Around 20 000 people in Stockholm stayed home on 23 Dec 2008 with sickness and vomiting. An unusually significant outbreak of norovirus disease has already affected about 10 care units. Now, hospital staff fear that the number of beds will not be enough this Christmas. Health officials urge people who have norovirus illness to stay at home and instead make contact with the medical information service by telephone. This aggressive virus has, during the last couple of weeks, spread to several hospitals in Stockholm County. At Karolinska University Hospital in Solna, 7 care units have been affected, and 3 have had to be closed. Since the weekend, 2 units at Stockholm South General Hospital and one at Sodertalje Hospital have been closed. The epidemic norovirus disease arrived unusually early 2008, and lab tests have shown that this year's epidemic is unusually widespread. On 22 Dec 2008, head doctors at Stockholm's hospitals held a telephone conference about the situation with regard to the availability of hospital beds during the holiday period. Capacity over the holidays is reduced but it was assured that emergency medical care would work as usual. However, the lack of hospital beds may make it necessary to move patients between the hospitals. [ProMed]

The first known Ebola infections in pigs may help researchers answer a question that's confounded them since the deadly virus was first discovered more than 30 years ago: where it comes from. International scientists will converge on farms in the Philippines to help local authorities discover how pigs contracted Ebola-Reston, a monkey-killing strain not known to harm people. The findings may help identify which species carries the virus in the wild without getting sick, enabling the pathogen to persist undetected in the environment. Knowing the natural host of Ebola will help people better protect themselves against one of the most-feared infectious diseases. African strains usually kill 50 per cent to 90 per cent of those infected through lethal bleeding and organ failure. Since the 1970s, scientists, veterinarians, microbiologists, and physicians have been looking at thousands of species to see if they can find this elusive reservoir. Ebola was first recognized in 1976 after an outbreak near the Ebola River in the Democratic Republic of Congo, formerly known as Zaire. Thirteen years later, Ebola-Reston was discovered in the United States in association with an outbreak of viral hemorrhagic fever among monkeys imported from the Philippines to Reston, Virginia. The virus was found among Philippine monkeys in the US again in 1990 and 1996, and in Italy in 1992. In October 2008, for the first time, the strain was found in Philippine pigs. The infected pigs were traced to 2 commercial and 2 backyard farms in 3 provinces north of Manila. A 2005 study published in the journal Nature found evidence of symptomless infection by Ebola in 3 species of fruit bat in West Africa, indicating that these animals may be acting as a reservoir for the virus. [ProMed]

A new species of bacterium that causes leprosy has been identified through intensive genetic analysis of a pair of lethal infections, a research team reports in the December 2008 issue of the American Journal of Clinical Pathology. All cases of leprosy, an ancient disease that still maims and kills in the developing world, previously had been thought to be caused by a single species of bacterium. There are hundreds of thousands of new cases of leprosy worldwide each year, but the disease is rare in the United States, with 100-200 new cases annually, mostly among immigrants. Leprosy initially attacks skin and nerve cells. It can be successfully treated with antibiotics in its early and intermediate stages. In 2002 the researchers developed a way to identify unusual bacteria by analyzing small but significant differences in the 16S ribosomal RNA gene. Across a group of bacteria called mycobacteria, the 16S rRNA gene is 93 to 100 percent identical. There are 110 species of mycobacteria, with those causing tuberculosis and leprosy the best known. The lethal bacterium's 16S rRNA gene sequence differed by 2.1 percent. In all previously studied _M. leprae_ strains, no variation in the 16S rRNA gene had been noted at all. Analysis of the other 5 genes turned up more differences. The researchers named the new species Mycobacterium lepromatosis and have since confirmed it as the cause of 2 lethal cases in Singapore. One of the puzzles of leprosy is that _M. leprae_ strains collected worldwide are virtually identical, while the clinical features of the disease and its severity vary greatly both geographically and from person to person. Evidence suggests that individual host immune factors play the key role in determining how the disease progresses. [ProMed]

The Oklahoma State Department of Health announced on November 29 that the Country Cottage restaurant in Locust Grove, Oklahoma has undergone a rigorous inspection process and has been cleared to resume normal business operations. The restaurant had been closed since August 25 after being identified as the source of a large foodborne outbreak resulting in severe diarrheal illness. The restaurant passed an inspection conducted by state and local health inspectors on November 12. The inspection included environmental swabbing of 35 locations within the restaurant, and no _E. coli_ O111 contamination was identified. The outbreak was linked in August 2008 to contamination by _E. coli_ O111, a rare toxin-producing bacterium not normally associated with a foodborne outbreak of the magnitude experienced in Oklahoma. While no single food item was found to be the source of illness at the restaurant, the Oklahoma State Department of Health believes several different foods became contaminated with the _E. coli_ O111 bacteria, leading to exposure of restaurant customers. Health officials note that toxin-producing _E. coli_ are notoriously difficult to culture from food or the environment. This provided a challenge throughout the investigation. Despite testing numerous surfaces within the restaurant, various food items, stool specimens from food handlers, and well water specimens, no specimen yielded the _E. coli_ O111 bacteria. A total of 341 outbreak-related cases were reported; 56 were children less than 18 years of age. 72 persons were hospitalized; one person died. [ProMed]

Rotavirus infection is the leading cause of severe acute diarrhoea among young children worldwide. An estimated 527 000 children aged less than 5 years die from rotavirus diarrhoea each year, with greater than 85 percent of these deaths occurring in low-income countries of Africa and Asia. Two licensed rotavirus vaccines have shown efficacy of 85-98 percent against severe rotavirus diarrhoea in trials conducted in the Americas and Europe, and they have been introduced into routine immunization programs in 11 countries in these regions and in Australia. Of the 4936 rotavirus-positive specimens from all regions for which strains were characterized, 325 were from the African Region, 388 specimens were from the Region of the Americas, 323 were from the European Region, 1290 were from the Eastern Mediterranean Region, and 2610 were from the Southeast Asian and the Western Pacific regions. The presented data demonstrate the substantial burden of rotavirus diarrhoea worldwide and highlight the potential health impact of vaccination. [ProMed]

During 2008, Michigan, including the city of Flint, has been experiencing a significant syphilis outbreak. The number of reported cases has surpassed 100, representing the largest number of syphilis cases in this area in the last 30 years. The Michigan Department of Community Health (MDCH) has been working closely with local officials to intervene in the spread of infection. Efforts to conduct rapid surveillance and case investigation, along with targeted screening and education, have resulted in effective management of newly reported cases. Recently, 5 cases of congenital syphilis have been identified, and are being closely managed. This occurs when a woman is infected during pregnancy and is not adequately treated. As a result, local officials immediately distributed enhanced CDC and MDCH guidelines for syphilis screening during pregnancy and at delivery. Syphilis in Alberta is no longer confined to high-risk groups such as sex trade workers and their customers. It now infects teens as young as 15 and seniors as old as 86, as well as college students and married couples. The number of reported cases of syphilis province-wide has continued to grow. In 2006, there were 197 confirmed cases reported. In 2007, according to Alberta Health, there were 250. Between January and June 2008, there were another 92 confirmed cases. In 2002, by contrast, there were only 17 cases reported for the whole year. Meanwhile, between 2005 and 2007, 14 babies in Alberta were born with congenital syphilis and 5 of them died. [ProMed]

