-borne illness to be aware of. Others include:

 

• Anaplasmosis
• Babesiosis
• Ehrlichiosis
• Lyme disease
• Rocky Mountain spotted fever
• Other spotted fevers
• Southern Tick-Associated Rash Illness
• Other tickborne diseases

 

All of which illustrates the need to become more aware of the threat posed by these vicious vectors, and proactive in preventing them from passing on their diseases to you and your family.

»» Read More

NEJM: Emergence Of A New Bacterial Cause Of Ehrlichiosis

 

(Photo Credit- CDC)

# 5736

 

 

Ehrlichiosis (aka HME) is the generic name used to describe an infection that affects the white blood cells of humans and other mammals caused by several varieties of tickborne bacteria.

 

Similar to Anaplasmosis (HGA), the two are differentiated by the type of white blood cells they affect (HGA affects granulocytes and HME affects monocytes), and the bacterial cause of the infection.

 

Until recently, Ehrlichiosis has been identified with just two bacterial infections: Ehrlichia chaffeensis and E. ewingii.

 

Anaplasmosis, on the other hand, is caused by Anaplasma phagocytophilum infection.

 

 

The CDC maintains an extensive Ehrlichiosis web page, that includes epidemiological data and prevention advice.  The following map shows the incidence of Ehrlichiosis by state in 2008.

 

 

 

Today, the NEJM has an article that describes the discovery of a third bacterial cause of Ehrlichiosis detected first detected in Minnesota and Wisconsin in 2009.

 

Emergence of a New Pathogenic Ehrlichia Species, Wisconsin and Minnesota

August 4, 2011 | B.S. Pritt and Others

A newly discovered ehrlichia species closely related to E. muris was identified as a cause of illness in three people in Minnesota and one in Wisconsin. The syndrome is described, and the likely vector identified. Physicians need to be aware of this new ehrlichia species to ensure appropriate testing, treatment, and regional surveillance.

 

 

 

Briefly, 4 patients showing signs and symptoms of ehrlichiosis, but who did not test positive for E. chaffeensis or E. ewingii, underwent additional testing.

 

They were found to be infected by a previously unidentified ehrlichia species, which has provisionally been designated Ehrlichia muris-like (EML). 

 

Subsequently, PCR analysis of 697 Ixodes scapularis ticks collected in Minnesota & Wisconsin showed that 17 were positive for this newly discovered ehrlichia species.

 

The good news is that this bacterial infection appears to respond well to the same treatment (Doxycycline) as the other forms of ehrlichiosis.

 

The list of tickborne illnesses that one may encounter in the United States is long, and growing. As my last blog indicated (see NRDC Report: Climate Change and Health Threats) climate change may affect the size and geographic spread of many of these vector-borne diseases.

 

The CDC lists a number of diseases carried by ticks in the United States, including: 

 

• Anaplasmosis is transmitted to humans by tick bites primarily from the blacklegged tick (Ixodes scapularis) in the northeastern and upper midwestern U.S. and the western blacklegged tick (Ixodes pacificus) along the Pacific coast.
• Babesiosis is transmitted by the blacklegged tick (Ixodes scapularis) and is found primarily in the eastern U.S.
• Ehrlichiosis is transmitted to humans by the lone star tick (Ambylomma americanum), found primarily in the southcentral and eastern U.S.
• Lyme disease is transmitted by the blacklegged tick (Ixodes scapularis) in the northeastern U.S. and upper Midwestern U.S. and the western blacklegged tick (Ixodes pacificus) along the Pacific coast.
• Rickettsia parkeri Rickettsiosis is transmitted to humans by the Gulf Coast tick (Amblyomma maculatum).
• Rocky Mountain Spotted Fever (RMSF) is transmitted by the American dog tick (Dermacentor variabilis), Rocky Mountain wood tick (Dermacentor andersoni), and the brown dog tick (Rhipicephalus sangunineus) in the U.S. The brown dog tick and other tick species are associated with RMSF in Central and South America.
• STARI (Southern Tick-Associated Rash Illness) is transmitted via bites from the lone star tick (Ambylomma americanum), found in the southeastern and eastern U.S.
• Tickborne relapsing fever (TBRF) is transmitted to humans through the bite of infected soft ticks. TBRF has been reported in 15 states: Arizona, California, Colorado, Idaho, Kansas, Montana, Nevada, New Mexico, Ohio, Oklahoma, Oregon, Texas, Utah, Washington, and Wyoming and is associated with sleeping in rustic cabins and vacation homes.
• Tularemia is transmitted to humans by the dog tick (Dermacentor variabilis), the wood tick (Dermacentor andersoni), and the lone star tick (Amblyomma americanum). Tularemia occurs throughout the U.S.
• 364D Rickettsiosis (Rickettsia phillipi, proposed) is transmitted to humans by the Pacific Coast tick (Dermacentor occidentalis ticks). This is a new disease that has been found in California.

