Tuesday, August 22, 2017

PRO/EDR> Hemorrhagic disease - Nigeria (04): (KW) RFI [EXTERNAL]

HEMORRHAGIC DISEASE - NIGERIA (04): (KWARA) REQUEST FOR INFORMATION
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A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

A request for information (RFI) on the hemorrhagic disease outbreak
reported in Nigeria was sent to EpiCore surveillance project
volunteers. An initial synopsis of EpiCore responses was posted in
ProMED-mail. Hemorrhagic disease - Nigeria (02): (KW)
http://promedmail.org/post/20170813.5247854. Below is a recent update
of the responses received. Lassa virus appears to have been ruled out
as the etiologic agent even though a case was detected in Kwara
[ProMED-mail. Lassa fever - West Africa (32): Nigeria
http://promedmail.org/post/20170819.5262007].

ProMED-mail is grateful for the numerous Epicore and subscriber
responses to the request for information on the mysterious disease
with hemorrhagic manifestations that has affected mostly the Fulani
people, in the Ifelodun Local Government Area of Kwara State, Nigeria.
- Mod.LK

Responses in this update:
[1] Norovirus gastroenteritis as causative agent
[2] Investigation by government
[3] Yagba West LGA in neighboring Kogi State
[4] Deaths and symptoms
[5] Food poisoning

******
[1] Norovirus gastroenteritis as causative agent
Norovirus gastroenteritis disease has been diagnosed as the mostly
likely cause of the disputed mortalities in Kogi State Nigeria.
Norovirus is stated to be the commonest cause of serious of
gastroenteritis and also of foodborne disease outbreaks:
<http://naijagists.com/gastroenteritis-disease-outbreak-kills-62-kogi-state-nigeria-39-others-reportedly-ill/>.
It will need to be confirmed if the similar outbreak in adjoining
Kwara is also norovirus gastroenteritis disease, if it has a common
source, and why Fulani settlements are mostly affected.

--
communicated by:
Olutayo Olajide Babalobi
Lecturer and Consultant Epizootiologist
(One Health, Participatory Epizootiology and Veterinary ICT Research
Group)
Department of Veterinary Public Health and Preventive Medicine
Faculty of Veterinary Medicine
University of Ibadan
Ibadan, Nigeria
<tayobabalobi@gmail.com>

[Norovirus are single-stranded RNA viruses enclosed in a non-enveloped
protein coat, in the family Caliciviridae. Norovirus infections cause
diarrhea in some of those who are exposed and vomiting in others and
are asymptomatic in about one 3rd of [infected individuals]. After an
incubation period of 10 to 51 hours, the disease often begins with
vomiting, followed by abdominal cramps, fever (in 37 to 45 per cent of
cases), watery diarrhea, and other constitutional symptoms such as
headache, chills, and myalgias. The illness normally lasts only 2-3
days but can last longer (4-6 days) in nosocomial outbreaks and among
children under 11 years of age. Virus can be shed in low titers for up
to 8 weeks in previously healthy persons and for more than a year in
patients who are immunocompromised. Fatalities have been reported in
association with outbreaks of gastroenteritis among elderly people in
nursing home facilities and, in the United Kingdom, an estimated 80
deaths from norovirus infections occur each year among people over 64
years of age. Recent reports have suggested possible associations of
norovirus infection with necrotizing enterocolitis in newborns, with
benign seizures in infants, and with exacerbations of inflammatory
bowel disease in pediatric patients; further study is needed to
confirm these links.

[excerpted and edited from: RI Glass, UD Parashar, MK Estes. N Engl J
Med. 2009; 361:1776-178. DOI: 10.1056/NEJMra0804575]

Although not a common feature, haemorrhage has been noted in norovirus
infections in children
http://jmm.microbiologyresearch.org/content/journal/jmm/10.1099/jmm.0.000046
and
https://link.springer.com/content/pdf/10.1186%2Fs12887-016-0699-2.pdf;
and in immunocompromised people
http://www.nejm.org/doi/full/10.1056/NEJMra1207742. - Mods.SH/LK]

******
[2] Investigation by government
The Kogi State government on Saturday [August 2017] revealed that
those who died from a mysterious disease in the state were not victims
of Lassa fever. The state government also said it would investigate
and count the number of grave sites of those affected to determine the
actual number of people who died as a result of the mysterious disease
suspected to be gastroenteritis and malaria.
For details please visit
<https://www.today.ng/news/nigeria/6166/mysterious-deaths-caused-lassa-fever-kogi-govt>.

Whatever is finally resolved that the outbreak is, 2 related questions
need be addressed:
1. Why is the Fulani/Fulani settlement appear to be a risk factor?
2. Is outbreak notification more among the Fulani or are they more
susceptible?

--
communicated by:
Olutayo Olajide Babalobi
[details above]
<tayobabalobi@gmail.com>

******
[3] Yagba West LGA in neighboring Kogi State
I just read that a similar (if not the same) human disease incident is
occurring in the adjoining Yagba West LGA in neighboring Kogi State
(<https://en.wikipedia.org/wiki/Yagba_West>). It is also instructive
that the Fulani are worst hit. However, Lassa fever has been ruled out
after sample test
(<http://www.vanguardngr.com/2017/08/just-strange-disease-kills-50-people-kogi/>).

Extract:
A strange disease whose symptoms include diarrhea, bloodstained
vomiting and high fever has killed 50 people at Okunran, Okoloke and
Isanlu-Esa villages in Yagba West Local Government of Kogi State.
Initial reports had suspected Lassa fever, but medics told Dr Saka
Audu, commissioner for health, who visited the affected areas on
Thursday [August 2017], that it was a strange disease that was
unknown. "We initially suspected lassa Fever after getting some
misleading reports about people bleeding around, so we made a
diagnosis for viral haemorrhagic fever (lassa fever), but the result
was negative," Dr Jannette Hathorn, a consultant at ECWA Hospital,
Egbe told Audu.

She said the 1st case was that of a child of 2 1/2 years, who died 12
hours after he was brought to the hospital. "We are sure it is not
Lassa fever; but our concern is that we do not know exactly what is
happening. We have not arrived at a definitive diagnosis. "Two adult
patients were also brought here; one showed symptoms of ulcer-viral
illness, but there was no bleeding component of any haemorrhagic
symptom. "We isolated them and both of them were treated for malaria.
When they started improving, we let them go.

"Another parent brought a child to the hospital and pleaded for help.
He said that 50 people had died in their village with similar symptoms
of bloodstained vomiting, diarrhea and fever. "When the child died, we
called the World Health Organisation (WHO). Yesterday [Wed 16 Aug
2017], their officials came and took samples of everything; we must
know exactly what we are dealing with," she said.

