A measles outbreak last year in Indiana in which 34 people became ill was spread by a 17-year-old U.S. girl who visited Romania without being vaccinated. The U.S. Centers for Disease Control and Prevention detailed the cause of the outbreak -- the largest in the United States since 1996 -- in an annual report on measles. CDC said there were 66 confirmed cases of measles in the United States in 2005, with no deaths. The 37 cases of measles in 2004 were the fewest ever recorded in the United States. The highly infectious, sometimes fatal viral illness has largely been eliminated in the United States by vaccination. The reason why this outbreak in Indiana didn't become larger was in large part because the surrounding community was highly immunized. Fifty of the 66 people who contracted measles in the United States in 2005 were unvaccinated. Seventeen were infected while traveling abroad. A smaller outbreak was traced to a 6-year-old visitor from Nigeria who was hospitalized in Ohio, and another limited outbreak occurred among people who had returned to Texas after a family reunion in Mexico. Before the measles vaccine was introduced in the 1960s, there were about 450 000 measles cases and an average of 450 measles deaths annually in the United States. [ProMed]

An epidemic of highly infectious gastroenteritis, which is due mainly to norovirus infection, is spreading rapidly across the country. On Fri 15 Dec 2006, 4 elderly patients died after being hospitalized earlier this month for suspected gastroenteritis. The average number of patients suffering from the disease across all districts stood at a record 1983 late in November 2006. Although the spread of norovirus infection is mainly thought of as being caused by food poisoning, especially through foods such as raw oysters, there are many cases of people becoming infected from the vomit of others suffering from the disease. In one case earlier this month, 347 guests and workers at a hotel close to Tokyo, came down with the disease. It is believed others became infected after vomit from one of the guests was not properly cleaned up. The vomit was apparently wiped up with paper towels and a neutral detergent. However, the infectivity of noroviruses is not destroyed by neutral detergent, and treatment with chloride bleach is advised. In addition, norovirus can still be spread for up to about 10 days after it has dried up, and only a tiny amount of the virus is required to make someone ill. Schools and facilities for the elderly are particularly prone to outbreaks of the infection, with norovirus typically spreading through contact with door knobs and handrails touched by an infected person. This year's outbreak of infectious gastroenteritis caused mainly by norovirus infection was the worst in the past 25 years. [ProMed]

Ebola virus may have killed more than 5000 gorillas in West Africa - enough to send them into extinction if people continue to hunt them. Ebola hemorrhagic fever is one of the most virulent virus diseases ever seen, killing between 50 percent and 90 percent of victims. The World Health Organization says that it killed 1200 people infected between its discovery in 1976 and 2004. The virus is transmitted by direct contact with blood, organs or other bodily fluids. There is no cure or good treatment, although several groups are working on vaccines. Several experts have noted that chimpanzees and gorillas are also killed by the virus, and suspect that people may have caught it from infected apes - perhaps when hunting them. In 2001 and 2002, several outbreaks of Ebola had begun killing people along the Gabon-Congo border. By October 2002, the researchers had found 32 dead gorillas, and of the 12 they tested for Ebola, 9 were positive. Eventually the researchers counted 221 dead gorillas. Based on what they and other experts knew, they extrapolated what the total impact must be to come up with the estimate of 5500 gorillas killed by Ebola in that area. [ProMed]

According to the Jamaican Health Ministry, there are now 13 confirmed malaria cases which are all confined to the Kingston area. Five children are among the 13 persons diagnosed with the insect-borne disease. The Ministry says the children have been hospitalised, but none is considered to be critical. Several persons suspected to have contracted the disease are also in health facilities. The Health Ministry says that all health centres will be on the alert and that it has the matter under control. Several breeding sites of the anopheles mosquito which transmits malaria have been identified in some areas and have been destroyed. The Ministry is also recommending that all mass gatherings in the affected areas be suspended. Jamaica is considered historically free of malaria. To evaluate the recent cases, it should be known which strain of malaria the patients have been infected with, and in addition their history, i.e. recent travel or migration. A recent outbreak in the Bahamas consisted of cases by asymptomatic immigrants from a malaria-endemic country, and this could also be the situation in Jamaica. [ProMed]

Nearly 1/4th of the buffalo have died at the state-owned Maxwell Wildlife Refuge (Canada), home to one of the oldest surviving wild buffalo herds. The animals are infected with Mycoplasma bovis, a bacterium that causes pneumonia, mastitis and arthritis in cattle. It was 1st detected in some U.S. cattle in the 1960s. For buffalo, it is especially virulent. The bacteria are spread by sneeze droplets or nose-to-nose contact. Maxwell Wildlife Refuge, in northwest McPherson County, is home to the state's largest buffalo herd, which until a few weeks ago had 200 animals. Since the disease struck, 47 have died and another 3 may have the disease. More than 25 million buffalo roamed the prairies in the United States 2 centuries ago. By the 1890s, their ranks had been reduced to less than a thousand. Until about 40 years ago, buffalo were near extinction, and the 2800-acre refuge was one of the few places in the nation to help nurture the species. [ProMed]

More than 700 people aboard a trans-Atlantic cruise have fallen ill with flu-like symptoms. The outbreak, thought to be caused by a norovirus, struck people aboard the Carnival Cruise Lines' Liberty. The ship left Rome on Fri 3 Nov 2006 with about 2800 paying passengers and more than 1150 crew members. The boat was due in Ft. Lauderdale on Sun 19 Nov 2006. Within 24 hours of sailing a lot of people got sick. Noroviruses affect 23 million Americans annually, according to the CDC. A dozen incidents of the illness have been reported on cruise ships so far in 2006. Noroviruses are enteric viruses present in the stool or vomit of infected people, and cause severe diarrhea, nausea and vomiting. The virus can be spread through the air. Most people recover with no lasting side effects. Severe dehydration can be a problem, especially for the very young, the very old and people with weakened immune systems. Prevention of transmission is best achieved by thorough hand-washing, and rubbing hands for at least 24 seconds with soap and warm water. [ProMed]

8 more staff members at Children's Hospital Boston have tested positive for whooping cough, bringing to 33 the number of workers infected as of 7 Nov 2006. The outbreak at Children's Hospital is the largest in recent memory at a Boston healthcare facility. With the latest confirmatory lab results, the Children's outbreak has now eclipsed a cluster of cases in September 2006 at St. Vincent Hospital in Worcester, where 30 staff members were diagnosed with the highly infectious bacterial disease, also known as pertussis. According to the state Department of Public Health, 15 to 35 healthcare workers state wide come down with the disease during a typical year. Disease investigators have said they believe whooping cough was carried into Children's Hospital by a 19-month-old patient. They continue to investigate whether a 3-year-old girl who has the illness contracted it at the hospital or before she arrived there. So far, no hospital workers or patients have faced life-threatening complications as a result of the outbreak. Workers with symptoms are sent home for 5 days and told to take antibiotics before they can return to their jobs. [ProMed]

