An outbreak of anthrax that claimed the lives of 13 drug addicts has officially been declared over, but the contaminated heroin that caused it could soon be back on the streets. The 1st cases of anthrax poisoning were reported in December 2009, and there were a total of 47 cases of anthrax poisoning among heroin users over the next 7 months. However, no new cases of anthrax poisoning have been reported since July 2010, and the national Outbreak Control Team has now officially declared the outbreak over. According to specialists there is still no way to prepare or use heroin that will remove this risk. Anyone who does continue to use heroin should seek urgent medical advice if they develop redness and swelling at injection sites or other symptoms of general illness such as fever, chills or a severe headache, as early antibiotic treatment can be life-saving. There have been a lot of heroin supply problems recently because of a fungus affecting the Afghan crop and a lot of big police seizures. The contaminated heroin may have been stockpiled, and if there is a drought, it could be sold again. Significant amounts of heroin are exported from Afghanistan into Russia but apparently without similar cases. [ProMed]

Frogs in Australia and the United States may be recovering from a fungal disease that has decimated amphibian populations around the world. Between 1990 and 1998, the populations of several frog species in Australia plummeted due to chytridiomycosis infection, but a recent survey suggests the frogs are re-establishing themselves. Barred river frogs, the tusked frog and several tree frog species have returned to areas where they had almost disappeared, and some species have even reached pre-infection levels, Australian researchers say. There are also signs of recovery in the United States. Researchers say mountain yellow-legged frogs, once "driven virtually to extinction," are returning. The big question is, are frogs now beating the fungal infection? American researchers have separately determined that recovering frogs are living with low-level infections of the fungus. It is possible, they say, the fungus has weakened in the areas where frogs are recovering. [ProMed]

Since beginning of 2010, 23 cases due to Streptococcus suis infection and 5 fatalities have been reported in Phetchabun province (Thailand). Recently, 3 more cases were reported from another province after eating 'Larb' and 'Lu Mu' (Laos meat salad made with raw pork and raw pork blood). Cases were sent to hospital by relatives. At present, all cases have recovered. The illness caused by the bacterium Streptococcus suis is mostly found in northern region of Thailand because some people prefer to consume 'Larb' and 'Lu Mu', which are made from raw pork. Symptoms of infection include high fever and acute deafness, which may occur on one side or both. Other symptoms include headache and vomiting. Deaths may occur in severe infections. Health officials stated that people should abstain from eating raw meat especially 'Larb' and 'Lu Mu' and take care of themselves. According to the Annual Epidemiology Surveillance Report (AESR) 2009 from the Bureau of Epidemiology, Thailand, in 2009 there were 159 cases due to Streptococcus suis infection. The attack rate was 0.25 per 100 000 population. The male to female ratio was 3 to 1. The peak of illness was reported in May 2009 (22 cases). [ProMed]

Poliovirus has been detected in Delhi's sewage triggering fears that the disease might spread. Sources said the detection was made during a sewage surveillance programme conducted between April and June this year 2010 in east Delhi areas. The samples have been sent to the World Health Organization (WHO) for further study. Delhi is among the high risk zones for prevalence of polio because of influx of migrant population. Health officials said the new surveillance programme is aimed at identifying and tracking the wild poliovirus in the environment. Polio spreads through the faecal-oral route and can be found in faecal particles present in sewage. So, even when no human cases are reported, sampling from the environment can alert health authorities. The sewage surveillance has been intensified in the capital following detection of wild poliovirus in 2 major drains between the months of April and June 2010. Delhi has not reported any human cases this year, in 2009 there were 4 polio cases reported. Health officials said that more than 100 000 people migrate to the city every day and most of the viruses are carried by them. [ProMed]

The 1st cases of Alkhurma haemorrhagic fever to be seen outside Saudi Arabia are reported online in the December 2010 edition of Emerging Infectious Diseases. The researchers indicate that 2 people who visited a camel market in Egypt at different times during 2010 developed symptoms of the disease after returning to Italy. The virus, which is classified as a high-biosafety pathogen, infects camels and sheep. Most human cases of Alkhurma haemorrhagic fever are seen in butchers, who are more likely to come in contact with contaminated blood of an infected animal. But people can also catch the virus through the bite of an infected tick or by drinking unpasteurised milk. The disease is fatal in about 25 per cent of patients. It was discovered in the mid-1990s and named after the city where the 1st fatal case occurred. About 40 cases have been reported since then, never outside Saudi Arabia. The 1st case of imported disease described by the authors, a 64 year old man, told doctors that he got bitten on the foot by what looked like a tick while visiting a camel market in April 2010. Within 2 days after the bite, he developed a high fever, chills, and nausea among other symptoms. Initial tests ruled out dengue and West Nile viruses, but after suspecting that a flavivirus might be involved, medical scientists used specific methods to identify genetic material very similar to that of the Alkhurma virus. Weeks later, blood samples from another patient also tested positive for this virus. The 2 patients visited the region around one month apart. [ProMed; Carletti F. et al., Emerg Infect Dis. 2010; 16(12) and Alzahrani AG, et al. Emerg Infect Dis. 2010, 16(12)]

A case of malaria was reported on 12 Nov 2010 at the Regional Health Agency in Alsace. This patient was infected a month ago by mosquitoes that escaped from a parcel of food from Cameroon. The 1st clinical features appeared 15 days later, and the patient was examined at a hospital in Strasbourg, where the diagnosis was made. The patient is well. He lives in the district of Neudorf, Strasbourg, near the airfield of the Polygon. Other mosquitoes escaped and were able to bite other people near his home, although the risk is very low. That is why the LRA asks those involved to consider a diagnosis of malaria based on the 3 phases of symptomatic illness: chills, headache, vomiting; fever of rapid ascent (40°C) with malaise; profuse sweats accompanied by a drop in temperature and fatigue. People with an unexplained fever, especially if they reside in the area of the airfield Polygon, must also have their diagnosis confirmed by a thick smear. This case is equivalent to what is called "airport malaria", where mosquitoes infected in a malaria-endemic country escape, for instance, from an airplane, and in this case a parcel, and bite a person close by. [ProMed]

According to reports from the Madrid Health Council, another person died in Madrid as a result of legionellosis, bringing the number of deaths to 5 since the onset of this outbreak, which has affected so far a total of 46 other people. The Health Council has sealed another 8 cooling towers due to high Legionella contamination, bringing to 12 the number of sealed towers. Of the 46 cases of legionellosis in the outbreak, 30 have been discharged, 7 remain hospitalized and 4 have not required hospitalization. From the moment when the outbreak was reported, the Madrid Health Council ordered the cleaning of all the towers that were inspected, and samples were taken from 179 of them. To date, 736 inspections have been carried out. Of the culture results available, 122 have tested negative and 31 positive for Legionella pneumophila serogroup 1. Legionellosis is an infectious disease caused by a Gram-negative bacillus of the genus Legionella, most commonly Legionella pneumophila. Legionnaires' disease is the acute pneumonic form of the disease. Legionnaires' disease is acquired by inhalation of an infectious dose of aerosolized Legionella. Water temperatures of 25-40 C support the highest concentrations of the organism in water storage tanks of plumbing systems. Aerosolization of the contaminated warm water can occur in showers, spa pools, sprays in groceries, fountains, and cooling towers. [ProMed]

