Title: Travel Notice For Bali: Rabies Outbreak
Date: October 31, 2011
Source: Examiner

Abstract: The Centers for Disease Control and Prevention (CDC) has issued outbreak notice for travelers going to the tourist destination of Bali, Indonesia. So far this year there has been 15 reported deaths from the viral disease.

According to the outbreak notice, most cases have been confirmed near popular tourist destinations on the southern tip of Bali.

But because this situation is constantly evolving, the CDC is advising travelers to take precautions for the entire island.

The CDC offers the following advice to travelers to the area:

1. Avoid animal bites.
2. Avoid touching all animals, including wild animals and pets. Pets in other countries may not have been vaccinated against 
3. Resist the urge to rescue animals with the intent to bring them home to the United States. Dogs and cats may be infected with rabies but not show signs until several days or weeks after you first encounter them.
4. Supervise children closely, especially around dogs, cats, and wildlife such as monkeys. This is important since children are more likely to be bitten by animals, may not report the bite, and may have more severe injuries from animal bites.
5. If you are traveling with your pet, supervise your pet closely and do not allow it to play with local animals, especially strays.
6. Act quickly if an animal bites or scratches you.
7. Wash the wound well with soap and water.
8. See a doctor right away, even if you don’t feel sick or your wound is not serious. To prevent rabies, you may need to start a series of vaccinations immediately.
9. To get vaccinated, be prepared to travel back to the United States or to another area. (Adequate vaccination for exposure to rabies is not available in all parts of the world.)
10. After you return home, tell your doctor or state health department that you were bitten or scratched during travel.

Rabies is an acute viral infection that is transmitted to humans or other mammals usually through the saliva from a bite of an infected animal. It is also rarely contracted through breaks in the skin or contact with mucous membranes.

According to the Control of Communicable Diseases Manual, all mammals are susceptible to rabies. Raccoons, skunks, foxes, bats, dogs, coyotes and cats are the likely suspects. Other animals like otters and ferrets are also high risk. Mammals like rabbits, squirrels, rodents and opossums are rarely infected.

Some infected animals can appear very aggressive, attacking for no reason. Some may act very tame.

The symptoms of rabies are as follows. Initially, like in many diseases, the symptoms are non-specific; fever, headache and malaise. This may last several days. At the site of the bite there may be some pain and discomfort. Symptoms then progress to more severe: confusion, delirium, abnormal behavior and hallucinations. If it gets this far, the disease is nearly 100% fatal.

The only treatment for human exposure to rabies is rabies-specific immune globulin and rabies immunization. Appropriate treatment started soon after the exposure will protect an exposed person from the disease
(Examiner, 2011)

Title: CDC Issues Travel Notice For Nigeria Because Of Lassa Outbreak
Date: April 28, 2012

Abstract: The US Centers for Disease Control and Prevention (CDC) issued a travel notice Wednesday because of the increasing number of cases of the deadly hemorrhagic fever, Lassa.

According to the CDC notice dated April 25, the Nigerian Federal Ministry of Health has reported the disease nineteen of the country’s 36 states in 2012.

As of April 13, 2012, there were reports of 818 suspected cases, including 84 deaths. At this time, 131 cases have been confirmed by laboratory testing. Seven deaths have also been reported among health care workers.

Lassa fever is an acute viral illness that occurs in West Africa. The virus, a member of the virus family Arenaviridae, is a single-stranded RNA virus and is zoonotic, or animal-borne.

Lassa fever is a significant cause of morbidity and mortality. While Lassa fever is mild or has no observable symptoms in about 80% of people infected with the virus, the remaining 20% have a severe multisystem disease.

The animal host of Lassa virus is a rodent known as the "multimammate rat" of the genus Mastomys. Humans are infected with Lassa through aerosol or direct contact with excreta from the rodent. Laboratory infections do occur primarily through contaminated needles.

The symptoms of Lassa fever typically occur 1-3 weeks after the patient comes into contact with the virus. These include fever, retrosternal pain (pain behind the chest wall), sore throat, back pain, cough, abdominal pain, vomiting, diarrhea, conjunctivitis, facial swelling, proteinuria (protein in the urine), and mucosal bleeding. Neurological problems have also been described, including hearing loss, tremors, and encephalitis.

The CDC offers the following recommendations to avoid Lassa fever for travelers to Nigeria:

Avoid contact with rats, especially rat urine and feces.

· Put food away in rodent-proof containers.

· Keep the home clean and rodent proof.

· Trap rats in and around homes.

· Do not eat rats.

Stay away from germs:

· Wash hands well and often with soap, and teach children to wash their hands, too.

· Do not share eating or drinking utensils.