Audu, who described the situation as "serious", said the visit was to
assess it "especially since many lives have been lost to the disease".
"We want to determine the cause of these mysterious deaths and then
proffer solution to it. "Government is committed to assisting the
people irrespective of how remote their settlements may be. We must
ensure that we take healthcare to the door steps of rural dwellers.
"We want to reassure the people that government is with them and will
take full responsibility of those who are already ill, so as to arrest
the spread of this disease. "For now, what is clear and confirmed is
that it is not lassa fever; but whatever it is, we will carry out
further investigation and come up with definitive diagnosis," Audu
said.

He said that the information about the outbreak of the strange disease
came to government last week [week of Sun 6 Aug 2017] and a technical
team was immediately sent to take samples which were sent to General
Hospital Irrua, Edo State, for definitive investigation. "We are
digging into the real cause of this ailment. All hands are on deck
toward unraveling the definitive cause of the mysterious deaths among
the kids," the commissioner assured.

According to him, the Fulani settlers have been reported to be the
worst hit by the disease which broke out 3 weeks ago. Ardo Damina
Ibrahim, leader of the Fulani settlement, told newsmen that the 1st
case was reported 3 weeks ago, adding that children were worst hit.
"We at first used herbs to treat the patients but had to rush to the
hospital after recording several deaths," he said. He explained that
parents became more confused when doctors could not ascertain the
cause of the illness, saying that many died in the hospital while
others were discharged without any cure. "We have lost more than 50
people and still have many helpless patients at home,'' he said.

Oba Joshua Ogunyanda, the traditional ruler of the community, who
thanked the commissioner for visiting the area in spite of the
difficult terrain, said that he ran to the Yagba Local Government when
the disease broke out. "We are confident that the disease will soon be
brought under control with the commitment that you have shown," he
said. The commissioner later gave N50 000 [USD 138] to the leader of
the Fulani community to transport the sick patients to Lokoja for
proper treatment
(<http://www.vanguardngr.com/2017/08/just-strange-disease-kills-50-people-kogi/>).

(Yagba West is a Local Government Area in Kogi State, Nigeria, in the
west of the state adjoining Kwara State. Its headquarters are in the
town of Odo Ere. <https://en.wikipedia.org/wiki/Yagba_West>)

--
communicated by:
Olutayo Olajide Babalobi
[details above]
<tayobabalobi@gmail.com>

******
[4] Deaths and symptoms
One respondent reported 2nd hand that the date of onset of the
outbreak was [Sun 23 July2017] and since then approximately 120 people
have died around the Oro-Ago area. The infected individuals
experienced intermittent headaches and severe stomach pain.
Approximately 1-1.5 hours after onset, they started vomiting blood.
Those who were unable to vomit blood died within 6 hours. But those
who vomited blood survived for about 3 days before dying.

--
communicated by:
Olutayo Olajide Babalobi
[details above]
<tayobabalobi@gmail.com>

******
[5] Food poisoning
The outbreak is likely to be poisoning due to a longstanding feud
between local crop farmers and settled pastoralist/itinerant nomadic
pastoralist. I learnt that the present Kwara State governor is from
the affected area and the government is overwhelmed by the armed
itinerant nomads who are taking over the place. That could explain why
government officials are denying what seems obvious -- a sporadic and
deliberate food poisoning targeted at the Fulani 'nuisance' likely by
the indigenous Yorubas that is becoming recurrent/endemic.

I am still expecting feedbacks from both Kwara State based Fulani
contact and also from Kwara state based resident veterinarians.

--
communicated by:
Olutayo Olajide Babalobi
[details above]
<tayobabalobi@gmail.com>

[The cause of this situation remains unclear. We thank Olutayo Olajide
Babalobi for providing such information as we have and hope for a
definitive explanation in due course. - Mod.SH

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/19690>.]

[See Also:
Lassa fever - West Africa (32): Nigeria
http://promedmail.org/post/20170819.5262007
Hemorrhagic disease - Nigeria (03): (KO) fatal, RFI
http://promedmail.org/post/20170819.5261349
Hemorrhagic disease - Nigeria (02): (KW)
http://promedmail.org/post/20170813.5247854
Hemorrhagic disease - Nigeria: RFI
http://promedmail.org/post/20170811.5244725]
.................................................lk/ec/sh
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are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
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or archived material.
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Posted on 8/22/2017 02:51:00 AM | Categories:

Monday, August 21, 2017

PRO/EDR> Malaria - South Sudan [EXTERNAL]

MALARIA - SOUTH SUDAN
*********************
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: Mon 21 Aug 2017
Source: Sudan Tribune [edited]
<http://www.sudantribune.com/spip.php?article63300>


An outbreak of malaria in South Sudan has killed over 4000 people
since February [2017], a senior health official disclosed last week
[week of Sun 13 Aug 2017]. "This year's malaria is the most severe the
country has ever seen," Dr Isaac Mapeer, the deputy head of the
Malaria Control Program at South Sudan's Ministry of Health, told
Anadolu Agency on [Thu 17 Aug 2017]. A total of over 900 000 malaria
cases had so far been registered, according to Mapeer. "Up to 4073
deaths were recorded since February [2017], while 2000 deaths were
reported in 2016", he stressed.

Malaria is a life-threatening mosquitoborne blood disease caused by a
plasmodium parasite, which is usually transmitted to humans through
the bite of the anopheles mosquito. Once an infected mosquito bites a
human, the parasites multiply in the host's liver before infecting and
destroying red blood cells.

According to the senior health official, the country's Epidemic Task
Force, headed by the Ministry of Health in partnership with United
Nations Office for the Coordination of Humanitarian Affairs (OCHA) and
other partners has also stepped up efforts to fight the disease.

The health official, however, decried the lack of funds to fight
malaria and appealed for donations to help fight the disease. In July
[2017], OCHA said more than 76 per cent of disease-related deaths in
South Sudan are from malaria.

--
communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[According to the WHO 2016 World Malaria Report
(<http://apps.who.int/iris/bitstream/10665/252038/1/9789241511711-eng.pdf?ua=1>),
malaria control in South Sudan was entirely dependent on foreign aid
donations and the report stated that 60 per cent of the population
sleeps under an impregnated bed net.

However, the civil war in the country probably means that malaria
control activities and probably drug distribution have been impaired,
which could be one explanation for the reported outbreak. - Mod.EP

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/8402>.]