A rare type of the liver disease, hepatitis E, has killed 3 people in Cornwall and caused at least 55 more across the UK to fall ill. Hepatitis E is generally thought to be caused by poor sanitary conditions and previously it had been assumed that British sufferers had caught the disease abroad. The recent patients however did not fit the usual criteria: Not only had the patients not travelled abroad but they didn't fit the normal age range for the virus. In other parts of the world it usually affects the young. However in the cases being seen in the UK, it is the middle aged and elderly, particularly men. Patients with liver problems admitted to hospital will be checked to see if the problems had been caused by hepatitis E. It is acknowledged that pigs and pork can harbour hepatitis E virus and that this may be the cause of the disease in cases where there has not been any foreign travel. There have been 3 deaths related to hepatitis E infection over the last 7 years and around 60 cases of hepatitis E in Cornwall and Devon between 1999 and 2010. One victim of the disease, a 59-year-old man, contracted hepatitis E and died in July 2006. Most people clear the infection without treatment, however people with weakened immune systems or liver disease may need closer observation. There is no vaccine against hepatitis E. In 2008, 4 people in Britain fell ill with the virus after a world cruise. Infected shellfish were found to be the cause. [ProMed]

Far from having diminished, the measles epidemic raging in France since 2008 up to the present has involved more than 5000 cases. Since 2005, the health authorities had failed to anticipate that this resurgence of measles would restore measles to the status of a notifiable disease. The French measles elimination program was established in 2005, including setting a target of 95 percent vaccination coverage by 2 years of age and an annual incidence of less than 0.1 cases per 100 000 inhabitants. However, it was found that measles virus circulation intensified in early 2010, with over 3000 cases between January and August with a peak incidence in April 2010. In the 1st 8 months of 2010, the proportion of hospitalized cases, among reported cases, is 34 percent. This high figure is accounted for by a higher rate of notification of hospitalized cases and an increased incidence in infants under one year of age and in young adults, where the complications of measles virus infection are more common and more severe. Since the epidemic began, 4 people have died of measles complications. The circulation of the virus is affecting the entire metropolitan area of France, with a high incidence observed in certain departments over 15 cases per 100 000 inhabitants. This situation is the result of inadequate vaccination. [ProMed]

A never-before detected strain of virus that killed more than one-3rd of a monkey colony at a U.S. laboratory appears to have 'jumped' from the animals to sicken a human scientist, researchers report. Although it's an unusual move for that type of virus and does warrant further monitoring, the researchers stress there is no cause for alarm at this time. There is no evidence the virus has spread beyond the single scientist -- who recovered from her illness -- nor is there even proof that the virus would be transmissible between humans. The scientist appears to have caught the virus while investigating an outbreak of illness among a colony of monkeys at the California National Primate Research Center in Davis. Among the monkeys, the virus was highly contagious and deadly: Of 55 monkeys housed at the center, 23 became seriously ill with upper respiratory symptoms that progressed to pneumonia and an inflammation of the liver. Broad-spectrum antibiotics did not help the monkeys, suggesting that the pneumonia was caused by the virus and not a secondary bacterial infection. Researchers later determined the cause of the illness was an adenovirus, a broad class of viruses that can cause everything from relatively harmless respiratory illnesses such as the common cold, to pneumonia, as well as gastroenteritis, conjunctivitis and inflammation of the liver in people. The new strain, however, had never before been identified. The scientist who fell ill had been in close contact with the monkeys. Though she became seriously ill with pneumonia around the same time the monkeys were falling ill, she was not hospitalized and recovered after about 4 weeks. [ProMed]

Fruit compote may be the most likely culprit which sickened visitors to the Russian pavilion at Folklorama this past August in Winnipeg. The report details the probable cause of the verotoxigenic E. coli and its effect on 37 people who either attended the pavilion or who fell victim to secondary spread of the E. coli O157:H7 bacterium. Only 3 of the total 40 cases were not linked to the pavilion. According to the Outbreak Report, a study was then undertaken to determine the identity of the specific food item which was contaminated with E. coli, with. 5 patients were hospitalized with 1 case admitted to ICU and 17 people visited an emergency room. There was 1 case of hemolytic uremic syndrome. Analysis narrowed down the mostly likely choice to the compote over other sources, partially because the compote was served with both the vegetarian and non-vegetarian platters. The most plausible source of contamination of the compote could have either been from cross-contamination from raw or undercooked ground beef, which is the most common source of E. coli in food products, which was also being handled at the same time in the kitchen. Interviews with the kitchen staff revealed that most of the food was cooked in a pressure cooker. However, the compote was cooked in a separate pot. [ProMed]

An outbreak of legionnaires' disease, which saw 2 deaths and 22 people infected, has been officially declared over. An 85 year old man and a 49 year old woman both died in cases linked to the outbreak. No new cases of the disease have been identified since the last person fell ill on 10 Sep 2010. Both our microbiological and epidemiological investigations indicate that there are a number of potential sources for these 22 cases. The outbreak area involved a corridor 12 km on either side of a road between two towns. People were linked to the outbreak if they lived in, or visited, this area in the 2 weeks before they fell ill. All 22 cases required hospital treatment. The HSE has inspected all registered cooling towers and evaporative condensers; 28 in total. 4 industrial sites were closed but none were confirmed as the source. They are all now back in operation. HSE and council environmental health officers also visited more than 100 other workplaces. Public Health Wales said their investigations had identified 2 distinct clusters -- 6 people with legionnaires' linked to a small geographical area. Microbiological results from the 7 human samples that have been grown show that every one is genetically distinct, suggesting a different source of infection for each of these 7 cases. [ProMed]

State health officials say a woman in Lake County (Oregon) has been diagnosed with bubonic plague, the 1st diagnosis of plague in Oregon in 15 years. Plague can be treated with antibiotics. Health officials are now trying to determine the source of the infection. The typical sign of the most common form of human plague is a swollen and very tender lymph gland, accompanied by pain. Bubonic plague should be suspected when a person develops a swollen gland, fever, chills, headache, and extreme exhaustion, and has a history of possible exposure to infected rodents, rabbits, or fleas. A person usually becomes ill with bubonic plague 2 to 6 days after being infected. When bubonic plague is left untreated, plague bacteria invade the bloodstream where they multiply and then spread rapidly throughout the body to cause a severe and often fatal condition. Infection of the lungs with the plague bacterium causes the pneumonic form of plague, a severe respiratory illness. The infected person may experience high fever, chills, cough, and breathing difficulty and may expel bloody sputum. If plague patients are not given specific antibiotic therapy, the disease can progress rapidly to death. About 14 per cent of all plague cases in the United States lead are fatal. [ProMed]