· Clean surfaces that are frequently touched (such as toys, doorknobs, tables, and counters) regularly with soap and water or with cleaning wipes.

· Avoid close contact with sick people.

Seek Medical Care:

If you have traveled to the area and develop symptoms of fever, headache, sore throat, muscle pain, chest pain, nausea, vomiting, diarrhea, and abdominal pain, see a doctor or healthcare provider right away. Be sure to tell your doctor or healthcare provider that you have recently traveled to Nigeria (Examiner, 2012)Title: CDC Issues Leptospirosis Warning For Travelers To Peru
Date: May 11, 2012
Source: Examiner

Abstract: Massive flooding in the Loreto region of Peru has created a serious outbreak of the bacterial infection, leptospirosis. Authorities say it is the worst flooding in Peru in two decades.

Peru has recorded more than 300 leptospirosis cases and 3 deaths since the beginning of the year.

The outbreak has prompted the US Centers for Disease Control and Prevention (CDC) to issue a travel notice on Friday, May 11.

The CDC notes that there is no vaccine to prevent leptospirosis and offers the following advice for travelers to flooded regions:

1. Avoid swallowing flood waters or water from lakes, rivers, and swamps. Wear protective clothing, especially footwear, if you are wading in flood waters or other areas that might be contaminated.

2. Avoid wading in flooded areas, especially if you have any cuts or abrasions.

3. Avoid contact with environments contaminated with animal urine.

4. Talk to your health care provider about taking medicine to help prevent leptospirosis. Be sure to tell your health care provider about all your planned activities.

The CDC advises adult travelers to Loretto, Peru to consider antibiotic prophylaxis. They recommend 200 mg oral doxycycline, started 1–2 days before and continuing through the period of exposure. Doxycycline can be used for prophylaxis for both leptospirosis and malaria.

Health officials say indications for prophylactic doxycycline use for children < 8 years of age have not been established.

Leptospirosis is a bacterial zoonotic disease caused by the corkscrew shaped organism, Leptospira. It goes by several other names depending on the locale; mud fever, swamp fever, sugar cane and Fort Bragg fever, among others. It is a disease of both humans and animals.

The rat is the main host to Leptospira. However other animals such as cattle, pigs, horses, dogs, rodents, and wild animals.

People become infected by direct or indirect contact with the urine of these animals. Contact with urine-contaminated water is extremely important. Contaminated food and soil containing animal urine are other potential sources of infection.

The bacterium enters through contact with skin. Especially through cuts or breaks in the skin and through mucous membranes like the eyes.

Found worldwide, it was long considered an occupational disease (miners, farming, vets, and sugarcane harvesting and sewer workers), it is increasingly associated with recreational water sports and camping.

Symptoms of leptospirosis, if present, appear in up to 4 weeks after exposure. Sometimes the person will show no symptoms or mild flu-like symptoms.

According to the CDC, Leptospirosis may occur in two phases; after the first phase, with fever, chills, headache, muscle aches, vomiting, or diarrhea, the patient may recover for a time but become ill again. If a second phase occurs, it is more severe; the person may have kidney or liver failure (jaundice) or meningitis. This phase is also called Weil's disease.

Leptospirosis is confirmed by laboratory testing of a blood or urine sample.

The infection can be treated with antibiotics (penicillin and doxycycline), especially if started early in the disease. For very ill patients, intensive care support and IV antibiotic may be necessary (Examiner, 2012)

Title: U.S. Officials Sound Worldwide Alert For Yosemite Hantavirus Risk
Date: September 5, 2012
Fox News

Abstract: U.S. health officials have sent warnings to 39 other countries that their citizens who stayed in Yosemite National Park tent cabins this summer may have been exposed to a deadly mouse-borne hantavirus, a park service epidemiologist said.

Of the 10,000 people thought to be at risk of contracting hantavirus pulmonary syndrome from their stays in Yosemite between June and August, some 2,500 live outside the United States, Dr. David Wong told Reuters in an interview.

Wong said U.S. Department of Health and Human Services officials notified 39 countries over the weekend, most of them in the European Union, that their residents may have been exposed to the deadly virus.

The lung disease has so far killed two men and sickened four other people, all U.S. citizens, prompting the U.S. Centers for Disease Control and Prevention to issue a health alert.

Officials are concerned that more Yosemite visitors could develop the lung disease in the next month or so. Most of the victims identified so far were believed to have been infected while staying in one of 91 "Signature" tent-style cabins in the park's popular Curry Village camping area.

There is no cure for the disease, but early detection through blood tests greatly increases survival rates.

"I want people to know about this so they take it seriously," Wong said. "We're doing our due diligence to share the information."