[See Also:
2016
---
Malaria - South Sudan: (NB), RFI:
http://promedmail.org/post/20160107.3917625
2015
---
Malaria - South Sudan (02): (NB):
http://promedmail.org/post/20151018.3725039
Malaria - South Sudan: (WR)
http://promedmail.org/post/20150823.3596739
2014
---
Malaria - Sudan: (DW), expired and counterfeit medicines
http://promedmail.org/post/20141206.3015679
2012
---
Malaria - South Sudan: (NB)
http://promedmail.org/post/20121013.1341426
2011
---
Malaria - South Sudan: (Unity)
http://promedmail.org/post/20111002.2968
2010
---
2010 Malaria - Africa: counterfeit drugs
http://promedmail.org/post/20100209.0446
2008
---
Malaria - Africa: substandard & counterfeit drugs
http://promedmail.org/post/20080508.1566
2007
---
Malaria - Kenya: counterfeit artemisinin
http://promedmail.org/post/20070906.2939]
.................................................sb/ep/ec/sh
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information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
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Posted on 8/21/2017 02:01:00 PM | Categories:

PRO/EDR> Legionellosis - Spain: (VC) [EXTERNAL]

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

[1]
Date: Fri 18 Aug 2017 16:04
Source: Levante [in Spanish, trans.KS, edited]
<http://www.levante-emv.com/comunitat-valenciana/2017/08/18/salud-publica-eleva-siete-casos/1606017.html>


The Directorate General of Public Health of the Ministry of Universal
Healthcare and Public Health reports that it has been notified of a
new case of legionnaires' [disease], the 7th related to the outbreak
in the downtown area of Calicanto de Chiva, which has claimed the life
of one victim, as revealed by Levante-EMV and confirmed later by the
ministry. As has been reported by the regional administration, this
case is a 59 year old woman who displayed symptoms in July [2017] and
was admitted to the General Hospital of Valencia where, after
performing various tests (including for legionellosis, which was
initially negative), she was diagnosed with pneumonia. She received
antibiotic treatment and has now received a clean bill of health.

Yesterday [Thu 17 Aug 2017] the patient was seen for follow-up and,
since she worked in the risk zone, the legionellosis tests were
repeated and a positive result was confirmed today [Fri 18 Aug 2017].
The explanation given by the public health service is that
legionellosis can appear in urine up to 3 months after the infection
clears, confirming that the pneumonia that was treated in July [2017]
was caused by legionella [bacteria]. However, she has already been
discharged and her condition is good.

The Department of Public Health would like to emphasize that there is
not a new outbreak, since the woman displayed symptoms at the end of
July [2017] and has already been cured.

[byline: David Laguía]

--
communicated by
Kathryn Soderholm
<kathryn.soderholm@gmail.com>

******
[2]
Date: Wed 16 Aug 2017 07:30 EDT
Source: El Pais [in Spanish, trans.KS, edited]
<https://elpais.com/ccaa/2017/08/16/valencia/1502878254_552429.html>


An outbreak of legionellosis, with 6 cases identified but none of them
seriously ill, in the housing development of Calicanto de Chiva
(Valencia) has required the supply of drinking water to be cut off
until 8:00 am today [Thu 17 Aug 2017] to allow the cleaning of the
reservoir, the origin of the outbreak, sources within the Ministry of
Health have confirmed.

The Department of Health detected an outbreak in the housing
development of Calicanto de Chiva (Valencia) affecting 6 people, 2 of
whom remain hospitalized in the Hospital of Manises, although their
condition is not serious.

The origin of the outbreak, according to the 1st studies, could be in
the development's water supply, which is being cleaned and chlorinated
1st thing today [Wed 16 Aug 2017], says the Department of Health. Last
[Mon 14 Aug 2017] a meeting took place between members of the Chiva
City Council, public health technicians, and representatives of the
water management company, and it was decided to clean the reservoir
and the affected facilities.

First thing this morning [Wed 16 Aug 2017], the water management
company began emptying the tank, which is being chlorinated, and after
a few hours they will refill the tank and distribute the treated water
to the pipes over 12 hours so that it will disinfect the distribution
system. The sources calculate that at 8.00 am this [Thu 17 Aug 2017]
the disinfection process will be done and the residents of the
Calicanto development will have water again.

Public health recommended to the City of Chiva and the water
management firm, as well as residents, that internal networks be
sanitized, for example, in the case of electric and gas heaters, that
water tanks be left plugged in and the water be kept at a temperature
of at least 60 degrees Celsius [140 °F].

After any absence of more than 10 days, or at least once a year, the
water system has to be cleaned and disinfected. To do this, disinfect
the faucet [tap] diffusers and showers, descale them with conventional
anti-scale cleaner and immerse them in a bucket with dilute bleach for
30 minutes (simply add a coffee cup filled with commercial bleach to a
5 litre [1.32 gallon] bucket of water). It is also advisable to run
cold water and hot water through all faucets in the house
simultaneously for 5 minutes, and, in the case of faucet diffusers and
showers, replace those that are deteriorated.

[byline: Jordi Vicent]

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

[Calicanto de Chiva is a development in the city of Chiva; Chiva had a
population of 15 652 residents in 2014 and is 20 minutes west [by car]
of the coastal city of Valencia
(<https://es.wikipedia.org/wiki/Chiva>). A map of Chiva can be found
at <https://www.google.com/maps/place/46370+Chiva,+Valencia,+Spain>.

Detection of soluble legionella antigen in urine specimens is a rapid
method that can provide an early diagnosis of infection due to
_Legionella pneumophila_ serogroup 1, the commonest cause of
legionnaires' disease in most localities. The assay will not detect
organisms other than _Legionella pneumophila_ serogroup 1. Excretion
of legionella antigen in urine may vary among patients. Legionella
antigenuria can be detected as early as one day after onset of
symptoms and persists for days to weeks. Some individuals have been
shown to excrete antigen for extended periods of time (up to one year
after acute infection (1).

No information is given in the news reports above concerning
genotyping both the clinical and environmental legionella isolates,
which would help confirm transmission pathways.

1. Kohler RB, Winn WC, Wheat LJ. Onset and duration of urinary antigen
excretion in legionnaires disease, J Clin Microbiol. 1984; 20:605-7.
Available at: <http://jcm.asm.org/content/20/4/605.short>. - Mod.ML

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/62798>.]

[See Also:
2016
---
Legionellosis - Spain (04): (AR) ex Peru, hotel, RFI
http://promedmail.org/post/20161203.4673830
Legionellosis - Spain (03): (CM) outbreak 2015-16, report, fountain
susp http://promedmail.org/post/20161112.4624561
Legionellosis - Spain (02): (CT) fatal, hotel
http://promedmail.org/post/20161008.4545840
Legionellosis - Spain: (CM) large outbreak, fatal, update
http://promedmail.org/post/20160103.3907865
2015
---
Legionellosis - Spain (03): (CM) large outbreak, fatal
http://promedmail.org/post/20151224.3889986
Legionellosis - Spain (02): (CM)
http://promedmail.org/post/20151217.3869362
Legionellosis - Spain: (VC)
http://promedmail.org/post/20150316.3233796]
.................................................ml/ec/sh
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and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
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or archived material.
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Posted on 8/21/2017 01:57:00 PM | Categories:

PRO/AH/EDR> Crimean-Congo hem. fever - Pakistan (10): (PB) advice issued [EXTERNAL]

CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (10): (PUNJAB) ADVICE
ISSUED
***********************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1] Case from Rawalpindi Punjab
Date: Sun 20 Aug 2017
Source: The News [edited]
<https://www.thenews.com.pk/print/224669-Patient-tested-positive-at-HFH>


A patient undergoing treatment at one of the 3 teaching hospitals in
town, Holy Family Hospital, tested positive for Crimean-Congo
hemorrhagic fever (CCHF) on [Sat 19 Aug 2017]. The patient was taken
to the Holy Family Hospital on [Mon 14 Aug 2017] from Tehsil Hazro of
District Attock, some 80 kilometres [49.70 mi] from Rawalpindi.