Holland America's Zuiderdam has been hit by an unusually large outbreak of what appears to be norovirus infection, the flu-like stomach bug that causes diarrhoea and vomiting. More than 12% of passengers on board the vessel (224 out of 1820) came down with the illness during a 17 night voyage that ended on Monday Nov 10, 2008. According to the Centers for Disease Control and Prevention (CDC) in Atlanta, it's the 1st time this year that an outbreak has surpassed 10 per cent of passengers on a ship, a rare occurrence. CDC says Holland America has sent additional staff to the Zuiderdam to help clean and disinfect it. The line also delayed the ship's departure on Monday Nov 10 to allow for extra cleaning. CDC officials boarded the ship and are now testing stool samples to determine whether the outbreak is indeed norovirus. Holland America has struggled with gastrointestinal illness 2008 on its ships, with 6 outbreaks documented by CDC. Only 2 other lines have had more than one outbreak: Norwegian Cruise Line (4) and Princess Cruises (2). Holland America also led the industry in gastrointestinal illnesses in 2007 with 5 outbreaks and in 2006 with 7 outbreaks, according to CDC statistics. Sometimes called the "24-hour flu", norovirus is the commonest cause of stomach illness in the United States, accounting for around half of all cases. It breaks out regularly in schools, nursing homes, hospitals, offices, and other places where people congregate. [ProMed]

On 21 Oct 2008, the national reference laboratory for rabies in Italy confirmed a case of rabies in a fox in the Friuli-Venezia Giulia Region of north-eastern Italy. This fox was euthanized on 10 Oct 2008 after it attacked a person who was out walking in a forest in Resia district, close to the borders with Austria and Slovenia. The results were positive for 'classical' rabies virus by PCR testing. Italy has been rabies free since 1995, although rabies has been found in foxes in this area previously, most recently in 1992. In previous cases foxes appear to have crossed the border from Slovenia and Austria, although the risk of rabies in the northern and eastern border regions of Italy has long been recognised. Local routine preventive policies in Italy reflect the ongoing risk across the borders, and include compulsory vaccination of domestic animals and livestock which graze outside in those districts close to the border. Local controls put in place in response to the present case include vaccination and restriction of movement of dogs in the Chiusaforte, Resiutta, Resia, and Venzone districts, enhanced surveillance of wildlife, and oral vaccination of wild foxes. This area is alpine and forested and not a major tourist destination. However the following advice has been given for travellers from the UK: Those who are travelling to the northern and eastern border regions of Italy should avoid contact with wild and domestic animals. However, if they are licked, scratched or bitten by a wild or domestic animal they should wash the area thoroughly with soap and water and seek urgent medical advice either in Italy, or on their return home. [ProMed]

The Health Protection Agency has been responding to an isolated case of inhalation anthrax. The patient concerned is being treated in intensive care at a London hospital. Anthrax is a disease caused by spores that live in the environment. It can cause a skin infection (cutaneous anthrax) or as in this case, inhalation anthrax, when the spores are inhaled into the lungs. Inhalation anthrax is very rare and is not passed from person to person. According to an expert the patient made and then played animal skin drums for a living. It was through making these drums that exposure to and inhalation of anthrax spores on an imported animal hide has taken place. The risk to others who play these drums is very low. It is the process of removing the animal hairs during the making of drums that can put people at risk. It is important that anyone who makes drums from imported animal hides is aware of this risk and knows about the symptoms of anthrax. Skin (cutaneous) anthrax causes a lesion which will develop from an inflamed pimple into an ulcer with a black centre and extensive swelling. The infection usually responds well to early treatment with antibiotics. Inhalation anthrax begins with flu-like symptoms followed by severe breathing difficulties and leads to blood poisoning. Anthrax infections associated with the handling of untanned animal hides are now extremely rare in the UK. [ProMed]

A viral outbreak on Prince of Wales Island killed one woman and forced 7 others to be medically evacuated to a health clinic. Health officials said that there are 34 suspected or confirmed cases of adenovirus 14 infection, an air and liquid borne virus commonly associated with winter respiratory illnesses, though it is thought that there are more unconfirmed cases. In general, Adenoviruses are fairly common and can cause a bunch of symptoms including cold-like symptoms and lower respiratory illnesses like bronchitis and pneumonia. Usually, the illness is fairly mild. Most people will be uncomfortable for a week or 2 but will go right through it. The woman who died suffered from chronic obstructive lung disease and that the 7 people hospitalized all had pre-existing lung conditions. The best way to prevent spreading the virus is for people to wash their hands with warm, soapy water for at least 20 seconds and to avoid contact with those who are sick. The virus is most commonly spread through coughing and sneezing and can live on surfaces for a short period of time. Prior to the outbreak in Prince of Wales, there had been a few isolated cases of adenovirus 14 infection in Alaska. But the state had never seen a cluster of adenovirus 14 cases before. In the past 2 years, there have been outbreaks of the virus in Oregon, Washington and Texas. As with other viruses, there is a range in the severity of the illness an individual may experience. Those suffering from other health problems should contact their health care providers immediately if they experience any of the adenovirus symptoms. [ProMed]

A British woman has died from a rare disease after being scratched by a wild rat. The rat had been trapped in a bird feeder in her garden and the 56-year-old woman was injured while trying to free it. The woman was not wearing protective gloves and suffered scratches and cuts to her fingers as she struggled to free the rodent from the wire feeding device. Within days she developed flu-like symptoms and 48 hours later died from the rare Weil's disease, which is a severe form of leptospirosis, caused by bacteria found in the urine of wild animals. As a rule leptospirosis victims experience severe headaches and flu-like symptoms but the severe form, which is Weil's disease, causes jaundice and liver damage, and can be fatal, but it usually only affects 10 percent of leptospirosis victims. It is a bacterial disease that affects humans and a wide range of animals, including mammals, birds, amphibians, and reptiles but is relatively rare in humans. The infection is usually transmitted to humans when fresh water that has been contaminated by animal urine comes into contact with unhealed breaks in the skin, eyes, or with the mucous membranes. It is most commonly carried by rats, mice, and voles but a wide range of other mammals including dogs, deer, rabbits, hedgehogs, cows, sheep, and even certain marine mammals are also able to carry and transmit the disease; dogs may pick it up by licking the urine of an infected animal from grass or soil, or drinking from an infected puddle. [ProMed]

Climate change, habitat destruction, and disease threaten to wipe out over half of Europe's frog, toad, and newt species by the middle of the century, the Zoological Society of London warned on 25 Sep 2008. In a speech at London Zoo, ZSL a researcher said a recent study had shown that warmer winters in southern England had affected the hibernation of toads, forcing them to use more of their energy reserves and resulting in them emerging from winter in poor health. He said that survival rates among female toads were dropping. The number one threat has been and will be habitat loss, and there are also threats from pollution and introduction of new species. There's now evidence coming out that climate change is having or will have a strong impact, while the other thing that is a problem is infectious disease. Overall there are over 80 species of amphibian in Europe, a large proportion distributed around the Mediterranean basin. As conditions change many specialised amphibian species, or those who cannot move to other habitats for example because they live on islands, would be unable to adapt. A recent international global assessment found that over 30 percent of amphibian species are globally threatened, a much higher percentage than for either birds or mammals, and that in some regions, waves of extinctions have occurred over the past 3 decades due to disease, habitat loss and over-harvesting for the food and pet trade. [ProMed]

The tally of people who got sick after eating food from a New York restaurant earlier in September 2008 rose to 236 by September 23, 2008, but public health officials say the outbreak is levelling off. 3 of the people who got sick were hospitalized, but they have recovered and been discharged. Lab tests have identified a germ, Campylobacter, which could be a major cause of the outbreak. Evidence of that bacterium was found in 6 of 7 stool samples collected from people who got sick. The germ is one of the most common causes of diarrhoea, affecting more than 2.4 million Americans every year. The bacterium is most commonly found in poultry, but 10 to 15 percent of clams and oysters can be contaminated with it. People usually become infected by eating undercooked chicken, beef, or seafood. Public health officials suspect raw mahogany clams caused the outbreak of gastrointestinal illness because the vast majority of people who got sick said they ate them. Raw bivalve mollusc ingestion has long been recognized to be a source of outbreaks of bacterial and viral enteric diseases. Typical pathogens involved are the typhoid fever bacillus, hepatitis A virus, Norwalk virus, and both _cholera_ and parahaemolyticus species of Vibrio. The risk of contamination of shellfish in coastal waters is increased after periods of heavy rain and flooding and is especially high if shellfish are harvested from uncertified, sewage-contaminated waters. [ProMed]

