Saturday, September 29, 2012

WHO: Novel coronavirus not easily transmissible person-to-person


In a follow-up to an article I wrote on last weekend, the World Health Organization issued an update on the novel coronavirus on Thursday saying there have no new cases of the virus reported.

The two confirmed cases to date have occurred in a  previously healthy, 49 year-old male Qatari national with travel history to Saudi Arabia prior to onset of illness and a a 60 year-old Saudi national who died.

According to the WHO, from the information available thus far, it appears that the novel coronavirus cannot be easily transmitted from person-to-person.

WHO is working closely with the national authorities of the involved countries (Qatar, Saudi Arabia, United Kingdom) and international partners in order to better understand the public health risk from the novel coronavirus.

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Friday, September 21, 2012

Christchurch health reports increase in syphilis in gay and bi men, internet ‘hook-ups’ blamed

Treponema pallidum  Image/CDC

Anonymous sexual hookups arranged over the internet is the likely reason for an “incredible rise” in syphilis young gay and bi men in Christchurch, according  to Dr Edward Coughlan of Christchurch.

As reported on the website, Friday, Coughlan notes the incidence of Syphilis, primarily amongst men who have sex with men in their early 20s, has surged in the past eight months with over 50 men in the city now diagnosed with syphilis.

The report continues to say, half of the young men identified in Christchurch who contracted the disease still had no symptoms and were only identified through contact tracing starting with men who already had symptoms.

Coughlan says reaching vulnerable sexually active men with alerts to ensure they practise safer sexual techniques and also get tested every three to six months is difficult as internet-based contact sites such as dating sites and locator apps such as Grinder tend to isolate such men from glbti-focussed community health initiatives. He says the Canterbury District Health Boardand the NZ AIDS Foundation are currently looking at initiatives to reach these men and head off a further blowout of syphilis.

Syphilis is a sexually transmitted infection (STI) caused by the bacterium, Treponema pallidum. The most common way to get syphilis is by having sexual contact (oral, genital or anal) with an infected person. The secondary lesions are also infective and contact with them could transmit the bacteria. It can also be transmitted from an infected mother to her baby (congenital transmission). It can also be transmitted through blood transfusion, though extremely rare because of testing of donors.

Because of the fragility of the organism, you cannot get syphilis from eating utensils, pools or toilets.

Syphilis goes through four stages that can overlap:

Primary Syphilis

The first symptom of primary syphilis is frequently a small, round, firm ulcer called a chancre (pronounced “shanker”) at the place the bacteria enters the body (usually the penis, vulva or vagina, but it may appear on the cervix, tongue or lips). There is usually just one chancre, however there can be many. Swollen lymph nodes in these areas are common.

The chancre usually appears in about 3 weeks after infection, but can occur anytime from 9-90 days after infection.

Because chancres are painless and can occur inside the body, you may not notice it. It disappears after 3-6 weeks whether you are treated or not. If primary syphilis goes untreated, it then moves into the secondary stage.

Secondary Syphilis

The most common symptom of this stage is a non-itchy rash. The rash is usually on the palms of the hands (see below) and soles of the feet, it can cover the whole body or only a select few areas. This occurs 2-10 weeks after the chancre heals. Other common symptoms are sore throat, fatigue, headache, swollen glands and less frequently hair loss and lesions in the mouth.
Much like primary syphilis, secondary syphilis will disappear even without treatment. If untreated it goes into the latent and tertiary stages.

Latent Syphilis

This is the hidden stage of syphilis. At this stage there are no symptoms. This stage can last for weeks or decades.

Early latent syphilis is still an infectious stage and you can transmit the disease to your partner. In late latent syphilis, the risk of infecting a partner is low or absent.

Signs and symptoms may never return or if untreated it goes into the most serious stage, tertiary syphilis.

Tertiary Syphilis

Even without treatment only a minority of infected people develop these horrible complications. In this stage, the bacteria will damage the heart, eyes, brain, bones, joints and central nervous system. This can happen decades after the initial infection. This can result in blindness, deafness, memory loss, heart disease and death. Neurosyphilis is one of the most severe signs of this stage.

Congenital syphilis can results in miscarriages, premature births and stillbirths. Some infants with congenital syphilis have symptoms at birth, but most develop symptoms later. Sore on infected babies are infectious so holding and kissing infected babies could transmit the disease.

It is very easy to detect early stages of syphilis through blood tests that detect antibodies. The U.S. Preventive Services Task Force and other major medical organizations recommend that all pregnant women be screened for syphilis. The bacteria can be visualized through special microscopic techniques from the primary chancre or other sores .

