Young people in a region in Scotland have been hit with an outbreak of syphilis. The National Health Service has seen a surge in cases of the sexually transmitted infection among heterosexual people aged 15 to 25. The number of cases currently stands at about 20 -- compared to a usual 3 or 4 -- and those affected pass on the disease to partners in unprotected sex about 50 percent of the time, leading to fears the problem could escalate. The health board has launched an investigation into potential sources of the outbreak, as well as increasing clinic hours for testing. And young people have been urged to get themselves tested in a bid to stop the spread of the disease. Over summer 2013 there was a small number of cases that seemed slightly unusual. From autumn onwards, there were suddenly more, but it has not been pinpointed where it came in. If left untreated, syphilis can cause permanent damage to the brain, the nervous system, and also the heart. Symptoms, which include ulcers, disappear but the infection stays. The longer someone goes untreated the worse the syphilis can become. A simple blood test is all that is needed to diagnose it, while treatment is usually a course of antibiotics. [ProMed]

The UK National Health Service has failed to use an effective method of sterilising surgical instruments contaminated with the human form of "mad cow" disease because it did not fit in with its established washing procedures, according to a leading specialist in variant Creutzfeldt-Jakob disease (vCJD). The result is that hundreds of people have had their lives blighted by surgery performed with instruments possibly contaminated with the prion protein responsible for vCJD. The specialist led one of a number of research groups that came up with novel ways of destroying the lethal prion protein, which sticks to the stainless steel of surgical instruments like superglue and can survive the high temperatures of hospital autoclaves. The solution that was developed was a combination of enzymes and detergents, like a sort of bespoke biological washing powder which very effectively prion-decontaminated metal surfaces. Currently several hundred people have been notified that they have been exposed to potentially contaminated surgical instruments. They've had to be notified that they've had a significant exposure to prions because they are expected to take precautions. They are not allowed to be blood donors and if they go on to have surgery they have to notify the surgeons that they are high risk individuals. About 200 hospital patients have been told that they have been exposed to the vCJD prion. Of the 177 people in the UK who have died of vCJD, 3 received contaminated blood, and the rest are assumed to have been infected by meat or meat products contaminated with bovine spongiform encephalopathy (BSE). Almost all of the 177 cases of vCJD -- the human form of "mad cow" disease -- have been contracted through eating contaminated meat or meat products before the introduction of controls to limit the spread of bovine spongiform encephalopathy (BSE) from cattle to people. Three of these deaths, however, are believed to have resulted from blood donors infected with vCJD, but showing no clinical symptoms. There is one further case of a person who died of something else but who was shown at post-mortem to be infected following a blood transfusion. Latest estimates suggest that up to one in 2000 people in Britain could be carriers of vCJD. Because the prion protein responsible for vCJD is found in a wide range of tissues, such as spleen, tonsils and appendix, the fear is that asymptomatic carriers may spread the infection to others through contaminated surgical instruments and blood donations. [ProMed]

Tularemia is a zoonosis caused by Francisella tularensis (bacteria) and has been reported for the first time in a hare in The Netherlands. The causative bacterium is a Gram-negative rod, 0.2-0.5 micrometre x 0.7-1.0 micrometre, non-motile and non-spore-forming organism that is an obligate aerobe with optimal growth at 37 degrees Celsius. It occurs naturally in rabbits and hares, in rodents, such as voles, and beavers. A wide range of other mammals and several species of birds have also been reported to be infected. Among domestic animals, the cat seems to be able to act as a carrier of the bacterium. Two types of _F. tularensis_ are recognised on the basis of cultural characteristics, epidemiology, and virulence in some hosts. Tularemia is largely confined to the Northern Hemisphere and is not normally found in the tropics or the Southern Hemisphere. F. tularensis (Type A) is associated with lagomorphs in North America. It is transmitted primarily by ticks and biting flies, is highly virulent for humans and domestic rabbits, and most of the isolates ferment glycerol. F. tularensis (Type B) occurs mainly in aquatic rodents such as beavers in northern North America, and in hares and small rodents in Eurasia. The disease is characterised by fever, depression and septicaemia. In humans, there may be ulcers or abscesses at the site of inoculation and swelling of the regional lymph nodes. It is important to understand that there is a high risk of direct infection of humans by direct contact with this organism. According to the most recent 6-month OIE report, tularemia was reported as present in 6 countries (Czech Republic, Denmark, Sweden, France, Germany, and Switzerland). In addition, Spain and the United States have reported the disease limited to certain zones. In 82 countries the disease has never been reported. Although Tularemia had not been reported in the Netherlands since 1953, this event should not come as a surprise since the disease is present in the surrounding countries such as Germany, France and Belgium. [ProMed]