An outbreak of hepatitis A has affected the Czech Republic since July 2008. Although the epicenter is still Prague, the disease has already spread to Central Bohemia, and some cases were also reported from North Moravia. Approximately 130 people developed symptoms of hepatitis A in the Czech Republic in 2007. 2008 approximately 440 cases have been identified and their number is increasing. The worst situation is seen in Prague, where some 260 infected individuals have been reported. The mayor of Prague has taken steps to halt the spread of the disease. In early September 2008, a mass vaccination of drug addicts and homeless people was conducted -- that is, the groups at highest risk. Recently there have been approximately 40 000 Euros earmarked for the disinfection of primary schools and public transportation. The number of people infected will continue to grow for a month, at a minimum, and will culminate in late October or early November 2008. Hepatitis A is transmitted through contact with infected urine, blood and sexual contact. Although hepatitis A is not as dangerous as hepatitis B and C, it has a complicated treatment and spreads easily. To prevent transmission, experts recommend washing hands frequently and avoid sharing hygiene and personal use products. Once contracted, hepatitis A routinely causes tiredness and discomfort: patients are required by their doctor to adhere to a strict diet and to limit physical activities until the disease has run its course and patients' health begins to improve, a process which can take months. [ProMed]

Officials could move to close Tasmania's 330 million wild abalone fishery -- the largest in the world -- after a devastating virus was detected in specimens at a processing plant. The abalone viral ganglioneuritis, which has a high mortality rate, has already devastated wild abalone fisheries off Victoria. The discovery of infected abalone at a southern Tasmanian seafood processing plant has officials scrambling to determine if the virus is present in wild populations off the state's southern coast. The virus has been spreading slowly through waters off the Victorian coast, decimating abalone populations there since 2005, and strict bio-security measures are in place to isolate the Tasmanian fishery. The annual landed catch is valued at approx. USD 87.6 million, and its export worth is multiplied by a factor of 3, to USD 263.2 million. Abalone viral ganglioneuritis is a highly virulent herpes-like virus, undescribed in Australia before 2005, and still not well characterized. The virus affects the nervous tissue of abalone and rapidly causes death. The virus can be spread through direct contact, through the water column without contact, and in mucus that infected abalone produce before dying. The virus is thought to survive only a short time when out of a moist environment. [ProMed]

There is rising concern about resistance to oseltamivir (Tamiflu) in influenza A/H1N1 viruses. A Dutch team this week reported the death of a leukemia patient who was infected with an H1N1 virus that was resistant to the antiviral drug. The Dutch authors said the case suggests that Tamiflu-resistant H1N1 viruses can cause disease, despite evidence from animal studies that the resistance mutation makes the viruses much less dangerous. The publication said the man's virus was also resistant to amantadine, an older antiviral drug. On 20 Aug 2008, the World Health Organization (WHO) reported that 31 percent of influenza A/H1N1 isolates from 16 countries that conducted recent tests carried the H274Y mutation, which confers resistance to Tamiflu. Resistance levels ranged from 100 percent (10 of 10 isolates) in Australia to 13 percent (4 of 32 isolates) in Chile. Emergence of the oseltamivir-resistant H1N1 virus was first noted in Norway in January, and since then researchers have found the virus in 35 countries, including the United States and Canada. The spread of the oseltamivir-resistant H1N1 virus has puzzled experts because it has not been clearly linked to treatment with the drug. In an editorial published by Eurosurveillance in January 2008, authorities said resistant viruses with the H274Y mutation had been seen in previous flu seasons but were rare and did not spread easily. But the more recent H1N1 isolates with the mutation were "fitter" and were spreading in the community, they wrote. [ProMed]

A veterinary nurse and her dog have contracted bovine tuberculosis (TB), raising fears that the high level of disease in some parts of the country could spread to more humans and pets. The woman, from Cornwall, has been treated for the respiratory infection. Her daughter has also been tested for the disease and has received medication. Information setting out the most likely scenario of whether the nurse was infected by the dog, or vice-versa, is expected to be published soon. It is believed that the woman was involved in testing cattle for bovine TB. It is extremely rare for people to contract the disease, but there is a greater risk for farmers and vets who work closely with infected animals. In 2007 there were 4137 outbreaks, a record in modern times, and 28 175 cattle were slaughtered as a result. Disease can be passed from a cat or dog to humans through open wounds or abscesses, coughs, and sneezes. According to the Health Protection Agency, in 2006 there were 33 cases of bovine TB in humans reported in Britain. Health officials said that the disease had been found in 2 dogs and 11 cats so far in 2008. [ProMed]

A new Chinese study has reported a dramatic spike in rabies infections. The research shows that in some provinces of China the number of human rabies cases has jumped since the new millennium. In China, human rabies was largely under control during the years 1990-1996, via nation-wide rabies vaccination programmes. Since the end of the century, however, cases of human rabies have jumped high enough to trigger a warning sign for control and prevention. Rabies, an infection of the nervous system transmitted by animal bites, causes over 50 000 deaths each year around the world. During recent years, most of the research on control of rabies has concentrated on the development of post-exposure treatment. For this study data from 22 527 human rabies cases were obtained from a surveillance database from the Ministry of Health of China. Between 1990 and 1996 only 159 cases of rabies were reported, but this figure had leapt to 3279 cases in 2006. The authors found that rabies was most frequently encountered in the south western and southern territories of China, especially in highly populated areas. Most of the patients were children or teenagers, and most contracted the disease after being bitten by a dog, usually on the head and neck. The authors describe that in the worst-affected province, Guangdong, 62.5 percent of patients did not receive proper treatment on their wounds, 92.5 percent did not receive adequate post-exposure vaccination and 91.25 percent did not receive any anti-rabies immunoglobulin. Rabies is a vaccine-preventable disease, and it is still a significant public health problem in many countries of Asia and Africa. [ProMed]

A horse in Florida has contracted the rare parasitic disease equine piroplasmosis. Blood and tissue testing of a 7-year-old gelding that had been euthanized after a 3-week illness confirmed the presence of the disease in the animal. State officials immediately quarantined the Manatee County premises in which the horse resided, as well as 2 adjacent properties containing horses pending a determination of their status. Equine piroplasmosis is a blood borne parasitic disease primarily transmitted to horses by ticks or contaminated needles. The disease was eradicated from Florida in the 1980s, and the tick species believed to transmit the disease in other countries have not been identified in Florida in many years. This disease is not directly contagious from one horse to another but requires direct blood transfer. Human infection with equine piroplasmosis is extremely rare. Acutely affected horses can have depression, fever, anemia (decreased red blood cells), jaundiced (yellow) mucous membranes, and low platelet counts. In its milder form, the disease causes horses to appear weak and show lack of appetite. Some horses become chronic carriers of the disease. Equine piroplasmosis results from infection by the protozoa Babesia caballi or Babesia equi. Equine piroplasmosis can be diagnosed by identification of the organisms in Giemsa stained blood or organ smears. Disinfectants and sanitation are not generally effective against the spread of tick-borne infections. [ProMed]

