Health Vigilance For The Chinese New Years

 

Source CDC - The year of the snake begins Sunday, February 10,

 

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For many Asian cultures it is a long held tradition that people return home to attend a reunion dinner with their families on the eve of the lunar New Year.

 

In Korea it is called Seollal.

 

In Vietnam, it is called  Tết Nguyên Đán or Feast of the First Morning.  Tết for short.

 

In China, it is called  Chinese New Year or Lunar New Year, or simply, The Spring Festival.

 

While Cambodia celebrates their own Khmer New Year in mid-April, the Chinese New Year is widely observed by many people of that nation as well. 

 

 

But by whatever name, the lunar new year is the most important holiday in all of Asia. And each year this annual return to one’s home -called Chunyun, or the Spring Festival travel season - sparks the largest human migration on the planet.

 

As you might imagine, these mass migrations (along with mass gatherings) are of considerable interest to public health officials and epidemiologists.

 

Chunyun begins about 15 days before the Lunar New Year and runs for about 40 days total, during which time more than 2 billion passenger journeys will be made (mostly via crowded rail and bus) across Asia.

 

We get an idea of just how crowded these public conveyances can be from a 2006 China Daily report Adult diaper sales soar before long trips home.

 

They report the sale of adult diapers spikes for Chunyun because so many passengers are crammed into trains and buses that getting to a restroom can be impossible.

 

In 2011, in Study: Viruses With A Ticket To Ride, we looked at research on the incidence of ARI (Acute Respiratory Infection) presenting within 5 days of train or tram travel in the UK.

 

Their finding?

 

Recent  bus  or  tram  use  within  five  days  of  symptom  onset  was  associated  with  an  almost  six-fold  increased  risk  of  consulting  for  ARI  (adjusted  OR=5.94  95%  CI  1.33- 26.5)

 

And this was for normal levels of passengers, not the standing room only conditions often experienced during Chunyun travels across Asia.  

 

This year, the Lunar New year will be observed between February 9th – 12th.

 

Duck and chicken are popular dishes served during these reunion dinners, and so the live markets do tremendous business this time of year.

 

A concern once again this winter - as yesterday we learned of 3 human H5N1 infections over the past two weeks in Cambodia - all connected to contact with or preparation of infected poultry (see WHO/Cambodian MOH Statement On H5N1 Cases).

 

Each year public health officials in Asia, and around the world, keep a close watch for signs of any disease outbreaks that might be exacerbated by this intense period of travel.

 

Of course, it should be pointed out that since 2009, Chunyun has not precipitated a major resurgence in the H1N1 pandemic virus across Asia.

 

Nor has any feared third wave of influenza followed Carnival in Rio, the Super Bowl, or the the World Cup in South Africa.

 

So while each year there are concerns about bird flu being brought back to the cities from rural locations by Chunyun travelers, we haven’t seen that happen (yet).

 

There are, however, a number of less exotic health problems commonly associated with mass gatherings and migrations (including mosquito borne illnesses, influenza, food poisoning, etc.), so each year the CDC posts some travel advice for those planning a trip to Asia.

 

Good Luck. Good Health. Good Cheer. Happy Lunar New Year!

The year of the snake begins Sunday, February 10, 2013, and many travelers will visit Asia to celebrate the Lunar New Year. If you are traveling to Asia, the Centers for Disease Control and Prevention (CDC) would like to share information and tips that will help you stay healthy and safe during your trip.

 

Every destination, even in different areas of the same country, has unique health issues that travelers need to be aware of. To find specific information about the areas you plan to visit, see the East Asia, South Asia, and Southeast Asia regional pages on the CDC Travelers’ Health website, or click on the country or countries you will be visiting on the destinations page.

Important Health Information

• Illnesses spread by mosquitoes, such as malaria, dengue fever, and Japanese encephalitis, are common throughout Asia, so it is very important to take steps to prevent mosquito and other insect bites. You may also need to take prescription medicine to protect against malaria or get a vaccine against Japanese encephalitis. Talk to your doctor about prevention steps that are right for you and your destination.
• Food and water. Eating contaminated food and drinking contaminated water can cause illnesses such as hepatitis A, typhoid fever, and travelers’ diarrhea. Read about how to prevent these diseases by visiting the Safe Food and Water page on the Travelers’ Health website.
• Seasonal flu. Annual vaccination of all people 6 months of age and older is recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP). Travelers who want to reduce their risk of flu should receive the flu vaccine at least 2 weeks before departure. Children 6 months through 8 years of age may need to receive two doses of the vaccine to be fully protected. Learn more about the flu vaccine by reading Key Facts about Seasonal Flu Vaccine.

(Continue . . . )

 

We’ve seen fewer reports of human H5N1 infections this fall and winter across Asia, and so hopefully this year’s Chunyun - like all those since bird flu re-emerged in 2003 – will prove equally unremarkable.

 

But as we’ve seen this flu season with H3N2, it doesn’t take a novel flu virus to cause a good deal of morbidity and mortality in a population.

 

So we’ll be watching for signs of other increased viral illness across Asia over the coming weeks.

»» Read More

The Risks Of Chikungunya Outbreaks In The United States

 

Credit Wikipedia

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Chikungunya, up until about a decade ago, was a little known mosquito-borne disease first described in Tanganyika in the early 1950s. For the next five decades it was sporadically seen across eastern and central Africa.

 

That is, until 2005, when Chikungunya made a surprise jump to the Indian Ocean island of Réunion. There, it infected nearly 1/3rd of the island’s 770,000 residents (see 2006 EID article Chikungunya Disease Outbreak, Reunion Island) in just a matter of months.

 

Chikungunya typically produces a fever, severe muscle and joint pain, and headaches. The symptoms usually go away after a few weeks, but some patients can sustain permanent disability, and some deaths have been reported.

 

In the eight years since that  jump, `Chik’ has spread further across the Indian Ocean, Southeast Asia, and even briefly into northern Italy.

 

While the virus isn't normally found in Europe, the vector, the Aedes mosquito, is.  All it took was one infected traveler to arrive infected with the virus to start the chain of transmission.

 

 

I told the story several years ago in It's A Smaller World After All, but the short version is that a traveler, returning from India, brought the virus to Italy in 2007 which led to more than 290 cases reported in the province of Ravenna, which is in northeast Italy.

