We receive daily updates about disease outbreaks worldwide. As global citizens, we are not immune to health incidents.

CHOLERA CONFIRMED IN HAITI

Date: 21 Oct 2010

An outbreak of cholera was confirmed in Haiti on October 21, 2010. Cholera had not been documented in Haiti for decades so cholera outbreaks were considered unlikely in Haiti immediately following the earthquake in January, 2010. For a cholera outbreak to occur, two conditions have to be met: (1) there must be significant breaches in the water, sanitation, and hygiene infrastructure used by groups of people, permitting large-scale exposure to food or water contaminated with Vibrio cholerae organisms; and (2) cholera must be present in the population. While it is unclear how cholera was re-introduced to Haiti, both of these conditions now exist.

Cholera infection is most often asymptomatic or causes a mild gastroenteritis. However, about 5% of infected persons develop severe, dehydrating, acute watery diarrhea. The first line of treatment for cholera is rehydration. Administration of oral rehydration salts and, when necessary, intravenous fluids and electrolytes in a timely manner with adequate volumes will reduce case-fatality rates to <1%. Severe cases of cholera should be treated with antimicrobial agents to which the circulating strain is susceptible. Antimicrobial treatment is not recommended for mild cases of cholera and should never be used as “chemoprophylaxis” to prevent cholera on a mass scale.

As with other causes of acute watery diarrhea, the prevention and control of cholera require surveillance, heightened measures to ensure the safety of drinking water and food, and appropriate facilities and practices for disposal of feces and for handwashing. Although using vaccines to control an outbreak of cholera is complex, oral cholera vaccines are being considered for use among high-risk populations in Haiti.

DENGUE FEVER IN KEY WEST

Date: Apr 2010

Key West reported its first dengue outbreak in 50 years.If any place in the U.S. was ripe for a re-emergence of dengue virus, it was Florida. All the necessary factors for disease transmission were present: an abundance of a competent mosquito vector, Aedes aegypti; frequent opportunities for viral introduction by international travelers; a susceptible population; and a climate that lends itself to frequent human-mosquito contact. These fears were realized in September 2009, when three cases of locally acquired dengue were detected in Old Town Key West within a 2-week period (visit Locally Acquired Dengue --- Key West, Florida, 2009--2010). These were the first cases discovered in Florida since 1934. The Monroe County Health Department, Florida Department of Health, the Florida Keys Mosquito Control District and CDC’s Dengue Branch launched an investigation to determine the extent of the outbreak, how it started, factors associated with dengue infection and how the outbreak could be stopped.

EARTHQUAKES IN HAITI cause deaths, injuries, disruption of services

Date: 26 Jan 2010

A 7.0 magnitude earthquake struck Haiti on the afternoon of January 12 and was followed by powerful aftershocks, including one January 20, 22 and 26. Extensive damage resulted, particularly in the Port-au-Prince area in Ouest department. The Delmas and Leogane districts of the Ouest department were also heavily affected, as was the capital of Sud-Est department, Jacmel.

Volunteers traveling to Haiti to help with earthquake relief efforts should be aware and properly protected against diseases that arise after a disaster. With water supplies being stalled and contaminated, the risk of waterborne disease outbreaks like Typhoid and Hepatitis A are increased.The potential new mass of displaced persons could create crowded, unsanitary conditions that facilitate the spread of contagious infections.

The risk of disease outbreaks increases following such events, largely due to contaminated water, crowded conditions and lack of shelter. Homelessness is associated with psychological stressors as well as the physical risks of sun exposure, insect-borne illnesses and injury. People are beginning to settle into makeshift shelters. As many as 600 settlements have been spontaneously established in available open spaces. Security is an issue, especially for the estimated 1 million orphans. Disease outbreaks are common in refugee camps, where people live in crowded and unsanitary conditions. Some diarrhea cases have been reported, with no details yet available. Suspected cases of measles were eventually determined to be chicken pox. Tetanus is also an increasing problem.

MENINGITIS CLAIMS FOUR IN MIAMI
Irony for South Floridians, World Meningitis Day is April 25, 2009

Miami, FL- 4/23/09- A virulent strain of meningitis, Neisseria meningitidis W-135, is responsible for the deaths of four people in South Florida. Eight others have been infected in the past six months.

These deaths come just days before the first annual World Meningitis Day which begins April 25, 2009. The day is meant to raise awareness and educate Americans about the dangers of contracting the meningococcal disease. “We recognize the dangers of meningitis and the importance of being vaccinated against the disease,” said Fran Lessans, CEO of Passport Health, the largest provider of travel medical services and immunizations in the U.S.

Although the W-135 strain can be treated with vigorous, early intervention with antibiotics, Lessans warned that this is a fast-acting strain and “death can sometimes occur within hours of first symptoms.”

Neisseria meningitidis is the leading cause of bacterial meningitis in the United States. According to the CDC, serogroups B,C and Y are the major causes of meningococcal disease. Among those over age eleven, 75% of cases are caused by serogroups C, Y, or W-135. “The vaccines available in the United States protect against these 3 serogroups and there is plenty of vaccine available in Miami and throughout the U.S.,” commented Lessans after stating that the general population, especially those at risk, often does not get vaccinated.

Meningitis is an infection of the fluid surrounding the spinal cord and brain. Children and young adults, especially those living in close quarters or sharing utensils, dishes, bottles cigarettes and glasses are at higher risk; although persons of any age can become infected. “Most people don’t realize that even second hand smoking may put you at risk. The bacteria or viruses are exhaled with the smoke and breathed in by other people in the room,” stated Lessans.

Of the two causes of infection, bacterial meningitis is often more serious and has a higher fatality rate than viral meningitis. Symptoms include fever, headache, stiff neck, sensitivity to light, rash and sometimes seizures.

Officials in Miami-Dade are urging hospitals and doctors to notify the Miami-Dade Health Department as soon as they discover any new cases so they can take protective measures. For more information on vaccinations visit www.PassportHealthMiami.com or call 305-642-9889 to make an appointment.

HEPATITIS B AND C, HIV, COLONOSCOPY -
UNITED STATES OF AMERICA: (TENNESSEE, FLORIDA & GEORGIA), ALERT
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A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Fri 27 Mar 2009
Source: msnbc Health, Associated Press report [edited]
<http://www.msnbc.msn.com/id/29916792/>

10 colonoscopy patients have hepatitis
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Equipment used on thousands of patients [more than 10 000 -- see comment below. - Mod.JW] at 3 facilities wasn't properly sterilized.
The Veterans Affairs (VA) department says 10 people have tested positive [so far] for infectious liver disease since they were exposed to contaminated colonoscopy equipment. The 10 are among thousands of patients who have been warned to get blood tests since being treated at VA facilities in Murfreesboro, Tennessee, Miami [Florida] & Augusta, Georgia. All 3 sites failed to properly sterilize equipment between treatments.

VA spokeswoman Katie Roberts said Friday [27 Mar 2009] that 4 Tennessee patients have tested positive for hepatitis B. A total of 6 have tested positive for hepatitis C, a potentially life-threatening form of the viral infection that can cause permanent liver damage.

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Communicated by:
ProMED-mail Rapporteur Brent Barrett

[The Miami VA notified about 3260 patients who received colonoscopies between May 2004 and March 12 of this year [2009] that they may have been exposed to hepatitis B, hepatitis C or HIV. It has suspended colonoscopies. At the Murfreesboro hospital, 6400 veterans might have been exposed, according to the VA. At the Augusta, Ga., VA hospital, 1100 veterans might have been exposed.
<Miami Herald article>