Federal health officials said on December 18, 2007 that they are investigating dozens of blood infections in at least 2 states that have been linked to medical syringes contaminated with bacteria. About 40 people have been sickened in Illinois and Texas, including 20 outpatients from a Medical Center in Chicago. No deaths have been reported. The doctors in the medical center traced the infections to heparin-filled syringes the patients used during home treatment for cancer and other ailments. Heparin is a blood thinner and the syringes are used to keep clear catheters and intravenous lines. The infections were caused by bacteria called Serratia marcescens, found in a single batch of heparin-filled syringes. Syringes from that batch also were sent to Colorado, Florida and Pennsylvania but infections so far have turned up only in Illinois and Texas. The infections can cause fever and chills. They can be serious but generally respond well to antibiotics. However, of the 20 outpatients who fell ill, 14 required hospitalization. [ProMed]

The UK, the USA and Canada are facing growing fears over a drug-resistant bacterium being brought back by wounded soldiers from Afghanistan and Iraq that threatens to contaminate civilian hospitals. Canada's public health service last week revealed it had ordered the screening of all its wounded soldiers being repatriated from Afghanistan. The bacterium, Acinetobacter baumannii, 1st emerged as an infection afflicting USA service personnel returning from the war in Iraq in 2003-04. It was described by a scientific journal specializing in hospital epidemiology as the "most important emerging hospital-acquired pathogen worldwide." The journal added that it was potentially a major threat to public health due to its ability to mutate rapidly and develop a resistance to all known drugs. Although different types of Acinetobacter have been known for decades in hospitals, the new T strain identified in the injured troops is particularly virulent and has been observed to appear in USA servicemen within 2 hours of being admitted to a field hospital. So far, 27 servicemen have died from the infection. [ProMed]

Three children between 3 and 12 years of age have contracted hepatitis C virus infection in a public hospital in Barcelona. The children were receiving treatment in the hemodialysis unit. A failure in the hygiene protocol, which was not noticed by the nurse, resulted in contact with contaminated material. The incident occurred last March and investigation has not yet been completed. The center has cited 18 other children who were on dialysis during the same dates. Of these 18 children, 14 have been tested and are free of the virus. The main hypothesis of the investigation is directed at the practice of sharing an ampoule of antibiotic that was administered to the 1st child affected. Hospital officials mentioned at a press conference that there are a multitude of possible causes. The 3 children infected with hepatitis C have already received the desired kidney transplant. The hemodialysis unit is equipped with 5 machines and 5 beds, which are served by 2 nurses and one assistant. The directors of the hospital denied that the hygienic protocol failure (the use of single vial antibiotics for multiple patients) was related to an excessive workload endured by professionals. The hospital performs about a thousand hemodialysis sessions each year. Hepatitis C virus is transmitted through blood, similar to HIV, but it is much more easily transmitted. [ProMed]

The New Mexico Department of Health announced today that a 34-year-old man from McKinley County was diagnosed with the state's 3rd case of hantavirus pulmonary syndrome this year. The man was hospitalized and is now recovering at home. People are usually exposed to hantaviruses around their homes, especially when they clean out enclosed areas that have lots of mouse droppings. Hantaviruses cause a deadly disease transmitted by infected rodents through urine, droppings or saliva. People can contract the disease when they breathe in aerosolized virus. The deer mouse is the main reservoir for hantavirus in New Mexico. Early symptoms of infection are fever and muscle aches, possibly with chills, headache, nausea, vomiting, diarrhea, abdominal pain and cough. Symptoms develop one to 5 weeks after rodent exposure. Although there is no specific treatment for the infection, chances for recovery are better if medical attention is sought early. To protect yourself, avoid contact with mice and other rodents. Other important steps are: i) air out closed up buildings before entering, ii) seal up homes and cabins so mice can't enter, iii) trap mice until they are all gone, iv) clean up nests and droppings using a disinfectant, v) put hay, wood, and compost piles as far as possible from your home, vi) get rid of trash and junk piles and vii) don't leave your pet food and water where mice can get to it. In 2006, New Mexico had 8 cases of hantavirus from where 3 patients died. Since hantavirus was discovered in 1993, there have been 76 cases and 31 deaths in New Mexico. [ProMed]

Canterbury's Medical Officer of Health is urging people to thoroughly heat cocktail sausages before eating them following an outbreak of an illness among children who had consumed them. An investigation by the Canterbury District Health Board's Community and Public Health division has found 6 children under 5 years old with yersiniosis had eaten cocktail sausages. Symptoms of the infection usually last about 48 hours and include diarrhea, possibly stomach pains, but usually no vomiting. The problem appears to have occurred from mid October to early November 2007. It is believed more people, particularly children, could have been affected by the illness. The cocktail sausages were given to most of the children over the counter. While cocktail sausages are cooked during their preparation they are not ready-to-eat foods. Further heating before eating is required to destroy any bacteria that may have contaminated them after they were made. The 2 species of Yersinia associated with food borne disease are pseudotuberculosis and enterocolitica. The latter species can be associated with abdominal pain as a hallmark symptom. Yersiniosis can mimic appendicitis, but may also cause infections of other sites such as wounds, joints, and the urinary tract. Strains of Y. enterocolitica can be found in meats (pork, beef, lamb, etc.), oysters, fish, and raw milk. Some strains of these organisms can be associated with blood transfusion-associated illnesses due to an ability to grow at refrigerator temperatures. [ProMed]

A child is being treated in a Toronto Hospital for a case of meningitis caused by a worrisome multi-drug resistant strain of the Streptococcus pneumoniae bacteria. In children, Streptococcus pneumoniae - also known as pneumococcus - often causes ear infections, though it can also cause pneumonia, bloodstream infections and meningitis, an infection of the fluid in spinal cord and around the brain. The unidentified child\\\'s illness was caused by a variant of the 19A strain of Streptococcus pneumoniae that is resistant to the antibiotic ceftriaxone, a treatment staple for bacterial meningitis in children. When it became apparent that the initial treatment regime wasn\\\'t working, a number of other antibiotics were tried without success. Eventually doctors turned to levofloxicin, a powerful antibiotic not typically used in meningitis in children. That drug was effective against the bacteria. Multi-drug resistant variants of 19A have recently been reported to be causing pneumococcal disease in parts of the northeastern United States. Infectious disease experts at the University of Rochester, N.Y. reported at a major medical conference earlier in the fall 2007 that they had seen a number of cases of ear infections in children caused by a 19A variant that was resistant to all antibiotics approved for treatment of ear infections in the United States. [ProMed]

A wildlife biologist at Grand Canyon National Park most likely died from the plague contracted while performing a necropsy on a mountain lion that later tested positive for the disease. The 37 year old became ill on 30 Oct 2007 and called out sick from for a couple of days before being found dead in his home 2 Nov 2007. Tests were positive for pneumonic plague. Officials said 49 people who came in contact with York were given antibiotics as a precaution. None have shown symptoms of the disease. The biologist had skinned the cougar and was exposed to its internal organs during the necropsy he performed 3 days before developing symptoms. The cougar, which had died from the plague, was believed to have remained in back-country areas where park visitors wouldn't normally go, officials said. The National Park Service is planning to review its safety guidelines for wildlife biologists and make possible recommendations for improvements. An average of 13 plague cases are reported in the USA each year. A total of 14 percent of cases are fatal, according to the CDC. Plague is transmitted primarily by fleas and direct contact with infected animals. When the disease causes pneumonia, it can be transmitted from an infected person to a non-infected person by airborne cough droplets. Cases are treatable with antibiotics. [ProMed]