Q fever is a worldwide zoonosis caused by the bacterium Coxiella burnetii which is common in a wide range of wild and domestic animals. Cattle and small ruminants, in particular sheep and goats, have been associated with large human outbreaks. Humans become infected primarily by inhaling aerosols that are contaminated by C. burnetii. Most infections remain asymptomatic but in about 40 percent lead to a febrile disease, pneumonia and/or hepatitis. Chronic infections, mainly endocarditis, are observed in 3 to 5 percent of cases, with an increased risk for pregnant women and persons with heart valve disorders or impaired immunity. Q fever in humans is a notifiable disease in The Netherlands, where now a 2nd large outbreak of Q fever is reported that started in the 1st half of 2008. Since the spring of 2008, a marked increase in notified Q fever cases has been observed with a total of 677 cases notified up to 24 Jul 2008. This is by far the largest community outbreak of Q fever ever reported in the literature. Other European countries such as Denmark and Germany have also reported a changing epidemiology of Q fever and an increase in cases in 2008 but not to the same extent as in The Netherlands. The sharp increase in cases in the spring and the widespread pattern of this community outbreak with more than 600 cases reported in 2008 is alarming. To date there has been no conclusive evidence as for the source(s) of the epidemic. Antibodies against the bacterium Coxiella burnetii, are found throughout the country in sheep and goats. [ProMed]

As of 25 Jul 2008, 32 100 people have applied for medical treatment for tick bite in Kemerovo Oblast (Russia). This is 18.5 percent more than the number of people who applied for treatment during the same period last year. Among those, there are 6148 children, whereas by comparison last year there were 5628 children in total. 99.4 percent of those who sought medical assistance received appropriate emergency treatment. 758 people have been admitted to hospital on suspicion of tick-borne encephalitis virus infection. This number is 30.7 percent greater than in 2007. 67 people have been registered with a confirmed diagnosis of tick-borne encephalitis virus infection. By comparison, during the whole course of 2007, only 64 cases were diagnosed. So far, there has been one fatality, an 8-year-old child. Altogether, 62 600 people have been vaccinated against tick-borne encephalitis. 25 800 ampoules of immunoglobulin are available for urgent treatment. Tick-borne encephalitis, also known as Central European encephalitis or Russian spring-summer encephalitis is a Flavivirus infection of the central nervous system. The 2 most important genotypes of tick-borne encephalitis virus are the European and Far Eastern genotypes, transmitted by the hard ticks Ixodes ricinus and I. persulcatus, respectively. Human infections are acquired through bites of infected ticks or, rarely, by ingesting unpasteurized dairy products primarily from infected goats, sheep or cows. [ProMed]

A dead rabbit that tested positive for plague was found in Pueblo West, Colorado. On July 25, the County Health Department crews dusted prairie dog holes in north Pueblo West to kill fleas that can carry plague. Plague was confirmed following tests on a dead rabbit found by a resident recently. Plague is relatively common in rabbits and rodents. It can infect humans and domestic animals if they are bitten by a flea that has had contact with an infected mouse, rabbit, prairie dog or other wild animal. Pets that spend time outdoors, especially in rural areas, should be treated regularly for fleas and should be kept on a leash in areas where rodents and other potential plague carriers are known to live. Homeowners should clear their properties of plant materials, lumber or debris that provide attractive cover for rabbits, mice and rats. Known rodent habitats should be treated with flea powder or other insecticides. When spending time in rural areas likely to harbour rabbits, prairie dogs and rodents, wearing insect repellent and long pants, tucked into socks, can prevent flea bites. Humans should avoid all contact with wild animals and rodents that are known to be potential carriers of plague, and should never handle a sick or dead animal. Signs of plague infection include a sudden fever, fatigue and general malaise. The disease is treatable in humans and animals but is more easily treated if caught early. [ProMed]

The season's 1st 2 cases of the mosquito borne illness La Crosse encephalitis have been confirmed in 2 children in western North Carolina. Both children are recovering after contracting the virus. La Crosse is the most common mosquito borne virus affecting North Carolinians and is largely confined to western North Carolina. There were 10 reported cases of the virus in North Carolina in 2007. La Crosse symptoms occur from a few days to a couple of weeks after being bitten by an infected mosquito. These symptoms include fever, headache, nausea, and vomiting. In more severe cases, convulsions, tremors, and coma can occur. Children under 16 years of age and the elderly are the most susceptible to the disease. The disease is rarely fatal, but a child in North Carolina did die as a result of infection in 2001. Public health officials are telling people to take measures to make their homes less mosquito-friendly, including i) removing any containers that can hold water, ii) keeping gutters clean and in good repair, iii) repairing leaky faucets and changing the water in bird baths and pet bowls at least twice a week and iv) checking window and door screens. People can also protect their families from mosquito bites by using mosquito repellants, wearing light-coloured long pants and long-sleeved shirts, and reducing time spent outdoors in the early morning and early evening when mosquitoes are most active. No vaccine against LACV is available. [ProMed]

The largest measles out break in the United States in more than a decade has now spread to a total of 15 states. Cases 1st began popping up in May 2008, when more than 70 people in a dozen states came down with the illness. According to federal health officials, most of those who contracted measles were not vaccinated against the highly contagious virus. The Centers for Disease Control and Prevention (CDC) said in a statement that the outbreak has been traced to travellers who became sick overseas, returned home, and then spread it to others. Health officials are warning against the trend of parents not immunizing their children, saying that failing to do so could have devastating effects on the health of the country and world as a whole. According to experts, outbreaks and epidemics will continue throughout the developed world. Just last month (June 2008), British health officials said that measles had become an epidemic there for the 1st time since the mid-1990's due to parents not immunizing their children. Measles is a highly contagious disease caused by a virus that typically grows in cells lining the back of the throat and lungs. Symptoms include: coughing, runny nose, high fever, and a rash that usually starts on the face and spreads to the rest of the body. One in 5 measles suffers may experience a more severe illness which could include ear infections, diarrhoea, pneumonia, chronic neurological deficits, encephalitis, and even death. In poorer countries, measles remains a leading cause of death amongst children. This outbreak comes just 8 years after the virus was declared virtually dead in the US, thanks to a vaccination program which began in the 1960s. [ProMed]

6 New Jersey residents became ill recently after ingesting a small amount of torch oil which was mistaken for apple juice. One individual, an elderly woman, died 2 days after mistaking the lamp oil for apple juice. Earlier in the month an 8-year-old girl was hospitalized in critical condition and was placed on a ventilator also after mistaking the torch oil for apple juice. The child survived her illness but will live the rest of her life with damaged lungs. When accidentally taken by mouth, such lamp oils can enter the lungs causing pneumonia and death. Jugs containing lamp oils must be stored in a locked cabinet away from storage of food and drinks. It is unfortunate that the container and the colour of the oil so closely resemble that of apple juice. Most of these oils contain paraffins and petroleum distillates. Even the smallest amounts of the paraffin oils when ingested find their way into the lungs and set up severe chemical reactions resulting usually in severely damaged lungs. Low viscosity, low surface tension and low volatility are features of lamp oils contributing to chemical pneumonia. Toxicity from hydrocarbon ingestion can affect many different organs, but the lungs are the most commonly affected. Once ingestion has occurred, the induction of vomiting can exacerbate the condition and result in more of the paraffin and petroleum distillates reaching the lungs. This is a medical emergency and the container as well as the patient should be transported to an emergency room. The container hopefully retains the label identifying the various contents and providing the physician with a method of recommended treatment. [ProMed]

Since April 2008, 851 persons infected with Salmonella enterica serotype Saintpaul with the same genetic fingerprint have been identified in 36 US states (see also b-safe News of 05.06.08). These were identified because clinical laboratories in all states send strains to their State public health laboratory for characterization. Among the 581 persons with information available, illnesses began between 10 Apr 2008 and 20 Jun 2008, including 173 who became ill on 1 Jun 2008 or later. At least 105 persons were hospitalized. No deaths have been officially attributed to this outbreak. Now 41 more cases of the outbreak strain have been added to the list with no more states involved so far. More importantly, the date of onset of illness continues to become later, now 20 Jun 2008, a full 18 days after the 1st CDC report. As more and more cases continue to occur, interest is growing towards alternative or additional sources of _S. Saintpaul. As well, no tomatoes yielding the outbreak strain, have been found. Health officials say that 3 weeks after the FDA warned consumers to avoid certain types of tomatoes linked to the outbreak, people are still falling ill. The CDC launched a new round of interviews by end of June. Food safety experts caution that outbreaks are very difficult to trace back to their source, especially tomatoes, which are often mixed and matched at the packing plant to get uniform sizes and ripeness. [ProMed]