The confirmation of the patient has strengthened doubts that the
population in the region may face a possible spike of CCHF ahead of
Eidul Azha [Islamic festival] when sacrificial animals are being
brought to the town in bulk.

However, it is important that this is not the 1st confirmed case of
CCHF this year [2017] at the HFH. Data reveal that this year, [2017],
a total of 22 suspected cases of CCHF were admitted to HFH, 5 of whom
tested positive for the disease while 17 were negative. Studies show
that the CCHF is caused by Nairovirus of the Bunyaviridae family
transmitted to humans by the bite of hyalomma tick found on the skin
of animals including goat and sheep or by direct contact with the
blood of an infected animal or human. The case fatality rate ranges
from 2 to 50 per cent. CCHF was 1st described in Crimea in 1944 and
identified in 1956 in Congo.

It is worth mentioning here that the disease was 1st reported in
Pakistan in 1976 but the numbers of cases have risen dramatically
since 2000, with 50 to 60 patients being reported annually. It is
important that the CCHF is endemic in Pakistan.

The patient is undergoing treatment at the HFH in isolation. He is
stable, said the head of the Department of Infectious Diseases at
Rawalpindi Medical University, assistant professor Dr Muhammad Mujeeb
Khan while talking to 'The News' on [Sat 19 Aug 2017]. To avoid CCHF,
he suggested that proper preventive measures should be taken while
handling animals. It is better to establish water ponds carrying DEET
or potassium permanganate and animals should be passed through it to
clear their skin, he said.

[byline: Muhammad Qasim]

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

******
[2] CCHF advisory notice
Date: Fri 18 Aug 2017
Source: Pakistan Today [edited]
<https://www.pakistantoday.com.pk/2017/08/18/nih-issues-advisory-on-congo-fever-for-eid-ul-azha/>


The National Institute of Health (NIH) issued an advisory notice on
[Fri 18 Aug 2017] on prevention and control of Crimean-Congo
hemorrhagic fever (CCHF) for upcoming Eid-ul-Azha.

According to NIH, the objective of this advice was to sensitize human
and animal health care authorities to further strengthen and improve
the level of preparedness in prevention and control of CCHF.

The notice, which was issued by the NIH Field Epidemiology and Disease
Surveillance Division, said that the CCHF is a widespread disease
caused by a tickborne virus (Nairovirus) of the Bunyaviridae family
with a case fatality rate of 10 to 40 per cent. It added that the
ticks, especially of the _Hyalomma_ genus, are both a reservoir and a
vector for the CCHF while numerous wild and domestic animals such as
cattle, buffaloes, goats and sheep are silent carriers of this virus,
and the adult ticks feed on these animals.

The notice said that although Balochistan remains the most affected
province, cases have been reported from almost all parts of the
country.

During 2016, out of 101 confirmed cases, 33 patients died. During
2017, till date, a total of 41 confirmed cases have been reported
including 16 from Balochistan, 15 from Punjab, 7 from Khyber
Pakhtunkhwa (KP) and 3 from FATA.

The advisory notice said that the virus is transmitted to the people
either through tick bites or through contact with the infected animal
blood or tissues during and immediately after slaughtering them.
Public health workers along with animal herders, veterinarians,
para-veterinary staff, livestock workers, animal merchants, butchers
and slaughterhouse workers are at risk of the disease. Apart from the
above mentioned, people close to or taking care of a suspected
patient, and individuals involved in burial practices are also at a
risk of getting infected, it added. There is currently no vaccine
available for humans and the only way to reduce infection is by
raising awareness.

The notice further added that public health advice should focus on
several aspects including wearing protective clothing -- such as long
sleeves and trousers. People should be advised to wear light coloured
clothes during a visit to the animal market to allow easy detection of
ticks, and to regularly examine clothing and skin for ticks and if
found, removing them safely and using approved repellents on clothing
and skin.

Similarly, citizens have been asked not to crush the ticks, wear
gloves and other protective clothing while handling animals or their
tissues, notably during slaughtering, butchering and culling
procedures in slaughterhouses or at home. They have also been asked to
avoid close physical contact with infected people, wearing gloves and
protective equipment when taking care of them. People are also asked
to wash hands frequently during caring or after visiting a patient.

The notice stated that insect repellents are the most effective in
warding off ticks in human populations.

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

[The National Institute of Health Pakistan has issued this CCHF
advisory notice in view of the upcoming Eid Ul Adha, when large
numbers of livestock and cattle are moved from rural areas to urban
markets for sale and subsequent slaughter.

More spatial repellent products are becoming commercially available.
These products, containing active ingredients such as metofluthrin and
allethrin, augment aerosol insecticide sprays, vaporizing mats, and
mosquito coils, which have been available for some time. Such products
can help to clear rooms or areas of mosquitoes (spray aerosols) or
repel mosquitoes from a circumscribed area (coils, spatial
repellents). Although many of these products appear to have repellent
or insecticidal activity under particular conditions, they have not
yet been adequately evaluated in peer-reviewed studies for their
efficacy in preventing vectorborne disease. Travelers should
supplement the use of these products with repellent on skin or
clothing and using bed nets in areas where vectorborne diseases are a
risk or biting arthropods are noted
[<https://wwwnc.cdc.gov/travel/yellowbook/2018/the-pre-travel-consultation/protection-against-mosquitoes-ticks-other-arthropods>].

CDC has evaluated information published in peer-reviewed scientific
literature and data available from EPA to identify several types of
EPA-registered products that provide repellent activity sufficient to
help people reduce the bites of disease-carrying mosquitoes. Products
containing the following active ingredients typically provide
reasonably long-lasting protection:

- DEET (chemical name: N,N-diethyl-m-toluamide or
N,N-diethyl-3-methyl-benzamide). Products containing DEET include, but
are not limited to, Off!, Cutter, Sawyer, and Ultrathon.
- Picaridin (KBR 3023 [Bayrepel] and icaridin outside the US;
chemical name: 2-(2-hydroxyethyl)-1-piperidinecarboxylic acid
1-methylpropyl ester). Products containing picaridin include, but are
not limited to, Cutter Advanced, Skin So Soft Bug Guard Plus, and
Autan (outside the US).
- Oil of lemon eucalyptus (OLE) or PMD (chemical name:
para-menthane-3,8-diol), the synthesized version of OLE. Products
containing OLE and PMD include, but are not limited to, Repel and Off
! Botanicals. This recommendation refers to EPA-registered products
containing the active ingredient OLE (or PMD). "Pure" oil of lemon
eucalyptus (essential oil not formulated as a repellent) is not
recommended; it has not undergone similar, validated testing for
safety and efficacy and is not registered with EPA as an insect
repellent.
- IR3535 (chemical name: 3-[N-butyl-N-acetyl]-aminopropionic acid,
ethyl ester). Products containing IR3535 include, but are not limited
to, Skin So Soft Bug Guard Plus Expedition and SkinSmart.
- 2-undecanone (chemical name: methyl nonyl ketone). The product
BioUD contains 2-undecanone.