A superbug which kills hundreds of patients a year has been found on 32 farms in the UK. The discovery raises fears that the infection is spreading to the human population through meat and milk. The bug - Extended-Spectrum Beta-Lactamases Escherichia coli (ESBL E. coli) - causes around 30 000 cases of blood poisoning and urinary tract infection each year. It is known to have killed hundreds of people over the past 5 years, although some experts put the annual death toll as high as 4000. The "super E. coli" is thought to have developed a high degree of resistance to antibiotics through their use in intensive livestock operations. Its spread from farm to farm has mirrored the rise in the number of infections and deaths in the human population. Experts at the Health Protection Agency are investigating a possible link between the bugs found in livestock and the sale of meat and milk. The findings show evidence of people carrying these bacteria in their gut. If this is found to be commonplace in the general population; this may point towards the food chain being a potential source. [ProMed]

A new strain of bacteria is emerging as a major cause of childhood infections but even drug-resistant versions of the bug can be killed off with the right antibiotics. Doctors and parents should be aware of it, however, and switch antibiotics for children with severe infections who do not respond quickly to standard therapy. The bacterium is a type of Streptococcus pneumoniae that is not one of the 7 strains covered in a routine childhood vaccine Pneumococcal germs cause ear infections, meningitis, pneumonia, and blood infections. The vaccine has greatly reduced the number of infections among not only children, but also older adults. It is clear that a 75 percent reduction in the number of severe pneumococcal cases has occurred since 2000. For the drug-resistant strains of S. pneumoniae the antibiotic vancomycin will work, or combination therapy with vancomycin and cefotaxime or ceftriaxone. Healthy children are not considered at serious risk from the infection but children with sickle cell disease, HIV infection, lung disease, diabetes, or kidney disease need special attention. [ProMed]

A health crisis is looming over the island as the Ministry of Health and Environment has confirmed 100 cases of leptospirosis. Infections are probably enhanced by hurricane Dean in August 2007 and the heavy rains currently lashing the island. The Minister of Health and Environment, urged persons to use rat baits to prevent any further spread of the disease. In order to contain leptospirosis health officials have launched a very serious attack on rats. Leptospirosis is spread by eating foods or handling water contaminated by urine of infected animal; tending infected animals; bathing or wading in stagnant water frequented by animals, especially after flood rains. Leptospirosis is a zoonosis caused by the spirochete Leptospira. It is usually transmitted to humans from asymptomatic carrier animals (for example rodents and domesticated animals, such as dogs, pigs, and cattle) that intermittently or continuously excrete the organisms in their urine. Exposure occurs usually by contact of broken skin or mucous membranes with water or muddy soil contaminated by urine from these chronically infected animals. Person-to-person spread is not known to occur. Leptospirosis is endemic in Jamaica, and outbreaks follow flooding after heavy rains in autumn. In fact, leptospirosis has been documented serologically in domestic animals (pigs, cows and goats) and Leptospira have been isolated from soil and water samples in Jamaica. [ProMed]

A strain of virus best known for causing colds and "stomach flu" is becoming more common and more dangerous, US scientists report. They said that adenovirus 21 was surprisingly common and was causing an unexpected level of severe disease and deaths. The researchers used a new test developed by the US CDC. Adenoviruses cause colds, bronchitis, and stomach upsets, but can also cause chronic airway obstruction, a heart infection called myocarditis, a sometimes-deadly bowel condition called intussusception, and sudden infant death at birth. Scientists at the University of Iowa were trying to get a handle on which types of adenoviruses were most common and which were causing serious outbreaks of disease. The researchers used the test on 2200 samples from 22 US medical facilities, including 8 military sites. Military personnel are especially susceptible to outbreaks of all kinds of disease, including adenoviruses. Adenovirus 21 was found in 1 per cent of specimens in 2004, but in 2.4 per cent in 2006. And it was making people much sicker than the other strains, killing 50 per cent of bone marrow transplant patients, for instance. These patients are at extra risk from infections as their entire immune systems are destroyed before they get transplants of new bone marrow tissue. [ProMed]

An unreported infection with a dangerous pathogen and other biosafety breaches at a Texas university are fueling an already heated debate about safety at U.S. biodefense labs (see also b-safe News of July 12 and September 13). Although some scientists and biosafety experts say the extensive breakdown in procedures at Texas A&M is probably exceptional, they too worry that many incidents are going unreported. The scrutiny is sending tremors through university administrators and the microbiology community, which is struggling with how to both ensure safety and gain the public's trust. One idea under discussion is an anonymous national accident reporting system that would enable institutions to learn from one another's mistakes. Winning public confidence could determine whether several proposed labs, such as one being built in Boston, will be allowed to operate at biosecurity level 4. There were thousands of lab-acquired infections before the 1970s, when labs began installing hoods, shields around centrifuges, and other safeguards. Oversight became stricter after 2001 when federal agencies beefed up a regulation, called the select-agent rule, for the handling of pathogens such as anthrax and the Ebola virus that are potential bioweapons. The rule requires that lab workers get a security clearance for working on the roughly 80 select agents and toxins; that select agent labs be inspected and workers undergo training; and that lab exposures and losses of select agents be reported to CDC. About 14,000 people at 400 labs now have select-agent authorization. Workers who make a mistake are often embarrassed and may fear angering their supervisor, and institutions worry about the damage to their reputation. There's one fact that nobody disputes: The risk of accidents in biosafety labs goes up with the number of workers. [Science, 2007, Vol 317, No. 5846, 1852-1854 ]

A Ugandan man tasked with guarding a Marburg virus-infected mine crept into the underground of the mine only to be infected with the Ebola-like disease. The mine was closed when the epidemic struck the western area situated in a forest reserve, killing one person, but the 58 miners were monitored by the health ministry, as were the people they had come in contact with. The epidemic was declared over in early August 2007 but health ministry officials said that a man who was guarding the closed mine "sneaked" in, contracting the disease and that he is currently under treatment. Uganda has contained an outbreak of Marburg disease among gold miners, but contacts of the 2 known cases must now make sure they don't spread the deadly virus through sexual activity. WHO expert Pierre Formenty said investigators had collected hundreds of bats from the mine, which they suspect may be a possible reservoir of the disease. Authorities believe the virus might have been transmitted from the hundreds of thousands of bats dwelling in the scores of tunnels of the mines or from monkeys in a government forest reserve where the mines are situated. The Marburg virus which is similar to but less virulent than Ebola, was isolated in 1967 in Germany's Marburg Virus Institute from monkeys which were imported from Uganda. [ProMed, see also news from 09.08.2007]