Between 1 Jan and 16 Sep 2006, there were 446 cases of viral meningitis in the region of Madrid, an increase of 260 compared with the same period in 2005. The cumulative incidence detected for the period was 7 cases per 100 000 inhabitants. Three quarters of the cases were in children under 15 years of age. The age group with the highest incidence is 1-4 years (55 cases per 100 000), in children younger than 1 year (53 cases per 100 000) and in children aged 5-9 years (46 cases per 100 000). Eleven per cent of cases were linked to other cases, particularly through household and school contact. Enterovirus has so far been confirmed by serological or polymerase chain reaction in samples from 49 patients (11%). Strains identified were mainly echovirus 30 (62%) and echovirus 6 (19%). The increase of cases has also been observed in other regions of Spain. Many different viruses can cause aseptic meningitis, but enteroviruses are responsible for more than 80 percent of cases in which the cause is identified. Enteroviruses are typically transmitted through the faecal-oral or oral-oral routes and through respiratory droplets. Good hygiene is recommended: frequent and thorough hand washing, disinfection of contaminated surfaces with household cleaners (such as diluted bleach solution), and avoidance of sharing utensils and drinking containers [ProMed]

A fungal disease that threatens to wipe out many amphibians is thriving because of climate change: researchers studying amphibians at a national park in Spain show that rising temperatures are closely linked to outbreaks of the chytrid fungus. Chytrid fungus is a major contributor to the decline of amphibian populations around the world, threatening many species with extinction. It is a global emerging amphibian pathogen which is one of the worst vertebrate infectious diseases found so far. More than 100 species of amphibians are known to be affected by the chytrid fungus (Batrachochytrium dendrobatidis). Some are very susceptible and die quickly while others which are more resistant are carriers of the pathogen. The disease is already credited with wiping out frogs and toads in large numbers in Australia and South America. The chytrid fungus infects the skins of amphibians such as frogs, toads, salamanders and newts and interferes with their ability to absorb water. Warming temperatures could be reducing the amphibians' ability to mount a successful immune response to the fungus. Amphibians are cold-blooded so their ability to respond to the pathogen could change along with the external temperature. On the other hand, global warming could be increasing the fungus' ability to grow faster on the amphibian and cause more disease. [ProMed]

2006's lethal outbreak of E. coli in fresh spinach from the Salinas Valley was caused by a particularly malevolent breed of the bacteria that had previously sickened 109 Americans in 31 states. Scientists have been tracking outbreaks of E. coli O157:H7 since it appeared in undercooked hamburger in 1982. Within this dangerous microbial family, however, scientists have since recorded the genetic fingerprints of 20 000 subtypes. All of the victims in the spinach outbreak this summer were sickened by a single subtype labeled EXHX01.0124. It may be the most dangerous strain of O157:H7 yet detected. Half of those made ill by the bacteria were hospitalized, kidney failure rates in children were more than triple the norm, and 3 people have died. It is unlikely that scientists will ever discover how the 0124 strain arrived in the Salinas Valley, but the record shows in retrospect that it had been silently spreading throughout the country for at least 8 years. The 0124 subtype accounts for less than 1 percent of the strains reported each year, but it has been increasingly prevalent. There are 73 000 cases of E. coli O157:H7 food poisoning each year. Typically, E. coli O157:H7 causes severe cramping and bloody diarrhea, and about 10 percent of children who get it develop a life-threatening kidney damage called hemolytic uremic syndrome. [ProMed]

For the 1st time since 1959, there's a human case of rabies in Indiana. A 10-year-old in Marshall County was bitten by a bat in June 2006 and just recently started showing symptoms that led to encephalitis. The child is now in the hospital and doctors hope they have caught this case in time. The health department says that anyone who has been bitten by a bat or other wild animal should go to the doctor and report it to the health department. It is not clear from the report whether this patient received post-exposure immunisation at an early enough stage to abort rabies virus infection, or whether the child's doctors are relying on the treatment protocol which led to the recovery of a 15-year-old girl who developed symptoms of rabies following a bat bite in Fond du-Lac Wisconsin in 2004. The recent development of symptoms of encephalitis in the patient after a delay of more than 3 months is not a welcome development. Only 5 people in the world besides the Fond du Lac girl are known to have survived rabies virus infection after the onset of symptoms, but they had received standard treatment, a series of rabies vaccine shots, or vaccine ahead of time. [ProMed]

Six people who spent a night clubbing near Birmingham (UK) in late 2004 have contracted bovine tuberculosis. One man has been identified as the source of the outbreak, and one woman who was infected has died. This is the 1st time in decades that human-to-human transmission of bovine tuberculosis has been documented in the United Kingdom and coincides with a steady increase in the rate of infection in cattle. Nearly one per cent of the British herd is now thought to carry the disease. In the 1930s, around 40 per cent of cattle in the UK were infected with tuberculosis, and around 2000 people a year died from the disease, mostly as a result of drinking unpasteurized milk or coming into close contact with the animals. Pasteurization and the introduction of routine tuberculosis testing in cattle brought this under control but, in recent years, bovine TB has been on the rise. Although called bovine tuberculosis, the bacillus has a broad host range, including cattle, pigs, goats, cats, dogs, badgers, foxes, marsupials, rabbits, sheep, horses, and deer. [ProMed]

In response to a 4th case of botulism being linked to a carrot juice, the FDA is warning consumers not to drink 450 ml and 1 liter plastic bottles of this special producer. Consumers should discard this product. FDA is also reiterating its advice to consumers to keep carrot juice -- including pasteurized carrot juice -- refrigerated. To date, one link between the illness and the consumers appears to be that the juice they drank was not properly refrigerated once it was in the home, which allowed the Clostridium botulinum spores to grow and produce toxin. C. botulinum is a bacterium commonly found in soil. Under certain conditions these bacteria can produce a toxin that if ingested can result in botulism, a disease that may cause paralysis or death. Symptoms of botulism can include: double-vision, droopy eyelids, altered voice, trouble with speaking or swallowing, and paralysis on both sides of the body that progresses from the neck down, possibly followed by difficulty in breathing. Adequate refrigeration is one of the keys to food safety and is essential to preventing bacterial growth. Refrigerator temperatures should be no higher than 40 degrees F and freezer temperatures no higher then 0 degrees F. Consumers should check the temperatures occasionally with an appliance thermometer. Consumers should look for the words "Keep Refrigerated" on juice labels so they know which products must be kept refrigerated. [ProMed]