A health board is investigating 4 cases of the infection due to Legionella bacteria linked to gardening compost. 2 patients are being treated in intensive care while 2 more have been discharged from hospital. The 4 people affected are keen gardeners between the ages of 62 and 84. This type of Legionella bacteria is quite rare in that unlike other strains it has never been identified in man-made water systems, like cooling towers. The health agencies are working with experts to trace the source of the infection and samples of the compost have been sent for testing. It is known that all of the 4 cases are keen gardeners and had purchased different products containing compost prior to acquiring the infection. Gardening is a healthy hobby but there are risks and it is important that people take some simple precautions when working in their garden or with gardening products. The symptoms of this strain of Legionella include headaches, diarrhoea, or a dry cough followed by pneumonia. Most people recover after treatment with antibiotics but those with underlying medical problems are more vulnerable. It is not known exactly how the infection is passed from compost to people but health experts assume it is through breathing in very small dust particles or drops of contaminated water. The infection is not transmitted from person to person. Anyone handling garden materials such as potting mix, mulches, composts, or garden soils is advised to open bags carefully, wear gloves and keep doors to greenhouses or sheds open when potting plants or filling hanging baskets. Gardeners are also advised to wear a mask if the air is dusty, particularly indoors, and to wash their hands immediately after using compost and before smoking. The same strain killed a Scots gardener and made 5 others sick in May 2012. [ProMed]

The European Centre for Disease Prevention and Control [ECDC] reported 12 new cases of West Nile fever in middle of August 2013 in the countries of the European Union. West Nile fever is an illness caused by the mosquito-borne West Nile virus. Of the new cases, 9 occurred in Greece, with 4 cases in Attiki, 2 in Kavala, 2 in Xanthi and one in Thessaloniki. Hungary reported its 1st case in Pest county and Romania reported its 1st confirmed case in Galati county. Pest county was affected by West Nile fever in 2012, while Galati county was affected in both 2011 and 2010. Austria reported a confirmed case of West Nile fever infection, but the case is still under investigation. There were 44 new cases of West Nile fever reported in the middle of August 2013 in neighbouring countries. The Russian Federation reported 26 cases. Of these cases, 10 were from areas with previous case reports: Saratov oblast with 4, Astrakhan oblast with 3 and Volgograd oblast with 3. Of the cases, 16 were from newly affected areas, including 8 in the Samarskaya oblast, 4 in the Rostovskaya oblast, 2 from the Lipetskaya oblast, one from the Voronezhskaya oblast and one from the Adygeya republic. Serbia reported 10 new cases, including 7 cases in Grad Beograd, and one case each in the Sremski district, Podunavski district and Macva district. Israel reported 8 new cases, including 4 in the Central district, 2 in Haifa and 2 in Tel Aviv. The ECDC's West Nile fever maps report the geographic distribution of reported human West Nile fever cases in the EU and neighbouring countries. The information is meant to help authorities responsible for blood safety in areas with ongoing West Nile virus transmission to support the implementation of legislation for blood safety. 2013 has been an active West Nile virus (WNV) transmission season so far. With 2-3 months of WNV transmission remaining in most of these countries, more cases can be expected. Presumably, health authorities in the affected countries are advising citizens to avoid mosquito bites. A HealthMap / ProMED-mail map of Europe showing the locations of the countries mentioned can be accessed at: http://healthmap.org/r/1-q1. [ProMed]

Dozens of people have been hospitalized in Italy after eating pesto sauce contaminated with botulism bacteria. More than 50 people, who had eaten jarred pesto from a local producer, sought help at local hospitals after suffering symptoms including vomiting, diarrhoea, and high fevers. Tests on the pesto showed the presence of the bacterium Clostridium botulinum, which produces the botulinum toxin which when ingested causes a life-threatening kind of food poisoning. The victims are almost all from the area around Genoa, the birthplace of the famous pasta sauce. Six of those admitted, including 2 children, were kept in overnight for observation as further tests are carried out. The local producer responsible for the outbreak has been growing the area's renowned basil for almost 2 centuries, but only recently started selling pre-prepared jars of the sauce. The company alerted health authorities on Fri 19 Jul 2013, pulling the jars from supermarket shelves. The company said that they have done everything they should do to take care of their customers, spending 25 000 Euros a year on laboratory analyses to avoid such episodes. The name pesto comes from "pestello", the Italian word for the pestle, which was once used to grind basil, garlic and cheese into the well-loved sauce. The earliest known record of the sauce is from an 1865 cookbook "Genovese Recipes", in which it is defined as "beaten basil and garlic which is used to season pasta." [ProMed]