Published data indicate that repellent efficacy and duration of
protection vary considerably among products and among mosquito and
tick species. Product efficacy and duration of protection are also
markedly affected by ambient temperature, level of activity, amount of
perspiration, exposure to water, abrasive removal, and other factors.
In general, higher concentrations of active ingredient provide longer
duration of protection, regardless of the active ingredient. Products
with less than 10 per cent active ingredient may offer only limited
protection, often 1-2 hours. Products that offer sustained-release or
controlled-release (microencapsulated) formulations, even with lower
active ingredient concentrations, may provide longer protection times.
Studies suggest that concentrations of DEET above approximately 50 per
cent do not offer a marked increase in protection time against
mosquitoes; DEET efficacy tends to plateau at a concentration of about
50 per cent. CDC recommends using products with at least 20 per cent
DEET on exposed skin to reduce biting by ticks that may spread
disease.
DEET-containing repellents prevent both mosquito and tick bites.
Health Canada recommends using a product containing no more than 10
per cent DEET for children up to 12 years of age. However, products
with a DEET concentration of 10 per cent or less should not be used
for exposures lasting longer than 1 h to 2 h because they may not be
effective in preventing tick bites. For children over 12 years of age
and adults, a repellent containing up to 30 per cent DEET can be used
as recommended on the product label. In the United States, 30 per cent
DEET is approved for children aged 2 months of age and older.
Reapplication of DEET is indicated only if the estimated protection
period has passed and a significant risk of arthropod bites remains.
Adverse events from DEET are rare. Contact dermatitis and eye
irritation are the commonest side effects. Toxic encephalopathy has
been reported, usually with prolonged or excessive use, or occasional
DEET ingestion
[<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4173961/pdf/pch-19-326.pdf>].

Permethrin, a synthetic pyrethroid , is highly effective both as an
insecticide and as a repellent. It is not licensed to be used as a
topical repellent but can be sprayed on clothing (mesh jackets, hats,
shoes) bed nets and camping gear to repel and kill ticks, mosquitoes
and other insects. - Mod.UBA

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/941>.]

[See Also:
Crimean-Congo hem. fever - Pakistan (09): (PB)
http://promedmail.org/post/20170806.5229643
Crimean-Congo
hem. fever - Pakistan (08): (PB)
http://promedmail.org/post/20170724.5200783
Crimean-Congo
hem. fever - Pakistan (07): Balochistan
http://promedmail.org/post/20170706.5154318
Crimean-Congo
hem. fever - Pakistan (06): Islamabad ex Khyber
Pakhtunkhwa http://promedmail.org/post/20170611.5094216
Undiagnosed illness - Pakistan (02): (NW) Crimean-Congo hem. fever
CCHF conf. http://promedmail.org/post/20170606.5087887
Crimean-Congo
hem. fever - Pakistan (05): (BA)
http://promedmail.org/post/20170508.5019548
Crimean-Congo
hem. fever - Pakistan (04): (BA)
http://promedmail.org/post/20170424.4989435
Crimean-Congo
hem. fever - Pakistan (03): (PB)
http://promedmail.org/post/20170420.4981151
Crimean-Congo
hem. fever - Pakistan (02): (PB)
http://promedmail.org/post/20170317.4906841
Crimean-Congo
hem. fever - Pakistan: (IS) susp, not
http://promedmail.org/post/20170316.4904498
2016
---
Crimean-Congo hem. fever - Pakistan (25): (SD) new case
http://promedmail.org/post/20161101.4598918
Crimean-Congo
hem. fever - Pakistan (24): (SD) new case, fatal
http://promedmail.org/post/20161017.4564439
Crimean-Congo
hem. fever - Pakistan (23): (SD) new case, fatal
http://promedmail.org/post/20161005.4536108
Crimean-Congo
hem. fever - Pakistan (22): (NW, PB) new cases
http://promedmail.org/post/20160927.4516191
Crimean-Congo
hem. fever - Pakistan (21): (PB) new case
http://promedmail.org/post/20160922.4508287
Crimean-Congo
hem. fever - Pakistan (20): (PB, BA) fatal
http://promedmail.org/post/20160919.4499623
Crimean-Congo
hem. fever - Pakistan (15): (BA)
http://promedmail.org/post/20160905.4465412
Crimean-Congo
hem. fever - Pakistan (10): cases, emergency measures
http://promedmail.org/post/20160825.4436463
Crimean-Congo
hem. fever - Pakistan (05): (PB)
http://promedmail.org/post/20160801.4383881
Crimean-Congo
hem. fever - Pakistan: (PB)
http://promedmail.org/post/20160319.4106315
2015
---
Crimean-Congo hem. fever - Pakistan (20): (PB)
http://promedmail.org/post/20151208.3849322
Crimean-Congo
hem. fever - Pakistan (10): (BA)
http://promedmail.org/post/20150918.3653698
Crimean-Congo
hem. fever - Pakistan (05): ex Afghanistan, Iran
http://promedmail.org/post/20150625.3465423
Crimean-Congo
hem. fever - Pakistan: (SD)
http://promedmail.org/post/20150115.3095371]
.................................................sb/uba/ec/sh
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
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Posted on 8/21/2017 01:49:00 PM | Categories:

PRO/AH/EDR> Salmonellosis, st Kiambu - USA (05): papaya, more serotypes [EXTERNAL]

SALMONELLOSIS, SEROTYPE KIAMBU - USA (05): PAPAYA, MORE SEROTYPES
*****************************************************************
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: Fri 18 Aug 2017 9:45 AM ET
Source: CDC, _Salmonella_ Homepage, 2017 Outbreaks [edited][edited]
<https://www.cdc.gov/salmonella/kiambu-07-17/index.html>


Multistate outbreak of salmonella infections linked to imported
Maradol papayas
---------------------------------------------------------------
Since the last update on 11 Aug 2017, 34 more ill people were added to
this investigation from 11 states.