An ongoing anthrax outbreak raises concerns the disease could become endemic in drug users. Heroin laced with anthrax has killed 16 people in the UK (13 in Scotland, 3 in England) over the past 9 months. The ongoing outbreak is the largest the country has seen for decades and the 1st ever recorded in injecting drug users. With cases still turning up (last case was in late August 2010), questions linger as to whether the infection will persist in this population, and how the drug became contaminated in the 1st place. Since December 2009, infection with anthrax bacteria has been confirmed in 47 people in Scotland, and officials have investigated hundreds more suspected cases. At least 2 cases linked to the outbreak were also spotted in Germany. Only one case of anthrax in an injecting drug user has ever been seen before, in Norway in 2000. Both the transmission route and symptoms of these cases of anthrax differ from the existing 3 forms of the disease, which are known as cutaneous (skin), gastrointestinal or inhalational anthrax. As a result of the current outbreak, these anthrax cases are now recognised as a new form of the disease. [ProMed]

Duck eggs and duck products have been implicated in a national outbreak of salmonellosis which, according to the Health Protection Agency [HPA], has led to the hospitalization of 2 people and the death of one. The outbreak involves Salmonella enterica serotype Typhimurium DT8, a strain, which is often associated with ducks. According to the HPA, there have been 63 reports of human infection in England and Northern Ireland in 2010, compared with 47 in 2009 and 34 in 2008. It became clear from the investigations of the HPA that the increase was related to the consumption of duck products, mainly eggs. A spokeswoman for the HPA said there had been an acceleration in the number of salmonella cases over the summer months, with the greatest concentration in the south-east and north-west of the country. She added that the cases relate to commercial flocks of ducks, not backyard flocks. The Food Standards Agency has subsequently issued a statement reminding consumers and caterers of the importance of good hygiene when handling and preparing duck eggs. Duck eggs may occasionally be contaminated with salmonella, both on their shells or, more rarely, internally. Duck eggs should be cooked thoroughly until both the white and yolk are solid. [ProMed]

Angola and the Democratic Republic of Congo (DR Congo) are experiencing outbreaks of wild poliovirus type 1. In Angola, the outbreak which began in April 2007, has 2010 spread to re-infect previously polio-free areas in Angola as well as to neighbouring DR Congo. Given the recent progress achieved in Nigeria (99 per cent reduction in cases in 2010 compared with the same period in 2009), in western Africa (no cases since 1 May 2010) and the Horn of Africa (no cases in more than 12 months), central Africa is now considered to be the greatest risk to Africa's polio eradication efforts. Angola's outbreak is currently the only geographically expanding outbreak in Africa. In 2010, outbreak response in Angola and DR Congo has been inadequate to stop transmission of the imported viruses. Independent monitoring of supplementary immunization activities indicate that as many as 25 per cent of children are regularly missed in key areas of Angola. The outbreaks require urgent action to reach a higher proportion of children with oral polio vaccine across Angola and DR Congo and improve surveillance across Angola and DR Congo. According to recommendation of the WHO, travellers to and from Angola and DR Congo should be fully protected by vaccination. [ProMed]

According to the Dutch government a 10-year-old cow in the Netherlands has tested positive for BSE [bovine spongiform encephalitis], more commonly known as "mad cow" disease, the 1st such result in more than 2 years. The government ministry responsible for food quality said the animal tested positive for the brain-wasting disease bovine spongiform encephalopathy at a slaughterhouse. It was the 1st positive test for BSE in the country since May 2008. A spokesman for the ministry told Reuters the cow's meat was withdrawn from the food chain after a 1st positive test, while a 2nd test confirmed the result. All cows sent to slaughter in the country are tested and held aside for the results before their meat enters the system. Mad cow disease is of particular concern because it is thought to cause a related brain-wasting disease in humans who have eaten contaminated meat. A total of 3 people have died in the Netherlands from variant Creutzfeldt-Jakob disease. The last reported death was in January 2009. In 2009, the number of slaughtered cows, older than 30 months, which were compulsorily tested in Dutch slaughterhouses for
BSE, was about 405 000 -- all with negative results. [ProMed]

On a farm in Ariege in the Southern of France, bovine tuberculosis has been detected. The 83 animals on the farm have been culled as a precaution. 12 other farms in the area are under supervision. The authorities have informed the farmers about the disease and the precautions in the region. The suspicion dates back to April 2010 when one of the animals appeared to have lesions, as shown during a routine inspection at the abattoir. However, it took several weeks before the authorities could definitively say it concerned bovine tuberculosis. The prefect -- the regional representative of the state -- offered all affected farmers all possible help and assistance. In addition, both the prefect as a representative of the regional meat organization emphasized that there is no danger to public health. In France, an average of 30 cases of the disease is detected per year. Bovine tuberculosis is common in Great Britain. Thousands of farms in England and Wales are affected and every year thousands of animals are culled. [ProMed]

The number of people killed by the so-called "West Nile virus" in northern Greece has risen to 8, which brings to 92 the number of people infected by the bite of the tiger mosquito, which transmits the disease. That is the new summary of the epidemic unleashed in early August 2010 by the Greek Center for Disease Control and Prevention, following the death yesterday of the 8th infected person and registration of 15 new cases of the disease. In the total of the 92 cases are included 44 patients who have been discharged, 37 hospitalized individuals -- 8 of them in intensive-care units -- and 3 infected individuals who have not been interned in hospitals, in addition to the 8 fatalities. In more than half the cases, the disease has affected the central nervous system of patients, most of whom are elderly. The West Nile virus causes encephalitis. In the affected regions transfusions and blood donations have been banned. The Greek Ministry of Health has also enacted a temporary ban on the donation of blood by people who have been visiting the northern states in recent weeks. The number of infected people continues to slowly increase, with a risk of continued WV virus transmission until cold weather arrives. The Asian tiger mosquito (Aedes albopictus) has become established in Greece and it is capable of transmitting WN virus. [ProMed]

Alberta Heath Services is reminding Albertans to keep clean, as an outbreak of viral meningitis has spread across the province. Symptoms start out much like a summer cold with dry coughs or fevers, but since April 2010, 90 of those colds turned into reported cases of viral meningitis in Alberta. The cases reported concern people between the ages of 10 and 30, and for people who do recreational activities in large groups. A lot of the cases have been related to sports tournaments and recreational activities. Albertans are encouraged to avoid sharing water bottles or soft drinks, to wash hands thoroughly, and to clean surfaces of gym equipment and common household surfaces. The majority of viral meningitis cases don't cause death and of the 90 recent viral meningitis cases in Alberta, no one has died from the disease. Viral meningitis can cause fever, dry cough, headaches, body aches, weakness, tiredness and rash and can usually last 7 to 10 days. It is an inflammation of the membranes that cover the brain and spinal cord. Most cases, particularly during the summer and autumn months, are caused by enteroviruses. The viruses can also stay on surfaces for days and can be transferred from objects. Viruses also can spread directly when infected people cough or sneeze and send droplets containing the virus into the air we breathe. [ProMed]