A pit bull that attacked 4 children and an adult in central Spain was infected with rabies, marking the 1st recorded case of the disease on the Iberian Peninsula in almost 4 decades. Authorities in the province Castile-La Mancha have declared a state of high alert and ordered the compulsory vaccination of all dogs and cats within an 29 km radius of where the attacks took place. The owner of the dog has been arrested for several counts of criminal negligence resulting in injury, and for failing to have the correct license for a dangerous breed. It is thought that he deliberately doctored veterinary records of the pit bull cross after bringing it into Spain from Morocco. The dog bit 3 children, aged 2, 6 and 12, as well as a 17 year old boy in the village of Arges, near Toledo early in June 2013. It was immediately killed and was confirmed to have been rabid following tests. All bitten persons were discharged after being given rabies inoculations, apart from the 2 year old, who was kept in hospital after being bitten in the face. The regional government has ordered all cats, dogs, and ferrets in the danger zone to be vaccinated against the disease within 15 days. Some 60 000 dogs in 56 villages are thought to be at risk. At least 7 dogs have already been identified as possibly being infected with rabies and have been put in quarantine for one month. Mainland Spain was officially declared rabies free in 1975 after successful campaigns to stamp out the disease. There have been occasional examples recorded in Spain's North African enclaves of Ceuta and Melilla, cities on Morocco's Mediterranean coast. It is understood that the rabid pit bull cross was bred in Spain but spent 4 months in Morocco, only returning between 11 May 2013 and 10 Jun 2013. [ProMed]

Zika virus (ZIKV) has been detected in the blood of a 45 year old Canadian woman who recently returned from a vacation in southern Thailand. ZIKV is a flavivirus which was first reported from Thailand in 1954. The patient traveled with other family members to Bangkok in January 2013 and spent a week there without noticing many mosquito bites. The party went to Phuket Island early February, traveling and spending time at various beaches where the patient noted many more mosquito bites as she was told that it was mosquito season. On her return to Bangkok, she changed her hotel to one by the river, where she sustained numerous bites on her exposed skin. Most noticeably her leg became inflamed and itchy, to which she applied cortisone cream. She flew back to Canada and on the flight described feeling restless, irritable, with a headache, chills, and sore back, in addition to the itching and inflammation of the mosquito bitten areas. Three days after her return to Alberta, Canada, she felt feverish, was diaphoretic, nauseous with vomiting, extremely fatigued, and noted blisters in her mouth. After a brief respite from her symptoms she developed a severe backache, for which she sought medical assistance at a local emergency department. The physician tested her for a variety of infectious etiologies, including dengue fever, malaria and measles, but did not admit her for observation or management. A number of serum samples collected over 30 days were tested for dengue and some were found positive for that virus. However, the lack of a dengue seroconversion on a convalescent serum and the unusual nature of the rash, prompted to investigate for a probable flavivirus etiology through a molecular approach, which led to the diagnosis of ZIKV infection. The patient made a relatively uneventful recovery, about two and a half to three weeks after her initial symptoms. None of her immediate family members described overt symptoms, such as fever and rash, although they had stated that they were also bitten by mosquitoes during their stay in Bangkok. It is another example of the transport of virus infections half way around the world in this age of rapid flights, and the need for clinicians to be able to quickly find out about infections occurring in distant localities. [ProMed]

Public health agencies in 5 states are assessing the rabies risk for hundreds of people who may have had close contact with an infected organ donor and 4 transplant recipients, one of whom died. About 200 medical workers, relatives, and others were assessed for potential exposure in Maryland, where the man who received an infected kidney died. Fewer than 2 dozen were urged to get the rabies vaccine as a preventive measure. In Florida, about 90 people were identified as potentially exposed, and 3 were offered the rabies vaccine. The only potential exposures were people who worked with the patient or the transplanted organ. Health officials in Georgia and North Carolina are also involved in the epidemiological investigation prompted by the Maryland man's death from rabies in late February 2013, nearly 18 months after he got the kidney. Doctors in Florida didn't test the 20 year old donor for rabies before he died in September 2011. His heart, liver, and other kidney went to recipients in Florida, Georgia, and Illinois. They started getting the vaccine in March 2013, and none has had rabies symptoms. A rabies expert said they have a strong chance of surviving since they haven't shown any symptoms. Health officials say the virus can be spread through the infected person's saliva and mucous membranes, but human-to-human transmission is rare. The federal Centers for Disease Control and Prevention (CDC) in Atlanta say there has been only one documented instance of transmission by a bite in the US. The CDC investigators are still trying to learn how the transplant donor got infected with the raccoon rabies virus that was found in his brain tissue and that of the Maryland man. Federal guidelines published in 2012 for evaluating organ donors with encephalitis urge "extreme caution" if the suspected cause is a viral pathogen, such as rabies. Experts say rabies transmission through solid organ transplants is rare. There have been just 2 other documented instances worldwide, one in Germany and a 2004 US case in which all 4 recipients died. [ProMed]