Hepatitis E virus infections can be fatal in pregnant women but until recently doctors thought the disease was confined to China, India, and developing countries. Now Europeans are also contracting the disease here according to scientists at the Society for General Microbiology's 161st meeting at the University of Edinburgh, UK. Hepatitis E virus is one of the few viruses which has been shown to be transmitted directly from animals through food. It was recently thought to be confined to developing countries, and although scientists are still unsure exactly how it spreads to people, direct contact with pigs or eating contaminated pork products is a likely route. Where hepatitis E virus is identified in Europe, the strain is usually closely related to the viruses found in pigs in the same country. Far fewer cases of hepatitis E virus are reported than actually occur, since doctors currently rarely ask for the relevant diagnostic tests in many industrialized countries. Genetic material from hepatitis E viruses has already been detected in pig livers being offered for sale in Japan, USA and the Netherlands, proving that European pigs are in contact with hepatitis E. Wild boar products could present a similar risk. Up to 3 per cent of blood donors in Europe show evidence of exposure to the virus through detectable antibodies. [ProMed]

A young Russian biologist who was taking samples to a collaborative institute in France has been accused of attempting to smuggle bioweapons by Russia's federal security service, the FSB. He has been interrogated repeatedly by FSB agents and prevented from leaving the country. His job also now looks uncertain. But experts say that the accusations are absurd. Oleg Mediannikov's Kafkaesque nightmare began on 12 December 2006 at Moscow's Sheremetyevo airport, as he was about to board a plane to Marseilles. Customs officials confiscated 20 phials containing non-pathogenic strains of a typhus vaccine approved by the Russian health ministry for export to France, along with Mediannikov's computer and USB memory sticks. Mediannikov was allowed to continue his trip to Marseilles without the samples. On his return to Moscow in January, he was told that the confiscated material had been sent to a secret laboratory for an 'expert assessment'. On 13 February, he intended to go on a tourist trip to Cameroon, only to learn at Moscow's Domodedovo airport that there was an official order preventing him from leaving the country. His passport was confiscated and returned two months later by regular post. People guilty of illicit trafficking of weapons-delivery systems can be sentenced to up to seven years in prison. Typhus bacteria are not considered potential bioterrorism agents by other governments. More than eight months on, the interrogations continue. Mediannikov's case illustrates a worrying resurgence in Russian scientists being accused of wrong-doing. [Nature 449, 122-123 (13 September 2007)]

On Jun 30 the CDC ordered the lab to stop all work on "select agents and toxins" while it investigated reports of lab workers infected with the category B bioterrorism agents Brucella and Coxiella burnetti. The new CDC report says the lab's suspension will continue until the safety problems are corrected. In late July the CDC sent a team of 18 investigators to examine the lab. A 21-page report on the CDC investigation was released. Among other findings, the CDC team reported that: a) some work, including experiments with Brucella, had not been approved by the CDC's Division of Select Agents and Toxins, b) documentation of corrective actions taken after previous inspections was deficient, c) biosafety manuals contained inadequate information on the risks posed by the agents or toxins under study or the research being performed on them, d) Individuals entered the labs without proper clearance and proper protective equipment, e) inventory oversight for the select agents was inadequate, f) an aerosol chamber used for animal studies opened directly into the research laboratory, g) research animals were not disposed of properly, h) the lab's security plan was not based on a site-specific risk assessment and did not properly address procedures for moving select agents between buildings, i) in at least seven instances, unapproved personnel had access to select agents, j) logs of people who accessed select agent labs were not kept properly, k) protective clothing was worn outside the laboratory. The university said in August that the lab worker who was infected with Brucella wasn't authorized to work with the agent and that the lab wasn't cleared to perform experiments with the organism. It's unclear if the US Department of Health and Human Services will penalize the university or press criminal charges for not reporting the lab worker's Brucella infection. [http://www.cidrap.umn.edu/cidrap/content/bt/bioprep/news/sep0507biolab.html]

On 15 Nov 2006, the Maine Department of Health and Human Services was notified of a case of salmonellosis in an employee of a facility that produced poultry vaccine. When a 2nd case of salmonellosis in another employee at the same facility was reported on 25 Nov 2006, MDHHS began an outbreak investigation. Results of that investigation suggested that 21 employees of the facility became ill during a 1 month period from exposure to a strain of Salmonella enterica Serotype enteritidis that was used in vaccine production. Infection was thought to have resulted from environmental contamination after the spill of a liquid containing a high concentration of the organism: on 9 Nov 2006, a spill of approximately 1-1.5 liters of liquid occurred in the fermentation room of the production area of the facility; the liquid contained 20 000 000 000 to 50 000 000 000 colony forming units per milliliter of S. enteritidis. The room was unoccupied at the time the spill occurred. The worker who was regularly assigned to this room reported finding liquid overflowing onto the floor from the fermentation apparatus when he entered the room, wearing personal protective equipment (PPE) (e.g., biohazard suit, hat, booties, mask, and gloves). He cleaned up the spill using a mop, a 5 percent bleach solution, and a commercial disinfectant effective against the organism. The mop was autoclaved before disposal in a room 30 feet away (room A) used for cleaning and sterilizing laboratory supplies and equipment for vaccine production. The facility did not have a written spill procedure or a spill clean-up kit. As a result, MDHHS recommended that the facility improve its infection control procedures to better protect workers. [ProMed]

A 90-year-old nursing home patient died from stomach flu in 2006, marking the 1st time US health officials confirmed that the highly contagious bug is sometimes fatal. The North Carolina woman so far is the only person for whom lab tests confirmed norovirus as the killer, but health officials believe the virus killed at least 18 others and caused thousands of illnesses in 2006. Noroviruses are a group of viruses that cause stomach flu, or gastroenteritis. They also are sometimes called Norwalk-like viruses. Health officials don't systematically count and diagnose norovirus cases. But winter 2006-2007 seemed to be particularly nasty, with more than 1300 outbreaks reported in 24 states. In the outbreaks 2 new strains of norovirus were identified. In recent years, cruise ships have become famous norovirus carriers, with several large outbreaks grabbing headlines. The virus is particularly dangerous for the very old, the frail, and the very young. Symptoms include nausea, vomiting, diarrhea, and stomach cramping. Some people also suffer a low-grade fever, chills, headache, muscle aches, and tiredness. The illness often begins suddenly, but in most people symptoms last only one or 2 days. There's no good treatment for norovirus. The virus is spread through food, personal contact, and touching contaminated surfaces. [ProMed]

A large outbreak of more than 600 cases of gastrointestinal illness has been reported in the Dominican Republic, originating at the Bahia Principe San Juan resort in Puerto Plata. The illness experienced has generally been self-limiting of 12 to 24 hours duration. Vomiting and diarrhoea are the most commonly reported symptoms, with abdominal discomfort and fever reported much less frequently. Two flights containing symptomatic and asymptomatic travellers returned to the United Kingdom on Thu 9 Aug 2007. The planes were disinfected and then returned to service. General practitioners, infectious diseases doctors or other healthcare workers who may see patients recently returned from the Dominican Republic, are asked to request stool samples for microbiological and viral analysis, providing a full travel history. The illness has features suggestive of a viral aetiology, and 2 specimens from cases in England and Wales have been confirmed as being positive for norovirus. Several cases have had Entamoeba histolytica identified by local laboratories in the Dominican Republic but for the majority of cases the symptoms are not consistent with this being the cause of illness. By now is has been confirmed in the laboratory that this outbreak of gastroenteritis was caused by a norovirus infection. The association of 2 genotypes of norovirus and possibly some cases of Entamoeba histolytica with this outbreak suggests lapses in hygiene at the hotel. The Bahia Principe hotel is currently closed to new guests. [ProMed]