Veterinarians at White and White Veterinary Hospital in Ennis, Montana, have diagnosed the 1st case of plague this summer in an indoor/outdoor pet cat. Over the years, veterinarians there have diagnosed numerous cases of plague and tularemia, all in domestic cats and in the summer months. A diagnosis of plague is confirmed either by growing the culprit bacteria from a fine needle aspirate or by demonstrating an increase in antibodies in the cat from the onset of the disease, compared to a convalescent blood sample taken 3 to 4 weeks later. An independent lab in Colorado confirmed the cat did have plague. The cat has since made a full recovery. Indoor/outdoor cats in rural areas that hunt rodents are the most likely to encounter the 2 diseases. Signs in animals include swollen lymph nodes, lethargy, anorexia and a high fever. The causative bacterium, Yersinia pestis, is transmitted to people through fleabites and direct contact with infected animals. Each rodent species is host to one or more species of fleas which, when infected, are carriers. These fleas generally do not infest other animals unless their natural hosts are unavailable. Domestic cats and dogs can also contract plague from infective fleas. They may carry infected fleas home to their owners or, especially cats, serve as a direct source of infection. [ProMed]

Following the discovery of an African swine fever (ASF) outbreak on a farm in Santa Giusta, Oristano, 278 pigs have been killed and destroyed. According to initial investigations, this could be a single incident. However, difficult days are ahead for not less than 250 farmers. These piggeries are located within the declared area of surveillance: the territory of Santa Giusta with 10 farms within 3 km. For the next 1.5 months, they will not be allowed to slaughter or move any pigs. The ban on slaughter and handling is one of the main measures of the protocol activated by the health authorities in order to prevent the serious losses (up to 80 percent mortality) known to be caused by ASF. In other words, the economy of the entire pig industry in the area is at stake. And since there is no vaccination against the spread of ASF, prevention is the only remaining weapon. ASF arrived in the south of Sardinia in 1978, probably due to administration of contaminated swill. Later the virus spread to other parts of the island, particularly the center. The disease became endemic in Sardinia due to several factors: many pig farms lack barriers (such as fences, hedges, natural barriers, etc.); pigs are farmed according to traditional practices, such as grazing free-range herds on vast communal lands; there is a considerable wild-boar population. [ProMed]

The total number of persons infected or colonised with vancomycin resistant enterococci mandatorily reported to the Swedish Institute for Infectious Disease Control increased dramatically during 2007 and 2008. During a period of 20 months from 1 Jul 2007 to 28 Feb 2009, a total of 760 cases were reported compared with 194 cases reported during the entire period from 2000 to 2006. This rise was mainly attributed to a wide dissemination of vancomycin resistant enterococci, which started in a number of hospitals in Stockholm in the autumn of 2007 and was followed by dissemination in various healthcare facilities (hospitals and homes for the elderly) in a further 2 Swedish counties in 2008. The majority of the cases (97 percent) were acquired in Sweden and among these, healthcare-acquired Enterococcus faecium vanB dominated. Particular emphasis was placed on countermeasures such as screening, contact tracing, cleaning procedures, education in accurate use of infection control practices, as well as increasing awareness of hygiene among patients and visitors. With these measures the dissemination rate decreased substantially, but new infections with the E. faecium vanB strain were still detected. The cause of the dissemination is unknown, and no major changes in the general hospital infection control policies such as changes of nurses/bed ratios or antibiotic policies had been introduced that could explain the increased vancomycin resistance prevalence. [T Soderblom, O Aspevall, M Erntell, G Hedin, et al., ProMed]

A cat in Pueblo West tested positive for tularemia, a potentially serious illness that can be passed on to humans. The Health Department said the cat was an indoor/outdoor cat, and officials are working with the cat's owners regarding medical concerns. Tularemia is a potentially serious illness caused by a bacteria found in animals, especially rodents, rabbits, and prairie dogs. Health officials said the illness can be passed on to humans in a variety of
ways including: being bitten by an infected tick, deerfly, or other insect; handling infected animal carcasses; eating or drinking contaminated food or water; breathing in the bacteria. Tularemia can be fatal if it is not treated with the right antibiotics. Health officials said the best way to keep your pets safe is to not let them roam or eat dead animals and to keep an eye on their health. [ProMed]

An outbreak of rabies in northern Italy has neighbouring Switzerland preparing for the worst, according to the Federal Veterinary Office. While the affected area is around 100 km from the Swiss border, officials are keeping a close eye on the situation. Switzerland has been free of the deadly virus since 1998. For the 1st time in a long time, there's the small possibility that rabies will be re-introduced by foxes. Italy has seen an alarming increase in rabies cases: from 9 in 2008 to 69 in 2009 and 199 in the 1st half of 2010. Most of the affected animals were foxes, but there were also some dogs, cats, deer and other mammals. It is believed that virus-carrying foxes wandered into Italy from Eastern Europe, where rabies is quite common. The Swiss have long been involved in working against the virus. In the 1960's and 1970's the authorities ordered chicken heads stuffed with vaccine to be placed on the ground in high-risk countryside areas. Commercially produced bait has now replaced the bird leftovers. These brown snack bars have a fishy flavour to conceal the taste of the medicine. It is the standard way to fight rabies among wild animals, which are difficult for vets to reach with vaccine shots. [ProMed]

Giardia cases have risen almost 50 per cent nationwide in the past 3 months, with concerns about an outbreak in the Wellington region. National giardia cases rose to 555 in the quarter from January to March 2010 -- up on 375 cases from October-December 2009 and compared to 470 in the same quarter in 2009. There were 8 cases recorded in the Wellington region the first week in June. The gut-residing parasite, which is found in animals and humans, is passed through faeces but lives on in environments such as waterways for a long time. It can cause diarrhoea, stomach cramps and nausea, among other symptoms. The common symptoms make the parasite hard to diagnose but any stool sample tested positive for giardia must be notified to Regional Public Health. Giardia cases fluctuated from week to week, but concerns were usually raised if there seemed to be a connection between the cases, such as if they were in the same geographic region. Measures to avoid its spread include washing hands thoroughly before and after food preparation, and boiling water from roofs and waterways for at least a minute. [ProMed]