As of Sunday 24 Sep 2006, 173 persons infected with the outbreak strain of E. coli O157:H7 have been reported to CDC from 25 states. The outbreak is thought to originate from contaminated spinach. Among the ill persons, 92 (53 percent) were hospitalized, 28 (16 percent) developed a type of kidney failure called hemolytic uremic syndrome (HUS), and one adult died. The peak time when illnesses began was 30 Aug to 1 Sep 2006 -- 35 percent of persons with the outbreak strain became ill on one of those 3 days. Utah Public Health Laboratory (UPHL) has isolated E. coli O157 from an opened package of spinach. The package came from the refrigerator of a patient who ate some of the spinach before becoming ill. UPHL completed DNA tests yesterday and determined that the DNA 'fingerprint' matches that of the outbreak strain. This is the 2nd laboratory in the country to confirm the presence of the E. coli outbreak strain in spinach. Currently, health officials are advising consumers to not eat any fresh spinach or salad blends containing spinach grown in the 3 counties in California implicated in the current E. coli O157:H7 outbreak: Monterey County, San Benito County, and Santa Clara County. Frozen and canned spinach can be safely eaten. E. coli O157:H7 in spinach can be killed by cooking at 72°C for 15 seconds. [ProMed]

Hundreds of garden birds are falling victim to a disease that is spreading across Britain. Wildlife veterinary experts were alerted to the problem after householders reported a number of mystery deaths in their gardens. Experts identified the cause as a protozoan parasite that causes the disease trichomoniasis, which leaves birds so lethargic that they find it difficult to fly. Death can occur within 3 weeks of infection. House sparrows, chaffinches and goldfinches are affected, and there have been outbreaks of the disease in Scotland, Wales, south-western England and the Midlands. Vets said there was no link to avian flu, and the parasite posed no risk to human health. It is thought that the sharing of feeders and baths leads to the spread of infection between the garden birds. The RSPB has emphasised the importance of good hygiene, saying birdbaths and feeders should be regularly washed and moved around the garden to prevent infection. One factor may be the unusually hot weather in Britain this year, which may have helped diseases to spread. [ProMed]

In June and in August there have been in Sweden 4 outbreaks of norovirus gastroenteritis where raspberries were the suspected vehicle of infection. All the outbreaks occurred in the south western part of the country. In total, 43 people became ill and all these people had eaten raspberries as part of various different dishes. All of the suspected raspberries in these outbreaks were the same brand, and from the same distributor in Sweden who imported these from China. By end of August 2 batches of raspberries were withdrawn from the market. Outbreaks of gastroenteritis caused by norovirus from frozen imported raspberries have been reported from several European countries in recent years. Soft fruits, raspberries in particular, are a frequent source of gastroenteritis since such produce is harvested by hand, frozen for distribution with minimal pre-cleaning, and with minimal preparation before consumption. The rapidity of onset of illness in the Swedish outbreaks suggests gross contamination of the fruit. [ProMed]

Utah health officials say Salinas Valley lettuce may be responsible for an E. coli outbreak in their state in June 2006 that sickened 73 people, including 3 who developed kidney failure. The iceberg lettuce was served in salads from a Wendy's restaurant in North Ogden, Utah, which catered a teachers' conference at a junior high school. At least 2 women, one who ate salad at the conference and one who didn't attend the conference but ate a hamburger with lettuce from the same restaurant, experienced serious complications. One of the women is now on a kidney transplant list. The other was on dialysis for several weeks and nearly had to have her large intestine removed. Just where between field and fork the lettuce was contaminated is unknown. In the past decade more than 400 people nationwide have been sickened in leafy-produce-related E. coli outbreaks, including 2 people who died. Investigations into these outbreaks, often done weeks and months after they occur, rarely reveal how or when the lettuce is tainted. The outbreak involved E. coli O121:H19, a rare form of the bacteria that normally live in the intestines of humans and animals. Most E. coli outbreaks connected to leafy greens in the past decade have involved the 0157:H7 strain. [ProMed]

Pigs can play an important role in the genetic reassortment of influenza viruses and a reservoir for another lineage of influenza viruses that have the ability to reassort and be transmitted between species. On March and April 2006, novel H3N1 influenza A viruses were isolated from pigs with respiratory diseases at two different commercial swine farms in Korea. Genetic and phylogenetic analyses of the sequences of all eight viral RNA segments showed that the novel H3N1 swine influenza viruses were reassortants that acquired the hemagglutinin gene from an H3 human-like virus, and other genes from swine influenza viruses that are currently circulating in Korea. Serologic and virologic tests in the infected farms suggested that pig-to-pig and farm-to-farm transmissions occurred. Clinical signs in pigs and experimentally infected mice suggest the potential to transmit the virus between swine and other mammalian hosts. Further surveillance will be needed to determine whether this novel subtype will continue to circulate in the Korean swine population. [.Shin JY et al. J Clin Microbiol. 2006 Aug 23, Epub ahead of print]

A cluster of 5 cases (4 children and an adult) of Vero cytotoxin-producing _E. coli_ O157 (VTEC O157) with links to home paddling pools was identified in Greater Manchester in June 2006. An investigation revealed that the initial source of exposure may have been that the index case (one of the children) had been playing in a local brook and had fallen in during the 10 days prior to the onset of symptoms. The common epidemiological link for the remaining children was that they had all shared home paddling pools with the index case while the index case was still symptomatic with diarrhea. The adult case was the parent of one of the affected children. Three of the children were admitted to hospital with hemolytic uraemic syndrome (HUS) but all appear to have made a good recovery. Isolates from all cases were confirmed as being phage type (PT) 21/28 with genes for Vero cytotoxin 2. This is the most common VTEC O157 type in the UK. Comparison of the isolates from the 4 children using pulsed field gel electrophoresis showed that 3 had indistinguishable profiles and one had a profile clearly related to this. Levels of chlorination in domestic water supplies are typically not sufficient to disinfect a home paddling pool. [ProMed]

An outbreak of anthrax that began in early July 2006, the largest ever recorded in Saskatchewan, has now killed at least 746 farm animals in that province and neighbouring Manitoba. The outbreak, which has led to at least 146 farms being quarantined, is the largest on the prairies since record-keeping began in the 1950s. In Manitoba, 118 animals have died on 17 farms. Canadian public health officials emphasize that the risk of anthrax infection to people is extremely low. More than 250 000 animals have been privately vaccinated and 18 000 vaccinated by the Canadian government. Among affected animals are cattle, horses, bison, sheep, and goats. Anthrax cannot pass between people. However, in mid-July 2006, cutaneous, or skin, anthrax, developed in a Canadian farmer, presumably via contact with an infected animal. Cutaneous anthrax is much less serious than inhalational anthrax. The farmer has since fully recovered. Meanwhile, across Manitoba's southern border, northwestern Minnesota has seen the state's worst anthrax outbreak since 1919. Since mid-June 2006, 23 farms in 4 counties have experienced anthrax infection, resulting in 68 cattle, bison, and horse fatalities. In 1919, 42 farms were affected. [ProMed]