Syphilis, which had been so rare that health officials believed it would be eliminated by 2005, is becoming more common in New York City and throughout the country, the New York Times reports. Some 260 cases were diagnosed in the city during the 1st quarter of 2007, which is more than twice the number diagnosed during the 1st quarter of 2006. The condition, which had been largely limited to men who have sex with men, is becoming more common in women (10 cases occurred in women, after 10 years of nearly no female cases). Risky behaviours and unsafe sex appear to be on the rise, the article notes. And many health experts warned that a spike in HIV cases could come on the heels of the syphilis outbreak. The total number of cases of syphilis reported annually in the United States declined dramatically in the 1940's to a low in 2000. In 2000, the rate of primary and secondary syphilis in the United States was 2.1 cases per 100 000 population. From 2001 to 2004, the primary and secondary syphilis rate increased nationally to 2.7. Infectious syphilis can increase the chance of HIV transmission 3 to 5 fold and infectious syphilis in women can be followed by an increase in neonatal syphilis. The problem is not isolated to the US; in Canada, syphilis is now reported to be 9 times the rate it was in 1997. [ProMed]

Health experts in Uganda have linked the outbreak of the deadly Marburg hemorrhagic fever in the western part of the country to a monkey similar to those that were responsible for the 1st outbreak in 1967. The head of the national task force to fight the spread of the epidemic told that preliminary investigations showed that the virus may have been passed to one of the 2 victims by a Colobus monkey which had been slaughtered. Samples of the skin of the monkey have been sent for further analysis. At the beginning of August the Ugandan government announced that 2 cases of Marburg hemorrhagic fever had been identified at a gold mine, 250km west of Kampala. One of the 2 miners confirmed to have contracted the virus died on 14 Jul 2007 and another miner was recovering after being treated. A task force is monitoring more than 140 people who are believed to have come into contact with the 2 miners. The government has set up isolation units at a hospital in Kampala. Marburg hemorrhagic fever, like Ebola hemorrhagic fever, is a highly deadly and contagious disease characterized by sudden onset of high fever and bleeding, resulting into death within a week if untreated. The virus can be transmitted through close contact with blood and other body fluids from carriers who have developed clinical symptoms. It can also be transmitted following exposure to contaminated items, such as bedding and clothing of the patients. The virus is named after Marburg, a city in Germany, where the 1st outbreak occurred in 1967 among laboratory workers doing research on monkeys imported from Uganda in order to prepare a polio vaccine. [ProMed]

A group of 33 veterinary students and 2 teachers contracted a laboratory-confirmed Q fever infection during a training course on a sheep farm in Slovenia in March 2007. The disease is caused by Coxiella burnetii, an intracellular bacterium found worldwide in various species of farm and domestic animals. On 17 Apr 2007, the Communicable Disease Centre at the National Public Health Institute was informed about a case of Q fever in an 18-year-old student of a veterinary high school. The patient had developed high fever and a severe headache. Chest x-ray showed pneumonia. The student reported that her classmates in the same school year had been complaining about similar symptoms. As part of their training, 45 of the students spent several hours between on farm, together with 3 teachers. They were trimming sheep's feet, disinfecting wounds, and applying intramuscular vitamins and anti-helminthic injections as a preventive measure to healthy animals in a stable with approximately 500 sheep. Among 48 exposed individuals, there were 34 with fever (38 deg C or more) with or without a headache; 4 individuals had serious headaches only, but were not sure about fever, and 3 individuals reported symptoms of a common cold; 7 individuals were asymptomatic. The test results confirmed acute Q fever in 36 individuals. The 1st Q fever outbreak among humans in Slovenia was mentioned in 1954. Between 1996 and 2005, between 0 and 5 Q fever cases were notified annually in Slovenia. The regions endemic for Q fever have never been determined in Slovenia. [ProMed]

Huagong Road in Beijing, is a dusty stretch of ramshackle auto repair shops, family-run restaurants. Early July, a young man became the latest victim of a rabies epidemic that has astonished national and international health officials. According to official health figures, rabies is now the deadliest infectious disease in China. Rarely fatal in the West, rabies is killing more than 200 people in China per month, outpacing tuberculosis deaths in 13 of the last 14 months. In 1996, figures show only 163 Chinese died from rabies. In 2006, the disease killed 3215 and chinese public health official touched off an international storm of criticism by ordering a mass extermination of dogs in some areas, e.g. in the province of Yunnan, where more than 50 000 dogs were hanged or electrocuted in a single week. Another worker was bitten by the same dog as the young man in late May, but he got rabies shots after the incident and is fine. Police have gotten tough enforcing a 2003 "one-family, one-dog" policy in 8 city districts in Beijing. Beijing is home to 550 000 registered canines. But there is believed to be an equal number still unregistered. More than 140 000 people turned up at city hospitals in 2006 to be treated for dog bites. A massive canine vaccination campaign coupled with a vigorous public education effort to get pets vaccinated and to seek post-exposure treatment when bitten, alerting health care providers to administer proper post-exposure treatment, and elimination of stray dogs could sharply reduce human rabies cases. [ProMed]

Several people who mysteriously became sick after camping on the west side of Utah Lake might have contracted tularemia, officials at the Utah Department of Health said. While they are still awaiting lab confirmation of the diagnosis, officials issued an advisory to avoid contracting the infectious bacterium, which commonly causes fever and swollen lymph nodes. A treatable infection, tularemia usually spreads through tick and deerfly bites, but it also can be contracted through mosquitoes or by direct contact with an infected animal. Outdoor enthusiasts are advised to wear long, light-colored pants tucked into boots or socks and long-sleeved shirts, stay on marked trails, avoid walking in tall grasses, use repellents containing DEET and avoid direct contact with wild animals including their faeces and carcasses. Symptoms are: fever, chills, drenching sweats, muscle aches, malaise, nausea, vomiting, and weight loss usually appear 3 to 5 days after exposure to Francisella tularensis, but can take as long as 14 days. Diagnosis is usually made on the basis of positive cultures of blood or other infected material or serology. Tularemia is usually treated with gentamicin or streptomycin for 7 to 14 days, although other antibiotics, such as fluoroquinolones (e.g., ciprofloxacin or levofloxacin) or tetracyclines (minocyclne and doxycycline) are also effective. If untreated, the overall death rate is 5-15 percent; less than one percent of appropriately treated patients die. [ProMed]

The CDC on 30 Jun 2007, ordered a biodefense research laboratory at Texas A&M University to stop all work on select agents and toxins while it investigates reports of lab workers infected with Brucella and Coxiella burnetii. The Sunshine Project, a non-profit group that monitors biodefense research safety, recently reported the alleged lab accidents, along with related alleged violations of federal law. In April 2007, it reported that a Texas A&M researcher had been infected with Brucella after a February 2006 aerosol chamber mishap and that the school did not immediately notify the CDC as required by federal law. On 26 Jun 2007, the watchdog group reported that the exposure of 3 other Texas A&M workers to C. burnetii, which causes Q fever, was confirmed in April 2006 but also was not reported to the CDC. According to the Sunshine Project, Texas A&M notified the CDC about the case of brucellosis in April 2007, a year after the worker's illness was confirmed. Shortly after Texas A&M report, representatives from the CDC ordered the lab to stop its work on all select agents and toxins until further notice. The CDC outlined the concerns it has about the lab, which include the adequacy of biosafety plans, security of the facility from unauthorized visitors, occupational safety protocols, authorization from the CDC to work with certain agents, and compliance with federal select agent regulations. The University believed that the threshold for reporting worker exposure was a confirmed illness. Coxiella burnetii causes an influenza-like disease in humans that is rarely fatal. However, it is highly infectious when it becomes airborne and is inhaled by humans. Brucellosis presents fever and a wide range of other possible manifestations, such as arthritis, hepatitis, and meningitis. Symptoms can be prolonged, but the disease is rarely fatal. [ProMed]