Whooping cough is now an epidemic in California, and is on pace to break a 50-year record for infections for the year. As of 15 Jun 2010, California had 910 recorded cases of the highly contagious disease, and 5 babies -- all under 3 months of age -- have died from the disease this year. This year's surge in cases of whooping cough, is a 4-fold increase from the same period last year, when 219 cases were recorded. Officials fear that with the number of known and suspected cases at 1510, the state is on track to beat 1958's record 3847 cases; midway through that year, 1200 cases had been reported. Nationally, 23 weeks into 2010, there were 4656 cases of whooping cough, compared with 6017 cases in the same period in 2009, according to the Centers for Disease Control and Prevention. Health officials say whooping cough is cyclical and tends to peak every 2 to 5 years. A typical case starts with a cough and runny nose for one to 2 weeks, followed by weeks or months of rapid coughing fits that sometimes end with a whooping sound. Fever is rare. Unimmunized or incompletely immunized babies are particularly vulnerable. A total of 3 vaccines are administered for whooping cough, from 2 to 6 months of age. Neither vaccine nor surviving the illness provides lifetime immunity. [ProMed]

Between 20 and 80 people each year suffer from a severe infection of leishmaniasis, a disease that is transmitted from animal – mostly dogs -- to humans, causing fever and swollen liver and spleen and is fatal in up to 5 percent of cases. As explained by by experts, this disease has become in recent years on a "forgotten disease" despite the sandfly which transmits it being endemic in Spain and infecting 5 of every hundred dogs per year. On the human side, leishmaniasis is particularly virulent in immunocompromised patients (HIV, cancer or malnutrition mainly) and may occur in 2 forms: the visceral, more serious and the cutaneous, more benign and prevalent, that manifests itself through skin ulcers, which are often confused with psoriasis. Regarding the incidence of canine leishmaniasis, regions in Spain most affected so far are Andalusia, Palme Mallorca, Valencia and Catalonia. However, in recent years it has been shown that not only the typical Mediterranean climate zones are prone to the disease. According to the latest data, areas of northern Spain are registering more and more cases of dogs affected by leishmaniasis. In the Basque Country, Galicia and Madrid, infections in dogs have increased 50 percent in the last 15 years. [ProMed]

There is a new outbreak of Legionnaires Disease in Alcoy (Alicante, Spain), where 4 cases have already been confirmed. 2 of the victims are currently in the hospital improving favourably. Meanwhile the regional health authority has said that the 4 cases were all localized and appear linked. This raises the outbreaks seen in the town since 1999 to 16, during which time 300 people have been affected and 11 have died. The regional health authority wants to avoid the use of the word 'outbreak' which technically can only be used if there are 3 more cases and that a connection can be found between them. The last 2 outbreaks in the town were linked to asphalting machinery. Legionnaires' disease is the acute pneumonic form of disease caused by Legionella bacteria, usually Legionella pneumophila. Legionnaires' disease is usually acquired by inhalation by a susceptible person of an infectious dose of aerosolized Legionella. Risk factors in adults include age over 50 years, cigarette smoking, diabetes, chronic heart or lung disease, and a suppressed immune system. Usually a building's contaminated water system is incriminated as the source. Legionella are found primarily in the hot water portion of plumbing systems and in cooling towers. [ProMed]

Researchers reported at the beginning of June that 2 extra mutations set the stage for the seasonal influenza virus to evolve into a form that now resists 3 of the 4 drugs designed to fight it. Their study provides a way for scientists to keep an eye out for dangerous mutations in new flu viruses, including the ongoing pandemic of H1N1 swine flu. Only 4 drugs are on the market to treat flu and 2, the adamantines, are useless against virtually all circulating strains because the viruses have evolved resistance. Tamiflu, known generically as oseltamivir, is the current drug of choice. It comes as a pill. An inhaled drug that works in a similar manner is called Relenza, or zanamivir generically. Both can help reduce flu symptoms if taken quickly and can keep the most vulnerable patients out of the hospital, or keep them alive if they are severely ill. But 2 years ago the common circulating strain of seasonal H1N1 developed resistance to Tamiflu. Doctors were surprised, because the mutation that help the virus evade the effects of Tamiflu also usually made it a weak virus that did not infect or spread well. Seasonal flu kills between 250 000 and 500 000 people every year globally. Currently 'swine flu' is easily treated by Tamiflu but that could change at any time. [ProMed; www.sciencemag.org/cgi/content/abstract/sci;328/5983/1272]

The H1N1 pandemic is not yet over, although its most intense activity has passed in many parts of the world, the World Health Organisation (WHO) said on June 3 after a review of the flu outbreak by independent experts. The WHO emergency committee, composed of 15 external advisers, said it remained critical for countries to maintain vigilance concerning the pandemic, including necessary public health measures for disease control and surveillance. Based on the committee's recommendation, the outbreak, widely known as swine flu, remains at phase 6 on the WHO's pandemic scale, which has been at the top level of 6 since June 2009. The next meeting will decide to recommend whether to retain that level, declare the pandemic has passed, or move into a transitional "post-peak" phase. WHO experts say that the virus remains a threat to some vulnerable people, notably pregnant women, young children and those with respiratory problems, and such groups would continue to need vaccinations. The WHO has been accused of exaggerating the dangers of the H1N1 outbreak, which emerged in April 2009. Symptoms suffered by most people infected with the virus have been mild. Laboratory tests have confirmed more than 18 000 deaths from H1N1 infection, according to WHO figures, but the actual global death toll is much higher and will take at least a year after the pandemic ends to establish. The virus is currently most active in parts of the Caribbean and Southeast Asia. [ProMed]

State and local health officials are investigating a cluster of food-borne infections that sickened 7 people in 3 Texas counties this year, killing 2 of them. The patients developed listeriosis, a bacterial infection. Listeria monocytogenes bacteria are found widely in the environment, including vegetables and animals. Outbreaks are sometimes linked to foods such as soft cheeses and deli meats contaminated after processing. Genetic analysis found the identical strain of bacteria in all the patients, suggesting they were infected by the same food item. But because of the small numbers and the dispersal of cases -- 2 of the patients lived 300 miles apart -- it might be difficult to pinpoint the cause. Most healthy people aren't in danger from listeriosis though they sometimes experience flu-like symptoms. But in the elderly, pregnant women and people whose immune systems are weakened by illness, the fatality rate from the infection can reach 20 percent. The Centers for Disease Control and Prevention (CDC) estimate that 2500 become seriously ill each year with listeriosis, and 500 of them die. Symptoms of listeriosis can include fever, muscle aches, nausea and diarrhea. If the infection spreads to the nervous system, it can cause headaches, confusion, vertigo and convulsions. [ProMed]