If it is suspected to be neurosyphilis, testing can be done on spinal fluid.

It is easy to treat syphilis in the early stages with one injection of Penicillin. Later stages or neurosyphilis may take daily doses given by IV in a hospital. It is important to note in late syphilis, any damage done to organs cannot be reversed.

Having a syphilis chancre can increase the transmission of HIV up to 5-fold.

To reduce your risk of syphilis and other sexually transmitted diseases, practice safe sex:

• Avoid sex, or have mutually monogamous sex with one partner who is uninfected.
• Talk with your sex partners about your HIV status and history of other sexually transmitted infections.
• If you don’t know the STI status of your partner, use a latex condom with each sexual contact.
• Avoid excessive use of alcohol or other drugs, which can cloud your judgment and lead to unsafe sexual practices.

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Sunday, September 16, 2012

Indian Man Dies From Rabies 25 Years After Dog Bite

Rabid dog Photo/CDC
While that vast majority of human rabies cases have an incubation period of less than 90 days, researchers from Goa Medical College (GMC), in Goa, India suspect they have a case of the deadly viral disease in a man who was possibly exposed to a rabid dog a quarter of a century ago.

The highly unusual case is documented in the recent issue of the Annals of Indian Academy of Neurology.
The 48-year-old man from Karnataka working in Goa was diagnosed with rabies in 2009, 25 years after receiving a dog bite on the leg at the age of 23.
This was the only known contact he had according to the man’s own medical history. He was never treated or vaccinated against the virus when the biting incident occurred.
According to the case report:
During the clinical examination, he was anxious and scared at the sight of water, flow of air under a fan and had photophobia, as noted by the medical residents and consultants. Two days after admission, suddenly, he went to the bathroom, washed his face and drank a glass of water. The photophobia and aerophobia had reduced. He was conscious, alert and well oriented to time and space and did not have laryngeal stridor or pharyngeal spasm. He had no previous history of any neurological illness or seizure disorder prior to admission to this hospital. Although the features of hydrophobia and photophobia suggested rabies encephalitis, he had a well-maintained consciousness level with no neurological deficits and the act of drinking water cast doubt on the diagnosis and he was referred to the general hospital for further management. However, he went to a private hospital in the zone. Within a few hours, he had hematemesis and he aspirated and succumbed.
Upon autopsy, histologic examination suggested  an encephalitic pathology.
In addition, the presence of intraneuronal Negri bodies were noted in the neurons. Researchers say the inclusions could be specifically immunolabeled with antibody to nuclear capsid protein of rabies virus thus establishing the definitive diagnosis of rabies encephalitis.
Virology studies could not be performed as the brain was received in 10% formalin.
The scientists note that the vast majority of rabies cases appear within one year incubation, most of these within 3 months:
Majority of the cases have an incubation period between 31 and 90 days. In the literature, the overall reported incubation period varies from 30 days in 30% of the cases, 31-90 days in 54%, greater than 90 days in 15% and in 1% of the cases beyond 1 year is recorded. In a cohort of 47 cases studied following autopsy at a single center in South India, the median incubation period recorded was 60 days (range 7 days to 4 years).
They point out documented cases  of extended length incubation such as a case in a Vietnamese girl who immigrated to Australia who had an incubation period exceeding 6.5 years. They also note that other cases seen have shown incubation times of up to 19 years.
Researchers have not ruled out the theoretical possibility of another recent insignificant exposure to the virus-carrying animal vector could not be ruled out completely, such as a dog lick on a minor scratch for example.
The study closes with the following statement:
We wish to suggest that giving credence to the actively forthcoming clinical history from a cognitively sound and conscious patient before death correlating with pathological diagnosis and acknowledging the rare cases of rabies with long incubation period is essential to further the knowledge about the phenomenon of very long incubation in cases of rabies encephalitis, although the evidence in the present case is, to an extent, tentative. The anatomical site of viral latency and the mechanism of reactivation of rabies, a neurotropic virus, remains an enigma to be unraveled.
According to the website, rabies in humans is 100% preventable through prompt appropriate medical care. Yet, more than 55,000 people (20,000 in India according to the paper), mostly in Africa and Asia, die from rabies every year  – a rate of one person every ten minutes. The most important global source of rabies in humans is from uncontrolled rabies in dogs. Children are often at greatest risk from rabies. They are more likely to be bitten by dogs, and are also more likely to be severely exposed through multiple bites in high-risk sites on the body. Severe exposures make it more difficult to prevent rabies unless access to good medical care is immediately available. This major source of rabies in humans can be eliminated through ensuring adequate animal vaccination and control, educating those at risk, and enhancing access of those bitten to appropriate medical care.
Shankar SK, Mahadevan A, Sapico SD, Ghodkirekar M, Pinto R, Madhusudana SN. Rabies viral encephalitis with proable 25 year incubation period!. Ann Indian Acad Neurol [serial online] 2012 [cited 2012 Sep 16];15:221-3. Available from:
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Saturday, September 15, 2012