In recent weeks, 3 people in south east Sweden were reported to have developed mild to severe wound infections caused by non-agglutinating (not O1 or O139) and non-toxin-producing Vibrio cholerae bacteria after outdoor water contact (Baltic Sea and possibly an irrigating pond). All 3 people had skin breakages, and 2 had other underlying diseases. Environmental water samples from various sources have been analyzed, and several samples from Baltic Sea coastal waters and from 4 lakes have tested positive for non-agglutinating and non-toxin-producing V. cholerae. The weather has been hot and sunny in Sweden during Jul 2006, and unusually high surface water temperatures of over 20 degrees C recorded. There are 200 serotypes of the bacterium V. cholerae, of which O1 and O139 are toxin-producing and cause classical cholera with profuse, watery diarrhea (sometimes exceeding 20 litres per day). Variants of the bacteria that are non-agglutinating and non-toxin-producing may rarely cause wound infections, mild diarrhea, and external otitis in people with skin breakages who bathe outdoors in warm, brackish water. The optimal growth conditions for these bacteria include a salinity of 0.4-1.7 percent and a water temperature exceeding 20 degrees C. The last case of imported classical cholera to Sweden was notified in 2004. [ProMed]

The incidence of viral meningitis has increased dramatically in the Madrid region in 2006. Since January it has afflicted 411 people, almost 3 times more than the total for the same period in 2005. Eighty per cent of the patients are under 15 years of age, and 2 have died. The disease generally takes a benign form and cyclical epidemic outbreaks occur every 5-6 years. There is neither a vaccine nor specific treatment. The last large outbreak occurred in 2000 and affected 994 people. A report of the Regional Department of Health reveals that the current outbreak is exhibiting great virulence, with an average of 25 cases per week. The term meningitis embraces a wide range of viral and bacterial infectious agents which affect the membranes that cover the brain. The most serious form, against which there is a vaccine, is meningitis C, caused by a bacterium which can kill 15-25 per cent of patients. More benign forms of meningitis are associated with viral infection. Viral meningitis can be caused by more than 20 different viruses. This outbreak is thought to be caused by enteroviruses, which usually produce mild forms of the disease. The symptoms of all the meningitis cases include fever, headache, and neck stiffness. Even in a mild case of viral meningitis physicians recommend a brief hospital stay, to allow exclusion of the more serious meningitis B or C by laboratory diagnosis. If the meningitis is confirmed as viral, the patient is sent home with symptomatic treatment against the fever and the pains. Very rarely the disease lasts more than 10 or 15 days. [ProMed]

A scottish meat processing plant which has suffered an outbreak of rare Q-fever is bracing itself for more cases after some 25 workers have been taken ill, 11 of whom have been diagnosed with the disease. While 4 men received treatment in hospital for the flu-like illness, many more of the plant's 250 workers are awaiting the results of blood tests. The area where the infection happened is undergoing now deep disinfection. Q fever can result in chronic infection if not treated swiftly with antibiotics. The disease is caused by the organism Coxiella burnetii, which lives in farm animals such as sheep, cattle and goats as well as wild animals and ticks. Airborne infection is possible for those who work in close contact with farm animals. Other modes of transmission to humans, including tick bites and human-to-human transmission, are rare. The incubation period for Q fever varies depending on the number of organisms that initially infect the patient. Infection with greater numbers of organisms will result in shorter incubation periods. Most patients become ill within 2-3 weeks after exposure. Those who recover fully from infection may possess lifelong immunity against re-infection. The organisms are resistant to heat, drying and many common disinfectants. These features enable the bacteria to survive for long periods in the environment. [ProMed]

Chefs failing to read the labelling on boxes of Korean oysters have been blamed for hundreds of cases of food poisoning at a rugby test match at Auckland's Eden Park last month. About 352 people developed norovirus-associated gastroenteritis resulting in nausea, vomiting, diarrhoea, stomach cramps, fever and chills, from eating the oysters, a report released by Auckland Regional Public Health Service said. The report said the caterers ran out of New Zealand-reared oysters and served the imported ones. Although labelling on the packaging indicated the oysters should be cooked, this was not done. The New Zealand Food Safety Authority said oyster imports from Korea have been put on hold until the authority was satisfied they were safe. The report also revealed that subsequent to the Eden Park outbreak there were 2 further foodborne illness incidents implicating imported Korean oysters. The report said that the 2 cases involved steaks where the steak was stuffed or garnished with lightly cooked oysters. These outbreaks suggest that even with a cooking process, the risk of infection may still be significant. [ProMed]

For the first time Koi herpesvirus (KHV) was detected in a common carp, Cyprinus carpio, collected from a fish kill during May 2006 at Twin Buttes Reservoir near San Angelo, Texas. Also known as carp nephritis and gill necrosis virus (CNGV), KHV is highly contagious, infects both common carp and ornamental koi carp, and can result in high mortality rates. Biologists from the Texas Parks and Wildlife Department (TPWD) investigated the kill and estimated 500 dead common carp along a 1-km segment of shoreline, which converts to thousands of dead fish in the reservoir. Surface water temperature was 22C and dissolved oxygen measured 9.2 mg/L. One moribund fish was collected and shipped to the Southeastern Cooperative Fish Disease Project at Auburn University where KHV DNA was detected using the polymerase chain reaction (PCR). A concomitant Flavobacterium columnare infection was also observed, and it is unclear what role the virus played in the fish kill. This is the 1st known report of KHV in the state, and the virus has the potential to affect wild populations as well as TPWD hatcheries, which use koi carp as a forage for some species of captive brood stock. [ProMed]

An outbreak of anthrax has been detected in free-ranging wood bison in the Slave River Lowlands (SRL) in the Northwest Territories, Canada. Anthrax is endemic in this region, with 6 documented outbreaks between 1963 and 2001 killing at least 925 bison. During a routine anthrax surveillance flight by end of June, a single dead bison was found in a north western prairie. The carcass was sprayed with formaldehyde (22 liters of 10 percent formalin) to prevent scavenging and do a superficial site decontamination. During an additional surveillance of the area by helicopter, a 2nd mature bull was found dead in the same prairie. A field diagnostic test was run on both animals and one animal tested positive for anthrax. A surveillance flight conducted on Saturday 1 Jul 2006 detected an additional 11 fresh carcasses, bringing the total to date to 14. All but one of the cases are mature males, consistent with the pattern seen in anthrax outbreaks in bison in northern Canada. The Anthrax Emergency Response Plan was immediately implemented. In addition to media communications and area closures to reduce disease risk to humans, this plan includes surveillance, testing and carcass treatment/disposal (by burning and chemical disinfection). The principal goal of proper and timely carcass disposal is to reduce environmental contamination with anthrax spores, and thereby reduce the severity and/or frequency of future outbreaks. [ProMed]