The patients of an Edmonton dentist who quit his practice in February 2008 after testing positive for hepatitis B will now be contacted and told about the situation. Health authorities started calling patients of the dentist beginning in mid of June. Health officials said that the chance the disease was transmitted to any of the dentist's 1400 patients is very low; somewhere between one in 10 000 and one in 100 000. Although the chances are small, officials decided to inform the public upfront rather then having it be found out later. Health officials said the 37-year-old dentist has been co-operative and gave permission for his name to be released so that his current and past patients can be tested as a precaution. There are no current rules forcing dentists to get tested for infectious diseases, but if they find out they have one it must be reported. Health officials said children above 10 and adults up to the age around 28 are likely immune to hepatitis B as a result of elementary school vaccinations. Hepatitis B virus (HBV) is a serious disease caused by a virus that attacks the liver. HBV can cause lifelong infection, cirrhosis of the liver, liver cancer, liver failure, and death. HBV is transmitted through activities that involve percutaneous or mucosal contact with infectious blood or body fluids. HBV is not spread through food or water, sharing eating utensils, breastfeeding, hugging, kissing, hand contact, coughing, or sneezing. [ProMed]

New York City health officials are investigating a laboratory-confirmed case of pneumonic tularaemia in a Brooklyn resident. The patient presented to the hospital in early June 2008 with a one-week history of fever, headache, sweats, left sided chest pain, and shortness of breath. Pleural fluid culture yielded small, slow-growing Gram negative bacteria that were referred a laboratory for identification. The organism was confirmed as Francisella tularensis. The patient reported camping in Gateway National Recreation Area in Brooklyn 4 days prior to the onset of his symptoms. Since 1965, there have been 15 other reported cases, with the last case occurring in 2007 in a Staten Island child. In the USA, about 100-200 cases are reported annually, with most occurring in the south, central, and western states; the case fatality rate is about 1.0 per cent. Tularaemia is caused by F. tularensis, a small, non-motile, Gram negative intracellular bacterium. It can be found in a variety of animal hosts, notably lagomorphs (rabbits and hares), aquatic rodents (muskrats, beavers, and water voles), other rodents (water and wood rats and mice), squirrels, and cats. Tularaemia is highly infectious, with as few as 10 organisms needed to cause disease. Humans can develop severe and sometimes fatal illness, but do not transmit the disease to others. The typical incubation period is 3 to 5 days, with a range of one to 14 days. [ProMed]

Following the publication in a Sunday paper of information concerning the 1st 3 identified cases of farm-animal methicillin-resistant Staphylococcus aureus (MRSA) in humans in the UK, the Soil Association is calling on the Government to publish interim results of its testing for MRSA in pigs, which has been ongoing since the beginning of 2008 and introduce a comprehensive testing programme for MRSA in other farm-animal species. The Scottish MRSA Reference Laboratory has identified 3 patients in Scotland suffering from a new type of MRSA infection, not previously identified in the UK. It is a strain which has been spreading rapidly across continental Europe and some other countries, affecting both farm animals and humans. In the Netherlands and some other countries, a high proportion of pigs and other farm animals are already carriers of this MRSA and there have been many cases of humans becoming colonised due to contact with animals, and then developing serious MRSA infections. Although this MRSA strain was only first detected in humans in the Netherlands as recently as 2003, by 2007 approximately 30 percent of all cases of human MRSA in the Netherlands originated from this strain. [ProMed]

CDC is collaborating with public health officials in several states and the Food and Drug Administration to investigate an ongoing multistate outbreak of human Salmonella enterica serotype Saintpaul infections. An epidemiologic investigation conducted by the New Mexico and Texas Departments of Health and the Indian Health Service using interviews comparing foods eaten by ill and well persons has identified consumption of raw tomatoes as the likely source of the illnesses in New Mexico and Texas. The specific type and source of tomatoes are under investigation; however, preliminary data suggest that large tomatoes, including Roma and red round are the source. Since late April 2008, 40 persons infected with S. Saintpaul with the same genetic fingerprint have been identified in Texas (21 persons) and New Mexico (19 persons). At least 17 persons were hospitalized. No deaths have been reported. In New Mexico and Texas, until the source of the implicated tomatoes is determined, persons with increased risk of severe infection, including infants, elderly persons, and those with impaired immune systems, should not eat raw Roma or red round tomatoes other than those sold attached to the vine or grown at home. [ProMed]

Enteroviruses generally cause mild disease; however, neonates are at higher risk for severe illness because of the immaturity of their immune systems. During 2007 a novel strain of Human coxsackievirus B1 phylogenetically distinct from previously circulating strains, appeared as a serious neonatal pathogen. Human coxsackievirus B1 for the 1st time was the predominant enterovirus in the United States, accounting for 113 (25 percent) of 444 enterovirus infections with known serotypes. Phylogenetic analysis of the 2007 human coxsackievirus B1 strains suggested that the cases resulted from widespread circulation of a single genetic lineage. The 3 distinct clusters of severe enterovirus illness, including illnesses caused by human coxsackievirus B1, detected in several US states during 2007. The year 2007 also was unusual for the number of human coxsackievirus B1-associated fatalities: 5 fatal cases were reported for the year. Human coxsackievirus B-associated deaths are reported rarely, and had not been reported previously to the US National Enterovirus Surveillance System. Human coxsackievirus B1-associated neonatal disease appears now to rank as a novel emerging disease in the USA. [ProMed]

Emergency measures are being implemented to halt a measles outbreak. Health chiefs in London have ordered National Health Service trusts to offer MMR [mumps, measles and rubella] jabs in quick succession amid a surge in measles. There have been over 200 cases in southeast London in the 1st 5 months of 2008. It comes after a record 1000 were recorded nationally in 2007. The Health Protection Agency said it hoped that offering the 2 jabs within months instead of 2 years apart would help stem the rise. Similar steps were taken when there was a high concentration of cases in north London in 2007. Measles virus is a highly infectious virus. It starts with a fever and conjunctivitis before a rash develops. The rash often lasts about a week, and other complications can include pneumonia and diarrhoea. The MMR jab is used to immunise children against the disease. Before the triple vaccine was introduced in the late 1980s, there were 20 deaths a year on average in the UK. But since the early 1990s, there has just been one in total. At least 95 percent of children need to have the triple-jab to create herd immunity to stop the disease spreading, but London in particular has struggled to reach that. [ProMed]

Rural residents received a warning on 7 May 2008 when Fremont County public health officials announced the 1st local case of hanta virus, which is fatal in nearly half of all cases. In Colorado a resident died from the disease in February 2008. The virus is carried in the saliva, urine, and droppings of deer mice (Peromyscus maniculatus), which are found in rural areas and pose a significant risk when residents perform spring cleaning and open up cabins, buildings, sheds, and barns. Infection occurs when the virus becomes airborne and is inhaled, or by direct contact with rodents, their droppings, or nests. Vacuuming an area without first wetting it down does not provide protection. However, the disease cannot be transmitted from person to person. Hantavirus infection begins with high fever, severe body aches, a headache, and vomiting 1-6 weeks after exposure. Initially, there are no respiratory symptoms present; however, within 1-5 days, the illness quickly progresses to respiratory distress, including a cough and difficulty breathing, while the lungs fill with fluid. No effective treatment exists for the disease, so prevention is the key to avoiding infection. Homes can be rodent-proofed by eliminating food sources for rodents and removing abandoned vehicles, wood, brush, and junk piles where rodents hide. The small, gray house mice (Mus musculus) commonly found in urban areas do not carry the disease. Deer mice are brown on top and white underneath, and feature large ears relative to their head size. [ProMed]