 

The concern is that the same sort of introduction could happen elsewhere in Europe, or here in the United States, just as we saw with West Nile Virus in 1999 (see DVBID: Final West Nile Report For 2012) and with Dengue Fever in 2010 (see MMWR: Dengue Fever In Key West)

 

The two primary mosquito vectors of Chikungunya are the Aedes aegypti and Aedes albopictus (cite WHO FAQ) both of which can be found across many regions of the Americas.

Aedes albopictus (Asian Tiger) Mosquito - Wikipedia

Dark blue: Native range
Dark green: introduced (as of December 2007)

 

The risk is considered great enough that early last year, the CDC and PAHO (Pan American Health Organization) put together a 161-page guide on preparing for the arrival of Chikungunya to the Americas (see Preparedness and Response for Chikungunya Virus Introduction in the Americas).

 

All of which serves as prelude to a report that appeared last month in PloS Neglected Tropical Diseases called:

 

Modeling Dynamic Introduction of Chikungunya Virus in the United States

Abstract (reparagraphed for readability)

Chikungunya is a mosquito-borne viral infection of humans that previously was confined to regions in central Africa. However, during this century, the virus has shown surprising potential for geographic expansion as it invaded other countries including more temperate regions.

 

With no vaccine and no specific treatment, the main control strategy for Chikungunya remains preventive control of mosquito populations. In consideration for the risk of Chikungunya introduction to the US, we developed a model for disease introduction based on virus introduction by one individual. Our study combines a climate-based mosquito population dynamics stochastic model with an epidemiological model to identify temporal windows that have epidemic risk. We ran this model with temperature data from different locations to study the geographic sensitivity of epidemic potential.

 

We found that in locations with marked seasonal variation in temperature there also was a season of epidemic risk matching the period of the year in which mosquito populations survive and grow. In these locations controlling mosquito population sizes might be an efficient strategy.

 

But, in other locations where the temperature supports mosquito development all year the epidemic risk is high and (practically) constant. In these locations, mosquito population control alone might not be an efficient disease control strategy and other approaches should be implemented to complement it.

 

Our results strongly suggest that, in the event of an introduction and establishment of Chikungunya in the US, endemic and epidemic regions would emerge initially, primarily defined by environmental factors controlling annual mosquito population cycles. These regions should be identified to plan different intervention measures.

In addition, reducing vector: human ratios can lower the probability and magnitude of outbreaks for regions with strong seasonal temperature patterns. This is the first model to consider Chikungunya risk in the US and can be applied to other vector borne diseases.

(Continue . . . )

 

More background on this modeling study is available from the Cornell University Press Office.

 

 

Chances seen rising for chikungunya outbreaks in NYC, Atlanta, Miami

ITHACA, N.Y. – Global travel and climate warming could be creating the right conditions for outbreaks of a new virus in this country, according to a new Cornell University computer model.

 

The model predicts that outbreaks of chikungunya, a painful virus transported by travelers and spread by the invasive Asian tiger mosquito, could occur in 2013 in New York City during August and September, in Atlanta from June through September, and year-round in Miami. The probability of a disease outbreak is correlated with temperature, as warmer weather allows the Asian tiger mosquito to breed faster and grow in numbers, according to the study published in the November issue of PLOS Neglected Tropical Diseases.

 

According to the simulation, there is a high probability of a chikungunya outbreak if a single infected person arrives in New York in July or August and is bitten by an Asian tiger mosquito. The risks are the same, but with wider time frames, for transmission in Atlanta and Miami, according to the paper.

 

Asian tiger mosquitoes were introduced to the United States in Texas in the 1980s; they are established up the East Coast into New Jersey and are rising in numbers in New York City. The aggressive mosquito outcompetes local varieties and transmits more than 20 pathogens, including chikungunya and dengue, said Laura Harrington, associate professor of entomology and the study’s senior author.

 

“The virus is moving in people, and resident mosquito populations are picking it up,” Harrington said.

 

The model estimates that with typical regional temperatures, a chikungunya outbreak in New York would infect about one in 5,000 people, said Diego Ruiz-Moreno, a postdoctoral associate and the paper’s lead author

 

“However, this number would increase drastically as temperatures rise due to climate change,” Ruiz-Moreno said.

(Continue . . . )

 

While this study focused on Chikungunya, much the same could be said about the potential for seeing Dengue, Malaria, or even Yellow Fever making inroads in the United States and Europe. 

 

In March of 2010 the journal  Eurosurveillance carried a series of articles on vector borne diseases and their potential to impact those living in Europe. One of the articles, Yellow fever and dengue: a threat to Europe? by P. Reiter, had these sobering comments about the future of vector-borne illnesses in Europe.

 

The history of dengue and yellow fever in Europe is evidence that conditions are already suitable for transmission. The establishment of Ae. albopictus has made this possible, and the possibility will increase as the species expands northwards, or if Ae. aegypti is re-established.

 

The epidemic of chikungunya in northern Italy in 2007 [8,49] confirms that Ae. albopictus is capable of supporting epidemic transmission, although laboratory studies indicate that the strain of virus involved was particularly adapted to this species [50,51].

 

Nevertheless, it is not unreasonable to assume that climatic conditions that permit malaria transmission will also support transmission of yellow fever and dengue, in which case transmission could extend into northern Europe [52].

 

Reason enough that if you live in - or are visiting  - a mosquito prone area, to remember to follow the `5 D’s’  (courtesy Florida Department of Health).

 

»» Read More

Fresh Reports Of Cholera In Cuba

Photo Credit  Wikipedia

 

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In the beginning of July (see Media: Reports Of Cholera In Cuba) we began to get multiple reports of cholera in Cuba, reports that were at first denied - and then later confirmed - but played down by local and national officials.

 

While the source of that outbreak was not given, there was media speculation that it may have been imported by returning medical and humanitarian relief personnel who served in Haiti during their recent (and ongoing) cholera epidemic.

 

The CDC posted the following in their Travels’ notices, in August.

 

Outbreak Notice Cholera in Cuba

Updated: August 22, 2012

What Is the Current Situation?