A new strain of malaria has killed 55 people and infected more than 18 000 others in India's eastern state of West Bengal since January 2006, the World Health Organization and the state government said on Monday. They said that all the deaths could be a result of poor surveillance and drug resistance. In the famous tea district of Darjeeling, almost 2400 people have been infected with malaria since January 2006, compared with just 700 in the same period of 2005. Officials at the School of Tropical Medicine in Kolkata say a new strain of Plasmodium falciparum, the deadliest form of the malaria, is the likely cause of the infections. The new strain has been tracked to Myanmar, has mutated and has become drug-resistant: traditional drugs seem to have little effect and cocktails of drug will be tried out to fight it. [ProMed]

Hantavirus pulmonary syndrome (HPS) is a rodent-borne viral disease characterized by severe pulmonary illness and a case-fatality ratio of 30-40 percent. Sin Nombre virus causes the majority of HPS cases in the United States, and the deer mouse (Peromyscus maniculatus) is its predominant reservoir. HPS is characterized by a febrile illness (i.e., temperature >101.0 degrees F) associated with bilateral diffuse interstitial edema of the lungs developing within 72 hours of hospitalization in a previously healthy person; radiographically, the edema can resemble acute respiratory distress syndrome. Annually, the majority of HPS cases occur in spring and summer; however, the seasonality of HPS can vary by elevation, location and cases have been identified throughout the winter and early spring. Since recognition of the disease in 1993, CDC has confirmed 438 cases of HPS (as of May 2006) reported from 30 states among residents of 32 states; 35 percent (154) of these cases were fatal. During the period Jan to Mar 2006, a total of nine confirmed cases of HPS were reported from Arizona, New Mexico, North Dakota, Texas, and Washington. Hantavirus infection can occur after exposure to infectious virus in rodent saliva or excreta. [ProMed]

There is now evidence that a new human genotype is susceptible to variant Creutzfeldt-Jakob disease (vCJD) infection. A previous prevalence study showed accumulation of prion protein (a marker of vCJD infection) in 3 out of 12 674 appendix and tonsil specimens. In this recent study, the prion protein gene (PRNP) was sequenced for 2 of the 3 positive samples. These 2 positive samples were found to be valine homozygous (VV) at codon 129 of the PRNP. This genotype is present in approximately 10 percent of the UK population. This is the 1st time that evidence of vCJD infection has been found in codon 129 valine homozygotes. To date, there have been 191 definite or probable clinical cases of vCJD reported worldwide; 161 in the United Kingdom (UK), a further 25 from other European countries and 5 cases outside Europe. All of those tested have been methionine homozygous (MM) at codon 129 in the PRNP, which is found in approximately 40 percent of the UK population. This new information on the PRNP codon 129 genotype shows that the entire UK population (that is, all PRNP codon 129 genotypes) is susceptible to vCJD infection. [ProMed]

Passengers on the cruise ship "Sea Princess" disembarked on Friday after their trip was cut short when 200 travellers fell ill with gastroenteritis. The ship docked at its home port of Southampton, a day earlier than scheduled. A spokesman of the ship company said that most passengers had recovered and only about 8 were still ill. The ship, on a week-long cruise, missed out a visit to Lisbon to allow extra time for the vessel to be disinfected. According to the released information the illness had not originated on board, but had been brought from onshore. Disembarking passengers said they were confined to their cabins in a bid to stop the spread of the infection, which caused severe vomiting and diarrhoea. The illness is thought to be the highly contagious norovirus that affected 600 passengers on board of another cruise ship in 2003. This is the 2nd cruise ship to have terminated a cruise early and docked at a port in the UK in the same week, though the 2 incidents are unrelated. The first involved the Van Gogh on a cruise to north Norway that was terminated at Harwich due to an outbreak of viral gastroenteritis. The viral gastroenteritis in each case was attributed to an outbreak of norovirus infection, but so far there has been no formal confirmation in either case. [ProMed]

There's a serious health warning for those heading outdoors this weekend. San Luis Obispo County Public Health confirmed that a dead squirrel tested positive for plague. It's likely others are infected with the potentially deadly disease. A plea today to people heading to parks, beaches, or anywhere wild rodents roam: don't feed the animals. The dead rodent could have passed the plague bacteria on via the flea to another rodent. The plague is an infectious bacterial disease spread by rodents and their fleas. Humans can contract the disease if exposed to infected fleas or if they handle infected animals, which includes feeding them. Health officers are not releasing the name of the Morro Bay park where the infected squirrel was found, but they're warning everyone to avoid contact with wild rodents and walking near their burrows. They also advise leaving your pets at home during outings and warn that cats are highly susceptible to plague and can spread the disease to humans. Symptoms of plague include high fever, chills, headaches, and swollen glands. Individuals who develop these symptoms should seek immediate medical attention. If caught early, plague is treatable with antibiotics; if untreated, it can be deadly. In the last 36 years, 39 human cases of the plague have been confirmed in California. [ProMed]

In April 2006, CDC reported on an ongoing multistate investigation of Fusarium keratitis occurring predominantly among contact lens wearers. The epidemiologic developments in this investigation indicate an association with Bausch & Lomb's ReNu with MoistureLoc contact lens solution. Fusarium keratitis is a fungal infection of the cornea, preceded usually by trauma to the eye. Fusarium keratitis is treated with antifungal medication but can be severe and sometimes result in vision loss and the need for corneal transplantation. As of 18 May 2006, CDC had received reports of 130 confirmed cases of Fusarium keratitis infection. Cases have been reported from 26 states and one territory. As a result of this infection, corneal transplantation was required in 37 of 120 cases. Among the 130 patients with confirmed cases, 125 reported wearing contact lenses, and 118 were able to identify which contact lens solution(s) they had used during the month before onset of infection. Given the association between Fusarium keratitis and MoistureLoc, Bausch & Lomb announced its decision to voluntarily recall and permanently remove this contact lens solution from the worldwide market on 15 May 2006. Contact lens wearers should immediately discontinue use of this solution and consult an eye-care professional regarding use of an appropriate alternative product for cleaning or disinfecting lenses. [ProMed]

Since more than one month ago, more than 700 pupils of a primary school in a district of China have contracted mumps. Nearly 100 pupils who suffered from the disease were forced to stay home. Up to now, an average of 10-20 students daily have been affected and ordered not to attend class. The district health and education authorities are involved in an investigation of the outbreak. A teacher of the school explained that the mumps first appeared in a student in March 2006. The school arranged for this student to stay at home. The next day, another student fell ill similarly, and the school made the same arrangement. Between that time and May 1st, few students were ill. Shortly after May 1, the cases mounted considerably. The school authority admits to having insufficient knowledge of the outbreak. Besides taking the measure of home quarantine, the school did not disinfect the classrooms or engage in vaccine inoculation of the other students. [ProMed]