Last week, park officials shut down the insulated "Signature" tent cabins after finding deer mice, which carry the disease and can burrow through holes the size of pencil erasers, infesting the double walls.

Officials are continuing to investigate additional possible cases of the disease, which has killed 64 Californians and about 590 Americans since it was identified in 1993, Wong said.

Early symptoms include headache, fever, muscle aches, shortness of breath and coughing. The virus may incubate for up to six weeks after exposure and can lead to severe breathing difficulties and death.

Experts say hantavirus, which kills 36 percent of those it infects, has never been known to be transmitted between humans.

Four of those known to be infected at Yosemite this summer slept in the insulated tent cabins. One slept elsewhere in Curry Village, located in a valley beneath the iconic Half Dome rock formation, and the sixth case remains under investigation.

One man from northern California and another from Pennsylvania died, while three victims have recovered and a fourth remains hospitalized, the state Department of Public Health said.

Nearly 4 million people visit Yosemite each year, attracted to the park's dramatic scenery and hiking trails. Roughly 70 percent of those visitors congregate in Yosemite Valley, where Curry Village is located.

Hantavirus is carried in viral particles inhaled from rodent feces and urine. People also can be infected by eating contaminated food, touching contaminated surfaces or being bitten by infected rodents.

Hantavirus previously infected two Yosemite visitors, one in 2000 and another in 2010, but at higher elevations (Fox News, 2012).

Title: Health Officials Warn Fair Attendees Not To Pet Pigs Due To Swine Flu Fears
Date: August 31, 2012
Fox News

Abstract: Don't pet the pigs.

It's the season for state and county fairs, and health officials have issued warning to fairgoers to be careful around pigs because of the 'new' swine flu spreading from the animals to people.

The first death associated with this new flu, otherwise known as H3N2v influenza virus, is a 61-year-old Ohio woman, according to the Ohio Department of Health.

She was not identified but lived in Madison County. She became ill after contact with hogs at the Ross County Fair.

Federal health authorities have reported 288 cases of the strain this summer. The state health director said most of Ohio's cases have been mild; however, he still urges people to be cautious - especially children, pregnant women and those with weakened immune systems.

Pigs get the flu, too, and can spread it to people. The Centers for Disease Control and Prevention has been tracking sporadic cases since last year, when the new strain was first seen in people. A concern: the new strain has a gene from the 2009 pandemic strain that might let it spread more easily than pig viruses normally do.

So far, that seems to be the case for pigs to people, but it hasn't been spreading easily from person to person - which is the greater concern.

But even regular flu can be a serious illness, so people should be careful if they're going be around pigs, said Dr. Joseph Bresee, the CDC's chief of influenza epidemiology.

Fairgoers are advised to wash their hands and avoid taking food and drinks into livestock barns.

With summer and fall fairs, "we're likely to see additional cases," Bresee told reporters during a teleconference earlier this month.

He said work has begun on a vaccine for the new strain in case it ever becomes more of a threat (Fox News, 2012).

Title: CDC Issues A Travel Notice For Tioman Island, Malaysia Due To Sarcocystis
Date: September 11, 2012

Abstract: The global sentinel surveillance system, GeoSentinel has notified the Centers for Disease Control and Prevention (CDC) of four cases of the parasitic disease, sarcocystosis, in travelers to the Malaysian vacation spot, Tioman Island.

This has prompted the CDC to issue a travel notice Monday and offer preventive measures for travelers to Tioman Island.

Sarcocystosis is a disease caused by a parasite called Sarcocystis. Sarcocystosis occurs in tropical or subtropical countries, including countries in Southeast Asia.

The parasite is most prevalent in areas where livestock is raised.

Sarcocystosis manifests itself in humans in one of two ways: as an intestinal disease that produces diarrhea, or more commonly as an infection of the muscles causing myalgia, muscle weakness, edema and fever.

People are infected through ingestion of food, water, or soil contaminated with infected animal feces.

The travelers described by GeoSentinal returned fromMalaysia with severe muscle pain.

Currently, there is no proven prophylaxis or therapeutic treatment for either intestinal or tissue sarcocystosis (Examiner, 2012).

Title: Texas Health Department Issues A Pertussis Health Advisory
Date: September 11, 2012
Global Dispatch

Abstract: Not only are Texas health officials battling the worst West Nile virus outbreak in years, but they are also dealing with an increase in pertussis, or whooping cough cases including the most fatalities seen in the state in seven years.

According to a Texas Department of State Health Services press release, there have been six deaths and more than 1,000 confirmed cases of pertussis in Texas so far this year.

The six deaths so far this year are the most for a single year since 2005. There were 961 total Texas cases of pertussis last year, down from a peak of 3,358 in 2009.