This list should help illustrate the importance of everyone becoming `tick aware’, and doing what they can to avoid exposure. 

The CDC suggests taking the following precautions:

 

Preventing Tick Bites

While it is a good idea to take preventive measures against ticks year-round, be extra vigilant in warmer months (April-September) when ticks are most active.

Avoid Direct Contact with Ticks

• Avoid wooded and bushy areas with high grass and leaf litter.
• Walk in the center of trails.

Repel Ticks with DEET or Permethrin

• Use repellents that contain 20% or more DEET (N, N-diethyl-m-toluamide) on the exposed skin for protection that lasts up to several hours. Always follow product instructions. Parents should apply this product to their children, avoiding hands, eyes, and mouth.
• Use products that contain permethrin on clothing. Treat clothing and gear, such as boots, pants, socks and tents. It remains protective through several washings. Pre-treated clothing is available and remains protective for up to 70 washings.
• Other repellents registered by the Environmental Protection Agency (EPA) may be found at http://cfpub.epa.gov/oppref/insect/.

Find and Remove Ticks from Your Body

• Bathe or shower as soon as possible after coming indoors (preferably within two hours) to wash off and more easily find ticks that are crawling on you.
• Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body upon return from tick-infested areas. Parents should check their children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and especially in their hair.
• Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats, and day packs. Tumble clothes in a dryer on high heat for an hour to kill remaining ticks.

»» Read More

Minnesota: Powassan Virus Fatality

 

 

(Photo Credit- CDC)

# 5663

 

 

News today of the first known death in the state of Minnesota from the Powassan Virus (POW), a rare but sometimes deadly Flavivirus  in the same family of arboviruses  as West Nile Virus (WNV), Dengue Fever, St. Louis Encephalitis, and Yellow Fever.

 

Minnesota’s  Department of Health has details on this fatality in the press release below, after which I’ll return with more on this rare infection.

 

 

News Release
June 29, 2011

Minnesota records first death from tick-borne Powassan virus

State health officials emphasize the importance of preventing tick bites

 

A woman in her 60s from northern Minnesota has died from a brain infection due to Powassan (POW) virus. This is the first death in the state attributed to the disease. One other likely POW case has been identified this year in Minnesota, in an Anoka County man in his 60s who was hospitalized with a brain infection and is now recovering at home. POW virus is transmitted through the bite of an infected tick.

 

Both 2011 cases became ill in May after spending time outdoors and noticing tick bites. The fatal case was likely exposed to ticks near her home. The case from Anoka County might have been exposed near his home or at a cabin in northern Minnesota.

 

Health officials say this death serves as a reminder of the vital importance of preventing tick bites. “Although Powassan cases are rarely identified, it is a severe disease which is fatal in about 10 percent of cases nationwide, and survivors may have long-term neurological problems” said Dr. Ruth Lynfield, state epidemiologist with the Minnesota Department of Health (MDH).

 

“Powassan disease is caused by a virus and is not treatable with antibiotics, so preventing tick bites is crucial.”

(Continue . . . )

 

The Powassan Virus (POW) was first identified in 1958 in Powassan, Ontario following the death of a child from the infection.  Later, a species of ticks (Dermacentor andersoni) collected in Colorado in 1952 were shown to carry the same virus.

 

The virus can be transmitted by the same species of ticks that carry Lyme disease, anaplasmosis, and babesiosis (bacterial or parasitic infections).

 

The animal reservoir for the virus appears to encompass a wide range of mammals. According to the Canadian Cooperative Wildlife Health Center the virus has been identified with:

 

. . . the Woodchuck (Marmota monax) and the tick Ixodes cookei seem to be particularly important, but infection rates can be high in Red Squirrels (Tamiasciurus hudsonicus), Grey Squirrels (Sciurus carolinensis), Eastern Chipmunks (Tamias striatus), Porcupines (Erethizon dorsatum), Deer Mice (Peromyscus maniculatus), voles (Microtus sp.), Snowshoe Hares (Lepus americanus), Striped Skunks (Mephitis mephitis) and Raccoons (Procyon lotor).

 

Human POW infection appears to be very rare, but difficulties in testing, the variability of illness severity, and similarity of symptoms to other illnesses may be clouding that picture.