A total of 3 swans found dead in eastern France may have been killed by the deadly H5N1 bird flu virus. Tests are in the process of being confirmed at the reference laboratory of the French food safety agency to determine whether it was the highly pathogenic H5N1 strain. The disease was also found in the Czech Republic in June 2007. In 2006 some 13 European Union member states had confirmed cases of bird flu: Germany, Austria, Denmark, Italy, Greece, Britain, the Czech Republic, Poland, Slovakia, Slovenia, Sweden, France and Hungary. In France the virus was found in more than 60 wild birds and at a farm with 11 000 turkeys. It had not been detected in the country since April 2006. More than 30 countries have reported outbreaks in the past year, in most cases involving wild birds such as swans. Globally, the H5N1 virus has killed nearly 200 people out of over 300 known cases, according to the World Health Organisation. None of the victims were from Europe. [ProMed]

The South Australian Department of Health has confirmed a Q fever outbreak that has struck down 3 people who live near a goat abattoir northeast of Adelaide. People become infected by breathing in contaminated dust from droppings of infected animals. The health officials said people should not be concerned as the 12 cases of the fever diagnosed so far in 2007 was a low number compared with other colds and influenza. Q fever was first described in Australia and was called "Query fever" because the causative agent was initially unknown. Coxiella burnetii, (discovered in 1937) is an agent that can be resistant to heat and desiccation and highly infectious by the aerosol route. A single inhaled organism may start the infection. In non-human primates, the dose to kill 50 percent of the primates was found to be 1.7 organisms. Cattle, sheep, and goats are the primary reservoirs of C. burnetii. The pathogen does not usually cause clinical disease in these animals, although abortion in goats and sheep has been linked to C. burnetii infection. Organisms are excreted in milk, urine, and faeces of infected animals. Contact with contaminated wool is known to be a mode of transmission. Infection of humans usually occurs by inhalation of these organisms from air that contains airborne and contaminated barnyard dust. Humans are often very susceptible to the disease, and very few organisms may be required to cause infection. Human to human transmission, are rare. An earlier outbreak of infection in 51 persons in Scotland, UK, was tied to a meat processing plant and appeared to spread via aerosol for at least 1/2 mile. [ProMed]

In New York health authorities urged 4500 people treated by a local anaesthesiologist to get tested for hepatitis, saying 3 patients may have been infected with the liver-damaging disease while the doctor was giving them anesthesia. They were mailing letters to everyone at risk and noted that the disease cannot be spread by casual contact. All 3 people treated by the doctor in August 2006 were diagnosed with hepatitis C in recent months. Laboratory tests and other evidence suggest they were infected while getting intravenous anesthesia drugs during outpatient medical procedures. The state Health Department said the agency had not established that the doctor is guilty of doing anything wrong. City authorities said they were contacting everyone treated by the same anesthesiologist while he or she practiced at 10 different medical offices in New York City. The doctor has stopped practicing during the investigation. The authorities stressed that intravenous medications are very safe when standard infection-control procedures are followed. Hepatitis C is a virus that can cause scarring or other damage to the liver. It often does not cause noticeable symptoms, although some people experience flu-like symptoms, a yellowing of the skin and the whites of the eyes, dark urine and pale faeces. There are several treatments available. [ProMed]

On Wed 7 Jun 2007, health officials warned Missourians to guard against tick bites, after the death of a child bitten by a tick in a north eastern part of the state. The child became ill after being bitten by a tick and died after 10 days of intensive medical care. Tests performed at the hospital showed the child was infected with ehrlichiosis. State officials declined to release any additional information about where the child may have been bitten. The state health department reports a 2007 rise in tick-borne diseases such as ehrlichiosis and Rocky Mountain spotted fever. Other tick-borne diseases reported in Missouri in 2007 include tularemia and Lyme-like disease. So far, 16 cases of ehrlichiosis have been reported. In the past 5 years, Missouri has seen an average of 9 cases per year during the same time period. Tick-borne illnesses cannot be quickly diagnosed through testing, but treatment decisions will be made on clinical evidence and the likelihood of tick exposure. Health officials said if a person has been bitten by a tick and experiences a sudden fever, headache, rash, achy muscles and nausea, the person should contact a doctor for evaluation. Tick-borne diseases can be effectively treated with appropriate antibiotics, especially when caught at an early stage. [ProMed]

A man infected with drug-resistant tuberculosis may have exposed fellow air passengers on two trans-Atlantic flights this May 2007 to the potentially lethal disease. Passengers may need to be tested for the infection. The infected man may have exposed other travellers to a strain of extensively drug-resistant tuberculosis, a lung disease that doesn't respond to most available treatments. The man, a U.S. citizen, was ordered into isolation. The authorities seek to determine where all the passengers on the flight originated, so they can be notified. How many countries are involved still isn't known. About 49 cases of XDR-TB were reported to federal health officials from 1993 through 2006, and each cost about USD 500’000 to treat. The disease is particularly threatening to people with damaged immune systems, such as AIDS patients. While many people are infected with tuberculosis have no symptoms, AIDS allows the bacteria to overcome the patient's immune defences more quickly. About two-thirds of those infected with XDR-TB die. While the infected man may not have been particularly contagious while on the flights, people who were sitting closest to him were at highest risk of exposure. The last time a federal order was used to isolate a patient was in 1963: that patient had smallpox, a highly contagious virus that killed about one of every 3 infected people. [ProMed]

State health officials in Colorado confirmed on 25 May 2007 that the death of a domestic cat was caused by plague. They said that that a case of cat plague is a public health concern, but that this fact is however not an uncommon finding in areas where plague is circulating. So far this year, at least 15 squirrels have tested positive for plague in the Denver metro area. Additionally, a rabbit at City Park in Denver also tested positive for plague, and a monkey from the Denver Zoo was confirmed to have died from the bacteria. Last year plague was found in wild animals in 25 different Colorado counties. State health officials say cats are very susceptible to contracting plague because they will commonly eat rodents which were infected. It was stated that in 2006 year, 23 cats were diagnosed with plague. Officials say cats infected with plague become extremely ill and have many of the same symptoms humans do: high fever, severe lethargy and swollen lymph nodes. Dogs are generally resistant to plague, but can bring infected fleas into the home. Officials say most human plague cases occur from infected fleabites, but can also result from direct contact with blood of an infected animal. [ProMed]