The Bavarian State Office for Health and Food Safety, confirmed that since the beginning of 2010, already 38 hantavirus infection cases have been counted. There are already more than throughout last year: for the full year 2009 there were 21 cases reported. It was further indicated that nationwide the Robert Koch Institute has registered 213 cases so far in 2010. The spread of the virus is essentially connected with the occurrence of bank voles, which are considered the main transmitter of the rampant transmission of the Bavaria hantavirus species Puumala virus. The bank voles survived the past winter well because they would have had much food. In particular, the population would have survived well because there are many beechnuts. However, the percentage of bank voles that harbour the virus is unclear. The transmission to humans occurs through the respiratory tract. The main problem are the faeces, urine, and the dust in which the infected animals shed virus. Even when gardening or when sweeping garden houses and basements there is a risk of inhaling the dust kicked up. Experts therefore recommend that these activities be carried out while wearing a mask. The disease is similar to the flu with a few days with fever, headache, abdominal, and back pain. [ProMed]

A molecular survey of 16 057 mosquitoes captured in southwest Germany during the summer of 2009 demonstrated the presence of Sindbis virus (SINV) in mosquitos. Phylogenetic analysis of the German SINV strains linked them with Swedish SINV strains, the causative agent of Ockelbo disease in humans. This 1st molecular survey of SINV in Germany demonstrates the presence of SINV in 3 different mosquito species (Culex torrentium, Culex pipiens and Anopheles maculipennis sensu lato). The close phylogenetic relationship of German SINV strains with Swedish SINV strains suggests that migratory birds serve as a host for the virus, allowing the dissemination of SINV over large areas within a short period of time. Future studies will investigate the risk of human SINV infections in Germany in areas with high SINV infection rates in mosquitoes. [Hanna Jost, Alexandra Bialonski, Volker Storch, Stephan Gunther, Norbert Becker, and Jonas Schmidt-Chanasit. 2010. Isolation and Phylogenetic Analysis of Sindbis Viruses from Mosquitoes in Germany. J Clin Microbiol 48(5): 1900-1903]

A dangerous bacterium found in soil has claimed the lives of 10 people in the Northern Territory in Australia. Melioidosis caused by Burkholderia pseudomallei usually strikes during the northern Australian wet season, which runs from about November until April. About 20 to 30 infections usually occur each wet season, resulting in between 2 and 4 deaths. But this wet season has seen the number of infections surge. This year there were 72 cases so far, which is over 3 times what is would normally expected and well ahead of any other season. And 10 of those people have sadly passed away from the melioidosis. All of the people who have died have been aged over 30 and had pre-existing medical conditions, including diabetes, lung disease, and alcohol problems. The bacteria live in the soil in the tropics and people can become unwell either inhaling the bacteria if they come into close contact with it or acquiring the infection through the skin via a cut or a sore. Melioidosis may present at any age, but peaks in the 4th and 5th decades of life, affecting men more than women. The most commonly recognized presentation of melioidosis is pneumonia, associated with high fever, significant muscle aches, chest pain and respiratory secretions, which can be purulent, significant in quantity, and associated with on-and-off bright red blood. [ProMed]

The Ministry of Health has reported an outbreak of measles in the area of the municipality of Jumilla (Murcia), with 65 cases since late February 2010. Most of them, with 4 exceptions, involved citizens of Bulgarian and Romanian origin with a history of deficiencies in vaccination. The 1st cases date back to the last week of February 2010, when there were 2 isolated outbreaks, one in a family of Romanian origin whose children were not vaccinated. In total, 2 members had the disease but were isolated until recovery by medical personnel. The other outbreak, which had its origin in Jumilla also in the last week of February 2010, was regarded as "more important” with 65 cases accumulating to date. From the 65 cases recorded, the majority are Bulgarians, except for a local nurse and 3 other adults. These cases of measles are a matter of concern for the regional administration, since the disease had been virtually eradicated in this area and had not been recorded in recent years except for a single case of a citizen of North Africa from Andalusia in 2001 whose infection did not spread. The disease symptoms are mild fever or high fever, sneezing, a catarrhal process that spreads through the air, and the appearance of a skin rash spread over his face, chest and arms, with a slight redness. Measles is a disease which can have complications, for example in immunocompromised individuals.

A new report by the Centers for Disease Control and Prevention (CDC) confirmed a new strain of norovirus, which, in Louisiana, has sickened dozens and forced the closure of some oyster harvest areas. Because the strain is new, few people are immune to it causing more outbreaks. Several oyster beds were closed recently due to the norovirus outbreak, though they are being re-opened mid April, after tests determined them to be safe for harvesting oysters. The beds were closed after tests linked the norovirus outbreak to those beds. While norovirus outbreaks are common, it is transmitted from person to person, but those infected generally recover within one to 2 days. People can become infected by eating and drinking food contaminated by norovirus, touching objects infected and them touching their mouths, and direct contact with someone infected with norovirus. DHH tips to avoid becoming infected with norovirus are: - Frequently wash your hands, especially after toilet visits. - Carefully wash fruits and vegetables, and fully cook oysters before eating them. - Thoroughly clean and disinfect contaminated surfaces immediately after an episode of illness by using a bleach-based household cleaner. Noroviruses are a group of related, single-stranded RNA, non-enveloped viruses that cause acute gastroenteritis in humans. It appears that immunity may be strain-specific and lasts only a few months; therefore, given the genetic variability of noroviruses, individuals are likely to be repeatedly infected throughout their lifetimes. [ProMed]

An E. coli O157:H7 infection mainly results from eating uncooked food, drinking contaminated water and unpasteurized milk, and working with cattle. Diagnosed with this potentially deadly E. coli strain, one child has succumbed to the disease and 3 other children are recovering following the outbreak of the disease at the Vancouver, Washington, day care center, according to the health officials. The 4-year-old boy who died of the disease was hospitalized on 19 Mar 2010 after he was found infected with E. coli O157:H7 bacterium. Soon, 3 other children were also admitted but they have been released after the treatment. Further, the officials informed that 22 children and 4 adults were also tested. Out of these, 6 tested positive for the strain but they were not admitted as they showed no symptoms of the disease. The health officials are confident that the infection has not spread further, and they are closely investigating the cause of the disease. The cause of the cluster is yet not known, but the officials are certain that the bacteria did not come from food or water. The outbreak could be the result of unhygienic conditions at the state day care center as hands are not washed properly after toilet use or diaper change. [ProMed]

Police are investigating a Melbourne doctor who is believed to have infected 12 patients with hepatitis C virus while working at a private clinic in 2009. The Medical Practitioners Board of Victoria is expected to announce by April 9 2010 that the doctor was suspended as soon as health authorities realised some of his female patients had been infected with the same strain of the virus he was carrying. A newspaper believes that the Department of Health discovered the link through testing of the patients' blood. The most common way people get hepatitis C in Australia is by sharing drug-injecting equipment such as needles. It can also be spread by needlestick injuries in healthcare settings. People who receive blood transfusions in Australia have a low risk of getting hepatitis C because since February 1990, donations have been tested for the presence of hepatitis C virus. The Victorian Department of Health recently reported a substantial increase in hepatitis C infections. Its latest figures show 662 new cases were reported by doctors during the 2nd quarter of 2009, i.e. 25 per cent more than in the same period in 2008. About 70 per cent of people infected with hepatitis C virus may develop a chronic form of the disease. Of these people, about 1/5th will develop cirrhosis, which is scarring of the liver that can lead to liver cancer. [ProMed]