A family of very dangerous bacteria -- untreatable and often deadly – is spreading through hospitals across the USA, and doctors fear that it may soon be too late to stop them. These are bacteria present a triple threat: 1) they are resistant to nearly all antibiotics, 2) they have high mortality rates, killing half of people with serious infections and 3) they can spread their resistance to other bacteria. So far, this particular class of bacteria, called carbapenem-resistant Enterobacteriaceae (CRE), has been found only in hospitals or nursing homes, rather than in the community. But officials sounded the alarm partly because, if the bacteria's spread isn't contained soon, even common infections could become untreatable. In 2001, only 1.2 percent of the common family of bacteria, Enterobacteriaceae, were resistant to carbapenem antibiotics – the strongest class available. By 2011, that figure jumped to 4.2 percent. In the 1st half of 2012, nearly 200 hospitals treated at least one of these infections. When antibiotics no longer help a patient, doctors are resorting to alternatives, such as surgery to cut out infected tissue. Perhaps the greatest threat from CRE is its ability to share its resistance genes with other bacteria. So although CRE's spread is somewhat limited today, it could potentially share its resistance with far more common bacteria, such as E. coli. There is a program for hospitals, called "Detect and protect": Hospitals need to find out which, if any, of their patients have CRE, including patients transferred from other facilities. They should take precautions, such as wearing gloves and gowns, to prevent spreading the bug, even dedicating separate rooms, machines, and staff for those infected. Hospital staff should remove invasive devices, such as catheters, as soon as possible. These devices can spread bacteria deep into the body. Lastly, doctors need to prescribe antibiotics more judiciously. About half of antibiotic prescriptions are either unnecessary or inappropriate. There is little chance that an effective drug to kill CRE bacteria will be produced in the coming years, since manufacturers have no new antibiotics in development that show promise. [ProMed]

For the 1st time, scientists have found evidence of the African Ebola virus in Asian fruit bats, suggesting that the virus is far more widespread around the world than had been previously known. That does not mean that outbreaks of hemorrhagic fever are inevitable, but the possibility exists: bats are believed to drink out of jars attached to trees to collect tasty date palm sap, and fatal outbreaks in Bangladesh of Nipah virus, which is not related to Ebola virus, have been blamed on fresh sap contaminated with bat saliva, urine, or faeces. Palm sap gatherers should be encouraged to put bamboo covers on their collecting jars to keep bats out. These bats roost in caves, but there are very few caves in Bangladesh, so scientists put up mist nets outside old ruins. The scientists would untangle the bats, draw blood and take saliva, urine, and fecal samples, and release them. Five of them reacted to tests for antibodies to the Zaire Ebola virus. The researchers did not find any virus itself, so it was not possible to do genetic sequencing and see exactly how close the match to the African strain was. Although closely related species of fruit bats are found in Africa, India, and China, their territories do not overlap and these bats don't migrate long distances, so it is likely the virus had been in a bat ancestor species for millenniums. A related virus, Ebola Reston, which is not known to sicken humans, has been found in Philippines fruit bats, and an "Ebola-like" virus has been found in insect-eating bats in Spain. But the match in Bangladesh was closest to Zaire Ebola virus. Ebola virus was at first thought to be a gorilla virus, because human outbreaks began after people ate the bodies of dead gorillas. But scientists believe that bats are the natural reservoir and that primates may get infected by eating fruit that bats have drooled or defecated on. [ProMed]

A total of 3 more people have been struck down by listeriosis after eating soft cheese. The cases in New South Wales (NSW) follow 7 cases last week. They bring the total number of people affected nationwide to 21. 2 Australians have died and a pregnant woman has miscarried following the outbreak. The people ate cheese products that have since been recalled. Tests are still under way to confirm a direct link with the current outbreak, according to NSW Health. It follows an earlier recall of Brie and Camembert cheeses on 19 Dec 2012 after the 1st cases were identified. Listeria has a 70-day incubation period so new cases could still emerge. NSW Health acting director of health protection said all of the recent cases involved people aged over 65 with one person in a serious condition. "These cases highlight the need for people to check their fridges to see if they have any of the recalled cheeses and discard or return to the place of purchase any cheese that is on the list of recalled products," he said in a statement. Listeria are bacteria that can affect a number of food products but particularly soft cheeses including Brie and Camembert. The infection may cause minor or no symptoms in healthy individuals but can be particularly dangerous for the elderly, pregnant women and people with compromised immune systems, such as cancer patients. Early symptoms include fever, headache, tiredness, aches and pains. [ProMed]