The Cuban Ministry of Health has confirmed the first cholera outbreak in Cuba in more than a century. As of July 31, 2012, 236 confirmed cases and 3 deaths have been reported in the cities of Manzanillo, Bayamo, Yara, and Campechuela Niquero in Granma Province. Currently, cases are limited to Granma Province, mostly in Manzanillo. According to the Cuban Ministry of Public Health, control measures have been implemented, including public awareness campaigns and efforts to ensure safe drinking water and to improve environmental sanitation.

The Pan American Health Organization (PAHO) (PDF) is also closely monitoring this situation.

 

By the end of August, the Cuban government declared the outbreak over (see Global Post story).  A month later (see Havanna Times’ More Cholera in Eastern Cuba) Cuban officials once again acknowledged a small outbreak in the eastern province of Granma, where nine cases had been confirmed.

In November, after the passage of Hurricane Sandy, reports of fresh outbreaks of cholera began to emerge, such as this report in the Havana Times on November 22nd.

 

More Cholera Cases Reported in Eastern Cuba

November 22, 2012

HAVANA TIMES — The cholera epidemic has spread to the eastern provinces of Santiago de Cuba, Guantanamo and Holguin, with dozens of people hospitalized and some municipalities facing critical conditions, reports Hablemos Press.

 

Sources in the public health-care industry and residents in the east of the country have confirmed off-the-record the proliferation of the epidemic that has plagued Cuba since last June. They noted that the province of Guantanamo could be declared in quarantine.

(Continue . . . )

 

 

Officially, the Cuban government has remained silent regarding fresh cholera cases, and has said little about outbreaks of Dengue fever as well.  

 

Yesterday, the Miami Herald/El Nuevo Herald carried a long, eye-opening report, challenging the official Cuban silence on these issues.

 

Cuba stays silent about deadly cholera outbreak

It’s the disease that the government doesn’t acknowledge, because it might deter tourists from coming to the island.

Posted on Saturday, 12.08.12

Life on the island

(Excerpt)

Cuba, especially the eastern third of the island, is suffering through an alarming outbreak of cholera — as well as the mosquito-borne dengue fever — brewed in its decrepit water and sewer systems and fueled by Hurricane Sandy’s floods, according to residents.

 

More than a dozen deaths have been reliably reported. Hospitals and prisons have been quarantined at times. Schools have been shut down, and so have restaurants and street kiosks selling juices and other products made with water.

(Continue . . .)

 

 

Although the Cuban medical system is often highly praised, the island’s infrastructure – particularly potable water delivery and sewage treatment – are insufficient for their population, and are often reported to be in disrepair. 

 

Two factors that could help Cholera to remain an ongoing threat on the island for some time to come.

»» Read More

Looking For Zebras

  

Google Search Screenshot

 

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Every day a small, dedicated group of volunteers around the world begin their day with a pot of coffee, an internet connection, and the goal of finding hints of `a zebra’ – an unusual or exotic disease outbreak – from hundreds of news sources around the globe.

 

You see the results of their work often in this blog, or on Crof's H5N1, and in the daily listings of `flu forums’ like FluTrackers and the Flu Wiki.  

 

Sure, Crof and I hunt for, find, and translate many of our own articles, but its a big internet and and even bigger world. So we often rely on the dozens of newshounds who spend countless hours scouring the internet, looking for tiny morsels of potentially important information. 

 

This is difficult, exacting, sometimes mind-numbing work.  Particularly when dealing with languages like Arabic or Chinese.

  

As you can see, just finding the articles that need to be translated is a major undertaking.

 

Once a likely article is found, newshounds use a variety of translation methods (including the linguistic prowess of native speakers) to turn Bahasan, or Arabic, Spanish, French, or Chinese into some semblance of English. Often, when we must rely on machine translations, we use more than one translation system, to try to get the most readable result.

 

Even then, it takes experience and knowledge of idioms and local customs to properly interpret these stories - skills that many of these newshounds have developed over these many months (and sometimes years) of volunteer work.

 

All the more remarkable, these newshounds are uncompensated for their time and effort.  They do it because they believe it is important.

 

You’ll see that Crof and I try to credit these volunteer newshounds whenever we use the fruits of their labor because recognition is pretty much the only reward (other than personal satisfaction) they get. 

 

An incomplete list of some of the more prolific newshounds would include:

Gert van der Hoek, Ronan Kelly, Giuseppe Michieli, Tetano, Shiloh, Diane Morin, Pathfinder, Missouri Watcher, Treyfish, Alert, Tonka, Laidback Al, Carol@SC, Sharon Sanders, Alaska Denise, Hawkeye, Arkanoid Legent, Catbird,  Commonground, Shannon, Mingus, mixin & AlohaOR.

 

There are many others, including some that work on other forums than FluTrackers and the Flu Wiki.  So my apologies to those who I failed to mention.

 

Last April, when a mysterious pneumonia swept a hospital in Jordan the newshounds at FluTrackers began a thread on the outbreak, and over the next 7 days made 90 posts, including scores of Arabic news article translations.

 

We now know that this incident was the first known outbreak of the novel coronavirus now garnering considerable attention in the Middle East. 

 

Most of the time, outbreaks like this turn out to be something far less exotic, like seasonal influenza, Dengue or Chikungunya.  But the truth is, most disease outbreaks – regardless of their cause – start out looking pretty much the same; a cluster of flu-like-illnesses or pneumonias.

 

So newshounds take all of these outbreaks seriously, accepting that most will turn out to be something other than zebras, but documenting them anyway.

 

Because, like the cluster of unexplained pneumonias last April, sometimes they make sense only in retrospect. 

 

Today we’ve a good example of an `odd’ news report posted by Gert van der Hoek on FluTrackers that may – or may not – become a bigger story in the days to come.

 

The thread is Brazil: unknown respiratory disease, and it contains a machine translated account of five patients being transferred to a larger hospital due to an unknown pneumonia.  According to the news report, another 14 people have similar symptoms.

 

Here is an excerpt from the news report:

 

02/12/2012
Respiratory syndrome patients are transferred from Bethlehem to Curuçá

From the newsroom  Para News Agency

The State Department of Public Health (Sespa) decided to transfer to Bethlehem five patients with clinical gentler, who were admitted to the Hospital Municipal Curuçá with symptoms of acute respiratory syndrome because as yet undefined.

The aim is to ensure better care of the sick, whose cases are still being investigated by the Epidemiological Monitoring of Sespa in conjunction with the 3rd Regional Center for Health in Castlebay, the Municipal Health Curuçá, Central Laboratory of the State (Lacen), Centre Skill Scientific Renato Chaves (CPC) and Instituto Evandro Chagas.