The epidemic situation for rabies has reached the highest levels of concern in Moscow. There were 257 animal rabies cases in 2009, more than 10-fold the means of previous years. The federal service of phytosanitary and veterinary surveillance considers taking unprecedented measure to control the epidemic, like banning movements of pets to suburban cottages, cancelling a show dog exhibition and mass immunization of wild and domestic animals. The veterinarians say that the situation was worse only during the post-WW2 years, when the annual numbers were above 2000 cases. Only the mass shooting of stray dogs, foxes and raccoon dogs controlled the epidemic. These measures were so effective that almost nobody remembered about rabies until the late 60s. A regional health official announced during a conference that there were from 2 to dozens of rabies cases from the 1970s until recently, when the number of cases increased to hundreds. The situation is worst in the North-West of Moscow oblast where the natural conditions are favourable for maintaining the rabies epidemic. The officials say that each weekend, about 30 000 pets are being carried to the suburban country cottages, where these animals are at risk to become infected and bring the infection into the Moscow region. [ProMed]

A veterinary student was diagnosed with West Nile virus (WNV) in May 2009 after performing a necropsy on a 4-month-old Welsh pony from Gauteng, South Africa. Six days after performing the necropsy, the student developed fever, malaise, muscle pain, stiff neck and a severe headache. A rash appeared 2 days later and symptoms persisted for approximately 10 days. Genetic analysis extracted from the student and the pony identified lineage 2 WNV - a fatal form of the virus previously diagnosed in horses in South Africa in 2008. WNV is a mosquito-born flavivirus that circulates primarily in birds and mosquitoes. Humans and horses are considered incidental, dead-end hosts for WNV. An infected horse does not normally pose a risk for infecting humans with WNV since the virus is present at very low levels in the blood, insufficient to infect mosquitoes. The student used a bone saw and was the one that removed the brain from the horse and would have had much more exposure to droplets. The veterinarians did not take extra precaution besides wearing gloves when doing horse autopsies since they did not see them as being high risk for zoonotic diseases in Africa. Veterinarians should therefore be wearing eye protection, gloves, and masks when doing post-mortem surgery on animals with fatal encephalitis [ProMed]

There has been an increase in listeriosis cases in Ontario this year and 2 people have died. On average, Ontario expects to see an average of 40 reported cases of listeriosis per year, and about 8 by March. Between 1 Jan and 11 March 2010, there have been 14 reported cases. So far, only 10 of the 14 reported cases have been investigated. Aside from the 2 deaths, 7 people were hospitalized. At least 2 of the non-fatal cases have been linked to recently recalled ham and salami products from a Toronto-based company. They were both hospitalized but are now recovering. The Canadian Food Inspection Agency is warning consumers that a product from this company may have been contaminated with the bacteria Listeria monocytogenes. Food contaminated with Listeria may not appear spoiled in any way. Symptoms include high fever, severe headache, neck stiffness and nausea. Listeriosis is, in most cases, a mild and self-limiting disease. However, pregnant women, the elderly, or people with weak immune systems are at a greater risk of death because the infection can lead to blood poisoning or meningitis. 22 people in Canada died of listeriosis in 2009. [ProMed]

During the last decade, Crimean-Congo hemorrhagic fever (CCHF) emerged and/or re-emerged in several Balkan countries, Turkey, southwestern regions of the Russian Federation and the Ukraine, with considerable high fatality rates. Reasons for re-emergence of CCHF include climate and anthropogenic factors such as changes in land use, agricultural practices or hunting activities, movement of livestock that may influence host-tick-virus dynamics. In order to be able to design prevention and control measures targeted at the disease, mapping of endemic areas and risk assessment for CCHF in Europe should be completed. Furthermore, areas at risk for further CCHF expansion should be identified and human, vector and animal surveillance be strengthened. CCHF is an acute, highly-contagious viral zoonosis transmitted to humans mainly by ticks of the genus Hyalomma, but also through direct contact with blood or tissues of viraemic hosts. In humans CCHF typically presents with high fever of sudden onset, malaise, severe headache and gastrointestinal symptoms. Prominent hemorrhages may occur in late stages of the disease with published fatality rates ranging from 10 percent to 50 percent. The disease is endemic in parts of Africa, Asia, the Middle East and eastern Europe. [ProMed]

Notifications of Q fever in the Netherlands - that in earlier years averaged 17 human cases annually- increased to 168 cases in 2007, 1000 in 2008, and over 2000 in 2009. The most affected area is the highly agricultural southern province of Noord Brabant, but cases have also been reported from neighbouring provinces. The disease has now been confirmed on a total of 73 dairy goat farms and 2 sheep farms. The specific epidemiology of Q fever in the Netherlands is most likely related to intensive goat farming in the proximity of densely populated areas. Dutch authorities have introduced a number of measures to try to control the spread of the outbreak. These include mandatory vaccination of small ruminants (initially in the affected regions but extended throughout the country in 2010 to include holdings of more than 50 sheep or dairy goats, and premises such as petting farms and zoos), a general ban on breeding, and fortnightly Q fever bulk milk testing on all farms with 50 or more dairy goats or dairy sheep. In December 2009 a cull commenced of all pregnant dairy goats, whether vaccinated or unvaccinated, on infected farms. Non-pregnant females were spared but are banned from use for breeding purposes during their lifetime. [ProMed]

A dangerous hantavirus is spreading in Baden-Wurttemberg. Since the beginning of this year, 85 cases have been reported in the administrative district of Stuttgart. The number is unusually high for the season and exceeded the previous record year of 2007 with 41 cases in the same period. This leaves an expectation of high infection levels in the coming months. The number of cases have been piling up since December 2009. According to health information, hantavirus disease manifests itself usually in the form of a common cold with sudden onset and high fever. In addition, infected individuals have head and body aches and abdominal pain. The illness lasts about 3 weeks and more than half of those affected are hospitalized. Some patients develop kidney failure. A vaccine does not exist. Hantaviruses are maintained in wild rodents that spread the virus primarily through faeces and urine. Humans usually become infected by inhaling dust with excreta contaminated with the pathogen. The red-backed vole, Myodes glareolus, whose principal food is beechnuts, is the main reservoir. The current incidence is probably due to a particularly high population of red-backed voles. [ProMed]