An outbreak of salmonella in Germany has infected more than 250 people and killed 2. The Klinikum Fulda, a 924-bed hospital in the town of Fulda, said 233 patients and staff had been infected by the outbreak, along with a further 23 people in a nursing home attached to the institution. Most of those infected were not seriously affected by the bacteria, which usually stems from contaminated food (often egg products). The hospital said 2 women over the age of 80 had died as a direct result of infection, one of them in the nursing home. The death of another woman in her 70s was indirectly linked to the salmonella. Of those infected at the hospital, 145 were patients and 88 were employees. An outbreak was 1st logged at the hospital in late April of this year; since then, the number of reported infections has risen steadily. Salmonella bacteria are frequently responsible for foodborne illnesses and may cause vomiting, abdominal pain, and bouts of fever. Outbreaks of salmonellosis in hospitals and long-term care facilities are not uncommon. The elderly and those with serious underlying diseases are more likely to become severely ill. The use of antacids, H2 blockers, and proton pump inhibitors are known to increase susceptibility to salmonellosis by decreasing gastric acidity, thus increasing the effective inoculum reaching the small intestine. Use of antibiotics has also been demonstrated to increase susceptibility. [ProMed]

Between 1 Mar and 5 Apr 2007, 11 cases of measles were notified in the canton of Geneva, Switzerland. The most recent cases before this cluster dated back to April 2005. A clinical case of measles is defined as a patient presenting with rash and fever greater than 38°C as well as one of the following: cough, coryza, or conjunctivitis. A confirmed case is a clinical case with positive specific IgM and/or a positive PCR test, or a clinical case with a clear epidemiological link to a laboratory-confirmed case. In 2006, the maximum allowed delay for notification of cases to health authorities was reduced from one week to 24 hours from diagnosis. Due to this recommendation six cases were notified within hours of diagnosis. In Switzerland, measles vaccination was introduced in 1969 and included one dose in the national immunisation plan in 1987. A 2nd dose has been recommended at 4 to 7 years of age since 1996, and at 15-24 months since 2001. Measles vaccination is not mandatory, and overall coverage of 24-35 month old infants was 82.3 per cent in 1999-2003. The immunisation status is known for 10 of the 11 cases, none of who was vaccinated (refusal for 9 cases and parental request for delayed vaccination for one 2 year old infant). Four patients were hospitalised for pneumonia and/or general malaise and weakness, with one teenage girl requiring intensive care. All patients recovered. Four cases had complications including pneumonia and otitis media. [ProMed]

Hantaviruses (family Bunyaviridae) are rodent-borne pathogens and occur worldwide. Hantavirus infections in Europe and Asia can result in a hemorrhagic fever with renal syndrome of different severity. In Germany, the predominant species is Puumala virus. Its main reservoir is in bank voles (Myodes glareolus), which predominantly live in forested areas dominated by deciduous trees. The disease is characterised by an abrupt onset, and the major symptoms include fever, abdominal pain and other gastrointestinal symptoms, headache, and back pain. Patients occasionally develop acute renal failure that may require haemodialysis. The virus is transmitted to humans through inhalation of aerosolised rodent faeces. It is reported that in endemic areas the incidence of hantavirus infections among humans is related to the size of the bank vole population and prevalence of the virus. Peaks in the bank vole population occur every 3 to 4 years and may result in an increase in human cases. In Germany, the number of notified hantavirus infections has considerably increased since the beginning of the year 2007. Laboratory diagnosis is based either on detection of nucleic acid or on immunologic methods. In the period from 1 Jan 2007 to 15 Apr 2007, 164 symptomatic hantavirus cases were reported to the Robert Koch-Institute. In the comparable time period of the years 2001 to 2006, the mean number of reported cases was only 38. No hantavirus cases were reported in children younger than 10 years of age. The majority of infections in 2007 (127 or 77 percent) were acquired in Baden-Wuerttemberg. [ProMed]

An algae bloom that sickens birds and mammals is especially virulent this spring. A particularly virulent outbreak of a naturally occurring toxin off the California coast has been linked to the deaths of hundreds of marine mammals and birds in recent weeks. Local beaches have been littered with sick and dead pelicans, sea lions and dolphins. The toxin, domoic acid, is produced by microscopic algae and has become increasingly prevalent in recent years. Scientists suspect the upsurge has been caused by such things as overfishing, destruction of wetlands and pollution, all of which have harmed fisheries and allowed algae to flourish. Although the toxin has not been definitively linked to all the recent deaths, many of the dead animals -- including 5 species of birds -- tested positive for domoic acid poisoning. Domoic acid, which accumulates in shellfish and fish and is then passed on to the birds and animals that eat them, has occurred each spring over the past decade as ocean water warms and algae bloom. In humans, domoic acid poisoning can cause vomiting, nausea, diarrhea, abdominal cramps, headache, dizziness, confusion, disorientation, loss of short-term memory, weakness, seizures, cardiac arrhythmias, coma and possibly death. Humans can be affected after eating contaminated shellfish, but cannot be poisoned simply by swimming in the ocean. [ProMed]

Rabies is a viral infection that causes acute, progressive encephalitis and is considered to be universally fatal. However, during 2004, an unvaccinated Wisconsin patient received a new medical treatment and became the first documented survivor of rabies who had not received preexposure vaccination or postexposure prophylaxis (PEP). To consider use of the Wisconsin rabies treatment protocol, the disease must be diagnosed as early in the course as possible, which requires enhanced clinical awareness of the disease among health-care providers. Although initial signs and symptoms of rabies are nonspecific, a history of an animal bite or travel to a rabies-indigenous country, combined with clinical signs such as paresthesia, hypersalivation, dysphagia, hydrophobia or aerophobia, behavioral changes, or sudden autonomic instability, should lead to a strong suspicion of rabies. Human rabies is preventable with proper wound care and timely, appropriate administration of human rabies immune globulin and rabies vaccine before onset of clinical symptoms. PEP is recommended for all persons who have been bitten or scratched by an animal suspected to have rabies virus and for all persons whose mucous membranes have been exposed to the virus. [ProMed]

As of late Fri 13 Apr 2007, a stomach bug that forced the suspension of a junior badminton tournament in Christchurch has been sourced to a caterer working at the opening dinner. Vomiting and diarrhoea affected more than 90 people at the Australasian under-17 Junior Badminton Championships. Players, coaches and officials were all affected, while the caterer became ill the night after the dinner, within a few hours of preparing a rice salad. The Canterbury District Health Board's community and public health division identified the source as one of the contract workers working in the kitchen during the shared dinner held as part of the tournament's opening ceremonies. Norovirus is spread directly from person to person, but could involve an intermediate vector, such as food. The tournament organising committee's decision to suspend play for 24 hours on 11 April helped bring the outbreak to an end, with no further cases reported since then. Because the worker could not have known it at the time, he has been shedding virus during the preparation of the food, no action was taken against the firm. An unusual feature of this outbreak is its apparent association with a single individual who was excreting sufficient amounts of virus prior to exhibiting signs of infection to be responsible for gross contamination of a single item of food. [ProMed]