Patients transferred to the capital will be admitted to the Unit Diagnosis of Meningitis (UDM), the University Hospital João de Barros Barreto, under monitoring of infectious disease. In addition to these five people, 14 more showed symptoms of the disease since the beginning of the outbreak in Curuçá Municipal Hospital, where a 17-year-old died in the ICU of the Holy House, on the evening of Saturday, 01.

(Continue . . . )

 

Armed with this information, I did a quick search myself, and found several other news reports regarding this `outbreak’, which may be viral, bacterial, or possibly even the result of chemical or radioactive exposure.

 

A report, dated yesterday from the Diario do Para, states:

 

Sai result today on infection in hospital

Monday, 03/12/2012, 1:47 a.m.

The State Department of Health (SESPA) has no information about what the real focus of the contamination in Unit Joint Health Dr. Henrique Alves de Christo, located in the municipality of Curuçá, northeastern state. The complaint made by the hospital staff said that about 10 employees were contaminated by alleged leakage of a chemical used to make dental x-ray. Some employees are hospitalized in Curuçá and others were taken to Bethlehem for treatment.

 

Since last week the SESPA became aware of the case and is investigating the complaint on two lines of research. One is that the symptoms reported by employees can be caused by bacteria or a respiratory virus.

 

Laboratory technicians Central State (Lacen) and Epidemiological Surveillance investigating the case. The result of tests performed by teams due out today (Monday).

(Continue . . . )

 

 

Is this a `Zebra’?

 

We won’t know that until more information comes in. Most turn out to be less than earthshaking in their impact.  But every once in awhile . . .

 

The point is, these stories – whether they turn out to be something of global importance or not – are being monitored, organized, and posted every day by the newshounds of Flublogia – making a historical record available for anyone who wants to look.

 

 

I couldn’t do a lot of what I do in this blog without their capable assistance, and for that, they get my profound thanks and admiration.

 

 

_________________________________________________

The term `Zebra’ comes from the famous adage, retold to almost every beginning medical student, is that if you are in Central Park, and you hear hoof beats coming up behind you . . . think horses . . not zebras.

 

Simply put, doctors should always seek to rule out the most likely diagnoses first, not some obscure and exotic disease.

 

The caveat being that every once in awhile you run into a zebra.

»» Read More

ECDC Risk Assessment: Dengue In Madeira

 

Credit Wikipedia

 

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As we’ve seen often over the past few decades, Dengue fever continues its geographic expansion, spurred on both by climate change and the ease of human travel around the globe.

 

All it takes is for a traveler to be bitten by an infected mosquito in one region, and then travel to another region while viremic where suitable mosquito hosts can be encountered, to import the virus into a new place.

 

The explosive growth of Dengue around the world is well illustrated by the following graph from the World Health Organization.  In just over 20 years (1980-2000) the number of countries reporting Dengue Fever cases doubled.

 

What this graph doesn’t indicate is another doubling of dengue cases over the past 5 years.  

 

In 2009, it was Key West in South Florida that saw the introduction, likely through tourism, of the virus (see MMWR: Dengue Fever In Key West).

 

For the first time in their history – and In just over 6 weeks time - more than 1,357 cases of Dengue Fever have been reported in the Autonomous region of Madeira, an island with just over a quarter of a million residents, located 1000 km west of Portugal.

 

With more than a million visitors a year, Madeira is a popular vacation spot, and that adds greatly to the local economy.  But that also increases the risk of importing the virus via an infected traveler.

 

 

The ECDC has updated their earlier Risk Assessment (issued October 10th) today. While they acknowledge that dengue transmission is likely to continue at least through the end of the year, they do not recommend trade or travel restriction beyond the disinfestations currently being implemented. 

 

Update: risk assessment on dengue cases in Madeira

20 Nov 2012

The Autonomous Region of Madeira constituted the first known occurrence of locally transmitted dengue infection on the island on 3 October 2012 when the Public Health Authority of Portugal reported two cases of dengue infection in residents. These infections in patients residing in Madeira mark the first sustained transmission of dengue in the European Union since the 1920s.

 

Local transmission of dengue infection has been now established for several weeks on Madeira and as of 11 November 2012, the Portuguese Ministry of Health reported 1 357 cases of dengue infection from the public health sector in Madeira. 669 of these cases were laboratory confirmed, 688 probable cases. Since the beginning of the outbreak, 89 patients were hospitalised and five currently remain in hospital. So far, 25 patients have been diagnosed with dengue after returning from the island: cases were reported from mainland Portugal (nine), the UK (six), Germany (seven), Sweden (one) and France (two).

 

In the meantime, Portuguese and regional health authorities have been implementing control measures to limit extension of the outbreak to reduce the risk of sustained transmission locally and that of exportation of infected vectors from the island. In addition, ECDC provided technical assistance to the health authorities in Madeira in their efforts to control the outbreak by deploying an expert mission from 22 October until 16 November. Following this visit, ECDC updated its initial rapid risk assessment on the situation. The updated assessment reconfirms that the current epidemiological situation does not imply any trade or travel restriction beyond the disinfestations implemented on the island at present.

 

However, residents as well as tourists are strongly advised to take individual protective measures – like using repellents – to avoid mosquito bites. Dengue is transmitted by a daytime mosquito (Aedes aegypti) and thus protective measures should be applied throughout the whole day.

 

The latest data indicate that the outbreak is still on-going and its exact development cannot be anticipated at this point of time. With tourists visiting Madeira, continued import of dengue cases from the island to other EU countries is to be expected until the mosquito population is decreased and transmission interrupted.

 

Anyone who develops a fever or flu-like symptoms (with severe headache, retro-orbital pain, myalgia, arthralgia and maculo-papular rash) within two weeks of returning from a trip to Madeira should seek medical advice.

Read the full update of the ECDC rapid risk assessment

»» Read More

Thanksgiving Roll Call 2012

@FLA_MEDIC on Twitter

 

While a bit hard to believe, this makes my seventh Thanksgiving blogging at Avian Flu Diary.

 

In November of 2006 I began what has turned out to be a joyous tradition for me - taking the time to publicly acknowledge and thank those working in the public health arena to prevent, or mitigate, global health threats.