 

The Minnesota Department of Health advises:

 

How common is POW disease?

Physician-diagnosed POW disease is very rare. Fewer than 60 cases have been identified in the U.S. and Canada since 1958. From 2008-2010, six cases of POW encephalitis or meningitis have been reported in Minnesota. These cases lived in or had visited wooded areas in north central or east central counties (Cass, Carlton, Hubbard, Itasca, or Kanabec).

 

It is possible that other cases of suspected viral encephalitis or meningitis during times of peak tick-borne disease transmission (May to October) are due to POW virus.

 

 

In light of this fatality, the Minnesota Health Department is advising health providers:

 

• Medical providers should consider the possibility of POW virus infection in patients with central nervous system disease who have recent histories of activities in wooded areas (with or without known tick bites) during Minnesota’s warm weather months.
• The only laboratories that offer testing for POW virus are at state health departments (including MDH) and CDC. At this time, no commercial laboratories offer serologic testing for the virus.
• Serum or CSF specimens from patients with central nervous system disease can be submitted directly to the MDH Public Health Laboratory for arboviral disease testing, including POW virus.

 

Complicating matters, the state of Minnesota is facing a potential shutdown of government services at midnight tonight due to a budget impasse that could adversely affect state laboratory testing services.

 

Admittedly, the odds of contracting the Powassan virus are exceedingly low. More people are struck and killed by lightning each year or killed by bee stings.

 

But when you consider the wide panoply of tickborne diseases found in the United States;

 

Lyme disease, anaplasmosis, babesiosis, TBE (tick borne encephalitis), Rocky Mountain Spotted Fever, Ehrlichiosis, STARI (Southern Tick-Associated Rash Illness), Tickborne relapsing fever (TBRF), Rickettsiosis, and Tularemia . . . 

 

. . .  well, the odds of getting sick from a tick bite go up considerably. 

 

Lyme disease alone is considered responsible for 20,000+ infections each year (MMWR  Lyme Disease --- United States, 2003—2005).

 

Which means that preventing tick bites, and looking for and removing ticks as quickly as possible, are important steps to take after visiting tick-endemic areas.

 

Since it is summer, and tick season, a few timely reminders:

 

 

Lastly, the CDC offers the following advice:

 

Preventing Tick Bites

While it is a good idea to take preventive measures against ticks year-round, be extra vigilant in warmer months (April-September) when ticks are most active.

Avoid Direct Contact with Ticks

• Avoid wooded and bushy areas with high grass and leaf litter.
• Walk in the center of trails.

Repel Ticks with DEET or Permethrin

• Use repellents that contain 20% or more DEET (N, N-diethyl-m-toluamide) on the exposed skin for protection that lasts up to several hours. Always follow product instructions. Parents should apply this product to their children, avoiding hands, eyes, and mouth.
• Use products that contain permethrin on clothing. Treat clothing and gear, such as boots, pants, socks and tents. It remains protective through several washings. Pre-treated clothing is available and remains protective for up to 70 washings.
• Other repellents registered by the Environmental Protection Agency (EPA) may be found at http://cfpub.epa.gov/oppref/insect/.

Find and Remove Ticks from Your Body

• Bathe or shower as soon as possible after coming indoors (preferably within two hours) to wash off and more easily find ticks that are crawling on you.
• Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body upon return from tick-infested areas. Parents should check their children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and especially in their hair.
• Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats, and day packs. Tumble clothes in a dryer on high heat for an hour to kill remaining ticks.

»» Read More

Referral: Maryn McKenna On Tick Borne Illnesses

 

 

 

# 5323

 

 

Our favorite scary disease girl, Maryn McKenna, has just published a terrific article in Condé Nast’s SELF Magazine on the growing tide of tick borne illnesses across the United States.

 

As a Lymie who went misdiagnosed for years, and who after treatment still deals with post-Lyme syndrome, I identify greatly with the stories Maryn writes so eloquently about in this article.

 

But as she points out, it isn’t just Lyme disease any more;  babesiosis, ehrlichiosis, STARI, and anaplasmosis are all carried by ticks, and on the rise.

 

Given the spread of these pathogens (even encroaching into large cities) - and how frequently they go undiagnosed - you really should put this article at the top of your morning’s reading list.

 

 

The Rising Dangers of Ticks

As tiny ticks proliferate across the country, they are spreading diseases you—and your doctor—probably haven't heard of. SELF investigates a growing threat to your health and the blood supply you depend on. —Maryn McKenna

(Continue . . .)

»» Read More