Eight new cases of mumps have been confirmed in the Halifax area, bringing the total number to 32. Public health officials said Thursday (5 Apr 2007) they continue to investigate the outbreak, which began in February 2007. Mumps is an infectious disease easily spread through close contact with an infected person, by sneezing, kissing, or even breathing. Symptoms include fever, aches and pains, and swollen or tender salivary glands. Serious cases are rare, but they can lead to inflammation of the brain, meningitis, arthritis, and deafness. Women infected with mumps while pregnant are at a greater risk of miscarriage. In Nova Scotia, children are immunized against mumps, but young adults can still get it. Health officials stated that the outbreak started when someone infected with mumps visited the province. It was advised anyone with the illness to stay away from people for at least 9 days after being diagnosed. This is the 3rd outbreak of mumps to hit Nova Scotia in 2 years. There were 13 reported cases in the spring of 2005 and 19 cases that fall, mostly involving university-age adults. All doctors in Nova Scotia are required by law to report cases of mumps. [ProMed]

Comparison of partial genomic sequences of US and European norovirus strains suggests that the GII.4 strains circulating in the US (Minerva) belong to the same new variant lineage as that identified in Europe (GII.4 2006 (b) variant). Work is ongoing to clarify the relationship between the US and European emergent norovirus variants in greater detail. GII.4 noroviruses have predominated globally in the last 10 years, and several variants have emerged in different parts of the world. However, it remains unclear why these variants are more successful, and which sequence changes are most significant. This complicates definition of a new norovirus strain or variant. Harmonization of methods for identifying new emergent strains, and rapid communication, will help to better understand the evolution and potential differences in virulence associated with the spread of new variant viruses. Norovirus activity in Europe is monitored through the FBVE network (the foodborne viruses in Europe network) which is a cooperation of epidemiologists and virologists in 13 countries who report outbreaks to a central database on the web. From a significant part of the outbreaks, sequence and typing information is available besides epidemiological information. [ProMed]

Utah County health officials issued a warning against raw milk consumption after 7 cases of a potentially severe foodborne illness were linked to products from the same dairy. State investigators are now collecting milk samples at the dairy that will be tested. There have been 15 confirmed cases of the illness and 7 of the cases were traced back to raw milk of one producer. All of the cases have tested positive for Campylobacter, a common bacterial infection that can cause diarrhea, cramping, abdominal pain, and fever that can last about a week. Severe cases can result in a life-threatening infection. Most people fall ill within one to 10 days after exposure. Doctors are required to report the disease, which was first brought to the health department's attention on Mon 19 Mar 2007. Only one person has been hospitalized and several of the sick are from the same family. In 2006, the county recorded 39 cases of the disease, but not all were linked to the consumption of raw food products. Epidemiologists are conducting DNA tests and looking at 16 markers to determine if all 15 cases are linked. This Dairy producer uses about 100 gallons of raw milk daily and is believed to sell that within a 48-hour period. [ProMed]

The officials of a hospital in Madrid, together with spanish Public Health officials are currently investigating the origin of 11 cases of Aspergillus infection in elderly patients, of whom 4 died in the last 2 months. However, it was pointed out that it is very difficult to determine that the aforementioned microorganism was the cause of these deaths, but it was recognized that the fungus contributes to the severity of the condition in patients who are already ill. Aspergillosis is caused by the fungus Aspergillus. This particular fungus is often found in decaying material, such as piles of dead leaves, rotting vegetation, as might be found in compost heaps, and stored commodities such as grain. Aspergillus fumigatus, A. niger, and A. flavus are some of the species that can cause invasive infections, and they are often linked with the so-called "sick building syndrome". Aspergillus growth may be a problem indoors, especially in damp older buildings. Aspergillus can cause invasive lung disease and may form fungal balls in the lungs, particularly if there are previous tuberculosis scars or abscesses, whether old or active. Invasive aspergillosis may appear with clinical symptoms initially similar to the flu, such as fever, aches, chills, headaches, and include shortness of breath, vision difficulties, and bloody sputum. It may cause allergic symptoms similar to asthma conditions, frequently resulting in fever, wheezing, coughing and weight loss. Generally, with proper treatment and a responsive immune system, patients make a gradual recovery. [ProMed]

In February 2007, 3 patients received human immunodeficiency virus (HIV)-positive organs as a result of an error made in the documentation by an employee at the hospital in northern Italy. The person wrote "negative" instead of "positive" after reading the automatically generated print-out report of the results of laboratory analyses, including blood testing for HIV. Three organs (2 kidneys and a liver) were transplanted to 3 distinct recipients. Further blood tests routinely performed in 2 other laboratories that collect and analyze blood samples for tissue storing in tissue banks showed that these organs were taken from an HIV-infected donor. The 3 organ recipients were informed of the possibility of being infected with HIV on the same day that the donor's HIV status was revealed to the transplant organization network. An international task force comprised of leading experts in infectious diseases has since taken responsibility for the treatment of the 3 patients. All 3 organ recipients have since tested positive for HIV, but the public health authorities stated that it would take about one year to be able to make a general commentary on their health condition. The accident, unprecedented in Italy's 40-year history of organ transplantation, was concluded to be entirely due to human error and negligence of procedures and guidelines. [ProMed]

Officials at Barrie's Royal Victoria Hospital are investigating whether any recent patient deaths can be linked to a virulent strain of Clostridium difficile infection. Since January 2007, 43 people at the facility have been diagnosed with the bacterium. The hospital says the bug is aggressive, and the large spike in cases has led them to believe it may be the dangerous "Quebec" strain that killed 2000 people in that province since 2003. 3 new cases of C. difficile infection have been identified, bringing their total number of current cases to 17. Precautions include keeping patients in private rooms, having anyone entering the room wear gloves and gowns as well as having people wash their hands as they enter or leave the room. The ribotype 027 strain is the more virulent strain that has caused more severe disease in North America and Europe. The strain has a deletion in one reading frame which is felt to be a negative regulator of the production of toxins A and B and may be responsible for the recognized enhanced toxin production of the strain. C. difficile control in the health care setting involves not only aggressive infection control measures but also prudent control of the overuse of antimicrobial agents. [ProMed]

US scientists have confirmed the 1st reported case of pig meningitis in a human being in North America. The patient is a previously healthy 59-year-old farmer from upstate New York who was hospitalized with meningitis. The hospital's preliminary tests revealed the presence of Streptococcus suis, a bacterium prevalent in pigs, which can lead to meningitis. It was shown that the strains of Streptococcus suis strains found in both the farmer and the pigs from his farm were identical. Farmers can contract the disease from handling pigs and their faeces. Butchers are also at risk. Washing hands and cooking pork thoroughly can minimize the risk. Streptococcus suis has occasionally affected humans in Europe over the last 20 years. However, people have regularly contracted the disease in Southeast Asia, especially China, where a 2005 outbreak resulted in 204 human cases with 38 deaths, and some 600 pigs killed. In 2005, South America also documented its 1st case from Argentina. All human cases of Streptococcus suis have originated with an animal infecting a human. Public health officials have no fears that the pig bacteria will spread from one human to another. [ProMed]

Spanish researchers from Barcelona University say their country's pig industry is broadly infected by the hepatitis E virus. It is even feared the virus cannot be eradicated. The veterinary faculty at Barcelona's university recently studied to what extent pigs in Spain are infected with the hepatitis E virus. This virus is capable of transferring from pigs to humans and causing severe liver infections. The researchers studied a total of 41 Spanish pig-production sites and used the ELISA test to trace hepatitis E. At 40 sites they found the animals were carrying antibodies against the virus, meaning that the virus was present or had been present at 97.6 percent of the sites. Especially the older sows appeared to be carrying the virus: 60.8 percent of the animals proved to be doing so. In young piglets, up to 6-weeks old, 36.2 percent proved to be infected. In older piglets, the infection ratio was even higher. The outcome of the research is soon to be published. The researchers now say that hepatitis E has most probably become endemic in the Spanish pig industry. [ProMed]