 

Each year I update this essay to include some new people, and to mention some of the friends I've met along the way on this remarkable journey through Flublogia.

 

While I pen AFD alone, this is by no means a solitary effort.  I rely (heavily) on the the advice, expertise, hard work, and generosity of dozens of others in Flublogia, without whom, this blog would not be possible.

 

This is my once-a-year chance to thank them. You’ll find earlier editions of this roll call at:

 

Thanksgiving Roll Call 2011

Thanksgiving Roll Call - 2010

Thanksgiving Roll Call 2009

Thanksgiving Roll Call - 2008

Thanksgiving Roll Call, Redux

AVIAN FLU THANKSGIVING ROLL CALL

Over the years this list has grown in length to the point where it is a bit unwieldy, and so this year I’m trimming it down a bit.

 

This is, in no way, a complete list.

 

But it’s a start.

 

You may know some of these people by name, and some by the organizations they represent, while others you may not be aware of at all. So, in no particular order, a tip of the hat and a world of thanks go to:

 

Kudos first to the career members of the HHS, CDC, and FDA who during the spring of 2009 were faced with an emerging pandemic during a time of political transition. The kind of work they do in the face of an outbreak was nicely dramatized last year in the movie Contagion (see  The `Contagion’ Conversation Continues).

 

There are countless people at the CDC, the NIH, the WHO, ECDC, FAO, and OIE who are working, mostly anonymously and often in less than optimal conditions, to promote better public health and hopefully to prevent the next pandemic.

 

And there are the researchers and scientists, too numerous to mention, but who’s work moves us closer to understanding infectious diseases. 

 

A woefully inadequate list of flu researchers would include:

 

Dr. Robert G. Webster at St. Jude’s Research Hospital, Greg Poland of the Mayo Clinic, John Oxford, Professor of Virology at St Bartholomew’s and the Royal London Hospital, Dr. Allison E. Aiello at the University of Michigan,  Professor Peter Doherty, and Richard Webby of St. Judes, Ab Osterhaus and  Ron Fouchier of Erasmus Medical Center in Rotterdam, and Chairul A. Nidom, at the Tropical Disease Centre at Airlangga University.

 

And there are universities and medical centers around the world; places like the University of Minnesota, St. Judes Research Hospital, UPMC Center For Biosecurity,The University of South Florida, Australian National University, and Baylor College of Medicine in Houston, which are major sponsors of influenza and emerging infectious disease research - along with others too numerous to mention.

 

Readers of this blog no doubt have noticed that I’ve referenced the work of CIDRAP  often over the years. The reason is simple: The reporting from CIDRAP News  is always first rate, with most of the heavy lifting done by Editor Robert Roos, and Lisa Schnirring.

 

Besides, Dr. Michael Osterholm, Director of CIDRAP, is arguably the best spokesperson on pandemic influenza in the country.  Before devoting his attentions to CIDRAP, Dr. Osterholm served for 24 years (1975-1999) in various roles at the Minnesota Department of Health (MDH), the last 15 as state epidemiologist and chief of the Acute Disease Epidemiology Section.

 

I consider myself fortunate indeed to have become friends with Lisa, Robert, Nick Kelley – CIDRAPs Preparedness Program Coordinator - and Dr. Osterholm.

 

All of them have been very supportive of me, and my blog, and I am very grateful.

 

CIDRAP, of course, is made up of more than just the handful of people I've mentioned. A more complete list is available here along with their mission statement.

 

This year I get to add a new friend, Dr. John Sinnott, MD FACP FIDSA and Director of the Florida Infectious Disease Institute, who has been extraordinarily kind to this blogger.

 

I’d be remiss if I didn’t mention another generous MD, Dr. Michael Greger, Director of Public Health and Animal Agriculture at the Humane Society of the United States, and author of Bird Flu: A Virus of Our Own Hatching. The entire text of which is available online, without charge (thank you Dr. Greger!).

 

Among members of the fourth estate, there are some truly remarkable science and health writers and reporters.

 

Helen Branswell, health reporter for the Canadian Press, has produced some of the finest reportage on the emergence of the H5N1 virus (and now H1N1) as exists anywhere in the world, and she started back when few had heard of the threat.

 

Her writing is clear, concise, and absent of the breathless prose that many lesser journalists rely upon.  Whenever I find a Branswell article, I know in advance it is going to be well worth reading.

 

Maggie Fox, who has recently moved over to NBC News from the National Journal (and before that, Reuters), is another standout in the world of health reporting.

 

Maggie has an advantage over many other news reporters in that she understands the science, having completed fellowships at the National Institutes of Health on Genomics, at Harvard Medical School on infectious disease, and at the University of Maryland on child and family health policy.

 

Declan Butler, senior reporter for Nature, and blogger, who very early on called the attention of the world to the pandemic threat, and who has used Google Earth to great effect mapping avian flu outbreaks around the world.

 

And for overall excellence in science writing I would also hasten to mention Carl Zimmer at The Loom and Ed Yong at Not Exactly Rocket Science, both hosted by Discover Magazine.

 

Other luminaries in the health & science field include Jason Gale of Bloomberg,  Patrick Thibodeau of ComputerWorld, Betsy McKay at the Wall Street Journal, Robert Bazell at NBC News and Dr. Richard Besser at ABC News. 

 

On the Internet we have a number of dedicated and astute bloggers, and they too deserve special mention.  Among them:

 

Crawford Kilian, author of Crofsblog, was one of the first to devote his blog to pandemic flu – but has branched out to cover many of the neglected diseases and disasters - like Dengue, Malaria, Chikungunya, and the Cholera epidemic in Haiti.

 

Writer and blogger Maryn McKenna lends considerable talent and expertise to Flublogia, particularly on the antimicrobial resistance front.

 

In 2010 her second book, SUPERBUG: The Fatal Menace of MRSA was published to sterling reviews (you can read my review here). Her Superbug Blog continues to be one the best resources on antibiotic resistance issues available online.

 

Maryn is also the author of Beating Back The Devil, the inside story of the CDC’s Epidemic Intelligence Service, and an upcoming book on MRSA.

 

Ian York, who now works at the CDC, also pens the  wonderful Mystery Rays blog (although his work schedule has severely limited his blogging). His eclectic meanderings through the world (and history) of infectious diseases are a delight for disease geeks and highly recommended.