Hundreds of holiday-makers are being tested for Hepatitis E after an outbreak on board P&O liner Aurora. Seven passengers contracted the virus during an 11-week world cruise which ended in Southampton on 28 March 2008. A further 600 on board have been sent a letter from the Health Protection Agency (HPA) requesting a blood sample. The HPA advises that the virus, which affects the liver, can be fatal but only in rare cases. It is thought the passengers caught the virus through eating or drinking contaminated food. The ship has rigorous public health procedures and underwent a formal public health inspection recently in which it scored very highly. The HPA said 1100 passengers volunteered to be screened, but only a sample of 600 have been selected to be sent a questionnaire asking them what they ate and drank on board and requesting a blood sample if they have been exposed to the virus. The cruise has visited many locations including countries in which Hepatitis E is endemic. Person-to-person transmission is very uncommon and unlikely. Symptoms of the illness, which is a severe form of liver inflammation, include yellowing of the skin and eyes and darkening of the urine. It can take up to 60 days to appear in patients and takes up to 4 weeks to clear. [ProMed]

A total of 19 children have died and more than 700 others fallen ill in an outbreak of a lethal intestinal virus in Fuyang City, east China's Anhui Province, since March 2008. Hospitals in Fuyang, in northwest Anhui, started to take in children with fever, along with blisters, ulcers in the mouth, or rashes on the hands and feet, in early March 2008. Some of the victims were diagnosed with brain, heart, and lung damage. Most of the victims were aged between 2 and 6. By 26 Apr 2008, there were 789 cases of infections. A total of 204 children remain in hospital for further medical observation, of whom, 4 are said to be in critical condition. Schools, kindergartens, and villages are being inspected for hygiene. Enterovirus 71 can cause hand-foot-mouth disease, which usually starts with a slight fever followed by blisters of ulcers in the mouth and on the hands and feet. It may cause high fever, meningitis, encephalitis, pulmonary edema and paralysis in a small number of children. Paralysis is more common in children under 2 years of age and meningitis is more common in children from 2-5 years of age. Infections could lead to high mortalities in serious cases and neither vaccine nor therapeutic treatment is available. Cases of fatal encephalitis occurred during outbreaks of HFMD due to human enterovirus 71 infection in Malaysia in 1997 and in Taiwan in 1998. The strains isolated from Mainland China are closely related to most isolates from Taiwan, but different from most strains isolated elsewhere. Recent molecular data indicate that human enterovirus 71 is a rapidly evolving virus, which may be one reason why HFMD outbreaks are more severe in some parts of Asia. [ProMed]

In early January 2008, the Vancouver Island Health Authority declared an outbreak of human metapneumovirus infection at an extended-care facility. More than 60 of 150 residents at the facility were infected with the virus and 4 eventually died during the outbreak that lasted around 6 weeks. Human metapneumovirus is a human respiratory pathogen 1st discovered in 2001. It can cause both upper and lower respiratory tract disease and can lead to serious illness in the young, those with suppressed immune systems, and the chronically ill. Although human metapneumovirus has only recently been discovered, increasing diagnostic capability is defining it as an important human respiratory pathogen. In 2001 researchers at the Erasmus Medical Center in Rotterdam reported the discovery of a novel pneumovirus (a type of virus previously associated only with avians) present in young children with respiratory tract disease. The virus was recovered from 28 children and identified as a tentative new member of the genus Metapneumovirus of the family Paramyxoviridae, based on virological data, sequence homology and gene organisation. The clinical symptoms of the children from whom the human metapneumovirus was isolated were similar to those caused by respiratory syncytial virus infection, ranging from upper respiratory tract disease to severe bronchiolitis and pneumonia. From serological studies the researchers concluded that by the age of 5 years virtually all children in the Netherlands have been exposed to human metapneumovirus and that the virus has been circulating in humans for at least 50 years. Subsequently the same virus was found to be equally prevalent worldwide. [ProMed]

Last week Egypt's health ministry announced the death of a 30-year-old woman from the H5N1 strain of bird flu. It is the 22nd human death from bird flu among 49 cases in the country since the disease was first discovered in Egypt in 2006. The woman first showed signs of infection on 2 Apr 2008 and was taken on 9 Apr 2008 to a Cairo hospital, where she died. This case was Egypt's 2nd death from the disease in a week. On Saturday April 5, a 19-year-old boy from the Nile Delta province of Beheira, died in hospital after being unsuccessfully treated with Tamiflu. In January, 4 people died of the disease in just one week, after safety precautions had been relaxed in the belief that the virus had disappeared when no case had been reported for 6 months. Egypt's location on major bird migration routes and the widespread practice of keeping domestic fowl near living quarters have led to it being the hardest-hit country outside Asia. Despite a government ban on raising poultry on rooftops -- an age-old tradition in Egypt -- chicken, ducks, and geese continue to exist on many rooftops, alongside a multitude of pigeon coops. Earlier this year, the health minister warned against slackness in the preventative measures taken to fight bird flu. Health ministry officials repeatedly urged the public to remain vigilant and deplored the relaxation of precautions. Women and children have borne the brunt of the virus because of their role in taking care of domestic fowl. The authorities recommend eating factory-farmed chicken whose origins can be traced. Almost 2 years since H5N1 appeared in Egypt, the country has become one of the most affected in the world. [ProMed]

The Florida Department of Health is waiting on the results of lab tests to determine what caused an outbreak of Staphylococcus aureus infections among 12 people treated at a Tallahassee pain clinic. Health officials, who have been tracking the cases, say the S. aureus strain is not the drug-resistant form of the bacterium. Four other patients were hospitalized for observations but were not confirmed as having staphylococcal infections. Infectious disease specialists who inspected the Pain Institute of North Florida ruled out skin contact or unsanitary equipment as a cause. The main focus of the investigation is a batch of medicine that was likely contaminated. Lab results are expected to arrive soon. After getting an injection about 2 weeks ago at the pain clinic a 64-year-old woman said she felt some relief from her severe back pain. But then she started experiencing severe pain on her left side. She began hallucinating, and pretty soon she couldn't recognize her own children. She had to scream when touched because the pain was so great. Staff from the Pain Institute called her and her husband and told her to get a blood culture and to report to the emergency room at a regional Medical Centre. She was diagnosed with a S. aureus infection and began treatment with antibiotics immediately. A week and a half after checking into the hospital on 24 Mar 2008, she was feeling much better. 17 people were hospitalized for observation or treatment in connection with the outbreak. Based on the nature of the infections, the outbreak was likely caused by contaminated medicine, since the injuries were at the site where the medicine was deposited, i.e. deep in the tissues. [ProMed]

An outbreak of mumps, which appears to have spread to Western Australia (WA) from the Northern Territory (NT), has caused about 10 times the usual number of cases so far in 2008. A total of 46 cases of the childhood infection had been reported to health authorities by the middle of February 2008 compared with 4 cases at the same time last year and 6 in early 2006. The Health Department, which is investigating the outbreak, described the number of cases as surprising and well above normal. They appeared to be part of an outbreak which started in a boarding school in the Northern Territory last year and spread into parts of WA. Mumps is a contagious infection caused by a virus and occurs mainly in school-aged children. It had become rarer thanks to the MMR vaccine which protects against mumps, measles and rubella and is given to children when they are babies and as they start preschool. Infection spreads when a person breathes in the mumps virus that has been coughed into the air by an infectious person. The mumps virus can also spread from person to person via direct contact with infected saliva. Serious complications from the mumps are uncommon but can include inflammation of the brain, spinal cord and pancreas, hearing loss and sterility. The Department of Health continues to encourage parents to make sure their children's immunisations are up-to-date. The routine time for the MMR vaccination is at 12 months then again at 4 years. [ProMed]