The health advisory is to urge people to get vaccinated against the disease.

Five of the deaths were among infants under two months old, the age at which the first pertussis vaccination is recommended. This underscores how important it is for parents and others around newborns to make sure they have received the recommended doses of vaccine. The sixth death was of an unvaccinated older child with underlying medical conditions.

Whooping cough is caused by the bacterium, Bordetella pertussis. This vaccine-preventable disease is spread through direct contact with respiratory discharges via the airborne route.

Pertussis goes through a series of stages in the infected person; initially a irritating cough followed by repeated, violent coughing. The disease gets its nickname by coughing without inhaling air giving the characteristic high-pitched whoop. Certain populations may not have the typical whoop like infants and adults.

It is highly communicable, especially in very early stages and the beginning of coughing episodes, for approximately the first 2 weeks. Then the communicability gradually decreases and at 3 weeks it is negligible, though the cough my last for months.

Those that are not immunized are susceptible to this disease. Young infants and school aged children (who are frequently the source ofinfection for younger siblings) are at greatest risk (Global Dispatch, 2012).

Title: DHS Issues Updated Guidance For Responding To A Wide-Area Anthrax Attack
October 24, 2012

DHS has issued an updated version of its previously-published guidance for protecting first responders during the first week following a wide-area aerosol anthrax attack.

“Protective measures addressed in the guidance include medical countermeasures (i.e., drugs, vaccine), personal protective equipment (PPE), and other possible work practices,” explains a Federal Register notice published by DHS on Oct. 22.

The original version of this new DHS report, which is now entitled Guidance for Protecting Responders’ Health During the First Week Following a Wide-Area Aerosol Anthrax Attack, was published in 2009. Since then, the department has solicited feedback from the public and received comments from a variety of respondents, including academics, responders, political leaders and government agencies. The latest version has incorporated many of those comments and the latest thinking on how to respond to an anthrax attack.

In its new guidance, DHS works with a hypothetical scenario in which a wide-area aerosol anthrax attack has occurred in a large U.S. city. In this scenario, B. anthracis spores would be released from a ground-based vehicle (such as a truck-mounted sprayer) or an airborne vehicle (such as a crop duster). “The affected area could encompass hundreds of square miles and could potentially expose hundreds of thousands of people to spores, which, once inhaled, could cause extensive illness and death in the affected population,” says the DHS guidance.

To counter such threats, current recommendations call for a “post-exposure prophylaxis” (PEP) regime that includes the timely administration of a minimum of a 60-day course of oral antimicrobial drugs, in combination with three doses of anthrax vaccine adsorbed,” says the guidance.

Typically, these drugs are administered before an anthrax attack and are not currently licensed for “post-exposure use,” the guidance explains. However, during an emergency declared by the Secretary of Health and Human Services, the Food and Drug Administration could issue an “emergency use authorization” to administer such vaccines immediately after an attack.

The guidance describes the urgent need to distribute antimicrobial drugs promptly after an attack, and explains how various jurisdictions are considering the establishment of either community Points of Dispensing (PODs) or a “postal model” for rapid distribution (GSN, 2012).

Title: Vietnam HFMD Outbreak Surges Past 100,000, CDC Issues Travel Notice
November 8, 2012

The Vietnamese Ministry of Health (MoH) is reporting a large-scale outbreak, rivaling last year’s numbers. This has prompted federal health officials in the United States to issue recommendations for travelers to the Southeast Asian country, according to a Centers for Disease Control and Prevention (CDC) travel notice Nov. 7.

According to the MoH, there were approximately 116,418 people in 63 provinces confirmed with hand, foot, and mouth disease (HFMD) from January1 to October 7 2012; 42 people in 15 provinces have died.

More than half of the cases and nine out of ten fatalities are from the southern region of the country.

HFMD is typically a benign and self-limiting disease. Most common in young children, it presents as fever, oral lesions and rash on the hands, feet and buttocks. The oral lesions consist of rapidly-ulcerating vesicles on the buccal mucosa, tongue, palate and gums. The rash consists of papulovesicular lesions on the palms, fingers and soles, which generally persist for seven to 10 days, and maculopapular lesions on the buttocks.

However, complications associated with HFMD caused by EV-71 include encephalitis, aseptic meningitis, acute flaccid paralysis, pulmonary edema or hemorrhage and myocarditis. Most deaths in HFMD occur as a result of pulmonary edema or hemorrhage.

EV-71 has been implicated in HFMD outbreaks in Southeast Asia over the several years. EV 71 is a non-polio enterovirus.

There is no vaccine available to prevent HFMD or specific treatment for the viral disease.

Prevention from HFMD is through personal hygiene (Examiner, 2012).