 

In 2009, after several years of email correspondence, I finally got to meet the irrepressible (and now zombified!)  Scott McPherson. We were both part of the CIDRAP H1N1 summit in September 2009, and I got to spend two glorious days hanging out with him and Indigo Girl (of the AllNurses forum), forming what we called The Flu Amigos.

 

A fellow Floridian, Scott is the CIO of the Florida House of Representatives, and rubs elbows with State and Federal officials every day. 

 

His insights, often sprinkled with a dash of healthy whimsy, are always a pleasure to read.  I remain hopeful that Scott will resume blogging on a regular basis again in the future.

 

While not necessarily flu-centric, some other bloggers of note that I follow, and recommend include:

Vincent Racaniello’s always excellent Virology Blog, which devotes a good deal of time to influenza.   His TWiV and TWiP  podcasts are also highly recommended.

 

Assistant Professor of Epidemiology, Tara Smith’s blog Aetiology and Celeste Monforton and Liz Borkowski of The Pump Handle are highly recommended as well.

 

Jim Garrow’s The Face of the Matter explores emergency communications in an age of social media.

 

And for a variety of infectious disease news, there’s Giuseppe Michieli’s eclectic A Time’s Memory.

 

And for more variety, there’s David Dobbs of Neuron Culture and Nedra Weinreich at Spare Change.

 

And last, but hardly least, there’s Dr. Peter Sandman who, along with his wife and colleague  Dr. Jody Lanard, produce a wealth of invaluable risk management and pandemic communications advice on their Risk Communication Website.

 

Relatively new are the Twitter generated daily newspapers, like Cesar Sanchez’s Microbiology Daily, and All Hands’s Emergency Management Daily and Business Continuity Daily, Jim Garrow’s Public Health Daily, and Dave Walker’s Healthcare Daily.

 

In a special category I mention author, journalist, filmmaker, and friend Peter Christian Hall who’s pandemic novel American Fever (see It Gives You Fever ) was published in paperback this year.

 

After the release of the movie `Contagion’ -  Peter interviewed flu bloggers for The Huffington Post (see Contagion Grips ‘Flublogia').

 

And every day outside of the limelight dozens of hardworking flubies scour foreign language news reports, using search engines, text-finding software, and translating programs to bring us the latest tidbits of news from around the world.

 

While there are many who contribute, some of the names that pop up most often on the sites I visit include: Gert van der Hoek, Shiloh, Pathfinder, Emily, Sally, Giuseppe Michieli, Treyfish, Commonground,  Carol@SC, mojo, bgw in MT, Readymom, Sharon Sanders, Cottontop, dbg, Tetano, Diane Morin, Missouriwatcher, and Ronan Kelly.

 

There are many others, of course.  My sincere apologies to those I failed to name.

 

I’ve written numerous times about the work they do, but if you want to know how they do it, check out Newshounds: They Cover The Pandemic Front. The work they do is remarkable. And I couldn't do much of what I do without them.  Thank you all.

 

The owners and moderators of the flu forums deserve mention, too. 

 

Labors of love, and devourer's of both time and money, flu forums provide a place for laymen and professionals to gather to discuss the various aspects of pandemic planning, and quite often, the science behind influenza and epidemiology.

 

The founders and moderators do a terrific job keeping things on track, and do so without compensation.  Most of the time, the costs (which can run into the hundreds of dollars each month) are borne by the owners.

 

There are a number of flu forums out there, but the two where I hang my hat are the Flu Wiki and  Flutrackers. Each has their own style and personality, and in many cases, members of one forum belong to several other forums as well.

 

The Flu Wiki, the first of the dedicated flu forums, was founded by DemFromCt, Pogge, and Melanie Matson.  In 2008, we lost Melanie after a long illness.  She was a pioneer, and an activist, and is greatly missed.

You can read more about her, and her legacy, here.

FluTrackers, founded by Sharon Sanders (but run with the aid of dozens of tireless volunteer moderators), boasts nearly 2,000 members and prides themselves on maintaining an impressive library of scientific literature on pandemic influenza and other emerging infectious diseases.

 

Sharon is also a dear friend, fellow Floridian, confidant, and unindicted co-conspirator.  

 

There is also Francophones des FluTrackers, which is a French language section of Flutrackers, moderated by Muscade, Éditeur et Directeur.

 

And then there are the flubies, which number in the thousands. Some are active posters on the flu forums, while others take a more passive role.  Many have become activists in their communities.

 

Readymom, whom I've highlighted before in these pages, runs her own website Emergency Home Preparation.

 

Starting in mid-2007, more than a dozen volunteers worked to put together the GetPandemicReady.Org website.   There you will find more than 3 dozen easy-to-follow preparedness guides, written by some pretty familiar names from the Flu Forums.

 

Now is a good time to remind my readers that agencies like the Red Cross, Red Crescent, CARE, Save The Children, UNICEF, and others are working around the world every day to combat poverty and disease, including pandemic flu.

 

They could use your support.

 

These NGO’s do a great deal with very little, and even small donations can help make a difference.

 

Often forgotten, I also send out thanks to all who wear the uniform of our country, and who will are often called upon to be on the front lines during any crisis, including a pandemic.

 

This includes our military and national guard troops, both at home and abroad. You guys and gals do a tough, often thankless job, 365 days a year; and are deserving of both our respect and our nation's gratitude.

 

Please know, you have mine.

 

There are hundreds of thousands of doctors, nurses, technicians, EMT's, paramedics, firefighters, and law enforcement officers out there who put it on the line each and every day. I'm proud to have been able to be a part of that universe. And my thanks, and fervent best wishes go out to each of you.

 

And of course, thanks go to the readers of these forums and blogs. There are far more of you out there than you imagine.

 

Those that post on flu forums, or comment on blog sites are just the tip of the iceberg. Ninety percent of our visitors read and absorb the information here, and say nothing. We know you are out there because our web counter software logs every visit.

 

No, I’m not going to `out' anyone. Your secret is safe with me.

 

But even this humble blog gets visits every day from hundreds of corporations, government agencies, financial institutions, and even medical research facilities. Names that you would readily recognize. And that is both extremely gratifying and humbling at the same time.