The Minstry of Health has confirmed 16 deaths due to aflatoxin poisoning in 3 districts of Eastern Province in Kenya. A total of 40 patients have been admitted to the district hospitals with symptoms suggestive of aflatoxin poisoning. The aflatoxin poisoning was due to eating contaminated maize. The last outbreak in 2004 caused over 130 deaths. There is a clustering of cases in residents of the same household, all of whom shared the same maize stored from last year’s harvest. Aflatoxin is a naturally occurring mycotoxin produced by 2 types of mold: Aspergillus flavus and Aspergillus parasiticus. A. flavus is common and widespread in nature and is most often found when certain grains are grown under stressful conditions such as drought. The mold occurs in soil, decaying vegetation, hay, and grains undergoing microbiological deterioration and invades all types of organic substrates whenever and wherever the conditions are favorable for its growth. Favorable conditions include high moisture content and high temperature. At least 13 different types of aflatoxin are produced in nature, with aflatoxin B1 the most toxic. Aflatoxins are acutely toxic and have been shown to be carcinogenic for humans. [ProMed]

Tests have found no evidence of anthrax in samples of soil, sediment and water at a south Wales farm where 2 cows died of the disease. Anthrax was confirmed on a fram near Cardiff, last Sunday after 2 of 6 dead cattle were shown to be infected. But the Welsh Assembly Government said negative results in the latest tests indicated the risk to animals was low. Restrictions on land and livestock may be lifted if there are no more cases. Environment Minister Carwyn Jones had said last week that vets believed a pool was the source of the anthrax on the farm. Officials also said they thought the outbreak was linked to a similar positive anthrax test at the same farm 35 years ago. Since the latest case was confirmed, the farm has remained sealed off, with footpaths shut and the dead cows' carcasses incinerated. The Health Protection Agency said it had now found no evidence of anthrax in any of the 15 environmental samples it took from locations considered the most likely sources of infection. The main risk is to the farmer from direct contact with infected animals. As illness in humans is usually caused by direct contact with diseased animals, it is unlikely that any persons using the public rights of way would be exposed to the infection. The possibility of infection through inhalation or ingestion of the spores is even more remote and does not present a risk in these circumstances. This is the 1st case of anthrax in Britain since a cow died on another farm 4 years ago. [ProMed]

Measles re-emerged in some counties in Germany in 2005, despite increasing vaccination coverage rates in children at school entry in recent years, which had led to decreasing incidences (with the lowest incidence ever recorded, 0.2 cases per 100 000 inhabitants in 2004). Regional outbreaks have been detected by the mandatory reporting system in the states of Hessen and Bavaria. Although both outbreaks led to similar incidences in the affected areas (14 and 12 cases per 100 000 inhabitants, respectively) they differed in age distribution, transmission patterns, and measles virus genotype. In Hessen, 223 cases were submitted, from which 160 belonged to 41 clusters mainly defined by family or household contacts. Attack rate was highest in children aged 1-4 years (102 cases per 100 000). Results of measles virus diagnosis showed genotype D4 and identical nucleotide sequences for all analysed cases from Hesse. In Bavaria, 279 cases were submitted, most of which had occurred in schools and preschool facilities. Age-specific attack rate was highest in children aged 5-9 years (129 cases per 100 000). Laboratory diagnosed viruses were identified as genotype D6 and were identical at the nucleotide level. In both outbreaks the vast majority of cases (95 per cent in Hessen and 98 per cent in Bavaria) were in unvaccinated children. Despite high average vaccination coverage levels, local variations may lead to regionally limited outbreaks. [ProMed]

The state of Iowa has been experiencing a large mumps outbreak that began in December 2005. As of 10 Apr 2006, a total of 515 possible mumps cases have been reported during 2006. This outbreak has spread across Iowa, and mumps activity, possibly linked to the Iowa outbreak, is under investigation in 6 neighboring states. Mumps is an acute viral infection characterized by a nonspecific prodrome, including myalgia, anorexia, headache, and fever, followed by acute onset of unilateral or bilateral tender swelling of salivary glands. Approximately 20 percent of infections are asymptomatic, and nearly 50 percent are associated with nonspecific or primarily respiratory symptoms. Complications include inflammation of the testicles, ovaries, or breasts, meningitis/encephalitis, spontaneous abortion, and deafness. Transmission occurs by direct contact with respiratory droplets or saliva. The incubation period is 14-18 days from exposure to onset of symptoms. Health officials have identified 2 persons who had mumps diagnosed and were potentially infectious during travel on 9 different commercial flights involving 2 airlines during 26 Mar-2 Apr 2006. A multistate investigation has been initiated by CDC. The risk for transmission of respiratory infectious diseases during air travel might depend on several factors, including 1) immunity of passengers; 2) infectiousness of the organism; 3) degree of shedding of the pathogen by infected passengers; 4) hygienic practices of infectious passengers; 5) proximity of others to infectious passengers; 6) hygienic practices of the other passengers/crew; 7) flight duration; and 8) cabin environment of the aircraft. [ProMed]

The 5th employee of the Cummings School of Veterinary Medicine at Tufts University who was accidentally exposed to a toxin that causes botulism has been released from the hospital. All 5 employees, who were in a lab Wed, 5 Apr 2006 when a tabletop centrifuge malfunctioned and broke a tube containing a milligram of botulinum toxin, have been released from UMass Memorial Medical Center, University Campus, Worcester. 4 of the employees were released late that night; the 5th was kept overnight for observation. According to a statement released yesterday, 7 Apr 2006, by the school, none of the 5 employees experienced any symptoms related to possible botulinum exposure. The laboratory is back to normal operations, and employee training will be reinforced. School officials said there was never a spill or release of the toxin beyond the centrifuge, and there was never any risk to the public. According to the FDA, botulinum toxin can paralyze and kill if consumed in food, but is also safely used, in a purified form, as a medicine to control certain involuntary muscle contractions. It is also commonly known for its cosmetic uses under the brand name Botox. The school was using the botulinum toxin to study food-borne and waterborne diseases under a contract with the NIH. [ProMed]

This week, two research groups are independently reporting results that help explain why the H5N1 avian influenza virus is so lethal to humans but so difficult to spread. Unlike human influenza viruses, H5N1 preferentially infects cells in the lower respiratory tract. Residing deep in the airways, the virus is not easily expelled by coughing and sneezing, the usual route of spread. The H5N1 virus has killed 98 of the 177 humans it has infected. The two reports, which used different strategies but reached the same conclusion, suggest just what sort of mutation would be needed. One research team tested various tissues of the human respiratory tract for receptors to which the virus can bind. Human flu viruses preferentially bind to what are known as a 2,6 galactose receptors, which populate the human respiratory tract from the nose to the lungs. Avian viruses prefer a 2,3 galactose receptors, which are common in birds but were thought to be nearly absent in humans. Using marker molecules that bind to one receptor or the other, the team found that humans also have a 2,3 galactose receptors, but only in and around the alveoli. These findings also explain clinical anomalies such as why nasal swabs of H5N1 patients are less reliable than throat swabs in detecting the virus. [www.sciencemag.org/cgi/content/abstract/1125548]