Rabies is what killed a 16-year-old in Santa Maria on the 18th Mar 2008, and public health officials are trying to track down a companion who recently travelled with the teenager from Mexico. The boy came into the Marian Medical Center on the 18th Mar 2008 delirious and drooling, and was having trouble breathing. He required resuscitation immediately, but doctors were not able to save his life. If the brain is infected, there is no direct treatment for it. In the United States, it is extremely rare for humans to contract rabies, and that's especially true locally: the last case in Santa Barbara was 80 years ago in 1927. There are some cases in the US, but they usually come from a wild animal bite. On the West Coast, that usually means a bat or a skunk while raccoons are usually the culprits on the East Coast. Domestic animals very rarely have rabies these days, though within the past 5 years, rabies detected on a dog travelling through Santa Barbara County and in a dead cat that had been bitten by a bat. The majority of human cases of rabies in the United States since 1980 have been associated with the bat variant rabies virus. According to CDC statistics 21 of the 36 human cases (58 percent) have been associated with bat variants since 1980. Officials believe that the boy contracted the disease in Mexico, because he had not been in the United States long enough to have had the disease take its course. The time from bite to death from rabies is variable, and depends on where the bite occurs. If it's closer to the brain, the disease can take hold rather quickly. However, if caught early, post-exposure prophylaxis will cure a victim in most cases. [ProMed]

Health authorities are warning people to protect themselves against mosquito bites following a 3-fold increase in mosquito-borne viruses in the 1st 2 months of the year. There were 380 cases of Ross River virus in New South Wales (NSW) in January and February 2008, up from 78 for the same period last year. Barmah Forest virus cases almost doubled to 121 over the same period, and more are expected March 2008 as the mosquito season peaks. Recent rainfall has been blamed for the explosion in mosquito numbers and cases of the viruses, which cause debilitating symptoms such as tiredness, sore and swollen joints, rashes, and fever. The potentially fatal Murray Valley encephalitis virus (MVEV) has been detected in mosquitoes in some areas. In rare cases the virus can also be transmitted to humans by mosquitoes, causing permanent brain damage and death. Health officials urged people travelling throughout the state over Easter to take precautions such as wearing insect repellent and loose clothing; and avoiding going outside around dusk and dawn particularly when fishing, camping, or bush-walking. Epidemics of benign polyarthritis were recorded in Australia as early as 1927, and the etiologic agent, Ross River virus, was isolated in 1963. Fortunately, illness in humans -- although occasionally prolonged and painful -- is not fatal, and recovery is complete. Presently there are no vaccines for the control of these virus infections. [ProMed]

Multidrug-resistant tuberculosis (MDR-TB)has been recorded at the highest rates ever, according to a report published by end of February 2008. The report presents findings from the largest survey to date on the scale of drug resistance in tuberculosis: it is based on data collected between 2002 and 2006 on 90 000 TB patients in 81 countries. It found that extensively drug-resistant tuberculosis (XDR-TB), a virtually untreatable form of the respiratory disease, has been recorded in 45 countries. The report also found a link between HIV infection and MDR-TB. Surveys in Latvia and Ukraine found nearly twice the level of MDR-TB among TB patients living with HIV compared with TB patients without HIV. Based on the analysis of the survey data, WHO estimates there are nearly half a million new cases of MDR-TB a year, which is about 5 percent of 9 million new TB cases of all types. The highest rate was recorded in Baku, the capital of Azerbaijan, where nearly a quarter of all new TB cases (22.3 percent) were reported as multidrug-resistant. These rates surpass the highest levels of drug resistance published in the last WHO report in 2004. Surveys in China also suggest that MDR-TB is widespread there. For the 1st time, the global survey includes analysis of XDR-TB. [ProMed]

A restaurant in Hawaii dumped all its food and everything disposable on 26 Feb 2008 and began to disinfect the restaurant from top to bottom after the worst outbreak of E. coli 0157:H7 in the state's history. 6 customers who ate there suffered bloody diarrhoea in December 2007 and in February 2008, even after the restaurant corrected health inspection violations. When the restaurant failed a 2nd inspection on 8 Feb 2008, the owners agreed to the unprecedented steps of cleaning and disinfecting the restaurant before the Health Department shut it down. After the shutdown the employees began a 2-day sanitation education program at the restaurant. In each of the 6 cases, the patients had eaten at the restaurant within 7 days of their symptoms. After the positive diagnosis, restaurant inspectors spent 4 hours at the restaurant on Christmas Eve watching the operation. Among other violations, employees did not wash their hands. And raw food and items that touched raw food were mingled with cooked food that was ready to be served. After the second outbreak in February the owners of the restaurant agreed to i) hire a private food-safety consultant, ii) have the owners, managers, and employees attend a free, 2-day sanitization course at the restaurant, iii) destroy all food and disposable items such as plastic forks, napkins, and chopsticks, iv) sanitize all equipment and interior spaces from the floor to the walls to the ceiling and v) get rid of anything that could not be sanitized. [ProMed]

The nation's 1st known cases of antibiotic-resistant meningococcal disease surfaced in northwest Minnesota and eastern North Dakota over the past year. The drug-resistant strains are the latest evidence of antibiotic overuse, particularly in patients whose colds are viral and not bacterial. The 2 Minnesota cases turned up in January 2008, one involving a 53-year-old person who died and the other involving a 22-year-old student. The North Dakota case in January 2007 involved a child at a daycare facility. The bacterial strains in all 3cases are similar, but the patients had no known connections. Health officials believe these strains are simply circulating in the region. As much as 15% of the people carry meningococcal bacteria in their throats or noses, but only few people develop severe infections. Health experts stressed that these 1st cases are significant but shouldn't worry the general public or cause people to demand preventive treatment. All 3 patients developed meningitis, a swelling of the brain and spinal cord, and required hospital care. Vaccination for meningococcal meningitis is recommended for the 11-20 year old persons. While a vaccine protects against two-thirds of these bacterial infections, it wouldn't have worked against this particular strain. Meningitis cases are somewhat rare, with an average of 24 per year since 2000 in Minnesota. A total of 22 deaths have been linked to the bacterial infection from 2000 through 2006 in the state, 10 of them involving people 23 or younger. Meningitis is a contagious bacterial infection caused by Neisseria meningitides, which colonizes the nasopharynx, and is spread by respiratory droplets. [ProMed]

Five more children in San Diego have tested positive for measles, bringing to 11 the total number of cases in a month-long outbreak that has affected schools and Hawaii. The potentially fatal and highly contagious disease takes several weeks to run its course. The outbreak -- San Diego County's 1st since 1991 -- began in Switzerland. All the patients, from infants to a 9-year-old, were not vaccinated either because they were younger than one -- the minimum age for measles inoculation -- or because their parents objected to having them vaccinated. There is a lot of misinformation about vaccines, and more and more parents are choosing not to vaccinate their children. More than 400 cases of measles occur in Switzerland each year, about triple the total in the United States. Most frequently when patients are taken to the health sector for diagnosis and treatment, they are often in the most highly infectious stage of the illness. Unvaccinated individuals are at high risk of infection when exposed to the virus, and serve as further transmitters of the virus when they become infected. Approximately 30 percent of measles cases have some complication. In the USA, the overall case fatality rate for measles was 0.2 percent, but in developing countries with high rates of malnutrition, the case fatality rate has been reported to be as high as 20 to 30 percent. [ProMed]