Massachusetts health officials report fourth human case of EEE


Several towns on Massachusetts’s South Shore have been placed on a “High” Eastern Equine Encephalitis (EEE) threat level after a Plymouth County resident was confirmed positive for the mosquito borne viral infection.
According to a Massachusetts Department of Public Health (DPH) news release Thursday, the patient, in his 60s, is the fourth human case of EEE in the state this year.
This prompted health officials to raise the EEE threat level in the towns of Duxbury, Marshfield, Norwell, and Plymouth.
The DPH says communities, which have been designated at “High” risk of EEE, are urged to cancel all planned evening outdoor events for the remainder of the season until the first hard frost. Mosquito control projects will be increasing ground spraying activities in these communities.
The current EEE patient is hospitalized and being treating for the infection. Massachusetts has reported one fatality as a result of EEE this year.
In addition to the EEE cases, DPH also reported the confirmation of the 14th human case of West Nile Virus(WNV) in a Massachusetts resident this year.
DPH State Epidemiologist Dr. Al DeMaria said, "Today’s announcement is yet another serious reminder that the threat of mosquito-borne illness is still with us, and will remain so until we see the first hard overnight frost”.
Eastern Equine Encephalitis is a mosquito-borne virus that is quite rare in the United States, with only 5-10 cases reported annually according to the Centers for Disease Control and Prevention (CDC). EEE virus is one of several mosquito-transmitted viruses that can cause inflammation of the brain (encephalitis).
It is not transmitted from person to person.
People at highest risk of getting this infection are those who live in or visit woodland habitats, and people who work outside or participate in outdoor recreational activities, because of greater exposure to potentially infected mosquitoes.
Symptoms usually start from a few days to more than a week after getting bit by an infected mosquito. These include a sudden onset of headache, high fever, chills, and vomiting. The disease can progress to disorientation, seizures, and coma. It is fatal in approximately 30 percent of the cases.
There is no specific treatment for this infection and a vaccine is not available for prevention.
The CDC advises the public to take the following preventive measures to prevent mosquito-borne diseases:
• Use insect repellent containing DEET, picaridin, IR3535 or oil of lemon eucalyptus on exposed skin and/or clothing. The repellent/insecticide permethrin can be used on clothing to protect through several washes. Always follow the directions on the package.
• Wear long sleeves and pants when weather permits.
• Have secure, intact screens on windows and doors to keep mosquitoes out.
• Eliminate mosquito breeding sites by emptying standing water from flower pots, buckets, barrels, and other containers. Drill holes in tire swings so water drains out. Keep children’s wading pools empty and on their sides when they aren’t being used.
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Monday, September 10, 2012

Bacillus cereus outbreak at Belgian day care center sickens 20 children

Bacillus cereus bacteria grown on sheep’s blood agar Image/CDC

The Federal Agency for the Safety of the Food Chain (AFSCA) in Belgium reported last week an foodborne outbreak at a Borgerhout day care center which resulted in at least 20 children suffering with the symptoms of vomiting.

Upon notification, the agency immediately conducted a thorough inspection of the establishment. Several samples of leftover food and vomit were collected. They were immediately sent for analysis at the Scientific Institute of Public Health.

It turned out that Bacillus cereus was discovered in both the food and vomit samples.

No specific food source was mentioned in the AFSCA press release.

Bacillus cereus is an aerobic, spore-forming bacterium found in the soil and the environment worldwide. It commonly found in low levels in raw, dried and processed foods.

A well recognized and common cause of food poisoning worldwide,Bacillus cereus causes two types of toxins: a diarrheal type and a vomiting type.

The diarrheal type of this food poisoning is usually associated with meats, milk and vegetables. The onset for the disease is from 8-16 hours and it lasts 12 to 14 hours.

The vomiting type of this food poisoning is due to rice, grains, cereals and other starchy foods.
The onset is quite rapid (30 minutes to 6 hours) and usually lasts a day or so. This type is frequently associated with outbreaks due to cooked rice held at room temperature.

This type of food poisoning is rarely fatal and cannot be transmitted from person to person.