Federal researchers say neurocysticercosis, a brain infection caused by a pork tapeworm, is a growing public health problem in the United States, especially in states bordering Mexico, where the disease is endemic. Neurocysticercosis is the primary cause of epilepsy in endemic areas. Oral-faecal contamination is the standard route of transmission. Neurocysticercosis occurs when the larvae of a pork tapeworm known as Taenia solium enter and infect the brain and spinal cord and form cysts. A person infected with the intestinal tapeworm stage of the infection will shed tapeworm eggs in bowel movements. Tapeworm eggs that are accidentally swallowed by other people can cause infection. These eggs are spread through food, water or surfaces contaminated with faeces. So if you have people cooking for you or handling your food who are tapeworm carriers and don't have good personal hygiene, you will be exposed to the eggs of the tapeworm and become infected by swallowing food they touch. [ProMed]

At least 5 million people in Egypt are infected with the hepatitis C virus (HCV). The annual infection rate is more than 70 000 new cases, of which at least 35 000 would have chronic hepatitis C. Hepatitis C virus is a lethal virus which can cause liver cirrhosis and cancer. Egypt has one of the highest prevalence rates of the virus in the world. An estimated 10-15 percent of the population, some 8-10 million people, are carrying hepatitis C virus antibodies, meaning that they either have or at one time had the virus. Five million of those are actively infected. No vaccine is available for HCV although it can be treated with a combination of drugs if detected early enough. As it may take up to 30 years for a patient to display symptoms of HCV infection or for the disease to become active, the full extent of the problem has only recently become known. The main risk factor is treatment in the past for schistosomiasis. At that time, the Ministry treated people in the villages without using disposable syringes. In addition to cases among the older population, new infections are still being recorded, due to poor medical practices and behavioural factors. Deaths from liver disease are, therefore, expected to increase in Egypt within the next 20 years. [ProMed]

In bovine spongiform encephalopathy (BSE), or mad cow disease, the brain is destroyed by spongiform plaques composed of misfolded prion protein. Cows that lacked the prion protein should be resistant to the disease, although it’s unclear whether loss of the normal form of the prion protein would be detrimental to health. Kuroiwa and colleagues have generated cloned cows in which both alleles of the prion protein are knocked out. A thorough health assessment of the animalsat ages up to 20 months reveals only slight differences from wild-type animals. An initial in vitro assay suggests that the animals will indeed be resistant to BSE. The assay measures propagation of misfolded prion protein in brain samples inoculated with brain tissue from BSE-positive animals. Only the prion-free samples block propagation, whereas the wild-type samples do not. In vivo tests of BSE resistance are underway. [Richt et al. 2007, Nature Biotechnology, 25 (1), 132-138]

On 13 Sep 2006, the Georgia Public Health Laboratory reported that it had received 8 Salmonella enterica serotype Montevideo isolates from South Georgia Medical Center between 28 Aug to 5 Sep 2006. On average, this region reports approximately 5 cases per year of Salmonella Montevideo infection. Due to the drastic increase in cases, an investigation was initiated. A questionnaire was developed to evaluate sources of possible exposure including animal contact, water sources, grocery stores, restaurants and specific food. Of the 72 cases, 19 patients were hospitalized and no deaths were reported. Following interviews of 52 of the 72 patients, the investigation revealed that a common fast food restaurant in Valdosta was the source of the outbreak strain. A Environmental Health specialist inspected the restaurant and found no major violations. Investigators found that the restaurant had been closed for remodeling and reopened on 18 Aug 2006, and was utilizing a brand new meat slicer, which was tested positive for Salmonella. All food items that may have been in contact with the slicer were thrown away and additional food items were collected for testing. Though the new slicer had been cleaned and sanitized, the organism was still detected on the blade cover. According to restaurant staff, the equipment was cleaned several times a day and was disassembled and sanitized each night. The cause of the problem was determined to be a faulty piece on the equipment, which according to the manufacturer, should have been sealed with silicone. No exposure to the outbreak strain was identified after the slicer was removed from the restaurant. [ProMed]

Valley fever is at epidemic levels in Arizona, afflicting 56 percent more people in 2006 than in 2005. A record 5493 Arizonans were diagnosed with the disease, but as in years past, health officials say thousands of other cases went unreported. Health officials are unsure what caused the increase but point to weather changes as a possible culprit. The wet winter of 2005, followed by many dry months in 2006, was a probable one-2 punch that has wreaked havoc on the lungs and joints of many residents. Valley fever is an infection in the lungs caused by a fungus, Coccidioides immitis, found in soils primarily in southwestern states. The fungus flourishes in rain, and then is stirred into the air in dry conditions. About 60 percent of the people who inhale the micron-sized spore and contract the disease have mild symptoms. The patients may suffer extreme pain in joints and difficulty in breathing, and sometimes, the infection migrates to the brain. 28 Arizonans died of valley fever in 2005; the count of deaths in 2006 was unavailable. Antibiotics don't work on valley fever. The most common treatment is anti-fungal medication. [ProMed]

An epidemic of viral gastroenteritis has spread to at least 29 health-care institutions across Montreal, making it the worst of its kind in a decade, public-health officials say. Both patients and staff are falling ill, and elective surgery is being cancelled to free beds at some hospitals. Experts warn the epidemic -- which is also ripping through neighbourhoods outside hospitals -- hasn't peaked yet. Experts suspect that a new, more contagious strain of the Norovirus has emerged, causing the epidemic. Until now, the outbreaks have had little impact on hospital operations. In on hospital a total of 12 patients and 8 staff have developed viral gastroenteritis, an inflammatory illness that causes fever, vomiting and diarrhea and lasts 24 to 72 hours. Less than 3 weeks ago, six Montreal hospitals were hit with outbreaks of gastroenteritis. By yesterday, that number had jumped to 13. Sixteen nursing homes are grappling with gastro outbreaks, up from 10 in December 2006. Officials explained that the hospital outbreaks probably originated in the community. The virus is transmitted via the fecal-oral route, and people visiting hospitals have unwittingly passed it on to patients. [ProMed]

There could be a fresh outbreak of a potentially deadly disease in the Northern Territory of Australia. One man has died from melioidosis in 2006 and there have been 27 further cases. Melioidosis is caused by the bacterium Burkholderia pseudomallei found in some tropical soils. The bacterium lives deeper in the soil during the dry season but is brought to the surface after heavy rainfalls. Small cuts and sores on the hands and feet provide a route of infection, but are largely avoidable if simple protective measures are followed. Melioidosis can be fatal and requires prompt and aggressive antibiotic treatment. The disease can cause many symptoms, including skin ulcers or sores that fail to heal, abscesses, unexplained fevers, weight loss, fatigue, cough, shortness of breath, abdominal pain, urinary symptoms and, occasionally, neurological problems such as headache and confusion. People most at risk of developing melioidosis have an underlying condition that impairs the immune system including diabetes, heavy alcohol intake, cancer, advanced age, and kidney or lung disease. [ProMed]