 

It has been an amazing journey, these past seven years blogging on influenza and emerging infectious diseases.  I've been fortunate enough to meet scores of people, either in person, or via email or chat, from around the world due to this blog.

 

I've collected more than a few good friends along the way. To all of those who have written me, thank you.  And keep them coming.   I appreciate each and every email.

 

Even the ones with suggestions as to what I should do with my blog.

And lastly, a special thank you (in no particular order) to just some of the people in the flu community and my life who have gone out of their way to extend kindness, friendship, and counsel to this old medic. 

 

To Sharon & Lance, Camille, Scott and Crof, Maryn, Maggie and Helen, MTO & Lisa & Nick & Robert at CIDRAP, Chacal & Family, Dr. John Sinnott, Dr. Jody Lanard, Peter C. Hall, Anne, Phytosleuth, Eric Starbuck, Rolf, Dr. Michael Greger, Cheryl, Cliff, Jim in Thailand, Anne, Seazar, Paul, Joel, AnnieRn, Caroldn,and Bonnie  (and many more I've no doubt  left out) a special holiday thanks to you and your families.  

 

You guys, whether you know it or not, help light the path for me every day.

 

And to everyone else, a safe, happy, and healthy Holiday.

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Dengue Update: Puerto Rico, Florida & The Americas

 

# 6702

 

While not reaching the levels we saw during their 2010 Dengue epidemic, Puerto Rico is once again seeing epidemic levels of the mosquito-borne virus, as evidenced by this latest chart from the CDC.  

 

As indicated by the red line, the number of cases over the past couple of weeks has been climbing like a homesick angel. 

 

Health Secretary Lorenzo Gonzalez of the Puerto Rico Health Department declared a Dengue epidemic on the island (PDF Link – in Spanish) in early October after six people died or the disease, two of them children.

 

This week, Florida also reported its third locally acquired Dengue case (see Another Central Florida dengue case confirmed) of 2012. This latest case was identified in Osceola County, and a fourth suspected case is being investigated.

 

While once a serious problem in Florida, through aggressive mosquito control efforts during the 1940s Dengue and Malaria were both eliminated from the Sunshine State – and remained so for nearly a half century.

 

In 2009 – for the first time in more than 50 years – we started to see a small number of locally acquired Dengue cases showing up in Key West (see MMWR: Dengue Fever In Key West), and in 2010 they totaled 65 cases in Key West and 1 each in Broward and Miami-Dade County.

 

The number of cases dropped in 2011, and have been low once again in 2012.

 

The concern is - with millions of visitors arriving each year, many from regions where these diseases are endemic – there are plenty of opportunities to re-introduce the virus.

 

The CDC’s MMWR in a report in May of 2010 on Locally Acquired Dengue in Key West, had this to say:

 

Cases of dengue in returning U.S. travelers have increased steadily during the past 20 years (8). Dengue is now the leading cause of acute febrile illness in U.S. travelers returning from the Caribbean, South America, and Asia (9).

 

Many of these travelers are still viremic upon return to the United States and potentially capable of introducing dengue virus into a community with competent mosquito vectors.

 

In truth, it may take many such introductions of Dengue or Malaria to an area before the right combination of weather, insect vectors, and ongoing transmission occur to enable it to get a foothold in a community.

 

But Florida’s latest Arbovirus Surveillance report lists more than 90 cases of Imported Dengue this year:

 

Ninety-four cases of dengue with onset in 2012 have been reported in individuals with travel history to a dengue endemic country in the two weeks prior to onset. Countries of origin were Brazil, Colombia, Cuba (21), Dominican Republic (9), Ecuador (4), El Salvador (2), Ghana, Guyana (2), Haiti (14), Honduras, India, Jamaica (17), Mexico (2), Nicaragua, Panama, Philippines, Puerto Rico (6), South Africa, Sri Lanka, St. Vincent, Suriname, Trinidad (4), and Turks & Caicos.

Counties reporting cases were Brevard (3), Broward (17), Collier, Duval (2), Hillsborough (4), Lee (2), Marion, Miami-Dade (36), Orange (12), Palm Beach (6), Pinellas (2), Polk, Sarasota (2), Seminole (3), and Volusia (2). Nine of the cases were reported in non-Florida residents.

 

The state has also reported more than 50 cases of Imported Malaria, although no locally acquired cases have been reported.

 

Fifty-three imported cases of malaria with onset in 2012 have been reported.  Countries of origin were: Afghanistan (2), Cameroon, Central African Republic, Colombia, Costa Rica, Ethiopia, Ghana (5), Guyana (2), Haiti (9), Honduras (3), India, Ivory Coast (3), Kenya, Liberia (2), Nigeria (8), Pakistan, Peru, Sierra Leone (2), South Africa, Sub Saharan Africa, Sudan, Togo, Uganda, Zambia, and multiple African countries (2).

Counties reporting cases were: Alachua, Brevard, Broward (8), Charlotte, Duval (6), Hillsborough (6), Lake (2), Leon, Manatee, Marion, Martin, Miami-Dade (7), Orange (5), Osceola (2), Palm Beach (4), Pinellas (3), Polk, Seminole, and Volusia. Five of the cases were reported in non-Florida residents.

 

A broader perspective comes from PAHO, who's Oct 31st update shows nearly 1 million cases of Dengue in the Americas this year.

 

An interactive map view of Dengue activity in the Americas, and around the world, can be seen via the CDC-Healthmap collaborative DengueMap.

 

 

Although the overall risk of contracting a mosquito-borne illness in Florida or Puerto Rico remains very small, reports of Dengue (along with West Nile, EEE, SLEV, and other rare arboviral threats) are reason enough that health departments continue to urge people to remember to follow the `5 D’s’:

 

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WHO: Yellow Fever Outbreak In Sudan

 

Source Lancet Infect Dis. 2011;11:622-32 via CDC

 

# 6681

 

For three weeks the newshounds on FluTrackers (among others) have been keeping track of a disease outbreak  in Sudan that has claimed several dozen lives.

 

Today, the World Health Organization’s regional office for the Eastern Mediterranean has posted the following notice (h/t Ronan Kelley on FluTrackers), indicating they’ve been notified of a yellow fever outbreak in that country.