As of [16 Aug 2017], 173 people infected with the outbreak strains of
_Salmonella_ Kiambu (51), _S._ Thompson (111), _S._ Agona (7), or _S._
Gaminara (4) have been reported from 21 states. A list of the states
and the number of cases in each is shown:

States / Case count
Connecticut / 6
Delaware / 4
Iowa / 2
Illinois / 3
Kentucky / 4
Louisiana / 1
Maryland / 8
Massachusetts / 8
Michigan / 1
Minnesota / 4
Missouri / 1
North Carolina / 5
New Jersey / 36
New York / 50
Ohio / 1
Oklahoma / 4
Pennsylvania / 8
Tennessee / 1
Texas / 9
Virginia / 16
Wisconsin / 1
Total / 173

New Jersey and New York together account for 50 per cent of the cases
and the epicurve can be seen at
<https://www.cdc.gov/salmonella/kiambu-07-17/epi.html>.

Illnesses started on dates ranging from [17 May 2017] to [31 Jul
2017]. Ill people range in age from less than 1 year to 95, with a
median age of 38. Some information is not available for all of the ill
people. Among 169 ill people, 101 (60 per cent) are female. Among 135
people, 91 (67 per cent) are of Hispanic ethnicity. Among 136 people,
58 (43 per cent) have been hospitalized. One death was reported from
New York City.

Illnesses that occurred after [18 Jul 2017], might not be reported yet
due to the time it takes between when a person becomes ill and when
the illness is reported. This takes an average of 2 to 4 weeks.

Investigation update
--------------------
As was reported in the update on [4 Aug 2017], FDA tested other
papayas imported from Mexico and isolated several types of salmonella
bacteria, including _S._ Agona, _S._ Kiambu, _S._ Gaminara, _S._
Thompson, and _S._ Senftenberg. Investigators compared pulsed-field
gel electrophoresis and whole genome sequencing results of salmonella
isolates from the papayas to isolates from ill people in the CDC
PulseNet database. CDC has now identified 11 people infected with the
same strains of either _S._ Agona (7) or _S._Gaminara (4). These 11
illnesses have been added to the case count for this outbreak. Among 5
for whom information was available, all 5 (100 per cent) reported
eating or possibly eating papayas in the week before becoming ill.

This investigation is ongoing. Updates will be provided when more
information is available.

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

[The epicurve clearly shows the change in serotype cases over time;
the 1st 5 weeks of the cluster of salmonellosis were almost all
serotype Kiambu with sporadic cases after that, the next 3 weeks were
almost all related to serotype Thompson, and since 18 Jul 2017, a
majority of the cases have been serotype Agona. The cases of serotype
Gaminara and most of the cases of serotype Agona have likely occurred
after the curve's dates. It is not surprising that cases of Agona and
Gaminara are now being reported as they had already been isolated from
papayas that were recalled. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/106>.]

[See Also:
Salmonellosis - USA (08): (WI) shelled peas, farmers' markets, alert
http://promedmail.org/post/20170814.5248978
Salmonellosis - USA (07): (NE) restaurant susp
http://promedmail.org/post/20170804.5227893
Salmonellosis, st Kiambu - USA (04): papayas, 2nd serotype
http://promedmail.org/post/20170814.5248901
Salmonellosis, st Kiambu - USA (03): papayas, 2nd serotype, more
recalls http://promedmail.org/post/20170809.5238781
Salmonellosis, st Kiambu - USA (02): papayas, 2nd serotype, recall
http://promedmail.org/post/20170807.5233115
Salmonellosis, st Kiambu - USA: papayas
http://promedmail.org/post/20170722.5197237
Salmonellosis - USA (06): (MD) papayas
http://promedmail.org/post/20170721.5195333
Salmonellosis, st Typhimurium - USA (02): laboratory-acquired
http://promedmail.org/post/20170720.5191390
Salmonellosis - USA (05): live poultry, multiple serotypes
http://promedmail.org/post/20170717.5182934
Salmonellosis, st. Enteritidis - USA (02): (MI) raw eggs
http://promedmail.org/post/20170709.5160072
Salmonellosis, st anatum - USA: imported hot peppers, 2016
http://promedmail.org/post/20170629.5140485
Salmonellosis - USA (04): live poultry, multiple serotypes
http://promedmail.org/post/20170602.5078031
Salmonellosis - USA (03): (MT) live poultry
http://promedmail.org/post/20170512.5031181
Salmonellosis - USA (02): (MO) restaurant link
http://promedmail.org/post/20170425.4993475
Salmonellosis - USA: (MO) http://promedmail.org/post/20170419.4981114
Salmonellosis, st Enteritidis - USA: restaurant chain, truffle oil,
2015 http://promedmail.org/post/20170317.4906263
Salmonellosis, st Typhimurium - USA: (OR) hazelnuts
http://promedmail.org/post/20170107.4749026
2016
---
Salmonellosis, st Heidelberg - USA: multidrug resistance, cattle
contact http://promedmail.org/post/20161130.4663570
Salmonellosis, st Enteritidis - USA (02): (AL) wedding, chicken
http://promedmail.org/post/20161123.4647935
Salmonellosis - USA (16): (HI) seaweed, expanded recall
http://promedmail.org/post/20161118.4638175
Salmonellosis - USA (15): (HI) seaweed
http://promedmail.org/post/20161108.4615103
Salmonellosis - USA (14): (IL) chili cook-off, alert
http://promedmail.org/post/20161105.4608828
Salmonellosis, st Javiana - USA: (AZ) susp. frozen shrimp
http://promedmail.org/post/20161019.4570858
Salmonellosis, serotype Oranienburg - USA: shell eggs
http://promedmail.org/post/20161004.4535919
Salmonellosis, st Saintpaul - USA: (UT) raw milk
http://promedmail.org/post/20160902.4461209
Salmonellosis - USA (13): (MD) detention center
http://promedmail.org/post/20160827.4445805
Salmonellosis, st Reading, st Abony - USA: sprouts, alert, recall
http://promedmail.org/post/20160808.4401541
Salmonellosis - USA (12): (WA) pork, st I 4,[5, 12:i:-
http://promedmail.org/post/20160726.4371010
Salmonellosis - USA (11): (AK)
http://promedmail.org/post/20160726.4370897
Salmonellosis, otter - USA: (WI) zoo
http://promedmail.org/post/20160712.4340423
Salmonellosis - USA (10): (TX) restaurant
http://promedmail.org/post/20160615.4288680
Salmonellosis, multiple serotypes - USA (02): live poultry
http://promedmail.org/post/20160605.4266428
Salmonellosis, multiple serotypes - USA: pet turtles
http://promedmail.org/post/20160520.4230368
Salmonellosis, st. Enteritidis - USA: (MN, VA) packaged kale salad,
alert, recall http://promedmail.org/post/20160517.4226922
Salmonellosis - USA (09): (MI) live poultry, multiple serotypes
http://promedmail.org/post/20160505.4203696
Salmonellosis - USA (08): FDA, contaminated raw retail meat & poultry,
resistance http://promedmail.org/post/20160501.4195399]
.................................................sb/ll/mj/sh
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************************
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************************************************************
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Posted on 8/21/2017 10:03:00 AM | Categories:

PRO/AH/EDR> Hepatitis E - UK (03): gt 3, European sausage [EXTERNAL]

HEPATITIS E - UK (03): GENOTYPE 3, EUROPEAN SAUSAGE
***************************************************
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: Sun 20 Aug 2017 13:39 BST
Source: International Business Times [edited]
<http://www.ibtimes.co.uk/leading-uk-supermarket-may-have-infected-thousands-people-pig-virus-1635815>


Thousands of British pork lovers may already be infected by a strain
of hepatitis transmitted by some products which are imported and being
sold at a leading UK supermarket, according to fresh analysis compiled
by scientists from Public Health England (PHE). Experts traced the
shopping habits of 60 infected people to a form of own-brand sausages
from a retailer known only as "supermarket X". The British government
has declined to name the specific shop, but multiple sources
reportedly told The Sunday Times that it was Tesco.