Improper storage of food stuffs is the issue. Bacillus cereus spores can survive boiling and if the food, rice for example is stored at ambient temperature, the spores can germinate into toxin producing bacteria.

Then the person eats the rice contaminated with the pre-formed toxin that causes the illness.

The vomiting type of toxin is also heat resistant, much like the enterotoxin that causes Staphylococcus aureus food poisoning, and cooking will not destroy the toxin.

To prevent B. cereus food poisoning the key is to thoroughly cook food and if you do not eat it immediately, hold it at 140°F or refrigerate promptly. Do not let the food cool slowly.

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Monday, September 3, 2012

Nigeria reports 77 polio cases in first 8 months of 2012

poliovirus   Image/CDC

The Global Polio Eradication Initiative describes Nigeria:
Nigeria is one of the most entrenched reservoirs of wild poliovirus in the world. It is the only country with ongoing transmission of all three serotypes: wild poliovirus type 1, wild poliovirus type 3, and circulating vaccine-derived poliovirus type 2.
According to a report in the Guardian Nigeria Monday, with five new cases of the Wild Polio Virus (WPV) reported last week, the number of confirmed outbreak in the country between January and August 2012 has hit 77.
The Global Polio Eradication Initiative said in their Weekly Polio Update, of the five newest cases reported this week; four of the cases were WPV1s from Katsina and one WPV3 from Yobe.
This has prompted the Nigerian government to announce an immunization campaign in 11 states commencing on September 23.
In addition, the next Expert Review Committee on Polio Eradication and Routine Immunization (ERC) is expected to meet on September10 to 11, to review impact of the national emergency action plan and recommend strategies going forward.
There are three countries left on the planet that have not succeeded in interrupting polio transmission and are considered endemic: Afghanistan, Nigeria and Pakistan.
Polio is caused by the poliovirus types 1, 2 and 3. All three types cause paralysis, with wild poliovirus type 1 being isolated from paralysis cases most often.
This viral infection is primarily spread from person to person through the fecal-oral route. However, in places where sanitation is very good,transmission though throat secretions may be considered more important.
Polio is recognized in about 1 percent of infections by flaccid paralysis, while over 90 percent of infections are unapparent.
Paralysis of poliomyelitis is usually asymmetric and the site of paralysis depends on the location of nerve cell destruction on the spinal cord or brain stem. Legs are affected more often than the arms.
Paralysis of the respiration can be life threatening.
Most cases of polio are in children under the age of three.
Prevention of polio is through immunization, either through the live oral poliovirus vaccine (OPV) or the inactivated poliovirus vaccine (IPV).
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Sunday, September 2, 2012

Vietnam reports first case of ‘brain-eating amoeba’

Photo/United States Army Center of Military History

A 25-year-old man perished to the amoebic infection after contracting it while trying to catch fish in a pond in his hometown.

According to a Saigon Giai Phong report, Dr. Nguyen Van Vinh Chau, director of the Tropical Diseases Hospital in Ho Chi Minh City, assured the public on August 30 not to be worried about ‘Naegleria fowleri’, the brain-eating amoeba, saying it’s quite rare with only 144 cases reported since 1965 worldwide.

Dr. Chau said that this is the first case of its kind in the country.

How do you get this microscopic creature and what exactly does it do to you? People typically get it by swimming, jumping or playing in freshwater and get the water up their nose. From there the parasite travels to the brain and spinal cord and necrotizes, or basically eats brain tissue.

The disease is known as primary amoebic meningoencephalitis (PAM) and it has a very rapid progression. Typical symptoms may start after a day or two; headache, fever, nausea and vomiting. Later symptoms may include seizures, irrational behavior, hallucinations and finally coma and death. The course of the disease typically last about a week. Because the symptoms are very similar to bacterial meningitis, PAM may not even be considered in the diagnosis.

Fortunately, it’s a pretty rare disease, unfortunately, treatment is usually unsuccessful with only a handful of people surviving infection.

You should always assume there is some risk when swimming in freshwater. The location and number of amoeba present in a body of water varies from time to time. The Centers of Disease Control and Prevention recommends these four steps to reduce your risk of infection:

• Avoid water-related activities in bodies of warm freshwater, hot springs, and thermally-polluted water such as water around power plants.
• Avoid water-related activities in warm freshwater during periods of high water temperature and low water levels.
• Hold the nose shut or use nose clips when taking part in water-related activities in bodies of warm freshwater such as lakes, rivers, or hot springs.
• Avoid digging in or stirring up the sediment while taking part in water-related activities in shallow, warm freshwater areas.

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