Nearly 200 children in Somalia have been paralysed with polio since the disease re-emerged in July 2005, and the virus is spreading in the lawless country, the World Health Organisation (WHO) said on Friday Mar 24. A nationwide vaccination campaign is being launched on Mar 26, 2006 to try to reach 1.4 million Somali children aged under 5. Polio, caused by a viral infection involving the brain and spinal cord, can paralyse a child for life within hours. In about 10 percent of cases there is a full recovery. Since July 2005, 4 in 5 of the cases were recorded in the capital Mogadishu, where the virus now seems to be on the decline after immunisation campaigns, but it has spread to Lower Juba in the south and Mudug in the northeast. In all, the crippling virus is now been reported in 8 of Somalia's 19 regions. Somalia is the 19th country reinfected with polio since Nigeria's northern state of Kano suspended immunisations in 2003, allowing the virus to spread to neighbouring countries. Vaccinations resumed after a 10-month ban imposed after religious leaders said they could cause sterility or spread HIV/AIDS. The WHO launched a worldwide campaign in 1988 to wipe out polio, but failed to reach its target of halting transmission worldwide by the end of 2005. [ProMed]

An occurrence of botulism that is possibly the worst incident on record worldwide has brought emergency shipments of antitoxin from Canada, England and the USA. Thai and international health officials called for antitoxin serum from USA CDC, from England, and from Canada to treat more than 100 villagers in Thailand's northern Nan province who contracted botulism from contaminated bamboo shoots prepared in a traditional manner. The head of Thailand's Communicable Disease Control Department said that 168 villagers contracted botulism after eating the traditionally-prepared bamboo shoots that had been stored in aluminum trays. Shortly after eating the shoots they began to suffer similar symptoms, including vomiting, diarrhea, difficulty swallowing, dry mouths and muscle weakness. Among the villagers, 143 were admitted to hospital, with 33 of them needing respirators to assist their breathing, another 36 awaiting medical examinations to determine whether they need respirators, while the remaining 74 patients are hospitalized under close medical supervision. The number of the patients intoxicated by botulinum is the largest reported incident of botulism ever in Thailand. Normally, Thailand experiences only one or 2 patients per year from the illness annually. Bamboo shoot products on shelves and in the markets were collected and destroyed by the provincial public health office. [ProMed]

Malaysia said another child in Sarawak died 2 days ago from hand, foot and mouth disease, bringing the total since December 2005 to 5, in an outbreak the health ministry has called an epidemic. 2 of the deaths were caused by enterovirus 71, the more virulent type of the group of enteroviruses that cause hand, foot and mouth disease. All 488 kindergartens and 9 primary schools in Sarawak state, on the island of Borneo, are closed for 2 weeks. Sarawak is trying to prevent a repeat of 1997, when 31 children died from the disease. The nation of 26 million people is speeding up efforts to contain the disease, which had infected 3269 children in Sarawak as of 8 Mar 2006. That's more than 10 times the number of cases of 2005. Malaysia has outbreaks of hand, foot and mouth illness, characterized by fever, mouth sores and blisters, about every 3 years. Sarawak had 2113 cases in 2003, and 3560 in 2000. The disease is common in children, and in most cases, sufferers recover without medical treatment in 7 to 10 days. The illness is unrelated to foot and mouth disease found among cattle, sheep, and swine. The enterovirus group includes polioviruses, coxsackieviruses, echoviruses and other enteroviruses. [ProMed]

New start at b-safe Ltd! The formation of the biosafety institute was based on two assumptions: biosafety training would get mandatory in Switzerland and the b-safe Ltd will be approved as a training institution by the Federal Office of Public Health. Soon after its start it got clear that both conditions can not be fulfilled easily. The b-safe Ltd was founded anyway in 2003, especially because possible mandates of the pharmaceutical industry seemed at hand. In a own study this fact turned out to be unrealistic. The handicap of a "nice to have" versus a "need to have" biosafety training accompanied b-safe Ltd from the beginning and many of the courses were not well attended. However, the courses were always rated to be good or very good by the participants. According to its activities the b-safe Ltd will be downsized beginning at 1st march 2006 and will be operated by Dr. Urs Pauli and Dr. Bruno Unternährer. The office at the Fabrikstrasse 29 in Bern and the homepage (www.b-safe.ch) will be continued. Since the fomation of b-safe Ltd, the biosafety field has changed quite a bit and the interest of biosafety training has increased. This fact makes us confident that b-safe Ltd has a successful future. [b-safe Ltd]

The New York City man who contracted inhalation anthrax after working with untreated animal hides remained in a serious condition, as the authorities awaited results of laboratory tests. The 44 year old man is believed to have inhaled anthrax spores while working with unprocessed goatskins he brought into the United States from Africa. The man, who used the hides to make traditional African drums, collapsed on 16 Feb 2006 after performing in Mansfield, Pennsylvania. His apartment in Manhattan and his studio at a warehouse in Brooklyn where he worked with the skins tested positive for anthrax. A Dodge van the man is believed to have used to transport the hides also tested positive. 7 people have been given antibiotics as a precaution. The man's health worsened last Friday, when he was downgraded from stable to serious condition at the hospital. A hospital spokeswoman did not provide details on his condition, except to say that doctors were working with experts from the Department of Health and the federal Centers for Disease Control and Prevention on his treatment. [ProMed]

After the 1988 World Health Assembly resolution to eradicate poliomyelitis globally, the number of polio-endemic countries decreased from 125 in 1988 to 6 in 2003. However, during 2002-2005, a total of 21 previously polio-free countries were affected by importations of wild poliovirus (WPV) type 1 and had outbreaks of greater than 100 polio cases. Comprehensive sequencing data enabled tracing of the origins and routes of virus importations. The number of polio cases ranged from one in Eritrea to large outbreaks in Yemen (478 cases), Indonesia (299), Somalia (154), and Sudan (146). WPV type 1 importations and subsequent transmission has had a major impact (e.g., on finances and human resources) on the Global Polio Eradication Initiative. During 2005, a total of 1000 polio cases (54 percent of the global total of 1856) were reported from countries with outbreaks caused by importation. The risk for importation is greatest for countries adjacent to polio-endemic countries; however, globalization and international migration pose a risk for reintroduction of WPV to all countries. Despite substantial progress toward polio eradication during 2002--2005, the potential for WPV importation and transmission underscores the importance of sustained political and financial support to avoid resurgence of polio worldwide. [ProMed]