 

Yellow fever hits Central and South Darfur

29 October 2012 – Sudan’s Federal Ministry of Health has notified the World Health Organization (WHO) of a yellow fever outbreak in seven localities in Central and South Darfur. Since the first week of October, a total of 84 suspected cases, including 32 deaths, have been reported from the districts of Azoom, Kass, Mershing, Nertiti, Nyala, Wadi Salih and Zalingei.

 

The Federal Ministry of Health has said that the immediate priority is to control the vector, reinforce the disease surveillance system and raise public awareness of prevention and control of this disease. Preparations for a mass vaccination campaign are underway to vaccinate the at-risk population in Darfur.

 

Yellow fever is spread by mosquitoes. There is no specific treatment for yellow fever, only supportive care to treat dehydration and fever, and blood transfusion, if and when needed. It is a preventable disease with symptoms and severity varying from case to case. Protective measures such as the use of bednets, insect repellent and long clothing are considered the best methods to contain an outbreak.

 

Vaccination is the single most important measure for preventing yellow fever.

 

The Federal Ministry of Health, WHO and other health partners are working on the ground to ensure timely containment of the outbreak.

 

Yellow fever (aka Yellow Jack) is a viral disease transmitted by the Aedes mosquito (and others). There is a relatively safe, and effective, vaccine available and travelers to parts of equatorial Africa and South America are often advised to get it.

 

The CDC’s 2012 Yellow Book describes the clinical presentation this way:

 

Asymptomatic or clinically inapparent infection is believed to occur in most people infected with YFV. For people who develop symptomatic illness, the incubation period is typically 3–6 days.

 

The initial illness presents as a nonspecific influenzalike syndrome with sudden onset of fever, chills, headache, backache, myalgias, prostration, nausea, and vomiting. Most patients improve after the initial presentation.

 

After a brief remission of hours to a day, approximately 15% of patients progress to a more serious or toxic form of the disease characterized by jaundice, hemorrhagic symptoms, and eventually shock and multisystem organ failure. The case-fatality ratio for severe cases with hepatorenal dysfunction is 20%–50%.

 

In the 18th and 19th century Yellow fever caused major epidemics in Europe and in the United States, up the Atlantic seaboard and as far north as New England (Boston was hard hit in 1780, and Philadelphia saw several thousand deaths in 1793).

 

Yellow Fever has been cited as one of the primary reasons why the French abandoned their attempt to build a Panama canal in the late 1800’s, as the combined burden of Yellow Fever and Malaria reportedly claimed the lives of more than 20,000 construction workers.

 

 

For more on the fascinating history of `Yellow Jack’, I would point you to Ian York’s excellent Mystery Rays blog, where he gives us some terrific background in:

 

Yellow fever, stasis, and diversification

The deadliest, most awe-inspiring of the plagues

The good old days

 

While currently not a threat in Europe and the United States, yellow fever is on the radar screens of some epidemiologists as climate change, and the spread of suitable vectors, continue.

 

This from Eurosurveillance in 2010, and it is an excellent overview of the issue.

 

Eurosurveillance, Volume 15, Issue 10, 11 March 2010

 

Yellow fever and dengue: a threat to Europe?

P Reiter

The introduction and rapidly expanding range of Aedes albopictus in Europe is an iconic example of the growing risk of the globalisation of vectors and vector-borne diseases.

The history of yellow fever and dengue in temperate regions confirms that transmission of both diseases could recur, particularly if Ae. aegypti, a more effective vector, were to be re-introduced.  The article is a broad overview of the natural history and epidemiology of both diseases in the context of these risks.

 

 

You can find more information on yellow fever at these websites:

 

http://www.cdc.gov/yellowfever/

http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/yellow-fever.htm

http://www.who.int/topics/yellow_fever/en/

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Central Florida Man Diagnosed With Dengue

# 6680

 

 

A Seminole county man, aged 19, has been diagnosed with what is believed to be locally acquired Dengue, according to a press release today from the Orange County Health Department.

 

HEALTH HEALTH ADVISORY – DEPARTMENTS  INVESTIGATING LOCALLY ACQUIRED DENGUE FEVER CASE

Tuesday, October 30, 2012 -

ORLANDO – The Seminole and Orange County Health Departments are investigating a locally acquired case of dengue fever near the Seminole and Orange County line by the University of Central Florida. The 19 year old Seminole County man was diagnosed with dengue fever based on symptoms and confirmed by laboratory tests. The individual is recovering from this illness.

 

Dengue fever is a viral disease transmitted by a type of mosquito common to the southeastern United States and the tropics. It is not spread from person to person. Mosquitoes usually bite at dusk and dawn, but the mosquitoes that carry dengue bite during the day as well – especially indoors, in shady areas, or when the weather is cloudy.

 

Though some people may experience little to no symptoms; the most commons symptoms of dengue include high fever (over 101 degrees Fahrenheit), severe headache, severe pain behind the eyes, muscle, joint and bone pain, rash, loss of appetite, nausea and vomiting. There is no specific medication or vaccine for dengue fever. If you are experiencing symptoms consistent with dengue fever, please call your healthcare provider to see if you need to be seen.

 

The health departments encourage all residents and visitors to help lower mosquito populations by taking appropriate measures to guard against these diseases by practicing Drain and Cover. 

This includes:

DRAIN standing water:
• Drain water from garbage cans, buckets, pool covers, coolers, toys, flowerpots or any other containers where sprinkler or rainwater has collected.
• Discard old tires, drums, bottles, cans, pots and pans, broken appliances and
other items that aren't being used.
• Empty and clean birdbaths and pets' water bowls at least once or twice a week.
• Protect boats and vehicles from rain with tarps that don't accumulate water.
• Maintain swimming pools in good condition and appropriately chlorinated. Empty plastic swimming pools when not in use.

 

The most recent Florida Arbovirus Surveillance Report (Oct 27th) only lists one other locally acquired case of Dengue in Florida in 2012 (see Miami Reports Locally Acquired Dengue Case).

 

This compared to 28 cases reported in 2009, and then 63 locally-acquired cases in Key West, one in Broward County, and one in Miami-Dade County for 2010.

 

The following year, 2011, saw a significant reduction in cases with just three locally acquired in Miami-Dade County, two in Palm Beach County, and one each in Martin and Hillsborough counties.

 

Although cooler weather has finally arrived in the Sunshine state, we’ve yet to see a freeze, and so mosquitoes are still active.  For this reason, the Florida DOH recommends.

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