At least 11 linked outbreaks of gastroenteritis with a total of 260 cases have occurred in Denmark in mid January 2010. Investigations showed that the outbreaks were caused by norovirus of several genotypes and by enterotoxigenic E. coli. Lettuce of the Lollo Bionda type grown in France was found to be the cause. Taken together, the 11 outbreaks comprised approximately 480 potentially exposed persons and approximately 260 cases with symptoms of gastroenteritis. All outbreaks occurred in groups of people (company employees, course attendees, etc.) who had lunch delivered from catering companies. Based on the fact that lettuce of the same kind from the same supplier was present in all outbreaks, lettuce from the French supplier in question bought after 1 Jan 2010 was recalled from the Danish market on 22 Jan 2010. How the lettuce became contaminated is as yet unknown, but it will be important to establish this in order to prevent similar outbreaks in the future. The last large such outbreak occurred in 2006 and was also caused by imported fresh produce. [ProMed]

High rates of the most effective type of malaria-fighting drugs sold in 3 African countries are poor quality -- including nearly half the pills sampled in Senegal -- raising fears of increased drug resistance that could wipe out the last weapon left to battle a disease that kills 1 million people each year, according to a US report released Monday February 8. Between 16 percent and 40 percent of artemisinin-based drugs sold in Senegal, Madagascar, and Uganda failed quality testing, including having impurities or not containing enough active ingredient, the survey found. Artemisinin-based drugs are the only affordable treatment for malaria left in the global medicine cabinet. Other drugs have already lost effectiveness due to resistance, which builds when not enough medicine is taken to kill all of the mosquito-transmitted parasites. If artemisinin-based drugs stop working, there is no good replacement and experts worry many people could die. It is worrisome that almost all of the poor-quality data that was obtained was a result of inadequate amounts of active (ingredients) or the presence of impurities in the product [ProMed]

Tests carried out at the Health Protection Agency (HPA) and Germany's Robert Koch Institute (RKI) and Friedrich-Loeffler Institute (FLI) on the strain of anthrax isolated from a heroin user who died in Germany in mid December 2009 have shown it is indistinguishable from strains isolated from anthrax cases in Scotland. This suggests that the anthrax contamination in both countries, thought to originate in the heroin supply, could share a common source. This could suggest that the contamination of the heroin may have occurred prior to distribution of the heroin in Scotland and Germany. Of 18 confirmed anthrax isolates from Scottish cases by the HPA's Special Pathogens Reference Laboratory at Porton Down, 14 have so far been confirmed as being of the same strain, with further isolates awaiting confirmation. Typing on the isolate from the German patient has now confirmed it is also of the same strain. These results suggest that the outbreak may be associated with anthrax contamination from a single source. To date in Scotland there have been a total of 19 confirmed cases in Scotland, of whom a total of 9 individuals have died. A further case of anthrax in a patient living in London with a history of heroin use has also been confirmed by the Health Protection Agency (HPA). [ProMed]

Legionnaires' disease in Germany
Currently an investigation is ongoing to explore and control an outbreak of Legionnaires' disease affecting 65 people as of 22 Jan 2010, in the cities of Ulm and Neu-Ulm, southwest Germany. A hitherto unidentified wet cooling system in these twin cities is considered as the most likely source of infection. On 5 Jan 2010, Ulm University Hospital informed the local health office of a cluster of hospitalisations due to community-acquired pneumonia caused by Legionella pneumophila. As of Fri 22 Jan 2010, 65 cases including 5 deaths were under investigation by the local and regional health authorities. With only a few exceptions all cases were living or working in Ulm or Neu-Ulm in southwest Germany. For 40 cases the onset of symptoms was during the last week of December 2009. Investigations are in progress to identify the potential source of this outbreak by comparing environmental isolates from the patients' homes and wet cooling systems from the areas of both cities. According to the patient interviews, the cases had no common exposure to water supplies in public buildings, hotels, sport facilities, or similar sources. This is the largest community-associated outbreak of Legionnaires' disease recognised in Germany so far. [ProMed]

The pandemic (H1N1) 2009 influenza virus outbreak remains moderate and its effects are probably closer to those of 1957 and 1968 than the far more deadly 1918 version, according to the World Health Organization. The H1N1 pandemic appears to be easing in the northern hemisphere but could still cause infections until winter ends in April. It is too soon to say what would happen once the southern hemisphere enters winter and the virus becomes more infectious. The 1918 pandemic, known as the Spanish flu, swept around the world at the end of World War One, killing some 40-50 million people. Populations should continue to be vaccinated, official of the WHO said, reiterating that the vaccine is safe and effective. Nearly 14 000 official deaths have been reported by more than 200 countries since the virus emerged in North America last April 2009, but it will take at least 1-2 years after the pandemic ends to establish the true toll. WHO experts say the actual death rate could be much higher than the number of laboratory-confirmed cases so far and data on H1N1 outbreaks in Africa are scarce. [ProMed]

A fox - that was killed by police after it bit a New Jersey man - has tested positive for rabies. On Thu 31 Dec 2009, the state Department of Health and Senior Services confirmed the suspected diagnosis of rabies virus. Two people were bitten by the fox: a 9-year-old child was bitten on 24 Dec 2009 and an adult male was bitten on Christmas day. After responding to the 1st incident, police searched the area but could not locate the fox. During the 2nd incident the fox was immediately located and killed by police. None of the bites were life threatening injuries, but had the victims not received a series of rabies shots, it could have been. It seems this fox was an isolated case. In the past, raccoons have been the usual suspects, but now it is rare that a raccoon will host the rabies virus. Also small animals, squirrels and rodents can contract the disease. Rabies virus is found in the saliva of a rabid animal and is transmitted by a bite, or possibly by contamination of an open cut. Bats, raccoons, skunks, groundhogs, foxes, cats, and dogs represent about 95 percent of animals diagnosed with rabies in the United States. Domestic farm animals and other wild animals may also become infected. Rabid animals display vicious aggressive behaviour. [ProMed]

A growing number of people in Ireland are falling victim to a potentially fatal infection linked to contact with farm animals and water sports. The number of cases of leptospirosis rose to 30 in 2008, compared to 22 in 2007. It caused the death of one elderly patient, as well as 17 hospitalisations. A total of 10 picked up the illness on farms and 9 had been involved in water sports like canoeing, swimming outdoors and a triathlon. Others were infected while gardening, spending time by a river bank or holidaying in a tropical destination. Leptospirosis in Ireland is usually picked up from rats, although a milder form can be caught from cattle or dogs. Leptospirosis is transmitted to humans by contact with the urine of rats, cattle, foxes, rodents and other wild animals. It is an infectious condition that can cause a range of different symptoms such as mild flu-like symptoms. In severe cases, it can result in multiple organ failure and internal bleeding. Animals, such as rats, pigs and dogs, can become infected by bacteria called leptospires. They can then contaminate a water source by urinating into it. If a human comes into close contact with the infected water, such as through the eyes, mouth, and nose or cuts in their skin, they can become infected with leptospirosis. Dog owners and those who work with dogs may be at risk if hygiene is inadequate. Recent cases have occurred in golfers who retrieved golf balls from stagnant pools. [ProMed]