The strain, hepatitis E, is typically found in pork products imported
into the UK from Europe. According to the PHE website, signs of the
disease in humans vary from no symptoms to liver failure. In rare
cases, it can prove fatal, particularly in pregnant women. This week
(20 Aug 2017), the Sunday Times reported that research completed back
in 2016 was withheld from publication until now over alleged
"sensitivity".

Scientists believe that imported pork products infect 150 000-200 000
British citizens a year. The paper said: "The implicated products are
pork sausages, which require cooking prior to consumption, and
ready-to-eat pre-packed sliced ham." It noted that "Only supermarket
X, especially own brand, was significantly associated with [the
virus]."

Tesco has not commented on the findings, but told The Sunday Times
that it had already started a conversation with the Food Standards
Agency (FSA) about how to minimize the spread of such viruses. "The
association with the supermarket does not infer any blame," PHE said.

One scientist, professor Richard Tedder of the government's National
Infection Service agency, agreed. "Something appears to have changed
in animal husbandry so too many pigs are infected at slaughter. This
is a problem for meat producers and all retailers, not just one."

Person to person transmission of the virus is very rare, however it
has been known to pass on via blood transfusions, PHE has said. The
numbers of confirmed hepatitis E cases and infections increased
significantly between 2010 and 2016, it warned. According to a report
on PigWorld [<http://tinyurl.com/yd4fd34r>], a spokesperson from the
National Pig Association (NPA) acknowledged the sudden spike in cases
but said that "further research and surveillance" was required to
"determine the true cause of the rise in hepatitis E cases in the UK."
The statement continued: "NPA recommends that consumers follow the
advice from the Food Standards Agency that pork and sausages should be
cooked thoroughly until steaming hot throughout, with no pink or red
in the center, to greatly reduce the risk of infection."

[byline: Jason Murdock]

--
communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[The publication cited is:
Said B, Usdin M, Warburton F, et al. Pork products associated with
human infection caused by an emerging phylotype of hepatitis E virus
in England and Wales. Epidemiol Infect. 2017; 145(12): 2417-23. doi:
10.1017/S0950268817001388. Epub 2017 Jul 31;
<https://www.ncbi.nlm.nih.gov/pubmed/28756783>
--------------------------------------------------------------------
Abstract
--------
"Since 2010, human hepatitis E infections have increased in England
and Wales. Most cases are locally acquired and caused by hepatitis E
virus genotype 3 (HEV G3). HEV G3 is linked to the consumption of pork
products. The increase is associated with the emergence of a new
phylotype, HEV G3-group 2 (G3-2, also known as G3abcdhij). 60
individuals with confirmed hepatitis E infection and no history of
travel outside the UK were recruited: 19 were infected with HEV
G3-group 1 (G3-1 or G3efg) and 41 with G3-2. Epidemiological data
relating to usual shopping habits and consumption of ham and sausages
were analysed together with typing data to identify any associations
with HEV phylotype. Study participants who purchased ham and/or
sausage from a major supermarket were more likely to have HEV G3-2
infection (relative risks 1.85, P = 0·06, CI 0·97-3·53). The HEV
G3-2 phylotype has not been detected in indigenous UK pigs and it is
suggested that human infections could be the result of consumption of
products made from pork originating outside the UK. This does not
infer blame on the supermarket but the epidemiology of HEV is dynamic
and reflects complex animal husbandry practices which need to be
explored further."

This report underscores the importance of zoonotic hepatitis E
(primarily genotype 3) as the cause of hepatitis E emergence in
Europe. There are currently 7 genotypes of HEV and genotypes 1 and 2
are not zoonotic and cause most of the HEV infections in Africa and
Asia. It is these genotypes that cause increased morbidity and
mortality in pregnant women. Most of the zoonotic hepatitis E cases
have been recognized in the developed world, are associated with
foodborne disease (usually undercooked pork products) and are caused
by genotype 3. In addition, infection with genotype 3 when occurring
in immunocompromised hosts (especially solid organ transplant
recipients) can cause chronic infection which can progress to
cirrhosis. Ribavirin has been used to treat such individuals with
chronic infection.

The author's summary of their work states "Study participants who
purchased ham and/or sausage from a major supermarket were more likely
to have HEV G3-2 infection (Relative risks 1.85, P = 0·06, CI
0·97-3·53)" although the posting above quotes the paper (?in the
full text which is not available to this moderator) as "Only
supermarket X, especially own brand, was significantly associated with
[the virus]." The statistics noted in the summary gives a relative
risk of 1.85 which supports an increased risk of almost 2 times but
the p value of 0.06 and a confidence interval overlapping 1.0 both do
not reach statistical significance so "more likely" is better than
"significantly associated". Be that as it may, there is no doubt that
acquisition of zoonotic HEV in Europe is clearly linked to ingestion
of undercooked pork products that was carrying the virus. Adequate
cooking and appropriate kitchen practices to avoid cross-contamination
will minimize, if not erase totally, this risk. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/40>.]