Fears over the impact of a new strain of the deadly Clostridium difficile superbug were heightened recently after it emerged that 3 more patients have died in a hospital in Ireland. As health chiefs battle to contain a superbug outbreak, the number of deaths linked to C. difficile since summer 2007 rose to 23 till February 2008. Medical experts have attributed the official outbreak to the emergence of a more virulent form of the bacteria called ribotype 027. The bacterium causes diarrhoea and can even lead to a rupturing of the bowel. It tends to affect the elderly. It is understood this is the 1st time this strain has surfaced in Northern Ireland. Restrictions on hospital visiting were among an extensive package of measures aimed at fighting the bug. C. difficile is the most common cause of bacterial diarrhea and pseudomembranous colitis in hospitalized patients. Recent outbreaks of _C. difficile_-associated diarrhea with increased severity, high relapse rate, and significant mortality, have been related to the emergence of a new, hypervirulent C. difficile strain in North America, Japan, and Europe. These epidemic strains are characteristically resistant to fluoroquinolones. Preventing the spread of C. difficile in healthcare facilities involves clinical and microbiologic surveillance of hospitalized patients with diarrhea for C. difficile and heightened infection control measures, including prompt patient isolation of patients. [ProMed]

Preliminary results from a survey of antiviral drug susceptibility among seasonal influenza viruses circulating in Europe has revealed that some of the A influenza viruses (H1N1) in circulation this winter are resistant to the antiviral drug, Tamiflu. So far, 148 samples of influenza A viruses isolated during November and December from 10 European countries have been tested by the EU. Of the 148 samples, 19 showed evidence of resistance to Tamilflu. Of the samples that tested positive for resistance to Tamiflu 12 came from Norway. This was from a total of 16 virus samples sent for testing. Given the initial indication of a high level of resistance to Tamiflu in the A H1N1 viruses circulating in Norway, the Norwegian authorities notified their EU partners and the WHO of this situation. Experts from the European Centre for Disease Prevention and Control (ECDC), the European Commission and the WHO are currently assessing the significance of the data. At this stage it is impossible to say what the level of resistance is in influenza across Europe. However from the limited data, the proportion of influenza viruses exhibiting resistance to Tamiflu must be significant, but not as high as in Norway. People who become ill with the Tamilflu resistant strain do not appear to become any sicker than people infected with "normal" seasonal influenza. It should be remembered that any influenza A can cause severe disease or death in vulnerable people (e.g. older people and the very young). [ProMed]

A 50-year-old Eddy County man has been confirmed with New Mexico's 1st plague case of 2008. The man was hospitalized but now is recovering at home. The man most likely was exposed to plague while hunting and skinning rabbits a few days before falling ill. Health officials also reported that 8 people were potentially exposed to pneumonic plague, a dangerous form of the disease, when a cat in Santa Fe County developed pneumonic plague before it died. All 8 people are receiving antibiotics to prevent pneumonic plague. Plague is a bacterial disease of rodents generally transmitted to humans through the bites of infected fleas. It also can be transmitted by direct contact with infected animals. Most people become ill 2-7 days after being infected. Symptoms of bubonic plague in humans include fever; chills; painful swollen lymph nodes in the groin, armpit or neck and sometimes headache, vomiting and diarrhea. Septicemic plague, which occurs when the bacteria spread to the blood, also can bring a high fever, abdominal pain and diarrhea. Pneumonic plague involves the lungs and is the form that can spread directly from person to person. New Mexico reported 5 human cases of plague in 2007 with one fatality and eight human plague cases were reported in the state in 2006 with 3 fatalities. [ProMed]

A person has died and 3 more are fighting for their lives in intensive care after contracting melioidosis in Australia. A further 7 people have been diagnosed with the tropical disease this wet season, but have since been treated. No children have been affected. Melioidosis is caused by the bacteria Burkholderia pseudomallei. It killed 5 people in Australia during the last Wet, and more than 30 cases were reported. Melioidosis can enter the body through small cuts in the skin. It can also be contracted through inhalation of dust, droplets, or swallowing contaminated water. People with diabetes, alcoholism, and kidney or lung disease are at more risk. Health officials urged people to wear protective clothing if working in the garden or in muddy or wet areas. Infection due to Burkholderia pseudomallei is endemic in focal areas of South East Asia and northern Australia. Also a disease of animals, melioidosis is not truly a zoonosis, since it is not transmitted from animals to man but rather both acquire the infection from its soil reservoir. The melioidosis bacillus is intrinsically insensitive to many antimicrobials. A commonly recommended initial parenteral therapy for severe disease is a treatment with different antibiotics for 20 weeks. This prolonged course is to diminish the risk of relapse. There is no commercially available vaccine for melioidosis prevention in man, although experimental vaccines are under development and have been used in animals. [ProMed]

On 19 Nov 2007, a 34-year-old woman was admitted to a Medical Centre in Amsterdam in the Netherlands that experienced dizziness, nausea and general malaise since 16 Nov 2007. On 24 Oct 2007, at the start of a 2-week holiday trip through Kenya, a small bat had flown against her face. While she was hitting away the animal, it made 2 bleeding scratches on the right side of her nose. The incident took place in a camping site between Nairobi and Mombasa, at dusk, while she was brushing her teeth. The wound was washed with soap and cleaned with an alcohol solution. The warden of the campsite and medical personnel of the neighbouring health centre were not aware of the existence of rabies in bats in the area and no further action was recommended. The woman and her husband then continued the holiday trip. On admission to the medical centre in the Netherlands, passive and active post-exposure prophylaxis for rabies was initiated. However, the patient's neurological clinical picture deteriorated quickly. Despite all efforts, the patient died on 8 Dec 2007, 23 days after the onset of illness. Rabies is a fatal zoonotic disease in humans, preventable if adequate measures are applied shortly after a suspected infection. This fatal incident shows that in a rabies endemic area PEP has to be applied in case of every, however minor, bite or scratch exposure to a mammalian animal, including bats. [ProMed]

Public health officials are urging hospitals to do a better job of promoting hand-washing after dozens of people were sickened by norovirus at 3 Boston hospitals in recent weeks. The Boston Globe reports that at Massachusetts General Hospital, 31 staffers and 13 patients fell ill with the gastrointestinal disease, which causes vomiting and diarrhea but generally leaves no lasting health effects. While the virus is difficult to stop entirely, experts say hospitals can slow its spread by encouraging employees to vigorously wash their hands with alcohol-based gel or soap after treating patients. Norovirus is living up to its reputation as the "winter vomiting bug" and hospitals are particularly vulnerable at this time of year. Currently at least 56 hospital wards in England and Wales have been closed to new admissions and it has been estimated that more than 100 000 people a week in the UK are contracting norovirus infection. It should be noted that noroviruses are resistant to inactivation by organic solvents and therefore alcohol-based cleansing agents may not have any additional advantage over conventional soap and water hand cleansing in controlling the spread of infection. [ProMed]

On 14 Nov 2007, a general practitioner in the Nijmegen region of the Netherlands called the Municipal Health Service. He reported 3 patients complaining of high fever, vomiting, diarrhea and headache, all of whom had visited a bird show in a rural town. The bird show, organised by the local bird society, took place between 31 Oct and 4 Nov 2007. In the following days, the show was open to the public. According to the organisation committee, about 200 people, mainly members of bird societies in the region of Nijmegen and their families, visited the show. On 15 Nov , it became clear that at least 18 people, all connected to the local bird association, had become ill with the symptoms mentioned above after visiting the show; 7 of them were hospitalised. On 16 Nov, one of 2 sputum samples and one of 6 throat swabs that had been taken from 6 of the hospitalised patients tested positive for Chlamydophila psittaci. All visitors to the bird show have been invited for serological screening and to complete a questionnaire in order to get a better estimate of the attack rate and help clarify possible risk factors associated with infection. [ProMed]