Lab tests show the cases of meningococcal disease that recently killed 3 members of the USA military community in Germany within a week were unrelated. 3 different strains of the disease killed a 20-year-old soldier, a 26-year-old civilian and the 23-year-old wife of a soldier. The lab results indicate that there is not an epidemic at hand. No other cases of meningococcal disease are being treated by USA clinics in Germany. The germs that cause meningococcal disease are spread in droplets through the mouth and nose by direct and prolonged contact, such as kissing, or by the sharing of utensils or directly sneezing into someone's face. Persons who had contact with the 3 victims have been given antibiotic pills. According to the German government, the annual occurrence of the disease in Germany is slightly less than one person in 100 000. Since the beginning of 2006 there have been at least 64 confirmed cases in Germany. [ProMed]

By the end of December 2005, a total of 159 cases of variant Creutzfeldt-Jakob disease (vCJD) had been reported in the United Kingdom, of which 153 have so far resulted in death. Elsewhere, numbers remain small, with 15 cases in France, 4 in Ireland, 2 in the United States, and one each in Canada, Italy, Japan, the Netherlands, Portugal, Saudi Arabia and Spain. In the UK, 5 deaths from vCJD were reported in 2005, 4 fewer than the previous year's total of 9. Results from modeling the incidence of deaths indicate that the current epidemic wave reached a peak of 28 deaths in 2000 and has since declined. Extrapolating this trend gives an estimate of 2 deaths in the next 12 months. With 6 patients alive at the end of 2005, however, a prediction of 2 deaths is likely to be an underestimate. It is important to note that, to date, all vCJD cases have been methionine homozygote at codon 129 of the prion protein gene. Preclinical vCJD infection has, however, been reported in a heterozygous patient after blood transfusion from a donor who subsequently developed vCJD. Although the initial epidemic wave is now in decline, it is possible that there will be further epidemics of cases in other genetic groups. There is also the possibility of continuing person to person transmission through certain forms of health care (for instance, in relation to surgery, blood transfusion or treatment with plasma products). It is essential, therefore, to maintain and promote active surveillance of CJD to investigate these possibilities. [ProMed]

The Hong Kong government said on Wednesday that 2 dead birds had tested positive for the deadly H5N1 bird flu virus. 3 people who came into contact with the fowl and ate another chicken that had also been around. Preliminary results for these people are expected today. The two animals double the number of dead birds that Hong Kong government tests in the past 2 weeks have shown to have H5N1. As a precaution, the government will cull all poultry within 5 km of the small holding where one chicken died and also close the city's walk-in aviaries and a large nature reserve. It was unclear where the chicken caught the deadly disease. The chicken was smuggled into Hong Kong on 26 Jan 2006 without symptoms and became ill on 31 Jan 2006. Hong Kong farms have strict biosecurity measures in place that keep poultry from coming into contact with wild birds, but there are many small, unprotected backyard farms raising small flocks. [ProMed]

The WHO factsheet incorporates the most recent findings on the H5N1 avian influenza virus. The virus has infected 149 people and killed 80, the most recent deaths and infections in Turkey not included. Bird droppings may be a significant source of its spread to both people and birds. For example, the highly pathogenic H5N1 virus can survive in bird feces for at least 35 days at low temperature (4 degrees C). At a much higher temperature (37 degrees C), H5N1 viruses have been shown to survive, in fecal samples, for 6 days. Poultry, especially those kept in small backyard flocks, are the main source of the virus. Such situations create abundant opportunities for human exposure to the virus, especially when birds enter households or are brought into households during adverse weather, or when they share areas where children play or sleep. The incubation period for H5N1 avian influenza may be longer than that for normal seasonal influenza, which is around 2 to 3 days. Current data for H5N1 infection indicate an incubation period ranging from 2 to 8 days and possibly as long as 17 days. Initial symptoms include a high fever, usually with a temperature higher than 38 degrees C and influenza-like symptoms. And with H5N1 infection, all patients have developed pneumonia, and usually very early on the illness. [WHO, www.who.int/csr/disease/avian_influenza/avianinfluenza_factsheetJan2006/en/index.html]

The english health officials are alarmed: Clostridium difficile, a common gut bacterium, seems to have mutated into a life threatening bug. The mutant named 027 has already been detected in 15 hospital and 25 deaths are attributed to it. Clostridium difficile one of the numerous gut bacteria, which colonize the intestinal tract breaking up food components and eliminating toxins. Is the normal gut flora impaired by drugs, such as antibiotics, killing the beneficial bacteria, the Clostridium bacteria produce a cell toxin, which leads to heavy diarrhea. If the gut flora is restored, the infection disappears without any adverse effects. However, patients with the mutant form 027 develop life threatening symptoms within a few days. According to researchers this is due to a higher toxin production of the mutated Clostridium. Furthermore the mutated bug has the potential to spread from the hospitals to the general public. [Die Welt]

Human cases of avian influenza may be both more common and less lethal than has been reported, Swedish and Vietnamese researchers reported last Monday. A survey of Vietnamese residents shows that people who handled or cared for sick chickens were more likely to report some sort of flu-like illness in 2004. While the study cannot prove these people were infected with avian influenza, it suggests that infections may be going undetected. The verified human cases of highly pathogenic avian influenza in Viet Nam may represent only a selection of the most severely ill patients. The study included 45 478 randomly selected inhabitants in Viet Nam. They found that 8149 people, or close to 18 percent, reported having some sort of flu-like illness and that about 25 percent of all those surveyed lived in households reporting sick or dead poultry. The flu-like illness attributed to direct contact with sick or dead poultry was estimated to be 650 to 750 cases. The epidemiological data are consistent with transmission of mild, highly pathogenic avian influenza to humans and suggest that transmission could be more common than anticipated, though close contact seems required. [ProMed]

Health officials in Oklahoma announced last week that people who drank raw, un-pasteurized milk or cream sold by Swan Bros. Dairy from 4-19 Dec 2005 may have been exposed to rabies virus. So far, 62 people have begun receiving a regimen of rabies vaccinations. Most healthy people who drank the milk or cream are not at risk for contracting rabies. However, people with certain medical conditions, including suppressed immune systems or oral sores, were informed to call the Health Department to determine whether post-exposure treatment is needed. The post exposure injections can cause side effects, including redness, fever and fatigue, so shots are given only to those who are at high risk for rabies. There have been no documented cases of human rabies because of consumption of milk from a rabid animal. However, because there is a theoretical chance for transmission, the Health Department decided to issue a public health alert. The infected cow's milk was mixed with the milk of up to 70 other healthy cows, therefore diluting any infected milk that could have been present. Additional tests are being run to determine whether there was any of the virus in the milk. [ProMed]