[See Also:
Hepatitis E - Europe (02): 2005-2015
http://promedmail.org/post/20170629.5140079
Hepatitis E - UK (02): EU pork products, commentary
http://promedmail.org/post/20170523.5057366
Hepatitis E - UK: EU pork products
http://promedmail.org/post/20170522.5055004
Hepatitis E - France (03): rabbit source
http://promedmail.org/post/20170517.5042542
Hepatitis E - Australia: 1st postransfusion case, zoonotic
http://promedmail.org/post/20170426.4996999
Hepatitis E - Europe: blood donation screening
http://promedmail.org/post/20170423.4983952
Hepatitis E - France (02): comment
http://promedmail.org/post/20170116.4769936
Hepatitis E - France: platelet transfusion-related
http://promedmail.org/post/20170115.4763642
2016
---
Hepatitis E - Germany: gt 3, asymptomatic, 2011
http://promedmail.org/post/20160904.4461204
Hepatitis E - Europe: zoonotic
http://promedmail.org/post/20160828.4445881
2015
---
Hepatitis E - Japan: 1st chronic cases
http://promedmail.org/post/20151027.3747156
Hepatitis E - France: 2013, raw pork stuffing
http://promedmail.org/post/20151021.3733016
Hepatitis E - UK: undercooked imported pork sausage, 2014
http://promedmail.org/post/20150908.3631747
Hepatitis E, pet rabbit - Italy
http://promedmail.org/post/20150517.3367922
Hepatitis E - Spain: HIV infected individuals
http://promedmail.org/post/20150314.3230174
2014
---
Hepatitis E - UK: undercooked pork sausage
http://promedmail.org/post/20141111.2946919
Hepatitis E - France: (VR) raw pork liver sausage
http://promedmail.org/post/20141010.2850748
Hepatitis E - Australia: (NSW), undercooked pork liver
http://promedmail.org/post/20140914.2773538
Hepatitis E - Germany: genotype 3, transfusion related
http://promedmail.org/post/20140529.2506353
2013
---
Hepatitis E - UK: pork sausages, alert
http://promedmail.org/post/20130915.1946331
Guillain-Barre
syndrome - Portugal: hepatitis E virus, genotype 3
http://promedmail.org/post/20130824.1898358
Hepatitis E - Netherlands: blood donors
http://promedmail.org/post/20130801.1858965]
.................................................sb/ll/mj/sh
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Posted on 8/21/2017 09:59:00 AM | Categories:

PRO/AH> African swine fever - Europe (20): update, international impact [EXTERNAL]

AFRICAN SWINE FEVER - EUROPE (20): UPDATE, INTERNATIONAL IMPACT
***************************************************************
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: Fri 18 Aug 2017
Source: The Pirbright Institute, UK, News [edited]
<https://www.pirbright.ac.uk/news/2017/08/african-swine-fever-advance-through-europe>


The continued advance of African swine fever (ASF) through eastern
European countries has triggered concern amongst pig farmers and
governing bodies. DEFRA [UK Department for Environment, Food, and
Rural Affairs] has upgraded the threat to the UK from 'very low' to
'low' -- meaning the risk is "rare but could occur" (EFSA [European
Food Safety Authority] terminology). This severe disease of pigs
entered Europe through Georgia in 2007, and has since continued to the
Russian Federation and eastern Europe, including EU countries in the
Baltic States, Poland and very recently the Czech Republic, in wild
boar. In early August 2017, an outbreak was confirmed for the 1st time
in Romania among backyard pigs.

African swine fever is caused by infection with ASF virus (ASFV),
which can have fatality rates of up to 100 per cent. The virus causes
acute disease in domestic pigs and wild boar, and may cause varying
clinical signs that are similar to other pig diseases such as high
fever, lethargy and loss of appetite. Pigs may also die suddenly
without clinical signs.

Although the virus does not cause disease in humans, the impact it has
on the economy, especially through trade and farming, is substantial.
As a consequence of ASF in Poland and the Baltic States the value of
pork and pig exports was reduced by USD 960 million (2014-2015). In
Denmark, the predicted impact of an ASF outbreak is estimated at USD
12 million in direct losses and USD 349 million in exports.

Unless the appropriate control measures are put in place, additional
outbreaks could occur across Europe, further into Russia and beyond to
Asia. An outbreak in the UK is unlikely as imports of meat and pigs
are extremely well regulated and the UK does not have a wild boar
population substantial enough or widespread enough to maintain an
outbreak. However, personal imports of pork products from affected
areas could result in disease incursion if deliberately or accidently
fed to pigs or wild boar, actions which are illegal.

The seriousness of an outbreak for some countries could be far worse
than others; China is home to over half the world's pig population and
an outbreak of ASF could result in devastating consequences. In a
Veterinary Record article [see reference below] world-expert on ASF Dr
Linda Dixon leader of the ASF group at The Pirbright Institute,
outlines the factors that increase the likelihood of ASF spreading to
China and highlights areas that could be improved to reduce the risk
of an outbreak including biosecurity.

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

[Subscribers may refer to more data in the article above, addressing
the following questions:
- how does ASF spread?
- how quickly does it spread?
- how can the spread of ASFV be prevented?
- what is The Pirbright Institute doing to help?

The last item includes the following statement: "The vaccine research
is crucial for the prevention and control of ASF, and good progress
has so far been made. An effective vaccine will enable better control
and prevention measures to be put in place in the future, helping stem
the losses currently being suffered by farmers around the world."

The editorial "Preparing for the worst: African swine fever in China",
by Linda K Dixon, was recently published in the Veterinary Record [
Vet Rec. 2017; 181: 115-6, doi: 10.1136/vr.j3525.
<http://veterinaryrecord.bmj.com/content/vetrec/181/5/115.full.pdf>].

The European Commission's working document SANTE-2017-10272 (36 pages)
of 31 Jan 2017, titled "Blueprint and roadmap on the possible
development of a vaccine for African swine fever prepared by the
African Swine Fever EU reference laboratory on Commission request" is
available at
<https://ec.europa.eu/food/sites/food/files/safety/docs/cff_animal_vet-progs_asf_blue-print-road-map.pdf>.
- Mod.AS

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/6010>.]

[See Also:
African swine fever - Europe (19): Ukraine (DP), domestic swine, OIE
http://promedmail.org/post/20170819.5261628
African swine fever - Europe (18): Czech Republic (ZK) wild boar,
spread, control http://promedmail.org/post/20170819.5260788
African swine fever - Europe (17): Romania (SM) domestic, 1st rep, OIE
http://promedmail.org/post/20170801.5218650
African swine fever - Europe (16): Czech Republic (ZK) wild boar,
Hungary, alert http://promedmail.org/post/20170726.5207022
2016
---
African swine fever - Europe (11): Russia, control, economic impact
http://promedmail.org/post/20160830.4451464
2014
---
African swine fever - Europe (05): Latvia, Lithuania, Poland, wild
boar control http://promedmail.org/post/20140321.2345369
African swine fever - Europe (02): (EU) prevention, control,
epidemiology http://promedmail.org/post/20140215.2280473
African swine fever - Europe: Lithuania, Russia, wild boar control,
OIE http://promedmail.org/post/20140211.2271563
African swine fever - Lithuania (04): (AS, VI) wild boar, int'l
implications, control http://promedmail.org/post/20140127.2236069
2012
---
African swine fever - Ukraine (05): international trade
http://promedmail.org/post/20120827.1265882
African swine fever - Ukraine (04): Europe, threat, FAO
http://promedmail.org/post/20120822.1257502]
.................................................arn/mj/sh
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ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************************
Donate to ProMED-mail. Details available at:
<http://www.isid.org/donate/>
************************************************************
Visit ProMED-mail's web site at <http://www.promedmail.org>.
Send all items for posting to: promed@promedmail.org (NOT to
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Posted on 8/21/2017 09:54:00 AM | Categories: